246 results on '"intensity-modulated radiotherapy (IMRT)"'
Search Results
202. 前立腺癌強度変調放射線治療における骨照合法に対するコーンビームCTを用いた組織照合法の優位性
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Sato, Hiraku
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cone-beam computed tomography (CBCT) ,soft tissue-based setup ,image-guided radiotherapy (IGRT) ,intensity-modulated radiotherapy (IMRT) ,equipment and supplies ,prostate cancer - Abstract
Purpose: To test the superiority of a soft tissue-based setup using cone-beam computed tomography (CBCT) to a bony structure-based setup using the ExacTrac system in intensity-modulated radiotherapy (IMRT) for prostate cancer. Methods: We studied 20 patients with localized prostate cancer who received IMRT between November 2010 and February 2012. After the initial setup, the pelvic bony structure-based setup and ExacTrac system were applied. After that, CBCT and a soft tissue-based setup were used. A shift in the isocenter between the ExacTrac-based and CBCT-based setup was recorded in the anterior-posterior (AP), superior-inferior (SI), and left-right (LR) axes. The shift was considered an inter-fractional prostate shift. Post-treatment CBCT was also taken once a week to measure the intra-fractional prostate shift, based on the coordinates of the isocenter between pre- and post-treatment CBCT. The planning target volume (PTV) margins were determined van Herk's method. We measured the elapsed time required for soft tissue matching and the entire treatment time using CBCT. Results: The means ± standard deviation (SD) of the inter- and intra-fractional shifts were 0.9 ± 2.8 mm and −0.30 ± 1.4 mm in the AP, 0.9 ± 2.2 mm and −0.1 ± 1.2 mm in the SI, and 0.1 ± 0.7mm in the LR. The PTV margins in the cases of bony structure-based and soft tissue-based setup were 7.3 mm and 2.7 mm in the AP, 5.8 mm and 2.3 mm in the SI, and 1.9 mm and 1.2 mm in the LR. Even though the median elapsed time using CBCT was expanded in 5.9 minutes, the PTV margins were significantly reduced. Conclusions: We found the calculated PTV margins in the soft tissue-based setup using CBCT were small, and this arrangement was superior to the bony structure-based setup in prostate IMRT., 学位の種類: 博士(医学). 報告番号: 甲第4061号. 学位記番号: 新大院博(医)甲第650号. 学位授与年月日: 平成27年9月24日, Journal of Applied Clinical Medical Physics. 2015, 16(5), 239-245., 新大院博(医)甲第650号
- Published
- 2015
203. Adverse effect of smoking on prognosis in human papillomavirus-associated oropharyngeal carcinoma
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Journal Article ,oropharyngeal carcinoma ,intensity-modulated radiotherapy (IMRT) ,human papillomavirus (HPV) ,smoking ,radiotherapy - Abstract
Background The purpose of this retrospective study was to identify prognostic factors in a cohort of patients with oropharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT). Methods Medical records of 142 patients treated with (chemo)radiotherapy between September 2005 and September 2011 were reviewed and the human papillomavirus (HPV) status was determined by polymerase chain reaction (PCR) analysis. Potential prognostic factors for 3-year locoregional control and overall survival (OS) were evaluated. Results HPV-positive patients (n = 82) had locoregional control and OS of 78% and 79%, respectively. Significant prognostic factors on multivariate analysis were smoking (p = .03) for locoregional control and OS, and comorbidity (p = .04) for OS. Further stratification was done according to smoking behavior in HPV-positive patients. Locoregional control in current smokers was 67% compared to 86% in never smokers and former smokers, respectively (p = .02). Conclusion Smoking was the only modifiable prognostic factor in HPV-positive patients. Therefore, active stop-smoking programs must be integrated in the routine management of patients to maximize treatment results.
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- 2016
204. Intensity-modulated radiotherapy does not decrease the risk of malnutrition in esophageal cancer patients during radiotherapy compared to three-dimensional conformal radiation therapy.
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Wang C, Lu M, Zhou T, Zhao S, and Guan S
- Abstract
Background: Esophageal cancer is a lethal disease of global scope. Radiotherapy is the main method to treat esophageal cancer; however, it concurrently leads to malnutrition. Intensity-modulated radiotherapy (IMRT) is superior to three-dimensional conformal radiation therapy (3D-CRT) in dosimetry and clinical outcomes. In this cohort study, we aimed to compare the effect of 3D-CRT and IMRT on malnutrition status., Methods: We retrospectively included 79 esophageal cancer patients (IMRT: n=27, 3D-CRT: n=52) who received radiotherapy. We collected nutrition indexes at the beginning, the second week, and the end of radiotherapy. Paired-T test was used to evaluate the nutrition status during radiotherapy in each group. Chi-square test and independent-sample T -test were applied to compare the dynamic changes of indexes between IMRT and 3D-CRT groups., Results: The baselines of the two groups are comparable. Nutrition Risk Screening 2002 (NRS-2002) score, body weight, BMI, hemoglobin, lymphocyte, total protein, and albumin values were significantly reduced during radiotherapy in both groups. The dynamic changes of nutrition indexes during radiotherapy were not significantly different between the IMRT and 3D-CRT groups. Besides, no difference was found for radiation esophagitis or treatment completion between the two groups., Conclusions: Malnutrition occurs in esophageal cancer patients during radiotherapy. IMRT did not significantly decrease the risk of malnutrition compared to 3D-CRT., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare., (2019 Journal of Thoracic Disease. All rights reserved.)
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- 2019
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205. Radiotherapy for stage IVa thymoma-Shanghai Chest experience.
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Wang C, Gao L, and Fang W
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To investigate the effect of two modalities, radiotherapy (RT) and surgery plus entire hemithoracic radiotherapy (EHRT), on stage IVa thymoma. Patients enrolled in this study meet the following criteria: histologically proven thymoma; primary stage IVa or pleural dissemination after initial curative treatment. One treatment modality is intensity-modulated radiotherapy (IMRT) for pleural lesions with a dose ranging from 30-50 Gy, the other is macroscopically surgical resection plus EHRT with a dose of 13 Gy in 13 fractions. From July 2012 to April 2018, there were totally 56 patients enrolled in this study. The median age was 45 years old (range, 20-75 years old). There were 35 male and 21 female patients. The histology subtype distribution was 1 AB, 8 B1, 20 B2 and 27 B3, respectively. Thirty-one patients received IMRT for pleural dissemination and the response rate (CR + PR) was 97%. The mean local control time was 40 months (95% CI, 32.6-47.3 months). The in-field and out-field recurrence were 32% and 94%, respectively. The 2-year progression free survival (PFS) was 18%. While for patients who were treated by surgery plus EHRT, the in- and out-field recurrence were 8% and 16%, respectively. The 2-year PFS was 40%. The 2-year PFS for B1, B2 and B3 were 20%, 50% and 23%, respectively (P=0.255). Major toxicity occurred in IMRT group, 5 died of radiation-induced pneumonitis. Both IMRT and surgery plus EHRT showed good local control for stage IVa thymoma. Since stage IVa thymoma has a tendency to involve the whole hemithorax, surgery plus EHRT has a potential to produce longer PFS., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/med.2019.02.01). The series “Dedicated to the 9th International Thymic Malignancy Interest Group Annual Meeting (ITMIG 2018)” was commissioned by the editorial office without any funding or sponsorship. WF serves as an unpaid Editor-in-Chief of Mediastinum. The authors have no other conflicts of interest to declare., (2019 Mediastinum. All rights reserved.)
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- 2019
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206. Dosimetric comparisons of craniospinal axis irradiation using helical tomotherapy, volume-modulated arc therapy and intensity-modulated radiotherapy for medulloblastoma.
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Sun Y, Liu G, Chen W, Chen T, Liu P, Zeng Q, Hong J, and Wei R
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Background: To evaluate the potential dosimetric gains of helical tomotherapy (HT) versus intensity-modulated radiotherapy (IMRT) and volume-modulated arc therapy (VMAT) for craniospinal axis irradiation (CSI) of medulloblastoma., Methods: A total of 36 treatment plans were calculated retrospectively for 12 patients with medulloblastoma receiving CSI using HT with TomoTherapy Hi-Art Software (Version 2.0.7) (Accuray, Madison, WI, USA). For each case, the other two different delivery techniques were re-planned with IMRT/VMAT optimized with Eclipse treatment planning system (TPS) (Version 11.0.31). Homogeneity index (HI) and conformity index (CI) of the planning target volume (PTV) and organs at risk (OARs) sparing were analyzed. Differences in plans were evaluated using paired-samples t -test for various dosimetric parameters., Results: HT yielded the highest CI in all PTV coverage including PTV of gross tumor volume (PGTV) (HT: 0.7163; VMAT: 0.6688; IMRT: 0.6096), PTVbrain (HT: 0.8490; VMAT: 0.8384; IMRT: 0.7815) and PTVspine (HT: 0.5904; VMAT: 0.5862; IMRT: 0.5797). Meanwhile, HT yielded better HI in PGTV (HT: 0.0543; VMAT: 0.0759; IMRT: 0.0736), PTVbrain (HT: 0.5525; VMAT: 0.5619; IMRT: 0.5554) and PTVspine (HT: 0.0700; VMAT: 0.0782; IMRT: 0.0877). As for OARs, HT demonstrated marked superiority in critical organs including maximal/mean doses of brainstem PRV, optical chiasm and optic nerves., Conclusions: For CSI of medulloblastoma, HT offers superior outcomes in terms of PTV conformity, PTV homogeneity and critical OAR sparing as compared with IMRT/VMAT., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tcr.2019.01.30). The authors have no conflicts of interest to declare., (2019 Translational Cancer Research. All rights reserved.)
- Published
- 2019
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207. Omitting Elective Irradiation of the Contralateral Retropharyngeal Nodes in Oropharyngeal Squamous Cell Carcinoma Treated with Intensity-modulated Radiotherapy.
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Nagatsuka M, Hughes RT, Shenker RF, Frizzell BA, and Greven KM
- Abstract
Introduction: The use of intensity-modulated radiation therapy (IMRT) in head and neck cancers has allowed for selective sparing of low-risk or uninvolved lymph nodes. In oropharyngeal cancers, the benefits and risks of omitting contralateral retropharyngeal lymph nodes (RPLN) remain uncertain. This study examines the outcomes of elective coverage of contralateral RPLN in oropharyngeal cancer treated with definitive IMRT., Methods: We analyzed 54 patients with newly diagnosed unilateral tonsil or base of tongue squamous cell carcinoma with at most unilateral neck involvement (cN0-N2b) and no RPLN involvement. These patients had no prior head and neck irradiation and were treated with definitive radiotherapy or chemoradiotherapy between 2012 and 2017. Cumulative incidences of local/regional/distant failure were estimated using competing risks methodology, and overall survival (OS) was estimated using the Kaplan-Meier method., Results: All patients received elective nodal coverage to the ipsilateral RPLN, and 38 (62%) patients did not receive elective treatment of the contralateral RPLN. There were no significant differences in baseline characteristics. There were no contralateral RPLN failures observed. When comparing patients who received contralateral RP treatment with those who did not, there were no significant differences in two-year local failure (23% vs. 9%, p = 0.09), regional failure (18% vs. 4%, p = 0.12), or distant failure (15% vs. 9%, p = 0.62). Two-year OS was 89%. Mean parotid dose was not significantly lower after sparing vs. treating the contralateral RPLN (median 25.6 vs. 32.7 Gy, p = 0.15)., Conclusions: The omission of contralateral RPLN irradiation in tonsil or tongue base carcinomas with unilateral neck involvement is safe without compromising disease control., Competing Interests: The authors have declared that no competing interests exist.
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- 2019
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208. Re: Clinical Outcomes of Helical Tomotherapy for Super-Elderly Patients with Localized and Locally Advanced Prostate Cancer: Comparison with Patients under 80 Years of Age
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Atsushi Okazaki, Tetsuo Sekihara, Noriyuki Okonogi, Hiroyuki Katoh, Kazutoshi Murata, Masahiro Onishi, Tomoaki Tamaki, Yosuke Takakusagi, Yu Ohkubo, Takashi Nakano, Hidemasa Kawamura, and Takuya Kaminuma
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Male ,Oncology ,medicine.medical_specialty ,Health, Toxicology and Mutagenesis ,Urinary system ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Locally advanced ,helical tomotherapy (TOMO) ,Tomotherapy ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Prostate ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Cumulative incidence ,intensity-modulated radiotherapy (IMRT) ,Aged ,Aged, 80 and over ,Radiation ,business.industry ,Prostatic Neoplasms ,Neoplasms, Second Primary ,Radiotherapy Dosage ,prostate cancer ,medicine.disease ,Surgery ,Radiation therapy ,medicine.anatomical_structure ,super-elderly patients ,Latency stage ,Toxicity ,Radiotherapy, Intensity-Modulated ,business - Abstract
We investigated the clinical outcomes of helical tomotherapy in 23 patients aged ≥80 years with localized and locally advanced prostate cancer and compared the results with data from 171 patients under 80 years. All patients received helical tomotherapy in our hospital between September 2009 and October 2012. The median follow-up periods were 35 months in the aged group and 34 months in the younger group. The median prescribed dose in helical tomotherapy was 78 Gy in 39 fractions (range, 72-78 Gy). The 3-year overall survival and biochemical relapse-free rates were 92% and 96% in the aged group and 99.4% and 97.3% in the younger group, respectively. There was no significant difference between the two groups in the biochemical relapse-free rates. The 3-year cumulative incidences of late Grade 2 or higher rectal toxicity and urinary toxicity were 13% and 4.8% in the aged group and 7.0% and 1.2% in the younger group, respectively. There was no significant difference between the aged group and the younger group in the cumulative incidence rates of rectal toxicity or urinary toxicity. No patients exhibited Grade 4 or higher toxicity, and all patients improved with conservative therapy. Helical tomotherapy in super-elderly patients with localized and locally advanced prostate cancer had good biochemical control rates without severe late toxicity. Definitive helical tomotherapy may be the treatment of choice for patients with localized and locally advanced prostate cancer, even in those older than 80 years of age.
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- 2016
209. Improved normal tissue sparing in head and neck radiotherapy using biological cost function based-IMRT
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N. Anderson, M. Rolfo, Catherine Lawford, Morikatsu Wada, Vincent Khoo, and D. Lim Joon
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Larynx ,Male ,Cancer Research ,medicine.medical_specialty ,Dose avoidance ,medicine.medical_treatment ,Open Access Article ,03 medical and health sciences ,0302 clinical medicine ,Head and neck radiotherapy ,Relative biological effectiveness ,medicine ,Dosimetry ,Humans ,Biological cost functions ,Organ Sparing Treatments ,Intensity-modulated radiotherapy (IMRT) ,Radiation treatment planning ,Head and neck cancer ,Neoplasm Staging ,Monte Carlo algorithms ,business.industry ,Radiotherapy Planning, Computer-Assisted ,Middle Aged ,medicine.disease ,Surgery ,Radiation therapy ,medicine.anatomical_structure ,Oncology ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Carcinoma, Squamous Cell ,Female ,Radiotherapy, Intensity-Modulated ,Radiotherapy, Conformal ,Nuclear medicine ,business ,Head ,Monte Carlo Method ,Neck ,Relative Biological Effectiveness - Abstract
Intensity-modulated radiotherapy (IMRT) has reduced the impact of acute and late toxicities associated with head and neck radiotherapy. Treatment planning system (TPS) advances in biological cost function based optimization (BBO) and improved segmentation techniques have increased organ at risk (OAR) sparing compared to conventional dose-based optimization (DBO). A planning study was undertaken to compare OAR avoidance in DBO and BBO treatment planning. Simultaneous integrated boost treatment plans were produced for 10 head and neck patients using both planning systems. Plans were compared for tar get coverage and OAR avoidance. Comparisons were made using the BBO TPS Monte Carlo dose engine to eliminate differences due to inherent algorithms. Target coverage (V95%) was maintained for both solutions. BBO produced lower OAR doses, with statistically significant improvement to left (12.3%, p 5 0.005) and right parotid mean dose (16.9%, p 5 0.004), larynx V50 Gy (71.0%, p 5 0.005), spinal cord (21.9%, p , 0.001) and brain stem dose maximums (31.5%, p 5 0.002). This study observed improved OAR avoidance with BBO planning. Further investigations will be undertaken to review any clinical benefit of this improved planned dosimetry.
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- 2011
210. The six-bank multi-leaf system : A large field size, high resolution collimator for advanced
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leaf width ,leaf design ,IMRT sequencer ,intensity-modulated radiotherapy (IMRT) ,linear accelerator ,image-guide radiotherapy (IGRT) ,penumbra width (80-20%) ,radiation therapy ,multi-leaf collimator (MLC) ,step-and-shoot sequencer - Abstract
A linear accelerator (linac) is the most commonly used device for treatment of patients with cancer in external beam radiotherapy (EBRT). The Linac delivers a high-energy ionizing radiation (photons or electrons) to the region of the patient's tumor. The absorption of radiation in the treated area damages the diseased cells. To minimize irradiation of healthy tissue beams should be shaped. Commonly, this is achieved by using a multi-leaf collimator (MLC). The motivation for this work was given by the fact that a conventional Linac/MLC, currently available on the market, was designed for conformal radiotherapy, but is nowadays also used for intensity-modulated radiotherapy (IMRT). In this thesis the first goal was to understand and to quantify the impact of Linac/MLC design parameters on IMRT treatment plans. The investigated parameters were: leaf width of the MLC, leaf transmission related to the thickness of the leaves, and penumbra related primarily to the source size. For this purpose, various head and neck IMRT plans were evaluated using the Plato and Pinnacle treatment planning systems. Lead by those findings, and a desire to obtain a collimator which could deliver large field size with high resolution field shaping, we present an alternative design of a multi-leaf collimator, called a six-bank MLC. The MLC system consists of three layers of two opposing leaf banks. The layers are rotated 60 degrees relative to each other. The leaves in each bank have a standard width of 1 cm projected at the isocentre. This is a novelty compared to the existing systems which can achieve either large field size with low resolution field shaping, or small field size with high resolution field shaping. For the six-bank MLC which would function as a multi-purpose collimator, suitable for all types of treatments, two methods for delivering IMRT were developed. In a low-resolution mode similar segments can be delivered as with a conventional two-bank MLC with a leaf width of 1 cm. The performance in high-resolution mode is comparable to that of a mini-MLC, but a trade-off had to be made between accuracy and number of segments. Finally, an analytical model of the optimal MLC leaves design was made, and was used to find the optimal leaf design parameters for a six-bank MLC. In conclusion, Linac/MLC design is of great importance for IMRT treatment of patients. By further improvement of image-guided radiotherapy (IGRT) and application of on-line position verification on a daily basis, additional reduction of margins will be possible. This would lead to a great benefit enhancement of a six-bank MLC over the conventional MLCs.
- Published
- 2006
211. The six-bank multi-leaf system : A large field size, high resolution collimator for advanced
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Topolnjak, R. and University Utrecht
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Geneeskunde ,leaf width ,leaf design ,IMRT sequencer ,intensity-modulated radiotherapy (IMRT) ,linear accelerator ,image-guide radiotherapy (IGRT) ,penumbra width (80-20%) ,radiation therapy ,multi-leaf collimator (MLC) ,step-and-shoot sequencer - Abstract
A linear accelerator (linac) is the most commonly used device for treatment of patients with cancer in external beam radiotherapy (EBRT). The Linac delivers a high-energy ionizing radiation (photons or electrons) to the region of the patient's tumor. The absorption of radiation in the treated area damages the diseased cells. To minimize irradiation of healthy tissue beams should be shaped. Commonly, this is achieved by using a multi-leaf collimator (MLC). The motivation for this work was given by the fact that a conventional Linac/MLC, currently available on the market, was designed for conformal radiotherapy, but is nowadays also used for intensity-modulated radiotherapy (IMRT). In this thesis the first goal was to understand and to quantify the impact of Linac/MLC design parameters on IMRT treatment plans. The investigated parameters were: leaf width of the MLC, leaf transmission related to the thickness of the leaves, and penumbra related primarily to the source size. For this purpose, various head and neck IMRT plans were evaluated using the Plato and Pinnacle treatment planning systems. Lead by those findings, and a desire to obtain a collimator which could deliver large field size with high resolution field shaping, we present an alternative design of a multi-leaf collimator, called a six-bank MLC. The MLC system consists of three layers of two opposing leaf banks. The layers are rotated 60 degrees relative to each other. The leaves in each bank have a standard width of 1 cm projected at the isocentre. This is a novelty compared to the existing systems which can achieve either large field size with low resolution field shaping, or small field size with high resolution field shaping. For the six-bank MLC which would function as a multi-purpose collimator, suitable for all types of treatments, two methods for delivering IMRT were developed. In a low-resolution mode similar segments can be delivered as with a conventional two-bank MLC with a leaf width of 1 cm. The performance in high-resolution mode is comparable to that of a mini-MLC, but a trade-off had to be made between accuracy and number of segments. Finally, an analytical model of the optimal MLC leaves design was made, and was used to find the optimal leaf design parameters for a six-bank MLC. In conclusion, Linac/MLC design is of great importance for IMRT treatment of patients. By further improvement of image-guided radiotherapy (IGRT) and application of on-line position verification on a daily basis, additional reduction of margins will be possible. This would lead to a great benefit enhancement of a six-bank MLC over the conventional MLCs.
- Published
- 2006
212. Pretreatment risk stratification of feeding tube use in patients treated with intensity-modulated radiotherapy for head and neck cancer.
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Anderson NJ, Jackson JE, Smith JG, Wada M, Schneider M, Poulsen M, Rolfo M, Fahandej M, Gan H, Joon DL, and Khoo V
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- Adult, Aged, Aged, 80 and over, Deglutition Disorders therapy, Female, Head and Neck Neoplasms pathology, Humans, Lymphadenopathy complications, Lymphatic Metastasis, Male, Middle Aged, Prognosis, Retrospective Studies, Young Adult, Enteral Nutrition statistics & numerical data, Head and Neck Neoplasms radiotherapy, Radiotherapy, Intensity-Modulated adverse effects, Risk Assessment
- Abstract
Background: The purpose of this study was to establish a risk stratification model for feeding tube use in patients who undergo intensity-modulated radiotherapy (IMRT) for head and neck cancers., Methods: One hundred thirty-nine patients treated with definitive IMRT (+/- concurrent chemotherapy) for head and neck mucosal cancers were included in this study. Patients were recommended a prophylactic feeding tube and followed up by a dietician for at least 8 weeks postradiotherapy (post-RT). Potential prognostic factors were analyzed for risk and duration of feeding tube use for at least 25% of dietary requirements., Results: Many variables had significant effects on risk and/or duration of feeding tube use in univariate analyses. Subsequent multivariable analysis showed that T classification ≥3 and level 2 lymphadenopathy were the best independent significant predictors of higher risk and duration of feeding tube use, respectively, in oral cavity, pharyngeal, and supraglottic primaries., Conclusion: In patients treated with definitive IMRT, T classification ≥3 and level 2 lymphadenopathy can potentially stratify patients into 4 risk groups for developing severe dysphagia requiring feeding tube use., (© 2018 Wiley Periodicals, Inc.)
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- 2018
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213. Trends in Physics Contributions to the 'Red Journal': A 30-year Journey and Comparison to Global Trends.
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Yaparpalvi R, Ohri N, Tomé WA, and Kalnicki S
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Introduction: In this study, we catalogued physics contributions in the Red Journal over the past three decades and compared publication trends with global publication trends., Methods: We used the website of the Red Journal (International Journal of Radiation Oncology, Biology, and Physics) to access physics contributions published between 1988 and 2017. The contributions were catalogued following taxonomy guidelines endorsed by the American Association of Physicists in Medicine. From each issue, publications classified as "Physics Contributions" or as "Technical Innovations" or listed a physicist as one of the primary authors was indexed. Results are presented using descriptive statistics; chi-square [Formula: see text]
2 testing were utilized to examine trends in contributions over 10-year time intervals. For global trend comparison of Red Journal physics contributions, we utilized PubMed database to obtain publication counts on the topics of interest., Results: A total of 2,852 physics contributions were indexed (86 volumes and 436 issues). Overall, 76% of contributions were photon-beam therapy applications, 15% brachytherapy, 7% particle-beam therapy, and 3% electron-beam therapy. [Formula: see text]2 analyses revealed significant changes in this distribution over time (p<0.001). Brachytherapy accounted for 23% of publications in the first decade, compared to 7% in the third decade. Particle beam therapy accounted for 4% of publications in the first decade and 12% in the third decade. Among treatment techniques, three-dimensional conformal radiation therapy (3D-CRT) accounted for 64% of contributions in the first decade, compared to 3% in the third decade. Intensity-modulated radiation therapy (IMRT)/volumetric modulated arc therapy (VMAT) accounted for 4% in the first decade, compared to 54% in the third decade. Significant increases in the proportions of studies focused on motion management, functional imaging for treatment planning, and radiation safety/quality assurance during the third decade were observed (p<0.001)., Conclusion: Trends of physics publications in the Red Journal and globally, in general, largely mirror technological advances in the field of radiation oncology. These changes reflect a technological transition in the field over three decades from beam's-eye-view designed static treatment ports to functional imaging and knowledge-based treatment planning with biological dose optimization and real-time tumor tracking., Competing Interests: The authors have declared that no competing interests exist.- Published
- 2018
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214. Clinical results of dynamic tumor tracking intensity-modulated radiotherapy with real-time monitoring for pancreatic cancers using a gimbal mounted linac.
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Goto Y, Ashida R, Nakamura A, Itasaka S, Shibuya K, Akimoto M, Mukumoto N, Matsumoto S, Kanai M, Isoda H, Masui T, Kodama Y, Nakamura M, Takaori K, Mizowaki T, and Hiraoka M
- Abstract
Objectives: We performed dynamic tumor-tracking IMRT (DTT-IMRT) in locally advanced pancreatic cancer (LAPC) patients using a gimbaled linac of Vero4DRT. The purpose of this study is to report the first clinical results., Methods: From June 2013 to June 2015, eleven LAPC patients enrolled in this study and DTT-IMRT was successfully performed. The locoregional progression free survival (LRPFS), distant metastasis free survival (DMFS), overall survival (OS), hematologic and gastrointestinal (GI) toxicities were evaluated. Oncologic outcomes were estimated using Kaplan-Meier analysis, and toxicities using CTCAE v4.0., Results: The median radiation dose was 48 Gy (range, 45-51) in 15 fractions. Concurrent chemoradiotherapy (CCRT) was performed using gemcitabine in 9 patients and S-1 in one, while one patient refused. With a median follow-up of 22.9 months, 1-year LRPFS, DMFS, and OS rates were 90.9%, 70.7%, and 100%, respectively. Median survival time was 23.6 months. Grade-3 leucopenia and neutropenia were observed in two (18%) and one patient (9%), respectively. Grade-2 acute GI toxicity occurred in 2 patients (18%) and late grade-3 in 1 patient (9%)., Conclusions: Preliminarily application of DTT-IMRT using a gimbaled linac on CCRT in LAPC patients resulted in excellent locoregional control and OS without severe toxicity., Competing Interests: CONFLICTS OF INTEREST T. Mizowaki accepted a donation for research from Mitsubishi Heavy Industries.
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- 2018
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215. Is a clinical target volume (CTV) necessary for locally advanced non-small cell lung cancer treated with intensity-modulated radiotherapy? -a dosimetric evaluation of three different treatment plans.
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Xia F, Zhou L, Yang X, Chu L, Zhang X, Chu J, Hu W, and Zhu Z
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Background: The aim of this study was to determine the feasibility of omitting the clinical target volume (CTV) in patients with locally advanced non-small cell lung cancer (NSCLC) treated with intensity-modulated radiotherapy (IMRT) by comparing dosimetric characteristics of three different IMRT plans with or without CTV implementation., Methods: Thirteen patients with stage III NSCLC were reviewed. Target volumes were contoured such that the planning target volume (PTV) derived from the gross tumor volume (GTV) directly was named PTV_g and that from GTV plus CTV margin was named PTV_c. The PTV margin to generate PTV_g or PTV_c was the same within each case. Three IMRT plans were retrospectively generated to deliver: (I) 60 Gy to PTV_g in plan_routine; (II) 60 Gy to PTV_c in plan_CTV, and (III) 50 Gy to PTV_c while the dose was simultaneously escalated to 60 Gy to PTV_g in plan_SIB, achieved using the simultaneous integrated boost (SIB) technique. Optimization was performed to minimize the dose volumes of the irradiated normal lung, heart, esophagus, and spinal cord. Dose distributions and dosimetric indexes for the target volumes and critical structures in the three plans were computed and compared., Results: In plan_routine, the 50-Gy isodose line covered at least 95% of the GTV plus CTV margins in all 13 patients. The statistics showed better sparing of the organs at risk (OAR) in plan_routine than in plan_CTV, and the best OAR sparing in plan_SIB., Conclusions: In patients with locally advanced lung cancer, IMRT planning without CTV implementation provides sufficient dose coverage of subclinical disease while reducing the dose to normal tissues. The omission of CTV was feasible in our cohort of patients. However, when CTV was implemented, IMRT planning that included the SIB technique had further dosimetric benefits to the patients. This strategy thus merits further evaluation in clinical trials., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.
- Published
- 2017
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216. 18 F-Fluoromisonidazole positron emission tomography/CT-guided volumetric-modulated arc therapy-based dose escalation for hypoxic subvolume in nasopharyngeal carcinomas: A feasibility study.
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Qiu J, Lv B, Fu M, Wang X, Zheng X, and Zhuo W
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- Adult, Carcinoma pathology, Feasibility Studies, Female, Humans, Magnetic Resonance Imaging methods, Male, Middle Aged, Misonidazole analogs & derivatives, Nasopharyngeal Carcinoma, Nasopharyngeal Neoplasms diagnostic imaging, Nasopharyngeal Neoplasms pathology, Positron Emission Tomography Computed Tomography methods, Radiation Injuries prevention & control, Radiation Tolerance, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted methods, Sampling Studies, Treatment Outcome, Tumor Burden, Carcinoma diagnostic imaging, Carcinoma radiotherapy, Nasopharyngeal Neoplasms radiotherapy, Organs at Risk radiation effects, Radiotherapy, Intensity-Modulated methods
- Abstract
Background: The purpose of this study is to investigate the feasibility of a simultaneously integrated boost to the hypoxic subvolume of nasopharyngeal carcinomas (NCPs) under the guidance of
18 F-fluoromisonidazole (FMISO) positron emission tomography (PET)/CT using volumetric-modulated arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) techniques., Methods: Eight patients with NPC were treated with simultaneous integrated boost-IMRT (treatment plan named IMRT70) with dose prescriptions of 70 Gy, 66 Gy, 60 Gy, and 54 Gy to the gross tumor volume (GTV), positive neck nodes, the planning target volume (PTV), and the clinically negative neck, respectively. Based on the same datasets, experimental plans with the same dose prescription plus a dose boost of 14 Gy (an escalation of 20% of the prescription dose) to the hypoxic volume target contoured on the pretreatment18 F-FMISO PET/CT imaging were generated using IMRT and VMAT techniques, respectively (represented by IMRT84 and VMAT84). Two or more arcs (approximately 2-2.5 arcs, totally rotating angle <1000 degrees) were used in VMAT plans and 9 equally separated fields in IMRT plans. Dosimetric parameters, total monitor units, and delivery time were calculated for comparative study of plan quality and delivery efficiency between IMRT84 and VMAT84., Results: In experimental plans, hypoxic target volumes successfully received the prescribed dose of 84 Gy in compliance with other dose constraints with either the IMRT technique or the VMAT technique. In terms of the target coverage, dose homogeneity, and organs at risk (OAR) sparing, there was no statistically significant difference between the actual treatment plan of IMRT70 and experimental plans. The total monitor unit of VMAT84 (525.7 ± 39.8) was significantly less than IMRT70 (1171.5 ± 167; P = .001) and IMRT84 (1388.3 ± 151.0; P = .001) per fraction, with 55.1% and 62.1% reduction. The average machine delivery time was 3.5 minutes for VMAT plans in comparison with approximately 8 minutes for IMRT plans, resulting in a reduction factor of 56.2%. For experimental plans, the 3D gamma index average was over 98.0% with no statistical significant difference when a 3%/3 mm gamma passing rate criteria was used., Conclusion: With the guidance of18 F-FMISO PET/CT imaging, dose escalation to hypoxic zones within NPC could be achieved and delivered efficiently with the VMAT technique in comparison with the IMRT technique., (© 2017 Wiley Periodicals, Inc.)- Published
- 2017
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217. Intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy for stage I-II natural killer/T-cell lymphoma nasal type: dosimetric and clinical results
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Ye Guo, Weigang Hu, Juan Huang, Xuejun Ma, Qian-wen Shen, and Lanfei Chen
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Oncology ,Adult ,Male ,Organs at Risk ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Lymphoma, T-Cell ,Young Adult ,Internal medicine ,medicine ,Three-dimensional conformal radiotherapy (3DCRT) ,Humans ,Radiology, Nuclear Medicine and imaging ,Intensity-modulated radiotherapy (IMRT) ,Treatment outcome ,Radiometry ,Lymph node ,Aged ,Neoplasm Staging ,Proportional Hazards Models ,Retrospective Studies ,business.industry ,Research ,Radiotherapy Planning, Computer-Assisted ,Induction chemotherapy ,Retrospective cohort study ,Radiotherapy Dosage ,Chemoradiotherapy ,Middle Aged ,medicine.disease ,Natural killer T cell ,Parotid gland ,Lymphoma ,Radiation therapy ,stomatognathic diseases ,medicine.anatomical_structure ,Radiology Nuclear Medicine and imaging ,Female ,Radiology ,Radiotherapy, Intensity-Modulated ,Nature killer (NK)/T-cell lymphoma ,Radiotherapy, Conformal ,business - Abstract
Background This study was to compare radiotherapy treatment planning and treatment outcomes following three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) in stage I-II natural killer (NK)/T-cell lymphoma. Methods The cases of 94 patients with stage I-II NK/T-cell lymphoma, nasal type in the upper aerodigestive tract who treated between May 2005 and Dec 2008 were reviewed. These patients received radiotherapy with or without induction chemotherapy. Definitive radiotherapy was conducted using 3DCRT in 47 patients and IMRT in the other 47 patients with a regional field and a total dose of 50 Gy. Dosimetric pmeters of radiation treatment plans, local control probability (LCP), overall survival (OS), and toxicities were analyzed and compared between 3DCRT and IMRT. Results From the dosimetric analysis, IMRT demonstrated significantly better dose coverage and homogeneity than 3DCRT. However, after a median follow-up of 46 months, IMRT was not associated with improvements in 4y-OS (80.9% for 3DCRT vs. 82.7% for IMRT, p=0.87) or 4y-LCP (86.3% for 3DCRT vs. 88.9% for IMR p=0.85). Of the 18 patients who received cervical lymph node irradiation, those in the IMRT group received a lower mean parotid dose. Furthermore, at-risk organs were strictly kept within the safe dose range in both groups, and no severe late toxicity was observed. Conclusions IMRT provided better dose coverage than 3DCRT, although it failed to provide LCP and OS benefits. Definitive radiotherapy with a regional field and a total dose of 50 Gy is efficient and safe for NK/T-cell lymphoma using either IMRT or 3DCRT. However, IMRT may have the potential to reduce parotid gland hypofunction following cervical irradiation.
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- 2013
218. Minimal Rectal Toxicity in the Setting of Comorbid Crohn's Disease Following Prostate Cancer Radiotherapy with a Hydrogel Rectal Spacer.
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Singh R, Jackson PS, Blake M, Cutlip J, and Sharma S
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We present one of the first cases of a prostate cancer (PCa) patient with inflammatory bowel disease (IBD) treated with intensity-modulated radiotherapy (IMRT) and a hydrogel rectal spacer. A 73-year-old male with a past medical history significant for Crohn's disease (CD) and the recent diagnosis of T1cN0M0 high-risk PCa was referred for definitive radiotherapy. Given the patient's history of CD and the possible increased risk of gastrointestinal (GI) toxicity and disease exacerbation, prior to IMRT, a hydrogel spacer was placed between the prostate and the anterior rectal wall to further minimize irradiation to the rectum. The patient then received IMRT (78 Gy/2 Gy fractions at a 100 percent isodose line). Over the course of treatment, Radiation Therapy Oncology Group (RTOG) Grade 1 GI toxicities of mild diarrhea were noted during the fifth and sixth weeks of treatment as well as an RTOG Grade 1 genitourinary (GU) toxicity of a decrease in the urinary stream that resolved with tamsulosin. At the 3, 6, 9, and 12-month follow-ups, bowel movements and urinary stream were reported to be at baseline with prostate-specific antigen (PSA) levels of 0.18 ng/mL and 0.03 ng/mL at the three and nine-month follow-ups, respectively. As such, this case report suggests that IBD patients with localized PCa may be viable candidates for radiotherapy given the promising results of hydrogel spacers in combination with IMRT in limiting rectal toxicity., Competing Interests: The authors have declared that no competing interests exist.
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- 2017
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219. Unknown primary head and neck squamous cell carcinoma in the era of fluorodeoxyglucose-positron emission tomography/CT and intensity-modulated radiotherapy.
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de Ridder M, Klop M, Hamming-Vrieze O, de Boer J, Jasperse B, Smit L, Vogel W, van den Brekel M, and Al-Mamgani A
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- Aged, Analysis of Variance, Carcinoma, Squamous Cell mortality, Carcinoma, Squamous Cell secondary, Cohort Studies, Disease-Free Survival, Female, Head and Neck Neoplasms mortality, Head and Neck Neoplasms secondary, Humans, Male, Middle Aged, Neoplasms, Unknown Primary diagnostic imaging, Neoplasms, Unknown Primary radiotherapy, Netherlands, Positron Emission Tomography Computed Tomography methods, Prognosis, Proportional Hazards Models, Retrospective Studies, Risk Assessment, Survival Analysis, Treatment Outcome, Carcinoma, Squamous Cell diagnostic imaging, Carcinoma, Squamous Cell radiotherapy, Fluorodeoxyglucose F18, Head and Neck Neoplasms diagnostic imaging, Head and Neck Neoplasms radiotherapy, Radiotherapy, Intensity-Modulated methods
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Background: The diagnosis and treatment of head and neck carcinoma of unknown primary (CUP) have changed with the introduction of fluorodeoxyglucose-positron emission tomography (FDG-PET)/CT and intensity-modulated radiotherapy (IMRT), with potential implications for outcome., Methods: We conducted a retrospective analysis of 80 patients with head and neck CUP who were PET-staged and treated with curative intention using IMRT between 2006 and 2016 in the Netherlands Cancer Institute. Patient, tumor, and treatment demographics were recorded and oncologic outcomes were analyzed., Results: Local control was 100% in mucosal irradiated patients. Regional control was 90%. Ten patients developed distant metastases, which were associated with N3, extracapsular extension (ECE) and lower neck positive lymph nodes. Overall survival (OS) at 5 years was 62% and disease-specific survival was 78%. ECE, N3 neck, multiple levels of positive lymph nodes, and positive lymph nodes in the lower neck were associated with worse prognosis., Conclusion: Locoregional outcome of head and neck CUP managed with modern techniques is good. Future research needs to focus on reducing toxicity and patients prone for distant metastasis., (© 2017 Wiley Periodicals, Inc.)
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- 2017
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220. Consideration of Dose Error in Dynamic MLC IMRT Using MLC Speed Control with Dose Rate Change.
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Kojima H, Takigami M, Asano T, Hatanaka Y, Aizawa K, and Ishikawa M
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- Radiotherapy Planning, Computer-Assisted, Technology, Radiologic, Radiotherapy Dosage, Radiotherapy, Intensity-Modulated methods
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In dynamic multi-leaf collimator (MLC) intensity-modulated radiotherapy (IMRT), the accuracy of delivered dose is influenced by the positional accuracy of the moving MLC. In order to assess the accuracy of the delivered dose during dynamic MLC IMRT, the delivered dose error in dynamic MLC IMRT using the MLC speed control with dose rate change was investigated. Sweeping gap sequence irradiation was performed with constant MLC leaf speed at 0.6 to 5 cm/s or changed MLC speed (4 steps). The positional accuracy of the moving MLC was evaluated from the trajectory log file. Absorbed dose measurements with sweeping field (Field size: 10 cm×10 cm, MLC leaf speed: 0.6 to 2.7 cm/s, MLC leaf gap width: 0.2 to 2.0 cm) were performed. The delivered dose error at each gap width was evaluated according to MLC leaf speed change. MLC positional errors and changes in delivered dose according to MLC leaf speed were within 0.07 mm and 0.6%, respectively, for all measurements. Beam hold-off did not occur under any conditions. We confirmed that TrueBeam can regulate MLC leaf speed below the maximum limit (2.5 cm/s) by changing the dose rate in real-time during irradiation in dynamic MLC IMRT. MLC gap error during irradiation was estimated within 0.2 mm at the maximum dose rate from the results of absolute dose measurements using dynamic MLC irradiation. In conclusion, TrueBeam can use the maximum dose rate for the treatment planning of dynamic MLC IMRT, which has an advantage of shorter treatment time.
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- 2017
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221. Reduced toxicity with three-dimensional conformal radiotherapy or intensity-modulated radiotherapy compared with conventional two-dimensional radiotherapy for esophageal squamous cell carcinoma: a secondary analysis of data from four prospective clinical trials.
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Deng JY, Wang C, Shi XH, Jiang GL, Wang Y, Liu Y, and Zhao KL
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- Adult, Aged, Aged, 80 and over, Esophageal Squamous Cell Carcinoma, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Prospective Studies, Retrospective Studies, Treatment Outcome, Carcinoma, Squamous Cell radiotherapy, Esophageal Neoplasms radiotherapy, Radiation Injuries etiology, Radiotherapy, Conformal adverse effects, Radiotherapy, Intensity-Modulated adverse effects
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We conducted a retrospective analysis to assess the toxicity and long-term survival of esophageal squamous cell carcinoma patients treated with three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT) versus conventional two-dimensional radiotherapy (2DRT). All data in the present study were based on four prospective clinical trials conducted at our institution from 1996 to 2004 and included 308 esophageal squamous cell carcinoma patients treated with 2DRT or 3DCRT/IMRT. Based on the inclusion and exclusion criteria, 254 patients were included in the analysis. Of these patients, 158 were treated with 2DRT, whereas 96 were treated with 3DCRT/IMRT. The rates of ≥Grade3 acute toxicity of the esophagus and lung were 11.5% versus 28.5% (P = 0.002) and 5.2% versus 10.8% (P = 0.127) in the 3DCRT/IMRT and 2DRT groups, respectively. The incidences of ≥Grade 3 late toxicity of the esophagus and lungs were 3.1% versus 10.7% (P = 0.028) and 3.1% versus 5.7% (P = 0.127) in the 3DCRT/IMRT and 2DRT groups, respectively. The 1-year, 3-year and 5-year estimated overall survival rates were 81%, 38% and 34% in the 3DCRT/IMRT group and 79%, 44% and 31% in the 2DRT group, respectively (P = 0.628). The 1-year, 3-year and 5-year local control rates were 88%, 71% and 66% in the 3DCRT/IMRT group and 84%, 66% and 60% in the 2DRT group, respectively (P = 0.412). Fewer incidences of acute and late toxicities were observed in esophageal squamous cell carcinoma patients treated with 3DCRT/IMRT compared with those treated with 2DRT. No significant survival benefit was observed with the use of 3DCRT/IMRT., (© 2015 International Society for Diseases of the Esophagus.)
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- 2016
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222. Erratum to: Strahlentherapie und Onkologie, Volume 186 (No. 10) Guckenberger M, Ok S, Polat B, Sweeney RA, Flentje M. Toxicity after Intensity-Modulated, Image-Guided Radiotherapy for Prostate Cancer. Strahlenther Onkol 2010;186:535–43 (DOI 10.1007/s00066-010-2144-z)
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Guckenberger, Matthias, Ok, Sami, Polat, Bülent, Sweeney, Reinhart A., and Flentje, Michael
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- 2010
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223. Effectiveness and toxicity of hypofractionated high-dose intensity-modulated radiotherapy versus 2- and 3-dimensional radiotherapy in incurable head and neck cancer.
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van Beek KM, Kaanders JH, Janssens GO, Takes RP, Span PN, and Verhoef CG
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- Adult, Aged, Aged, 80 and over, Humans, Male, Middle Aged, Mucositis complications, Retrospective Studies, Head and Neck Neoplasms radiotherapy, Radiation Dose Hypofractionation, Radiotherapy, Intensity-Modulated
- Abstract
Background: This retrospective study evaluates efficacy and tolerability of high-dose hypofractionated radiotherapy (RT) in patients with head and neck cancer., Methods: All patients with head and neck cancer treated between September 2003 and September 2013 with 12 × 4 Gy RT were included. Two and 3D-RT or intensity-modulated radiotherapy (IMRT) were used. Overall survival (OS), tumor response, and palliative effect were evaluated., Results: Palliative effect occurred in 63% of 81 included patients, lasted a median of 4.6 months, and was correlated with tumor response (p = .006). Median OS was 7.2 months. Confluent mucositis occurred more often in patients treated with 2D/3D-RT than IMRT (26% vs 44%; p = .04) and lasted for a median of 2 weeks., Conclusion: High-dose hypofractionated RT resulted in meaningful palliation in 63%, lasting for almost 5 months. IMRT should be the technique of choice, as it results in less high-grade toxicity. The 12 × 4 schedule should be opted for patients with reasonable functional capacities and a life expectancy of >6 months. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1264-E1270, 2016., (© 2015 Wiley Periodicals, Inc.)
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- 2016
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224. Radiation modality use and cardiopulmonary mortality risk in elderly patients with esophageal cancer.
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Lin SH, Zhang N, Godby J, Wang J, Marsh GD, Liao Z, Komaki R, Ho L, Hofstetter WL, Swisher SG, Mehran RJ, Buchholz TA, Elting LS, and Giordano SH
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- Aged, Aged, 80 and over, Cardiovascular Diseases etiology, Female, Humans, Imaging, Three-Dimensional, Lung Diseases etiology, Male, Medicare, Odds Ratio, Propensity Score, Registries, Risk Assessment, SEER Program, Texas epidemiology, Treatment Outcome, United States epidemiology, Cardiovascular Diseases mortality, Esophageal Neoplasms radiotherapy, Lung Diseases mortality, Organ Sparing Treatments methods, Radiotherapy, Conformal adverse effects, Radiotherapy, Intensity-Modulated adverse effects
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Background: It is currently unclear whether the superior normal organ-sparing effect of intensity-modulated radiotherapy (IMRT) compared with 3-dimensional radiotherapy (3D) has a clinical impact on survival and cardiopulmonary mortality in patients with esophageal cancer (EC)., Methods: The authors identified 2553 patients aged > 65 years from the Surveillance, Epidemiology, and End Results (SEER)-Medicare and Texas Cancer Registry-Medicare databases who had nonmetastatic EC diagnosed between 2002 and 2009 and were treated with either 3D (2240 patients) or IMRT (313 patients) within 6 months of diagnosis. The outcomes of the 2 cohorts were compared using inverse probability of treatment weighting adjustment., Results: Except for marital status, year of diagnosis, and SEER region, both radiation cohorts were well balanced with regard to various patient, tumor, and treatment characteristics, including the use of IMRT versus 3D in urban/metropolitan or rural areas. IMRT use increased from 2.6% in 2002 to 30% in 2009, whereas the use of 3D decreased from 97.4% in 2002 to 70% in 2009. On propensity score inverse probability of treatment weighting-adjusted multivariate analysis, IMRT was not found to be associated with EC-specific mortality (hazard ratio [HR], 0.93; 95% confidence interval [95% CI], 0.80-1.10) or pulmonary mortality (HR, 1.11; 95% CI, 0.37-3.36), but was significantly associated with lower all-cause mortality (HR, 0.83; 95% CI, 0.72-0.95), cardiac mortality (HR, 0.18; 95% CI, 0.06-0.54), and other-cause mortality (HR, 0.54; 95% CI, 0.35-0.84). Similar associations were noted after adjusting for the type of chemotherapy, physician experience, and sensitivity analysis removing hybrid radiation claims., Conclusions: In this population-based analysis, the use of IMRT was found to be significantly associated with lower all-cause mortality, cardiac mortality, and other-cause mortality in patients with EC., (© 2015 American Cancer Society.)
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- 2016
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225. Long-term survival and late complications in intensity-modulated radiotherapy of locally recurrent T1 to T2 nasopharyngeal carcinoma.
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Tian YM, Guan Y, Xiao WW, Zeng L, Liu S, Lu TX, Zhao C, and Han F
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- Adult, Aged, Carcinoma, Cranial Nerve Diseases etiology, Feasibility Studies, Female, Follow-Up Studies, Headache etiology, Humans, Male, Middle Aged, Nasal Mucosa pathology, Nasopharyngeal Carcinoma, Nasopharyngeal Neoplasms pathology, Necrosis etiology, Neoplasm Recurrence, Local pathology, Prognosis, Temporal Lobe pathology, Nasopharyngeal Neoplasms mortality, Nasopharyngeal Neoplasms radiotherapy, Neoplasm Recurrence, Local mortality, Neoplasm Recurrence, Local radiotherapy, Radiotherapy, Intensity-Modulated adverse effects
- Abstract
Background: We investigated the feasibility of reirradiation with intensity-modulated radiotherapy (IMRT) for recurrent T1 to T2 nasopharyngeal carcinoma (NPC) by assessing long-term survival and late complication rates., Methods: Sixty patients who had been previously irradiated were diagnosed with locally recurrent T1 to T2 NPC and underwent reirradiation with IMRT. Severe radiation toxicities were assessed., Results: The median follow-up time was 40.0 months. The 5-year local failure-free survival (LFFS), distant failure-free survival (DFFS), and overall survival (OS) rates were 85.7%, 96.1%, and 67.2%, respectively. Independent prognostic factors included primary gross tumor volume >20 cm and the presence of significant complications. The most common severe complications were headache (31.6%), mucosal necrosis (30.0%), cranial neuropathy (25.0%), and temporal lobe necrosis (21.6%). Thirty-nine patients (65.0%) developed at least one severe complication and 18 patients died as a result., Conclusion: Excellent disease control can be achieved by reirradiation with IMRT for recurrent T1 to T2 NPC. However, the main challenge remains severe late complications., (© 2015 Wiley Periodicals, Inc.)
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- 2016
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226. Intensity-Modulated Radiation Therapy Versus 3D Conformal Radiotherapy for Postoperative Gynecologic Cancer: Are They Covering the Same Planning Target Volume?
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Lukovic J, Patil N, D'souza D, Millman B, Yaremko BP, Leung E, Whiston F, Hajdok G, and Wong E
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Background and Purpose: This study compares dosimetric parameters of planning target volume (PTV) coverage and organs at risk (OAR) sparing when postoperative radiotherapy for gynecologic cancers is delivered using volumetric modulated arc therapy (VMAT) versus a four-field (4FLD) box technique., Material and Methods: From July to December 2012, women requiring postoperative radiation for gynecologic cancers were treated with a standardized VMAT protocol. Two sets of optimized 4FLD plans were retrospectively generated: one based on standard anatomical borders (4FLD) and one based on the clinical target volume (CTV) created for VMAT with a 2 cm expansion guiding field border placement (4FLD+2). Ninety-five percent isodose curves were generated to evaluate PTV coverage., Results: VMAT significantly improved dose conformity compared with 4FLD and 4FLD+2 plans (p < 0.001) and provided additional coverage of the PTV posteriorly and superiorly, corresponding to coverage of the presacral and proximal iliac vessels. There was a significant reduction in dose to all OARs with VMAT, including a 58% reduction in the volume of the small bowel receiving more than 45 Gy (p=0.005)., Conclusions: Despite treating a larger volume, radiotherapy using a 4FLD technique is less homogenous and provides inferior coverage of the PTV compared with VMAT. With meticulous treatment planning and delivery, VMAT effectively encompasses the PTV and minimizes dose to OARs.
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- 2016
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227. Intensity-modulated radiotherapy prolongs the survival of patients with nasopharyngeal carcinoma compared with conventional two-dimensional radiotherapy: A 10-year experience with a large cohort and long follow-up.
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Zhang MX, Li J, Shen GP, Zou X, Xu JJ, Jiang R, You R, Hua YJ, Sun Y, Ma J, Hong MH, and Chen MY
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- Adolescent, Adult, Aged, Aged, 80 and over, Carcinoma, Child, Disease-Free Survival, Female, Humans, Male, Middle Aged, Multivariate Analysis, Nasopharyngeal Carcinoma, Nasopharyngeal Neoplasms pathology, Neoplasm Staging, Prognosis, Retrospective Studies, Treatment Outcome, Young Adult, Nasopharyngeal Neoplasms radiotherapy, Radiotherapy methods, Radiotherapy, Intensity-Modulated methods
- Abstract
Background: To evaluate the survival benefit of intensity-modulated radiotherapy (IMRT) compared with conventional two-dimensional radiotherapy (2D-CRT) in nasopharyngeal carcinoma (NPC) using a large cohort with long follow-up., Methods: We retrospectively analysed 7081 non-metastatic NPC patients who received curative IMRT or 2D-CRT from February 2002 to December 2011., Results: Of the 7081 patients, 2245 (31.7%) were administered IMRT, while 4836 (68.3%) were administered 2D-CRT. At 5 years, the patients administered IMRT had significantly higher local relapse-free survival (LRFS), loco-regional relapse-free survival (LRRFS), progression-free survival (PFS) and overall survival (OS) (95.6%, 92.5%, 82.1% and 87.4%, respectively) than those administered 2D-CRT (90.8%, 88.5%, 76.7% and 84.5%, respectively; p<0.001). The distant metastasis-free survival (DMFS) was higher for IMRT than 2D-CRT, with borderline significance (87.6% and 85.7%, respectively; p=0.056). However, no difference was observed between IMRT and 2D-CRT in nodal relapse-free survival (NRFS; 96.3% and 97.4%, respectively; p=0.217). Multivariate analyses showed that IMRT was an independent protective prognostic factor for LRFS, LRRFS and PFS, but not NRFS, DMFS or OS., Conclusions: IMRT provided an improved LRFS, LRRFS and PFS in both the early and advanced T classifications and overall stage for non-disseminated NPC compared with 2D-CRT. However, no significant advantage was observed in NRFS, DMFS or OS when IMRT was used., (Copyright © 2015 Elsevier Ltd. All rights reserved.)
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- 2015
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228. Clinical outcomes of helical tomotherapy for super-elderly patients with localized and locally advanced prostate cancer: comparison with patients under 80 years of age.
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Okonogi N, Katoh H, Kawamura H, Tamaki T, Kaminuma T, Murata K, Ohkubo Y, Takakusagi Y, Onishi M, Sekihara T, Okazaki A, and Nakano T
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- Aged, Aged, 80 and over, Humans, Male, Prostatic Neoplasms radiotherapy, Radiotherapy, Intensity-Modulated adverse effects
- Abstract
We investigated the clinical outcomes of helical tomotherapy in 23 patients aged ≥80 years with localized and locally advanced prostate cancer and compared the results with data from 171 patients under 80 years. All patients received helical tomotherapy in our hospital between September 2009 and October 2012. The median follow-up periods were 35 months in the aged group and 34 months in the younger group. The median prescribed dose in helical tomotherapy was 78 Gy in 39 fractions (range, 72-78 Gy). The 3-year overall survival and biochemical relapse-free rates were 92% and 96% in the aged group and 99.4% and 97.3% in the younger group, respectively. There was no significant difference between the two groups in the biochemical relapse-free rates. The 3-year cumulative incidences of late Grade 2 or higher rectal toxicity and urinary toxicity were 13% and 4.8% in the aged group and 7.0% and 1.2% in the younger group, respectively. There was no significant difference between the aged group and the younger group in the cumulative incidence rates of rectal toxicity or urinary toxicity. No patients exhibited Grade 4 or higher toxicity, and all patients improved with conservative therapy. Helical tomotherapy in super-elderly patients with localized and locally advanced prostate cancer had good biochemical control rates without severe late toxicity. Definitive helical tomotherapy may be the treatment of choice for patients with localized and locally advanced prostate cancer, even in those older than 80 years of age., (© The Author 2015. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.)
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- 2015
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229. Impact of obesity on outcomes after definitive dose-escalated intensity-modulated radiotherapy for localized prostate cancer.
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Wang LS, Murphy CT, Ruth K, Zaorsky NG, Smaldone MC, Sobczak ML, Kutikov A, Viterbo R, and Horwitz EM
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- Adult, Aged, Aged, 80 and over, Disease-Free Survival, Dose Fractionation, Radiation, Humans, Kallikreins blood, Male, Middle Aged, Neoplasm Metastasis, Obesity blood, Obesity pathology, Proportional Hazards Models, Prostate-Specific Antigen blood, Prostatic Neoplasms blood, Prostatic Neoplasms mortality, Prostatic Neoplasms pathology, Radiotherapy, Intensity-Modulated, Treatment Outcome, Obesity mortality, Prostatic Neoplasms radiotherapy
- Abstract
Background: Previous publications have demonstrated conflicting results regarding body mass index (BMI) and prostate cancer (CaP) outcomes after definitive radiotherapy (RT) before the dose escalation era. The goal of the current study was to determine whether increasing BMI was associated with outcomes in men with localized CaP who were treated with dose-escalated RT., Methods: The authors identified patients with localized (T1b-T4N0M0) CaP who were treated with definitive intensity-modulated RT and image-guided RT from 2001 through 2010. BMI was analyzed as a continuous variable. Adjusting for confounders, multivariable competing risk and Cox proportional hazards regression models were used to assess the association between BMI and the risk of biochemical failure (BF), distant metastases (DM), cause-specific mortality (CSM), and overall mortality., Results: Of the 1442 patients identified, approximately 20% had a BMI <25 kg/m(2) , 48% had a BMI of 25 to 29.9 kg/m(2) , 23% had a BMI of 30 to 34.9 kg/m(2) , 6% had a BMI of 35 to 39.9 kg/m(2) , and 4% had a BMI of ≥40 kg/m(2) . The median follow-up was 47.6 months (range, 1-145 months), with a median age of 68 years (range, 36-89 years). The median dose was 78 grays (range, 76-80 grays) and 30% of patients received androgen deprivation therapy. Increasing BMI was found to be inversely associated with age (P<.001) and pretreatment prostate-specific antigen level (P = .018). On multivariable analysis, increasing BMI was associated with an increased risk of BF (hazard ratio [HR], 1.03; 95% confidence interval [95% CI], 1.00-1.07 [P = .042]), DM (HR, 1.07; 95% CI, 1.02-1.11 [P = .004]), CSM (HR, 1.15; 95% CI, 1.07-1.23 [P<.001]), and overall mortality (HR, 1.05; 95% CI, 1.02-1.08 [P = .004])., Conclusions: For patients with CaP receiving dose-escalated intensity-modulated RT with daily image-guidance, increasing BMI appears to be associated with an increased risk of BF, DM, CSM, and overall mortality., (© 2015 American Cancer Society.)
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- 2015
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230. Salvage endoscopic nasopharyngectomy and intensity-modulated radiotherapy versus conventional radiotherapy in treating locally recurrent nasopharyngeal carcinoma.
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Zou X, Han F, Ma WJ, Deng MQ, Jiang R, Guo L, Liu Q, Mai HQ, Hong MH, and Chen MY
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- Adult, Carcinoma, Chemotherapy, Adjuvant methods, China, Female, Humans, Male, Middle Aged, Nasopharyngeal Carcinoma, Natural Orifice Endoscopic Surgery methods, Nose, Radiotherapy, Conformal methods, Survival Analysis, Treatment Outcome, Nasopharyngeal Neoplasms therapy, Neoplasm Recurrence, Local therapy, Radiotherapy, Intensity-Modulated methods, Salvage Therapy methods
- Abstract
Background: Although endoscopic nasopharyngectomy and intensity-modulated radiotherapy (IMRT) have been reported to be useful in treating isolated local recurrent nasopharyngeal carcinoma (NPC), their efficacy needs to be revaluated with comparison to 2D conventional radiotherapy (RT)., Methods: Four hundred ten patients with recurrent NPC were retrospectively analyzed, among whom the patients underwent IMRT, endoscopic nasopharyngectomy, and 2D conventional RT., Results: The 5-year overall survival (OS) and distant metastasis-free survival were significantly higher in endoscopic nasopharyngectomy and IMRT groups than in 2D conventional RT group both in the entire series and in the subgroup of patients with recurrent T1 to 2 NPC (p < .05), except in the subgroup of recurrent T3 to 4 stratifications (IMRT vs 2D conventional RT; 28.8% vs 16.8%; p = .351). Furthermore, endoscopic nasopharyngectomy was associated with better OS than IMRT in the recurrent T1 to 2 subgroup (79.2% vs 62.1%; p = .007). Multivariate analysis indicated therapeutic modality was an independent predictor of OS and distant metastasis-free survival (p < .001)., Conclusion: Endoscopic nasopharyngectomy and IMRT are associated with an improved OS and distant metastasis-free survival of patients with recurrent NPC compared to 2D conventional RT in early recurrent disease., (© 2014 Wiley Periodicals, Inc.)
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- 2015
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231. NRG Oncology/RTOG 0921: A phase 2 study of postoperative intensity-modulated radiotherapy with concurrent cisplatin and bevacizumab followed by carboplatin and paclitaxel for patients with endometrial cancer.
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Viswanathan AN, Moughan J, Miller BE, Xiao Y, Jhingran A, Portelance L, Bosch WR, Matulonis UA, Horowitz NS, Mannel RS, Souhami L, Erickson BA, Winter KA, Small W Jr, and Gaffney DK
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- Adult, Aged, Aged, 80 and over, Bevacizumab administration & dosage, Chemoradiotherapy, Adjuvant, Cisplatin administration & dosage, Disease-Free Survival, Endometrial Neoplasms pathology, Endometrial Neoplasms surgery, Female, Humans, Hysterectomy, Lymph Node Excision, Middle Aged, Paclitaxel administration & dosage, Postoperative Period, Radiotherapy, Intensity-Modulated, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Endometrial Neoplasms drug therapy, Endometrial Neoplasms radiotherapy
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Background: The current study was conducted to assess acute and late adverse events (AEs), overall survival (OS), pelvic failure, regional failure, distant failure, and disease-free survival in a prospective phase 2 clinical trial of bevacizumab and pelvic intensity-modulated radiotherapy (IMRT) with chemotherapy in patients with high-risk endometrial cancer., Methods: Patients underwent a hysterectomy and lymph node removal, and had ≥1 of the following high-risk factors: grade 3 carcinoma with >50% myometrial invasion, grade 2 or 3 disease with any cervical stromal invasion, or known extrauterine extension confined to the pelvis. Treatment included pelvic IMRT and concurrent cisplatin on days 1 and 29 of radiation and bevacizumab (at a dose of 5 mg/kg on days 1, 15, and 29 of radiation) followed by adjuvant carboplatin and paclitaxel for 4 cycles. The primary endpoint was grade ≥3 AEs occurring within the first 90 days (toxicity was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events [version 4.0])., Results: A total of 34 patients were accrued from November 2009 through December 2011, 30 of whom were eligible and received study treatment. Seven of 30 patients (23.3%; 1-sided 95% confidence interval, 10.6%-36.0%) developed grade ≥3 treatment-related nonhematologic toxicities within 90 days; an additional 6 patients experienced grade ≥3 toxicities between 90 and 365 days after treatment. The 2-year OS rate was 96.7% and the disease-free survival rate was 79.1%. No patient developed a within-field pelvic failure and no patients with International Federation of Gynecology and Obstetrics stage I to IIIA disease developed disease recurrence after a median follow-up of 26 months., Conclusions: Postoperative bevacizumab added to chemotherapy and pelvic IMRT appears to be well tolerated and results in high OS rates at 2 years for patients with high-risk endometrial carcinoma., (© 2015 American Cancer Society.)
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- 2015
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232. Clinical outcomes associated with evolving treatment modalities and radiation techniques for base-of-tongue carcinoma: thirty years of institutional experience.
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Chen LA, Anker CJ, Hunt JP, Buchmann LO, Grossmann KF, Boucher K, Fang LM, Shrieve DC, and Hitchcock YJ
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- Adult, Aged, Aged, 80 and over, Carcinoma diagnosis, Chemotherapy, Adjuvant adverse effects, Combined Modality Therapy, Diagnostic Imaging, Female, Humans, Male, Middle Aged, Neoplasm Staging, Radiotherapy, Adjuvant adverse effects, Radiotherapy, Adjuvant methods, Tongue Neoplasms diagnosis, Treatment Outcome, Carcinoma pathology, Carcinoma therapy, Tongue Neoplasms pathology, Tongue Neoplasms therapy
- Abstract
Curative treatment for base-of-tongue squamous cell carcinoma (BOT SCC) has evolved over time; however, comparative outcomes analysis for various treatment strategies is lacking. The authors reviewed the evolution of treatment modality and radiotherapy (RT) technique for 231 consecutive BOT SCC patients at our institution between 1981 and 2011. Treatment modalities included definitive chemoradiotherapy (chemoRT) (42%), definitive RT (33%), surgery followed by RT (20%), and surgery alone (5%). RT techniques included external beam plus interstitial brachytherapy (EBRT + IB) (37%), conventional EBRT (29%), intensity-modulated radiation therapy ± simultaneous integrated boost (IMRT ± SIB) (34%). Clinical characteristics and outcomes were stratified by modality or RT technique. Treatment modality evolved from definitive RT (1980s-1990s) to definitive chemoRT (1990s-2000s). RT technique evolved from EBRT + IB (1980s-1990s) to conventional EBRT (1990s-2000s) to IMRT + SIB (2000s). With median alive follow-up of 6 years (0.3-28 years), the 5-year LC, LRC, and OS rates were 80%, 73%, and 51%. There was no difference in distribution of gender, age, stage among treatment modalities. Definitive chemoRT had improved LRC (HR 1.6) and OS (HR 1.7) compared to definitive RT. IMRT + SIB had improved LRC (HR 3.2), DFS (HR 3.4), and OS (HR 3.0) compared to conventional EBRT. Over the past 30 years, BOT SCC treatment has undergone major paradigm shifts that incorporate nonsurgical functional preservation, concurrent chemotherapy, and advanced RT techniques. Excellent locoregional control and survival outcomes are associated with accelerated IMRT with chemotherapy., (© 2014 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)
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- 2015
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233. Outcomes of intensity-modulated radiotherapy versus conventional radiotherapy for hypopharyngeal cancer.
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Mok G, Gauthier I, Jiang H, Huang SH, Chan K, Witterick IJ, O'Sullivan B, Waldron JN, Bayley AJ, Cho BC, Cummings BJ, Dawson LA, Hope AJ, Kim JJ, and Ringash J
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- Adult, Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Carcinoma, Squamous Cell drug therapy, Carcinoma, Squamous Cell mortality, Carcinoma, Squamous Cell pathology, Cohort Studies, Disease-Free Survival, Female, Follow-Up Studies, Head and Neck Neoplasms drug therapy, Head and Neck Neoplasms mortality, Head and Neck Neoplasms pathology, Humans, Hypopharyngeal Neoplasms drug therapy, Hypopharyngeal Neoplasms mortality, Hypopharyngeal Neoplasms pathology, Kaplan-Meier Estimate, Male, Middle Aged, Multivariate Analysis, Neoplasm Recurrence, Local mortality, Ontario, Proportional Hazards Models, Radiotherapy Dosage, Radiotherapy, Conformal adverse effects, Radiotherapy, Intensity-Modulated adverse effects, Retrospective Studies, Risk Assessment, Squamous Cell Carcinoma of Head and Neck, Survival Analysis, Time Factors, Treatment Outcome, Carcinoma, Squamous Cell radiotherapy, Head and Neck Neoplasms radiotherapy, Hypopharyngeal Neoplasms radiotherapy, Neoplasm Recurrence, Local pathology, Radiotherapy, Conformal methods, Radiotherapy, Intensity-Modulated methods
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Background: The purpose of this study was to discuss if the adoption of intensity-modulated radiotherapy (IMRT) for hypopharyngeal squamous cell carcinoma (SCC) has improved the outcome., Methods: We compared 3-dimensional (3D) radiotherapy (RT) and IMRT in all patients with hypopharyngeal SCC treated with curative intent RT or chemoradiation therapy (CRT) from January 1, 2000, to February 28, 2010. Locoregional control, overall survival (OS), distant relapse rate, larynx preservation rate, and enteral feeding tube duration were analyzed., Results: Of 181 consecutive patients, 90 received 3D-RT and 91 received IMRT. At 3 years, the IMRT group had higher locoregional control compared with the 3D-RT group (75% vs 58%; p = .003), but similar OS (50% vs 52%; p = .99), distant relapse rate (23% vs 20%; p = .79), and larynx-preservation rate (90% vs 86%; p = .16). The 2-year enteral feeding tube dependency rate was similar in both groups (19% vs 18%; p = .12)., Conclusion: Patients with hypopharyngeal SCC treated with IMRT showed a higher locoregional control compared with 3D-RT. However, distant-relapse rate and OS remain comparable between treatment techniques., (© 2014 Wiley Periodicals, Inc.)
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- 2015
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234. Efficacy of intensity-modulated radiotherapy with concurrent carboplatin in nasopharyngeal carcinoma.
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Songthong A, Chakkabat C, Kannarunimit D, and Lertbutsayanukul C
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Background: The aim of the prospective phase II study was to evaluate the efficacy and toxicities of concurrent carboplatin with intensity-modulated radiotherapy (IMRT) in the treatment of nasopharyngeal carcinoma (NPC)., Patients and Methods: Between October 2005 and November 2011, 73 stage II-IVB NPC patients received IMRT 70 Gy concurrently with three cycles of carboplatin (AUC 5) every three weeks, followed by three cycles of adjuvant carboplatin (AUC 5) and 5-FU (1,000 mg/m(2)/day for four days) every four weeks. All patients were evaluated for tumour response using response evaluation criteria in solid tumour (RECIST) criteria, survival analysis using Kaplan-Meier methods, and toxicities according to common terminology criteria for adverse events (CTCAE) version 4.0., Results: At three months after chemoradiation, 82.2% and 17.8% of patients achieved complete and partial response, respectively. With a median follow-up of 48.1 months (1.3-97.8 months), 9.6% and 17.8% had local recurrence and distant metastasis, respectively. The median survival was not reached. A three-year overall survival was 83.6% and a progression-free survival was 65.3%. Regarding treatment compliance, 97.2%, 68.5% and 69.8% completed radiation treatment, concurrent carboplatin and adjuvant chemotherapy, respectively. Grade 3-4 acute toxicities were oral mucositis (16.4%), dysphagia (16.4%), xerostomia (15.1%) and haematotoxicity (6.8%)., Conclusions: Carboplatin concurrently with IMRT provided excellent tumour response, manageable toxicities and good compliance. This should be considered as an alternative treatment for NPC patients.
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- 2015
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235. Intensity-modulated whole pelvic radiotherapy provides effective dosimetric outcomes for cervical cancer treatment with lower toxicities.
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Lv Y, Wang F, Yang L, and Sun G
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- Adult, Aged, Female, Humans, Middle Aged, Pelvis, Radiotherapy Dosage, Treatment Outcome, Radiotherapy, Conformal adverse effects, Radiotherapy, Conformal methods, Radiotherapy, Intensity-Modulated adverse effects, Radiotherapy, Intensity-Modulated methods, Uterine Cervical Neoplasms radiotherapy
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Purpose: To compare the efficacy of intensity-modulated radiotherapy, three-dimensional conformal radiotherapy, and conventional radiotherapy for cervical cancer treatment., Materials and Methods: Whole pelvis intensity-modulated radiotherapy, three-dimensional conformal radiotherapy, and conventional radiotherapy plans were designed for 16 patients with stage IIB cervical cancer, each using the prescribed dose of 50.4 Gy/28 fractions. Dose-volume histograms of the target volume and organs at risk were evaluated., Results: Compared to the 3D conformal and conventional radiotherapy plans, the intensity-modulated radiotherapy plan demonstrated superior conformal treatment. The mean planning target volume dose of all three plans reached the target effective therapeutic dose. The planning target volume dose of the intensity-modulated radiotherapy plan was significantly higher than that of either the three-dimensional conformal radiotherapy or conventional radiotherapy plan (P<0.05). When more than 30 Gy was administered in intensity-modulated radiotherapy, organs at risk including the small intestine, rectum, bladder, and bone marrow received a significantly reduced volume of radiation. In comparison of the average planning target volume doses, significant volume reductions in irradiation of organs at risk were obtained with full bladders., Conclusions: An intensity-modulated radiotherapy plan with appropriate margins encompassing the primary tumour and potential microscopic pelvic disease reduces the dose to organs at risk without compromising target coverage. Intensity-modulated radiotherapy is an appropriate definitive treatment for patients with cervical cancer., (Copyright © 2014. Published by Elsevier SAS.)
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- 2014
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236. Effect of total dose and fraction size on survival of patients with locally recurrent nasopharyngeal carcinoma treated with intensity-modulated radiotherapy: a phase 2, single-center, randomized controlled trial.
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Tian YM, Zhao C, Guo Y, Huang Y, Huang SM, Deng XW, Lin CG, Lu TX, and Han F
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- Adult, Aged, Carcinoma, Cause of Death, Female, Humans, Male, Middle Aged, Multivariate Analysis, Nasopharyngeal Carcinoma, Nasopharyngeal Neoplasms mortality, Nasopharyngeal Neoplasms pathology, Neoplasm Recurrence, Local mortality, Radiotherapy Dosage, Treatment Failure, Tumor Burden, Nasopharyngeal Neoplasms radiotherapy, Neoplasm Recurrence, Local radiotherapy, Radiotherapy, Intensity-Modulated adverse effects
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Background: The optimal model of total dose and fraction size for patients with locally recurrent nasopharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT) remains unclear. The authors designed a randomized phase 2 clinical trial to investigate the efficacy of 2 different models, with the objective of determining an optimal model., Methods: Between January 2003 and December 2007, a total of 117 patients with locally recurrent nonmetastatic nasopharyngeal carcinoma were randomized to 2 different models of total dose and fraction size: group A (59 patients) received 60 gray in 27 fractions and group B (58 patients) received 68 gray in 34 fractions. Both groups received 5 daily fractions per week. All patients received IMRT alone., Results: The median follow-up was 25.0 months. The 5-year overall survival in group A was higher than that in group B (44.2% vs 30.3%; P =.06), and the local failure-free survival in group A was slightly lower than that in group B (63.7% vs 71.0%; P =.41). Severe late complications were the main cause of death. The incidences of mucosal necrosis and massive hemorrhage in patients in group B were significantly higher than those among patients in group A at 50.8% versus 28.8% (P =.02) and 31.0% versus 18.6% (P =.12), respectively. Tumor volume (P<.01) and model of total dose and fraction size (P =.03) were found to be significant factors for mucosal necrosis and massive hemorrhage., Conclusions: Appropriately decreasing the total dose and increasing the fraction size can achieve local control similar to that achieved with a higher dose after IMRT; furthermore, it can improve overall survival by significantly reducing the incidence of severe late complications including mucosal necrosis and massive hemorrhage., (© 2014 American Cancer Society.)
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- 2014
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237. Clinical outcomes among patients with head and neck cancer treated by intensity-modulated radiotherapy with and without adaptive replanning.
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Chen AM, Daly ME, Cui J, Mathai M, Benedict S, and Purdy JA
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- Aged, Carcinoma, Squamous Cell diagnosis, Cohort Studies, Disease-Free Survival, Dose-Response Relationship, Radiation, Female, Head and Neck Neoplasms diagnosis, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Prognosis, Radiotherapy Dosage, Radiotherapy, Intensity-Modulated adverse effects, Retrospective Studies, Risk Assessment, Squamous Cell Carcinoma of Head and Neck, Survival Analysis, Treatment Outcome, Carcinoma, Squamous Cell mortality, Carcinoma, Squamous Cell radiotherapy, Head and Neck Neoplasms mortality, Head and Neck Neoplasms radiotherapy, Radiotherapy Planning, Computer-Assisted, Radiotherapy, Intensity-Modulated methods
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Background: The purpose of this study was to determine the effect of adaptive replanning on clinical outcome among patients treated by intensity-modulated radiotherapy (IMRT) for head and neck cancer., Methods: Three hundred seventeen patients underwent IMRT with daily image-guidance for newly diagnosed squamous cell carcinoma of the head and neck to a median dose of 66 Gy (range, 60-74 Gy). Of these 317 patients, 51 (16%) underwent adaptive radiotherapy with modification of the original IMRT midway during treatment., Results: The 2-year local-regional control was 88% for patients treated with adaptive replanning compared with 79% for patients treated without (p = .01). The median time to local-regional recurrence for the 4 patients treated by adaptive radiotherapy was 7 months (range, 3-15 months) with all failures occurring within the high-dose planning target volume (PTV)., Conclusion: Although the use of routine replanning is probably not necessary, our findings do suggest a significant benefit in appropriately selected patients., (© 2014 Wiley Periodicals, Inc.)
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- 2014
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238. Management of the lymph node-positive neck in the patient with human papillomavirus-associated oropharyngeal cancer.
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Garden AS, Gunn GB, Hessel A, Beadle BM, Ahmed S, El-Naggar AK, Fuller CD, Byers LA, Phan J, Frank SJ, Morrison WH, Kies MS, Rosenthal DI, and Sturgis EM
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- Adult, Aged, Aged, 80 and over, Chemotherapy, Adjuvant, Female, Follow-Up Studies, Humans, Lymph Nodes surgery, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Recurrence, Local epidemiology, Neoplasm Staging, Oropharyngeal Neoplasms epidemiology, Oropharyngeal Neoplasms pathology, Papillomavirus Infections virology, Positron-Emission Tomography, Radiotherapy, Adjuvant, Texas epidemiology, Time Factors, Tomography, X-Ray Computed, Alphapapillomavirus, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Lymph Nodes pathology, Neck Dissection, Neoadjuvant Therapy methods, Oropharyngeal Neoplasms therapy, Oropharyngeal Neoplasms virology, Papillomavirus Infections complications
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Background: The goal of the current study was to assess the rates of recurrence in the neck for patients with lymph node-positive human papillomavirus-associated cancer of the oropharynx who were treated with definitive radiotherapy (with or without chemotherapy)., Methods: This is a single-institution retrospective study. Methodology included database search, and statistical testing including frequency analysis, Kaplan-Meier tests, and comparative tests including chi-square, logistic regression, and log-rank., Results: The cohort consisted of 401 patients with lymph node-positive disease who underwent radiotherapy between January 2006 and June 2012. A total of 388 patients had computed tomography restaging, and 251 had positron emission tomography and/or ultrasound as a component of their postradiation staging. Eighty patients (20%) underwent neck dissection, and 21 patients (26%) had a positive specimen. The rate of neck dissection increased with increasing lymph node stage, and was lower in patients who had positron emission tomography scans or ultrasound in addition to computed tomography restaging. The median follow-up was 30 months. The 2-year actuarial neck recurrence rate was 7% and 5%, respectively, in all patients and those with local control. Lymph node recurrence rates were greater in current smokers (P = .008). There was no difference in lymph node recurrence rates noted between patients who did and those who did not undergo a neck dissection (P = .4) CONCLUSIONS: A treatment strategy of (chemo)radiation with neck dissection performed based on response resulted in high rates of regional disease control in patients with human papillomavirus-associated oropharyngeal cancer., (© 2014 American Cancer Society.)
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- 2014
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239. Comparison of daily versus nondaily image-guided radiotherapy protocols for patients treated with intensity-modulated radiotherapy for head and neck cancer.
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Yu Y, Michaud AL, Sreeraman R, Liu T, Purdy JA, and Chen AM
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- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Dose Fractionation, Radiation, Feasibility Studies, Female, Head and Neck Neoplasms diagnostic imaging, Humans, Male, Middle Aged, Radiotherapy Setup Errors, Tomography, X-Ray Computed, Young Adult, Head and Neck Neoplasms radiotherapy, Radiotherapy, Image-Guided methods, Radiotherapy, Intensity-Modulated
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Background: The purpose of this study was to determine the feasibility of nondaily image-guided radiotherapy (RT) strategies with intensity-modulated radiotherapy (IMRT) for head and neck cancer., Methods: Alignment data was analyzed from 103 consecutive patients treated by IMRT for head and neck cancer who had undergone daily imaging with onboard mega-voltage CT (MVCT), resulting in 3275 images. Geometric setup errors that would have occurred using less-than-daily imaging were hypothetically estimated for 4 temporal less-than-daily image-guided RT protocols., Results: For image-guided RT on the first fraction, weekly image-guided RT, first 5 + weekly image-guided RT, and alternating day image-guided RT, the respective incidences of geometric miss were 50.5%, 33.8%, 30.1%, and 15.7% assuming 3-mm uncertainty margins; and 18.7%, 11.7%, 10.3%, and 4.1% with 5-mm margins., Conclusion: Less-than-daily image-guided RT strategies result in a high incidence of potential miss when 3-mm uncertainty margins are utilized. Less-than-daily image-guided RT strategies should incorporate margins of at least 5 mm., (Copyright © 2013 Wiley Periodicals, Inc.)
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- 2014
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240. Adaptive replanning intensity-modulated radiotherapy for choroidal metastasis of breast cancer using optical coherence tomography.
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Inoue T, Masai N, Oh RJ, Shiomi H, and Hashida N
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- Breast Neoplasms pathology, Breast Neoplasms radiotherapy, Choroid Neoplasms pathology, Female, Humans, Melanoma pathology, Middle Aged, Radiotherapy Dosage, Treatment Outcome, Choroid Neoplasms radiotherapy, Choroid Neoplasms secondary, Melanoma radiotherapy, Melanoma secondary, Radiotherapy Planning, Computer-Assisted methods, Radiotherapy, Image-Guided methods, Tomography, Optical Coherence methods
- Abstract
Swept source optical coherence tomography (SS-OCT) is a convenient method for precise, early-stage detection of choroidal metastatic lesions, involving assessment of tumor response, and for regular follow-up studies. Using information obtained with SS-OCT, we performed intensity-modulated radiotherapy (IMRT) for a patient with choroidal metastasis from breast cancer with more accuracy than had been previously possible. We made replanning adaptive radiotherapy (ART) three times based on the rapid tumor shrinkage detected by weekly assessments with SS-OCT. Accordingly, the planning target volume (PTV) decreased from 1.6 cm(3) to 0.61 cm(3) (38%), with 0.95 cm(3) (59%) and 0.75 cm(3) (46%) as intermediate values during the treatment course. The D0.1 cm3 of the right optic nerve was also reduced from 1.70 Gy/fraction to 0.69 Gy/faction, with 1.41 Gy/fraction and 1.29 Gy/fraction as intermediate values. Adaptive replanning IMRT made it possible to perform locally curative treatment of the metastatic choroidal lesion with a higher dose for the PTV, and a lower dose for organs at risk (OARs).
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- 2014
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241. Surgical treatment and radiotherapy of epidermoid cyst with malignant transformation in cerebellopontine angle.
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Feng R, Gu X, Hu J, Lang L, Bi H, Guo J, and Pan L
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We report surgical treatment and radiotherapy of an extremely rare case of malignant epidermoid cyst located in cerebellopontine angle. MRI and CT demonstrated the lesion with partial enhancement and calcification. During operation, we found the tumor attached tightly to surrounding tissue. Finally we achieved near total resection of it. Histopathology confirmed the diagnosis of epidermoid cyst with malignant transformation. With adjuvant radiotherapy, the patient underwent excellent recovery, and follow-up MRI demonstrated no obvious residue or recurrence of the tumor. Malignant epidermoid cyst can be diagnosed radiologically in combination with clinical presentation. Maximal removal plus adjuvant radiotherapy is the treatment of choice, although the general prognosis of it is poor.
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- 2014
242. Changes in parotid gland morphology and function in patients treated with intensity-modulated radiotherapy for nasopharyngeal and oropharyngeal tumors.
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Obinata K, Nakamura M, Carrozzo M, Macleod I, Carr A, Shirai S, and Ito H
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Objective: To evaluate the morphological changes of the parotid glands in patients treated with intensity-modulated radiotherapy (IMRT) for nasopharyngeal and oropharyngeal tumors and the correlations with parotid function., Methods: Ten patients with nasopharyngeal and oropharyngeal tumors treated with IMRT between May 2009 and January 2010 at Hokkaido University Hospital were included in this study. In the morphological assessment of the parotid glands, the sizes and computed tomography (CT) numbers of the bilateral parotid glands before and after IMRT with CT were calculated. For functional assessment of the parotid glands, we conducted the Saxon test and used a visual analog scale (VAS) for xerostomia evaluation., Results: Reductions in saliva secretion were observed in the patients treated with IMRT for nasopharyngeal and oropharyngeal tumors, and there was a significant correlation between the reduction in saliva secretion and the VAS. The reductions in the parotid gland size and CT number were larger on the ipsilateral side than on the contralateral side. The reduction in saliva secretion was not significantly correlated with the reduction in parotid gland size, but was significantly correlated with the reduction in CT number., Conclusions: Morphological and functional changes of the parotid glands were observed after IMRT for nasopharyngeal and oropharyngeal tumors, and preservation of the contralateral parotid glands was only partly achieved. Among the morphological changes of the parotid glands, the CT number may be considered a predictor of parotid function after radiotherapy.
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- 2014
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243. Whole breast and excision cavity radiotherapy plan comparison: Conformal radiotherapy with sequential boost versus intensity-modulated radiation therapy with a simultaneously integrated boost.
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Small K, Kelly C, Beldham-Collins R, and Gebski V
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Introduction: A comparative study was conducted comparing the difference between (1) conformal radiotherapy (CRT) to the whole breast with sequential boost excision cavity plans and (2) intensity-modulated radiation therapy (IMRT) to the whole breast with simultaneously integrated boost to the excision cavity. The computed tomography (CT) data sets of 25 breast cancer patients were used and the results analysed to determine if either planning method produced superior plans., Methods: CT data sets from 25 past breast cancer patients were planned using (1) CRT prescribed to 50 Gy in 25 fractions (Fx) to the whole-breast planning target volume (PTV) and 10 Gy in 5Fx to the excision cavity and (2) IMRT prescribed to 60 Gy in 25Fx, with 60 Gy delivered to the excision cavity PTV and 50 Gy delivered to the whole-breast PTV, treated simultaneously. In total, 50 plans were created, with each plan evaluated by PTV coverage using conformity indices, plan maximum dose, lung dose, and heart maximum dose for patients with left-side lesions., Results: CRT plans delivered the lowest plan maximum doses in 56% of cases (average CRT = 6314.34 cGy, IMRT = 6371.52 cGy). They also delivered the lowest mean lung dose in 68% of cases (average CRT = 1206.64 cGy, IMRT = 1288.37 cGy) and V20 in 88% of cases (average CRT = 20.03%, IMRT = 21.73%) and V30 doses in 92% of cases (average CRT = 16.82%, IMRT = 17.97%). IMRT created more conformal plans, using both conformity index and conformation number, in every instance, and lower heart maximum doses in 78.6% of cases (average CRT = 5295.26 cGy, IMRT = 5209.87 cGy)., Conclusion: IMRT plans produced superior dose conformity and shorter treatment duration, but a slightly higher planning maximum and increased lung doses. IMRT plans are also faster to treat on a daily basis, with shorter fractionation.
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- 2013
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244. Changes in parotid gland morphology and function in patients treated with intensity-modulated radiotherapy for nasopharyngeal and oropharyngeal tumors
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Shinichi Shirai, Iain Macleod, Hitoshi Ito, Marco Carrozzo, Andrew Carr, Kenichi Obinata, and Motoyasu Nakamura
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Pathology ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Parotid gland ,Radiation therapy ,Nasopharyngeal and oropharyngeal tumors ,stomatognathic diseases ,medicine.anatomical_structure ,stomatognathic system ,Radiology Nuclear Medicine and imaging ,Morphological and functional changes ,medicine ,Oral and maxillofacial surgery ,Radiology, Nuclear Medicine and imaging ,In patient ,Original Article ,Dentistry (miscellaneous) ,sense organs ,Intensity modulated radiotherapy ,Intensity-modulated radiotherapy (IMRT) ,skin and connective tissue diseases ,business - Abstract
Objective To evaluate the morphological changes of the parotid glands in patients treated with intensity-modulated radiotherapy (IMRT) for nasopharyngeal and oropharyngeal tumors and the correlations with parotid function. Methods Ten patients with nasopharyngeal and oropharyngeal tumors treated with IMRT between May 2009 and January 2010 at Hokkaido University Hospital were included in this study. In the morphological assessment of the parotid glands, the sizes and computed tomography (CT) numbers of the bilateral parotid glands before and after IMRT with CT were calculated. For functional assessment of the parotid glands, we conducted the Saxon test and used a visual analog scale (VAS) for xerostomia evaluation. Results Reductions in saliva secretion were observed in the patients treated with IMRT for nasopharyngeal and oropharyngeal tumors, and there was a significant correlation between the reduction in saliva secretion and the VAS. The reductions in the parotid gland size and CT number were larger on the ipsilateral side than on the contralateral side. The reduction in saliva secretion was not significantly correlated with the reduction in parotid gland size, but was significantly correlated with the reduction in CT number. Conclusions Morphological and functional changes of the parotid glands were observed after IMRT for nasopharyngeal and oropharyngeal tumors, and preservation of the contralateral parotid glands was only partly achieved. Among the morphological changes of the parotid glands, the CT number may be considered a predictor of parotid function after radiotherapy.
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245. A randomized phase II/III study of adverse events between sequential (SEQ) versus simultaneous integrated boost (SIB) intensity modulated radiation therapy (IMRT) in nasopharyngeal carcinoma; preliminary result on acute adverse events
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A. Songthong, Danita Kannarunimit, Chakkapong Chakkabat, and Chawalit Lertbutsayanukul
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Nasopharyngeal neoplasm ,Antineoplastic Agents ,Kaplan-Meier Estimate ,Gastroenterology ,Disease-Free Survival ,law.invention ,Intensity-Modulated Radiotherapy (IMRT) ,Randomized controlled trial ,law ,Internal medicine ,Carcinoma ,medicine ,Mucositis ,otorhinolaryngologic diseases ,Simultaneous integrated boost ,Humans ,Radiology, Nuclear Medicine and imaging ,Adverse effect ,neoplasms ,Nasopharyngeal Carcinoma ,business.industry ,Research ,Nasopharyngeal Neoplasms ,Chemoradiotherapy ,Middle Aged ,medicine.disease ,Surgery ,Radiation therapy ,stomatognathic diseases ,Nasopharyngeal carcinoma ,Oncology ,Radiology Nuclear Medicine and imaging ,Female ,Radiotherapy, Intensity-Modulated ,Cisplatin ,business ,therapeutics - Abstract
Background To investigate acute and late toxicities comparing sequential (SEQ-IMRT) versus simultaneous integrated boost intensity modulated radiotherapy (SIB-IMRT) in nasopharyngeal carcinoma (NPC) patients. Methods Newly diagnosed stage I-IVB NPC patients were randomized to receive SEQ-IMRT or SIB-IMRT, with or without chemotherapy. SEQ-IMRT consisted of two sequential radiation treatment plans: 2Gy x 25 fractions to low-risk planning target volume (PTV-LR) followed by 2Gy x 10 fractions to high-risk planning target volume (PTV-HR). In contrast, SIB-IMRT consisted of only one treatment plan: 2.12Gy and 1.7Gy x 33 fractions to PTV-HR and PTV-LR, respectively. Toxicities were evaluated according to CTCAE version 4.0. Results Between October 2010 and November 2013, 122 eligible patients were randomized between SEQ-IMRT (54 patients) and SIB-IMRT (68 patients). With median follow-up time of 16.8 months, there was no significant difference in toxicities between the two IMRT techniques. During chemoradiation, the most common grade 3–5 acute toxicities were mucositis (15.4 % vs 13.6 %, SEQ vs SIB, p = 0.788) followed by dysphagia (9.6 % vs 9.1 %, p = 1.000) and xerostomia (9.6 % vs 7.6 %, p = 0.748). During the adjuvant chemotherapy period, 25.6 % and 32.7 % experienced grade 3 weight loss in SEQ-IMRT and SIB-IMRT (p = 0.459). One-year overall survival (OS) and progression-free survival (PFS) were 95.8 % and 95.5 % in SEQ-IMRT and 98 % and 90.2 % in SIB-IMRT, respectively (p = 0.472 for OS and 0.069 for PFS). Conclusion This randomized, phase II/III trial comparing SIB-IMRT versus SEQ-IMRT in NPC showed no statistically significant difference between both IMRT techniques in terms of acute adverse events. Short-term tumor control and survival outcome were promising.
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246. Improvement in toxicity in high risk prostate cancer patients treated with image-guided intensity-modulated radiotherapy compared to 3D conformal radiotherapy without daily image guidance
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Jung Hun Oh, Tobias Pommer, Peter Meidahl Petersen, Per Munck af Rosenschöld, Svend Aage Engelholm, Joseph O. Deasy, and Joen Sveistrup
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Male ,Organs at Risk ,Oncology ,medicine.medical_specialty ,Multivariate analysis ,medicine.medical_treatment ,Rectum ,Disease-Free Survival ,Prostate cancer ,Imaging, Three-Dimensional ,Fiducial Markers ,Risk Factors ,Prostate ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Intensity-modulated radiotherapy (IMRT) ,Radiation Injuries ,Aged ,Retrospective Studies ,Image-guided radiation therapy ,Radiotherapy ,Toxicity ,business.industry ,Research ,Radiotherapy Planning, Computer-Assisted ,Prostatic Neoplasms ,Middle Aged ,medicine.disease ,Radiation therapy ,medicine.anatomical_structure ,Radiology Nuclear Medicine and imaging ,Radiotherapy, Intensity-Modulated ,Radiology ,Radiotherapy, Conformal ,Image-guided radiotherapy (IGRT) ,business ,Fiducial marker ,therapeutics ,Radiotherapy, Image-Guided - Abstract
Background Image-guided radiotherapy (IGRT) facilitates the delivery of a very precise radiation dose. In this study we compare the toxicity and biochemical progression-free survival between patients treated with daily image-guided intensity-modulated radiotherapy (IG-IMRT) and 3D conformal radiotherapy (3DCRT) without daily image guidance for high risk prostate cancer (PCa). Methods A total of 503 high risk PCa patients treated with radiotherapy (RT) and endocrine treatment between 2000 and 2010 were retrospectively reviewed. 115 patients were treated with 3DCRT, and 388 patients were treated with IG-IMRT. 3DCRT patients were treated to 76 Gy and without daily image guidance and with 1–2 cm PTV margins. IG-IMRT patients were treated to 78 Gy based on daily image guidance of fiducial markers, and the PTV margins were 5–7 mm. Furthermore, the dose-volume constraints to both the rectum and bladder were changed with the introduction of IG-IMRT. Results The 2-year actuarial likelihood of developing grade > = 2 GI toxicity following RT was 57.3% in 3DCRT patients and 5.8% in IG-IMRT patients (p = 2 GI toxicity compared to IG-IMRT (p
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