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Sample records for breast intensity-modulated radiotherapy

  1. Dosimetric comparison of intensity modulated radiotherapy techniques and standard wedged tangents for whole breast radiotherapy

    International Nuclear Information System (INIS)

    Fong, Andrew; Bromley, Regina; Beat, Mardi; Vien, Din; Dineley, Jude; Morgan, Graeme

    2009-01-01

    Full text: Prior to introducing intensity modulated radiotherapy (IMRT) for whole breast radiotherapy (WBRT) into our department we undertook a comparison of the dose parameters of several IMRT techniques and standard wedged tangents (SWT). Our aim was to improve the dose distribution to the breast and to decrease the dose to organs at risk (OAR): heart, lung and contralateral breast (Contra Br). Treatment plans for 20 women (10 right-sided and 10 left-sided) previously treated with SWT for WBRT were used to compare (a) SWT; (b) electronic compensators IMRT (E-IMRT); (c) tangential beam IMRT (T-IMRT); (d) coplanar multi-field IMRT (CP-IMRT); and (e) non-coplanar multi-field IMRT (NCP-IMRT). Plans for the breast were compared for (i) dose homogeneity (DH); (ii) conformity index (CI); (iii) mean dose; (iv) maximum dose; (v) minimum dose; and dose to OAR were calculated (vi) heart; (vii) lung and (viii) Contra Br. Compared with SWT, all plans except CP-IMRT gave improvement in at least two of the seven parameters evaluated. T-IMRT and NCP-IMRT resulted in significant improvement in all parameters except DH and both gave significant reduction in doses to OAR. As on initial evaluation NCP-IMRT is likely to be too time consuming to introduce on a large scale, T-IMRT is the preferred technique for WBRT for use in our department.

  2. Cardiac avoidance in breast radiotherapy: a comparison of simple shielding techniques with intensity-modulated radiotherapy

    International Nuclear Information System (INIS)

    Landau, David; Adams, Elizabeth J.; Webb, Steve; Ross, Gillian

    2001-01-01

    Background and purpose: Adjuvant breast radiotherapy (RT) is now part of the routine care of patients with early breast cancer. However, analysis of the Early Breast Cancer Trialists' Collaborative suggests that patients with the lowest risk of dying of breast cancer are at significant risk of cardiac mortality due to longer relapse-free survival. Patients with a significant amount of heart in the high-dose volume have been shown to be at risk of fatal cardiac events. This study was designed to assess whether conformal planning or intensity-modulated radiotherapy (IMRT) techniques allow reduced cardiac irradiation whilst maintaining full target coverage. Material and methods: Ten patients with early breast cancer were available for computed tomography (CT) planning. Each had at least 1 cm maximum heart depth within the posterior border of conventional tangents. For each patient, plans were generated and compared using dose volume histograms for planning target volume (PTV) and organs at risk. The plans included conventional tangents with and without shielding. The shielding was designed to either completely spare the heart or to shield as much heart as possible without compromising PTV coverage. IMRT plans were also prepared using two- and four-field tangential and six-field arc-like beam arrangements. Results: PTV homogeneity was better for the tangential IMRT techniques. For all patients, cardiac irradiation was reduced by the addition of partial cardiac shielding to conventional tangents, without compromise of PTV coverage. The two- and four-field IMRT techniques also reduced heart doses. The average percentage volume of heart receiving >60% of the prescription dose was 4.4% (range 1.0-7.1%) for conventional tangents, 1.5% (0.2-3.9%) for partial shielding, 2.3% (0.5-4.6%) for the two-field IMRT technique and 2.2% (0.4-5.6%) for the four-field IMRT technique. For patients with larger maximum heart depths the four-field IMRT plan achieved greater heart sparing

  3. Breast-conserving radiation therapy using combined electron and intensity-modulated radiotherapy technique

    International Nuclear Information System (INIS)

    Li, J.G.; Williams, S.S.; Goffinet, D.R.; Boer, A.L.; Xing, L.

    2000-01-01

    An electron beam with appropriate energy was combined with four intensity modulated photon beams. The direction of the electron beam was chosen to be tilted 10-20 laterally from the anteroposterior direction. Two of the intensity-modulated photon beams had the same gantry angles as the conventional tangential fields, whereas the other two beams were rotated 15-25' toward the anteroposterior directions from the first two photon beams. An iterative algorithm was developed which optimizes the weight of the electron beam as well as the fluence profiles of the photon beams for a given patient. Two breast cancer patients with early-stage breast tumors were planned with the new technique and the results were compared with those from 3D planning using tangential fields as well as 9-field intensity-modulated radiotherapy (IMRT) techniques. The combined electron and IMRT plans showed better dose conformity to the target with significantly reduced dose to the ipsilateral lung and, in the case of the left-breast patient, reduced dose to the heart, than the tangential field plans. In both the right-sided and left-sided breast plans, the dose to other normal structures was similar to that from conventional plans and was much smaller than that from the 9-field IMRT plans. The optimized electron beam provided between 70 to 80% of the prescribed dose at the depth of maximum dose of the electron beam. The combined electron and IMRT technique showed improvement over the conventional treatment technique using tangential fields with reduced dose to the ipsilateral lung and the heart. The customized beam directions of the four IMRT fields also kept the dose to other critical structures to a minimum. (author)

  4. Intensity modulated conformal radiotherapy

    International Nuclear Information System (INIS)

    Noel, Georges; Moty-Monnereau, Celine; Meyer, Aurelia; David, Pauline; Pages, Frederique; Muller, Felix; Lee-Robin, Sun Hae; David, Denis Jean

    2006-12-01

    This publication reports the assessment of intensity-modulated conformal radiotherapy (IMCR). This assessment is based on a literature survey which focussed on indications, efficiency and safety on the short term, on the risk of radio-induced cancer on the long term, on the role in the therapeutic strategy, on the conditions of execution, on the impact on morbidity-mortality and life quality, on the impact on the health system and on public health policies and program. This assessment is also based on the opinion of a group of experts regarding the technical benefit of IMCR, its indications depending on the cancer type, safety in terms of radio-induced cancers, and conditions of execution. Before this assessment, the report thus indicates indications for which the use of IMCR can be considered as sufficient or not determined. It also proposes a technical description of IMCR and helical tomo-therapy, discusses the use of this technique for various pathologies or tumours, analyses the present situation of care in France, and comments the identification of this technique in foreign classifications

  5. Intensity modulated radiotherapy with fixed collimator jaws for locoregional left-sided breast cancer irradiation.

    Science.gov (United States)

    Wang, Juanqi; Yang, Zhaozhi; Hu, Weigang; Chen, Zhi; Yu, Xiaoli; Guo, Xiaomao

    2017-05-16

    The purpose of this study is to evaluate the intensity modulated radiotherapy (IMRT) with the fixed collimator jaws technique (FJT) for the left breast and regional lymph node. The targeted breast tissue and the lymph nodes, and the normal tissues were contoured for 16 left-sided breast cancer patients previously treated with radiotherapy after lumpectomy. For each patient, treatment plans using different planning techniques, i.e., volumetric modulated arc therapy (VMAT), tangential IMRT (tangential-IMRT), and IMRT with FJT (FJT-IMRT) were developed for dosimetric comparisons. A dose of 50Gy was prescribed to the planning target volume. The dose-volume histograms were generated, and the paired t-test was used to analyze the dose differences. FJT-IMRT had similar mean heart volume receiving 30Gy (V30 Gy) with tangential-IMRT (1.5% and 1.6%, p = 0.41), but inferior to the VMAT (0.8%, p < 0.001). In the average heart mean dose comparison, FJT-IMRT had the lowest value, and it was 0.6Gy lower than that for the VMAT plans (p < 0.01). A significant dose increase in the contralateral breast and lung was observed in VMAT plans. Compared with tangential-IMRT and VMAT plans, FJT-IMRT reduced the mean dose of thyroid, humeral head and cervical esophageal by 47.6% (p < 0.01) and 45.7% (p < 0.01), 74.3% (p =< 0.01) and 73% (p =< 0.01), and 26.7% (p =< 0.01) and 29.2% (p =< 0.01). In conclusion, compared with tangential-IMRT and VMAT, FJT-IMRT plan has the lowest thyroid, humeral head and cervical esophageal mean dose and it can be a reasonable treatment option for a certain subgroup of patients, such as young left-breast cancer patients and/or patients with previous thyroid disease.

  6. Intensity-Modulated Radiotherapy Results in Significant Decrease in Clinical Toxicities Compared With Conventional Wedge-Based Breast Radiotherapy

    International Nuclear Information System (INIS)

    Harsolia, Asif; Kestin, Larry; Grills, Inga; Wallace, Michelle; Jolly, Shruti; Jones, Cortney; Lala, Moinaktar; Martinez, Alvaro; Schell, Scott; Vicini, Frank A.

    2007-01-01

    Purpose: We have previously demonstrated that intensity-modulated radiotherapy (IMRT) with a static multileaf collimator process results in a more homogenous dose distribution compared with conventional wedge-based whole breast irradiation (WBI). In the present analysis, we reviewed the acute and chronic toxicity of this IMRT approach compared with conventional wedge-based treatment. Methods and Materials: A total of 172 patients with Stage 0-IIB breast cancer were treated with lumpectomy followed by WBI. All patients underwent treatment planning computed tomography and received WBI (median dose, 45 Gy) followed by a boost to 61 Gy. Of the 172 patients, 93 (54%) were treated with IMRT, and the 79 patients (46%) treated with wedge-based RT in a consecutive fashion immediately before this cohort served as the control group. The median follow-up was 4.7 years. Results: A significant reduction in acute Grade 2 or worse dermatitis, edema, and hyperpigmentation was seen with IMRT compared with wedges. A trend was found toward reduced acute Grade 3 or greater dermatitis (6% vs. 1%, p = 0.09) in favor of IMRT. Chronic Grade 2 or worse breast edema was significantly reduced with IMRT compared with conventional wedges. No difference was found in cosmesis scores between the two groups. In patients with larger breasts (≥1,600 cm 3 , n = 64), IMRT resulted in reduced acute (Grade 2 or greater) breast edema (0% vs. 36%, p <0.001) and hyperpigmentation (3% vs. 41%, p 0.001) and chronic (Grade 2 or greater) long-term edema (3% vs. 30%, p 0.007). Conclusion: The use of IMRT in the treatment of the whole breast results in a significant decrease in acute dermatitis, edema, and hyperpigmentation and a reduction in the development of chronic breast edema compared with conventional wedge-based RT

  7. Reproducible deep-inspiration breath-hold irradiation with forward intensity-modulated radiotherapy for left-sided breast cancer significantly reduces cardiac radiation exposure compared to inverse intensity-modulated radiotherapy.

    Science.gov (United States)

    Bolukbasi, Yasemin; Saglam, Yucel; Selek, Ugur; Topkan, Erkan; Kataria, Anglina; Unal, Zeynep; Alpan, Vildan

    2014-01-01

    To investigate the objective utility of our clinical routine of reproducible deep-inspiration breath-hold irradiation for left-sided breast cancer patients on reducing cardiac exposure. Free-breathing and reproducible deep-inspiration breath-hold scans were evaluated for our 10 consecutive left-sided breast cancer patients treated with reproducible deep-inspiration breath-hold. The study was based on the adjuvant dose of 50 Gy in 25 fractions of 2 Gy/fraction. Both inverse and forward intensity-modulated radiotherapy plans were generated for each computed tomography dataset. Reproducible deep-inspiration breath-hold plans with forward intensity-modulated radiotherapy significantly spared the heart and left anterior descending artery compared to generated free-breathing plans based on mean doses - free-breathing vs reproducible deep-inspiration breath-hold, left ventricle (296.1 vs 94.5 cGy, P = 0.005), right ventricle (158.3 vs 59.2 cGy, P = 0.005), left anterior descending artery (171.1 vs 78.1 cGy, P = 0.005), and whole heart (173.9 vs 66 cGy, P = 0.005), heart V20 (2.2% vs 0%, P = 0.007) and heart V10 (4.2% vs 0.3%, P = 0.007) - whereas they revealed no additional burden on the ipsilateral lung. Reproducible deep-inspiration breath-hold and free-breathing plans with inverse intensity-modulated radiotherapy provided similar organ at risk sparing by reducing the mean doses to the left ventricle, left anterior descending artery, heart, V10-V20 of the heart and right ventricle. However, forward intensity-modulated radiotherapy showed significant reduction in doses to the left ventricle, left anterior descending artery, heart, right ventricle, and contralateral breast (mean dose, 248.9 to 12.3 cGy, P = 0.005). The mean doses for free-breathing vs reproducible deep-inspiration breath-hold of the proximal left anterior descending artery were 1.78 vs 1.08 Gy and of the distal left anterior descending artery were 8.11 vs 3.89 Gy, whereas mean distances to the 50 Gy

  8. Randomized Controlled Trial of Forward-Planned Intensity Modulated Radiotherapy for Early Breast Cancer: Interim Results at 2 Years

    International Nuclear Information System (INIS)

    Barnett, Gillian C.; Wilkinson, Jennifer S.; Moody, Anne M.; Wilson, Charles B.; Twyman, Nicola; Wishart, Gordon C.; Burnet, Neil G.; Coles, Charlotte E.

    2012-01-01

    Purpose: This single-center randomized trial was designed to investigate whether intensity-modulated radiotherapy (IMRT) reduces late toxicity in patients with early-stage breast cancer. Methods and Materials: The standard tangential plans of 1,145 nonselected patients were analyzed. The patients with inhomogeneous plans were randomized to a simple method of forward-planned IMRT or standard radiotherapy (RT). The primary endpoint was serial photographic assessment of breast shrinkage. Results: At 2 years, no significant difference was found in the development of any photographically assessed breast shrinkage between the patients randomized to the interventional or control group (odds ratio, 1.51; 95% confidence interval, 0.83–1.58; p = .41). The patients in the control group were more likely to develop telangiectasia than those in the IMRT group (odds ratio, 1.68; 95% confidence interval 1.13–2.40; p = .009). Poor baseline surgical cosmesis resulted in poor overall cosmesis at 2 years after RT. In patients who had good surgical cosmesis, those randomized to IMRT were less likely to deteriorate to a moderate or poor overall cosmesis than those in the control group (odds ratio, 0.63; 95% confidence interval, 0.39–1.03, p = .061). Conclusions: IMRT can lead to a significant reduction in telangiectasia at comparatively early follow-up of only 2 years after RT completion. An important component of breast induration and shrinkage will actually result from the surgery and not from the RT. Surgical cosmesis is an important determinant of overall cosmesis and could partially mask the longer term benefits of IMRT at this early stage.

  9. Minimising contralateral breast dose in post-mastectomy intensity-modulated radiotherapy by incorporating conformal electron irradiation

    NARCIS (Netherlands)

    van der Laan, Hans Paul; Korevaar, Erik W; Dolsma, Willemtje; Maduro, John H; Langendijk, Johannes A

    PURPOSE: To assess the potential benefit of incorporating conformal electron irradiation in intensity-modulated radiotherapy (IMRT) for loco-regional post-mastectomy RT. PATIENTS AND METHODS: Ten consecutive patients that underwent left-sided mastectomy were selected for this comparative planning

  10. Optimization of Breast Cancer Treatment by Dynamic Intensity Modulated Electron Radiotherapy

    National Research Council Canada - National Science Library

    Gaffney, David K; Leavitt, Dennis D

    2006-01-01

    .... standard photon tangent breast fields show that a more uniform dose distribution is achievable by dynamic electron arc, match-line inhomogeneities can be minimized or avoided, and dose to lung...

  11. Prone breast forward intensity-modulated radiotherapy for Asian women with early left breast cancer. Factors for cardiac sparing and clinical outcomes

    International Nuclear Information System (INIS)

    Chen Jenny Lingyu; Cheng Jason Chiahsien; Kuo Sunghsin; Chan Hsingmin; Chen Yuhsuan; Huang Yusen

    2013-01-01

    Since December 2009, after breast-conserving surgery for Stage 0-I cancer of the left breast, 21 women with relatively pendulous breasts underwent computed tomography prone and supine simulations. The adjuvant radiotherapy was 50 Gy in 25 fractions to the left breast alone. Four plans-conventional wedged tangents and forward intensity-modulated radiotherapy (fIMRT) in supine and prone positions-were generated. fIMRT generated better homogeneity in both positions. Prone position centralized the breast tissue by gravity and also shortened the breast width which led to better conformity in both planning techniques. Prone fIMRT significantly reduced doses to left lung, Level I and Level II axilla. The mean cardiac doses did not differ between positions. Among the four plans, prone fIMRT produced the best target dosimetry and normal organ sparing. In subgroup analysis, patients with absolute breast depth >7 cm in the prone position or breast depth difference >3 cm between positions had significant cardiac sparing with prone fIMRT. Sixteen patients with significant cardiac sparing in prone position were treated using prone fIMRT and the others using supine fIMRT. All patients received a supine electron tumor bed boost of 10 Gy in 5 fractions. No patients developed Grade 2 or worse acute or late toxicities. There was no difference in the number of segments or beams, monitor units, treatment time, or positioning reproducibility between prone and supine positions. At a median follow-up time of 26.8 months, no locoregional or distant recurrence or death was noted. (author)

  12. Intensity modulated radiotherapy (IMRT) in bilateral retinoblastoma

    International Nuclear Information System (INIS)

    Atalar, Banu; Ozyar, Enis; Gunduz, Kaan; Gungor, Gorkem

    2010-01-01

    External beam radiotherapy (EBRT) for retinoblastoma has traditionally been done with conventional radiotherapy techniques which resulted high doses to the surrounding normal tissues. A 20 month-old girl with group D bilateral retinoblastoma underwent intensity modulated radiotherapy (IMRT) to both eyes after failing chemoreduction and focal therapies including cryotherapy and transpupillary thermotherapy. In this report, we discuss the use of IMRT as a method for reducing doses to adjacent normal tissues while delivering therapeutic doses to the tumour tissues compared with 3-dimensional conformal radiotherapy (3DCRT). At one year follow-up, the patient remained free of any obvious radiation complications. Image guided IMRT provides better dose distribution than 3DCRT in retinoblastoma eyes, delivering the therapeutic dose to the tumours and minimizing adjacent tissue damage

  13. [Accelerated partial breast irradiation with image-guided intensity-modulated radiotherapy following breast-conserving surgery - preliminary results of a phase II clinical study].

    Science.gov (United States)

    Mészáros, Norbert; Major, Tibor; Stelczer, Gábor; Zaka, Zoltán; Mózsa, Emõke; Fodor, János; Polgár, Csaba

    2015-06-01

    The purpose of the study was to implement accelerated partial breast irradiation (APBI) by means of image-guided intensity-modulated radiotherapy (IG-IMRT) following breast-conserving surgery (BCS) for low-risk early invasive breast cancer. Between July 2011 and March 2014, 60 patients with low-risk early invasive (St I-II) breast cancer who underwent BCS were enrolled in our phase II prospective study. Postoperative APBI was given by means of step and shoot IG-IMRT using 4 to 5 fields to a total dose of 36.9 Gy (9×4.1 Gy) using a twice-a-day fractionation. Before each fraction, series of CT images were taken from the region of the target volume using a kV CT on-rail mounted in the treatment room. An image fusion software was used for automatic image registration of the planning and verification CT images. Patient set-up errors were detected in three directions (LAT, LONG, VERT), and inaccuracies were adjusted by automatic movements of the treatment table. Breast cancer related events, acute and late toxicities, and cosmetic results were registered and analysed. At a median follow-up of 24 months (range 12-44) neither locoregional nor distant failure was observed. Grade 1 (G1), G2 erythema, G1 oedema, and G1 and G2 pain occurred in 21 (35%), 2 (3.3%), 23 (38.3%), 6 (10%) and 2 (3.3%) patients, respectively. No G3-4 acute side effects were detected. Among late radiation side effects G1 pigmentation, G1 fibrosis, and G1 fat necrosis occurred in 5 (8.3%), 7 (11.7%), and 2 (3.3%) patients, respectively. No ≥G2 late toxicity was detected. Excellent and good cosmetic outcome was detected in 45 (75%) and 15 (25%) patients. IG-IMRT is a reproducible and feasible technique for the delivery of APBI following conservative surgery for the treatment of low-risk, early-stage invasive breast carcinoma. Preliminary results are promising, early radiation side effects are minimal, and cosmetic results are excellent.

  14. Accelerated partial breast irradiation using intensity-modulated radiotherapy versus whole breast irradiation: 5-year survival analysis of a phase 3 randomised controlled trial.

    Science.gov (United States)

    Livi, Lorenzo; Meattini, Icro; Marrazzo, Livia; Simontacchi, Gabriele; Pallotta, Stefania; Saieva, Calogero; Paiar, Fabiola; Scotti, Vieri; De Luca Cardillo, Carla; Bastiani, Paolo; Orzalesi, Lorenzo; Casella, Donato; Sanchez, Luis; Nori, Jacopo; Fambrini, Massimiliano; Bianchi, Simonetta

    2015-03-01

    Accelerated partial breast irradiation (APBI) has been introduced as an alternative treatment method for selected patients with early stage breast cancer (BC). Intensity-modulated radiotherapy (IMRT) has the theoretical advantage of a further increase in dose conformity compared with three-dimensional techniques, with more normal tissue sparing. The aim of this randomised trial is to compare the local recurrence and survival of APBI using the IMRT technique after breast-conserving surgery to conventional whole-breast irradiation (WBI) in early stage BC. This study was performed at the University of Florence (Florence, Italy). Women aged more than 40years affected by early BC, with a maximum pathological tumour size of 25mm, were randomly assigned in a 1:1 ratio to receive either WBI or APBI using IMRT. Patients in the APBI arm received a total dose of 30 Gy to the tumour bed in five daily fractions. The WBI arm received 50Gy in 25 fractions, followed by a boost on the tumour bed of 10Gy in five fractions. The primary end-point was occurrence of ipsilateral breast tumour recurrences (IBTRs); the main analysis was by intention-to-treat. This trial is registered with ClinicalTrials.gov, number NCT02104895. A total of 520 patients were randomised (260 to external WBI and 260 to APBI with IMRT) between March 2005 and June 2013. At a median follow-up of 5.0 years (Interquartile Range (IQR) 3.4-7.0), the IBTR rate was 1.5% (three cases) in the APBI group (95% confidence interval (CI) 0.1-3.0) and in the WBI group (three cases; 95% CI 0.0-2.8). No significant difference emerged between the two groups (log rank test p=0.86). We identified seven deaths in the WBI group and only one in the APBI group (p=0.057). The 5-year overall survival was 96.6% for the WBI group and 99.4% for the APBI group. The APBI group presented significantly better results considering acute (p=0.0001), late (p=0.004), and cosmetic outcome (p=0.045). To our knowledge, this is the first randomised

  15. Intensity modulated radiotherapy and 3D conformal radiotherapy for whole breast irradiation: a comparative dosimetric study and introduction of a novel qualitative index for plan evaluation, the normal tissue index

    International Nuclear Information System (INIS)

    Yim, Jackie; Suttie, Clare; Bromley, Regina; Morgia, Marita; Lamoury, Gillian

    2015-01-01

    We report on a retrospective dosimetric study, comparing 3D conformal radiotherapy (3DCRT) and hybrid intensity modulated radiotherapy (hIMRT). We evaluated plans based on their planning target volume coverage, dose homogeneity, dose to organs at risk (OARs) and exposure of normal tissue to radiation. The Homogeneity Index (HI) was used to assess the dose homogeneity in the target region, and we describe a new index, the normal tissue index (NTI), to assess the dose in the normal tissue inside the tangent treatment portal. Plans were generated for 25 early-stage breast cancer patients, using a hIMRT technique. These were compared with the 3DCRT plans of the treatment previously received by the patients. Plan quality was evaluated using the HI, NTI and dose to OARs. The hIMRT technique was significantly more homogenous than the 3DCRT technique, while maintaining target coverage. The hIMRT technique was also superior at minimising the amount of tissue receiving D 105% and above (P < 0.0001). The ipsilateral lung and contralateral breast maximum were significantly lower in the hIMRT plans (P < 0.05 and P < 0.005), but the 3DCRT technique achieved a lower mean heart dose in left-sided breast cancer patients (P < 0.05). Hybrid intensity modulated radiotherapy plans achieved improved dose homogeneity compared to the 3DCRT plans and superior outcome with regard to dose to normal tissues. We propose that the addition of both HI and NTI in evaluating the quality of intensity modulated radiotherapy (IMRT) breast plans provides clinically relevant comparators which more accurately reflect the new paradigm of treatment goals and outcomes in the era of breast IMRT

  16. Intensity modulated radiotherapy and 3D conformal radiotherapy for whole breast irradiation: a comparative dosimetric study and introduction of a novel qualitative index for plan evaluation, the normal tissue index

    Energy Technology Data Exchange (ETDEWEB)

    Yim, Jackie; Suttie, Clare; Bromley, Regina; Morgia, Marita; Lamoury, Gillian [Department of Radiation Oncology, Royal North Shore Hospital, St Leonards, New South Wales (Australia)

    2015-09-15

    We report on a retrospective dosimetric study, comparing 3D conformal radiotherapy (3DCRT) and hybrid intensity modulated radiotherapy (hIMRT). We evaluated plans based on their planning target volume coverage, dose homogeneity, dose to organs at risk (OARs) and exposure of normal tissue to radiation. The Homogeneity Index (HI) was used to assess the dose homogeneity in the target region, and we describe a new index, the normal tissue index (NTI), to assess the dose in the normal tissue inside the tangent treatment portal. Plans were generated for 25 early-stage breast cancer patients, using a hIMRT technique. These were compared with the 3DCRT plans of the treatment previously received by the patients. Plan quality was evaluated using the HI, NTI and dose to OARs. The hIMRT technique was significantly more homogenous than the 3DCRT technique, while maintaining target coverage. The hIMRT technique was also superior at minimising the amount of tissue receiving D{sub 105%} and above (P < 0.0001). The ipsilateral lung and contralateral breast maximum were significantly lower in the hIMRT plans (P < 0.05 and P < 0.005), but the 3DCRT technique achieved a lower mean heart dose in left-sided breast cancer patients (P < 0.05). Hybrid intensity modulated radiotherapy plans achieved improved dose homogeneity compared to the 3DCRT plans and superior outcome with regard to dose to normal tissues. We propose that the addition of both HI and NTI in evaluating the quality of intensity modulated radiotherapy (IMRT) breast plans provides clinically relevant comparators which more accurately reflect the new paradigm of treatment goals and outcomes in the era of breast IMRT.

  17. Intensity-Modulated Radiotherapy for Pancreatic Adenocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Abelson, Jonathan A.; Murphy, James D.; Minn, Ann Yuriko; Chung, Melody [Department of Radiation Oncology, Stanford University, Stanford, CA (United States); Fisher, George A.; Ford, James M.; Kunz, Pamela [Department of Medical Oncology, Stanford University, Stanford, CA (United States); Norton, Jeffrey A.; Visser, Brendan C.; Poultsides, George A. [Department of Surgical Oncology, Stanford University, Stanford, CA (United States); Koong, Albert C. [Department of Radiation Oncology, Stanford University, Stanford, CA (United States); Chang, Daniel T., E-mail: dtchang@stanford.edu [Department of Radiation Oncology, Stanford University, Stanford, CA (United States)

    2012-03-15

    Purpose: To report the outcomes and toxicities in patients treated with intensity-modulated radiotherapy (IMRT) for pancreatic adenocarcinoma. Methods and Materials: Forty-seven patients with pancreatic adenocarcinoma were treated with IMRT between 2003 and 2008. Of these 47 patients, 29 were treated adjuvantly and 18 definitively. All received concurrent 5-fluorouracil chemotherapy. The treatment plans were optimized such that 95% of the planning target volume received the prescription dose. The median delivered dose for the adjuvant and definitive patients was 50.4 and 54.0 Gy, respectively. Results: The median age at diagnosis was 63.9 years. For adjuvant patients, the 1- and 2-year overall survival rate was 79% and 40%, respectively. The 1- and 2-year recurrence-free survival rate was 58% and 17%, respectively. The local-regional control rate at 1 and 2 years was 92% and 80%, respectively. For definitive patients, the 1-year overall survival, recurrence-free survival, and local-regional control rate was 24%, 16%, and 64%, respectively. Four patients developed Grade 3 or greater acute toxicity (9%) and four developed Grade 3 late toxicity (9%). Conclusions: Survival for patients with pancreatic cancer remains poor. A small percentage of adjuvant patients have durable disease control, and with improved therapies, this proportion will increase. Systemic therapy offers the greatest opportunity. The present results have demonstrated that IMRT is well tolerated. Compared with those who received three-dimensional conformal radiotherapy in previously reported prospective clinical trials, patients with pancreatic adenocarcinoma treated with IMRT in our series had improved acute toxicity.

  18. Dosimetric comparison of moderate deep inspiration breath-hold and free-breathing intensity-modulated radiotherapy for left-sided breast cancer.

    Science.gov (United States)

    Chi, F; Wu, S; Zhou, J; Li, F; Sun, J; Lin, Q; Lin, H; Guan, X; He, Z

    2015-05-01

    This study determined the dosimetric comparison of moderate deep inspiration breath-hold using active breathing control and free-breathing intensity-modulated radiotherapy (IMRT) after breast-conserving surgery for left-sided breast cancer. Thirty-one patients were enrolled. One free breathe and two moderate deep inspiration breath-hold images were obtained. A field-in-field-IMRT free-breathing plan and two field-in-field-IMRT moderate deep inspiration breath-holding plans were compared in the dosimetry to target volume coverage of the glandular breast tissue and organs at risks for each patient. The breath-holding time under moderate deep inspiration extended significantly after breathing training (Pinspiration breath-holding in the target volume coverage. The volume of the ipsilateral lung in the free-breathing technique were significantly smaller than the moderate deep inspiration breath-holding techniques (Pinspiration breath-holding plans. There were no significant differences in target volume coverage between the three plans for the field-in-field-IMRT (all P>0.05). The dose to ipsilateral lung, coronary artery and heart in the field-in-field-IMRT were significantly lower for the free-breathing plan than for the two moderate deep inspiration breath-holding plans (all Pinspiration breath-holding plans. The whole-breast field-in-field-IMRT under moderate deep inspiration breath-hold with active breathing control after breast-conserving surgery in left-sided breast cancer can reduce the irradiation volume and dose to organs at risks. There are no significant differences between various moderate deep inspiration breath-holding states in the dosimetry of irradiation to the field-in-field-IMRT target volume coverage and organs at risks. Copyright © 2015 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  19. Anterior Myocardial Territory May Replace the Heart as Organ at Risk in Intensity-Modulated Radiotherapy for Left-Sided Breast Cancer

    International Nuclear Information System (INIS)

    Tan Wenyong; Liu Dong; Xue Chenbin; Xu Jiaozhen; Li Beihui; Chen Zhengwang; Hu Desheng; Wang Xionghong

    2012-01-01

    Purpose: We investigated whether the heart could be replaced by the anterior myocardial territory (AMT) as the organ at risk (OAR) in intensity-modulated radiotherapy (IMRT) of the breast for patients with left-sided breast cancer. Methods and Materials: Twenty-three patients with left-sided breast cancer who received postoperative radiation after breast-conserving surgery were studied. For each patient, we generated five IMRT plans including heart (H), left ventricle (LV), AMT, LV+AMT, and H+LV as the primary OARs, respectively, except both lungs and right breast, which corresponded to IMRT(H), IMRT(LV), IMRT(AMT), IMRT(LV+AMT), and IMRT(H+LV). For the planning target volumes and OARs, the parameters of dose–volume histograms were compared. Results: The homogeneity index, conformity index, and coverage index were not compromised significantly in IMRT(AMT), IMRT(LV) and IMRT(LV+ AMT), respectively, when compared with IMRT(H). The mean dose to the heart, LV, and AMT decreased 5.3–21.5% (p < 0.05), 19.9–29.5% (p < 0.05), and 13.3–24.5% (p < 0.05), respectively. Similarly, the low (e.g., V5%), middle (e.g., V20%), and high (e.g., V30%) dose-volume of the heart, LV, and AMT decreased with different levels. The mean dose and V10% of the right lung increased by 9.2% (p < 0.05) and 27.6% (p < 0.05), respectively, in IMRT(LV), and the mean dose and V5% of the right breast decreased significantly in IMRT(AMT) and IMRT(LV+AMT). IMRT(AMT) was the preferred plan and was then compared with IMRT(H+LV); the majority of dose–volume histogram parameters of OARs including the heart, LV, AMT, both lungs, and the right breast were not statistically different. However, the low dose-volume of LV increased and the middle dose-volume decreased significantly (p < 0.05) in IMRT(AMT). Also, those of the right lung (V10%, V15%) and right breast (V5%, V10%) decreased significantly (p < 0.05). Conclusions: The AMT may replace the heart as the OAR in left-sided breast IMRT after breast

  20. Treatment of left sided breast cancer for a patient with funnel chest: volumetric-modulated arc therapy vs. 3D-CRT and intensity-modulated radiotherapy.

    Science.gov (United States)

    Haertl, Petra M; Pohl, Fabian; Weidner, Karin; Groeger, Christian; Koelbl, Oliver; Dobler, Barbara

    2013-01-01

    This case study presents a rare case of left-sided breast cancer in a patient with funnel chest, which is a technical challenge for radiation therapy planning. To identify the best treatment technique for this case, 3 techniques were compared: conventional tangential fields (3D conformal radiotherapy [3D-CRT]), intensity-modulated radiotherapy (IMRT), and volumetric-modulated arc therapy (VMAT). The plans were created for a SynergyS® (Elekta, Ltd, Crawley, UK) linear accelerator with a BeamModulator™ head and 6-MV photons. The planning system was Oncentra Masterplan® v3.3 SP1 (Nucletron BV, Veenendal, Netherlands). Calculations were performed with collapsed cone algorithm. Dose prescription was 50.4 Gy to the average of the planning target volume (PTV). PTV coverage and homogeneity was comparable for all techniques. VMAT allowed reducing dose to the ipsilateral organs at risk (OAR) and the contralateral breast compared with IMRT and 3D-CRT: The volume of the left lung receiving 20 Gy was 19.3% for VMAT, 26.1% for IMRT, and 32.4% for 3D-CRT. In the heart, a D(15%) of 9.7 Gy could be achieved with VMAT compared with 14 Gy for IMRT and 46 Gy for 3D-CRT. In the contralateral breast, D(15%) was 6.4 Gy for VMAT, 8.8 Gy for IMRT, and 10.2 Gy for 3D-CRT. In the contralateral lung, however, the lowest dose was achieved with 3D-CRT with D(10%) of 1.7 Gy for 3D-CRT, and 6.7 Gy for both IMRT and VMAT. The lowest number of monitor units (MU) per 1.8-Gy fraction was required by 3D-CRT (192 MU) followed by VMAT (518 MU) and IMRT (727 MU). Treatment time was similar for 3D-CRT (3 min) and VMAT (4 min) but substantially increased for IMRT (13 min). VMAT is considered the best treatment option for the presented case of a patient with funnel chest. It allows reducing dose in most OAR without compromising target coverage, keeping delivery time well below 5 minutes. Copyright © 2013 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

  1. Intensity-modulated three-dimensional conformal radiotherapy

    International Nuclear Information System (INIS)

    Mohan, Radhe

    1996-01-01

    Optimized intensity-modulated treatments one of the important advances in photon radiotherapy. Intensity modulation provides a greatly increased control over dose distributions. Such control can be maximally exploited to achieve significantly higher levels of conformation to the desired clinical objectives using sophisticated optimization techniques. Safe, rapid and efficient delivery of intensity-modulated treatments has become feasible using a dynamic multi-leaf collimator under computer control. The need for all other field shaping devices such as blocks, wedges and compensators is eliminated. Planning and delivery of intensity-modulated treatments is amenable to automation and development of class solutions for each treatment site and stage which can be implemented not only at major academic centers but on a wide scale. A typical treatment involving as many as 10 fields can be delivered in times shorter than much simpler conventional treatments. The main objective of the course is to give an overview of the current state of the art of planning and delivery methods of intensity-modulated treatments. Specifically, the following topics will be covered using representative optimized plans and treatments: 1. A typical procedure for planning and delivering an intensity-modulated treatment. 2. Quantitative definition of criteria (i.e., the objective function) of optimization of intensity-modulated treatments. Clinical relevance of objectives and the dependence of the quality of optimized intensity-modulated plans upon whether the objectives are stated purely in terms of simple dose or dose-volume criteria or whether they incorporate biological indices. 3. Importance of the lateral transport of radiation in the design of intensity-modulated treatments. Impact on dose homogeneity and the optimum choice of margins. 4. Use of intensity-modulated treatments in escalation of tumor dose for the same or lower normal tissue dose. Fractionation of intensity-modulated treatments

  2. Intensity-modulated three-dimensional conformal radiotherapy

    International Nuclear Information System (INIS)

    Mohan, Radhe

    1997-01-01

    Optimized intensity-modulated treatments one of the important advances in photon radiotherapy. Intensity modulation provides a greatly increased control over dose distributions. Such control can be maximally exploited to achieve significantly higher levels of conformation to the desired clinical objectives using sophisticated optimization techniques. Safe, rapid and efficient delivery of intensity-modulated treatments has become feasible using a dynamic multi-leaf collimator under computer control. The need for all other field shaping devices such as blocks, wedges and compensators is eliminated. Planning and delivery of intensity-modulated treatments is amenable to automation and development of class solutions for each treatment site and stage which can be implemented not only at major academic centers but on a wide scale. A typical treatment involving as many as 10 fields can be delivered in times shorter than much simpler conventional treatments. The main objective of the course is to give an overview of the current state of the art of planning and delivery methods of intensity-modulated treatments. Specifically, the following topics will be covered using representative optimized plans and treatments: 1. A typical procedure for planning and delivering an intensity-modulated treatment. 2. Quantitative definition of criteria (i.e., the objective function) of optimization of intensity-modulated treatments. Clinical relevance of objectives and the dependence of the quality of optimized intensity-modulated plans upon whether the objectives are stated purely in terms of simple dose or dose-volume criteria or whether they incorporate biological indices. 3. Importance of the lateral transport of radiation in the design of intensity-modulated treatments. Impact on dose homogeneity and the optimum choice of margins. 4. Use of intensity-modulated treatments in escalation of tumor dose for the same or lower normal tissue dose. Fractionation of intensity-modulated treatments

  3. Collimator setting optimization in intensity modulated radiotherapy

    International Nuclear Information System (INIS)

    Williams, M.; Hoban, P.

    2001-01-01

    Full text: The aim of this study was to investigate the role of collimator angle and bixel size settings in IMRT when using the step and shoot method of delivery. Of particular interest is minimisation of the total monitor units delivered. Beam intensity maps with bixel size 10 x 10 mm were segmented into MLC leaf sequences and the collimator angle optimised to minimise the total number of MU's. The monitor units were estimated from the maximum sum of positive-gradient intensity changes along the direction of leaf motion. To investigate the use of low resolution maps at optimum collimator angles, several high resolution maps with bixel size 5 x 5 mm were generated. These were resampled into bixel sizes, 5 x 10 mm and 10 x 10 mm and the collimator angle optimised to minimise the RMS error between the original and resampled map. Finally, a clinical IMRT case was investigated with the collimator angle optimised. Both the dose distribution and dose-volume histograms were compared between the standard IMRT plan and the optimised plan. For the 10 x 10 mm bixel maps there was a variation of 5% - 40% in monitor units at the different collimator angles. The maps with a high degree of radial symmetry showed little variation. For the resampled 5 x 5 mm maps, a small RMS error was achievable with a 5 x 10 mm bixel size at particular collimator positions. This was most noticeable for maps with an elongated intensity distribution. A comparison between the 5 x 5 mm bixel plan and the 5 x 10 mm showed no significant difference in dose distribution. The monitor units required to deliver an intensity modulated field can be reduced by rotating the collimator and aligning the direction of leaf motion with the axis of the fluence map that has the least intensity. Copyright (2001) Australasian College of Physical Scientists and Engineers in Medicine

  4. The study of target delineation and target movement of whole breast assisted by active breathing control in intensity modulated radiotherapy after breast conservative surgery

    International Nuclear Information System (INIS)

    Li Jianbing; Yu Jinming; Ma Zhifang; Lu Jie; Sun Tao; Guo Shoufang; Wang Jingguo

    2009-01-01

    Objective: To explore the influence of different delineators and different delineating time on target determination of the whole breast and to explore intrafraction and interfraction target displacements of the breast on moderate deep inspiration breathing hold (mDIBH) assisted by active breathing control (ABC) alter breast conservative surgery. Methods: Twenty patients received primary CT-simulation assisted by ABC to get five sets of CT image on the three breathing condition which included one set from free breath (FB), two sets from mDIBH and two sets from deep expiration breathing control (DEBH). After radiotherapy with ten to fifteen fractions, the repeat CT-simulation was carried out to get the same five sets of CT image as the primary CT- simulation. The whole breast target were delineated at different time by the same delineator and delineated respectively by five delineators on the first set of CT images got with mDIBH from the primary CT-simulation, and to compare the influence of delineator and delineating time on the whole breast target. The total silver clips in the cavity were marked respectively on the two sets of CT images got with mDIBH from the primary CT-simulation, and to compare the intrafraction displacement of geometric body structured by the total of silver clips. The two ribs near the isocentric plane of the breast target were delineated respectively on two sets of the mDIBH CT image from the primary CT-simulation and on one set of the mDIBH CT image from the repeat CT-simulation, and comparing the movement of the point of interest (POI) of the ribs delineated to get the value of intrafraction and interfraction thoracic expansion. Results: There was not statistically significant between the four volumes of whole breast targets delineated by the same delineator at different time, but with statistics significant between the volumes of whole breast target delineated by the different delineators ( F=19.681, P=0.000). There was not statistically

  5. Dose profile analysis of small fields in intensity modulated radiotherapy

    International Nuclear Information System (INIS)

    Medel B, E.; Tejeda M, G.; Romero S, K.

    2015-10-01

    Full text: Small field dosimetry is getting a very important worldwide task nowadays. The use of fields of few centimeters is more common with the introduction of sophisticated techniques of radiation therapy, as Intensity Modulated Radiotherapy (IMRT). In our country the implementation of such techniques is just getting started and whit it the need of baseline data acquisition. The dosimetry under small field conditions represents a challenge for the physicists community. In this work, a dose profile analysis was done, using various types of dosimeters for further comparisons. This analysis includes the study of quality parameters as flatness, symmetry, penumbra, and other in-axis measurements. (Author)

  6. Dose profile analysis of small fields in intensity modulated radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Medel B, E. [IMSS, Centro Medico Nacional Manuel Avila Camacho, Calle 2 Nte. 2004, Barrio de San Francisco, 72090 Puebla, Pue. (Mexico); Tejeda M, G.; Romero S, K., E-mail: romsakaren@gmail.com [Benemerita Universidad Autonoma de Puebla, Facultad de Ciencias Fisico Matematicas, Av. San Claudio y 18 Sur, Ciudad Universitaria, 72570 Puebla, Pue.(Mexico)

    2015-10-15

    Full text: Small field dosimetry is getting a very important worldwide task nowadays. The use of fields of few centimeters is more common with the introduction of sophisticated techniques of radiation therapy, as Intensity Modulated Radiotherapy (IMRT). In our country the implementation of such techniques is just getting started and whit it the need of baseline data acquisition. The dosimetry under small field conditions represents a challenge for the physicists community. In this work, a dose profile analysis was done, using various types of dosimeters for further comparisons. This analysis includes the study of quality parameters as flatness, symmetry, penumbra, and other in-axis measurements. (Author)

  7. Accelerated partial breast irradiation using intensity modulated radiotherapy versus whole breast irradiation: Health-related quality of life final analysis from the Florence phase 3 trial.

    Science.gov (United States)

    Meattini, Icro; Saieva, Calogero; Miccinesi, Guido; Desideri, Isacco; Francolini, Giulio; Scotti, Vieri; Marrazzo, Livia; Pallotta, Stefania; Meacci, Fiammetta; Muntoni, Cristina; Bendinelli, Benedetta; Sanchez, Luis Jose; Bernini, Marco; Orzalesi, Lorenzo; Nori, Jacopo; Bianchi, Simonetta; Livi, Lorenzo

    2017-05-01

    Accelerated partial breast irradiation (APBI) represents a valid option for selected early breast cancer (BC). We recently published the 5-year results of the APBI-IMRT-Florence phase 3 randomised trial (NCT02104895), showing a very low rate of disease failure, with acute and early-late toxicity in favour of APBI. We present the early and 2-year follow-up health-related quality of life (HRQoL) results. Eligible patients were women aged more than 40 years with early BC suitable for breast-conserving surgery. APBI consisted of 30 Gy in five fractions delivered with IMRT technique. Standard whole breast irradiation (WBI) consisted of 50 Gy in 25 fractions plus a 10 Gy in five fractions boost on tumour bed. A total of 520 patients were enrolled in the phase 3 trial. Overall, 205 patients (105 APBI and 100 WBI) fully completed all the given questionnaires and were therefore included in the present analysis. As HRQoL assessment, patients were asked to complete the European Organisation for Research and Treatment of Cancer QLQ-C30, and the BR23 questionnaires at the beginning (T0), at the end (T1) and after 2 years from radiation (T2). No significant difference between the two arms at QLQ-C30 and BR23 scores emerged at T0. Global health status (p = 0.0001), and most scores of the functional and symptom scales of QLQ-C30 at T1 showed significant differences in favour of the APBI arm. Concerning the BR23 functional and symptom scales, the body image perception, future perspective and breast and arm symptoms were significantly better in the APBI group. Similar significant results emerged at T2: significant differences in favour of APBI emerged for GHS (p = 0.0001), and most functional and symptom QLQ-C30 scales. According to QLQ-BR23 module, among the functional scales, the body image perception and the future perspective were significantly better in the APBI group (p = 0.0001), whereas among the symptom scales significant difference emerged by breast and arm

  8. Intensity-modulated radiotherapy for cancers in childhood

    International Nuclear Information System (INIS)

    Leseur, J.; Le Prise, E.; Leseur, J.; Carrie, C.; Beneyton, V.; Bernier, V.; Beneyton, V.; Mahee, M.A.; Supiot, S.

    2009-01-01

    Approximately 40-50% of children with cancer will be irradiated during their treatment. Intensity-modulated radiotherapy (I.M.R.T.) by linear accelerator or helical tomo-therapy improves dose distribution in target volumes and normal tissue sparing. This technology could be particularly useful for pediatric patients to achieve an optimal dose distribution in complex volumes close to critical structures. The use of I.M.R.T. can increase the volume of tissue receiving low-dose radiation, and consequently carcinogenicity in childhood population with a good overall survival and long period of life expectancy. This review will present the current and potential I.M.R.T. indications for cancers in childhood, and discuss the benefits and problems of this technology aiming to define recommendations in the use of I.M.R.T. and specific doses constraints in Pediatrics. (authors)

  9. Intensity-modulated radiotherapy -the State of the Art

    International Nuclear Information System (INIS)

    Ling, C.

    2002-01-01

    Full text: In the last two decades of the last century, the development of three-dimensional conformal radiotherapy (3D-CRT) has substantially reduces the volume of critical organs irradiated to high doses, and has permitted the increase of tumor dose without concomitant increase in normal tissue complication. At Memorial Sloan Kettering Cancer Center, a clinical trial in cancer of the prostate has accrued >1600 patient and the prescription dose has been escalated to 81 Gy with 3D-CRT, and to 86.4 Gy using intensity modulated radiotherapy (IMRT), with promising results. 3D-CRT and IMRT involves the delineation of target and non-target structures from patient-specific 3D image data-sets (primarily CT, sometimes supplemented with MRI, PET etc.), the calculation and display of 3D dose distributions, the analysis and evaluation of structure-specific dose-volume data (DVH-dose volume histogram), radiation delivery with computer-controlled multileaf collimators (MLC), and treatment verification with electronic portal images. However, the dose distribution conformality achieved with 3D-CRT can be further improved by the use of computer-optimized IMRT. In addition, the treatment design phase of 3D-CRT involves several iterative steps and can be time-consuming, particularly when the anatomical geometry is complex. Thus, IMRT is an incremental advance from 3D-CRT with two key enhancements: 1) computerized iterative treatment plan optimization, and 2) the use of intensity-modulated radiation beams. To deliver the IM beams, one efficacious approach is to use MLC in the dynamic mode, using the so-called sliding-window technique, i.e. the leaves of the MLC are in motion while the radiation is being delivered. Since 1995, we have treated over 1500 patients with IMRT. This discussion shall describe the physical aspects of IMRT, emphasizing those features and benefits unique to this approach. Pertinent clinical results will also be briefly presented

  10. Image-guided intensity-modulated radiotherapy for refractory bilateral breast cancer in a patient with extensive cutaneous metastasis in the chest and abdominal walls

    Directory of Open Access Journals (Sweden)

    Lu YF

    2016-05-01

    Full Text Available Yueh-Feng Lu,1 Yu-Chin Lin,2 Kuo-Hsin Chen,3,4 Pei-Wei Shueng,1 Hsin-Pei Yeh,1 Chen-Hsi Hsieh1,5,6 1Division of Radiation Oncology, Department of Radiology, 2Division of Oncology and Hematology, Department of Medicine, 3Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, 4Department of Electrical Engineering, Yuan-Ze University, Taoyuan, 5Department of Medicine, 6Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan Abstract: Treatment for bilateral breast cancer with chest wall and abdominal skin invasion normally involves conventional radiotherapy (RT; however, conventional RT provides inadequate target volume coverage and excessive treatment of large volumes of normal tissue. Helical tomotherapy (HT has the ability to deliver continuous craniocaudal irradiation that suppresses junction problems and provides good conformity of dose distribution. A 47-year-old female with stage IV bilateral breast cancer with chest wall and pectoralis major muscle invasion, lymphadenopathy, bilateral pleural effusion, and multiple bone metastases received chemotherapy and target therapy beginning in January 2014; 4 months after the initiation of chemotherapy, computed tomography revealed progression of chest and abdominal wall invasion. A total dose of 70.2 Gy was delivered to both breasts, the chest wall, the abdominal wall, and the bilateral supraclavicular nodal areas in 39 fractions via HT. The total planning target volume was 4,533.29 cm3. The percent of lung volume receiving at least 20 Gy (V20 was 28%, 22%, and 25% for the right lung, left lung, and whole lung, respectively. The mean dose to the heart was 8.6 Gy. Follow-up computed tomography revealed complete response after the RT course. Grade 1 dysphagia, weight loss, grade 2 neutropenia, and grade 3 dermatitis were noted during the RT course. Pain score decreased from 6 to 1. No cardiac, pulmonary, liver, or intestinal toxicity

  11. Intensity modulated tangential beam irradiation of the intact breast

    International Nuclear Information System (INIS)

    Hong, L.; Hunt, M.; Chui, C.; Forster, K.; Lee, H.; Lutz, W.; Yahalom, J.; Kutcher, G.J.; McCormick, B.

    1997-01-01

    Purpose/Objective: The purpose of this study was to evaluate the potential benefits of intensity modulated tangential beams in the irradiation of the intact breast. The primary goal was to develop an intensity modulated treatment which would substantially decrease the dose to coronary arteries, lung and contralateral breast while still using a standard tangential beam arrangement. Improved target dose homogeneity, within the limits imposed by opposed fields, was also desired. Since a major goal of the study was the development of a technique which was practical for use on a large population of patients, the design of 'standard' intensity profiles analogous in function to conventional wedges was also investigated. Materials and Methods: Three dimensional treatment planning was performed using both conventional and intensity modulated tangential beams. Plans were developed for both the right and left breast for a range of patient sizes and shapes. For each patient, PTV, lung, heart, origin and peripheral branches of the coronary artery, and contralateral breast were contoured. Optimum tangential beam direction and shape were designed using Beams-Eye-View display and then used for both the conventional and intensity modulated plans. For the conventional plan, the optimum wedge combination and beam weighting were chosen based on the dose distribution in a single transverse plane through the field center. Intensity modulated plans were designed using an algorithm which allows the user to specify the prescribed, maximum and minimum acceptable doses and dose volume constraints for each organ of interest. Plans were compared using multiple dose distributions and DVHs. Results: Significant improvements in the doses to critical structures were achieved using the intensity modulated plan. Coronary artery dose decreased substantially for patients treated to the left breast. Ipsilateral lung and contralateral breast doses decreased for all patients. For one patient treated to

  12. Outcome after intensity modulated radiotherapy for anaplastic thyroid carcinoma

    International Nuclear Information System (INIS)

    He, Xiayun; Li, Duanshu; Hu, Chaosu; Wang, Zhuoying; Ying, Hongmei; Wu, Yi

    2014-01-01

    Anaplastic thyroid carcinoma (ATC) is a malignancy with one of the highest fatality rates. We reviewed our recent clinical experience with intensity modulated radiotherapy (IMRT) combined with surgery and chemotherapy for the management of ATC. 13 patients with ATC who were treated by IMRT in our institution between October 2008 and February 2011, have been analyzed. The target volume for IMRT was planned to include Gross tumor volume (GTV): primary tumor plus any N + disease (66 Gy/33 F/6.6 W), with elective irradiation of thyroid bed, bilateral level II through VI and mediastinal lymph nodes to the level of the carina (54-60 Gy). Seven patients received surgical intervention and eleven patients had chemotherapy. The median radiotherapy dose to GTV was 60 Gy/30 fractions/6 weeks. The median survival time of the 13 patients was 9 months. The direct causes of death were distant metastases (75%) and progression of the locoregional disease (25%). Ten patients were spared dyspnea and tracheostomy because their primary neck lesion did not progress. The results showed that IMRT combined by surgery and chemotherapy for ATC might be beneficial to improve locoregional control. Further new therapies are needed to control metastases

  13. Intensity-modulated tangential beam irradiation of the intact breast

    International Nuclear Information System (INIS)

    Hong, L.; Hunt, M.; Chui, C.; Spirou, S.; Forster, K.; Lee, H.; Yahalom, J.; Kutcher, G.J.; McCormick, B.

    1999-01-01

    Purpose: To evaluate the potential benefits of intensity modulated tangential beams in the irradiation of the intact breast. Methods and Materials: Three-dimensional treatment planning was performed on five left and five right breasts using standard wedged and intensity modulated (IM) tangential beams. Optimal beam parameters were chosen using beams-eye-view display. For the standard plans, the optimal wedge angles were chosen based on dose distributions in the central plane calculated without inhomogeneity corrections, according to our standard protocol. Intensity-modulated plans were generated using an inverse planning algorithm and a standard set of target and critical structure optimization criteria. Plans were compared using multiple dose distributions and dose volume histograms for the planning target volume (PTV), ipsilateral lung, coronary arteries, and contralateral breast. Results: Significant improvements in the doses to critical structures were achieved using intensity modulation. Compared with a standard-wedged plan prescribed to 46 Gy, the dose from the IM plan encompassing 20% of the coronary artery region decreased by 25% (from 36 to 27 Gy) for patients treated to the left breast; the mean dose to the contralateral breast decreased by 42% (from 1.2 to 0.7 Gy); the ipsilateral lung volume receiving more than 46 Gy decreased by 30% (from 10% to 7%); the volume of surrounding soft tissue receiving more than 46 Gy decreased by 31% (from 48% to 33%). Dose homogeneity within the target volume improved greatest in the superior and inferior regions of the breast (approximately 8%), although some decrease in the medial and lateral high-dose regions (approximately 4%) was also observed. Conclusion: Intensity modulation with a standard tangential beam arrangement significantly reduces the dose to the coronary arteries, ipsilateral lung, contralateral breast, and surrounding soft tissues. Improvements in dose homogeneity throughout the target volume can also be

  14. Intensity-modulated radiotherapy for lymphoma involving the mediastinum

    International Nuclear Information System (INIS)

    Goodman, Karyn A.; Toner, Sean; Hunt, Margie; Wu, Elisa J.; Yahalom, Joachim

    2005-01-01

    Purpose: To determine the feasibility, potential advantage, and indications for intensity-modulated radiotherapy (IMRT) in the treatment of Hodgkin's lymphoma or non-Hodgkin's lymphoma involving excessively large mediastinal disease volumes or requiring repeat RT. Methods and materials: Sixteen patients with Hodgkin's lymphoma (n = 11) or non-Hodgkin's lymphoma (n = 5) undergoing primary radiotherapy or repeat RT delivered via an IMRT plan were studied. The indications for using an IMRT plan were previous mediastinal RT (n = 5) or extremely large mediastinal treatment volumes (n 11). For each patient, IMRT, conventional parallel-opposed (AP-PA), and three-dimensional conformal (3D-CRT) plans were designed using 6-MV X-rays to deliver doses ranging from 18 to 45 Gy (median, 36 Gy). The plans were compared with regard to dose-volume parameters. The IMRT/AP-PA and IMRT/3D-CRT ratios were calculated for each parameter. Results: For all patients, the mean lung dose was reduced using IMRT, on average, by 12% compared with AP-PA and 14% compared with 3D-CRT. The planning target volume coverage was also improved using IMRT compared with AP-PA but was not different from the planning target volume coverage obtained with 3D-CRT. Conclusion: In selected patients with Hodgkin's lymphoma and non-Hodgkin's lymphoma involving the mediastinum, IMRT provides improved planning target volume coverage and reduces pulmonary toxicity parameters. It is feasible for RT of large treatment volumes and allows repeat RT of relapsed disease without exceeding cord tolerance. Additional follow-up is necessary to determine whether improvements in dose delivery affect long-term morbidity and disease control

  15. Dosimetric Comparison of Intensity-Modulated Radiotherapy Plans, With or Without Anterior Myocardial Territory and Left Ventricle as Organs at Risk, in Early-Stage Left-Sided Breast Cancer Patients

    International Nuclear Information System (INIS)

    Tan Wenyong; Wang Xiaohong; Qiu Dasheng; Liu Dong; Jia Shaohui; Zeng Fanyu; Chen Zhengwang; Li Beihui; Xu Jiaozhen; Wei Lai; Hu Desheng

    2011-01-01

    Purpose: We evaluated heart sparing using an intensity-modulated radiotherapy (IMRT) plan with the left ventricle (LV) and/or the anterior myocardial territory (AMT) as additional organs at risk (OARs). Methods and Materials: A total of 10 patients with left-sided breast cancer were selected for dosimetric planning. Both lungs, the right breast, heart, LV, and AMT were defined as OARs. We generated one tangential field plan and four IMRT plans for each patient. We examined the dose–volume histogram parameters of the planning target volume and OARs. Results: Compared with the tangential field plan, the mean dose to the heart in the IMRT plans did not show significant differences; however, the dose to the AMT and LV decreased by 18.7–45.4% and 10.8–37.4%, respectively. The maximal dose to the heart decreased by 18.6–35.3%, to the AMT by 22.0–45.1%, and to the LV by 23.5–45.0%, And the relative volumes of the heart (V ≥12 ), AMT (V >11 ) and LV (V >10 ) decreased significantly with different levels, respectively. The volume of the heart, AMT, LV, both lungs, and right breast receiving ≥5 Gy showed a significant increase. Compared with the IMRT (H) plan, the mean dose to the heart, AMT, and LV decreased by 17.5–21.5%, 25.2–29.8%, and 22.8–29.8% and the maximal dose by 13.6–20.6%, 23.1–29.6%, and 17.3–29.1%, respectively. The IMRT plans for both lungs and the right breast showed no significant differences. Conclusions: The IMRT plans with the addition of the AMT and/or LV as OARs considerably increased heart sparing. We recommend including the LV as an additional OAR in such plans.

  16. Prostate Bed Motion During Intensity-Modulated Radiotherapy Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Klayton, Tracy; Price, Robert; Buyyounouski, Mark K.; Sobczak, Mark [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); Greenberg, Richard [Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); Li, Jinsheng; Keller, Lanea; Sopka, Dennis [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); Kutikov, Alexander [Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); Horwitz, Eric M., E-mail: eric.horwitz@fccc.edu [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States)

    2012-09-01

    Purpose: Conformal radiation therapy in the postprostatectomy setting requires accurate setup and localization of the prostatic fossa. In this series, we report prostate bed localization and motion characteristics, using data collected from implanted radiofrequency transponders. Methods and Materials: The Calypso four-dimensional localization system uses three implanted radiofrequency transponders for daily target localization and real-time tracking throughout a course of radiation therapy. We reviewed the localization and tracking reports for 20 patients who received ultrasonography-guided placement of Calypso transponders within the prostate bed prior to a course of intensity-modulated radiation therapy at Fox Chase Cancer Center. Results: At localization, prostate bed displacement relative to bony anatomy exceeded 5 mm in 9% of fractions in the anterior-posterior (A-P) direction and 21% of fractions in the superior-inferior (S-I) direction. The three-dimensional vector length from skin marks to Calypso alignment exceeded 1 cm in 24% of all 652 fractions with available setup data. During treatment, the target exceeded the 5-mm tracking limit for at least 30 sec in 11% of all fractions, generally in the A-P or S-I direction. In the A-P direction, target motion was twice as likely to move posteriorly, toward the rectum, than anteriorly. Fifteen percent of all treatments were interrupted for repositioning, and 70% of patients were repositioned at least once during their treatment course. Conclusion: Set-up errors and motion of the prostatic fossa during radiotherapy are nontrivial, leading to potential undertreatment of target and excess normal tissue toxicity if not taken into account during treatment planning. Localization and real-time tracking of the prostate bed via implanted Calypso transponders can be used to improve the accuracy of plan delivery.

  17. Intensity-modulated radiotherapy for neoadjuvant treatment of gastric cancer

    International Nuclear Information System (INIS)

    Knab, Brian; Rash, Carla; Farrey, Karl; Jani, Ashesh B.

    2006-01-01

    Radiation therapy plays an integral role in the treatment of gastric cancer in the postsurgery setting, the inoperable/palliative setting, and, as in the case of the current report, in the setting of neoadjuvant therapy prior to surgery. Typically, anterior-posterior/posterior-anterior (AP/PA) or 3-field techniques are used. In this report, we explore the use of intensity-modulated radiotherapy (IMRT) treatment in a patient whose care was transferred to our institution after 3-field radiotherapy (RT) was given to a dose of 30 Gy at an outside institution. If the 3-field plan were continued to 50 Gy, the volume of irradiated liver receiving greater than 30 Gy would have been unacceptably high. To deliver the final 20 Gy, an opposed parallel AP/PA plan and an IMRT plan were compared to the initial 3-field technique for coverage of the target volume as well as dose to the kidneys, liver, small bowel, and spinal cord. Comparison of the 3 treatment techniques to deliver the final 20 Gy revealed reduced median and maximum dose to the whole kidney with the IMRT plan. For this 20-Gy boost, the volume of irradiated liver was lower for both the IMRT plan and the AP/PA plan vs. the 3-field plan. Comparing the IMRT boost plan to the AP/PA boost-dose range ( 10 Gy) in comparison to the AP/PA plan. The IMRT boost plan also irradiated a smaller volume of the small bowel compared to both the 3-field plan and the AP/PA plan, and also delivered lower dose to the spinal cord in comparison to the AP/PA plan. Comparison of the composite plans revealed reduced dose to the whole kidney using IMRT. The V20 for the whole kidney volume for the composite IMRT plan was 30% compared to approximately 60% for the composite AP/PA plan. Overall, the dose to the liver receiving greater than 30 Gy was lower for the composite IMRT plan and was well below acceptable limits. In conclusion, our study suggests a dosimetric benefit of IMRT over conventional planning, and suggests an important role for

  18. Pleural Intensity-Modulated Radiotherapy for Malignant Pleural Mesothelioma

    International Nuclear Information System (INIS)

    Rosenzweig, Kenneth E.; Zauderer, Marjorie G.; Laser, Benjamin; Krug, Lee M.; Yorke, Ellen; Sima, Camelia S.; Rimner, Andreas; Flores, Raja; Rusch, Valerie

    2012-01-01

    Purpose: In patients with malignant pleural mesothelioma who are unable to undergo pneumonectomy, it is difficult to deliver tumoricidal radiation doses to the pleura without significant toxicity. We have implemented a technique of using intensity-modulated radiotherapy (IMRT) to treat these patients, and we report the feasibility and toxicity of this approach. Methods and Materials: Between 2005 and 2010, 36 patients with malignant pleural mesothelioma and two intact lungs (i.e., no previous pneumonectomy) were treated with pleural IMRT to the hemithorax (median dose, 46.8 Gy; range, 41.4–50.4) at Memorial Sloan-Kettering Cancer Center. Results: Of the 36 patients, 56% had right-sided tumors. The histologic type was epithelial in 78%, sarcomatoid in 6%, and mixed in 17%, and 6% had Stage I, 28% had Stage II, 33% had Stage III, and 33% had Stage IV. Thirty-two patients (89%) received induction chemotherapy (mostly cisplatin and pemetrexed); 56% underwent pleurectomy/decortication before IMRT and 44% did not undergo resection. Of the 36 patients evaluable for acute toxicity, 7 (20%) had Grade 3 or worse pneumonitis (including 1 death) and 2 had Grade 3 fatigue. In 30 patients assessable for late toxicity, 5 had continuing Grade 3 pneumonitis. For patients treated with surgery, the 1- and 2-year survival rate was 75% and 53%, and the median survival was 26 months. For patients who did not undergo surgical resection, the 1- and 2-year survival rate was 69% and 28%, and the median survival was 17 months. Conclusions: Treating the intact lung with pleural IMRT in patients with malignant pleural mesothelioma is a safe and feasible treatment option with an acceptable rate of pneumonitis. Additionally, the survival rates were encouraging in our retrospective series, particularly for the patients who underwent pleurectomy/decortication. We have initiated a Phase II trial of induction chemotherapy with pemetrexed and cisplatin with or without pleurectomy

  19. Pleural Intensity-Modulated Radiotherapy for Malignant Pleural Mesothelioma

    Energy Technology Data Exchange (ETDEWEB)

    Rosenzweig, Kenneth E., E-mail: ken.rosenzweig@mountsinai.org [Department of Radiation Oncology, Mount Sinai Medical Center, New York, NY (United States); Zauderer, Marjorie G. [Department of Medicine, Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Laser, Benjamin [Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI (United States); Krug, Lee M. [Department of Medicine, Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Yorke, Ellen [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Sima, Camelia S. [Department of Epidemiology/Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Rimner, Andreas [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Flores, Raja [Department of Surgery, Mount Sinai Medical Center, New York, NY (United States); Rusch, Valerie [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

    2012-07-15

    Purpose: In patients with malignant pleural mesothelioma who are unable to undergo pneumonectomy, it is difficult to deliver tumoricidal radiation doses to the pleura without significant toxicity. We have implemented a technique of using intensity-modulated radiotherapy (IMRT) to treat these patients, and we report the feasibility and toxicity of this approach. Methods and Materials: Between 2005 and 2010, 36 patients with malignant pleural mesothelioma and two intact lungs (i.e., no previous pneumonectomy) were treated with pleural IMRT to the hemithorax (median dose, 46.8 Gy; range, 41.4-50.4) at Memorial Sloan-Kettering Cancer Center. Results: Of the 36 patients, 56% had right-sided tumors. The histologic type was epithelial in 78%, sarcomatoid in 6%, and mixed in 17%, and 6% had Stage I, 28% had Stage II, 33% had Stage III, and 33% had Stage IV. Thirty-two patients (89%) received induction chemotherapy (mostly cisplatin and pemetrexed); 56% underwent pleurectomy/decortication before IMRT and 44% did not undergo resection. Of the 36 patients evaluable for acute toxicity, 7 (20%) had Grade 3 or worse pneumonitis (including 1 death) and 2 had Grade 3 fatigue. In 30 patients assessable for late toxicity, 5 had continuing Grade 3 pneumonitis. For patients treated with surgery, the 1- and 2-year survival rate was 75% and 53%, and the median survival was 26 months. For patients who did not undergo surgical resection, the 1- and 2-year survival rate was 69% and 28%, and the median survival was 17 months. Conclusions: Treating the intact lung with pleural IMRT in patients with malignant pleural mesothelioma is a safe and feasible treatment option with an acceptable rate of pneumonitis. Additionally, the survival rates were encouraging in our retrospective series, particularly for the patients who underwent pleurectomy/decortication. We have initiated a Phase II trial of induction chemotherapy with pemetrexed and cisplatin with or without pleurectomy

  20. Prone Breast Intensity Modulated Radiation Therapy: 5-Year Results

    Energy Technology Data Exchange (ETDEWEB)

    Osa, Etin-Osa O.; DeWyngaert, Keith [Department of Radiation Oncology, New York University School of Medicine, New York, New York (United States); Roses, Daniel [Department of Surgery, New York University School of Medicine, New York, New York (United States); Speyer, James [Department of Medical Oncology, New York University School of Medicine, New York, New York (United States); Guth, Amber; Axelrod, Deborah [Department of Surgery, New York University School of Medicine, New York, New York (United States); Fenton Kerimian, Maria [Department of Radiation Oncology, New York University School of Medicine, New York, New York (United States); Goldberg, Judith D. [Department of Population Health, New York University School of Medicine, New York, New York (United States); Formenti, Silvia C., E-mail: Silvia.formenti@nyumc.org [Department of Radiation Oncology, New York University School of Medicine, New York, New York (United States)

    2014-07-15

    Purpose: To report the 5-year results of a technique of prone breast radiation therapy delivered by a regimen of accelerated intensity modulated radiation therapy with a concurrent boost to the tumor bed. Methods and Materials: Between 2003 and 2006, 404 patients with stage I-II breast cancer were prospectively enrolled into 2 consecutive protocols, institutional trials 03-30 and 05-181, that used the same regimen of 40.5 Gy/15 fractions delivered to the index breast over 3 weeks, with a concomitant daily boost to the tumor bed of 0.5 Gy (total dose 48 Gy). All patients were treated after segmental mastectomy and had negative margins and nodal assessment. Patients were set up prone: only if lung or heart volumes were in the field was a supine setup attempted and chosen if found to better spare these organs. Results: Ninety-two percent of patients were treated prone, 8% supine. Seventy-two percent had stage I, 28% stage II invasive breast cancer. In-field lung volume ranged from 0 to 228.27 cm{sup 3}, mean 19.65 cm{sup 3}. In-field heart volume for left breast cancer patients ranged from 0 to 21.24 cm{sup 3}, mean 1.59 cm{sup 3}. There was no heart in the field for right breast cancer patients. At a median follow-up of 5 years, the 5-year cumulative incidence of isolated ipsilateral breast tumor recurrence was 0.82% (95% confidence interval [CI] 0.65%-1.04%). The 5-year cumulative incidence of regional recurrence was 0.53% (95% CI 0.41%-0.69%), and the 5-year overall cumulative death rate was 1.28% (95% CI 0.48%-3.38%). Eighty-two percent (95% CI 77%-85%) of patients judged their final cosmetic result as excellent/good. Conclusions: Prone accelerated intensity modulated radiation therapy with a concomitant boost results in excellent local control and optimal sparing of heart and lung, with good cosmesis. Radiation Therapy Oncology Group protocol 1005, a phase 3, multi-institutional, randomized trial is ongoing and is evaluating the equivalence of a similar dose and

  1. Accelerated partial breast irradiation using intensity-modulated radiotherapy technique compared to whole breast irradiation for patients aged 70 years or older: subgroup analysis from a randomized phase 3 trial.

    Science.gov (United States)

    Meattini, Icro; Saieva, Calogero; Marrazzo, Livia; Di Brina, Lucia; Pallotta, Stefania; Mangoni, Monica; Meacci, Fiammetta; Bendinelli, Benedetta; Francolini, Giulio; Desideri, Isacco; De Luca Cardillo, Carla; Scotti, Vieri; Furfaro, Ilaria Francesca; Rossi, Francesca; Greto, Daniela; Bonomo, Pierluigi; Casella, Donato; Bernini, Marco; Sanchez, Luis; Orzalesi, Lorenzo; Simoncini, Roberta; Nori, Jacopo; Bianchi, Simonetta; Livi, Lorenzo

    2015-10-01

    The purpose of this study was to report the efficacy and the safety profile on the subset of selected early breast cancer (BC) patients aged 70 years or older from a single-center phase 3 trial comparing whole breast irradiation (WBI) to accelerated partial breast irradiation (APBI) using intensity-modulated radiation therapy technique. Between 2005 and 2013, 520 patients aged more than 40 years old were enrolled and randomly assigned to receive either WBI or APBI in a 1:1 ratio. Eligible patients were women with early BC (maximum diameter 2.5 cm) suitable for breast conserving surgery. This study is registered with ClinicalTrials.gov, NCT02104895. A total of 117 patients aged 70 years or more were analyzed (58 in the WBI arm, 59 in the APBI arm). At a median follow-up of 5-years (range 3.4-7.0), the ipsilateral breast tumor recurrence (IBTR) rate was 1.9 % in both groups. No significant difference between the two groups was identified (log-rank test p = 0.96). The 5-year disease-free survival (DFS) rates in the WBI group and APBI group were 6.1 and 1.9 %, respectively (p = 0.33). The APBI group presented significantly better results in terms of acute skin toxicity, considering both any grade (p = 0.0001) and grade 2 or higher (p = 0.0001). Our subgroup analyses showed a very low rate and no significant difference in terms of IBTR, using both WBI and APBI. A significant impact on patients compliance in terms of acute and early late toxicity was shown, which could translate in a consistent improvement of overall quality of life.

  2. Transition from 2-D radiotherapy to 3-D conformal and intensity modulated radiotherapy

    International Nuclear Information System (INIS)

    2008-05-01

    Cancer is one of the leading causes of death globally and radiotherapy is currently an essential component in the management of cancer patients, either alone or in combination with surgery or chemotherapy, both for cure or palliation. It is now recognized that safe and effective radiotherapy service needs not only substantial capital investment in radiotherapy equipment and specially designed facilities but also continuous investment in maintenance and upgrading of the equipment to comply with the technical progress, but also in training the staff. The recent IAEA-TECDOC publication 'Setting up a Radiotherapy Programme: Clinical, Medical Physics, Radiation Protection and Safety Aspects' provides general guidelines for designing and implementing radiotherapy services in Member States. Advances in computer technology have enabled the possibility of transitioning from basic 2- dimensional treatment planning and delivery (2-D radiotherapy) to a more sophisticated approach with 3-dimensional conformal radiotherapy (3-D CRT). Whereas 2-D radiotherapy can be applied with simple equipment, infrastructure and training, transfer to 3-D conformal treatments requires more resources in technology, equipment, staff and training. A novel radiation treatment approach using Intensity Modulated Radiation Therapy (IMRT) that optimizes the delivery of radiation to irregularly shaped tumour volumes demands even more sophisticated equipment and seamless teamwork, and consequentially more resources, advanced training and more time for treatment planning and verification of dose delivery than 3-D CRT. Whereas 3-D CRT can be considered as a standard, IMRT is still evolving. Due to the increased interest of Member States to the modern application of radiotherapy the IAEA has received a number of requests for guidance coming from radiotherapy departments that wish to upgrade their facilities to 3-D CRT and IMRT through Technical Cooperation programme. These requests are expected to increase

  3. Intensity-modulated radiotherapy significantly reduces xerostomia compared with conventional radiotherapy

    International Nuclear Information System (INIS)

    Braam, Petra M.; Terhaard, Chris H.J. M.D.; Roesink, Judith M.; Raaijmakers, Cornelis P.J.

    2006-01-01

    Purpose: Xerostomia is a severe complication after radiotherapy for oropharyngeal cancer, as the salivary glands are in close proximity with the primary tumor. Intensity-modulated radiotherapy (IMRT) offers theoretical advantages for normal tissue sparing. A Phase II study was conducted to determine the value of IMRT for salivary output preservation compared with conventional radiotherapy (CRT). Methods and Materials: A total of 56 patients with oropharyngeal cancer were prospectively evaluated. Of these, 30 patients were treated with IMRT and 26 with CRT. Stimulated parotid salivary flow was measured before, 6 weeks, and 6 months after treatment. A complication was defined as a stimulated parotid flow rate <25% of the preradiotherapy flow rate. Results: The mean dose to the parotid glands was 48.1 Gy (SD 14 Gy) for CRT and 33.7 Gy (SD 10 Gy) for IMRT (p < 0.005). The mean parotid flow ratio 6 weeks and 6 months after treatment was respectively 41% and 64% for IMRT and respectively 11% and 18% for CRT. As a result, 6 weeks after treatment, the number of parotid flow complications was significantly lower after IMRT (55%) than after CRT (87%) (p = 0.002). The number of complications 6 months after treatment was 56% for IMRT and 81% for CRT (p = 0.04). Conclusions: IMRT significantly reduces the number of parotid flow complications for patients with oropharyngeal cancer

  4. Cervix carcinomas: place of intensity-modulated radiotherapy

    International Nuclear Information System (INIS)

    Barillot, I.

    2009-01-01

    While indications of modulated intensity radiation therapy (I.M.R.T.) are perfectly defined in head and neck and prostate cancer patients, this technique remains under evaluation for gynecologic tumours. The implementation of conformal three dimensional radiotherapy in the late 1990 has been the first important step for optimisation of treatment of cervix carcinomas, as it permitted a better target coverage with a significant reduction of the bladder dose. However, this technique often leads to an irradiation of a larger volume of rectum in locally advanced stages and could only spare a limited amount of intestine. I.R.M.T. is one of the optimisation methods potentially efficient for a better sparing of digestive tract during irradiation of cervix carcinomas. The aim of this literature review is to provide the arguments supporting this hypothesis, and to define the place of this technique for dose escalation. (authors)

  5. Automation of the solution type of intensity modulated radiation therapy with direct planning neoplastic breast lesions

    International Nuclear Information System (INIS)

    Fuente Rosales, Liset De La; Larrinaga Cortina, Eduardo Francisco

    2009-01-01

    Breast cancer ranks first among the lesions malignancies involving the Cuban women and the second in mortality only surpassed by lung injury. The breast-conserving surgery is becoming less appeal, with an increase in the choice of radiotherapy to the breast operated, and the surgical bed. Intensity Modulated Radiation Therapy, IMRT has demonstrated better results in the dose distribution for irradiation dimensional treatment breast shaping, 3DCRT. We developed a MATLAB application to obtain the solution type to direct planning IMRT for breast neoplasm. The technique was implemented in the Planning System Treatment Plus Theraplan v3.8 and Precise1 ELEKTA linear accelerator. Static segments are constructed for each portal of incidence and Excel files are exported as the positions of the blades. The technique was validated with a patient, which he performed a radiographic study of computerized axial tomography planning purposes. The standard solution built is consistent with those reported internationally and consists of a segment type and at least two segments of type B. The assignment of the relative weights of the segments is done manually by trial and error procedure, with the general rule of 90% by weight assigned to segment A and the remaining 10% divided equally between B-type segments IMRT breast obtained in a dose 17% homogeneity better than 3DCRT and reduced the average dose in the lung ipsilateral 15%. (author)

  6. Evidence-based review: Quality of life following head and neck intensity-modulated radiotherapy

    International Nuclear Information System (INIS)

    Scott-Brown, Martin; Miah, Aisha; Harrington, Kevin; Nutting, Chris

    2010-01-01

    Inverse planned Intensity modulated radiotherapy (IMRT) can minimize the dose to normal structures and therefore can reduce long-term radiotherapy-related morbidity and may improve patients' long-term quality of life. Despite overwhelming evidence that IMRT can reduce late functional deficits in patients with head and neck cancer, treated with radiotherapy, a review of the published literature produced conflicting results with regard to quality of life outcomes. Following a critical appraisal of the literature, reasons for the discrepant outcomes are proposed.

  7. Fatal pneumonitis associated with postoperative intensity-modulated radiotherapy in lung cancer: Case report and review

    OpenAIRE

    HU, YAN; LI, JINGJING; SU, XIAOYAN

    2012-01-01

    Radiation pneumonitis (RP) is the most significant complication of acute treatment-related toxicities in lung cancer. Intensity-modulated radiotherapy (IMRT) with inverse planning enables us to achieve the desired dose distribution. However, there are many high-risk procedures associated with lung irradiation, including chemotherapy and surgery. We report a case of fatal treatment-related pneumonitis, where the patient had undergone postoperative IMRT for lung cancer. Following completion of ...

  8. Radiation efficacy and biological risk from whole-breast irradiation via intensity modulated radiation therapy (IMRT)

    Science.gov (United States)

    Desantis, David M.

    Radiotherapy is an established modality for women with breast cancer. During the delivery of external beam radiation to the breast, leakage, scattered x-rays from the patient and the linear accelerator also expose healthy tissues and organs outside of the breast, thereby increasing the patient's whole-body dose, which then increases the chance of developing a secondary, radiation-induced cancer. Generally, there are three IntensityModulated Radiotherapy (IMRT) delivery techniques from a conventional linear accelerator; forward planned (FMLC), inverse planned 'sliding window' (DMLC), and inverse planned 'step-and-shoot' (SMLC). The goal of this study was to determine which of these three techniques delivers an optimal dose to the breast with the least chance of causing a fatal, secondary, radiation-induced cancer. A conventional, non-IMRT, 'Wedge' plan also was compared. Computerized Tomography (CT) data sets for both a large and small sized patient were used in this study. With Varian's Eclipse AAA algorithm, the organ doses specified in the revised ICRP 60 publication were used to calculate the whole-body dose. Also, an anthropomorphic phantom was irradiated with thermoluminescent dosimeters (TLD) at each organ site for measured doses. The risk coefficient from the Biological Effects of Ionizing Radiation (BEIR) VII report of 4.69 x 10-2 deaths per Gy was used to convert whole-body dose to risk of a fatal, secondary, radiation-induced cancer. The FMLC IMRT delivered superior tumor coverage over the 3D conventional plan and the inverse DMLC or SMLC treatment plans delivered clinically equivalent tumor coverage. However, the FMLC plan had the least likelihood of inadvertently causing a fatal, secondary, radiation-induced cancer compared to the inverse DMLC, SMLC, and Wedge plans.

  9. Local failure patterns for patients with nasopharyngeal carcinoma after intensity-modulated radiotherapy

    International Nuclear Information System (INIS)

    Li, Jia-xin; Huang, Shao-min; Jiang, Xin-hua; Ouyang, Bin; Han, Fei; Liu, Shuai; Wen, Bi-xiu; Lu, Tai-xiang

    2014-01-01

    To investigate the clinical feature and the local failure patterns after intensity-modulated radiotherapy for nasopharyngeal carcinoma. Between March 2007 and July 2009, 710 patients with nasopharyngeal carcinoma were treated with intensity-modulated radiotherapy. The magnetic resonance imagings obtained at recurrence were registered with the original planning computed tomography for dosimetry analysis. With a median follow-up of 38 months, 34 patients have developed local recurrence (32 cases valid). The incidence of invasion to nasopharynx, parapharyngeal space and the retropharyngeal space by the primary tumors was 100%, 75.0% and 62.5%, respectively, but 78.1%, 34.4% and 21.9% at recurrence, respectively. The rate of invasion to ethmoid sinus was 3.1% by the primary tumors but 28.1% at recurrence (p = 0.005). The topographic analysis of the local failure patterns showed 'central' in 16 patients; 'marginal' in 9; and 'outside' in 7. The median volumes of primary gross tumor were 45.84 cm 3 in the central failure group, 29.44 cm 3 in the marginal failure group, and 21.52 cm 3 in the outside failure group, respectively (p = 0.012), and the median volumes of primary clinical target1 were 87.28 cm 3 , 61.90 cm 3 and 58.74 cm 3 in the three groups, respectively (p = 0.033). In patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy, the recurrent tumors had their unique characteristic and regularity of invasion to adjacent structures. 'Central' failure was the major local failure pattern. The volumes of primary gross tumor and clinical target1 were significantly correlated with recurrent patterns. Employ more aggressive approaches to tumor cells which will be insensitive to radiotherapy may be an effective way to reduce the central failure

  10. Implementation of intensity-modulated conformational radiotherapy for cervical cancers at the Alexis Vautrin Centre

    International Nuclear Information System (INIS)

    Renard-Oldrini, Sophie

    2010-01-01

    As platinum salt based concomitant conformational radiotherapy and chemotherapy have been used as a standard treatment for cervical cancers but resulted in digestive and haematological toxicities, this research thesis reports the application of intensity-modulated conformational radiation therapy. After having recalled some epidemiological, anatomical aspects, diagnosis and treatments aspects regarding cervical cancer, the author presents this last treatment technique (principles, benefits, practical implementation). The author discusses results obtained by an experiment during which seven patients have been treated by simple conformational radiation therapy, and four by intensity-modulated conformational radiation therapy. Results are discussed in terms of volumes (clinical target volume, growth target volume, planned target volume), dosimetric results, toxicities (urine and skin), weight loss [fr

  11. Isocentric integration of intensity-modulated radiotherapy with electron fields improves field junction dose uniformity in postmastectomy radiotherapy.

    Science.gov (United States)

    Wright, Pauliina; Suilamo, Sami; Lindholm, Paula; Kulmala, Jarmo

    2014-08-01

    In postmastectomy radiotherapy (PMRT), the dose coverage of the planning target volume (PTV) with additional margins, including the chest wall, supraclavicular, interpectoral, internal mammary and axillar level I-III lymph nodes, is often compromised. Electron fields may improve the medial dose coverage while maintaining organ at risk (OAR) doses at an acceptable level, but at the cost of hot and cold spots at the electron and photon field junction. To improve PMRT dose coverage and uniformity, an isocentric technique combining tangential intensity-modulated (IM)RT fields with one medial electron field was implemented. For 10 postmastectomy patients isocentric IMRT with electron plans were created and compared with a standard electron/photon mix and a standard tangent technique. PTV dose uniformity was evaluated based on the tolerance range (TR), i.e. the ratio of the standard deviation to the mean dose, a dice similarity coefficient (DSC) and the 90% isodose coverage and the hot spot volumes. OAR and contralateral breast doses were also recorded. IMRT with electrons significantly improved the PTV dose homogeneity and conformity based on the TR and DSC values when compared with the standard electron/photon and tangent technique (p electron/photon mix, IMRT smoothed the dose gradient in the electron and photon field junction and the volumes receiving a dose of 110% or more were reduced by a third. For all three strategies, the OAR and contralateral breast doses were within clinically tolerable limits. Based on these results two-field IMRT combined with an electron field is a suitable strategy for PMRT.

  12. A Comparison of Helical Intensity-Modulated Radiotherapy, Intensity-Modulated Radiotherapy, and 3D-Conformal Radiation Therapy for Pancreatic Cancer

    International Nuclear Information System (INIS)

    Poppe, Matthew M.; Narra, Venkat; Yue, Ning J.; Zhou Jinghao; Nelson, Carl; Jabbour, Salma K.

    2011-01-01

    We assessed dosimetric differences in pancreatic cancer radiotherapy via helical intensity-modulated radiotherapy (HIMRT), linac-based IMRT, and 3D-conformal radiation therapy (3D-CRT) with regard to successful plan acceptance and dose to critical organs. Dosimetric analysis was performed in 16 pancreatic cases that were planned to 54 Gy; both post-pancreaticoduodenectomy (n = 8) and unresected (n = 8) cases were compared. Without volume modification, plans met constraints 75% of the time with HIMRT and IMRT and 13% with 3D-CRT. There was no statistically significantly improvement with HIMRT over conventional IMRT in reducing liver V35, stomach V45, or bowel V45. HIMRT offers improved planning target volume (PTV) dose homogeneity compared with IMRT, averaging a lower maximum dose and higher volume receiving the prescription dose (D100). HIMRT showed an increased mean dose over IMRT to bowel and liver. Both HIMRT and IMRT offer a statistically significant improvement over 3D-CRT in lowering dose to liver, stomach, and bowel. The results were similar for both unresected and resected patients. In pancreatic cancer, HIMRT offers improved dose homogeneity over conventional IMRT and several significant benefits to 3D-CRT. Factors to consider before incorporating IMRT into pancreatic cancer therapy are respiratory motion, dose inhomogeneity, and mean dose.

  13. Rationale and development of image-guided intensity-modulated radiotherapy post-prostatectomy: the present standard of care?

    Science.gov (United States)

    Murray, Julia R; McNair, Helen A; Dearnaley, David P

    2015-01-01

    The indications for post-prostatectomy radiotherapy have evolved over the last decade, although the optimal timing, dose, and target volume remain to be well defined. The target volume is susceptible to anatomical variations with its borders interfacing with the rectum and bladder. Image-guided intensity-modulated radiotherapy has become the gold standard for radical prostate radiotherapy. Here we review the current evidence for image-guided techniques with intensity-modulated radiotherapy to the prostate bed and describe current strategies to reduce or account for interfraction and intrafraction motion.

  14. [Positioning errors of CT common rail technique in intensity-modulated radiotherapy for nasopharyngeal carcinoma].

    Science.gov (United States)

    Tian, Fei; Xu, Zihai; Mo, Li; Zhu, Chaohua; Chen, Chaomin

    2012-11-01

    To evaluate the value of CT common rail technique for application in intensity-modulated radiotherapy for nasopharyngeal carcinoma (NPC). Twenty-seven NPC patients underwent Somatom CT scans using the Siemens CTVision system prior to the commencement of the radiotherapy sessions. The acquired CT images were registered with the planning CT images using the matching function of the system to obtain the linear set-up errors of 3 directions, namely X (left to right), Y (superior to inferior), and Z (anterior to posterior). The errors were then corrected online on the moving couch. The 27 NPC patients underwent a total of 110 CT scans and the displacement deviations of the X, Y and Z directions were -0.16∓1.68 mm, 0.25∓1.66 mm, and 0.33∓1.09 mm, respectively. CT common rail technique can accurately and rapidly measure the space error between the posture and the target area to improve the set-up precision of intensity-modulated radiotherapy for NPC.

  15. Dosimetric comparison of three-dimensional conformal and intensity modulated radiotherapy in brain glioma

    International Nuclear Information System (INIS)

    Lu Jie; Zhang Guifang; Bai Tong; Yin Yong; Fan Tingyong; Wu Chaoxia

    2009-01-01

    Objective: To investigate the dosimetry advantages of intensity modulated radiotherapy (IMRT)of brain glioma compared with that of three-dimensional conformal radiotherapy (SD CRT). Methods: Ten patients with brain glioma were enrolled in this study. Three-dimensional conf0rmal and intensity modulated radiotherapy plans were performed for each patient. The dose distributions of target volume and normal tissues, conformal index (CI) and heterogeneous index (HI) were analyzed using the dose-volume histogram (DVH). The prescription dose was 60 Gy in 30 fractions. Results: IMRT plans decrease the maximum dose and volume of brainstem, mean dose of affected side parotid and maximum dose of spinal-cord. The CI for PTV of IMRT was superior to that of SD CRT, the HI for PTV has no statistical significance of the two model plans. Conclusions: IMRT plans can obviously decrease the dose and volume of brainstem. IMRT is a potential method in the treatment of brain glioma, and dose escalation was possible in patients with brain glioma. (authors)

  16. Comparison of conventional radiotherapy and intensity-modulated radiotherapy for post-operative radiotherapy for primary extremity soft tissue sarcoma

    International Nuclear Information System (INIS)

    Stewart, Alexandra J.; Lee, Young K.; Saran, Frank H.

    2009-01-01

    Introduction: Doses in conventional radiotherapy for extremity soft tissue sarcoma (STS) potentially exceed normal tissue tolerances. This study compares 3D-conformal radiotherapy (3D-CRT) with intensity-modulated radiotherapy (IMRT) in optimising target volume coverage and minimising integral dose to organs-at-risk (OAR). Methods and materials: Ten patients undergoing post-operative radiotherapy for extremity STS were assessed. PTV 1 was defined as tumour bed plus 5 cm superiorly/inferiorly and 3 cm circumferentially, PTV 2 was defined as 2 cm isotropically. OAR were defined as whole femur, neurovascular bundle, tissue corridor and normal tissue outside PTV 1 . For each patient 2-phase 3D-CRT was compared to 2/3 field (2/3f) and 4/5 field (4/5f) IMRT with simultaneous integrated boost (SIB). The primary planning objective was to minimise femur and skin corridor dose. Volumetric analysis and conformity and heterogeneity indices were used for plan comparison. Results: A planning protocol containing dose/volume constraints for target and OAR was defined. 4/5f IMRT showed greatest conformity and homogeneity. IMRT resulted in significantly lower femur V45 using 2/3f (p = 0.01) and 4/5f (p = 0.0009) than 3D-CRT. 4/5f IMRT resulted in significantly lower normal tissue V55 (p = 0.004) and maximum dose (p = 0.04) than 3D-CRT. Conclusions: A reproducible set of planning guidelines and dose-volume constraints for 3D-CRT and IMRT planning for extremity sarcomas was devised. 4/5f IMRT with SIB resulted in better target coverage and significantly decreased OAR dose. Further evaluation of this technique within a clinical trial is recommended to demonstrate that the technical benefit of the more complex technique translates into patient-derived benefit by reducing late toxicity.

  17. Stereotactic Image-Guided Intensity Modulated Radiotherapy Using the HI-ART II Helical Tomotherapy System

    International Nuclear Information System (INIS)

    Holmes, Timothy W.; Hudes, Richard; Dziuba, Sylwester; Kazi, Abdul; Hall, Mark; Dawson, Dana

    2008-01-01

    The highly integrated adaptive radiation therapy (HI-ART II) helical tomotherapy unit is a new radiotherapy machine designed to achieve highly precise and accurate treatments at all body sites. The precision and accuracy of the HI-ART II is similar to that provided by stereotactic radiosurgery systems, hence the historical distinction between external beam radiotherapy and stereotactic procedures based on differing precision requirements is removed for this device. The objectives of this work are: (1) to describe stereotactic helical tomotherapy processes (SRS, SBRT); (2) to show that the precision and accuracy of the HI-ART meet the requirements defined for SRS and SBRT; and (3) to describe the clinical implementation of a stereotactic image-guided intensity modulated radiation therapy (IG-IMRT) system that incorporates optical motion management

  18. Fatal pneumonitis associated with postoperative intensity-modulated radiotherapy in lung cancer: Case report and review.

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    Hu, Yan; Li, Jingjing; Su, Xiaoyan

    2013-02-01

    Radiation pneumonitis (RP) is the most significant complication of acute treatment-related toxicities in lung cancer. Intensity-modulated radiotherapy (IMRT) with inverse planning enables us to achieve the desired dose distribution. However, there are many high-risk procedures associated with lung irradiation, including chemotherapy and surgery. We report a case of fatal treatment-related pneumonitis, where the patient had undergone postoperative IMRT for lung cancer. Following completion of radiotherapy, the patient developed progressive dyspnea. A chest computed tomography (CT) scan revealed the presence of diffuse reticular interstitial processes and honeycombing in both lungs. The fibrotic change in both lungs in a transverse view was compatible with low-dose irradiation of non-target organs at risk. Acute radiation pneumonitis was diagnosed. For patients receiving postoperative IMRT, low-dose irradiation volumes should be considered for lungs, as well as strict dose-volume histogram (DVH) parameters.

  19. Intensity modulated radiotherapy in early stage Hodgkin lymphoma patients: Is it better than three dimensional conformal radiotherapy?

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    De Sanctis Vitaliana

    2012-08-01

    Full Text Available Abstract Background Cure rate of early Hodgkin Lymphoma are high and avoidance of late toxicities is of paramount importance. This comparative study aims to assess the normal tissue sparing capability of intensity-modulated radiation therapy (IMRT versus standard three-dimensional conformal radiotherapy (3D-CRT in terms of dose-volume parameters and normal tissue complication probability (NTCP for different organs at risk in supradiaphragmatic Hodgkin Lymphoma (HL patients. Methods Ten HL patients were actually treated with 3D-CRT and all treatments were then re-planned with IMRT. Dose-volume parameters for thyroid, oesophagus, heart, coronary arteries, lung, spinal cord and breast were evaluated. Dose-volume histograms generated by TPS were analyzed to predict the NTCP for the considered organs at risk, according to different endpoints. Results Regarding dose-volume parameters no statistically significant differences were recorded for heart and origin of coronary arteries. We recorded statistically significant lower V30 with IMRT for oesophagus (6.42 vs 0.33, p = 0.02 and lungs (4.7 vs 0.1 p = 0.014 for the left lung and 2.59 vs 0.1 p = 0.017 for the right lung and lower V20 for spinal cord (17.8 vs 7.2 p = 0.02. Moreover the maximum dose to the spinal cord was lower with IMRT (30.2 vs 19.9, p Conclusions In HL male patients IMRT seems feasible and accurate while for women HL patients IMRT should be used with caution.

  20. Intensity-Modulated Radiotherapy for Cervical Lymph Node Metastases From Unknown Primary Cancer

    International Nuclear Information System (INIS)

    Madani, Indira; Vakaet, Luc; Bonte, Katrien; Boterberg, Tom; Neve, Wilfried de

    2008-01-01

    Purpose: To compare the effectiveness of intensity-modulated radiotherapy (IMRT) and conventional (two-dimensional) radiotherapy in the treatment of cervical lymph node metastases from unknown primary cancer (UPC). Methods and Materials: Between February 2003 and September 2006, 23 patients with UPC of squamous cell carcinoma were treated with IMRT. Extended putative mucosal and bilateral nodal sites were irradiated to a median dose of 66 Gy. In 19 patients, IMRT was performed after lymph node dissection, and in 4 patients primary radiotherapy was given. The conventional radiotherapy group (historical control group) comprised 18 patients treated to a median dose of 66 Gy between August 1994 and October 2003. Results: Twenty patients completed treatment. As compared with conventional radiotherapy, the incidence of Grade 3 acute dysphagia was significantly lower in the IMRT group (4.5% vs. 50%, p = 0.003). By 6 months, Grade 3 xerostomia was detected in 11.8% patients in the IMRT group vs. 53.4% in the historical control group (p = 0.03). No Grade 3 dysphagia or skin fibrosis was observed after IMRT but these were noted after conventional radiotherapy (26.7%, p = 0.01) and 26.7%, p = 0.03) respectively). With median follow-up of living patients of 17 months, there was no emergence of primary cancer. One patient had persistent nodal disease and another had nodal relapse at 5 months. Distant metastases were detected in 4 patients. The 2-year overall survival and distant disease-free probability after IMRT did not differ significantly from those for conventional radiotherapy (74.8% vs. 61.1% and 76.3% vs. 68.4%, respectively). Conclusions: Use of IMRT for UPC resulted in lower toxicity than conventional radiotherapy, and was similar in efficacy

  1. Volumetric intensity-modulated Arc (RapidArc therapy for primary hepatocellular carcinoma: comparison with intensity-modulated radiotherapy and 3-D conformal radiotherapy

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    Chen Chia-Wen

    2011-06-01

    Full Text Available Abstract Background To compare the RapidArc plan for primary hepatocellular carcinoma (HCC with 3-D conformal radiotherapy (3DCRT and intensity-modulated radiotherapy (IMRT plans using dosimetric analysis. Methods Nine patients with unresectable HCC were enrolled in this study. Dosimetric values for RapidArc, IMRT, and 3DCRT were calculated for total doses of 45~50.4 Gy using 1.8 Gy/day. The parameters included the conformal index (CI, homogeneity index (HI, and hot spot (V107% for the planned target volume (PTV as well as the monitor units (MUs for plan efficiency, the mean dose (Dmean for the organs at risk (OAR and the maximal dose at 1% volume (D1% for the spinal cord. The percentage of the normal liver volume receiving ≥ 40, > 30, > 20, and > 10 Gy (V40 Gy, V30 Gy, V20 Gy, and V10 Gy and the normal tissue complication probability (NTCP were also evaluated to determine liver toxicity. Results All three methods achieved comparable homogeneity for the PTV. RapidArc achieved significantly better CI and V107% values than IMRT or 3DCRT (p p mean of the normal liver than did 3DCRT or RapidArc (p = 0.001. 3DCRT had higher V40 Gy and V30 Gy values for the normal liver than did RapidArc or IMRT. Although the V10 Gy to the normal liver was higher with RapidArc (75.8 ± 13.1% than with 3DCRT or IMRT (60.5 ± 10.2% and 57.2 ± 10.0%, respectively; p p = 0.02. Conclusions RapidArc provided favorable tumor coverage compared with IMRT or 3DCRT, but RapidArc is not superior to IMRT in terms of liver protection. Further studies are needed to establish treatment outcome differences between the three approaches.

  2. Intensity-modulated radiotherapy in high-grade gliomas: Clinical and dosimetric results

    International Nuclear Information System (INIS)

    Narayana, Ashwatha; Yamada, Josh; Berry, Sean; Shah, Priti B.S.; Hunt, Margie; Gutin, Philip H.; Leibel, Steven A.

    2006-01-01

    Purpose: To report preliminary clinical and dosimetric data from intensity-modulated radiotherapy (IMRT) for malignant gliomas. Methods and Materials: Fifty-eight consecutive high-grade gliomas were treated between January 2001 and December 2003 with dynamic multileaf collimator IMRT, planned with the inverse approach. A dose of 59.4-60 Gy at 1.8-2.0 Gy per fraction was delivered. A total of three to five noncoplanar beams were used to cover at least 95% of the target volume with the prescription isodose line. Glioblastoma accounted for 70% of the cases, and anaplastic oligodendroglioma histology (pure or mixed) was seen in 15% of the cases. Surgery consisted of biopsy only in 26% of the patients, and 80% received adjuvant chemotherapy. Results: With a median follow-up of 24 months, 85% of the patients have relapsed. The median progression-free survival time for anaplastic astrocytoma and glioblastoma histology was 5.6 and 2.5 months, respectively. The overall survival time for anaplastic glioma and glioblastoma was 36 and 9 months, respectively. Ninety-six percent of the recurrences were local. No Grade IV/V late neurologic toxicities were noted. A comparative dosimetric analysis revealed that regardless of tumor location, IMRT did not significantly improve target coverage compared with three-dimensional planning. However, IMRT resulted in a decreased maximum dose to the spinal cord, optic nerves, and eye by 16%, 7%, and 15%, respectively, owing to its improved dose conformality. The mean brainstem dose also decreased by 7%. Intensity-modulated radiotherapy delivered with a limited number of beams did not result in an increased dose to the normal brain. Conclusions: It is unlikely that IMRT will improve local control in high-grade gliomas without further dose escalation compared with conventional radiotherapy. However, it might result in decreased late toxicities associated with radiotherapy

  3. Head and neck cancers: clinical benefits of three-dimensional conformal radiotherapy and of intensity-modulated radiotherapy

    International Nuclear Information System (INIS)

    Giraud, P.; Jaulerry, C.; Brunin, F.; Zefkili, S.; Helfre, S.; Chauvet, I.; Rosenwald, J.C.; Cosset, J.M.

    2002-01-01

    The conformal radiotherapy approach, three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT), is based on modern imaging modalities, efficient 3-D treatment planning systems, sophisticated immobilization systems and rigorous quality assurance and treatment verification. The central objective of conformal radiotherapy is to ensure a high dose distribution tailored to the limits of the target volume while reducing exposure of normal tissues. These techniques would then allow further tumor dose escalation. Head-and-neck tumors are some of the most attractive localizations to test conformal radiotherapy. They combine ballistic difficulties due to particularly complex shapes (nasopharynx, ethmoid) and problems due to the number and low tolerance of neighbouring organs like parotids, eyes, brainstem and spinal cord. The therapeutic irradiation of head-and-neck tumors thus remains a challenge for the radiation oncologist. Conformal radiotherapy does have a significant potential for improving local control and reducing toxicity when compared to standard radiotherapy. However, in the absence of prospective randomized trials, it is somewhat difficult at present to evaluate the real benefits drawn from 3DCRT and IMRT. The published clinical reports on the use of conformal radiotherapy are essentially dealing with dosimetric comparisons on relatively small numbers of patients. Recently, a few publications have emphasized the clinical experience several precursor teams with a suitable follow-up. This paper describes the current state-of-the-art of 3DCRT and IMRT in order to evaluate the impact of these techniques on head-and-neck cancers irradiation. (authors)

  4. Hypofractionated Concomitant Intensity-Modulated Radiotherapy Boost for High-Risk Prostate Cancer: Late Toxicity

    Energy Technology Data Exchange (ETDEWEB)

    Quon, Harvey [Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada); Cheung, Patrick C.F., E-mail: patrick.cheung@sunnybrook.ca [Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada); Loblaw, D. Andrew; Morton, Gerard; Pang, Geordi; Szumacher, Ewa; Danjoux, Cyril [Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada); Choo, Richard [Department of Radiation Oncology, Mayo Clinic, Rochester, MN (United States); Thomas, Gillian [Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON (Canada); Department of Radiation Oncology, University of Toronto, Toronto, ON (Canada); Kiss, Alex; Mamedov, Alexandre; Deabreu, Andrea [Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON (Canada)

    2012-02-01

    Purpose: To report the acute and late toxicities of patients with high-risk localized prostate cancer treated using a concomitant hypofractionated, intensity-modulated radiotherapy boost combined with long-term androgen deprivation therapy. Methods and Materials: A prospective Phase I-II study of patients with any of the following: clinical Stage T3 disease, prostate-specific antigen level {>=}20 ng/mL, or Gleason score 8-10. A dose of 45 Gy (1.8 Gy/fraction) was delivered to the pelvic lymph nodes with a concomitant 22.5 Gy prostate intensity-modulated radiotherapy boost, to a total of 67.5 Gy (2.7 Gy/fraction) in 25 fractions within 5 weeks. Image guidance was performed using three gold seed fiducials. The National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0, and Radiation Therapy Oncology Group late morbidity scores were used to assess the acute and late toxicities, respectively. Biochemical failure was determined using the Phoenix definition. Results: A total of 97 patients were treated and followed up for a median of 39 months, with 88% having a minimum of 24 months of follow-up. The maximal toxicity scores were recorded. The grade of acute gastrointestinal toxicity was Grade 0 in 4%, 1 in 59%, and 2 in 37%. The grade of acute urinary toxicity was Grade 0 in 8%, 1 in 50%, 2 in 39%, and 3 in 4%. The grade of late gastrointestinal toxicity was Grade 0 in 54%, 1 in 40%, and 2 in 7%. No Grade 3 or greater late gastrointestinal toxicities developed. The grade of late urinary toxicity was Grade 0 in 82%, 1 in 9%, 2 in 5%, 3 in 3%, and 4 in 1% (1 patient). All severe toxicities (Grade 3 or greater) had resolved at the last follow-up visit. The 4-year biochemical disease-free survival rate was 90.5%. Conclusions: A hypofractionated intensity-modulated radiotherapy boost delivering 67.5 Gy in 25 fractions within 5 weeks combined with pelvic nodal radiotherapy and long-term androgen deprivation therapy was well tolerated, with low rates

  5. Rationale and development of image-guided intensity-modulated radiotherapy post-prostatectomy: the present standard of care?

    Directory of Open Access Journals (Sweden)

    Murray JR

    2015-11-01

    Full Text Available Julia R Murray,1,2 Helen A McNair,2 David P Dearnaley1,2 1Academic Urology Unit, Institute of Cancer Research, London, 2Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK Abstract: The indications for post-prostatectomy radiotherapy have evolved over the last decade, although the optimal timing, dose, and target volume remain to be well defined. The target volume is susceptible to anatomical variations with its borders interfacing with the rectum and bladder. Image-guided intensity-modulated radiotherapy has become the gold standard for radical prostate radiotherapy. Here we review the current evidence for image-guided techniques with intensity-modulated radiotherapy to the prostate bed and describe current strategies to reduce or account for interfraction and intrafraction motion. Keywords: radiotherapy, prostate cancer, post-prostatectomy, image-guided radiation therapy

  6. Cardiac Exposure in the Dynamic Conformal Arc Therapy, Intensity-Modulated Radiotherapy and Volumetric Modulated Arc Therapy of Lung Cancer.

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    Xin Ming

    Full Text Available To retrospectively evaluate the cardiac exposure in three cohorts of lung cancer patients treated with dynamic conformal arc therapy (DCAT, intensity-modulated radiotherapy (IMRT, or volumetric modulated arc therapy (VMAT at our institution in the past seven years.A total of 140 lung cancer patients were included in this institutional review board approved study: 25 treated with DCAT, 70 with IMRT and 45 with VMAT. All plans were generated in a same commercial treatment planning system and have been clinically accepted and delivered. The dose distribution to the heart and the effects of tumor laterality, the irradiated heart volume and the beam-to-heart distance on the cardiac exposure were investigated.The mean dose to the heart among all 140 plans was 4.5 Gy. Specifically, the heart received on average 2.3, 5.2 and 4.6 Gy in the DCAT, IMRT and VMAT plans, respectively. The mean heart doses for the left and right lung tumors were 4.1 and 4.8 Gy, respectively. No patients died with evidence of cardiac disease. Three patients (2% with preexisting cardiac condition developed cardiac disease after treatment. Furthermore, the cardiac exposure was found to increase linearly with the irradiated heart volume while decreasing exponentially with the beam-to-heart distance.Compared to old technologies for lung cancer treatment, modern radiotherapy treatment modalities demonstrated better heart sparing. But the heart dose in lung cancer radiotherapy is still higher than that in the radiotherapy of breast cancer and Hodgkin's disease where cardiac complications have been extensively studied. With strong correlations of mean heart dose with beam-to-heart distance and irradiated heart volume, cautions should be exercised to avoid long-term cardiac toxicity in the lung cancer patients undergoing radiotherapy.

  7. Development of a quality control system in intensity modulated radiotherapy (IMRT)

    International Nuclear Information System (INIS)

    Souza, Roberto Salomon de; Braz, Delson

    2013-01-01

    The more complex the technique of radiotherapy is, the more refined the quality control must be. The technique of Intensity Modulated Radiotherapy (IMRT) is one of the technological innovations that gained space in the whole worlds in the last decade whose parameters of quality control are not fully established yet. The present work developed a phantom for quality control in IMRT to be implemented in the routine of the Radiotherapy Quality Control Program (PQRT) of the Brazilian National Cancer Institute (INCa). The device consists of a block formed by several polystyrene slice with TDLs and radiochromic film inserted. It should be sent (or taken) to the Program participating institutions to be irradiated under certain conditions and then be returned to the PQRT., where the discrepancy degree between the planned treatment and those effectively delivered will be evaluated. The system was validated through the test cases and the pilot program preformed in nine radiotherapy centers that perform IMRT in the southeast region of Brazil. (author)

  8. [Intensity modulated radiation therapy for patients with gynecological malignancies after hysterectomy and chemotherapy/radiotherapy].

    Science.gov (United States)

    Chen, Zhen-yun; Ma, Yue-bing; Sheng, Xiu-gui; Zhang, Xiao-ling; Xue, Li; Song, Qu-qing; Liu, Nai-fu; Miao, Hua-qin

    2007-04-01

    To investigate the value of intensity modulated radiation therapy (IMRT) for patient with gynecological malignancies after treatment of hysterectomy and chemotherapy/radiotherapy. All 32 patients with cervical or endometrial cancer after hysterectomy received full course IMRT after 1 to 3 cycles of chemotherapy (Karnofsky performance status(KPS) > or =70). Seventeen of these patients underwent postoperative preventive irradiation and the other 15 patients were pelvic wall recurrence and/or retroperitoneal lymph node metastasis, though postoperative radiotherapy and/or chemotherapy had been given after operation. The median dose delivered to the PTV was 56.8 Gy for preventive irradiation, and 60.6 Gy for pelvic wall recurrence or retroperioneal lymph node metastasis irradiation. It was required that 90% of iso-dose curve could covere more than 99% of GTV. However, The mean dose irradiated to small intestine, bladder, rectum, kidney and spinal cord was 21.3 Gy, 37.8 Gy, 35.3 Gy, 8.5 Gy, 22.1 Gy, respectively. Fourteen patients presented grade I (11 patients) or II (3 patients) digestive tract side-effects, Five patients developed grade I or II bone marrow depression. Twelve patients had grade I skin reaction. The overall 1-year survival rate was 100%. The 2- and 3- year survival rate for preventive irradiation were both 100%, but which was 5/7 and 3/6 for the patients with pelvic wall recurrence or retroperioneal lymph node metastasis. Intensity modulated radiation therapy can provide a better dose distribution than traditional radiotherapy for both prevention and pelvic wall recurrence or retroperioneal lymph node metastasis. The toxicity is tolerable. The adjacent organs at risk can well be protected.

  9. Patterns of local-regional failure after primary intensity modulated radiotherapy for nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Kong, Fangfang; Ying, Hongmei; Du, Chengrun; Huang, Shuang; Zhou, Junjun; Chen, Junchao; Sun, Lining; Chen, Xiaohui; Hu, Chaosu

    2014-01-01

    To analyze patterns of local-regional failure after primary intensity modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC). A total of 370 non-metastatic NPC patients consecutively treated with IMRT (with or without chemotherapy) were analyzed. Radiotherapy was administered using a simultaneous integrated boost (SIB) technique at the total prescribed dose of 66-70.4Gy (2.0-2.2Gy per fraction). The location and extent of local-regional failures were transferred to the pretreatment planning computed tomography (CT) for dosimetric analysis. The dose of radiation received by V recur (volume of recurrence) was calculated and analyzed with dose-volume histogram (DVH). Failures were classified as: 'in field' if 95% of V recur was within the 95% isodose, 'marginal' if 20% to 95% of V recur was within the 95% isodose, or 'outside' if less than 20% of V recur was inside the 95% isodose. With a median follow up of 26 months, 25 local-regional failures were found in 18 patients. The 1- and 2-year actuarial local-regional control rates for all patients were 99.7% and 95.5% respectively. Among the 22 local–regional failures with available diagnostic images, 16 (64%) occurred within the 95% isodose lines and were considered in-field failures; 3 (12%) were marginal and 3 (12%) were outside-field failures. Intensity-modulated radiotherapy provides excellent local-regional control for NPC. In-field failures are the main patterns for local-regional recurrence. Reducing the coverage of critical adjacent tissues in CTV purposefully for potential subclinical diseases was worth of study. Great attention in all IMRT steps is necessary to reduce potential causes of marginal failures. More studies about radioresistance are needed to reduce in-field failures

  10. 'Tongue-and-groove' effect in intensity modulated radiotherapy with static multileaf collimator fields

    International Nuclear Information System (INIS)

    Que, W; Kung, J; Dai, J

    2004-01-01

    The 'tongue-and-groove problem' in step-and-shoot delivery of intensity modulated radiotherapy is investigated. A 'tongue-and-groove' index (TGI) is introduced to quantify the 'tongue-and-groove' effect in step-and-shoot delivery. Four different types of leaf sequencing methods are compared. The sliding window method and the reducing level method use the same number of field segments to deliver the same intensity map, but the TGI is much less for the reducing level method. The leaf synchronization method of Van Santvoort and Heijmen fails in step-and-shoot delivery, but a new method inspired by the method of Van Santvoort and Heijmen is shown to eliminate 'tongue-and-groove' underdosage completely

  11. Ballistic optimisation with intensity modulation with integration of a concomitant boost for the radiotherapy of glioblastomas

    International Nuclear Information System (INIS)

    Supper, C.; Franceries, X.; Supper, C.; Vieillevigne, L.; Ken, S.; Simon, L.; Rives, M.; Moyal, E.; Delannes, M.; Noel, A.; Laprie, A.; Franceries, X.; Ken, S.; Laprie, A.; Noel, A.

    2010-01-01

    The authors report a study aimed at the optimisation of the ballistics of intensity-modulated conformation radiotherapy (IMRT) treatment with a boost for the preparation of a multi-centric prospective trial financed by a program on glioblastoma treatment. This treatment consists in using the boost technique to obtain an increase of the dose delivered by the IMRT in sites presenting a strong predictive value for relapse. These sites are defined by means of magnetic resonance spectrometric imagery. Conformation indexes, planning target volumes, doses delivered to organs at risk are analysed. The proximity of organs at risk was the main difficulty, but a good dosimetry has been obtained with the use of five coplanar beams. Short communication

  12. Study on the possibility of using a 60 Co therapeutical unity in Intensity Modulated Radiotherapy (IMRT)

    International Nuclear Information System (INIS)

    Dantas, Samuel Cesar

    2009-06-01

    With the increasing advances in complex treatment techniques, there is a tendency to obtain more sophisticated equipment to deliver the dose. The use of 3D conformal radiotherapy is now routine in many radiotherapy facilities as well as the utilization of intensity modulated radiotherapy (IMRT). Both are usually implemented using linear accelerators equipped with multi leaves collimators, which create the conformity and the fluence distributions required. However, the complexity of increasingly sophisticated equipment, such as linear accelerators, requires a frequent quality control of their operation, as well as a detailed and constant maintenance. Even carrying out these procedures, the accelerators may present technical problems interrupting for a long time a treatment using the IMRT technique. Despite the clear practical and technological advantages that linear accelerators have on 60 Co irradiators, these devices occupy an important place in radiotherapy, mainly due to the low cost of equipment installation and maintenance when compared to those required by accelerators. Many radiotherapy facilities that work with IMRT have tele therapeutic isocentric 60 Co units. In principle, such equipment would be able to be used for treatment with IMRT using compensating blocks to modulate the beam. This study investigates this possibility and shows that it is feasible. The comparison of treatment plans of a head-and-neck cancer and other of a cancer of the central nervous system, based on a 60 Co irradiator and a Linac 2300 C/D, presented advantages for the 60 Co irradiator. Furthermore; the delivery of dose obtained with the two systems showed themselves equivalent when compared to their respective plans. (author)

  13. Intensity modulated radiotherapy for sinonasal malignancies with a focus on optic pathway preservation

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    Chi Alexander

    2013-01-01

    Full Text Available Abstract Purpose To assess if intensity-modulated radiotherapy (IMRT can possibly lead to improved local control and lower incidence of vision impairment/blindness in comparison to non-IMRT techniques when treating sinonasal malignancies; what is the most optimal dose constraints for the optic pathway; and the impact of different IMRT strategies on optic pathway sparing in this setting. Methods and materials A literature search in the PubMed databases was conducted in July, 2012. Results Clinical studies on IMRT and 2D/3D (2 dimensional/3 dimensional RT for sinonasal malignancies suggest improved local control and lower incidence of severe vision impairment with IMRT in comparison to non-IMRT techniques. As observed in the non-IMRT studies, blindness due to disease progression may occur despite a lack of severe toxicity possibly due to the difficulty of controlling locally very advanced disease with a dose ≤ 70 Gy. Concurrent chemotherapy’s influence on the the risk of severe optic toxicity after radiotherapy is unclear. A maximum dose of ≤ 54 Gy with conventional fractionation to the optic pathway may decrease the risk of blindness. Increased magnitude of intensity modulation through increasing the number of segments, beams, and using a combination of coplanar and non-coplanar arrangements may help increase dose conformality and optic pathway sparing when IMRT is used. Conclusion IMRT optimized with appropriate strategies may be the treatment of choice for the most optimal local control and optic pathway sparing when treating sinonasal malignancy.

  14. Dynamic intensity-modulated non-coplanar arc radiotherapy (INCA) for head and neck cancer

    International Nuclear Information System (INIS)

    Krayenbuehl, Jerome; Davis, J. Bernard; Ciernik, I. Frank

    2006-01-01

    Background and purpose: To define the potential advantages of intensity-modulated radiotherapy (IMRT) applied using a non-coplanar dynamic arc technique for the treatment of head and neck cancer. Materials and methods: External beam radiotherapy (EBRT) was planned in ten patients with head and neck cancer using coplanar IMRT and non-coplanar arc techniques, termed intensity modulated non-coplanar arc EBRT (INCA). Planning target volumes (PTV1) of first order covered the gross tumor volume and surrounding clinical target volume treated with 68-70 Gy, whereas PTV2 covered the elective lymph nodes with 54-55 Gy using a simultaneous internal boost. Treatment plan comparison between IMRT and INCA was carried out using dose-volume histogram and 'equivalent uniform dose' (EUD). Results: INCA resulted in better dose coverage and homogeneity of the PTV1, PTV2, and reduced dose delivered to most of the organs at risk (OAR). For the parotid glands, a reduction of the mean dose of 2.9 (±2.0) Gy was observed (p 0.002), the mean dose to the larynx was reduced by 6.9 (±2.9) Gy (p 0.003), the oral mucosa by 2.4 (±1.1) Gy (p < 0.001), and the maximal dose to the spinal cord by 3.2 (±1.7) Gy (p = 0.004). The mean dose to the brain was increased by 3.0 (±1.4) Gy (p = 0.002) and the mean lung dose increased by 0.2 (±0.4) Gy (p = 0.87). The EUD suggested better avoidance of the OAR, except for the lung, and better coverage and dose uniformity were achieved with INCA compared to IMRT. Conclusion: Dose delivery accuracy with IMRT using a non-coplanar dynamic arc beam geometry potentially improves treatment of head and neck cancer

  15. The clinical implementation of respiratory-gated intensity-modulated radiotherapy

    International Nuclear Information System (INIS)

    Keall, Paul; Vedam, Sastry; George, Rohini; Bartee, Chris; Siebers, Jeffrey; Lerma, Fritz; Weiss, Elisabeth; Chung, Theodore

    2006-01-01

    The clinical use of respiratory-gated radiotherapy and the application of intensity-modulated radiotherapy (IMRT) are 2 relatively new innovations to the treatment of lung cancer. Respiratory gating can reduce the deleterious effects of intrafraction motion, and IMRT can concurrently increase tumor dose homogeneity and reduce dose to critical structures including the lungs, spinal cord, esophagus, and heart. The aim of this work is to describe the clinical implementation of respiratory-gated IMRT for the treatment of non-small cell lung cancer. Documented clinical procedures were developed to include a tumor motion study, gated CT imaging, IMRT treatment planning, and gated IMRT delivery. Treatment planning procedures for respiratory-gated IMRT including beam arrangements and dose-volume constraints were developed. Quality assurance procedures were designed to quantify both the dosimetric and positional accuracy of respiratory-gated IMRT, including film dosimetry dose measurements and Monte Carlo dose calculations for verification and validation of individual patient treatments. Respiratory-gated IMRT is accepted by both treatment staff and patients. The dosimetric and positional quality assurance test results indicate that respiratory-gated IMRT can be delivered accurately. If carefully implemented, respiratory-gated IMRT is a practical alternative to conventional thoracic radiotherapy. For mobile tumors, respiratory-gated radiotherapy is used as the standard of care at our institution. Due to the increased workload, the choice of IMRT is taken on a case-by-case basis, with approximately half of the non-small cell lung cancer patients receiving respiratory-gated IMRT. We are currently evaluating whether superior tumor coverage and limited normal tissue dosing will lead to improvements in local control and survival in non-small cell lung cancer

  16. Dose to the intracranial arteries in stereotactic and intensity-modulated radiotherapy for skull base tumors

    International Nuclear Information System (INIS)

    Nieder, Carsten; Grosu, Anca L.; Stark, Sybille; Wiedenmann, Nicole; Busch, Raymonde; Kneschaurek, Peter; Molls, Michael

    2006-01-01

    Purpose: To examine retrospectively the maximum dose to the large skull base/intracranial arteries in fractionated stereotactic radiotherapy (FSRT) and intensity-modulated radiotherapy (IMRT), because of the potential risk of perfusion disturbances. Methods and Materials: Overall, 56 patients with tumors adjacent to at least one major artery were analyzed. Our strategy was to perform FSRT with these criteria: 1.8 Gy per fraction, planning target volume (PTV) enclosed by the 95% isodose, maximum dose 107%. Dose limits were applied to established organs at risk, but not the vessels. If FSRT planning failed to meet any of these criteria, IMRT was planned with the same objectives. Results: In 31 patients (median PTV, 23 cm 3 ), the FSRT plan fulfilled all criteria. No artery received a dose ≥105%. Twenty-five patients (median PTV, 39 cm 3 ) needed IMRT planning. In 11 of 25 patients (median PTV, 85 cm 3 ), no plan satisfying all our criteria could be calculated. Only in this group, moderately increased maximum vessel doses were observed (106-110%, n = 7, median PTV, 121 cm 3 ). The median PTV dose gradient was 29% (significantly different from the 14 patients with satisfactory IMRT plans). Three of the four patients in this group had paranasal sinus tumors. Conclusion: The doses to the major arteries should be calculated in IMRT planning for critical tumor locations if a dose gradient >13% within the PTV can not be avoided because the PTV is large or includes air cavities

  17. Dosimetric evaluation of an ipsilateral intensity modulated radiotherapy beam arrangement for parotid malignancies

    International Nuclear Information System (INIS)

    Yirmibesoglu, Eda; Fried, David V.; Kostich, Mark; Rosenman, Julian; Shockley, William; Weissler, Mark; Zanation, Adam; Chera, Bhishamjit

    2013-01-01

    We conducted a dosimetric comparison of an ipsilateral beam arrangement for intensity modulated radiotherapy (IMRT) with off-axis beams. Six patients who received post-operative radiotherapy (RT) for parotid malignancies were used in this dosimetric study. Four treatment plans were created for each CT data set (24 plans): 1) ipsilateral 4-field off-axis IMRT (4fld-OA), 2) conventional wedge pair (WP), 3) 7 field co-planar IMRT (7fld), and 4) ipsilateral co-planar 4-field quartet IMRT (4fld-CP). Dose, volume statistics for the planning target volumes (PTVs) and planning risk volumes (PRVs) were compared for the four treatment techniques. Wedge pair plans inadequately covered the deep aspect of the PTV. The 7-field IMRT plans delivered the largest low dose volumes to normal tissues. Mean dose to the contralateral parotid was highest for 7 field IMRT. Mean dose to the contralateral submandibular gland was highest for 7 field IMRT and WP. 7 field IMRT plans had the highest dose to the oral cavity. The mean doses to the brainstem, spinal cord, ipsilateral temporal lobe, cerrebellum and ipsilateral cochlea were similar among the four techniques. For postoperative treatment of the parotid bed, 4-field ipsilateral IMRT techniques provided excellent coverage while maximally sparing the contralateral parotid gland and submandibular gland

  18. A Monte Carlo dosimetric quality assurance system for dynamic intensity-modulated radiotherapy

    International Nuclear Information System (INIS)

    Takegawa, Hideki; Yamamoto, Tokihiro; Miyabe, Yuki; Teshima, Teruki; Kunugi, Tomoaki; Yano, Shinsuke; Mizowaki, Takashi; Nagata, Yasushi; Hiraoka, Masahiro

    2005-01-01

    We are developing a Monte Carlo (MC) dose calculation system, which can resolve dosimetric issues derived from multileaf collimator (MLC) design for routine dosimetric quality assurance (QA) of intensity-modulated radiotherapy (IMRT). The treatment head of the medical linear accelerator equipped with MLC was modeled using the EGS4 MC code. A graphical user interface (GUI) application was developed to implement MC dose computation in the CT-based patient model and compare the MC calculated results with those of a commercial radiotherapy treatment planning (RTP) system, Varian Eclipse. To reduce computation time, the EGS4 MC code has been parallelized on massive parallel processing (MPP) system using the message passing interface (MPI). The MC treatment head model and MLC model were validated by the measurement data sets of percentage depth dose (PDD) and off-center ratio (OCR) in the water phantom and the film measurements for the static and dynamic test patterns, respectively. In the treatment head model, the MC calculated results agreed with those of measurements for both of PDD and OCR. The MC could reproduce all of the MLC dosimetric effects. A quantitative comparison between the results of MC and Eclipse was successfully performed with the GUI application. Parallel speed-up became almost linear. An MC dosimetric QA system for dynamic IMRT has been developed, however there were large dose discrepancies between the MC and the measurement in the MLC model simulation, which are now being investigated. (author)

  19. Use of 3D-printers to create intensity-modulated radiotherapy compensator blocks.

    Science.gov (United States)

    Avelino, Samuel R; Silva, Luis Felipe O; Miosso, Cristiano J

    2012-01-01

    Intensity-Modulated Radiotherapy (IMRT) is an important tool for cancer treatment. It concentrates high radiation doses in complex target volumes, while sparing the surrounding tissues. IMRT is traditionally performed using Multileaf Collimators (MLC) or Compensator Blocks. The conventional way used to manufacture IMRT compensator blocks, which uses milling machines, is an important drawback over the MLC method, due to high operational and production costs. In this research, we developed a simpler alternative method to manufacture an IMRT compensator block from a fluency map generated by a commercial treatment planning system (TPS). This map was converted into a mold, and then printed using a 3D printer. The final IMRT compensator block was achieved by filling the mold with cerrobend alloy. To validate this method a quality assurance was performed using dosimetric films to compare the measured dose distributions to those predicted by the TPS system. This comparison showed a good agreement among 8 dose profiles from each situation, with a maximum RMS error of 8.84 % for the tested profiles. This suggests that the 3D printers can be effectively used to manufacture IMRT compensator blocks. The main advantage to this approach is that it can be fully conducted inside a radiotherapy facility, which results in lower costs and production times.

  20. Spinal cordd biological safety comparison of intensity modulated radiotherapy and conventional radiation therapy

    International Nuclear Information System (INIS)

    Xilinbaoleri; Xu Wanlong; Chen Gang; Liu Hao; Wang Ruozheng; Bai Jingping

    2010-01-01

    Objective: To compare the spine intensity modulated radiation therapy (IMRT) and the conventional radiation therapy on the beagle spinal cord neurons, in order to prove the biological safety of IMRT of the spinal cord. Methods: Twelve selected purebred beagles were randomly divided into 2 groups. A beagle clinical model of tumor was mimiced in the ninth and tenth thoracic vertebrae. Then the beagles were irradiated by 2 different models of intensity modulated radiotherapy and conventional radiation therapy, with the total irradiation doses of 50 and 70 Gy. The samples of spinal cord were taken out from the same position of the nine and tenth thoracic vertebrae at the third month after radiation.All the samples were observed by the electron microscope, and the Fas and HSP70 expression in spinal cord neurons were evaluated by immunohistochemistry method. Terminal deoxynucleatidyl transferase mediated dUTP nick and labeling (TUNEL) technique was used to examine the apoptotic cells in the spinal cord. Results: The neurons in the spinal cord of IMRT group were mainly reversible injury, and those in the conventional radiation therapy were mainly apoptosis. Compared with the conventional radiation therapy group [50 Gy group, (7.3 ± 1.1)%; 70 Gy group, (11.3 ± 1.4)%], the apoptosis rate of the spinal cord neurons of the intensity modulated radiotherapy group [50 Gy group, (1.2 ± 0.7)%; 70 Gy group (2.5 ± 0.8)%] was much lower[(50 Gy group, t=0.022, P<0.05; 70 Gy group, t=0.017, P<0.05)]. The expression levels of Fas in the IMPT group (50 Gy group, 4.6 ± 0.8; 70 Gy group, 7.4 ± 1.1) were also much lowerthan those in the other group (50 Gy group, 15.1 ± 6.4; 70 Gy group, 19.3 ± 7.6. 50 Gy group, t=0.231, P<0.05; 70 Gy group, t=0.457, P<0.05), while the expression levels of HSP70 in the IMPT group (50 Gy group, 9.1 ± 0.8; 70 Gy group, 7.3 ± 1.4)were much higher than those in the conventional radiation therapy group (50 Gy group, 2.1 ± 0.9; 70 Gy group, 1.7 ± 0

  1. RISK FACTORS FOR HEARING LOSS IN PATIENTS TREATED WITH INTENSITY-MODULATED RADIOTHERAPY FOR HEAD-AND-NECK TUMORS

    NARCIS (Netherlands)

    Zuur, Charlotte L.; Simis, Yvonne J.; Lamers, Emmy A.; Hart, Augustinus A.; Dreschler, Wouter A.; Balm, Alfons J.; Rasch, Coen R.

    2009-01-01

    Purpose: Radiotherapy (RT) is a common treatment of head-and-neck carcinoma. The objective of this study was to perform a prospective multivariate assessment of the dose-effect relationship between intensity-modulated RT and hearing loss. Methods and Materials: Pure tone audiometry at 0.250-16 kHz

  2. Long-term decision regret after post-prostatectomy image-guided intensity-modulated radiotherapy.

    Science.gov (United States)

    Shakespeare, Thomas P; Chin, Stephen; Manuel, Lucy; Wen, Shelly; Hoffman, Matthew; Wilcox, Shea W; Aherne, Noel J

    2017-02-01

    Decision regret (DR) may occur when a patient believes their outcome would have been better if they had decided differently about their management. Although some studies investigate DR after treatment for localised prostate cancer, none report DR in patients undergoing surgery and post-prostatectomy radiotherapy. We evaluated DR in this group of patients overall, and for specific components of therapy. We surveyed 83 patients, with minimum 5 years follow-up, treated with radical prostatectomy (RP) and post-prostatectomy image-guided intensity-modulated radiotherapy (IG-IMRT) to 64-66 Gy following www.EviQ.org.au protocols. A validated questionnaire identified DR if men either indicated that they would have been better off had they chosen another treatment, or they wished they could change their mind about treatment. There was an 85.5% response rate, with median follow-up post-IMRT 78 months. Adjuvant IG-IMRT was used in 28% of patients, salvage in 72% and ADT in 48%. A total of 70% of patients remained disease-free. Overall, 16.9% of patients expressed DR for treatment, with fourfold more regret for the RP component of treatment compared to radiotherapy (16.9% vs 4.2%, P = 0.01). DR for androgen deprivation was 14.3%. Patients were regretful of surgery due to toxicity, not being adequately informed about radiotherapy as an alternative, positive margins and surgery costs (83%, 33%, 25% and 8% of regretful patients respectively). Toxicity caused DR in the three radiotherapy-regretful and four ADT-regretful patients. Patients were twice as regretful overall, and of surgery, for salvage vs adjuvant approaches (both 19.6% vs 10.0%). Decision regret after RP and post-prostatectomy IG-IMRT is uncommon, although patients regret RP more than post-operative IG-IMRT. This should reassure urologists referring patients for post-prostatectomy IG-IMRT, particularly in the immediate adjuvant setting. Other implications include appropriate patient selection for RP (and

  3. Dosimetry comparison of irradiation with conformal radiotherapy, intensity modulated radiotherapy, conformal radiotherapy in stereotactic conditions and robotic stereotactic radiotherapy for benign brain tumours

    International Nuclear Information System (INIS)

    Spasic, E.; Noel, A.; Buchheit, I.; Bernier, V.

    2011-01-01

    Purpose. - To compare several techniques in order to determine the best treatment for benign brain tumours. Methods and patients. - A retrospective study was performed for five patients who received 3D-conformal radiotherapy, intensity modulated radiotherapy or CyberKnife R . These patients had a meningioma, a pituitary tumour, a cranio-pharyngioma or a neurinoma. In each case, these treatment plans were optimised and compared with the three other dosimetries. Radiobiological or positioning parameters were evaluated, as well as dosimetric parameters, in order to compare treatments with different characteristics. Results. - The dosimetric parameters showed that the choice of treatment seemed to be determined mostly by tumour size, shape and proximity with organs at risk (not tumour localisation). Whereas the results showed no significant deviations with regards to the radiobiological parameters. Therefore, with these parameters, it was difficult to give priority to a treatment. Conclusions. - With regards to benign brain tumours of medium or large size, intensity modulated radiotherapy seemed the recommended treatment. It enabled to obtain a good ratio between efficacy and toxicity for tumours that are really close to organs at risk. Concerning small benign brain tumours, the CyberKnife R was probably the best treatment. (authors)

  4. Reduced Acute Bowel Toxicity in Patients Treated With Intensity-Modulated Radiotherapy for Rectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Samuelian, Jason M. [Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ (United States); Callister, Matthew D., E-mail: Callister.matthew@mayo.edu [Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ (United States); Ashman, Jonathan B. [Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ (United States); Young-Fadok, Tonia M. [Division of Colorectal Surgery, Mayo Clinic, Scottsdale, AZ (United States); Borad, Mitesh J. [Division of Hematology-Oncology, Mayo Clinic, Scottsdale, AZ (United States); Gunderson, Leonard L. [Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ (United States)

    2012-04-01

    Purpose: We have previously shown that intensity-modulated radiotherapy (IMRT) can reduce dose to small bowel, bladder, and bone marrow compared with three-field conventional radiotherapy (CRT) technique in the treatment of rectal cancer. The purpose of this study was to review our experience using IMRT to treat rectal cancer and report patient clinical outcomes. Methods and Materials: A retrospective review was conducted of patients with rectal cancer who were treated at Mayo Clinic Arizona with pelvic radiotherapy (RT). Data regarding patient and tumor characteristics, treatment, acute toxicity according to the Common Terminology Criteria for Adverse Events v 3.0, tumor response, and perioperative morbidity were collected. Results: From 2004 to August 2009, 92 consecutive patients were treated. Sixty-one (66%) patients were treated with CRT, and 31 (34%) patients were treated with IMRT. All but 2 patients received concurrent chemotherapy. There was no significant difference in median dose (50.4 Gy, CRT; 50 Gy, IMRT), preoperative vs. postoperative treatment, type of concurrent chemotherapy, or history of previous pelvic RT between the CRT and IMRT patient groups. Patients who received IMRT had significantly less gastrointestinal (GI) toxicity. Sixty-two percent of patients undergoing CRT experienced {>=}Grade 2 acute GI side effects, compared with 32% among IMRT patients (p = 0.006). The reduction in overall GI toxicity was attributable to fewer symptoms from the lower GI tract. Among CRT patients, {>=}Grade 2 diarrhea and enteritis was experienced among 48% and 30% of patients, respectively, compared with 23% (p = 0.02) and 10% (p = 0.015) among IMRT patients. There was no significant difference in hematologic or genitourinary acute toxicity between groups. In addition, pathologic complete response rates and postoperative morbidity between treatment groups did not differ significantly. Conclusions: In the management of rectal cancer, IMRT is associated with a

  5. Incidence of and Risk Factors for Mastoiditis after Intensity Modulated Radiotherapy in Nasopharyngeal Carcinoma.

    Directory of Open Access Journals (Sweden)

    Ji-Jin Yao

    Full Text Available To report the incidence of and risk factors for mastoiditis after intensity-modulated radiotherapy (IMRT in nasopharyngeal carcinoma (NPC.Retrospective analysis of pretreatment and follow-up magnetic resonance imaging (MRI data for 451 patients with NPC treated with IMRT at a single institution. The diagnosis of mastoiditis was based on MRI; otomastoid opacification was rated as Grade 0 (none, 1 (mild, 2 (moderate or 3 (severe by radiologists blinded to clinical outcome. This study mainly focused on severe mastoiditis; patients were divided into three groups: the G0M (Grade 0 mastoiditis before treatment group, G1-2M (Grade 1 to 2 mastoiditis before treatment group and G3M (Grade 3 mastoiditis before treatment group. The software SAS9.3 program was used to analyze the data.For the entire cohort, the incidence of Grade 3 mastoiditis was 20% before treatment and 31%, 19% and 17% at 3, 12 and 24 months after radiotherapy, respectively. In the G0M group, the incidence of severe mastoiditis was 0% before treatment and 23%, 15% and 13% at 3, 12 and 24 months after radiotherapy, respectively. Multivariate analysis revealed T category (OR=0.68, 95% CI = 0.469 to 0.984, time (OR=0.668, 95% CI = 0.59 to 0.757 and chemotherapy (OR=0.598, 95% CI = 0.343 to 0.934 were independent factors associated with severe mastoiditis in the G0M group after treatment.Mastoiditis, as diagnosed by MRI, occurs as a progressive process that regresses and resolves over time in patients with NPC treated using IMRT.

  6. Postoperative Irradiation of Gynecologic Malignancies: Improving Treatment Delivery Using Aperture-Based Intensity-Modulated Radiotherapy

    International Nuclear Information System (INIS)

    Nadeau, Sylvain; Bouchard, Myriam; Germain, Isabelle; Raymond, Paul-Emile; Beaulieu, Frederic; Beaulieu, Luc; Roy, Rene; Gingras, Luc

    2007-01-01

    Purpose: To evaluate dosimetric and treatment delivery advantages of aperture-based intensity-modulated radiotherapy (AB-IMRT) for the treatment of patients receiving whole pelvic radiotherapy for gynecologic malignancies. Methods and Materials: Nineteen patients undergoing pelvic radiotherapy after resection of endometrial cancers were selected. A 45-Gy dose was prescribed to the target volume delineated on a planning CT scan. An in-house inverse planning system, Ballista, was used to develop a treatment plan using aperture-based multileaf collimator segments. This approach was compared with conventional four-field, enlarged four-field, and static beamlet-based IMRT (BB-IMRT) techniques in terms of target coverage, dose-volume histogram statistics for surrounding normal tissues, and numbers of segments and monitor units (MU). Results: Three quarters (76.4%) of the planning target volume received the prescription dose with conventional four-field plans. With adequate target coverage, the Ballista plans significantly reduced the volume of bowel and bladder irradiated at the prescribed dose (p < 0.001), whereas the two approaches provided equivalent results for the rectum (p 0.5). On the other hand, AB-IMRT and BB-IMRT plans showed only small differences in dose-volume histogram statistics of unknown clinical impact, whereas Ballista plan delivery required on average 73% and 59% fewer segments and MU, respectively. Conclusion: With respect to conventional techniques, AB-IMRT for the treatment of gynecologic malignancies provides dosimetric advantages similar to those with BB-IMRT but with clear treatment delivery improvements

  7. Evaluation of electronic imaging device portal 'Portal Dosimetry' in quality control in intensity modulated radiotherapy

    International Nuclear Information System (INIS)

    Watanabe, Erika Yumi

    2010-01-01

    In this paper we present commissioning testing and evaluation of the use of Varian's portal dosimetry in the quality assurance of intensity-modulated radiotherapy. The commissioning tests were performed to characterize the portal dosimetry in terms dosimetric and to assess the its possible application in radiotherapy. These tests demonstrated that portal dosimetry has all the characteristics to be used for dosimetry in radiotherapy such as linear response with dose, the independence of dose rate, reproducibility, and others. The evaluation of the use of portal dosimetry in quality control of IMRT was performed in two steps: assessing the ability of the device to detect errors deliberately introduced in simple and complex fluences. Errors of known magnitude were introduced in certain areas of fluences and was carried out quality control of these fluences with portal dosimetry and three dosimetric systems: ionization chamber, film and array of ionization chambers. The data obtained from the portal were compared with those of other devices and all were able to identify errors introduced satisfactorily, the values, normalized to the original fluence, obtained with the portal dosimetry were similar to the ionization chamber and the array of ion chambers (seven29) and differing in up to 2% of the values obtained with the films. The fluences measured with the portal dosimetry were evaluated both quantitatively and qualitatively. The index of the gamma function provided by software analysis of portal dosimetry showed no defined rules of behavior in relation to the errors introduced and for this reason the qualitative analysis has proved indispensable in cases evaluated. (author)

  8. A Dosimetric Evaluation of Conventional Helmet Field Irradiation Versus Two-Field Intensity-Modulated Radiotherapy Technique

    International Nuclear Information System (INIS)

    Yu, James B.; Shiao, Stephen L.; Knisely, Jonathan

    2007-01-01

    Purpose: To compare dosimetric differences between conventional two-beam helmet field irradiation (external beam radiotherapy, EBRT) of the brain and a two-field intensity-modulated radiotherapy (IMRT) technique. Methods and Materials: Ten patients who received helmet field irradiation at our institution were selected for study. External beam radiotherapy portals were planned per usual practice. Intensity-modulated radiotherapy fields were created using the identical field angles as the EBRT portals. Each brain was fully contoured along with the spinal cord to the bottom of the C2 vertebral body. This volume was then expanded symmetrically by 0.5 cm to construct the planning target volume. An IMRT plan was constructed using uniform optimization constraints. For both techniques, the nominal prescribed dose was 3,000 cGy in 10 fractions of 300 cGy using 6-MV photons. Comparative dose-volume histograms were generated for each patient and analyzed. Results: Intensity-modulated radiotherapy improved dose uniformity over EBRT for whole brain radiotherapy. The mean percentage of brain receiving >105% of dose was reduced from 29.3% with EBRT to 0.03% with IMRT. The mean maximum dose was reduced from 3,378 cGy (113%) for EBRT to 3,162 cGy (105%) with IMRT. The mean percent volume receiving at least 98% of the prescribed dose was 99.5% for the conventional technique and 100% for IMRT. Conclusions: Intensity-modulated radiotherapy reduces dose inhomogeneity, particularly for the midline frontal lobe structures where hot spots occur with conventional two-field EBRT. More study needs to be done addressing the clinical implications of optimizing dose uniformity and its effect on long-term cognitive function in selected long-lived patients

  9. Dose deviations caused by positional inaccuracy of multileaf collimator in intensity modulated radiotherapy

    International Nuclear Information System (INIS)

    Wang, H.C.; Chui, C.S.; Tsai, H.Y.; Chen, C.H.; Tsai, L.F.

    2008-01-01

    Introduction: Multileaf collimator (MLC) is currently a widely used system in the delivery of intensity modulated radiotherapy (IMRT). The accuracy of the multileaf position plays an important role in the final outcome of the radiation treatment. According to ICRU recommendation, a dose inaccuracy over than 5% of prescribed dose affects treatment results. In order to quantify the influence of leaf positional errors on dose distribution, we set different MLC positional inaccuracy from 0 to 6 mm for step-and-shoot IMRT in clinical cases. Two-dimensional dose distributions of radiotherapy plans with different leaf displacements generated with a commercial treatment planning system. And verification films were used to measure two-dimensional dose distributions. Then a computerized dose comparison system will be introduced to analyze the dose deviations. Materials/methods: We assumed MLC positional inaccuracy from 0 to 6 mm for step-and-shoot IMRT in clinical cases by simulating the different leaf displacements with a commercial treatment planning system. Then we transferred the treatment plans with different leaf offset that may be happened in clinical situation to linear accelerator. Verification films (Kodat EDR2) were well positioned within solid water phantoms to be irradiated by the simulated plans. The films were scanned to display two-dimensional dose distributions. Finally, we compared with the dose distributions with MLC positional inaccuracy by a two-dimensional dose comparison software to analyze the deviations in Gamma indexes and normalized agreement test (NAT) values. Results: In general, the data show that larger leaf positional error induces larger dose error. More fields used for treatment generate lesser errors. Besides, leaf position relative to a field influences the degree of dose error. A leaf lying close to the border of a field leads to a more significant dose deviation than a leaf in the center. Algorithms for intensity modulation also affect

  10. Integral test phantom for dosimetric quality assurance of image guided and intensity modulated stereotactic radiotherapy.

    Science.gov (United States)

    Létourneau, Daniel; Keller, Harald; Sharpe, Michael B; Jaffray, David A

    2007-05-01

    The objective of this work is to develop a dosimetric phantom quality assurance (QA) of linear accelerators capable of cone-beam CT (CBCT) image guided and intensity-modulated radiotherapy (IG-IMRT). This phantom is to be used in an integral test to quantify in real-time both the performance of the image guidance and the dose delivery systems in terms of dose localization. The prototype IG-IMRT QA phantom consisted of a cylindrical imaging phantom (CatPhan) combined with an array of 11 radiation diodes mounted on a 10 cm diameter disk, oriented perpendicular to the phantom axis. Basic diode response characterization was performed for 6 and 18 MV photons. The diode response was compared to planning system calculations in the open and penumbrae regions of simple and complex beam arrangements. The clinical use of the QA phantom was illustrated in an integral test of an IG-IMRT treatment designed for a clinical spinal radiosurgery case. The sensitivity of the phantom to multileaf collimator (MLC) calibration and setup errors in the clinical setting was assessed by introducing errors in the IMRT plan or by displacing the phantom. The diodes offered good response linearity and long-term reproducibility for both 6 and 18 MV. Axial dosimetry of coplanar beams (in a plane containing the beam axes) was made possible with the nearly isoplanatic response of the diodes over 360 degrees of gantry (usually within +/-1%). For single beam geometry, errors in phantom placement as small as 0.5 mm could be accurately detected (in gradient > or = 1% /mm). In clinical setting, MLC systematic errors of 1 mm on a single MLC bank introduced in the IMRT plan were easily detectable with the QA phantom. The QA phantom demonstrated also sufficient sensitivity for the detection of setup errors as small as 1 mm for the IMRT delivery. These results demonstrated that the prototype can accurately and efficiently verify the entire IG-IMRT process. This tool, in conjunction with image guidance

  11. Integral test phantom for dosimetric quality assurance of image guided and intensity modulated stereotactic radiotherapy

    International Nuclear Information System (INIS)

    Letourneau, Daniel; Keller, Harald; Sharpe, Michael B.; Jaffray, David A.

    2007-01-01

    The objective of this work is to develop a dosimetric phantom quality assurance (QA) of linear accelerators capable of cone-beam CT (CBCT) image guided and intensity-modulated radiotherapy (IG-IMRT). This phantom is to be used in an integral test to quantify in real-time both the performance of the image guidance and the dose delivery systems in terms of dose localization. The prototype IG-IMRT QA phantom consisted of a cylindrical imaging phantom (CatPhan) combined with an array of 11 radiation diodes mounted on a 10 cm diameter disk, oriented perpendicular to the phantom axis. Basic diode response characterization was performed for 6 and 18 MV photons. The diode response was compared to planning system calculations in the open and penumbrae regions of simple and complex beam arrangements. The clinical use of the QA phantom was illustrated in an integral test of an IG-IMRT treatment designed for a clinical spinal radiosurgery case. The sensitivity of the phantom to multileaf collimator (MLC) calibration and setup errors in the clinical setting was assessed by introducing errors in the IMRT plan or by displacing the phantom. The diodes offered good response linearity and long-term reproducibility for both 6 and 18 MV. Axial dosimetry of coplanar beams (in a plane containing the beam axes) was made possible with the nearly isoplanatic response of the diodes over 360 deg. of gantry (usually within ±1%). For single beam geometry, errors in phantom placement as small as 0.5 mm could be accurately detected (in gradient ≥1%/mm). In clinical setting, MLC systematic errors of 1 mm on a single MLC bank introduced in the IMRT plan were easily detectable with the QA phantom. The QA phantom demonstrated also sufficient sensitivity for the detection of setup errors as small as 1 mm for the IMRT delivery. These results demonstrated that the prototype can accurately and efficiently verify the entire IG-IMRT process. This tool, in conjunction with image guidance capabilities

  12. Recovery of Salivary Function: Contralateral Parotid-sparing Intensity-modulated Radiotherapy versus Bilateral Superficial Lobe Parotid-sparing Intensity-modulated Radiotherapy.

    Science.gov (United States)

    Miah, A B; Gulliford, S L; Morden, J; Newbold, K L; Bhide, S A; Zaidi, S H; Hall, E; Harrington, K J; Nutting, C M

    2016-09-01

    To establish whether there is a difference in recovery of salivary function with bilateral superficial lobe parotid-sparing intensity-modulated radiotherapy (BSLPS-IMRT) versus contralateral parotid-sparing IMRT (CLPS-IMRT) in patients with locally advanced head and neck squamous cell cancers. A dosimetric analysis was carried out on data from two studies in which patients received BSLPS-IMRT (PARSPORT II) or CLPS-IMRT (PARSPORT). Acute (National Cancer Institute, Common Terminology Criteria for adverse events - NCI CTCAEv3.0) and late (Late Effects of Normal Tissue- subjective, objective, management analytical - LENTSOMA and Radiation Therapy Oncology Group) xerostomia scores were dichotomised: recovery (grade 0-1) versus no recovery (≥grade 2). Incidence of recovery of salivary function was compared between the two techniques and dose-response relationships were determined by fitting dose-response curves to the data using non-linear logistic regression analysis. Seventy-one patients received BSLPS-IMRT and 35 received CLPS-IMRT. Patients received 65 Gy in 30 fractions to the primary site and involved nodal levels and 54 Gy in 30 fractions to elective nodal levels. There were significant differences in mean doses to contralateral parotid gland (29.4 Gy versus 24.9 Gy, P < 0.005) and superficial lobes (26.8 Gy versus 30.5 Gy, P = 0.02) for BSLPS and CLPS-IMRT, respectively. Lower risk of long-term ≥grade 2 subjective xerostomia (LENTSOMA) was reported with BSLPS-IMRT (odds ratio 0.50; 95% confidence interval 0.29-0.86; P = 0.012). The percentage of patients who reported recovery of parotid saliva flow at 1 year was higher with BSLPS-IMRT compared with CLPS-IMRT techniques (67.1% versus 52.8%), but the difference was not statistically significant (P = 0.12). For the whole parotid gland, the tolerance doses, D50, were 25.6 Gy (95% confidence interval 20.6-30.5), k = 2.7 (0.9-4.5) (CLPS-IMRT) and 28.9 Gy (26.1-31.9), k = 2.4 (1.4-3.4) (BSLPS

  13. Nasopharynx carcinoma treatment: from the conventional radiotherapy to the conformal radiotherapy with intensity modulation

    International Nuclear Information System (INIS)

    Mokaouim, K.; Grehange, G.; Truc, G.; Peingnaux, K.; Martin, E.; Zanetta, S.; Bruchon, Y.; Bonnetain, F.; Maingon, P.

    2009-01-01

    The objective of this study was to evaluate retrospectively the impact of factors linked to the radiotherapy realisation on the local and locoregional control, the global survival, the survival without disease of patients suffering of naso-pharynx carcinoma. Conclusion: the patients suffering of a nasopharynx carcinoma treated by irradiation associated to chemotherapy have an improved global survival and an improved survival without disease. The conformal radiotherapy with or without modulated intensity reduce the risk of serous otitis, trismus and xerostomia at long term. It seems necessary to realize multi centric studies with a longer period of follow up before asserting the advantages of the I.M.R.T. in comparison to the classical and conformal technique in the treatment of naso-pharynx carcinomas. (N.C.)

  14. Intensity Modulated Radiotherapy (IMRT) and Fractionated Stereotactic Radiotherapy (FSRT) for children with head-and-neck-rhabdomyosarcoma

    International Nuclear Information System (INIS)

    Combs, Stephanie E; Behnisch, Wolfgang; Kulozik, Andreas E; Huber, Peter E; Debus, Jürgen; Schulz-Ertner, Daniela

    2007-01-01

    The present study evaluates the outcome of 19 children with rhabdomyosarcoma of the head-and-neck region treated with Intensity Modulated Radiotherapy (IMRT) or Fractionated Stereotactic Radiotherapy (FSRT) between August 1995 and November 2005. We treated 19 children with head-and-neck rhabdomyosarcoma with FSRT (n = 14) or IMRT (n = 5) as a part of multimodal therapy. Median age at the time of radiation therapy was 5 years (range 2–15 years). All children received systemic chemotherapy according to the German Soft Tissue Sarcoma Study protocols. Median size of treatment volume for RT was 93,4 ml. We applied a median total dose of 45 Gy (range 32 Gy – 54 Gy) using a median fractionation of 5 × 1,8 Gy/week (range 1,6 Gy – 1,8 Gy). The median time interval between primary diagnosis and radiation therapy was 5 months (range 3–9 months). After RT, the 3- and 5-year survival rate was 94%. The 3- and 5-year actuarial local control rate after RT was 89%. The actuarial freedom of distant metastases rate at 3- and 5-years was 89% for all patients. Radiotherapy was well tolerated in all children and could be completed without interruptions > 4 days. No toxicities >CTC grade 2 were observed. The median follow-up time after RT was 17 months. IMRT and FSRT lead to excellent outcome in children with head-and-neck RMS with a low incidence of treatment-related side effects

  15. Intensity-Modulated Whole Abdominal Radiotherapy After Surgery and Carboplatin/Taxane Chemotherapy for Advanced Ovarian Cancer: Phase I Study

    International Nuclear Information System (INIS)

    Rochet, Nathalie; Sterzing, Florian; Jensen, Alexandra D.; Dinkel, Julien; Herfarth, Klaus K.; Schubert, Kai; Eichbaum, Michael H.; Schneeweiss, Andreas; Sohn, Christof; Debus, Juergen; Harms, Wolfgang

    2010-01-01

    Purpose: To assess the feasibility and toxicity of consolidative intensity-modulated whole abdominal radiotherapy (WAR) after surgery and chemotherapy in high-risk patients with advanced ovarian cancer. Methods and Materials: Ten patients with optimally debulked ovarian cancer International Federation of Gynecology and Obstetrics Stage IIIc were treated in a Phase I study with intensity-modulated WAR up to a total dose of 30 Gy in 1.5-Gy fractions as consolidation therapy after adjuvant carboplatin/taxane chemotherapy. Treatment was delivered using intensity-modulated radiotherapy in a step-and-shoot technique (n = 3) or a helical tomotherapy technique (n = 7). The planning target volume included the entire peritoneal cavity and the pelvic and para-aortal node regions. Organs at risk were kidneys, liver, heart, vertebral bodies, and pelvic bones. Results: Intensity-modulated WAR resulted in an excellent coverage of the planning target volume and an effective sparing of the organs at risk. The treatment was well tolerated, and no severe Grade 4 acute side effects occurred. Common Toxicity Criteria Grade III toxicities were as follows: diarrhea (n = 1), thrombocytopenia (n = 1), and leukopenia (n = 3). Radiotherapy could be completed by all the patients without any toxicity-related interruption. Median follow-up was 23 months, and 4 patients had tumor recurrence (intraperitoneal progression, n = 3; hepatic metastasis, n = 1). Small bowel obstruction caused by adhesions occurred in 3 patients. Conclusions: The results of this Phase I study showed for the first time, to our knowledge, the clinical feasibility of intensity-modulated whole abdominal radiotherapy, which could offer a new therapeutic option for consolidation treatment of advanced ovarian carcinoma after adjuvant chemotherapy in selected subgroups of patients. We initiated a Phase II study to further evaluate the toxicity of this intensive multimodal treatment.

  16. Intensity-modulated whole abdominal radiotherapy after surgery and carboplatin/taxane chemotherapy for advanced ovarian cancer: phase I study.

    Science.gov (United States)

    Rochet, Nathalie; Sterzing, Florian; Jensen, Alexandra D; Dinkel, Julien; Herfarth, Klaus K; Schubert, Kai; Eichbaum, Michael H; Schneeweiss, Andreas; Sohn, Christof; Debus, Juergen; Harms, Wolfgang

    2010-04-01

    To assess the feasibility and toxicity of consolidative intensity-modulated whole abdominal radiotherapy (WAR) after surgery and chemotherapy in high-risk patients with advanced ovarian cancer. Ten patients with optimally debulked ovarian cancer International Federation of Gynecology and Obstetrics Stage IIIc were treated in a Phase I study with intensity-modulated WAR up to a total dose of 30 Gy in 1.5-Gy fractions as consolidation therapy after adjuvant carboplatin/taxane chemotherapy. Treatment was delivered using intensity-modulated radiotherapy in a step-and-shoot technique (n = 3) or a helical tomotherapy technique (n = 7). The planning target volume included the entire peritoneal cavity and the pelvic and para-aortal node regions. Organs at risk were kidneys, liver, heart, vertebral bodies, and pelvic bones. Intensity-modulated WAR resulted in an excellent coverage of the planning target volume and an effective sparing of the organs at risk. The treatment was well tolerated, and no severe Grade 4 acute side effects occurred. Common Toxicity Criteria Grade III toxicities were as follows: diarrhea (n = 1), thrombocytopenia (n = 1), and leukopenia (n = 3). Radiotherapy could be completed by all the patients without any toxicity-related interruption. Median follow-up was 23 months, and 4 patients had tumor recurrence (intraperitoneal progression, n = 3; hepatic metastasis, n = 1). Small bowel obstruction caused by adhesions occurred in 3 patients. The results of this Phase I study showed for the first time, to our knowledge, the clinical feasibility of intensity-modulated whole abdominal radiotherapy, which could offer a new therapeutic option for consolidation treatment of advanced ovarian carcinoma after adjuvant chemotherapy in selected subgroups of patients. We initiated a Phase II study to further evaluate the toxicity of this intensive multimodal treatment.

  17. Quality of life in patients with nasopharyngeal carcinoma after intensity modulated radiotherapy

    International Nuclear Information System (INIS)

    Ma Liqin; Zhang Yu; Pan Jianji; Yang Ling; Kong Xiangquan; Ni Xiaolei

    2009-01-01

    Objective: To analyze the status of quality of life (QOL) and the related factors in patients with nasopharyngeal carcinoma (NPC) after radiotherapy, and to explore the significance of intensity modulated radiotherapy (IMRT) in decreasing side effects and improving QOL. Methods: A questionnaire including 35 items was designed according to EORTC QLQ-30 and the related symptoms and side effects of NPC. 142 NPC patients surviving with disease-free after radiotherapy were surveyed for the evaluation of QOL. The median follow-up was 25 months. The information of social demography and clinical details were collected. The patients were divided into IMRT group (75 patients) and conventional radiotherapy (CRT) group (67 patients). A statistical software package SAS 8.1 was used to compare the marks of QOL between the groups and analyze the influencing factors. Results: In IMRT group and CRT group, the marks of affective cognitive domain were 82.8 ± 14.7 and 77.5 ± 16.0 (t=2.07, P=0.040); and the marks of disease and treatment-related symptoms, and reactive domain were 78.9 ± 10.3 and 69.8 ± 13.3 (t=4.59, P= 0.000). The marks were significantly different in xerostomia, trismus, deglutitoy choke, hoarseness, restriction of neck movement and dysphagia (P<0.05). Of the influencing factors of QOL, the domain of body function was sex (regression coefficient was -4.692), the self-evaluation of total QOL were follow-up time and educational background (regression coefficients were -0.618 and 12.316, respectively), the financial status was family monthly income per capita (regression coefficient was -11.133), and the disease and treatment-related symptoms and reactive domain were group (techniques of radiation) and age (regression coefficients were -9.384 and -5.853, respectively). Conclusions: IMRT could improve the QOL through decreasing the side effects of patients with NPC including xerostomia, trismus, restriction of neck movement and dysphagia. Sex, age, family monthly

  18. Pelvic Ewing sarcomas. Three-dimensional conformal vs. intensity-modulated radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Mounessi, F.S.; Lehrich, P.; Haverkamp, U.; Eich, H.T. [Muenster Univ. (Germany). Dept. of Radiation Oncology; Willich, N. [Muenster Univ. (Germany). Dept. of Radiation Oncology; Universitaetsklinikum Muenster (Germany). RiSK - Registry for the Evaluation of Late Side Effects after Radiotherapy in Childhood and Adolescence; Boelling, T. [Center for Radiation Oncology, Osnabrueck (Germany)

    2013-04-15

    The goal of the present work was to assess the potential advantage of intensity-modulated radiotherapy (IMRT) over three-dimensional conformal radiotherapy (3D-CRT) planning in pelvic Ewing's sarcoma. A total of 8 patients with Ewing sarcoma of the pelvis undergoing radiotherapy were analyzed. Plans for 3D-CRT and IMRT were calculated for each patient. Dose coverage of the planning target volume (PTV), conformity and homogeneity indices, as well as further parameters were evaluated. Results The average dose coverage values for PTV were comparable in 3D-CRT and IMRT plans. Both techniques had a PTV coverage of V{sub 95} > 98 % in all patients. Whereas the IMRT plans achieved a higher conformity index compared to the 3D-CRT plans (conformity index 0.79 {+-} 0.12 vs. 0.54 {+-} 0.19, p = 0.012), the dose distribution across the target volumes was less homogeneous with IMRT planning than with 3D-CRT planning. This difference was statistically significant (homogeneity index 0.11 {+-} 0.03 vs. 0.07 {+-} 0.0, p = 0.035). For the bowel, D{sub mean} and D{sub 1%}, as well as V{sub 2} to V{sub 60} were reduced in IMRT plans. For the bladder and the rectum, there was no significant difference in D{sub mean}. However, the percentages of volumes receiving at least doses of 30, 40, 45, and 50 Gy (V{sub 30} to V{sub 50}) were lower for the rectum in IMRT plans. The volume of normal tissue receiving at least 2 Gy (V{sub 2}) was significantly higher in IMRT plans compared with 3D-CRT, whereas at high dose levels (V{sub 30}) it was significantly lower. Compared to 3D-CRT, IMRT showed significantly better results regarding dose conformity (p = 0.012) and bowel sparing at dose levels above 30 Gy (p = 0.012). Thus, dose escalation in the radiotherapy of pelvic Ewing's sarcoma can be more easily achieved using IMRT. (orig.)

  19. Improved Planning Time and Plan Quality Through Multicriteria Optimization for Intensity-Modulated Radiotherapy

    International Nuclear Information System (INIS)

    Craft, David L.; Hong, Theodore S.; Shih, Helen A.; Bortfeld, Thomas R.

    2012-01-01

    Purpose: To test whether multicriteria optimization (MCO) can reduce treatment planning time and improve plan quality in intensity-modulated radiotherapy (IMRT). Methods and Materials: Ten IMRT patients (5 with glioblastoma and 5 with locally advanced pancreatic cancers) were logged during the standard treatment planning procedure currently in use at Massachusetts General Hospital (MGH). Planning durations and other relevant planning information were recorded. In parallel, the patients were planned using an MCO planning system, and similar planning time data were collected. The patients were treated with the standard plan, but each MCO plan was also approved by the physicians. Plans were then blindly reviewed 3 weeks after planning by the treating physician. Results: In all cases, the treatment planning time was vastly shorter for the MCO planning (average MCO treatment planning time was 12 min; average standard planning time was 135 min). The physician involvement time in the planning process increased from an average of 4.8 min for the standard process to 8.6 min for the MCO process. In all cases, the MCO plan was blindly identified as the superior plan. Conclusions: This provides the first concrete evidence that MCO-based planning is superior in terms of both planning efficiency and dose distribution quality compared with the current trial and error–based IMRT planning approach.

  20. Intensity-modulated radiotherapy in head and neck cancers: in which direction are we heading?

    International Nuclear Information System (INIS)

    Lal, Punita; Verma, Mranalini; Maria Das, K.J.; Kumar, Shaleen

    2016-01-01

    Radiotherapy (RT) is one of the treatment modalities, which most of the time used in the treatment of most head and neck cancers with/without chemotherapy either as a definitive treatment or adjuvant/postoperated or for symptoms palliation, but it is always accompanied by late sequelae such as xerostomia and dysphagia. These two major sequelae have a significant effect on patient's quality of life even after cure of disease. However, with the advancement of modern techniques such as intensity-modulated RT (IMRT) which effectively spares the parotid glands has a significant effect, proven in randomized trials, for xerostomia as well as dysphagia. IMRT to spare dysphagia and aspiration related structure (DARSs) has also been studied extensively. To improve the results further, nowadays, we focus on use of functional imaging at the time of RT planning and/or use of image guidance for the adaptation during RT treatment as well as focus on to reduce neurocognition effects of treatment by sparing brain. (author)

  1. PET/CT scanning guided intensity-modulated radiotherapy in treatment of recurrent ovarian cancer

    Energy Technology Data Exchange (ETDEWEB)

    Du, Xue-lian, E-mail: duxuelian23800@yahoo.com.cn [Department of Gynecologic Oncology, Shandong Cancer Hospital, Jinan 250117 (China); Shandong Academy of Medical Science, Jinan 250012 (China); Jiang, Tao, E-mail: melody23800@yahoo.com.cn [Department of Gynecologic Oncology, Shandong Cancer Hospital, Jinan 250117 (China); Shandong Academy of Medical Science, Jinan 250012 (China); Sheng, Xiu-gui, E-mail: jnsd2000@yahoo.cn [Department of Gynecologic Oncology, Shandong Cancer Hospital, Jinan 250117 (China); Shandong Academy of Medical Science, Jinan 250012 (China); Li, Qing-shui, E-mail: lqs1966@126.com [Department of Gynecologic Oncology, Shandong Cancer Hospital, Jinan 250117 (China); Shandong Academy of Medical Science, Jinan 250012 (China); Wang, Cong, E-mail: jnwc1981@hotmail.com [Department of Gynecologic Oncology, Shandong Cancer Hospital, Jinan 250117 (China); Shandong Academy of Medical Science, Jinan 250012 (China); Yu, Hao, E-mail: jnyh2200@sina.com [Department of Gynecologic Oncology, Shandong Cancer Hospital, Jinan 250117 (China); Shandong Academy of Medical Science, Jinan 250012 (China)

    2012-11-15

    Objective: This study was undertaken to evaluate the clinical contribution of positron emission tomography using {sup 18}F-fluorodeoxyglucose and integrated computer tomography (FDG-PET/CT) guided intensity-modulated radiotherapy (IMRT) for treatment of recurrent ovarian cancer. Materials and methods: Fifty-eight patients with recurrent ovarian cancer from 2003 to 2008 were retrospectively studied. In these patients, 28 received PET/CT guided IMRT (PET/CT-IMRT group), and 30 received CT guided IMRT (CT-IMRT group). Treatment plans, tumor response, toxicities and survival were evaluated. Results: Changes in GTV delineation were found in 10 (35.7%) patients based on PET-CT information compared with CT data, due to the incorporation of additional lymph node metastases and extension of the metastasis tumor. PET/CT guided IMRT improved tumor response compared to CT-IMRT group (CR: 64.3% vs. 46.7%, P = 0.021; PR: 25.0% vs. 13.3%, P = 0.036). The 3-year overall survival was significantly higher in the PET-CT/IMRT group than control (34.1% vs. 13.2%, P = 0.014). Conclusions: PET/CT guided IMRT in recurrent ovarian cancer patients improved the delineation of GTV and reduce the likelihood of geographic misses and therefore improve the clinical outcome.

  2. Intensity-Modulated Radiotherapy in Postoperative Treatment of Oral Cavity Cancers

    International Nuclear Information System (INIS)

    Gomez, Daniel R.; Zhung, Joanne E.; Gomez, Jennifer; Chan, Kelvin; Wu, Abraham J.; Wolden, Suzanne L.; Pfister, David G.; Shaha, Ashok; Shah, Jatin P.; Kraus, Dennis H.; Wong, Richard J.; Lee, Nancy Y.

    2009-01-01

    Purpose: To present our single-institution experience of intensity-modulated radiotherapy (IMRT) for oral cavity cancer. Methods and Materials: Between September 2000 and December 2006, 35 patients with histologically confirmed squamous cell carcinoma of the oral cavity underwent surgery followed by postoperative IMRT. The sites included were buccal mucosa in 8, oral tongue in 11, floor of the mouth in 9, gingiva in 4, hard palate in 2, and retromolar trigone in 1. Most patients had Stage III-IV disease (80%). Ten patients (29%) also received concurrent postoperative chemotherapy with IMRT. The median prescribed radiation dose was 60 Gy. Results: The median follow-up for surviving patients was 28.1 months (range, 11.9-85.1). Treatment failure occurred in 11 cases as follows: local in 4, regional in 2, and distant metastases in 5. Of the 5 patients with distant metastases, 2 presented with dermal metastases. The 2- and 3-year estimates of locoregional progression-free survival, distant metastasis-free survival, disease-free survival, and overall survival were 84% and 77%, 85% and 85%, 70% and 64%, and 74% and 74%, respectively. Acute Grade 2 or greater dermatitis, mucositis, and esophageal reactions were experienced by 54%, 66%, and 40% of the patients, respectively. Documented late complications included trismus (17%) and osteoradionecrosis (5%). Conclusion: IMRT as an adjuvant treatment after surgical resection for oral cavity tumors is feasible and effective, with promising results and acceptable toxicity

  3. Magnetic resonance assessment of prostate localization variability in intensity-modulated radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Villeirs, Geert M.; Meerleer, Gert O. de; Verstraete, Koenraad L.; Neve, Wilfried J. de

    2004-01-01

    Purpose: To measure prostate motion with magnetic resonance imaging (MRI) during a course of intensity-modulated radiotherapy. Methods and materials: Seven patients with prostate carcinoma were scanned supine on a 1.5-Tesla MRI system with weekly pretreatment and on-treatment HASTE T2-weighted images in 3 orthogonal planes. The bladder and rectal volumes and position of the prostatic midpoint (PMP) and margins relative to the bony pelvis were measured. Results: All pretreatment positions were at the mean position as computed from the on-treatment scans in each patient. The PMP variability (given as 1 SD) in the anterior-posterior (AP), superior-inferior (SI), and right-left (RL) directions was 2.6, 2.4, and 1.0 mm, respectively. The largest variabilities occurred at the posterior (3.2 mm), superior (2.6 mm), and inferior (2.6 mm) margins. A strong correlation was found between large rectal volume (>95th percentile) and anterior PMP displacement. A weak correlation was found between bladder volume and superior PMP displacement. Conclusions: All pretreatment positions were representative of the subsequent on-treatment positions. A clinical target volume (CTV) expansion of 5.3 mm in any direction was sufficient to ascertain a 95% coverage of the CTV within the planning target volume (PTV), provided that a rectal suppository is administered to avoid rectal overdistension and that the patient has a comfortably filled bladder (<300 mL)

  4. Dose determination in radiotherapy for photon beams modified by static intensity modulators

    International Nuclear Information System (INIS)

    Castellanos Lopez, M.E.

    1998-01-01

    The static intensity modulators, used in radiotherapy, modify the spectral composition of the beam and lead to specific problems of the dose calculation. The aim of this work was to establish a three dimensional calculation, global and accurate, adapted to the primary-diffused separation algorithm and valid for any static modulator type. A theoretical study, experimentally verified, allowed the evaluation of the primary fluence, resulting from metallic sheets placed between photons beams of 6 to 23 MV nominal energy. It has been showed that the diffused, coming from the modulators, could be neglected for weak thickness and for the relative dose variation. In return it leads to significant variations of many % on the absolute dose and must be take into account for the bigger thicknesses. Corrective methods for the primary fluence have been proposed. From the energy spectra of the beam, the metallic modulator influence has been studied on the primary and diffused components of the dose and improvements of the calculation method have been proposed. These improvements are based on the modulator representation as a transmission matrix and on semi-empirical corrective factors. (A.L.B.)

  5. Towards using a Monolithic Active Pixel Sensor for in vivo beam monitoring of Intensity Modulated Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Page, R.F., E-mail: ryan.page@bristol.ac.uk [H.H. Wills Physics Laboratory, University of Bristol, Tyndall Avenue, Bristol BS8 1TL (United Kingdom); Abbott, N.L.; Davies, J.; Dyke, E.L.; Randles, H.J. [H.H. Wills Physics Laboratory, University of Bristol, Tyndall Avenue, Bristol BS8 1TL (United Kingdom); Velthuis, J.J. [H.H. Wills Physics Laboratory, University of Bristol, Tyndall Avenue, Bristol BS8 1TL (United Kingdom); Bristol Haematology and Oncology Centre, University Hospitals Bristol, NHS Foundation Trust (United Kingdom); Fletcher, S.; Gregory, S.D.; Hall, C.; John, A.; Lawrence, H.; Stevens, P.H. [Bristol Haematology and Oncology Centre, University Hospitals Bristol, NHS Foundation Trust (United Kingdom); Hugtenburg, R.P.; Tunbridge, V. [Swansea University, Singleton Park, Swansea SA2 8PP (United Kingdom)

    2013-12-11

    The use of Intensity Modulated Radiotherapy (IMRT) for cancer treatments is entering wider use. These treatments involve using a complex configuration of field modifying components, known as Multileaf Collimators (MLC), to dynamically shape the beam. A treatment consists of a sequence of irregular shaped fields, which means real time monitoring and verification is essential. In the current framework the treatment plans are verified before the patient is treated, but not during. The aim of our collaboration is to monitor the treatment being given to the patient. This is achieved by placing a camera system using an ultra-thin Monolithic Active Pixel Sensor (MAPS) upstream of the patient. -- Highlights: •A Monolithic Active Pixel Sensor was used to measure the shape of an IMRT field. •The sensor was positioned upstream of the patient causing only a ∼ 0.1% attenuation. •Edges of Multileaf Collimators were determined using edge reconstruction techniques. •The reconstructed edge precision was measured to be 52±4μm for a single frame. •Edge positions from the sensor and film are compared and found to be within error.

  6. Accuracy of inhomogeneity correction algorithm in intensity-modulated radiotherapy of head-and-neck tumors.

    Science.gov (United States)

    Yoon, Myonggeun; Lee, Doo-Hyun; Shin, Dongho; Lee, Se Byeong; Park, Sung Yong; Cho, Kwan Ho

    2007-01-01

    We examined the degree of calculated-to-measured dose difference for nasopharyngeal target volume in intensity-modulated radiotherapy (IMRT) based on the observed/expected ratio using patient anatomy with humanoid head-and-neck phantom. The plans were designed with a clinical treatment planning system that uses a measurement-based pencil beam dose-calculation algorithm. Two kinds of IMRT plans, which give a direct indication of the error introduced in routine treatment planning, were categorized and evaluated. The experimental results show that when the beams pass through the oral cavity in anthropomorphic head-and-neck phantom, the average dose difference becomes significant, revealing about 10% dose difference to prescribed dose at isocenter. To investigate both the physical reasons of the dose discrepancy and the inhomogeneity effect, we performed the 10 cases of IMRT quality assurance (QA) with plastic and humanoid phantoms. Our result suggests that the transient electronic disequilibrium with the increased lateral electron range may cause the inaccuracy of dose calculation algorithm, and the effectiveness of the inhomogeneity corrections used in IMRT plans should be evaluated to ensure meaningful quality assurance and delivery.

  7. Clinical Results after High-Dose Intensity-Modulated Radiotherapy for High-Risk Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Valérie Fonteyne

    2012-01-01

    Full Text Available Purpose. Patients with high-risk prostate cancer (PC can be treated with high-dose intensity-modulated radiotherapy (IMRT and long-term androgen deprivation (AD. In this paper we report on (i late toxicity and (ii biochemical (bRFS and clinical relapse-free survival (cRFS of this combined treatment. Methods. 126 patients with high-risk PC (T3-4 or PSA >20 ng/mL or Gleason 8–10 and ≥24 months of followup were treated with high-dose IMRT and AD. Late toxicity was recorded. Biochemical relapse was defined as PSA nadir +2 ng/mL. Clinical relapse was defined as local failure or metastases. Results. The incidence of late grade 3 gastrointestinal and genitourinary toxicity was 2 and 6%, respectively. Five-year bRFS and cRFS were 73% and 86% respectively. AD was a significant predictor of bRFS (P=0.001 and cRFS (P=0.01. Conclusion. High-dose IMRT and AD for high-risk PC offers excellent biochemical and clinical control with low toxicity.

  8. A dosimetric comparison of proton and intensity-modulated photon radiotherapy for pediatric parameningeal rhabdomyosarcomas.

    Science.gov (United States)

    Kozak, Kevin R; Adams, Judith; Krejcarek, Stephanie J; Tarbell, Nancy J; Yock, Torunn I

    2009-05-01

    We compared tumor and normal tissue dosimetry of proton radiation therapy with intensity-modulated radiation therapy (IMRT) for pediatric parameningeal rhabdomyosarcomas (PRMS). To quantify dosimetric differences between contemporary proton and photon treatment for pediatric PRMS, proton beam plans were compared with IMRT plans. Ten patients treated with proton radiation therapy at Massachusetts General Hospital had IMRT plans generated. To facilitate dosimetric comparisons, clinical target volumes and normal tissue volumes were held constant. Plans were optimized for target volume coverage and normal tissue sparing. Proton and IMRT plans provided acceptable and comparable target volume coverage, with at least 99% of the CTV receiving 95% of the prescribed dose in all cases. Improved dose conformality provided by proton therapy resulted in significant sparing of all examined normal tissues except for ipsilateral cochlea and mastoid; ipsilateral parotid gland sparing was of borderline statistical significance (p = 0.05). More profound sparing of contralateral structures by protons resulted in greater dose asymmetry between ipsilateral and contralateral retina, optic nerves, cochlea, and mastoids; dose asymmetry between ipsilateral and contralateral parotids was of borderline statistical significance (p = 0.05). For pediatric PRMS, superior normal tissue sparing is achieved with proton radiation therapy compared with IMRT. Because of enhanced conformality, proton plans also demonstrate greater normal tissue dose distribution asymmetry. Longitudinal studies assessing the impact of proton radiotherapy and IMRT on normal tissue function and growth symmetry are necessary to define the clinical consequences of these differences.

  9. A comparison of morbidity following conformal versus intensity-modulated radiotherapy for urinary bladder cancer.

    Science.gov (United States)

    Søndergaard, Jimmi; Holmberg, Mats; Jakobsen, Annette Ross; Agerbæk, Mads; Muren, Ludvig Paul; Høyer, Morten

    2014-10-01

    In radiotherapy (RT) of urinary bladder cancer, the use of intensity-modulated RT (IMRT) opens for sparing of considerable intestinal volumes. The purpose of the present study was to investigate the acute and late toxicities following either conformal RT (CRT) or IMRT for bladder cancer, and to correlate the toxicities to dose-volume parameters. The study included 116 consecutively treated patients with muscle-invasive bladder cancer who received either CRT (n = 66) or IMRT (n = 50) during 2007-2010. Acute side effects were retrospectively collected whereas late effects were assessed by a cross-sectional evaluation by telephone interview of 44 recurrence-free patients. Acute and late toxicities were scored according to the Common Terminology Criteria for Adverse Event (CTCAE) version 3.0. Acute diarrhoea grade ≥ 2 was more frequent in patients treated by CRT (56%) compared to IMRT (30%) (p = 0.008). Logistic regression analysis showed a correlation between acute diarrhoea and bowel cavity dose-volume parameters in the 10-50 Gy range. Severe late toxicity (grade ≥ 3) was recorded in 10% of the total cohort, with no statistical difference between the IMRT and CRT groups. Patients treated with IMRT for bladder cancer had significantly less acute diarrhoea compared to those treated with CRT, but there was no significant difference in late morbidity between the groups. The risk of acute diarrhoea was related to the volume of bowel irradiated.

  10. Surface dose measurement with Gafchromic EBT3 film for intensity modulated radiotherapy technique

    Science.gov (United States)

    Akbas, Ugur; Kesen, Nazmiye Donmez; Koksal, Canan; Okutan, Murat; Demir, Bayram; Becerir, Hatice Bilge

    2017-09-01

    Accurate dose measurement in the buildup region is extremely difficult. Studies have reported that treatment planning systems (TPS) cannot calculate surface dose accurately. The aim of the study was to compare the film measurements and TPS calculations for surface dose in head and neck cancer treatment using intensity modulated radiation therapy (IMRT). IMRT plans were generated for 5 head and neck cancer patients by using Varian Eclipse TPS. Quality assurance (QA) plans of these IMRT plans were created on rando phantoms for surface dose measurements. EBT3 films were cut in size of 2.5 x 2.5 cm2 and placed on the left side, right side and the center of larynx and then the films were irradiated with 6 MV photon beams. The measured doses were compared with TPS. The results of TPS calculations were found to be lower compared to the EBT3 film measurements at all selected points. The lack of surface dose calculation in TPS should be considered while evaluating the radiotherapy plans.

  11. The value of image-guided intensity-modulated radiotherapy in challenging clinical settings

    Science.gov (United States)

    Treece, S J; Mukesh, M; Rimmer, Y L; Tudor, S J; Dean, J C; Benson, R J; Gregory, D L; Horan, G; Jefferies, S J; Russell, S G; Williams, M V; Wilson, C B; Burnet, N G

    2013-01-01

    Objective To illustrate the wider potential scope of image-guided intensity-modulated radiotherapy (IG-IMRT), outside of the “standard” indications for IMRT. Methods Nine challenging clinical cases were selected. All were treated with radical intent, although it was accepted that in several of the cases the probability of cure was low. IMRT alone was not adequate owing to the close proximity of the target to organs at risk, the risk of geographical miss, or the need to tighten planning margins, making image-guided radiotherapy an essential integral part of the treatment. Discrepancies between the initial planning scan and the daily on-treatment megavoltage CT were recorded for each case. The three-dimensional displacement was compared with the margin used to create the planning target volume (PTV). Results All but one patient achieved local control. Three patients developed metastatic disease but benefited from good local palliation; two have since died. A further patient died of an unrelated condition. Four patients are alive and well. Toxicity was low in all cases. Without daily image guidance, the PTV margin would have been insufficient to ensure complete coverage in 49% of fractions. It was inadequate by >3 mm in 19% of fractions, and by >5 mm in 9%. Conclusion IG-IMRT ensures accurate dose delivery to treat the target and avoid critical structures, acting as daily quality assurance for the delivery of complex IMRT plans. These patients could not have been adequately treated without image guidance. Advances in knowledge IG-IMRT can offer improved outcomes in less common clinical situations, where conventional techniques would provide suboptimal treatment. PMID:23255544

  12. Intensity modulated whole pelvic radiotherapy in patients with cervix cancer: analysis of acute toxicity

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Young Min; Lee, Hyung Sik; Hur, Won Joo; Cha, Moon Seok; Kim, Hyun Ho [School of Medicine, Dong-A University, Busan (Korea, Republic of)

    2006-12-15

    To evaluate acute toxicities in cervix cancer patients receiving intensity modulated whole pelvic radiation therapy (IM-WPRT). Between August 2004 and April 2006, 17 patients who underwent IM-WPRT were analysed. An intravenous contrast agent was used for radiotherapy planning computed tomography (CT). The central clinical target volume (CTV) included the primary tumor, uterus, vagina, and parametrium. The nodal CTV was defined as the lymph nodes larger than 1 cm seen on CT and the contrased-enhanced pelvic vessels. The planning target volume (PTV) was the 1-cm expanded volume around the central CTV, except for a 5-mm expansion from the posterior vagina, and the nodal PTV was defined as the nodal CTV plus a 1.5 cm margin. IM-WPRT was prescribed to deliver a dose of 50 Gy to more than 95% of the PTV. Acute toxicity was assessed with common toxicity criteria up to 60 days after radiotherapy. Grade 1 nausea developed in 10 (58.9%) patients, and grade 1 and 2 diarrhea developed in 11 (64.7%) and 1 (5.9%) patients, respectively. No grade 3 or higher gastrointestinal toxicity was seen. Leukopenia, anemia, and thrombocytopenia occurred in 15 (88.2%). 7 (41.2%), and 2 (11.8%) patients, respectively, as hematologic toxicities. Grade 3 leukopenia developed in 2 patients who were treated with concurrent chemoradiotherapy. IM-WPRT can be a useful treatment for cervix cancer patients with decreased severe acute toxicities and a resultant improved compliance to whole pelvic irradiation.

  13. Intensity modulated radiotherapy for locally advanced and metastatic pancreatic cancer: a mono-institutional retrospective analysis

    International Nuclear Information System (INIS)

    Wang, Zheng; Ren, Zhi-Gang; Ma, Ning-Yi; Zhao, Jian-Dong; Zhang, Zhen; Ma, Xue-Jun; Long, Jiang; Xu, Jin; Jiang, Guo-Liang

    2015-01-01

    To evaluate the role of intensity modulated radiotherapy (IMRT) for locally advanced pancreatic cancer (LAPC) and metastatic pancreatic cancer (MPC), and the prognostic factors in the setting of multidisciplinary approach strategies. 63 patients with LAPC and MPC receiving IMRT in our institution were retrospectively identified. Information on patient baseline, treatment characteristics and overall survival (OS) time were collected. Data of pain relief and toxicity were evaluated. Univariate and multivariate analyses were conducted to investigate the prognostic factors. All patients received IMRT with a median dose of 46.0 Gy. The median OS for LAPC and MPC patients were 15.7 months and 8.0 months, respectively (p = 0.029). Symptomatic improvements were observed in the 44 patients with abdominal/back pain after radiotherapy (RT) or concurrent chemoradiotherapy (CCRT), particularly in those with severe pain. Only 13.9% and 14.8% cases presented Grade ≥ 3 hematologic toxicities in RT and CCRT group, while no cases developed Grade ≥ 3 non-hematologic toxicities in both groups. Multivariate analysis indicated that tumors located in pancreas body/tail (HR 0.28, p = 0.008), pretreatment CA19-9 < 1000 U/mL (HR 0.36, p = 0.029) and concurrent chemotherapy (HR 0.37, p = 0.016) were independent favorable predictors for OS. CCRT further improved OS for LAPC and MPC with acceptable toxicities, and use of RT markedly alleviated pain. Tumors located in pancreas body/tail, pretreatment CA19-9 level of < 1000 U/mL and CCRT were associated with better OS. However, regional intra-arterial chemotherapy did not show any survival benefit in our study

  14. Promising results with image guided intensity modulated radiotherapy for muscle invasive bladder cancer

    International Nuclear Information System (INIS)

    Whalley, D.; Caine, H.; McCloud, P.; Guo, L.; Kneebone, A.; Eade, T.

    2015-01-01

    To describe the feasibility of image guided intensity modulated radiotherapy (IG-IMRT) using daily soft tissue matching in the treatment of bladder cancer. Twenty-eight patients with muscle-invasive carcinoma of the bladder were recruited to a protocol of definitive radiation using IMRT with accelerated hypofractionation with simultaneous integrated boost (SIB). Isotropic margins of .5 and 1 cm were used to generate the high risk and intermediate risk planning target volumes respectively. Cone beam CT (CBCT) was acquired daily and a soft tissue match was performed. Cystoscopy was scheduled 6 weeks post treatment. The median age was 83 years (range 58-92). Twenty patients had stage II or III disease, and eight were stage IV. Gross disease received 66 Gy in 30 fractions in 11 patients (ten with concurrent chemotherapy) or 55 Gy in 20 fractions for those of poorer performance status or with palliative intent. All patients completed radiation treatment as planned. Three patients ceased chemotherapy early due to toxicity. Six patients (21 %) had acute Grade ≥ 2 genitourinary (GU) toxicity and six (21 %) had acute Grade ≥ 2 gastrointestinal (GI) toxicity. Five patients (18 %) developed Grade ≥2 late GU toxicity and no ≥2 late GI toxicity was observed. Nineteen patients underwent cystoscopy following radiation, with complete response (CR) in 16 cases (86 %), including all patients treated with chemoradiotherapy. Eight patients relapsed, four of which were local relapses. Of the patients with local recurrence, one underwent salvage cystectomy. For patients treated with definitive intent, freedom from locoregional recurrence (FFLR) and overall survival (OS) was 90 %/100 % for chemoradiotherapy versus 86 %/69 % for radiotherapy alone. IG- IMRT using daily soft tissue matching is a feasible in the treatment of bladder cancer, enabling the delivery of accelerated synchronous integrated boost with good early local control outcomes and low toxicity

  15. Toxicity after intensity-modulated, image-guided radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Flentje, Michael; Guckenberger, Matthias; Ok, Sami; Polat, Buelent; Sweeney, Reinhart A.

    2010-01-01

    Purpose: To evaluate toxicity after dose-escalated radiotherapy for prostate cancer using intensity-modulated treatment planning (IMRT) and image-guided treatment (IGRT) delivery. Patients and Methods: 100 patients were treated with simultaneous integrated boost (SIB) IMRT for prostate cancer: doses of 76.23 Gy and 60 Gy in 33 fractions were prescribed to the prostate and the seminal vesicles, respectively, for intermediate- and high-risk patients (n = 74). The total dose was 73.91 Gy in 32 fractions for low-risk patients and after transurethral resection of the prostate (n = 26). The pelvic lymphatics were treated with 46 Gy in 25 fractions in patients with high risk of lymph node metastases using an SIB to the prostate (n = 25). IGRT was practiced with cone-beam computed tomography. Acute and late gastrointestinal (GI) and genitourinary (GU) toxicity was evaluated prospectively (CTCAE v3.0). Results: Treatment was completed as planned by all patients. Acute GI and GU toxicity grade ≥ 2 was observed in 12% and 42% of the patients, respectively, with 4% suffering from GU toxicity grade 3. 6 weeks after treatment, the incidence of acute toxicity grade ≥ 2 had decreased to 12%. With a median follow-up of 26 months, late GI and GU toxicity grade ≥ 2 was seen in 1.5% and 7.7% of the patients at 24 months. Four patients developed late toxicity grade 3 (GI n = 1; GU n = 3). Presence of acute GI and GU toxicity was significantly associated with late GI (p = 0.0007) and GU toxicity (p = 0.006). Conclusion: High-dose radiotherapy for prostate cancer using IMRT and IGRT resulted in low rates of acute toxicity and preliminary results of late toxicity are promising. (orig.)

  16. Investigation of the added value of high-energy electrons in intensity-modulated radiotherapy: four clinical cases

    International Nuclear Information System (INIS)

    Korevaar, Erik W.; Huizenga, Henk; Loef, Johan; Stroom, Joep C.; Leer, Jan Willem H.; Brahme, Anders

    2002-01-01

    Purpose: Intensity-modulated radiotherapy (IMRT) with photon beams is currently pursued in many clinics. Theoretically, inclusion of intensity- and energy-modulated high-energy electron beams (15-50 MeV) offers additional possibilities to improve radiotherapy treatments of deep-seated tumors. In this study the added value of high-energy electron beams in IMRT treatments was investigated. Methods and Materials: In a comparative treatment planning study, conventional treatment plans and various types of IMRT plans were constructed for four clinical cases (cancer of the bladder, pancreas, chordoma of the sacrum, and breast). The conventional plans were used for the actual treatment of the patients. The IMRT plans were optimized using the Orbit optimization code (Loef et al., 2000) with a radiobiologic objective function. The IMRT plans were either photon or combined electron and photon beam plans, with or without dose homogeneity constraints assuming standard or increased radiosensitivities of organs at risk. Results: Large improvements in expected treatment outcome are found using IMRT plans compared to conventional plans, but differences in tumor control probability (TCP) and normal tissue complication probabilities (NTCP) values between IMRT plans with and without electrons are small. However, the use of electrons improves the dose-volume histograms for organs at risk, especially at lower dose levels (e.g., 0-40 Gy). Conclusions: This preliminary study indicates that addition of higher energy electrons to IMRT can only marginally improve treatment outcome for the selected cases. The dose-volume histograms of organs at risk show improvements for IMRT with higher energy electrons, which may reduce tumor induction but does not substantially reduce NTCP

  17. Dosimetric studies of cadmium free alloy used in compensator based intensity modulated radiotherapy

    Science.gov (United States)

    Kaushik, Sandeep; Punia, Rajesh; Tyagi, Atul; Singh, Mann P.

    2017-10-01

    Aim of this study was to investigate dosimetric properties of cadmium free alloy which is used in compensator based intensity modulated radiotherapy (cIMRT). A mixture of lead, bismuth and tin was used to prepare the alloy whose melting point is 90-95 °C. Slabs of different thicknesses ranging from 0.71 cm to 6.14 cm were prepared. Density of alloy was measured by Archimedes' principle using water. For six megavolt (6 MV) photon beam energy transmission, linear effective attenuation coefficient (μeff), tissue phantom ratio (TPR1020), beam hardening, surface dose (Ds), percentage depth dose (PDD) and effect of scatter has been measured and analyzed for different field sizes and different thickness of compensator. Effect of extended source to detector distance (SDD) on transmissions and μeff was measured. The density of alloy was found to be 9.5456 g/cm3. At SDD of 100 cm, μeff was observed 0.4253 cm-1 for a field size of 10×10 cm 2. Calculated TPR1020 was found to be within 3% of experimental TPR1020 . It was found to be increasing with increasing thickness of compensator. Ds was found to decrease with thickness of compensator and increase with wider collimator opening due to increased scattered dose. Compensator slabs of 1 cm, 1.98 cm and 4.16 cm decreased surface dose by 4.2%, 6.1% and 9.5% respectively for a field size of 10×10 cm2 at 100 cm SDD. For small field size of 3×3 cm2 and 5×5 cm2 PDDs are increased from 3.0% to 5.5% of open beam PDDs as compensator thickness increased from 1 cm to 6.14 cm at a depth of 10 cm in water while variation in PDD is insignificant in for larger field sizes 10×10 cm2 to 20×20 cm2. A high degree of intensity modulation is essential in cIMRT and it can be achieved with this compensator material. Dosimetric properties analyzed in this study establish this alloy as a reliable, reusable, optimally dense and cost effective compensator material.

  18. Radiotherapy for breast cancer

    International Nuclear Information System (INIS)

    Boljesikova, E.; Ligacova, A.

    2012-01-01

    Radiotherapy plays an important role in the treatment of breast carcinoma, reduces local recurrences about 20% (after breast conserving surgery or mastectomy), reduces 15 y mortality for cancer about 5%. The irradiation volumes can cover whole breast ± boost, partial breast, chest wall and regional lymph nodes. In contribution are analysed indications of radiotherapy, radiation techniques with focus on new trends, altered fractionation, partial breast irradiation and toxicity. (author)

  19. Reduced Acute Bowel Toxicity in Patients Treated With Intensity-Modulated Radiotherapy for Rectal Cancer

    International Nuclear Information System (INIS)

    Samuelian, Jason M.; Callister, Matthew D.; Ashman, Jonathan B.; Young-Fadok, Tonia M.; Borad, Mitesh J.; Gunderson, Leonard L.

    2012-01-01

    Purpose: We have previously shown that intensity-modulated radiotherapy (IMRT) can reduce dose to small bowel, bladder, and bone marrow compared with three-field conventional radiotherapy (CRT) technique in the treatment of rectal cancer. The purpose of this study was to review our experience using IMRT to treat rectal cancer and report patient clinical outcomes. Methods and Materials: A retrospective review was conducted of patients with rectal cancer who were treated at Mayo Clinic Arizona with pelvic radiotherapy (RT). Data regarding patient and tumor characteristics, treatment, acute toxicity according to the Common Terminology Criteria for Adverse Events v 3.0, tumor response, and perioperative morbidity were collected. Results: From 2004 to August 2009, 92 consecutive patients were treated. Sixty-one (66%) patients were treated with CRT, and 31 (34%) patients were treated with IMRT. All but 2 patients received concurrent chemotherapy. There was no significant difference in median dose (50.4 Gy, CRT; 50 Gy, IMRT), preoperative vs. postoperative treatment, type of concurrent chemotherapy, or history of previous pelvic RT between the CRT and IMRT patient groups. Patients who received IMRT had significantly less gastrointestinal (GI) toxicity. Sixty-two percent of patients undergoing CRT experienced ≥Grade 2 acute GI side effects, compared with 32% among IMRT patients (p = 0.006). The reduction in overall GI toxicity was attributable to fewer symptoms from the lower GI tract. Among CRT patients, ≥Grade 2 diarrhea and enteritis was experienced among 48% and 30% of patients, respectively, compared with 23% (p = 0.02) and 10% (p = 0.015) among IMRT patients. There was no significant difference in hematologic or genitourinary acute toxicity between groups. In addition, pathologic complete response rates and postoperative morbidity between treatment groups did not differ significantly. Conclusions: In the management of rectal cancer, IMRT is associated with a

  20. Reduced acute bowel toxicity in patients treated with intensity-modulated radiotherapy for rectal cancer.

    Science.gov (United States)

    Samuelian, Jason M; Callister, Matthew D; Ashman, Jonathan B; Young-Fadok, Tonia M; Borad, Mitesh J; Gunderson, Leonard L

    2012-04-01

    We have previously shown that intensity-modulated radiotherapy (IMRT) can reduce dose to small bowel, bladder, and bone marrow compared with three-field conventional radiotherapy (CRT) technique in the treatment of rectal cancer. The purpose of this study was to review our experience using IMRT to treat rectal cancer and report patient clinical outcomes. A retrospective review was conducted of patients with rectal cancer who were treated at Mayo Clinic Arizona with pelvic radiotherapy (RT). Data regarding patient and tumor characteristics, treatment, acute toxicity according to the Common Terminology Criteria for Adverse Events v 3.0, tumor response, and perioperative morbidity were collected. From 2004 to August 2009, 92 consecutive patients were treated. Sixty-one (66%) patients were treated with CRT, and 31 (34%) patients were treated with IMRT. All but 2 patients received concurrent chemotherapy. There was no significant difference in median dose (50.4 Gy, CRT; 50 Gy, IMRT), preoperative vs. postoperative treatment, type of concurrent chemotherapy, or history of previous pelvic RT between the CRT and IMRT patient groups. Patients who received IMRT had significantly less gastrointestinal (GI) toxicity. Sixty-two percent of patients undergoing CRT experienced ≥Grade 2 acute GI side effects, compared with 32% among IMRT patients (p = 0.006). The reduction in overall GI toxicity was attributable to fewer symptoms from the lower GI tract. Among CRT patients, ≥Grade 2 diarrhea and enteritis was experienced among 48% and 30% of patients, respectively, compared with 23% (p = 0.02) and 10% (p = 0.015) among IMRT patients. There was no significant difference in hematologic or genitourinary acute toxicity between groups. In addition, pathologic complete response rates and postoperative morbidity between treatment groups did not differ significantly. In the management of rectal cancer, IMRT is associated with a clinically significant reduction in lower GI toxicity

  1. The importance of prostate bed tilt during postprostatectomy intensity-modulated radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Bell, Linda J., E-mail: Linda.Bell1@health.nsw.gov.au [Northern Sydney Cancer Centre, Radiation Oncology Department, Royal North Shore Hospital, St Leonards, New South Wales (Australia); Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales (Australia); Cox, Jennifer [Northern Sydney Cancer Centre, Radiation Oncology Department, Royal North Shore Hospital, St Leonards, New South Wales (Australia); Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales (Australia); Eade, Thomas; Rinks, Marianne; Kneebone, Andrew [Northern Sydney Cancer Centre, Radiation Oncology Department, Royal North Shore Hospital, St Leonards, New South Wales (Australia)

    2014-10-01

    Variations in rectal and bladder filling can create a tilt of the prostate bed, which generates the potential for a geographic miss during postprostatectomy radiotherapy. The aim of this study is to assess the effect that bladder and rectum filling has on planning target volume angle, to determine a method to assess prostate bed tilt leading to potential geographic miss, and to discuss possible implementation issues. The cone-beam computed tomography images (n = 377) of 40 patients who received postprostatectomy radiotherapy with intensity-modulated radiotherapy were reviewed. The amount of tilt in the prostate bed was defined as the angle change between 2 surgical clips, one in the upper prostate bed and another in the lower. A potential geographic miss was defined as movement of any clip of more than 1 cm in any direction or 0.5 cm posteriorly when aligned to bone anatomy. Variations in bladder and rectum size were correlated with the degree of prostate bed tilt, and the rate of potential geographic miss was determined. A possible clinical use of prostate bed tilt was then assessed for different imaging techniques. A tilt of more than 10° was seen in 20.2% of images, which resulted in a 57.9% geographic miss rate of the superior clip. When tilt remained within 10°, there was only a 9% rate of geographic miss. Potential geographic miss of the inferior surgical clip was rare, occurring in only 1.9% of all images reviewed. The most common occurrence when the prostate bed tilt increased by more than 10° was a smaller bladder and larger rectum (6.4% of all images). The most common occurrence when the prostate bed tilt decreased by more than 10° was a larger bladder and smaller rectum (1.3% of all images). Significant prostate bed tilt (>± 10°) occurred in more than 20% of images, creating a 58% rate of geographic miss. Greatest prostate bed tilt occurred when the bladder size increased or reduced by more than 2 cm or the superior rectum size increased by more

  2. Neural stem cell sparing by linac based intensity modulated stereotactic radiotherapy in intracranial tumors

    International Nuclear Information System (INIS)

    Oehler, Julia; Brachwitz, Tim; Wendt, Thomas G; Banz, Nico; Walther, Mario; Wiezorek, Tilo

    2013-01-01

    Neurocognitive decline observed after radiotherapy (RT) for brain tumors in long time survivors is attributed to radiation exposure of the hippocampus and the subventricular zone (SVZ). The potential of sparing capabilities for both structures by optimized intensity modulated stereotactic radiotherapy (IMSRT) is investigated. Brain tumors were irradiated by stereotactic 3D conformal RT or IMSRT using m3 collimator optimized for PTV and for sparing of the conventional OARs (lens, retina, optic nerve, chiasm, cochlea, brain stem and the medulla oblongata). Retrospectively both hippocampi and SVZ were added to the list of OAR and their dose volume histograms were compared to those from two newly generated IMSRT plans using 7 or 14 beamlets (IMSRT-7, IMSRT-14) dedicated for optimized additional sparing of these structures. Conventional OAR constraints were kept constant. Impact of plan complexity and planning target volume (PTV) topography on sparing of both hippocampi and SVZ, conformity index (CI), the homogeneity index (HI) and quality of coverage (QoC) were analyzed. Limits of agreement were used to compare sparing of stem cell niches with either IMSRT-7 or IMSRT-14. The influence of treatment technique related to the topography ratio between PTV and OARs, realized in group A-D, was assessed by a mixed model. In 47 patients CI (p ≤ 0.003) and HI (p < 0.001) improved by IMSRT-7, IMSRT-14, QoC remained stable (p ≥ 0.50) indicating no compromise in radiotherapy. 90% of normal brain was exposed to a significantly higher dose using IMSRT. IMSRT-7 plans resulted in significantly lower biologically effective doses at all four neural stem cell structures, while contralateral neural stem cells are better spared compared to ipsilateral. A further increase of the number of beamlets (IMSRT-14) did not improve sparing significantly, so IMSRT-7 and IMSRT-14 can be used interchangeable. Patients with tumors contacting neither the subventricular zone nor the cortex benefit

  3. Comparing of dose distribution between intensity-modulated radiotherapy simultaneous integrated boost and conventional radiotherapy for cervical cancer patients

    International Nuclear Information System (INIS)

    Zhu Lihong; Xu Bo; Wu Hao; Su Xing; Han Shukui

    2009-01-01

    Objective: To assess the feasibility of applying intensity-modulated radiotherapy (IMRT) simultaneous integrated boost (SIB) to replace conventional radiotherapy (CR) plus brachytherapy of whole pelvis in locally advanced cervical cancer (LACC). Methods: Five LACC patients based difference position of uterus were chosen and worked out CR and IMRT SIB plans respectively. Dose distributions were compared between IMRT SIB and CR. Results: When uterus was in ante-,neutral-, retro-pnsition and deviation respectively, IMRT SIB could provide enough and homogeneous dose distribution for target volume and reduce irradiated volumes and doses for organs at risk (recta, bladder and small intestine) than CR. The doses of the A, B, and fundus of uterus were higher in IMRT SIB than CR. However, in ease of small intestine was close to or encircled the uterus, the targets volume dose would be inadequacy. Conclusions: LACC IMRT SIB's dose distribution is better than CR (except excess ante-position) and may help to treat those patients who couldn't be suitable with brachytherapy. (authors)

  4. Magnetic resonance sialography for investigating major salivary gland duct system after intensity-modulated radiotherapy of nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Ou Dan; He Xiayun; Zhang Yunyan

    2013-01-01

    We investigated the value of magnetic resonance sialography for evaluating xerostomia induced by intensity-modulated radiotherapy for nasopharyngeal carcinoma. Fourteen patients with nasopharyngeal carcinoma were treated with intensity-modulated radiotherapy. Salivary function was assessed by magnetic resonance sialography and subjective evaluation criteria pre-treatment, 1 week and 1 year post-radiotherapy. A magnetic resonance sialography categorical scoring system was used to compare the visibility of salivary ducts. The average mean dose was 38.93 Gy to the parotid glands and 59.34 Gy to the submandibular glands. Before radiotherapy, the visibility scores of both the parotid and submandibular ducts increased after secretion stimulation. The scores decreased and the response to stimulation was attenuated 1 week post-radiotherapy. For most of the parotid ducts, the visibility score improved at 1 year post-radiotherapy both at rest and under stimulation, but not for the submandibular ducts. With a median follow-up of 12.3 months, 8/12 patients had grade 1 xerostomia and 4/12 had grade 2 xerostomia. Magnetic resonance sialography allows non-invasive evaluation of radiation-induced ductal changes in the major salivary glands and enables reliable prediction of radiation-induced xerostomia. (author)

  5. Evaluation of detector array technology for the verification of advanced intensity-modulated radiotherapy

    Science.gov (United States)

    Hussien, Mohammad

    Purpose: Quality assurance (QA) for intensity modulated radiotherapy (IMRT) has evolved substantially. In recent years, various ionization chamber or diode detector arrays have become commercially available, allowing pre-treatment absolute dose verification with near real-time results. This has led to a wide uptake of this technology to replace point dose and film dosimetry and to facilitate QA streamlining. However, arrays are limited by their spatial resolution giving rise to concerns about their response to clinically relevant deviations. The common factor in all commercial array systems is the reliance on the gamma index (γ) method to provide the quantitative evaluation of the measured dose distribution against the Treatment Planning System (TPS) calculated dose distribution. The mathematical definition of the gamma index presents computational challenges that can cause a variation in the calculation in different systems. The purpose of this thesis was to evaluate the suitability of detector array systems, combined with their implementation of the gamma index, in the verification and dosimetry audit of advanced IMRT. Method: The response of various commercial detector array systems (Delta4®, ArcCHECK®, and the PTW 2D-Array seven29™ and OCTAVIUS II™ phantom combination, Gafchromic® EBT2 and composite EPID measurements) to simulated deliberate changes in clinical IMRT and VMAT plans was evaluated. The variability of the gamma index calculation in the different systems was also evaluated by comparing against a bespoke Matlab-based gamma index analysis software. A novel methodology for using a commercial detector array in a dosimetry audit of rotational radiotherapy was then developed. Comparison was made between measurements using the detector array and those performed using ionization chambers, alanine and radiochromic film. The methodology was developed as part of the development of a national audit of rotational radiotherapy. Ten cancer centres were

  6. Intensity Modulated Radiotherapy (IMRT) in the postoperative treatment of an adenocarcinoma of the endometrium complicated by a pelvic kidney

    OpenAIRE

    Castilho, Marcus S; Jacinto, Alexandre A; Viani, Gustavo A; Campana, Andre; Carvalho, Juliana; Ferrigno, Robson; Novaes, Paulo ERS; Fogaroli, Ricardo C; Salvajoli, Joao V

    2006-01-01

    Abstract Background Pelvic Radiotherapy (RT) as a postoperative treatment for endometrial cancer improves local regional control. Brachytherapy also improves vaginal control. Both treatments imply significant side effects that a fine RT technique can help avoiding. Intensity Modulated RT (IMRT) enables the treatment of the target volume while protecting normal tissue. It therefore reduces the incidence and severity of side effects. Case We report on a 50 year-old patient with a serous-papilif...

  7. Toxicity after post-prostatectomy image-guided intensity-modulated radiotherapy using Australian guidelines.

    Science.gov (United States)

    Chin, Stephen; Aherne, Noel J; Last, Andrew; Assareh, Hassan; Shakespeare, Thomas P

    2017-12-01

    We evaluated single institution toxicity outcomes after post-prostatectomy radiotherapy (PPRT) via image-guided intensity-modulated radiation therapy (IG-IMRT) with implanted fiducial markers following national eviQ guidelines, for which late toxicity outcomes have not been published. Prospectively collected toxicity data were retrospectively reviewed for 293 men who underwent 64-66 Gy IG-IMRT to the prostate bed between 2007 and 2015. Median follow-up after PPRT was 39 months. Baseline grade ≥2 genitourinary (GU), gastrointestinal (GI) and sexual toxicities were 20.5%, 2.7% and 43.7%, respectively, reflecting ongoing toxicity after radical prostatectomy. Incidence of new (compared to baseline) acute grade ≥2 GU and GI toxicity was 5.8% and 10.6%, respectively. New late grade ≥2 GU, GI and sexual toxicity occurred in 19.1%, 4.7% and 20.2%, respectively. However, many patients also experienced improvements in toxicities. For this reason, prevalence of grade ≥2 GU, GI and sexual toxicities 4 years after PPRT was similar to or lower than baseline (21.7%, 2.6% and 17.4%, respectively). There were no grade ≥4 toxicities. Post-prostatectomy IG-IMRT using Australian contouring guidelines appears to have tolerable acute and late toxicity. The 4-year prevalence of grade ≥2 GU and GI toxicity was virtually unchanged compared to baseline, and sexual toxicity improved over baseline. This should reassure radiation oncologists following these guidelines. Late toxicity rates of surgery and PPRT are higher than following definitive IG-IMRT, and this should be taken into account if patients are considering surgery and likely to require PPRT. © 2017 The Royal Australian and New Zealand College of Radiologists.

  8. Candidate Dosimetric Predictors of Long-Term Swallowing Dysfunction After Oropharyngeal Intensity-Modulated Radiotherapy

    International Nuclear Information System (INIS)

    Schwartz, David L.; Hutcheson, Katherine; Barringer, Denise; Tucker, Susan L.; Kies, Merrill; Holsinger, F. Christopher; Ang, K. Kian; Morrison, William H.; Rosenthal, David I.; Garden, Adam S.; Dong Lei; Lewin, Jan S.

    2010-01-01

    Purpose: To investigate long-term swallowing function in oropharyngeal cancer patients treated with intensity-modulated radiotherapy (IMRT), and to identify novel dose-limiting criteria predictive for dysphagia. Methods and Materials: Thirty-one patients with Stage IV oropharyngeal squamous carcinoma enrolled on a Phase II trial were prospectively evaluated by modified barium swallow studies at baseline, and 6, 12, and 24 months post-IMRT treatment. Candidate dysphagia-associated organs at risk were retrospectively contoured into original treatment plans. Twenty-one (68%) cases were base of tongue and 10 (32%) were tonsil. Stage distribution was T1 (12 patients), T2 (10), T3 (4), T4 (2), and TX (3), and N2 (24), N3 (5), and NX (2). Median age was 52.8 years (range, 42-78 years). Thirteen patients (42%) received concurrent chemotherapy during IMRT. Thirteen (42%) were former smokers. Mean dose to glottic larynx for the cohort was limited to 18 Gy (range, 6-39 Gy) by matching IMRT to conventional low-neck fields. Results: Dose-volume constraints (V30 < 65% and V35 < 35% for anterior oral cavity and V55 < 80% and V65 < 30% for high superior pharyngeal constrictors) predictive for objective swallowing dysfunction were identified by univariate and multivariate analyses. Aspiration and feeding tube dependence were observed in only 1 patient at 24 months. Conclusions: In the context of glottic laryngeal shielding, we describe candidate oral cavity and superior pharyngeal constrictor organs at risk and dose-volume constraints associated with preserved long-term swallowing function; these constraints are currently undergoing prospective validation. Strict protection of the glottic larynx via beam-split IMRT techniques promises to make chronic aspiration an uncommon outcome.

  9. Dosimetric comparison using different multileaf collimeters in intensity-modulated radiotherapy for upper thoracic esophageal cancer

    Directory of Open Access Journals (Sweden)

    Fu Yuchuan

    2010-07-01

    Full Text Available Abstract Purpose To study the impacts of multileaf collimators (MLC width [standard MLC width of 10 mm (sMLC and micro-MLC width of 4 mm (mMLC] in the intensity-modulated radiotherapy (IMRT planning for the upper thoracic esophageal cancer (UTEC. Methods and materials 10 patients with UTEC were retrospectively planned with the sMLC and the mMLC. The monitor unites (MUs and dose volume histogram-based parameters [conformity index (CI and homogeneous index (HI] were compared between the IMRT plans with sMLC and with mMLC. Results The IMRT plans with the mMLC were more efficient (average MUs: 703.1 ± 68.3 than plans with the sMLC (average MUs: 833.4 ± 73.8 (p p 5 (3260.3 ± 374.0 vs 3404.5 ± 374.4/gEUD (1815.1 ± 281.7 vs 1849.2 ± 297.6 of the spinal cord, the V10 (33.2 ± 6.5 vs 34.0 ± 6.7, V20 (16.0 ± 4.6 vs 16.6 ± 4.7, MLD (866.2 ± 174.1 vs 887.9 ± 172.1 and gEUD (938.6 ± 175.2 vs 956.8 ± 171.0 of the lungs were observed in the plans with the mMLC, respectively (p Conclusions Comparing to the sMLC, the mMLC not only demonstrated higher efficiencies and more optimal target coverage, but also considerably improved the dose sparing of OARs in the IMRT planning for UTEC.

  10. Carotid sparing intensity modulated radiotherapy on early glottic cancer: Preliminary study

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Hoon Sik; Jeong, Bae Kwon; Jeong, Ho Jin; Song, Jin Ho; Kim, Jin Pyeong; Park, Jung Je; Woo, Seung Hoon; Kang, Ki Mun [Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju (Korea, Republic of)

    2016-03-15

    To compare the dose distribution between carotid sparing intensity modulated radiotherapy (IMRT) and opposed lateral field technique (LAFT), and to determine the effects of carotid sparing IMRT in early glottic cancer patients who have risk factors for atherosclerosis. Ten early glottic cancer patients were treated with carotid sparing IMRT. For each patient, the conventional LAFT plan was developed for comparison. IMRT and LAFT plans were compared in terms of planning target volume (PTV) coverage, conformity index, homogeneity index, and the doses to planning organ at risk volume (PRV) for carotid arteries, spinal cord and pharyngeal constrictor muscle. Recurrence was not observed in any patients during the follow-up period. V95% for PTV showed no significant difference between IMRT and LAFT plans, while V100% was significantly higher in the IMRT plan (95.5% vs. 94.6%, p = 0.005). The homogeneity index (11.6%) and conformity index (1.4) in the IMRT plan were significantly better than those in the LAFT plans (8.5% and 5.1, respectively) (p = 0.005). The median V5Gy (90.0%), V25Gy (13.5%), and V50Gy (0%) for carotid artery PRV in the IMRT plan were significantly lower than those in the LAFT plan (99.1%, 89.0%, and 77.3%, respectively) (p = 0.005). Our study suggests that carotid sparing IMRT can significantly decrease the dose to carotid arteries compared to LAFT, and it would be considered for early glottic cancer patient with high risk of atherosclerosis.

  11. Quality assurance and dosimetric analysis of intensity modulation radiotherapy using compensators for head and neck cancers

    Science.gov (United States)

    Tyagi, Atul; Nangia, Sapna; Chufal, Kundan S.; Mishra, Maninder B.; Ghosh, Dhananjay; Supe, Sanjay S.; Singh, Man P.

    2009-01-01

    In this study we describe our experience in implementing compensator based intensity modulated radiotherapy (cIMRT) for head and neck cancer with regard to pre treatment quality assurance (QA), dosimetric parameters and other technical detail. This study represents the analysis of initial 48 patients who underwent cIMRT for head and neck cancers. All patients were treated with pre treatment QA in terms of point dose with ion chamber and spatial dose comparison with film dosimetry. In our study for all 48 patients, compensators revealed a deviation in central axis dose of 2% ± 1.8% in terms of cumulative calculated versus measured dose. Target coverage for high dose volume (70 Gy) was adequate in terms of volume receiving 93% and 95% of the prescription dose, which was 98.5% and 97.5% respectively. Parotid and other critical organs were spared adequately. Contralateral parotid (CLP) was spared. V30 Gy and V35 Gy was 55.9% and 36.8% for CLP and average dose was 31.7 Gy. Median variation in cumulative measured dose versus cumulative calculated dose was 1.8% (SD + 1.8) and mean variation was 2.5% (95%CI 1.5, 2.6). Range was 0 to 7%. cIMRT is practically feasible. Our QA tests revealed high degree of concordance between cumulative measured doses versus cumulative calculated doses. All dosimetric parameters were within acceptable limits. The manufacturing of compensator is cumbersome but it is a one time job followed by easy treatment delivery and simple QA procedure, high monitor unit (MU) efficiency and less treatment time. cIMRT is easy to implement and now can be applied to larger number of patients with different type of tumor.

  12. Concurrent chemotherapy for T4 classification nasopharyngeal carcinoma in the era of intensity-modulated radiotherapy.

    Directory of Open Access Journals (Sweden)

    Cai-neng Cao

    Full Text Available To evaluate concurrent chemotherapy for T4 classification nasopharyngeal carcinoma (NPC treated by intensity-modulated radiotherapy (IMRT.From July 2004 to June 2011, 180 non-metastatic T4 classification NPC patients were retrospectively analyzed. Of these patients, 117 patients were treated by concurrent chemoradiotherapy (CCRT using IMRT and 63 cases were treated by IMRT alone.The median follow-up time was 58.97 months (range, 2.79-114.92 months. For all the patients, the 1, 3 and 5-year local failure-free survival (LFFS rates were 97.7%, 89.2% and 85.9%, regional failure free survival (RFFS rates were 98.9%, 94.4% and 94.4%, distant failure-free survival (DFFS rates were 89.7%, 79.9% and 76.2%, and overall survival (OS rates were 92.7%, 78.9% and 65.3%, respectively. No statistically significant difference was observed in LFFS, RFFS, DFFS and OS between the CCRT group and the IMRT alone group. No statistically significant difference was observed in acute toxicity except leukopenia (p = 0.000 during IMRT between the CCRT group and the IMRT alone group.IMRT alone for T4 classification NPC achieved similar treatment outcomes in terms of disease local control and overall survival as compared to concurrent chemotherapy plus IMRT. However, this is a retrospective study with a limited number of patients, such results need further investigation in a prospective randomized clinical trial.

  13. Acceleration of intensity-modulated radiotherapy dose calculation by importance sampling of the calculation matrices

    International Nuclear Information System (INIS)

    Thieke, Christian; Nill, Simeon; Oelfke, Uwe; Bortfeld, Thomas

    2002-01-01

    In inverse planning for intensity-modulated radiotherapy, the dose calculation is a crucial element limiting both the maximum achievable plan quality and the speed of the optimization process. One way to integrate accurate dose calculation algorithms into inverse planning is to precalculate the dose contribution of each beam element to each voxel for unit fluence. These precalculated values are stored in a big dose calculation matrix. Then the dose calculation during the iterative optimization process consists merely of matrix look-up and multiplication with the actual fluence values. However, because the dose calculation matrix can become very large, this ansatz requires a lot of computer memory and is still very time consuming, making it not practical for clinical routine without further modifications. In this work we present a new method to significantly reduce the number of entries in the dose calculation matrix. The method utilizes the fact that a photon pencil beam has a rapid radial dose falloff, and has very small dose values for the most part. In this low-dose part of the pencil beam, the dose contribution to a voxel is only integrated into the dose calculation matrix with a certain probability. Normalization with the reciprocal of this probability preserves the total energy, even though many matrix elements are omitted. Three probability distributions were tested to find the most accurate one for a given memory size. The sampling method is compared with the use of a fully filled matrix and with the well-known method of just cutting off the pencil beam at a certain lateral distance. A clinical example of a head and neck case is presented. It turns out that a sampled dose calculation matrix with only 1/3 of the entries of the fully filled matrix does not sacrifice the quality of the resulting plans, whereby the cutoff method results in a suboptimal treatment plan

  14. An algorithm for fast beam angle selection in intensity modulated radiotherapy.

    Science.gov (United States)

    Vaitheeswaran, R; Narayanan, V K Sathiya; Bhangle, Janhavi R; Nirhali, Amit; Kumar, Namitha; Basu, Sumit; Maiya, Vikram

    2010-12-01

    This article aims to introduce a novel algorithm for fast beam angle selection in intensity modulated radiotherapy (IMRT). The algorithm models the optimization problem as a beam angle ranking problem and chooses suitable beam angles according to their rank. A new parameter called "beam intensity profile perturbation score (BIPPS)" is used for ranking the beam angles. The BIPPS-based beam angle ranking implicitly accounts for the dose-volume effects of the involved structures. A simulated phantom case with obvious optimal beam angles is used to verify the validity of the presented technique. In addition, the efficiency of the algorithm was examined in three clinical cases (prostate, pancreas, and head and neck) in terms of DVH and dose distribution. In all cases, the judgment of the algorithm's efficiency was based on the comparison between plans with equidistant beams (equal-angle-plan) and plans with beams obtained using the algorithm (suitable-angle-plan). It is observed from the study that the beam angle ranking function over BIPPS instantly picks up a suitable set of beam angles for a specific case. It takes only about 15 min for choosing the suitable beam angles even for the most complicated cases. The DVHs and dose distributions confirm that the proposed algorithm can efficiently reduce the mean or maximum dose to OARs, while guaranteeing the target coverage and dose uniformity. On the average, about 17% reduction in the mean dose to critical organs, such as rectum, bladder, kidneys and parotids, is observed. Also, about 12% (averaged) reduction in the maximum dose to critical organs (spinal cord) is observed in the clinical cases presented in this study. This study demonstrates that the algorithm can be effectively applied to IMRT scenarios to get fast and case specific beam angle configurations.

  15. Concurrent Chemotherapy and Intensity-Modulated Radiotherapy for Locoregionally Advanced Laryngeal and Hypopharyngeal Cancers

    International Nuclear Information System (INIS)

    Lee, Nancy Y.; O'Meara, William; Chan, Kelvin; Della-Bianca, Cesar; Mechalakos, James G.; Zhung, Joanne; Wolden, Suzanne L.; Narayana, Ashwatha; Kraus, Dennis; Shah, Jatin P.; Pfister, David G.

    2007-01-01

    Purpose: To perform a retrospective review of laryngeal/hypopharyngeal carcinomas treated with concurrent chemotherapy and intensity-modulated radiotherapy (IMRT). Methods and Materials: Between January 2002 and June 2005, 20 laryngeal and 11 hypopharyngeal carcinoma patients underwent IMRT with concurrent platinum-based chemotherapy; most patients had Stage IV disease. The prescription of the planning target volume for gross, high-risk, and low-risk subclinical disease was 70, 59.4, and 54 Gy, respectively. Acute/late toxicities were retrospectively scored using the Common Toxicity Criteria scale. The 2-year local progression-free, regional progression-free, laryngectomy-free, distant metastasis-free, and overall survival rates were calculated using the Kaplan-Meier method. Results: The median follow-up of the living patients was 26 months (range, 17-58 months). The 2-year local progression-free, regional progression-free, laryngectomy-free, distant metastasis-free, and overall survival rate was 86%, 94%, 89%, 92%, and 63%, respectively. Grade 2 mucositis or higher occurred in 48% of patients, and all experienced Grade 2 or higher pharyngitis during treatment. Xerostomia continued to decrease over time from the end of RT, with none complaining of Grade 2 toxicity at this analysis. The 2-year post-treatment percutaneous endoscopic gastrostomy-dependency rate for those with hypopharyngeal and laryngeal tumors was 31% and 15%, respectively. The most severe late complications were laryngeal necrosis, necrotizing fascitis, and a carotid rupture resulting in death 3 weeks after salvage laryngectomy. Conclusion: These preliminary results have shown that IMRT achieved encouraging locoregional control of locoregionally advanced laryngeal and hypopharyngeal carcinomas. Xerostomia improved over time. Pharyngoesophageal stricture with percutaneous endoscopic gastrostomy dependency remains a problem, particularly for patients with hypopharyngeal carcinoma and, to a lesser

  16. Intensity-Modulated Radiotherapy for Head and Neck Cancer of Unknown Primary: Toxicity and Preliminary Efficacy

    International Nuclear Information System (INIS)

    Klem, Michelle L.; Mechalakos, James G.; Wolden, Suzanne L.; Zelefsky, Michael J.; Singh, Bhuvanesh; Kraus, Dennis; Shaha, Ashok; Shah, Jatin; Pfister, David G.; Lee, Nancy Y.

    2008-01-01

    Purpose: Unknown primary head and neck cancers often require comprehensive mucosal and bilateral neck irradiation. With conventional techniques, significant toxicity can develop. Intensity-modulated radiotherapy (IMRT) has the potential to minimize the toxicity. Methods and Materials: Between 2000 and 2005, 21 patients underwent IMRT for unknown primary head and neck cancer at our center. Of the 21 patients, 5 received IMRT with definitive intent and 16 as postoperative therapy; 14 received concurrent chemotherapy and 7 IMRT alone. The target volumes included the bilateral neck and mucosal surface. The median dose was 66 Gy. Acute and chronic toxicities, esophageal strictures, and percutaneous endoscopic gastrostomy tube dependence were evaluated. Progression-free survival, regional progression-free survival, distant metastasis-free survival, and overall survival were estimated with Kaplan-Meier curves. Results: With a median follow-up of 24 months, the 2-year regional progression-free survival, distant metastasis-free survival, and overall survival rate was 90%, 90%, and 85%, respectively. Acute grade 1 and 2 xerostomia was seen in 57% and 43% of patients, respectively. Salivary function improved with time. Percutaneous endoscopic gastrostomy tube placement was required in 72% with combined modality treatment and 43% with IMRT alone. Only 1 patient required percutaneous endoscopic gastrostomy support at the last follow-up visit. Two patients treated with combined modality and one treated with IMRT alone developed esophageal strictures, but all had improvement or resolution with dilation. Conclusion: The preliminary analysis of IMRT for unknown primary head and neck cancer has shown acceptable toxicity and encouraging efficacy. The analysis of the dosimetric variables showed excellent tumor coverage and acceptable doses to critical normal structures. Esophageal strictures developed but were effectively treated with dilation. Techniques to limit the esophageal dose

  17. Dosimetric validation of new semiconductor diode dosimetry system for intensity modulated radiotherapy

    Directory of Open Access Journals (Sweden)

    Rajesh Kinhikar

    2012-01-01

    Full Text Available Introduction: The new diode Isorad was validated for intensity modulated radiotherapy (IMRT and the observations during the validation are reported. Materials and Methods: The validation includes intrinsic precision, post-irradiation stability, dose linearity, dose-rate effect, angular response, source to surface (SSD dependence, field size dependence, and dose calibration. Results: The intrinsic precision of the diode was more than 1% (1 σ. The linearity found in the whole range of dose analyzed was 1.93% (R 2 = 1. The minimum and maximum variation in the measured and calculated dose were found to be 0.78% (with 25 MU at ioscentre and 4.8% (with 1000 MU at isocentre, respectively. The maximal variation in angular response with respect to arbitrary angle 0° found was 1.31%. The diode exhibited a 51.7% and 35% decrease in the response in the 35 cm and 20 cm SSD range, respectively. The minimum and the maximum variation in the measured dose from the diode and calculated dose were 0.82% (5 cm × 5 cm and 3.75% (30 cm × 30 cm, respectively. At couch 270°, the response of the diode was found to vary maximum by 1.4% with ΁ 60 gantry angle. Mean variation between measured dose with diode and planned dose by TPS was found to be 1.3% (SD 0.75 for IMRT patient-specific quality assurance. Conclusion: For the evaluation of IMRT, use of cylindrical diode is strongly recommended.

  18. Is Planned Neck Dissection Necessary for Head and Neck Cancer After Intensity-Modulated Radiotherapy?

    International Nuclear Information System (INIS)

    Yao Min; Hoffman, Henry T.; Chang, Kristi; Funk, Gerry F.; Smith, Russell B.; Tan Huaming; Clamon, Gerald H.; Dornfeld, Ken; Buatti, John M.

    2007-01-01

    Purpose: The objective of this study was to determine regional control of local regional advanced head and neck squamous cell carcinoma (HNSCC) treated with intensity-modulated radiotherapy (IMRT), along with the role and selection criteria for neck dissection after IMRT. Methods and Materials: A total of 90 patients with stage N2A or greater HNSCC were treated with definitive IMRT from December 1999 to July 2005. Three clinical target volumes were defined and were treated to 70 to 74 Gy, 60 Gy, and 54 Gy, respectively. Neck dissection was performed for selected patients after IMRT. Selection criteria evolved during this period with emphasis on post-IMRT [ 18 F] fluorodeoxyglucose positron emission tomography in recent years. Results: Median follow-up for all patients was 29 months (range, 0.2-74 months). All living patients were followed at least 9 months after completing treatment. Thirteen patients underwent neck dissection after IMRT because of residual lymphadenopathy. Of these, 6 contained residual viable tumor. Three patients with persistent adenopathy did not undergo neck dissection: 2 refused and 1 had lung metastasis. Among the remaining 74 patients who were observed without neck dissection, there was only 1 case of regional failure. Among all 90 patients in this study, the 3-year local and regional control was 96.3% and 95.4%, respectively. Conclusions: Appropriately delivered IMRT has excellent dose coverage for cervical lymph nodes. A high radiation dose can be safely delivered to the abnormal lymph nodes. There is a high complete response rate. Routine planned neck dissection for patients with N2A and higher stage after IMRT is not necessary. Post-IMRT [ 18 F] fluorodeoxyglucose positron emission tomography is a useful tool in selecting patients appropriate for neck dissection

  19. Comparison of intensity-modulated radiotherapy and 3-dimensional conformal radiotherapy as adjuvant therapy for gastric cancer.

    Science.gov (United States)

    Minn, A Yuriko; Hsu, Annie; La, Trang; Kunz, Pamela; Fisher, George A; Ford, James M; Norton, Jeffrey A; Visser, Brendan; Goodman, Karyn A; Koong, Albert C; Chang, Daniel T

    2010-08-15

    The current study was performed to compare the clinical outcomes and toxicity in patients treated with postoperative chemoradiotherapy for gastric cancer using intensity-modulated radiotherapy (IMRT) versus 3-dimensional conformal radiotherapy (3D CRT). Fifty-seven patients with gastric or gastroesophageal junction cancer were treated postoperatively: 26 with 3D CRT and 31 with IMRT. Concurrent chemotherapy was capecitabine (n=31), 5-fluorouracil (5-FU) (n=25), or none (n=1). The median radiation dose was 45 Gy. Dose volume histogram parameters for kidney and liver were compared between treatment groups. The 2-year overall survival rates for 3D CRT versus IMRT were 51% and 65%, respectively (P=.5). Four locoregional failures occurred each in the 3D CRT (15%) and the IMRT (13%) patients. Grade>or=2 acute gastrointestinal toxicity was found to be similar between the 3D CRT and IMRT patients (61.5% vs 61.2%, respectively) but more treatment breaks were needed (3 vs 0, respectively). The median serum creatinine from before radiotherapy to most recent creatinine was unchanged in the IMRT group (0.80 mg/dL) but increased in the 3D CRT group from 0.80 mg/dL to 1.0 mg/dL (P=.02). The median kidney mean dose was higher in the IMRT versus the 3D CRT group (13.9 Gy vs 11.1 Gy; P=.05). The median kidney V20 was lower for the IMRT versus the 3D CRT group (17.5% vs 22%; P=.17). The median liver mean dose for IMRT and 3D CRT was 13.6 Gy and 18.6 Gy, respectively (P=.19). The median liver V30 was 16.1% and 28%, respectively (PCancer Society.

  20. Intensity Modulated Radiotherapy (IMRT and Fractionated Stereotactic Radiotherapy (FSRT for children with head-and-neck-rhabdomyosarcoma

    Directory of Open Access Journals (Sweden)

    Huber Peter E

    2007-09-01

    Full Text Available Abstract Background The present study evaluates the outcome of 19 children with rhabdomyosarcoma of the head-and-neck region treated with Intensity Modulated Radiotherapy (IMRT or Fractionated Stereotactic Radiotherapy (FSRT between August 1995 and November 2005. Methods We treated 19 children with head-and-neck rhabdomyosarcoma with FSRT (n = 14 or IMRT (n = 5 as a part of multimodal therapy. Median age at the time of radiation therapy was 5 years (range 2–15 years. All children received systemic chemotherapy according to the German Soft Tissue Sarcoma Study protocols. Median size of treatment volume for RT was 93,4 ml. We applied a median total dose of 45 Gy (range 32 Gy – 54 Gy using a median fractionation of 5 × 1,8 Gy/week (range 1,6 Gy – 1,8 Gy. The median time interval between primary diagnosis and radiation therapy was 5 months (range 3–9 months. Results After RT, the 3- and 5-year survival rate was 94%. The 3- and 5-year actuarial local control rate after RT was 89%. The actuarial freedom of distant metastases rate at 3- and 5-years was 89% for all patients. Radiotherapy was well tolerated in all children and could be completed without interruptions > 4 days. No toxicities >CTC grade 2 were observed. The median follow-up time after RT was 17 months. Conclusion IMRT and FSRT lead to excellent outcome in children with head-and-neck RMS with a low incidence of treatment-related side effects.

  1. Intensity modulated radiotherapy of upper abdominal malignancies: dosimetric comparison with 3D conformal radiotherapy and acute toxicity

    International Nuclear Information System (INIS)

    Nour, Alaa Ahmad; Alaradi, Aziz; Mohamed, Adel; Altuwaijri, Saleh; Rudat, Volker

    2013-01-01

    The goal of this study was to assess a possible dosimetric advantage of intensity modulated radiotherapy (IMRT) of upper abdominal malignancies compared to three-dimensional conformal radiotherapy (3DCRT), and to assess the impact of IMRT on acute toxicity. Thirty-one unselected consecutive patients with upper abdominal malignancies were treated with definitive (n =16) or postoperative (n =15) IMRT. Twenty-one patients (67.7%) received concomitant chemotherapy. 3DCRT plans were generated for comparison, and analysis of variance (ANOVA) for repeated measurements was used to test for significant difference of dosimetric parameters. Acute toxicity was assessed weekly using the Common Terminology Criteria for Adverse Events (CTCAE) grading scale. IMRT plans showed a small but statistically significant improvement of the conformity index compared to 3DCRT plans (difference (95% confidence interval), -0.06 (−0.109 to-0.005); p = 0.03). The homogeneity index was not significantly improved (p = 0.10). A significantly reduced high dose volume on cost of a significantly increased low dose volume was observed for the kidneys. The acute toxicity appeared to be less than commonly reported for corresponding patients treated with 3DCRT. No patient developed grade 3 or 4 non-hematological acute toxicity, and the most common grade 2 toxicity was vomiting (9.7%). IMRT offers the potential of a clinically relevant dosimetric advantage compared to 3DCRT in terms of a reduced acute toxicity. Further optimization of the radiotherapy technique and more clinical trials are required before IMRT is routinely used for upper abdominal malignancies

  2. Dosimetric Comparison of Three Different Involved Nodal Irradiation Techniques for Stage II Hodgkin's Lymphoma Patients: Conventional Radiotherapy, Intensity-Modulated Radiotherapy, and Three-Dimensional Proton Radiotherapy

    International Nuclear Information System (INIS)

    Chera, Bhishamjit S.; Rodriguez, Christina; Morris, Christopher G.; Louis, Debbie; Yeung, Daniel; Li Zuofeng; Mendenhall, Nancy P.

    2009-01-01

    Purpose: To compare the dose distribution to targeted and nontargeted tissues in Hodgkin's lymphoma patients using conventional radiotherapy (CRT), intensity-modulated RT (IMRT), and three-dimensional proton RT (3D-PRT). Methods and Materials: CRT, IMRT, and 3D-PRT treatment plans delivering 30 cobalt Gray equivalent (CGE)/Gy to an involved nodal field were created for 9 Stage II Hodgkin's lymphoma patients (n = 27 plans). The dosimetric endpoints were compared. Results: The planning target volume was adequately treated using all three techniques. The IMRT plan produced the most conformal high-dose distribution; however, the 3D-PRT plan delivered the lowest mean dose to nontarget tissues, including the breast, lung, and total body. The relative reduction in the absolute lung volume receiving doses of 4-16 CGE/Gy for 3D-PRT compared with CRT ranged from 26% to 37% (p < .05), and the relative reduction in the absolute lung volume receiving doses of 4-10 CGE/Gy for 3D-PRT compared with IMRT was 48-65% (p < .05). The relative reduction in absolute total body volume receiving 4-30 CGE/Gy for 3D-PRT compared with CRT was 47% (p < .05). The relative reduction in absolute total body volume receiving a dose of 4 CGE/Gy for 3D-PRT compared with IMRT was 63% (p = .03). The mean dose to the breast was significantly less for 3D-PRT than for either IMRT or CRT (p = .03) The mean dose and absolute volume receiving 4-30 CGE/Gy for the heart, thyroid, and salivary glands were similar for the three modalities. Conclusion: In this favorable subset of Hodgkin's lymphoma patients without disease in or below the hila, 3D-PRT significantly reduced the dose to the breast, lung, and total body. These observed dosimetric advantages might improve the clinical outcomes of Hodgkin's lymphoma patients by reducing the risk of late radiation effects related to low-to-moderate doses in nontargeted tissues.

  3. Temporary organ displacement coupled with image-guided, intensity-modulated radiotherapy for paraspinal tumors

    International Nuclear Information System (INIS)

    Katsoulakis, Evangelia; Thornton, Raymond H; Yamada, Yoshiya; Solomon, Stephen B; Maybody, Majid; Housman, Douglas; Niyazov, Greg; Riaz, Nadeem; Lovelock, Michael; Spratt, Daniel E; Erinjeri, Joseph P

    2013-01-01

    To investigate the feasibility and dosimetric improvements of a novel technique to temporarily displace critical structures in the pelvis and abdomen from tumor during high-dose radiotherapy. Between 2010 and 2012, 11 patients received high-dose image-guided intensity-modulated radiotherapy with temporary organ displacement (TOD) at our institution. In all cases, imaging revealed tumor abutting critical structures. An all-purpose drainage catheter was introduced between the gross tumor volume (GTV) and critical organs at risk (OAR) and infused with normal saline (NS) containing 5-10% iohexol. Radiation planning was performed with the displaced OARs and positional reproducibility was confirmed with cone-beam CT (CBCT). Patients were treated within 36 hours of catheter placement. Radiation plans were re-optimized using pre-TOD OARs to the same prescription and dosimetrically compared with post-TOD plans. A two-tailed permutation test was performed on each dosimetric measure. The bowel/rectum was displaced in six patients and kidney in four patients. One patient was excluded due to poor visualization of the OAR; thus 10 patients were analyzed. A mean of 229 ml (range, 80–1000) of NS 5-10% iohexol infusion resulted in OAR mean displacement of 17.5 mm (range, 7–32). The median dose prescribed was 2400 cGy in one fraction (range, 2100–3000 in 3 fractions). The mean GTV D min and PTV D min pre- and post-bowel TOD IG-IMRT dosimetry significantly increased from 1473 cGy to 2086 cGy (p=0.015) and 714 cGy to 1214 cGy (p=0.021), respectively. TOD increased mean PTV D95 by 27.14% of prescription (p=0.014) while the PTV D05 decreased by 9.2% (p=0.011). TOD of the bowel resulted in a 39% decrease in mean bowel D max (p=0.008) confirmed by CBCT. TOD of the kidney significantly decreased mean kidney dose and D max by 25% (0.022). TOD was well tolerated, reproducible, and facilitated dose escalation to previously radioresistant tumors abutting critical structures while

  4. Target volume and position variations during intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma

    Directory of Open Access Journals (Sweden)

    Tan W

    2013-11-01

    Full Text Available Wenyong Tan,* Yanping Li,* Guang Han, Jiaozhen Xu, Xiaohong Wang, Ying Li, Desheng HuDepartment of Radiation Oncology, Hubei Cancer Hospital, Wuhan, People's Republic of China*These authors contributed equally to this workPurpose: Considerable anatomical changes occur during intensity-modulated radiotherapy (IMRT for nasopharyngeal carcinoma (NPC. This study aimed to quantify volumetric and positional variations of the target volume during IMRT.Materials and methods: Twenty patients with locally advanced NPC who received concurrent (13 patients or sequential (seven patients chemoradiotherapy were prospectively recruited and underwent planning computed tomography (CT and six repeat CTs (every five fractions. Each repeat CT was rigidly registered to the planning CT. Gross tumor volume (GTV and elective clinical target volume (CTV were manually delineated on each axial CT image. CTVs of the primary tumor and lymph nodes were expanded with 5 mm margins to corresponding GTVs, with necessary modifications. Volume loss, system and random errors, and the mean and three-dimensional vector displacements were calculated and compared statistically.Results: Volumes of the primary tumor and small (>1 cm, ≤3 cm and large (>3 cm positive neck lymph nodes decreased at a rate of 2.6%, 3.7%, and 3.9% per treatment day, respectively. CTVs of the primary tumor, lymph nodes, and elective region decreased 1.5%, 2.3%, and 0.3% per treatment day, respectively. Average displacements of the GTVs and CTVs were <1.3 mm in all directions. GTVs and CTVs of the large and small lymph nodes shifted medially by 0.8–1.3 and 0.6–1.2 mm, respectively, on average. Average three-dimensional displacements of the GTVs and CTVs were 3.4–4.3 mm and 2.5–3.7 mm, respectively. Volume loss and displacements in most directions were significantly larger in patients receiving concurrent chemoradiotherapy than in those receiving sequential therapy. Volume loss and displacements of the

  5. Intensity modulation in breast radiotherapy: Development of an innovative field-in-field technique at Institut Gustave-Roussy; Modulation d'intensite en radiotherapie mammaire: developpement d'une methode innovante de champ dans le champ a l'institut Gustave-Roussy

    Energy Technology Data Exchange (ETDEWEB)

    Heymann, S.; Bourhis, J.; Bourgier, C. [Departement d' oncologie radiotherapie, institut de cancerologie Gustave-Roussy, 114, rue edouard-Vaillant, 94805 Villejuif (France); Verstraet, R.; Pichenot, C.; Vergne, E.; Lefkopoulos, D. [Departement de physique, institut de cancerologie Gustave-Roussy, 114, rue edouard-Vaillant, 94805 Villejuif (France); Husson, F.; Kafrouni, H.; Mahe, J.; Kandalaft, B. [Societe Dosisoft, 45/47, avenue Carnot, 94230 Cachan (France); Marsiglia, H. [Departement d' oncologie radiotherapie, institut de cancerologie Gustave-Roussy, 114, rue edouard-Vaillant, 94805 Villejuif (France); Universite de Florence, Florence (Italy)

    2011-12-15

    Purpose. - To assess the potential dosimetric gain of pre-segmentation modulated radiotherapy (OAPS, DosiSoft{sup TM}) of breast, compared to routine 3D conformal radiotherapy. Patients and methods. - Twenty patients treated with conservative surgery for breast cancer (9 right and 11 left sided) with various breast volume (median 537 cm{sup 3}; range [100-1049 cm{sup 3}]) have been selected. For each patient, we have delineated a breast volume and a compensation volume (target volumes), as well as organs at risk (lungs and heart). Two treatment plans have been generated: one using the routine 3D conformal technique and the other with the pre-segmentation algorithm of DosiSoft{sup TM} (OAPS). The dose distribution were analyzed using the conformity index for target volumes, mean dose and V 30 Gy for the heart, and mean dose, V 20 Gy and V 30 Gy for lungs. Results. - Over the 20 patients, the conformity index increased from 0.897 with routine technique to 0.978 with OAPS (P < 0,0001). For heart and lung, OAPS decreased irradiation (mean cardiac dose 1,3 vs 1,6 Gy [P < 0,0001] and pulmonary V 20 Gy 6,6 vs 7,1 [P < 0,0001]). Conclusion. - OAPS (DosiSoft{sup TM}) is an original method of segmentation of breast. It is automatic, fast and easy, and is able to increase the conformity index, while sparing organ at risk. (authors)

  6. Radiotherapy for Early Mediastinal Hodgkin Lymphoma According to the German Hodgkin Study Group (GHSG): The Roles of Intensity-Modulated Radiotherapy and Involved-Node Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Koeck, Julia, E-mail: Julia_Koeck@gmx.net [Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim (Germany); Abo-Madyan, Yasser [Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim (Germany); Department of Radiation Oncology, Faculty of Medicine, Cairo University, Cairo (Egypt); Lohr, Frank; Stieler, Florian [Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim (Germany); Kriz, Jan; Mueller, Rolf-Peter [Department of Radiation Oncology, University of Cologne, Cologne (Germany); Wenz, Frederik [Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim (Germany); Eich, Hans Theodor [Department of Radiation Oncology, University of Cologne, Cologne (Germany)

    2012-05-01

    Purpose: Cure rates of early Hodgkin lymphoma (HL) are high, and avoidance of late complications and second malignancies have become increasingly important. This comparative treatment planning study analyzes to what extent target volume reduction to involved-node (IN) and intensity-modulated (IM) radiotherapy (RT), compared with involved-field (IF) and three-dimensional (3D) RT, can reduce doses to organs at risk (OAR). Methods and Materials: Based on 20 computed tomography (CT) datasets of patients with early unfavorable mediastinal HL, we created treatment plans for 3D-RT and IMRT for both the IF and IN according to the guidelines of the German Hodgkin Study Group (GHSG). As OAR, we defined heart, lung, breasts, and spinal cord. Dose-volume histograms (DVHs) were evaluated for planning target volumes (PTVs) and OAR. Results: Average IF-PTV and IN-PTV were 1705 cm{sup 3} and 1015 cm{sup 3}, respectively. Mean doses to the PTVs were almost identical for all plans. For IF-PTV/IN-PTV, conformity was better with IMRT and homogeneity was better with 3D-RT. Mean doses to the heart (17.94/9.19 Gy for 3D-RT and 13.76/7.42 Gy for IMRT) and spinal cord (23.93/13.78 Gy for 3D-RT and 19.16/11.55 Gy for IMRT) were reduced by IMRT, whereas mean doses to lung (10.62/8.57 Gy for 3D-RT and 12.77/9.64 Gy for IMRT) and breasts (left 4.37/3.42 Gy for 3D-RT and 6.04/4.59 Gy for IMRT, and right 2.30/1.63 Gy for 3D-RT and 5.37/3.53 Gy for IMRT) were increased. Volume exposed to high doses was smaller for IMRT, whereas volume exposed to low doses was smaller for 3D-RT. Pronounced benefits of IMRT were observed for patients with lymph nodes anterior to the heart. IN-RT achieved substantially better values than IF-RT for almost all OAR parameters, i.e., dose reduction of 20% to 50%, regardless of radiation technique. Conclusions: Reduction of target volume to IN most effectively improves OAR sparing, but is still considered investigational. For the time being, IMRT should be considered for

  7. Image-guided radiotherapy in near real time with intensity-modulated radiotherapy megavoltage treatment beam imaging.

    Science.gov (United States)

    Mao, Weihua; Hsu, Annie; Riaz, Nadeem; Lee, Louis; Wiersma, Rodney; Luxton, Gary; King, Christopher; Xing, Lei; Solberg, Timothy

    2009-10-01

    To utilize image-guided radiotherapy (IGRT) in near real time by obtaining and evaluating the online positions of implanted fiducials from continuous electronic portal imaging device (EPID) imaging of prostate intensity-modulated radiotherapy (IMRT) delivery. Upon initial setup using two orthogonal images, the three-dimensional (3D) positions of all implanted fiducial markers are obtained, and their expected two-dimensional (2D) locations in the beam's-eye-view (BEV) projection are calculated for each treatment field. During IMRT beam delivery, EPID images of the megavoltage treatment beam are acquired in cine mode and subsequently analyzed to locate 2D locations of fiducials in the BEV. Simultaneously, 3D positions are estimated according to the current EPID image, information from the setup portal images, and images acquired at other gantry angles (the completed treatment fields). The measured 2D and 3D positions of each fiducial are compared with their expected 2D and 3D setup positions, respectively. Any displacements larger than a predefined tolerance may cause the treatment system to suspend the beam delivery and direct the therapists to reposition the patient. Phantom studies indicate that the accuracy of 2D BEV and 3D tracking are better than 1 mm and 1.4 mm, respectively. A total of 7330 images from prostate treatments were acquired and analyzed, showing a maximum 2D displacement of 6.7 mm and a maximum 3D displacement of 6.9 mm over 34 fractions. This EPID-based, real-time IGRT method can be implemented on any external beam machine with portal imaging capabilities without purchasing any additional equipment, and there is no extra dose delivered to the patient.

  8. Physical and clinical aspects of the dynamic intensity-modulated radiotherapy of 21 patients

    International Nuclear Information System (INIS)

    Engler, Mark J.; Tsai, J.-S.; Ulin, Kenneth; Wu Julian; Ling, Marilyn N.; Fagundes, Marcio; Kramer, Bradley; Wazer, David E.

    1996-01-01

    Purpose: To describe the physical and clinical aspects of the dynamic intensity modulated radiotherapy of 21 patients. Methods and Materials: Dynamic, intensity modulated radiotherapy (IMR) was given to 21 patients with advanced or recurrent disease. 13 patients were immobilized with head screws, and 8, with non-invasive thermoplastic masks. The system was selected because it was designed de novo from a well established simulated annealing optimization model (SA), and with stringent leakage requirements and rapid leaf transit time for a multi leaf collimator (MLC). The system included a 6 MV linear accelerator (linac), an MLC, a quad processing computer system with SA software, a computer MLC controller with inclinometers and interlocks to stop radiation upon potential MLC or linac gantry fault detection, and immobilization devices attached to CT and treatment tables. The MLC was built around a 2 x 20 array of leaves with 9 half value layers of attenuation of the primary beam (99.8%). Over a trillion (2 40 ) beamlet patterns were dynamically changeable per deg. of linac gantry rotation. With all leaves shut, transmission was within a secondary collimator standard of < 0.5% of the primary beam. MLC control was via touch screen computer, and a disk drive which read beam pattern sequences from a disk generated by the planning system. Planning included 3D CT and magnetic resonance localization of regions of interest (ROI). The SA cost function incorporated idealized dose-volume parameter sets of up to 21 ROI/patient. Relative importance and spatial pre-eminance of each ROI were quantified into the constraint set, together with an instrument data file (IDR) built from depth dose and crossplot data of 8 x 8 to 20 x 200 mm field sizes and patterns measured with small diodes in a water tanc phantom. Planner output included dose volume histograms, tabulated dosimetry statistics, 2D dose distributions, and 3D translucent renderings of patient surfaces with underlying colored

  9. Determining optimal planning target volume and image guidance policy for post-prostatectomy intensity modulated radiotherapy.

    Science.gov (United States)

    Bell, Linda J; Cox, Jennifer; Eade, Thomas; Rinks, Marianne; Herschtal, Alan; Kneebone, Andrew

    2015-07-26

    There is limited information available on the optimal Planning Target Volume (PTV) expansions and image guidance for post-prostatectomy intensity modulated radiotherapy (PP-IMRT). As the prostate bed does not move in a uniform manner, there is a rationale for anisotropic PTV margins with matching to soft tissue. The aim of this study is to find the combination of PTV expansion and image guidance policy for PP-IMRT that provides the best balance of target coverage whilst minimising dose to the organs at risk. The Cone Beam CT (CBCT) images (n = 377) of 40 patients who received PP-IMRT with daily online alignment to bony anatomy (BA) were reviewed. Six different PTV expansions were assessed: 3 published PTV expansions (0.5 cm uniform, 1 cm uniform, and 1 + 0.5 cm posterior) and 3 further anisotropic PTV expansions (Northern Sydney Cancer Centre (NSCC), van Herk, and smaller anisotropic). Each was assessed for size, bladder and rectum coverage and geographic miss. Each CBCT was rematched using a superior soft tissue (SST) and averaged soft tissue (AST) match. Potential geographic miss was assessed using all PTV expansions except the van Herk margin. The 0.5 cm uniform expansion yielded the smallest PTV (median volume = 222.3 cc) and the 1 cm uniform expansion yielded the largest (361.7 cc). The Van Herk expansion includes the largest amount of bladder (28.0 %) and rectum (36.0 %) and the 0.5 cm uniform expansion the smallest (17.1 % bladder; 10.2 % rectum). The van Herk PTV expansion had the least geographic miss with BA matching (4.2 %) and the 0.5 cm uniform margin (28.4 %) the greatest. BA matching resulted in the highest geographic miss rate for all PTVs, followed by SST matching and AST matching. Changing from BA to an AST match decreases potential geographic miss by half to two thirds, depending on the PTV expansion, to image guidance policy for PP-IMRT is daily average soft tissue matching using CBCT scans with a small anisotropic PTV expansion of 0

  10. Post-nerve-sparing prostatectomy, dose-escalated intensity-modulated radiotherapy: effect on erectile function

    International Nuclear Information System (INIS)

    Bastasch, Michael D.; Teh, Bin S.; Mai, W.-Y.; Carpenter, L. Steven; Lu, Hsin H.; Chiu, J. Kam; Woo, Shiao Y.; Grant, Walter H.; Miles, Brian J.; Kadmon, Dov; Butler, E. Brian

    2002-01-01

    Purpose: The advent of widespread prostate-specific antigen screening has resulted in more younger, potent men being diagnosed with early-stage, organ-confined prostate cancer amenable to definitive surgery. Nerve-sparing prostatectomy is a relatively new surgical advance in the treatment of prostate cancer. Very few data exist on the effect of postoperative radiotherapy (RT) on erectile function after nerve-sparing prostatectomy. They are based on conventional techniques using moderate doses of radiation, 45-54 Gy. Intensity-modulated RT (IMRT) is becoming more widespread because it allows dose escalation with increased sparing of the surrounding normal tissue. We investigated the effect of postprostatectomy, high-dose IMRT on patients' erectile function. Methods and Materials: A review of patient records found 51 patients treated between April 1998 and December 2000 with IMRT after unilateral or bilateral nerve-sparing prostatectomy. The pathologic disease stage in these patients was T2 in 47.4% and T3 in 52.6%. Postoperatively, 4 patients received hormonal ablation consisting of one injection of Lupron Depot (30 mg) 2 months before RT. The median age was 65 years (range 46-77) at the time of RT. The prescribed dose was 64 Gy (range 60-66). The mean dose was 69.6 Gy (range 64.0-72.3). Erectile function was assessed before and after RT by questionnaires. Sexual potency was defined as erectile rigidity adequate for vaginal penetration. Results: Of the 51 patients, 18 (35.3%) maintained their potency and 33 (64.7%) became impotent after nerve-sparing prostatectomy. Patients who underwent bilateral nerve-sparing prostatectomy had higher rates of postoperative potency than did those who underwent unilateral nerve-sparing surgery (72.2% vs. 27.8%; p=0.025). The follow-up for the entire group was 19.5 months. All 18 patients (100%) who were potent postoperatively remained potent after RT. The median follow-up for the 18 potent patients was 27.2 months, significantly

  11. Dosimetric investigation of breath-hold intensity-modulated radiotherapy for pancreatic cancer

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, Mitsuhiro; Kishimoto, Shun; Iwamura, Kohei; Shiinoki, Takehiro; Nakamura, Akira; Matsuo, Yukinori; Shibuya, Keiko; Hiraoka, Masahiro [Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto 606-8507 (Japan); Department of Radiological Technology, Faculty of Medical Science, Kyoto College of Medical Science, Nantan, Kyoto 622-0041 (Japan); Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto 606-8507 (Japan)

    2012-01-15

    Purpose: To experimentally investigate the effects of variations in respiratory motion during breath-holding (BH) at end-exhalation (EE) on intensity-modulated radiotherapy (BH-IMRT) dose distribution using a motor-driven base, films, and an ionization chamber. Methods: Measurements were performed on a linear accelerator, which has a 120-leaf independently moving multileaf collimator with 5-mm leaf width at the isocenter for the 20-cm central field. Polystyrene phantoms with dimensions of 40 x 40 x 10 cm were set on a motor-driven base. All gantry angles of seven IMRT plans (a total of 35 fields) were changed to zero, and doses were then delivered to a film placed at a depth of 4 cm and an ionization chamber at a depth of 5 cm in the phantom with a dose rate of 600 MU/min under the following conditions: pulsation from the abdominal aorta and baseline drift with speeds of 0.2 mm/s (BD{sub 0.2mm/s}) and 0.4 mm/s (BD{sub 0.4mm/s}). As a reference for comparison, doses were also delivered to the chamber and film under stationary conditions. Results: In chamber measurements, means {+-} standard deviations of the dose deviations between stationary and moving conditions were -0.52% {+-} 1.03% (range: -3.41-1.05%), -0.07% {+-} 1.21% (range: -1.88-4.31%), and 0.03% {+-} 1.70% (range: -2.70-6.41%) for pulsation, BD{sub 0.2mm/s}, and BD{sub 0.4mm/s}, respectively. The {gamma} passing rate ranged from 99.5% to 100.0%, even with the criterion of 2%/1 mm for pulsation pattern. In the case of BD{sub 0.4mm/s}, the {gamma} passing rate for four of 35 fields (11.4%) did not reach 90% with a criterion of 3%/3 mm. The differences in {gamma} passing rate between BD{sub 0.2mm/s} and BD{sub 0.4mm/s} were statistically significant for each criterion. Taking {gamma} passing rates of > 90% as acceptable with a criterion of 3%/3 mm, large differences were observed in the {gamma} passing rate between the baseline drift of {<=}5 mm and that of >5 mm (minimum {gamma} passing rate: 92.0% vs 82

  12. Evaluation of xerostomia following intensity modulated radiotherapy (IMRT) for head and neck cancer patients

    International Nuclear Information System (INIS)

    Lee, Seok Ho; Kim, Tae Hyun; Chie, Eui Kyu

    2004-01-01

    This study was done to evaluate xerostomia following intensity modulated radiotherapy for patients with head and neck cancer, and to analyze the correlation between the dosimetric parameters and xerostomia parameters. From February till October 2003, 13 patients with 3 months of follow-up were evaluated for xerostomia after being treated for head and neck cancer with IMRT. Their median age was 57 years (range:43 ∼ 77). Xerostomia were assessed with a 4-question xerostomia questionnaire score (XQS) and a test for salivary flow rates (unstimulated and stimulated). The patients were also given a validated LENT SOMA scale (LSC) questionnaire. The evaluations were completed before radiation therapy (pre-RT) and at 1 and. 3 months after radiation therapy (RT). We evaluated xerostomia at pre-RT, 1 and, 3 months after RT. The association between the xerostomia parameters (XQS and LSC) and salivary flow rates (unstimulated and stimulated: USFR and SSFR) was assessed at 1 and 3 months after RT. All 13 patients showed no significant changes in XQS, LSC and Salivary Flow rates. As a result, we couldn't find out about xerostomia development. Based on the total mean parotid dose, 3,500 cGy, we divided these patients into two groups. The 8 patients (< 3,500 cGy) showed no significant changes in XQS, LSC and Salivary Flow rates. However, in 5 patients (≥ 3,500 cGy), there was a significant increase in USFR and, SSFR at 3 months after RT, and for the XQS and, LSC at 1 and 3 months after RT. The correlation between XQS and, LSC, and USFR and, SSFR in all patients (13) was significant at 3 months after RT. The correlation had a tendency to the decrease for USFR and, SSFR in proportion to the increase of XQS and, LSC. Base on the results of this study, IMRT seem to be an effective treatment to significantly decrease the xerostomia. XQS and, LSC seem to be a effective tool for predicting the xerostomia. A total parotid gland mean dose of < 3,500 cGy should be a planning goal if

  13. Salivary Gland Tumors Treated With Adjuvant Intensity-Modulated Radiotherapy With or Without Concurrent Chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Schoenfeld, Jonathan D., E-mail: jdschoenfeld@partners.org [Department of Radiation Oncology, Harvard Radiation Oncology Program, Boston, MA (United States); Sher, David J. [Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women' s Hospital, Boston, MA (United States); Norris, Charles M. [Department of Surgery, Division of Otolaryngology, Brigham and Women' s Hospital, Boston, MA (United States); Haddad, Robert I.; Posner, Marshall R. [Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (United States); Department of Medicine, Brigham and Women' s Hospital, Boston, MA (United States); Balboni, Tracy A.; Tishler, Roy B. [Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women' s Hospital, Boston, MA (United States)

    2012-01-01

    Purpose: To analyze the recent single-institution experience of patients with salivary gland tumors who had undergone adjuvant intensity-modulated radiotherapy (IMRT), with or without concurrent chemotherapy. Patients and Methods: We performed a retrospective analysis of 35 salivary gland carcinoma patients treated primarily at the Dana-Farber Cancer Institute between 2005 and 2010 with surgery and adjuvant IMRT. The primary endpoints were local control, progression-free survival, and overall survival. The secondary endpoints were acute and chronic toxicity. The median follow-up was 2.3 years (interquartile range, 1.2-2.8) among the surviving patients. Results: The histologic types included adenoid cystic carcinoma in 15 (43%), mucoepidermoid carcinoma in 6 (17%), adenocarcinoma in 3 (9%), acinic cell carcinoma in 3 (9%), and other in 8 (23%). The primary sites were the parotid gland in 17 (49%), submandibular glands in 6 (17%), tongue in 4 (11%), palate in 4 (11%), and other in 4 (11%). The median radiation dose was 66 Gy, and 22 patients (63%) received CRT. The most common chemotherapy regimen was carboplatin and paclitaxel (n = 14, 64%). A trend was seen for patients undergoing CRT to have more adverse prognostic factors, including Stage T3-T4 disease (CRT, n = 12, 55% vs. n = 4, 31%, p = .29), nodal positivity (CRT, n = 8, 36% vs. n = 1, 8%, p = .10), and positive margins (n = 13, 59% vs. n = 5, 38%, p = .30). One patient who had undergone CRT developed an in-field recurrence, resulting in an overall actuarial 3-year local control rate of 92%. Five patients (14%) developed distant metastases (1 who had undergone IMRT only and 4 who had undergone CRT). Acute Grade 3 mucositis, esophagitis, and dermatitis occurred in 8%, 8%, and 8% (1 each) of IMRT patients and in 18%, 5%, and 14% (4, 1, and 3 patients) of the CRT group, respectively. No acute Grade 4 toxicity occurred. The most common late toxicity was Grade 1 xerostomia (n = 8, 23%). Conclusions: Treatment of

  14. Nasopharyngeal Carcinoma in Children: Comparison of Conventional and Intensity-Modulated Radiotherapy

    International Nuclear Information System (INIS)

    Laskar, Siddhartha; Bahl, Gaurav; Muckaden, MaryAnn; Pai, Suresh K.; Gupta, Tejpal; Banavali, Shripad; Arora, Brijesh; Sharma, Dayanand; Kurkure, Purna A.; Ramadwar, Mukta; Viswanathan, Seethalaxhmi; Rangarajan, Venkatesh; Qureshi, Sajid; Deshpande, Deepak D.; Shrivastava, Shyam K.; Dinshaw, Ketayun A.

    2008-01-01

    Purpose: To evaluate the efficacy of intensity-modulated radiotherapy (IMRT) in reducing the acute toxicities associated with conventional RT (CRT) in children with nasopharyngeal carcinoma. Patients and Methods: A total of 36 children with nonmetastatic nasopharyngeal carcinoma, treated at the Tata Memorial Hospital between June 2003 and December 2006, were included in this study. Of the 36 patients, 28 were boys and 8 were girls, with a median age of 14 years; 4 (11%) had Stage II and 10 (28%) Stage III disease at presentation. All patients had undifferentiated carcinoma and were treated with a combination of chemotherapy and RT. Of the 36 patients, 19 underwent IMRT and 17 underwent CRT. Results: After a median follow-up of 27 months, the 2-year locoregional control, disease-free, and overall survival rate was 76.5%, 60.6%, and 71.3%, respectively. A significant reduction in acute Grade 3 toxicities of the skin (p = 0.006), mucous membrane (p = 0.033), and pharynx (p = 0.035) was noted with the use of IMRT. The median time to the development of Grade 2 toxicity was delayed with IMRT (skin, 35 vs. 25 days, p = 0.016; mucous-membrane, 39 vs. 27 days, p = 0.002; and larynx, 50 vs. 28 days, p = 0.009). The duration of RT significantly influenced disease-free survival on multivariate analysis (RT duration >52 days, hazard ratio = 5.49, 95% confidence interval, 1.14-26.45, p = 0.034). The average mean dose to the first and second planning target volume was 71.8 Gy and 62.5 Gy with IMRT compared with 66.3 Gy (p = 0.001) and 64.4 Gy (p = 0.046) with CRT, respectively. Conclusion: The results of our study have shown that IMRT significantly reduces and delays the onset of acute toxicity, resulting in improved tolerance and treatment compliance for children with nasopharyngeal carcinoma. Also, IMRT provided superior target coverage and normal tissue sparing compared with CRT

  15. Statistical process control applied to intensity modulated radiotherapy pretreatment controls with portal dosimetry

    International Nuclear Information System (INIS)

    Villani, N.; Noel, A.; Villani, N.; Gerard, K.; Marchesi, V.; Huger, S.; Noel, A.; Francois, P.

    2010-01-01

    Purpose The first purpose of this study was to illustrate the contribution of statistical process control for a better security in intensity modulated radiotherapy (I.M.R.T.) treatments. This improvement is possible by controlling the dose delivery process, characterized by pretreatment quality control results. So, it is necessary to put under control portal dosimetry measurements (currently, the ionisation chamber measurements were already monitored by statistical process control thanks to statistical process control tools). The second objective was to state whether it is possible to substitute ionisation chamber with portal dosimetry in order to optimize time devoted to pretreatment quality control. Patients and methods At Alexis-Vautrin center, pretreatment quality controls in I.M.R.T. for prostate and head and neck treatments were performed for each beam of each patient. These controls were made with an ionisation chamber, which is the reference detector for the absolute dose measurement, and with portal dosimetry for the verification of dose distribution. Statistical process control is a statistical analysis method, coming from industry, used to control and improve the studied process quality. It uses graphic tools as control maps to follow-up process, warning the operator in case of failure, and quantitative tools to evaluate the process toward its ability to respect guidelines: this is the capability study. The study was performed on 450 head and neck beams and on 100 prostate beams. Results Control charts, showing drifts, both slow and weak, and also both strong and fast, of mean and standard deviation have been established and have shown special cause introduced (manual shift of the leaf gap of the multi-leaf collimator). Correlation between dose measured at one point, given with the E.P.I.D. and the ionisation chamber has been evaluated at more than 97% and disagreement cases between the two measurements were identified. Conclusion The study allowed to

  16. Intensity-modulated whole pelvic radiotherapy in women with gynecologic malignancies

    International Nuclear Information System (INIS)

    Mundt, Arno J.; Lujan, Anthony E.; Rotmensch, Jacob; Waggoner, Steven E.; Yamada, S. Diane; Fleming, Gini; Roeske, John C.

    2002-01-01

    Purpose: To describe our initial clinical experience with intensity-modulated whole pelvic radiotherapy (IM-WPRT) in women with gynecologic malignancies. Methods and Materials: Between February 2000 and August 2001, 40 gynecology patients underwent IM-WPRT. After fabrication of customized immobilization, all patients underwent contrast-enhanced CT, and a clinical target volume was contoured consisting of the upper vagina, parametria, uterus (if present), and presacral and pelvic lymph node regions. The clinical target volume was expanded by 1 cm to create a planning target volume (PTV). Using commercially available software, 7- or 9-field, 6-MV, coplanar IM-WPRT plans were generated for all patients. The worst acute gastrointestinal and genitourinary toxicity during treatment was scored on a 4-point scale: 0, none; 1, mild, no medications required; 2, moderate, medications required; and 3, severe, treatment breaks or cessation, hospitalization. As a comparison, acute toxicities in 35 previously treated conventional WPRT patients were analyzed. No significant differences were noted in the clinicopathologic and treatment factors between the two groups. Results: IM-WPRT plans provided excellent PTV coverage, with considerable sparing of the surrounding normal tissues. On average, 98.1% of the PTV received the prescription dose. The average percentage of the PTV receiving 110% and 115% of the prescription dose was 9.8% and 0.2%, respectively. IM-WPRT was well tolerated, with no patient developing Grade 3 toxicity. Grade 2 acute gastrointestinal toxicity was less common in the IM-WPRT group (60 vs. 91%, p=0.002) than in the conventional WPRT group. Moreover, the percentage of IM-WPRT and WPRT patients requiring no or only infrequent antidiarrheal medications was 75% and 34%, respectively (p=0.001). Although less Grade 2 genitourinary toxicity was seen in the IM-WPRT group (10% vs. 20%), this difference was not statistically significant (p=0.22). Conclusion: IM-WPRT is a

  17. Forward-planned intensity modulated radiation therapy using a cobalt source: A dosimetric study in breast cancer

    Directory of Open Access Journals (Sweden)

    Savino Cilla

    2013-01-01

    Full Text Available This analysis evaluates the feasibility and dosimetric results of a simplified intensity-modulated radiotherapy (IMRT treatment using a cobalt-therapy unit for post-operative breast cancer. Fourteen patients were included. Three plans per patient were produced by a cobalt-60 source: A standard plan with two wedged tangential beams, a standard tangential plan optimized without the use of wedges and a plan based on the forward-planned "field-in-field" IMRT technique (Co-FinF where the dose on each of the two tangential beams was split into two different segments and the two segments weight was determined with an iterative process. For comparison purposes, a 6-MV photon standard wedged tangential treatment plan was generated. D mean , D 98% , D 2% , V 95% , V 107%, homogeneity, and conformity indices were chosen as parameters for comparison. Co-FinF technique improved the planning target volume dose homogeneity compared to other cobalt-based techniques and reduced maximum doses (D 2% and high-dose volume (V 110% . Moreover, it showed a better lung and heart dose sparing with respect to the standard approach. The higher dose homogeneity may encourage the adoption of accelerated-hypofractionated treatments also with the cobalt sources. This approach can promote the spread of breast conservative treatment in developing countries.

  18. A fixed-jaw method to protect critical organs during intensity-modulated radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Jiayun; Chen, Xinyuan [Department of Radiation Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences, Beijing (China); Huang, Manni, E-mail: dai_jianrong@163.com [Department of Gynecologic Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences, Beijing (China); Dai, Jianrong, E-mail: huangmanni@csco.org.cn [Department of Radiation Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences, Beijing (China)

    2014-01-01

    Intensity-modulated radiotherapy (IMRT) plays an important role in cancer radiotherapy. For some patients being treated with IMRT, the extremely low tolerances of critical organs (such as lens, ovaries, and testicles) cannot be met during treatment planning. The aim of this article is to introduce a new planning method to overcome that problem. In current planning practice, jaw positions are automatically set to cover all target volumes by the planning system (e.g., Pinnacle{sup 3} system). Because of such settings, critical organs may be fully blocked by the multileaf collimator (MLC), but they still sit in the field that is shaped by collimator jaws. These critical organs receive doses from the transmission and leakage of MLC leaves. We manually fixed jaw positions to block them to further reduce such doses. This method has been used for different treatment sites in our clinic, and it was thoroughly evaluated in patients with radical hysterectomy plus ovarian transposition after surgery. For each patient, 2 treatment plans were designed with the same optimization parameters: the original plan with automatically chosen jaw positions (called O-plan) and the plan with fixed-jaw positions (named F-plan). In the F-plan, the jaws were manually fixed to block the ovaries. For target coverage, the mean conformity index (CI) of the F-plan (1.28 ± 0.02) was remarkably lower than that of the O-plan (1.53 ± 0.09) (p < 0.05). The F-plan and the O-plan performed similarly in target dose homogeneity. Meanwhile, for the critical organ sparing, the mean dose of both ovaries were much lower in the F-plan than that in the O-plan (p < 0.05). The V{sub 20}, V{sub 30}, and V{sub 40} of bladder were also lower in the F-plan (93.57 ± 1.98, 73.99 ± 5.76, and 42.33 ± 3.7, respectively) than those in the O-plan (97.98 ± 1.11, 85.07 ± 4.04, and 49.71 ± 3.63, respectively) (p < 0.05). The maximum dose to the spinal cord planning organ at risk (OAR) volume (PRV) in the O-plan (3940

  19. BENEFITS OF INTENSITY-MODULATED RADIOTHERAPY (IMRT IN PATIENTS WITH HEAD AND NECK MALIGNANCIES- A SINGLE INSTITUTION EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Sherry Seasor Abraham

    2017-09-01

    Full Text Available BACKGROUND Radiotherapy and surgery are the principal curative modalities in treatment of head and neck cancer. Conventional twodimensional and three-dimensional conformal radiotherapy result in significant side effects and altered quality of life. IntensityModulated Radiotherapy (IMRT can spare the normal tissues, while delivering a curative dose to the tumour-bearing tissues. This study reveals the role of IMRT in head and neck cancer in view of normal tissue sparing with good tumour control. MATERIALS AND METHODS Radical radiotherapy was given using linear accelerator up to a dose of 66 to 70 gray in 30 to 33 fractions (intensity-modulated radiotherapy with simultaneous integrated boost over 6 to 7 weeks to 56 eligible patients. Concurrent cisplatin was given to patients with locally-advanced disease up to a dose of 40 mg/m2 weekly once along with radiation. The patients were monitored weekly once during the treatment for acute skin and mucosal toxicities using the RTOG scoring criteria. After the treatment, locoregional response was assessed and recorded at 6 weeks, 3 months and 6 months intervals. RESULTS Severe skin toxicity (grade III or more was seen in approximately 7% patients. Severe mucosal toxicity (grade III or more was seen in approximately 80% of patients. IMRT technique showed better skin sparing compared to 3D conformal radiotherapy. Severe mucosal toxicity was slightly higher in this study due to the simultaneous integrated boost technique used for dose intensification to the mucosa, which results in better primary tumour control. At the end of 6 months, 75% patients achieved locoregional control and residual/recurrent disease was seen in 25% of patients. IMRT offered good locoregional control with less skin toxicity and acceptable mucosal toxicity. The results were similar to the previous study reports using IMRT. CONCLUSION IMRT is a better treatment option in locally-advanced head and neck malignancies providing good

  20. Automation and Intensity Modulated Radiation Therapy for Individualized High-Quality Tangent Breast Treatment Plans

    International Nuclear Information System (INIS)

    Purdie, Thomas G.; Dinniwell, Robert E.; Fyles, Anthony; Sharpe, Michael B.

    2014-01-01

    Purpose: To demonstrate the large-scale clinical implementation and performance of an automated treatment planning methodology for tangential breast intensity modulated radiation therapy (IMRT). Methods and Materials: Automated planning was used to prospectively plan tangential breast IMRT treatment for 1661 patients between June 2009 and November 2012. The automated planning method emulates the manual steps performed by the user during treatment planning, including anatomical segmentation, beam placement, optimization, dose calculation, and plan documentation. The user specifies clinical requirements of the plan to be generated through a user interface embedded in the planning system. The automated method uses heuristic algorithms to define and simplify the technical aspects of the treatment planning process. Results: Automated planning was used in 1661 of 1708 patients receiving tangential breast IMRT during the time interval studied. Therefore, automated planning was applicable in greater than 97% of cases. The time for treatment planning using the automated process is routinely 5 to 6 minutes on standard commercially available planning hardware. We have shown a consistent reduction in plan rejections from plan reviews through the standard quality control process or weekly quality review multidisciplinary breast rounds as we have automated the planning process for tangential breast IMRT. Clinical plan acceptance increased from 97.3% using our previous semiautomated inverse method to 98.9% using the fully automated method. Conclusions: Automation has become the routine standard method for treatment planning of tangential breast IMRT at our institution and is clinically feasible on a large scale. The method has wide clinical applicability and can add tremendous efficiency, standardization, and quality to the current treatment planning process. The use of automated methods can allow centers to more rapidly adopt IMRT and enhance access to the documented

  1. Treatment Planning Study to Determine Potential Benefit of Intensity-Modulated Radiotherapy Versus Conformal Radiotherapy for Unresectable Hepatic Malignancies

    International Nuclear Information System (INIS)

    Eccles, Cynthia L.; Bissonnette, Jean-Pierre; Craig, Tim; Taremi, Mojgan; Wu Xia; Dawson, Laura A.

    2008-01-01

    Purpose: To compare intensity-modulated radiotherapy (IMRT) with conformal RT (CRT) for hypofractionated isotoxicity liver RT and explore dose escalation using IMRT for the same/improved nominal risk of liver toxicity in a treatment planning study. Methods and Materials: A total of 26 CRT plans were evaluated. Prescription doses (24-54 Gy within six fractions) were individualized on the basis of the effective liver volume irradiated maintaining ≤5% risk of radiation-induced liver disease. The dose constraints included bowel (0.5 cm 3 ) and stomach (0.5 cm 3 ) to ≤30 Gy, spinal cord to ≤25 Gy, and planning target volume (PTV) to ≤140% of the prescribed dose. Two groups were evaluated: (1) PTV overlapping or directly adjacent to serial functioning normal tissues (n = 14), and (2) the liver as the dose-limiting normal tissue (n = 12). IMRT plans using direct machine parameter optimization maintained the CRT plan beam arrangements, an estimated radiation-induced liver disease risk of 5%, and underwent dose escalation, if all normal tissue constraints were maintained. Results: IMRT improved PTV coverage in 19 of 26 plans (73%). Dose escalation was feasible in 9 cases by an average of 3.8 Gy (range, 0.6-13.2) in six fractions. Three of seven plans without improved PTV coverage had small gross tumor volumes (≤105 cm 3 ) already receiving 54 Gy, the maximal prescription dose allowed. In the remaining cases, the PTV range was 9.6-689 cm 3 ; two had overlapped organs at risk; and one had four targets. IMRT did not improve these plans owing to poor target coverage (n = 2) and nonliver (n = 2) dose limits. Conclusion: Direct machine parameter optimization IMRT improved PTV coverage while maintaining normal tissue tolerances in most CRT liver plans. Dose escalation was possible in a minority of patients

  2. Radiotherapy of intensity modulated VS conformational in the treatment of carcinoma of the prostate. A dosimetric comparison

    International Nuclear Information System (INIS)

    Rodriguez Martin, G.; Garcia Vicente, F.; Zapatero Laborda, A.; Bermudez Luna, R.; Roch Gonzalez, M.; Perez Gonzalez, L.; Torres Escobar, J. J.

    2013-01-01

    The intensity modulated (IMRT) radiation therapy is a technique of high conformation which, by its nature, has as one of its main directions prostate cancer radiotherapy treatment. The purpose of this work is presents results of the dosimetric indicators collected in our hospital a number of patients of carcinoma of the prostate with standard three-dimensional Conformal technique (3D-CRT) and IMRT. Aims to demonstrate and quantify with a statistical methodology that, establishing an adequate Protocol of IMRT, significant reductions in risk organ doses can be obtained by keeping the same prescription to the white volume. (Author)

  3. Adoption of Intensity Modulated Radiation Therapy For Early-Stage Breast Cancer From 2004 Through 2011

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Elyn H. [Yale School of Medicine, New Haven, Connecticut (United States); Mougalian, Sarah S. [Yale School of Medicine, New Haven, Connecticut (United States); Yale Cancer Center, New Haven, Connecticut (United States); Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut (United States); Soulos, Pamela R. [Yale School of Medicine, New Haven, Connecticut (United States); Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut (United States); Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut (United States); Smith, Benjamin D. [Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas (United States); Haffty, Bruce G. [Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey (United States); Gross, Cary P. [Yale School of Medicine, New Haven, Connecticut (United States); Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut (United States); Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut (United States); Yu, James B., E-mail: james.b.yu@yale.edu [Yale School of Medicine, New Haven, Connecticut (United States); Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut (United States); Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (United States)

    2015-02-01

    Purpose: Intensity modulated radiation therapy (IMRT) is a newer method of radiation therapy (RT) that has been increasingly adopted as an adjuvant treatment after breast-conserving surgery (BCS). IMRT may result in improved cosmesis compared to standard RT, although at greater expense. To investigate the adoption of IMRT, we examined trends and factors associated with IMRT in women under the age of 65 with early stage breast cancer. Methods and Materials: We performed a retrospective study of early stage breast cancer patients treated with BCS followed by whole-breast irradiation (WBI) who were ≤65 years old in the National Cancer Data Base from 2004 to 2011. We used logistic regression to identify factors associated with receipt of IMRT (vs standard RT). Results: We identified 11,089 women with early breast cancer (9.6%) who were treated with IMRT and 104,448 (90.4%) who were treated with standard RT, after BCS. The proportion of WBI patients receiving IMRT increased yearly from 2004 to 2009, with 5.3% of WBI patients receiving IMRT in 2004 and 11.6% receiving IMRT in 2009. Further use of IMRT declined afterward, with the proportion remaining steady at 11.0% and 10.7% in 2010 and 2011, respectively. Patients treated in nonacademic community centers were more likely to receive IMRT (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.30-1.43 for nonacademic vs academic center). Compared to privately insured patients, the uninsured patients (OR, 0.81; 95% CI, 0.70-0.95) and those with Medicaid insurance (OR, 0.87; 95% CI, 0.79-0.95) were less likely to receive IMRT. Conclusions: The use of IMRT rose from 2004 to 2009 and then stabilized. Important nonclinical factors associated with IMRT use included facility type and insurance status.

  4. Individualized Selection of Beam Angles and Treatment Isocenter in Tangential Breast Intensity Modulated Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Penninkhof, Joan, E-mail: j.penninkhof@erasmusmc.nl [Department of Radiation Oncology, Erasmus M.C. Cancer Institute, Rotterdam (Netherlands); Spadola, Sara [Department of Radiation Oncology, Erasmus M.C. Cancer Institute, Rotterdam (Netherlands); Department of Physics and Astronomy, Alma Mater Studiorum, University of Bologna, Bologna (Italy); Breedveld, Sebastiaan; Baaijens, Margreet [Department of Radiation Oncology, Erasmus M.C. Cancer Institute, Rotterdam (Netherlands); Lanconelli, Nico [Department of Physics and Astronomy, Alma Mater Studiorum, University of Bologna, Bologna (Italy); Heijmen, Ben [Department of Radiation Oncology, Erasmus M.C. Cancer Institute, Rotterdam (Netherlands)

    2017-06-01

    Purpose and Objective: Propose a novel method for individualized selection of beam angles and treatment isocenter in tangential breast intensity modulated radiation therapy (IMRT). Methods and Materials: For each patient, beam and isocenter selection starts with the fully automatic generation of a large database of IMRT plans (up to 847 in this study); each of these plans belongs to a unique combination of isocenter position, lateral beam angle, and medial beam angle. The imposed hard planning constraint on patient maximum dose may result in plans with unacceptable target dose delivery. Such plans are excluded from further analyses. Owing to differences in beam setup, database plans differ in mean doses to organs at risk (OARs). These mean doses are used to construct 2-dimensional graphs, showing relationships between: (1) contralateral breast dose and ipsilateral lung dose; and (2) contralateral breast dose and heart dose (analyzed only for left-sided). The graphs can be used for selection of the isocenter and beam angles with the optimal, patient-specific tradeoffs between the mean OAR doses. For 30 previously treated patients (15 left-sided and 15 right-sided tumors), graphs were generated considering only the clinically applied isocenter with 121 tangential beam angle pairs. For 20 of the 30 patients, 6 alternative isocenters were also investigated. Results: Computation time for automatic generation of 121 IMRT plans took on average 30 minutes. The generated graphs demonstrated large variations in tradeoffs between conflicting OAR objectives, depending on beam angles and patient anatomy. For patients with isocenter optimization, 847 IMRT plans were considered. Adding isocenter position optimization next to beam angle optimization had a small impact on the final plan quality. Conclusion: A method is proposed for individualized selection of beam angles in tangential breast IMRT. This may be especially important for patients with cardiac risk factors or an

  5. Adoption of Intensity Modulated Radiation Therapy For Early-Stage Breast Cancer From 2004 Through 2011

    International Nuclear Information System (INIS)

    Wang, Elyn H.; Mougalian, Sarah S.; Soulos, Pamela R.; Smith, Benjamin D.; Haffty, Bruce G.; Gross, Cary P.; Yu, James B.

    2015-01-01

    Purpose: Intensity modulated radiation therapy (IMRT) is a newer method of radiation therapy (RT) that has been increasingly adopted as an adjuvant treatment after breast-conserving surgery (BCS). IMRT may result in improved cosmesis compared to standard RT, although at greater expense. To investigate the adoption of IMRT, we examined trends and factors associated with IMRT in women under the age of 65 with early stage breast cancer. Methods and Materials: We performed a retrospective study of early stage breast cancer patients treated with BCS followed by whole-breast irradiation (WBI) who were ≤65 years old in the National Cancer Data Base from 2004 to 2011. We used logistic regression to identify factors associated with receipt of IMRT (vs standard RT). Results: We identified 11,089 women with early breast cancer (9.6%) who were treated with IMRT and 104,448 (90.4%) who were treated with standard RT, after BCS. The proportion of WBI patients receiving IMRT increased yearly from 2004 to 2009, with 5.3% of WBI patients receiving IMRT in 2004 and 11.6% receiving IMRT in 2009. Further use of IMRT declined afterward, with the proportion remaining steady at 11.0% and 10.7% in 2010 and 2011, respectively. Patients treated in nonacademic community centers were more likely to receive IMRT (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.30-1.43 for nonacademic vs academic center). Compared to privately insured patients, the uninsured patients (OR, 0.81; 95% CI, 0.70-0.95) and those with Medicaid insurance (OR, 0.87; 95% CI, 0.79-0.95) were less likely to receive IMRT. Conclusions: The use of IMRT rose from 2004 to 2009 and then stabilized. Important nonclinical factors associated with IMRT use included facility type and insurance status

  6. A dosimetric comparison of fan-beam intensity modulated radiotherapy with gamma knife stereotactic radiosurgery for treating intermediate intracranial lesions

    International Nuclear Information System (INIS)

    Ma Lijun; Xia Ping; Verhey, Lynn J.; Boyer, Arthur L.

    1999-01-01

    Purpose: To compare and evaluate treatment plans for the fan-beam intensity modulated radiotherapy and the Gamma Knife radiosurgery for treating medium-size intracranial lesions (range 4-25 cm 3 ). Methods and Materials: Treatment plans were developed for the Leksell Gamma Knife and a fan-beam inverse treatment planning system for intensity modulated radiotherapy. Treatment plan comparisons were carried out using dose-volume histogram (DVH), tissue-volume ratio (TVR), and maximum dose to the prescription dose (MDPD) ratio. The study was carried out for both simulated targets and clinical targets with irregular shapes and at different locations. Results: The MDPD ratio was significantly greater for the Gamma Knife plans than for the fan-beam IMRT plans. The Gamma Knife plans produced equivalent TVR values to the fan-beam IMRT plans. Based on the DVH comparison, the fan-beam IMRT delivered significantly more dose to the normal brain tissue than the Gamma Knife. The results of the comparison were found to be insensitive to the target locations. Conclusion: The Gamma Knife is better than the fan-beam IMRT in sparing normal brain tissue while producing equivalent tumor dose conformity for treating medium-size intracranial lesions. However, the target dose homogeneity is significantly better for the fan-beam IMRT than for the Gamma Knife

  7. Is "pelvic radiation disease" always the cause of bowel symptoms following prostate cancer intensity-modulated radiotherapy?

    Science.gov (United States)

    Min, Myo; Chua, Benjamin; Guttner, Yvonne; Abraham, Ned; Aherne, Noel J; Hoffmann, Matthew; McKay, Michael J; Shakespeare, Thomas P

    2014-02-01

    Pelvic radiation disease (PRD) also widely known as "radiation proctopathy" is a well recognised late side-effect following conventional prostate radiotherapy. However, endoscopic evaluation and/or specialist referral for new or persistent post-prostate radiotherapy bowel symptoms is not routine and serious diagnoses may potentially be missed. Here we report a policy of endoscopic evaluation of bowel symptoms persisting >90 days post radiotherapy for prostate cancer. A consecutive series of 102 patients who had radical prostate intensity-modulated radiotherapy (IMRT)/image-guided radiotherapy (IGRT) and who had new or ongoing bowel symptoms or positive faecal occult blood tests (FOBT) on follow up visits more than three months after treatment, were referred for endoscopic examination. All but one (99%) had full colonoscopic investigation. Endoscopic findings included gastric/colonic/rectal polyps (56%), diverticular disease (49%), haemorrhoids (38%), radiation proctopathy (29%), gastritis/oesophagitis (8%) and rarer diagnoses, including bowel cancer which was found in 3%. Only four patients (4%) had radiation proctopathy without associated pathology and 65 patients (63%) had more than one diagnosis. If flexible sigmoidoscopy alone were used, 36.6% of patients and 46.6% patients with polyp(s) would have had their diagnoses missed. Our study has shown that bowel symptoms following prostate IMRT/IGRT are due to numerous diagnoses other than PRD, including malignancy. Routine referral pathways should be developed for endoscopic evaluation/specialist review for patients with new or persistent bowel symptoms (or positive FOBT) following prostate radiotherapy. This recommendation should be considered for incorporation into national guidelines. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  8. Is “pelvic radiation disease” always the cause of bowel symptoms following prostate cancer intensity-modulated radiotherapy?

    International Nuclear Information System (INIS)

    Min, Myo; Chua, Benjamin; Guttner, Yvonne; Abraham, Ned; Aherne, Noel J.; Hoffmann, Matthew; McKay, Michael J.; Shakespeare, Thomas P.

    2014-01-01

    Background: Pelvic radiation disease (PRD) also widely known as “radiation proctopathy” is a well recognised late side-effect following conventional prostate radiotherapy. However, endoscopic evaluation and/or specialist referral for new or persistent post-prostate radiotherapy bowel symptoms is not routine and serious diagnoses may potentially be missed. Here we report a policy of endoscopic evaluation of bowel symptoms persisting >90 days post radiotherapy for prostate cancer. Methods and materials: A consecutive series of 102 patients who had radical prostate intensity-modulated radiotherapy (IMRT)/image-guided radiotherapy (IGRT) and who had new or ongoing bowel symptoms or positive faecal occult blood tests (FOBT) on follow up visits more than three months after treatment, were referred for endoscopic examination. All but one (99%) had full colonoscopic investigation. Results: Endoscopic findings included gastric/colonic/rectal polyps (56%), diverticular disease (49%), haemorrhoids (38%), radiation proctopathy (29%), gastritis/oesophagitis (8%) and rarer diagnoses, including bowel cancer which was found in 3%. Only four patients (4%) had radiation proctopathy without associated pathology and 65 patients (63%) had more than one diagnosis. If flexible sigmoidoscopy alone were used, 36.6% of patients and 46.6% patients with polyp(s) would have had their diagnoses missed. Conclusions: Our study has shown that bowel symptoms following prostate IMRT/IGRT are due to numerous diagnoses other than PRD, including malignancy. Routine referral pathways should be developed for endoscopic evaluation/specialist review for patients with new or persistent bowel symptoms (or positive FOBT) following prostate radiotherapy. This recommendation should be considered for incorporation into national guidelines

  9. Simultaneous Integrated Boost Using Intensity-Modulated Radiotherapy Compared With Conventional Radiotherapy in Patients Treated With Concurrent Carboplatin and 5-Fluorouracil for Locally Advanced Oropharyngeal Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Clavel, Sebastien, E-mail: sebastien.clavel@umontreal.ca [Department of Radiation Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Nguyen, David H.A.; Fortin, Bernard [Department of Radiation Oncology, Hopital Maisonneuve-Rosemont, Montreal, QC (Canada); Despres, Philippe [Department of Radiation Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Khaouam, Nader [Department of Radiation Oncology, Hopital Maisonneuve-Rosemont, Montreal, QC (Canada); Donath, David [Department of Radiation Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Soulieres, Denis [Department of Medical Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Guertin, Louis [Department of Head and Neck Surgery, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Nguyen-Tan, Phuc Felix [Department of Radiation Oncology, Hopital Maisonneuve-Rosemont, Montreal, QC (Canada)

    2012-02-01

    Purpose: To compare, in a retrospective study, the toxicity and efficacy of simultaneous integrated boost using intensity-modulated radiotherapy (IMRT) vs. conventional radiotherapy (CRT) in patients treated with concomitant carboplatin and 5-fluorouracil for locally advanced oropharyngeal cancer. Methods and Materials: Between January 2000 and December 2007, 249 patients were treated with definitive chemoradiation. One hundred patients had 70 Gy in 33 fractions using IMRT, and 149 received CRT at 70 Gy in 35 fractions. Overall survival, disease-free survival, and locoregional control were estimated using the Kaplan-Meier method. Results: Median follow-up was 42 months. Three-year actuarial rates for locoregional control, disease-free survival, and overall survival were 95.1% vs. 84.4% (p = 0.005), 85.3% vs. 69.3% (p = 0.001), and 92.1% vs. 75.2% (p < 0.001) for IMRT and CRT, respectively. The benefit of the radiotherapy regimen on outcomes was also observed with a Cox multivariate analysis. Intensity-modulated radiotherapy was associated with less acute dermatitis and less xerostomia at 6, 12, 24, and 36 months. Conclusions: This study suggests that simultaneous integrated boost using IMRT is associated with favorable locoregional control and survival rates with less xerostomia and acute dermatitis than CRT when both are given concurrently with chemotherapy.

  10. Cardiac Side-effects From Breast Cancer Radiotherapy.

    Science.gov (United States)

    Taylor, C W; Kirby, A M

    2015-11-01

    Breast cancer radiotherapy reduces the risk of cancer recurrence and death. However, it usually involves some radiation exposure of the heart and analyses of randomised trials have shown that it can increase the risk of heart disease. Estimates of the absolute risks of radiation-related heart disease are needed to help oncologists plan each individual woman's treatment. The risk for an individual woman varies according to her estimated cardiac radiation dose and her background risk of ischaemic heart disease in the absence of radiotherapy. When it is known, this risk can then be compared with the absolute benefit of the radiotherapy. At present, many UK cancer centres are already giving radiotherapy with mean heart doses of less than 3 Gy and for most women the benefits of the radiotherapy will probably far outweigh the risks. Technical approaches to minimising heart dose in breast cancer radiotherapy include optimisation of beam angles, use of multileaf collimator shielding, intensity-modulated radiotherapy, treatment in a prone position, treatment in deep inspiration (including the use of breath-hold and gating techniques), proton therapy and partial breast irradiation. The multileaf collimator is suitable for many women with upper pole left breast cancers, but for women with central or lower pole cancers, breath-holding techniques are now recommended in national UK guidelines. Ongoing work aims to identify ways of irradiating pan-regional lymph nodes that are effective, involve minimal exposure of organs at risk and are feasible to plan, deliver and verify. These will probably include wide tangent-based field-in-field intensity-modulated radiotherapy or arc radiotherapy techniques in combination with deep inspiratory breath-hold, and proton beam irradiation for women who have a high predicted heart dose from intensity-modulated radiotherapy. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  11. Treatment with intensity-modulated radiation therapy (IMRT) for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Marta, G.N.; Hanna, S.A.; Gadia, R.

    2014-11-15

    Through the development of four relevant clinical questions related with the proposed subject, we tried to present the main evidence for safety, toxicity and effectiveness using different radiotherapy techniques. The study population consisted of female patients of all ages with primary breast cancer treated with radiation therapy to the whole breast, regardless of histological type, staging, context of treatment (radical, adjuvant or palliative) and whether comorbidities were present or not. For this, a systematic review of the literature was performed in primary scientific research databases (Medline - Pubmed; Embase - Elsevier; Lilacs - Bireme; Cochrane Library - Central Register of Controlled Trials). All articles available until July 22, 2013, were included. The search strategy used for Medline research is described in Appendix. Articles were selected based on critical evaluation in search of the best available evidence. Recommendations were prepared based on discussion with the writing group, composed of three members of the Brazilian Society of Radiotherapy. The guideline was reviewed by an independent group specializing in evidence-based clinical guidelines. After completion, the guideline was made available for public consultation for 15 days and the suggestions forwarded to the writers for evaluation and consideration into the final text. Objective: to assess the most appropriate method of radiation therapy for treating patients with primary breast tumors. (author)

  12. Analysis of Factors Influencing the Development of Xerostomia during Intensity-Modulated Radiotherapy

    Science.gov (United States)

    Randall, Ken; Stevens, Jason; Yepes, Juan Fernando; Randall, Marcus E.; Kudrimoti, Mahesh; Feddock, Jonathan; Xi, Jing; Kryscio, Richard J.; Miller, Craig S.

    2013-01-01

    OBJECTIVES Factors influencing xerostomia during intensity-modulated radiation therapy (IMRT) were assessed. METHODS A 6-week study of 32 head and neck cancer (HNC) patients was performed. Subjects completed the Xerostomia Inventory (XI) and provided stimulated saliva (SS) at baseline, week two and at end of IMRT. Influence of SS flow rate (SSFR), calcium and mucin 5b (MUC5b) concentrations and radiation dose on xerostomia was determined. RESULTS HNC subjects experienced mean SSFR decline of 36% by visit two (N=27; p=0.012) and 57% by visit three (N=20; p=0.0004), Concentrations of calcium and MUC5b increased, but not significantly during IMRT (p>0.05). Xerostomia correlated most with decreasing salivary flow rate as determined by Spearman correlations (pxerostomia. PMID:23523462

  13. VERIDOS: a new tool for quality assurance for intensity modulated radiotherapy.

    Science.gov (United States)

    Wiezorek, Tilo; Schwedas, Michael; Scheithauer, Marcel; Salz, Henning; Bellemann, Matthias; Wendt, Thomas G

    2002-12-01

    The use of intensity modulated radiation fields needs an extended quality assurance concept. This consists of a linac related part and a case related part. Case related means the verification of an individual treatment plan, optimized on a CT data set of an individual patient and prepared for the treatment of this patient. This part of the quality assurance work is usually time consuming, delivers only partially quantitative results and is uncomfortable without additional help. It will be shown in this paper how the software VERIDOS will improve the optimization of the case related part of the quality assurance work. The main function of the software is the quantitative comparison of the calculated dose distribution from the treatment planning software with the measured dose distribution of an irradiated phantom. Several additional functions will be explained. Two self-developed phantoms made of RW3 (solid water) and GAFCHROMIC films or Kodak EDR2 films for the measurement of the dose distributions were used. VERIDOS was tested with the treatment planning systems Helay-TMS and Brainscan. VERIDOS is a suitable tool for the import of calculated dose matrices from the treatment planning systems Helax-TMS and Brainscan and of measured dose matrices exported from the dosimetry software Mephysto (PTW). The import from other treatment planning systems and scanning software applications for film dosimetry is generally possible. In such case the import function has to be adapted to the special header of the import matrix. All other functions of this software tool like normalization (automatically, manually), working with corrections (ground substraction, factors), overlay/comparison of dose distributions, difference matrix, cutting function (profiles) and export functions work reliable. VERIDOS improves the optimization of the case related part of the quality assurance work for intensity modulated radiation therapy (IMRT). The diverse functions of the software offer the

  14. Dose reduction to normal tissues as compared to the gross tumor by using intensity modulated radiotherapy in thoracic malignancies

    Directory of Open Access Journals (Sweden)

    Bhalla NK

    2006-08-01

    Full Text Available Abstract Background and purpose Intensity modulated radiotherapy (IMRT is a powerful tool, which might go a long way in reducing radiation doses to critical structures and thereby reduce long term morbidities. The purpose of this paper is to evaluate the impact of IMRT in reducing the dose to the critical normal tissues while maintaining the desired dose to the volume of interest for thoracic malignancies. Materials and methods During the period January 2002 to March 2004, 12 patients of various sites of malignancies in the thoracic region were treated using physical intensity modulator based IMRT. Plans of these patients treated with IMRT were analyzed using dose volume histograms. Results An average dose reduction of the mean values by 73% to the heart, 69% to the right lung and 74% to the left lung, with respect to the GTV could be achieved with IMRT. The 2 year disease free survival was 59% and 2 year overall survival was 59%. The average number of IMRT fields used was 6. Conclusion IMRT with inverse planning enabled us to achieve desired dose distribution, due to its ability to provide sharp dose gradients at the junction of tumor and the adjacent critical organs.

  15. Implementation of an image guided intensity-modulated protocol for post-prostatectomy radiotherapy: planning data and acute toxicity outcomes.

    Science.gov (United States)

    Chua, Benjamin; Min, Myo; Wood, Maree; Edwards, Sarah; Hoffmann, Matthew; Greenham, Stuart; Kovendy, Andrew; McKay, Michael J; Shakespeare, Thomas P

    2013-08-01

    There is substantial interest in implementation of image-guided intensity-modulated radiotherapy (IG-IMRT) in the post-prostatectomy setting. We describe our implementation of IG-IMRT, and examine how often published organ-at-risk (OAR) constraints were met. Furthermore, we evaluate the incidence of acute genitourinary and gastrointestinal toxicities when patients were treated according to our protocol. Patients were eligible if they received post-prostatectomy radiotherapy (PPRT). Planning data were collected prospectively, and toxicity assessments were collected before, during and after treatment. Seventy-five eligible patients received either 64 Gy (19%) or 66 Gy (81%) in a single phase to the prostate bed. Suggested rectal dose-constraints of V40Gy image guidance. Non-IMRT OAR constraints were met in most cases. IMRT-specific constraints were less often achieved despite margin reductions, suggesting the need for review of guidelines. Severe toxicity was rare, and most patients did not experience deterioration in urinary or bowel function attributable to radiotherapy. © 2013 The Authors. Journal of Medical Imaging and Radiation Oncology © 2013 The Royal Australian and New Zealand College of Radiologists.

  16. Spine radiosurgery for the local treatment of spine metastases: Intensity-modulated radiotherapy, image guidance, clinical aspects and future directions

    Energy Technology Data Exchange (ETDEWEB)

    Moraes, Fabio Ynoe de; Neves-Junior, Wellington Furtado Pimenta; Hanna, Samir Abdallah; Carvalho, Heloisa de Andrade [Hospital Sirio-Libanes, Sao Paulo, SP (Brazil). Departamento de Radioterapia; Taunk, Neil Kanth; Yamada, Yoshiya [Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, NY (United States); Laufer, Ilya, E-mail: fymoraes@gmail.com [Memorial Sloan Kettering Cancer Center, Department of Neurosurgery, New York, NY (United States)

    2016-02-15

    Many cancer patients will develop spinal metastases. Local control is important for preventing neurologic compromise and to relieve pain. Stereotactic body radiotherapy or spinal radiosurgery is a new radiation therapy technique for spinal metastasis that can deliver a high dose of radiation to a tumor while minimizing the radiation delivered to healthy, neighboring tissues. This treatment is based on intensity-modulated radiotherapy, image guidance and rigid immobilization. Spinal radiosurgery is an increasingly utilized treatment method that improves local control and pain relief after delivering ablative doses of radiation. Here, we present a review highlighting the use of spinal radiosurgery for the treatment of metastatic tumors of the spine. The data used in the review were collected from both published studies and ongoing trials. We found that spinal radiosurgery is safe and provides excellent tumor control (up to 94% local control) and pain relief (up to 96%), independent of histology. Extensive data regarding clinical outcomes are available; however, this information has primarily been generated from retrospective and non randomized prospective series. Currently, two randomized trials are enrolling patients to study clinical applications of fractionation schedules spinal Radiosurgery. Additionally, a phase I clinical trial is being conducted to assess the safety of concurrent stereotactic body radiotherapy and ipilimumab for spinal metastases. Clinical trials to refine clinical indications and dose fractionation are ongoing. The concomitant use of targeted agents may produce better outcomes in the future. (author)

  17. Intensity Modulated Radiotherapy (IMRT) in the postoperative treatment of an adenocarcinoma of the endometrium complicated by a pelvic kidney

    International Nuclear Information System (INIS)

    Castilho, Marcus S; Jacinto, Alexandre A; Viani, Gustavo A; Campana, Andre; Carvalho, Juliana; Ferrigno, Robson; Novaes, Paulo ERS; Fogaroli, Ricardo C; Salvajoli, Joao V

    2006-01-01

    Pelvic Radiotherapy (RT) as a postoperative treatment for endometrial cancer improves local regional control. Brachytherapy also improves vaginal control. Both treatments imply significant side effects that a fine RT technique can help avoiding. Intensity Modulated RT (IMRT) enables the treatment of the target volume while protecting normal tissue. It therefore reduces the incidence and severity of side effects. We report on a 50 year-old patient with a serous-papiliferous adenocarcinoma of the uterus who was submitted to surgical treatment without lymph node sampling followed by Brachytherapy, and Chemotherapy. The patient had a pelvic kidney, and was therefore treated with IMRT. So far, the patient has been free from relapse and with normal kidney function. IMRT is a valid technique to prevent the kidney from radiation damage

  18. Intensity Modulated Radiotherapy (IMRT in the postoperative treatment of an adenocarcinoma of the endometrium complicated by a pelvic kidney

    Directory of Open Access Journals (Sweden)

    Novaes Paulo ERS

    2006-11-01

    Full Text Available Abstract Background Pelvic Radiotherapy (RT as a postoperative treatment for endometrial cancer improves local regional control. Brachytherapy also improves vaginal control. Both treatments imply significant side effects that a fine RT technique can help avoiding. Intensity Modulated RT (IMRT enables the treatment of the target volume while protecting normal tissue. It therefore reduces the incidence and severity of side effects. Case We report on a 50 year-old patient with a serous-papiliferous adenocarcinoma of the uterus who was submitted to surgical treatment without lymph node sampling followed by Brachytherapy, and Chemotherapy. The patient had a pelvic kidney, and was therefore treated with IMRT. So far, the patient has been free from relapse and with normal kidney function. Conclusion IMRT is a valid technique to prevent the kidney from radiation damage.

  19. Experience with combination of docetaxel, cisplatin plus 5-fluorouracil chemotherapy, and intensity-modulated radiotherapy for locoregionally advanced nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Du Chengrun; Ying Hongmei; Zhou Junjun; Hu Chaosu; Zhang Youwang

    2013-01-01

    Our aim was to evaluate the efficacy and toxicity of cisplatin, fluorouracil, and docetaxel chemotherapy plus intensity-modulated radiotherapy (IMRT) for locoregionally advanced nasopharyngeal carcinoma (NPC). Sixty patients with locoregionally advanced NPC were enrolled. Patients received IMRT plus three courses of neoadjuvant chemotherapy and two courses of adjuvant chemotherapy consisting of docetaxel (60 mg/m 2 /day on day 1), cisplatin (25 mg/m 2 /day on days 1-3), and 5-fluorouracil (500 mg/m 2 /day on days 1-3). The overall response rate to neoadjuvant chemotherapy was 89%. Three months after the completion of radiotherapy, 53 (93%) patients achieved complete regression, 3 (5%) achieved partial response (PR), and 1 experienced liver metastasis. However, among the 3 PR patients, 2 patients had no evidence of relapse in the follow-up. With a median follow-up of 27 months (range, 6-43), the 2-year estimated locoregional failure-free survival, distant failure-free survival, progression-free survival, and overall survival were 96.6, 93.3, 89.9, and 98.3%, respectively. Leukopenia was the main adverse effect in chemotherapy; 14 patients experienced grade 3 or grade 4 neutropenia, and 1 patient developed febrile neutropenia. The nonhematological adverse events included alopecia, nausea, vomiting, anorexia, and diarrhea. The incidence of grade 3 acute radiotherapy-related mucositis was 28.3%; no grade 4 acute mucositis was observed. No grade 3 or grade 4 hematological toxicity occurred during radiotherapy. None of the patients had interrupted radiotherapy. The common late adverse effects included xerostomia and hearing impairment. Neoadjuvant-adjuvant chemotherapy using cisplatin, fluorouracil, plus docetaxel combined with IMRT was an effective and well-tolerated alternative for advanced NPC. (author)

  20. Travelling for treatment; does distance and deprivation affect travel for intensity-modulated radiotherapy in the rural setting for head and neck cancer?

    Science.gov (United States)

    Cosway, B; Douglas, L; Armstrong, N; Robson, A

    2017-06-01

    NHS England has commissioned intensity-modulated radiotherapy for head and neck cancers from Newcastle hospitals for patients in North Cumbria. This study assessed whether travel distances affected the decision to travel to Newcastle (to receive intensity-modulated radiotherapy) or Carlisle (to receive conformal radiotherapy). All patients for whom the multidisciplinary team recommended intensity-modulated radiotherapy between December 2013 and January 2016 were included. Index of multiple deprivation scores and travel distances were calculated. Patients were also asked why they chose their treating centre. Sixty-nine patients were included in this study. There were no significant differences in travel distance (p = 0.53) or index of multiple deprivation scores (p = 0.47) between patients opting for treatment in Carlisle or Newcastle. However, 29 of the 33 patients gave travel distance as their main reason for not travelling for treatment. Quantitatively, travel distance and deprivation does not impact on whether patients accept intensity-modulated radiotherapy. However, patients say distance is a major barrier for access. Future research should explore how to reduce this.

  1. VERIDOS: A new tool for quality assurance for intensity modulated radiotherapy

    International Nuclear Information System (INIS)

    Wiezorek, T.; Schwedas, M.; Scheithauer, M.; Salz, H.; Wendt, T.G.; Bellemann, M.

    2002-01-01

    Background: The use of intensity modulated radiation fields needs an extended quality assurance concept. This consists of a linac related part and a case related part. Case related means the verification of an individual treatment plan, optimized on a CT data set of an individual patient and prepared for the treatment of this patient. This part of the quality assurance work is usually time consuming, delivers only partially quantitative results and is uncomfortable without additional help. It will be shown in this paper how the software VERIDOS will improve the optimization of the case related part of the quality assurance work. Material and Methods: The main function of the software is the quantitative comparison of the calculated dose distribution from the treatment planning software with the measured dose distribution of an irradiated phantom. Several additional functions will be explained. Two self-developed phantoms made of RW3 (solid water) and GAFCHROMIC films or Kodak EDR2 films for the measurement of the dose distributions were used. VERIDOS was tested with the treatment planning systems Helax-TMS and Brainscan. Results: VERIDOS is a suitable tool for the import of calculated dose matrices from the treatment planning systems Helax-TMS and Brainscan and of measured dose matrices exported from the dosimetry software Mephysto (PTW). The import from other treatment planning systems and scanning software applications for film dosimetry is generally possible. In such case the import function has to be adapted to the special header of the import matrix. All other functions of this software tool like normalization (automatically, manually), working with corrections (ground substraction, factors), overlay/comparison of dose distributions, difference matrix, cutting function (profiles) and export functions work reliable. Conclusions: VERIDOS improves the optimization of the case related part of the quality assurance work for intensity modulated radiation therapy

  2. Random and systematic beam modulator errors in dynamic intensity modulated radiotherapy

    International Nuclear Information System (INIS)

    Parsai, Homayon; Cho, Paul S; Phillips, Mark H; Giansiracusa, Robert S; Axen, David

    2003-01-01

    This paper reports on the dosimetric effects of random and systematic modulator errors in delivery of dynamic intensity modulated beams. A sliding-widow type delivery that utilizes a combination of multileaf collimators (MLCs) and backup diaphragms was examined. Gaussian functions with standard deviations ranging from 0.5 to 1.5 mm were used to simulate random positioning errors. A clinical example involving a clival meningioma was chosen with optic chiasm and brain stem as limiting critical structures in the vicinity of the tumour. Dose calculations for different modulator fluctuations were performed, and a quantitative analysis was carried out based on cumulative and differential dose volume histograms for the gross target volume and surrounding critical structures. The study indicated that random modulator errors have a strong tendency to reduce minimum target dose and homogeneity. Furthermore, it was shown that random perturbation of both MLCs and backup diaphragms in the order of σ = 1 mm can lead to 5% errors in prescribed dose. In comparison, when MLCs or backup diaphragms alone was perturbed, the system was more robust and modulator errors of at least σ = 1.5 mm were required to cause dose discrepancies greater than 5%. For systematic perturbation, even errors in the order of ±0.5 mm were shown to result in significant dosimetric deviations

  3. Random and systematic beam modulator errors in dynamic intensity modulated radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Parsai, Homayon [Department of Radiation Oncology, University of Washington, Box 356043, Seattle, WA 98195 (United States); Cho, Paul S [Department of Radiation Oncology, University of Washington, Box 356043, Seattle, WA 98195 (United States); Phillips, Mark H [Department of Radiation Oncology, University of Washington, Box 356043, Seattle, WA 98195 (United States); Giansiracusa, Robert S [Department of Radiation Oncology, University of Washington, Box 356043, Seattle, WA 98195 (United States); Axen, David [Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, V6T 1Z1 (Canada)

    2003-05-07

    This paper reports on the dosimetric effects of random and systematic modulator errors in delivery of dynamic intensity modulated beams. A sliding-widow type delivery that utilizes a combination of multileaf collimators (MLCs) and backup diaphragms was examined. Gaussian functions with standard deviations ranging from 0.5 to 1.5 mm were used to simulate random positioning errors. A clinical example involving a clival meningioma was chosen with optic chiasm and brain stem as limiting critical structures in the vicinity of the tumour. Dose calculations for different modulator fluctuations were performed, and a quantitative analysis was carried out based on cumulative and differential dose volume histograms for the gross target volume and surrounding critical structures. The study indicated that random modulator errors have a strong tendency to reduce minimum target dose and homogeneity. Furthermore, it was shown that random perturbation of both MLCs and backup diaphragms in the order of {sigma} = 1 mm can lead to 5% errors in prescribed dose. In comparison, when MLCs or backup diaphragms alone was perturbed, the system was more robust and modulator errors of at least {sigma} = 1.5 mm were required to cause dose discrepancies greater than 5%. For systematic perturbation, even errors in the order of {+-}0.5 mm were shown to result in significant dosimetric deviations.

  4. The Role of Pretreatment FDG-PET in Nasopharyngeal Carcinoma Treated With Intensity-Modulated Radiotherapy

    International Nuclear Information System (INIS)

    Liu, Wen-Shan; Wu, Ming-Fang; Tseng, Hsien-Chun; Liu, Jung-Tung; Weng, Jui-Hung; Li, Yueh-Chun; Lee, Jong-Kang

    2012-01-01

    Purpose: Pretreatment with 2- [ 18 F] fluorodeoxyglucose positron emission tomography ( 18 F-FDG-PET) was evaluated as a predictor of local failure-free survival (LFFS), disease-free survival (DFS), and overall survival (OS) in patients with nonkeratinizing nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT) alone or concurrently with chemotherapy (CCRT). Patients and Methods: Seventy-five M0 NPC patients who received FDG-PET before treatment were analyzed. The primary tumor FDG uptake was measured as the maximum standardized uptake value (SUVmax). The LFFS, DFS, and OS were calculated by the Kaplan-Meier method, and the differences were evaluated on log-rank test. The prognostic significance was assessed by univariate and multivariate analyses. Results: Eighteen patients received IMRT alone and 57 received CCRT. The mean SUVmax was significantly higher in 12 patients with locoregional or distant failure than in those without failure (p 18 F-FDG uptake (SUVmax >5) indicates poor outcome in patients with NPC.

  5. The Role of Pretreatment FDG-PET in Nasopharyngeal Carcinoma Treated With Intensity-Modulated Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Wen-Shan [School of Medicine, Chung Shan Medical University and Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan (China); Wu, Ming-Fang [School of Medicine, Chung Shan Medical University and Division of Medical Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan (China); Tseng, Hsien-Chun [School of Medicine, Chung Shan Medical University and Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan (China); Liu, Jung-Tung [School of Medicine, Chung Shan Medical University and Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan (China); Weng, Jui-Hung [Department of Nuclear Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan (China); Li, Yueh-Chun [School of Medicine, Chung Shan Medical University and Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan (China); Lee, Jong-Kang, E-mail: jongkanglee@hotmail.com [School of Medicine, Chung Shan Medical University and Department of Nuclear Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan (China)

    2012-02-01

    Purpose: Pretreatment with 2- [{sup 18}F] fluorodeoxyglucose positron emission tomography ({sup 18}F-FDG-PET) was evaluated as a predictor of local failure-free survival (LFFS), disease-free survival (DFS), and overall survival (OS) in patients with nonkeratinizing nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT) alone or concurrently with chemotherapy (CCRT). Patients and Methods: Seventy-five M0 NPC patients who received FDG-PET before treatment were analyzed. The primary tumor FDG uptake was measured as the maximum standardized uptake value (SUVmax). The LFFS, DFS, and OS were calculated by the Kaplan-Meier method, and the differences were evaluated on log-rank test. The prognostic significance was assessed by univariate and multivariate analyses. Results: Eighteen patients received IMRT alone and 57 received CCRT. The mean SUVmax was significantly higher in 12 patients with locoregional or distant failure than in those without failure (p <0.001). On multivariate analysis, the SUVmax was the only significant variable for 5-year LFFS (p = 0.017) and DFS (p = 0.000) but not for OS (p = 0.065). Conclusion: SUVmax is a potential independent prognostic predictor of clinical outcomes in patients with nasopharyngeal carcinoma treated with IMRT alone or with CCRT. A high {sup 18}F-FDG uptake (SUVmax >5) indicates poor outcome in patients with NPC.

  6. Treatment outcome of localized prostate cancer by 70 Gy hypofractionated intensity-modulated radiotherapy with a customized rectal balloon

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Jung; Kim, Jun Won; Hong, Sung Joon; Rha, Koon Ho; Lee, Chang Geol; Yang, Seung Choul; Choi, Young Deuk; Suh, Chang Ok; Cho, Jae Ho [Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-09-15

    We aimed to analyze the treatment outcome and long-term toxicity of 70 Gy hypofractionated intensity-modulated radiotherapy (IMRT) for localized prostate cancer using a customized rectal balloon. We reviewed medical records of 86 prostate cancer patients who received curative radiotherapy between January 2004 and December 2011 at our institution. Patients were designated as low (12.8%), intermediate (20.9%), or high risk (66.3%). Thirty patients received a total dose of 70 Gy in 28 fractions over 5 weeks via IMRT (the Hypo-IMRT group); 56 received 70.2 Gy in 39 fractions over 7 weeks via 3-dimensional conformal radiotherapy (the CF-3DRT group, which served as a reference for comparison). A customized rectal balloon was placed in Hypo-IMRT group throughout the entire radiotherapy course. Androgen deprivation therapy was administered to 47 patients (Hypo-IMRT group, 17; CF-3DRT group, 30). Late genitourinary (GU) and gastrointestinal (GI) toxicity were evaluated according to the Radiation Therapy Oncology Group criteria. The median follow-up period was 74.4 months (range, 18.8 to 125.9 months). The 5-year actuarial biochemical relapse-free survival rates for low-, intermediate-, and high-risk patients were 100%, 100%, and 88.5%, respectively, for the Hypo-IMRT group and 80%, 77.8%, and 63.6%, respectively, for the CF-3DRT group (p < 0.046). No patient presented with acute or late GU toxicity > or =grade 3. Late grade 3 GI toxicity occurred in 2 patients (3.6%) in the CF-3DRT group and 1 patient (3.3%) in the Hypo-IMRT group. Hypo-IMRT with a customized rectal balloon resulted in excellent biochemical control rates with minimal toxicity in localized prostate cancer patients.

  7. Nasopharyngeal Carcinoma Treated with Precision-Oriented Radiation Therapy Techniques Including Intensity-Modulated Radiotherapy: Preliminary Results

    Directory of Open Access Journals (Sweden)

    Wen-Shan Liu

    2004-02-01

    Full Text Available This paper reports preliminary results with intensity-modulated radiotherapy (IMRT in nasopharyngeal carcinoma (NPC. Between August 2000 and May 2001, we treated 19 patients with NPC using IMRT. Twelve patients had stage I-II disease and seven had stage III-IV disease. Six patients received 9.0-19.8 Gy three-dimensional conformal radiotherapy (3D-CRT before IMRT and 18 patients received a brachytherapy boost after IMRT. The mean follow-up time was 13.0 months. All patients with stage II-IV disease except one received two cycles of chemoradiotherapy with cisplatin and 5-fluorouracil (5-FU during radiotherapy, followed by two to four cycles of chemotherapy after radiotherapy. Tumor response was assessed using clinical examination and computerized tomography or magnetic resonance imaging. The mean doses administered to the gross tumor volume and clinical tumor volume were 70.9 Gy and 63.2 Gy, respectively. The mean doses administered to the right and left parotid glands were 38.1 Gy and 38.6 Gy, respectively. All 19 patients had a complete response of primary and lymph node disease. Grade III mucositis developed during chemoradiotherapy in 15 patients (79%. In addition, clinical grade I xerostomia was recorded in nine patients, grade II in nine, and grade III in one. This study demonstrated that 3D-CRT, IMRT, intracavitary brachytherapy, and chemotherapy are effective and safe methods to treat NPC. Although IMRT treatment spared parotid gland function, its efficacy may be significantly influenced by disease stage and location of the neck lymph nodes. More cases and a longer follow-up to assess survival and complications are planned.

  8. Dysphagia in head and neck cancer patients following intensity modulated radiotherapy (IMRT

    Directory of Open Access Journals (Sweden)

    Huber Gerhard

    2011-01-01

    Full Text Available Abstract Background To evaluate the objective and subjective long term swallowing function, and to relate dysphagia to the radiation dose delivered to the critical anatomical structures in head and neck cancer patients treated with intensity modulated radiation therapy (IMRT, +/- chemotherapy, using a midline protection contour (below hyoid, ~level of vertebra 2/3. Methods 82 patients with stage III/IV squamous cell carcinoma of the larynx, oropharynx, or hypopharynx, who underwent successful definitive (n = 63, mean dose 68.9Gy or postoperative (n = 19, mean dose 64.2Gy simultaneous integrated boost (SIB -IMRT either alone or in combination with chemotherapy (85% with curative intent between January 2002 and November 2005, were evaluated retrospectively. 13/63 definitively irradiated patients (21% presented with a total gross tumor volume (tGTV >70cc (82-173cc; mean 106cc. In all patients, a laryngo-pharyngeal midline sparing contour outside of the PTV was drawn. Dysphagia was graded according subjective patient-reported and objective observer-assessed instruments. All patients were re-assessed 12 months later. Dose distribution to the swallowing structures was calculated. Results At the re-assessment, 32-month mean post treatment follow-up (range 16-60, grade 3/4 objective toxicity was assessed in 10%. At the 32-month evaluation as well as at the last follow up assessment mean 50 months (16-85 post-treatment, persisting swallowing dysfunction grade 3 was subjectively and objectively observed in 1 patient (1%. The 5-year local control rate of the cohort was 75%; no medial marginal failures were observed. Conclusions Our results show that sparing the swallowing structures by IMRT seems effective and relatively safe in terms of avoidance of persistent grade 3/4 late dysphagia and local disease control.

  9. A particle swarm optimization algorithm for beam angle selection in intensity-modulated radiotherapy planning

    International Nuclear Information System (INIS)

    Li Yongjie; Yao Dezhong; Yao, Jonathan; Chen Wufan

    2005-01-01

    Automatic beam angle selection is an important but challenging problem for intensity-modulated radiation therapy (IMRT) planning. Though many efforts have been made, it is still not very satisfactory in clinical IMRT practice because of overextensive computation of the inverse problem. In this paper, a new technique named BASPSO (Beam Angle Selection with a Particle Swarm Optimization algorithm) is presented to improve the efficiency of the beam angle optimization problem. Originally developed as a tool for simulating social behaviour, the particle swarm optimization (PSO) algorithm is a relatively new population-based evolutionary optimization technique first introduced by Kennedy and Eberhart in 1995. In the proposed BASPSO, the beam angles are optimized using PSO by treating each beam configuration as a particle (individual), and the beam intensity maps for each beam configuration are optimized using the conjugate gradient (CG) algorithm. These two optimization processes are implemented iteratively. The performance of each individual is evaluated by a fitness value calculated with a physical objective function. A population of these individuals is evolved by cooperation and competition among the individuals themselves through generations. The optimization results of a simulated case with known optimal beam angles and two clinical cases (a prostate case and a head-and-neck case) show that PSO is valid and efficient and can speed up the beam angle optimization process. Furthermore, the performance comparisons based on the preliminary results indicate that, as a whole, the PSO-based algorithm seems to outperform, or at least compete with, the GA-based algorithm in computation time and robustness. In conclusion, the reported work suggested that the introduced PSO algorithm could act as a new promising solution to the beam angle optimization problem and potentially other optimization problems in IMRT, though further studies need to be investigated

  10. Dysphagia in head and neck cancer patients following intensity modulated radiotherapy (IMRT)

    International Nuclear Information System (INIS)

    Peponi, Evangelia; Glanzmann, Christoph; Willi, Bettina; Huber, Gerhard; Studer, Gabriela

    2011-01-01

    To evaluate the objective and subjective long term swallowing function, and to relate dysphagia to the radiation dose delivered to the critical anatomical structures in head and neck cancer patients treated with intensity modulated radiation therapy (IMRT, +/- chemotherapy), using a midline protection contour (below hyoid, ~level of vertebra 2/3). 82 patients with stage III/IV squamous cell carcinoma of the larynx, oropharynx, or hypopharynx, who underwent successful definitive (n = 63, mean dose 68.9Gy) or postoperative (n = 19, mean dose 64.2Gy) simultaneous integrated boost (SIB) -IMRT either alone or in combination with chemotherapy (85%) with curative intent between January 2002 and November 2005, were evaluated retrospectively. 13/63 definitively irradiated patients (21%) presented with a total gross tumor volume (tGTV) >70cc (82-173cc; mean 106cc). In all patients, a laryngo-pharyngeal midline sparing contour outside of the PTV was drawn. Dysphagia was graded according subjective patient-reported and objective observer-assessed instruments. All patients were re-assessed 12 months later. Dose distribution to the swallowing structures was calculated. At the re-assessment, 32-month mean post treatment follow-up (range 16-60), grade 3/4 objective toxicity was assessed in 10%. At the 32-month evaluation as well as at the last follow up assessment mean 50 months (16-85) post-treatment, persisting swallowing dysfunction grade 3 was subjectively and objectively observed in 1 patient (1%). The 5-year local control rate of the cohort was 75%; no medial marginal failures were observed. Our results show that sparing the swallowing structures by IMRT seems effective and relatively safe in terms of avoidance of persistent grade 3/4 late dysphagia and local disease control

  11. Patterns of nodal failure after intensity modulated radiotherapy for nasopharyngeal carcinoma.

    Science.gov (United States)

    Li, Jin-Gao; Venigalla, Praveen; Leeman, Jonathan E; LaPlant, Quincey; Setton, Jeremy; Sherman, Eric; Tsai, Jillian; McBride, Sean; Riaz, Nadeem; Lee, Nancy

    2017-02-01

    To evaluate the sites of nodal failure (NF) of nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT). Retrospective chart review. We reviewed the records of 165 patients with nonmetastatic NPC treated with IMRT between July 1998 and April 2011 at our institution. Recurrent nodes were delineated on imaging and coregistered with the original treatment planning computed tomography. Failures were assessed as in-field, out-field, or marginal based on the relative volumes of the recurrent nodes covered by the original dose distribution. Ten patients had NF at a median follow-up of 70.4 months for surviving patients. The 3- and 5-year overall survival and NF rates were 88.7%, 76.0% and 5.8%, 7.7%, respectively. Six of the nodal failures were in-field, of which five occurred in level II; whereas four had out-field failures, all of which were in the protected parotid gland area. There were no recurrences in level 1b despite this region being protected. The cumulative 3- and 5-year failure rates in the parotid gland area were 2.2% and 3.1%, respectively. Three patients with parotid failure initially had subcentimeter, nonspecific nodules in the same locations of the parotid gland as the recurrent nodes. Nodal failure is uncommon after IMRT in NPC. Recurrence in the parotid gland region accounts for all of the out-field failures and 40% of NF in our study. Comprehensive assessment of nodules in or around the parotid gland is therefore a key aspect of treatment planning and follow-up. 4. Laryngoscope, 2016 127:377-382, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  12. Adjuvant intensity-modulated proton therapy in malignant pleural mesothelioma. A comparison with intensity-modulated radiotherapy and a spot size variation assessment

    Energy Technology Data Exchange (ETDEWEB)

    Lorentini, S. [Agenzia Provinciale per la Protonterapia (ATreP), Trento (Italy); Padova Univ. (Italy). Medical Physics School; Amichetti, M.; Fellin, F.; Schwarz, M. [Agenzia Provinciale per la Protonterapia (ATreP), Trento (Italy); Spiazzi, L. [Brescia Hospital (Italy). Medical Physics Dept.; Tonoli, S.; Magrini, S.M. [Brescia Hospital (Italy). Radiation Oncology Dept.

    2012-03-15

    Intensity-modulated radiation therapy (IMRT) is the state-of-the-art treatment for patients with malignant pleural mesothelioma (MPM). The goal of this work was to assess whether intensity-modulated proton therapy (IMPT) could further improve the dosimetric results allowed by IMRT. We re-planned 7 MPM cases using both photons and protons, by carrying out IMRT and IMPT plans. For both techniques, conventional dose comparisons and normal tissue complication probability (NTCP) analysis were performed. In 3 cases, additional IMPT plans were generated with different beam dimensions. IMPT allowed a slight improvement in target coverage and clear advantages in dose conformity (p < 0.001) and dose homogeneity (p = 0.01). Better organ at risk (OAR) sparing was obtained with IMPT, in particular for the liver (D{sub mean} reduction of 9.5 Gy, p = 0.001) and ipsilateral kidney (V{sub 20} reduction of 58%, p = 0.001), together with a very large reduction of mean dose for the contralateral lung (0.2 Gy vs 6.1 Gy, p = 0.0001). NTCP values for the liver showed a systematic superiority of IMPT with respect to IMRT for both the esophagus (average NTCP 14% vs. 30.5%) and the ipsilateral kidney (p = 0.001). Concerning plans obtained with different spot dimensions, a slight loss of target coverage was observed along with sigma increase, while maintaining OAR irradiation always under planning constraints. Results suggest that IMPT allows better OAR sparing with respect to IMRT, mainly for the liver, ipsilateral kidney, and contralateral lung. The use of a spot dimension larger than 3 x 3 mm (up to 9 x 9 mm) does not compromise dosimetric results and allows a shorter delivery time.

  13. Recurrence in Region of Spared Parotid Gland After Definitive Intensity-Modulated Radiotherapy for Head and Neck Cancer

    International Nuclear Information System (INIS)

    Cannon, Donald M.; Lee, Nancy Y.

    2008-01-01

    Purpose: To discuss the implications of three examples of periparotid recurrence after definitive intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC). Methods and Materials: We present 3 patients with HNC who underwent definitive IMRT with concurrent chemotherapy and later had treatment failure in or near a spared parotid gland. Two patients had bilateral multilevel nodal disease, and all had Level II nodal disease ipsilateral to the site of recurrence. The patients were treated using dose-painting IMRT with a dose of 70 Gy to the gross tumor volume and 59.4 Gy or 54 Gy to the high-risk or low-risk clinical tumor volume, respectively. The parotid glands were spared bilaterally. The patients had not undergone any surgical treatment for HNC before radiotherapy. Results: All patients had treatment failure in the region of a spared parotid gland. Failure in the 2 patients with bilateral multilevel nodal involvement occurred in the periparotid lymph nodes. The third patient developed a dermal metastasis near the tail of a spared parotid gland. On pretreatment imaging, the 2 patients with nodal failure had small nonspecific periparotid nodules that showed no hypermetabolic activity on positron emission tomography. Conclusion: For HNC patients receiving definitive IMRT, nonspecific positron emission tomography-negative periparotid nodules on pretreatment imaging should raise the index of suspicion for subclinical disease in the presence of multilevel or Level II nodal metastases. Additional evaluation of such nodules might be indicated before sparing the ipsilateral parotid gland

  14. Treatment planning comparison of electron arc therapy and photon intensity modulated radiotherapy for Askin's tumor of chest wall

    International Nuclear Information System (INIS)

    Jamema, Swamidas V.; Sharma, Pramod K.; Laskar, Siddhartha; Deshpande, Deepak D.; Shrivastava, Shyam K.

    2007-01-01

    Background and Purpose: A dosimetric study to quantitatively compare radiotherapy treatment plans for Askin's tumor using Electron Arc (EA) vs. photon Intensity Modulated Radiotherapy (IMRT). Materials and methods: Five patients treated with EA were included in this study. Treatment plans were generated for each patient using EA and IMRT. Plans were compared using dose volume histograms (DVH) of the Planning Target Volume (PTV) and Organs at Risk (OAR). Results: IMRT resulted in superior PTV coverage, and homogeneous dose distribution compared to EA. For EA, 92% of the PTV was covered to 85% of the dose compared to IMRT in which 96% was covered to 95% of the dose. V 107 that represents the hot spot within the PTV was more in IMRT compared to EA: 7.4(±2)% vs. 3(±0.5)%, respectively. With PTVs located close to the spinal cord (SC), the dose to SC was more with EA, whereas for PTVs located away from the SC, the dose to SC was more with IMRT. The cardiac dose profile was similar to that of SC. Ipsilateral lung received lower doses with IMRT while contralateral lung received higher dose with IMRT compared to EA. For non-OAR normal tissues, IMRT resulted in large volumes of low dose regions. Conclusions: IMRT resulted in superior PTV coverage and sparing of OAR compared to EA plans. Although IMRT seems to be superior to EA, one needs to keep in mind the volume of low dose regions associated with IMRT, especially while treating young children

  15. The early adoption of intensity-modulated radiotherapy and stereotactic body radiation treatment among older Medicare beneficiaries with prostate cancer.

    Science.gov (United States)

    Jacobs, Bruce L; Yabes, Jonathan G; Lopa, Samia H; Heron, Dwight E; Chang, Chung-Chou H; Schroeck, Florian R; Bekelman, Justin E; Kahn, Jeremy M; Nelson, Joel B; Barnato, Amber E

    2017-08-01

    Several new prostate cancer treatments have emerged since 2000, including 2 radiotherapies with similar efficacy at the time of their introduction: intensity-modulated radiotherapy (IMRT) and stereotactic body radiation therapy (SBRT). The objectives of this study were to compare their early adoption patterns and identify factors associated with their use. By using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, patients who received radiation therapy during the 5 years after IMRT introduction (2001-2005) and the 5 years after SBRT introduction (2007-2011) were identified. The outcome of interest was the receipt of new radiation therapy (ie, IMRT or SBRT) compared with the existing standard radiation therapies at that time. The authors fit a series of multivariable, hierarchical logistic regression models accounting for patients nested within health service areas to examine the factors associated with the receipt of new radiation therapy. During 2001 to 2005, 5680 men (21%) received IMRT compared with standard radiation (n = 21,555). Men who received IMRT were older, had higher grade tumors, and lived in more populated areas (P adoption rate for IMRT was substantially higher than that for SBRT (44% vs 4%; P adoption rates of IMRT and SBRT at the time of their introduction. Further investigation of the nonclinical factors associated with this difference is warranted. Cancer 2017;123:2945-54. © 2017 American Cancer Society. © 2017 American Cancer Society.

  16. Locoregionally advanced nasopharyngeal carcinoma treated with intensity-modulated radiotherapy plus concurrent weekly cisplatin with or without neoadjuvant chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Wee, Chan Woo; Keam, Bhum Suk; Heo, Dae Seog; Sung, Myung Whun; Won, Tae Bin; Wu, Hong Gyun [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2015-06-15

    The outcomes of locoregionally advanced nasopharyngeal carcinoma patients treated with concurrent chemoradiation (CCRT) using intensity-modulated radiotherapy (IMRT) with/without neoadjuvant chemotherapy (NCT) were evaluated. Eighty-three patients who underwent NCT followed by CCRT (49%) or CCRT with/without adjuvant chemotherapy (51%) were reviewed. To the gross tumor, 67.5 Gy was prescribed. Weekly cisplatin was used as concurrent chemotherapy. With a median follow-up of 49.4 months, the 5-year local control, regional control, distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival rates were 94.7%, 89.3%, 77.8%, 68.0%, and 81.8%, respectively. In multivariate analysis, the American Joint Committee on Cancer stage (p = 0.016) and N stage (p = 0.001) were negative factors for DMFS and DFS, respectively. Overall, NCT demonstrated no benefit and an increased risk of severe hematologic toxicity. However, compared to patients treated with CCRT alone, NCT showed potential of improving DMFS in stage IV patients. CCRT using IMRT resulted in excellent local control and survival outcome. Without evidence of survival benefit from phase III randomized trials, NCT should be carefully administered in locoregionally advanced nasopharyngeal carcinoma patients who are at high-risk of developing distant metastasis and radiotherapy-related mucositis. The results of ongoing trials are awaited.

  17. Can dosimetric parameters predict acute hematologic toxicity in rectal cancer patients treated with intensity-modulated pelvic radiotherapy?

    International Nuclear Information System (INIS)

    Wan, Juefeng; Liu, Kaitai; Li, Kaixuan; Li, Guichao; Zhang, Zhen

    2015-01-01

    To identify dosimetric parameters associated with acute hematologic toxicity (HT) in rectal cancer patients undergoing concurrent chemotherapy and intensity-modulated pelvic radiotherapy. Ninety-three rectal cancer patients receiving concurrent capecitabine and pelvic intensity-modulated radiation therapy (IMRT) were analyzed. Pelvic bone marrow (PBM) was contoured for each patient and divided into three subsites: lumbosacral spine (LSS), ilium, and lower pelvis (LP). The volume of each site receiving 5–40 Gy (V 5, V10, V15, V20, V30, and V40, respectively) as well as patient baseline clinical characteristics was calculated. The endpoint for hematologic toxicity was grade ≥ 2 (HT2+) leukopenia, neutropenia, anemia or thrombocytopenia. Logistic regression was used to analyze correlation between dosimetric parameters and grade ≥ 2 hematologic toxicity. Twenty-four in ninety-three patients experienced grade ≥ 2 hematologic toxicity. Only the dosimetric parameter V40 of lumbosacral spine was correlated with grade ≥ 2 hematologic toxicity. Increased pelvic lumbosacral spine V40 (LSS-V40) was associated with an increased grade ≥ 2 hematologic toxicity (p = 0.041). Patients with LSS-V40 ≥ 60 % had higher rates of grade ≥ 2 hematologic toxicity than did patients with lumbosacral spine V40 < 60 % (38.3 %, 18/47 vs.13 %, 6/46, p =0.005). On univariate and multivariate logistic regression analysis, lumbosacral spine V40 and gender was also the variable associated with grade ≥ 2 hematologic toxicity. Female patients were observed more likely to have grade ≥ 2 hematologic toxicity than male ones (46.9 %, 15/32 vs 14.8 %, 9/61, p =0.001). Lumbosacral spine -V40 was associated with clinically significant grade ≥ 2 hematologic toxicity. Keeping the lumbosacral spine -V40 < 60 % was associated with a 13 % risk of grade ≥ 2 hematologic toxicity in rectal cancer patients undergoing concurrent chemoradiotherapy

  18. The Failure Patterns of Oral Cavity Squamous Cell Carcinoma After Intensity-Modulated Radiotherapy-University of Iowa Experience

    International Nuclear Information System (INIS)

    Yao Min; Chang, Kristi; Funk, Gerry F.; Lu Heming; Tan Huaming; Wacha, Judith C; Dornfeld, Kenneth J.; Buatti, John M.

    2007-01-01

    Purpose: Determine the failure patterns of oral cavity squamous cell carcinoma (SCC) treated with intensity-modulated radiotherapy (IMRT). Methods and Materials: Between May 2001 and July 2005, 55 patients with oral cavity SCC were treated with IMRT for curative intent. Forty-nine received postoperative IMRT, 5 definitive IMRT, and 1 neoadjuvant. Three target volumes were defined (clinical target CTV1, CTV2, and CTV3). The failure patterns were determined by coregistration or comparison of the treatment planning computed tomography to the images obtained at the time of recurrence. Results: The median follow-up for all patients was 17.1 months (range, 0.27-59.3 months). The median follow-up for living patients was 23.9 months (range, 9.3-59.3 months). Nine patients had locoregional failures: 4 local failures only, 2 regional failures only, and 3 had both local and regional failures. Five patients failed distantly; of these, 3 also had locoregional failures. The 2-year overall survival, disease-specific survival, local recurrence-free survival, locoregional recurrence-free survival, and distant disease-free survival was 68%, 74%, 85%, 82%, and 89%, respectively. The median time from treatment completion to locoregional recurrence was 4.1 months (range, 3.0-12.1 months). Except for 1 patient who failed in contralateral lower neck outside the radiation field, all failed in areas that had received a high dose of radiation. The locoregional control is strongly correlated with extracapsular extension. Conclusions: Intensity-modulated RT is effective for oral cavity SCC. Most failures are in-field failures. Further clinical studies are necessary to improve the outcomes of patients with high-risk features, particularly for those with extracapsular extension

  19. Risk Factors for Hearing Loss in Patients Treated With Intensity-Modulated Radiotherapy for Head-and-Neck Tumors

    International Nuclear Information System (INIS)

    Zuur, Charlotte L.; Simis, Yvonne J.; Lamers, Emmy A.; Hart, Augustinus A.; Dreschler, Wouter A.; Balm, Alfons J.; Rasch, Coen R.

    2009-01-01

    Purpose: Radiotherapy (RT) is a common treatment of head-and-neck carcinoma. The objective of this study was to perform a prospective multivariate assessment of the dose-effect relationship between intensity-modulated RT and hearing loss. Methods and Materials: Pure tone audiometry at 0.250-16 kHz was obtained before and after treatment in 101 patients (202 ears). All patients received full-course intensity-modulated RT (range, 56-70 Gy), with a median cochlear dose of 11.4 Gy (range, 0.2-69.7). Results: Audiometry was performed 1 week before and a median of 9 weeks (range, 1-112) after treatment. The mean hearing deterioration at pure tone average air-conduction 1-2-4 kHz was small (from 28.6 dB HL to 30.1 dB HL). However, individual patients showed clinically significant hearing loss, with 10-dB threshold shift incidences of 13% and 18% at pure tone averages air-conduction 1-2-4 kHz and 8-10-12.5 kHz, respectively. Post-treatment hearing capability was unfavorable in the case of greater inner ear radiation doses (p <0.0001), unfavorable baseline hearing capability (p <0.0001), green-eyed patients (p <0.0001), and older age (p <0.0001). Using multivariate analysis, a prediction of individual hearing capabiltity after treatment was made. Conclusion: RT-induced hearing loss in the mean population is modest. However, clinically significant hearing loss was observed in older patients with green eyes and unfavorable pretreatment hearing. In these patients, the intended radiation dose may be adjusted according to the proposed predictive model, aiming to decrease the risk of ototoxicity.

  20. Intensity-modulated radiotherapy for localized nasopharyngeal amyloidosis. Case report and literature review

    International Nuclear Information System (INIS)

    Luo, Ming; Peng, Gang; Shi, Liangliang; Li, Zhenyu; Fei, Shijiang; Ding, Qian; Cheng, Jing; Ming, Xing

    2016-01-01

    Primary localized amyloidosis is characterized by the deposition of amyloid proteins restricted to one organ, without systemic involvement. Primary nasopharyngeal amyloidosis is an exceedingly rare condition, for which the standard treatment remains unknown. Because of its challenging anatomical position, surgery alone hardly results in complete resection of the localized amyloidosis. Therefore, an interdisciplinary planning board to design optimal treatment is of particular importance. A 39-year-old man presented with a several-week history of nasal obstruction and epistaxis. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed the presence of a retro-odontoid nonenhancing soft tissue mass. The endoscopic biopsy demonstrated that the mass was amyloid in nature. An extensive systemic workup revealed an absence of inflammatory process, systemic amyloidosis, or plasma cell dyscrasia. The patient was treated with a combination of surgery and radiotherapy, showing no evidence of recurrence or progression at his 1-year follow-up. Primary solitary amyloidosis is a rare form of amyloidosis. To the best of our knowledge, this is the first report of a nasopharyngeal amyloidosis case treated with excision and radiation leading to complete remission. Because of the difficulty for surgeons to achieve radical resection with such lesions, radiotherapy proved to be an excellent adjuvant treatment in this case. (orig.) [de

  1. Limited Advantages of Intensity-Modulated Radiotherapy Over 3D Conformal Radiation Therapy in the Adjuvant Management of Gastric Cancer

    International Nuclear Information System (INIS)

    Alani, Shlomo; Soyfer, Viacheslav; Strauss, Natan; Schifter, Dan; Corn, Benjamin W.

    2009-01-01

    Purpose: Although chemoradiotherapy was considered the standard adjuvant treatment for gastric cancer, a recent Phase III trial (Medical Research Council Adjuvant Gastric Infusional Chemotherapy [MAGIC]) did not include radiotherapy in the randomization scheme because it was considered expendable. Given radiotherapy's potential, efforts needed to be made to optimize its use for treating gastric cancer. We assessed whether intensity-modulated radiotherapy (IMRT) could improve upon our published results in patients treated with three-dimensional (3D) conformal therapy. Methods and Materials: Fourteen patients with adenocarcinoma of the stomach were treated with adjuvant chemoradiotherapy using a noncoplanar four-field arrangement. Subsequently, a nine-field IMRT plan was designed using a CMS Xio IMRT version 4.3.3 module. Two IMRT beam arrangements were evaluated: beam arrangement 1 consisted of gantry angles of 0 deg., 53 deg., 107 deg., 158 deg., 204 deg., 255 deg., and 306 deg.. Beam arrangement 2 consisted of gantry angles of 30 deg., 90 deg., 315 deg., and 345 deg.; a gantry angle of 320 deg./couch, 30 deg.; and a gantry angle of 35 o /couch, 312 o . Both the target volume coverage and the dose deposition in adjacent critical organs were assessed in the plans. Dose-volume histograms were generated for the clinical target volume, kidneys, spine, and liver. Results: Comparison of the clinical target volumes revealed satisfactory coverage by the 95% isodose envelope using either IMRT or 3D conformal therapy. However, IMRT was only marginally better than 3D conformal therapy at protecting the spine and kidneys from radiation. Conclusions: IMRT confers only a marginal benefit in the adjuvant treatment of gastric cancer and should be used only in the small subset of patients with risk factors for kidney disease or those with a preexisting nephropathy.

  2. Limited advantages of intensity-modulated radiotherapy over 3D conformal radiation therapy in the adjuvant management of gastric cancer.

    Science.gov (United States)

    Alani, Shlomo; Soyfer, Viacheslav; Strauss, Natan; Schifter, Dan; Corn, Benjamin W

    2009-06-01

    Although chemoradiotherapy was considered the standard adjuvant treatment for gastric cancer, a recent Phase III trial (Medical Research Council Adjuvant Gastric Infusional Chemotherapy [MAGIC]) did not include radiotherapy in the randomization scheme because it was considered expendable. Given radiotherapy's potential, efforts needed to be made to optimize its use for treating gastric cancer. We assessed whether intensity-modulated radiotherapy (IMRT) could improve upon our published results in patients treated with three-dimensional (3D) conformal therapy. Fourteen patients with adenocarcinoma of the stomach were treated with adjuvant chemoradiotherapy using a noncoplanar four-field arrangement. Subsequently, a nine-field IMRT plan was designed using a CMS Xio IMRT version 4.3.3 module. Two IMRT beam arrangements were evaluated: beam arrangement 1 consisted of gantry angles of 0 degrees , 53 degrees , 107 degrees , 158 degrees , 204 degrees , 255 degrees , and 306 degrees . Beam arrangement 2 consisted of gantry angles of 30 degrees , 90 degrees , 315 degrees , and 345 degrees ; a gantry angle of 320 degrees /couch, 30 degrees ; and a gantry angle of 35 degrees /couch, 312 degrees . Both the target volume coverage and the dose deposition in adjacent critical organs were assessed in the plans. Dose-volume histograms were generated for the clinical target volume, kidneys, spine, and liver. Comparison of the clinical target volumes revealed satisfactory coverage by the 95% isodose envelope using either IMRT or 3D conformal therapy. However, IMRT was only marginally better than 3D conformal therapy at protecting the spine and kidneys from radiation. IMRT confers only a marginal benefit in the adjuvant treatment of gastric cancer and should be used only in the small subset of patients with risk factors for kidney disease or those with a preexisting nephropathy.

  3. Intensity-Modulated Radiotherapy for Locally Advanced Non-Small-Cell Lung Cancer: A Dose-Escalation Planning Study

    International Nuclear Information System (INIS)

    Lievens, Yolande; Nulens, An; Gaber, Mousa Amr; Defraene, Gilles; De Wever, Walter; Stroobants, Sigrid; Van den Heuvel, Frank

    2011-01-01

    Purpose: To evaluate the potential for dose escalation with intensity-modulated radiotherapy (IMRT) in positron emission tomography-based radiotherapy planning for locally advanced non-small-cell lung cancer (LA-NSCLC). Methods and Materials: For 35 LA-NSCLC patients, three-dimensional conformal radiotherapy and IMRT plans were made to a prescription dose (PD) of 66 Gy in 2-Gy fractions. Dose escalation was performed toward the maximal PD using secondary endpoint constraints for the lung, spinal cord, and heart, with de-escalation according to defined esophageal tolerance. Dose calculation was performed using the Eclipse pencil beam algorithm, and all plans were recalculated using a collapsed cone algorithm. The normal tissue complication probabilities were calculated for the lung (Grade 2 pneumonitis) and esophagus (acute toxicity, grade 2 or greater, and late toxicity). Results: IMRT resulted in statistically significant decreases in the mean lung (p <.0001) and maximal spinal cord (p = .002 and 0005) doses, allowing an average increase in the PD of 8.6-14.2 Gy (p ≤.0001). This advantage was lost after de-escalation within the defined esophageal dose limits. The lung normal tissue complication probabilities were significantly lower for IMRT (p <.0001), even after dose escalation. For esophageal toxicity, IMRT significantly decreased the acute NTCP values at the low dose levels (p = .0009 and p <.0001). After maximal dose escalation, late esophageal tolerance became critical (p <.0001), especially when using IMRT, owing to the parallel increases in the esophageal dose and PD. Conclusion: In LA-NSCLC, IMRT offers the potential to significantly escalate the PD, dependent on the lung and spinal cord tolerance. However, parallel increases in the esophageal dose abolished the advantage, even when using collapsed cone algorithms. This is important to consider in the context of concomitant chemoradiotherapy schedules using IMRT.

  4. A Novel Dose Constraint to Reduce Xerostomia in Head-and-Neck Cancer Patients Treated With Intensity-Modulated Radiotherapy

    International Nuclear Information System (INIS)

    Strigari, Lidia; Benassi, Marcello; Arcangeli, Giorgio; Bruzzaniti, Vicente; Giovinazzo, Giuseppe; Marucci, Laura

    2010-01-01

    Purpose: To investigate the predictors of incidence and duration of xerostomia (XT) based on parotid glands (PG), submandibular glands (SMG), and both glands taken as a whole organ (TG) in head-and-neck cancer patients treated with intensity-modulated radiotherapy. Methods and Materials: A prospective study was initiated in May 2003. Sixty-three head-and-neck patients (44 with nasopharynx cancer) were included in the analysis. Using the dose-volume histogram the PG, SMG, and TG mean doses were calculated. Unstimulated and stimulated salivary flow were measured and XT-related questionnaires were compiled before and at 3, 6, 12, 18, and 24 months after radiotherapy. Salivary gland toxicity was evaluated using the Radiation Therapy Oncology Group scale, and Grade ≥3 toxicity was used as the endpoint. The XT incidence was investigated according to descriptive statistics and univariate and multivariate analysis. The Bonferroni method was used for multiple comparison adjustment. Results: After a reduced flow at 3 months after radiotherapy, recovery of salivary flow was observed over time. Primary site and salivary gland mean doses and volumes were identified in univariate analysis as prognostic factors. Multivariate analysis confirmed that TG mean dose (p = 0.00066) and pretreatment stimulated salivary flow (p = 0.00420) are independent factors for predicting XT. Conclusion: The TG mean dose correlates with XT as assessed by Radiation Therapy Oncology Group criteria, salivary output, and XT-related questionnaires. Our results suggest that TG mean dose is a candidate dose constraint for reducing XT, requiring considerably more validation in non-nasopharyngeal cancer patients.

  5. Intrafractional prostate motion during online image guided intensity-modulated radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Budiharto, Tom; Slagmolen, Pieter; Haustermans, Karin; Maes, Frederik; Junius, Sara; Verstraete, Jan; Oyen, Raymond; Hermans, Jeroen; Van den Heuvel, Frank

    2011-01-01

    Introduction: Intrafractional motion consists of two components: (1) the movement between the on-line repositioning procedure and the treatment start and (2) the movement during the treatment delivery. The goal of this study is to estimate this intrafractional movement of the prostate during prostate cancer radiotherapy. Material and methods: Twenty-seven patients with prostate cancer and implanted fiducials underwent a marker match procedure before a five-field IMRT treatment. For all fields, in-treatment images were obtained and then processed to enable automatic marker detection. Combining the subsequent projection images, five positions of each marker were determined using the shortest path approach. The residual set-up error (RSE) after kV-MV based prostate localization, the prostate position as a function of time during a radiotherapy session and the required margins to account for intrafractional motion were determined. Results: The mean RSE and standard deviation in the antero-posterior, cranio-caudal and left-right direction were 2.3 ± 1.5 mm, 0.2 ± 1.1 mm and -0.1 ± 1.1 mm, respectively. Almost all motions occurred in the posterior direction before the first treatment beam as the percentage of excursions >5 mm was reduced significantly when the RSE was not accounted for. The required margins for intrafractional motion increased with prolongation of the treatment. Application of a repositioning protocol after every beam could decrease the 1 cm margin from CTV to PTV by 2 mm. Conclusions: The RSE is the main contributor to intrafractional motion. This RSE after on-line prostate localization and patient repositioning in the posterior direction emphasizes the need to speed up the marker match procedure. Also, a prostate IMRT treatment should be administered as fast as possible, to ensure that the pre-treatment repositioning efforts are not erased by intrafractional prostate motion. This warrants an optimized workflow with the use of faster treatment

  6. Small scale photon beams measurement and modeling for Intensity-modulated radiotherapy and radio-surgery

    International Nuclear Information System (INIS)

    Abdul Hadi, Talal

    2017-01-01

    The advanced techniques of radiotherapy use very small fields in case small tumors such as in the brain to irradiate precisely the lesion. This work concerns the measurement absorbed dose in small field of 0.5 x 0.5 cm 2 to 3 x 3 cm 2 . However, the measurement dose in small fields is characterized by high gradient dose and a leak of lateral electronic equilibrium. That requires use a detector having an adapted sensitive volume and adapted spatial resolution. The detectors marketed are not perfectly compatible with these conditions. Actually, there is no international methodological consensus, nor a metrological reference for measurement dose in small fields. The IAEA (International Atomic Energy Agency) protocol 398 used to calculate the absorbed dose at 10 cm x 10 cm is not suitable for small fields. In absence a referenced detector, the dosimetric data measurement is verified using a Gafchromic films due to its excellent spatial resolution. We measure using conventional detectors (ionization chambers and/or Gafchromic films) the leakage dose at a point outside of irradiated field. The dosimetric data such as output factor (OF), percentage depth dose (PDD) and off-axis ratio (OAR) were also carried out by the diode. The correlation between the on-axis dose and off-axis dose is the subject of our study. This study proposes an experimental method to calculate the on-axis dose in small field for stereotactic radiotherapy. The method is based on the out of field leakage measurement. This model can be used to validate dose and output factor measurement. The experimental validation of the present method was performed for square and rectangular fields with sizes ranging from 0.5 cm x 0.5 cm to 10 cm x 10 cm. (author) [fr

  7. DARS: a phase III randomised multicentre study of dysphagia- optimised intensity- modulated radiotherapy (Do-IMRT) versus standard intensity- modulated radiotherapy (S-IMRT) in head and neck cancer

    International Nuclear Information System (INIS)

    Petkar, Imran; Rooney, Keith; Roe, Justin W. G.; Patterson, Joanne M.; Bernstein, David; Tyler, Justine M.; Emson, Marie A.; Morden, James P.; Mertens, Kathrin; Miles, Elizabeth; Beasley, Matthew; Roques, Tom; Bhide, Shreerang A.; Newbold, Kate L.; Harrington, Kevin J.; Hall, Emma; Nutting, Christopher M.

    2016-01-01

    Persistent dysphagia following primary chemoradiation (CRT) for head and neck cancers can have a devastating impact on patients’ quality of life. Single arm studies have shown that the dosimetric sparing of critical swallowing structures such as the pharyngeal constrictor muscle and supraglottic larynx can translate to better functional outcomes. However, there are no current randomised studies to confirm the benefits of such swallow sparing strategies. The aim of Dysphagia/Aspiration at risk structures (DARS) trial is to determine whether reducing the dose to the pharyngeal constrictors with dysphagia-optimised intensity- modulated radiotherapy (Do-IMRT) will lead to an improvement in long- term swallowing function without having any detrimental impact on disease-specific survival outcomes. The DARS trial (CRUK/14/014) is a phase III multicentre randomised controlled trial (RCT) for patients undergoing primary (chemo) radiotherapy for T1-4, N0-3, M0 pharyngeal cancers. Patients will be randomised (1:1 ratio) to either standard IMRT (S-IMRT) or Do-IMRT. Radiotherapy doses will be the same in both groups; however in patients allocated to Do-IMRT, irradiation of the pharyngeal musculature will be reduced by delivering IMRT identifying the pharyngeal muscles as organs at risk. The primary endpoint of the trial is the difference in the mean MD Anderson Dysphagia Inventory (MDADI) composite score, a patient-reported outcome, measured at 12 months post radiotherapy. Secondary endpoints include prospective and longitudinal evaluation of swallow outcomes incorporating a range of subjective and objective assessments, quality of life measures, loco-regional control and overall survival. Patients and speech and language therapists (SLTs) will both be blinded to treatment allocation arm to minimise outcome-reporting bias. DARS is the first RCT investigating the effect of swallow sparing strategies on improving long-term swallowing outcomes in pharyngeal cancers. An integral

  8. DARS: a phase III randomised multicentre study of dysphagia- optimised intensity- modulated radiotherapy (Do-IMRT) versus standard intensity- modulated radiotherapy (S-IMRT) in head and neck cancer.

    Science.gov (United States)

    Petkar, Imran; Rooney, Keith; Roe, Justin W G; Patterson, Joanne M; Bernstein, David; Tyler, Justine M; Emson, Marie A; Morden, James P; Mertens, Kathrin; Miles, Elizabeth; Beasley, Matthew; Roques, Tom; Bhide, Shreerang A; Newbold, Kate L; Harrington, Kevin J; Hall, Emma; Nutting, Christopher M

    2016-10-06

    Persistent dysphagia following primary chemoradiation (CRT) for head and neck cancers can have a devastating impact on patients' quality of life. Single arm studies have shown that the dosimetric sparing of critical swallowing structures such as the pharyngeal constrictor muscle and supraglottic larynx can translate to better functional outcomes. However, there are no current randomised studies to confirm the benefits of such swallow sparing strategies. The aim of Dysphagia/Aspiration at risk structures (DARS) trial is to determine whether reducing the dose to the pharyngeal constrictors with dysphagia-optimised intensity- modulated radiotherapy (Do-IMRT) will lead to an improvement in long- term swallowing function without having any detrimental impact on disease-specific survival outcomes. The DARS trial (CRUK/14/014) is a phase III multicentre randomised controlled trial (RCT) for patients undergoing primary (chemo) radiotherapy for T1-4, N0-3, M0 pharyngeal cancers. Patients will be randomised (1:1 ratio) to either standard IMRT (S-IMRT) or Do-IMRT. Radiotherapy doses will be the same in both groups; however in patients allocated to Do-IMRT, irradiation of the pharyngeal musculature will be reduced by delivering IMRT identifying the pharyngeal muscles as organs at risk. The primary endpoint of the trial is the difference in the mean MD Anderson Dysphagia Inventory (MDADI) composite score, a patient-reported outcome, measured at 12 months post radiotherapy. Secondary endpoints include prospective and longitudinal evaluation of swallow outcomes incorporating a range of subjective and objective assessments, quality of life measures, loco-regional control and overall survival. Patients and speech and language therapists (SLTs) will both be blinded to treatment allocation arm to minimise outcome-reporting bias. DARS is the first RCT investigating the effect of swallow sparing strategies on improving long-term swallowing outcomes in pharyngeal cancers. An integral

  9. Intensity-modulated radiotherapy plus nimotuzumab with or without concurrent chemotherapy for patients with locally advanced nasopharyngeal carcinoma

    Directory of Open Access Journals (Sweden)

    Huang JF

    2017-12-01

    Full Text Available Jianfeng Huang,1,* Qinzhou Zou,1,* Danqi Qian,1 Leyuan Zhou,1 Bo Yang,1 Jianjun Chu,1 Qingfeng Pang,2 Kewei Wang,2 Fuzheng Zhang1 1Department of Radiation Oncology, Affiliated Hospital of Jiangnan University, 2Department of Epidemiology, Wuxi Medical School of Jiangnan University, Wuxi, Jiangsu, People’s Republic of China *These authors contributed equally to this work Objective: This study aimed to evaluate the safety and efficacy of intensity-modulated radiotherapy (IMRT plus nimotuzumab with or without concurrent chemotherapy (CCT for patients with locally advanced nasopharyngeal carcinoma (LA-NPC. Patients and methods: A total of 50 newly diagnosed patients with LA-NPC treated at the Affiliated Hospital of Jiangnan University between November 2011 and January 2017 were retrospectively analyzed. All patients received the combined treatment modality of nimotuzumab plus IMRT. Nimotuzumab was administered concurrently with IMRT at a weekly dose of 200 mg. Neoadjuvant, concurrent or adjuvant chemotherapy with the doublet regimen of taxanes (docetaxel or paclitaxel plus platinum (cisplatin or nedaplatin were administered. Among the 50 patients, 43 (86.0% received ≥6 cycles of nimotuzumab (median 7 cycles, range 2–14 cycles and 29 (58.0% received two cycles of CCT with docetaxel plus nedaplatin. Results: With a median follow-up of 28.0 months, the 2-year progression-free survival (PFS and overall survival were 83.29% (95% confidence interval [CI]: 67.93%–91.72% and 97.67% (95% CI: 84.62%–99.67%, respectively. Both univariate and multivariate analyses revealed that cycles of nimotuzumab were significantly associated with PFS. Patients who received ≥6 cycles of nimotuzumab showed a better PFS than those receiving <6 cycles (P=0.006, whereas the addition of CCT failed to improve PFS. Oral mucositis was the most common adverse event, which was recorded as grade 3–4 in 18 (36.0% patients. Besides, two (4.0% patients experienced

  10. Intensity-modulated radiotherapy for localized nasopharyngeal amyloidosis. Case report and literature review

    Energy Technology Data Exchange (ETDEWEB)

    Luo, Ming [Hubei University of Medicine, Department of Clinical Oncology, Taihe Hospital, Shiyan, Hubei (China); Peng, Gang; Shi, Liangliang; Li, Zhenyu; Fei, Shijiang; Ding, Qian; Cheng, Jing [HuaZhong University of Science and Technology, Cancer Center, Union Hospital, Tongji Medical College, Wuhan (China); Ming, Xing [Hubei University of Medicine, Department of infection control and prevention, Taihe Hospital, Shiyan, Hubei (China)

    2016-12-15

    Primary localized amyloidosis is characterized by the deposition of amyloid proteins restricted to one organ, without systemic involvement. Primary nasopharyngeal amyloidosis is an exceedingly rare condition, for which the standard treatment remains unknown. Because of its challenging anatomical position, surgery alone hardly results in complete resection of the localized amyloidosis. Therefore, an interdisciplinary planning board to design optimal treatment is of particular importance. A 39-year-old man presented with a several-week history of nasal obstruction and epistaxis. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed the presence of a retro-odontoid nonenhancing soft tissue mass. The endoscopic biopsy demonstrated that the mass was amyloid in nature. An extensive systemic workup revealed an absence of inflammatory process, systemic amyloidosis, or plasma cell dyscrasia. The patient was treated with a combination of surgery and radiotherapy, showing no evidence of recurrence or progression at his 1-year follow-up. Primary solitary amyloidosis is a rare form of amyloidosis. To the best of our knowledge, this is the first report of a nasopharyngeal amyloidosis case treated with excision and radiation leading to complete remission. Because of the difficulty for surgeons to achieve radical resection with such lesions, radiotherapy proved to be an excellent adjuvant treatment in this case. (orig.) [German] Die primaere lokalisierte Amyloidose ist durch die Ablagerung von Amyloidproteinen gekennzeichnet, die sich auf ein Organ beschraenkt, also nicht systemisch ist. Eine primaere Amyloidose im Nasen-Rachen-Raum ist ausserordentlich selten, bisher gibt es keine Standardtherapie. Ihre anatomische Position bedeutet eine Herausforderung, nur selten resultiert eine chirurgische Intervention in einer vollstaendigen Resektion der lokalisierten Amyloidose. Daher ist die Beteiligung mehrerer Disziplinen fuer eine optimale Behandlung von besonderer

  11. 3D-Conformal Versus Intensity-Modulated Postoperative Radiotherapy of Vaginal Vault: A Dosimetric Comparison

    International Nuclear Information System (INIS)

    Cilla, Savino; Macchia, Gabriella; Digesu, Cinzia; Deodato, Francesco; Romanella, Michele; Ferrandina, Gabriella; Padula, Gilbert; Picardi, Vincenzo; Scambia, Giovanni; Piermattei, Angelo; Morganti, Alessio Giuseppe

    2010-01-01

    We evaluated a step-and-shoot IMRT plan in the postoperative irradiation of the vaginal vault compared with equispaced beam arrangements (3-5) 3D-radiotherapy (RT) optimized plans. Twelve patients were included in this analysis. Four plans for each patient were compared in terms of dose-volume histograms, homogeneity index (HI), and conformity index (CI): (1) 3 equispaced beam arrangement 3D-RT; (2) 4 equispaced beam arrangement 3D-RT; (3) 5 equispaced beam arrangement 3D-RT; (4) step-and-shoot IMRT technique. CI showed a good discrimination between the four plans. The mean scores of CI were 0.58 (range: 0.38-0.67) for the 3F-CRT plan, 0.58 (range: 0.41-0.66) for 4F-CRT, 0.62 (range: 0.43-0.68) for 5F-CRT and 0.69 (range: 0.58-0.78) for the IMRT plan. A significant improvement of the conformity was reached by the IMRT plan (p mean , V90%, V95%, V100% was recorded for rectal and bladder irradiation with the IMRT plan. Surprisingly, IMRT supplied a significant dose reduction also for rectum and bladder V30% and V50%. A significant dosimetric advantage of IMRT over 3D-RT in the adjuvant treatment of vaginal vault alone in terms of treatment conformity and rectum and bladder sparing is shown.

  12. Short-course intensity-modulated radiotherapy for localized prostate cancer with daily transabdominal ultrasound localization of the prostate gland

    International Nuclear Information System (INIS)

    Mohan, Dasarahally S.; Kupelian, Patrick A.; Willoughby, Twyla R.

    2000-01-01

    Purpose: To present our initial observations on the clinical feasibility of the technique of short-course intensity-modulated radiotherapy (SCIM-RT) in the treatment of localized prostate cancer coupled with daily transabdominal ultrasound localization of the prostate. The proposed regimen consists of a hypofractionated course delivering 70.0 Gy in 28 fractions. Methods and Materials: The treatment data of the first 51 patients treated with SCIM-RT at the Cleveland Clinic Foundation are presented in this report. The technique consisted of intensity-modulated radiotherapy using 5 static fields (anterior, 2 laterals, and 2 anterior obliques). Inverse plans were generated by the Corvus treatment-planning system. The treatment delivery was performed with a Varian Dynamic Multileaf Collimator. The target was the prostate only in patients with low-risk disease (stage T1-T2, pretreatment PSA ≤10, and biopsy Gleason ≤6). The target was the prostate and seminal vesicles in patients with high-risk disease (stage T3 or pretreatment PSA >10 or biopsy Gleason ≥7). In the Corvus planning system, the margins for the planning target volume (PTV) were 4 mm posteriorly, 8 mm laterally, and 5 mm in all other directions. A total of 70.0 Gy (mean prostate dose approximately 75 Gy) was prescribed in all cases at 2.5 Gy per fraction to be delivered in 28 fractions over 5((1)/(2)) weeks. Prior to treatment delivery, the patients were minimally immobilized on the treatment table, only using lasers and skin marks. The location of the prostate gland was verified daily with the BAT transabdominal ultrasound system and patient position adjustments were performed accordingly. Fifty-one patients completed therapy between October 1998 and May 1999. Results: The dose was prescribed to an isodose line ranging from 82.0% to 90.0% (mean: 87.2%). The range of the individual prostate mean doses was 73.5 to 78.5 Gy (average: 75.3 Gy). The range of the maximum doses was 77.4 to 84.5 Gy (average: 80

  13. Long-term Results of Post-operative Pelvic Image guided Intensity Modulated Radiotherapy in Gynecological Malignancies.

    Science.gov (United States)

    Agrawal, Rashi; Prithiviraj, Sowmiya; Singh, Dinesh; Zamre, Vaishali; Agrawal, Sandeep; Goel, Arun Kumar; Gupta, Kanika; Subramanian, Bala

    2017-05-01

    To assess late clinical outcomes with image guided intensity modulated radiotherapy (IG- IMRT) in gynecological malignancies. We have been practicing IG IMRT for gynecological malignancies since January 2009. Here we are presenting our experience with this modern technique at median follow up of 38 months. During whole treatment bladder filling protocol was followed. Both target volumes and critical structures were contoured according to RTOG guidelines. Dose prescribed to clinical target volume (postop bed and nodal volume) was 50.4 Gy in 28 fractions. Cone beam CT (CBCT) scans were taken to quantify the status of target volume and normal structures. 80 patients were evaluated and analyzed who were treated from January 2009 to December 2014. Median age of our patients was 56.5 years. Out of eighty, forty four patients (55%) were of carcinoma endometrium and the rest 36 (45%) were of carcinoma cervix. None of our patients experienced late grade 3 or 4 bladder toxicity. Although late grade 3 and 4 bowel and rectal toxicity was experienced by single patient. 2.5% patients developed local recurrence, 5% patient developed nodal with distant metastases and 6.25% only distant metastases. Three of our patients developed lung cancer as second primary during follow up. 76.2% atients are alive with regular follow up. Our study concluded that IG IMRT increases patient compliance and reduces long-term side effects in post-operative gynecological malignancies without compromising local-regional control, disease free survival and overall survival.

  14. Intensity-modulated conformal radiotherapy in the anal canal cancer. Report of technological assessment. Updating of the 2006 report

    International Nuclear Information System (INIS)

    2015-07-01

    As intensity-modulated conformal radiotherapy (IMCR) has already been technologically assessed in 2006 with a positive opinion for some treatments and a negative one for others, and as this technique displays some interesting properties for the treatment of pelvic cancers (optimisation of dose distribution, preservation of sane tissues, reduction of secondary effects during irradiation), this report proposes an assessment of clinical safety and efficiency of IMCR in the treatment of an anal canal cancer. After a discussion of generalities, of histological and epidemiological data, and of knowledge regarding treatment and follow-up of this cancer, the report presents the IMCR technique, some regulatory aspects, and its applications to the considered cancer. The methodology adopted for this assessment is then presented. Based on various studies and clinical results, the IMCR clinical safety and efficiency in the treatment of the anal canal cancer are discussed and assessed. Recommendations produced by different medical professional bodies are reported. Opinion of experts and a synthesis of stakeholders are then proposed

  15. Can Intensity-Modulated Radiotherapy Preserve Oral Health-Related Quality of Life of Nasopharyngeal Carcinoma Patients?

    International Nuclear Information System (INIS)

    Pow, Edmond H.N.; Kwong, Dora L.W.; Sham, Jonathan S.T.; Lee, Victor H.F.; Ng, Sherry C.Y.

    2012-01-01

    Purpose: To investigate the changes in salivary function and oral health-related quality of life for patients with nasopharyngeal carcinoma treated by intensity-modulated radiotherapy (IMRT). Methods and Materials: A total of 57 patients with early-stage nasopharyngeal carcinoma received IMRT. The parotid and whole saliva flow was measured, and the Medical Outcomes Study 36-item short form, European Organization for Research and Treatment of Cancer Quality of Life questionnaire-C30, European Organization for Research and Treatment of Cancer Quality of Life questionnaire 35-item head-and-neck module, and Oral Health Impact Profile questionnaires were completed at baseline and 2, 6, 12, 18, and 24 months after IMRT. Results: Parotid saliva flow recovered fully after 1 year and maintained. Whole saliva flow recovered partially to 40% of baseline. A general trend of deterioration in most quality of life scales was observed after IMRT, followed by gradual recovery. Persistent oral-related symptoms were found 2 years after treatment. Conclusion: IMRT for early-stage nasopharyngeal carcinoma could only partially preserve the whole salivary function and oral health-related quality of life.

  16. 3D radiation therapy or intensity-modulated radiotherapy for recurrent and metastatic cervical cancer: the Shanghai Cancer Hospital experience.

    Directory of Open Access Journals (Sweden)

    Su-Ping Liu

    Full Text Available We evaluate the outcomes of irradiation by using three-dimensional radiation therapy (3D-RT or intensity-modulated radiotherapy (IMRT for recurrent and metastatic cervical cancer. Between 2007 and 2010, 50 patients with recurrent and metastatic cervical cancer were treated using 3D-RT or IMRT. The median time interval between the initial treatment and the start of irradiation was 12 (6-51 months. Salvage surgery was performed before irradiation in 5 patients, and 38 patients received concurrent chemotherapy. Sixteen patients underwent 3D-RT, and 34 patients received IMRT. Median follow-up for all the patients was 18.3 months. Three-year overall survival and locoregional control were 56.1% and 59.7%, respectively. Three-year progression-free survival and disease-free survival were 65.3% and 64.3%, respectively. Nine patients developed grade 3 leukopenia. Grade 5 acute toxicity was not observed in any of the patients; however, 2 patients developed Grade 3 late toxicity. 3D-RT or IMRT is effective for the treatment of recurrent and metastatic cervical cancer, with the 3-year overall survival of 56.1%, and its complications are acceptable. Long-term follow-up and further studies are needed to confirm the role of 3D-RT or IMRT in the multimodality management of the disease.

  17. Impact of xerostomia on dysphagia after chemotherapy-intensity-modulated radiotherapy for oropharyngeal cancer: Prospective longitudinal study.

    Science.gov (United States)

    Vainshtein, Jeffrey M; Samuels, Stuart; Tao, Yebin; Lyden, Teresa; Haxer, Marc; Spector, Matthew; Schipper, Matthew; Eisbruch, Avraham

    2016-04-01

    The purpose of this study was to assess how xerostomia affects dysphagia. Prospective longitudinal studies of 93 patients with oropharyngeal cancer treated with definitive chemotherapy-intensity-modulated radiotherapy (IMRT). Observer-rated dysphagia (ORD), patient-reported dysphagia (PRD), and patient-reported xerostomia (PRX) assessment of the swallowing mechanics by videofluoroscopy (videofluoroscopy score), and salivary flow rates, were prospectively assessed from pretherapy through 2 years. ORD grades ≥2 were rare and therefore not modeled. Of patients with no/mild videofluoroscopy abnormalities, a substantial proportion had PRD that peaked 3 months posttherapy and subsequently improved. Through 2 years, highly significant correlations were observed between PRX and PRD scores for all patients, including those with no/mild videofluoroscopy abnormalities. Both PRX and videofluoroscopy scores were highly significantly associated with PRD. On multivariate analysis, PRX score was a stronger predictor of PRD than the videofluoroscopy score. Xerostomia contributes significantly to PRD. Efforts to further decrease xerostomia, in addition to sparing parotid glands, may translate into improvements in PRD. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1605-E1612, 2016. © 2015 Wiley Periodicals, Inc.

  18. Sparing of the submandibular glands by intensity modulated radiotherapy in the treatment of head and neck cancer

    International Nuclear Information System (INIS)

    Saarilahti, Kauko; Kouri, Mauri; Collan, Juhani; Kangasmaeki, Aki; Atula, Timo; Joensuu, Heikki; Tenhunen, Mikko

    2006-01-01

    Background and purpose: The submandibular glands produce most of the unstimulated saliva output and are the key in prevention of radiation-related xerostomia. We investigated whether sparing of the submandibular function is feasible with intensity modulated radiotherapy (IMRT). Patients and methods: Thirty-six patients diagnosed with head and neck cancer were treated with IMRT and had at least one parotid gland excluded from the planning target volume. In a subset, of these patients (n=18) where the risk of cancer recurrence in the contralateral submandibular region was judged low, the contralateral submandibular gland was spared from full-dose irradiation. The total unstimulated and stimulated salivary flow rates and adverse effects were monitored. Results: Twelve months following IMRT mean unstimulated saliva flow was 60% of the baseline value among patients who had one submandibular gland spared and 25% among those who did not (P=0.006). Patients whose contralateral submandibular was spared reported less grade two or three xerostomia (4 vs. 11; P=0.018), and used less saliva substitutes. No cancer recurrences were detected at the vicinity of the spared glands during a median follow-up time of 31 months. Conclusions: Submandibular gland sparing with IMRT is safe in selected patients treated for head and neck cancer. It is effective in prevention of radiation-associated xerostomia

  19. Secondary radiation doses of intensity-modulated radiotherapy and proton beam therapy in patients with lung and liver cancer.

    Science.gov (United States)

    Kim, Seonkyu; Min, Byung Jun; Yoon, Myonggeun; Kim, Jinsung; Shin, Dong Ho; Lee, Se Byeong; Park, Sung Yong; Cho, Sungkoo; Kim, Dae Hyun

    2011-03-01

    To compare the secondary radiation doses following intensity-modulated radiotherapy (IMRT) and proton beam therapy (PBT) in patients with lung and liver cancer. IMRT and PBT were planned for three lung cancer and three liver cancer patients. The treatment beams were delivered to phantoms and the corresponding secondary doses during irradiation were measured at various points 20-50 cm from the beam isocenter using ion chamber and CR-39 detectors for IMRT and PBT, respectively. The secondary dose per Gy (i.e., a treatment dose of 1Gy) from PBT for lung and liver cancer, measured 20-50 cm from the isocenter, ranged from 0.17 to 0.086 mGy. The secondary dose per Gy from IMRT, however, ranged between 5.8 and 1.0 mGy, indicating that PBT is associated with a smaller dose of secondary radiation than IMRT. The internal neutron dose per Gy from PBT for lung and liver cancer, 20-50 cm from the isocenter, ranged from 0.03 to 0.008 mGy. The secondary dose from PBT is less than or compatible to the secondary dose from conventional IMRT. The internal neutron dose generated by the interaction between protons and body material is generally much less than the external neutron dose from the treatment head. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  20. Comparing treatment outcomes of different chemotherapy sequences during intensity modulated radiotherapy for advanced N-stage nasopharyngeal carcinoma patients

    International Nuclear Information System (INIS)

    Sun, Xueming; Zeng, Lei; Chen, Chunyan; Huang, Ying; Han, Fei; Xiao, Weiwei; Liu, Shuai; Lu, Taixiang

    2013-01-01

    N-stage is related to distant metastasis of nasopharyngeal carcinoma (NPC) patients. We performed this study to compare the efficacy of different chemotherapy sequences in advanced N-stage (N2 and N3) NPC patients treated with intensity modulated radiotherapy (IMRT). From 2001 to 2008, 198 advanced N-stage NPC patients were retrospectively analyzed. Thirty-three patients received IMRT alone. Concurrent chemoradiotherapy (CCRT) was delivered to 72 patients, neoadjuvant chemotherapy (NACT) + CCRT to 82 patients and CCRT + adjuvant chemotherapy (AC) to 11 patients. The 5-year overall survival rate, recurrence-free survival rate, distant metastasis-free survival rate and progress-free survival rate were 47.7% and 73.1%(p<0.001), 74.5% and 91.3% (p = 0.004), 49.2% and 68.5% (p = 0.018), 37.5% and 63.8% (p<0.001) in IMRT alone and chemoradiotherapy group. Subgroup analyses indicated that there were no significant differences among the survival curves of CCRT, NACT + CCRT and CCRT + AC groups. The survival benefit mainly came from CCRT. However, there was only an improvement attendency in distant metastasis-free survival rate of CCRT group (p = 0.107) when compared with RT alone group, and NACT + CCRT could significantly improve distant metastasis-free survival (p = 0.017). For advanced N-stage NPC patients, NACT + CCRT might be a reasonable treatment strategy

  1. Recommendation for a contouring method and atlas of organs at risk in nasopharyngeal carcinoma patients receiving intensity-modulated radiotherapy

    International Nuclear Information System (INIS)

    Sun, Ying; Yu, Xiao-Li; Luo, Wei; Lee, Anne W.M.; Wee, Joseph Tien Seng; Lee, Nancy; Zhou, Guan-Qun; Tang, Ling-Long; Tao, Chang-Juan; Guo, Rui; Mao, Yan-Ping; Zhang, Rong; Guo, Ying; Ma, Jun

    2014-01-01

    Background and purpose: To recommend contouring methods and atlas of organs at risk (OARs) for nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy, in order to help reach a consensus on interpretations of OARs delineation. Methods and materials: Two to four contouring methods for the middle ear, inner ear, temporal lobe, parotid gland and spinal cord were identified via systematic literature review; their volumes and dosimetric parameters were compared in 41 patients. Areas under the receiver operating characteristic curves for temporal lobe contouring were compared in 21 patients with unilateral temporal lobe necrosis (TLN). Results: Various contouring methods for the temporal lobe, middle ear, inner ear, parotid gland and spinal cord lead to different volumes and dosimetric parameters (P < 0.05). For TLN, D1 of PRV was the most relevant dosimetric parameter and 64 Gy was the critical point. We suggest contouring for the temporal lobe, middle ear, inner ear, parotid gland and spinal cord. A CT–MRI fusion atlas comprising 33 OARs was developed. Conclusions: Different dosimetric parameters may hinder the dosimetric research. The present recommendation and atlas, may help reach a consensus on subjective interpretation of OARs delineation to reduce inter-institutional differences in NPC patients

  2. Performance evaluation of an algorithm for fast optimization of beam weights in anatomy-based intensity modulated radiotherapy

    International Nuclear Information System (INIS)

    Ranganathan, Vaitheeswaran; Sathiya Narayanan, V.K.; Bhangle, Janhavi R.; Gupta, Kamlesh K.; Basu, Sumit; Maiya, Vikram; Joseph, Jolly; Nirhali, Amit

    2010-01-01

    This study aims to evaluate the performance of a new algorithm for optimization of beam weights in anatomy-based intensity modulated radiotherapy (IMRT). The algorithm uses a numerical technique called Gaussian-Elimination that derives the optimum beam weights in an exact or non-iterative way. The distinct feature of the algorithm is that it takes only fraction of a second to optimize the beam weights, irrespective of the complexity of the given case. The algorithm has been implemented using MATLAB with a Graphical User Interface (GUI) option for convenient specification of dose constraints and penalties to different structures. We have tested the numerical and clinical capabilities of the proposed algorithm in several patient cases in comparison with KonRad inverse planning system. The comparative analysis shows that the algorithm can generate anatomy-based IMRT plans with about 50% reduction in number of MUs and 60% reduction in number of apertures, while producing dose distribution comparable to that of beamlet-based IMRT plans. Hence, it is clearly evident from the study that the proposed algorithm can be effectively used for clinical applications. (author)

  3. Performance evaluation of an algorithm for fast optimization of beam weights in anatomy-based intensity modulated radiotherapy

    Directory of Open Access Journals (Sweden)

    Ranganathan Vaitheeswaran

    2010-01-01

    Full Text Available This study aims to evaluate the performance of a new algorithm for optimization of beam weights in anatomy-based intensity modulated radiotherapy (IMRT. The algorithm uses a numerical technique called Gaussian-Elimination that derives the optimum beam weights in an exact or non-iterative way. The distinct feature of the algorithm is that it takes only fraction of a second to optimize the beam weights, irrespective of the complexity of the given case. The algorithm has been implemented using MATLAB with a Graphical User Interface (GUI option for convenient specification of dose constraints and penalties to different structures. We have tested the numerical and clinical capabilities of the proposed algorithm in several patient cases in comparison with KonRad® inverse planning system. The comparative analysis shows that the algorithm can generate anatomy-based IMRT plans with about 50% reduction in number of MUs and 60% reduction in number of apertures, while producing dose distribution comparable to that of beamlet-based IMRT plans. Hence, it is clearly evident from the study that the proposed algorithm can be effectively used for clinical applications.

  4. Prognostic Value of Subclassification Using MRI in the T4 Classification Nasopharyngeal Carcinoma Intensity-Modulated Radiotherapy Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Chen Lei [State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou (China); Liu Lizhi [State Key Laboratory of Oncology in South China, Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou (China); Chen Mo; Li Wenfei; Yin Wenjing [State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou (China); Lin Aihua [Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou (China); Sun Ying [State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou (China); Li Li [State Key Laboratory of Oncology in South China, Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou (China); Ma Jun, E-mail: majun2@mail.sysu.edu.cn [State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou (China)

    2012-09-01

    Purpose: To subclassify patients with the T4 classification nasopharyngeal carcinoma (NPC), according to the seventh edition of the American Joint Committee on Cancer staging system, using magnetic resonance imaging (MRI), and to evaluate the prognostic value of subclassification after intensity-modulated radiotherapy (IMRT). Methods and Materials: A total of 140 patients who underwent MRI and were subsequently histologically diagnosed with nondisseminated classification T4 NPC received IMRT as their primary treatment and were included in this retrospective study. T4 patients were subclassified into two grades: T4a was defined as a primary nasopharyngeal tumor with involvement of the masticator space only; and T4b was defined as involvement of the intracranial region, cranial nerves, and/or orbit. Results: The 5-year overall survival (OS) rate and distant metastasis-free survival (DMFS) rate for T4a patients (82.5% and 87.0%, respectively), were significantly higher than for T4b patients (62.6% and 66.8%; p = 0.033 and p = 0.036, respectively). The T4a/b subclassification was an independent prognostic factor for OS (hazard ratio = 2.331, p = 0.032) and DMFS (hazard ratio = 2.602, p = 0.034), and had no significant effect on local relapse-free survival. Conclusions: Subclassification of T4 patients, as T4a or T4b, using MRI according to the site of invasion, has prognostic value for the outcomes of IMRT treatment in NPC.

  5. Improved Dosimetric and Clinical Outcomes With Intensity-Modulated Radiotherapy for Head-and-Neck Cancer of Unknown Primary Origin

    International Nuclear Information System (INIS)

    Chen, Allen M.; Li Baoqing; Farwell, D. Gregory; Marsano, Joseph; Vijayakumar, Srinivasan; Purdy, James A.

    2011-01-01

    Purpose: To compare differences in dosimetric, clinical, and quality-of-life endpoints among a cohort of patients treated by intensity-modulated radiotherapy (IMRT) and conventional radiotherapy (CRT) for head-and-neck cancer of unknown primary origin. Methods and Materials: The medical records of 51 patients treated by radiation therapy for squamous cell carcinoma of the head and neck presenting as cervical lymph node metastasis of occult primary origin were reviewed. Twenty-four patients (47%) were treated using CRT, and 27 (53%) were treated using IMRT. The proportions of patients receiving concurrent chemotherapy were 54% and 63%, respectively. Results: The 2-year estimates of overall survival, local-regional control, and disease-specific survival for the entire patient population were 86%, 89%, and84%, respectively. There were no significant differences in any of these endpoints with respect to radiation therapy technique (p > 0.05 for all). Dosimetric analysis revealed that the use of IMRT resulted in significant improvements with respect to mean dose and V30 to the contralateral (spared) parotid gland. In addition, mean doses to the ipsilateral inner and middle ear structures were significantly reduced with IMRT (p < 0.05 for all). The incidence of severe xerostomia in the late setting was 58% and 11% among patients treated by CRT and IMRT, respectively (p < 0.001). The percentages of patients who were G-tube dependent at 6 months after treatment were 42% and 11%, respectively (p < 0.001). Conclusions: IMRT results in significant improvements in the therapeutic ratio among patients treated by radiation therapy for head-and-neck cancer of unknown primary origin.

  6. Patient-reported intestinal toxicity from whole pelvis intensity-modulated radiotherapy: First quantification of bowel dose-volume effects.

    Science.gov (United States)

    Sini, Carla; Noris Chiorda, Barbara; Gabriele, Pietro; Sanguineti, Giuseppe; Morlino, Sara; Badenchini, Fabio; Cante, Domenico; Carillo, Viviana; Gaetano, Marcella; Giandini, Tommaso; Landoni, Valeria; Maggio, Angelo; Perna, Lucia; Petrucci, Edoardo; Sacco, Vincenzo; Valdagni, Riccardo; Rancati, Tiziana; Fiorino, Claudio; Cozzarini, Cesare

    2017-08-01

    Intestinal toxicity is commonly experienced during whole-pelvis intensity-modulated radiotherapy (WPRT) for prostate cancer. The aim of the current study was to assess bowel dose-volume relationships for acute patient-reported intestinal symptoms of patients treated with WPRT for prostate cancer. Complete data of 206 patients were available; the median dose to pelvic nodes was 51.8Gy (range 50.4-54.4, 1.7-2Gy/fr). Intestinal symptoms were assessed as changes in the Inflammatory Bowel Disease Questionnaire scores relative to the Bowel Domain (IBDQ-B) between baseline and radiotherapy mid-point/end. The 25th percentiles of the most severe worsening from baseline (ΔIBDQ-B) were set as end-points. The impact of bowel loops and sigmoid colon dose-volume/surface parameters as well as selected clinical parameters were investigated using multivariate logistic regression. Analyses were focused on the four questions showing a median ΔIBDQ-B>0. No dose volume/surface parameters were predictive, other than ΔIBDQ5≥3 (loose stools): when grouping patients according to bowel DVHs (high risk: V20>470cc, V30>245cc, V42>110cc; low risk: all the remaining patients), a two-variable model including high-risk DVH-shape (OR: 9.3) and age (protective, OR: 0.94) was assessed. The model showed good calibration (slope: 1.003, R 2 =0.92) and was found to be robust after bootstrap-based internal validation. Constraining the bowel loops may reduce the risk of loose stools. The risk is higher for younger patients. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Evolution of treatment for nasopharyngeal cancer – Success and setback in the intensity-modulated radiotherapy era

    International Nuclear Information System (INIS)

    Lee, Anne W.M.; Ng, Wai Tong; Chan, Lucy L.K.; Hung, Wai Man; Chan, Connie C.C.; Sze, Henry C.K.; Chan, Oscar S.H.; Chang, Amy T.Y.; Yeung, Rebecca M.W.

    2014-01-01

    Background and purpose: To assess the therapeutic gains and setbacks as we evolved from the 2-dimensional radiotherapy (2DRT) to conformal 3-dimensional (3DRT) and to intensity-modulated (IMRT) era. Materials and methods: 1593 consecutive patients from 1994 to 2010 were retrospectively analyzed. Evolving changes in the different era included advances in staging investigation, radiotherapy technique, dose escalation, and use of chemotherapy. Results: The 3DRT era achieved significant improvement in local failure-free rate (L-FFR), disease-specific survival (DSS) and overall survival (OS). Neurological damage and bone/soft tissue necrosis were significantly reduced. However, the improvement in distant failure-free rate (D-FFR) was insignificant, and more hearing impairment occurred due to chemotherapy. Significantly higher D-FFR was achieved in the IMRT era, but L-FFR did not show further improvement. 5-Year DSS increased from 78% in the 2DRT, to 81% in the 3DRT, and 85% in the IMRT era, while the corresponding neurological toxicity rate decreased from 7.4% to 3.5% and 1.8%. Conclusions: Significant improvement in survival and reduction of serious toxicity was achieved as we evolved from 2DRT to 3DRT and IMRT era; the therapeutic ratio for all T-categories improved with more conformal techniques. Improvements in tumor control were attributed not only to advances in RT technique, but also to better imaging and increasing use of potent chemotherapy. However, it should also be noted that hearing impairment significantly increased due to chemotherapy, L-FFR reached a plateau in the 3DRT era, and it is worrisome that the result for T4 remained unsatisfactory. Besides exploring for more potent chemotherapy and innovative methods, the guideline on dose constraint should be re-visited to optimize the therapeutic ratio

  8. Parotid Gland Dose in Intensity-Modulated Radiotherapy for Head and Neck Cancer: Is What You Plan What You Get?

    International Nuclear Information System (INIS)

    O'Daniel, Jennifer C.; Garden, Adam S.; Schwartz, David L.; Wang He; Ang, Kian K.; Ahamad, Anesa; Rosenthal, David I.; Morrison, William H.; Asper, Joshua A.; Zhang Lifei; Tung Shihming; Mohan, Radhe; Dong Lei

    2007-01-01

    Purpose: To quantify the differences between planned and delivered parotid gland and target doses, and to assess the benefits of daily bone alignment for head and neck cancer patients treated with intensity-modulated radiotherapy (IMRT). Methods and Materials: Eleven head and neck cancer patients received two CT scans per week with an in-room CT scanner over the course of their radiotherapy. The clinical IMRT plans, designed with 3-mm to 4-mm planning margins, were recalculated on the repeat CT images. The plans were aligned using the actual treatment isocenter marked with radiopaque markers (BB) and bone alignment to the cervical vertebrae to simulate image-guided setup. In-house deformable image registration software was used to map daily dose distributions to the original treatment plan and to calculate a cumulative delivered dose distribution for each patient. Results: Using conventional BB alignment led to increases in the parotid gland mean dose above the planned dose by 5 to 7 Gy in 45% of the patients (median, 3.0 Gy ipsilateral, p = 0.026; median, 1.0 Gy contralateral, p = 0.016). Use of bone alignment led to reductions relative to BB alignment in 91% of patients (median, 2 Gy; range, 0.3-8.3 Gy; 15 of 22 parotids improved). However, the parotid dose from bone alignment was still greater than planned (median, 1.0 Gy, p = 0.007). Neither approach affected tumor dose coverage. Conclusions: With conventional BB alignment, the parotid gland mean dose was significantly increased above the planned mean dose. Using daily bone alignment reduced the parotid dose compared with BB alignment in almost all patients. A 3- to 4-mm planning margin was adequate for tumor dose coverage

  9. Efficacy and Toxicity of Chemoradiotherapy Using Intensity-Modulated Radiotherapy for Unknown Primary of Head and Neck

    International Nuclear Information System (INIS)

    Sher, David J.; Balboni, Tracy A.; Haddad, Robert I.; Norris, Charles M.; Posner, Marshall R.; Wirth, Lori J.; Goguen, Laura A.; Annino, Donald; Tishler, Roy B.

    2011-01-01

    Purpose: No single standard treatment paradigm is available for head-and-neck squamous cell carcinoma of an unknown primary (HNCUP). Bilateral neck radiotherapy with mucosal axis irradiation is widely used, with or without chemotherapy and/or surgical resection. Intensity-modulated radiotherapy (IMRT) is a highly conformal method for delivering radiation that is becoming the standard of care and might reduce the long-term treatment-related sequelae. We report the Dana-Farber Cancer Institute experience with IMRT-based treatment for HNCUP. Patients and Materials: A retrospective study of all patients treated at the Dana-Farber Cancer Institute for HNCUP with IMRT between August 2004 and January 2009. The primary endpoint was overall survival; the secondary endpoints were locoregional and distant control, and acute and chronic toxicity. Results: A total of 24 patients with HNCUP were included. Of these patients, 22 had Stage N2 disease or greater. All patients underwent neck computed tomography, positron emission tomography-computed tomography, and examination under anesthesia with directed biopsies. Of the 24 patients, 22 received concurrent chemotherapy, and 7 (29%) also underwent induction chemotherapy. The median involved nodal dose was 70 Gy, and the median mucosal dose was 60 Gy. With a median follow-up of 2.1 years, the 2-year actuarial overall survival and locoregional control rate was 92% and 100%, respectively. Only 25% of the patients had Grade 2 xerostomia, although 11 patients (46%) required esophageal dilation for stricture. Conclusion: In a single-institution series, IMRT-based chemoradiotherapy for HNCUP was associated with superb overall survival and locoregional control. The xerostomia rates were promising, but the aggressive therapy was associated with significant rates of esophageal stenosis.

  10. Grading xerostomia by physicians or by patients after intensity-modulated radiotherapy of head-and-neck cancer

    International Nuclear Information System (INIS)

    Meirovitz, Amichay; Murdoch-Kinch, Carol Anne; Schipper, Mathew; Pan, Charlie; Eisbruch, Avraham

    2006-01-01

    Purpose: To assess observer-based vs. patient self-reported scoring of xerostomia after intensity-modulated radiotherapy (IMRT) of head-and-neck (HN) cancer. Methods: A total of 38 patients who had received IMRT for HN cancer underwent xerostomia evaluations 6 to 24 months after completion of therapy using three methods each time: (1) Grading by 3 observers according to the Radiotherapy Oncology Group/European Organization for Research and Therapy of Cancer (RTOG/EORTC) system; (2) patient self-reported validated xerostomia questionnaire (XQ); and (3) major salivary gland flow measurements. Results: The interobserver agreement regarding the RTOG/EORTC grades was moderate: κ-coefficient 0.54 (95% CI = 0.31-0.76). The correlations between the average RTOG/EORTC grades and the salivary flow rates were not statistically significant. A trend for significant correlation was observed between these grades and the percent (relative to the pretherapy) nonstimulated salivary flow rates (p = 0.07), but not with the percent stimulated flow rates. Better correlations were found between grading made more than the median time (15 min) after the last liquid sipping and the nonstimulated (but not the stimulated) flows compared with grading made shortly after sipping. In contrast, significant correlations were found between the XQ scores and the nonstimulated (p < 0.005) and the stimulated (p < 0.005) salivary flow rates, as well as with the percentages of the corresponding pretherapy values (p = 0.002 and 0.038, respectively). No significant correlation was found between the RTOG/EORTC grades and the XQ scores. The observer-based grades underestimated the severity of xerostomia compared with the patient self-reported scores. Conclusions: Patient self-reported, rather than physician-assessed scores, should be the main end points in evaluating xerostomia

  11. The influence of breathing motion on intensity modulated radiotherapy in the step-and-shoot technique: phantom measurements for irradiation of superficial target volumes

    Energy Technology Data Exchange (ETDEWEB)

    Thilmann, Christoph [Klinische Kooperationseinheit Radioonkologie des Deutschen Krebsforschungszentrums, INF 280, 69120 Heidelberg (Germany); Haering, Peter [Medizinische Physik des Deutschen Krebsforschungszentrums, INF 280, 69120 Heidelberg (Germany); Thilmann, Lennart [Klinische Kooperationseinheit Radioonkologie des Deutschen Krebsforschungszentrums, INF 280, 69120 Heidelberg (Germany); Unkelbach, Jan [Medizinische Physik des Deutschen Krebsforschungszentrums, INF 280, 69120 Heidelberg (Germany); Rhein, Bernhard [Medizinische Physik des Deutschen Krebsforschungszentrums, INF 280, 69120 Heidelberg (Germany); Nill, Simeon [Medizinische Physik des Deutschen Krebsforschungszentrums, INF 280, 69120 Heidelberg (Germany); Huber, Peter [Klinische Kooperationseinheit Radioonkologie des Deutschen Krebsforschungszentrums, INF 280, 69120 Heidelberg (Germany); Janisch, Elisabeth [Medizinische Physik des Deutschen Krebsforschungszentrums, INF 280, 69120 Heidelberg (Germany); Thieke, Christian [Klinische Kooperationseinheit Radioonkologie des Deutschen Krebsforschungszentrums, INF 280, 69120 Heidelberg (Germany); Debus, Juergen [Klinische Radiologie des Universitaetsklinikums Heidelberg, INF 400, 69120 Heidelberg (Germany)

    2006-03-21

    For intensity modulated radiotherapy (IMRT) of deep-seated tumours, dosimetric variations of the original static dose profiles due to breathing motion can be primarily considered as blurring effects known from conventional radiotherapy. The purpose of this dosimetric study was to clarify whether these results are transferable to superficial targets and to quantify the additional effect of fractionation. A solid polystyrene phantom and an anthropomorphic phantom were used for film and ion chamber dose measurements. The phantoms were installed on an electric driven device and moved with a frequency of 6 or 12 cycles per minute and an amplitude of 4 mm or 10 mm. A split beam geometry of two adjacent asymmetric fields and an IMRT treatment plan with 12 fields for irradiation of the breast were investigated. For the split beam geometry the dose modifications due to unintended superposition of partial fields were reduced by fractionation and completely smoothed out after 20 fractions. IMRT applied to the moving phantom led to a more homogeneous dose distribution compared to the static phantom. The standard deviation of the target dose which is a measure of the dose homogeneity was 10.3 cGy for the static phantom and 7.7 cGy for a 10 mm amplitude. The absolute dose values, measured with ionization chambers, remained unaffected. Irradiation of superficial targets by IMRT in the step-and-shoot technique did not result in unexpected dose perturbations due to breathing motion. We conclude that regular breathing motion does not jeopardize IMRT of superficial target volumes. (note)

  12. Australian survey on current practices for breast radiotherapy.

    Science.gov (United States)

    Dundas, Kylie L; Pogson, Elise M; Batumalai, Vikneswary; Boxer, Miriam M; Yap, Mei Ling; Delaney, Geoff P; Metcalfe, Peter; Holloway, Lois

    2015-12-01

    Detailed, published surveys specific to Australian breast radiotherapy practice were last conducted in 2002. More recent international surveys specific to breast radiotherapy practice include a European survey conducted in 2008/2009 and a Spanish survey conducted in 2009. Radiotherapy techniques continue to evolve, and the utilisation of new techniques, such as intensity-modulated radiation therapy (IMRT), is increasing. This survey aimed to determine current breast radiotherapy practices across Australia. An online survey was completed by 50 of the 69 Australian radiation therapy treatment centres. Supine tangential beam whole breast irradiation remains the standard of care for breast radiotherapy in Australia. A growing number of institutions are exploring prone positioning and IMRT utilisation. This survey demonstrated a wide variation in the benchmarks used to limit and report organ at risk doses, prescribed dose regimen, and post-mastectomy bolus practices. This survey also indicated, when compared with international literature, that there may be less interest in or uptake of external beam partial breast irradiation, prone positioning, simultaneous integrated boost and breath hold techniques. These are areas where further review and research may be warranted to ensure Australian patients are receiving the best care possible based on the best evidence available. This survey provides insight into the current radiotherapy practice for breast cancer in Australia. © 2015 The Royal Australian and New Zealand College of Radiologists.

  13. Australian survey on current practices for breast radiotherapy

    International Nuclear Information System (INIS)

    Dundas, Kylie L.; Pogson, Elise M.; Metcalfe, Peter; Batumalai, Vikneswary; Boxer, Mirian M.; Yap, Mei LIng; Delaney, Geoff P.; Holloway, Lois

    2015-01-01

    Detailed, published surveys specific to Australian breast radiotherapy practice were last conducted in 2002. More recent international surveys specific to breast radiotherapy practice include a European survey conducted in 2008/2009 and a Spanish survey conducted in 2009. Radiotherapy techniques continue to evolve, and the utilisation of new techniques, such as intensity-modulated radiation therapy (IMRT), is increasing. This survey aimed to determine current breast radiotherapy practices across Australia. An online survey was completed by 50 of the 69 Australian radiation therapy treatment centres. Supine tangential beam whole breast irradiation remains the standard of care for breast radiotherapy in Australia. A growing number of institutions are exploring prone positioning and IMRT utilisation. This survey demonstrated a wide variation in the benchmarks used to limit and report organ at risk doses, prescribed dose regimen, and post-mastectomy bolus practices. This survey also indicated, when compared with international literature, that there may be less interest in or uptake of external beam partial breast irradiation, prone positioning, simultaneous integrated boost and breath hold techniques. These are areas where further review and research may be warranted to ensure Australian patients are receiving the best care possible based on the best evidence available. This survey provides insight into the current radiotherapy practice for breast cancer in Australia.

  14. Implementation of image-guided intensity-modulated accelerated partial breast irradiation. Three-year results of a phase II clinical study

    International Nuclear Information System (INIS)

    Meszaros, Norbert; Major, Tibor; Stelczer, Gabor; Zaka, Zoltan; Takacsi-Nagy, Zoltan; Fodor, Janos; Polgar, Csaba; Mozsa, Emoke; Pukancsik, David

    2017-01-01

    To report 3-year results of accelerated partial breast irradiation (APBI) using image-guided intensity-modulated radiotherapy (IG-IMRT) following breast conserving surgery (BCS) for low-risk early invasive breast cancer. Between July 2011 and March 2014, 60 patients with low-risk early invasive breast cancer underwent BCS and were enrolled in this phase II prospective study. The total dose was 36.9 Gy (9 fractions of 4.1 Gy, two fractions/day). Patient setup errors were detected in LAT, LONG and VERT directions. Local tumour control, survival results, early and late side effects and cosmetic outcome were assessed. At a median follow-up of 39 months, all patients were alive and neither locoregional nor distant failure occurred. One contralateral breast cancer and two new primary malignancies outside the breast were observed. No grade (G) 3-4 acute toxicity was detected. G1 and G2 erythema occurred in 21 (35%) and 2 (3.3%) patients, respectively; while G1 oedema was observed in 23 (38.8%) cases. G1 and G2 pain was reported by 6 (10%) and 2 (3.3%) patients, respectively. Among the late radiation side effects, G1 pigmentation or telangiectasia, G1 fibrosis and G1 asymptomatic fat necrosis occurred in 10 (16.7%), 7 (11.7%) and 3 (5%) patients, respectively. No ≥ G2 late toxicity was detected. Cosmetic outcome was excellent in 43 (71.7%) and good in 17 (28.3%) patients. IG-IMRT is a reproducible and feasible technique for delivery of external beam APBI following BCS for treatment of low-risk, early-stage invasive breast carcinoma. In order to avoid toxicity, image guidance performed before each radiation fraction is necessary to minimize the PTV. Three-year results are promising, early and late radiation side-effects are minimal, and cosmetic results are excellent to good. (orig.) [de

  15. Optimization and quality assurance of an image-guided radiation therapy system for intensity-modulated radiation therapy radiotherapy

    International Nuclear Information System (INIS)

    Tsai, Jen-San; Micaily, Bizhan; Miyamoto, Curtis

    2012-01-01

    To develop a quality assurance (QA) of XVI cone beam system (XVIcbs) for its optimal imaging-guided radiotherapy (IGRT) implementation, and to construe prostate tumor margin required for intensity-modulated radiation therapy (IMRT) if IGRT is unavailable. XVIcbs spatial accuracy was explored with a humanoid phantom; isodose conformity to lesion target with a rice phantom housing a soap as target; image resolution with a diagnostic phantom; and exposure validation with a Radcal ion chamber. To optimize XVIcbs, rotation flexmap on coincidency between gantry rotational axis and that of XVI cone beam scan was investigated. Theoretic correlation to image quality of XVIcbs rotational axis stability was elaborately studied. Comprehensive QA of IGRT using XVIcbs has initially been explored and then implemented on our general IMRT treatments, and on special IMRT radiotherapies such as head and neck (H and N), stereotactic radiation therapy (SRT), stereotactic radiosurgery (SRS), and stereotactic body radiotherapy (SBRT). Fifteen examples of prostate setup accounted for 350 IGRT cone beam system were analyzed. IGRT accuracy results were in agreement ± 1 mm. Flexmap 0.25 mm met the manufacturer's specification. Films confirmed isodose coincidence with target (soap) via XVIcbs, otherwise not. Superficial doses were measured from 7.2–2.5 cGy for anatomic diameters 15–33 cm, respectively. Image quality was susceptible to rotational stability or patient movement. IGRT using XVIcbs on general IMRT treatments such as prostate, SRT, SRS, and SBRT for setup accuracy were verified; and subsequently coordinate shifts corrections were recorded. The 350 prostate IGRT coordinate shifts modeled to Gaussian distributions show central peaks deviated off the isocenter by 0.6 ± 3.0 mm, 0.5 ± 4.5 mm in the X(RL)- and Z(SI)-coordinates, respectively; and 2.0 ± 3.0 mm in the Y(AP)-coordinate as a result of belly and bladder capacity variations. Sixty-eight percent of confidence was within

  16. [Preliminary application of kilo-volt cone-beam computed tomography to intensity-modulated radiotherapy of nasopharyngeal carcinoma].

    Science.gov (United States)

    Wang, Jin; Xu, Feng; Bai, Sen; Zhang, Hong; Zhong, Ren-Ming; Li, Yan; Li, Xiao-Yu

    2008-07-01

    The intensity-modulated radiotherapy (IMRT) with its highly conformed dose distribution to nasopharyngeal cancer (NPC) and the surrounding critical organs is being accepted increasingly in clinical practice. Due to the steep dose fall-offs of IMRT at the target margin, precise patient positioning and verification are required. This study was to evaluate the role of kilo-volt cone-beam computed tomography (kV-CBCT) in guiding the accurate positioning of IMRT for NPC. kV-CBCT was performed on 22 NPC patients before radiotherapy. The acquired CBCT were co-registered with the planning CT for online set-up correction and offline planning target volume (PTV) analysis. The 22 patients received a total of 754 kV-CBCT scans. Among the 505 scans before couch correction, the detection rates of deviation of < or =2 mm were 76.4% in left-to-right (X) direction, 76.0% in superior-to-inferior (Y) direction, and 85.7% in anterior-to-posterior (Z) directionû among the 106 scans after correction, the detection rates were 97.2%, 97.2%, and 100% in X, Y and Z directions, respectivelyû among the 143 scans after treatment, the detection rates were 87.4%, 87.6%, and 90.0%, respectively. The overall setup errors in X, Y and Z directions were (-0.7+/-1.6) mm, (-0.7+/-1.8) mm and (-0.3+/-1.7) mm, respectively, before correctionû (-0.4+/-0.8) mm, (0.3+/-0.8) mm and (0.0+/-0.7) mm, respectively, after correctionû (0.2+/-1.2) mm, (0.3+/-1.3) mm and (0.1+/-1.1) mm, respectively, after treatment. The maximal PTV margin was 4.0 mm before correction and 2.1 mm after correction. kV-CBCT image-guided radiotherapy may improve the set-up precision of IMRT for NPC.

  17. Investigation of conformal and intensity-modulated radiation therapy techniques to determine the absorbed fetal dose in pregnant patients with breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Öğretici, Akın, E-mail: akinogretici@gmail.com; Akbaş, Uğur; Köksal, Canan; Bilge, Hatice

    2016-07-01

    The aim of this research was to investigate the fetal doses of pregnant patients undergoing conformal radiotherapy or intensity-modulated radiation therapy (IMRT) for breast cancers. An Alderson Rando phantom was chosen to simulate a pregnant patient with breast cancer who is receiving radiation therapy. This phantom was irradiated using the Varian Clinac DBX 600 system (Varian Medical System, Palo Alto, CA) linear accelerator, according to the standard treatment plans of both three-dimensional conformal radiation therapy (3-D CRT) and IMRT techniques. Thermoluminescent dosimeters were used to measure the irradiated phantom's virtually designated uterus area. Thermoluminescent dosimeter measurements (in the phantom) revealed that the mean cumulative fetal dose for 3-D CRT is 1.39 cGy and for IMRT it is 8.48 cGy, for a pregnant breast cancer woman who received radiation treatment of 50 Gy. The fetal dose was confirmed to increase by 70% for 3-D CRT and 40% for IMRT, if it is closer to the irradiated field by 5 cm. The mean fetal dose from 3-D CRT is 1.39 cGy and IMRT is 8.48 cGy, consistent with theoretic calculations. The IMRT technique causes the fetal dose to be 5 times more than that of 3-D CRT. Theoretic knowledge concerning the increase in the peripheral doses as the measurements approached the beam was also practically proven.

  18. Long-term results of forward intensity-modulated radiation therapy for patients with early-stage breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ha, Boram; Suh, Hyun Suk; Lee, Ji Hae; Lee, Kyung Ja; Lee, Rena; Moon, Byung In [Ewha Womans University College of Medicine, Seoul (Korea, Republic of)

    2013-12-15

    To observe long-term clinical outcomes for patients with early-stage breast cancer treated with forward intensity-modulated radiation therapy (IMRT), including local control and clinical toxicities. We retrospectively analyzed a total of 214 patients with stage I-II breast cancer who were treated with breast conserving surgery followed by adjuvant breast radiation therapy between 2001 and 2008. All patients were treated using forward IMRT. The whole breast was irradiated to a dose of 50 to 50.4 Gy followed by an 8 to 12 Gy electron boost to the surgical bed. The median age was 46 years (range, 21 to 82 years) and the medial follow-up time was 7.3 years (range, 2.4 to 11.7 years). Stage T1 was 139 (65%) and T2 was 75 (35%), respectively. Ipsilateral breast recurrence was observed in 3 patients. The 5- and 10-year local control rates were 99.1% and 97.8%, respectively. The cosmetic outcome was evaluated according to the Harvard scale and 89.4% of patients were scored as excellent or good. The whole breast radiation therapy as an adjuvant treatment using a forward IMRT technique showed excellent long-term local control as well as favorable outcomes of toxicity and cosmesis.

  19. Dosimetric comparison of the related parameters between simultaneous integrated boost intensity-modulated radiotherapy and sequential boost conformal radiotherapy for postoperative malignant glioma of the brain

    International Nuclear Information System (INIS)

    Shao Qian; Lu Jie; Li Jianbin; Sun Tao; Bai Tong; Liu Tonghai; Yin Yong

    2011-01-01

    Objective: To compare the dosimetric of different parameter of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) with sequential boost conformal radiotherapy (SB-CRT) for postoperative malignant glioma of the brain. Methods: Ten patients with malignant glioma of brain were selected to study. Each patient was simulated all by CT and MRI, and the imagings of CT and MRI were all sent to Pinnacle 3 planning system. The fusion technology with MR-CT imaging was used on Pinnacle 3 planning system. The target volume was delineated and defined based on MRI. The postoperative residual lesion and resection cavity were defined as gross tumor volume (GTV) and expanded GTV some scope was defined as clinical target volume (CTV). The margins of GTV expanded 10 mm and 25 mm were defined as CTV1 and CTV2 respectively. CTV1 and CTV2 all enlarged 5 mm were defined as PTV1 and PTV2 respectively. The plans of simultaneous integrated boost intensity-modulated radiotherapy and sequential boost conformal radiotherapy were respectively designed for each patient using Pinnacle 3 planning system and the dosimetric of different parameter was compared. The prescribe dose of SIB-IMRT was PTV1: 62.5 Gy/25 f, PTV2: 50.0 Gy/25 f; and SB-CRT was PTV1: 66.0 Gy/33 f, PTV2: 50.0 Gy/25 f. The dosimetries of different parameters of SIB-IMRT and SB-CRT were compared by using Paired-Samples T Test. Results: The maximum and mean dose of PTV1, PTV2, and brainstem were of significant difference (P 0.05). Conclusion: The SIB-IMRT plan is better than the SB-CRT plan. The CI and HI of SIB-IMRT are superior to SB-CRT. At the same time, it can preserve the important organs such as brainstem and reduce the mean dose of whole brain. On the other hand it can shorten the total period of therapy time. (authors)

  20. Cardiac dose sparing and avoidance techniques in breast cancer radiotherapy

    International Nuclear Information System (INIS)

    Shah, Chirag; Badiyan, Shahed; Berry, Sameer; Khan, Atif J.; Goyal, Sharad; Schulte, Kevin; Nanavati, Anish; Lynch, Melanie; Vicini, Frank A.

    2014-01-01

    Breast cancer radiotherapy represents an essential component in the overall management of both early stage and locally advanced breast cancer. As the number of breast cancer survivors has increased, chronic sequelae of breast cancer radiotherapy become more important. While recently published data suggest a potential for an increase in cardiac events with radiotherapy, these studies do not consider the impact of newer radiotherapy techniques commonly utilized. Therefore, the purpose of this review is to evaluate cardiac dose sparing techniques in breast cancer radiotherapy. Current options for cardiac protection/avoidance include (1) maneuvers that displace the heart from the field such as coordinating the breathing cycle or through prone patient positioning, (2) technological advances such as intensity modulated radiation therapy (IMRT) or proton beam therapy (PBT), and (3) techniques that treat a smaller volume around the lumpectomy cavity such as accelerated partial breast irradiation (APBI), or intraoperative radiotherapy (IORT). While these techniques have shown promise dosimetrically, limited data on late cardiac events exist due to the difficulties of long-term follow up. Future studies are required to validate the efficacy of cardiac dose sparing techniques and may use surrogates for cardiac events such as biomarkers or perfusion imaging

  1. Induction chemotherapy with nedaplatin with 5-FU followed by intensity-modulated radiotherapy concurrent with chemotherapy for locoregionally advanced nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Zheng Jijun; Wang Ge; Yang, G.Y.

    2010-01-01

    This Phase II study was conducted to evaluate the activity and feasibility of a regimen of nedaplatin and 5-fluorouracil as induction chemotherapy, followed by intensity-modulated radiotherapy concurrent with chemotherapy in patients with locoregionally advanced nasopharyngeal carcinoma. Patients received neoadjuvant chemotherapy comprised two cycles of 5-fluorouracil at 700 mg/m 2 /day administered on days 1-4 as continuous intravenous infusion and nedaplatin (100 mg/m 2 administered intravenous (i.v.) over 2 h) given after the administration of 5-fluorouracil on day 1, repeated every 3 weeks, followed by intensity-modulated radiotherapy concurrent with nedaplatin. During intensity-modulated radiotherapy, nedaplatin was administered at a dose of 100 mg/m 2 intravenous infusion on days 1, 22 and 43, given -60 min before radiation. Fifty-nine (95.8%) of the 60 patients were assessable for response. Thirty-eight cases of complete response and 14 cases of partial response were confirmed after completion of chemoradiation, with the objective response rate of 86.7% (95% confidence interval (CI), 78.1-95.3%). The median follow-up period was 48 months (range, 30-62 months). The 3-year progression-free survival and overall survival were 75.0% (95% CI, 63.0-87.0%) and 85.5% (95% CI, 75.9-95.1%). No patient showed Grade 3 or higher renal dysfunction. The most commonly observed late effect was xerostomia, but the severity diminished over time, and the detectable xerostomia at 24 months was 10.2%. There were no treatment-related deaths during this study. Neoadjuvant chemotherapy with nedaplatin and 5-fluorouracil followed by concomitant nedaplatin and intensity-modulated radiotherapy is an effective and safe treatment for Southern China patients affected by locoregionally advanced nasopharyngeal carcinoma. (author)

  2. Intensity modulated radiotherapy for localized prostate cancer: rigid compliance to dose-volume constraints as a warranty of acceptable toxicity?

    International Nuclear Information System (INIS)

    Chen, Michael J; Nadalin, Wladmir; Weltman, Eduardo; Hanriot, Rodrigo M; Luz, Fábio P; Cecílio, Paulo J; Cruz, José C da; Moreira, Frederico R; Santos, Adriana S; Martins, Lidiane C

    2007-01-01

    To report the toxicity after intensity modulated radiotherapy (IMRT) for patients with localized prostate cancer, as a sole treatment or after radical prostatectomy. Between August 2001 and December 2003, 132 patients with prostate cancer were treated with IMRT and 125 were evaluable to acute and late toxicity analysis, after a minimum follow-up time of one year. Clinical and treatment data, including normal tissue dose-volume histogram (DVH) constraints, were reviewed. Gastro-intestinal (GI) and genito-urinary (GU) signs and symptoms were evaluated according to the Radiation Therapy Oncology Group (RTOG) toxicity scales. Median prescribed dose was 76 Gy. Median follow-up time was of 26.1 months. From the 125 patients, 73 (58.4%) presented acute Grade 1 or Grade 2 GI and 97 (77.2%) presented acute Grade 1 or Grade 2 GU toxicity. Grade 3 GI acute toxicity occurred in only 2 patients (1.6%) and Grade 3 GU acute toxicity in only 3 patients (2.4%). Regarding Grade 1 and 2 late toxicity, 26 patients (20.8%) and 21 patients (16.8%) presented GI and GU toxicity, respectively. Grade 2 GI late toxicity occurred in 6 patients (4.8%) and Grade 2 GU late toxicity in 4 patients (3.2%). None patient presented any Grade 3 or higher late toxicity. Non-conformity to DVH constraints occurred in only 11.2% of treatment plans. On univariate analysis, no significant risk factor was identified for Grade 2 GI late toxicity, but mean dose delivered to the PTV was associated to higher Grade 2 GU late toxicity (p = 0.042). IMRT is a well tolerable technique for routine treatment of localized prostate cancer, with short and medium-term acceptable toxicity profiles. According to the data presented here, rigid compliance to DHV constraints might prevent higher incidences of normal tissue complication

  3. Phase II study of gemcitabine plus cisplatin chemotherapy combined with intensity modulated radiotherapy in locoregionally advanced nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Ou Dan; He Xiayun; Hu Chaosu; Ying Hongmei; Zhu Guopei

    2012-01-01

    Objective: To evaluate the efficacy and toxicity of gemcitabine plus cisplatin (GP) chemotherapy combined with intensity-modulated radiation therapy (IMRT) in locoregionally advanced nasopharyngeal carcinoma (NPC). Methods: 71 patients (Stage III: 41, Stage IV A : 30) with locoregionally advanced NPC were entered this study. Neoadjuvant chemotherapy was consisted of cisplatin 25 mg/m 2 intravenously on d1-3 and gemcitabine 1000 mg/m 2 in 30 minutes intravenous infusion on days 1 and 8, every 3 weeks for 2 cycles. Adjuvant chemotherapy consisted of 2 cycles of the same GP regimen was given at 28 days after the end of radiotherapy. The prescription doses was 66.0-70.4 Gy to the gross tumor volume, 66 Gy to positive neck nodes, 60 Gy to the high-risk clinical target volume, 54 Gy to the low-risk clinical target volume. Results: The overall response rate to neoadjuvant chemotherapy was 91.2%, acute toxicity was mainly grade 1-2 myleosuppression. All patients completed IMRT. The median follow-up duration was 38 months. The 3-year nasopharyngeal local control, regional control, distant metastasis-free survival rate and overall survival rate were 93%, 99%, 91%, 90%, respectively. Severe late toxicities included grade 3 trismus in 1 patient, grade 3 hearing impairment in 2 patients and cranial nerve palsy in 2 patients, respectively. No grade 4 late toxicities were observed. Conclusions: The combination of GP chemotherapy and IMRT for locoregionally advanced nasopharyngeal carcinoma is well-tolerated, convenient, effective, and warrants further studies of more proper cycles of GP regimen. (authors)

  4. Rectal toxicity after intensity modulated radiotherapy for prostate cancer: Which rectal dose volume constraints should we use?

    International Nuclear Information System (INIS)

    Fonteyne, Valérie; Ost, Piet; Vanpachtenbeke, Frank; Colman, Roos; Sadeghi, Simin; Villeirs, Geert; Decaestecker, Karel; De Meerleer, Gert

    2014-01-01

    Background: To define rectal dose volume constraints (DVC) to prevent ⩾grade2 late rectal toxicity (LRT) after intensity modulated radiotherapy (IMRT) for prostate cancer (PC). Material and methods: Six hundred thirty-seven PC patients were treated with primary (prostate median dose: 78 Gy) or postoperative (prostatic bed median dose: 74 Gy (adjuvant)–76 Gy (salvage)) IMRT while restricting the rectal dose to 76 Gy, 72 Gy and 74 Gy respectively. The impact of patient characteristics and rectal volume parameters on ⩾grade2 LRT was determined. DVC were defined to estimate the 5% and 10% risk of developing ⩾grade2 LRT. Results: The 5-year probability of being free from ⩾grade2 LRT, non-rectal blood loss and persisting symptoms is 88.8% (95% CI: 85.8–91.1%), 93.4% (95% CI: 91.0–95.1%) and 94.3% (95% CI: 92.0–95.9%) respectively. There was no correlation with patient characteristics. All volume parameters, except rectal volume receiving ⩾70 Gy (R70), were significantly correlated with ⩾grade2 LRT. To avoid 10% and 5% risk of ⩾grade2 LRT following DVC were derived: R40, R50, R60 and R65 <64–35%, 52–22%, 38–14% and 5% respectively. Conclusion: Applying existing rectal volume constraints resulted in a 5-year estimated risk of developing late ⩾grade2 LRT of 11.2%. New rectal DVC for primary and postoperative IMRT planning of PC patients are proposed. A prospective evaluation is needed

  5. Multi-centre experience of implementing image-guided intensity-modulated radiotherapy using the TomoTherapy platform

    International Nuclear Information System (INIS)

    Dean, J.C.; Tudor, G.S.J.; Mott, J.H.; Dunlop, P.R.; Morris, S.L.; Harron, E.C.; Christian, J.A.; Sanghera, P.; Elsworthy, M.; Burnet, N.G.

    2013-01-01

    Use of image guided (IG) intensity modulated radiotherapy (IMRT) is increasing, and helical tomotherapy provides an effective, integrated solution. Practical experience of implementation, shared at a recent UK TomoTherapy Users' meeting, may help centres introducing these techniques using TomoTherapy or other platforms. Seven centres participated, with data shared from 6, varying from 2500 - 4800 new patients per year. Case selection of patients “most likely” to benefit from IG-IMRT was managed in all centres by multi-professional groups comprising clinical oncologists, physicists, treatment planners and radiographers. Radical treatments ranged from 94% to 100%. The proportions of tumour types varied substantially: head and neck: range 0%–100% (mean of centres 50%), prostate: 3%–96% (mean of centres 28%). Head and neck cases were considered most likely to benefit from IMRT, prostate cases from IGRT, or IG-IMRT if pelvic nodes were being treated. IMRT was also selected for complex target volumes, to avoid field junctions, for technical treatment difficulties, and retreatments. Across the centres, every patient was imaged every day, with positional correction before treatment. In one centre, for prostate patients including pelvic treatment, the pelvis was also imaged weekly. All centres had designed a ‘ramp up’ of patient numbers, which was similar in 5. One centre, treating 96% prostate patients, started with 3 and increased to 36 patients per day within 3 months. The variation in case mix implies wide applicability of IG-IMRT. Daily on-line IGRT with IMRT can be routinely implemented into busy departments

  6. Australasian Gastrointestinal Trials Group (AGITG) Contouring Atlas and Planning Guidelines for Intensity-Modulated Radiotherapy in Anal Cancer

    International Nuclear Information System (INIS)

    Ng, Michael; Leong, Trevor; Chander, Sarat; Chu, Julie; Kneebone, Andrew; Carroll, Susan; Wiltshire, Kirsty; Ngan, Samuel; Kachnic, Lisa

    2012-01-01

    Purpose: To develop a high-resolution target volume atlas with intensity-modulated radiotherapy (IMRT) planning guidelines for the conformal treatment of anal cancer. Methods and Materials: A draft contouring atlas and planning guidelines for anal cancer IMRT were prepared at the Australasian Gastrointestinal Trials Group (AGITG) annual meeting in September 2010. An expert panel of radiation oncologists contoured an anal cancer case to generate discussion on recommendations regarding target definition for gross disease, elective nodal volumes, and organs at risk (OARs). Clinical target volume (CTV) and planning target volume (PTV) margins, dose fractionation, and other IMRT-specific issues were also addressed. A steering committee produced the final consensus guidelines. Results: Detailed contouring and planning guidelines and a high-resolution atlas are provided. Gross tumor and elective target volumes are described and pictorially depicted. All elective regions should be routinely contoured for all disease stages, with the possible exception of the inguinal and high pelvic nodes for select, early-stage T1N0. A 20-mm CTV margin for the primary, 10- to 20-mm CTV margin for involved nodes and a 7-mm CTV margin for the elective pelvic nodal groups are recommended, while respecting anatomical boundaries. A 5- to 10-mm PTV margin is suggested. When using a simultaneous integrated boost technique, a dose of 54 Gy in 30 fractions to gross disease and 45 Gy to elective nodes with chemotherapy is appropriate. Guidelines are provided for OAR delineation. Conclusion: These consensus planning guidelines and high-resolution atlas complement the existing Radiation Therapy Oncology Group (RTOG) elective nodal ano-rectal atlas and provide additional anatomic, clinical, and technical instructions to guide radiation oncologists in the planning and delivery of IMRT for anal cancer.

  7. Clinical comparative investigation using intensity-modulated radiotherapy combined with concurrent chemotherapy for the local advanced nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Zhao Yingchao; Dai Xiaofang; Wu Gang; Zhao Yanxia; Luo Ming

    2009-01-01

    Objective: To research the early effects and side-effects of the local advanced nasopharyngeal carcinoma patients using intensity-modulated radiotherapy (IMRT) combined with concurrent chemotherapy. Methods: From January 2005 to January 2007, 60 patients with nasopharyngeal carcinoma of stage m-IV b were received IMRT combined with concurrent chemotherapy in our center. Sixty patients were divided into paclitaxel concurrent group (32 patients) and cisplatin concurrent group (28 patients). The prescribing doses of the primary tumor were 68-72 Gy for each group. The patients of paclitaxel concurrent group received 5-7 times pacitaxel liposome chemotherapy of 30 mg · m -2 ·. The patients of cisplatin concurrent group received 5-7 times cisplatin chemotherapy of 30 mg · m -2 · week -1 . Results: As to the side-effects, the patients of the cisplatin concurrent group got earlier radiodermatitis and radiation-induced mucositis but also got significantly higher rate of radiodermatitis, radiation-induced mucositis, radiation-induced leucopenia and gastrointestinal toxicity, as well as the loss of weight. No significant difference was found on liver and renal functions between two groups.Four patients (12.5%) of the paclitaxel concurrent group were broken-off, which was much better than the cisplatin concurrent group. There was no significant difference on the specific length of break-off time, the 2-year overall survival rate and the 2-year diseaee-free survival rate between two groups. Conclusions: IMRT combined with concurrent chemotherapy of paclitaxel liposome for local advanced nasopharyngeal carcinoma results in less side-effects and better tolerance than IMRT combined with concurrent cisplatin chemotherapy. (authors)

  8. Spatial and Dosimetric Variability of Organs at Risk in Head-and-Neck Intensity-Modulated Radiotherapy

    International Nuclear Information System (INIS)

    Robar, James L.; Day, Allan Nova; Clancey, James; Kelly, Robin; Yewondwossen, Mammo; Hollenhorst, Helmut; Rajaraman, Murali; Wilke, Derek

    2007-01-01

    Purpose: The accuracy of intensity-modulated radiotherapy (IMRT) delivery may be compromised by random spatial error and systematic anatomic changes during the treatment course. We present quantitative measurements of the spatial variability of head-and-neck organs-at-risk and demonstrate the resultant dosimetric effects. Methods and Materials: Fifteen consecutive patients were imaged weekly using computed tomography during the treatment course. Three-dimensional displacements were calculated for the superior and inferior brainstem; C1, C6, and T2 spinal cord; as well as the lateral and medial aspects of the parotid glands. The data were analyzed to show distributions of spatial error and to track temporal changes. The treatment plan was recalculated on all computed tomography sets, and the dosimetric error was quantified in terms of the maximal dose difference (brainstem and spinal cord) or the mean dose difference and the volume receiving 26 Gy (parotid glands). Results: The mean three-dimensional displacement was 2.9 mm for the superior brainstem, 3.4 mm for the inferior brainstem, 3.5 mm for the C1 spine, 5.6 mm for the C6 spine and 6.0 mm for the T2 spine. The lateral aspects of both parotid glands showed a medial translation of 0.85 mm/wk, and glands shrank by 4.9%/wk. The variability of the maximal dose difference was described by standard deviations ranging from 5.6% (upper cord) to 8.0% (lower cord.) The translation of the left parotid resulted in an increase of the mean dose and the volume receiving 26 Gy. Conclusion: Random spatial and dosimetric variability is predominant for the brainstem and spinal cord and increases at more inferior locations. In contrast, the parotid glands demonstrated a systematic medial translation during the treatment course and thus sparing may be compromised

  9. Long-term results of intensity-modulated radiotherapy concomitant with chemotherapy for hypopharyngeal carcinoma aimed at laryngeal preservation

    International Nuclear Information System (INIS)

    Liu, Wen-Shan; Su, Mao-Chang; Lee, Huei; Hsin, Chung-Han; Chou, Ying-Hsiang; Liu, Jung-Tung; Wu, Ming-Fang; Tseng, Szu-Wen; Lee, Jong-Kang; Tseng, Hsien-Chun; Wang, Tzu-Hwei

    2010-01-01

    The objective of this retrospective study is to investigate laryngeal preservation and long-term treatment results in hypopharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT) combined with chemotherapy. Twenty-seven patients with hypopharyngeal carcinoma (stage II-IV) were enrolled and underwent concurrent chemoradiotherapy. The chemotherapy regimens were monthly cisplatin and 5-fluorouracil for six patients and weekly cisplatin for 19 patients. All patients were treated with IMRT with simultaneous integrated boost technique. Acute and late toxicities were recorded based on CTCAE 3.0 (Common Terminology Criteria for Adverse Events). The median follow-up time for survivors was 53.0 months (range 36-82 months). The initial complete response rate was 85.2%, with a laryngeal preservation rate of 63.0%. The 5-year functional laryngeal, local-regional control, disease-free and overall survival rates were 59.7%, 63.3%, 51.0% and 34.8%, respectively. The most common greater than or equal to grade 3 acute and late effects were dysphagia (63.0%, 17 of 27 patients) and laryngeal stricture (18.5%, 5 of 27 patients), respectively. Patients belonging to the high risk group showed significantly higher risk of tracheostomy compared to the low risk group (p = 0.014). After long-term follow-up, our results confirmed that patients with hypopharyngeal carcinoma treated with IMRT concurrent with platinum-based chemotherapy attain high functional laryngeal and local-regional control survival rates. However, the late effect of laryngeal stricture remains a problem, particularly for high risk group patients

  10. Volumetric tumor burden and its effect on brachial plexus dosimetry in head and neck intensity-modulated radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Romesser, Paul B.; Qureshi, Muhammad M.; Kovalchuk, Nataliya; Truong, Minh Tam, E-mail: mitruong@bu.edu

    2014-07-01

    To determine the effect of gross tumor volume of the primary (GTV-P) and nodal (GTV-N) disease on planned radiation dose to the brachial plexus (BP) in head and neck intensity-modulated radiotherapy (IMRT). Overall, 75 patients underwent definitive IMRT to a median total dose of 69.96 Gy in 33 fractions. The right BP and left BP were prospectively contoured as separate organs at risk. The GTV was related to BP dose using the unpaired t-test. Receiver operating characteristics curves were constructed to determine optimized volumetric thresholds of GTV-P and GTV-N corresponding to a maximum BP dose cutoff of > 66 Gy. Multivariate analyses were performed to account for factors associated with a higher maximal BP dose. A higher maximum BP dose (> 66 vs ≤ 66 Gy) correlated with a greater mean GTV-P (79.5 vs 30.8 cc; p = 0.001) and ipsilateral GTV-N (60.6 vs 19.8 cc; p = 0.014). When dichotomized by the optimized nodal volume, patients with an ipsilateral GTV-N ≥ 4.9 vs < 4.9 cc had a significant difference in maximum BP dose (64.2 vs 59.4 Gy; p = 0.001). Multivariate analysis confirmed that an ipsilateral GTV-N ≥ 4.9 cc was an independent predictor for the BP to receive a maximal dose of > 66 Gy when adjusted individually for BP volume, GTV-P, the use of a low anterior neck field technique, total planned radiation dose, and tumor category. Although both the primary and the nodal tumor volumes affected the BP maximal dose, the ipsilateral nodal tumor volume (GTV-N ≥ 4.9 cc) was an independent predictor for high maximal BP dose constraints in head and neck IMRT.

  11. Clinical outcome of extended-field irradiation vs. pelvic irradiation using intensity-modulated radiotherapy for cervical cancer.

    Science.gov (United States)

    Ouyang, Yi; Wang, Yanhong; Chen, Kai; Cao, Xinping; Zeng, Yiming

    2017-12-01

    The aim of the present study was to evaluate the distinctions in survival and toxicity between patients with cervical cancer with common iliac node or para-aortic node involvement, who were treated with extended-field intensity-modulated radiotherapy (EF-IMRT) and patients with or without lower involved pelvic nodes, who were treated with pelvic IMRT. A total of 55 patients treated with EF-IMRT and 52 patients treated with pelvic IMRT at the Sun Yat-Sen University Cancer Center (Guangzhou, China) were retrospectively analyzed. Patients treated with EF-IMRT had the highest level of lymph node involvement to the para-aortic or common iliac nodes, while patients treated with pelvic IMRT had no para-aortic or common iliac nodes involved (Pirradiation was a protective prognostic factor for OS and DFS. A total of 16 patients in the EF-IMRT group and 13 patients in the pelvic IMRT group experienced treatment failure (P=0.67), with the patterns of failure being the same for the two groups (P=0.88). The cumulative incidence of grade 3 and 4 acute toxicities in the EF-IMRT group was 34.5%, in comparison with 19.2% in the pelvic group (P=0.048). The results of the present study suggest that patients with cervical cancer with grossly involved common iliac or para-aortic nodes should be electively subjected to EF irradiation to improve the survival and alter patterns of recurrence. Notably, EF irradiation delivered via IMRT exhibits an increased toxicity incidence, however, this remains within an acceptable range.

  12. Cervical Lymph Node Metastases From Unknown Primary Cancer: A Single-Institution Experience With Intensity-Modulated Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Villeneuve, Hugo, E-mail: hugo.villeneuve@umontreal.ca [Department of Radiation Oncology, Centre hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Despres, Philippe; Fortin, Bernard; Filion, Edith; Donath, David [Department of Radiation Oncology, Centre hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Soulieres, Denis [Department of Medical Oncology, Centre hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Guertin, Louis; Ayad, Tarek; Christopoulos, Apostolos [Department of Head and Neck Surgery, Centre hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Nguyen-Tan, Phuc Felix [Department of Radiation Oncology, Centre hospitalier de l' Universite de Montreal, Montreal, QC (Canada)

    2012-04-01

    Purpose: To determine the effectiveness and rate of complications of intensity-modulated radiotherapy (IMRT) in the treatment of cervical lymph node metastases from unknown primary cancer. Methods and Materials: Between February 2005 and November 2008, 25 patients with an unknown primary cancer underwent IMRT, with a median radiation dose of 70 Gy. The bilateral neck and ipsilateral putative pharyngeal mucosa were included in the target volume. All patients had squamous cell carcinoma, except for 1 patient who had adenosquamous differentiation. They were all treated with curative intent. Of the 25 included patients, 20 were men and 5 were women, with a median age of 54 years. Of these patients, 3 had Stage III, 18 had Stage IVa, and 4 had Stage IVb. Of the 25 patients, 18 (72%) received platinum-based chemotherapy in a combined-modality setting. Neck dissection was reserved for residual disease after definitive IMRT. Overall survival, disease-free survival, and locoregional control were calculated using the Kaplan-Meier method. Results: With a median follow-up of 38 months, the overall survival, disease-free survival, and locoregional control rates were all 100% at 3 years. No occurrence of primary cancer was observed during the follow-up period. The reported rates of xerostomia reduced with the interval from the completion of treatment. Nine patients (36%) reported Grade 2 or greater xerostomia at 6 months, and only 2 (8%) of them reported the same grade of salivary function toxicity after 24 months of follow-up. Conclusion: In our institution, IMRT for unknown primary cancer has provided good overall and disease-free survival in all the patients with an acceptable rate of complications. IMRT allowed us to address the bilateral neck and ipsilateral putative pharyngeal mucosa with minimal late salivary function toxicity. The use of concurrent chemotherapy and IMRT for more advanced disease led to good clinical results with reasonable toxicities.

  13. Australasian Gastrointestinal Trials Group (AGITG) Contouring Atlas and Planning Guidelines for Intensity-Modulated Radiotherapy in Anal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ng, Michael, E-mail: mng@radoncvic.com.au [Radiation Oncology Victoria, Victoria (Australia); Leong, Trevor [Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria (Australia); University of Melbourne (Australia); Chander, Sarat; Chu, Julie [Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria (Australia); Kneebone, Andrew [Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, NSW (Australia); University of Sydney (Australia); Carroll, Susan [Department of Radiation Oncology, Sydney Cancer Centre, Royal Prince Alfred Hospital, NSW (Australia); University of Sydney (Australia); Wiltshire, Kirsty [Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria (Australia); Ngan, Samuel [Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria (Australia); University of Melbourne (Australia); Kachnic, Lisa [Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA (United States)

    2012-08-01

    Purpose: To develop a high-resolution target volume atlas with intensity-modulated radiotherapy (IMRT) planning guidelines for the conformal treatment of anal cancer. Methods and Materials: A draft contouring atlas and planning guidelines for anal cancer IMRT were prepared at the Australasian Gastrointestinal Trials Group (AGITG) annual meeting in September 2010. An expert panel of radiation oncologists contoured an anal cancer case to generate discussion on recommendations regarding target definition for gross disease, elective nodal volumes, and organs at risk (OARs). Clinical target volume (CTV) and planning target volume (PTV) margins, dose fractionation, and other IMRT-specific issues were also addressed. A steering committee produced the final consensus guidelines. Results: Detailed contouring and planning guidelines and a high-resolution atlas are provided. Gross tumor and elective target volumes are described and pictorially depicted. All elective regions should be routinely contoured for all disease stages, with the possible exception of the inguinal and high pelvic nodes for select, early-stage T1N0. A 20-mm CTV margin for the primary, 10- to 20-mm CTV margin for involved nodes and a 7-mm CTV margin for the elective pelvic nodal groups are recommended, while respecting anatomical boundaries. A 5- to 10-mm PTV margin is suggested. When using a simultaneous integrated boost technique, a dose of 54 Gy in 30 fractions to gross disease and 45 Gy to elective nodes with chemotherapy is appropriate. Guidelines are provided for OAR delineation. Conclusion: These consensus planning guidelines and high-resolution atlas complement the existing Radiation Therapy Oncology Group (RTOG) elective nodal ano-rectal atlas and provide additional anatomic, clinical, and technical instructions to guide radiation oncologists in the planning and delivery of IMRT for anal cancer.

  14. Normalization of prostate specific antigen in patients treated with intensity modulated radiotherapy for clinically localized prostate cancer

    International Nuclear Information System (INIS)

    Schmitz, Matthew D; Padula, Gilbert DA; Chun, Patrick Y; Davis, Alan T

    2010-01-01

    The purpose of this study was to determine the expected time to prostate specific antigen (PSA) normalization with or without neoadjuvant androgen deprivation (NAAD) therapy after treatment with intensity modulated radiotherapy (IMRT) for patients with clinically localized prostate cancer. A retrospective cohort research design was used. A total of 133 patients with clinical stage T1c to T3b prostate cancer (2002 AJCC staging) treated in a community setting between January 2002 and July 2005 were reviewed for time to PSA normalization using 1 ng/mL and 2 ng/mL as criteria. All patients received IMRT as part of their management. Times to PSA normalization were calculated using the Kaplan-Meier method. Significance was assessed at p < 0.05. Fifty-six of the 133 patients received NAAD (42.1%). Thirty-one patients (23.8%) received radiation to a limited pelvic field followed by an IMRT boost, while 99 patients received IMRT alone (76.2%). The times to serum PSA normalization < 2 ng/mL when treated with or without NAAD were 298 ± 24 and 302 ± 33 days (mean ± SEM), respectively (p > 0.05), and 303 ± 24 and 405 ± 46 days, respectively, for PSA < 1 ng/mL (p < 0.05). Stage T1 and T2 tumors had significantly increased time to PSA normalization < 1 ng/mL in comparison to Stage T3 tumors. Also, higher Gleason scores were significantly correlated with a faster time to PSA normalization < 1 ng/mL. Use of NAAD in conjunction with IMRT leads to a significantly shortened time to normalization of serum PSA < 1 ng/mL in patients with clinically localized prostate cancer

  15. Hypofractionated intensity-modulated radiotherapy with temozolomide chemotherapy may alter the patterns of failure in patients with glioblastoma multiforme

    International Nuclear Information System (INIS)

    Reddy, Krishna; Chen, Changhu; Gaspar, Laurie E.; Kavanagh, Brian D.

    2014-01-01

    The objective of this study was to report the patterns of failure in patients with glioblastoma multiforme (GBM) treated on a phase II trial of hypofractionated intensity-modulated radiotherapy (hypo-IMRT) with concurrent and adjuvant temozolomide (TMZ). Patients with newly diagnosed GBM post-resection received postoperative hypo-IMRT to 60Gy in 10 fractions. TMZ was given concurrently at 75mg/m 2 /day for 28 consecutive days and adjuvantly at 150–200mg/m 2 /day for 5 days every 28 days. Radiographic failure was defined as any new T1-enhancing lesion or biopsy-confirmed progressive enhancement at the primary site. MRIs obtained at the time of failure were fused to original hypo-IMRT plans. Central, in-field, marginal and distant failure were defined as ≥95%, 80% to 95%, any to 80% and 0% of the volume of a recurrence receiving 60Gy, respectively. Twenty-four patients were treated on the trial. Median follow-up was 14.8 months (range 2.7–34.2). Seventeen of 24 patients experienced radiographic failure: one central, five in-field, two marginal, eight distant and one both in-field and distant. Two of the eight distant failures presented with leptomeningeal disease. Two other patients died without evidence of radiographic recurrence. Five of 24 patients demonstrated asymptomatic, gradually progressive in-field T1 enhancement, suggestive of post-treatment changes, without clear evidence of failure; three of these patients received a biopsy/second resection, with 100% radiation necrosis found. The median overall survival of this group was 33.0 months. A 60-Gy hypo-IMRT treatment delivered in 6-Gy fractions with TMZ altered the patterns of failure in GBM, with more distant failures.

  16. Level IB nodal involvement in oropharyngeal carcinoma: implications for submandibular gland-sparing intensity-modulated radiotherapy.

    Science.gov (United States)

    Yu, Yao; Daly, Megan E; Farwell, D Gregory; Luu, Quang; Gandour-Edwards, Regina; Donald, Paul J; Chen, Allen M

    2015-03-01

    Submandibular gland-sparing intensity-modulated radiotherapy (SMG-sparing IMRT) has been proposed to reduce xerostomia following head and neck irradiation. However, the safety of this practice has been questioned. Data from a large surgical series of oropharyngeal carcinoma patients were extracted to identify clinicopathological correlates for submandibular involvement and to create a risk stratification scheme to guide decision making to refine selection guidelines for SMG-sparing IMRT. Clinicopathologic analysis. The medical records of 153 consecutive patients with squamous cell carcinoma of the oropharynx treated by primary surgery and neck dissection were reviewed. Univariate and multivariate analysis was performed with logistic regression to identify factors predictive of submandibular involvement. Recursive partitioning was used to develop risk stratification schemas based on preoperative data alone and in combination with pathologic data to guide treatment decisions in the definitive and postoperative settings, respectively. Submandibular (level IB) nodal dissection was performed in 119 heminecks (85 ipsilateral and 17 contralateral). The incidence of submandibular involvement was 18%. Young age, T3-4 disease, N2b-3 disease, and perineural invasion were identified as risk factors for submandibular nodal involvement on multivariate analysis (P submandibular involvement were identified: age >60 years and N0-2a disease (low risk, 2%), age ≤60 years and T1-2N2b-3 (intermediate risk, 16%), age ≤60 years and T3-4N2b-3 disease (high risk, 57%). These data provide assurances that SMG-sparing IMRT can reasonably be offered to appropriately selected patients. Risk stratification schemas were successfully developed for SMG-sparing IMRT in both the definitive and adjuvant settings. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  17. SU-E-T-608: Performance Comparison of Four Commercial Treatment Planning Systems Applied to Intensity-Modulated Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Cao, Y; Li, R; Chi, Z [The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, CN, Shijiazhuang, Hebei (China)

    2014-06-01

    Purpose: To compare the performances of four commercial treatment planning systems (TPS) used for the intensity-modulated radiotherapy (IMRT). Methods: Ten patients of nasopharyngeal (4 cases), esophageal (3 cases) and cervical (3 cases) cancer were randomly selected from a 3-month IMRT plan pool at one radiotherapy center. For each patient, four IMRT plans were newly generated by using four commercial TPS (Corvus, Monaco, Pinnacle and Xio), and then verified with Matrixx (two-dimensional array/IBA Company) on Varian23EX accelerator. A pass rate (PR) calculated from the Gamma index by OminiPro IMRT 1.5 software was evaluated at four plan verification standards (1%/1mm, 2%/2mm, 3%/3mm, 4%/4mm and 5%/5mm) for each treatment plan. Overall and multiple pairwise comparisons of PRs were statistically conducted by analysis of covariance (ANOVA) F and LSD tests among four TPSs. Results: Overall significant (p>0.05) differences of PRs were found among four TPSs with F test values of 3.8 (p=0.02), 21.1(>0.01), 14.0 (>0.01), 8.3(>0.01) at standards of 1%/1mm to 4%/4mm respectively, except at 5%/5mm standard with 2.6 (p=0.06). All means (standard deviation) of PRs at 3%/3mm of 94.3 ± 3.3 (Corvus), 98.8 ± 0.8 (Monaco), 97.5± 1.7 (Pinnacle), 98.4 ± 1.0 (Xio) were above 90% and met clinical requirement. Multiple pairwise comparisons had not demonstrated a consistent low or high pattern on either TPS. Conclusion: Matrixx dose verification results show that the validation pass rates of Monaco and Xio plans are relatively higher than those of the other two; Pinnacle plan shows slight higher pass rate than Corvus plan; lowest pass rate was achieved by the Corvus plan among these four kinds of TPS.

  18. Intensity-modulated radiotherapy with simultaneous modulated accelerated boost technique and chemotherapy in patients with nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Fareed, Muhammad M; AlAmro, Abdullah S; Bayoumi, Yasser; Tunio, Mutahir A; Ismail, Abdul S; Akasha, Rashad; Mubasher, Mohamed; Al Asiri, Mushabbab

    2013-01-01

    To present our experience of intensity-modulated radiotherapy (IMRT) with simultaneous modulated accelerated radiotherapy (SMART) boost technique in patients with nasopharyngeal carcinoma (NPC). Sixty eight patients of NPC were treated between April 2006 and December 2011 including 45 males and 23 females with mean age of 46 (range 15–78). Stage distribution was; stage I 3, stage II 7, stage III 26 and stage IV 32. Among 45 (66.2%) evaluated patients for presence of Epstein-Barr virus (EBV), 40 (88.8%) were positive for EBV. Median radiation doses delivered to gross tumor volume (GTV) and positive neck nodes were 66–70 Gy, 63 Gy to clinical target volume (CTV) and 50.4 Gy to clinically negative neck. In addition 56 (82.4%) patients with bulky tumors (T4/N2+) received neoadjuvant chemotherapy 2–3 cycles (Cisplatin/Docetaxel or Cisplatin/Epirubicin or Cisplatin/5 Flourouracil). Concurrent chemotherapy with radiation was weekly Cisplatin 40 mg/m 2 (40 patients) or Cisplatin 100 mg/m 2 (28 patients). With a median follow up of 20 months (range 3–43), one patient developed local recurrence, two experienced regional recurrences and distant failure was seen in 3 patients. Estimated 3 year disease free survival (DFS) was 94%. Three year DFS for patients with EBV was 100% as compared to 60% without EBV (p = 0.0009). Three year DFS for patients with undifferentiated histology was 98% as compared to 82% with other histologies (p = 0.02). Acute grade 3 toxicity was seen as 21 (30.9%) having G-III mucositis and 6 (8.8%) with G-III skin reactions. Late toxicity was minimal and loss of taste was seen in 3 patients (7.5%) at time of analysis. IMRT with SMART in combination with chemotherapy is feasible and effective in terms of both the clinical response and safety profile. EBV, histopathology and nodal involvement were found important prognostic factors for locoregional recurrence

  19. Intensity-Modulated Radiotherapy Reduces Gastrointestinal Toxicity in Patients Treated With Androgen Deprivation Therapy for Prostate Cancer

    International Nuclear Information System (INIS)

    Sharma, Navesh K.; Li Tianyu; Chen, David Y.; Pollack, Alan; Horwitz, Eric M.; Buyyounouski, Mark K.

    2011-01-01

    Purpose: Androgen deprivation therapy (AD) has been shown to increase late Grade 2 or greater rectal toxicity when used concurrently with three-dimensional conformal radiotherapy (3D-CRT). Intensity-modulated radiotherapy (IMRT) has the potential to reduce toxicity by limiting the radiation dose received by the bowel and bladder. The present study compared the genitourinary and gastrointestinal (GI) toxicity in men treated with 3D-CRT+AD vs. IMRT+AD. Methods and Materials: Between July 1992 and July 2004, 293 men underwent 3D-CRT (n = 170) or IMRT (n = 123) with concurrent AD (<6 months, n = 123; ≥6 months, n = 170). The median radiation dose was 76 Gy for 3D-CRT (International Commission on Radiation Units and Measurements) and 76 Gy for IMRT (95% to the planning target volume). Toxicity was assessed by a patient symptom questionnaire that was completed at each visit and recorded using a Fox Chase Modified Late Effects Normal Tissue Task radiation morbidity scale. Results: The mean follow-up was 86 months (standard deviation, 29.3) for the 3D-CRT group and 40 months (standard deviation, 9.7) for the IMRT group. Acute GI toxicity (odds ratio, 4; 95% confidence interval, 1.6-11.7; p = .005) was significantly greater with 3D-CRT than with IMRT and was independent of the AD duration (i.e., <6 vs. ≥6 months). The interval to the development of late GI toxicity was significantly longer in the IMRT group. The 5-year Kaplan-Meier estimate for Grade 2 or greater GI toxicity was 20% for 3D-CRT and 8% for IMRT (p = .01). On multivariate analysis, Grade 2 or greater late GI toxicity (hazard ratio, 2.1; 95% confidence interval, 1.1-4.3; p = .04) was more prevalent in the 3D-CRT patients. Conclusion: Compared with 3D-CRT, IMRT significantly decreased the acute and late GI toxicity in patients treated with AD.

  20. Intensity-modulated radiotherapy vs. parotid-sparing 3D conformal radiotherapy. Effect on outcome and toxicity in locally advanced head and neck cancer

    International Nuclear Information System (INIS)

    Lambrecht, M.; Nevens, D.; Nuyts, S.

    2013-01-01

    Background and purpose: Intensity-modulated radiotherapy (IMRT) has rapidly become standard of care in the management of locally advanced head and neck squamous cell carcinoma (HNSCC). In this study, our aim was to retrospectively investigate the effect of the introducing IMRT on outcome and treatment-related toxicity compared to parotid-sparing 3D conformal radiotherapy (3DCRT). Material and methods: A total of 245 patients with stage III and IV HNSCC treated with primary radiotherapy between January 2003 and December 2010 were included in this analysis: 135 patients were treated with 3DCRT, 110 patients with IMRT. Groups were compared for acute and late toxicity, locoregional control (LRC), and overall survival (OS). Oncologic outcomes were estimated using Kaplan-Meier analysis and compared using a log-rank test. Acute toxicity was analyzed according to the Common Terminology Criteria for Adverse Events v3.0 and late toxicity was scored using the RTOG/EORTC late toxicity scoring system. Results: Median follow-up was 35 months in the IMRT group and 68 months in the 3DCRT group. No significant differences were found in 3-year LRC and OS rates between the IMRT group and 3DCRT group. Significantly less acute mucositis ≥ grade 3 was observed in the IMRT group (32% vs. 44%, p = 0.03). There was significantly less late xerostomia ≥ grade 2 in the IMRT group than in the 3DCRT group (23% vs. 68%, p < 0.001). After 24 months, there was less dysphagia ≥ grade 2 in the IMRT group although differences failed to reach statistical significance. Conclusion: The introduction of IMRT in the radiotherapeutic management of locally advanced head and neck cancer significantly improved late toxicity without compromising tumor control compared to a parotid-sparing 3D conformal radiotherapy technique. (orig.)

  1. Parotid-sparing intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma: Preserved parotid function after IMRT on quantitative salivary scintigraphy, and comparison with historical data after conventional radiotherapy

    International Nuclear Information System (INIS)

    Hsiung, C.-Y.; Ting, H.-M.; Huang, H.-Y.; Lee, C.-H.; Huang, E.-Y.; Hsu, H.-C.

    2006-01-01

    Purpose: To evaluate the parotid function after parotid-sparing intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC). Methods and Materials: From March 2003 to May 2004, 16 patients with nonmetastatic NPC underwent parotid-sparing IMRT. Eight of these patients had Stage III or IV NPC based on the 1997 American Joint Committee on Cancer staging system. The post-IMRT parotid function was evaluated by quantitative salivary scintigraphy and represented by the maximal excretion ratio (MER) of the parotid gland after sialogogue stimulation. The parotid function of 16 NPC patients who were previously treated with conventional radiotherapy was reviewed as the historical control. Results: In the parotid-sparing IMRT group, all 16 patients were alive and without cancer at the end of follow-up period (median, 24.2 months). The mean parotid MER was 53.5% before radiotherapy, 10.7% at 1 month post-IMRT, and 23.3% at 9 months post-IMRT. In the conventional radiotherapy group, the mean parotid MER was 0.6% at 6 to 12 months postradiotherapy. The difference was statistically significant (23.3% vs. 0.6%, p < 0.001, Mann-Whitney test). In the IMRT group, the mean parotid doses ranged from 33.2 Gy to 58.8 Gy (average, 43.9 Gy). The correlation between the mean parotid dose and the percentage decrease of parotid MER at 9 months post-IMRT (dMER) was statically significant (p = 0.008, Pearson correlation). Conclusions: Although the mean parotid doses are relatively high, the significant preservation of parotid function is achieved with IMRT for NPC patients. The significant correlation between mean parotid dose and parotid dMER demonstrates the dose-function relationship of the parotid gland

  2. Skull base meningiomas: Long-term results and patient self-reported outcome in 507 patients treated with fractionated stereotactic radiotherapy (FSRT) or intensity modulated radiotherapy (IMRT)

    International Nuclear Information System (INIS)

    Combs, Stephanie E.; Adeberg, Sebastian; Dittmar, Jan-Oliver; Welzel, Thomas; Rieken, Stefan; Habermehl, Daniel; Huber, Peter E.; Debus, Jürgen

    2013-01-01

    Purpose: To evaluate long-term outcome of high-precision photon radiotherapy in 507 patients with skull base meningiomas. Methods and materials: At the time of radiation therapy, most patients presented with clinical symptoms including double vision, headache, nausea, trigeminal or facial nerve dysfunction or exophthalmus. In general tumors extended into several regions of the skull base. In 54%, prior neurosurgical intervention was performed, which was a partial resection or biopsy in 266 patients. Treatment was delivered using a 6 MV linear accelerator or the tomotherapy system. Fractionated stereotactic radiotherapy (FSRT) was applied in 376 patients (74%) and intensity modulated radiotherapy (IMRT) in 131 patients (26%). A median total dose of 57.6 Gy (range 25–68 Gy) was prescribed in median (range 1.6–5 Gy). To evaluate long-term toxicity as well as quality of life (QOL), we sent out a detailed questionnaire put together with special questions regarding the skull base location of the tumors. Special focus was long-term sequelae including visual deficits, cranial nerve deficits, headaches, fatigue or any other symptoms impairing overall QOL. The median follow-up time was 107 months (range 1–270 months). Results: Overall treatment was well tolerated. Local control for the whole cohort was 95% at 5 years and 88% at 10 years. Patients with benign histology had significant higher local control than high-grade meningiomas. For benign meningiomas, local control was 91% at 10 years. For high-risk meningiomas, local control was 81% at 5 years and 53% at 10 years. QOL was unchanged in 47.7% of the patients, and 37.5% showed improvement. Most patients reported an improvement of symptoms or steady state; in only few patients disorders worsened over time or side effects developed. Conclusion: Precision photon radiotherapy leads to long-term tumor control with minimal side effects, but also with preservation of QOL in patients with skull base meningiomas

  3. Intensity-modulated radiotherapy vs. parotid-sparing 3D conformal radiotherapy. Effect on outcome and toxicity in locally advanced head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lambrecht, M.; Nevens, D.; Nuyts, S. [University Hospitals Leuven (Belgium). Dept. of Radiation Oncology

    2013-03-15

    Background and purpose: Intensity-modulated radiotherapy (IMRT) has rapidly become standard of care in the management of locally advanced head and neck squamous cell carcinoma (HNSCC). In this study, our aim was to retrospectively investigate the effect of the introducing IMRT on outcome and treatment-related toxicity compared to parotid-sparing 3D conformal radiotherapy (3DCRT). Material and methods: A total of 245 patients with stage III and IV HNSCC treated with primary radiotherapy between January 2003 and December 2010 were included in this analysis: 135 patients were treated with 3DCRT, 110 patients with IMRT. Groups were compared for acute and late toxicity, locoregional control (LRC), and overall survival (OS). Oncologic outcomes were estimated using Kaplan-Meier analysis and compared using a log-rank test. Acute toxicity was analyzed according to the Common Terminology Criteria for Adverse Events v3.0 and late toxicity was scored using the RTOG/EORTC late toxicity scoring system. Results: Median follow-up was 35 months in the IMRT group and 68 months in the 3DCRT group. No significant differences were found in 3-year LRC and OS rates between the IMRT group and 3DCRT group. Significantly less acute mucositis {>=} grade 3 was observed in the IMRT group (32% vs. 44%, p = 0.03). There was significantly less late xerostomia {>=} grade 2 in the IMRT group than in the 3DCRT group (23% vs. 68%, p < 0.001). After 24 months, there was less dysphagia {>=} grade 2 in the IMRT group although differences failed to reach statistical significance. Conclusion: The introduction of IMRT in the radiotherapeutic management of locally advanced head and neck cancer significantly improved late toxicity without compromising tumor control compared to a parotid-sparing 3D conformal radiotherapy technique. (orig.)

  4. Simultaneous integrated boost intensity-modulated radiotherapy versus 3-dimensional conformal radiotherapy in preoperative concurrent chemoradiotherapy for locally advanced rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Bong Kyung; Kang, Min Kyul; Kim, Jae Chul [Dept. of Radiation Oncology, Kyungpook National University School of Medicine, Daegu (Korea, Republic of); Kim, Min Young; Choi, Gyu Seog; Kim, Jong Gwang; Kang, Byung Woog; Kim, Hye Jin; Park, Soo Yeun [Kyungpook National University Chilgok Hospital, Kyungpook National University School of Medicine, Daegu (Korea, Republic of)

    2017-09-15

    To evaluate the feasibility of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) for preoperative concurrent chemoradiotherapy (PCRT) in locally advanced rectal cancer (LARC), by comparing with 3-dimensional conformal radiotherapy (3D-CRT). Patients who were treated with PCRT for LARC from 2015 January to 2016 December were retrospectively enrolled. Total doses of 45 Gy to 50.4 Gy with 3D-CRT or SIB-IMRT were administered concomitantly with 5-fluorouracil plus leucovorin or capecitabine. Surgery was performed 8 weeks after PCRT. Between PCRT and surgery, one cycle of additional chemotherapy was administered. Pathologic tumor responses were compared between SIB-IMRT and 3D-CRT groups. Acute gastrointestinal, genitourinary, hematologic, and skin toxicities were compared between the two groups based on the RTOG toxicity criteria. SIB-IMRT was used in 53 patients, and 3D-CRT in 41 patients. After PCRT, no significant differences were noted in tumor responses, pathologic complete response (9% vs. 7%; p = 1.000), pathologic tumor regression Grade 3 or higher (85% vs. 71%; p = 0.096), and R0 resection (87% vs. 85%; p = 0.843). Grade 2 genitourinary toxicities were significantly lesser in the SIB-IMRT group (8% vs. 24%; p = 0.023), but gastrointestinal toxicities were not different across the two groups. SIB-IMRT showed lower GU toxicity and similar tumor responses when compared with 3D-CRT in PCRT for LARC.

  5. A comparison of swallowing dysfunction after three-dimensional conformal and intensity-modulated radiotherapy. A systematic review by the Italian Head and Neck Radiotherapy Study Group

    International Nuclear Information System (INIS)

    Ursino, Stefano; Morganti, Riccardo; Cristaudo, Agostino; Paiar, Fabiola; D'Angelo, Elisa; Lohr, Frank; Mazzola, Rosario; Merlotti, Anna; Russi, Elvio Grazioso; Musio, Daniela; Alterio, Daniela; Bacigalupo, Almalina

    2017-01-01

    Dysphagia is one of the most important treatment-related side effects in head and neck cancer (HNC), as it can lead to severe life-threating complications such as aspiration pneumonia and malnutrition. Intensity-modulated radiotherapy (IMRT) could reduce swallowing dysfunction by producing a concave dose distribution and reducing doses to the swallowing-related organs at risk (SWOARs). The aim of this study was to review the current literature in order to compare swallowing outcomes between IMRT and three-dimensional conformal radiotherapy (3DCRT). A search was conducted in the PubMed and Embase databases to identify studies on swallowing outcomes, both clinically and/or instrumentally assessed, after 3DCRT and IMRT. Dysphagia-specific quality of life and objective instrumental data are summarized and discussed. A total of 262 papers were retrieved from the searched databases. An additional 23 papers were retrieved by hand-searching the reference lists. Ultimately, 22 papers were identified which discussed swallowing outcomes after 3DCRT and IMRT for HNC. No outcomes from randomized trials were identified. Despite several methodological limitations, reports from the current literature seem to suggest better swallowing outcomes with IMRT compared to 3DCRT. Further improvements are likely to result from the increased use of IMRT plans optimized for SWOAR sparing. (orig.) [de

  6. Comparison of long-term efficacy between intensity-modulated radiotherapy with concurrent chemotherapy and neoadjuvant chemotherapy followed by intensity-modulated radiotherapy with concurrent chemotherapy in patients with locally advanced nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Guan Ying; Sun Xueming; Zeng Lei; Chen Chunyan; Han Fei; Lu Taixiang

    2014-01-01

    Objective: To compare the long-term efficacy between two radiochemotherapy regimens for locally advanced nasopharyngeal carcinoma (NPC): intensity-modulated radiotherapy with concurrent chemotherapy (CCRT) versus neoadjuvant chemotherapy (NACT) followed by CCRT. Methods: A retrospective analysis was performed on the clinical data of 278 patients with locally advanced NPC who were admitted to our hospital from 2001 to 2008. Of the 278 patients, 133 received CCRT, and 145 received NACT followed by CCRT (NACT + CCRT). Results: The follow-up rate was 96.6%. The 5-year overall survival (OS),distant metastasis-free survival (DMFS), recurrence-free survival (RFS), and progression-free survival (PFS) were 78.1%, 78.0%, 90.6%, and 72.0%, respectively. There were no significant differences between the CCRT group and NACT + CCRT group in 5-year OS (79.9% vs. 76.4%, P=0.443), DMFS (77.1% vs. 78.9%, P=0.972), RFS (91.6% vs. 89.8%, P=0.475), and PFS (71.6% vs. 72.2%, P=0.731). Subgroup analysis showed that compared with CCRT, NACT + CCRT did not significantly improve 5-year RFS in T 3-4 N 0-1 patients (90.7% vs. 86.9%, P=0.376) and did not significantly improve 5-year DMFS in patients with advanced N-stage disease (57.6% vs. 69.7%, P=0.275). There were significantly higher numbers of individuals with neutropenia,decrease in hemoglobin, and upper gastrointestinal reactions in patients treated with NACT + CCRT than in those treated with CCRT (100 vs. 52, P=0.000; 64 vs. 35, P=0.010; 90 vs. 63, P=0.044). Conclusions: Compared with CCRT,NACT + CCRT does not significantly improve the prognosis in patients with locally advanced NPC and leads to significant increases in grade ≥ 3 toxicities (neutropenia, decrease in hemoglobin, and upper gastrointestinal reactions). The role of NACT in the treatment of locally advanced NPC needs further study. (authors)

  7. Prospective Trial of High-Dose Reirradiation Using Daily Image Guidance With Intensity-Modulated Radiotherapy for Recurrent and Second Primary Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Chen, Allen M.; Farwell, D. Gregory; Luu, Quang; Cheng, Suzan; Donald, Paul J.; Purdy, James A.

    2011-01-01

    Purpose: To report a single-institutional experience using intensity-modulated radiotherapy with daily image-guided radiotherapy for the reirradiation of recurrent and second cancers of the head and neck. Methods and Materials: Twenty-one consecutive patients were prospectively treated with intensity-modulated radiotherapy from February 2006 to March 2009 to a median dose of 66 Gy (range, 60-70 Gy). None of these patients received concurrent chemotherapy. Daily helical megavoltage CT scans were obtained before each fraction as part of an image-guided radiotherapy registration protocol for patient alignment. Results: The 1- and 2-year estimates of in-field control were 72% and 65%, respectively. A total of 651 daily megavoltage CT scans were obtained. The mean systematic shift to account for interfraction motion was 1.38 ± 1.25 mm, 1.79 ± 1.45 mm, and 1.98 ± 1.75 mm for the medial-lateral, superior-inferior, and anterior-posterior directions, respectively. Pretreatment shifts of >3 mm occurred in 19% of setups in the medial-lateral, 27% in the superior-inferior, and 33% in the anterior-posterior directions, respectively. There were no treatment-related fatalities or hospitalizations. Complications included skin desquamation, odynophagia, otitis externa, keratitis, naso-lacrimal duct stenosis, and brachial plexopathy. Conclusions: Intensity-modulated radiotherapy with daily image guidance results in effective disease control with relatively low morbidity and should be considered for selected patients with recurrent and second primary cancers of the head and neck.

  8. SU-E-T-809: Volumetric Modulated Arc Radiotherapy Vs. Intensity-Modulated Radiotherapy for Locally Advanced Laryngeal Carcinoma: A Dosimetric Study

    Energy Technology Data Exchange (ETDEWEB)

    Lu, J-Y; Huang, B-T; Zhang, W-Z; Yan, L-J [Cancer Hospital of Shantou University Medical College, Shantou, Guangdong (China)

    2015-06-15

    Purpose: To compare volumetric modulated arc radiotherapy (VMAT) technique with fixed-gantry intensity-modulated radiotherapy (IMRT) technique for locally advanced laryngeal carcinoma. Methods: CT datasets of eleven patients were included. Dual-arc VMAT and 7-field IMRT plans, which were created based on the Eclipse treatment planning system, were compared in terms of dose-volume parameters, conformity index (CI) and homogeneity index (HI) of planning target volume (PTV), as well as organ-at-risk (OAR) sparing, planning time, monitor units (MUs) and delivery time. Results: Compared with the IMRT plans, the VMAT plans provided lower D2% and better CI/HI for the high-risk PTV (PTV1), and provided better CI and comparable HI for the low-risk PTV (PTV2). Concerning the OAR sparing, the VMAT plans demonstrated significantly lower Dmax of the spinal cord (planning OAR volume, PRV) and brainstem (PRV), as well as lower Dmean and V30Gy of the right parotid. No significant differences were observed between the two plans concerning the doses delivered to the thyroid, carotid, oral cavity and left parotid. Moreover, the VMAT planning (147 ± 18 min) consumed 213% more time than the IMRT planning (48 ± 10 min). The MUs of the VMAT plans (556 ± 52) were 64% less than those of the IMRT plans (1684 ± 409), and the average delivery time (2.1 ± 0.1 min) was 66% less than that of the IMRT plans (6.3 ± 0.7 min). Conclusion: Compared with the IMRT technique, the VMAT technique can achieve superior target dose distribution and better sparing of the spinal cord, brainstem and right parotid, with less MUs and less delivery time. It is recommended for the radiotherapy of locally advanced laryngeal carcinoma.

  9. Radiotherapy for Adult Medulloblastoma: Evaluation of Helical Tomotherapy, Volumetric Intensity Modulated Arc Therapy, and Three-Dimensional Conformal Radiotherapy and the Results of Helical Tomotherapy Therapy

    Directory of Open Access Journals (Sweden)

    Sun Zong-wen

    2018-01-01

    Full Text Available Introduction. All adult medulloblastoma (AMB patients should be treated with craniospinal irradiation (CSI postoperatively. Because of the long irradiation range, multiple radiation fields must be designed for conventional radiotherapy technology. CSI can be completed in only one session with helical tomotherapy (HT. We evaluated the dose of HT, volumetric intensity modulated arc therapy (VMAT, and three-dimensional conformal radiotherapy (3D-CRT of AMB and the results of 5 cases of AMB treated with HT. Methods. Complete craniospinal and posterior cranial fossa irradiation with HT, VMAT, and 3D-CRT and dose evaluation were performed. And results of 5 cases of AMB treated with HT were evaluated. Results. A large volume of tissue was exposed to low dose radiation in the organs at risk (OAR, while a small volume was exposed to high dose radiation with HT. The conformity and uniformity of the targets were good with HT and VMAT, and the volume of targets exposed to high dose with VMAT was larger than that of HT. The uniformity of 3D-CRT was also good, but the dose conformity was poor. The main toxicity was hematologic toxicity, without 4th-degree bone marrow suppression. There was 3rd-degree inhibition in the white blood cells, hemoglobin, and platelets. The three female patients suffered menstrual disorders during the course of radiation. Two female patients with heavy menstruation suffered 3rd-degree anemia inhibition, and 2 patients suffered amenorrhea after radiotherapy. Although menstrual cycle was normal, the third patient was not pregnant. Conclusion. CSI with HT is convenient for clinical practice, and the side effects are mild. With good conformity and uniformity, VMAT can also be used for selection in CSI. For poor conformity, 3D-CRT should not be the priority selection for CSI. In female patients, the ovaries should be protected.

  10. Development of three-dimensional radiotherapy techniques in breast cancer

    Science.gov (United States)

    Coles, Charlotte E.

    Radiotherapy following conservation surgery decreases local relapse and death from breast cancer. Currently, the challenge is to minimise the morbidity caused by this treatment without losing efficacy. Despite many advances in radiation techniques in other sites of the body, the majority of breast cancer patients are still planned and treated using 2-dimensional simple radiotherapy techniques. In addition, breast irradiation currently consumes 30% of the UK's radiotherapy workload. Therefore, any change to more complex treatment should be of proven benefit. The primary objective of this research is to develop and evaluate novel radiotherapy techniques to decrease irradiation of normal structures and improve localisation of the tumour bed. I have developed a forward-planned intensity modulated (IMRT) breast radiotherapy technique, which has shown improved dosimetry results compared to standard breast radiotherapy. Subsequently, I have developed and implemented a phase III randomised controlled breast IMRT trial. This National Cancer Research Network adopted trial will answer an important question regarding the clinical benefit of breast IMRT. It will provide DNA samples linked with high quality clinical outcome data, for a national translational radiogenomics study investigating variation in normal tissue toxicity. Thus, patients with significant late normal tissue side effects despite good dose homogeneity will provide the best model for finding differences due to underlying genetics. I evaluated a novel technique using high definition free-hand 3-dimensional (3D) ultrasound in a phantom study, and the results suggested that this is an accurate and reproducible method for tumour bed localisation. I then compared recognised methods of tumour bed localisation with the 3D ultrasound method in a clinical study. The 3D ultrasound technique appeared to accurately represent the shape and spatial position of the tumour cavity. This tumour bed localisation research

  11. Long-Term Outcomes of Early-Stage Nasopharyngeal Carcinoma Patients Treated With Intensity-Modulated Radiotherapy Alone

    International Nuclear Information System (INIS)

    Su Shengfa; Han Fei; Zhao Chong; Chen Chunyan; Xiao Weiwei; Li Jiaxin; Lu Taixiang

    2012-01-01

    Purpose: Reports of intensity-modulated radiotherapy (IMRT) for early-stage nasopharyngeal carcinoma (NPC) have been limited. The present study evaluated the long-term survival outcomes and toxicity of early-stage NPC patients treated with IMRT alone. Methods and Materials: Between February 2001 and January 2008, 198 early-stage (T1-T2bN0-N1M0) NPC patients had undergone IMRT alone. The data from these patients were retrospectively analyzed. The patients were treated to 68 Gy at 2.27 Gy/fraction prescribed to the planning target volume of the primary nasopharygeal gross tumor volume. The Radiation Therapy Oncology Group scoring system was used to assess the toxicity. Results: At a median follow-up of 50.9 months (range, 12–104), the 5-year estimated disease-specific survival, local recurrence-free survival, and distant metastasis-free survival rate was 97.3%, 97.7%, and 97.8%, respectively. The 5-year local recurrence-free survival rate was 100% for those with Stage T1 and T2a and 94.2% for those with Stage T2b lesions (p = 0.252). The 5-year distant metastasis-free survival rate for Stage T1N0, T2N0, T1N1, and T2N1 patients was 100%, 98.8%, 100%, and 93.8%, respectively (p = .073). All local recurrence occurred in patients with T2b lesions. Five patients developed distant metastasis. Of these 5 patients, 4 had had Stage T2bN1 disease and 1 had had Stage T2bN0 disease with retropharyngeal lymph node involvement. The most common acute toxicities were mainly Grade 1 or 2. At 24 months after IMRT, no Grade 3 or 4 xerostomia had developed, and 62 (96.9%) of 64 evaluated patients were free of trismus; only 2 patients (3.1%) had Grade 1 trismus. Radiation encephalopathy and cranial nerve injury were not observed. Conclusions: IMRT alone for Stage T1N0, T2N0, T1N1, and T2N1 yielded satisfactory survival outcomes with acceptable toxicity, and no differences were found in survival outcomes among these four subgroups. Patients with Stage T2b lesions might have relatively

  12. Image-guided intensity-modulated radiotherapy for patients with locally advanced gastric cancer: a clinical feasibility study.

    Science.gov (United States)

    Badakhshi, Harun; Gruen, Arne; Graf, Reinhold; Boehmer, Dirk; Budach, Volker

    2014-01-01

    The aim of this study was to determine the medical and technical feasibility of intensity-modulated radiotherapy (IMRT) in high-risk nonmetastatic gastric cancer stage II and III after primary gastrectomy and D2 lymphadenectomy. A prospective nonrandomized phase II trial was performed on 25 consecutive patients with gastric cancer with high risk (T3-4, N1-3, G2-3, R0-1). The dose delivered was 45 Gy (1.80 Gy per fraction) in IMRT technique. Concurrent 5-fluorouracil-based chemotherapy at 225 mg/m(2) was administered as a continuous intravenous infusion. Primary endpoints were acute gastrointestinal toxicity (CTC 4.0) and technical feasibility of IMRT in regard to dose planning and radiation delivery. Early acute events were defined as clinical and chemical adverse effects of IMRT and concurrent chemotherapy during treatment. By definition, 90 days after the end of IMRT has been evaluated as acute-phase toxicity. No patient had grade 4 or higher acute adverse events. Clinical grade 3 toxicity occurred in two patients (8%) with diarrhea and in one case (4%) with nausea. Hematological changes with grade 3 occurred in three cases (12%) with hemoglobin decrease, in five cases (25%) as leukopenia, and in one case (4%) with thrombocytopenia. The mean dose for liver was 16 Gy and the percentage volume exceeding 30 Gy (V30) was 21%. Mean dose for right and left kidney was 9 and 13 Gy, respectively, and V20 was 9% and 13%, respectively. Heart received a median dose of 15 Gy and V40 was 17%. The mean dose to the bowel was 11 Gy and V40 was 6%. Spinal cord had at maximum 33 Gy in median. Specifics of dose distribution, including the coverage, for the target region were as follows: minimum was 33 Gy, maximum 48.6 Gy, and mean dose 44.6 Gy. The prescribed dose (45 Gy) covered 99% and 95% of planning target volume (OTV) in 66% and 92% of cases, respectively. Median PTV was 15.77 ml (range, 805-3,604 ml). The data support the practical feasibility of IMRT in adjuvant treatment in

  13. Plasma Epstein-Barr viral DNA complements TNM classification of nasopharyngeal carcinoma in the era of intensity-modulated radiotherapy.

    Science.gov (United States)

    Zhang, Lu; Tang, Lin-Quan; Chen, Qiu-Yan; Liu, Huai; Guo, Shan-Shan; Liu, Li-Ting; Guo, Ling; Mo, Hao-Yuan; Zhao, Chong; Guo, Xiang; Cao, Ka-Jia; Qian, Chao-Nan; Zeng, Mu-Sheng; Shao, Jian-Yong; Sun, Ying; Ma, Jun; Hong, Ming-Huang; Mai, Hai-Qiang

    2016-02-02

    The objective of this study is to verify the prognostic value of pretreatment plasma Epstein-Barr viral deoxyribonucleic acid (pEBV DNA) levels in nasopharyngeal carcinoma (NPC) patients to complement TNM classification based on the application of the intensity-modulated radiotherapy (IMRT) technique. In total, 1467 patients staged at I-IVa-b (M0) and treated with IMRT were retrospectively analyzed at our cancer center from January 2007 to December 2010. Patient survival among different stages and EBV DNA levels were compared. Outcome analyses of different stages and EBV DNA levels revealed that patients in stages II-III with low EBV DNA levels had similar survival as that of patients in stages IVa-b with low EBV DNA (5-yr overall survival (OS), 94.7% vs. 92.9% (P = 0.141), progression failure-free survival (PFS), 87.2% vs. 89.0% (P = 0.685), distant metastasis failure-free survival (DMFS), 93.5% vs. 92.4% (P = 0.394) and locoregional failure-free survival (LRFS), 93.8% vs. 96.3% (P = 0.523)). Conversely, patients in stages II-III with high EBV DNA had better survival than patients in stages IVa-b with high EBV DNA (5-yr OS, 82.7% vs. 71.7% (P = 0.001), PFS, 70.7% vs. 66.2% (P = 0.047), DMFS, 79.6% vs. 74.8% (P = 0.066) and LRFS, 89.3% vs. 87.6% (P = 0.425)) but poorer survival than patients in stages IVa-b with low EBV DNA (5-yr OS, 82.7% vs. 92.9% (P = 0.025), PFS, 70.7% vs. 89.0, (P < 0.001), DMFS, 79.6% vs. 92.4%, (P = 0.001), LRFS, 89.3% vs. 96.3%, (P = 0.022)). pEBV DNA is a strong prognostic factor for patients with NPC when complemented with TNM staging in the era of IMRT application.

  14. Long-Term Outcomes of Early-Stage Nasopharyngeal Carcinoma Patients Treated With Intensity-Modulated Radiotherapy Alone

    Energy Technology Data Exchange (ETDEWEB)

    Su Shengfa [State Key Laboratory of Oncology in Southern China, Guangzhou (China); Department of Radiation Oncology, Cancer Center, Sun Yat-Sen University, Guangzhou (China); Department of Oncology, GuiYang Medical College Hospital, Guiyang, Guizhou (China); Han Fei; Zhao Chong; Chen Chunyan; Xiao Weiwei; Li Jiaxin [State Key Laboratory of Oncology in Southern China, Guangzhou (China); Department of Radiation Oncology, Cancer Center, Sun Yat-Sen University, Guangzhou (China); Lu Taixiang, E-mail: ssf2010@sina.cn [State Key Laboratory of Oncology in Southern China, Guangzhou (China); Department of Radiation Oncology, Cancer Center, Sun Yat-Sen University, Guangzhou (China)

    2012-01-01

    Purpose: Reports of intensity-modulated radiotherapy (IMRT) for early-stage nasopharyngeal carcinoma (NPC) have been limited. The present study evaluated the long-term survival outcomes and toxicity of early-stage NPC patients treated with IMRT alone. Methods and Materials: Between February 2001 and January 2008, 198 early-stage (T1-T2bN0-N1M0) NPC patients had undergone IMRT alone. The data from these patients were retrospectively analyzed. The patients were treated to 68 Gy at 2.27 Gy/fraction prescribed to the planning target volume of the primary nasopharygeal gross tumor volume. The Radiation Therapy Oncology Group scoring system was used to assess the toxicity. Results: At a median follow-up of 50.9 months (range, 12-104), the 5-year estimated disease-specific survival, local recurrence-free survival, and distant metastasis-free survival rate was 97.3%, 97.7%, and 97.8%, respectively. The 5-year local recurrence-free survival rate was 100% for those with Stage T1 and T2a and 94.2% for those with Stage T2b lesions (p = 0.252). The 5-year distant metastasis-free survival rate for Stage T1N0, T2N0, T1N1, and T2N1 patients was 100%, 98.8%, 100%, and 93.8%, respectively (p = .073). All local recurrence occurred in patients with T2b lesions. Five patients developed distant metastasis. Of these 5 patients, 4 had had Stage T2bN1 disease and 1 had had Stage T2bN0 disease with retropharyngeal lymph node involvement. The most common acute toxicities were mainly Grade 1 or 2. At 24 months after IMRT, no Grade 3 or 4 xerostomia had developed, and 62 (96.9%) of 64 evaluated patients were free of trismus; only 2 patients (3.1%) had Grade 1 trismus. Radiation encephalopathy and cranial nerve injury were not observed. Conclusions: IMRT alone for Stage T1N0, T2N0, T1N1, and T2N1 yielded satisfactory survival outcomes with acceptable toxicity, and no differences were found in survival outcomes among these four subgroups. Patients with Stage T2b lesions might have relatively

  15. A hybrid algorithm for instant optimization of beam weights in anatomy-based intensity modulated radiotherapy: a performance evaluation study

    International Nuclear Information System (INIS)

    Vaitheeswaran, Ranganathan; Sathiya Narayanan, V.K.; Bhangle, Janhavi R.; Nirhali, Amit; Kumar, Namita; Basu, Sumit; Maiya, Vikram

    2011-01-01

    The study aims to introduce a hybrid optimization algorithm for anatomy-based intensity modulated radiotherapy (AB-IMRT). Our proposal is that by integrating an exact optimization algorithm with a heuristic optimization algorithm, the advantages of both the algorithms can be combined, which will lead to an efficient global optimizer solving the problem at a very fast rate. Our hybrid approach combines Gaussian elimination algorithm (exact optimizer) with fast simulated annealing algorithm (a heuristic global optimizer) for the optimization of beam weights in AB-IMRT. The algorithm has been implemented using MATLAB software. The optimization efficiency of the hybrid algorithm is clarified by (i) analysis of the numerical characteristics of the algorithm and (ii) analysis of the clinical capabilities of the algorithm. The numerical and clinical characteristics of the hybrid algorithm are compared with Gaussian elimination method (GEM) and fast simulated annealing (FSA). The numerical characteristics include convergence, consistency, number of iterations and overall optimization speed, which were analyzed for the respective cases of 8 patients. The clinical capabilities of the hybrid algorithm are demonstrated in cases of (a) prostate and (b) brain. The analyses reveal that (i) the convergence speed of the hybrid algorithm is approximately three times higher than that of FSA algorithm (ii) the convergence (percentage reduction in the cost function) in hybrid algorithm is about 20% improved as compared to that in GEM algorithm (iii) the hybrid algorithm is capable of producing relatively better treatment plans in terms of Conformity Index (CI) (∼ 2% - 5% improvement) and Homogeneity Index (HI) (∼ 4% - 10% improvement) as compared to GEM and FSA algorithms (iv) the sparing of organs at risk in hybrid algorithm-based plans is better than that in GEM-based plans and comparable to that in FSA-based plans; and (v) the beam weights resulting from the hybrid algorithm are

  16. 3D-conformal-intensity modulated radiotherapy with compensators for head and neck cancer: clinical results of normal tissue sparing

    Directory of Open Access Journals (Sweden)

    Koscielny Sven

    2006-06-01

    Full Text Available Abstract Background To investigate the potential of parotic gland sparing of intensity modulated radiotherapy (3D-c-IMRT performed with metallic compensators for head and neck cancer in a clinical series by analysis of dose distributions and clinical measures. Materials and methods 39 patients with squamous cell cancer of the head and neck irradiated using 3D-c-IMRT were evaluable for dose distribution within PTVs and at one parotid gland and 38 patients for toxicity analysis. 10 patients were treated primarily, 29 postoperatively, 19 received concomittant cis-platin based chemotherapy, 20 3D-c-IMRT alone. Initially the dose distribution was calculated with Helax ® and photon fluence was modulated using metallic compensators made of tin-granulate (n = 22. Later the dose distribution was calculated with KonRad ® and fluence was modified by MCP 96 alloy compensators (n = 17. Gross tumor/tumor bed (PTV 1 was irradiated up to 60–70 Gy, [5 fractions/week, single fraction dose: 2.0–2.2 (simultaneously integrated boost], adjuvantly irradiated bilateral cervical lymph nodes (PTV 2 with 48–54 Gy [single dose: 1.5–1.8]. Toxicity was scored according the RTOG scale and patient-reported xerostomia questionnaire (XQ. Results Mean of the median doses at the parotid glands to be spared was 25.9 (16.3–46.8 Gy, for tin graulate 26 Gy, for MCP alloy 24.2 Gy. Tin-granulate compensators resulted in a median parotid dose above 26 Gy in 10/22, MCP 96 alloy in 0/17 patients. Following acute toxicities were seen (°0–2/3: xerostomia: 87%/13%, dysphagia: 84%/16%, mucositis: 89%/11%, dermatitis: 100%/0%. No grade 4 reaction was encountered. During therapy the XQ forms showed °0–2/3: 88%/12%. 6 months postRT chronic xerostomia °0–2/3 was observed in 85%/15% of patients, none with °4 xerostomia. Conclusion 3D-c-IMRT using metallic compensators along with inverse calculation algorithm achieves sufficient parotid gland sparing in virtually all advanced

  17. The clinical feasibility and effect of online cone beam computer tomography-guided intensity-modulated radiotherapy for nasopharyngeal cancer

    International Nuclear Information System (INIS)

    Wang Jin; Bai Sen; Chen Nianyong; Xu Feng; Jiang Xiaoqin; Li Yan; Xu Qingfeng; Shen Yali; Zhang Hong; Gong Youling; Zhong Renming; Jiang Qingfeng

    2009-01-01

    Background and purpose: Online adaptive correction in image-guided intensity-modulated radiotherapy appeared to be a promising approach for precision radiation treatment in head and neck tumors. This protocol was designed to evaluate the clinical feasibility and effect of online cone beam computed tomography (CBCT) guidance in IMRT of nasopharyngeal cancer (NPC). Methods and materials: The Elekta Synergy system, which integrates an X-ray volumetric imager (XVI), was used to deliver radiation treatment for 22 cases of NPC. The acquired CBCT was registered to the planning CT for online and offline analysis. The systematic and random setup errors, as well as planning target volume (PTV) margin, were calculated at different correction threshold levels. The impact of online setup correction on dosimetry was evaluated by simulation of pre-correction errors. Results: The correction-of-setup-errors frequencies for 1, 2 and 3 mm thresholds were 41.3-53.9%, 12.7-21.2% and 6.3-10.3%, respectively. Online correction was effective at the 2 mm threshold level for all three axes. The pre-correction systematic errors for the whole group ranged 1.1-1.3 mm, and the random errors were also 1.1-1.3 mm. After online correction, the systematic and random errors ranged 0.4-0.5 mm and 0.7-0.8 mm, respectively, in the three directions. The PTV margins for the pre-correction, pretreatment and post-treatment positions were 3.5-4.2 mm, 1.6-1.8 mm and 2.5-3.2 mm, respectively, in three directions. Analysis of hypothetical dosimetric change due to a translational isocenter shift of 3 mm showed that if no correction was applied, the mean maximum dose to both the brain stem and spinal cord would be increased by 10 Gy, the mean dose to the left and right parotids would be increased by 7.8 and 8.5 Gy, respectively, and the dose to target volumes would be decreased: 4 Gy for 95% GTV and 5.6 Gy for 95% CTV 60. Conclusions: CBCT-based online correction increased the accuracy of IMRT for NPC and

  18. The impact of rectal and bladder variability on target coverage during post-prostatectomy intensity modulated radiotherapy

    International Nuclear Information System (INIS)

    Bell, Linda J.; Cox, Jennifer; Eade, Thomas; Rinks, Marianne; Kneebone, Andrew

    2014-01-01

    Background and purpose: Accuracy when delivering post-prostatectomy intensity modulated radiotherapy (IMRT) is crucial. The aims of this study were to quantify prostate bed movement and determine what amount of bladder or rectum size variation creates the potential for geographic miss. Methods and materials: The Cone Beam CT (CBCT) images (n = 377) of forty patients who received post-prostatectomy IMRT with daily on-line alignment to bony anatomy were reviewed. Prostate bed movement was estimated using the location of surgical clips in the upper and lower sections of the PTV and correlated with rectal and bladder filling (defined as changes in the cross sectional diameter at defined levels). The number of potential geographic misses caused by bladder and rectum variation was calculated assuming a uniform CTV to PTV expansion of 1 cm except 0.5 cm posteriorly. Results: Variations in bladder filling of >2 cm larger, ±1 cm, or >2 cm smaller occurred in 3.4%, 56.2%, and 15.1% of images respectively with potential geographic misses in the upper prostate bed of 61.5%, 9.9% and 26.3% respectively. Variations in rectal filling in the upper prostate bed of >1.5 cm larger, 1.5 cm larger to 1 cm smaller, and >1 cm smaller occurred in 17.2%, 75.6%, and 7.2% of images respectively. These variations resulted in geographic misses in the upper prostate bed in 29.2%, 12.3%, and 63.0% of images respectively. Variations in bladder and rectal filling in the lower prostate bed region had minimal impact on geographic misses. Conclusions: Bladder and rectal size changes at treatment affect prostate bed coverage, especially in the upper aspect of the prostate bed. The greatest potential for geographic miss occurred when either the bladder increased in size or when the rectum became smaller. Ensuring a full bladder and empty rectum at simulation will minimise this risk. Our data also support anisotropic PTV margins with larger margins superiorly than inferiorly

  19. A method for geometrical verification of dynamic intensity modulated radiotherapy using a scanning electronic portal imaging device

    International Nuclear Information System (INIS)

    Ploeger, Lennert S.; Smitsmans, Monique H.P.; Gilhuijs, Kenneth G.A.; Herk, Marcel van

    2002-01-01

    In order to guarantee the safe delivery of dynamic intensity modulated radiotherapy (IMRT), verification of the leaf trajectories during the treatment is necessary. Our aim in this study is to develop a method for on-line verification of leaf trajectories using an electronic portal imaging device with scanning read-out, independent of the multileaf collimator. Examples of such scanning imagers are electronic portal imaging devices (EPIDs) based on liquid-filled ionization chambers and those based on amorphous silicon. Portal images were acquired continuously with a liquid-filled ionization chamber EPID during the delivery, together with the signal of treatment progress that is generated by the accelerator. For each portal image, the prescribed leaf and diaphragm positions were computed from the dynamic prescription and the progress information. Motion distortion effects of the leaves are corrected based on the treatment progress that is recorded for each image row. The aperture formed by the prescribed leaves and diaphragms is used as the reference field edge, while the actual field edge is found using a maximum-gradient edge detector. The errors in leaf and diaphragm position are found from the deviations between the reference field edge and the detected field edge. Earlier measurements of the dynamic EPID response show that the accuracy of the detected field edge is better than 1 mm. To ensure that the verification is independent of inaccuracies in the acquired progress signal, the signal was checked with diode measurements beforehand. The method was tested on three different dynamic prescriptions. Using the described method, we correctly reproduced the distorted field edges. Verifying a single portal image took 0.1 s on an 866 MHz personal computer. Two flaws in the control system of our experimental dynamic multileaf collimator were correctly revealed with our method. First, the errors in leaf position increase with leaf speed, indicating a delay of

  20. Outcomes of Patients With Head-and-Neck Cancer of Unknown Primary Origin Treated With Intensity-Modulated Radiotherapy

    International Nuclear Information System (INIS)

    Shoushtari, Asal; Saylor, Drew; Kerr, Kara-Lynne; Sheng, Ke; Thomas, Christopher; Jameson, Mark; Reibel, James; Shonka, David; Levine, Paul; Read, Paul

    2011-01-01

    Purpose: To analyze survival, failure patterns, and toxicity in patients with head-and-neck carcinoma of unknown primary origin (HNCUP) treated with intensity-modulated radiotherapy (IMRT). Methods and materials: Records from 27 patients with HNCUP treated during the period 2002-2008 with IMRT were reviewed retrospectively. Nodal staging ranged from N1 to N3. The mean preoperative dose to gross or suspected disease, Waldeyer's ring, and uninvolved bilateral cervical nodes was 59.4, 53.5, and 51.0 Gy, respectively. Sixteen patients underwent neck dissection after radiation and 4 patients before radiation. Eight patients with advanced nodal disease (N2b-c, N3) or extracapsular extension received chemotherapy. Results: With a median follow-up of 41.9 months (range, 25.3-93.9 months) for nondeceased patients, the 5-year actuarial overall survival, disease-free survival, and nodal control rates were 70.9%, 85.2%, and 88.5%, respectively. Actuarial disease-free survival rates for N1, N2, and N3 disease were 100%, 94.1%, and 50.0%, respectively, at 5 years. When stratified by nonadvanced (N1, N2a nodal disease without extracapsular spread) vs. advanced nodal disease (N2b, N2c, N3), the 5-year actuarial disease-free survival rate for the nonadvanced nodal disease group was 100%, whereas for the advanced nodal disease group it was significantly lower at 66.7% (p = 0.017). Three nodal recurrences were observed: in 1 patient with bulky N2b disease and 2 in patients with N3 disease. No nodal failures occurred in patients with N1 or N2a disease who received only radiation and surgery. Conclusion: Definitive IMRT to 50-56 Gy followed by neck dissection results in excellent nodal control and overall and disease-free survival, with acceptable toxicity for patients with T0N1 or nonbulky T0N2a disease without extracapsular spread. Patients with extracapsular spread, advanced N2 disease, or N3 disease may benefit from concurrent chemotherapy, targeted therapeutic agents, or

  1. Intensity modulated radiotherapy (IMRT) for patients of the Brazilian unified health system (SUS): an analysis of 508 treatments two years after the technique implementation

    Energy Technology Data Exchange (ETDEWEB)

    Oliveira, Harley Francisco de; Trevisan, Felipe Amstalden; Bighetti, Viviane Marques; Guimaraes, Flavio da Silva; Amaral, Leonardo Lira; Barbi, Gustavo Lazaro; Borges, Leandro Federiche; Peria, Fernanda Maris, E-mail: harley@fmrp.usp.br [Universidade de Sao Paulo (FMRP/USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina

    2014-11-15

    Objective: the offering of high-technology radiotherapy to the population assisted by the Brazilian unified health system (SUS) is limited since it is not included in the system’s list of procedures and, many times, because of the insufficient installed capacity and lack of specialized human resources. Thus the access to intensity-modulated radiotherapy (IMRT) is restricted to few centers in Brazil. The present study is aimed at presenting the characteristics of the first 508 cases treated with IMRT during the first years after the technique implementation in a university hospital. Materials and methods: the first consecutive 508 cases of IMRT treatment completed in the period from May/2011 to September/2013 were reviewed. Static multi leaf was the technique employed. Results: amongst 4,233 treated patients, 12.5% were submitted to IMRT. Main indications for the treatment included cancers located in the skull, head and neck and prostate. Intensity modulated radiotherapy was utilized in about 30% of cranial and 50% of prostate treatments. Treatment toxicity was observed in 4% of the patients. Conclusion: because of restricted access to radiotherapy in addition to lack of coverage for the procedure, IMRT indications for SUS patients should be based on institutional clinical protocols, with special attention to the reduction of toxicity. (author)

  2. Dosimetric Comparison of Combined Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy Versus IMRT Alone for Pelvic and Para-Aortic Radiotherapy in Gynecologic Malignancies

    Energy Technology Data Exchange (ETDEWEB)

    Berman Milby, Abigail [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States); Both, Stefan, E-mail: both@uphs.upenn.edu [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States); Ingram, Mark; Lin, Lilie L. [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States)

    2012-03-01

    Purpose: To perform a dosimetric comparison of intensity-modulated radiotherapy (IMRT), passive scattering proton therapy (PSPT), and intensity-modulated proton therapy (IMPT) to the para-aortic (PA) nodal region in women with locally advanced gynecologic malignancies. Methods and Materials: The CT treatment planning scans of 10 consecutive patients treated with IMRT to the pelvis and PA nodes were identified. The clinical target volume was defined by the primary tumor for patients with cervical cancer and by the vagina and paravaginal tissues for patients with endometrial cancer, in addition to the regional lymph nodes. The IMRT, PSPT, and IMPT plans were generated using the Eclipse Treatment Planning System and were analyzed for various dosimetric endpoints. Two groups of treatment plans including proton radiotherapy were created: IMRT to pelvic nodes with PSPT to PA nodes (PSPT/IMRT), and IMRT to pelvic nodes with IMPT to PA nodes (IMPT/IMRT). The IMRT and proton RT plans were optimized to deliver 50.4 Gy or Gy (relative biologic effectiveness [RBE)), respectively. Dose-volume histograms were analyzed for all of the organs at risk. The paired t test was used for all statistical comparison. Results: The small-bowel V{sub 20}, V{sub 30}, V{sub 35}, andV{sub 40} were reduced in PSPT/IMRT by 11%, 18%, 27%, and 43%, respectively (p < 0.01). Treatment with IMPT/IMRT demonstrated a 32% decrease in the small-bowel V{sub 20}. Treatment with PSPT/IMRT showed statistically significant reductions in the body V{sub 5-20}; IMPT/IMRT showed reductions in the body V{sub 5-15}. The dose received by half of both kidneys was reduced by PSPT/IMRT and by IMPT/IMRT. All plans maintained excellent coverage of the planning target volume. Conclusions: Compared with IMRT alone, PSPT/IMRT and IMPT/IMRT had a statistically significant decrease in dose to the small and large bowel and kidneys, while maintaining excellent planning target volume coverage. Further studies should be done to

  3. Dosimetric study of volumetric arc modulation with RapidArc and intensity-modulated radiotherapy in patients with cervical cancer and comparison with 3-dimensional conformal technique for definitive radiotherapy in patients with cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Guy, Jean-Baptiste [Department of Radiation Oncology, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest en Jarez (France); Falk, Alexander T. [Department of Radiation Oncology, Centre Antoine Lacassagne, Nice (France); Auberdiac, Pierre [Department of Radiation Oncology, Clinique Claude Bernard, Albi (France); Cartier, Lysian; Vallard, Alexis [Department of Radiation Oncology, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest en Jarez (France); Ollier, Edouard [Department of Pharmacology-Toxicology, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Priest en Jarez (France); Trone, Jane-Chloé; Khodri, Moustapha [Department of Radiation Oncology, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest en Jarez (France); Chargari, Cyrus [Department of Radiation Oncology, Hôpital d’instruction de Armées du Val-de-Grâce, Paris (France); Magné, Nicolas, E-mail: nicolas.magne@icloire.fr [Department of Radiation Oncology, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest en Jarez (France)

    2016-04-01

    Introduction: For patients with cervical cancer, intensity-modulated radiation therapy (IMRT) improves target coverage and allows dose escalation while reducing the radiation dose to organs at risk (OARs). In this study, we compared dosimetric parameters among 3-dimensional conformal radiotherapy (3D-CRT), “step-and-shoot” IMRT, and volumetric intensity-modulated arc radiotherapy (VMAT) in a series of patients with cervical cancer receiving definitive radiotherapy. Computed tomography (CT) scans of 10 patients with histologically proven cervical cancer treated with definitive radiation therapy (RT) from December 2008 to March 2010 at our department were selected for this study. The gross tumor volume (GTV) and clinical target volume (CTV) were delineated following the guidelines of the Gyn IMRT consortium that included cervix, uterus, parametrial tissues, and the pelvic nodes including presacral. The median age was 57 years (range: 30 to 85 years). All 10 patients had squamous cell carcinoma with Federation of Gynecology and Obstetrics (FIGO) stage IB-IIIB. All patients were treated by VMAT. OAR doses were significantly reduced for plans with intensity-modulated technique compared with 3D-CRT except for the dose to the vagina. Between the 2 intensity-modulated techniques, significant difference was observed for the mean dose to the small intestine, to the benefit of VMAT (p < 0.001). There was no improvement in terms of OARs sparing for VMAT although there was a tendency for a slightly decreased average dose to the rectum: − 0.65 Gy but not significant (p = 0.07). The intensity modulation techniques have many advantages in terms of quality indexes, and particularly OAR sparing, compared with 3D-CRT. Following the ongoing technologic developments in modern radiotherapy, it is essential to evaluate the intensity-modulated techniques on prospective studies of a larger scale.

  4. Intensity-modulated radiotherapy and involved-node concept in patients with Hodgkin lymphoma: Experience of the Gustave-Roussy Institute

    International Nuclear Information System (INIS)

    Paumier, A.; Khodari, W.; Ghalibafian, M.; Blanchard, P.; Al Hamokles, H.; Bhari, M.; Lessard, N.; Girinsky, T.; Beaudre, A.

    2011-01-01

    Purpose. - To assess the clinical outcome of the involved-node radiotherapy concept with the use of intensity modulated radiotherapy (IMRT) in patients with localized supra-diaphragmatic Hodgkin lymphoma. Patients and methods. - Patients with early-stage supra-diaphragmatic Hodgkin lymphoma were treated with chemotherapy prior to irradiation. Radiation treatments were delivered using the involved-node radiotherapy (INRT) concept according to the EORTC guidelines. Intensity modulated radiotherapy was performed free-breathing. Results. - Forty-seven patients with Hodgkin lymphoma (44 patients with primary Hodgkin lymphoma and three patients with recurrent disease) entered the study from January 2003 to December 2010. The median age was 31 years (range 17 to 62). Thirty patients had stage I-IIA, 14 had stage I-IIB disease and three had relapse. Forty-two patients received three to six cycles of adriamycin, bleomycin, vinblastine and dacarbazine (ABVD). The median radiation dose to patients was 36 Gy (range: 20-40). Protection of various organs at risk was satisfactory. The median follow-up was 57.4 months (range: 5.4-94.3). For patients with primary Hodgkin lymphoma, the 5-year survival and 5-year progression-free survival rates were 96% (95% confidence interval: 80-99) and 92% (95% confidence interval: 78-97), respectively. None of the three patients with recurrent disease has relapsed. Recurrences occurred in three patients: one was in-field relapse and two were visceral recurrences. Grade 3 acute lung toxicity (transient pneumonitis) occurred in one case. Conclusion. - Our results suggest that patients with localized Hodgkin lymphoma can be safely and efficiently treated using the involved node irradiation concept and intensity modulated irradiation. (authors)

  5. Evaluation of two tomotherapy-based techniques for the delivery of whole-breast intensity-modulated radiation therapy

    International Nuclear Information System (INIS)

    Gonzalez, Victor J.; Buchholz, Daniel J.; Langen, Katja M.; Olivera, Gustavo H.; Chauhan, Bhavin; Meeks, Sanford L.; Ruchala, Kenneth J.; Haimerl, Jason; Lu Weiguo; Kupelian, Patrick A.

    2006-01-01

    Purpose: To evaluate two different techniques for whole-breast treatments delivered using the Hi-ART II tomotherapy device. Methods and Materials: Tomotherapy uses the standard rotational helical delivery. Topotherapy uses a stationary gantry while delivering intensity-modulated treatments. CT scans from 5 breast cancer patients were used. The prescription dose was 50.4 Gy. Results: On average, 99% of the target volume received 95% of prescribed dose with either technique. If treatment times are restricted to less than 9 min, the average percentage ipsilateral lung receiving ≥20 Gy was 22% for tomotherapy vs. 10% for topotherapy. The ipsilateral lung receiving ≥50.4 Gy was 4 cc for tomotherapy vs. 27 cc for topotherapy. The percentage of left ventricle receiving ≥30 Gy was 14% with tomotherapy vs. 4% for topotherapy. The average doses to the contralateral breast and lung were 0.6 and 0.8 Gy, respectively, for tomotherapy vs. 0.4 and 0.3 Gy for topotherapy. Conclusions: Tomotherapy provides improved target dose homogeneity and conformality over topotherapy. If delivery times are restricted, topotherapy reduces the amount of heart and ipsilateral lung volumes receiving low doses. For whole-breast treatments, topotherapy is an efficient technique that achieves adequate target uniformity while maintaining low doses to sensitive structures

  6. Intensity-modulated radiotherapy for laryngeal and hypopharyngeal cancer. Minimization of late dysphagia without jeopardizing tumor control

    Energy Technology Data Exchange (ETDEWEB)

    Modesto, Anouchka; Laprie, Anne; Graff, Pierre; Rives, Michel [Institut Universitaire du Cancer, Department of Radiation Oncology, Institut Claudius Regaud, Toulouse (France); Vieillevigne, Laure [Institut Universitaire du Cancer, Department of Medical Physics, Toulouse (France); Sarini, Jerome; Vergez, Sebastien; Farenc, Jean-Claude [Institut Universitaire du Cancer, Department of Head and Neck Surgery, Toulouse (France); Delord, Jean-Pierre [Institut Universitaire du Cancer, Department of Medical Oncology, Toulouse (France); Vigarios, Emmanuelle [Centre Hospitalo Universitaire de Rangueil, Dental Surgery Department, Toulouse (France); Filleron, Thomas [Institut Universitaire du Cancer, Department of Biostatistics, Toulouse (France)

    2014-11-01

    The purpose of this work was to retrospectively determine the value of intensity-modulated radiotherapy (IMRT) in patients with laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC), on outcome and treatment-related toxicity compared to 3-dimensional conformal radiotherapy (3D-CRT). A total of 175 consecutive patients were treated between 2007 and 2012 at our institution with curative intent RT and were included in this study: 90 were treated with 3D-CRT and 85 with IMRT. Oncologic outcomes were estimated using Kaplan-Meier statistics; acute and late toxicities were scored according to the Common Toxicity Criteria for Adverse Events scale v 3.0. Median follow-up was 35 months (range 32-42 months; 95% confidence interval 95 %). Two-year disease-free survival did not vary, regardless of the technique used (69 % for 3D-CRT vs. 72 %; for IMRT, p = 0.16). Variables evaluated as severe late toxicities were all statistically lower with IMRT compared with 3D-CRT: xerostomia (0 vs. 12 %; p < 0.0001), dysphagia (4 vs. 26 %; p < 0.0001), and feeding-tube dependency (1 vs 13 %; p = 0.0044). The rates of overall grade ≥ 3 late toxicities for the IMRT and 3D-CRT groups were 4.1 vs. 41.4 %, respectively (p < 0.0001). IMRT for laryngeal and hypopharyngeal cancer minimizes late dysphagia without jeopardizing tumor control and outcome. (orig.) [German] Das Ziel dieser Studie war es, retrospektiv den Nutzen der intensitaetsmodulierten Strahlentherapie (IMRT) in der Behandlung von Patienten mit Plattenepithelkarzinom von Kehlkopf und Hypopharynx (LHSCC) zu bewerten und mit dem Outcome und den Spaetfolgen der 3-D-konformalen Strahlentherapie (3D-CRT) zu vergleichen. Insgesamt wurden zwischen Januar 2007 und Dezember 2012175 LHSCC-Patienten mit einer RT behandelt und in die Studie aufgenommen: 85 Patienten wurden mit 3D-CRT und 90 Patienten mit IMRT behandelt.Das onkologische Outcome wurde mittels Kaplan-Meier-Statistik ermittelt und Akut- und Spaettoxizitaeten anhand der CTCAE

  7. Quality of Life and Survival Outcome for Patients With Nasopharyngeal Carcinoma Receiving Three-Dimensional Conformal Radiotherapy vs. Intensity-Modulated Radiotherapy-A Longitudinal Study

    International Nuclear Information System (INIS)

    Fang, F.-M.; Chien, C.-Y.; Tsai, W.-L.; Chen, H.-C.; Hsu, H.-C.; Lui, C.-C.; Huang, T.-L.

    2008-01-01

    Purpose: To investigate the changes of quality of life (QoL) and survival outcomes for patients with nasopharyngeal carcinoma (NPC) treated by three-dimensional conformal radiotherapy (3D-CRT) vs. intensity-modulated radiotherapy (IMRT). Methods and Materials: Two hundred and three newly diagnosed NPC patients, who were curatively treated by 3D-CRT (n = 93) or IMRT (n = 110) between March 2002 and July 2004, were analyzed. The distributions of clinical stage according to American Joint Committee on Cancer 1997 were I: 15 (7.4%), II: 78 (38.4%), III: 74 (36.5%), and IV: 36 (17.7%). QoL was longitudinally assessed by the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the EORTC QLQ-H and N35 questionnaires at the five time points: before RT, during RT (36 Gy), and 3 months, 12 months, and 24 months after RT. Results: The 3-year locoregional control, metastasis-free survival, and overall survival rates were 84.8%, 76.7%, and 81.7% for the 3D-CRT group, respectively, compared with 84.2%, 82.6%, and 85.4% for the IMRT group (p value > 0.05). A general trend of maximal deterioration in most QoL scales was observed during RT, followed by a gradual recovery thereafter. There was no significant difference in most scales between the two groups at each time point. The exception was that patients treated by IMRT had a both statistically and clinically significant improvement in global QoL, fatigue, taste/smell, dry mouth, and feeling ill at the time point of 3 months after RT. Conclusions: The potential advantage of IMRT over 3D-CRT in treating NPC patients might occur in QoL outcome during the recovery phase of acute toxicity

  8. SU-E-T-302: Dosimetric Comparison Between Volumetric Modulated Arc Radiotherapy and Intensity-Modulated Radiotherapy for Locally Recurrent Nasopharyngeal Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Lu, J-Y; Huang, B-T; Zhang, J-Y; Ma, C-C [Cancer Hospital of Shantou University Medical College, Shantou, Guangdong (China)

    2015-06-15

    Purpose: To compare volumetric modulated arc radiotherapy (VMAT) technique with fixed-gantry intensity-modulated radiotherapy (IMRT) technique for locally recurrent nasopharyngeal carcinoma. Methods: CT datasets of eleven nasopharyngeal-carcinoma patients were included. Dual-arc VMAT and seven-field IMRT plans were created for each case, and were then compared in terms of conformity index (CI), homogeneity index (HI) of the planning target volume (PTV), organ-at-risk (OAR) sparing, monitor unit (MU) and delivery time. Results: The D98% (near-minimal dose) of PTV in the VMAT plans was slightly lower than that of the IMRT plans (P < 0.05), while the CI was higher than that of the IMRT plans (P < 0.05). No significant difference was found in the HI between the two plans (P > 0.05). Compared with the IMRT plans, the VMAT plans demonstrated lower Dmean (mean dose) of the bilateral temporal lobes and the whole surrounding normal tissue (P < 0.05), but slightly higher Dmean of brainstem (P < 0.05). In terms of the other OARs, no significant differences were found (P > 0.05). The MUs of the VMAT plans (672 ± 112) was significantly lower than that of the IMRT plans (917 ± 206), by 25 ± 13% (P < 0.05). The average delivery time of the VMAT plans (2.3 ± 0.1 min) was less than that of the IMRT plans (5.1 ± 0.4 min), by 54 ± 3%. Conclusion: For locally recurrent nasopharyngeal carcinoma, the VMAT technique could achieve equivalent or superior dose distribution of the target and better protect the bilateral temporal lobes, compared with the IMRT technique. Moreover, it could reduce the MU and delivery time effectively.

  9. Functional Image-Guided Radiotherapy Planning in Respiratory-Gated Intensity-Modulated Radiotherapy for Lung Cancer Patients With Chronic Obstructive Pulmonary Disease

    Energy Technology Data Exchange (ETDEWEB)

    Kimura, Tomoki, E-mail: tkkimura@hiroshima-u.ac.jp [Department of Radiation Oncology, Hiroshima University, Graduate School of Biomedical Sciences, Hiroshima City (Japan); Nishibuchi, Ikuno; Murakami, Yuji; Kenjo, Masahiro; Kaneyasu, Yuko; Nagata, Yasushi [Department of Radiation Oncology, Hiroshima University, Graduate School of Biomedical Sciences, Hiroshima City (Japan)

    2012-03-15

    Purpose: To investigate the incorporation of functional lung image-derived low attenuation area (LAA) based on four-dimensional computed tomography (4D-CT) into respiratory-gated intensity-modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT) in treatment planning for lung cancer patients with chronic obstructive pulmonary disease (COPD). Methods and Materials: Eight lung cancer patients with COPD were the subjects of this study. LAA was generated from 4D-CT data sets according to CT values of less than than -860 Hounsfield units (HU) as a threshold. The functional lung image was defined as the area where LAA was excluded from the image of the total lung. Two respiratory-gated radiotherapy plans (70 Gy/35 fractions) were designed and compared in each patient as follows: Plan A was an anatomical IMRT or VMAT plan based on the total lung; Plan F was a functional IMRT or VMAT plan based on the functional lung. Dosimetric parameters (percentage of total lung volume irradiated with {>=}20 Gy [V20], and mean dose of total lung [MLD]) of the two plans were compared. Results: V20 was lower in Plan F than in Plan A (mean 1.5%, p = 0.025 in IMRT, mean 1.6%, p = 0.044 in VMAT) achieved by a reduction in MLD (mean 0.23 Gy, p = 0.083 in IMRT, mean 0.5 Gy, p = 0.042 in VMAT). No differences were noted in target volume coverage and organ-at-risk doses. Conclusions: Functional IGRT planning based on LAA in respiratory-guided IMRT or VMAT appears to be effective in preserving a functional lung in lung cancer patients with COPD.

  10. SU-E-T-808: Volumetric Modulated Arc Radiotherapy Vs. Intensity-Modulated Radiotherapy for Early-Stage Nasopharyngeal Carcinoma: A Dosimetric Study

    Energy Technology Data Exchange (ETDEWEB)

    Lu, J-Y; Huang, B-T; Zhang, W-Z [Cancer Hospital of Shantou University Medical College, Shantou, Guangdong (China)

    2015-06-15

    Purpose: To compare volumetric modulated arc radiotherapy (VMAT) technique with fixed-gantry intensity-modulated radiotherapy (IMRT) technique for early-stage nasopharyngeal carcinoma. Methods: CT datasets of ten patients with early-stage nasopharyngeal carcinoma were included. Dual-arc VMAT and nine-field IMRT plans were generated for each case, and were then compared in terms of planning-target-volume (PTV) coverage, conformity index (CI) and homogeneity index (HI), as well as organ-at-risk (OAR) sparing, planning time, monitor units (MUs) and delivery time. Results: Compared with the IMRT plans, the VMAT plans provided comparable HI and CI of PTVnx (PTV of primary tumor of nasopharynx), superior CI and inferior HI of PTVnd (PTV of lymph nodes), as well as superior CI and comparable HI of PTV60 (high-risk PTV). The VMAT plans provided better sparing of the spinal cord, oral cavity and normal tissue, but inferior sparing of the brainstem planning OAR volume (PRV), larynx and parotids, as well as comparable sparing of the spinal cord PRV, brainstem, lenses, optic nerves, optic chiasm. Moreover, the average planning time (181.6 ± 36.0 min) for the VMAT plans was 171% more than that of the IMRT plans (68.1 ± 7.6 min). The MUs of the VMAT plans (609 ± 43) were 70% lower than those of the IMRT plans (2071 ± 262), while the average delivery time (2.2 ± 0.1 min) was 66% less than that of the IMRT plans (6.6 ± 0.4 min). Conclusion: Compared with the IMRT technique, the VMAT technique can achieve similar or slightly superior target dose distribution, with no significant advantages on OAR sparing, and it can achieve significant reductions of MUs and delivery time.

  11. Temporal lobe injury after re-irradiation of locally recurrent nasopharyngeal carcinoma using intensity modulated radiotherapy: clinical characteristics and prognostic factors.

    Science.gov (United States)

    Liu, Shuai; Lu, Taixiang; Zhao, Chong; Shen, Jingxian; Tian, Yunming; Guan, Ying; Zeng, Lei; Xiao, Weiwei; Huang, Shaomin; Han, Fei

    2014-09-01

    Temporal lobe injury (TLI) is a debilitating complication after radiotherapy for nasopharyngeal carcinoma (NPC), especially in patients who suffer treatment relapses and receive re-irradiation. We explored the clinical characteristics and prognostic factors of TLI in locally recurrent NPC (rNPC) patients after re-irradiation using intensity modulated radiotherapy (IMRT). A total of 454 temporal lobes (TLs) from 227 locally rNPC patients were reviewed. The clinical characteristics of TLI were analyzed. In the two radiotherapy courses, the equivalent dose in 2 Gy per fraction (EQD2) for the TLs was recalculated to facilitate comparison of the individual data. The median follow-up time was 31 (range, 3-127) months. After re-irradiation using IMRT, 31.3 % (71/227) of patients developed TLI. The median latency of TLI was 15 (range, 4-100) months. Univariate and multivariate analysis showed that the interval time (IT) between the two courses of radiotherapy and the summation of the maximum doses of the two radiotherapy courses (EQD2 - ∑max) were independent factors influencing TLI. The 5-year incidence of TLI for an IT ≤26 or >26 months was 35.9 and 53.7 % respectively (p = 0.024). The median maximum doses delivered to the injured TLs were significantly higher than was the case for the uninjured TLs after two courses of radiotherapy (135.3 and 129.8 Gy, respectively: p 2-year interval was found to be relatively safe.

  12. Implementation and utility of a daily ultrasound-based localization system with intensity-modulated radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Morr, Jody; DiPetrillo, Thomas; Tsai, J.-S.; Engler, Mark; Wazer, David E. MD.

    2002-01-01

    Purpose: To evaluate the clinical feasibility of daily computer-assisted transabdominal ultrasonography for target position verification in the setting of intensity-modulated radiotherapy (IMRT) for prostate cancer. Methods and Materials: Twenty-three patients with clinically localized prostate cancer were treated using a sequential tomotherapy IMRT technique (Peacock) and daily computer-assisted transabdominal ultrasonography (BAT) for target localization. Patients were instructed to maintain a full bladder and were placed in the supine position using triangulation tattoos and a leg immobilizer to minimize pelvic rotation. The BAT ultrasound system is docked to the treatment collimator and electronically imports the CT simulation target contours and isocenter. The system is able to use the machine isocenter as a reference point to overlay the corresponding CT contours onto the ultrasound images captured in the transverse and sagittal planes. A touch screen menu is used to maneuver the CT contours in three dimensions such that they match the ultrasound images. The system then displays the three-dimensional couch shifts required to produce field alignment. Data were prospectively collected to measure the frequency by which useful ultrasound images were obtained, the amount of time required for localization/setup, and the direction/magnitude of the positional adjustments. Results: Of the 23 patients, the BAT ultrasound system produced images of sufficient quality to perform the overlay of the CT contours in 19 patients such that positional verification could be reliably performed. Poor image quality was associated with patient inability to maintain a full bladder, large body habitus, or other anatomic constraints. Of the 19 assessable patients, a total of 185 treatment alignments were performed (mean 8.8/patient). For all cases, the average time required for the daily ultrasound imaging and positional adjustments was 11.9 min. After the initial 5 cases, the user

  13. Clinical efficacy of percutaneous vertebroplasty combined with intensity-modulated radiotherapy for spinal metastases in patients with NSCLC

    Directory of Open Access Journals (Sweden)

    Li Y

    2015-08-01

    Full Text Available Yi Li,1,2 Yi Qing,1 Zhimin Zhang,3 Mengxia Li,1 Jiaying Xie,1 Ge Wang,1 Dong Wang1 1Department of Cancer Center, Research Institute of Surgery, Daping Hospital, Third Military Medical University, 2Department of Oncology, Beibei Traditional Chinese Medical Hospital, Chongqing, 3Department of Oncology, Wuhan General Hospital of Guangzhou Command, People’s Liberation Army, Wuhan, Hubei, People’s Republic of China Objective: This study aimed to evaluate the safety and efficacy of percutaneous vertebroplasty (PVP combined with intensity-modulated radiotherapy (IMRT for metastatic lesions of patients with non-small-cell lung cancer (NSCLC at centrum vertebrae.Methods: A total of 39 patients with spinal metastatic NSCLC (stage IV were treated with PVP followed by IMRT (30 Gy/10F/2 W for metastatic lesion at centrum vertebrae under local anesthesia. Retrospective analysis was done with medical records and radiological data. The change of visual analog scale (VAS, activities of daily living, and kyphotic angle was measured preoperatively. The presence of complications was assessed preoperatively (baseline at 24 hours, 1 week, and 1, 3, 6, 12, and 24 months postoperatively, or until the patient died or was lost to follow-up. Survival was assessed in the group.Results: A total of 39 consecutive patients were successfully treated with PVP via a translateral approach and IMRT. Their mean VAS score decreased from 7.93±1.09 preoperatively to 4.14±1.15 by the 24-hour postoperative time point and was 3.92±1.23 at 1 week, 4.27±1.93 at 1 month, 3.24±1.35 at 3 months, 2.27±0.96 at 6 months, and 2.59±1.55 at 12 months after the procedure. The mean VAS score at all of the postoperative time points was decreased significantly from the preoperative baseline score (P<0.05. Activities of daily living evaluation showed that the patients had a significantly high life quality after the combined approach (50.9±11.7 vs 82.3±9.9, P<0.05. No severe complications

  14. Assessment of renal function after conformal radiotherapy and intensity-modulated radiotherapy by functional 1H-MRI and 23Na-MRI

    International Nuclear Information System (INIS)

    Haneder, S.; Michaely, H.J.; Schoenberg, S.O.; Konstandin, S.; Schad, L.R.; Siebenlist, K.; Wertz, H.; Wenz, F.; Lohr, F.; Boda-Heggemann, J.

    2012-01-01

    Purpose: Adjuvant radiochemotherapy (RCHT) improves survival of patients with locally advanced gastric cancer. Conventional three-dimensional conformal radiotherapy (3D-CRT) results in ablative doses to a significant amount of the left kidney, while image-guided intensity-modulated radiotherapy (IG-IMRT) provides excellent target coverage with improved kidney sparing. Few long-term results on IMRT for gastric cancer, however, have been published. Functional magnetic resonance imaging (fMRI) at 3.0 T including blood oxygenation-level dependent (BOLD) imaging, diffusion-weighted imaging (DWI) and, for the first time, 23 Na imaging was used to evaluate renal status after radiotherapy with 3D-CRT or IG-IMRT. Patients and methods Four disease-free patients (2 after 3D-CRT and 2 after IMRT; FU for all patients > 5 years) were included in this feasibility study. Morphological sequences, axial DWI images, 2D-gradient echo (GRE)-BOLD images, and 23 Na images were acquired. Mean values/standard deviations for ( 23 Na), the apparent diffusion coefficient (ADC), and R2 * values were calculated for the upper/middle/lower parts of both kidneys. Corticomedullary 23 Na-concentration gradients were determined. Results: Surprisingly, IG-IMRT patients showed no morphological alterations and no statistically significant differences of ADC and R2 * values in all renal parts. Values for mean corticomedullary 23 Na-concentration matched those for healthy volunteers. Results were similar in 3D-CRT patients, except for the cranial part of the left kidney. This was atrophic and presented significantly reduced functional parameters (p = 0.001 - p = 0.033). Reduced ADC values indicated reduced cell density and reduced extracellular space. Cortical and medullary R2 * values of the left cranial kidney in the 3D-CRT group were higher, indicating more deoxygenated hemoglobin due to reduced blood flow/oxygenation. ( 23 Na) of the renal cranial parts in the 3D-CRT group was significantly reduced

  15. External validation of three dimensional conformal radiotherapy based NTCP models for patient-rated xerostomia and sticky saliva among patients treated with intensity modulated radiotherapy

    International Nuclear Information System (INIS)

    Beetz, Ivo; Schilstra, Cornelis; Luijk, Peter van; Christianen, Miranda E.M.C.; Doornaert, Patricia; Bijl, Henk P.; Chouvalova, Olga; Heuvel, Edwin R. van den; Steenbakkers, Roel J.H.M.; Langendijk, Johannes A.

    2012-01-01

    Purpose: The purpose of this study was to investigate the ability of predictive models for patient-rated xerostomia (XER 6M ) and sticky saliva (STIC 6M ) at 6 months after completion of primary (chemo)radiation developed in head and neck cancer patients treated with 3D-conformal radiotherapy (3D-CRT) to predict outcome in patients treated with intensity modulated radiotherapy (IMRT). Methods and materials: Recently, we published the results of a prospective study on predictive models for patient-rated xerostomia and sticky saliva in head and neck cancer patients treated with 3D-CRT (3D-CRT based NTCP models). The 3D-CRT based model for XER 6M consisted of three factors, including the mean parotid dose, age, and baseline xerostomia (none versus a bit). The 3D-CRT based model for STIC 6M consisted of the mean submandibular dose, age, the mean sublingual dose, and baseline sticky saliva (none versus a bit). In the current study, a population consisting of 162 patients treated with IMRT was used to test the external validity of these 3D-CRT based models. External validity was described by the explained variation (R 2 Nagelkerke) and the Brier score. The discriminative abilities of the models were calculated using the area under the receiver operating curve (AUC) and calibration (i.e. the agreement between predicted and observed outcome) was assessed with the Hosmer–Lemeshow “goodness-of-fit” test. Results: Overall model performance of the 3D-CRT based predictive models for XER 6M and STIC 6M was significantly worse in terms of the Brier score and R 2 Nagelkerke among patients treated with IMRT. Moreover the AUC for both 3D-CRT based models in the IMRT treated patients were markedly lower. The Hosmer–Lemeshow test showed a significant disagreement for both models between predicted risk and observed outcome. Conclusion: 3D-CRT based models for patient-rated xerostomia and sticky saliva among head and neck cancer patients treated with primary radiotherapy or

  16. Comparison of intensity-modulated radiotherapy, adaptive radiotherapy, proton radiotherapy, and adaptive proton radiotherapy for treatment of locally advanced head and neck cancer

    International Nuclear Information System (INIS)

    Simone, Charles B.; Ly, David; Dan, Tu D.; Ondos, John; Ning, Holly; Belard, Arnaud; O’Connell, John; Miller, Robert W.; Simone, Nicole L.

    2011-01-01

    Background and purpose: Various radiotherapy planning methods for locally advanced squamous cell carcinoma of the head and neck (SCCHN) have been proposed to decrease normal tissue toxicity. We compare IMRT, adaptive IMRT, proton therapy (IMPT), and adaptive IMPT for SCCHN. Materials and methods: Initial and re-simulation CT images from 10 consecutive patients with SCCHN were used to quantify dosimetric differences between photon and proton therapy. Contouring was performed on both CTs, and plans (n = 40 plans) and dose–volume histograms were generated. Results: The mean GTV volume decreased 53.4% with re-simulation. All plans provided comparable PTV coverage. Compared with IMRT, adaptive IMRT significantly reduced the maximum dose to the mandible (p = 0.020) and mean doses to the contralateral parotid gland (p = 0.049) and larynx (p = 0.049). Compared with IMRT and adaptive IMRT, IMPT significantly lowered the maximum doses to the spinal cord (p < 0.002 for both) and brainstem (p < 0.002 for both) and mean doses to the larynx (p < 0.002 for both) and ipsilateral (p = 0.004 IMRT, p = 0.050 adaptive) and contralateral (p < 0.002 IMRT, p = 0.010 adaptive) parotid glands. Adaptive IMPT significantly reduced doses to all critical structures compared with IMRT and adaptive IMRT and several critical structures compared with non-adaptive IMPT. Conclusions: Although adaptive IMRT reduced dose to several normal structures compared with standard IMRT, non-adaptive proton therapy had a more favorable dosimetric profile than IMRT or adaptive IMRT and may obviate the need for adaptive planning. Protons allowed significant sparing of the spinal cord, parotid glands, larynx, and brainstem and should be considered for SCCHN to decrease normal tissue toxicity while still providing optimal tumor coverage.

  17. The study of treatment value of concurrent chemotherapy for patients with esophageal carcinoma received three-dimensional conformal radiotherapy or intensity modulated radiotherapy

    International Nuclear Information System (INIS)

    Wang Lan; Wang Jun; Han Chun; Zhang Jing; Li Xiaoning; Gao Chao

    2011-01-01

    Objective: To observe the acute side effects, local control rate and survival rate of concurrent chemoradiotherapy (CC) and radiotherapy alone (R) for patients with esophageal carcinoma. Methods: From June 2006 to February 2009, 209 patients with esophageal carcinoma were observed, 105 of them were treated with CC. Of all the patients, 117 received three-dimensional conformal radiotherapy, 92 received intensity modulated radiotherapy, the median prescription dose was 60 Gy. The regimen of LFP (5-FU, cisplatin and calcium folinate) was selected for this study, side effects, local control rate and survival rate were observed and subsets analysis were performed. Results: The overall follow-up rate was 99.0%,there were 99 and 44 patients whose follow-up time was more than 2 and 3 years, respectively;for the CC group, the data were 45 and 14, respectively; and for the R group, 54 and 30, respectively. The 1-, 2-, 3-year local control rates of CC group and R group were 88.1%, 69.2%, 66.2% and 81.0%, 64.0%, 54.9% (χ 2 =2.31, P=0.128), respectively. The 1-, 2-, 3-year overall survival rates of CC group and R group were 84.4%, 52.9%, 45.6% and 75.2%, 50.7%, 37.0%(χ 2 =1.57, P=0.210), respectively. Subset analysis indicated that for the patients of N 0 group and whose length of GTV >7 cm, the local control rate of CC was significantly higher than that of radiotherapy alone (χ 2 =5.11, 7.66; P=0.024, 0.006). For N 0 group, the survival rate of CC was higher than that of R alone. (χ 2 =5.07, P=0.024). The incidence of WBC, PLT and HGB reduction for the two groups were 81.9% and 49.0% (χ 2 =36.45, P=0.000), 14.3% and 1.9% (χ 2 =10.54, P=0.006), and 24.8% and 2.9% (χ 2 =22.95, P=0.000), respectively. The incidence of nausea, vomiting and constipation for the two groups were 63.8% and 7.7% (χ 2 =71.52, P=0.000), respectively. The incidence of ≥2 grade esophagitis of CC group and R group were 48.57% and 38.46% (χ 2 =2.17, P=0.141), respectively. The incidence of ≥2

  18. Whole Abdominopelvic Radiotherapy Using Intensity-Modulated Arc Therapy in the Palliative Treatment of Chemotherapy-Resistant Ovarian Cancer With Bulky Peritoneal Disease: A Single-Institution Experience

    International Nuclear Information System (INIS)

    De Meerleer, Gert; Vandecasteele, Katrien; Ost, Piet; Delrue, Louke; Denys, Hannelore; Makar, Amin; Speleers, Bruno; Van Belle, Simon; Van den Broecke, Rudy; Fonteyne, Valerie; De Neve, Wilfried

    2011-01-01

    Purpose: To retrospectively review our experience with whole abdominopelvic radiotherapy (WAPRT) using intensity-modulated arc therapy in the palliative treatment of chemotherapy-resistant ovarian cancer with bulky peritoneal disease. Methods and Materials: Between April 2002 and April 2008, 13 patients were treated with WAPRT using intensity-modulated arc therapy. We prescribed a dose of 33 Gy to be delivered in 22 fractions of 1.5 Gy to the abdomen and pelvis. All patients had International Federation of Gynecology and Obstetrics Stage III or IV ovarian cancer at the initial diagnosis. At referral, the median age was 61 years, and the patients had been heavily pretreated with surgery and chemotherapy. All patients had symptoms from their disease, including gastrointestinal obstruction or subobstruction in 6, minor gastrointestinal symptoms in 2, pain in 4, ascites in 1, and vaginal bleeding in 2. A complete symptom or biochemical response required complete resolution of the patient's symptoms or cancer antigen-125 level. A partial response required ≥50% resolution of these parameters. The actuarial survival was calculated from the start of radiotherapy. Results: The median overall survival was 21 weeks, with a 6-month overall survival rate of 45%. The 9 patients who completed treatment obtained a complete symptom response, except for ascites (partial response). The median and mean response duration (all symptoms grouped) was 24 and 37 weeks, respectively. Of the 6 patients presenting with obstruction or subobstruction, 4 obtained a complete symptom response (median duration, 16 weeks). Conclusion: WAPRT delivered using intensity-modulated arc therapy offers important palliation in the case of peritoneal metastatic ovarian cancer. WAPRT resolved intestinal obstruction for a substantial period.

  19. Comparison of effectiveness of intensity-modulated radiotherapy with conventional two-dimensional radiotherapy for patients with locally recurrent nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Ma Wenjuan; Zhang Jinshan; Cao Kajia; Xia Weixiong

    2012-01-01

    Objective: To compare the efficacy and side-effects in locally recurrent nasopharyngeal carcinoma (NPC) treated by intensity-modulated radiotherapy (IMRT) and two-dimensional conventional radiotherapy (2DCRT). Methods: Among the 292 newly diagnosed, nonmetastatic recurrent NPC, 211 were treate with IMRT and 81 with 2DCRT. All patients were staged according to the seventh edition of the UICC 2009 staging system. Kaplan-Meier and Logrank methods were used for survival analysis. A Cox proportional hazard model was used to examine prognostic factors. Results: The follow-up rate was 91.8%, there are 38 patients in 2DCRT and 106 patients in IMRT group was followed more than 3 years. There were significant differences in the 3-year actuarial overall survival (OS) rate (36.9% and 51.3%, χ 2 =8.44, P=0.004) and local progression-free survival (LRFS) rate (63.3% and 86.0%, χ 2 =13.83, P=0.000), and no significant differences in actuarial distant metastasis free survival rates (79.0% and 83.5%, χ 2 =0.25, P=0.618) between the 2DCRT group and the IMRT group. Multivariate analysis showed that T category and IMRT (yes vs. no) were the independently prognostic factors for OS and LRFS (χ = 9.51, 5.20, P=0.002, 0.023 and χ = 4.84, 9.24, P=0.027, 0.002). The incidence of grade 3 and 4 trismus and radiation-induced encephalopathy were 19.9%, 8.1% for the IMRT group and 43.2%, 24.7% for the 2DCRT group (χ 2 =16.37, P=0.000 and χ 2 =14.64%, P=0.000). whereas, severe mucosa necrosis and/or massive hemorrhage in the nasopharynx was observed in IMRT group which was not common in 2DCRT (33.2% : 7.4%, χ 2 =2.019, P=0.000). Conclusions: Higher local tumor control and overall survival were achieved by IMRT than 2DCRT, the incidence of severe trismus and radiation-induced encephalopathy was also reduced by IMRT, in cost of a higher incidence of mucosa necrosis and/or massive hemorrhage in the nasopharynx. (authors)

  20. A comparison of swallowing dysfunction after three-dimensional conformal and intensity-modulated radiotherapy. A systematic review by the Italian Head and Neck Radiotherapy Study Group

    Energy Technology Data Exchange (ETDEWEB)

    Ursino, Stefano; Morganti, Riccardo; Cristaudo, Agostino; Paiar, Fabiola [University Hospital S. Chiara, Radiation Oncology, Pisa (Italy); D' Angelo, Elisa; Lohr, Frank [University Hospital, Radiation Oncology, Modena (Italy); Mazzola, Rosario [Sacro Cuore-Don Calabria Cancer Care Center, Radiation Oncology, Negrar-Verona (Italy); Merlotti, Anna; Russi, Elvio Grazioso [S. Croce e Carle Hospital, Radiation Oncology, Cuneo (Italy); Musio, Daniela [University Hospital La Sapienza, Radiation Oncology, Roma (Italy); Alterio, Daniela [European Institute of Oncology, Radiation Oncology, Advanced Radiotherapy Center, Milan (Italy); Bacigalupo, Almalina [AOU IRCCS San Martino - IST National Cancer Research Institute and University, Radiation Oncology, Genoa (Italy)

    2017-11-15

    Dysphagia is one of the most important treatment-related side effects in head and neck cancer (HNC), as it can lead to severe life-threating complications such as aspiration pneumonia and malnutrition. Intensity-modulated radiotherapy (IMRT) could reduce swallowing dysfunction by producing a concave dose distribution and reducing doses to the swallowing-related organs at risk (SWOARs). The aim of this study was to review the current literature in order to compare swallowing outcomes between IMRT and three-dimensional conformal radiotherapy (3DCRT). A search was conducted in the PubMed and Embase databases to identify studies on swallowing outcomes, both clinically and/or instrumentally assessed, after 3DCRT and IMRT. Dysphagia-specific quality of life and objective instrumental data are summarized and discussed. A total of 262 papers were retrieved from the searched databases. An additional 23 papers were retrieved by hand-searching the reference lists. Ultimately, 22 papers were identified which discussed swallowing outcomes after 3DCRT and IMRT for HNC. No outcomes from randomized trials were identified. Despite several methodological limitations, reports from the current literature seem to suggest better swallowing outcomes with IMRT compared to 3DCRT. Further improvements are likely to result from the increased use of IMRT plans optimized for SWOAR sparing. (orig.) [German] Dysphagie ist eine der wichtigsten Nebenwirkungen bei der Behandlung von Kopf-Hals-Tumoren (HNC), da sie zu lebensbedrohlichen Komplikationen wie Aspirationspneumonien und Mangelernaehrung fuehren kann. Durch Erzeugung konkaver Dosisverteilungen und durch die Reduzierung der Dosis an schluckrelevanten Strukturen (SWOAR) kann die IMRT Schluckstoerungen moeglicherweise vermindern. Ziel dieser Studie war es, die gegenwaertige Literaturlage hinsichtlich der Schluckfunktion nach IMRT und konformaler dreidimensionaler Strahlentherapie (3DCRT) systematisch zu ueberpruefen. Studien, die die

  1. Dosimetry comparison of irradiation with conformal radiotherapy, intensity modulated radiotherapy, conformal radiotherapy in stereotactic conditions and robotic stereotactic radiotherapy for benign brain tumours; Comparaison dosimetrique de la radiotherapie conformationnelle, la radiotherapie conformationnelle avec modulation d'intensite, la radiotherapie conformationnelle en conditions stereotaxiques et la radiotherapie en conditions stereotaxiques robotisee des tumeurs cerebrales benignes

    Energy Technology Data Exchange (ETDEWEB)

    Spasic, E.; Noel, A. [Departement de radiophysique, centre Alexis-Vautrin, avenue de Bourgogne, 54511 Vandoeuvre-les-Nancy cedex (France); UMR 7039 CNRS, centre de recherche en automatique de Nancy (Cran), BP 239, 54506 Vandoeuvre-les-Nancy cedex (France); Cran UMR 7039, faculte des sciences et techniques, universite Henri-Poincare Nancy 1, BP 239, 54506 Vandoeuvre-les-Nancy cedex (France); Cran UMR 7039, institut national polytechnique de Lorraine, BP 239, 54506 Vandoeuvre-les-Nancy cedex (France); Buchheit, I.; Bernier, V. [Departement de radiophysique, centre Alexis-Vautrin, avenue de Bourgogne, 54511 Vandoeuvre-les-Nancy cedex (France)

    2011-07-15

    Purpose. - To compare several techniques in order to determine the best treatment for benign brain tumours. Methods and patients. - A retrospective study was performed for five patients who received 3D-conformal radiotherapy, intensity modulated radiotherapy or CyberKnife{sup R}. These patients had a meningioma, a pituitary tumour, a cranio-pharyngioma or a neurinoma. In each case, these treatment plans were optimised and compared with the three other dosimetries. Radiobiological or positioning parameters were evaluated, as well as dosimetric parameters, in order to compare treatments with different characteristics. Results. - The dosimetric parameters showed that the choice of treatment seemed to be determined mostly by tumour size, shape and proximity with organs at risk (not tumour localisation). Whereas the results showed no significant deviations with regards to the radiobiological parameters. Therefore, with these parameters, it was difficult to give priority to a treatment. Conclusions. - With regards to benign brain tumours of medium or large size, intensity modulated radiotherapy seemed the recommended treatment. It enabled to obtain a good ratio between efficacy and toxicity for tumours that are really close to organs at risk. Concerning small benign brain tumours, the CyberKnife{sup R} was probably the best treatment. (authors)

  2. A comparison of forward and inverse treatment planning for intensity-modulated radiotherapy of head and neck cancer

    International Nuclear Information System (INIS)

    Baer, Werner; Schwarz, Marco; Alber, Markus; Bos, Luc J.; Mijnheer, Ben J.; Rasch, Coen; Schneider, Christoph; Nuesslin, Fridtjof; Damen, Eugene M.F.

    2003-01-01

    Background and purpose: To compare intensity-modulated treatment plans of patients with head and neck cancer generated by forward and inverse planning. Materials and methods: Ten intensity-modulated treatment plans, planned and treated with a step and shoot technique using a forward planning approach, were retrospectively re-planned with an inverse planning algorithm. For this purpose, two strategies were applied. First, inverse planning was performed with the same beam directions as forward planning. In addition, nine equidistant, coplanar incidences were used. The main objective of the optimisation process was the sparing of the parotid glands beside an adequate treatment of the planning target volume (PTV). Inverse planning was performed both with pencil beam and Monte Carlo dose computation to investigate the influence of dose computation on the result of the optimisation. Results: In most cases, both inverse planning strategies managed to improve the treatment plans distinctly due to a better target coverage, a better sparing of the parotid glands or both. A reduction of the mean dose by 3-11 Gy for at least one of the parotid glands could be achieved for most of the patients. For three patients, inverse planning allowed to spare a parotid gland that had to be sacrificed by forward planning. Inverse planning increased the number of segments compared to forward planning by a factor of about 3; from 9-15 to 27-46. No significant differences for PTV and parotid glands between both inverse planning approaches were found. Also, the use of Monte Carlo instead of pencil beam dose computation did not influence the results significantly. Conclusion: The results demonstrate the potential of inverse planning to improve intensity-modulated treatment plans for head and neck cases compared to forward planning while retaining clinical utility in terms of treatment time and quality assurance

  3. Dosimetric benefit of DMLC tracking for conventional and sub-volume boosted prostate intensity-modulated arc radiotherapy

    DEFF Research Database (Denmark)

    Pommer, T.; Falk, Marianne; Poulsen, Per Rugaard

    2013-01-01

    This study investigated the dosimetric impact of uncompensated motion and motion compensation with dynamic multileaf collimator (DMLC) tracking for prostate intensity modulated arc therapy. Two treatment approaches were investigated; a conventional approach with a uniform radiation dose...... during the first 75 s. A research DMLC tracking system was used for real-time motion compensation with optical monitoring for position input. The gamma index was used for evaluation, with measurements with a static phantom or the planned dose as reference, using 2% and 2 mm gamma criteria. The average...

  4. Phase II study evaluating consolidation whole abdominal intensity-modulated radiotherapy (IMRT) in patients with advanced ovarian cancer stage FIGO III - The OVAR-IMRT-02 Study

    International Nuclear Information System (INIS)

    Rochet, Nathalie; Debus, Juergen; Kieser, Meinhard; Sterzing, Florian; Krause, Sonja; Lindel, Katja; Harms, Wolfgang; Eichbaum, Michael H; Schneeweiss, Andreas; Sohn, Christof

    2011-01-01

    The prognosis for patients with advanced FIGO stage III epithelial ovarian cancer remains poor despite the aggressive standard treatment, consisting of maximal cytoreductive surgery and platinum-based chemotherapy. The median time to recurrence is less than 2 years, with a 5-years survival rate of -20-25%. Recurrences of the disease occur mostly intraperitoneally. Ovarian cancer is a radiosensitive tumor, so that the use of whole abdominal radiotherapy (WAR) as a consolidation therapy would appear to be a logical strategy. WAR used to be the standard treatment after surgery before the chemotherapy era; however, it has been almost totally excluded from the treatment of ovarian cancer during the past decade because of its high toxicity. Modern intensity-modulated radiation therapy (IMRT) has the potential of sparing organs at risk like kidneys, liver, and bone marrow while still adequately covering the peritoneal cavity with a homogenous dose. Our previous phase I study showed for the first time the clinical feasibility of intensity-modulated WAR and pointed out promising results concerning treatment tolerance. The current phase-II study succeeds to the phase-I study to further evaluate the toxicity of this new treatment. The OVAR-IMRT-02 study is a single-center one arm phase-II trial. Thirty seven patients with optimally debulked ovarian cancer stage FIGO III having a complete remission after chemotherapy will be treated with intensity-modulated WAR as a consolidation therapy. A total dose of 30 Gy in 20 fractions of 1.5 Gy will be applied to the entire peritoneal cavity including the liver surface and the pelvic and para-aortic node regions. Organ at risk are kidneys, liver (except the 1 cm-outer border), heart, vertebral bodies and pelvic bones. Primary endpoint is tolerability; secondary objectives are toxicity, quality of life, progression-free and overall survival. Intensity-modulated WAR provides a new promising option in the consolidation treatment of

  5. Phase II study evaluating consolidation whole abdominal intensity-modulated radiotherapy (IMRT) in patients with advanced ovarian cancer stage FIGO III--the OVAR-IMRT-02 Study.

    Science.gov (United States)

    Rochet, Nathalie; Kieser, Meinhard; Sterzing, Florian; Krause, Sonja; Lindel, Katja; Harms, Wolfgang; Eichbaum, Michael H; Schneeweiss, Andreas; Sohn, Christof; Debus, Juergen

    2011-01-28

    The prognosis for patients with advanced FIGO stage III epithelial ovarian cancer remains poor despite the aggressive standard treatment, consisting of maximal cytoreductive surgery and platinum-based chemotherapy. The median time to recurrence is less than 2 years, with a 5-years survival rate of -20-25%. Recurrences of the disease occur mostly intraperitoneally.Ovarian cancer is a radiosensitive tumor, so that the use of whole abdominal radiotherapy (WAR) as a consolidation therapy would appear to be a logical strategy. WAR used to be the standard treatment after surgery before the chemotherapy era; however, it has been almost totally excluded from the treatment of ovarian cancer during the past decade because of its high toxicity. Modern intensity-modulated radiation therapy (IMRT) has the potential of sparing organs at risk like kidneys, liver, and bone marrow while still adequately covering the peritoneal cavity with a homogenous dose.Our previous phase I study showed for the first time the clinical feasibility of intensity-modulated WAR and pointed out promising results concerning treatment tolerance. The current phase-II study succeeds to the phase-I study to further evaluate the toxicity of this new treatment. The OVAR-IMRT-02 study is a single-center one arm phase-II trial. Thirty seven patients with optimally debulked ovarian cancer stage FIGO III having a complete remission after chemotherapy will be treated with intensity-modulated WAR as a consolidation therapy.A total dose of 30 Gy in 20 fractions of 1.5 Gy will be applied to the entire peritoneal cavity including the liver surface and the pelvic and para-aortic node regions. Organ at risk are kidneys, liver (except the 1 cm-outer border), heart, vertebral bodies and pelvic bones.Primary endpoint is tolerability; secondary objectives are toxicity, quality of life, progression-free and overall survival. Intensity-modulated WAR provides a new promising option in the consolidation treatment of ovarian

  6. Phase II study evaluating consolidation whole abdominal intensity-modulated radiotherapy (IMRT in patients with advanced ovarian cancer stage FIGO III - The OVAR-IMRT-02 Study

    Directory of Open Access Journals (Sweden)

    Eichbaum Michael H

    2011-01-01

    Full Text Available Abstract Background The prognosis for patients with advanced FIGO stage III epithelial ovarian cancer remains poor despite the aggressive standard treatment, consisting of maximal cytoreductive surgery and platinum-based chemotherapy. The median time to recurrence is less than 2 years, with a 5-years survival rate of -20-25%. Recurrences of the disease occur mostly intraperitoneally. Ovarian cancer is a radiosensitive tumor, so that the use of whole abdominal radiotherapy (WAR as a consolidation therapy would appear to be a logical strategy. WAR used to be the standard treatment after surgery before the chemotherapy era; however, it has been almost totally excluded from the treatment of ovarian cancer during the past decade because of its high toxicity. Modern intensity-modulated radiation therapy (IMRT has the potential of sparing organs at risk like kidneys, liver, and bone marrow while still adequately covering the peritoneal cavity with a homogenous dose. Our previous phase I study showed for the first time the clinical feasibility of intensity-modulated WAR and pointed out promising results concerning treatment tolerance. The current phase-II study succeeds to the phase-I study to further evaluate the toxicity of this new treatment. Methods/design The OVAR-IMRT-02 study is a single-center one arm phase-II trial. Thirty seven patients with optimally debulked ovarian cancer stage FIGO III having a complete remission after chemotherapy will be treated with intensity-modulated WAR as a consolidation therapy. A total dose of 30 Gy in 20 fractions of 1.5 Gy will be applied to the entire peritoneal cavity including the liver surface and the pelvic and para-aortic node regions. Organ at risk are kidneys, liver (except the 1 cm-outer border, heart, vertebral bodies and pelvic bones. Primary endpoint is tolerability; secondary objectives are toxicity, quality of life, progression-free and overall survival. Discussion Intensity-modulated WAR provides

  7. Development of a quality control system in intensity modulated radiotherapy (IMRT); Desenvolvimento de um sistema para controle de qualidade em radioterapia de intensidade modulada (IMRT)

    Energy Technology Data Exchange (ETDEWEB)

    Souza, Roberto Salomon de, E-mail: salomon@inca.gov.br [Instituto Nacional de Cancer (PQRT/INCA), Rio de Janeiro, RJ (Brazil). Programa de Qualidade em Radioterapia; Rosa, Luiz A.R. da, E-mail: lrosa@ird.gov.br [Instituto de Radioprotecao e Dosimetria (IRD/CNEN-RJ), Rio de Janeiro, RJ (Brazil); Braz, Delson, E-mail: delson@lin.ufrj.br [Coordenacao dos Programas de Pos-Graduacao em Engenharia (COPPE/UFRJ), RJ (Brazil)

    2013-11-01

    The more complex the technique of radiotherapy is, the more refined the quality control must be. The technique of Intensity Modulated Radiotherapy (IMRT) is one of the technological innovations that gained space in the whole worlds in the last decade whose parameters of quality control are not fully established yet. The present work developed a phantom for quality control in IMRT to be implemented in the routine of the Radiotherapy Quality Control Program (PQRT) of the Brazilian National Cancer Institute (INCa). The device consists of a block formed by several polystyrene slice with TDLs and radiochromic film inserted. It should be sent (or taken) to the Program participating institutions to be irradiated under certain conditions and then be returned to the PQRT., where the discrepancy degree between the planned treatment and those effectively delivered will be evaluated. The system was validated through the test cases and the pilot program preformed in nine radiotherapy centers that perform IMRT in the southeast region of Brazil. (author)

  8. Hypofractionated boost to the dominant tumor region with intensity modulated stereotactic radiotherapy for prostate cancer: a sequential dose escalation pilot study.

    Science.gov (United States)

    Miralbell, Raymond; Mollà, Meritxell; Rouzaud, Michel; Hidalgo, Alberto; Toscas, José Ignacio; Lozano, Joan; Sanz, Sergi; Ares, Carmen; Jorcano, Sandra; Linero, Dolors; Escudé, Lluís

    2010-09-01

    To evaluate the feasibility, tolerability, and preliminary outcomes in patients with prostate cancer treated according to a hypofractionated dose escalation protocol to boost the dominant tumor-bearing region of the prostate. After conventional fractionated external radiotherapy to 64 to 64.4 Gy, 50 patients with nonmetastatic prostate cancer were treated with an intensity-modulated radiotherapy hypofractionated boost under stereotactic conditions to a reduced prostate volume to the dominant tumor region. A rectal balloon inflated with 60 cc of air was used for internal organ immobilization. Five, 8, and 8 patients were sequentially treated with two fractions of 5, 6, or 7 Gy, respectively (normalized total dose in 2 Gy/fraction [NTD(2 Gy)] 100 Gy, high-dose group). Androgen deprivation was given to 33 patients. Acute and late toxicities were assessed according to the Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer (RTOG/EORTC) scoring system. Two patients presented with Grade 3 acute urinary toxicity. The 5-year probabilities of >or=Grade 2 late urinary and late low gastrointestinal (GI) toxicity-free survival were 82.2% +/- 7.4% and 72.2% +/- 7.6%, respectively. The incidence and severity of acute or late toxicities were not correlated with low- vs. high-dose groups, pelvic irradiation, age, or treatment with or without androgen deprivation. The 5-year biochemical disease-free survival (b-DFS) and disease-specific survival were 98% +/- 1.9% and 100%, respectively. Intensity-modulated radiotherapy hypofractionated boost dose escalation under stereotactic conditions was feasible, and showed excellent outcomes with acceptable long-term toxicity. This approach may well be considered an alternative to high-dose-rate brachytherapy. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  9. Quality controls in intensity-modulated conformational radiotherapy. S.F.P.M. report nr 26, January 2010

    International Nuclear Information System (INIS)

    Valinta, Danielle; Poinsignon, Anne; Caron, Jerome; Dejean, Catherine; Corsetti, Dominique; Marcie, Serge; Mazurier, Jocelyne; Naudy, Suzanne; Aget, Helene; Marchesi, Vincent; Vieillevigne, Laure; Dedieu, Veronique; Bramoule, Celine; Caselles, Olivier; Lacaze, Brigitte; Mazurier, Jocelyne

    2009-08-01

    This report proposes a comprehensive presentation of the different controls which can be performed for the implementation of 3D intensity-modulated conformal radiation therapy (IMCR). The authors first present the IMCR principle by describing modes of production of modulated beams, the practical realisation of intensity modulation with Multi Leaf Collimator (MLC), multi leaf collimators, and the inverse planning system. They present the quality control of the accelerator (pre-requisites, linearity of the monitor chamber, symmetry and homogeneity), the quality control of multi leaf collimators (prerequisites, leaf absolute calibration, static mode, dynamic mode), the quality control of the treatment planning system (prerequisites, tests specific to IMCR, example in dynamic mode with the chair test), the quality control of the treatment plan (objective, necessary equipment and software solutions, measurement of point absolute dose, control of dose distribution, independent calculation of the number of monitor units), and the treatment verification (pre-treatment verification, patient repositioning during treatment). Finally, they indicate human means required for IMCR implementation, and formulate some recommendations for this implementation

  10. Volumetric modulated arc therapy is superior to conventional intensity modulated radiotherapy - a comparison among prostate cancer patients treated in an Australian centre

    Directory of Open Access Journals (Sweden)

    Haydu Lauren E

    2011-09-01

    Full Text Available Abstract Background Radiotherapy technology is expanding rapidly. Volumetric Modulated Arc Therapy (VMAT technologies such as RapidArc® (RA may be a more efficient way of delivering intensity-modulated radiotherapy-like (IM treatments. This study is an audit of the RA experience in an Australian department with a planning and economic comparison to IM. Methods 30 consecutive prostate cancer patients treated radically with RA were analyzed. Eight RA patients treated definitively were then completely re-planned with 3D conformal radiotherapy (3D; and a conventional sliding window IM technique; and a new RA plan. The acceptable plans and their treatment times were compared and analyzed for any significant difference. Differences in staff costs of treatment were computed and analyzed. Results Thirty patients had been treated to date with eight being treated definitely to at least 74 Gy, nine post high dose brachytherapy (HDR to 50.4Gy and 13 post prostatectomy to at least 64Gy. All radiotherapy courses were completed with no breaks. Acute rectal toxicity by the RTOG criteria was acceptable with 22 having no toxicity, seven with grade 1 and one had grade 2. Of the eight re-planned patients, none of the 3D (three-dimensional conformal radiotherapy plans were acceptable based on local guidelines for dose to organs at risk. There was no statistically significant difference in planning times between IM and RA (p = 0.792. IM had significantly greater MUs per fraction (1813.9 vs 590.2 p Conclusions 3D was incapable of covering a modern radiotherapy volume for the radical treatment of prostate cancer. These volumes can be treated via conventional IM and RA. RA was significantly more efficient, safe and cost effective than IM. VMAT technologies are a superior way of delivering IM-like treatments.

  11. Breast post-radiotherapy angiosarcoma

    International Nuclear Information System (INIS)

    Chavez, O.; Ocampo, P.; Repetto, M.; Schulz, D.; Rompato, S.; Batagelj, E.; Spadavecchia, G.

    2007-01-01

    Breast angiosarcoma after radiotherapy represents a rare pathology that have been increasing in the recent years because of the tendency to treat breast cancer with conservative therapeutic treatments. The forecast depends on the histological degree being the majority of high degree, with frequent lymphatic and local recurrences plus distance metastasis. The selected treatment is the mastectomy and also should be considered the adjuvant chemotherapy [es

  12. Impact of Intensity-Modulated Radiotherapy on Health-Related Quality of Life for Head and Neck Cancer Patients: Matched-Pair Comparison with Conventional Radiotherapy

    International Nuclear Information System (INIS)

    Graff, Pierre; Lapeyre, Michel; Desandes, Emmanuel; Ortholan, Cecile; Bensadoun, Rene-Jean; Alfonsi, Marc; Maingon, Philippe; Giraud, Philippe; Bourhis, Jean; Marchesi, Vincent; Mege, Alice; Peiffert, Didier

    2007-01-01

    Purpose: To assess the benefit of intensity-modulated radiotherapy (IMRT) compared with conventional RT for the quality of life (QOL) of head and neck cancer survivors. Methods and Materials: Cross-sectional QOL measures (European Organization for Research and Treatment of Cancer QOL questionnaire C30 and head and neck cancer module) were used with a French multicenter cohort of patients cured of head and neck cancer (follow-up ≥ 1 year) who had received bilateral neck RT (≥ 45 Gy) as a part of their initial treatment. We compared the QOL mean scores regarding RT modality (conventional RT vs. IMRT). The patients of the two groups were matched (one to one) according to the delay between the end of RT and the timing of the QOL evaluation and the T stage. Each QOL item was divided into two relevant levels of severity: 'not severe' (responses, 'not at all' and 'a little') vs. 'severe' (responses 'quite a bit' and 'very much'). The association between the type of RT and the prevalence of severe symptoms was approximated, through multivariate analysis using the prevalence odds ratio. Results: Two comparable groups (67 pairs) were available. Better scores were observed on the head and neck cancer module QOL questionnaire for the IMRT group, especially for dry mouth and sticky saliva (p < 0.0001). Severe symptoms were more frequent with conventional RT concerning saliva modifications and oral discomfort. The adjusted prevalence odds ratios were 3.17 (p = 0.04) for dry mouth, 3.16 (p = 0.02) for sticky saliva, 3.58 (p = 0.02) for pain in the mouth, 3.35 (p = 0.04) for pain in the jaw, 2.60 (p = 0.02) for difficulties opening the mouth, 2.76 (p = 0.02) for difficulties with swallowing, and 2.68 (p = 0.03) for trouble with eating. Conclusion: The QOL assessment of head and neck cancer survivors demonstrated the benefit of IMRT, particularly in the areas of salivary dysfunction and oral discomfort

  13. Results of the radiation dose of head, body and tail of hippocampus in nasopharyngeal carcinoma patients treated with intensity modulated radiotherapy.

    Science.gov (United States)

    Zong-Wen, Sun; Lei, Shi; Qinglin, Li; Yue, Kong; Feng-Lei, Du; Tie-Ming, Xie; Yong-Hong, Hua; Qiao-Ying, Hu; Xiao-Zhong, Chen; Yuan-Yuan, Chen; Ming, Chen

    2018-04-04

    This study is to analyze the radiation dose of head, body and tail of hippocampus (HC) of nasopharyngeal carcinoma (NPC) patients treated with intensity modulated radiotherapy (IMRT). Evaluate cognitive function of patients with Wechsler adult intelligence scale-Chinese revised (WAIS-CR). HC were segmented into HC head (HH), HC body (HB) and HC tail (HT) and the indexes were then analyzed. WAIS-CR was tested before and 3months after radiotherapy. The mean radiation dose of left and right HC was (1147 ± 976)cGy, (1011 ± 602)cGy respectively. The radiation dose and the volume exposed in different dose of HH, HB and HT decreased in turn. For 5 patients, before and after radiotherapy, the regular-order score was 8.60 ± 1.34, 8.0 ± 1.00 (P = 0.43), while the reverse-order score was 5.80 ± 0.84, 5.20 ± 0.84 (P = 0.07). The radiation dose of HH, HB and HT was different, and the radiation dose of HH was the highest, which should be emphasized especially.

  14. Radical chemo-irradiation using intensity-modulated radiotherapy for locally advanced head and neck cancer in elderly patients: Experience from a tertiary care center in South India.

    Science.gov (United States)

    Chalissery, J R; Sudheeran, P C; Varghese, K M; Venkatesan, K

    2016-01-01

    To assess the feasibility, tolerance and response of radical chemo irradiation using Intensity modulated Radiotherapy [IMRT] in elderly patients [age >65] with locally advanced head and neck cancer. Patients aged 65 and above [range 65 to 84years] registered in oncology outpatient unit in our institution between December 2011 to 2014, with stage III and IV head and neck cancer were treated with radical dose of radiotherapy using IMRT and concurrent chemotherapy with cisplatin 40mg/sq.m weekly. Response evaluation and toxicity profile assessment was done 6 to 8 weeks after completion of treatment and 3 monthly thereafter with median follow up of 3 years. Total number of patients analysed were 47. 43(91.5%) patients tolerated 66-.70Gy of radiotherapy and 4 or more cycles of weekly chemotherapy with cisplatin. First follow up evaluation at 6 to 8 weeks showed 81% patients having complete loco regional response. Grade III skin reaction and mucositis was noticed in 24% and 47% respectively. No grade III neutropenia observed. Median follow up of 3 years showed a complete local control in 53% and overall survival of 60%. Radical chemo irradiation with IMRT in elderly patients is a feasible option. Long term local control and overall survival benefits needs to be followed up.

  15. Heart and coronary artery protection in patients with mediastinal Hodgkin lymphoma treated with intensity-modulated radiotherapy: Dose constraints to virtual volumes or to organs at risk?

    International Nuclear Information System (INIS)

    Ghalibafian, Mithra; Beaudre, Anne; Girinsky, Theodore

    2008-01-01

    Background and purpose: To increase heart and coronary artery protection in patients with mediastinal Hodgkin lymphoma treated with intensity-modulated radiotherapy (IMRT). Materials and methods: Twenty patients with early-stage mediastinal Hodgkin lymphoma entered the study. IMRT was delivered to the initially involved lymph node volumes. Various virtual volumes (VVs) were designed to improve the protection of the heart and the origin of the coronary arteries, which were the organs at risk (OARs), while preserving adequate PTV coverage. The results obtained with VVs were then compared with those obtained with dose constraints assigned to OARs. Results: The most satisfactory VV was obtained using the PTV expansion concept. The best compromise between adequate PTV coverage and OAR protection was obtained with dose constraints assigned to the PTV expansion VV and to the origin of the coronary arteries. Conclusions: IMRT can be improved by using dose constraints assigned to the PTV expansion VV and/or to the origin of the coronary arteries

  16. Intraoperative radiotherapy in breast cancer: literature review

    International Nuclear Information System (INIS)

    Alfaro Hidalgo, Sabrina A.

    2013-01-01

    A literature review was performed on intraoperative radiotherapy of breast cancer. The strength and attractiveness is established of techniques of partial irradiation in the treatment of breast cancer. The benefit is originated to restrict the area immediate of radiotherapy to the tumor bed or quadrant index and identifying the benefit of being applied during the radiotherapy while surgical lumpectomy. The impact of local recurrence has been established using intraoperative radiotherapy. The advantages of intraoperative radiotherapy was compared in the management of the conservative surgery in early stages of breast cancer with external radiotherapy. Different methods of intraoperative radiotherapy have been compared and individual impact on local recurrence ranges. Intraoperative radiotherapy has had many advantages: radiobiological, technical, clinical, psychological and economical in the handling of conservative surgery in early stages of breast cancer, compared with external radiotherapy [es

  17. Assessment of planning target volume margins for intensity-modulated radiotherapy of the prostate gland: role of daily inter- and intrafraction motion.

    Science.gov (United States)

    Tanyi, James A; He, Tongming; Summers, Paige A; Mburu, Ruth G; Kato, Catherine M; Rhodes, Stephen M; Hung, Arthur Y; Fuss, Martin

    2010-12-01

    To determine planning target volume margins for prostate intensity-modulated radiotherapy based on inter- and intrafraction motion using four daily localization techniques: three-point skin mark alignment, volumetric imaging with bony landmark registration, volumetric imaging with implanted fiducial marker registration, and implanted electromagnetic transponders (beacons) detection. Fourteen patients who underwent definitive intensity-modulated radiotherapy for prostate cancer formed the basis of this study. Each patient was implanted with three electromagnetic transponders and underwent a course of 39 treatment fractions. Daily localization was based on three-point skin mark alignment followed by transponder detection and patient repositioning. Transponder positioning was verified by volumetric imaging with cone-beam computed tomography of the pelvis. Relative motion between the prostate gland and bony anatomy was quantified by offline analyses of daily cone-beam computed tomography. Intratreatment organ motion was monitored continuously by the Calypso® System for quantification of intrafraction setup error. As expected, setup error (that is, inter- plus intrafraction motion, unless otherwise stated) was largest with skin mark alignment, requiring margins of 7.5 mm, 11.4 mm, and 16.3 mm, in the lateral (LR), longitudinal (SI), and vertical (AP) directions, respectively. Margin requirements accounting for intrafraction motion were smallest for transponder detection localization techniques, requiring margins of 1.4 mm (LR), 2.6 mm (SI), and 2.3 mm (AP). Bony anatomy alignment required 2.1 mm (LR), 9.4 mm (SI), and 10.5 mm (AP), whereas image-guided marker alignment required 2.8 mm (LR), 3.7 mm (SI), and 3.2 mm (AP). No marker migration was observed in the cohort. Clinically feasible, rapid, and reliable tools such as the electromagnetic transponder detection system for pretreatment target localization and, subsequently, intratreatment target location monitoring

  18. Moderately Escalated Hypofractionated (ChemoRadiotherapy Delivered with Helical Intensity-Modulated Technique in Stage III Unresectable Non-Small Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Vittorio eDonato

    2013-11-01

    Full Text Available Purpose To assess clinical outcomes and toxicities in patients with stage III unresectable non-small cell lung cancer (NSCLC treated with a moderately escalated hypofractionated radiotherapy delivered with Helical Intensity-Modulated Technique in combination with sequential or concurrent chemotherapy.Methods and Materials Sixty-one consecutive patients considered non-progressive after 2 cycles of induction chemotherapy were treated with a moderately escalated hypofractionated radiation course of 30 daily fractions of 2.25-2.28 Gy each administered in 6 weeks up to a total dose of 67.5 Gy–68.4 Gy (range, 64.5 Gy–71.3 Gy. Thirty-two received sequential RT after 2 more cycles (total= 4 cycles of chemotherapy, while twenty-nine were treated with concurrent chemo-radiation. The target was considered the gross tumour volume and the clinically proven nodal regions, without elective nodal irradiation. Results With a median follow up of 27 months (range 6 to 40, one-year and 2-year OS rate for all patients was 77% and 53% respectively, with a median survival duration of 18.6 months in the sequential group and 24.1 months in the concomitant group. No Grade ≥ 4 acute and late toxicity was reported. Acute Grade 3 treatment-related pneumonitis was detected in 10% of patients. Two patients, both receiving the concurrent schedule, developed a Grade 3 acute esophagitis. The overall incidence of late Grade 3 lung toxicity was 5%. No patients experienced a Grade 3 late esophageal toxicity.Conclusions A moderately hypofractionated radiation course delivered with a Helical Intensity-Modulated Technique is a feasible treatment option for patients with unresectable locally advanced NSCLC receiving chemotherapy (sequentially or concurrently. Hypofractionated radiotherapy with a dedicated technique allows safely dose escalation, minimizing the effect of tumor repopulation that may occur with prolonged treatment time.

  19. High-dose intensity-modulated radiotherapy for prostate cancer using daily fiducial marker-based position verification: acute and late toxicity in 331 patients

    International Nuclear Information System (INIS)

    Lips, Irene M; Dehnad, Homan; Gils, Carla H van; Boeken Kruger, Arto E; Heide, Uulke A van der; Vulpen, Marco van

    2008-01-01

    We evaluated the acute and late toxicity after high-dose intensity-modulated radiotherapy (IMRT) with fiducial marker-based position verification for prostate cancer. Between 2001 and 2004, 331 patients with prostate cancer received 76 Gy in 35 fractions using IMRT combined with fiducial marker-based position verification. The symptoms before treatment (pre-treatment) and weekly during treatment (acute toxicity) were scored using the Common Toxicity Criteria (CTC). The goal was to score late toxicity according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) scale with a follow-up time of at least three years. Twenty-two percent of the patients experienced pre-treatment grade ≥ 2 genitourinary (GU) complaints and 2% experienced grade 2 gastrointestinal (GI) complaints. Acute grade 2 GU and GI toxicity occurred in 47% and 30%, respectively. Only 3% of the patients developed acute grade 3 GU and no grade ≥ 3 GI toxicity occurred. After a mean follow-up time of 47 months with a minimum of 31 months for all patients, the incidence of late grade 2 GU and GI toxicity was 21% and 9%, respectively. Grade ≥ 3 GU and GI toxicity rates were 4% and 1%, respectively, including one patient with a rectal fistula and one patient with a severe hemorrhagic cystitis (both grade 4). In conclusion, high-dose intensity-modulated radiotherapy with fiducial marker-based position verification is well tolerated. The low grade ≥ 3 toxicity allows further dose escalation if the same dose constraints for the organs at risk will be used

  20. Breath-hold technique in conventional APPA or intensity-modulated radiotherapy for Hodgkin's lymphoma. Comparison of ILROG IS-RT and the GHSG IF-RT

    Energy Technology Data Exchange (ETDEWEB)

    Kriz, Jan; Spickermann, Max; Lehrich, Philipp; Reinartz, Gabriele; Eich, Hans; Haverkamp, Uwe [University of Muenster, Department of Radiation Oncology, Muenster (Germany); Schmidberger, Heinz [University Mainz, Department of Radiation Oncology, Mainz (Germany)

    2015-09-15

    The present study addresses the role of intensity-modulated radiotherapy (IMRT) in contrast to standard RT (APPA) for patients with Hodgkin's lymphoma (HL) with a focus on deep inspiration breath-hold (DIBH) technique and a comparison between the International Lymphoma Radiation Oncology Group (ILROG) Involved Site Radiotherapy (IS-RT) versus the German Hodgkin Study Group (GHSG) Involved Field Radiotherapy (IF-RT). APPA treatment and 2 IMRT plans were compared for 11 patients with HL. Furthermore, treatment with DIBH versus free breathing (FB) and two different treatment volumes, i.e. IF-RT versus IS-RT, were compared. IMRT was planned as a sliding-window technique with 5 and 7 beam angles. For each patient 12 different treatment plans were calculated (132 plans). Following organs at risk (OAR) were analysed: lung, heart, spinal cord, oesophagus, female breast and skin. Comparisons of the different values with regard to dose-volume histograms (DVH), conformity and homogeneity indices were made. IS-RT reduces treatment volumes. With respect to the planning target volume (PTV), IMRT achieves better conformity but the same homogeneity. Regarding the D{sub mean} for the lung, IMRT shows increased doses, while RT in DIBH reduces doses. The IMRT shows improved values for D{sub max} concerning the spinal cord, whereas the APPA shows an improved D{sub mean} of the lung and the female breast. IS-RT reduces treatment volumes. Intensity-modulated radiotherapy shows advantages in the conformity. Treatment in DIBH also reduces the dose applied to the lungs and the heart. (orig.) [German] Ziel dieser Auswertung ist es, die konventionelle APPA-Feldanordnung mit der Intensitaetsmodulierten Radiotherapie (IMRT) bei Patienten mit Hodgkin-Lymphom (HL) zu vergleichen. Ein besonderer Fokus liegt hierbei auf der Bestrahlung in tiefer Inspiration und Atemanhaltetechnik (DIBH). Des Weiteren wurde die ''Involved-site''-Radiotherapie (IS-RT) der International

  1. Obtaining Normal Tissue Constraints Using Intensity Modulated Radiotherapy (IMRT) in Patients with Oral Cavity, Oropharnygeal, and Laryngeal Carcinoma

    International Nuclear Information System (INIS)

    Skinner, William K.J.; Muse, Evan D.; Yaparpalvi, Ravindra; Guha, Chandan; Garg, Madhur K.; Kalnicki, Shalom

    2009-01-01

    The purpose of this study was to evaluate normal tissue dose constraints while maintaining planning target volume (PTV) prescription without reducing PTV margins. Sixteen patients with oral cavity carcinoma (group I), 27 patients with oropharyngeal carcinoma (group II), and 28 patients with laryngeal carcinoma (group III) were reviewed. Parotid constraints were a mean dose to either parotid < 26 Gy (PP1), 50% of either parotid < 30 Gy (PP2), or 20 cc of total parotid < 20 Gy (PP3). Treatment was intensity modulated radiation therapy (IMRT) with simultaneous integrated boost (SIB). All patients met constraints for cord and brain stem. The mandibular constraints were met in 66%, 29%, and 57% of patients with oral, oropharyngeal, and laryngeal cancers, respectively. Mean dose of 26 Gy (PP1) was achieved in 44%, 41%, and 38% of oral, oropharyngeal, and laryngeal patients. PP2 (parotid constraint of 30 Gy to less than 50% of one parotid) was the easiest to achieve (group I, II, and III: 82%, 76%, and 78%, respectively). PP3 (20 cc of total parotid < 20 Gy) was difficult, and was achieved in 25%, 17%, and 35% of oral, oropharyngeal, and laryngeal patients, respectively. Mean parotid dose of 26 Gy was met 40% of the time. However, a combination of constraints allowed for sparing of the parotid based on different criteria and was met in high numbers. This was accomplished without reducing PTV-parotid overlap. What dose constraint best correlates with subjective and objective functional outcomes remains a focus for future study.

  2. Dosimetric comparison of intensity-modulated, conformal, and four-field pelvic radiotherapy boost plans for gynecologic cancer: a retrospective planning study

    International Nuclear Information System (INIS)

    Chan, Philip; Yeo, Inhwan; Perkins, Gregory; Fyles, Anthony; Milosevic, Michael

    2006-01-01

    To evaluate intensity-modulated radiation therapy (IMRT) as an alternative to conformal radiotherapy (CRT) or 4-field box boost (4FB) in women with gynecologic malignancies who are unsuitable for brachytherapy for technical or medical reasons. Dosimetric and toxicity information was analyzed for 12 patients with cervical (8), endometrial (2) or vaginal (2) cancer previously treated with external beam pelvic radiotherapy and a CRT boost. Optimized IMRT boost treatment plans were then developed for each of the 12 patients and compared to CRT and 4FB plans. The plans were compared in terms of dose conformality and critical normal tissue avoidance. The median planning target volume (PTV) was 151 cm 3 (range 58–512 cm 3 ). The median overlap of the contoured rectum with the PTV was 15 (1–56) %, and 11 (4–35) % for the bladder. Two of the 12 patients, both with large PTVs and large overlap of the contoured rectum and PTV, developed grade 3 rectal bleeding. The dose conformity was significantly improved with IMRT over CRT and 4FB (p ≤ 0.001 for both). IMRT also yielded an overall improvement in the rectal and bladder dose-volume distributions relative to CRT and 4FB. The volume of rectum that received the highest doses (>66% of the prescription) was reduced by 22% (p < 0.001) with IMRT relative to 4FB, and the bladder volume was reduced by 19% (p < 0.001). This was at the expense of an increase in the volume of these organs receiving doses in the lowest range (<33%). These results indicate that IMRT can improve target coverage and reduce dose to critical structures in gynecologic patients receiving an external beam radiotherapy boost. This dosimetric advantage will be integrated with other patient and treatment-specific factors, particularly internal tumor movement during fractionated radiotherapy, in the context of a future image-guided radiation therapy study

  3. Re-irradiation of unresectable recurrent head and neck cancer: using Helical Tomotherapy as image-guided intensity-modulated radiotherapy

    International Nuclear Information System (INIS)

    Jeong, Songmi; Yoo, Eun Jung; Kim, Ji Yoon; Han, Chi Wha; Kim, Ki Jun; Kay, Chul Seung

    2013-01-01

    Re-irradiation (re-RT) is considered a treatment option for inoperable locoregionally recurrent head and neck cancer (HNC) after prior radiotherapy. We evaluated the efficacy and safety of re-RT using Helical Tomotherapy as image-guided intensity-modulated radiotherapy in recurrent HNC. Patients diagnosed with recurrent HNC and received re-RT were retrospectively reviewed. Primary endpoint was overall survival (OS) and secondary endpoints were locoregional control and toxicities. The median follow-up period of total 9 patients was 18.7 months (range, 4.1 to 76 months) and that of 3 alive patients was 49 months (range, 47 to 76 months). Median dose of first radiotherapy and re-RT was 64.8 and 47.5 Gy10. Median cumulative dose of the two courses of radiotherapy was 116.3 Gy10 (range, 91.8 to 128.9 Gy10) while the median interval between the two courses of radiation was 25 months (range, 4 to 137 months). The response rate after re-RT of the evaluated 8 patients was 75% (complete response, 4; partial response, 2). Median locoregional relapse-free survival after re-RT was 11.9 months (range, 3.4 to 75.1 months) and 5 patients eventually presented with treatment failure (in-field failure, 2; in- and out-field failure, 2; out-field failure, 1). Median OS of the 8 patients was 20.3 months (range, 4.1 to 75.1 months). One- and two-year OS rates were 62.5% and 50%, respectively. Grade 3 leucopenia developed in one patient as acute toxicity, and grade 2 osteonecrosis and trismus as chronic toxicity in another patient. Re-RT using Helical Tomotherapy for previously irradiated patients with unresectable locoregionally recurrent HNC may be a feasible treatment option with long-term survival and acceptable toxicities.

  4. Re-irradiation of unresectable recurrent head and neck cancer: using Helical Tomotherapy as image-guided intensity-modulated radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Songmi; Yoo, Eun Jung; Kim, Ji Yoon; Han, Chi Wha; Kim, Ki Jun; Kay, Chul Seung [The Catholic University of Korea College of Medicine, Seoul (Korea, Republic of)

    2013-12-15

    Re-irradiation (re-RT) is considered a treatment option for inoperable locoregionally recurrent head and neck cancer (HNC) after prior radiotherapy. We evaluated the efficacy and safety of re-RT using Helical Tomotherapy as image-guided intensity-modulated radiotherapy in recurrent HNC. Patients diagnosed with recurrent HNC and received re-RT were retrospectively reviewed. Primary endpoint was overall survival (OS) and secondary endpoints were locoregional control and toxicities. The median follow-up period of total 9 patients was 18.7 months (range, 4.1 to 76 months) and that of 3 alive patients was 49 months (range, 47 to 76 months). Median dose of first radiotherapy and re-RT was 64.8 and 47.5 Gy10. Median cumulative dose of the two courses of radiotherapy was 116.3 Gy10 (range, 91.8 to 128.9 Gy10) while the median interval between the two courses of radiation was 25 months (range, 4 to 137 months). The response rate after re-RT of the evaluated 8 patients was 75% (complete response, 4; partial response, 2). Median locoregional relapse-free survival after re-RT was 11.9 months (range, 3.4 to 75.1 months) and 5 patients eventually presented with treatment failure (in-field failure, 2; in- and out-field failure, 2; out-field failure, 1). Median OS of the 8 patients was 20.3 months (range, 4.1 to 75.1 months). One- and two-year OS rates were 62.5% and 50%, respectively. Grade 3 leucopenia developed in one patient as acute toxicity, and grade 2 osteonecrosis and trismus as chronic toxicity in another patient. Re-RT using Helical Tomotherapy for previously irradiated patients with unresectable locoregionally recurrent HNC may be a feasible treatment option with long-term survival and acceptable toxicities.

  5. Quality Assurance Analysis of a Large Multicenter Practice: Does Increased Complexity of Intensity-Modulated Radiotherapy Lead to Increased Error Frequency?

    International Nuclear Information System (INIS)

    Olson, Adam C.; Wegner, Rodney E.; Scicutella, Carol; Heron, Dwight E.; Greenberger, Joel S.; Huq, M. Saiful; Bednarz, Gregory; Flickinger, John C.

    2012-01-01

    Purpose: Error reduction is an important concern in clinical medicine. Intensity-modulated radiotherapy (IMRT) is an important advancement in radiation oncology that increases the complexity of treatment, potentially increasing the error risk. We studied the frequency and severity of errors in a large multicenter practice to ascertain the impact of quality improvement interventions over time, IMRT, and type of practice. Methods and Materials: We analyzed prospective data from three academic and 16 community practice sites with 24,775 courses of radiotherapy (9,210 IMRT courses and 15,565 non-IMRT) between January 2006 and December 2009. All IMRT treatment was performed using one centralized dose planning center for all sites. Results: We prospectively identified various errors or potential errors in 0.14 % vs. 0.40 % of the IMRT vs. non-IMRT courses (13/9,210 vs. 62/15,565, p = 0.0004) and excluding potential errors: 0.03 % for IMRT vs. 0.21% for non-IMRT. We developed the Clinical Radiotherapy Error Severity Scale (CRESS) to classify error severity from 1 to 10, with 1 to 3 for potential or completely correctable errors, 4 to 5 for dose variations 5%. Multivariate analyses of CRESS values, severity >4, and any error (including potential) correlated significantly reduced errors with IMRT (p = 0.0001–0.0024) but found no significant difference between the academic and community practice sites and no change in error frequency over time despite implementation of 39 system-wide policy changes by the centralized quality improvement committee. Conclusions: Despite the increase in complexity with IMRT compared with conventional radiotherapy, it can be delivered with reduced error frequency.

  6. Matched case-control study of quality of life and xerostomia after intensity-modulated radiotherapy or standard radiotherapy for head-and-neck cancer: Initial report

    International Nuclear Information System (INIS)

    Jabbari, Siavash; Kim, Hyungjin M.; Feng, Mary; Lin, Alexander; Tsien, Christina; Elshaikh, Mohamed; Terrel, Jeffrey E.; Murdoch-Kinch, Carol; Eisbruch, Avraham

    2005-01-01

    Purpose: To compare quality of life (QOL) and xerostomia between head-and-neck cancer patients who received standard radiotherapy (RT) and patients matched by factors known to affect QOL who received intensity-modulated RT (IMRT). Methods and Materials: This was a prospective, longitudinal study of patients with head-and-neck cancer requiring bilateral neck irradiation who received IMRT at the University of Michigan and patients who received standard RT at affiliated clinics. Each patient received a validated head-and-neck cancer-related QOL questionnaire (HNQOL) consisting of four multi-item domains-Eating, Communication, Pain, and Emotion-and a validated patient-reported xerostomia questionnaire (XQ). In both questionnaires, the answers were scored 0-100, with higher scores denoting worse QOL or xerostomia. The questionnaires were given before therapy and at 1, 3, 6, 12, 18, and 24 months after the completion of therapy. Each standard RT patient was matched with several IMRT patients according to tumor site, stage, RT status (postoperative or definitive), and age. A linear mixed-effects model was fit to compare outcomes between the two treatment groups and to model trends over time. To account for matching, the differences in scores between the matched sets of patients were fit as a random intercept. Also, matching was taken into account in the model by using the standard error of the within-paired-groups differences. Results: Between 1997 and 2002, 10 patients who had received standard RT and answered the XQ and HNQOL through at least 1 year were included in the study. Each of these patients was matched with a subgroup of 2-5 patients (median, 3) who had received IMRT, had similar patient and tumor characteristics, and answered the same questionnaires. A total of 30 patients were included in the IMRT group. During the initial months after therapy, the XQ and HNQOL summary scores worsened significantly in both groups compared with the pretherapy scores. Starting

  7. [Dynamic observation on the short-term change of xerostomia after intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma].

    Science.gov (United States)

    Li, Yanjie; Zhao, Changqing

    2015-01-01

    To dynamically analyze the change of xerostomia in patients with nasopharyngeal carcinoma after radiotherapy by DW MRI. Twenty-three nasopharyngeal carcinoma patients confirmed by pathology were enrolled. Male/Female: 19/4. The age was from 37 to 69 years. The patients were divided into two groups: G1, Dmeanxerostomia was assessed. SPSS 13.0 and SAS 8.2 software were used to analyze the data. At the end of IMRT, the change tendency of ADC in parotid and submandibular glands value was different in patients with different degree of xerostomia (F = 11.52, P xerostomia could be found in patients within different irradiation dose groups (Z = -3.622, P xerostomia for patients at the end of IMRT (Z value was -0.791, -0.949, 2.488, all P > 0.05). A significant difference of xerostomia degree in patients was found at the various follow-up time after IMRT (χ(2) = 19.59, P xerostomia in patients with nasopharyngeal carcinoma after radiotherapy. The degrees of salivary gland function and dry mouth in patients with nasopharyngeal carcinoma damage evaluate with illuminated dose increases. The function of salivary gland gradually restored and the degree of dry mouth gradually reduce with the extension of time after radiotherapy.

  8. Plasma uric acid and tumor volume are highly predictive of outcome in nasopharyngeal carcinoma patients receiving intensity modulated radiotherapy

    International Nuclear Information System (INIS)

    Lin, Hui; Lin, Huan-Xin; Ge, Nan; Wang, Hong-Zhi; Sun, Rui; Hu, Wei-Han

    2013-01-01

    The combined predictive value of plasma uric acid and primary tumor volume in nasopharyngeal carcinoma (NPC) patients receiving intensity modulated radiation therapy (IMRT) has not yet been determined. In this retrospective study, plasma uric acid level was measured after treatment in 130 histologically-proven NPC patients treated with IMRT. Tumor volume was calculated from treatment planning CT scans. Overall (OS), progression-free (PFS) and distant metastasis-free (DMFS) survival were compared using Kaplan-Meier analysis and the log rank test, and Cox multivariate and univariate regression models were created. Patients with a small tumor volume (<27 mL) had a significantly better DMFS, PFS and OS than patients with a large tumor volume. Patients with a high post-treatment plasma uric acid level (>301 μmol/L) had a better DMFS, PFS and OS than patients with a low post-treatment plasma uric acid level. Patients with a small tumor volume and high post-treatment plasma uric acid level had a favorable prognosis compared to patients with a large tumor volume and low post-treatment plasma uric acid level (7-year overall OS, 100% vs. 48.7%, P <0.001 and PFS, 100% vs. 69.5%, P <0.001). Post-treatment plasma uric acid level and pre-treatment tumor volume have predictive value for outcome in NPC patients receiving IMRT. NPC patients with a large tumor volume and low post-treatment plasma uric acid level may benefit from additional aggressive treatment after IMRT

  9. Kidney-Sparing Methods for Extended-Field Intensity-Modulated Radiotherapy (EF-IMRT) in Cervical Carcinoma Treatment.

    Science.gov (United States)

    Kunogi, Hiroaki; Yamaguchi, Nanae; Terao, Yasuhisa; Sasai, Keisuke

    2016-01-01

    Coplanar extended-field intensity-modulated radiation therapy (EF-IMRT) targeting the whole-pelvic and para-aortic lymph nodes in patients with advanced cervical cancer results in impaired creatinine clearance. An improvement in renal function cannot be expected unless low-dose (approximately 10 Gy) kidney exposure is reduced. The dosimetric method should be considered during EF-IMRT planning to further reduce low-dose exposure to the kidneys. To assess the usefulness of non-coplanar EF-IMRT with kidney-avoiding beams to spare the kidneys during cervical carcinoma treatment in dosimetric analysis between non-coplanar and coplanar EF-IMRT, we compared the doses of the target organ and organs at risk, including the kidney, in 10 consecutive patients. To estimate the influence of EFRT on renal dysfunction, creatinine clearance values after treatment were also examined in 18 consecutive patients. Of these 18 patients, 10 patients who were included in the dosimetric analysis underwent extended field radiation therapy (EFRT) with concurrent chemotherapy, and eight patients underwent whole-pelvis radiation therapy with concurrent chemotherapy to treat cervical carcinoma between April 2012 and March 2015 at our institution. In the dosimetric analysis, non-coplanar EF-IMRT was effective at reducing low-dose (approximately 10 Gy) exposure to the kidneys, thus maintaining target coverage and sparing other organs at risk, such as the small bowel, rectum, and bladder, compared with coplanar EF-IMRT. Renal function in all 10 patients who underwent EFRT, including coplanar EF-IMRT (with kidney irradiation), was low after treatment, and differed significantly from that of the eight patients who underwent WPRT (no kidney irradiation) 6 months after the first day of treatment (P = 0.005). In conclusion, non-coplanar EF-IMRT should be considered in patients with advanced cervical cancer, particularly in patients with a long life expectancy or with pre-existing renal dysfunction.

  10. Comparative analysis of volumetric-modulated arc therapy and intensity-modulated radiotherapy for base of tongue cancer

    Directory of Open Access Journals (Sweden)

    L Nithya

    2014-01-01

    Full Text Available The aim of this study was to compare the various dosimetric parameters of dynamic multileaf collimator (MLC intensity modulated radiation therapy (IMRT plans with volumetric modulated arc therapy (VMAT plans for base of tongue cases. All plans were done in Monaco planning system for Elekta synergy linear accelerator with 80 MLC. IMRT plans were planned with nine stationary beams, and VMAT plans were done for 360° arc with single arc or dual arc. The dose to the planning target volumes (PTV for 70, 63, and 56 Gy was compared. The dose to 95, 98, and 50% volume of PTV were analyzed. The homogeneity index (HI and the conformity index (CI of the PTV 70 were also analyzed. IMRT and VMAT plan showed similar dose coverage, HI, and CI. Maximum dose and dose to 1-cc volume of spinal cord, planning risk volume (PRV cord, and brain stem were compared. IMRT plan and VMAT plan showed similar results except for the 1 cc of PRV cord that received slightly higher dose in VMAT plan. Mean dose and dose to 50% volume of right and left parotid glands were analyzed. VMAT plan gave better sparing of parotid glands than IMRT. In normal tissue dose analyses VMAT was better than IMRT. The number of monitor units (MU required for delivering the good quality of the plan and the time required to deliver the plan for IMRT and VMAT were compared. The number of MUs for VMAT was higher than that of IMRT plans. However, the delivery time was reduced by a factor of two for VMAT compared with IMRT. VMAT plans yielded good quality of the plan compared with IMRT, resulting in reduced treatment time and improved efficiency for base of tongue cases.

  11. Hemithoracic intensity-modulated radiotherapy using helical tomotherapy for patients after extrapleural pneumonectomy for malignant pleural mesothelioma

    International Nuclear Information System (INIS)

    Ebara, Takeshi; Kawamura, Hidemasa; Kaminuma, Takuya

    2012-01-01

    Postoperative hemithoracic irradiation is regarded as an important part of the curative treatment for resectable malignant pleural mesothelioma (MPM). Because the clinical target volume in postoperative MPM is irregular and surrounded by dose-limiting critical structures, intensity-modulated radiation therapy (IMRT) is thought to be suitable. However, postoperative hemithoracic IMRT remains experimental due to a high incidence of fatal pneumonitis. Therefore, a Phase I dose escalation study for hemithoracic IMRT using helical tomotherapy was planned, and the results of the first three patients are herein reported because this technique may provide benefits to such patients. For 3 patients with postoperative MPM, who were treated by extrapleural pneumonectomy (EPP), a radiation dose of 45.0 Gy in 25 fractions was given to cover 95% of the PTV. The lung V5s of the three patients were 14.3%, 10.0%, and 31.3%, respectively. The V5s of the present plans was smaller than that of the recent IMRT planning studies. The lung V20s of these patients were 2.4%, 2.2%, and 4.3%, respectively. Their MLDs were 4.3 Gy, 3.4 Gy, and 5.8 Gy, respectively. The follow-up periods of the patients were 26, 14 and 9 months from initiation of IMRT, respectively. All patients were alive, although local and contralateral recurrences had developed in 1 patient. Only 1 patient had Grade 2 acute esophagitis and nausea. There was no treatment-related pneumonitis. Hemithoracic IMRT using helical tomotherapy may play a crucial role in adjuvant treatment for MPM after EPP. (author)

  12. The risk of secondary cancer in nasopharyngeal carcinoma paediatric patients due to intensity modulated radiotherapy and mega-voltage cone beam computed tomography.

    Science.gov (United States)

    Sherif, Reham S; Attalla, Ehab M; Elshemey, Wael M; Madian, Noha G

    2017-06-01

    There is a growing interest in the study of radiation-induced secondary cancer. The aim of this work is (i) to estimate the peripheral doses attributable to intensity modulated radiotherapy (IMRT) and mega-voltage cone beam computed tomography (MV-CBCT) for some organs at risk (OARs) which surround the target being treated (Nasopharynx) in paediatric patients. (ii) To estimate the risk of radiation-induced secondary cancers attributable to patient setup verification imaging dose using MV-CBCT for Nasopharyngeal Carcinoma (NPC) in paediatric patients and comparing it with that attributable to the therapeutic dose using IMRT. Intensity modulated radiotherapy treatment planning of 10 NPC paediatric patients was carried out on KonRad release 2.2.23. The additional radiation doses to the patients attributable to MV-CBCT were calculated also using Xio Version 4.4. A paediatric phantom and thermoluminescent dosimeters (TLDs) were used to measure the patient doses attributable to IMRT. These doses were then compared with the calculated doses. The risk of induced secondary cancers attributable to IMRT and MV-CBCT was calculated and compared to each other. The absorbed doses (mean dose) for the OARs (Brain, Brain stem, spinal cord, thyroid, oesophagus, mandible, heart, optic nerve, lung and eye) were higher for the therapeutic dose than for the imaging dose used in the verification of patient position before and during the treatment. The risk of induced secondary cancers in thyroid, oesophagus and lung (the only organs from the OARs which have tabulated values for risk calculations) was higher for therapeutic dose (7.29 ± 0.73%, 2.62 ± 0.17% and 6.76 ± 0.87%, respectively) than for verification imaging dose (0.14 ± 0.00%, 0.06 ± 0.00%, 0.10 ± 0.03% respectively). The risk of secondary cancers attributable to verification imaging dose using MV-CBCT is very small compared to therapeutic dose using IMRT. Therefore, it is important to focus on the risk of

  13. Impact of gantry rotation time on plan quality and dosimetric verification. Volumetric modulated arc therapy (VMAT) vs. intensity modulated radiotherapy (IMRT)

    International Nuclear Information System (INIS)

    Pasler, Marlies; Wirtz, Holger; Lutterbach, Johannes

    2011-01-01

    To compare plan quality criteria and dosimetric accuracy of step-and-shoot intensity-modulated radiotherapy (ss-IMRT) and volumetric modulated arc radiotherapy (VMAT) using two different gantry rotation times. This retrospective planning study based on 20 patients was comprised of 10 prostate cancer (PC) and 10 head and neck (HN) cancer cases. Each plan contained two target volumes: a primary planning target volume (PTV) and a boost volume. For each patient, one ss-IMRT plan and two VMAT plans at 90 s (VMAT90) and 120 s (VMAT120) per arc were generated with the Pinnacle copyright planning system. Two arcs were provided for the PTV plans and a single arc for boost volumes. Dosimetric verification of the plans was performed using a 2D ionization chamber array placed in a full scatter phantom. VMAT reduced delivery time and monitor units for both treatment sites compared to IMRT. VMAT120 vs. VMAT90 increased delivery time and monitor units in PC plans without improving plan quality. For HN cases, VMAT120 provided comparable organs at risk sparing and better target coverage and conformity than VMAT90. In the VMAT plan verification, an average of 97.1% of the detector points passed the 3 mm, 3% γ criterion, while in IMRT verification it was 98.8%. VMAT90, VMAT120, and IMRT achieved comparable treatment plans. Slower gantry movement in VMAT120 plans only improves dosimetric quality for highly complex targets.

  14. Qualitative risk analysis in the process of treatment in radiation oncology for the steps performed by the technician/technologist in intensity modulated radiotherapy (lMRT)

    International Nuclear Information System (INIS)

    Teixeira, Flavia C.S.; Faria, Alessandra L.; Pereira, Danielle P.S.; Silva, Fabiana M.I.

    2013-01-01

    The efficacy of radiation therapy is to eradicate the tumor while preserving the integrity of normal tissues. Technological advances have allowed to develop techniques capable of modulating doses delivered to the target volume, providing more effective treatments. However, the operational complexity of these techniques makes the benefits offered are directly proportional to the chances of occurrences of serious errors. The objective of this work is to analyze the steps performed by the technician/technologist in Intensity Modulated Radiotherapy (IMRT), to detect possible errors in order to determine ways to mitigate them. After literature regarding errors in the radiation therapy, a prospective analysis was performed in the first half of 2012 in a radiation clinic located in the city of Rio de Janeiro, in which 11 technicians/technologists contributed to the survey data analysis. The method of risk analysis Failure Mode and Effects Analysis was used for prospective analysis of accidents/incidents, with respect to a qualitative assessment . The method allowed mapping 16 steps performed by technicians/technologists in the treatments with IMRT, identifying possible failures and their causes allowing to find ways to avoid possible errors. This analysis helped to confirm that the qualification and continuing education of technicians/technologists, allied to implement quality assurance programs and a computerized management can make a tool capable of IMRT to achieve the greatest challenge of radiotherapy. (author)

  15. Prospective investigation and literature review of tolerance dose on salivary glands using quantitative salivary gland scintigraphy in the intensity-modulated radiotherapy era.

    Science.gov (United States)

    Lee, Sea-Won; Kang, Keon Wook; Wu, Hong-Gyun

    2016-04-01

    The purpose of this study was to prospectively evaluate the scintigraphic results on patients who undergo intensity-modulated radiotherapy (IMRT) to investigate the tolerance doses for the salivary glands. Salivary scintigraphy was performed on 35 patients with head and neck cancer before the beginning of radiotherapy (RT), and then at 6 weeks and again at 3 months after the completion of RT. Xerostomia was recorded according to the Radiation Therapy and Oncology Group (RTOG) grade. Salivary function was evaluated by calculating the excretion rate changes (ΔF) for each salivary gland before and after RT. The parotid mean dose was significantly related to parotid ΔF and the submandibular gland mean dose to the submandibular gland ΔF. The parotid mean dose of 23 Gy was best correlated with the RTOG grades. The submandibular gland mean dose significantly related to ΔF ≤-50% and ≤-75% was 42 Gy. The parotid mean dose of 23 Gy and the submandibular gland mean dose of 42 Gy is feasible for salivary function preservation in the IMRT era. © 2016 Wiley Periodicals, Inc. Head Neck 38: E1746-E1755, 2016. © 2016 Wiley Periodicals, Inc.

  16. Definitive intensity-modulated radiotherapy concurrent with systemic therapy for oropharyngeal squamous cell carcinoma: Outcomes from an integrated regional Australian cancer centre

    International Nuclear Information System (INIS)

    Rahbari, Reza M.; McKay, Michael; Dwyer, Patrick; Winkley, Lauren; Hill, Jacques; Last, Andrew; Tahir, Abdul R.M.; Shakespeare, Thomas P.

    2016-01-01

    Oropharyngeal squamous cell carcinoma (OPSCC) incidence has increased over the past two decades largely because of an increase in human papilloma virus (HPV)-related OPSCC. We report here outcomes of definitive radiation therapy for OPSCC with simultaneous integrated boost intensity-modulated radiotherapy (IMRT) in a regional Australian cancer centre. We retrospectively reviewed electronic medical records (EMR) of all patients treated with IMRT for head and neck cancer. We included patients who received a curative intent IMRT for OPSCC (2010–2014). Of 61 patients, 80% were men, and the median age was 57 years. Ninety percent of our patients received concurrent systemic therapy, and 68% were p16 positive. The median radiotherapy dose received was 70 Gy in 35 fractions. The median follow up for surviving patients was 22 months. Twenty-four month actuarial data show that the loco-regional recurrence free, metastasis-free MFS, cancer-specific (CaSS) and overall survival percentages were 98.3%, 92.6%, 91% and 90.3%, respectively. We did not observe grades 4 or 5 acute or late toxicities, and 10 patients (16.2%) exhibited persistent grade 3 toxicity 6 months after completing the treatment. The results from curative IMRTs for OPSCC delivered in a regional cancer centre are comparable with results published by tertiary referral centres. A long-term follow up of this patient cohort will continue for further analyses and comparisons with tertiary centres.

  17. SU-E-P-58: Dosimetric Study of Conventional Intensity-Modulated Radiotherapy and Knowledge-Based Radiation Therapy for Postoperation of Cervix Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ma, C; Yin, Y [Shandong Tumor Hospital, Jinan, Shandong Provice (China)

    2015-06-15

    Purpose: To compare the dosimetric difference of the target volume and organs at risk(OARs) between conventional intensity-modulated radiotherapy(C-IMRT) and knowledge-based radiation therapy (KBRT) plans for cervix cancer. Methods: 39 patients with cervical cancer after surgery were randomly selected, 20 patient plans were used to create the model, the other 19 cases used for comparative evaluation. All plans were designed in Eclipse system. The prescription dose was 30.6Gy, 17 fractions, OARs dose satisfied to the clinical requirement. A paired t test was used to evaluate the differences of dose-volume histograms (DVH). Results: Comparaed to C-IMRT plan, the KBRT plan target can achieve the similar target dose coverage, D98,D95,D2,HI and CI had no difference (P≥0.05). The dose of rectum, bladder and femoral heads had no significant differences(P≥0.05). The time was used to design treatment plan was significant reduced. Conclusion: This study shows that postoperative radiotherapy of cervical KBRT plans can achieve the similar target and OARs dose, but the shorter designing time.

  18. Impact of gantry rotation time on plan quality and dosimetric verification. Volumetric modulated arc therapy (VMAT) vs. intensity modulated radiotherapy (IMRT)

    Energy Technology Data Exchange (ETDEWEB)

    Pasler, Marlies; Wirtz, Holger; Lutterbach, Johannes [Gemeinschaftspraxis fuer Strahlentherapie Singen-Friedrichshafen, Singen (Germany)

    2011-12-15

    To compare plan quality criteria and dosimetric accuracy of step-and-shoot intensity-modulated radiotherapy (ss-IMRT) and volumetric modulated arc radiotherapy (VMAT) using two different gantry rotation times. This retrospective planning study based on 20 patients was comprised of 10 prostate cancer (PC) and 10 head and neck (HN) cancer cases. Each plan contained two target volumes: a primary planning target volume (PTV) and a boost volume. For each patient, one ss-IMRT plan and two VMAT plans at 90 s (VMAT90) and 120 s (VMAT120) per arc were generated with the Pinnacle {sup copyright} planning system. Two arcs were provided for the PTV plans and a single arc for boost volumes. Dosimetric verification of the plans was performed using a 2D ionization chamber array placed in a full scatter phantom. VMAT reduced delivery time and monitor units for both treatment sites compared to IMRT. VMAT120 vs. VMAT90 increased delivery time and monitor units in PC plans without improving plan quality. For HN cases, VMAT120 provided comparable organs at risk sparing and better target coverage and conformity than VMAT90. In the VMAT plan verification, an average of 97.1% of the detector points passed the 3 mm, 3% {gamma} criterion, while in IMRT verification it was 98.8%. VMAT90, VMAT120, and IMRT achieved comparable treatment plans. Slower gantry movement in VMAT120 plans only improves dosimetric quality for highly complex targets.

  19. Utilization of intensity modulated beam radiotherapy (IMBXRT) to diminish dose to the parotid gland in head and neck cancer

    International Nuclear Information System (INIS)

    Shiao, W. Woo; Grant, Walter H.; Butler, E. Brian

    1996-01-01

    Purpose/Objective: To determine if intensity conformal modulated radiotherapy could diminish the radiation dose to the parotid gland in the treatment of primary head and neck cancer. Materials and Methods: The NOMOS Peacock treatment system was utilized in the planning and delivery of conformal radiotherapy for the following diseases: 1) an oropharyngeal cancer that extends from the soft palate to the tonsillar fossa without nodal disease, 2) laryngeal hypopharyngeal cancer without nodal disease, 3) and adenocystic carcinoma, that originated in the hard palate. Patients were treated to areas suspicious for microscopic disease (nodal disease in 1 and 2, perineural spread in 3) at 2 Gy per fraction for a tc of 50 Gy in five weeks. The primary disease was treated at 2.4 Gy per fraction for a total of 60 Gy over five weeks. The percent of the volume of each parotid gland receiving < 20 Gy, <25 Gy and <30 Gy retrospectively was determined for each of the above mentioned optimized plans. The patients were observed for the clinical development of xerostomia. Results: No patient developed clinically apparent xerostomia within one month of completion of radiotherapy. Conclusion: IMBXRT could reduce the volume to parotid glands receiving high radiation doses. Sparing of the parotid glands appear to be most easily accomplished when irradiating head and neck tumors that do not require regional nodal treatment. For head and neck cancer that requires nodal treatment it is possible to spare a significant portion of the parotid glands if the disease originates below the hyoid bone where the primary site is not in close proximity to the parotid glands. Objective salivary flow data are being obtained pre ar post treatment, to confirm the subjective impression of lack of clinical xerostomia. IMBXRT is potentially beneficial in decreasing the morbidity of xerostomia related to head and neck irradiation

  20. Conformal radiotherapy with intensity modulation and integrated boost in the head and neck cancers: experience of the Curie Institute

    International Nuclear Information System (INIS)

    Toledano, I.; Serre, A.; Bensadoun, R.J.; Ortholan, C.; Racadot, S.; Calais, G.; Alfonsi, M.; Giraud, P.; Graff, P.; Serre, A.; Bensadoun, R.J.; Ortholan, C.; Racadot, S.; Calais, G.; Alfonsi, M.; Giraud, P.

    2009-01-01

    The modulated intensity radiotherapy (I.M.R.T.) is used in the treatment of cancers in superior aero digestive tracts to reduce the irradiation of parotids and to reduce the delayed xerostomia. This retrospective study presents the results got on the fourteen first patients according an original technique of I.M.R.T. with integrated boost. It appears that this technique is feasible and allows to reduce the xerostomia rate without modifying the local control rate. To limit the average dose to the parotids under 30 Gy seems reduce the incidence of severe xerostomia. (N.C.)

  1. SU-E-T-483: In Vivo Dosimetry of Conventional and Rotational Intensity Modulated Radiotherapy Using Integral Quality Monitor (IQM)

    Energy Technology Data Exchange (ETDEWEB)

    Lin, L; Qian, J; Gonzales, R; Keck, J; Armour, E; Wong, J [Johns Hopkins University, Baltimore, MD (United States)

    2015-06-15

    Purpose: To investigate the accuracy, sensitivity and constancy of integral quality monitor (IQM), a new system for in vivo dosimetry of conventional intensity modulated radiation therapy (IMRT) or rotational volumetric modulated arc therapy (VMAT) Methods: A beta-version IQM system was commissioned on an Elekta Infinity LINAC equipped with 160-MLCs Agility head. The stationary and rotational dosimetric constancy of IQM was evaluated, using five-field IMRT and single-or double-arc VMAT plans for prostate and head-and-neck (H&N) patients. The plans were delivered three times over three days to assess the constancy of IQM response. Picket fence (PF) fields were used to evaluate the sensitivity of detecting MLC leaf errors. A single leaf offset was intentionally introduced during delivery of various PF fields with segment apertures of 3×1, 5×1, 10×1, and 24×1cm2. Both 2mm and 5mm decrease in the field width were used. Results: Repeated IQM measurements of prostate and H&N IMRT deliveries showed 0.4 and 0.5% average standard deviation (SD) for segment-by-segment comparison and 0.1 and 0.2% for cumulative comparison. The corresponding SDs for VMAT deliveries were 6.5, 9.4% and 0.7, 1.3%, respectively. Statistical analysis indicates that the dosimetric differences detected by IQM were significant (p < 0.05) in all PF test deliveries. The largest average IQM signal response of a 2 mm leaf error was found to be 2.1% and 5.1% by a 5mm leaf error for 3×1 cm2 field size. The same error in 24×1 cm2 generates a 0.7% and 1.4% difference in the signal. Conclusion: IQM provides an effective means for real-time dosimetric verification of IMRT/ VMAT treatment delivery. For VMAT delivery, the cumulative dosimetry of IQM needs to be used in clinical practice.

  2. Dosimetric benefit of DMLC tracking for conventional and sub-volume boosted prostate intensity-modulated arc radiotherapy

    Science.gov (United States)

    Pommer, Tobias; Falk, Marianne; Poulsen, Per R.; Keall, Paul J.; O'Brien, Ricky T.; Meidahl Petersen, Peter; Rosenschöld, Per Munck af

    2013-04-01

    This study investigated the dosimetric impact of uncompensated motion and motion compensation with dynamic multileaf collimator (DMLC) tracking for prostate intensity modulated arc therapy. Two treatment approaches were investigated; a conventional approach with a uniform radiation dose to the target volume and an intraprostatic lesion (IPL) boosted approach with an increased dose to a subvolume of the prostate. The impact on plan quality of optimizations with a leaf position constraint, which limited the distance between neighbouring adjacent MLC leaves, was also investigated. Deliveries were done with and without DMLC tracking on a linear acceleration with a high-resolution MLC. A cylindrical phantom containing two orthogonal diode arrays was used for dosimetry. A motion platform reproduced six patient-derived prostate motion traces, with the average displacement ranging from 1.0 to 8.9 mm during the first 75 s. A research DMLC tracking system was used for real-time motion compensation with optical monitoring for position input. The gamma index was used for evaluation, with measurements with a static phantom or the planned dose as reference, using 2% and 2 mm gamma criteria. The average pass rate with DMLC tracking was 99.9% (range 98.7-100%, measurement as reference), whereas the pass rate for untracked deliveries decreased distinctly as the average displacement increased, with an average pass rate of 61.3% (range 32.7-99.3%). Dose-volume histograms showed that DMLC tracking maintained the planned dose distributions in the presence of motion whereas traces with >3 mm average displacement caused clear plan degradation for untracked deliveries. The dose to the rectum and bladder had an evident dependence on the motion direction and amplitude for untracked deliveries, and the dose to the rectum was slightly increased for IPL boosted plans compared to conventional plans for anterior motion with large amplitude. In conclusion, optimization using a leaf position

  3. Prospective assessment of the quality of life before, during and after image guided intensity modulated radiotherapy for prostate cancer

    DEFF Research Database (Denmark)

    Sveistrup, Joen; Mortensen, Ole Steen; Bjørner, Jakob B.

    2016-01-01

    BACKGROUND: Radiotherapy (RT) in combination with androgen deprivation therapy (ADT) for prostate cancer (PCa) carries a risk of gastrointestinal (GI) and genitourinary toxicity, which might affect the quality of life (QoL). The purpose of this study was to assess the QoL in patients with PCa...... before, during and after radiotherapy (RT) and to compare the QoL 1 year after RT to a normal population. METHODS: The QoL was evaluated prospectively by the self-administered questionnaire SF-36 in 87 patients with PCa. The SF-36 was completed before RT (baseline), at start of RT, at end of RT and 1...... year after RT. A mixed model analysis was used to determine the changes in QoL at each time point compared to baseline. The patients' QoL 1 year after RT was compared to a normal population consisting of 462 reference subjects matched on age and education. RESULTS: One year after RT, patients reported...

  4. Five-year Results of Whole Breast Intensity Modulated Radiation Therapy for the Treatment of Early Stage Breast Cancer: The Fox Chase Cancer Center Experience

    Energy Technology Data Exchange (ETDEWEB)

    Keller, Lanea M.M., E-mail: Lanea.Keller@fccc.edu [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Sopka, Dennis M. [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Li Tianyu [Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA (United States); Klayton, Tracy; Li Jinsheng; Anderson, Penny R. [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Bleicher, Richard J.; Sigurdson, Elin R. [Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Freedman, Gary M. [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA (United States)

    2012-11-15

    Purpose: To report the 5-year outcomes using whole-breast intensity-modulated radiation therapy (IMRT) for the treatment of early-stage-breast cancer at the Fox Chase Cancer Center. Methods and Materials: A total of 946 women with early-stage breast cancer (stage 0, I, or II) were treated with IMRT after surgery with or without systemic therapy from 2003-2010. Whole-breast radiation was delivered via an IMRT technique with a median whole-breast radiation dose of 46 Gy and median tumor bed boost of 14 Gy. Endpoints included local-regional recurrence, cosmesis, and late complications. Results: With a median follow-up of 31 months (range, 1-97 months), there were 12 ipsilateral breast tumor recurrences (IBTR) and one locoregional recurrence. The 5-year actuarial IBTR and locoregional recurrence rates were 2.0% and 2.4%. Physician-reported cosmestic outcomes were available for 645 patients: 63% were considered 'excellent', 33% 'good', and <1.5% 'fair/poor'. For physician-reported cosmesis, boost doses {>=}16 Gy, breast size >900 cc, or boost volumes >34 cc were significantly associated with a 'fair/poor' cosmetic outcome. Fibrosis, edema, erythema, and telangectasia were also associated with 'fair/poor' physician-reported cosmesis; erythema and telangectasia remained significant on multivariate analysis. Patient-reported cosmesis was available for 548 patients, and 33%, 50%, and 17% of patients reported 'excellent', 'good', and 'fair/poor' cosmesis, respectively. The use of a boost and increased boost volume: breast volume ratio were significantly associated with 'fair/poor' outcomes. No parameter for patient-reported cosmesis was significant on multivariate analysis. The chances of experiencing a treatment related effect was significantly associated with a boost dose {>=}16 Gy, receipt of chemotherapy and endocrine therapy, large breast size, and electron boost energy

  5. Intensity modulated radiotherapy as neoadjuvant chemoradiation for the treatment of patients with locally advanced pancreatic cancer. Outcome analysis and comparison with a 3D-treated patient cohort

    Energy Technology Data Exchange (ETDEWEB)

    Combs, S.E.; Habermehl, D.; Kessel, K.; Brecht, I. [Univ. Hospital of Heidelberg (Germany). Dept. of Radiation Oncology; Bergmann, F.; Schirmacher, P. [Univ. Hospital of Heidelberg (Germany). Dept. of Pathology; Werner, J.; Buechler, M.W. [Univ. Hospital of Heidelberg (Germany). Dept. of Surgery; Jaeger, D. [National Center for Tumor Diseases (NCT), Heidelberg (Germany); Debus, J. [Univ. Hospital of Heidelberg (Germany). Dept. of Radiation Oncology; Deutsches Krebsforschungszentrum (DKFZ), Heidelberg (Germany). Clinical Cooperation Unit Radiation Oncology

    2013-09-15

    Background: To evaluate outcome after intensity modulated radiotherapy (IMRT) compared to 3D conformal radiotherapy (3D-RT) as neoadjuvant treatment in patients with locally advanced pancreatic cancer (LAPC). Materials and methods: In total, 57 patients with LAPC were treated with IMRT and chemotherapy. A median total dose of 45 Gy to the PTV {sub baseplan} and 54 Gy to the PTV {sub boost} in single doses of 1.8 Gy for the PTV {sub baseplan} and median single doses of 2.2 Gy in the PTV {sub boost} were applied. Outcomes were evaluated and compared to a large cohort of patients treated with 3D-RT. Results: Overall treatment was well tolerated in all patients and IMRT could be completed without interruptions. Median overall survival was 11 months (range 5-37.5 months). Actuarial overall survival at 12 and 24 months was 36 % and 8 %, respectively. A significant impact on overall survival could only be observed for a decrease in CA 19-9 during treatment, patients with less pre-treatment CA 19-9 than the median, as well as weight loss during treatment. Local progression-free survival was 79 % after 6 months, 39 % after 12 months, and 13 % after 24 months. No factors significantly influencing local progression-free survival could be identified. There was no difference in overall and progression-free survival between 3D-RT and IMRT. Secondary resectability was similar in both groups (26 % vs. 28 %). Toxicity was comparable and consisted mainly of hematological toxicity due to chemotherapy. Conclusion: IMRT leads to a comparable outcome compared to 3D-RT in patients with LAPC. In the future, the improved dose distribution, as well as advances in image-guided radiotherapy (IGRT) techniques, may improve the use of IMRT in local dose escalation strategies to potentially improve outcome. (orig.)

  6. Clinical results of conformal versus intensity-modulated radiotherapy using a focal simultaneous boost for muscle-invasive bladder cancer in elderly or medically unfit patients

    International Nuclear Information System (INIS)

    Lutkenhaus, Lotte J.; Os, Rob M. van; Bel, Arjan; Hulshof, Maarten C. C. M.

    2016-01-01

    For elderly or medically unfit patients with muscle-invasive bladder cancer, cystectomy or chemotherapy are contraindicated. This leaves radical radiotherapy as the only treatment option. It was the aim of this study to retrospectively analyze the treatment outcome and associated toxicity of conformal versus intensity-modulated radiotherapy (IMRT) using a focal simultaneous tumor boost for muscle-invasive bladder cancer in patients not suitable for cystectomy. One hundred eighteen patients with T2-4 N0-1 M0 bladder cancer were analyzed retrospectively. Median age was 80 years. Treatment consisted of either a conformal box technique or IMRT and included a simultaneous boost to the tumor. To enable an accurate boost delivery, fiducial markers were placed around the tumor. Patients were treated with 40 Gy in 20 fractions to the elective treatment volumes, and a daily tumor boost up to 55–60 Gy. Clinical complete response was seen in 87 % of patients. Three-year overall survival was 44 %, with a locoregional control rate of 73 % at 3 years. Toxicity was low, with late urinary and intestinal toxicity rates grade ≥ 2 of 14 and 5 %, respectively. The use of IMRT reduced late intestinal toxicity, whereas fiducial markers reduced acute urinary toxicity. Radical radiotherapy using a focal boost is feasible and effective for elderly or unfit patients, with a 3-year locoregional control of 73 %. Toxicity rates were low, and were reduced by the use of IMRT and fiducial markers. The online version of this article (doi:10.1186/s13014-016-0618-6) contains supplementary material, which is available to authorized users

  7. Late xerostomia after intensity-modulated conformational radiotherapy of upper aero-digestive tract cancers: study 2004-03 by the head and neck oncology and radiotherapy Group (Gortec)

    International Nuclear Information System (INIS)

    Toledano, I.; Lapeyre, M.; Graff, P.; Serre, C.; Bensadoun, R.J.; Bensadoun, R.J.; Ortholan, C.; Calais, G.; Alfonsi, M.; Giraud, P.; Racadot, S.

    2010-01-01

    The authors report a retrospective assessment of late xerostomia according to the RTOG (Radiation Therapy Oncology Group) classification of the European Organization for Research and Treatment of Cancer (EORTC) among patients treated by intensity-modulated conformational radiotherapy (IMRT) and suffering from upper aero-digestive tract carcinomas of different stages. Some of these patients have bee operated, and some have been treated by chemotherapy. It appears that the IMRT results in a reduction of late xerostomia, and even in an absence of salivary toxicity. Short communication

  8. Dose-Escalated Hypofractionated Intensity-Modulated Radiotherapy in High-Risk Carcinoma of the Prostate: Outcome and Late Toxicity

    Directory of Open Access Journals (Sweden)

    David Thomson

    2012-01-01

    Results. Median followup was 84 months. Five-year overall survival (OS was 83% and biochemical progression-free survival (bPFS was 50% for 57 Gy. Five-year OS was 75% and bPFS 58% for 60 Gy. At 7 years, toxicity by RTOG criteria was acceptable with no grade 3 or above toxicity. Compared with baseline, there was no significant change in urinary symptoms at 2 or 7 years. Bowel symptoms were stable between 2 and 7 years. All patients continued to have significant sexual dysfunction. Conclusion. In high-risk prostate cancer, dose-escalated hypofractionated radiotherapy using IMRT results in encouraging outcomes and acceptable late toxicity.

  9. Prospective assessment of the quality of life before, during and after image guided intensity modulated radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Sveistrup, Joen; Mortensen, Ole Steen; Bjørner, Jakob B; Engelholm, Svend Aage; Munck af Rosenschöld, Per; Petersen, Peter Meidahl

    2016-01-01

    Radiotherapy (RT) in combination with androgen deprivation therapy (ADT) for prostate cancer (PCa) carries a risk of gastrointestinal (GI) and genitourinary toxicity, which might affect the quality of life (QoL). The purpose of this study was to assess the QoL in patients with PCa before, during and after radiotherapy (RT) and to compare the QoL 1 year after RT to a normal population. The QoL was evaluated prospectively by the self-administered questionnaire SF-36 in 87 patients with PCa. The SF-36 was completed before RT (baseline), at start of RT, at end of RT and 1 year after RT. A mixed model analysis was used to determine the changes in QoL at each time point compared to baseline. The patients’ QoL 1 year after RT was compared to a normal population consisting of 462 reference subjects matched on age and education. One year after RT, patients reported significantly less pain and significantly fewer limitations due to their physical health compared to baseline. Compared to the normal population, patients reported significantly less pain 1 year after RT. However, patients also reported significantly less vitality, worse mental health as well as significantly more limitations due to physical and mental health 1 year after RT compared to the normal population. In this study, patients with PCa did not experience significant impairment in the QoL 1 year after RT compared to baseline. However, patients reported significantly worse mental health before, during and 1 year after RT compared to the normal population

  10. Five-year Results of Whole Breast Intensity Modulated Radiation Therapy for the Treatment of Early Stage Breast Cancer: The Fox Chase Cancer Center Experience

    International Nuclear Information System (INIS)

    Keller, Lanea M.M.; Sopka, Dennis M.; Li Tianyu; Klayton, Tracy; Li Jinsheng; Anderson, Penny R.; Bleicher, Richard J.; Sigurdson, Elin R.; Freedman, Gary M.

    2012-01-01

    Purpose: To report the 5-year outcomes using whole-breast intensity-modulated radiation therapy (IMRT) for the treatment of early-stage-breast cancer at the Fox Chase Cancer Center. Methods and Materials: A total of 946 women with early-stage breast cancer (stage 0, I, or II) were treated with IMRT after surgery with or without systemic therapy from 2003-2010. Whole-breast radiation was delivered via an IMRT technique with a median whole-breast radiation dose of 46 Gy and median tumor bed boost of 14 Gy. Endpoints included local-regional recurrence, cosmesis, and late complications. Results: With a median follow-up of 31 months (range, 1-97 months), there were 12 ipsilateral breast tumor recurrences (IBTR) and one locoregional recurrence. The 5-year actuarial IBTR and locoregional recurrence rates were 2.0% and 2.4%. Physician-reported cosmestic outcomes were available for 645 patients: 63% were considered “excellent”, 33% “good”, and 900 cc, or boost volumes >34 cc were significantly associated with a “fair/poor” cosmetic outcome. Fibrosis, edema, erythema, and telangectasia were also associated with “fair/poor” physician-reported cosmesis; erythema and telangectasia remained significant on multivariate analysis. Patient-reported cosmesis was available for 548 patients, and 33%, 50%, and 17% of patients reported “excellent”, “good”, and “fair/poor” cosmesis, respectively. The use of a boost and increased boost volume: breast volume ratio were significantly associated with “fair/poor” outcomes. No parameter for patient-reported cosmesis was significant on multivariate analysis. The chances of experiencing a treatment related effect was significantly associated with a boost dose ≥16 Gy, receipt of chemotherapy and endocrine therapy, large breast size, and electron boost energy. Conclusions: Whole-breast IMRT is associated with very low rates of local recurrence at 5 years, 83%-98% “good/excellent” cosmetic outcomes, and minimal

  11. Helical tomo-therapy in the anal canal cancer: dosimetric comparison with conformal radiotherapy with intensity modulation and classical conformal radiotherapy

    International Nuclear Information System (INIS)

    Ozsahin, M.; Ugurluer, G.; Ballerini, G.; Letenneur, G.; Zouhair, A.; Mirimanoff, R.O.

    2009-01-01

    A dosimetry comparison was made between helical tomo-therapy, I.M.R.T. and classical conformal three dimensional radiotherapy for twelve first patients that received a image guided radiotherapy, the toxicity was tackled with a minimum follow-up of fourteen months. In conclusion, the CT-guided radiotherapy allows to save organs at risks superior to I.M.R.T. and conformal radiotherapy and a best homogeneity in the target volume. the toxicity is moderated and the break time is limited. (N.C.)

  12. Image-guided intensity-modulated radiotherapy for prostate cancer: Dose constraints for the anterior rectal wall to minimize rectal toxicity

    International Nuclear Information System (INIS)

    Peterson, Jennifer L.; Buskirk, Steven J.; Heckman, Michael G.; Diehl, Nancy N.; Bernard, Johnny R.; Tzou, Katherine S.; Casale, Henry E.; Bellefontaine, Louis P.; Serago, Christopher; Kim, Siyong; Vallow, Laura A.; Daugherty, Larry C.; Ko, Stephen J.

    2014-01-01

    Rectal adverse events (AEs) are a major concern with definitive radiotherapy (RT) treatment for prostate cancer. The anterior rectal wall is at the greatest risk of injury as it lies closest to the target volume and receives the highest dose of RT. This study evaluated the absolute volume of anterior rectal wall receiving a high dose to identify potential ideal dose constraints that can minimize rectal AEs. A total of 111 consecutive patients with Stage T1c to T3a N0 M0 prostate cancer who underwent image-guided intensity-modulated RT at our institution were included. AEs were graded according to the Common Terminology Criteria for Adverse Events, version 4.0. The volume of anterior rectal wall receiving 5 to 80 Gy in 2.5-Gy increments was determined. Multivariable Cox regression models were used to identify cut points in these volumes that led to an increased risk of early and late rectal AEs. Early AEs occurred in most patients (88%); however, relatively few of them (13%) were grade ≥2. At 5 years, the cumulative incidence of late rectal AEs was 37%, with only 5% being grade ≥2. For almost all RT doses, we identified a threshold of irradiated absolute volume of anterior rectal wall above which there was at least a trend toward a significantly higher rate of AEs. Most strikingly, patients with more than 1.29, 0.73, or 0.45 cm 3 of anterior rectal wall exposed to radiation doses of 67.5, 70, or 72.5 Gy, respectively, had a significantly increased risk of late AEs (relative risks [RR]: 2.18 to 2.72; p ≤ 0.041) and of grade ≥ 2 early AEs (RR: 6.36 to 6.48; p = 0.004). Our study provides evidence that definitive image-guided intensity-modulated radiotherapy (IG-IMRT) for prostate cancer is well tolerated and also identifies dose thresholds for the absolute volume of anterior rectal wall above which patients are at greater risk of early and late complications

  13. Pretreatment combination of platelet counts and neutrophil–lymphocyte ratio predicts survival of nasopharyngeal cancer patients receiving intensity-modulated radiotherapy

    Directory of Open Access Journals (Sweden)

    Lin YH

    2017-05-01

    Full Text Available Yu-Hsuan Lin,1 Kuo-Ping Chang,2 Yaoh-Shiang Lin,2,3 Ting-Shou Chang2–4 1Department of Otolaryngology, Head and Neck Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 2Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, 3Department of Otolaryngology, Head and Neck Surgery, National Defense Medical Center, Taipei, 4Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China Background: Increased cancer-related inflammation has been associated with unfavorable clinical outcomes. The combination of platelet count and neutrophil–lymphocyte ratio (COP-NLR has related outcomes in several cancers, except for nasopharyngeal carcinoma (NPC. This study evaluated the prognostic value of COP-NLR in predicting outcome in NPC patients treated with intensity-modulated radiotherapy (IMRT.Materials and methods: We analyzed the data collected from 232 NPC patients. Pretreatment total platelet counts, neutrophil–lymphocyte ratio (NLR, and COP-NLR score were evaluated as potential predictors. Optimal cutoff values for NLR and platelets were determined using receiver operating curve. Patients with both elevated NLR (>3 and platelet counts (>300×109/L were assigned a COP-NLR score of 2; those with one elevated or no elevated value were assigned a COP-NLR a score of 1 or 0. Cox proportional hazards model was used to test the association of these factors and relevant 3-year survivals.Results: Patients (COP-NLR scores 1 and 2=85; score 0=147 were followed up for 55.19 months. Univariate analysis showed no association between pretreatment NLR >2.23 and platelet counts >290.5×109/L and worse outcomes. Multivariate analysis revealed that those with COP-NLR scores of 0 had better 3-year disease-specific survival (P=0.02, overall survival (P=0.024, locoregional relapse-free survival (P=0.004, and distant

  14. Prostate bed motion may cause geographic miss in post-prostatectomy image-guided intensity-modulated radiotherapy.

    Science.gov (United States)

    Bell, Linda J; Cox, Jennifer; Eade, Thomas; Rinks, Marianne; Kneebone, Andrew

    2013-12-01

    There is little data to guide radiation oncologists on appropriate margin selection in the post-prostatectomy setting. The aim of this study was to quantify interfraction variation in motion of the prostate bed to determine these margins. The superior and inferior surgical clips in the prostate bed were tracked on pretreatment cone beam CT images (n = 377) for 40 patients who had received post-prostatectomy radiotherapy. Prostate bed motion was calculated for the upper and lower segments by measuring the position of surgical clips located close to midline relative to bony anatomy in the axial (translational) and sagittal (tilt) planes. The frequency of potential geographic misses was calculated for either 1 cm or 0.5 cm posterior planning target volume margins. The mean magnitude of movement of the prostate bed in the anterior-posterior, superior-inferior and left-right planes, respectively, were as follows: upper portion, 0.50 cm, 0.28 cm, 0.10 cm; lower portion, 0.18 cm, 0.18 cm, 0.08 cm. The random and systematic errors, respectively, of the prostate bed motion in the anterior-posterior, superior-inferior and left-right planes, respectively, were as follows: upper portion, 0.47 cm and 0.50 cm, 0.28 cm and 0.27 cm, 0.11 cm and 0.11 cm; lower portion, 0.17 cm and 0.18 cm, 0.17 cm and 0.19 cm, 0.08 cm and 0.10 cm. Most geographic misses occurred in the upper prostate bed in the anterior-posterior plane. The median prostate bed tilt was 1.8° (range -23.4° to 42.3°). Variability was seen in all planes for the movement of both surgical clips. The greatest movement occurred in the anterior-posterior plane in the upper prostate bed, which could cause geographic miss of treatment delivery. The variability in the movement of the superior and inferior clips indicates a prostate bed tilt that would be difficult to correct with standard online matching techniques. This creates a strong argument for using anisotropic planning

  15. Beam angle selection for intensity-modulated radiotherapy (IMRT) treatment of unresectable pancreatic cancer: are noncoplanar beam angles necessary?

    Science.gov (United States)

    Chang, D S; Bartlett, G K; Das, I J; Cardenes, H R

    2013-09-01

    External beam radiation therapy with concurrent chemotherapy (CRT) is widely used for the treatment of unresectable pancreatic cancer. Noncoplanar (NCP) 3D conformal radiotherapy (3DCRT) and coplanar (CP) IMRT have been reported to lower the radiation dose to organs at risk (OARs). The purpose of this article is to examine the utility of noncoplanar beam angles in IMRT for the management of pancreatic cancer. Sixteen patients who were treated with CRT for unresectable adenocarcinoma of the pancreatic head or neck were re-planned using CP and NCP beams in 3DCRT and IMRT with the Varian Eclipse treatment planning system. Compared to CP IMRT, NCP IMRT had similar target coverage with slightly increased maximum point dose, 5,799 versus 5,775 cGy (p = 0.008). NCP IMRT resulted in lower mean kidney dose, 787 versus 1,210 cGy (p kidney dose, but did not improve other dose-volume criteria. The use of NCP beam angles is preferred only in patients with risk factors for treatment-related kidney dysfunction.

  16. Late sequelae and cosmetic outcome after radiotherapy in breast conserving therapy

    International Nuclear Information System (INIS)

    Dore, M.; Hennequin, C.

    2012-01-01

    Radiotherapy after breast-conserving therapy for early breast cancer is reported to adversely affect the cosmetic outcome. The incidence of radiation-induced fibro-atrophy is around 10% at 5 years. A better knowledge of its pathophysiology has revealed the essential role of activated fibroblasts and reactive oxygen species, mediated by TGF beta 1, allowing the development of antioxidant in the management of the established radiation-induced fibro-atrophy. Cosmetic sequelae are evaluated with standardized scales, such as the LENT-SOMA and must be monitored during at least 5 years. The main factors determining the occurrence of sequelae are a large breast volume, dose heterogeneity and the use of tumour bed boost after whole-breast radiation therapy. Intensity modulated radiotherapy and partial breast irradiation position themselves as a good alternatives to reduce the incidence of late skin side effects. The use of predictive tests of intrinsic radiosensitivity might fit into the therapeutic strategy. (authors)

  17. Definition and visualisation of regions of interest in post-prostatectomy image-guided intensity modulated radiotherapy.

    Science.gov (United States)

    Bell, Linda J; Cox, Jennifer; Eade, Thomas; Rinks, Marianne; Kneebone, Andrew

    2014-09-01

    Standard post-prostatectomy radiotherapy (PPRT) image verification uses bony anatomy alignment. However, the prostate bed (PB) moves independently of bony anatomy. Cone beam computed tomography (CBCT) can be used to soft tissue match, so radiation therapists (RTs) must understand pelvic anatomy and PPRT clinical target volumes (CTV). The aims of this study are to define regions of interest (ROI) to be used in soft tissue matching image guidance and determine their visibility on planning CT (PCT) and CBCT. Published CTV guidelines were used to select ROIs. The PCT scans (n = 23) and CBCT scans (n = 105) of 23 post-prostatectomy patients were reviewed. Details on ROI identification were recorded. Eighteen patients had surgical clips. All ROIs were identified on PCTs at least 90% of the time apart from mesorectal fascia (MF) (87%) due to superior image quality. When surgical clips are present, the seminal vesicle bed (SVB) was only seen in 2.3% of CBCTs and MF was unidentifiable. Most other structures were well identified on CBCT. The anterior rectal wall (ARW) was identified in 81.4% of images and penile bulb (PB) in 68.6%. In the absence of surgical clips, the MF and SVB were always identified; the ARW was identified in 89.5% of CBCTs and PB in 73.7%. Surgical clips should be used as ROIs when present to define SVB and MF. In the absence of clips, SVB, MF and ARW can be used. RTs must have a strong knowledge of soft tissue anatomy and PPRT CTV to ensure coverage and enable soft tissue matching.

  18. Definition and visualisation of regions of interest in post-prostatectomy image-guided intensity modulated radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Bell, Linda J, E-mail: linda.bell1@health.nsw.gov.au; Cox, Jennifer [Radiation Oncology Department, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales (Australia); Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales (Australia); Eade, Thomas; Rinks, Marianne; Kneebone, Andrew [Radiation Oncology Department, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales (Australia)

    2014-09-15

    Standard post-prostatectomy radiotherapy (PPRT) image verification uses bony anatomy alignment. However, the prostate bed (PB) moves independently of bony anatomy. Cone beam computed tomography (CBCT) can be used to soft tissue match, so radiation therapists (RTs) must understand pelvic anatomy and PPRT clinical target volumes (CTV). The aims of this study are to define regions of interest (ROI) to be used in soft tissue matching image guidance and determine their visibility on planning CT (PCT) and CBCT. Published CTV guidelines were used to select ROIs. The PCT scans (n = 23) and CBCT scans (n = 105) of 23 post-prostatectomy patients were reviewed. Details on ROI identification were recorded. Eighteen patients had surgical clips. All ROIs were identified on PCTs at least 90% of the time apart from mesorectal fascia (MF) (87%) due to superior image quality. When surgical clips are present, the seminal vesicle bed (SVB) was only seen in 2.3% of CBCTs and MF was unidentifiable. Most other structures were well identified on CBCT. The anterior rectal wall (ARW) was identified in 81.4% of images and penile bulb (PB) in 68.6%. In the absence of surgical clips, the MF and SVB were always identified; the ARW was identified in 89.5% of CBCTs and PB in 73.7%. Surgical clips should be used as ROIs when present to define SVB and MF. In the absence of clips, SVB, MF and ARW can be used. RTs must have a strong knowledge of soft tissue anatomy and PPRT CTV to ensure coverage and enable soft tissue matching.

  19. Definition and visualisation of regions of interest in post-prostatectomy image-guided intensity modulated radiotherapy

    International Nuclear Information System (INIS)

    Bell, Linda J; Cox, Jennifer; Eade, Thomas; Rinks, Marianne; Kneebone, Andrew

    2014-01-01

    Standard post-prostatectomy radiotherapy (PPRT) image verification uses bony anatomy alignment. However, the prostate bed (PB) moves independently of bony anatomy. Cone beam computed tomography (CBCT) can be used to soft tissue match, so radiation therapists (RTs) must understand pelvic anatomy and PPRT clinical target volumes (CTV). The aims of this study are to define regions of interest (ROI) to be used in soft tissue matching image guidance and determine their visibility on planning CT (PCT) and CBCT. Published CTV guidelines were used to select ROIs. The PCT scans (n = 23) and CBCT scans (n = 105) of 23 post-prostatectomy patients were reviewed. Details on ROI identification were recorded. Eighteen patients had surgical clips. All ROIs were identified on PCTs at least 90% of the time apart from mesorectal fascia (MF) (87%) due to superior image quality. When surgical clips are present, the seminal vesicle bed (SVB) was only seen in 2.3% of CBCTs and MF was unidentifiable. Most other structures were well identified on CBCT. The anterior rectal wall (ARW) was identified in 81.4% of images and penile bulb (PB) in 68.6%. In the absence of surgical clips, the MF and SVB were always identified; the ARW was identified in 89.5% of CBCTs and PB in 73.7%. Surgical clips should be used as ROIs when present to define SVB and MF. In the absence of clips, SVB, MF and ARW can be used. RTs must have a strong knowledge of soft tissue anatomy and PPRT CTV to ensure coverage and enable soft tissue matching

  20. Reirradiation of head and neck cancer in the era of intensity-modulated radiotherapy: Patient selection, practical aspects, and current evidence

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yeon Sil [Dept. of Radiation Oncology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul(Korea, Republic of)

    2017-03-15

    Locoregional failure is the most frequent pattern of failure in locally advanced head and neck cancer patients and it leads to death in most of the patients. Second primary tumors occurring in the other head and neck region reach up to almost 40% of long-term survivors. Recommended and preferred retreatment option in operable patients is salvage surgical resection, reporting a 5-year overall survival of up to 40%. However, because of tumor location, extent, and underlying comorbidities, salvage surgery is often limited and compromised by incomplete resection. Reirradiation with or without combined chemotherapy is an appropriate option for unresectable recurrence. Reirradiation is carefully considered with a case-by-case basis. Reirradiation protocol enrollment is highly encouraged prior to committing patient to an aggressive therapy. Radiation doses greater than 60 Gy are usually recommended for successful salvage. Despite recent technical improvement in intensity-modulated radiotherapy (IMRT), the use of concurrent chemotherapy, and the emergence of molecularly targeted agents, careful patient selection remain as the most paramount factor in reirradiation. Tumors that recur or persist despite aggressive prior chemoradiation therapy imply the presence of chemoradio-resistant clonogens. Treatment protocols that combine novel targeted radiosensitizing agents with conformal high precision radiation are required to overcome the resistance while minimizing toxicity. Recent large number of data showed that IMRT may provide better locoregional control with acceptable acute or chronic morbidities. However, additional prospective studies are required before a definitive conclusion can be drawn on safety and effectiveness of IMRT.

  1. Dosimetric evaluation of inspiration and expiration breath-hold for intensity-modulated radiotherapy planning of non-small cell lung cancer.

    Science.gov (United States)

    Tahir, Bilal A; Bragg, Christopher M; Lawless, Sarah E; Hatton, Matthew Q F; Ireland, Rob H

    2010-04-21

    The purpose of this study was to compare target coverage and lung tissue sparing between inspiration and expiration breath-hold intensity-modulated radiotherapy (IMRT) plans for patients with non-small cell lung cancer (NSCLC). In a prospective study, seven NSCLC patients gave written consent to undergo both moderate deep inspiration and end-expiration breath-hold computed tomography (CT), which were used to generate five-field IMRT plans. Dose was calculated with a scatter and an inhomogeneity correction algorithm. The percentage of the planning target volume (PTV) receiving 90% of the prescription dose (PTV(90)), the volume of total lung receiving >or=10 Gy (V(10)) and >or=20 Gy (V(20)) and the mean lung dose (MLD) were compared by the Student's paired t-test. Compared with the expiration plans, the mean +/- SD reductions for V(10), V(20) and MLD on the inspiration plans were 4.0 +/- 3.7% (p = 0.031), 2.5 +/- 2.3% (p = 0.028) and 1.1 +/- 0.7 Gy (p = 0.007), respectively. Conversely, a mean difference of 1.1 +/- 1.1% (p = 0.044) in PTV(90) was demonstrated in favour of expiration. When using IMRT, inspiration breath-hold can reduce the dose to normal lung tissue while expiration breath-hold can improve the target coverage. The improved lung sparing at inspiration may outweigh the modest improvements in target coverage at expiration.

  2. Comparison of intensity-modulated radiotherapy and volumetric-modulated arc therapy dose measurement for head and neck cancer using optical stimulated luminescence dosimeter

    Science.gov (United States)

    Lai, Lu-Han; Chuang, Keh-Shih; Lin, Hsin-Hon; Liu, Yi-Chi; Kuo, Chiung-Wen; Lin, Jao-Perng

    2017-11-01

    The in-vivo dose distributions of intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT), a newly developed technique, for head and neck cancer have been investigated for several years. The present study used a head-and-neck RANDO phantom to simulate the clinical conditions of nasopharyngeal carcinoma and compare the radiation doses between VMAT and IMRT. Three types of planning target volume (PTV) profiles were targeted by reducing the PTV surface margin by 0, 3, and 5 mm. An optically stimulated luminescence dosimeter was used to measure the surface doses. The results revealed that VMAT provided on average 16.8-13.8% lower surface doses within the PTV target areas than IMRT. When the PTV margin was reduced by 0 mm, the surface doses for IMRT reached their maximum value, accounting for 75.1% of its prescribed dose (Dp); however, the Dp value of VMAT was only 61.1%. When the PTV margin was reduced by 3 or 5 mm, the surface doses decreased considerably. The observed surface doses were insufficient when the tumours invaded the body surface; however, VMAT exerted larger skin-sparing effects than IMRT when the tumours away from the skin. These results suggest that the skin doses for these two techniques are insufficient for surface tumours. Notably, VMAT can provide lower skin doses for deep tumours.

  3. NOTE: Dosimetric evaluation of inspiration and expiration breath-hold for intensity-modulated radiotherapy planning of non-small cell lung cancer

    Science.gov (United States)

    Tahir, Bilal A.; Bragg, Christopher M.; Lawless, Sarah E.; Hatton, Matthew Q. F.; Ireland, Rob H.

    2010-04-01

    The purpose of this study was to compare target coverage and lung tissue sparing between inspiration and expiration breath-hold intensity-modulated radiotherapy (IMRT) plans for patients with non-small cell lung cancer (NSCLC). In a prospective study, seven NSCLC patients gave written consent to undergo both moderate deep inspiration and end-expiration breath-hold computed tomography (CT), which were used to generate five-field IMRT plans. Dose was calculated with a scatter and an inhomogeneity correction algorithm. The percentage of the planning target volume (PTV) receiving 90% of the prescription dose (PTV90), the volume of total lung receiving >= 10 Gy (V10) and >= 20 Gy (V20) and the mean lung dose (MLD) were compared by the Student's paired t-test. Compared with the expiration plans, the mean ± SD reductions for V10, V20 and MLD on the inspiration plans were 4.0 ± 3.7% (p = 0.031), 2.5 ± 2.3% (p = 0.028) and 1.1 ± 0.7 Gy (p = 0.007), respectively. Conversely, a mean difference of 1.1 ± 1.1% (p = 0.044) in PTV90 was demonstrated in favour of expiration. When using IMRT, inspiration breath-hold can reduce the dose to normal lung tissue while expiration breath-hold can improve the target coverage. The improved lung sparing at inspiration may outweigh the modest improvements in target coverage at expiration.

  4. Intensity-modulated radiotherapy using simultaneous-integrated boost for definitive treatment of locally advanced mucosal head and neck cancer: outcomes from a single-institution series

    International Nuclear Information System (INIS)

    Johnston, Meredith; Guo, Linxin; Hanna, Catherine; Back, Michael; Guminski, Alex; Lee, Adrian; Eade, Thomas; Veivers, David; Wignall, Andrew

    2013-01-01

    The study aims to report outcomes for patients treated using intensity-modulated radiotherapy (IMRT) with simultaneous-integrated boost and weekly cisplatin for American Joint Committee on Cancer stage III/IV mucosal head and neck squamous cell carcinomas (HNSCCs). Records for 67 patients treated definitively with IMRT for HNSCC were reviewed. By including only those treated with weekly cisplatin, 45 patients were eligible for analysis. Treatment outcomes, effect of patient, tumour and treatment characteristics on disease recurrence were analysed. All patients completed IMRT to 7000cGy in 35 fractions, with concurrent weekly cisplatin 40mg/m 2 (median 6 cycles). Median follow-up was 28 months for living patients. Two-year loco-regional recurrence-free, metastasis-free and overall survival were 85.4, 81.0 and 87.4%, respectively. Local recurrence occurred in three patients, and distant recurrence in eight patients. Our results show efficacy of IMRT and weekly cisplatin in the treatment of stage III/IV HNSCC at our institution with respect to loco-regional control.

  5. Consensus Guidelines for Delineation of Clinical Target Volume for Intensity-Modulated Pelvic Radiotherapy for the Definitive Treatment of Cervix Cancer

    International Nuclear Information System (INIS)

    Lim, Karen; Small, William; Portelance, Lorraine; Creutzberg, Carien; Juergenliemk-Schulz, Ina M.; Mundt, Arno; Mell, Loren K.; Mayr, Nina; Viswanathan, Akila; Jhingran, Anuja; Erickson, Beth; De Los Santos, Jennifer; Gaffney, David; Yashar, Catheryn; Beriwal, Sushil; Wolfson, Aaron

    2011-01-01

    Purpose: Accurate target definition is vitally important for definitive treatment of cervix cancer with intensity-modulated radiotherapy (IMRT), yet a definition of clinical target volume (CTV) remains variable within the literature. The aim of this study was to develop a consensus CTV definition in preparation for a Phase 2 clinical trial being planned by the Radiation Therapy Oncology Group. Methods and Materials: A guidelines consensus working group meeting was convened in June 2008 for the purposes of developing target definition guidelines for IMRT for the intact cervix. A draft document of recommendations for CTV definition was created and used to aid in contouring a clinical case. The clinical case was then analyzed for consistency and clarity of target delineation using an expectation maximization algorithm for simultaneous truth and performance level estimation (STAPLE), with kappa statistics as a measure of agreement between participants. Results: Nineteen experts in gynecological radiation oncology generated contours on axial magnetic resonance images of the pelvis. Substantial STAPLE agreement sensitivity and specificity values were seen for gross tumor volume (GTV) delineation (0.84 and 0.96, respectively) with a kappa statistic of 0.68 (p < 0.0001). Agreement for delineation of cervix, uterus, vagina, and parametria was moderate. Conclusions: This report provides guidelines for CTV definition in the definitive cervix cancer setting for the purposes of IMRT, building on previously published guidelines for IMRT in the postoperative setting.

  6. Dose-volume relationships for moderate or severe neck muscle atrophy after intensity-modulated radiotherapy in patients with nasopharyngeal carcinoma

    Science.gov (United States)

    Zhang, Lu-Lu; Wang, Xiao-Ju; Zhou, Guan-Qun; Tang, Ling-Long; Lin, Ai-Hua; Ma, Jun; Sun, Ying

    2015-01-01

    This study aimed to identify the dosimetric parameters and radiation dose tolerances associated with moderate or severe sternocleidomastoid muscle (SCM) atrophy after intensity-modulated radiotherapy (IMRT) in nasopharyngeal carcinoma (NPC). We retrospectively analysed 138 patients treated with IMRT between 2011 and 2012 for whom IMRT treatment plans and pretreatment and 3-year post-IMRT MRI scans were available. The association between mean dose (Dmean), maximum dose (Dmax), VX (% SCM volume that received more than X Gy), DX (dose to X% of the SCM volume) at X values of 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80 and SCM atrophy at 3 years after IMRT were analyzed. All dosimetric parameters, except V40, V50 and V80, were significantly associated with moderate or severe SCM atrophy. Multivariate analysis showed that V65 was an independent predictor of moderate or severe SCM atrophy (P atrophy. We suggest a limit of 21.47% for V65 to optimize NPC treatment planning, whilst minimizing the risk of moderate or severe SCM atrophy. PMID:26678599

  7. The Evolution of and Risk Factors for Neck Muscle Atrophy and Weakness in Nasopharyngeal Carcinoma Treated With Intensity-Modulated Radiotherapy

    Science.gov (United States)

    Zhang, Lu-Lu; Mao, Yan-Ping; Zhou, Guan-Qun; Tang, Ling-Long; Qi, Zhen-Yu; Lin, Li; Yao, Ji-Jin; Ma, Jun; Lin, Ai-Hua; Sun, Ying

    2015-01-01

    Abstract The aim of this study was to investigate the evolution of sternocleidomastoid muscle (SCM) atrophy in nasopharyngeal carcinoma (NPC) patients following intensity-modulated radiotherapy (IMRT), and the relationship between SCM atrophy and neck weakness. Data were retrospectively analyzed from 223 biopsy-proven NPC patients with no distant metastasis who underwent IMRT with or without chemotherapy. The volume of SCM was measured on pretreatment magnetic resonance imaging (MRI), and MRIs were conducted 1, 2, and 3 years after the completion of IMRT. Change in SCM volume was calculated and classified using the late effects of normal tissues–subjective, objective, management, and analytic system. The grade of neck muscle weakness, classified by the Common Terminology Criteria for Adverse Events V 3.0, was measured 3 years after the completion of IMRT. The average SCM atrophy ratio was −10.97%, −18.65%, and −22.25% at 1, 2, and 3 years postirradiation, respectively. Multivariate analysis indicated N stage and the length of time after IMRT were independent prognostic variables. There were significant associations between the degree of SCM atrophy and neck weakness. Radical IMRT can cause significant SCM atrophy in NPC patients. A more advanced N stage was associated with more severe SCM atrophy, but no difference was observed between N2 and N3. SCM atrophy progresses over time during the 3 years following IMRT. Grade of SCM atrophy is significantly associated with neck weakness. PMID:26252307

  8. Effect of MLC leaf position, collimator rotation angle, and gantry rotation angle errors on intensity-modulated radiotherapy plans for nasopharyngeal carcinoma

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    Bai, Sen; Li, Guangjun; Wang, Maojie; Jiang, Qinfeng; Zhang, Yingjie [State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan (China); Wei, Yuquan, E-mail: yuquawei@vip.sina.com [State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan (China)

    2013-07-01

    The purpose of this study was to investigate the effect of multileaf collimator (MLC) leaf position, collimator rotation angle, and accelerator gantry rotation angle errors on intensity-modulated radiotherapy plans for nasopharyngeal carcinoma. To compare dosimetric differences between the simulating plans and the clinical plans with evaluation parameters, 6 patients with nasopharyngeal carcinoma were selected for simulation of systematic and random MLC leaf position errors, collimator rotation angle errors, and accelerator gantry rotation angle errors. There was a high sensitivity to dose distribution for systematic MLC leaf position errors in response to field size. When the systematic MLC position errors were 0.5, 1, and 2 mm, respectively, the maximum values of the mean dose deviation, observed in parotid glands, were 4.63%, 8.69%, and 18.32%, respectively. The dosimetric effect was comparatively small for systematic MLC shift errors. For random MLC errors up to 2 mm and collimator and gantry rotation angle errors up to 0.5°, the dosimetric effect was negligible. We suggest that quality control be regularly conducted for MLC leaves, so as to ensure that systematic MLC leaf position errors are within 0.5 mm. Because the dosimetric effect of 0.5° collimator and gantry rotation angle errors is negligible, it can be concluded that setting a proper threshold for allowed errors of collimator and gantry rotation angle may increase treatment efficacy and reduce treatment time.

  9. Prospective Preference Assessment of Patients' Willingness to Participate in a Randomized Controlled Trial of Intensity-Modulated Radiotherapy Versus Proton Therapy for Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Shah, Anand; Efstathiou, Jason A.; Paly, Jonathan J.; Halpern, Scott D.; Bruner, Deborah W.; Christodouleas, John P.; Coen, John J.; Deville, Curtiland; Vapiwala, Neha; Shipley, William U.; Zietman, Anthony L.; Hahn, Stephen M.; Bekelman, Justin E.

    2012-01-01

    Purpose: To investigate patients’ willingness to participate (WTP) in a randomized controlled trial (RCT) comparing intensity-modulated radiotherapy (IMRT) with proton beam therapy (PBT) for prostate cancer (PCa). Methods and Materials: We undertook a qualitative research study in which we prospectively enrolled patients with clinically localized PCa. We used purposive sampling to ensure a diverse sample based on age, race, travel distance, and physician. Patients participated in a semi-structured interview in which they reviewed a description of a hypothetical RCT, were asked open-ended and focused follow-up questions regarding their motivations for and concerns about enrollment, and completed a questionnaire assessing characteristics such as demographics and prior knowledge of IMRT or PBT. Patients’ stated WTP was assessed using a 6-point Likert scale. Results: Forty-six eligible patients (33 white, 13 black) were enrolled from the practices of eight physicians. We identified 21 factors that impacted patients’ WTP, which largely centered on five major themes: altruism/desire to compare treatments, randomization, deference to physician opinion, financial incentives, and time demands/scheduling. Most patients (27 of 46, 59%) stated they would either “definitely” or “probably” participate. Seventeen percent (8 of 46) stated they would “definitely not” or “probably not” enroll, most of whom (6 of 8) preferred PBT before their physician visit. Conclusions: A substantial proportion of patients indicated high WTP in a RCT comparing IMRT and PBT for PCa.

  10. Intensity-modulated radiotherapy or volumetric-modulated arc therapy in patients with head and neck cancer: Focus on salivary glands dosimetry.

    Science.gov (United States)

    Vallard, Alexis; Guy, Jean-Baptiste; Mengue Ndong, Sylvie; Vial, Nicolas; Rivoirard, Romain; Auberdiac, Pierre; Méry, Benoîte; Langrand-Escure, Julien; Espenel, Sophie; Moncharmont, Coralie; Ben Mrad, Majed; Diao, Peng; Goyet, Dominique; Magné, Nicolas

    2016-07-01

    Despite radiotherapy (RT) technical improvements, high salivary dysfunction rates are still reported in patients with head and neck squamous cell carcinoma (HNSCC). The purpose of the present study was to report salivary glands dosimetry with volumetric-modulated arc therapy (VMAT) and intensity-modulated RT (IMRT). Dosimetry of consecutive patients receiving IMRT or VMAT for proven HNSCC between 2007 and 2013 were retrospectively reviewed. Data of 609 patients were studied. Mean dose, mean maximum dose, and mean percentage of salivary gland volume receiving at least 26 Gy (V26) of the contralateral parotid were 24.50 Gy (range, 0-70.4 Gy), 39.08 Gy (range, 0.38-76.45 Gy), and 40.92% (range, 0% to 100%), respectively. Mean and maximum dose on contralateral submandibular gland were 48.18 Gy (range, 0.19-70.73 Gy), and 61.25 Gy (range, 0-75.8 Gy), respectively. Target volume coverage still has to be prioritized over organs at risk (OAR) sparing with new RT techniques. Submandibular glands are not sufficiently taken into account in guidelines. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1028-1034, 2016. © 2016 Wiley Periodicals, Inc.

  11. The challenge in treating locally recurrent T3-4 nasopharyngeal carcinoma: the survival benefit and severe late toxicities of re-irradiation with intensity-modulated radiotherapy.

    Science.gov (United States)

    Tian, Yun-Ming; Huang, Wei-Zeng; Yuan, Xia; Bai, Li; Zhao, Chong; Han, Fei

    2017-06-27

    Effective treatments for patients with advanced locally recurrent nasopharyngeal carcinoma (NPC) are limited. This investigation was to determine the potential benefits from re-irradiation by intensity-modulated radiotherapy (IMRT) on survival and the effects of severe late toxicities. A retrospective study was conducted in 245 patients diagnosed with locally recurrent T3-T4 NPC who had undergone re-irradiation with IMRT. Follow-up data was colletedand factors associated with survival and severe late toxicities were analyzed. The 5-year local-regional failure-free survival, distant failure-free survival and overall survival rates were 60.9%, 78.3% and 27.5%, respectively. The presence of severe late complications, recurrent T4 disease and gross tumor volume >30 cm3 were associated with poor survival. The incidences of mucosal necrosis, temporal lobe necrosis, cranial neuropathy and trismus were 22.0%, 14.6%, 27.0% and 14.6% respectively. Re-irradiation with IMRT is an effective choice in patients with locally recurrent T3-T4 NPC. However, the survival benefits can be partly offset by severe late complications and optimum treatments in these patients remain a challenge.

  12. Dosimetric comparison of vaginal vault ovoid brachytherapy versus intensity-modulated radiation therapy plans in postoperative patients of cervical carcinoma following whole pelvic radiotherapy

    Directory of Open Access Journals (Sweden)

    Divya Khosla

    2014-01-01

    Full Text Available Introduction: Dosimetric study to compare high dose rate (HDR vaginal vault ovoid brachytherapy plan versus intensity-modulated radiation therapy (IMRT boost plan for doses delivered to target volume and organs at risk (OAR in postoperative patients of cervical carcinoma following whole pelvic radiotherapy (WPRT. Materials and Methods: Fifteen postoperative patients of cervical carcinoma suitable for vaginal ovoid brachytherapy following WPRT of 46 Gy/23 fractions/4.5 weeks were included. All were treated with brachytherapy (two sessions of 8.5 Gy each. The equivalent dose for IMRT was calculated by computing biologically effective dose of brachytherapy by linear quadratic model. Dose of brachytherapy (two sessions of 8.5 Gy was equivalent to IMRT dose of 26 Gy/13 fractions. Doses to target volume and OAR were compared between HDR and IMRT plans. Results: Target volume was well covered with both HDR and IMRT plans, but dose with brachytherapy was much higher (P < 0.05. Mean doses, doses to 0.1, 1, 2, and 5cc, 1/3 rd , 1/2, and 2/3 rd volume of bladder and rectum were significantly lower with HDR plans. Conclusion: In postoperative patients of cervical carcinoma, HDR brachytherapy following WPRT appears to be better than IMRT for tumor coverage and reducing dose to critical organs.

  13. PET/CT Staging Followed by Intensity-Modulated Radiotherapy (IMRT Improves Treatment Outcome of Locally Advanced Pharyngeal Carcinoma: a matched-pair comparison

    Directory of Open Access Journals (Sweden)

    Lütolf Urs M

    2007-06-01

    Full Text Available Abstract Background Impact of non-pharmacological innovations on cancer cure rates is difficult to assess. It remains unclear, whether outcome improves with 2- [18-F]-fluoro-2-deoxyglucose-positron emission tomography and integrated computer tomography (PET/CT and intensity-modulated radiotherapy (IMRT for curative treatment of advanced pharyngeal carcinoma. Patients and methods Forty five patients with stage IVA oro- or hypopharyngeal carcinoma were staged with an integrated PET/CT and treated with definitive chemoradiation with IMRT from 2002 until 2005. To estimate the impact of PET/CT with IMRT on outcome, a case-control analysis on all patients with PET/CT and IMRT was done after matching with eighty six patients treated between 1991 and 2001 without PET/CT and 3D-conformal radiotherapy with respect to gender, age, stage, grade, and tumor location with a ratio of 1:2. Median follow-up was eighteen months (range, 6–49 months for the PET/CT-IMRT group and twenty eight months (range, 1–168 months for the controls. Results PET/CT and treatment with IMRT improved cure rates compared to patients without PET/CT and IMRT. Overall survival of patients with PET/CT and IMRT was 97% and 91% at 1 and 2 years respectively, compared to 74% and 54% for patients without PET/CT or IMRT (p = 0.002. The event-free survival rate of PET/CT-IMRT group was 90% and 80% at 1 and 2 years respectively, compared to 72% and 56% in the control group (p = 0.005. Conclusion PET/CT in combination with IMRT and chemotherapy for pharyngeal carcinoma improve oncological therapy of pharyngeal carcinomas. Long-term follow-up is needed to confirm these findings.

  14. Image-guided, whole-pelvic, intensity-modulated radiotherapy for biochemical recurrence following radical prostatectomy in high-risk prostate cancer patients.

    Science.gov (United States)

    Byun, Sang Jun; Kim, Young Seok; Ahn, Hanjong; Kim, Choung-Soo

    2018-01-01

    The optimal field size of salvage radiotherapy (SRT) for biochemical recurrence, particularly for patients with high-risk prostate cancer, remains undefined. This retrospective analysis was performed to investigate oncological outcomes as well as treatment-related toxicity following salvage intensity-modulated radiotherapy (IMRT) to the whole pelvis and to compare the results with other studies implementing a small field size of the prostate bed. The medical records of 170 patients with high-risk prostate cancer who received SRT for biochemical recurrence following prostatectomy were reviewed. Whole-pelvic IMRT was administered with a median dose of 66 Gy in 30 fractions. To improve treatment accuracy, an endorectal balloon device and daily cone-beam computed tomography were utilized. Androgen-deprivation therapy combined with SRT was administered to 97 (57.1%) patients. Eventually, 68 (40.0%) patients showed biochemical progression (BCP) after SRT. With a median follow-up period of 56 months, the 5-year BCP-free survival was 38.6%. The overall and cause-specific survival rates were 90.9% and 96.7%, respectively. Regarding BCP-free survival analysis, pathological T stage, persistent prostate-specific antigen (PSA) elevation after prostatectomy, and preSRT PSA level were significant prognostic factors on univariate analysis. On multivariate analysis, pathological T stage and preSRT PSA value retained their significance. Acute and late grade-3 genitourinary toxicities were observed in one (0.6%) and five (2.9%) patients, respectively. One patient each developed acute and late grade-3 gastrointestinal toxicity. SRT to whole pelvis using IMRT and image guidance is as safe as SRT to the prostate bed, but its efficacy should be confirmed in ongoing randomized trials. PreSRT PSA was the only controllable prognostic factor, suggesting the benefit of early SRT.

  15. Image-guided, whole-pelvic, intensity-modulated radiotherapy for biochemical recurrence following radical prostatectomy in high-risk prostate cancer patients.

    Directory of Open Access Journals (Sweden)

    Sang Jun Byun

    Full Text Available The optimal field size of salvage radiotherapy (SRT for biochemical recurrence, particularly for patients with high-risk prostate cancer, remains undefined. This retrospective analysis was performed to investigate oncological outcomes as well as treatment-related toxicity following salvage intensity-modulated radiotherapy (IMRT to the whole pelvis and to compare the results with other studies implementing a small field size of the prostate bed.The medical records of 170 patients with high-risk prostate cancer who received SRT for biochemical recurrence following prostatectomy were reviewed. Whole-pelvic IMRT was administered with a median dose of 66 Gy in 30 fractions. To improve treatment accuracy, an endorectal balloon device and daily cone-beam computed tomography were utilized. Androgen-deprivation therapy combined with SRT was administered to 97 (57.1% patients.Eventually, 68 (40.0% patients showed biochemical progression (BCP after SRT. With a median follow-up period of 56 months, the 5-year BCP-free survival was 38.6%. The overall and cause-specific survival rates were 90.9% and 96.7%, respectively. Regarding BCP-free survival analysis, pathological T stage, persistent prostate-specific antigen (PSA elevation after prostatectomy, and preSRT PSA level were significant prognostic factors on univariate analysis. On multivariate analysis, pathological T stage and preSRT PSA value retained their significance. Acute and late grade-3 genitourinary toxicities were observed in one (0.6% and five (2.9% patients, respectively. One patient each developed acute and late grade-3 gastrointestinal toxicity.SRT to whole pelvis using IMRT and image guidance is as safe as SRT to the prostate bed, but its efficacy should be confirmed in ongoing randomized trials. PreSRT PSA was the only controllable prognostic factor, suggesting the benefit of early SRT.

  16. Intensity-Modulated Radiotherapy is Associated With Improved Global Quality of Life Among Long-term Survivors of Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Chen, Allen M.; Farwell, D. Gregory; Luu, Quang; Vazquez, Esther G.; Lau, Derick H.; Purdy, James A.

    2012-01-01

    Purpose: To compare the long-term quality of life among patients treated with and without intensity-modulated radiotherapy (IMRT) for head-and-neck cancer. Methods and Materials: University of Washington Quality of Life instrument scores were reviewed for 155 patients previously treated with radiation therapy for locally advanced head-and-neck cancer. All patients were disease free and had at least 2 years of follow-up. Eighty-four patients (54%) were treated with IMRT. The remaining 71 patients (46%) were treated with three-dimensional conformal radiotherapy (3D CRT) by use of initial opposed lateral fields matched to a low anterior neck field. Results: The mean global quality of life scores were 67.5 and 80.1 for the IMRT patients at 1 and 2 years, respectively, compared with 55.4 and 57.0 for the 3D CRT patients, respectively (p < 0.001). At 1 year after the completion of radiation therapy, the proportion of patients who rated their global quality of life as “very good” or “outstanding” was 51% and 41% among patients treated by IMRT and 3DCRT, respectively (p = 0.11). At 2 years, the corresponding percentages increased to 73% and 49%, respectively (p < 0.001). On multivariate analysis accounting for sex, age, radiation intent (definitive vs. postoperative), radiation dose, T stage, primary site, use of concurrent chemotherapy, and neck dissection, the use of IMRT was the only variable independently associated with improved quality of life (p = 0.01). Conclusion: The early quality of life improvements associated with IMRT not only are maintained but apparently become more magnified over time. These data provide powerful evidence attesting to the long-term benefits of IMRT for head-and-neck cancer.

  17. A quantitative assessment of volumetric and anatomic changes of the parotid gland during intensity-modulated radiotherapy for head and neck cancer using serial computed tomography

    International Nuclear Information System (INIS)

    Ajani, Abdallah A.; Qureshi, Muhammad M.; Kovalchuk, Nataliya; Orlina, Lawrence; Sakai, Osamu; Truong, Minh Tam

    2013-01-01

    To evaluate the change in volume and movement of the parotid gland measured by serial contrast-enhanced computed tomography scans in patients with head and neck cancer treated with parotid-sparing intensity-modulated radiotherapy (IMRT). A prospective study was performed on 13 patients with head and neck cancer undergoing dose-painted IMRT to 69.96 Gy in 33 fractions. Serial computed tomography scans were performed at baseline, weeks 2, 4, and 6 of radiotherapy (RT), and at 6 weeks post-RT. The parotid volume was contoured at each scan, and the movement of the medial and lateral borders was measured. The patient's body weight was recorded at each corresponding week during RT. Regression analyses were performed to ascertain the rate of change during treatment as a percent change per fraction in parotid volume and distance relative to baseline. The mean parotid volume decreased by 37.3% from baseline to week 6 of RT. The overall rate of change in parotid volume during RT was−1.30% per fraction (−1.67% and−0.91% per fraction in≥31 Gy and<31 Gy mean planned parotid dose groups, respectively, p = 0.0004). The movement of parotid borders was greater in the≥31 Gy mean parotid dose group compared with the<31 Gy group (0.22% per fraction and 0.14% per fraction for the lateral border and 0.19% per fraction and 0.06% per fraction for the medial border, respectively). The median change in body weight was−7.4% (range, 0.75% to−17.5%) during RT. A positive correlation was noted between change in body weight and parotid volume during the course of RT (Spearman correlation coefficient, r = 0.66, p<0.01). Head and neck IMRT results in a volume loss of the parotid gland, which is related to the planned parotid dose, and the patient's weight loss during RT

  18. A quantitative assessment of volumetric and anatomic changes of the parotid gland during intensity-modulated radiotherapy for head and neck cancer using serial computed tomography.

    Science.gov (United States)

    Ajani, Abdallah A; Qureshi, Muhammad M; Kovalchuk, Nataliya; Orlina, Lawrence; Sakai, Osamu; Truong, Minh Tam

    2013-01-01

    To evaluate the change in volume and movement of the parotid gland measured by serial contrast-enhanced computed tomography scans in patients with head and neck cancer treated with parotid-sparing intensity-modulated radiotherapy (IMRT). A prospective study was performed on 13 patients with head and neck cancer undergoing dose-painted IMRT to 69.96Gy in 33 fractions. Serial computed tomography scans were performed at baseline, weeks 2, 4, and 6 of radiotherapy (RT), and at 6 weeks post-RT. The parotid volume was contoured at each scan, and the movement of the medial and lateral borders was measured. The patient's body weight was recorded at each corresponding week during RT. Regression analyses were performed to ascertain the rate of change during treatment as a percent change per fraction in parotid volume and distance relative to baseline. The mean parotid volume decreased by 37.3% from baseline to week 6 of RT. The overall rate of change in parotid volume during RT was-1.30% per fraction (-1.67% and-0.91% per fraction in≥31Gy andparotid dose groups, respectively, p = 0.0004). The movement of parotid borders was greater in the≥31Gy mean parotid dose group compared with theparotid volume during the course of RT (Spearman correlation coefficient, r = 0.66, pparotid gland, which is related to the planned parotid dose, and the patient's weight loss during RT. Copyright © 2013 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

  19. Submandibular gland-sparing intensity modulated radiotherapy in the treatment of head and neck cancer. Sites of locoregional relapse and survival

    Energy Technology Data Exchange (ETDEWEB)

    Collan, Juhani; Kapanen, Mika; Nyman, Heidi; Joensuu, Heikki; Tenhunen, Mikko; Saarilahti, Kauko [Dept. of Oncology, Helsinki Univ. Central Hospital, Helsinki (Finland)], e-mail: kauko.saarilahti@hus.fi; Maekitie, Antti [Dept. of Otorhinolaryngology, Head and Neck Surgery, Helsinki Univ. Central Hospital, Helsinki (Finland)

    2012-07-15

    Background and purpose: To evaluate the patterns of locoregional relapse and survival following submandibular gland (SMG)-sparing intensity modulated radiotherapy (IMRT). Patients and methods: Eighty patients with laryngeal (n = 15), oropharyngeal (n = 50), hypopharyngeal (n = 11) or nasopharyngeal cancer (n = 4) were treated by submandibular gland-sparing IMRT for head and neck squamous cell cancer between July 2000 and December 2008. All patients were treated by bilateral IMRT. Thirty-nine (49%) received definitive radiotherapy (RT) and 41 (51%) postoperative RT. The contralateral parotid gland (PG) and SMG were included in the dose optimization planning program with intent to keep the mean doses for PG and SMG below 23 Gy and 28-30 Gy, respectively. The ipsilateral glands were also spared when considered feasible. Results: During a median follow-up time of 51 months (range, 24-117 months) nine local recurrent tumors were observed. Four of these nine patients were salvaged by surgery with no further recurrence. All local recurrences were located within the high-dose CTVs. None of the locally recurrent cancers were located at the vicinity of the spared PGs or SMGs. No recurrent tumors were observed in the contralateral neck. The Kaplan-Meier estimate for local control at five years following IMRT was 88 % for the whole cohort and the corresponding figure for local control following salvage surgery was 94 %. The estimates for five-year overall survival and disease-specific survival were 85 % and 90 %, respectively. Conclusion. In selected head and neck cancer patients who are estimated to have a low risk of cancer recurrence at the nodal levels I-II and who are treated with SMG-sparing IMRT the risk of cancer recurrence at the vicinity of the spared salivary glands is low.

  20. PET/CT Staging Followed by Intensity-Modulated Radiotherapy (IMRT) Improves Treatment Outcome of Locally Advanced Pharyngeal Carcinoma: a matched-pair comparison

    International Nuclear Information System (INIS)

    Rothschild, Sacha; Studer, Gabriela; Seifert, Burkhardt; Huguenin, Pia; Glanzmann, Christoph; Davis, J Bernard; Lütolf, Urs M; Hany, Thomas F; Ciernik, I Frank

    2007-01-01

    Impact of non-pharmacological innovations on cancer cure rates is difficult to assess. It remains unclear, whether outcome improves with 2- [18-F]-fluoro-2-deoxyglucose-positron emission tomography and integrated computer tomography (PET/CT) and intensity-modulated radiotherapy (IMRT) for curative treatment of advanced pharyngeal carcinoma. Forty five patients with stage IVA oro- or hypopharyngeal carcinoma were staged with an integrated PET/CT and treated with definitive chemoradiation with IMRT from 2002 until 2005. To estimate the impact of PET/CT with IMRT on outcome, a case-control analysis on all patients with PET/CT and IMRT was done after matching with eighty six patients treated between 1991 and 2001 without PET/CT and 3D-conformal radiotherapy with respect to gender, age, stage, grade, and tumor location with a ratio of 1:2. Median follow-up was eighteen months (range, 6–49 months) for the PET/CT-IMRT group and twenty eight months (range, 1–168 months) for the controls. PET/CT and treatment with IMRT improved cure rates compared to patients without PET/CT and IMRT. Overall survival of patients with PET/CT and IMRT was 97% and 91% at 1 and 2 years respectively, compared to 74% and 54% for patients without PET/CT or IMRT (p = 0.002). The event-free survival rate of PET/CT-IMRT group was 90% and 80% at 1 and 2 years respectively, compared to 72% and 56% in the control group (p = 0.005). PET/CT in combination with IMRT and chemotherapy for pharyngeal carcinoma improve oncological therapy of pharyngeal carcinomas. Long-term follow-up is needed to confirm these findings

  1. WE-G-BRF-01: Adaptation to Intrafraction Tumor Deformation During Intensity-Modulated Radiotherapy: First Proof-Of-Principle Demonstration

    Energy Technology Data Exchange (ETDEWEB)

    Ge, Y; OBrien, R; Shieh, C; Booth, J; Keall, P [Radiation Physics Laboratory, University of Sydney (Australia)

    2014-06-15

    Purpose: Intrafraction tumor deformation limits targeting accuracy in radiotherapy and cannot be adapted to by current motion management techniques. This study simulated intrafractional treatment adaptation to tumor deformations using a dynamic Multi-Leaf Collimator (DMLC) tracking system during Intensity-modulated radiation therapy (IMRT) treatment for the first time. Methods: The DMLC tracking system was developed to adapt to the intrafraction tumor deformation by warping the planned beam aperture guided by the calculated deformation vector field (DVF) obtained from deformable image registration (DIR) at the time of treatment delivery. Seven single phantom deformation images up to 10.4 mm deformation and eight tumor system phantom deformation images up to 21.5 mm deformation were acquired and used in tracking simulation. The intrafraction adaptation was simulated at the DMLC tracking software platform, which was able to communicate with the image registration software, reshape the instantaneous IMRT field aperture and log the delivered MLC fields.The deformation adaptation accuracy was evaluated by a geometric target coverage metric defined as the sum of the area incorrectly outside and inside the reference aperture. The incremental deformations were arbitrarily determined to take place equally over the delivery interval. The geometric target coverage of delivery with deformation adaptation was compared against the delivery without adaptation. Results: Intrafraction deformation adaptation during dynamic IMRT plan delivery was simulated for single and system deformable phantoms. For the two particular delivery situations, over the treatment course, deformation adaptation improved the target coverage by 89% for single target deformation and 79% for tumor system deformation compared with no-tracking delivery. Conclusion: This work demonstrated the principle of real-time tumor deformation tracking using a DMLC. This is the first step towards the development of an

  2. Patient-reported outcomes following parotid-sparing intensity-modulated radiotherapy for head and neck cancer. How important is dysphagia?

    Science.gov (United States)

    Roe, Justin W G; Drinnan, Michael J; Carding, Paul N; Harrington, Kevin J; Nutting, Christopher M

    2014-12-01

    Swallowing can be significantly affected during and following radiotherapy for head and neck cancer (HNC). The purpose of this study was to understand: (1) the trajectory of swallowing recovery following parotid-sparing intensity-modulated radiotherapy (IMRT) and (2) overall physical and social-emotional wellbeing and how patients prioritise swallowing following treatment. Sixty-one HNC patients completed questionnaires as part of a prospective study exploring patient-reported swallowing outcomes following parotid-sparing IMRT. Participants were asked to complete the M.D. Anderson Dysphagia Inventory (MDADI) and University of Washington Quality of Life Questionnaire (UW-QoL) v.04 before treatment and 3, 6 and 12months after treatment. Given the rise in human papilloma virus (HPV) and associated oropharyngeal cancers, we completed a sub analysis of the data in those participants. There was a significant reduction in the MDADI composite scores 3months after completion of treatment. Improvements were observed by 12months, however, scores did not recover to baseline. The recovery in physical function was limited in comparison to social-emotional recovery at 12months. When oropharyngeal cancer scores were analysed, there was not a substantial difference to the whole group results. There was a shift in priorities following treatment. Swallowing was highlighted as a concern by 44% of HNC patients up to 12months after treatment with swallowing-related factors (saliva, taste and chewing) rated highly. Patient reported swallowing outcomes were significantly affected from baseline to all follow-up time points and remained a priority concern at 12months following treatment. Overall social-emotional functioning does improve, suggesting that patients have the potential to adapt to their "new normal" following IMRT for HNC. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Using SPECT-guidance to protect functional lung with optimizing intensity modulated radiotherapy in stage III non-small cell lung cancer patients

    International Nuclear Information System (INIS)

    Wang Zhongtang; Li Baosheng; Sun Hongfu; Fang Yongcun; Chen Jinhu; Yan Jing

    2008-01-01

    Objective: To explore the possibility of using lung perfusion single photon emission computed tomography (SPECT) scans to protect functional lung with optimizing intensity modulated radiotherapy (IMRT) plan in patients with stage m non-small cell lung cancer (NSCLC). Methods: Twenty-four patients with stage III NSCLC who were candidated for radiotherapy were enrolled. All patients had PET-CT scans and SPECT scans. The two sets of images were accurately co-registered in the planning system. SPECT images were used to define a volume of functional lung (FL) and non-functional lung (NFL). The region of ≥30% maximum radioactive counts was FL and the other region was NFL. Then SPECT images were classified by comparing lung perfusion deficit with area of radiological abnormality. Grade O: no lung perfusion deficit. Grade 1: the size of radiological abnormality was similar to the area of lung perfusion deficit. Grade 2: the area of lung perfusion was bigger than that of radiological abnormality, and extended to 1 pulmonary lobe. Grade 3: the area of lung perfusion deficit exceed 1 pulmonary lobe. The optimized IMRT objective was to minimize the dose to FL. the difference between the two sets of IMRT plans was studied. Results: All patients had lung perfusion deficits, 8 patients with grade 1 damage, 6 patients with grade 2 damage, and 10 patient with grade 3 damage. After IMRT plan optimized, both the percentage of whole lung volume received dose (WLV) and the percentage of functional lung volume received dose (FLV) were decreased. However, the FLVs was decreased more significantly. There was significant difference in WLV 10 , WLV 15 , WLV 20 , WLV 25 , WLV 30 and FLV 10 , FLV 15 , FLV 20 , FLV 25 , FLV 30 between the two sets of IMRT plans (P<0.05). Conclusions: It is convenient to SPECT-guidance to protect functional lung with optimizing IMRT in stage III NSCLC patients, potentially reducing lung toxicity. (authors)

  4. Submandibular gland-sparing intensity modulated radiotherapy in the treatment of head and neck cancer: sites of locoregional relapse and survival.

    Science.gov (United States)

    Collan, Juhani; Kapanen, Mika; Mäkitie, Antti; Nyman, Heidi; Joensuu, Heikki; Tenhunen, Mikko; Saarilahti, Kauko

    2012-07-01

    To evaluate the patterns of locoregional relapse and survival following submandibular gland (SMG)-sparing intensity modulated radiotherapy (IMRT). Eighty patients with laryngeal (n = 15), oropharyngeal (n = 50), hypopharyngeal (n = 11) or nasopharyngeal cancer (n = 4) were treated by submandibular gland-sparing IMRT for head and neck squamous cell cancer between July 2000 and December 2008. All patients were treated by bilateral IMRT. Thirty-nine (49%) received definitive radiotherapy (RT) and 41 (51%) postoperative RT. The contralateral parotid gland (PG) and SMG were included in the dose optimization planning program with intent to keep the mean doses for PG and SMG below 23 Gy and 28-30 Gy, respectively. The ipsilateral glands were also spared when considered feasible. During a median follow-up time of 51 months (range, 24-117 months) nine local recurrent tumors were observed. Four of these nine patients were salvaged by surgery with no further recurrence. All local recurrences were located within the high-dose CTVs. None of the locally recurrent cancers were located at the vicinity of the spared PGs or SMGs. No recurrent tumors were observed in the contralateral neck. The Kaplan-Meier estimate for local control at five years following IMRT was 88% for the whole cohort and the corresponding figure for local control following salvage surgery was 94%. The estimates for five-year overall survival and disease-specific survival were 85% and 90%, respectively. In selected head and neck cancer patients who are estimated to have a low risk of cancer recurrence at the nodal levels I-II and who are treated with SMG-sparing IMRT the risk of cancer recurrence at the vicinity of the spared salivary glands is low.

  5. Accelerated Partial Breast Irradiation Is Safe and Effective Using Intensity-Modulated Radiation Therapy in Selected Early-Stage Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lewin, Alan A., E-mail: alanl@baptisthealth.net [Department of Radiation Oncology, Baptist Hospital of Miami, Miami, FL (United States); Derhagopian, Robert [Department of Surgery, Baptist Hospital of Miami, Miami, FL (United States); Saigal, Kunal; Panoff, Joseph E. [Department of Radiation Oncology, University of Miami, Miami, FL (United States); Abitbol, Andre; Wieczorek, D. Jay; Mishra, Vivek [Department of Radiation Oncology, Baptist Hospital of Miami, Miami, FL (United States); Reis, Isildinha; Ferrell, Annapoorna [Division of Biostatistics, University of Miami, Miami, FL (United States); Moreno, Lourdes [Department of Radiation Oncology, Baptist Hospital of Miami, Miami, FL (United States); Takita, Cristiane [Department of Radiation Oncology, University of Miami, Miami, FL (United States)

    2012-04-01

    Purpose: To report the feasibility, toxicity, cosmesis, and efficacy of using intensity-modulated radiation therapy (IMRT) with respiratory gating to deliver accelerated partial breast irradiation (APBI) in selected Stage I/II breast cancer after breast-conserving surgery. Methods and Materials: Eligible patients with node-negative Stage I/II breast cancer were prospectively enrolled in an institutional review board approved protocol to receive APBI using IMRT after breast-conserving surgery. The target volume was treated at 3.8 Gy/fraction twice daily for 5 days, to a total dose of 38 Gy. Results: Thirty-six patients were enrolled for a median follow-up time of 44.8 months. The median tumor size was 0.98 cm (range, 0.08-3 cm). The median clinical target volume (CTV) treated was 71.4 cc (range, 19-231 cc), with the mean dose to the CTV being 38.96 Gy. Acute toxicities included Grade 1 erythema in 44% of patients and Grade 2 in 6%, Grade 1 hyperpigmentation in 31% of patients and Grade 2 in 3%, and Grade 1 breast/chest wall tenderness in 1