Does selective pleural irradiation of malignant pleural mesothelioma allow radiation dose escalation?

Botticella, Angela; Defraene, Gilles; Nackaerts, Kristiaan; Deroose, Christophe M.; Coolen, Johan; Nafteux, Philippe; Vanstraelen, Bianca; Joosten, Simon A.; Michiels, Laurence; Peeters, Stéphanie; Ruysscher, Dirk De

doi:10.1007/s00066-017-1108-y

Cited by 7 publications

(2 citation statements)

References 25 publications

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“…For instance, several studies have shown that conventional static IMRT achieves better dose coverage and improved local control compared with 3DCRT ( 6 - 13 ) for MPM, while other studies have demonstrated that VMAT allows for even better dose conformality in a shorter delivery time compared with static IMRT, sparing potential organs at risk (OARs) during MPM radiotherapy ( 14 - 16 ). Moreover, several studies exploring the feasibility of prescription dose escalation using HT and VMAT have also been reported ( 17 - 21 ). However, little research has been published comparing the differences between HT and VMAT from a dosimetric escalation perspective.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric evaluation of helical tomotherapy and volumetric-modulated arc therapy for malignant pleural mesothelioma: a planning study for dose escalation

Zhang¹,

Lü²,

Jiang³

et al. 2021

Transl Cancer Res TCR

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Background To compare the dosimetric differences between helical tomotherapy (HT) and volumetric-modulated arc therapy (VMAT) treatment plans for inoperable malignant pleural mesothelioma (MPM). Methods Ten patients with inoperable MPM were retrospectively planned with the HT and VMAT techniques, and the dose-volume histogram (DVH)-based parameters of the planning target volume (PTV) and organs at risk (OARs) were compared. Results Compared with the VMAT plans, the target homogeneity index (HI) and conformity index (CI) of the HT plans were significantly better (HI: 1.04±0.01 vs. 1.11±0.03, CI: 0.80±0.07 vs. 0.71±0.12, respectively) (P<0.001, P=0.013, respectively). Regarding the OARs, including the ipsilateral lung, contralateral lung, heart, and spinal cord, the differences among the V30 (Vx: fraction of volume receiving >5, 10, 20, and 30 Gy, respectively) of the ipsilateral lung and V5, V10, and V20 of the contralateral lung were statistically significant (P=0.031, P=0.030, P=0.021, P=0.003, respectively). However, there was no significant differences between HT plans and VMAT plans, regarding the V5, V10 and V20 of the ipsilateral lung, V3 of the contralateral lung, V5 and Dmean of the heart, and Dmax of the cord. The treatment delivery time of the VMAT was significantly shorter than that of the HT (mean delivery time: 3.27±1.65 vs. 11.11±3.75 min, respectively) (P<0.001). Conclusions Compared to the VMAT plans, the HT plans not only demonstrated more optimal target coverage and conformity but also considerably reduced the dose-volume parameters of the OARs in both low-dose areas in contralateral lung and high-dose areas in ipsilateral lung and contralateral lung, which is correlated to radiation injury. However, the treatment delivery time of the HT plans was longer.

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Section: Introductionmentioning

confidence: 99%

Dosimetric evaluation of helical tomotherapy and volumetric-modulated arc therapy for malignant pleural mesothelioma: a planning study for dose escalation

Zhang¹,

Lü²,

Jiang³

et al. 2021

Transl Cancer Res TCR

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“…In initial experiences, intensity modulated proton therapy (IMPT) has shown feasibility and lower mean doses to the contralateral lung, heart, esophagus, liver, and ipsilateral kidney compared with IMRT [ 17 , 28 , 29 , 30 ]. Dose escalation has not been shown to significantly reduce local failure after EPP [ 15 , 30 , 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Use of Continuous Positive Airway Pressure (CPAP) to Limit Diaphragm Motion—A Novel Approach for Definitive Radiation Therapy for Inoperable Pleural Mesothelioma: A Pilot Study

Moore

Kindler

Allen

2021

Biology

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Malignant pleural mesothelioma (MPM) is a deadly disease and radiotherapy (RT) plays an important role in its management. Recent developments in technique have made it is possible to deliver RT to MPM in the intact lung. However, it is imperative to reduce normal lung doses. We present a pilot study examining the use of CPAP and VMAT radiotherapy to reduce toxicity when treating MPM, involving three consecutive patients with MPM, not amenable to surgery, who were treated according to Helsinki committee approval. Patients were simulated using four-dimentional CT simulation with the assistance of CPAP lung inflation, then were treated using both IMRT and VMAT techniques. Radiation lung dose was optimized based on accepted lung dose constraints. Patients were followed for toxicity as well as local control and survival. Results: Three patients were treated with CPAP-based IMRT treatment. These patients tolerated the treatment and DVH constraints were able to be met. The comparison plans among the four VMAT arcs and the IMRT static field treatment were able to accomplish the treatment planning objectives without significant advantages with either technique. The treatment combined with CPAP reduced the normal lung dose in MPM patients with intact lungs. This technique is worthy of further investigation.

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Tomotherapy in malignant mesothelioma: a planning study to establish dose constraints

et al. 2019

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Does selective pleural irradiation of malignant pleural mesothelioma allow radiation dose escalation?

Abstract: The omission of the elective irradiation of the whole ipsilateral pleural space allowed dose escalation from 49 Gy to more than 58 Gy in 4 of 12 chemonaive MPM patients. This strategy may form the basis for nonsurgical radical combined modality treatment of MPM.

Cited by 7 publications

References 25 publications

Dosimetric evaluation of helical tomotherapy and volumetric-modulated arc therapy for malignant pleural mesothelioma: a planning study for dose escalation

Dosimetric evaluation of helical tomotherapy and volumetric-modulated arc therapy for malignant pleural mesothelioma: a planning study for dose escalation

Use of Continuous Positive Airway Pressure (CPAP) to Limit Diaphragm Motion—A Novel Approach for Definitive Radiation Therapy for Inoperable Pleural Mesothelioma: A Pilot Study

Tomotherapy in malignant mesothelioma: a planning study to establish dose constraints

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