A Systematic Review on Intensity Modulated Radiation Therapy for Mediastinal Hodgkin’s Lymphoma

Buglione, Michela; Guerini, Andrea Emanuele; Filippi, Andrea Riccardo; Spiazzi, L.; Pasinetti, Nadia; Magli, A.; Toraci, Cristian; Borghetti, Paolo; Triggiani, Luca; Alghisi, A.; Costantino, Gianluca; Bertagna, Francesco; Levra, Niccolò Giaj; Pegurri, Ludovica; Magrini, Stefano Maria

doi:10.1016/j.critrevonc.2021.103437

Cited by 10 publications

(8 citation statements)

References 106 publications

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“…This could be explained by the radio-sensitizing effect of bortezomib [11] and the rapid turnover of the intestinal mucosa, and other classes of target therapy, such as cyclin-dependent kinase inhibitors [22], were also linked with unexpected severe radiationinduced enteritis [23]. Nonetheless, no increased toxicity was reported for the patients undergoing regimens including bortezomib during RT in our cohort.…”

Section: Concurrent Systemic Treatmentmentioning

confidence: 66%

RR Myelo POINT: A Retrospective Single-Center Study Assessing the Role of Radiotherapy in the Management of Multiple Myeloma and Possible Interactions with Concurrent Systemic Treatment

Guerini

Tucci

Alongi

et al. 2022

Cancers

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Background and purpose: Although chemotherapy, biological agents, and radiotherapy (RT) are cornerstones of the treatment of multiple myeloma (MM), the literature regarding the possible interactions of concurrent systemic treatment (CST) and RT is limited, and the optimal RT dose is still unclear. Materials and methods: We retrospectively analyzed the records of patients who underwent RT for MM at our institution from 1 January 2005 to 30 June 2020. The data of 312 patients and 577 lesions (treated in 411 accesses) were retrieved. Results: Most of the treated lesions involved the vertebrae (60%) or extremities (18.9%). Radiotherapy was completed in 96.6% of the accesses and, although biologically effective doses assuming an α/β ratio of 10 (BED 10) > 38 Gy and CST were significantly associated with higher rates of toxicity, the safety profile was excellent, with side effects grade ≥2 reported only for 4.1% of the accesses; CST and BED 10 had no impact on the toxicity at one and three months. Radiotherapy resulted in significant improvements in performance status and in a pain control rate of 87.4% at the end of treatment, which further increased to 96.9% at three months and remained at 94% at six months. The radiological response rate at six months (data available for 181 lesions) was 79%, with only 4.4% of lesions in progression. Progression was significantly more frequent in the lesions treated without CST or BED 10 < 15 Gy, while concurrent biological therapy resulted in significantly lower rates of progression. Conclusion: Radiotherapy resulted in optimal pain control rates and fair toxicity, regardless of BED 10 and CST; the treatments with higher BED 10 and CST (remarkably biological agents) improved the already excellent radiological disease control.

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Section: Concurrent Systemic Treatmentmentioning

confidence: 66%

RR Myelo POINT: A Retrospective Single-Center Study Assessing the Role of Radiotherapy in the Management of Multiple Myeloma and Possible Interactions with Concurrent Systemic Treatment

Guerini

Tucci

Alongi

et al. 2022

Cancers

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“…Radiation-induced cancer is classically defined as a stochastic process, although recent studies developed more complex models; therefore, there is no threshold point and even low doses may increase second neoplasms risk. This phenomenon is relevant especially for long-term survivors and has been extensively investigated for lymphoma and breast cancer patients, mostly focusing on second lung, breast and thyroid malignancies [29][30][31]. Nonetheless, some studies defined the risk of secondary liver cancer after breast irradiation, with conflicting results: while in some models, the lifetime attributable risk (LAR) for liver cancer induction after breast radiotherapy was extremely low [32], in other experiences high LAR estimates were obtained for liver in case of right-sided targets [33].…”

Section: Discussionmentioning

confidence: 99%

Dose Volume and Liver Function Test Relationship following Radiotheraphy for Right Breast Cancer: A Multicenter Study

Güzelöz,

Ayrancıoğlu,

Aktürk

et al. 2023

Current Oncology

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Objective: The liver is a critical organ at risk during right breast radiotherapy (RT). Liver function tests (LFTs) such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT) serve as biochemical markers for hepatobiliary damage. In this multicenter cross-sectional study, the effects of liver dose–volume on changes in LFTs pre- and post-RT in patients treated for right breast cancer were evaluated. Materials and Methods: Between January 2019 and November 2022, data from 100 patients who underwent adjuvant right breast RT across three centers were retrospectively assessed. Target volumes and normal structures were contoured per the RTOG atlas. Patients were treated with a total dose of 50 Gy in 25 fractions to the CTV, followed by a boost to the tumor bed where indicated. The percentage change in LFT values in the first two weeks post-RT was calculated. Statistics were analyzed with SPSS version 22 software, with significance set at p < 0.05. Statistical correlation between liver doses (in cGy) and the volume receiving specific doses (Vx in cc) on the change in LFTs were analyzed using Kolmogorov–Smirnov, Mann–Whitney U test. Results: The median age among the 100 patients was 56 (range: 29–79). Breast-conserving surgery was performed on 75% of the patients. The most common T and N stages were T1 (53%) and N0 (53%), respectively. None of the patients had distant metastasis or simultaneous systemic treatment with RT. A total of 67% of the treatments utilized the IMRT technique and 33% VMAT. The median CTV volume was 802 cc (range: 214–2724 cc). A median boost dose of 10 Gy (range: 10–16 Gy) was applied to 28% of the patients with electrons and 51% with IMRT/VMAT. The median liver volume was 1423 cc (range: 825–2312 cc). Statistical analyses were conducted on a subset of 57 patients for whom all three LFT values were available both pre- and post-RT. In this group, the median values for AST, ALT, and GGT increased up to 15% post-RT compared to pre-RT, and a median liver Dmean below 208 cGy was found significant. While many factors can influence LFT values, during RT planning, attention to liver doses and subsequent regular LFT checks are crucial. Conclusion: Due to factors such as anatomical positioning, planning technique, and breast posture, the liver can receive varying doses during right breast irradiation. Protecting patients from liver toxicity secondary to RT is valuable, especially in breast cancer patients with a long-life expectancy. Our study found that, even in the absence of any systemic treatment or risk factors, there was an average increase of nearly 15% in enzymes, indicating acute liver damage post-RT compared with pre-RT. Attention to liver doses during RT planning and regular follow-up with LFTs is essential.

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“…Modern radiotherapy techniques, such as intensity modulated radiotherapy (IMRT) allowed to provide a more conformal treatment, resulting in better OARs sparing. [6][7][8][9] On the other hand, the steeper dose fall-off offered by modern radiotherapy techniques increases the risk of target missing, therefore the integration of adequate imaging is crucial in every step of the therapeutic workflow, from the definition of target volumes and OARs to the assessment of appropriate treatment delivery through image-guided radiotherapy (IGRT).…”

Section: Introductionmentioning

confidence: 99%

“…Modern radiotherapy techniques, such as intensity modulated radiotherapy (IMRT) allowed to provide a more conformal treatment, resulting in better OARs sparing. 6 – 9 …”

Section: Introductionmentioning

confidence: 99%

Adoption of Hybrid MRI-Linac Systems for the Treatment of Brain Tumors: A Systematic Review of the Current Literature Regarding Clinical and Technical Features

Guerini,

Nici,

Magrini

et al. 2023

Technol Cancer Res Treat

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Background Possible advantages of magnetic resonance (MR)-guided radiation therapy (MRgRT) for the treatment of brain tumors include improved definition of treatment volumes and organs at risk (OARs) that could allow margin reductions, resulting in limited dose to the OARs and/or dose escalation to target volumes. Recently, hybrid systems integrating a linear accelerator and an magnetic resonance imaging (MRI) scan (MRI-linacs, MRL) have been introduced, that could potentially lead to a fully MRI-based treatment workflow. Methods We performed a systematic review of the published literature regarding the adoption of MRL for the treatment of primary or secondary brain tumors (last update November 3, 2022), retrieving a total of 2487 records; after a selection based on title and abstracts, the full text of 74 articles was analyzed, finally resulting in the 52 papers included in this review. Results and discussion Several solutions have been implemented to achieve a paradigm shift from CT-based radiotherapy to MRgRT, such as the management of geometric integrity and the definition of synthetic CT models that estimate electron density. Multiple sequences have been optimized to acquire images with adequate quality with on-board MR scanner in limited times. Various sophisticated algorithms have been developed to compensate the impact of magnetic field on dose distribution and calculate daily adaptive plans in a few minutes with satisfactory dosimetric parameters for the treatment of primary brain tumors and cerebral metastases. Dosimetric studies and preliminary clinical experiences demonstrated the feasibility of treating brain lesions with MRL. Conclusions The adoption of an MRI-only workflow is feasible and could offer several advantages for the treatment of brain tumors, including superior image quality for lesions and OARs and the possibility to adapt the treatment plan on the basis of daily MRI. The growing body of clinical data will clarify the potential benefit in terms of toxicity and response to treatment.

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A Systematic Review on Intensity Modulated Radiation Therapy for Mediastinal Hodgkin’s Lymphoma

Cited by 10 publications

References 106 publications

RR Myelo POINT: A Retrospective Single-Center Study Assessing the Role of Radiotherapy in the Management of Multiple Myeloma and Possible Interactions with Concurrent Systemic Treatment

RR Myelo POINT: A Retrospective Single-Center Study Assessing the Role of Radiotherapy in the Management of Multiple Myeloma and Possible Interactions with Concurrent Systemic Treatment

Dose Volume and Liver Function Test Relationship following Radiotheraphy for Right Breast Cancer: A Multicenter Study

Adoption of Hybrid MRI-Linac Systems for the Treatment of Brain Tumors: A Systematic Review of the Current Literature Regarding Clinical and Technical Features

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