Analysis of dose–volume histogram parameters for radiation pneumonitis after definitive concurrent chemoradiotherapy for esophageal cancer

Asakura, Hirofumi; Hashimoto, Takayuki; Zenda, Sadamoto; Harada, Hideyuki; Hirakawa, Kyoko; Mizumoto, Masashi; Furutani, Kazuhisa; Hironaka, Shuichi; Fuji, Hiroshi; Murayama, Shigeyuki; Boku, Narikazu; Nishimura, Tetsuo

doi:10.1016/j.radonc.2010.02.006

Cited by 66 publications

(47 citation statements)

References 21 publications

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“…However, the risk of RP would remain a major concern for dose escalation, even when applying novel RT techniques for the treatment of LEAC. Although V5 to the lung was highest under RA in the current study, the associated possibility of RP may have been indistinct because we merely compared the DVH parameters (20,21,24).…”

Section: Discussionmentioning

confidence: 79%

“…In a study investigating late toxicities for esophageal cancer patients who received extensive field CCRT, the 2-year cumulative incidence of grade 3 or greater late cardiopulmonary toxicities of was 7.2% (5/69) (9). In another study comparing DVH parameters for RP in LAEC patients treated with conventional RT, 10 (27%) patients developed grade 2 RP and 3 (8%) patients had grade 3 or higher RP (24). In general, the RP rates of esophageal cancer were lower than that of lung cancer (9,24).…”

Section: Discussionmentioning

confidence: 99%

“…In another study comparing DVH parameters for RP in LAEC patients treated with conventional RT, 10 (27%) patients developed grade 2 RP and 3 (8%) patients had grade 3 or higher RP (24). In general, the RP rates of esophageal cancer were lower than that of lung cancer (9,24). However, the risk of RP would remain a major concern for dose escalation, even when applying novel RT techniques for the treatment of LEAC.…”

Section: Discussionmentioning

confidence: 99%

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Radiotherapy for Esophageal Cancer Using Simultaneous Integrated Boost Techniques: Dosimetric Comparison of Helical TomoTherapy, Volumetric-Modulated Arc Therapy (RapidArc) and Dynamic Intensity-Modulated Radiotherapy

Wang

Chen

Chien

et al. 2013

Technol Cancer Res Treat

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This study compared TomoTherapy (TM), with Volumetric-Modulated Arc Therapy (RapidArc, RA), and dynamic intensity-modulated radiotherapy (dIMRT) for locally advanced esophageal cancer (LAEC) with a simultaneous integrated boost (SIB) technique with regard to the target coverage and sparing of organs at risk (OARs). Twelve patients receiving fourdimensional computed tomography simulation were enrolled for dosimetric comparison.Gross tumor volume was contoured with the maximum intensity projection method. Using an SIB method, Planning target volume low (PTVL) and planning target volume high (PTVH) were prescribed as 54 Gy and 60 Gy, respectively, each administered in 30 fractions. We compared the results of statistical analysis for target coverage, homogeneity index (HI) and conformity index (CI) of PTVs, parameters of OARs and monitor unit (MU) were compared for analysis. The HI for PTVH varied significantly for the 3 techniques of TM, RA, and dIMRT (4.38 6 0.86, 6.40 6 0.86, and 6.11 6 0.68, respectively; P , 0.001). The CI scores for PTVH also differed across TM, RA, and dIMRT (0.64 6 0.06, 0.53 6 0.06, and 0.59 6 0.05, respectively; P , 0.001). The HI for PTVL showed a significant difference among TM, RA, and dIMRT (15.44 6 0.88, 20.88 6 1.03 and 18.65 6 1.42, respectively; P , 0.001). The percentage of lung volume receiving 5 Gy (V5) and 20 Gy (V20) (for V5: TM 54.4 6 8.0%; RA 67.5 6 14.5%, P , 0.01; dIMRT 44.8 6 8.2%; for V20: 13.6 6 3.3%, 12.2 6 3.6%, 18.1 6 3.4%, P 5 0.001, respectively). For RA, the lung V5 ≥ 65% was observed in 6 patients and the V10 ≥ 50 % in one patient. TM, RA and dIMRT provided comparable coverage of the target and sparing of OARs. TM demonstrated superior CI and HI for tumor coverage and lowered the specified dose parameters for lung. RA provided an advantage in terms of the lowest MU and V20 of the lung, but its higher lung V5 was of some concern about lung toxicity.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Radiotherapy for Esophageal Cancer Using Simultaneous Integrated Boost Techniques: Dosimetric Comparison of Helical TomoTherapy, Volumetric-Modulated Arc Therapy (RapidArc) and Dynamic Intensity-Modulated Radiotherapy

Wang

Chen

Chien

et al. 2013

Technol Cancer Res Treat

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“…Investigators from United States reported that the volume of the lung spared from doses of 5 Gy or higher (VS5) was the factor most strongly associated with postoperative pulmonary complications (pneumonia and ARDS) for esophageal cancer patients treated with concurrent chemoradiotherapy followed by surgery [21]. In the treatment of esophageal cancer using definitive regimen of 60 Gy with concurrent chemoradiotherapy, investigators from Japan reported that the optimal V20 threshold to predict symptomatic radiation pneumonitis (grade 2) was 30.5 % [22]. Konski and colleagues proposed thresholds for symptomatic cardiac toxicities (pericardial effusion, myocardial infarction, and sick sinus syndrome) for whole-heart V20 of 70 %, V30 of 65 %, and V40 of 60 % [23].…”

Section: Dose Constraintsmentioning

confidence: 99%

Radiation Therapy

Ito¹

2014

Esophageal Squamous Cell Carcinoma

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Radiotherapy is indicated for the treatment of esophageal cancer both with curative intent and with palliative intent. Concurrent chemoradiotherapy is the standard treatment for patients in good condition who can receive chemotherapy, based on the result of randomized trial that compared chemoradiotherapy with radiotherapy alone. For locally advanced unresectable esophageal cancer, definitive chemoradiotherapy is the standard therapy with potentially curative intent. And for resectable esophageal cancer, definitive chemoradiotherapy is a treatment option in an attempt to preserve the esophagus from favorable results of clinical trials. These results are supported by salvage treatment in cases of residual or recurrent disease after chemoradiotherapy. However high mortality rate of salvage surgery and high incidence of late toxicities after chemoradiotherapy with higher radiation dose are important problems to be solved. Neoadjuvant chemoradiotherapy is standard treatment for locally advanced esophageal cancer in Western countries; however it is investigational in Japan. Combination chemotherapy of new agents and new radiotherapy technique such as intensity-modulated radiation therapy, protonbeam therapy, and heavy-particle radiotherapy have been evaluated in clinical trials to improve the treatment results including efficacy and toxicity.

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“…Advances in radiotherapy technique in particular, according to Liao et al 1 , allow to reach more precisely the tumor volume and preserve the normal tissue, with a consequent improvement of the results presented. Radiation pneumonitis is a major complication in this type of cancer in subjects treated with a definitive radiochemotherapy 5 . In addition, other malignant tumors are inoperable and the radiotherapy is the most important treatment modality, such as, for instance, for the non-small cells lung cancer (NSCLC) (advanced, located and non-operable) 6 .…”

Section: Introductionmentioning

confidence: 99%

Analysis of the physical activity effects and measurement of pro-inflammatory cytokines in irradiated lungs in rats

Bianchi¹,

Ropelle

Katashima³

et al. 2012

Acta Cir. Bras.

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Brazil. Tutor, responsible for conception, design, intellectual and scientific content of the study, critical analysis, final approval of manuscript. VI Full Professor, Department of Surgery, UNICAMP, Campinas-SP, Brazil. Critical revision and analysis of data. ABSTRACT PURPOSE:To study if the pre-radiotherapy physical activity has radio-protective elements, by measuring the radio-induced activation of pro-inflammatory cytokines as interleukin-6 (il-6), transforming growth factor -b (tgf -b), tumor necrosis factor -a (tnf-a) and protein beta kinase b (ikkb), through western blotting analysis. METHODS:A randomized study with 28 Wistar hannover rats, males, with a mean age of 90 days and weighing about 200 grams. The animals were divided into three groups: (GI, GII and GIII). GIII group were submitted to swimming for eight weeks (zero load, three times a week, about 30 minutes). Then, the groups (except the control group) were submitted to irradiation by cobalt therapy, single dose of 3.5 gray in the whole body. All animals were sacrificed by overdose of pentobarbital, according to the time for analysis of cytokines, and then a fragment of the lower lobe of the right lung went to western blotting analysis. RESULTS:The cytokines IKK b, TNF-a and IL-6 induced by radiation in the lung were lower in the exercised animals. However, exercise did not alter the radiation-induced increase in tgf-b. CONCLUSION:The results show a lower response in relation to inflammatory cytokines in the group that practiced the exercise preradiotherapy, showing that exercise can protect tissues from tissue damage due to irradiation.Key words: Radiotherapy. Radiation Pneumonitis. Pulmonary Fibrosis. Physical Therapy Modalities. Rats. RESUMO OBJETIVO:Verificar se a radioterapia pré-atividade física tem elementos de rádio-proteção, medindo-se a ativação de citocinas pró-inflamatórias como a interleucina-6 (IL-6), fator transformador de crescimento -b (TGF -b), fator de necrose tumoral -a (TNF-a) e quinase de proteína beta b (IKK b), por meio da análise blotting ocidental. MÉTODOS:Um estudo randomizado empregando 28 ratos Wistar Hannover, machos, com idade média de 90 dias e pesando cerca de 200 gramas. Os animais foram divididos em três grupos: (GI, GII e GIII). Os animais do grupo GIII foram submetidos à natação durante oito semanas (carga zero, três vezes por semana, cerca de 30 minutos). Então, os grupos (exceto o grupo controle) foram submetidos à irradiação por cobalto terapia, dose única de 3,5 cinza em todo o corpo. Todos os animais foram sacrificados por overdose de pentobarbital, de acordo com o tempo de análise de citocinas, em seguida, um fragmento do lobo inferior do pulmão direito foi a Bianchi RCG et al. -Acta Cirúrgica Brasileira -Vol. 27 (3) 2012análise de mata-borrão ocidental. RESULTADOS:As citocinas IKK b, TNF-a e IL-6 induzidas por radiação no pulmão foram menores nos animais que se exercitaram.No entanto, o exercício não alterou o aumento induzido pela radiação na TGF-b. CONCLUSÃO:Os resultados mostraram uma menor respost...

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Analysis of dose–volume histogram parameters for radiation pneumonitis after definitive concurrent chemoradiotherapy for esophageal cancer

Cited by 66 publications

References 21 publications

Radiotherapy for Esophageal Cancer Using Simultaneous Integrated Boost Techniques: Dosimetric Comparison of Helical TomoTherapy, Volumetric-Modulated Arc Therapy (RapidArc) and Dynamic Intensity-Modulated Radiotherapy

Radiotherapy for Esophageal Cancer Using Simultaneous Integrated Boost Techniques: Dosimetric Comparison of Helical TomoTherapy, Volumetric-Modulated Arc Therapy (RapidArc) and Dynamic Intensity-Modulated Radiotherapy

Radiation Therapy

Analysis of the physical activity effects and measurement of pro-inflammatory cytokines in irradiated lungs in rats

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