Cardiac radiation dose distribution, cardiac events and mortality in early-stage lung cancer treated with stereotactic body radiation therapy (SBRT)

Reshko, Leonid B.; Kalman, Noah S.; Hugo, Geoffrey D.; Weiß, Elisabeth H.

doi:10.21037/jtd.2018.04.42

Cited by 46 publications

(30 citation statements)

References 30 publications

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“…In a follow up study, Thor et al [ 2 ] revealed that dose to specific cardiac substructures such as the atria, ventricles, and pericardium were highly correlated with overall survival. These findings have been supported by several other groups, who also demonstrate a dose-dependent relationship between cardiac substructures and outcome[ 3 , 4 ]. Despite these findings, definition of such structures is not standard in radiation planning at this time.…”

Section: Introductionsupporting

confidence: 79%

Autosegmentation of cardiac substructures in respiratory-gated, non-contrasted computed tomography images

Farrugia

Singh

et al. 2021

WJCO

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BACKGROUND Radiation dose to specific cardiac substructures can have a significant on treatment related morbidity and mortality, yet definition of these structures is labor intensive and not standard. Autosegmentation software may potentially address these issues, however it is unclear whether this approach can be broadly applied across different treatment planning conditions. We investigated the feasibility of autosegmentation of the cardiac substructures in four-dimensional (4D) computed tomography (CT), respiratory-gated, non-contrasted imaging. AIM To determine whether autosegmentation can be successfully employed on 4DCT respiratory-gated, non-contrasted imaging. METHODS We included patients who underwent stereotactic body radiation therapy for inoperable, early-stage non-small cell lung cancer from 2007 to 2019. All patients were simulated via 4DCT imaging with respiratory gating without intravenous contrast. Generated structure quality was evaluated by degree of required manual edits and volume discrepancy between the autocontoured structures and its edited sister structure. RESULTS Initial 17-structure cardiac atlas was generated with 20 patients followed by three successive iterations of 10 patients using MIM software. The great vessels and heart chambers were reliably autosegmented with most edits considered minor. In contrast, coronary arteries either failed to be autosegmented or the generated structures required major alterations necessitating deletion and manual definition. Similarly, the generated mitral and tricuspid valves were poor whereas the aortic and pulmonary valves required at least minor and moderate changes respectively. For the majority of subsites, the additional samples did not appear to substantially impact the quality of generated structures. Volumetric analysis between autosegmented and its manually edited sister structure yielded comparable findings to the physician-based assessment of structure quality. CONCLUSION The use of MIM software with 30-sample subject library was found to be useful in delineating many of the heart substructures with acceptable clinical accuracy on respiratory-gated 4DCT imaging. Small volume structures, such as the coronary arteries were poorly autosegmented and require manual definition.

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Section: Introductionsupporting

confidence: 79%

Autosegmentation of cardiac substructures in respiratory-gated, non-contrasted computed tomography images

Farrugia

Singh

et al. 2021

WJCO

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“…Reshko and colleagues reported the range of doses given to cardiac substructures for over 70 patients treated with lung SBRT for early-stage lung cancer. 29 In that series, the median dose to the left ventricle (EQD2 adjusted) was 0.2 Gy, with a range from 0.02 Gy to 12 Gy. For the left anterior descending artery, the reported median EQD2 was 0.8 Gy, with a range from 0.02 Gy to 16 Gy.…”

Section: Discussionmentioning

confidence: 85%

Radiation Therapy Workflow and Dosimetric Analysis from a Phase 1/2 Trial of Noninvasive Cardiac Radioablation for Ventricular Tachycardia

Knutson

Samson

Hugo

et al. 2019

International Journal of Radiation Oncology*Biology*Physics

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In this manuscript, the authors detail the complete workflow for cardiac stereotactic body radiation therapy that was performed to treat patients with refractory ventricular tachycardia on a recently completed phase 1/2 trial. Included in this report are the dose-volume metrics Purpose: A prospective phase 1/2 trial for electrophysiologic guided noninvasive cardiac radioablation treatment of ventricular tachycardia (ENCORE-VT) demonstrating efficacy for arrhythmia control has recently been reported. The treatment workflow, report dose-volume metrics, and overall process improvements are described here. Methods and Materials: Patients receiving 25 Gy in a single fraction to the cardiac ventricular tachycardia substrate (identified on presimulation multimodality imaging) on the phase 1/2 trial were included for analysis. Planning target volume (PTV), R50, monitor unit ratio, and gradient measure values were compared over time using statistical process control. Outlier values in the dose-volume histogram (DVH) for PTV and organs at risk were identified by calculating inner fences based on the interquartile range. Median heart substructure doses are also reported.

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“…We reported two cardiac deaths in patients with severe cardiac and pulmonary diseases. By the DVH analysis and considering the location of the treated lesions away from central organs we did not ascribe these events as treatment-related death, also considering the recent literature on the correlation between dose to cardiac structures and cardiac event 36 .…”

Section: Discussionmentioning

confidence: 99%

Long term results of single high dose Stereotactic Body Radiotherapy in the treatment of primary lung tumors

Nicosia

Reverberi

Agolli

et al. 2019

Sci Rep

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Stereotactic body radiotherapy (SBRT) is a standard treatment for inoperable early-stage NSCLC, with local control rates comparable to surgical series. Promising results have been achieved utilizing a high single-dose schedule. The aim of our study was to evaluate long-term local control and toxicity in a series of patients treated with SBRT delivered in a single dose of 30 Gy. 44 patients affected by early stage NSCLC were treated with SBRT delivered in a single dose of 30 Gy. Survival and prognostic factors were retrospectively evaluated. Median follow-up was 34 months (range 3–81). Three- and 5-year local progression-free survival (LPFS) were 87.8% and 87.8% respectively (median 30 months; range 6–81 months), 3- and 5-year OS and CSS were 64.9% and 36.9%, 80.9% and 65.5%, respectively. Two (4.6%) cases of grade 3 pneumonitis occurred. At the univariate analysis lesion diameter ≤ 25 mm was predictive of better 5-year LPFS (95.8% versus 56.3%; p = 0.003) and 5-year PFS (69.8% versus 27.8%; p = 0.002). The results of our study indicated a high local control, survival and tolerability after a long-term follow-up with the use of SBRT 30 Gy single dose. Further prospective studies could better define the role of this regimen.

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Cardiac radiation dose distribution, cardiac events and mortality in early-stage lung cancer treated with stereotactic body radiation therapy (SBRT)

Cited by 46 publications

References 30 publications

Autosegmentation of cardiac substructures in respiratory-gated, non-contrasted computed tomography images

Autosegmentation of cardiac substructures in respiratory-gated, non-contrasted computed tomography images

Radiation Therapy Workflow and Dosimetric Analysis from a Phase 1/2 Trial of Noninvasive Cardiac Radioablation for Ventricular Tachycardia

Long term results of single high dose Stereotactic Body Radiotherapy in the treatment of primary lung tumors

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