Critical Structure Sparing in Stereotactic Ablative Radiotherapy for Central Lung Lesions: Helical Tomotherapy vs. Volumetric Modulated Arc Therapy

Chi, Alexander; Ma, P.; Fu, Guangbo; Hobbs, Gerry; Welsh, James S.; Nguyen, Nam P.; Jang, Seonghoe; Dai, Jianrong; Jin, Jing; Komaki, Ritsuko

doi:10.1371/journal.pone.0059729

Cited by 10 publications

(10 citation statements)

References 37 publications

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“…Deaths related to pulmonary or cardiopulmonary dysfunction due to high-dose delivered by 3D-CRT and IMRT are the most likely explanations for the outcomes of the RTOG 0617 (19). It can be reasonably assumed that more advanced radiotherapy technologies should be employed when high dose of radiation are applied to patients with locally advanced NSCLC, which brings us to the HT, a novel platform that has already shown the good ability in OARs sparing and can define the target more accurately in various sizes (20)(21)(22).…”

Section: Discussionmentioning

confidence: 99%

Feasibility and efficacy of helical intensity-modulated radiotherapy for stage III non-small cell lung cancer in comparison with conventionally fractionated 3D-CRT

Huang

Chen

et al. 2016

J. Thorac. Dis.

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Background:The standard treatment for stage III non-small-cell lung cancer (NSCLC) is still 60 Gy in conventional fractions combined with concurrent chemotherapy; however, the resulting local controls are disappointing. The aim of this study was to compare and assess the feasibility and efficacy of hypofractionated chemoradiotherapy using helical tomotherapy (HT) with conventional fractionation as opposed to using three-dimensional conformal radiotherapy (3D-CRT) for stage III NSCLC. Methods: Sixty-nine patients with stage III (AJCC 7th edition) NSCLC who underwent definitive radiation treatment at our institution between July 2011 and November 2013 were reviewed and analyzed retrospectively. A dose of 60 Gy in 20 fractions was delivered in the HT group (n=34), whereas 60 Gy in 30 fractions in the 3D-CRT group (n=35). Primary endpoints were toxicity, overall response rate, overall survival (OS) and progression-free survival (PFS). Results: The median follow-up period was 26.4 months. V20 (P=0.005), V30 (P=0.001), V40 (P=0.004), mean lung dose (P=0.000) and max dose of spinal cord (P=0.005) were significantly lower in the HT group than in the 3D-CRT group. There was no significant difference in the incidences of acute radiation pneumonitis (RP) ≥ grade 2 between the two groups, whereas the incidences of acute radiation esophagitis ≥ grade 2 were significantly lower in the HT group than in the 3D-CRT group (P=0.027). Two-year overall response rate was significantly higher in the HT group than in the 3D-CRT group (P=0.015). One-and 2-year OS rates were significantly higher in the HT group (95.0% and 68.7%, respectively) than in the 3D-CRT group (85.5% and 47.6%, respectively; P=0.0236). One-and 2-year PFS rates were significantly higher in the HT group (57.8% and 26.3%, respectively) than in the 3D-CRT group (32.7% and 11.4%, respectively; P=0.0351). Univariate analysis indicated that performance status (PS), T stage and radiotherapy technique were significant prognostic factors for both OS and PFS. Multivariate analysis indicated that PS and radiotherapy technique were independent prognostic factors of OS and PS was independent prognostic factor of PFS. Conclusions: Hypofractionated chemoradiotherapy via HT can shorten the radiotherapy time without increasing treatment-related toxicity. The preliminary findings are that OS and PFS can be improved by hypofractionated chemoradiotherapy via HT for patients with stage III NSCLC.

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Section: Discussionmentioning

confidence: 99%

Feasibility and efficacy of helical intensity-modulated radiotherapy for stage III non-small cell lung cancer in comparison with conventionally fractionated 3D-CRT

Huang

Chen

et al. 2016

J. Thorac. Dis.

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“…15 However, in the previous studies, HT was better in protection of surrounding tissues than VMRT and IMAT. 10,11 Therefore, whether the low-dose irradiation of large lung volumes or the high-dose irradiation of small lung volumes may be the main cause for pneumonitis is still uncertain. It is still controversial that whether low dose with high volume radiation or high dose with low volume radiation induces pneumonitis.…”

Section: Discussionmentioning

confidence: 99%

“…6 Compared with intensity-modulated RT (IMRT), single-arc intensity-modulated arc therapy (IMAT), 3-dimensional conformal RT (3D-CRT), volumetric-modulated arc therapy (VMAT), and helical tomotherapy (HT) may be superior to organs at risk (OARs) sparing and to providing higher target dose uniformity. [7][8][9][10] Recently, HT appears to be superior to VMAT in OAR sparing mainly in central lung cancer that requires conformal dose avoidance of multiple immediately adjacent OARs. 11 However, most studies focused on either central lung cancer or peripheral lung cancer in the early stage.…”

Section: Introductionmentioning

confidence: 99%

“…[7][8][9][10] Recently, HT appears to be superior to VMAT in OAR sparing mainly in central lung cancer that requires conformal dose avoidance of multiple immediately adjacent OARs. 11 However, most studies focused on either central lung cancer or peripheral lung cancer in the early stage. In this study, therefore, we compared the effects and safety on central and peripheral stage I lung cancer using IG-SBRT via HT.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Effects Between Central and Peripheral Stage I Lung Cancer Using Image-Guided Stereotactic Body Radiotherapy via Helical Tomotherapy

Huang

Shi

et al. 2015

Technol Cancer Res Treat

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Lung cancer is a common malignant tumor with high morbidity and mortality. Here we compared the effects and outcome between central and peripheral stage I lung cancer using image-guided stereotactic body radiotherapy. From June 2011 to July 2013, a total of 33 patients with stage I lung cancer were enrolled. A total of 50 Gy in 10 fractions or 60 Gy in 10 fractions was delivered in the central arm (n ¼ 18), while 50 Gy in 5 fractions in the peripheral arm (n ¼ 15). Statistical analyses were performed using logistic regression analysis and Kaplan-Meier method. The mean follow-up time was 38.1 months. Three-month, 1-, 2-, and 3-year overall response rates were 66.7%, 83.3%, 61.1%, and 72.2% and 66.7%, 80%, 80%, and 80% in the central and peripheral arms, respectively. Three-year local control rates (94.4% vs 93.3%, P ¼ .854), regional control rates (94.4% vs 86.7%, P ¼ .412), and distant control rates (64.2% vs 61.7%, P ¼ .509) had no differences between the central and the peripheral arms. Grade 2 radiation pneumonitis was observed in 6 of 18 patients in the central arm and in 1 of 15 patients in the peripheral arm (P ¼ .92). Grade 2 radiation esophagitis was 5.7% in the central arm, while none occurred in the peripheral arm (P ¼ .008). Five (15.1%) of all patients felt slight fatigue during radiotherapy. Other major complications were not observed. In conclusion, helical image-guided stereotactic body radiotherapy for central stage I lung cancer is safe and effective compared to peripheral stage I lung cancer.

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“…The CN 100 in coplanar VMAT and non-coplanar flattening filter-free VMAT are 0.79 and 0.81, respectively. 18 Chi et al 24 showed relatively lower CN 100 values of 0.61-0.64, calculated for the helical tomotherapy and VMAT plans. The CN 100 value of 0.72 in this report was comparable with the results of those studies.…”

Section: Lomax and Scheibmentioning

confidence: 96%

Dosimetric evaluation of compensator intensity modulation-based stereotactic body radiotherapy for Stage I non-small-cell lung cancer

Tajima

Nakayama

Itonaga

et al. 2015

BJR

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Objective: To evaluate the dosimetry of compensator intensity modulation-based stereotactic body radiotherapy (SBRT) [non-coplanar intensity-modulated radiotherapy (ncIMRT)], its use was compared with that of three-dimensional conformation-based SBRT, for patients with Stage I non-small-cell lung cancer (NSCLC). Methods: 21 consecutive patients with Stage I NSCLC were treated with ncIMRT or SBRT at Tokyo Medical University. To compare the two techniques, ncIMRT and SBRT plans for each patient were generated, where the planning target volume (PTV) coverages were adjusted to be equivalent to each other. The prescribed dose was set as 75 Gy in 30 fractions. PTV coverage, conformity index, conformation number (CN) and homogeneity index (HI) were used to compare the two strategies.Results: There was no statistically significant difference between PTV coverage for the 100%, 95% and 90% dose levels in the SBRT plan and those in the ncIMRT plan. The CN values were 0.53 6 0.13 in the SBRT plan and 0.72 6 0.10 in the ncIMRT plan. These values were significantly better than those of the SBRT plan (p , 0.001). The HI in the ncIMRT plan was 1.04 6 0.03%, which was also significantly better than that of SBRT. Conclusion: The ncIMRT plan provided superior conformity and reduced the doses to the lung for patients with Stage I NSCLC. Advances in knowledge: The delivery technique with compensator intensity modulation-based SBRT was evaluated. Concerning target motion, this is thought to be more robust and safer than SBRT for early-stage NSCLC.

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Critical Structure Sparing in Stereotactic Ablative Radiotherapy for Central Lung Lesions: Helical Tomotherapy vs. Volumetric Modulated Arc Therapy

Cited by 10 publications

References 37 publications

Feasibility and efficacy of helical intensity-modulated radiotherapy for stage III non-small cell lung cancer in comparison with conventionally fractionated 3D-CRT

Feasibility and efficacy of helical intensity-modulated radiotherapy for stage III non-small cell lung cancer in comparison with conventionally fractionated 3D-CRT

Comparison of Effects Between Central and Peripheral Stage I Lung Cancer Using Image-Guided Stereotactic Body Radiotherapy via Helical Tomotherapy

Dosimetric evaluation of compensator intensity modulation-based stereotactic body radiotherapy for Stage I non-small-cell lung cancer

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