Decreased heart dose with deep inspiration breath hold for the treatment of gastric lymphoma with IMRT

Christopherson, Kaitlin M.; Gunther, Jillian R.; Fang, Penny; Peterson, Stacy L.; Roach, Karen; Wong, Pei Fong; Mirković, Dragan; Lim, Tze Yee; He, Wei; Wang, Xin A.; Wang, Congjun; Garcia, J.; Dabaja, Bouthaina S.; Pinnix, Chelsea C.

doi:10.1016/j.ctro.2020.05.013

Cited by 12 publications

(10 citation statements)

References 21 publications

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“…19 Deep-inspiration breath-hold has also been shown to significantly decrease the radiation dose to the heart. 20 A recent series of 32 patients demonstrated that a reduced dose of 24 Gy could be used effectively, with no disease failures identified at 2 years. 21 These excellent outcomes compel the investigation of radiation dose deintensification with long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

Involved-site radiotherapy for Helicobacter pylori–independent gastric MALT lymphoma: 26 years of experience with 178 patients

Yahalom

Noy

et al. 2021

Blood Advances

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Treatment options for Helicobacter pylori–independent gastric mucosa-associated lymphoid tissue (MALT) lymphoma (GML) include surgery, immunotherapy, chemotherapy, and radiation therapy (RT). The purpose of this study was to investigate the efficacy and safety of RT and routine endoscopic surveillance, hypothesizing that most patients are curable with RT alone. We queried a single institution database at a tertiary referral cancer center for patients with H pylori–independent GML treated with RT between 1991 and 2017. Response was assessed by follow-up endoscopies (EGDs) starting 10 to 12 weeks post-RT. Computed tomography scans were also part of the follow-up program, and positron emission tomography was added when clinically appropriate. We identified 178 patients (median age, 63 years; range, 25-89 years); 86% had stage I disease, 7% had stage II disease, and 7% had stage IV disease. Median RT dose was 3000 cGy over 20 fractions. Ninety-five percent of patients exhibited complete pathologic response on posttreatment EGD. Two patients experienced grade 3 toxicity, and 2 patients experienced in-field secondary malignancies. Over a median follow-up of 6.2 years, 9.6% experienced local failures, and 11.8% developed distant sites of disease. Five-year and 10-year overall survival were 94% and 79%, respectively, from last date of RT. RT is a highly effective and safe treatment for GML with excellent overall survival and very rare acute or late treatment-related toxicities. Favorable outcomes from this large retrospective sample of patients provide credible and compelling support for RT as standard of care for H pylori–independent GML.

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Section: Discussionmentioning

confidence: 99%

Involved-site radiotherapy for Helicobacter pylori–independent gastric MALT lymphoma: 26 years of experience with 178 patients

Yahalom

Noy

et al. 2021

Blood Advances

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“…Several studies have attempted to reduce the heart dose by DIBH in cases of gastric lymphoma and breast cancer [8][9][10]. The DIBH technique is gated irradiation during deep inspiration, investigated by several studies, mostly focused on reducing the dose to the heart.…”

Section: Discussionmentioning

confidence: 99%

Tailored stereotactic radiotherapy technique using deep inspiration breath-hold to reduce stomach dose for cardiac radioablation

et al. 2021

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To provide a new insight on a novel safe cardiac radioablation using deep inspiration breath-hold (DIBH) to reduce gastrointestinal dose. Materials and Methods: For treating incessant ventricular tachycardia (VT) originated from left ventricle inferior scar abutting the stomach, a target delineation and treatment planning for cardiac radioablation was performed. With four different computed tomography (CT) scan protocols-DIBH, full expiration breath-hold, four-dimensional (4D) CT without and with abdominal compression, the distances between the target and the stomach were compared. Results: Among the protocols, the CT scan with DIBH showed largest distance between the target and the stomach and selected for the treatment planning. The prescribed dose was 25 Gy in a single fraction, and satisfactory dosimetric parameters were achieved with the DIBH. The patient was successfully treated with the DIBH, and experienced no acute toxicity. Conclusion:To gain the best benefit from cardiac radioablation, understanding the possible toxicity in the adjacent organs is crucial. By moving the heart with thoraco-diaphragmatic movement by DIBH, the target could be physically separated from the stomach.

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“…Due to the close proximity of the stomach to the base of the heart, motion management using the deep-inspiration breath-hold (DIBH) technique creates anatomical distance between the heart and the stomach and significantly reduces the dose of radiation to the heart [ 88 ]. Besides, modern radiation techniques and daily imaging also help to reduce the dose exposure to the heart.…”

Section: Toxicity Of Radiotherapy Treatmentmentioning

confidence: 99%

Development of Organ-Preserving Radiation Therapy in Gastric Marginal Zone Lymphoma

Rolf

Reinartz

Rehn

et al. 2022

Cancers

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Gastric marginal zone lymphoma (gMZL) of mucosa-associated lymphoid tissue (MALT) may persist even after H. pylori eradication, or it can be primarily Helicobacter pylori (H. pylori) independent. For patients without the successful eradication of lymphoma, or with progressive disease, treatment options have historically included partial or total gastrectomy. Presently, in these instances, curative radiation therapy (RT) is the current standard of care. This review emphasizes the historically changing role of radiation therapy in gMZL, progressing from large-volume RT without surgery, to localized RT, on its own, as a curative organ-preserving treatment. This overview shows the substantial progress in radiation therapy during the recent two to three decades, from high-dose, large-field techniques to low-dose, localized target volumes based on advanced imaging, three-dimensional treatment planning, and advanced treatment delivery techniques. RT has evolved from very large extended field techniques (EF) with prophylactic treatment of the whole abdomen and the supradiaphragmatic lymph nodes, applying doses between 30 and 50 Gy, to involved-field RT (IF), to the current internationally recommended involved site radiation therapy (ISRT) with a radiation dose of 24–30 Gy in gMZL. Stage-adapted RT is a highly effective and safe treatment with excellent overall survival rates and very rare acute or late treatment-related toxicities, as shown not only in retrospective studies, but also in large prospective multicenter studies, such as those conducted by the German Study Group on Gastrointestinal Lymphoma (DSGL). Further de-escalation of the radiation treatments with low-dose 20 Gy, as well as ultra-low-dose 4 Gy radiation therapy, is under investigation within ongoing prospective clinical trials of the International Lymphoma Radiation Oncology Group (ILROG) and of the German Lymphoma Alliance (GLA).

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Decreased heart dose with deep inspiration breath hold for the treatment of gastric lymphoma with IMRT

Cited by 12 publications

References 21 publications

Involved-site radiotherapy for Helicobacter pylori–independent gastric MALT lymphoma: 26 years of experience with 178 patients

Involved-site radiotherapy for Helicobacter pylori–independent gastric MALT lymphoma: 26 years of experience with 178 patients

Tailored stereotactic radiotherapy technique using deep inspiration breath-hold to reduce stomach dose for cardiac radioablation

Development of Organ-Preserving Radiation Therapy in Gastric Marginal Zone Lymphoma

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