Dosimetric Comparison Between Helical Tomotherapy and Volumetric Modulated Arc Therapy in Patients With Malignant Pleural Mesothelioma

Müdder, Thomas; Henkenberens, Christoph; Holz, Jasmin A.; Garbe, Stephan; Röhner, Fred; Stumpf, Sabina; Buchstab, Timo; Giordano, Frank A.; Leitzen, Christina

doi:10.1016/j.clon.2021.08.005

Cited by 4 publications

(4 citation statements)

References 27 publications

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“…Dosimetric parameters may differ between IMRT techniques, and it is unknown whether this influences toxicity profiles. In a study comparing HTT and VMAT dosimetric parameters, the PTV coverage of both techniques was similar, but the total lung V20 (26.7% vs. 31.1%) and D50 (24.8 vs. 22.9%) of HTT were better [17]. Although dose limits have been defined for the contralateral lung for IMRT applications in MPM treatment, there is no such definition for the ipsilateral lung.…”

Section: Discussionmentioning

confidence: 99%

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Trimodality therapy of malignant pleural mesothelioma with helical tomotherapy

Özyurt¹

2023

North Clin Istanbul

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M PM is an aggressive tumor that originates from the pleural surfaces and associated with asbestos exposure [1]. In recent studies some tumor suppressor genes, such as BAF-1, have been identified as factors in mesothelioma carcinogenesis [2].MPM is divided into 3 histopathological subgroups by WHO, which differ from each other in terms of prognosis: epithelioid, sarcomatoid, and biphasic. Epithelioid is the most common histopathological type with the best prognostic features, with a median survival of 14 months. Survival times of biphasic and sarcomatoid types were reported as 10 and 4 months, respectively [3].MPM treatment includes different approaches such as surgery, radiotherapy, and chemotherapy. Two surgical approaches are available: gross tumor resection and radical removal of visible disease with tissues, or conservative approaches such as tissue sparing and debulking. Extra-pleural pneumonectomy (EPP) is a radical ap- ABSTRACT OBJECTIVE:The purpose of this study was to determine the efficacy and tolerability of hemithoracic radiotherapy implemented with helical tomotherapy (HTT) in malignant pleural mesothelioma (MPM) patients. METHODS:Between October 2018 and December 2020, data from 11 MPM patients who received trimodality therapy, including lung-sparing surgery (pleurectomy-decortication, P/D), adjuvant chemotherapy (cisplatin+ pemetrexed), and radiotherapy, were retrospectively reviewed. HTT was used to deliver a total of 30 Gy, 50-54 Gy or 59.4-60 Gy to R2 disease with 1.8-2 Gy daily doses. Descriptive data are presented in number (percentage) or median (minimum-maximum). The Kaplan-Meier method was used to calculate survival data. In patients with toxicities, the risk organ doses were compared using the Mann-Whitney U test. RESULTS:The median follow-up was 20.5 (12-30) months. Two-year local control, disease-free, and overall survival rates were 48.5%, 49%, and 77.9%, respectively. The median prescribed dose for planning target volume (PTV) was 50.4±8.7 (30-60) Gy. Mean dose (D mean ) of total lung was 19.9±6 (10.4-26) Gy; the V20 (%) of ipsilateral and contralateral lungs were 89.±11.2 (62.7-100) and 0.7±2.1 (0.49-5.9), respectively. Esophageal D mean and maximum doses (D max ) were found as 21. 7±8.4 (7.4-34) and 53.1±10.4 (25.4-64.4) Gy, respectively. V30 (%) and Dmean of heart were 22.3%±13.4% (3.9-47) and 21±5.7 (10.8-29.3) Gy, respectively. D max of medulla spinalis (MS) was 38.6± 1.3 (13.7-48) Gy. Grade 1-2 radiation pneumonitis (RP) developed in 4 (36.4%) and esophagitis in 2 (18.2%) patients. RP was found to be associated with MS and esophageal doses (p<0.05). Myelitis was diagnosed in 1 (9.1%) patient (MS D max : 29 Gy).CONCLUSION: HTT can be used as part of trimodality therapy for MPM patients with acceptable toxicities. MS and esophageal doses should be considered for radiation pneumonitis risk, and new dose constraints for these organs should be defined.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Trimodality therapy of malignant pleural mesothelioma with helical tomotherapy

Özyurt¹

2023

North Clin Istanbul

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“…Another disadvantage of HT is the long beam-on time. According to dosimetric comparative studies between volumetric modulated arc therapy (VMAT) and HT, the beam-on time was approximately two times longer in HT than in VMAT 19 . Especially, HT-CSI has a longer beam-on time because of its wider treatment range than that for other treatment sites; thus, intrafractional movement is likely to occur.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary toxicity of craniospinal irradiation using helical tomotherapy

Lee

Kim

et al. 2022

Sci Rep

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Craniospinal irradiation using helical tomotherapy (HT-CSI) has advantages in aspects of homogeneous dose distribution. Physicians, however, still have concerns of pulmonary toxicity due to HT-CSI’s relatively large, low-dose irradiated volume from continuous and 360° rotation delivery. In this study, we investigated the pulmonary toxicity of HT-CSI. We retrospectively reviewed 105 patients who received HT-CSI between January 2014 and December 2019. Grade 2 + pulmonary toxicities were evaluated. Intensive systemic treatment was defined as systemic treatment administration before, during, and after HT-CSI. VX Gy was defined as % volume receiving ≥ X Gy. Thirteen patients (12.4%) presented with grade 2 + pulmonary toxicities after HT-CSI. Of these patients, only one experienced grade 2 radiation pneumonitis combined with pembrolizumab-induced pneumonitis. Conversely, pneumonia was observed in 12 patients. Intensive systemic treatment (p = 0.004), immunosuppressive drugs (p = 0.031), and bilateral lung V5 Gy ≥ 65% (p = 0.031) were identified as independent risk factors for pneumonia. The risk factor for pneumonia in pediatric patients were immunosuppressive drugs (p = 0.035) and bilateral lung V5 Gy ≥ 65% (p = 0.047). HT-CSI can be a safe treatment modality with tolerable pulmonary toxicities. Intensive systemic treatment, immunosuppressive drugs, and bilateral lung V5 Gy ≥ 65% were significantly associated with pneumonia. In these patients, close follow-up should be considered for proper management of pneumonia.

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“…The dosimetric efficacy of tomotherapy compared to other IMRT techniques, such as VMAT, has been reported for prostate cancer [16][17][18][19] and other treatment sites. [20][21][22][23][24][25][26] Recently, the RayStation treatment planning system (TPS) (RaySearch Lab; Stockholm, Sweden) implemented a new module that performs dose calculations for tomotherapy. The TPS is also available for robust optimization in treatment planning for worst-case scenarios.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of robust optimization against geometric uncertainties in TomoHelical planning for prostate cancer

Yagihashi

Inoue

Nagata

et al. 2022

J Applied Clin Med Phys

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Background Geometrical uncertainties in patients can severely affect the quality of radiotherapy. Purpose We evaluated the dosimetric efficacy of robust optimization for helical intensity‐modulated radiotherapy (IMRT) planning in the presence of patient setup uncertainty and anatomical changes. Methods Two helical IMRT plans for 10 patients with localized prostate cancer were created using either minimax robust optimization (robust plan) or a conventional planning target volume (PTV) margin approach (PTV plan). Plan robustness was evaluated by creating perturbed dose plans with setup uncertainty from isocenter shifts and anatomical changes due to organ variation. The magnitudes of the geometrical uncertainties were based on the patient setup uncertainty considered during robust optimization, which was identical to the PTV margin. The homogeneity index, and target coverage (TC, defined as the V100% of the clinical target volume), and organs at risk (OAR; rectum and bladder) doses were analyzed for all nominal and perturbed plans. A statistical t ‐test was performed to evaluate the differences between the robust and PTV plans. Results Comparison of the nominal plans showed that the robust plans had lower OAR doses and a worse homogeneity index and TC than the PTV plans. The evaluations of robustness that considered setup errors more than the PTV margin demonstrated that the worst‐case perturbed scenarios for robust plans had significantly higher TC while maintaining lower OAR doses. However, when anatomical changes were considered, improvement in TC from robust optimization was not observed in the worst‐case perturbed plans. Conclusions For helical IMRT planning in localized prostate cancer, robust optimization provides benefits over PTV margin–based planning, including better OAR sparing, and increased robustness against systematic patient‐setup errors.

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Dosimetric Comparison Between Helical Tomotherapy and Volumetric Modulated Arc Therapy in Patients With Malignant Pleural Mesothelioma

Cited by 4 publications

References 27 publications

Trimodality therapy of malignant pleural mesothelioma with helical tomotherapy

Trimodality therapy of malignant pleural mesothelioma with helical tomotherapy

Pulmonary toxicity of craniospinal irradiation using helical tomotherapy

Effectiveness of robust optimization against geometric uncertainties in TomoHelical planning for prostate cancer

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