Dosimetric Comparison of Helical Tomotherapy, Volume-Modulated Arc Therapy, and Fixed-Field Intensity-Modulated Radiation Therapy in Locally Advanced Nasopharyngeal Carcinoma

Lu, Shan; Fan, Huiqi; Hu, Xueyuan; Li, Xin; Kuang, Yingying; Yu, Deyang; Yang, Shanshan

doi:10.3389/fonc.2021.764946

Cited by 11 publications

(11 citation statements)

References 39 publications

(37 reference statements)

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“…It is worth mentioning that most of the previous dosimetric studies make dosimetric comparisons by regenerating a VMAT/ tomotherapy plan on the same patient with an existing tomotherapy/VMAT plan, which makes comparisons of clinical outcomes infeasible (4)(5)(6)(7). The current study compared the dosimetric parameters between patients who received tomotherapy and those who received VMAT directly, using PSM to control the balance of confounding factors that may affect dosimetry.…”

Section: Discussionmentioning

confidence: 99%

“…In the treatment of NPC, previous studies have shown that tomotherapy is superior or equivalent to VMAT in most dosimetric parameters, including the dose coverage of target volumes and the protections of the spinal cord, brainstem, temporal lobes, and parotids. On the other hand, VMAT has been reported to have significant advantages in shortening treatment time and protecting optic nerves and optic chiasm (4)(5)(6)(7). Besides, the hybrid IMRT/VMAT, which combines IMRT and VMAT, has shown the potential benefit of improving the dose distribution by increasing the freedom to find the optimal combination of angular sampling and intensity modulation (8,9).…”

Section: Introductionmentioning

confidence: 99%

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Volumetric modulated arc therapy versus tomotherapy for late T-stage nasopharyngeal carcinoma

Chen

Tang²,

Zhu³

et al. 2022

Front. Oncol.

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PurposeTo compare the dosimetric parameters and clinical outcomes between volumetric modulated arc therapy (VMAT) and tomotherapy for treating late T-stage nasopharyngeal carcinoma (NPC).MethodsPatients with non-metastatic late T-stage NPC who received definitive radiotherapy with tomotherapy or VMAT were selected. 1:1 propensity score matching (PSM) was used to control the balance of confounding factors. The dosimetric parameters and clinical outcomes were compared.ResultsA total of 171 patients were enrolled before matching, with 61 patients in the VMAT group and 110 patients in the tomotherapy group. In the post-PSM cohort, 54 sub-pairs of 108 patients were included after matching. Tomotherapy was superior to VMAT in the dosimetric parameters of planning target volumes, brainstem, spinal cord, lenses, and parotid glands but inferior in the optic nerves and optic chiasm. The tomotherapy group had a lower incidence of grade ≥ 3 acute mucositis (22.2% vs. 40.7%, p = 0.038) and a higher rate of complete response (83.3% vs. 66.7%, p = 0.046) after radiotherapy. However, there were no significant differences in locoregional failure-free survival (p = 0.375), distant metastasis-free survival (p = 0.529), or overall survival (p = 0.975) between the two groups.ConclusionTomotherapy is superior to VMAT in terms of most dosimetric parameters, with less acute mucositis and better short-term efficacy. There are no significant differences in the survival outcomes between the VMAT and tomotherapy groups.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Volumetric modulated arc therapy versus tomotherapy for late T-stage nasopharyngeal carcinoma

Chen

Tang²,

Zhu³

et al. 2022

Front. Oncol.

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“…HT delivers highly conformal dose distributions for head and neck cancer with an impressive ability to spare critical organs [6,7]. Compared to VMAT and IMRT in patients with NPC, HT presents a sharp dose gradient associated with optimal conformity, homogeneity, and better performance in sparing surrounding organs at risk (OARs) [5]. e dwindling 5-year incidence of TLN in NPC patients treated with IMRT is significantly higher than that in NPC patients treated with conventional RT, by 20% [8].…”

Section: Introductionmentioning

confidence: 99%

“…Intensity-modulated radiotherapy (IMRT) is a modern technique of RT for NPC. Volume-modulated arc therapy (VMAT) and helical tomotherapy (HT), image-guided arc radiotherapy techniques, are receiving additional attention compared with conventional IMRT for patients with NPC [ 5 ]. HT delivers highly conformal dose distributions for head and neck cancer with an impressive ability to spare critical organs [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Spotted Temporal Lobe Necrosis following Concurrent Chemoradiation Therapy Using Image-Guided Radiotherapy for Nasopharyngeal Carcinoma

Chiang

Liao

et al. 2022

Case Reports in Otolaryngology

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Background. To explore spotted temporal lobe necrosis (TLN) and changes in brain magnetic resonance imaging (MRI) after image-guided radiotherapy (IGRT) in a patient with nasopharyngeal carcinoma (NPC). Case presentation: a 57-year-old male was diagnosed with stage III NPC, cT1N2M0, in 2017. He underwent concurrent chemoradiation therapy (CCRT) with cisplatin (30 mg/m2) and 5- fluorouracil (5-FU, 500 mg/m2) plus IGRT with 70 Gy in 35 fractions for 7 weeks. The following MRI showed a complete response in the NPC. However, the patient suffered from fainting periodically when standing up approximately 3 years after CCRT. Neck sonography showed mild atherosclerosis (< 15%) of bilateral carotid bifurcations and bilateral small-diameter vertebral arteries, with reduced flow volume. The following MRI showed a 9 mm × 7 mm enhancing lesion in the right temporal lobe without locoregional recurrence, and TLN was diagnosed. The lesion was near the watershed area between the anterior temporal and temporo-occipital arteries. The volume of the necrotic lesion was 0.51 c.c., and the mean dose and Dmax of the lesion were 64.4 Gy and 73.7 Gy, respectively. Additionally, the mean dose, V45, D1 c.c. (dose to 1 ml of the temporal lobe volume), D0.5 c.c. and Dmax of the right and left temporal lobes were 11.1 Gy and 11.4 Gy, 8.5 c.c. and 6.7 c.c., 70.1 Gy and 67.1 Gy, 72.0 Gy and 68.8 Gy, and 74.2 Gy and 72.1 Gy, respectively. Conclusion. Spotted TLN in patients with NPC treated by IGRT may be difficult to diagnose due to a lack of clinical symptoms and radiological signs. Endothelial damage may occur in carotid and vertebral arteries within the irradiated area, affecting the small branches supplying the temporal lobe and inducing spotted TLN. Future research on the relationship between vessels and RT or CCRT and the development of TLN is warranted.

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Tomotherapy in synchronous and metachronous bilateral breast cancer: Clinical experience

Orda,

Shayakhmetov,

Baiturova

et al. 2024

J Applied Clin Med Phys

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Purpose of studyThe objective of this research is to present our firsthand experience and provide up‐to‐date data for the further study of cases involving simultaneous breast irradiation using helical Tomotherapy, ©Accuray Inc.MethodsThe radical treatment options for bilateral breast cancer are surgery, chemotherapy, and radiation therapy. Being that radiotherapy for bilateral breast cancer is challenging due to limitations in the geometry of modern radiotherapy equipment, helical Tomotherapy was chosen as an appropriate technique of irradiation. The retrospective review focused on the records of patients who underwent bilateral irradiation of the breast or chest wall and regional lymph nodes using helical Tomotherapy.ResultsOnly four patients with bilateral breast cancer completed a radiation therapy course in our center from 2018 to 2023. Two patients underwent radical mastectomy with lymph node dissection on both sides before irradiation. For the other two patients, radical mastectomy was done after neoadjuvant chemotherapy. Acute radiation toxicity scoring was based on Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Only mild adverse effects, such as general weakness and slight skin irritation below Grade 3, were observed, with no instances of skin swelling, dryness, or pigmentation noted. Evaluation of late complications revealed tissue fibrosis in the area of the internal mammary nodes and respiratory failure with various severity. Complications and deterioration in the cardiovascular system were not observed during the follow‐up period, which varied from 3 to 48 months.ConclusionOur results show the efficacy of using helical Tomotherapy considering positive outcomes, being that three out of four patients are in remission with low acute toxicity and late complications. There are a small number of articles describing bilateral breast cancer treatment with helical Tomotherapy. On this occasion, our data could contribute to the studies of tolerant doses for organs at risk and improve the parameters of treatment plans for bilateral breast cancer. Since the small sample of patients with bilateral breast cancer limits the study, a larger cohort of patients is essential to obtain statistically reliable results.

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Dosimetric Comparison of Helical Tomotherapy, Volume-Modulated Arc Therapy, and Fixed-Field Intensity-Modulated Radiation Therapy in Locally Advanced Nasopharyngeal Carcinoma

Cited by 11 publications

References 39 publications

Volumetric modulated arc therapy versus tomotherapy for late T-stage nasopharyngeal carcinoma

Volumetric modulated arc therapy versus tomotherapy for late T-stage nasopharyngeal carcinoma

Spotted Temporal Lobe Necrosis following Concurrent Chemoradiation Therapy Using Image-Guided Radiotherapy for Nasopharyngeal Carcinoma

Tomotherapy in synchronous and metachronous bilateral breast cancer: Clinical experience

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