Impact of Low-Dose Irradiation of the Lung and Heart on Toxicity and Pulmonary Function Parameters after Thoracic Radiotherapy

Schröder, Christina; Buchali, A.; Windisch, Paul; Vu, Erwin; Basler, Lucas; Zwahlen, Daniel R.; Forster, R. E.

doi:10.3390/cancers13010022

Cited by 11 publications

(7 citation statements)

References 37 publications

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“…In the OAR lung, it is of utmost importance to minimise radiation exposure as the tissue is highly sensitive to radiation (Marks et al 2010;Oertel et al 2021 Jun 12). However, several clinical studies, including this one, have shown that lung sparing with HT is feasible (Wilhelm-Buchstab et al 2020;Schröder et al 2020;. In our patient cohort, none had acute (< 6 months) severe radiationinduced lung injury, suggesting a beneficial effect of lung dose reduction, despite the fact that certain chemotherapeutic agents, such as fludarabine-containing regimens, are impacting on pulmonary outcome (Oertel et al 2021).…”

Section: Discussionmentioning

confidence: 65%

Whole body irradiation with intensity-modulated helical tomotherapy prior to haematopoietic stem cell transplantation: analysis of organs at risk by dose and its effect on blood kinetics

Köksal

Baumert

Jazmati

et al. 2023

J Cancer Res Clin Oncol

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Background Intensity-modulated helical tomotherapy (HT) is a promising technique in preparation for bone marrow transplantation. Nevertheless, radiation-sensitive organs can be substantially compromised due to suboptimal delivery techniques of total body irradiation (TBI). To reduce the potential burden of radiation toxicity to organs at risk (OAR), high-quality coverage and homogeneity are essential. We investigated dosimetric data from kidney, lung and thorax, liver, and spleen in relation to peripheral blood kinetics. To further advance intensity-modulated total body irradiation (TBI), the potential for dose reduction to lung and kidney was considered in the analysis. Patients and methods 46 patients undergoing TBI were included in this analysis, partially divided into dose groups (2, 4, 8, and 12 Gy). HT was performed using a rotating gantry to ensuring optimal reduction of radiation to the lungs and kidneys and to provide optimal coverage of other OAR. Common dosimetric parameters, such as D05, D95, and D50, were calculated and analysed. Leukocytes, neutrophils, platelets, creatinine, GFR, haemoglobin, overall survival, and graft-versus-host disease were related to the dosimetric evaluation using statistical tests. Results The mean D95 of the lung is 48.23%, less than half the prescribed and unreduced dose. The D95 of the chest is almost twice as high at 84.95%. Overall liver coverage values ranged from 96.79% for D95 to 107% for D05. The average dose sparing of all patients analysed resulted in an average D95 of 68.64% in the right kidney and 69.31% in the left kidney. Average D95 in the spleen was 94.28% and D05 was 107.05%. Homogeneity indexes ranged from 1.12 for liver to 2.28 for lung. The additional significance analyses conducted on these blood kinetics showed a significant difference between the 2 Gray group and the other three groups for leukocyte counts. Further statistical comparisons of the dose groups showed no significant differences. However, there were significant changes in the dose of OAR prescribed with dose sparing (e.g., lung vs. rib and kidney). Conclusion Using intensity-modulated helical tomotherapy to deliver TBI is a feasible method in preparation for haematopoietic stem cell transplantation. Significant dose sparing in radiosensitive organs such as the lungs and kidneys is achievable with good overall quality of coverage. Peripheral blood kinetics support the positive impact of HT and its advantages strongly encourage its implementation within clinical routine.

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Section: Discussionmentioning

confidence: 65%

Whole body irradiation with intensity-modulated helical tomotherapy prior to haematopoietic stem cell transplantation: analysis of organs at risk by dose and its effect on blood kinetics

Köksal

Baumert

Jazmati

et al. 2023

J Cancer Res Clin Oncol

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“…The need for dose reduction in patients receiving 4 Gy is questionable given that this dose may have minor toxic effects [ 19 ]. That is, a marginal reduction in lung tissue toxicity may not warrant the additional time needed to plan for lung sparing.…”

Section: Discussionmentioning

confidence: 99%

Lung sparing and ribcage coverage in total body irradiation delivered by helical tomotherapy

et al. 2022

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Purpose Helical tomotherapy (HT) is a viable method for delivering total body irradiation (TBI) when preparing patients for allogenic stem cell or bone-marrow transplantation. TBI can be planned to reduce the amount of radiation delivered to organs at risk, such as the lungs, with the aim of decreasing toxicity. However, it is important for the ribcage to receive the prescribed radiation dose in preparation for bone-marrow transplantation. In this retrospective study, we analyzed radiation dose coverage of the lungs and ribcage in patients who underwent TBI delivered by HT to achieve lung dose sparing. Methods Thirty-five patients were included in the analysis and divided into three groups based on their prescribed radiation dose (4, 8, or 12 Gy). HT was performed using a rotating gantry to reduce radiation to the lungs. Dosimetric parameters for the lungs and ribcage as well as dose-volume histograms were calculated. Results The mean lung D95 was 60.97%, 54.77%, and 37.44% of the prescribed dose for patients receiving 4 Gy, 8 Gy, and 12 Gy, respectively. Ribcage coverage was most optimal for patients receiving 4 Gy, with a D95 of 91.27% and mean homogeneity index of 1.17, whereas patients receiving 12 Gy had a mean D95 of 78.65% and homogeneity index of 1.37, which is still within the range recommended by treatment guidelines. Conclusions Using HT to achieve lung tissue sparing is a viable approach to minimizing pulmonic complications in patients undergoing TBI. As this planning adjustment does not compromise the dose and quality of coverage received by the ribcage, it is a feasible tool within conditioning regimens for allogeneic bone-marrow transplantation.

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“…This exposure can have long-term effects on the lungs 13 , including a slight increase in the risk of lung cancer, fibrosis (scarring of the lung tissue) and impaired lung function. Studies have shown that exposure to low doses, can lead to changes in the DNA of lung cells that can result in mutations and an increased risk of lung cancer.…”

Section: B Vmat and Low Doses (<10gy)mentioning

confidence: 99%

Hybrid VMAT-3DCRT as Breast Treatment Improvement Tool

Voyant¹,

Pinpin²,

Leschi³

et al. 2023

Preprint

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Impact of Low-Dose Irradiation of the Lung and Heart on Toxicity and Pulmonary Function Parameters after Thoracic Radiotherapy

Cited by 11 publications

References 37 publications

Whole body irradiation with intensity-modulated helical tomotherapy prior to haematopoietic stem cell transplantation: analysis of organs at risk by dose and its effect on blood kinetics

Whole body irradiation with intensity-modulated helical tomotherapy prior to haematopoietic stem cell transplantation: analysis of organs at risk by dose and its effect on blood kinetics

Lung sparing and ribcage coverage in total body irradiation delivered by helical tomotherapy

Hybrid VMAT-3DCRT as Breast Treatment Improvement Tool

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