Long-term cardiac mortality following radiation therapy for Hodgkin's disease: analysis with the relative seriality model

Eriksson, Fredrik; Gagliardi, Giovanna; Liedberg, Anette; Lax, Ingmar; Lee, Chung K.; Levitt, Seymour H.; Lind, Bengt K.; Rutqvist, Lars Erik

doi:10.1016/s0167-8140(00)00166-3

Cited by 96 publications

(54 citation statements)

References 31 publications

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“…However, this did not correlate with a significant reduction in risk for cardiac mortality as predicted by the relative seriality model (Table 3). This is likely due to the low probability for cardiac mortality in subvolumes receiving low doses (26) . The most pronounced differences among the three modalities in risk of cardiac mortality were observed for Patients 18 and 20, both of whom had mediastinal involvement in the region anterior to the heart and lungs.…”

Section: Resultsmentioning

confidence: 96%

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Late radiation toxicity in Hodgkin lymphoma patients: proton therapy's potential

Toltz

Shin

Mitrou

et al. 2015

J Applied Clin Med Phys

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In 2010, all young patients treated for intrathoracic Hodgkin lymphoma (HL) at one of 10 radiotherapy centers in the province of Quebec received 3D conformal photon therapy. These patients may now be at risk for late effects of their treatment, notably secondary malignancies and cardiac toxicity. We hypothesized that more complex radiotherapy, including intensity‐modulated proton therapy (IMPT) and possibly IMRT (in the form of helical tomotherapy (HT)), could benefit these patients. With institutional review board approval at 10 institutions, all treatment plans for patients under the age of 30 treated for HL during a six‐month consecutive period of 2010 were retrieved. Twenty‐six patients were identified, and after excluding patients with extrathoracic radiation or treatment of recurrence, 20 patients were replanned for HT and IMPT. Neutron dose for IMPT plans was estimated from published measurements. The relative seriality model was used to predict excess risk of cardiac mortality. A modified linear quadratic model was used to predict the excess absolute risk for induction of lung cancer and, in female patients, breast cancer. Model parameters were derived from published data. Predicted risk for cardiac mortality was similar among the three treatment techniques (absolute excess risk of cardiac mortality was not reduced for HT or IMPT (p>0.05,p>0.05) as compared to 3D CRT). Predicted risks were increased for HT and reduced for IMPT for secondary lung cancer (p<0.001,p<0.001) and breast cancers (p<0.001,p<0.001) as compared to 3D CRT.PACS numbers: 87.55.dh, 87.55.dk

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Section: Resultsmentioning

confidence: 96%

“…The probability of toxicity in the organ, P, is the product of the probability of toxicity of each subvolume relative to its fractional volume Δv ((1), (2)). The parameter values used for this model are listed in Table 2, (26)

P false(D false) = 2^{- e^{e γ (1 - \frac{D}{D_{50}})}}

P = {[1 - \prod_{i = 1}^{M} {[1 - {[P (D_{i})]}^{s}]}^{Δ v}]}^{\frac{1}{s}}

…”

Section: Methodsmentioning

confidence: 99%

Late radiation toxicity in Hodgkin lymphoma patients: proton therapy's potential

Toltz

Shin

Mitrou

et al. 2015

J Applied Clin Med Phys

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“…A LymanKutcher-Burman model was used to determine the probability of lung radiation pneumonitis (TD 50 =29.2 Gy, m=0.45, n=1, α/β=3 Gy) (12) and acute esophageal toxicity grade ≥2 (TD 50 =47 Gy, m=0.36, n=0.69, α/β=1.7 Gy) (13). A relative seriality model was instead used to calculate the probability of cardiac mortality (TD 50 =70.3 Gy, g=0.96, s=1, α/β=3 Gy) (14). In the specific case of the heart a Pearson product-moment correlation coefficient (P=0.05) was also employed to find the correlation between the amount of heart overlapping the PTV and the amount of volume covered by a certain amount of dose (i.e., V 5Gy ).…”

Section: Discussionmentioning

confidence: 99%

Limiting the risk of cardiac toxicity with esophageal-sparing intensity modulated radiotherapy for locally advanced lung cancers

et al. 2016

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Background: Intensity modulated radiotherapy (IMRT) is routinely utilized in the treatment of locally advanced non-small cell lung cancer (NSCLC). RTOG 0617 found that overall survival was impacted by increased low (5 Gy) and intermediate (30 Gy) cardiac doses. We evaluated the impact of esophageal-sparing IMRT on cardiac doses with and without the heart considered in the planning process and predicted toxicity compared to 3D-conventional radiotherapy (3DCRT). Methods: Ten consecutive patients with N2 Stage III NSCLC treated to 60 Gy in 30 fractions, betweenFebruary 2012 and September 2014, were evaluated. For each patient, 3DCRT and esophageal-sparing IMRT plans were generated. IMRT plans were then created with and without the heart considered in the optimization process. To compare plans, the dose delivered to 95% and 99% of the target (D 95% and D 99% ), and doses to the esophagus, lung and heart were compared by determining the volume receiving X dose (V XGy ) and the normal tissue complication probability (NTCP) calculated. Results: IMRT reduced maximum esophagus dose to below 60 Gy in all patients and produced significant reductions to V 50Gy , V 40Gy and esophageal NTCP. The cost of this reduction was a non-statistically, nonclinically significant increase in low dose (5 Gy) lung exposure that did not worsen lung NTCP. IMRT plans produced significant cardiac sparing, with the amount of improvement correlating to the amount of heart overlapping with the target. When included in plan optimization, for selected patients further sparing of the heart and improvement in heart NTCP was possible. Conclusions: Esophageal-sparing IMRT can significantly spare the heart even if it is not considered in the optimization process. Further sparing can be achieved if plan optimization constrains low and intermediate heart doses, without compromising lung doses.

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“…Although it may be difficult to demonstrate in patients with oesophageal cancer, it is likely that patients who are long-term survivors may see an increased risk of cardiac events, as seen in breast cancer [42] and lymphoma [43]. Tripp et al [44] have investigated changes in ejection fraction using multiple-gated acquisition cardiac scans before and after receipt of concurrent chemoradiation for oesophageal malignancies.…”

Section: Volumetric Modulated Arc Therapy For Oesophageal Malignanciesmentioning

confidence: 99%

Volumetric modulated arc therapy planning for distal oesophageal malignancies

Hawkins

Bedford²,

Warrington³

et al. 2012

BJR

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Objectives: Volumetric modulated arc therapy (VMAT) is a novel form of intensitymodulated radiation therapy that allows the radiation dose to be delivered in a single gantry rotation using conformal or modulated fields. The capability of VMAT to reduce heart and cord dose, while maintaining lung receiving 20 Gy ,20%, was evaluated for chemoradiation for oesophageal cancer. Methods: An optimised forward-planned four-field arrangement was compared with inverse-planned coplanar VMAT arcs with 35 control points for 10 patients with lower gastro-oesophageal tumours prescribed 54 Gy in 30 fractions. Conformal (cARC) and intensity-modulated (VMATi) arcs were considered. Plans were assessed and compared using the planning target volume (PTV) irradiated to 95% of the prescription dose (V95), volumes of lung irradiated to 20 Gy (V20), heart irradiated to 30 Gy (V30), spinal cord maximum dose and van't Riet conformation number (CN). The monitor units per fraction and delivery time were recorded for a single representative plan. Results: VMATi provided a significant reduction in the heart V30 (31% vs 55%; p50.02) with better CN (0.72 vs 0.65; p50.01) than the conformal plan. The treatment delivery was 1 min 28 s for VMAT compared with 3 min 15 s. Conclusion: For similar PTV coverage, VMATi delivers a lower dose to organs at risk than conformal plans in a shorter time, and this has warranted clinical implementation.

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Long-term cardiac mortality following radiation therapy for Hodgkin's disease: analysis with the relative seriality model

Cited by 96 publications

References 31 publications

Late radiation toxicity in Hodgkin lymphoma patients: proton therapy's potential

Late radiation toxicity in Hodgkin lymphoma patients: proton therapy's potential

Limiting the risk of cardiac toxicity with esophageal-sparing intensity modulated radiotherapy for locally advanced lung cancers

Volumetric modulated arc therapy planning for distal oesophageal malignancies

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