Risk factors related to interfractional variation in whole pelvic irradiation for locally advanced pelvic malignancies

Yoon, Won Sup; Yang, Dae Sik; Lee, J.A.; Lee, Sunwoong; Park, Y.J.; Kim, Chul Yong

doi:10.1007/s00066-011-0049-0

Cited by 14 publications

(7 citation statements)

References 28 publications

(25 reference statements)

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“…The treatment of choice is radical surgery with wide safety margins. Because recurrences after surgery alone are observed in 40-80% of cases, RT plays an important role in achieving local control in the primary or postoperative setting [2,4,5,12,14,16,17,18]; indications for RT are primarily unresectable or recurrent tumors and non-in-sano resected tumors. RT has a long tradition in the treatment of desmoids: In 1928, James Ewing, who was the first to propose RT as a treatment option, described that desmoid lesions respond ‘slowly but satisfactorily' to RT [19].…”

Section: Discussionmentioning

confidence: 99%

“…Radical resection of mesenteric desmoids is often unfeasible [13]. Radiotherapy (RT) plays an important role in the adjuvant treatment of soft tissue sarcomas [14,15]; however, its role in the management of desmoids is not clearly defined [9]. Indications for irradiation are local inoperability, large residual tumor (R2 resection), positive margins (R1 resection), and narrow safety margins after surgery of recurrent disease [3,16].…”

Section: Introductionmentioning

confidence: 99%

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Radiotherapy Is Effective for Desmoid Tumors (Aggressive Fibromatosis) - Long-Term Results of a German Multicenter Study

et al. 2014

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Background: Desmoids (aggressive fibromatosis) are defined as benign neoplasms of the connective tissue that arise from the deep muscle fascia, aponeurosis, tendons, and scar tissue. Recurrence rates between 40 and 80% were reported after surgery alone. We addressed the impact of radiation therapy (RT) in the management of aggressive fibromatosis. Patients and Methods: A large literature review was performed, and the data was compared with the results of a multicenter study of the German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD). Results: This analysis included 52 patients treated with RT. 37 patients received postoperative RT (20 patients after R2 resection and 17 patients after R1 resection). 15 patients received RT alone (6 patients with inoperable primary tumor and 9 patients with inoperable recurrent tumor). In the case of postoperative RT, a median dose of 50 Gy (range 50-60 Gy) was used; for definitive RT, a median dose of 55 Gy (range 55-65 Gy) was used. The local control rate was 79% for the whole group. The median follow-up was 44 month (range 8-62 months). Conclusion: Given the large number of patients, these data show that RT is highly effective in the treatment of desmoid tumors. RT is an attractive alternative to mutilating surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Radiotherapy Is Effective for Desmoid Tumors (Aggressive Fibromatosis) - Long-Term Results of a German Multicenter Study

et al. 2014

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“…Weber et al [ 11 ] examined 22 prostate patients in a positioning study and reported less 2-D reproducibility for the prone position. Patients with various pelvic malignancies were included in two other studies [ 10 , 14 ] in which a supine position, overall, turned out to be favorable. In these studies, a belly board was consistently used in the prone position, and there was no randomization regarding the treatment position.…”

Section: Discussionmentioning

confidence: 99%

“…It follows that the patient setup reproducibility is crucial for the precision of the dose delivery. Reproducibility may be influenced by several factors, such as the physical condition of the patient [ 8 ], body mass index (BMI) [ 9 , 10 ], use of immobilization devices [ 8 ], and whether patients are treated in the prone or supine position [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

A randomized study of the effect of patient positioning on setup reproducibility and dose distribution to organs at risk in radiotherapy of rectal cancer patients

et al. 2015

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BackgroundThe patient positioning in pelvic radiotherapy (RT) should be decided based on both reproducibility and on which position that yields the lowest radiation dose to the organs at risk (OAR), and thereby less side effects to patients. The present randomized study aimed to evaluate the influence of patient positioning on setup reproducibility and dose distribution to OAR in rectal cancer patients.MethodsNinety-one patients were randomized into receiving RT in either supine or prone position. The recruitment period was from 2005 to 2008. Position deviations were derived from electronic portal image registrations, and setup errors were defined as deviations between the expected and the actual position of bony landmarks. Setup deviations were expressed into three table shift values (∆x, ∆y, ∆z) from which the deviation vector were calculated. The estimated lengths of defined the main outcome and were compared between prone and supine positions using linear mixed model statistics. The mean volume of each 5 Gy increments between 5 and 45 Gy was calculated for the small bowel and the total bowel, and the dose volumes were compared between prone and supine position.Results and conclusionData from 83 patients was evaluable. The mean was 5.8 mm in supine position and 7.1 mm in prone position (p = 0.024), hence the reproducibility was significantly superior in supine position. However, the difference was marginal and may have borderline clinical importance. The irradiated volumes of the small bowel and the total bowel were largest in the supine position for all dose levels, but none of those were significantly different. The patient positioning in RT of rectal cancer patients may therefore be decided based on other factors such as the most comfortable position for the patients.

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“…Additionally, it was reported that their standard institutional 5 mm PTV margin may not be sufficient for PR treatment of obese prostate patients due to the increased difficulty of target localisation, alignment and immobilisation of internal bony anatomy [40,87]. Further investigation into the appropriate application of margins for obese patients using PR is warranted as studies have shown that patients with a BMI > 30 are more susceptible to interfraction variations [88]. One study has suggested that using pod immobilisation to reproduce the posterior contour for obese patients allows a repeatable water equivalent target [87].…”

Section: Plan Robustnessmentioning

confidence: 99%

Proton therapy- the modality of choice for future radiation therapy management of Prostate Cancer?

Mangan

Leech

2019

Technical Innovations & Patient Support in Radiation Oncolo

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Background: Proton Therapy (PR) is an emerging treatment for prostate cancer (Pca) patients. However, limited and conflicting data exists regarding its ability to result in fewer bladder and rectal toxicities compared to Photon Therapy (PT), as well as its cost efficiency and plan robustness. Materials and Methods: An electronic literature search was performed to acquire eligible studies published between 2007 and 2018. Studies comparing bladder and rectal dosimetry or Gastrointestinal (GI) and Genitourinary (GU) toxicities between PR and PT, the plan robustness of PR relative to motion and its cost efficiency for Pca patients were assessed. Results: 28 studies were eligible for inclusion in this review. PR resulted in improved bladder and rectal dosimetry but did not manifest as improved GI/GU toxicities clinically compared to PT. PR plans were considered robust when specific corrections, techniques, positioning or immobilisation devices were applied. PR is not cost effective for intermediate risk Pca patients; however PR may be cost effective for younger or high risk Pca patients. Conclusion: PR offers improved bladder and rectal dosimetry compared to PT but this does not specifically translate to improved GI/GU toxicities clinically. The robustness of PR plans is acceptable under specific conditions. PR is not cost effective for all Pca patients.

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Risk factors related to interfractional variation in whole pelvic irradiation for locally advanced pelvic malignancies

Abstract: Close surveillance through high-quality and frequent image guidance is recommended for patients with extensive variations of the initial five consecutive fractions or obesity.

Cited by 14 publications

References 28 publications

Radiotherapy Is Effective for Desmoid Tumors (Aggressive Fibromatosis) - Long-Term Results of a German Multicenter Study

Radiotherapy Is Effective for Desmoid Tumors (Aggressive Fibromatosis) - Long-Term Results of a German Multicenter Study

A randomized study of the effect of patient positioning on setup reproducibility and dose distribution to organs at risk in radiotherapy of rectal cancer patients

Proton therapy- the modality of choice for future radiation therapy management of Prostate Cancer?

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