Tolerance of organs at risk in small-volume, hypofractionated, image-guided radiotherapy for primary and metastatic lung cancers

Onimaru, Rikiya; Shirato, Hiroki; Shimizu, Satoru; Kitamura, Kei; Xu, Biao; Fukumoto, Shin Ichi; Chang, Ta Chen; Fujita, Katsuhisa; Oita, Masataka; Miyasaka, Kazuo; Nishimura, Masaharu; Dosaka‐Akita, Hirotoshi

doi:10.1016/s0360-3016(03)00095-6

Cited by 248 publications

(131 citation statements)

References 35 publications

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“…The organs at risk are normal lung tissue, spinal cord, brachial plexus, pulmonary artery, heart, esophagus, and the proximal bronchial tree (21,22). We can assume that the complication probabilities of OARs other than the proximal bronchial tree are negligible for both tumors whether a single or fractionated schedule is employed.…”

Section: Resultsmentioning

confidence: 99%

A Mathematical Study to Select Fractionation Regimen Based on Physical Dose Distribution and the Linear–Quadratic Model

Mizuta

Sugiyama

Date

et al. 2012

International Journal of Radiation Oncology*Biology*Physics

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107

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Mizuta 2 AbstractPurpose: Hypofractionated irradiation is often used in precise radiotherapy instead of conventional multi-fractionated irradiation. We propose a novel mathematical method for selecting a hypofractionated or multi-fractionated irradiation regime based on physical dose distribution adding to biological consideration.Methods and Materials: The linear quadratic (LQ) model was employed for the radiation effects on tumor and normal tissues, especially OARs. Based on the assumption that the OAR receives a fraction of the dose intended for the tumor, the minimization problem for the damage effect on the OAR was treated under the constraint that the radiation effect on the tumor is fixed.Results: For an N-time fractionated irradiation regime, the constraint of tumor lethality was described by an N-dimensional hypersphere. The total dose of the fractionated irradiations was considered for minimizing the damage effect on the OAR under the hypersphere condition. It was found that the advantage of hypofractionated or multi-fractionated irradiation therapies depends on the magnitude of the ratio of  parameters for the OAR and the tumor in the LQ model and the ratio of the dose for the OAR and the tumor.Conclusions: The present mathematical method shows that the multi-fractionated irradiation Mizuta 3 with a constant dose is better if the ratio of  for the OAR and the tumor is less than the ratio of the dose for the OAR and the tumor, while hypofractionated irradiation is better otherwise.

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Section: Resultsmentioning

confidence: 99%

A Mathematical Study to Select Fractionation Regimen Based on Physical Dose Distribution and the Linear–Quadratic Model

Mizuta

Sugiyama

Date

et al. 2012

International Journal of Radiation Oncology*Biology*Physics

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107

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“…The esophageal dose constraint in our study seems to be biologically higher than a D 0.5cc equal to 40 Gy 16 considering the fractionation number. Further investigation is needed to evaluate the tolerance dose of OAR in SBRT, but changes in dose constraints should be made with great care because the toxicities in serial organs like the esophagus and trachea are lethal [17,18].…”

Section: Discussionmentioning

confidence: 99%

Phase I study of stereotactic body radiation therapy for peripheral T2N0M0 non-small cell lung cancer (JCOG0702): Results for the group with PTV ⩾ 100 cc

Onimaru

Oda

Shibata

et al. 2017

Radiotherapy and Oncology

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Purpose: A dose escalation study to determine the recommended dose (RD) with stereotactic body radiation therapy (SBRT) for peripheral T2N0M0 non-small cell carcinomas (NSCLC) was conducted. The results of the group with PTV ≥ 100 cc is reported in this paper. Materials and Methods:The continual reassessment method (CRM) was used to determine the dose level that patients should be assigned to and to estimate the maximum tolerated dose (MTD). Dose limiting toxicity (DLT) was Grade 3 or higher radiation pneumonitis (RP), and Grade 2 or higher RP was used as a surrogate DLT. The RD was equal to the MTD. The dose was prescribed at D 95 of the PTV.Results: Thirteen patients were accrued. More patients should have been enrolled but we decided not to prolong the study period. No patients experienced Grade 3 RP. Two patients experienced Grade 2 RP at 50 Gy in 4 fractions. The predicted MTD was 50.2Gy. The posterior probability of the Grade 2 RP frequency over 40% was 5.3% for the dose level of 50 Gy. The RD was determined to be 50 Gy.

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“…However, we did not escalate the dose to OAR other than the lungs, because severe toxicity in serial organs like the esophagus, trachea, and large vessels due to SBRT can result in death [19][20][21][22]. Also, very high doses of irradiation to the heart and skin may cause serious complications such as coronary stenosis and skin necrosis, respectively [23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

Phase I study of stereotactic body radiation therapy for peripheral T2N0M0 non-small cell lung cancer with PTV < 100 cc using a continual reassessment method (JCOG0702)

Onimaru

Shirato

Shibata

et al. 2015

Radiotherapy and Oncology

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Key Words: phase I study, continual reassessment method, non-small cell lung cancer (NSCLC), stereotactic body radiotherapy, SBRT. Short running title: Previous presentationThis work was presented at the 55th Annual Meeting of the American Society for Radiation Oncology, September 22 -25, 2013 in Atlanta, GA. / 28Abstract Purpose: To estimate the maximum tolerated dose (MTD) and to determine the recommended dose (RD) of stereotactic body radiation therapy (SBRT) for peripheral T2N0M0 non-small cell carcinoma (NSCLC) with target volume (PTV) < 100 cc. Materials and Methods:The continual reassessment method (CRM) was used to determine the dose level that patients should be assigned to and to estimate the MTD. Dose limiting toxicity (DLT) was grade 3 radiation pneumonitis (RP) within 180 days after the start of SBRT, grade 2 RP was used as a surrogate DLT. The RD was equal to the MTD. The dose was prescribed at D 95 of the PTV.Results: Fifteen patients were accrued. Only 1 experienced grade 2 RP at 60 Gy in 4fractions. It was difficult to fulfill the dose constraints at 60 Gy in 4 fractions, and the maximum dose level assigned by CRM was changed to 55 Gy in 4 fractions. The lower limit of 95% of the credible interval exceeded the adjacent level, and the RD was determined as 55 Gy in 4 fractions. Conclusions:The RD of SBRT for peripheral T2N0M0 NSCLC with PTV < 100 cc was determined to be 55 Gy in 4 fractions. / 28

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Tolerance of organs at risk in small-volume, hypofractionated, image-guided radiotherapy for primary and metastatic lung cancers

Cited by 248 publications

References 35 publications

A Mathematical Study to Select Fractionation Regimen Based on Physical Dose Distribution and the Linear–Quadratic Model

A Mathematical Study to Select Fractionation Regimen Based on Physical Dose Distribution and the Linear–Quadratic Model

Phase I study of stereotactic body radiation therapy for peripheral T2N0M0 non-small cell lung cancer (JCOG0702): Results for the group with PTV ⩾ 100 cc

Phase I study of stereotactic body radiation therapy for peripheral T2N0M0 non-small cell lung cancer with PTV < 100 cc using a continual reassessment method (JCOG0702)

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