Tomotherapy PET-guided dose escalation

Maggio, A.; Cutaia, C.; Dia, A. Di; Bresciani, S.; Miranti, A.; Poli, Matteo Umberto; Mastro, E. Del; Garibaldi, E.; Gabriele, P.; Stasi, M.

doi:10.1007/s00066-015-0901-8

Cited by 9 publications

(1 citation statement)

References 26 publications

(50 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Albeit the evidence of potentially improved tumor control rates come from 3D-CRT studies, in general it is not conceivable to escalate RT doses beyond the conventional limits due to the severe toxicity concerns. In this regard, Maggio et al in their HT study investigated whether a safe escalated dose to the pleural space and PET/CT-positive areas was achievable in patients with unresectable MPM [28]. eir outcomes clearly proved that the HT procedure was able to safely escalate the total dose to at least 62.5 Gy in PET-positive regions, while treating the pleural cavity with 56 Gy in 25 fractions with no significant trade-off in OAR doses.…”

Section: Discussionmentioning

confidence: 99%

Dosimetric Comparison of Lung-Sparing Radiation Therapy between Volumetric Arc Therapy and Helical Tomotherapy for Unresectable Malignant Pleural Mesothelioma

Pehlivan

Sengul

Yeşil

et al. 2019

BioMed Research International

View full text Add to dashboard Cite

Objective. To compare volumetric arc therapy (VMAT) and helical tomotherapy (HT) plans in terms of dosimetric parameters in positron emission tomography- (PET-) computerized tomography- (CT-) based radiation therapy planning in unresectable malignant pleural mesothelioma (MPM). Methods. CT and coregistered PET-CT data from seven patients with histologically-proven MPM were utilized for VMAT and HT plans. Target volumes and organs at risk (OARs) were delineated. The prescription doses for planning target volume 1 (PTV1) and PTV2 were 45.0 Gy and 54 Gy in 1.8 Gy/fr, respectively. Each technique was evaluated in terms of target volume coverage and OAR doses. Findings. Although the maximum (p=0.001) and mean (p<0.001) doses of PTV1, and PTV2 (p<0.001 for maximum and p=0.001 for mean doses) favored the HT technique over VMAT, both techniques efficiently covered the target volumes. Additionally, HT also provided more homogeneous dose distribution (p<0.001) and numerically lower doses received by most OARs, but again both rotational techniques were successful in keeping the OAR doses below the universally accepted limits. The major disadvantage of the HT technique was the requirement for longer treatment times (7.4 versus 2.5 minutes/fr; p<0.001) to accomplish the intended treatment. Conclusion. Results of this dosimetric comparison clearly demonstrated the possibility of safe hemithoracic irradiation of medically/technically unresectable MPM patients with either of the two rotational RT techniques, namely the VMAT and HT. Clinically, considering their poor prognosis, these promising findings may open a potential new window for curative treatment of unresectable MPM patients, if further confirmed by future clinical studies.

show abstract

Section: Discussionmentioning

confidence: 99%

Dosimetric Comparison of Lung-Sparing Radiation Therapy between Volumetric Arc Therapy and Helical Tomotherapy for Unresectable Malignant Pleural Mesothelioma

Pehlivan

Sengul

Yeşil

et al. 2019

BioMed Research International

View full text Add to dashboard Cite

show abstract

Tomotherapy in malignant mesothelioma: a planning study to establish dose constraints

et al. 2019

View full text Add to dashboard Cite

Safety and efficacy of helical tomotherapy following lung-sparing surgery in locally advanced malignant pleural mesothelioma

Layer,

Fischer,

Dejonckheere

et al. 2023

Strahlenther Onkol

View full text Add to dashboard Cite

Purpose To assess the value of radiation therapy (RT) with helical tomotherapy (HT) in the management of locally advanced malignant pleural mesothelioma (MPM) receiving no or lung-sparing surgery. Methods Consecutive MPM cases not undergoing extrapleural pneumonectomy and receiving intensity-modulated (IM) HT were retrospectively evaluated for local control, distant control, progression-free survival (PFS), and overall survival (OS). Impact of age, systemic treatment, RT dose, and recurrence patterns was analyzed by univariate and multivariate analysis. As a secondary endpoint, reported toxicity was assessed. Results A total of 34 localized MPM cases undergoing IMHT were identified, of which follow-up data were available for 31 patients. Grade 3 side effects were experienced by 26.7% of patients and there were no grade 4 or 5 events observed. Median PFS was 19 months. Median OS was 20 months and the rates for 1‑ and 2‑year OS were 86.2 and 41.4%, respectively. OS was significantly superior for patients receiving adjuvant chemotherapy (p = 0.008). Conclusion IMHT of locally advanced MPM after lung-sparing surgery is safe and feasible, resulting in satisfactory local control and survival. Adjuvant chemotherapy significantly improves OS. Randomized clinical trials incorporating modern RT techniques as a component of trimodal treatment are warranted to establish an evidence-based standard of care pattern for locally advanced MPM.

show abstract

Tomotherapy PET-guided dose escalation

Abstract: The results of this study suggest that by using HT it is possible to safely escalate the dose delivery to at least 62.5 Gy in PET-positive areas while treating the pleural cavity to 56 Gy in 25 fractions without significantly increasing the dose to the surrounding normal organs.

Cited by 9 publications

References 26 publications

Dosimetric Comparison of Lung-Sparing Radiation Therapy between Volumetric Arc Therapy and Helical Tomotherapy for Unresectable Malignant Pleural Mesothelioma

Dosimetric Comparison of Lung-Sparing Radiation Therapy between Volumetric Arc Therapy and Helical Tomotherapy for Unresectable Malignant Pleural Mesothelioma

Tomotherapy in malignant mesothelioma: a planning study to establish dose constraints

Safety and efficacy of helical tomotherapy following lung-sparing surgery in locally advanced malignant pleural mesothelioma

Contact Info

Product

Resources

About