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1.
David E. Long Mark Tann Ke Huang Gregory Bartlett James O. Galle Yukie Furukawa Mary Maluccio John A. Cox Feng-Ming Kong Susannah G. Ellsworth 《Practical radiation oncology》2018,8(6):429-436
Purpose
Hepatobiliary iminodiacetic acid (HIDA) scans provide global and regional assessments of liver function that can serve as a road map for functional avoidance in stereotactic body radiation therapy (SBRT) planning. Functional liver image guided hepatic therapy (FLIGHT), an innovative planning technique, is described and compared with standard planning using functional dose-volume histograms. Thresholds predicting for decompensation during follow up are evaluated.Methods and materials
We studied 17 patients who underwent HIDA scans before SBRT. All SBRT cases were replanned using FLIGHT. The following dosimetric endpoints were compared for FLIGHT versus standard SBRT planning: functional residual capacity <15 Gy (FRC15HIDA), mean liver dose (MLD), equivalent uniform dose (EUD), and functional EUD (FEUD). Receiver operating characteristics curves were used to evaluate whether baseline HIDA values, standard cirrhosis scoring, and/or dosimetric data predicted clinical decompensation.Results
Compared with standard planning, FLIGHT significantly improved FRC15HIDA (mean improvement: 5.3%) as well as MLD, EUD, and FEUD (P < .05). Considerable interindividual variations in the extent of benefit were noted. Decompensation during follow-up was associated with baseline global HIDA <2.915%/min/m2, FRC15HIDA <2.11%/min/m2, and MELD ≥11 (P < .05).Conclusions
FLIGHT with HIDA-based parameters may complement blood chemistry-based assessments of liver function and facilitate individualized, adaptive liver SBRT planning. 相似文献2.
Rosanna Yeung Stephen R. Bowen Tobias R. Chapman Grayden T. MacLennan Smith Apisarnthanarax 《Practical radiation oncology》2018,8(4):287-293
Purpose
Normal liver-sparing with proton beam therapy (PBT) allows for dose escalation in the treatment of liver malignancies, but it may result in high doses to the chest wall (CW). CW toxicity (CWT) data after PBT for liver malignancies are limited, with most published reports describing toxicity after a combination of hypofractionated proton and photon radiation therapy. We examined the incidence and associated factors for CWT after hypofractionated PBT for liver malignancies.Methods and materials
We retrospectively reviewed the charts of 37 consecutive patients with liver malignancies (30 hepatocellular carcinoma, 6 intrahepatic cholangiocarcinoma, and 1 metastasis) treated with hypofractionated PBT. CWT was scored using Common Terminology Criteria for Adverse Events, version 4. Receiver-operating characteristic curves were used to identify patient and dosimetric factors associated with CWT and to determine optimal dose-volume histogram parameters/cutoffs. Cox regression univariate analysis was used to associate factors to time-dependent onset of CWT.Results
Thirty-nine liver lesions were treated with a median dose of 60 GyE (range, 35-67.5) in 15 fractions (range, 13-20). Median follow-up was 11 months (range, 2-44). Grade ≥2 and 3 CW pain occurred in 7 (19%) and 4 (11%) patients, respectively. Median time to onset of pain was 6 months (range, 1-14). No patients had radiographic rib fracture. On univariate analysis, CW equivalent 2 Gy dose with an α/β = 3 Gy (EQD2α/β=3), V57 >20 cm3 (hazard ratio [HR], 2.7; P = .004), V63 >17 cm3 (HR, 2.7; P = .003), and V78 >8 cm3 (HR, 2.6; P = .003) had the strongest association with grade ≥2 CW pain, as did tumor dose of >75 Gy EQD2α/β=10 (HR, 8.7; P = .03). No other patient factors were associated with CWT.Conclusions
CWT after hypofractionated PBT for liver malignancies is clinically relevant. For a 15-fraction regimen, V47 >20 cm3, V50 >17 cm3, and V58 >8 cm3 were associated with higher rates of CWT. Further investigation of PBT techniques to reduce CW dose are warranted. 相似文献3.
Sidharth Pant Raees Tonse Sadhana Kannan Aliasgar Moiyadi Prakash Shetty Sridhar Epari Ayushi Sahay Goda Jayant Sastri Rakesh Jalali Tejpal Gupta 《Practical radiation oncology》2018,8(5):e275-e284
Background
The role of early adjuvant radiation therapy (RT) in patients with atypical meningioma remains controversial. The goal of this work was to report the impact of timing of RT on outcomes in atypical meningioma.Methods and materials
Patients of atypical meningioma were identified through electronic search of institutional database. Following surgery, RT was delivered either in upfront adjuvant setting (early adjuvant RT) or after recurrence/progression (salvage RT).Results
There were 51 patients in the early adjuvant RT group and 30 patients in the salvage RT group. Six of 51 (12%) patients in the early adjuvant RT group recurred/progressed compared with 34 of 35 (97%) patients kept on observation after initial surgery. Thirty of these 34 patients received salvage RT, mostly after reexcision. Twelve of 30 (40%) patients recurred/progressed after salvage RT, compared with 6 of 51 (12%) patients after early adjuvant RT (P = .003). Post-RT 5-year progression-free survival was significantly better for early adjuvant RT compared to salvage RT (69% vs 28%, log-rank P < .001).Conclusions
Within the limitations of any retrospective analysis, upfront early adjuvant RT can significantly reduce the risk of local recurrence/progression in atypical meningiomas compared with initial observation. A sizeable proportion of patients who are observed initially recur/progress over time necessitating salvage therapy; however, reexcision followed by salvage RT may not be as effective as early adjuvant RT. 相似文献4.
Eva M. Bongers Angela Botticella David A. Palma Cornelis J.A. Haasbeek Andrew Warner Wilko F.A.R. Verbakel Ben Slotman Umberto Ricardi Suresh Senan 《Radiotherapy and oncology》2013
Purpose
To identify dosimetric factors that predict development of radiation pneumonitis (RP) following stereotactic or hypofractionated radiotherapy for lung tumors.Methods
Seventy-nine consecutive patients with either a planning target volume (PTV) > 100 cm3 (n = 69) or prior pneumonectomy or bi-lobectomy (n = 13) were identified. Radiation doses (range: 5–50 Gy, with 5 Gy increments) were converted to equivalent doses (EQD2 Gy) (α/β = 3). Total lung (TL), ipsilateral (IL) and contralateral lung (CL) volumes minus PTV, receiving 5 Gy (V5) up to 50 Gy (V50) and mean lung dose (MLD) were analyzed. Predictors of grade ?3 RP (CTCAEv4.03) were identified with concordance-statistics (C-statistic) and p-values used to quantify the performance of the model. Factors found to be significant were entered into a recursive partitioning analysis (RPA).Results
Median PTV was 150 cm3. Grade ?3 RP was observed in 8 patients (10%). In univariable analysis, CL-MLD, CL-V5-15, TL-MLD, TL-V5-V10 and ITV size were predictive of RP (p < 0.05). In multivariable analysis, contralateral MLD (p = .007) and ITV (p = .063) were the strongest predictors of grade ?3 RP, with excellent discrimination (C-statistic: 0.868).Conclusion
Contralateral MLD and ITV size are both strong predictors of grade ?3 RP post treatment. Planning constraints should aim to keep contralateral MLD below 3.6 Gy. 相似文献5.
Hirofumi Asakura Takayuki Hashimoto Hideyuki Harada Masashi Mizumoto Shuichi Hironaka Shigeyuki Murayama Tetsuo Nishimura 《Radiotherapy and oncology》2010,95(2):240-244
Purpose
To evaluate dose-volume histogram (DVH) parameters as predictors of radiation pneumonitis (RP) in esophageal cancer patients treated with definitive concurrent chemoradiotherapy.Patients and methods
Thirty-seven esophageal cancer patients treated with radiotherapy with concomitant chemotherapy consisting of 5-fluorouracil and cisplatin were reviewed. Radiotherapy was delivered at 2 Gy per fraction to a total of 60 Gy. For most of the patients, two weeks of interruption was scheduled after 30 Gy. The percentage of lung volume receiving more than 5-50 Gy in increments of 5 Gy (V5-V50, respectively), and the mean lung dose (MLD) were analyzed.Results
Ten (27%) patients developed RP of grade 2; 2 (5%), grade 3; 0 (0%), grade 4; and 1 (3%), grade 5. By univariate analysis, all DVH parameters (i.e., V5-V50 and MLD) were significantly associated with grade ?2 RP (p < 0.01). The incidences of grade ?2 RP were 13%, 33%, and 78% in patients with V20s of ?24%, 25-36%, and ?37%, respectively. The optimal V20 threshold to predict symptomatic RP was 30.5% according to the receiver operating characteristics curve analysis.Conclusion
DVH parameters were predictors of symptomatic RP and should be considered in the evaluation of treatment planning for esophageal cancer. 相似文献6.
Horatio R. Thomas Ming-Hui Chen Anthony V. D’Amico Charles L. Bennett Michael W. Kattan Oliver Sartor Karen Stein Paul L. Nguyen 《Clinical genitourinary cancer》2018,16(4):313-317
Background
Previous studies have reported conflicting results on the relationship between androgen deprivation therapy (ADT) and the risk of depression. We assessed whether ADT is associated with depression in a unique data set of men with recurrent prostate cancer.Patients and Methods
We studied a cohort of 656 men in the prospective COMPARE (Comprehensive, Multicenter, Prostate Adenocarcinoma) registry who experienced biochemical recurrence after radiation therapy (RT) only, radical prostatectomy (RP) with or without RT, or ADT with RP or RT. Multivariable logistic regression was used to determine the relationship between the modality of treatment and patient-reported depression.Results
Of 656 men, 44 (6.7%) experienced depression. The prevalence of depression stratified by treatment was 3.2% for RT only, 5.9% for RP with or without RT, and 9.1% for ADT plus RP or RT. Compared with RT-only, ADT plus RP or RT was associated with a significantly increased rate of depression (P = .031) and RP with or without RT was not (P = .195). On multivariate analysis adjusting for age and baseline comorbidities, the receipt of ADT was associated with an increased risk of depression (odds ratio, 3.29; 95% confidence interval, 1.11-9.76; P = .032) compared with RT only. No statistically significant difference was found in the risk of depression for men who received RP with or without RT versus RT only (odds ratio, 2.12; 95% confidence interval, 0.68-6.65; P = .19).Conclusion
Men with recurrent prostate cancer who underwent ADT were 3 times more likely to report experiencing depression. Treating physicians should discuss depression as a possible side effect when considering the use of ADT and should screen for depression in men who have received ADT. 相似文献7.
Yoonsun Chung Hong In Yoon Yong Bae Kim Seung Kwon Ahn Ki Chang Keum Chang-Ok Suh 《JOURNAL OF BREAST CANCER》2012,15(3):337-343
Purpose
We assessed the risk of radiation pneumonitis (RP) in terms of dosimetric parameters in breast cancer patients, who received radiotherapy using the partially wide tangent technique (PWT), following breast conservation surgery (BCS).Methods
We analyzed the data from 100 breast cancer patients who underwent radiotherapy using PWT. The entire breast, supraclavicular lymph node, and internal mammary lymph node (IMN) were irradiated with 50.4 Gy in 28 fractions. RP was scored on a scale of 0 to 5, based on Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer toxicity criteria. The dosimetric parameters, used in analysis for the ipsilateral lung, were the mean lung dose (MLD), V5 (percentage of lung volume that received a dose of 5 Gy or more)-V50, and normal tissue complication probability (NTCP).Results
Of the 100 patients, three suffered from symptomatic RP (symptom grade ≥2), but were relieved by supportive care. The risk of RP was not correlated with the treatment regimen. RP associated mostly with asymptomatic minimal pulmonary radiologic change or mild dry cough developed more frequently in the group with MLD ≥20.5 Gy or NTCP ≥23% than in the group with MLD <20.5 Gy and NTCP <23% (48.6% vs. 25.4%, p=0.018).Conclusion
Dosimetric parameters of MLD and NTCP were correlated with the incidence of RP, but the clinical impact was minimal. We suggest that PWT is a safe technique for the treatment of IMN for BCS patients with low risk of symptomatic RP. 相似文献8.
Li Ma WenFeng Ye QiWen Li Bin Wang GuangYu Luo ZhaoLin Chen SuPing Guo Bo Qiu Hui Liu 《Clinical lung cancer》2018,19(2):e211-e217
Introduction
To investigate the relationship between malnutrition and the severity of radiation pneumonitis (RP) in patients with lung cancer with normal baseline pulmonary function and lungs' V20 < 35% treated by intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy.Materials and Methods
A total of 150 patients with lung cancer who received definitive IMRT (≥ 60 Gy) and concurrent chemotherapy were enrolled. In the condition of normal baseline pulmonary function and strict constraints of the irradiation dose to normal lung tissues, we recorded Eastern Cooperative Oncology Group score; concurrent chemotherapy; clinical stage; the level of albumin (ALB), hemoglobin, and C-reactive protein; Subjective Global Assessment (SGA) scores; radiation esophagitis grade; V20 of lungs; and mean lung dose. These factors were correlated with RP using univariate and multivariate regression analyses.Results
Of 150 patients, 12 patients (8.0%) developed Grade 3 to 5 RP, 37 (24.6%) patients developed grade 3 to 5 esophageal toxicity. In univariate analysis, ALB level (P = .002), radiation esophagitis (P < .001), and SGA score (P < .001) were significantly associated with RP. Multivariate analysis revealed that SGA (P < .001) was the independent predictor of RP.Conclusions
SGA could be a predictor for RP in patients with lung cancer treated with definitive IMRT and concurrent chemotherapy. 相似文献9.
Gerben R. Borst Jasper Nijkamp Hiroki Shirato Michel M. van den Heuvel Joos V. Lebesque 《Radiotherapy and oncology》2009,91(3):307-313
Purpose
We evaluated the relationship between the mean lung dose (MLD) and the incidence of radiation pneumonitis (RP) after stereotactic body radiation therapy (SBRT), and compared this with conventional fractionated radiation therapy (CFRT).Materials and methods
For both SBRT (n = 128) and CFRT (n = 142) patients, RP grade ?2 was scored. Toxicity models predicting the probability of RP as a function of the MLD were fitted using maximum log likelihood analysis. The MLD was NTD (Normalized Total Dose) corrected using an α/β ratio of 3 Gy.Results
SBRT patients were treated with 6-12 Gy per fraction with a median MLD of 6.4 Gy (range: 1.5-26.5 Gy). CFRT patients were treated with 2 Gy or 2.25 Gy per fraction, the median MLD was 13.2 Gy (range: 3.0-23.0 Gy). The crude incidence rates of RP were 10.9% and 17.6% for the SBRT and CFRT patients, respectively. A significant dose-response relationship for RP was found after SBRT, which was not significantly different from the dose-response relationship for CFRT (p = 0.18).Conclusion
We derived a significant dose-response relationship between the risk of RP and the MLD for SBRT from the clinical data. This relation was not significantly different from the dose-response relation for CFRT, although statistical analysis was hampered by the low number of patients in the high dose range. 相似文献10.
Purpose
The purpose of this study is to evaluate the correlation between the conventional plan parameters and dosimetric parameters obtained from conformal radiotherapy (RT) planning, and between these parameters and radiation pneumontitis (RP) incidence.Methods
Clinical and dosimetric data of 122 patients that were treated with mastectomy and adjuvant 3D conformal RT (39% received 2-field RT [2-FRT], and in addition, 61% received 4-field RT [4-FRT]) were retrospectively analyzed. Central lung depth (CLD), maximum lung depth (MLD), and lung length were measured by the conventional plan. Lung dose-volume histograms (DVH) were created with conformal planning, and the lung volumes receiving 5 to 50 Gy (V5Gy to V50Gy) were calculated. Minimum (Dmin), maximum (Dmax), and mean doses (Dmean) for the ipsilateral lung and bilateral lungs were measured by DVH. Correlations between 3D dosimetric data and 2D radiographic parameters were analyzed.Results
The conventional plan parameters did not significantly differ between 2-FRT and 4-FRT. The conformal plan Dmin, Dmax, and Dmean values were higher in 4-FRT versus 2-FRT. CLD and MLD were correlated with DVH parameter V5Gy to V45Gy values for ipsilateral, as well as bilateral lungs for 2-FRT. MLD and ipsilateral Dmean via 2-FRT planning had the strongest positive correlation (r=0.76, p<0.01). Moderate correlations existed between CLD and ipsilateral and bilateral lung V5Gy-45Gy, and between MLD and bilateral lung V5Gy-45Gy values in 2-FRT. Only four patients developed symptomatic RP, 4 with 4-FRT and one with 2-FRT.Conclusion
The conformal plan parameters were strongly correlated with dose-volume parameters for breast 2-FRT. With only 4 cases of Grade 3 RP observed, our study is limited in its ability to provide definitive guidance, however assuming that CLD is an indicator for RP, V20Gy could be used as a predictor for RP and for 2-FRT. A well-defined parameters are still required to predict RP in 4-FRT. 相似文献11.
Wenji Guo Xuan Hui Salem Alfaifi Lori Anderson Scott Robertson Russell Hales Chen Hu Todd McNutt Stephen Broderick Jarushka Naidoo Richard Battafarano Stephen Yang K. Ranh Voong 《Practical radiation oncology》2018,8(4):e239-e248
Purpose
In patients with non-small cell lung cancer (NSCLC) who undergo trimodality therapy (chemoradiation followed by surgical resection), it is unknown whether limiting preoperative radiation dose to the uninvolved lung reduces postsurgical morbidity. This study evaluated whether radiation fall-off dose parameters to the contralateral lung that is unaffected by NSCLC are associated with postoperative complications in NSCLC patients treated with trimodality therapy.Methods and materials
We retrospectively reviewed NSCLC patients who underwent trimodality therapy between March 2008 and October 2016, with available restored digital radiation plans. Fischer's exact test was used to assess associations between patient and treatment characteristics and the development of treatment-related toxicity. Spearman rank correlation was used to measure the strength of association between dosimetric parameters.Results
Forty-six patients were identified who received trimodality therapy with intensity modulated radiation (median, 59.4 Gy; range, 45-70) and concurrent platinum doublet chemotherapy, followed by surgical resection. The median age was 64.9 years (range, 45.6-81.6). The median follow-up time was 1.9 years (range, 0.3-8.4). Twenty-four (52.2%) patients developed any-grade pulmonary toxicity and 14 (30.4%) patients developed grade 2+ pulmonary toxicity. There was an increased incidence of any-grade pulmonary toxicity in patients with contralateral lung volume receiving at least 20 Gy (V20) ≥7% compared with <7% (90%, n = 9 vs 41.7%, n = 15; P = .01). Similarly, contralateral lung V10 ≥20% was associated with an increased rate of any-grade pulmonary toxicity compared with V10 <20% (80%, n = 12 vs 38.7%, n = 12; P = .01). Pneumonectomy/bilobectomy was associated with grade 2+ pulmonary toxicity (P = .04).Conclusions
Patients who received a higher radiation fall-off dose volume parameter (V20 ≥7% and V10 ≥20%) to the contralateral uninvolved lung had a higher incidence of any-grade postoperative pulmonary toxicity. Limiting radiation fall-off dose to the uninvolved lung may be an important modifiable radiation parameter in limiting postoperative toxicity in trimodality patients. 相似文献12.
Daniel J. Lee Daniel A. Barocas Zhiguo Zhao Li-Ching Huang Tatsuki Koyama Matthew J. Resnick Ralph Conwill Dan McCollum Matthew R. Cooperberg Michael Goodman Sheldon Greenfield Ann S. Hamilton Mia Hashibe Sherrie H. Kaplan Lisa E. Paddock Antoinette M. Stroup Xiao-Cheng Wu David F. Penson Karen E. Hoffman 《Practical radiation oncology》2018,8(5):307-316
Purpose
Quality measures represent the standards of appropriate treatment agreed upon by experts in the field and often supported by data. The extent to which providers in the community adhere to quality measures in radiation therapy (RT) is unknown.Methods and materials
The Comparative Effectiveness Analysis of Surgery and Radiation study enrolled men with clinically localized prostate cancer in 2011 and 2012. Patients completed surveys and medical records were reviewed. Patients were risk-stratified according to D’Amico classification criteria. Patterns of care and compliance with 8 quality measures as endorsed by national consortia as of 2011 were assessed.Results
Overall, 926 men underwent definitive RT (69% external beam radiation therapy [EBRT]), 17% brachytherapy (BT), and 14% combined EBRT and BT with considerable variation in radiation techniques across risk groups. Most men who received EBRT had dose-escalated EBRT (>75 Gy; 93%) delivered with conventional fractionation (<2 Gy; 95%), intensity modulated RT (76%), and image guided RT (85%). Most men treated with BT received I125 (77%). Overall, 73% of the men received EBRT that was compliant with the quality measures (dose-escalation, image-guidance, appropriate use of androgen deprivation therapy, and appropriate treatment target) but only 60% of men received BT that was compliant with quality measures (postimplant dosimetry and appropriate dose). African-American men (64%) and other minorities (62%) were less likely than white men (77%) to receive EBRT that was compliant with quality measures.Conclusions
Most men who received RT for localized prostate cancer were treated with an appropriately high dose and received image guidance and intensity modulated RT. However, compliance with some nationally recognized quality measures was relatively low and varied by race. There are significant opportunities to improve the delivery of RT and especially for men of a minority race. 相似文献13.
Emanuele Cereda Silvia Cappello Sara Colombo Catherine Klersy Ilaria Imarisio Annalisa Turri Marilisa Caraccia Valeria Borioli Teresa Monaco Marco Benazzo Paolo Pedrazzoli Franco Corbella Riccardo Caccialanza 《Radiotherapy and oncology》2018,126(1):81-88
Background
To evaluate the benefit of oral nutritional supplements (ONS) in addition to nutritional counseling in head and neck cancer (HNC) patients undergoing radiotherapy (RT).Methods
In a single-center, randomized, pragmatic, parallel-group controlled trial (ClinicalTrials.gov: NCT02055833; February 2014–August 2016), 159 newly diagnosed HNC patients suitable for to RT regardless of previous surgery and induction chemotherapy were randomly assigned to nutritional counseling in combination with ONS (N?=?78) or without ONS (N?=?81) from the start of RT and continuing for up to 3 months after its end.Primary endpoint was the change in body weight at the end of RT. Secondary endpoints included changes in protein-calorie intake, muscle strength, phase angle and quality of life and anti-cancer treatment tolerance.Results
In patients with the primary endpoint assessed (modified intention-to-treat population), counseling plus ONS (N?=?67) resulted in smaller loss of body weight than nutritional counseling alone (N?=?69; mean difference, 1.6?kg [95%CI, 0.5–2.7]; P?=?0.006). Imputation of missing outcomes provided consistent findings. In the ONS-supplemented group, higher protein-calorie intake and improvement in quality of life over time were also observed (P?<?0.001 for all). The use of ONS reduced the need for changes in scheduled anti-cancer treatments (i.e. for RT and/or systemic treatment dose reduction or complete suspension, HR=0.40 [95%CI, 0.18–0.91], P?=?0.029).Conclusion
In HNC patients undergoing RT or RT plus systemic treatment, and receiving nutritional counseling, the use of ONS resulted in better weight maintenance, increased protein-calorie intake, improved quality of life and was associated with better anti-cancer treatment tolerance. 相似文献14.
Diana D. Shi Lauren M. Hertan Tai Chung Lam Sonia Skamene John H. Chi Michael Groff Charles H. Cho Marco L. Ferrone Mitchel Harris Yu-Hui Chen Tracy A. Balboni 《Practical radiation oncology》2018,8(5):e285-e294
Purpose
Assessing the stability of spinal metastases is critical for making treatment decisions. The spinal instability neoplastic score (SINS) was developed by the Spine Oncology Study Group to categorize tumor-related lesions; however, data describing its utility in predicting fractures in patients with spinal metastases are limited. The purpose of this study is to assess the validity of SINS in predicting new or worsening fracture after radiation therapy (RT) to spine metastases.Methods and materials
This is a retrospective analysis of patients treated with conventional RT alone (median total dose, 30 Gy; range, 8-47 Gy; median number of fractions, 10; range, 1-25) for spinal metastasis at Dana-Farber/Brigham and Women's Cancer Center from 2006 to 2013. SINS was calculated for each lesion (range, 0-18). The primary endpoint was time from RT start to radiographically documented new or worsening fracture or last disease assessment.Results
A total of 203 patients and 250 lesions were included in analysis. The percentages of lesions with SINS of 0 to 6, 7 to 12, and 13 to 18 were 38.8%, 54.8%, and 6.4%, respectively. Of 250 lesions, 20.4% developed new or worsening fractures; 14.4% for SINS 0 to 6, 21.2% for SINS 7 to 12, and 50.0% for SINS 13 to 18. Multivariate analysis adjusted for sex, age, Eastern Cooperative Oncology Group, histology, and total dose indicated that, compared with stable lesions (SINS 0-6), potentially unstable lesions (SINS 7-12) demonstrated a greater likelihood of new or worsening fracture that was not statistically significant (hazard ratio, 1.66; 95% confidence interval, 0.85-3.22; P = .14), and unstable lesions (SINS 13-18) were significantly more likely to develop to new or worsening fracture (hazard ratio, HR,4.37, 95% confidence interval, 1.80-10.61; P = .001).Conclusions
In this study of patients undergoing RT for spinal metastases, 20.4% developed new or worsening vertebral fractures. SINS is demonstrated to be a useful tool to assess fracture risk after RT. 相似文献15.
Daniel A. Hamstra Neil Mariados John Sylvester Dhiren Shah Eric Gross Richard Hudes David Beyer Steven Kurtzman Jeffrey Bogart R. Alex Hsi Michael Kos Rodney Ellis Mark Logsdon Shawn Zimberg Kevin Forsythe Hong Zhang Edward Soffen Patrick Francke Jeff Michalski 《Practical radiation oncology》2018,8(1):e7-e15
Background
We previously reported the results of a phase 3 trial evaluating a prostate/rectal hydrogel spacer during prostate intensity modulated radiation therapy, which resulted in decreased rectal dose and toxicity and less decline in bowel quality of life (QOL). A secondary analysis was performed to correlate penile bulb dose and sexual QOL.Methods and materials
Sexual QOL was measured with the Expanded Prostate Cancer Index Composite (EPIC) by mean scores, the proportion of patients with a minimal clinically important difference (MID), and analyses of the different items composing the sexual domain.Results
A total of 222 men enrolled with median follow-up of 37 months. Hydrogel reduced penile bulb mean dose, maximum dose, and percentage of penile bulb receiving 10 to 30 Gy (all P < .05) with mean dose indirectly correlated with erections sufficient for intercourse at 15 months (P = .03). Baseline EPIC was low (53 [standard deviation ± 24]) with no difference between arms (P > .1). A total of 41% (88/222) of men had adequate baseline sexual QOL (EPIC >60 (mean, 77 [± 8.3]). This subgroup at 3 years had better sexual function (P = .03) with a spacer with a smaller difference in sexual bother (P = .1), which resulted in a higher EPIC summary on the spacer arm (58 [±24.1] vs control 45 [± 24.4]) meeting threshold for MID without statistical significance (P = .07). There were statistically nonsignificant differences favoring spacer for the proportion of men with MID and 2× MID declines in sexual QOL with 53% vs 75% having an 11-point decline (P = .064) and 41% vs 60% with a 22-point decline (P = .11). At 3 years, more men potent at baseline and treated with spacer had “erections sufficient for intercourse" (control 37.5% vs spacer 66.7%, P = .046) as well as statistically higher scores on 7 of 13 items in the sexual domain (all P < .05).Conclusions
The use of a hydrogel spacer decreased dose to the penile bulb, which was associated with improved erectile function compared with the control group based on patient-reported sexual QOL. 相似文献16.
Jennifer Y. Wo Lorraine C. Drapek Andrzej Niemierko Brenda Silvia Bridget N. Noé Andrea L. Russo David T. Miyamoto Theodore S. Hong Jason A. Efstathiou Anthony L. Zietman Don S. Dizon 《Practical radiation oncology》2018,8(3):206-212
Background
Cancer patients treated with pelvic radiation therapy (RT) often experience sexual health–related side effects during and following treatment. A clinical needs assessment was used to evaluate sexual health needs and to determine how needs differed between patients receiving and who had completed RT.Methods and materials
A questionnaire was used to evaluate sexual health needs among patients treated with pelvic RT. All answers were rated using a 4-point Likert scale. Convenience sampling was used, and patients were stratified by whether they were on-treatment or in follow-up. Charts were reviewed for demographic, diagnostic, and treatment information. Pearson’s χ2 test and logistic regression analysis were used to analyze the associations between sexual health–related topics and clinical variables.Results
A total of 107 of 109 (98%) invited patients completed the questionnaire (46 females, 61 males; 52 undergoing RT, 54 completed RT). Most (75%) reported some degree of change in sexual health from the effects of cancer and/or treatment; 22% and 28% reported “quite a bit” or “very much” change, respectively. Sixty-nine percent reported that they experienced some degree of distress from sexual health changes (28% reported “very much” or “quite a bit” of distress). Seventy-six percent “agreed” or “strongly agreed” that they were interested in access to a multidisciplinary sexual health clinic (MSHC). Compared with patients currently receiving RT, patients in follow-up were significantly more likely to report worsening degrees of “change” (P = .008) and “distress” (P = .04) and to express interest in having access to an MSHC (P = .03).Conclusion
The majority of patients receiving pelvic RT reported a change in sexual health with associated distress, with more reports among those in follow-up. Patients undergoing pelvic RT expressed a high interest in attending a radiation oncology MSHC. Our findings emphasize the important role radiation oncologists can play in the quality of life of our patients. 相似文献17.
Katherina P. Farr Azza A. Khalil Ditte S. Møller Henrik Bluhme Stine Kramer Anni Morsing Cai Grau 《Radiotherapy and oncology》2018,126(2):307-311
Background and purpose
To examine radiation-induced changes in regional lung perfusion per dose level in 58 non-small-cell lung cancer (NSCLC) patients treated with intensity-modulated radiotherapy (IMRT).Material and methods
NSCLC patients receiving chemo-radiotherapy (RT) of minimum 60?Gy were included prospectively in the study. Lung perfusion single-photon emission computed tomography (SPECT/CT) was performed before and serially after RT. Changes (relative to baseline, %) in regional lung perfusion were correlated with regional dose. Toxicity outcome was radiation pneumonitis (RP) CTC grades 2–5.Results
Perfusion changes were associated with dose. Dose-dependent reduction in regional perfusion was observed at 3, 6 and 12?months of follow-up. Relative perfusion loss per dose bin was 4% at 1?month, 14% at 3?months, 13% at 6?months and 21% at 12?months after RT. In patients with RP, perfusion reduction was larger in high dose lung regions, compared to those without RP. Low dose regions, on the contrary, revealed perfusion gain in the patients with RP.Conclusion
Progressive dose dependent perfusion loss is manifested on SPECT up to 12?months following IMRT. These findings suggest that the dynamic change in perfusion may have prognostic value in predicting radiation pneumonitis in NSCLC patients treated with IMRT. 相似文献18.
Amy S. Yu Peter G. Maxim Billy W. Loo Michael F. Gensheimer 《Practical radiation oncology》2018,8(4):e199-e207
Purpose
Stereotactic ablative radiation therapy (SABR) to lung tumors close to the chest wall can cause rib fractures or chest wall pain. We evaluated and propose a clinically practical solution of using noncoplanar volumetric modulated arc radiation therapy (VMAT) to reduce chest wall dose from lung SABR.Methods and materials
Twenty lung SABR VMAT plans in which the chest wall volume receiving 30 Gy or higher (V30) exceeded 30 mL were replanned by noncoplanar VMAT with opposite 15° couch kicks. Dosimetric parameters including chest wall V30 and V40; lung V5, V10, V20, and mean dose; Paddick high-dose conformity index; intermediate-dose conformity index; and monitor units (MU) for each plan were used to evaluate the plan quality. The treatment time was also estimated by delivering the entire treatment. Two-sided paired t test was used to evaluate the difference of the dosimetric parameters between coplanar 1 arc (cVMAT1), coplanar 2 arcs (cVMAT2), and noncoplanar two arcs (nVMAT2) plans; differences with P < .05 were considered statistically significant.Results
V30 and V40 for chest wall were reduced on average by 20% ± 9% and 15% ± 11% (mean ± standard deviation) from cVMAT2 plans to nVMAT2 plans (P < .01 for both comparisons) and by 8% ± 7% and 16% ± 13% from cVMAT1 plans to cVMAT2 plans (P < .003 for both comparisons). The differences in lung mean dose were <0.2 Gy among cVMAT1, cVMAT2, and nVMAT2. There were no significant differences in lung V5, V10, and V20. On average, the number of MU increased 14% for nVMAT2 compared with cVMAT2. The Paddick high-dose conformity indexes were 0.88 ± 0.03, 0.89 ± 0.04, and 0.91 ± 0.03, and intermediate-dose conformity indexes were 3.88 ± 0.49, 3.80 ± 0.44 and 3.51 ± 0.38 for cVMAT1, cVMAT2, and nVMAT2, respectively.Conclusions
We found that noncoplanar VMAT plans are feasible, clinically practical to deliver, and significantly reduce V30 and V40 of chest wall without increasing lung dose. 相似文献19.
Julian C. Hong Elham Rahimy Cary P. Gross Timothy Shafman Xin Hu James B. Yu Rudi Ross Steven E. Finkelstein Arie Dosoretz Henry S. Park Pamela R. Soulos Suzanne B. Evans 《Practical radiation oncology》2018,8(3):e79-e86
Purpose
Adjuvant radiation therapy (RT) for breast cancer improves outcomes, but prior studies have documented substantive cardiac dose and cardiac risk. We assessed the mean heart dose (MHD) of RT and estimated the risk of RT-associated cardiac toxicity in women undergoing adjuvant RT for breast cancer in contemporary (predominantly) community practice.Methods and materials
We identified women with left-sided breast cancer receiving adjuvant RT between 2012 and 2014 from 94 centers across 16 states. We used bivariate analyses and multivariable linear regression to assess associations between RT techniques and MHD. Excess RT-related cardiac risk by age 80 was estimated for women diagnosed at age 60 using the previously reported relationship between MHD and cardiac risk.Results
Among 1161 women, 77.3% were treated in community practice and with breast conservation (77.8%). The most common techniques were free-breathing (92.2%), supine (94.8%), and fixed gantry intensity modulated RT (FG-IMRT; 46.9%). The median MHD was 2.76 Gy (interquartile range, 1.47-5.03). In multivariable analyses, the predicted median MHD with deep inspiration breath hold was 2.41 Gy compared with 3.86 Gy with free-breathing (P < .001). Three-dimensional conformal RT (3D-CRT) was associated with a lower predicted median MHD (2.78 Gy) than FG-IMRT (4.02 Gy) or rotational IMRT, 6.60 Gy, P < .001). For 60-year-old women with the median MHD of the study population (2.76 Gy) and no cardiovascular risk factors, the 20-year predicted excess risk of death from ischemic heart disease attributable to radiation was 3.5 excess events/1000 patients, in contrast to estimates of 8 events/1000 from prior analyses. The predicted risk of cardiac events varied based on radiation technique, with 4 excess events/1000 with 3D-CRT, 5 excess events/1000 with FG-IMRT, and 8 excess events/1000 with rotational IMRT.Conclusions
MHD varies substantially across patients and is influenced by technique in predominantly community settings. Overall risk of cardiac toxicity is modest. 相似文献20.
Ryoko Suzuki Steven H. Lin Xiong Wei Pamela K. Allen James W. Welsh Lauren A. Byers Ritsuko Komaki 《Radiotherapy and oncology》2018,126(3):499-505