共查询到20条相似文献，搜索用时 15 毫秒
1.
H.A.H. Mohamed M.A. Salem M.S. Elnaggar A. Gabr A.M. Abdelrheem 《Cancer radiothérapie》2018,22(3):236-240
Purpose
A prospective phase II study carried out to evaluate hypofractionated radiotherapy with concurrent gemcitabine for bladder preservation in the elderly patient with bladder cancer.Patients and methods
Thirty-one patients were enrolled, age ≥ 65 years, diagnosed with transitional cell carcinoma of the urinary bladder, after a maximum safe transurethral resection of a bladder tumour. They received 52.5 Gy in 20 fractions using 3D conformal radiotherapy with concurrent 100 mg/m2 gemcitabine weekly as a radiosensitizer.Results
All patients completed their radiation therapy course, while seven patients received their chemotherapy irregularly due to grade 3 toxicities. Twenty-five patients (80.6%) achieved a complete response. At 2-years, overall survival was 94.4% and disease-free survival was 72.6%. T3 and residual after transurethral resection are factors that adversely affect disease-free survival.Conclusion
Hypofractionated radiotherapy and gemcitabine as a radiosensitizer in elderly as organ preservation for transitional cell carcinoma bladder cancer have acceptable toxicity profile with good response rate and disease-free survival, keeping salvage cystectomy for persistence or recurrence of invasive cancer. 相似文献2.
C. Di Carlo M. Trignani L. Caravatta A. Vinciguerra A. Augurio F. Perrotti M. Di Tommaso M. Nuzzo S. Giancaterino M.D. Falco D. Genovesi 《Cancer radiothérapie》2018,22(2):120-125
Purpose
The aim of our study was to evaluate hippocampal irradiation in patients treated with fractionated stereotactic brain radiotherapy.Patients and methods
Retrospective hippocampal dosimetric analysis performed on 22 patients with one to four brain metastases treated with fractionated stereotactic radiotherapy using volumetric intensity-modulated arc therapy. Original plans did not include hippocampus as avoidance structure in optimization criteria; hippocampus was retrospectively delineated on magnetic resonance coregistered with planning CT and using as reference the RTOG 0933 atlas. Hippocampus was defined both as a single and as pair organ. Constraints analysed were: Dmax < 16 Gy, D40% < 7.3 Gy, D100% = Dmin < 9 Gy. Assuming a α/β ratio of 2 Gy, biologically equivalent dose in 2 Gy fractions was calculated. Hippocampal-sparing plans were developed in cases where hippocampal constraints were not respected in the original plan.Results
Among constraints analysed Dmax and D40% have been exceeded in ten out of 22 cases. The constraints were not respected in patients with more than one metastatic lesion and in three patients with only one lesion. Considering all exceeded constraints values in non-hippocampal sparing plans, the 50% of them was respected after replanning. No significant differences were found among conformity and homogeneity index between non-hippocampal sparing and hippocampal sparing plans.Conclusion
Volumetric intensity-modulated arc therapy hippocampal sparing plans significantly decreases dose to hippocampus assuring an equal target coverage and organs at risk avoiding. 相似文献3.
S. Lévy S. Chapet N. Scher K. Debbi A. Ruffier G. Bernadou Y. Pointreau G. Calais 《Cancer radiothérapie》2017,21(8):759-765
4.
J. Encaoua R. Abgral C. Leleu O. El Kabbaj P. Caradec D. Bourhis O. Pradier U. Schick 《Cancer radiothérapie》2017,21(4):267-275
Purpose
To study the impact on radiotherapy planning of an automatically segmented target volume delineation based on (18F)-fluorodeoxy-D-glucose (FDG)-hybrid positron emission tomography–computed tomography (PET-CT) compared to a manually delineation based on computed tomography (CT) in oesophageal carcinoma patients.Methods and materials
Fifty-eight patients diagnosed with oesophageal cancer between September 2009 and November 2014 were included. The majority had squamous cell carcinoma (84.5 %), and advanced stage (37.9 % were stade IIIA) and 44.8 % had middle oesophageal lesion. Gross tumour volumes were retrospectively defined based either manually on CT or automatically on coregistered PET/CT images using three different threshold methods: standard-uptake value (SUV) of 2.5, 40 % of maximum intensity and signal-to-background ratio. Target volumes were compared in length, volume and using the index of conformality. Radiotherapy plans to the dose of 50 Gy and 66 Gy using intensity-modulated radiotherapy were generated and compared for both data sets. Planification target volume coverage and doses delivered to organs at risk (heart, lung and spinal cord) were compared.Results
The gross tumour volume based manually on CT was significantly longer than that automatically based on signal-to-background ratio (6.4 cm versus 5.3 cm; P < 0.008). Doses to the lungs (V20, Dmean), heart (V40), and spinal cord (Dmax) were significantly lower on plans using the PTVSBR. The PTVSBR coverage was statistically better than the PTVCT coverage on both plans. (50 Gy: P < 0.0004 and 66 Gy: P < 0.0006).Conclusion
The automatic PET segmentation algorithm based on the signal-to-background ratio method for the delineation of oesophageal tumours is interesting, and results in better target volume coverage and decreased dose to organs at risk. This may allow dose escalation up to 66 Gy to the gross tumour volume. 相似文献5.
S. Wang Y.M. Kirova S.-C. Shan G. Cai D. Ou L. Cao R. Cai J.-Y. Chen 《Cancer radiothérapie》2018,22(8):767-772
Purpose
To evaluate the coverage of different levels of axillary lymph nodes and organs at risk according to the field design of AMAROS study (levels I–II–III–IV), breast tangents with supraclavicular and infraclavicular fields (levels II–III–IV) and high tangent fields to the breast after breast-conserving surgery.Materials and methods
We delineated the axillary lymph nodes levels I–IV in 34 patients treated with breast-conserving surgery and sentinel lymph nodes biopsy. Field design according to AMAROS study – levels I–IV in patients without axillary dissection – as well as irradiation of levels II–IV used in N+ patients after axillary dissection, and also high tangent fields was simulated. Mean dose levels and volumes covered by 95% or 80% isodoses were evaluated. Doses to ipsilateral lung, heart and brachial plexus were compared. Paired t test was used.Results
AMAROS study and levels II–IV plans delivered therapeutic dose to high axilla (levels II–IV), but the high tangent fields showed inefficacy to cover these volumes, P < 0.001). In terms of organs at risk, especially, ipsilateral lung, AMAROS study plan was found to significantly increase the volume receiving at least 10 Gy (I–IV:46.8%, II–IV: 39%), but also the volume receiving at least 20 Gy (I–IV: 39.3%, II–IV: 31.3%), and V30Gy (I–IV: 34.2% vs II–IV: 26.1%), as well as the mean dose (I–IV: 18.6 Gy, II–IV: 15.2 Gy, P < 0.001).Conclusions
The omission of axillary dissection and the axilla irradiation need is associated with high dose irradiation of the lungs, and with higher toxicity. The indication of axillary dissection or irradiation of low axilla could be individualized in relation with individual comorbidities and factors of risk. 相似文献6.
7.
C. Gamelon-Bénichou S. Oldrini C. Charra-Brunaud G. Vogin J. Salleron D. Peiffert 《Cancer radiothérapie》2017,21(3):171-179
Purpose
To evaluate prospectively chronic gastrointestinal toxicity in patients with cervical cancer treated with conventional irradiation or with intensity-modulated irradiation (IMRT).Patients and methods
Between June 2005 and September 2013, 109 patients underwent external radiotherapy followed by brachytherapy for cervical cancer at the “Institut de Cancérologie de Lorraine”. Each patient receiving IMRT was paired with a patient receiving conventional radiotherapy on the following criteria: concomitant chemotherapy, additional nodal dose, treatment of para-aortic lymph node area, age. The toxicity collection was prospective using the RTOG scale. The main objective was to compare the incidence of gastrointestinal toxicity chronic between the two groups. In a second time, the influence of dosimetric parameters on chronic GI toxicity was investigated. Comparisons of acute toxicity, chronic genitourinary toxicities, overall survival, disease-free survival were secondary objectives.Results
Sixty-six patients were able to be matched. Overall survival at 36 months was 71% in the conventional radiotherapy group against 73% in the IMRT group (P = 0.54). There was no significant difference between the two groups in terms of digestive chronic toxicity (P = 0.17), nor in terms acute gastrointestinal toxicities (P = 0.6445) and genitourinary (P = 0.5724). IMRT spared significantly small bowel (P = 0.0006) and rectum (P = 0.0046) from 30 Gy dose, and bladder from 45 Gy (P < 0.001). The incidence of genitourinary toxicity was significantly different between the two groups (P = 0.03) in favor of conventional radiotherapy.Conclusion
Our study does not seem to show significant difference in the occurrence of chronic gastrointestinal toxicities between the two groups. Clinical efficacy seems comparable. Larger studies with longer follow-up period should be conducted. 相似文献8.
I. Cho J.W. Park B. Cho J. Kwak S.M. Yoon J.P. Nesseler J. Park J.H. Kim 《Cancer radiothérapie》2018,22(8):754-762
Purpose
Stereotactic body radiation therapy is a promising treatment modality for locally advanced pancreatic cancer. To determine the optimal radiation treatment, we compared the plan characteristics of volumetric-modulated arc therapy and intensity-modulated radiation therapy when administered with stereotactic body radiation therapy to treat pancreatic cancer.Patients and methods
Fifteen patients with locally advanced pancreatic cancer were treated by stereotactic body radiation therapy at a dose of 24–32 Gy in four fractions with marker-guided gated volumetric-modulated arc therapy. Four dimensional-computed tomography scans were used to assess the target and surrounding normal organs. The same images, contours, and dose constraints were used for dual-arc volumetric-modulated arc therapy and 9-field intensity-modulated radiation therapy planning. Plans were compared using dosimetric parameters and treatment performance.Results
Volumetric-modulated arc therapy required significantly lower monitor units (1726 vs. 4188; P < 0.001) and shorter treatment delivery time in comparison with intensity-modulated radiation therapy (22.5 min vs. 52.4 min; P < 0.001). Regarding target volume coverage, both modalities demonstrated comparable results (V95%, 99.3% vs. 99.4%; P = 0.796). Both modalities satisfied the dosimetric determinants for duodenal toxicity and the maximum and mean doses administered to normal organ were also statistically similar.Conclusion
In comparison with 9-field intensity-modulated radiation therapy, volumetric-modulated arc therapy significantly reduces the number of monitoring units and treatment delivery times while administering similar dosimetric quality. Based on these results, volumetric-modulated arc therapy might be an appropriate treatment for locally advanced pancreatic cancer when combined with stereotactic body radiation therapy. 相似文献9.
V. Sarradin L. Simon A. Huynh J. Gilhodes T. Filleron F. Izar 《Cancer radiothérapie》2018,22(1):17-24
Purpose
Helical TomoTherapy® allows precise and homogeneous tumour coverage and excellent sparing of organs at risk. We present here our treatment technique, dosimetric results, and our first clinical data for patients receiving total body irradiation as part of the conditioning regimen before hematopoietic stem cell transplantation.Patients and methods
The cohort consisted of 11 patients who were treated in our institution between August 2014 and January 2016. The total dose was 12 Gy in six fractions in three days. We collected the dose distribution information in the treatment volumes, organs at risk and area of junction. We report retrospectively the clinical events during the first 6 months after the procedure.Results
Median age was 31 years (range, 18–57 years). Median D98% was 11.5 Gy (range: 6.6–11.9 Gy). The median of the mean doses to the lungs was 8.7 Gy (range: 8.5–9.3 Gy). The mean dose for the junction area was 12 Gy (range: 11.9–12.1 Gy). All patients had the total procedure, and all underwent successful engraftment. During the first six months, nine patients had at least one grade 3 or 4 toxicity that was due essentially to graft versus host disease. No patient had radiation pneumonitis. The toxicities were both more frequent and of higher grade during the first three months.Conclusion
Total body irradiation using helical TomoTherapy® is feasible. It allows a very good homogeneity of dose and conformity with an acceptable tolerance. It could deliver higher doses to sites at high risk of recurrence (bone marrow, sanctuary sites), while sparing major normal organs like lungs, liver, and kidneys. This reduction of dose could lead to reduced severity and frequency of late complications. 相似文献10.
M. Kruszyna S. Adamczyk A. Skrobała M. Skórska W. Suchorska K. Zaleska A. Kowalik W. Jackowiak J. Malicki 《Cancer radiothérapie》2017,21(5):345-351
Purpose
To measure out-of-field doses in a phantom model to better quantify this radiation.Material and methods
The individual contribution of photons and neutrons to the total out-of-field dose for 6 MV and 20 MV photons at open beam were measured in a purpose-designed water phantom. Radiation doses were measured at seven separate points (P1–P7) in the phantom with thermoluminescent detectors (TLD 100, 600, and 700) and GAFchromic? EBT films.Results
At a prescribed dose of 75 Gy to the isocentre, the photon dose level in the close-to-field area (P2) ranged from 2.0–2.5 Gy for 6 MV and 1.5–2.0 Gy for 20 MV; the total out-of-field doses at P2 and P7, respectively, were estimated to be as follows: for 6 MV: TLD 100 (< 3.23% and < 0.14%); radiochromic film (< 2.52% and < 0.03%); and for 20 MV: TLD 100 (< 2.94% and < 0.78%); TLD 700 (< 2.02% and < 0.14%); and radiochromic film (< 1.73% and < 0.01%). Although the dose decreased rapidly as the distance from the central beam axis increased, even distant doses could be as high as several centigrays. The neutron dose for 20 MV photons at a distance of 25 cm from the isocentre was 4.0 mSv/Gy.Conclusion
Our results show that in the close-to-field area, the dose level could be as high as 1.5 Gy assuming a prescribed dose of 75 Gy to the isocentre. By contrast, the doses delivered to more distant areas from the planning target volume were much lower (centigrays). These findings show that both 6 MV and 20 MV photons could produce dosimetrically important dose levels outside of the field. The data reported here may be of value to study the potential impact of even very low doses of radiation on human tissues. 相似文献11.
Purpose
To evaluate local control and adverse effects after postoperative hypofractionated stereotactic radiosurgery in patients with brain metastasis.Methods
We reviewed patients who had hypofractionated stereotactic radiosurgery (7.7 Gy × 3 prescribed to the 70% isodose line, with 2 mm planning target volume margin) following resection from March 2008 to January 2014. The primary endpoint was local failure defined as recurrence within the surgical cavity. Secondary endpoints were distant failure rates and the occurrence of radionecrosis.Results
Out of 95 patients, 39.2% had metastatic lesions from a non-small cell lung cancer primary tumour. The median Graded Prognostic Assessment score was 3 (48% of patients). One-year local control rates were 84%. Factors associated with improved local control were no cavity enhancement on pre-radiation MRI (P < 0.00001), planning target volume less than 12 cm3 (P = 0.005), Graded Prognostic Assessment score 2 or above (P = 0.009). One-year distant cerebral control rates were 56%. Thirty-three percent of patients received whole brain radiation therapy. Histologically proven radionecrosis of brain tissue occurred in 7.2% of cases. The size of the preoperative lesion and the volume of healthy brain tissue receiving 21 Gy (V21) were both predictive of the incidence of radionecrosis (P = 0.010 and 0.036, respectively).Conclusion
Adjuvant hypofractionated stereotactic radiosurgery to the postoperative cavity in patients with brain metastases results in excellent local control in selected patients, helps delay the use of whole brain radiation, and is associated with a relatively low risk of radionecrosis. 相似文献12.
A. Keller M. Doré D. Antoni I. Menoux F. Thillays J.B. Clavier G. Delpon D. Jarnet C. Bourrier F. Lefebvre S. Chibbaro I. Darié F. Proust G. Noël 《Cancer radiothérapie》2017,21(5):377-388
Purpose
To investigate the factors that potentially lead to brain radionecrosis after hypofractionated stereotactic radiotherapy targeting the postoperative resection cavity of brain metastases.Methods and materials
A retrospective analysis conducted in two French centres, was performed in patients treated with trifractionated stereotactic radiotherapy (3 × 7.7 Gy prescribed to the 70% isodose line) for resected brain metastases. Patients with previous whole-brain irradiation were excluded of the analysis. Radionecrosis was diagnosed according to a combination of criteria including clinical, serial imaging or, in some cases, histology. Univariate and multivariate analyses were performed to determine the predictive factors of radionecrosis including clinical and dosimetric variables such as volume of brain receiving a specific dose (V8 Gy–V22 Gy).Results
One hundred eighty-one patients, with a total of 189 cavities were treated between March 2008 and February 2015. Thirty-five patients (18.5%) developed radionecrosis after a median follow-up of 15 months (range: 3–38 months) after hypofractionated stereotactic radiotherapy. One third of patients with radionecrosis were symptomatic. Multivariate analysis showed that infra-tentorial location was predictive of radionecrosis (hazard ratio [HR]: 2.97; 95% confidence interval [95% CI]: 1.47–6.01; P = 0.0025). None V8 Gy–V22 Gy was associated with appearance of radionecrosis, even if V14 Gy trended toward significance (P = 0.059).Conclusion
Analysis of patients and treatment variables revealed that infratentorial location of brain metastases was predictive for radionecrosis after hypofractionated stereotactic radiotherapy for postoperative resection cavities. 相似文献13.
H. Carette J.-C. Faivre J. Salleron A.-S. Baumann L. Uwer C. Clément-Duchêne J.-M. Vignaud I. Petit J. Siat A. Tiotiu V. Beckendorf 《Cancer radiothérapie》2017,21(8):774-783
Purpose
Prophylactic radiotherapy to prevent procedure-tracts metastases from malignant pleural mesothelioma remains controversial and clinical practice varies. The purpose was to assess the efficacy of local radiotherapy in a single fraction of 10 Gy in preventing malignant seeding at intervention pleural site in patients with malignant pleural mesothelioma.Material and methods
This is a retrospective cohort study, including patients with histological confirmed malignant pleural mesothelioma treated by prophylactic irradiation to prevent interventional site metastases with a unique fraction of 10 Gy with 6 to 18 MeV, from January 1990 to December 2013 in the institut de cancérologie de Lorraine (Nancy, France).Results
Ninety-one patients were treated by irradiation in intervention site, involving 120 intervention pleural sites, 91 thoracoscopies, 17 thoracotomies with chest drain and 12 CT or ultrasound guided needle biopsies. The median follow-up was 7 months (interquartile between 3 and 15 months). The overall survival was 43.5% at 12 months. The local progression free survival was 43.7% at 12 month. The incidence of local recurrence was 8% at 12 months. The median interval from radiotherapy to local recurrence was 4 months (2; 32). No grade II or higher toxicity was observed.Conclusion
Irradiation of pleural intervention sites with a single fraction of 10 Gy is effective, well tolerated, simple, fast and cost effective. 相似文献14.
A. Arsène-Henry H.-P. Xu M. Robilliard W. El Amine É. Costa Y.M. Kirova 《Cancer radiothérapie》2018,22(3):241-247
Purpose
Intensity-modulated radiotherapy needs the strict delineation of target volumes as well as organs at risk and the time used for this procedure is long. The purpose of this study was to evaluate the Workflow Box system (Mirada Medical, UK) for automatic delineation and segmentation for everyday use of organs at risk and lymph nodes delineation in patients treated for early stage breast cancer.Material and methods
Twenty patients’ CT scans in treatment position for their breast cancer radiotherapy were delineated in respect of the ESTRO delineation guidelines to begin the creation of automatic delineation atlas. Then 30 other CT scans were delineated this time by the automatic delineation system and by the radiation oncologist (reference delineation plan). The precision of the delineation was evaluated using the overlap volume index and evaluation of standard deviation (SD).Results
The study of organs at risk has shown that the mean overlap volumes were between 0.49 (SD = 0.21) and 0.97 (ET = 0.03). Five organs at risk out of nine had overlap volumes at least 0.8. The mean overlap volume for all organs at risk was 0.77 (SD = 0.17). The system was less performing for the lymph nodes with a mean overlap volume of 0.43 (SD = 0.1) and ranging between 0.23 (SD = 0.13) and 0.52 (SD = 0.1). The use of this system reduced the delineation time by 40% per patient.Conclusions
For patients with breast cancer, the system for automatic delineation and segmentation Workflow Box (Mirada Medical, UK) permitted to safely shorten the time for delineation with acceptable organs at risk delineation. Improvement of lymph node volumes is needed. A new evaluation will be realized after using the system in routine practice. 相似文献15.
K.I. Cao L. Feuvret P. Herman S. Bolle T. Jouffroy F. Goudjil M. Amessis J. Rodriguez R. Dendale V. Calugaru 《Cancer radiothérapie》2018,22(1):31-37
Purpose
The aim of this study was to assess efficacy and safety of proton beam therapy of paragangliomas of the head and neck, rare benign tumours developed close to crucial structures such as cranial nerves and vascular tissues.Patients and methods
Ten patients with a paraganglioma of the head and neck were treated from 2001 to 2014 with image-guided proton therapy. Neurological and ear nose throat symptoms were collected in addition to audiometric testing, before and after the treatment. Acute and late toxicities were assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v4.Results
Median age at diagnosis was 52.6 years (range: 18.2–65.8 years). Proton therapy was the exclusive treatment in six patients and four patients had a postoperative radiotherapy. Median dose was 50.4 Gy relative biological effectiveness (RBE; range: 45.0–67.0 Gy). With a median follow-up of 24.6 months (range: 6.7–46.2 months), local tumour control rate was 100% (stable, n = 10). No upper grade 2 acute toxicity was reported. To the latest news, seven patients had controlled symptoms (improved, n = 1, stabilized, n = 6). One patient out of seven with initial tinnitus had a decrease in his symptoms, while the six other patients had a sustained stabilization.Conclusion
Proton beam therapy is an effective and well-tolerated treatment modality of skull base paragangliomas, with documented functional benefit. A longer follow-up is planned in order to assess local control and long-term toxicities. 相似文献16.
G.A. Turgeon L. Souhami N. Kopek V. Hirsh L. Ofiara S.L. Faria 《Cancer radiothérapie》2017,21(2):89-98
Purpose
Many Canadian institutions treat limited-disease small cell lung cancer with 40 Gy in 15 fractions delivered once-a-day in 3 weeks concomitantly with chemotherapy. This regimen is convenient and seems to be effective. Here, we report and compare with a literature review the outcomes of patients with limited-stage small cell lung cancer treated in our institution with this hypofractionated regimen.Patients and methods
From January 2004 to December 2012, patients with limited-stage small cell lung cancer treated curatively with platinum-based chemotherapy and concurrent thoracic radiotherapy at a dose of 40 Gy in 16 fractions once-a-day were eligible for this review.Results
Sixty-eight patients fit the analysis criteria, including ten patients with small pleural effusion. The median age was 66 years old. After a median follow-up of 77 months for those alive, the median survival was 28 months. At 3 and 5 years respectively, the locoregional control rates were 67 and 64%, while the overall survival rates were 40 and 35%. Prophylaxis cranial irradiation was delivered to 68% of the patients. Grade 2 and 3 acute esophagitis occurred in respectively 49 and 9% of the patients. There was no grade 4 radiation-induced toxicity. All patients, except for one, completed their thoracic irradiation course without interruption.Conclusion
Once-a-day hypofractionated radiation with concurrent chemotherapy followed by prophylactic cranial irradiation is a practical regimen. Based on our experience and the published literature, it appears to be similarly effective as regimens using twice-daily fractionation in 3 weeks, or once-daily in 6 to 7 weeks with higher radiotherapy doses. Further prospective comparisons of hypofractionation with the current recommendations are needed. 相似文献17.
C. Benhaïm G. Loos J.L. Achard L. Berger C. Caillé T. Frédéric-Moreau J. Biau M. Lapeyre 《Cancer radiothérapie》2017,21(1):28-33
Purpose
Intensity modulated radiotherapy for prostate cancer involves daily monitoring of the positioning of the prostate, possible with cone beam CT (CBCT). It allows increased accuracy compared to readjustments but induces an increase in the time dedicated to these medical checks. The aim of the study was to evaluate the possibility of delegation of this task to the radiation therapists by comparing their readjustments to the doctors.Patients and methods
Five consecutive patients treated with radiation for prostate cancer (76 Gy) were analysed. All had a daily CBCT for position control. The movements of the prostate relative to the bony part, the positional variations of the prostate measured by the radiation therapists and the doctors and medical time required to analyse imagery (filling of the rectum and bladder and perform a recalibration) were measured.Results
One hundred seventy-six CBCT were analysed or 980 steps in the three axes. The movements of the prostate relative to bony part were respectively at least 5 mm in 19%, 7% and 3% in the anterior–posterior, upper–lower and right–left axes. Changes readjustments between radiation therapists and doctors were in 95% of cases at the most 4 mm in the anterior–posterior and upper–lower axis, and 3 mm in the left–right axis. The time for medical use of the CBCT averaged 8 min 40 [4 to 22 min].Conclusion
The daily readjustment on the prostate using CBCT may be delegated to radiation therapists with acceptable concordance of less than 4 mm for 95% of measurements. An initial and ongoing training will ensure treatment safety. 相似文献18.
C. Demoor-Goldschmidt S. Chiavassa S. Josset M.-A. Mahé S. Supiot 《Cancer radiothérapie》2017,21(2):124-129
Purpose
Bilateral pulmonary radiotherapy in children and young adults aims to reduce the recurrence of lung metastases. The radiation field includes liver tissue, which is sensitive to even low radiation doses. We investigated the feasibility of respiratory gating radiotherapy using voluntary deep inspiration breath hold and its toxicity in these patients.Patients and method
A retrospective clinical review was conducted for all patients who had undergone bilateral pulmonary radiotherapy, with or without deep inspiration breath hold, treated in our institution between October 1999 and May 2012. A dosimetric study was conducted on seven consecutive children using 4D-scan data on free-breathing and a SpiroDyn’RX-system-scan on deep inspiration breath hold. A radiation treatment of 20 Gy was simulated.Results
Concerning the clinical study, seven patients of mean age 11.9 years (range: 4.9–21.1 years) were treated with free-breathing and ten patients of mean age 15.6 years (range: 8.6–19.7 years) were treated with deep inspiration breath hold for mainly Ewing sarcoma and nephroblastoma. Within six months of radiotherapy, all patients experienced mild liver toxicity (grade 1 or 2 altered levels of alanine/aspartate aminotransferase [n = 8 of 9] or cholestasis [n = 1 of 9]), which resolved completely with no difference between deep inspiration breath hold and free-breathing technique. Over a median follow-up of 2.6 years (range: 0.1–9.3 years), four patients died from disease progression (mean 1.5 years post-radiotherapy [range: 1.1–1.6 years]) and three experienced grade III–V lung toxicity. Concerning the dosimetric study, the irradiated liver volume was significantly lower with deep inspiration breath hold than free-breathing, for each isodose (V5: 73.80% versus 86.74%, P < 0.05; V20: 5.70% versus 26.44%, P < 0.05).Conclusions
The dosimetric data of respiratory-gated bilateral pulmonary radiotherapy showed a significantly spare of normal liver tissue. Clinical data showed that this technique is feasible even in young children. However, no liver toxicity difference between deep inspiration breath hold and free-breathing was shown. 相似文献19.
R. Sun X. Cuenca R. Itti S. Nguyen Quoc J.-P. Vernant J.-J. Mazeron C. Jenny M. Chea 《Cancer radiothérapie》2017,21(5):365-372
Purpose
Dynamic conformal radiotherapy with helical TomoTherapy® (HT) offers a more quantitative paradigm for total body irradiation. Treatment planning, delivery, dose verification of the first French experiences of total body irradiation using helical TomoTherapy® are presented.Materials and methods
Patients planned for total body irradiation at our institution from February 2012 to May 2013 were reported. Total body irradiation consisted in a single fraction of 2 Gy. Planning target volume was divided in two due to the limited translation length of the table. Delivery quality assurance was performed with cylindrical phantom, ionization chamber and films. Thermoluminescent dosimeters and radiochromic films were used for in vivo dosimetry and junction region heterogeneity assessment.Results
Six patients were included. One finally did not receive the treatment but dosimetric data were analyzed. Planned V95% was covered by D95% and V2% did not exceed D107% for five of the six patients. The mean relative difference between measured and calculated absolute dose of the Delivery quality assurance was always less than 2.5% (mean value ± SD: 1% ± 0.67%). Gamma index (3%; 3 mm) was less than 1 for at least 93% of the points (value ± SD: 97.4 ± 1.6% and 96.6 ± 2.5% for upper and lower part of treatment respectively). Difference between in vivo measured and calculated dose was above 5% for only two out of 15 points (maximum: 10.2%, mean: 0.73 ± 4.6%). Junction region heterogeneity was in average 5.8 ± 1%. The total treatment session of total body irradiation lasted 120 min, with a mean beam on time of 17.2 ± 0.6 and 11.2 ± 1.6 min for upper and lower part of the body respectively.Conclusion
Total body irradiation using helical TomoTherapy® guaranteed high dose homogeneity throughout the body and dose verification was achievable, showing small difference between planned and delivered doses. 相似文献20.
A. Bellière-Calandry G. Dupic F. Magnier V. Chassin V. Dedieu M. Lapeyre 《Cancer radiothérapie》2017,21(4):291-300