Acute toxicity of concomitant boost radiation therapy by volumetric-modulated arc therapy in head and neck cancers

2017 ◽  
Vol 16 (4) ◽  
pp. 423-430
Author(s):  
Kannan Perisamy ◽  
Ashutosh Mukherji ◽  
Saravanan Kandasamy ◽  
K. Sathyanarayan Reddy
Keyword(s):  
Radiation Therapy ◽  
Treatment Time ◽  
Radiation Therapy Oncology Group ◽  
Volumetric Modulated Arc Therapy ◽  
Concurrent Chemotherapy ◽  
Large Field ◽  
Concomitant Boost ◽  
Arc Therapy ◽  
Grade 3 ◽  
Boost Radiation

AbstractIntroductionVolumetric-modulated arc therapy (VMAT) is an advanced form of intensity-modulated radiation therapy that reduces treatment time without compromising plan quality. This study assessed acute toxicities in patients having carcinomas of oropharynx, larynx and hypopharynx treated with concomitant boost radiation therapy by VMAT.Materials and methodsIn this study, 30 patients of stages II–IVA disease were treated with concomitant boost radiation therapy using VMAT and those with stages III and IV also received concurrent chemotherapy with cisplatin 100 mg/m2 weekly thrice for two cycles. The total dose was 68·4 Gy/40 fractions/5.5 weeks (1·8 Gy/fraction/day to the large field for 28 fractions +1·5 Gy/fraction/day to boost field for the last 12 days of treatment). Radiation Therapy Oncology Group acute radiation morbidity scoring criteria was used to grade acute effects.ResultsAll patients completed scheduled treatment with median duration of 44 days. No grade 4 skin and mucosal toxicities were observed; grade 3 skin and mucosal toxicities seen in six (20%) and eight (26·67%) patients, respectively; grade 3 dysphagia and laryngeal toxicity in eight (26·67%) and three (10%) patients, respectively; two patients had grade 4 laryngeal toxicity. No grade 3 or grade 4 haematological toxicities were seen.ConclusionVMAT-based concomitant boost radiation therapy allows for dose escalation with good patient tolerance by limiting acute toxicities.

scholarly journals Volumetric Modulated Arc Therapy of the Pelvic Lymph Nodes to the Aortic Bifurcation in Higher Risk Prostate Cancer: Early Toxicity Outcomes

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Gina Hesselberg ◽  
Gerald Fogarty ◽  
Lauren Haydu ◽  
Nicole Dougheney ◽  
Phillip Stricker
Keyword(s):  
Prostate Cancer ◽  
Lymph Nodes ◽  
Radiation Therapy Oncology Group ◽  
Volumetric Modulated Arc Therapy ◽  
Toxicity Profile ◽  
Aortic Bifurcation ◽  
Pelvic Lymph Nodes ◽  
Arc Therapy ◽  
Grade 3 ◽  
Early Toxicity

Background. Treatment of pelvic lymph nodes (PLNs) in higher risk prostate carcinoma is controversial. The primary focus of the study was to evaluate the early toxicity profile for this cohort of patients treated with Volumetric Modulated Arc Therapy (VMAT).Methods. Patient, tumour, and treatment characteristics of those who received VMAT from May 2010 to December 2012 were analysed. A simplified contouring process of the PLNs to the aortic bifurcation was developed based on consensus guidelines. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicities were documented according to the Radiation Therapy Oncology Group (RTOG) Version 2 Guidelines. Successive Prostate Specific Antigen (PSA) values after treatment were measured on average 3 months apart.Results. 113 patients were treated between May 2010 to December 2012 with a median follow-up of 14 months. No patients experienced acute grade 3 or 4 GU and GI toxicity. Only 1 patient experienced a late grade 3 GU complication. No late grade 4 GU or GI events have yet occurred.Conclusions. This study reviews the first Australian experience of VMAT in the treatment of pelvic lymph nodes in prostate cancer, specifically to the level of the aortic bifurcation. It demonstrates a favorable acute toxicity profile whilst treating large PLN volumes with optimal dose coverage.

Dosimetric analysis and comparison of volumetric-modulated arc therapy versus intensity-modulated radiation therapy for liver carcinoma

2020 ◽  
pp. 1-3
Author(s):  
Bing-Hao Chiang ◽  
Erich Schnell ◽  
Kerry Hibbitts ◽  
Terence Herman ◽  
Salahuddin Ahmad
Keyword(s):  
Radiation Therapy ◽  
Normal Tissue ◽  
Treatment Time ◽  
Volumetric Modulated Arc Therapy ◽  
Liver Carcinoma ◽  
Dose Volume Histograms ◽  
Intensity Modulated ◽  
Normal Tissue Sparing ◽  
Arc Therapy ◽  
Tissue Sparing

Abstract Aim: This study dosimetrically compared volumetric-modulated arc therapy (VMAT) to intensity-modulated arc therapy (IMRT) for patients with liver carcinoma. Materials and methods: Ten patients with liver carcinoma previously treated with IMRT or VMAT were retrospectively selected for this study. Each patient received a total dose of 54 Gy in 1·8 Gy fractions. Dosimetric evaluations for each patient were performed using the dose–volume histograms (DVHs) for planning target volumes (PTVs) and organs at risk (OAR). All dosimetric parameters were statistically analysed using mean values, standard deviations and p-values for determining the significance. The conformality index (CI) and homogeneity index (HI) were calculated and compared. For efficiency evaluation, monitor units (MUs) and beam on times (BOT) were recorded. Results: Compared to IMRT, VMAT plans showed significant differences in the heterogeneity with p < 0·01 and insignificant differences in both conformality and normal tissue sparing. VMAT required marginally fewer mean MU and shorter BOT when compared to IMRT with insignificant differences. Conclusions: For radiation therapy treatment of liver carcinoma, IMRT and VMAT can achieve similar PTV coverage and normal tissue sparing. Treatment time is only marginally shorter with VMAT versus IMRT with insignificant differences.

NTENSITY-MODULATED RADIATION THERAPY WITH CONCURRENT CHEMOTHERAPY FOR NASOPHARYNGEAL CARCINOMA

2018 ◽  
Vol 8 (6) ◽  
pp. 105-113
Author(s):  
Tin Vo Nguyen ◽  
Tuong Pham Nguyen ◽  
Thanh Dang
Keyword(s):  
Radiation Therapy ◽  
Nasopharyngeal Carcinoma ◽  
Radiation Therapy Oncology Group ◽  
Nasopharyngeal Cancer ◽  
Tumour Response ◽  
Late Toxicity ◽  
Concurrent Chemotherapy ◽  
European Organization ◽  
Intensity Modulated ◽  
Grade 3

Purpose: To evaluate tumour response, acute and late toxicity in nasopharyngeal cancer (NPC) patients treated with intensity modulated radiotherapy (IMRT) with cisplatin chemotherapy. Materials and Methods: 33 NPC patients, received IMRT concurrently with four to six cycles of cisplatin (30 mg/m2/day) every six weeks between May 2016 and July 2018, were evaluated prospectively. The doses to the planning target volumes of primary tumor and involved lymph nodes, uninvolved regional nodal areas were 70 Gy and 50 Gy respectively. All patients were evaluated for tumour and node response using response evaluation criteria in solid tumour (RECIST) criteri, acute and late toxicities according to CTCAE version 3.0 (common terminology criteria for adverse events), RTOG/EORTC (Toxicity criteria of the Radiation Therapy Oncology Group/the European Organization for Research and Treatment of Cancer). Results: At three months after chemoradiation, 81.8% and 18.2% of patients achieved complete and partial response, respectively. Grade 3 acute toxicities were oral mucositis (6.1%), dermatitis (3%). Grade 3 late toxicities were xerostomia 2/33(6.1%). There was no grade 3 to grade 4 neck fibrosis and trismus, none of the patients developed mandibular bone necrosis. Conclusion:Cisplatin concurrently with IMRT provided excellent tumour response, manageable toxicities and good compliance. Key words: intensity-modulated radiation therapy, Concurrent chemotherapy and radiation therapy, nasopharyngeal carcinoma

Dosimetric comparison of volumetric modulated arc therapy and intensity modulated radiation therapy for anal cancer

2019 ◽  
Vol 19 (2) ◽  
pp. 190-192
Author(s):  
Bing-Hao Chiang ◽  
Kerry Hibbitts ◽  
Heather Ortega ◽  
Terence Herman ◽  
Salahuddin Ahmad
Keyword(s):  
Radiation Therapy ◽  
Treatment Time ◽  
Treatment Plan ◽  
Volumetric Modulated Arc Therapy ◽  
Anal Carcinoma ◽  
Intensity Modulated Radiation Therapy ◽  
Patient Comfort ◽  
Dose Volume Histograms ◽  
Intensity Modulated ◽  
Arc Therapy

AbstractAim:Volumetric modulated arc therapy (VMAT), an extension of intensity modulated radiation therapy (IMRT), employs modifications in gantry rotation speed, machine dose rate and multi-leaf collimator motion to deliver a three-dimensional dose distribution. This study compared VMAT to IMRT for patients with anal carcinoma.Materials and Methods:Sixteen patients previously treated with IMRT were retrospectively selected. Each patient received a total dose of 57·6–63·0 Gy in 1·8 Gy fractions. A single- or double-isocenter multi-arc VMAT treatment plan was generated using Eclipse RapidArc system with the same computed tomography image sets and optimisation constraints used for IMRT. Dose–volume histograms (DVHs) for planning target volumes (PTVs) and organs at risk (OARs), and monitor units (MUs) and beam on times (BOTs) were used for comparison. Results:IMRT and VMAT plans showed insignificant differences in PTV homogeneity and conformity and sparing hips and bowel. VMAT required fewer mean MU and shorter BOT per plan (1,597 MU, 2·66 min) compared to IMRT (2,571 MU, 4·29 min) with p < 0·0001. Conclusions:Fewer MU and shorter BOT for VMAT may decrease the damage from secondary radiation and treatment delivery uncertainty due to intra-fraction tumour motion, leading to higher machine throughput and improving patient comfort, with less treatment time.

Late rectal bleeding after volumetric-modulated arc therapy for localised prostatic cancer

2018 ◽  
Vol 18 (02) ◽  
pp. 165-168
Author(s):  
Yutaka Naoi ◽  
Kana Yamada ◽  
Chie Kurokawa ◽  
Hiroaki Kunogi ◽  
Yoshiro Sakamoto ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Adverse Effects ◽  
Rectal Bleeding ◽  
Locally Advanced ◽  
Volumetric Modulated Arc Therapy ◽  
Intensity Modulated Radiation Therapy ◽  
Arc Therapy ◽  
Late Adverse Effects ◽  
Grade 3

AbstractAimLate adverse effects following radiation therapy for prostate cancer involve the urinary and lower gastrointestinal tracts, with continuous rectal bleeding being the most serious issue. We focused on late adverse effects, particularly rectal bleeding after volumetric-modulated arc therapy (VMAT), for patients with locally advanced prostate cancer.Materials and MethodsSeventy-three patients with localized prostate cancer were treated with radiation therapy using VMAT with an image-guided radiation therapy system. Patient age at the start of irradiation ranged from 54 to 81 years (median, 71 years). The follow-up period ranged from 23 to 87 months (median, 57 months). The prescribed total irradiation dose was 76 Gy in 38 fractions.ResultsLate rectal bleeding was observed in 14 (19%) patients, with nine (12.3%), four (5.5%), and one (1.4%) being classified as grades 1, 2, and 3, respectively. One grade 3 patient with rectal bleeding had severe diabetes and was administered intravenous warfarin for cardiomyopathy.FindingsVMAT may provide better accuracy and involve fewer time constraints for patients compared with other intensity-modulated radiation therapy (IMRT) methods. The incidence of late rectal bleeding in VMAT is almost equivalent to that of other IMRT methods.

scholarly journals Early Clinical Outcomes, Patterns of Failure, and Acute Haematologic Toxicity of Image-Guided Volumetric Modulated Arc Therapy (IG-VMAT) in the Definitive Treatment of Locally Advanced Carcinoma Cervix

2018 ◽  
Vol 12 ◽  
pp. 117955491878399
Author(s):  
Irfan Ahmad ◽  
Kundan Singh Chufal ◽  
Irfan Bashir ◽  
Chandi Prasad Bhatt ◽  
Ram Bajpai ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Locally Advanced ◽  
Radiation Therapy Oncology Group ◽  
Volumetric Modulated Arc Therapy ◽  
Disease Free Survival ◽  
Concurrent Chemotherapy ◽  
Definitive Treatment ◽  
Failure Patterns ◽  
Image Guided ◽  
Arc Therapy

Purpose: To evaluate clinical outcomes and failure patterns in patients with locally advanced cervical cancer (LACC) treated definitively using image-guided volumetric-modulated arc therapy (IG-VMAT). Methods and materials: This retrospective review included 18 consecutively treated patients with LACC. Treatment consisted of IG-VMAT and concurrent chemotherapy followed by intracavitary radiotherapy. The primary end points were overall survival (OS) and disease-free survival (DFS). Acute haematologic toxicity was evaluated using Radiation Therapy Oncology Group (RTOG) criteria. Results: A total of 16 patients were either stage IIB or IIIB and the median follow-up was 30.5 months (interquartile range: 13-36.25 months). The 2-year DFS was 63.3% (95% confidence interval [CI]: 52.8%-72.4%) and 2-year OS was 72.2% (95% CI: 62.1%-80.5%). There were 7 treatment failures, predominantly in-field. Acute haematologic toxicity was low. Conclusions: IG-VMAT is associated with favourable outcomes for patients with LACC.

Concomitant Boost Radiation Plus Concurrent Cisplatin for Advanced Head and Neck Carcinomas: Radiation Therapy Oncology Group Phase II Trial 99-14

2005 ◽  
Vol 23 (13) ◽  
pp. 3008-3015 ◽  
Author(s):  
K. Kian Ang ◽  
Jonathan Harris ◽  
Adam S. Garden ◽  
Andy Trotti ◽  
Christopher U. Jones ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Head And Neck ◽  
Radiation Therapy Oncology Group ◽  
Survival Rates ◽  
Phase Iii ◽  
Concurrent Chemoradiation ◽  
Advanced Head ◽  
Oncology Group ◽  
Concomitant Boost ◽  
Grade 3

Purpose To investigate the feasibility of combining concomitant boost accelerated radiation regimen (AFX-C) with cisplatin and to assess its toxicity and the relapse pattern and survival in patients with advanced head and neck carcinoma (HNC). Patients and Methods Between April and November of 2000, 84 patients with stage III to IV HNC who met the eligibility criteria were enrolled; 76 of these patients were analyzable. Radiation consisted of 72 Gy in 42 fractions over 6 weeks (daily for 3.5 weeks, then twice a day for 2.5 weeks). Cisplatin dose was 100 mg/m2 on days 1 and 22. Tumor and clinical status were assessed, and acute late toxicities were graded. Results Sixty-five patients (86%) received both radiation and chemotherapy per protocol or with minor variations. The estimated 2-year locoregional relapse and distant metastasis rates were 34.7% and 16.1%, respectively. The estimated 2-year overall survival and disease-free survival rates were 71.6% and 53.5%, respectively. Three patients (4%) died of complications, 19 patients (25%) had acute grade 4 toxicity, and 49 patients (64%) had acute grade 3 toxicity. The 2-year cumulative incidence of late grade 3 to 5 toxicities was 51.3%. Conclusion These data showed that it was feasible to combine AFX-C with cisplatin. The compliance to therapy was high, and the locoregional control and survival rates achieved compared favorably with AFX-C alone or other concurrent chemoradiation regimens tested by the Radiation Therapy Oncology Group. A phase III trial comparing AFX-C plus cisplatin against standard radiation plus cisplatin is ongoing to determine whether the use of AFX-C in the concurrent chemoradiation setting further improves outcome.

Sign in / Sign up

Export Citation Format

Share Document