scholarly journals Analysis of cardiac toxicity after definitive chemoradiotherapy for esophageal cancer using a biological dose–volume histogram

2020 ◽  
Vol 61 (2) ◽  
pp. 298-306
Author(s):  
Yuki Takeuchi ◽  
Yuji Murakami ◽  
Tsubasa Kameoka ◽  
Masanori Ochi ◽  
Nobuki Imano ◽  
...  
Keyword(s):  
Risk Factors ◽  
Esophageal Cancer ◽  
Cardiac Toxicity ◽  
Dose Volume Histogram ◽  
Definitive Chemoradiotherapy ◽  
Heart Dose ◽  
Dose Volume ◽  
The Mean ◽  
Mean Heart Dose ◽  
The Relationship

Abstract This study aimed to evaluate the relationship between cardiac toxicity after definitive chemoradiotherapy (CRT) for esophageal cancer and the dose–volume histogram (DVH) of organs at risk (OARs) [using biological effective dose (BED)]. We analyzed the data of 83 patients with esophageal cancer treated using definitive CRT between 2001 and 2016. Furthermore, we evaluated pericardial effusion (PE) as a measure of cardiac toxicity. The median total irradiation dose was 60 (50.4–71) Gy. Symptomatic PE was observed in 12 (14%) patients. The heart and pericardium V5–V100-BED were significantly higher in patients with symptomatic PE than in those without symptomatic PE (heart: V5–V95-BED, P < 0.001; V100-BED, P = 0.0053, and pericardium: V5–V40-BED, V55–V95-BED, P < 0.001; V45–50-BED, V100-BED, P < 0.05, respectively). Receiver operating characteristic curve analysis showed that the dose–volume parameter of the pericardium and the heart that was most strongly associated with an adverse cardiac event was V80-BED, and the mean dose and the cut-off value were 27.38% and 61.7 Gy-BED, respectively. Multivariate analysis showed that the pericardium V80-BED and the mean heart dose-BED were risk factors for symptomatic PE (P < 0.001, respectively). We revealed the relationship between the irradiated dose of the OARs and symptomatic PE using a BED-based dose–volume histogram. Pericardium V80-BED and mean heart dose-BED were the most relevant risk factors for symptomatic PE.

PO-1074 Is the mean heart dose the best predictor of cardiac toxicity after Hodgkin Lymphoma irradiation?

2021 ◽  
Vol 161 ◽  
pp. S894
Author(s):  
R. Moujahed ◽  
M. Ben Rejeb ◽  
S. Ghorbel ◽  
A. Hamdoun ◽  
Z. Naimi ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Cardiac Toxicity ◽  
Heart Dose ◽  
The Mean ◽  
Mean Heart Dose

scholarly journals Dosimetric evaluation of deep inspiration breath hold for left-sided breast cancer: analysis of patient-specific parameters related to heart dose reduction

2020 ◽  
Vol 61 (3) ◽  
pp. 447-456 ◽  
Author(s):  
Ryohei Yamauchi ◽  
Norifumi Mizuno ◽  
Tomoko Itazawa ◽  
Hidetoshi Saitoh ◽  
Jiro Kawamori
Keyword(s):  
Dose Reduction ◽  
Patient Specific ◽  
Breath Hold ◽  
Relative Reduction ◽  
Deep Inspiration ◽  
Deep Inspiration Breath Hold ◽  
Heart Dose ◽  
Dose Volume ◽  
The Mean ◽  
Mean Heart Dose

Abstract Deep inspiration breath hold (DIBH) is a common method used worldwide for reducing the radiation dose to the heart. However, few studies have reported on the relationship between dose reduction and patient-specific parameters. The aim of this study was to compare the reductions of heart dose and volume using DIBH with the dose/volume of free breathing (FB) for patients with left-sided breast cancer and to analyse patient-specific dose reduction parameters. A total of 85 Asian patients who underwent whole-breast radiotherapy after breast-conserving surgery were recruited. Treatment plans for FB and DIBH were retrospectively generated by using an automated breast planning tool with a two-field tangential intensity-modulated radiation therapy technique. The prescribed dose was 50 Gy in 25 fractions. The dosimetric parameters (e.g., mean dose and maximum dose) in heart and lung were extracted from the dose–volume histogram. The relationships between dose–volume data and patient-specific parameters, such as age, body mass index (BMI), and inspiratory volume, were analyzed. The mean heart doses for the FB and DIBH plans were 1.56 Gy and 0.75 Gy, respectively, a relative reduction of 47%. There were significant differences in all heart dosimetric parameters (p < 0.001). For patients with a high heart dose in the FB plan, a relative reduction of the mean heart dose correlated with inspiratory volume (r = 0.646). There was correlation between the relative reduction of mean heart dose and BMI (r = −0.248). We recommend considering the possible feasibility of DIBH in low BMI patients because the degree of benefit from DIBH varied with BMI.

scholarly journals Volume-based algorithm of lung dose optimization in novel dynamic arc radiotherapy for esophageal cancer

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kuan-Heng Lin ◽  
Chen-Xiong Hsu ◽  
Shan-Ying Wang ◽  
Greta S. P. Mok ◽  
Chiu-Han Chang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Esophageal Cancer ◽  
Maximum Dose ◽  
Treatment Plan ◽  
Conformity Index ◽  
Lung Dose ◽  
Heart Dose ◽  
The Mean ◽  
Mean Lung Dose ◽  
Mean Heart Dose

AbstractThis study aims to develop a volume-based algorithm (VBA) that can rapidly optimize rotating gantry arc angles and predict the lung V5 preceding the treatment planning. This phantom study was performed in the dynamic arc therapy planning systems for an esophageal cancer model. The angle of rotation of the gantry around the isocenter as defined as arc angle (θA), ranging from 360° to 80° with an interval of 20°, resulting in 15 different θA of treatment plans. The corresponding predicted lung V5 was calculated by the VBA, the mean lung dose, lung V5, lung V20, mean heart dose, heart V30, the spinal cord maximum dose and conformity index were assessed from dose–volume histogram in the treatment plan. Correlations between the predicted lung V5 and the dosimetric indices were evaluated using Pearson’s correlation coefficient. The results showed that the predicted lung V5 and the lung V5 in the treatment plan were positively correlated (r = 0.996, p < 0.001). As the θA decreased, lung V5, lung V20, and the mean lung dose decreased while the mean heart dose, V30 and the spinal cord maximum dose increased. The V20 and the mean lung dose also showed high correlations with the predicted lung V5 (r = 0.974, 0.999, p < 0.001). This study successfully developed an efficient VBA to rapidly calculate the θA to predict the lung V5 and reduce the lung dose, with potentials to improve the current clinical practice of dynamic arc radiotherapy.

scholarly journals Examining the relationship between sepsis and oropharyngeal dysphagia in hospitalised elderly patients: a retrospective cohort study

2018 ◽  
Vol 9 (4) ◽  
pp. 256-261 ◽  
Author(s):  
Ayodele Sasegbon ◽  
Laura O’Shea ◽  
Shaheen Hamdy
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Elderly Person ◽  
Oropharyngeal Dysphagia ◽  
The Elderly ◽  
Common Source ◽  
Increased Risk ◽  
The Mean ◽  
The Relationship ◽  
New Onset

IntroductionElderly people are recognised to be at increased risk of oropharyngeal dysphagia (OPD), the causes of which are multifactorial. Our aim was to identify if sepsis is associated with OPD in the elderly during hospitalisation in the absence of known other risk factors for OPD.MethodsA hospital electronic database was searched for elderly patients (≥65 years) referred for assessment for suspected dysphagia between March 2013 and 2014. Exclusion criteria were age <65 years, pre-existing OPD or acute OPD secondary to acute intracranial event, space-occupying lesion or trauma. Data were collected on factors including age, sex, comorbidities, existing OPD, sepsis, microbiology, recovery of OPD and medication. Sepsis was defined as evidence of a systemic inflammatory response syndrome with a clinical suspicion of infection.ResultsA total of 301 of 1761 screened patients referred for dysphagia assessment met the inclusion criteria. The prevalence of sepsis and subsequent OPD was 16% (51/301). The mean age was 83 years (median 81 years). The most common comorbidity was dementia (31%). The majority (84%) failed to recover swallowing during their hospital stay, 12% had complications of aspiration and 35% died. The most common source of sepsis was from the chest (55%). Other factors contributing to the risk for dysphagia included delirium (22%) and neuroactive medication (41%). However, 10% of patients had sepsis and subsequent OPD without other identified risk factors.ConclusionThe prevalence of sepsis and subsequent dysphagia is significant and should be taken into account in any elderly person in hospital with new-onset OPD without other predisposing risk factors.

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