Effect of incorporation of preoperative CT scan on bladder doses and irradiated volume in postprostatectomy radiation therapy (pPRT).

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. e561-e561
Author(s):  
Mani Akhtari ◽  
Denley Ming Kee Yuan ◽  
Eugene C. Endres ◽  
Bao Minh Tran ◽  
Todd A. Swanson
Keyword(s):  
Radiation Therapy ◽  
Ct Scan ◽  
Radiation Therapy Oncology Group ◽  
Progression Free Survival ◽  
Target Volume ◽  
Consensus Definition ◽  
Prostate Bed ◽  
Patients At Risk ◽  
Preoperative Ct ◽  
Penile Bulb

e561 Background: pPRT increases local control, biochemical progression free survival, and even overall survival in patients with adverse features undergoing prostatectomy. The Radiation Therapy Oncology Group (RTOG) consensus definition of the clinical target volume (CTV) in 2010 was based on patterns of failure and anatomy without consideration of pre-operative imaging. This results in large volumes of bladder in the treatment field. Our study evaluates whether incorporation of pre-operative prostate volume can reduce the post-operative CTV and minimize dose to adjacent normal tissue. Methods: We reviewed records of all patients with available pre-operative pelvic CT scans treated at our institution with pPRT. The pre-operative CT scan was fused to the simulation CT. Post-operative CTV (CTV1) was delineated based on RTOG guidelines. A separate CTV (CTV2) was constructed, based on the intact prostate and proximal seminal vesicles. Plans were constructed for each CTV and doses to rectum, bladder, and penile bulb calculated, as well as concordance between the two CTVs and planning target volumes (PTVs). Paired student’s t-test was used to calculate difference between doses in the two different plans. Results: 10 patients’ plans were analyzed. Dosimetric parameters are shown in table 1. Volume of the bladder receiving 65 Gy or higher (V65) was significantly higher in CTV1. As would be expected, there were no significant differences in dose to either the rectum or penile bulb. Additionally, there was on average only 39% overlap between the CTVs and 60% between the PTVs in the two plans. Conclusions: Utilization of the pre-operative pelvic CT scan can aid in more accurate delineation of the CTV/PTV in prostate bed radiation therapy and decrease the bladder dose. As many patients at risk for pPRT have had this imaging performed preoperatively, in accordance with guidelines, incorporation of this data appears prudent. These findings need to be validated in a larger cohort. [Table: see text]

scholarly journals Dosimetric comparison between 3D conformal and intensity-modulated radiation therapy for prostate cancer

2010 ◽  
Vol 9 (2) ◽  
pp. 77-85 ◽  
Author(s):  
Courtney Buckey ◽  
Gregory Swanson ◽  
Sotirios Stathakis ◽  
Nikos Papanikolaou
Keyword(s):  
Radiation Therapy ◽  
Organs At Risk ◽  
External Beam Radiotherapy ◽  
Radiation Therapy Oncology Group ◽  
Intensity Modulated Radiation Therapy ◽  
Standard Of Care ◽  
Target Volume ◽  
Conformal Radiation Therapy ◽  
Intensity Modulated ◽  
3D Crt

AbstractBackground and Purpose: Intensity-modulated radiation therapy (IMRT) is considered by many to be the standard of care in the delivery of external-beam radiotherapy treatments to the prostate. The purpose of this study is to assess the validity of the purported benefits of IMRT.Materials and Methods: Treatment plans were produced for 10 patients using both 3D conformal radiation therapy (3D-CRT) and IMRT, utilising the dose constraints recommended by the Radiation Therapy Oncology Group (RTOG) 0415 protocol. Three IMRT modalities used in this study were linear accelerator based IMRT, helical tomotherapy, and serial tomotherapy. The prescription to the target, 76 Gy, was the same for all plans.Results: In general the 3D-CRT plans satisfied the RTOG criteria for planning target volume (PTV) coverage, and met or bettered the dose criteria for the organs at risk. PTV coverage was more homogeneous for the IMRT plans than the 3D-CRT plans but not significantly improved.Conclusions: Technically, because the IMRT plans required greater effort for the optimisation, longer treatment times and higher monitor units, the use of IMRT for the fulfilment of the protocol’s dosimetric goals was not justified using these constraints.

Initial report of Radiation Therapy Oncology Group (RTOG) 9802: Prospective studies in adult low-grade glioma (LGG)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 1500-1500 ◽  
Author(s):  
E. G. Shaw ◽  
B. Berkey ◽  
S. W. Coons ◽  
D. Brachman ◽  
J. C. Buckner ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Survival Time ◽  
Prospective Studies ◽  
Radiation Therapy Oncology Group ◽  
Local Treatment ◽  
Progression Free Survival ◽  
Low Grade ◽  
Initial Report ◽  
Free Survival

1500 Background: Treatment of adult LGG is controversial. Favorable patients (pts) (age <40 years [yrs] who undergo gross total resection [GTR]) are typically observed. Unfavorable pts (age ≥40 who have subtotal resection [STR] or biopsy [B]) are usually given initial radiation therapy (RT), reserving chemotherapy (historically procarbazine, CCNU and vincristine [PCV]) for recurrence. In 1998, the RTOG, in conjunction with SWOG, NCCTG, and ECOG initiated prospective studies of adult LGG, the results of which are reported herein. Methods: Favorable pts were observed postoperatively in a single arm Phase II study (Arm 1). Unfavorable pts were stratified by age, histology, KPS, and presence/absence of contrast enhancement on preoperative magnetic resonance imaging and randomized to either RT alone (54Gy in 30 fractions to a local treatment field) (Arm 2) or RT followed by 6 cycles of standard dose PCV (Arm 3). Reported results include overall survival (OS) rate, median overall survival time (MOST), progression-free survival (PFS) rate, and median progression-free survival time (MPFST). Survival data are compared using Wilcoxon p-values. Results: A total of 362 eligible/analyzable pts were accrued between 1998 and 2002. Median follow-up time is 4 years. For the 111 favorable pts observed on Arm 1, OS at 2- and 5-yrs is 99% and 94%. PFS at 2- and 5-yrs is 82% and 50%. For the 251 unfavorable pts on Arms 2 (RT alone) and 3 (RT+PCV), there was no difference in OS or PFS. OS at 2- and 5-yrs was 87% and 61% with RT alone versus (vs) 86% and 70% with RT+PCV (p=0.72). MOST was not reached in RT alone pts and was 6.0 yrs in RT+PCV pts. PFS at 2- and 5-yrs was 73% and 39% with RT alone vs 72% and 61% with RT+PCV (p=0.38). MPFST was 4.0 yrs with RT alone vs 6.0 yrs with RT+PCV. Acute grade 3–4 toxicity occurred in 9% of pts who received RT alone, 67% who received RT+PCV (mostly hematologic). There were no treatment deaths on either arm. Conclusions: 5-yr PFS was poor in all three arms ranging from 39% to 61%. Only half of favorable pts were disease-free at 5 yrs. In unfavorable pts, there was no OS advantage with the addition of PCV to RT. Both PFS and MPFST were better with the addition of PCV, but not significantly. Analysis of outcome by 1p19q status is pending. No significant financial relationships to disclose.

scholarly journals Benefit From Procarbazine, Lomustine, and Vincristine in Oligodendroglial Tumors Is Associated With Mutation of IDH

2014 ◽  
Vol 32 (8) ◽  
pp. 783-790 ◽  
Author(s):  
J. Gregory Cairncross ◽  
Meihua Wang ◽  
Robert B. Jenkins ◽  
Edward G. Shaw ◽  
Caterina Giannini ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Risk Allele ◽  
Germ Line ◽  
Radiation Therapy Oncology Group ◽  
Progression Free Survival ◽  
Wild Type ◽  
Free Survival ◽  
Oligodendroglial Tumors ◽  
Mutational Status ◽  
Germ Line Polymorphism

Purpose Patients with 1p/19q codeleted anaplastic oligodendroglial tumors who participated in RTOG (Radiation Therapy Oncology Group) 9402 lived much longer after chemoradiotherapy (CRT) than radiation therapy (RT) alone. However, some patients with noncodeleted tumors also benefited from CRT; survival curves separated after the median had been reached, and significantly more patients lived ≥ 10 years after CRT than RT. Thus, 1p/19q status may not identify all responders to CRT. Patients and Methods Using trial data, we inquired whether an IDH mutation or germ-line polymorphism associated with IDH-mutant gliomas identified the patients in RTOG 9402 who benefited from CRT. Results IDH status was evaluable in 210 of 291 patients; 156 (74%) had mutations. rs55705857 was evaluable in 245 patients; 76 (31%) carried the G risk allele. Both were associated with longer progression-free survival after CRT, and mutant IDH was associated with longer overall survival (9.4 v 5.7 years; hazard ratio [HR], 0.59; 95% CI, 0.40 to 0.86; P = .006). For those with wild-type tumors, CRT did not prolong median survival (1.3 v 1.8 years; HR, 1.14; 95% CI, 0.63 to 2.04; P = .67) or 10-year survival rate (CRT, 6% v RT, 4%). Patients with codeleted mutated tumors (14.7 v 6.8 years; HR, 0.49; 95% CI, 0.28 to 0.85; P = .01) and noncodeleted mutated tumors (5.5 v 3.3 years; HR, 0.56; 95% CI, 0.32 to 0.99; P < .05) lived longer after CRT than RT. Conclusion IDH mutational status identified patients with oligodendroglial tumors who did (and did not) benefit from alkylating-agent chemotherapy with RT. Although patients with codeleted tumors lived longest, patients with noncodeleted IDH-mutated tumors also lived longer after CRT.

Stereotactic radiosurgery for treatment of radiation-induced meningiomas: a multiinstitutional study

2021 ◽  
pp. 1-9
Author(s):  
Adomas Bunevicius ◽  
Mohand Suleiman ◽  
Samir Patel ◽  
Roberto Martínez Álvarez ◽  
Nuria E. Martinez Moreno ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Stereotactic Radiosurgery ◽  
Progression Free Survival ◽  
Target Volume ◽  
Cranial Irradiation ◽  
Who Grade ◽  
Cranial Radiation ◽  
Treatment Volume ◽  
Radiation Induced ◽  
Prescription Dose

OBJECTIVERadiation-induced meningiomas (RIMs) are associated with aggressive clinical behavior. Stereotactic radiosurgery (SRS) is sometimes considered for selected RIMs. The authors investigated the effectiveness and safety of SRS for the management of RIMs.METHODSFrom 12 institutions participating in the International Radiosurgery Research Foundation, the authors pooled patients who had prior cranial irradiation and were subsequently clinically diagnosed with WHO grade I meningiomas that were managed with SRS.RESULTSFifty-two patients underwent 60 SRS procedures for histologically confirmed or radiologically suspected WHO grade I RIMs. The median ages at initial cranial radiation therapy and SRS for RIM were 5.5 years and 39 years, respectively. The most common reasons for cranial radiation therapy were leukemia (21%) and medulloblastoma (17%). There were 39 multiple RIMs (35%), the mean target volume was 8.61 ± 7.80 cm3, and the median prescription dose was 14 Gy. The median imaging follow-up duration was 48 months (range 4–195 months). RIM progressed in 9 patients (17%) at a median duration of 30 months (range 3–45 months) after SRS. Progression-free survival at 5 years post-SRS was 83%. Treatment volume ≥ 5 cm3 predicted progression (HR 8.226, 95% CI 1.028–65.857, p = 0.047). Seven patients (14%) developed new neurological symptoms or experienced SRS-related complications or T2 signal change from 1 to 72 months after SRS.CONCLUSIONSSRS is associated with durable local control of RIMs in the majority of patients and has an acceptable safety profile. SRS can be considered for patients and tumors that are deemed suboptimal, poor surgical candidates, and those whose tumor again progresses after removal.

scholarly journals Significant Reduction of Late Toxicities in Patients With Extremity Sarcoma Treated With Image-Guided Radiation Therapy to a Reduced Target Volume: Results of Radiation Therapy Oncology Group RTOG-0630 Trial

2015 ◽  
Vol 33 (20) ◽  
pp. 2231-2238 ◽  
Author(s):  
Dian Wang ◽  
Qiang Zhang ◽  
Burton L. Eisenberg ◽  
John M. Kane ◽  
X. Allen Li ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Phase Ii Trial ◽  
Radiation Therapy Oncology Group ◽  
Target Volume ◽  
Oncology Group ◽  
Image Guided Radiation Therapy ◽  
Image Guided ◽  
Extremity Soft Tissue Sarcoma

Purpose We performed a multi-institutional prospective phase II trial to assess late toxicities in patients with extremity soft tissue sarcoma (STS) treated with preoperative image-guided radiation therapy (IGRT) to a reduced target volume. Patients and Methods Patients with extremity STS received IGRT with (cohort A) or without (cohort B) chemotherapy followed by limb-sparing resection. Daily pretreatment images were coregistered with digitally reconstructed radiographs so that the patient position could be adjusted before each treatment. All patients received IGRT to reduced tumor volumes according to strict protocol guidelines. Late toxicities were assessed at 2 years. Results In all, 98 patients were accrued (cohort A, 12; cohort B, 86). Cohort A was closed prematurely because of poor accrual and is not reported. Seventy-nine eligible patients from cohort B form the basis of this report. At a median follow-up of 3.6 years, five patients did not have surgery because of disease progression. There were five local treatment failures, all of which were in field. Of the 57 patients assessed for late toxicities at 2 years, 10.5% experienced at least one grade ≥ 2 toxicity as compared with 37% of patients in the National Cancer Institute of Canada SR2 (CAN-NCIC-SR2: Phase III Randomized Study of Pre- vs Postoperative Radiotherapy in Curable Extremity Soft Tissue Sarcoma) trial receiving preoperative radiation therapy without IGRT (P < .001). Conclusion The significant reduction of late toxicities in patients with extremity STS who were treated with preoperative IGRT and absence of marginal-field recurrences suggest that the target volumes used in the Radiation Therapy Oncology Group RTOG-0630 (A Phase II Trial of Image-Guided Preoperative Radiotherapy for Primary Soft Tissue Sarcomas of the Extremity) study are appropriate for preoperative IGRT for extremity STS.

224 Stereotactic Radiosurgery for Intracranial Ependymomas: An International Multicenter Study

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 261-261
Author(s):  
Hideyuki Kano ◽  
Or Cohen-Inber ◽  
Jason P Sheehan ◽  
David Mathieu ◽  
Yan-Hua Su ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Stereotactic Radiosurgery ◽  
Radiation Effects ◽  
Progression Free Survival ◽  
Target Volume ◽  
Low Grade ◽  
Intracranial Ependymoma ◽  
Failed Surgery ◽  
Fractionated Radiation Therapy ◽  
International Multicenter Study

Abstract INTRODUCTION Stereotactic radiosurgery (SRS) is a potentially important option for patients with intracranial ependymoma. We analyzed the outcomes of intracranial ependymoma patients who underwent SRS as a part of multimodality management. METHODS Four participating centers of the International Gamma Knife Research Foundation (IGKRF) identified 74 patients who underwent SRS for 95 intracranial ependymomas. The median patient age was 21 years (range, 1.8-80). All patients had previous surgical resection of their ependymomas, 64 had previous fractionated radiation therapy, and 26 had previous chemotherapy. Forty-three patients had low-grade ependymomas (53 tumors) and 31 patients had high-grade ependymomas (42 tumors). The median radiosurgery target volume was 3.7 cc (range, 0.03-36.8) and the median margin dose was 15 Gy (range, 10–22). RESULTS >At a median follow-up of 23 months after SRS (range, 3.3-220), 37 patients died. The overall survival after SRS was 77% at 1 year, 60% at 2 years, 52% at 3 years, and 45% at 5 years. The progression-free survival after SRS was 75% at 1 year, 65% at 2 years, 53% at 3 years, and 47% at 5 years. Factors associated with better PFS included low-grade ependymoma (P = 0.021) and higher margin dose (P = 0.013). The distant tumor relapse rate after SRS was 17% at 1 year, 26% at 2 years, 37% at 3 years, and 40% at 50 years. Symptomatic adverse radiation effects developed in 9 patients (12%). CONCLUSION SRS provides another management option for patients with intracranial ependymomas that have failed surgery and radiation therapy.

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