scholarly journals Advanced Technology Radiation Therapy with Dose Painting: Opportunities for Outcome Improvement for Management of Lymphoma

2021 ◽  
Vol 9 (7) ◽  
Author(s):  
Jon Glanzman ◽  
Maryann Bishop ◽  
John Roubil ◽  
Kara Benson ◽  
Rebecca Wang ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Normal Tissue ◽  
Target Volume ◽  
Advanced Technology ◽  
Patient Treatment ◽  
Primary Therapy ◽  
Dose Painting ◽  
Favorable Histology ◽  
Non Hodgkin Lymphoma ◽  
Altered Fractionation

Radiation therapy remains important in the modern management of both Hodgkin and non-Hodgkin lymphoma. Radiation is applied as both consolidation therapy post chemotherapy and primary therapy for selected limited volume clinically favorable histology. Application of modern therapy techniques permits more sparing of normal tissue in all anatomical locations. Modern image guidance permits both security in daily patient treatment set up and permits strategic titration of the planning target volume to further spare normal tissue. Four-dimensional planning makes certain targets are fully treated in all phases of the breathing cycle. Dose painting with altered fractionation permits identification of low, intermediate, and high-risk areas of concern and treat each in a single plan with multiple fractionation schemes saving both time of treatment and cost of therapy. In this paper we present multiple examples of the application of modern therapy techniques in lymphoma management and demonstrate advantages of modern radiation in several anatomical regions.

RTOG 0438: A phase I trial of highly conformal radiation therapy for patients with liver metastases.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 257-257 ◽  
Author(s):  
Alan W. Katz ◽  
Kathryn A. Winter ◽  
Laura A. Dawson ◽  
Michael C Schell ◽  
Joon-Hyung J. Kim ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Phase I ◽  
Liver Metastases ◽  
Normal Tissue ◽  
Phase I Trial ◽  
Target Volume ◽  
Institutional Setting ◽  
Eligibility Criteria ◽  
Conformal Radiation Therapy ◽  
Contrast Ct

257 Background: This multi-institutional phase I trial was conducted to determine the maximally tolerated dose (MTD) of hypofractionated, highly conformal radiation therapy (RT) in patients (pts) with liver metastases. Methods: Eligibility criteria included non-surgical pts with ≤ 5 liver metastases; total measurement for all lesions ≤ 8 cm. There were four dose levels (DLs) escalating from 35 Gy to 50 Gy in 5 Gy increments given in 10 fractions with defined normal tissue dose limits. Accrual began at 40 Gy. The clinical target volume (CTV) included all metastases identified on contrast CT/MRI with a 5 mm margin. The planning target margin ranged from 4 to 30 mm around the CTV. For quality assurance the Image-Guided Therapy Center (ITC) remote review tool was used to evaluate treatment planning images and dosimetry information. Dose limiting toxicities (DLTs) were defined as treatment-related grade (Gr) ≥ 4 hepatic, gastrointestinal (GI), thrombocytopenia, or radiation induced liver disease (RILD) within 90 days (dys) of the start of RT. Results: 26 pts were enrolled between 11/05 and 12/10, and 23 were evaluable; 8, 7, and 8 on the 40, 45, and 50 Gy DLs respectively. Two pts assigned to the 50 Gy DL received 35 Gy because of normal tissue constraints, therefore an additional 2 pts were accrued and treated at the 50 Gy DL. The study was temporarily closed for toxicity evaluation after 6 pts on each DL were followed for a minimum of 90 dys from start of treatment. There were no DLTs observed on any of the DLs. Four pts developed treatment-related Gr 3 toxicities; 2 each on the 45 and 50 Gy DLs. On the 45 Gy DL, 1 pt had two Gr 3 GI toxicities: enteritis (37 dys from RT start) and diarrhea (22 dys) while another pt had Gr 3 lymphopenia (23 dys). On the 50 Gy DL, 1 pt had Gr 3 hyperglycemia (74 dys) and another pt had three Gr 3 toxicities: lymphopenia (13 dys), colonic hemorrhage (325 dys), and GI obstruction (325 dys). Conclusions: When normal tissue constraints could be met, treatment of liver metastases with 50 Gy in 5 Gy/fx is feasible and safe in a multi-institutional setting. Further studies looking at higher doses and alternate fractionation regimens are warranted. Supported by RTOG U10 CA21661, CCOP U10 CA37422 and ATC U24 CA 81647 NCI grants.

scholarly journals Enhanced Protocols for CT Slice Thickness on Clinical Target Volume for 3d Radiation Therapy

2019 ◽  
Vol 8 (12) ◽  
pp. 1365-1370
Keyword(s):  
Computed Tomography ◽  
Radiation Therapy ◽  
Normal Tissue ◽  
Clinical Target Volume ◽  
Three Dimensional ◽  
Target Volume ◽  
Slice Thickness ◽  
Geometric Accuracy ◽  
Tumour Location ◽  
Cancer Diseases

Radiation Therapy is used to treat the cancer diseases by ionization of radiations. From the beginning the aim of radiation therapy is to cure the cancer without any side effects. Tumour location and type, geometric accuracy and involvement in anatomic area affect the output of radiation therapy in which the amount of radiation dose is given. The tumour is controlled by production of high dosage of radiation. The amount of dosage is limited by possibility of damage of normal tissue. To control the amount of dose, for three dimensional radiation therapy computed tomography (CT) slice thickness is proposed in this paper. This paper defines the changes of CTV (clinical target volume) using various computed tomography slice thickness on three dimensional radiation therapy. For all computed tomography datasets, planning of three dimensional treatments is achieved.

Anisotropic Bladder Planning Target Volume in Bladder Radiation Therapy

2019 ◽  
Vol 9 (1) ◽  
pp. 24-28 ◽  
Author(s):  
Khaled Adil ◽  
Marija Popovic ◽  
Fabio L. Cury ◽  
Sergio L. Faria ◽  
Marie Duclos ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Planning Target Volume ◽  
Target Volume

scholarly journals Synergies Radiotherapy-Immunotherapy in Head and Neck Cancers. A New Concept for Radiotherapy Target Volumes-“Immunological Dose Painting”

Medicina ◽  
2020 ◽  
Vol 57 (1) ◽  
pp. 6
Author(s):  
Camil Ciprian Mireştean ◽  
Anda Crişan ◽  
Călin Buzea ◽  
Roxana Irina Iancu ◽  
DragoşPetru Teodor Iancu
Keyword(s):  
Immune System ◽  
Synergistic Effect ◽  
Head And Neck ◽  
Multimodal Treatment ◽  
Clinical Target Volume ◽  
Locally Advanced ◽  
Target Volume ◽  
Head And Neck Cancers ◽  
Dose Painting ◽  
Target Volumes

The combination of immune checkpoint inhibitors and definitive radiotherapy is investigated for the multimodal treatment of cisplatin non-eligible locally advanced head and neck cancers (HNC). In the case of recurrent and metastatic HNC, immunotherapy has shown benefit over the EXTREME protocol, being already considered the standard treatment. One of the biggest challenges of multimodal treatment is to establish the optimal therapy sequence so that the synergistic effect is maximal. Thus, superior results were obtained for the administration of anti-CTLA4 immunotherapy followed by hypofractionated radiotherapy, but the anti-PD-L1 therapy demonstrates the maximum potential of radio-sensitization of the tumor in case of concurrent administration. The synergistic effect of radiotherapy–immunotherapy (RT–IT) has been demonstrated in clinical practice, with an overall response rate of about 18% for HNC. Given the demonstrated potential of radiotherapy to activate the immune system through already known mechanisms, it is necessary to identify biomarkers that direct the “nonresponders” of immunotherapy towards a synergistic RT–IT stimulation strategy. Stimulation of the immune system by irradiation can convert “nonresponder” to “responder”. With the development of modern techniques, re-irradiation is becoming an increasingly common option for patients who have previously been treated with higher doses of radiation. In this context, radiotherapy in combination with immunotherapy, both in the advanced local stage and in recurrent/metastatic of HNC radiotherapy, could evolve from the “first level” of knowledge (i.e., ballistic precision, dose conformity and homogeneity) to “level two” of “biological dose painting” (in which the concept of tumor heterogeneity and radio-resistance supports the need for doses escalation based on biological criteria), and finally to the “third level“ ofthe new concept of “immunological dose painting”. The peculiarity of this concept is that the radiotherapy target volumes and tumoricidal dose can be completely reevaluated, taking into account the immune-modulatory effect of irradiation. In this case, the tumor target volume can include even the tumor microenvironment or a partial volume of the primary tumor or metastasis, not all the gross and microscopic disease. Tumoricidal biologically equivalent dose (BED) may be completely different from the currently estimated values, radiotherapy treating the tumor in this case indirectly by boosting the immune response. Thus, the clinical target volume (CTV) can be replaced with a new immunological-clinical target volume (ICTV) for patients who benefit from the RT–IT association (Image 1).

Evaluation of set-up errors and estimation of set-up margin during external beam radiation therapy of prostate cancer using electronic portal imaging device (EPID)

2021 ◽  
pp. 1-8
Author(s):  
Daryoush Khoramian ◽  
Soroush Sistani ◽  
Bagher Farhood
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Target Volume ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Cancer Radiotherapy ◽  
Imaging Device ◽  
Portal Images ◽  
Set Up ◽  
Prostate Cancer Radiotherapy

Abstract Aim: In radiation therapy, accurate dose distribution in target volume requires accurate treatment setup. The set-up errors are unwanted and inherent in the treatment process. By achieving these errors, a set-up margin (SM) of clinical target volume (CTV) to planning target volume (PTV) can be determined. In the current study, systematic and random set-up errors that occurred during prostate cancer radiotherapy were measured by an electronic portal imaging device (EPID). The obtained values were used to propose the optimum CTV-to-PTV margin in prostate cancer radiotherapy. Materials and methods: A total of 21 patients with prostate cancer treated with external beam radiation therapy (EBRT) participated in this study. A total of 280 portal images were acquired during 12 months. Gross, population systematic (Σ) and random (σ) errors were obtained based on the portal images in Anterior–Posterior (AP), Medio-Lateral (ML) and Superior–Inferior (SI) directions. The SM of CTV to PTV were then calculated and compared by using the formulas presented by the International Commission on Radiation Units and Measurements (ICRU) 62, Stroom and Heijmen and Van Herk et al. Results: The findings showed that the population systematic errors during prostate cancer radiotherapy in AP, ML and SI directions were 1·40, 1·95 and 1·94 mm, respectively. The population random errors in AP, ML and SI directions were 2·09, 1·85 and 2·29 mm, respectively. The SM of CTV to PTV calculated in accordance with the formula of ICRU 62 in AP, ML and SI directions were 2·51, 2·68 and 3·00 mm, respectively. And according to Stroom and Heijmen, formula were 4·23, 5·19 and 5·48 mm, respectively. And Van Herk et al. formula were 4·96, 6·17 and 6·45 mm, respectively. Findings: The SM of CTV to PTV in all directions, based on the formulas of ICRU 62, Stroom and Heijmen and van Herk et al., were equal to 2·73, 4·98 and 5·86 mm, respectively; these values were obtained by averaging the margins in all directions.

The Role of Radiation Therapy in the Management of Primary Non-Hodgkin Lymphomas of the Central Nervous System: Clinical Study of 10 Cases

1986 ◽  
Vol 72 (6) ◽  
pp. 565-573 ◽  
Author(s):  
Adriano Di Marco ◽  
Luisa Rosta ◽  
Franco Campostrini ◽  
Andrea Bonetti ◽  
Mario Palazzi ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Radiation Therapy ◽  
Whole Brain Irradiation ◽  
Brain Irradiation ◽  
Non Hodgkin Lymphoma ◽  
Uncommon Disease ◽  
The Central Nervous System ◽  
Disseminated Disease ◽  
Clinical Conditions

A series of 10 patients with a primary non-Hodgkin lymphoma of the central nervous system were observed and treated by the authors. All were diagnosed after a pathologic examination of the surgical material; the lesions were supratentorial in all cases and unifocal in 9. In every case radiation therapy improved clinical conditions and in most cases even radiologic features of the patients. Four patients were alive and without evidence of disease many months after therapy. Four patients died with a relapse in the central nervous system; 3 of them had disseminated disease at the time of death. Two patients died for an unknown cause. Radiation therapy was performed with 60Co source with 2 opposed portals and the whole brain irradiation technique in all cases but 2. Doses ranged from 35 to 54 Gy. The recent literature on this uncommon disease and the most adequate therapeutic possibilities of radiation therapy and chemotherapy, or both, are discussed.

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