scholarly journals Advanced Radiotherapy Techniques for Mediastinal Lymphomas: Results from an Italian Survey

Hemato ◽  
2021 ◽  
Vol 2 (3) ◽  
pp. 496-504
Author(s):  
Anna Di Russo ◽  
Gabriele Simontacchi ◽  
Andrea Emanuele Guerini ◽  
Andrea Riccardo Filippi ◽  
Mario Levis ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Organs At Risk ◽  
Intensity Modulated Radiotherapy ◽  
University Hospitals ◽  
Image Guided Radiotherapy ◽  
Breathing Control ◽  
Mediastinal Lymphoma ◽  
Radiotherapy Techniques ◽  
Almost All ◽  
The Impact

Background: Multiple methods have been implemented to limit the impact of radiotherapy on patients affected by mediastinal lymphoma, including breathing control techniques, image-guided radiotherapy (IGRT) and intensity-modulated radiotherapy (IMRT), although the actual diffusion of such techniques is unclear. No surveys have been published to date evaluating the techniques adopted at different centers. Methods: A survey with a dedicated questionnaire was submitted to 195 Italian radiotherapy centers, assessing items regarding the characteristics of the center and clinical practice in the treatment of mediastinal lymphomas. Results: A total of 43 centers (22%) responded, the majority of which were university hospitals (37.2%) or cancer care centers (27.9%). In 95.4% of the centers, IMRT was used in the clinical practice, and the most frequently employed techniques were VMAT (48.8% of centers) and non-rotational IMRT (31.7%). Comparison of multiple plans was performed by 66.7% of the responding centers. Dose constraints for organs at risk were consistently prescribed. IGRT techniques were adopted by 93% of the centers, while breathing control or gating techniques were routinely used by only 25.6% of the centers. A necessity to standardize OAR constraints and define guidelines was perceived by almost all participants. Conclusions: Modern radiotherapy techniques are widely used in the Italian centers, although with heterogeneous characteristics.

scholarly journals Impact of advanced radiotherapy techniques and dose intensification on toxicity of salvage radiotherapy after radical prostatectomy

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Natsuo Tomita ◽  
Kaoru Uchiyama ◽  
Tomoki Mizuno ◽  
Mikiko Imai ◽  
Chikao Sugie ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Intensity Modulated Radiotherapy ◽  
Salvage Radiotherapy ◽  
Dose Intensification ◽  
Image Guided Radiotherapy ◽  
Gu Toxicity ◽  
Gi Toxicity ◽  
Radiotherapy Techniques ◽  
The Impact

AbstractThe safety and efficacy of dose-escalated radiotherapy with intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) remain unclear in salvage radiotherapy (SRT) after radical prostatectomy. We examined the impact of these advanced radiotherapy techniques and dose intensification on the toxicity of SRT. This multi-institutional retrospective study included 421 patients who underwent SRT at the median dose of 66 Gy in 2-Gy fractions. IMRT and IGRT were used for 225 (53%) and 321 (76%) patients, respectively. At the median follow-up of 50 months, the cumulative incidence of late grade 2 or higher gastrointestinal (GI) and genitourinary (GU) toxicities was 4.8% and 24%, respectively. Multivariate analysis revealed that the non-use of either IMRT or IGRT, or both (hazard ratio [HR] 3.1, 95% confidence interval [CI] 1.8–5.4, p < 0.001) and use of whole-pelvic radiotherapy (HR 7.6, CI 1.0–56, p = 0.048) were associated with late GI toxicity, whereas a higher dose ≥68 Gy was the only factor associated with GU toxicities (HR 3.1, CI 1.3–7.4, p = 0.012). This study suggested that the incidence of GI toxicities can be reduced by IMRT and IGRT in SRT, whereas dose intensification may increase GU toxicity even with these advanced techniques.

scholarly journals Deep inspiration breath hold versus free breathing technique in mediastinal radiotherapy for lymphoma

BJR|Open ◽  
2021 ◽  
Vol 3 (1) ◽  
pp. 20200067
Author(s):  
Orla Anne Houlihan ◽  
Guhan Rangaswamy ◽  
Mary Dunne ◽  
Christine Rohan ◽  
Louise O'Neill ◽  
...  
Keyword(s):  
Spinal Cord ◽  
At Risk ◽  
Clinical Practice ◽  
Organs At Risk ◽  
Free Breathing ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Deep Inspiration Breath Hold ◽  
The Impact

Objective: Radiotherapy plays an important role in the management of lymphoma and many patients with lymphoma are cured with treatment. Risk of secondary malignancy and long-term cardiac and pulmonary toxicity from mediastinal radiotherapy exists. Delivery of radiotherapy using a deep inspiration breath-hold (DIBH) technique increases lung volume and has the potential to reduce dose to heart and lungs. We undertook a prospective study to assess the dosimetric differences in DIBH and free breathing (FB) plans in patients requiring mediastinal radiotherapy in clinical practice. Methods: We performed both FB and DIBH planning scans on 35 consecutive patients with mediastinal lymphoma needing radiotherapy. Contours and plans were generated for both data sets and dosimetric data were compared. All patients were planned using volumetric modulated arc therapy (VMAT). Data were compared for FB and DIBH plans with each patient acting as their own control using the related-samples Wilcoxon signed rank test. Results: DIBH significantly reduced lung doses (mean 10.6 vs 11.4Gy, p < 0.0005; V20 16.8 vs 18.3%, p = 0.001) and spinal cord maximum dose (20.6 vs 22.8Gy, p = 0.001). DIBH increased breast V4 (38.5% vs 31.8%, p = 0.006) and mean right breast dose (4.2 vs 3.6Gy, p = 0.010). There was no significant difference in heart doses when the entire study cohort was considered, however, mean heart dose tended to be lower with DIBH for upper mediastinal (UM) tumours (4.3 vs 4.9Gy, p = 0.05). Conclusion: Our study describes the potential benefit of DIBH in a population reflective of clinical practice. DIBH can decrease radiation dose to lungs, heart and spinal cord, however, may increase dose to breasts. DIBH is not always superior to FB, and the clinical significance of differences in dose to organs at risk in addition to the time required to treat patients with DIBH must be considered when deciding the most appropriate radiotherapy technique for each patient. Advances in knowledge: To our knowledge, this is the largest study comparing DIBH and FB planning for patients with lymphoma receiving mediastinal radiotherapy in clinical practice. It demonstrates the impact of an increasingly common radiotherapy technique on dose to organs at risk and the subsequent potential for long-term radiotherapy side-effects.

The impact of image-guided radiotherapy (IGRT) for prostate cancer (PC) on radiotherapy (RT)-related acute toxicities and prostate-specific antigen (PSA) kinetics.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15110-e15110 ◽  
Author(s):  
Darren M. C. Poon ◽  
CM Leung ◽  
CM Chu ◽  
WY Lee ◽  
Louis Lee ◽  
...  
Keyword(s):  
Image Guidance ◽  
Prostate Gland ◽  
Specific Antigen ◽  
Three Dimensional ◽  
Intensity Modulated Radiotherapy ◽  
Image Guided Radiotherapy ◽  
Psa Kinetics ◽  
Significant Difference ◽  
Pre Treatment ◽  
The Impact

e15110 Background: IGRT for PC could potentially improve the therapeutic ratio by enhancing accuracy of delivery of radiation to the prostate gland. Our aim is to compare the treatment outcomes in terms of RT-related acute toxicities and PSA kinetics of PC patients (pts) undergoing radical intensity-modulated radiotherapy (IMRT) with or without image-guidance. Methods: A cohort of 21 consecutive pts treated by IGRT (I) from January 2010, when the IGRT system was introduced in our institution, was compared with an immediately precedent cohort of 21 pts receiving IMRT without image-guidance (Non-I). The prescription dose (76Gy in 38 fractions) and the treatment margins were the same between the 2 groups (gps). In the I gp, daily online verification and correction of treatment position was performed with reference to image registration of the daily pre-treatment on-board imaging with the corresponding digitally reconstructed radiographs, based on three-dimensional matching of three intra-prostatic fiducial markers. Androgen deprivation therapy was not used in both gps. Acute toxicities were scored weekly during the course of RT according to the Common Terminology Criteria for Adverse Events Version 4.02. The pre- and the post-RT PSA within 6 months after completion of RT were obtained. The PSA halving time (PSAHT) was calculated by first order kinetics. Results: There was no statistically significant difference regarding the baseline clinical characteristics (age, PSA at diagnosis, Gleason score, T staging) between the gps. No grade 3 or 4 acute genitourinary (GU) or gastrointestinal (GI) toxicities was encountered in either gps. Acute grade 1 or 2 GI toxicities were significantly less frequent in the I gp (23.8% vs 81.0%, p=0.001), and their median duration of such toxicity were also significantly shorter (0.33 week vs 1.38 week, p=0.004).The frequencies of acute grade 1 or 2 GU toxicities were comparable between both gps (66.6% vs 81.0%, p=0.45).The I gp had a shorter median PSAHT than the non-I gp (3.36 week vs 5.49 week, p=0.09). Conclusions: IGRT is effective in reducing acute GI toxicities in treatment of PC, and may have more favorable PSA kinetics.

scholarly journals Current Approaches in Prostate Cancer Radiotherapy

2021 ◽  
Author(s):  
Didem Karaçetin
Keyword(s):  
Prostate Cancer ◽  
Side Effects ◽  
Organs At Risk ◽  
Treatment Options ◽  
Target Volume ◽  
Image Guided Radiotherapy ◽  
Curative Radiotherapy ◽  
Localized Disease ◽  
Radiotherapy Techniques ◽  
Modern Radiotherapy

Prostate cancer is one of the most common tumor in males. Radical prostatectomy, radiotherapy and watchful waiting are the main treatment options in localized disease. Radiotherapy together with hormonotherapy is accepted as the standard of care in patients with advanced stages. Surgery or radiotherapy has comparable local control and survival outcomes in localized disease. During recent years a significant reduction in the rate of serious side effects has been achieved due to the development of modern radiotherapy techniques. With the use of these techniques such as Intensity-modulated radiotherapy (IMRT), Image-guided radiotherapy (IGRT), Stereotactic body radiotherapy (SBRT), high doses can be given safely and the rates of serious short - or long-term side effects have not exceeded 1 percent. Modern radiotherapy techniques allow dose escalation for the target volume, and due to its achievement of sharp dose gradient around the target volume and enable to increase radiation doses homogeneously within the target volume without exceeding the tolerance doses in organs at risk. In the last few years hypofractionation has gained popularity in the curative radiotherapy of prostate cancer

Dosimetric comparison of different radiotherapy techniques for the treatment of Retinoblastoma

2020 ◽  
pp. 1-6
Author(s):  
Jyotiman Nath ◽  
Pranjal Goswami ◽  
Partha Pratim Medhi ◽  
Gautam Sarma ◽  
Apurba Kumar Kalita ◽  
...  
Keyword(s):  
Organs At Risk ◽  
External Beam Radiotherapy ◽  
Volumetric Modulated Arc Therapy ◽  
Three Dimensional ◽  
Intensity Modulated Radiotherapy ◽  
Conformal Radiotherapy ◽  
Optic Chiasm ◽  
Target Volume ◽  
Target Coverage ◽  
Radiotherapy Techniques

Abstract Aim: This study aims to compare the dosimetric parameters among four different external beam radiotherapy techniques used for the treatment of retinoblastoma. Materials and methods: Computed tomography (CT) sets of five retinoblastoma patients who required radiotherapy to one globe were included. Four different plans were generated for each patient using three dimensional conformal radiotherapy (3DCRT), intensity modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT) and VMAT using flattening filter free (VMAT-FFF) beam techniques. Plans were compared for target coverage and organs at risk (OARs) sparing. Results: The target coverage of planning target volume (PTV) for all the four modalities were clinically acceptable with a V95 of 95 ± 0%, 97·6 ± 1·87%, 99·3 ± 0·5% and 99·17 ± 0·45% for 3DCRT, IMRT, VMAT and VMAT-FFF respectively. The VMAT and IMRT plans had better target coverage than the 3DCRT plans (p = 0·001 and p = 0·07 respectively). IMRT and VMAT plans were also found superior to 3DCRT plans in terms of OAR sparing like brainstem, optic chiasm, brain (p < 0·05). VMAT delivered significantly lower dose to the brainstem and contralateral optic nerve in comparison to IMRT. Use of VMAT-FFF beams did not show any benefit over VMAT in target coverage and OAR sparing. Conclusion: VMAT should be preferred over 3DCRT and IMRT for treatment of retinoblastoma owing to better target coverage and less dose to most of the OARs. However, IMRT and VMAT should be used with caution because of the increased low dose volumes to the OARs like contralateral lens and eyeball.

scholarly journals Impact of intra-fractional motion on dose distributions in lung IMRT

2020 ◽  
pp. 1-5
Author(s):  
Mikhail A. Chetvertkov ◽  
Oleg N. Vassiliev ◽  
Jinzhong Yang ◽  
He C. Wang ◽  
Amy Y. Liu ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Organs At Risk ◽  
Intensity Modulated Radiotherapy ◽  
Median Number ◽  
Clinical Treatment ◽  
Dose Distributions ◽  
Median Reduction ◽  
Treatment Plans ◽  
The Mean ◽  
The Impact

Abstract Aim: To investigate the impact of intra-fractional motion on dose distribution in patients treated with intensity-modulated radiotherapy (IMRT) for lung cancer. Materials and methods: Twenty patients who had undergone IMRT for non-small cell lung cancer were selected for this retrospective study. For each patient, a four-dimensional computed tomography (CT) image set was acquired and clinical treatment plans were developed using the average CT. Dose distributions were then recalculated for each of the 10 phases of respiratory cycle and combined using deformable image registration to produce cumulative dose distributions that were compared with the clinical treatment plans. Results: Intra-fractional motion reduced planning target volume (PTV) coverage in all patients. The median reduction of PTV covered by the prescription isodose was 3·4%; D98 was reduced by 3·1 Gy. Changes in the mean lung dose were within ±0·7 Gy. V20 for the lung increased in most patients; the median increase was 1·6%. The dose to the spinal cord was unaffected by intra-fractional motion. The dose to the heart was slightly reduced in most patients. The median reduction in the mean heart dose was 0·22 Gy, and V30 was reduced by 2·5%. The maximum dose to the oesophagus was also reduced in most patients, by 0·74 Gy, whereas V50 did not change significantly. The median number of points in which dose differences exceeded 3%/3 mm was 6·2%. Findings: Intra-fractional anatomical changes reduce PTV coverage compared to the coverage predicted by clinical treatment planning systems that use the average CT for dose calculation. Doses to organs at risk were mostly over-predicted.

The impact of introducing intensity modulated radiotherapy into routine clinical practice

2005 ◽  
Vol 77 (3) ◽  
pp. 241-246 ◽  
Author(s):  
Elizabeth A. Miles ◽  
Catharine H. Clark ◽  
M. Teresa Guerrero Urbano ◽  
Margaret Bidmead ◽  
David P. Dearnaley ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Intensity Modulated Radiotherapy ◽  
Routine Clinical Practice ◽  
Intensity Modulated ◽  
The Impact

Abstract WP314: Driving Stroke Care Within a Health System: The Impact of the University Hospitals System Stroke Program Clinical Practice Guideline for the Emergency Management of Acute Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Pavan Murty ◽  
Julie Fussner ◽  
Colin Beilman ◽  
Cathy Sila
Keyword(s):  
Clinical Practice ◽  
Health System ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Medical Management ◽  
Stroke Care ◽  
University Hospitals ◽  
The University ◽  
The Impact ◽  
Iv Tpa

Introduction: With 18 University Hospitals at 12 locations, UH Case Medical Center is second in the University HealthSystem Consortium ranking for patient transfers at 24% of total volume. In 2009, the University Hospitals System Stroke Program developed a Clinical Practice Guideline (UHSSP-CPG) with the goal of providing the same, high quality stroke care throughout the health system that included a triage and transfer algorithm. Methods: From 2011-2q2016 (annualized), 5666 hospital discharges from MS-DRGs 61-66 representing medical management of cerebral infarction (CI) and intracerebral hemorrhage (ICH) were analyzed from 6 UH Legacy hospitals- UH-Case CSC, 4 PSCs and 2 Stroke Ready Facilities (SRF). Advanced expertise (AE) was developed at 2 PSCs for medical management of CI (2014) and low risk ICH (2015, 2016). Results: From 2011 to 2016, total stroke discharges increased across the UHSSP by 22%; total CI by 14%; and total ICH by 68%. Total IV-tPA cases increased by 174%, representing an increase in IV-tPA utilization from 6% to 15% of total CI. At UH-Case CSC, total stroke discharges increased by 15%, especially for ICH which increased by 63%. At the PSC-AE hospitals, total stroke discharges increased by 133%; IV-tPA Drip and Keep by 1300%; and total ICH by 700%. Total stroke discharges decreased by 28% at the other PSC hospitals. Conclusions: Implementation of the UHSSP-CPG triage and transfer algorithm resulted in an increase in total stroke volume across the health system but shifted more patients with lower risk ischemic and hemorrhagic stroke to PSC within their community. This strategy promotes enhanced access of more complex stroke patients to UH-Case CSC. As hospitals continue to coalesce into systems, robust triage and transfer algorithms will play an increasingly important role in systems stroke care.

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