Pub Date : 2023-12-30Epub Date: 2023-11-03DOI: 10.21037/tro-22-23
Dennis Mah, Laura Happersett, Gabriely Del Rosario, Seng Boh Lim, Linda Hong
Background: Advanced bilateral breast cancers with local and regional nodal involvement are rare and challenging to plan due to conflicting demands of conformality, uniformity and sparing of organs at risk such as heart and lungs. Pencil beam scanning (PBS) protons have been shown to provide improved organ at risk (OAR) sparing, conformality and homogeneity compared to photon techniques including three-dimensional conformal radiotherapy, intensity modulated radiation therapy (IMRT), volumetric arc therapy (VMAT), and tomotherapy. We performed a blinded comparison between VMAT and PBS plans and extend this comparison with a case study of a patient win expander in situ during radiotherapy.
Methods: In this case-controlled study, five bilateral breast patients' clinical proton plan datasets were anonymized and replanned using VMAT. Additionally, for one patient with bilateral expanders, we compared two PBS planning techniques that are used clinically.
Results: For the similar target volume coverage, significant differences were found for heart and lung sparing, particularly for lower isodoses. For instance, mean lung V5 was 96.7% vs. 39% for VMAT vs. PBS and mean heart dose was 11.4 vs. 0.69 Gy (RBE) for VMAT vs. protons. The expander patient's plan did not differ significantly from whole breast or chest wall patients in terms of coverage or in gains from PBS compared to VMAT. For example, for comparable homogeneity indexes (HIs) of 1.2 (VMAT) and 1.1 (PBS), the mean heart dose is 11 vs. 1 Gy. The gains from PBS are approximately a factor of 10 compared to a factor of <2 for estimated gains to VMAT plans using deep inspiration breath hold (DIBH) described in the literature.
Conclusions: PBS provides better sparing of heart and lungs compared to VMAT in whole breast, chest wall and expander patients. Further study with more patients is required to validate these conclusions.
背景：伴有局部和区域淋巴结累及的晚期双侧乳腺癌是罕见的，由于对合规性、统一性和保留危险器官（如心脏和肺）的要求相互矛盾，因此很难计划。与包括三维适形放疗、调强放疗（IMRT）、体积弧线治疗（VMAT）和断层治疗在内的光子技术相比，铅笔束扫描（PBS）质子已被证明可以改善危及器官（OAR）的保护、适形性和均匀性。我们在VMAT和PBS计划之间进行了盲法比较，并将这种比较扩展到放疗期间患者原位扩张器的病例研究。方法：在本病例对照研究中，对5例双侧乳房患者的临床质子计划数据集进行匿名化并使用VMAT进行重新规划。此外，对于一名双侧扩张器患者，我们比较了两种临床使用的PBS计划技术。结果：对于相似的靶体积覆盖，发现了显著差异的心脏和肺的保留，特别是低等剂量。例如，VMAT和PBS的平均肺V5分别为96.7%和39%，VMAT和质子的平均心脏剂量分别为11.4 Gy和0.69 Gy （RBE）。扩张器患者的计划与全乳或胸壁患者在覆盖范围或PBS与VMAT相比的收益方面没有显着差异。例如，对于可比较的均匀性指数（HIs）为1.2 （VMAT）和1.1 (PBS)，平均心脏剂量为11 Gy vs. 1 Gy。结论：在全乳、胸壁和扩张器患者中，与VMAT相比，PBS提供了更好的心脏和肺部保护。需要更多患者的进一步研究来验证这些结论。
{"title":"A retrospective bilateral breast proton pencil beam scanning and photon volumetric arc therapy planning comparison.","authors":"Dennis Mah, Laura Happersett, Gabriely Del Rosario, Seng Boh Lim, Linda Hong","doi":"10.21037/tro-22-23","DOIUrl":"10.21037/tro-22-23","url":null,"abstract":"<p><strong>Background: </strong>Advanced bilateral breast cancers with local and regional nodal involvement are rare and challenging to plan due to conflicting demands of conformality, uniformity and sparing of organs at risk such as heart and lungs. Pencil beam scanning (PBS) protons have been shown to provide improved organ at risk (OAR) sparing, conformality and homogeneity compared to photon techniques including three-dimensional conformal radiotherapy, intensity modulated radiation therapy (IMRT), volumetric arc therapy (VMAT), and tomotherapy. We performed a blinded comparison between VMAT and PBS plans and extend this comparison with a case study of a patient win expander <i>in situ</i> during radiotherapy.</p><p><strong>Methods: </strong>In this case-controlled study, five bilateral breast patients' clinical proton plan datasets were anonymized and replanned using VMAT. Additionally, for one patient with bilateral expanders, we compared two PBS planning techniques that are used clinically.</p><p><strong>Results: </strong>For the similar target volume coverage, significant differences were found for heart and lung sparing, particularly for lower isodoses. For instance, mean lung V5 was 96.7% <i>vs.</i> 39% for VMAT <i>vs.</i> PBS and mean heart dose was 11.4 <i>vs.</i> 0.69 Gy (RBE) for VMAT <i>vs.</i> protons. The expander patient's plan did not differ significantly from whole breast or chest wall patients in terms of coverage or in gains from PBS compared to VMAT. For example, for comparable homogeneity indexes (HIs) of 1.2 (VMAT) and 1.1 (PBS), the mean heart dose is 11 <i>vs.</i> 1 Gy. The gains from PBS are approximately a factor of 10 compared to a factor of <2 for estimated gains to VMAT plans using deep inspiration breath hold (DIBH) described in the literature.</p><p><strong>Conclusions: </strong>PBS provides better sparing of heart and lungs compared to VMAT in whole breast, chest wall and expander patients. Further study with more patients is required to validate these conclusions.</p>","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":"7 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11623292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Long term-control via successful salvage therapy with cytoreductive surgery, chemotherapy, and radiotherapy for recurrence with intraperitoneal carcinomatosis of synchronous advanced ovarian and endometrial cancer: a case report","authors":"Shih-Min Lin, Yun-Hsin Tang","doi":"10.21037/tro-22-35","DOIUrl":"https://doi.org/10.21037/tro-22-35","url":null,"abstract":"","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48910312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. N. Ewongwo, T. Skrepnik, Brady B. Laughlin, Hitendra R. H. Patel, K. Howell, U. Goyal
{"title":"Prophylactic single fraction radiotherapy for the prevention of pathologic femoral fractures","authors":"A. N. Ewongwo, T. Skrepnik, Brady B. Laughlin, Hitendra R. H. Patel, K. Howell, U. Goyal","doi":"10.21037/tro-22-40","DOIUrl":"https://doi.org/10.21037/tro-22-40","url":null,"abstract":"","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42495395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Analyses of treatment outcomes in advanced vulvar cancer: treated with postoperative radiotherapy or definitive radiotherapy/ chemoradiotherapy","authors":"Hao-shen Cheng, L. Wang, Chien-Hsing Lu","doi":"10.21037/tro-22-28","DOIUrl":"https://doi.org/10.21037/tro-22-28","url":null,"abstract":"","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":"61 9-10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41294343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Editorial: Prophylactic single fraction radiotherapy for the prevention of pathologic femoral fractures","authors":"C. McLaughlin","doi":"10.21037/tro-23-7","DOIUrl":"https://doi.org/10.21037/tro-23-7","url":null,"abstract":"","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46565555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Luca Capone, Sara Antonia Allegretta, F. Bianciardi, B. Tolu, F. Rea, M. Giraffa, V. Confaloni, G. Raza, C. D’ambrosio, F. Cavallo, D. Marchesano, G. Grimaldi, Randa El Gahwary, Elisa Cinelli, G. Minniti, P. Gentile
{"title":"The impact of a mono-institutional experience in lung metastases treated with stereotactic body radiation therapy (SBRT): a retrospective analysis","authors":"Luca Capone, Sara Antonia Allegretta, F. Bianciardi, B. Tolu, F. Rea, M. Giraffa, V. Confaloni, G. Raza, C. D’ambrosio, F. Cavallo, D. Marchesano, G. Grimaldi, Randa El Gahwary, Elisa Cinelli, G. Minniti, P. Gentile","doi":"10.21037/tro-21-45","DOIUrl":"https://doi.org/10.21037/tro-21-45","url":null,"abstract":"","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45773818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Jaafari, R. Razine, A. E. Haroun, Z. Tahiri, L. Hessissen
{"title":"Childhood medulloblastoma in Morocco (middle-income country): therapeutic outcomes and survival","authors":"M. Jaafari, R. Razine, A. E. Haroun, Z. Tahiri, L. Hessissen","doi":"10.21037/tro-22-39","DOIUrl":"https://doi.org/10.21037/tro-22-39","url":null,"abstract":"","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49065243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yun-Hsuan Lin, Shih-Yu Huang, S. Chou, Tzu-Ting Huang, Yu-Ming Wang
{"title":"Dose escalation not improving outcome in esophageal cancer—still far from conclusive","authors":"Yun-Hsuan Lin, Shih-Yu Huang, S. Chou, Tzu-Ting Huang, Yu-Ming Wang","doi":"10.21037/tro-21-23","DOIUrl":"https://doi.org/10.21037/tro-21-23","url":null,"abstract":"","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48318225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dai-Wei Liu, Yen-Rong Fu, Shu-Hsin Liu, M. Chen, Ren-Jun Hsu, W. Hsu
{"title":"The risk of cardiovascular toxicity caused by cancer radiotherapy—a narrative review","authors":"Dai-Wei Liu, Yen-Rong Fu, Shu-Hsin Liu, M. Chen, Ren-Jun Hsu, W. Hsu","doi":"10.21037/tro-21-34","DOIUrl":"https://doi.org/10.21037/tro-21-34","url":null,"abstract":"","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47366402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hsuan-Ting Wang, Lung‐Sheng Wu, Y. Chou, Yung-Shin Yeh, Kun-Chi Yen, J. Chang, Hsiao-Chieh Huang
Background: Photon radiotherapy has been demonstrated as an emergent role for ablation of ventricular tachycardia (VT). Compare to photon radiotherapy, proton with rapidly distal fall off is an advantage in radiotherapy. Therefore, the feasibility assessment of a single fraction proton irradiation for VT instead of the photon therapy is investigated in this study. Methods: Two patients treated with and an implantable cardioverter-defibrillator (ICD) implantation and repeated catheter ablations were retrospective selected for study. Targeted lesions in image set, including left ventricular summit and right ventricular outflow tract septum and nearby organs at risk, were contoured by cardiologist and radiation oncologist. The target dose coverage and dose in organs at risk by using the photon volumetric arc therapy, proton wobbling and proton pencil beam scanning treatment technique were evaluated respectively. Results: In comparison of dose volume parameters and isodose distributions including R30, R50 (ratio of the 50% and 30% of prescription isodose volume to the volume of planning target volume (PTV) among three different techniques. The conformal index and homogeneity index in all type of treatment plans are demonstrated to deliver a conformal, homogeneous dose to the target area. And, showing no difference in the proton wobbling and proton pencil beam technique in nearly all result. Conclusions: This treatment planning study indicated that using the proton beam to treat VT is a feasible therapeutic option. Compared to photon therapy treatment planning, proton can offer lower radiation dose to heart and lung with the same conformal index. Nevertheless, several issues require consideration in future studies, including accurate patient localization, motion margin evaluation of respiration and heartbeat, dose measurement, and verification of small field irradiation.
{"title":"Feasibility assessment of proton treatment for ventricular tachycardia—treatment planning study","authors":"Hsuan-Ting Wang, Lung‐Sheng Wu, Y. Chou, Yung-Shin Yeh, Kun-Chi Yen, J. Chang, Hsiao-Chieh Huang","doi":"10.21037/tro-21-43","DOIUrl":"https://doi.org/10.21037/tro-21-43","url":null,"abstract":"Background: Photon radiotherapy has been demonstrated as an emergent role for ablation of ventricular tachycardia (VT). Compare to photon radiotherapy, proton with rapidly distal fall off is an advantage in radiotherapy. Therefore, the feasibility assessment of a single fraction proton irradiation for VT instead of the photon therapy is investigated in this study. Methods: Two patients treated with and an implantable cardioverter-defibrillator (ICD) implantation and repeated catheter ablations were retrospective selected for study. Targeted lesions in image set, including left ventricular summit and right ventricular outflow tract septum and nearby organs at risk, were contoured by cardiologist and radiation oncologist. The target dose coverage and dose in organs at risk by using the photon volumetric arc therapy, proton wobbling and proton pencil beam scanning treatment technique were evaluated respectively. Results: In comparison of dose volume parameters and isodose distributions including R30, R50 (ratio of the 50% and 30% of prescription isodose volume to the volume of planning target volume (PTV) among three different techniques. The conformal index and homogeneity index in all type of treatment plans are demonstrated to deliver a conformal, homogeneous dose to the target area. And, showing no difference in the proton wobbling and proton pencil beam technique in nearly all result. Conclusions: This treatment planning study indicated that using the proton beam to treat VT is a feasible therapeutic option. Compared to photon therapy treatment planning, proton can offer lower radiation dose to heart and lung with the same conformal index. Nevertheless, several issues require consideration in future studies, including accurate patient localization, motion margin evaluation of respiration and heartbeat, dose measurement, and verification of small field irradiation.","PeriodicalId":93236,"journal":{"name":"Therapeutic radiology and oncology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42901482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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