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Erratum to "Voice quality after surgery or radiotherapy for glottic T1 squamous cell carcinoma: Results of the VOQUAL study" [Cancer Radiother. 28 (2024) 373-379]. 声门 T1 鳞状细胞癌手术或放疗后的嗓音质量:28 (2024) 373-379] 的勘误。
Pub Date : 2024-10-29 DOI: 10.1016/j.canrad.2024.09.001
L Jan, J Labreuche, X Liem, B Rysman, M Morisse, G Mortuaire, F Mouawad
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引用次数: 0
[Short- and medium-term tolerance of hypofractionated prostate radiotherapy with simultaneous integrated boost]. [前列腺低分次同步综合增强放疗的短期和中期耐受性]。
Pub Date : 2024-08-23 DOI: 10.1016/j.canrad.2024.04.004
Laurène Larrivière, Stephane Supiot, Astrid Thomin, Simon Jan, Sofia Bakkar, Gilles Calais

Purpose: This retrospective study was conducted to ensure that irradiation of the pelvic lymph node areas associated with simultaneous hypofractionated boost to the prostate according to the protocol implemented at the university hospital of Tours (France) does not result in excess urinary and digestive toxicity in the short and medium term.

Materials and methods: The study population included patients with localized unfavourable intermediate or high-risk prostate cancer. The dose delivered was 65Gy in 25 fractions of 2.6Gy to the prostate and seminal vesicles, and 50Gy in 25 fractions of 2Gy to the pelvic lymph nodes. Acute toxicity events (between the start of radiotherapy and the first follow-up consultation) and medium-term toxicity events (after the first follow-up consultation) were assessed using the CTCAE version 5.0 classification.

Results: Sixty-three patients were treated according to the protocol between January 1st, 2020, and October 31st, 2022. The majority of them had high-risk prostate cancer (79%). The median follow-up was 15 months. Very few patients reported grade 3-4 toxicity acutely (6% urinary and 0% digestive toxicity) or in the medium term (7% urinary and 0% and digestive toxicity).

Conclusion: Radiotherapy of pelvic lymph node areas with simultaneous hypofractionated boost to the prostate is feasible, with low rates of severe acute and medium-term toxicity.

目的:本项回顾性研究旨在确保根据图尔大学医院(法国)实施的方案对盆腔淋巴结区域进行照射并同时对前列腺进行低分量照射不会在中短期内导致过多的泌尿和消化系统毒性:研究对象包括局部不理想的中度或高度危险前列腺癌患者。前列腺和精囊的放射剂量为 65Gy,25 次分次放射,每次 2.6Gy;盆腔淋巴结的放射剂量为 50Gy,25 次分次放射,每次 2Gy。急性毒性事件(放疗开始至首次复诊期间)和中期毒性事件(首次复诊后)采用 CTCAE 5.0 版分类进行评估:在2020年1月1日至2022年10月31日期间,63名患者按照方案接受了治疗。其中大多数患者患有高风险前列腺癌(79%)。中位随访时间为 15 个月。极少数患者报告了3-4级急性毒性(6%为泌尿系统毒性,0%为消化系统毒性)或中期毒性(7%为泌尿系统毒性,0%为消化系统毒性):结论:对盆腔淋巴结区进行放疗,同时对前列腺进行低分次照射是可行的,急性和中期严重毒性发生率较低。
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引用次数: 0
Outcomes of adjuvant lymph node field radiotherapy and immunotherapy for stage III melanoma. III期黑色素瘤淋巴结野外放疗和免疫疗法的辅助治疗效果。
Pub Date : 2024-08-21 DOI: 10.1016/j.canrad.2024.03.006
L Marxgut, A Desagneaux, A Bellier, S Mouret, J Charles, M Laramas, C Verry

Purpose: With the promising results of immunotherapy in patients with stage III melanoma, the role of adjuvant radiotherapy after resection and complete lymph-node dissection must be reassessed. We evaluate the outcomes and safety of adjuvant radiotherapy and immunotherapy compared to immunotherapy only in patients with resected stage III melanoma.

Patients and methods: This retrospective and single institution study included patients treated for a stage III melanoma with complete lymph-node dissection and adjuvant immunotherapy from January 2019 to December 2022. The radiotherapy associated with immunotherapy group was defined by completion of immunotherapy and adjuvant radiotherapy in the lymph-node dissection area. The primary endpoint was disease-free survival. The secondary endpoints were locoregional progression, incidence of adverse events grade 3 or above and disease-free survival rate in patients with high risk of locoregional recurrence.

Results: Thirty-three patients were included. Among them, twelve received adjuvant lymph-node field radiotherapy. The median duration of follow-up was 17months (range: 8-45months). Patients receiving radiotherapy and immunotherapy had a significantly higher disease stage and more frequent extracapsular extension. At 12months, the disease-free survival rate was 66.7% for the patients receiving immunotherapy alone (95% CI: 42.5-82.5%) and 83.3% for those receiving radiotherapy and immunotherapy (95% CI: 48.2-95.6%; P=0.131). The locoregional progression rate was 24% in patients receiving immunotherapy and 8% in patients receiving immunotherapy and radiotherapy (P=0.379). After adjuvant treatment, 6% of patients developed grade 3 or above immunotherapy-related events and none developed grade 3 or above radiation-related adverse events.

Conclusion: In patients with stage III melanoma, adjuvant lymph-node field radiotherapy combined with immunotherapy seems to be associated with longer disease-free survival, with acceptable tolerance. However, these results need to be confirmed by long-term and prospective studies.

目的:随着免疫疗法在III期黑色素瘤患者中取得良好疗效,必须重新评估切除术和完全淋巴结清扫术后辅助放疗的作用。我们对已切除的III期黑色素瘤患者接受辅助放疗和免疫治疗与仅接受免疫治疗的结果和安全性进行了评估:这项回顾性单机构研究纳入了2019年1月至2022年12月期间接受完全淋巴结清扫和辅助免疫治疗的III期黑色素瘤患者。在淋巴结清扫区域完成免疫治疗和辅助放疗的患者被定义为放疗联合免疫治疗组。主要终点是无病生存期。次要终点为局部进展、3级或以上不良反应发生率以及局部复发风险高的患者的无病生存率:共纳入 33 名患者。结果:共纳入 33 例患者,其中 12 例接受了淋巴结野辅助放疗。中位随访时间为 17 个月(8-45 个月)。接受放疗和免疫疗法的患者的疾病分期明显较高,囊外扩展也更为常见。12个月时,单独接受免疫疗法的患者无病生存率为66.7%(95% CI:42.5-82.5%),接受放疗和免疫疗法的患者无病生存率为83.3%(95% CI:48.2-95.6%;P=0.131)。接受免疫疗法的患者局部进展率为24%,接受免疫疗法和放疗的患者局部进展率为8%(P=0.379)。辅助治疗后,6%的患者出现了3级或以上免疫治疗相关事件,没有患者出现3级或以上放疗相关不良事件:结论:在III期黑色素瘤患者中,淋巴结野辅助放疗联合免疫治疗似乎能延长无病生存期,且耐受性可接受。然而,这些结果还需要长期和前瞻性研究来证实。
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引用次数: 0
Acute toxicity in patients with high-risk prostate cancer treated with stereotactic body radiation, with irradiation to the prostate and pelvic nodes. 前列腺和盆腔结节接受立体定向体放射治疗的高危前列腺癌患者的急性毒性。
Pub Date : 2024-03-27 DOI: 10.1016/j.canrad.2023.07.014
S Faria, M Duclos, F Cury, H Patrocinio, L Souhami

Purpose: Stereotactic body radiation therapy has been used for prostate cancer. However, the bulk of published studies on stereotactic body radiation therapy for prostate cancer has involved the irradiation of the prostate alone, without irradiation of the pelvic lymph nodes. We report our preliminary experience with this approach.

Material and methods: The files of patients with biopsy-proven prostate cancer treated with stereotactic body radiation therapy in our institution were reviewed. Stereotactic body radiation was delivered with intensity modulated-volumetric arctherapy with daily image-guidance. The prostate planning target volume included the prostate plus a margin of 5mm in all directions. The pelvic planning target volume included pelvic nodes plus an expansion of 6 to 7mm in all directions. The prostate planning target volume received a total dose of 36.25Gy delivered in five fractions on alternate days. The nodal planning target volume received a dose of 25Gy in the same five fractions. Patients were followed during treatment, after 1, and 3 months and every 6 months thereafter. Gastrointestinal and genitourinary toxicity was prospectively graded according to Common Terminology Criteria for Adverse Events.

Results: Among the 188 patients, 80 received stereotactic body radiation to the prostate and the pelvic nodes, while 108 received stereotactic body radiation to the prostate target only. Grade 2 acute gastrointestinal toxicity was 4% in both groups, and grade 2 acute genitourinary toxicity was 27% and 20% (P=0.9) for prostate only versus prostate and pelvis respectively. There was no grade 3 or higher acute gastrointestinal or genitourinary toxicity.

Conclusion: Stereotactic body radiation therapy in five fractions including the prostate and pelvic nodes, in patients with high-risk prostate cancer, has been feasible and safe in terms of acute toxicity.

目的:立体定向体放射治疗已被用于治疗前列腺癌。然而,已发表的关于前列腺癌立体定向体放射治疗的研究大多只照射前列腺,而不照射盆腔淋巴结。我们报告了采用这种方法的初步经验:我们回顾了在本院接受立体定向体放射治疗的经活检证实的前列腺癌患者的档案。立体定向体放射治疗采用强度调制-容积动脉放射治疗,每天进行图像引导。前列腺计划靶区包括前列腺和各方向5毫米的边缘。盆腔规划靶区包括盆腔结节,再向各个方向扩展 6 至 7 毫米。前列腺规划靶区接受的总剂量为 36.25Gy,分 5 次隔日照射。结节规划靶区接受了 25Gy 的剂量,同样分五次进行。患者在治疗期间、1 个月后和 3 个月后接受随访,此后每 6 个月随访一次。根据《不良事件通用术语标准》对胃肠道和泌尿生殖系统毒性进行了前瞻性分级:在188名患者中,80人接受了前列腺和盆腔结节的立体定向体放射治疗,108人仅接受了前列腺靶点的立体定向体放射治疗。两组患者中2级急性胃肠道毒性均为4%,2级急性泌尿生殖系统毒性分别为27%和20%(P=0.9),仅前列腺与前列腺和盆腔分别为27%和20%(P=0.9)。没有3级或以上急性胃肠道或泌尿生殖系统毒性:结论:对高危前列腺癌患者进行包括前列腺和盆腔结节在内的五次分次立体定向体放射治疗是可行的,而且在急性毒性方面也是安全的。
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引用次数: 0
Application of deep learning in radiation therapy for cancer. 深度学习在癌症放射治疗中的应用。
Pub Date : 2024-03-21 DOI: 10.1016/j.canrad.2023.07.015
X Wen, C Zhao, B Zhao, M Yuan, J Chang, W Liu, J Meng, L Shi, S Yang, J Zeng, Y Yang

In recent years, with the development of artificial intelligence, deep learning has been gradually applied to clinical treatment and research. It has also found its way into the applications in radiotherapy, a crucial method for cancer treatment. This study summarizes the commonly used and latest deep learning algorithms (including transformer, and diffusion models), introduces the workflow of different radiotherapy, and illustrates the application of different algorithms in different radiotherapy modules, as well as the defects and challenges of deep learning in the field of radiotherapy, so as to provide some help for the development of automatic radiotherapy for cancer.

近年来,随着人工智能的发展,深度学习逐渐被应用到临床治疗和研究中。在癌症治疗的重要方法--放射治疗中,它也找到了自己的应用方向。本研究总结了常用和最新的深度学习算法(包括变换器、扩散模型等),介绍了不同放疗的工作流程,阐述了不同算法在不同放疗模块中的应用,以及深度学习在放疗领域的缺陷和挑战,以期为癌症自动放疗的发展提供一些帮助。
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引用次数: 0
2023 A new French revolution: Organ preservation for rectal cancer. 2023 一场新的法国革命:保留器官治疗直肠癌
Pub Date : 2024-03-19 DOI: 10.1016/j.canrad.2024.02.001
J-P Gérard
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引用次数: 0
[Frameless trigeminal neuralgia radiosurgery with a dedicated linear accelerator: From equipment commissioning to initial clinical results]. [使用专用直线加速器进行无框架三叉神经痛放射外科手术:从设备调试到初步临床结果]。
Pub Date : 2024-03-14 DOI: 10.1016/j.canrad.2023.07.017
É Queyrel, M Lanaret, T Khalil, M Al Gahatany, R Chaix, J-J Lemaire, X Moisset, V Chassin, L Brun, V Dedieu, J Biau

Purpose: Radiosurgery for the treatment of trigeminal neuralgia delivers a very high dose in a single fraction, over a few millimeters, at a single isocenter placed along the nerve. We present here the different steps that have been performed to validate small beams by conical collimators, and report the clinical results of the first patients treated on Novalis Tx®, frameless.

Material and methods: First, the geometric accuracy of 4 and 6mm conical collimators was evaluated using Winston-Lutz tests; then dosimetric data acquisition was performed using high spatial resolution detectors (PTW 60019 microdiamond and a PTW 60017 E-diode). The corrective factors of the TRS 483 report were applied to calculate the collimator aperture factors. These dosimetric data were then compared with the data implemented in the iPlan® treatment planning system. Then end-to-end tests were performed to control the entire treatment process using an anthropomorphic phantom "STEEV". Between 2020 and 2022, 18 patients were treated for refractory trigeminal neuralgia on Novalis Tx®, frameless, with Exactrac® repositioning. A total of 17 patients were evaluated (one was lost to follow-up) using the BNI score for pain assessment and MRI with a median follow-up of 12 months.

Results: The quality criteria of geometric and dosimetric accuracy were met for the 6-mm cone but not for the 4-mm cone. All patients were treated with a 6-mm cone with a dose of 90Gy prescribed at the isocenter at the root entry zone. Initial pain control was obtained in 70.5% of our patients, and 53% maintained pain control with a median follow-up of 12 months. All recurrences occurred within 3 to 6 months after radiosurgery. No brainstem toxicity was observed. Six patients had non-disabling facial hypoesthesia, half of whom already had pretreatment hypoesthesia.

Conclusion: The treatment of trigeminal neuralgia on a dedicated linear accelerator is a highly technical treatment whose accuracy and safety are paramount. The physical measurements allowed the commissioning of the technique with a 6mm cone. Our first clinical results are in accordance with the literature.

目的:用于治疗三叉神经痛的放射外科手术可在沿神经放置的单个等中心,在几毫米的范围内以单个分量提供极高的剂量。我们在此介绍通过锥形准直器验证小光束的不同步骤,并报告第一批使用无框架 Novalis Tx® 治疗的患者的临床结果:首先,使用 Winston-Lutz 测试评估了 4 毫米和 6 毫米锥形准直器的几何精度;然后,使用高空间分辨率探测器(PTW 60019 微钻石和 PTW 60017 电子二极管)采集剂量数据。应用 TRS 483 报告中的校正系数计算准直器孔径系数。然后将这些剂量测定数据与 iPlan® 治疗计划系统中的数据进行比较。然后进行端到端测试,使用拟人化模型 "STEEV "控制整个治疗过程。2020 年至 2022 年期间,18 名难治性三叉神经痛患者接受了 Novalis Tx®、无框架和 Exactrac® 重新定位治疗。共有 17 名患者接受了疼痛评估 BNI 评分和核磁共振成像评估(其中一人失去随访),中位随访时间为 12 个月:结果:6 毫米锥体符合几何和剂量准确性的质量标准,但 4 毫米锥体不符合标准。所有患者均接受了 6 毫米锥形放射治疗,根部入口区等中心剂量为 90Gy。70.5%的患者最初的疼痛得到了控制,53%的患者在中位随访12个月后疼痛得到了控制。所有复发都发生在放射手术后的 3 到 6 个月内。没有观察到脑干毒性。六名患者出现了非致残性面部感觉减退,其中半数患者在治疗前已出现感觉减退:结论:使用专用直线加速器治疗三叉神经痛是一项技术含量很高的治疗方法,其准确性和安全性至关重要。通过物理测量,我们可以使用 6 毫米锥体进行治疗。我们的首次临床结果与文献报道相符。
{"title":"[Frameless trigeminal neuralgia radiosurgery with a dedicated linear accelerator: From equipment commissioning to initial clinical results].","authors":"É Queyrel, M Lanaret, T Khalil, M Al Gahatany, R Chaix, J-J Lemaire, X Moisset, V Chassin, L Brun, V Dedieu, J Biau","doi":"10.1016/j.canrad.2023.07.017","DOIUrl":"https://doi.org/10.1016/j.canrad.2023.07.017","url":null,"abstract":"<p><strong>Purpose: </strong>Radiosurgery for the treatment of trigeminal neuralgia delivers a very high dose in a single fraction, over a few millimeters, at a single isocenter placed along the nerve. We present here the different steps that have been performed to validate small beams by conical collimators, and report the clinical results of the first patients treated on Novalis Tx®, frameless.</p><p><strong>Material and methods: </strong>First, the geometric accuracy of 4 and 6mm conical collimators was evaluated using Winston-Lutz tests; then dosimetric data acquisition was performed using high spatial resolution detectors (PTW 60019 microdiamond and a PTW 60017 E-diode). The corrective factors of the TRS 483 report were applied to calculate the collimator aperture factors. These dosimetric data were then compared with the data implemented in the iPlan® treatment planning system. Then end-to-end tests were performed to control the entire treatment process using an anthropomorphic phantom \"STEEV\". Between 2020 and 2022, 18 patients were treated for refractory trigeminal neuralgia on Novalis Tx®, frameless, with Exactrac® repositioning. A total of 17 patients were evaluated (one was lost to follow-up) using the BNI score for pain assessment and MRI with a median follow-up of 12 months.</p><p><strong>Results: </strong>The quality criteria of geometric and dosimetric accuracy were met for the 6-mm cone but not for the 4-mm cone. All patients were treated with a 6-mm cone with a dose of 90Gy prescribed at the isocenter at the root entry zone. Initial pain control was obtained in 70.5% of our patients, and 53% maintained pain control with a median follow-up of 12 months. All recurrences occurred within 3 to 6 months after radiosurgery. No brainstem toxicity was observed. Six patients had non-disabling facial hypoesthesia, half of whom already had pretreatment hypoesthesia.</p><p><strong>Conclusion: </strong>The treatment of trigeminal neuralgia on a dedicated linear accelerator is a highly technical treatment whose accuracy and safety are paramount. The physical measurements allowed the commissioning of the technique with a 6mm cone. Our first clinical results are in accordance with the literature.</p>","PeriodicalId":93921,"journal":{"name":"Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140137618","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}
引用次数: 0
Comments on "An umbrella review exploring the effect of radiotherapy for head and neck cancer patients on the frequency of jaws osteoradionecrosis". 关于 "探讨头颈部癌症患者放疗对颌骨骨坏死发生率影响的综述 "的评论
Pub Date : 2024-03-13 DOI: 10.1016/j.canrad.2023.07.016
B Yilmaz, U Selek
{"title":"Comments on \"An umbrella review exploring the effect of radiotherapy for head and neck cancer patients on the frequency of jaws osteoradionecrosis\".","authors":"B Yilmaz, U Selek","doi":"10.1016/j.canrad.2023.07.016","DOIUrl":"https://doi.org/10.1016/j.canrad.2023.07.016","url":null,"abstract":"","PeriodicalId":93921,"journal":{"name":"Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140133528","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}
引用次数: 0
Stereotactic magnetic resonance imaging-guided radiotherapy for intracardiac metastases: A case report. 立体定向磁共振成像引导的心内转移瘤放射治疗:病例报告。
Pub Date : 2024-02-09 DOI: 10.1016/j.canrad.2023.06.033
M Michalet, R Tétreau, J-L Pasquié, O Chabre, D Azria

Adrenocortical carcinoma is a malignant tumor with a poor prognosis and a frequent metastatic extension. In very rare cases, a cardiac metastatic disease may occur, and surgical resection is essential for its management. MR-guided stereotactic radiotherapy is an attractive radiotherapy modality for the treatment of mobile thoracic tumors, enabling the target to be monitored continuously during irradiation, while the dosimetric plan can be adapted daily if necessary. We report here the case of a patient with intracardiac metastasis secondary to malignant adrenocortical carcinoma, treated with magnetic resonance imaging-guided stereotactic radiotherapy.

肾上腺皮质癌是一种恶性肿瘤,预后不良,常有转移。在极少数情况下,可能会发生心脏转移,因此手术切除是治疗的关键。磁共振引导下的立体定向放射治疗是治疗移动性胸部肿瘤的一种极具吸引力的放疗方式,它能在照射过程中持续监测靶点,同时在必要时每天调整剂量计划。我们在此报告了一例继发于恶性肾上腺皮质癌的心内转移患者,该患者接受了磁共振成像引导下的立体定向放射治疗。
{"title":"Stereotactic magnetic resonance imaging-guided radiotherapy for intracardiac metastases: A case report.","authors":"M Michalet, R Tétreau, J-L Pasquié, O Chabre, D Azria","doi":"10.1016/j.canrad.2023.06.033","DOIUrl":"https://doi.org/10.1016/j.canrad.2023.06.033","url":null,"abstract":"<p><p>Adrenocortical carcinoma is a malignant tumor with a poor prognosis and a frequent metastatic extension. In very rare cases, a cardiac metastatic disease may occur, and surgical resection is essential for its management. MR-guided stereotactic radiotherapy is an attractive radiotherapy modality for the treatment of mobile thoracic tumors, enabling the target to be monitored continuously during irradiation, while the dosimetric plan can be adapted daily if necessary. We report here the case of a patient with intracardiac metastasis secondary to malignant adrenocortical carcinoma, treated with magnetic resonance imaging-guided stereotactic radiotherapy.</p>","PeriodicalId":93921,"journal":{"name":"Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139716695","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}
引用次数: 0
Quality control of postoperative radiotherapy for non-small cell lung cancer: A study of mediastinal shift. 非小细胞肺癌术后放疗的质量控制:纵隔转移研究
Pub Date : 2024-02-05 DOI: 10.1016/j.canrad.2023.06.032
W Zhang, Y Zhang, W-W Ouyang, S Fa Su, Z Ma, Q-S Li, W Gang Yang, X Xia Chen, J Liu, B Lu

Purpose: This study aimed to assess the shifting patterns of the mediastinum, including the target volume and the isocenter point during the postoperative radiotherapy (PORT) process of non-small cell lung cancer (NSCLC), and to observe the occurrence of radiation injury. Additionally, we investigated the significance of mid-term assessment during the implementation of the PORT process.

Material and methods: We established coordinate axes based on bone anatomy and measured the mediastinum's three-dimensional direction and the shift of the isocenter point's shift in the PORT process. Statistical analysis was performed using Wilcoxon, Kruskal-Wallis, and the Chi-square test. P<0.05 was considered statistically significant.

Results: In this study, the analysis of patients revealed that the shift of anterior and posterior mediastinum (X), left and right mediastinum (Y), upper and lower mediastinum (Z), anterior and posterior isocenter point (Xi), and the left and right isocenter points (Yi) in the PORT process were 0.04-0.53, 0.00-0.84, 0.00-1.27, 0.01-0.86, and 0.00-0.66cm, respectively. The shift distance of the mediastinum was Z>Y>X, and the shift distance of the isocenter point was Xi>Yi. According to the ROC curve, the cut-off values were 0.263, 0.352, 0.405, 0.238, and 0.258, respectively, which were more significant than the cut-off values in 25 cases (25%), 30 cases (30%), 30 cases (30%), 17 cases (17%), and 15 cases (15%). In addition, there was a significant difference in the shift of the mediastinum and the isocenter point (all P=0.00). Kruskal-Wallis test showed no statistically significant difference between mediastinal shift and resection site in X, Y, and Z directions (P=0.355, P=0.239, P=0.256), surgical method (P=0.241, P=0.110, P=0.064). There was no significant difference in the incidence of RE and RP in PORT patients (P>0.05). No III-IV RP occurred. However, the incidence of ≥ grade III RE in the modified plan cases after M-S was significantly lower than in the original PORT patients, 0% and 7%, respectively (P=0.000).

Conclusion: In conclusion, this study provides evidence that mediastinal shift is a potential complication during the PORT process for patients with N2 stage or R1-2 resection following radical resection of NSCLC. This shift affects about 20-30% of patients, manifesting as actual radiation damage to normal tissue and reducing the local control rate. Therefore, mid-term repositioning of the PORT and revision of the target volume and radiation therapy plan can aid in maintaining QA and QC during the treatment of NSCLC patients and may result in improved patient outcomes.

目的:本研究旨在评估非小细胞肺癌(NSCLC)术后放疗(PORT)过程中纵隔的移动模式,包括靶体积和等中心点,并观察放射损伤的发生情况。此外,我们还研究了在实施 PORT 过程中进行中期评估的意义:我们根据骨解剖学建立了坐标轴,并测量了纵隔的三维方向和等中心点在 PORT 过程中的移动。采用 Wilcoxon、Kruskal-Wallis 和卡方检验进行统计分析。结果本研究对患者的分析显示,PORT 过程中前后纵隔(X)、左右纵隔(Y)、上下纵隔(Z)、前后等中心点(Xi)和左右等中心点(Yi)的移位分别为 0.04-0.53、0.00-0.84、0.00-1.27、0.01-0.86 和 0.00-0.66cm。纵隔移位距离为 Z>Y>X,等中心点移位距离为 Xi>Yi。根据 ROC 曲线,临界值分别为 0.263、0.352、0.405、0.238 和 0.258,分别比 25 例(25%)、30 例(30%)、30 例(30%)、17 例(17%)和 15 例(15%)的临界值显著。此外,纵隔和等中心点的移位也存在明显差异(均为 P=0.00)。Kruskal-Wallis检验显示,纵隔移位与切除部位在X、Y、Z方向(P=0.355、P=0.239、P=0.256)、手术方式(P=0.241、P=0.110、P=0.064)上差异无统计学意义。PORT患者的RE和RP发生率无明显差异(P>0.05)。没有发生Ⅲ-Ⅳ度 RP。然而,M-S后的改良计划病例中≥Ⅲ级RE的发生率明显低于原始PORT患者,分别为0%和7%(P=0.000):总之,本研究提供的证据表明,纵隔移位是NSCLC根治性切除术后N2期或R1-2切除术患者在PORT过程中可能出现的并发症。约有 20%-30% 的患者会受到这种移位的影响,表现为对正常组织的实际辐射损伤,并降低局部控制率。因此,在治疗 NSCLC 患者的过程中,中期重新定位 PORT 并修改靶体积和放疗计划有助于保持质量保证和质量控制,从而改善患者的预后。
{"title":"Quality control of postoperative radiotherapy for non-small cell lung cancer: A study of mediastinal shift.","authors":"W Zhang, Y Zhang, W-W Ouyang, S Fa Su, Z Ma, Q-S Li, W Gang Yang, X Xia Chen, J Liu, B Lu","doi":"10.1016/j.canrad.2023.06.032","DOIUrl":"https://doi.org/10.1016/j.canrad.2023.06.032","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to assess the shifting patterns of the mediastinum, including the target volume and the isocenter point during the postoperative radiotherapy (PORT) process of non-small cell lung cancer (NSCLC), and to observe the occurrence of radiation injury. Additionally, we investigated the significance of mid-term assessment during the implementation of the PORT process.</p><p><strong>Material and methods: </strong>We established coordinate axes based on bone anatomy and measured the mediastinum's three-dimensional direction and the shift of the isocenter point's shift in the PORT process. Statistical analysis was performed using Wilcoxon, Kruskal-Wallis, and the Chi-square test. P<0.05 was considered statistically significant.</p><p><strong>Results: </strong>In this study, the analysis of patients revealed that the shift of anterior and posterior mediastinum (X), left and right mediastinum (Y), upper and lower mediastinum (Z), anterior and posterior isocenter point (X<sub>i</sub>), and the left and right isocenter points (Y<sub>i</sub>) in the PORT process were 0.04-0.53, 0.00-0.84, 0.00-1.27, 0.01-0.86, and 0.00-0.66cm, respectively. The shift distance of the mediastinum was Z>Y>X, and the shift distance of the isocenter point was X<sub>i</sub>>Y<sub>i</sub>. According to the ROC curve, the cut-off values were 0.263, 0.352, 0.405, 0.238, and 0.258, respectively, which were more significant than the cut-off values in 25 cases (25%), 30 cases (30%), 30 cases (30%), 17 cases (17%), and 15 cases (15%). In addition, there was a significant difference in the shift of the mediastinum and the isocenter point (all P=0.00). Kruskal-Wallis test showed no statistically significant difference between mediastinal shift and resection site in X, Y, and Z directions (P=0.355, P=0.239, P=0.256), surgical method (P=0.241, P=0.110, P=0.064). There was no significant difference in the incidence of RE and RP in PORT patients (P>0.05). No III-IV RP occurred. However, the incidence of ≥ grade III RE in the modified plan cases after M-S was significantly lower than in the original PORT patients, 0% and 7%, respectively (P=0.000).</p><p><strong>Conclusion: </strong>In conclusion, this study provides evidence that mediastinal shift is a potential complication during the PORT process for patients with N2 stage or R1-2 resection following radical resection of NSCLC. This shift affects about 20-30% of patients, manifesting as actual radiation damage to normal tissue and reducing the local control rate. Therefore, mid-term repositioning of the PORT and revision of the target volume and radiation therapy plan can aid in maintaining QA and QC during the treatment of NSCLC patients and may result in improved patient outcomes.</p>","PeriodicalId":93921,"journal":{"name":"Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139699133","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}
引用次数: 0
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Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique
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