Background and objectives:The incidence of symptomatic radiation pneumonitis(RP)and its relationship with dose-volume histogram(DVH)parameters in non-small cell lung cancer(NSCLC)patients receiving epidermal growth fa...Background and objectives:The incidence of symptomatic radiation pneumonitis(RP)and its relationship with dose-volume histogram(DVH)parameters in non-small cell lung cancer(NSCLC)patients receiving epidermal growth factor receptortyrosine kinase inhibitors(EGFR-TKIs)and concurrent once-daily thoracic radiotherapy(TRT)remain unclear.We aim to analyze the values of clinical factors and dose-volume histogram(DVH)parameters to predict the risk for symptomatic RP in these patients.Methods:Between 2011 and 2019,we retrospectively analyzed and identified 85 patients who had received EGFR-TKIs and oncedaily TRT simultaneously(EGFR-TKIs group)and 129 patients who had received concurrent chemoradiotherapy(CCRT group).The symptomatic RP was recorded according to the Common Terminology Criteria for Adverse Event(CTCAE)criteria(grade 2 or above).Statistical analyses were performed using SPSS 26.0.Results:In total,the incidences of symptomatic(grade≥2)and severe RP(grade≥3)were 43.5%(37/85)and 16.5%(14/85)in EGFR-TKIs group vs 27.1%(35/129)and 10.1%(13/129)in CCRT group respectively.After 1:1 ratio between EGFR-TKIs group and CCRT group was matched by propensity score matching,chi-square test suggested that the incidence of symptomatic RP in the MATCHED EGFR-TKIs group was higher than that in the matched CCRT group(χ^(2)=4.469,P=0.035).In EGFRTKIs group,univariate and multivariate analyses indicated that the percentage of ipsilateral lung volume receiving≥30 Gy(ilV_(30))[odds ratio(OR):1.163,95%CI:1.036-1.306,P=0.011]and the percentage of total lung volume receiving≥20 Gy(tlV_(20))(OR:1.171,95%CI:1.031-1.330,P=0.015),with chronic obstructive pulmonary disease(COPD)or not(OR:0.158,95%CI:0.041-0.600,P=0.007),were independent predictors of symptomatic RP.Compared to patients with lower iIV_(30)/tlV_(20)values(ilV_(30)and tlV_(20)<cut-off point values)and without COPD,patients with higher ilV_(30)/tlV_(20)values(ilV_(30)and tlV_(20)>cut-off point values)and COPD had a significantly higher risk for developing symptomatic RP,with a hazard ratio(HR)of 1.350(95%CI:1.190-1.531,P<0.001).Conclusion:Patients receiving both EGFR-TKIs and once-daily TRT were more likely to develop symptomatic RP than patients receiving concurrent chemoradiotherapy.The ilV_(30),tlV_(20),and comorbidity of COPD may predict the risk of symptomatic RP among NSCLC patients receiving EGFR-TKIs and conventionally fractionated TRT concurrently.展开更多
Objective: To analyze the influencing factors for radiation-induced heart disease (RIHD) in a panel of cases with malignant thymic tumors treated by radiotherapy. Methods: 52 consecutive patients were treated by radi...Objective: To analyze the influencing factors for radiation-induced heart disease (RIHD) in a panel of cases with malignant thymic tumors treated by radiotherapy. Methods: 52 consecutive patients were treated by radiotherapy for malignant thymic tumor (14 at Masaoka stage II, 23 at stage III and 15 at stage IV). Treatment included radical (in 20), postoperative (in 14), preoperative (in 2) and palliative (in 16) radiotherapy. The conventional two-dimension (2D) radiation therapy was performed in forty-seven patients and three-dimension (3D) conformal radiation therapy has been used in 5 patients since October 2000. The total tumor dose ranged from 10 Gy to 84.5 Gy (median of 55 Gy). Chemotherapy was given in twenty-five patients before or after radiotherapy. The results of following-up could be obtained from the database and updated where appropriated. The dose volume histogram (DVH) of heart in radiotherapy for all patients was analyzed for the effective volume dose of heart. Result: The median following-up was 14 months (ranged from 0.6 to 111.3 months) in the study. RIHD was observed in seven patients. Cardiac toxicity of these seven patients were evaluated as SOMA grade 1-3. The median two-third effective volume dose of heart was 47.2 Gy (ranged from 8.3 Gy to 70.1 Gy) for conventional 2D radiotherapy, which correlated with thymic tumor dose (P<0.0001). The median two-third effective volume dose of heart was 35.3 Gy (ranged from 13 Gy to 38.7 Gy) for 3D conformal radiotherapy. The effective volume doses of heart were decreased by using 3D conformal radiotherapy (P=0.048). A significant association between cardiac toxicity and effective volume dose of heart was found in this study (P<0.0001). Cardiac toxicity accounted for 10.4% and 4.1% of patients receiving and not receiving adjuvant chemotherapy, respectively, and occurred earlier in radiochemotherapy group (P=0.0528). Multivariate analysis suggested that cardiac toxicity was significantly influenced by the effective volume dose of heart and chemotherapy. Conclusion: the results indicate that decreasing the effective volume dose of heart and carefully using chemotherapy drugs that have significant cardiotoxicity may reduce the probability of radiation-induced heart disease.展开更多
Objective: To investigate the best stereotactic irradiation (STI) technique in treatment of small lung tumors, using dose-volume statistics. Methods: Dose-volume histogram (DVH) of the study phantom consisting of CT u...Objective: To investigate the best stereotactic irradiation (STI) technique in treatment of small lung tumors, using dose-volume statistics. Methods: Dose-volume histogram (DVH) of the study phantom consisting of CT using the software of FOCUS-3D planning system. The beam was a 6MV X-ray from a Varian 2300C. The analysis data of Dose-volume statistics was from the technique used for: (1) 2–12 arcs; (2) 20°–45° separation angle of arcs; (3) 80°–160° of gantry rotation. Then we studied the difference of DVH with various irradiation techniques and the influence of target positions and field size by calculated to the distribution of dose from 20%–90% of the six targets in the lung with 3×3 cm2, 4×4 cm2 and 5×5 cm2 field size. Results: The volume irradiated pulmonary tissue was the smallest using a six non-coplanar 120° arcs with 30° separation between arcs in the hypothetical set up, the non-coplanar SRI was superiority than conventional one’s. The six targets were chosen in the right lung, the volume was the largest in geometric center and was decreased in hilus, bottom, anterior chest wall, lateral wall and apex of the lung in such an order. The DVH had significant change with an increasing field size. Conclusion: the irradiation damage of normal pulmonary tissue was the lowest using the six non-coplanar 120° arcs with a 30° separation between arcs by <5×5 cm2 field and the position of target was not a restricting factor.展开更多
Background: Radiotherapy (RT) techniques after Conservative Breast Surgery (CBS) vary. Three Dimension (3D) planning allows for better plan optimization compared to 2 Dimension (2D) plans and also allowing for creatin...Background: Radiotherapy (RT) techniques after Conservative Breast Surgery (CBS) vary. Three Dimension (3D) planning allows for better plan optimization compared to 2 Dimension (2D) plans and also allowing for creating Dose Volume Histograms (DVHs) for both Planning Target Volume (PTV) and Organs at Risk (OAR). Patients and Methods: Twenty consecutive patients with CBS planned for whole breast and supraclavicular (SCV) RT at the National Cancer Institute (NCI), Egypt between January and June 2016 were included in this study. All patients were planned clinically in 2D fashion with no more than 2 cm of ipsilateral lung allowed in the tangential fields “Limited 2D” (Limit-2D) then Target and OAR volumes were drawn according to the Radiation Therapy Oncology Group (RTOG) guidelines and 3D plans and a central slice PTV-based 2D plan, “Modified 2D” (Mod-2D), were performed in the same Computerized Tomography (CT) slices for each patient. Mono-Iso-Centeric technique (MIT) was used in 3D plans. DVH parameters were used to compare the three plans. Results: In 3D plans, compared to Limit-2D, coverage improved for the intact breast (V95% = 95% versus (Vs) 69%, p = 0.036) and SCVPTV (V90% = 90% Vs 65%, p = 0.01). The breast and SCV V 107%, V112% and Dmax were better with 3D plan however not statistical significant (NS). Junctional hot spots were 120% and 107% in the Limit-2D and 3D plans respectively (p = 0.04). The dose to the heart, mean (333 Vs 491 cGy), V10 (5% Vs 10%) and V20 (3% Vs 7%), Ipsilateral lung V20 (19% Vs 26%), and contra lateral breast D-max (205 Vs 462 cGy) were higher in 3D plans however NS, and the dose to the cord was the same. Comparison between 3D and Mod-2D showed better OAR sparing with 3D with mean heart dose (491 cGy Vs 782 cGy, p = 0.025) and Ipsilateral lung V20 (26% Vs 32%, p = 0.07% with statistically comparable target coverage. Conclusion: This study demonstrated that application of 3D plan using MIT improves coverage of breast and SCVPTVs with minimizing hot spot at the junctional area if compared with Limit-2D plans with comparable dose to OAR. When compared with Mod-2D plans, 3D plans not only had better target coverage but also better sparing of OAR, the latter was statistically significant.展开更多
文摘Background and objectives:The incidence of symptomatic radiation pneumonitis(RP)and its relationship with dose-volume histogram(DVH)parameters in non-small cell lung cancer(NSCLC)patients receiving epidermal growth factor receptortyrosine kinase inhibitors(EGFR-TKIs)and concurrent once-daily thoracic radiotherapy(TRT)remain unclear.We aim to analyze the values of clinical factors and dose-volume histogram(DVH)parameters to predict the risk for symptomatic RP in these patients.Methods:Between 2011 and 2019,we retrospectively analyzed and identified 85 patients who had received EGFR-TKIs and oncedaily TRT simultaneously(EGFR-TKIs group)and 129 patients who had received concurrent chemoradiotherapy(CCRT group).The symptomatic RP was recorded according to the Common Terminology Criteria for Adverse Event(CTCAE)criteria(grade 2 or above).Statistical analyses were performed using SPSS 26.0.Results:In total,the incidences of symptomatic(grade≥2)and severe RP(grade≥3)were 43.5%(37/85)and 16.5%(14/85)in EGFR-TKIs group vs 27.1%(35/129)and 10.1%(13/129)in CCRT group respectively.After 1:1 ratio between EGFR-TKIs group and CCRT group was matched by propensity score matching,chi-square test suggested that the incidence of symptomatic RP in the MATCHED EGFR-TKIs group was higher than that in the matched CCRT group(χ^(2)=4.469,P=0.035).In EGFRTKIs group,univariate and multivariate analyses indicated that the percentage of ipsilateral lung volume receiving≥30 Gy(ilV_(30))[odds ratio(OR):1.163,95%CI:1.036-1.306,P=0.011]and the percentage of total lung volume receiving≥20 Gy(tlV_(20))(OR:1.171,95%CI:1.031-1.330,P=0.015),with chronic obstructive pulmonary disease(COPD)or not(OR:0.158,95%CI:0.041-0.600,P=0.007),were independent predictors of symptomatic RP.Compared to patients with lower iIV_(30)/tlV_(20)values(ilV_(30)and tlV_(20)<cut-off point values)and without COPD,patients with higher ilV_(30)/tlV_(20)values(ilV_(30)and tlV_(20)>cut-off point values)and COPD had a significantly higher risk for developing symptomatic RP,with a hazard ratio(HR)of 1.350(95%CI:1.190-1.531,P<0.001).Conclusion:Patients receiving both EGFR-TKIs and once-daily TRT were more likely to develop symptomatic RP than patients receiving concurrent chemoradiotherapy.The ilV_(30),tlV_(20),and comorbidity of COPD may predict the risk of symptomatic RP among NSCLC patients receiving EGFR-TKIs and conventionally fractionated TRT concurrently.
文摘Objective: To analyze the influencing factors for radiation-induced heart disease (RIHD) in a panel of cases with malignant thymic tumors treated by radiotherapy. Methods: 52 consecutive patients were treated by radiotherapy for malignant thymic tumor (14 at Masaoka stage II, 23 at stage III and 15 at stage IV). Treatment included radical (in 20), postoperative (in 14), preoperative (in 2) and palliative (in 16) radiotherapy. The conventional two-dimension (2D) radiation therapy was performed in forty-seven patients and three-dimension (3D) conformal radiation therapy has been used in 5 patients since October 2000. The total tumor dose ranged from 10 Gy to 84.5 Gy (median of 55 Gy). Chemotherapy was given in twenty-five patients before or after radiotherapy. The results of following-up could be obtained from the database and updated where appropriated. The dose volume histogram (DVH) of heart in radiotherapy for all patients was analyzed for the effective volume dose of heart. Result: The median following-up was 14 months (ranged from 0.6 to 111.3 months) in the study. RIHD was observed in seven patients. Cardiac toxicity of these seven patients were evaluated as SOMA grade 1-3. The median two-third effective volume dose of heart was 47.2 Gy (ranged from 8.3 Gy to 70.1 Gy) for conventional 2D radiotherapy, which correlated with thymic tumor dose (P<0.0001). The median two-third effective volume dose of heart was 35.3 Gy (ranged from 13 Gy to 38.7 Gy) for 3D conformal radiotherapy. The effective volume doses of heart were decreased by using 3D conformal radiotherapy (P=0.048). A significant association between cardiac toxicity and effective volume dose of heart was found in this study (P<0.0001). Cardiac toxicity accounted for 10.4% and 4.1% of patients receiving and not receiving adjuvant chemotherapy, respectively, and occurred earlier in radiochemotherapy group (P=0.0528). Multivariate analysis suggested that cardiac toxicity was significantly influenced by the effective volume dose of heart and chemotherapy. Conclusion: the results indicate that decreasing the effective volume dose of heart and carefully using chemotherapy drugs that have significant cardiotoxicity may reduce the probability of radiation-induced heart disease.
文摘Objective: To investigate the best stereotactic irradiation (STI) technique in treatment of small lung tumors, using dose-volume statistics. Methods: Dose-volume histogram (DVH) of the study phantom consisting of CT using the software of FOCUS-3D planning system. The beam was a 6MV X-ray from a Varian 2300C. The analysis data of Dose-volume statistics was from the technique used for: (1) 2–12 arcs; (2) 20°–45° separation angle of arcs; (3) 80°–160° of gantry rotation. Then we studied the difference of DVH with various irradiation techniques and the influence of target positions and field size by calculated to the distribution of dose from 20%–90% of the six targets in the lung with 3×3 cm2, 4×4 cm2 and 5×5 cm2 field size. Results: The volume irradiated pulmonary tissue was the smallest using a six non-coplanar 120° arcs with 30° separation between arcs in the hypothetical set up, the non-coplanar SRI was superiority than conventional one’s. The six targets were chosen in the right lung, the volume was the largest in geometric center and was decreased in hilus, bottom, anterior chest wall, lateral wall and apex of the lung in such an order. The DVH had significant change with an increasing field size. Conclusion: the irradiation damage of normal pulmonary tissue was the lowest using the six non-coplanar 120° arcs with a 30° separation between arcs by <5×5 cm2 field and the position of target was not a restricting factor.
文摘Background: Radiotherapy (RT) techniques after Conservative Breast Surgery (CBS) vary. Three Dimension (3D) planning allows for better plan optimization compared to 2 Dimension (2D) plans and also allowing for creating Dose Volume Histograms (DVHs) for both Planning Target Volume (PTV) and Organs at Risk (OAR). Patients and Methods: Twenty consecutive patients with CBS planned for whole breast and supraclavicular (SCV) RT at the National Cancer Institute (NCI), Egypt between January and June 2016 were included in this study. All patients were planned clinically in 2D fashion with no more than 2 cm of ipsilateral lung allowed in the tangential fields “Limited 2D” (Limit-2D) then Target and OAR volumes were drawn according to the Radiation Therapy Oncology Group (RTOG) guidelines and 3D plans and a central slice PTV-based 2D plan, “Modified 2D” (Mod-2D), were performed in the same Computerized Tomography (CT) slices for each patient. Mono-Iso-Centeric technique (MIT) was used in 3D plans. DVH parameters were used to compare the three plans. Results: In 3D plans, compared to Limit-2D, coverage improved for the intact breast (V95% = 95% versus (Vs) 69%, p = 0.036) and SCVPTV (V90% = 90% Vs 65%, p = 0.01). The breast and SCV V 107%, V112% and Dmax were better with 3D plan however not statistical significant (NS). Junctional hot spots were 120% and 107% in the Limit-2D and 3D plans respectively (p = 0.04). The dose to the heart, mean (333 Vs 491 cGy), V10 (5% Vs 10%) and V20 (3% Vs 7%), Ipsilateral lung V20 (19% Vs 26%), and contra lateral breast D-max (205 Vs 462 cGy) were higher in 3D plans however NS, and the dose to the cord was the same. Comparison between 3D and Mod-2D showed better OAR sparing with 3D with mean heart dose (491 cGy Vs 782 cGy, p = 0.025) and Ipsilateral lung V20 (26% Vs 32%, p = 0.07% with statistically comparable target coverage. Conclusion: This study demonstrated that application of 3D plan using MIT improves coverage of breast and SCVPTVs with minimizing hot spot at the junctional area if compared with Limit-2D plans with comparable dose to OAR. When compared with Mod-2D plans, 3D plans not only had better target coverage but also better sparing of OAR, the latter was statistically significant.
