Purpose: To study the effect of escalating radiation dose;in intermediate and high risk prostate cancer patients;via online image-guidance on acute toxicities. Patients and Methods: thirty-eight prostate cancer patien...Purpose: To study the effect of escalating radiation dose;in intermediate and high risk prostate cancer patients;via online image-guidance on acute toxicities. Patients and Methods: thirty-eight prostate cancer patients were treated by using simultaneous integrated boost-intensity modulated radiation therapy (SIB-IMRT) with online image guided correction via kilo voltage cone beam computed tomography (KV-CBCT)/electronic portal imaging device (EPID) of trans-rectal ultrasound (TRUS)-inserted intraprostatic gold fiduciary markers. High-risk patients received a median dose of 80.5 Gy to prostate and 56 Gy to pelvic nodes in 35 fractions over 7 weeks. Intermediate-risk patients received a similar prostate dose over the same overall treatment time. Acute toxicity (bladder, rectal and bowel symptoms) was reported once weekly during the radiation course and up to 3 months from the end of the radiation course. Results: The image guided (IG)-IMRT allows escalating the radiation dose delivered to the prostate through minimizing the margin of setup error to less than 0.5 cm with subsequent sparing of nearby organs at risk. Out of thirty-eight patients, no patient developed >grade 1 acute rectal toxicity, 7.9% of patients experienced grade 3 urinary toxicity and there was no reported small intestinal toxicity. Conclusion: Escalating the radiation dose more than 80 Gy in intermediate and high risk prostate cancer patients was safe and not associated with grade 3 - 4 RTOG toxicity when guided by online verification of intra-prostatic fiducial markers.展开更多
The application of simultaneous integrated boost-intensity modulated radiotherapy(SIB-IMRT)in pediatric and adolescent nasopharyngeal carcinoma(NPC)is underevaluated.This study aimed to evaluate long-term outcome and ...The application of simultaneous integrated boost-intensity modulated radiotherapy(SIB-IMRT)in pediatric and adolescent nasopharyngeal carcinoma(NPC)is underevaluated.This study aimed to evaluate long-term outcome and late toxicities in pediatric and adolescent NPC after SIB-IMRT combined with chemotherapy.Thirty-four patients(aged 8–20 years)with histologically proven,non-disseminated NPC treated with SIB-IMRT were enrolled in this retrospective study.The disease stage distribution was as follows:stage I,1(2.9%);stage III,14(41.2%);and stage IV,19(55.9%).All patients underwent SIBIMRT and 30 patients also underwent cisplatin-based chemotherapy.The prescribed dose of IMRT was64–68 Gy in 29–31 fractions to the nasopharyngeal gross target volume.Within the median follow-up of 52months(range,9–111 months),1 patient(2.9%)experienced local recurrence and 4(11.8%)developed distant metastasis(to the lung in 3 cases and to multiple organs in 1 case).Four patients(11.8%)died due to recurrence or metastasis.The 5-year locoregional relapse–free survival,distant metastasis–free survival,disease-free survival,and overall survival rates were 97.1%,88.2%,85.3%,and 88.2%,respectively.The most common acute toxicities were grades 3–4 hematologic toxicities and stomatitis.Of the 24 patients who survived for more than 2 years,16(66.7%)and 15(62.5%)developed grades 1–2 xerostomia and ototoxicity,respectively.Two patients(8.3%)developed grade 3 ototoxicity;no grade 4 toxicities were observed.SIB-IMRT combined with chemotherapy achieves excellent long-term locoregional control in pediatric and adolescent NPC,with mild incidence of late toxicities.Distant metastasis is the predominant mode of failure.展开更多
Objective: The aim of the work was to compare the dosimetric results that were obtained by using two treatment planning systems (TPS) Siemens KonRad version 2.2.23, Elekta XiO version 4.4 to perform a simultaneous int...Objective: The aim of the work was to compare the dosimetric results that were obtained by using two treatment planning systems (TPS) Siemens KonRad version 2.2.23, Elekta XiO version 4.4 to perform a simultaneous integrated boost (SIB) for head and neck and central nervous system (CNS) cases in paediatric patients. Methods: The CT scan data for five paediatric patients, with head and neck and CNS tumors, were transferred into both of the TPSs. Clinical step-and-shoot intensity-modulated radiotherapy (IMRT) treatment plans were designed using 6 MV photon beam for delivery on a Siemens Oncor Accelerator with multileaf collimator MLC (82 leaf). Plans were optimized to achieve the same clinical objectives using the same beam energy, number and direction of beams. The analysis was based on isodose distributions, the dose volume histogram (DVH) for planning target volume (PTV) and the relevant organs at risk (OARs) as well as volume receiving 2 Gy and 5 Gy, also total number of segments, MU/segment, and the number of MU/cGy had been investigated. Treatment delivery time and conformation number were two other parameters in this study. Results: The segmentation using KonRad was more efficient, resulting in fewer segments (reduction between 13.2% and 48.3%), fewer MUs (reduction between 10.7% and 33%) and that reflected on treatment delivery times to be shorter by up to 8 min or 46%. In most of the cases KonRad had the highest volume receiving in excess of 2 and 5 Gy, and XiO showed the lowest. Also KonRad achieved slightly better conformality (0.76±0.054) than XiO (0.73±0.05) while XiO presented a higher modulation factor value (3.3 MU/cGy) than KonRad (2.4 MU/cGy). Conclusion: The KonRad treatment planning system was found to be superior to the XiO treatment planning system. This is true for the possible increase of radiation-induced secondary malignancies as well as for the local control.展开更多
文摘Purpose: To study the effect of escalating radiation dose;in intermediate and high risk prostate cancer patients;via online image-guidance on acute toxicities. Patients and Methods: thirty-eight prostate cancer patients were treated by using simultaneous integrated boost-intensity modulated radiation therapy (SIB-IMRT) with online image guided correction via kilo voltage cone beam computed tomography (KV-CBCT)/electronic portal imaging device (EPID) of trans-rectal ultrasound (TRUS)-inserted intraprostatic gold fiduciary markers. High-risk patients received a median dose of 80.5 Gy to prostate and 56 Gy to pelvic nodes in 35 fractions over 7 weeks. Intermediate-risk patients received a similar prostate dose over the same overall treatment time. Acute toxicity (bladder, rectal and bowel symptoms) was reported once weekly during the radiation course and up to 3 months from the end of the radiation course. Results: The image guided (IG)-IMRT allows escalating the radiation dose delivered to the prostate through minimizing the margin of setup error to less than 0.5 cm with subsequent sparing of nearby organs at risk. Out of thirty-eight patients, no patient developed >grade 1 acute rectal toxicity, 7.9% of patients experienced grade 3 urinary toxicity and there was no reported small intestinal toxicity. Conclusion: Escalating the radiation dose more than 80 Gy in intermediate and high risk prostate cancer patients was safe and not associated with grade 3 - 4 RTOG toxicity when guided by online verification of intra-prostatic fiducial markers.
基金Natural ScienceFoundation of China(No.81071836)Sun Yat-sen University5010 Projects(No.050243)
文摘The application of simultaneous integrated boost-intensity modulated radiotherapy(SIB-IMRT)in pediatric and adolescent nasopharyngeal carcinoma(NPC)is underevaluated.This study aimed to evaluate long-term outcome and late toxicities in pediatric and adolescent NPC after SIB-IMRT combined with chemotherapy.Thirty-four patients(aged 8–20 years)with histologically proven,non-disseminated NPC treated with SIB-IMRT were enrolled in this retrospective study.The disease stage distribution was as follows:stage I,1(2.9%);stage III,14(41.2%);and stage IV,19(55.9%).All patients underwent SIBIMRT and 30 patients also underwent cisplatin-based chemotherapy.The prescribed dose of IMRT was64–68 Gy in 29–31 fractions to the nasopharyngeal gross target volume.Within the median follow-up of 52months(range,9–111 months),1 patient(2.9%)experienced local recurrence and 4(11.8%)developed distant metastasis(to the lung in 3 cases and to multiple organs in 1 case).Four patients(11.8%)died due to recurrence or metastasis.The 5-year locoregional relapse–free survival,distant metastasis–free survival,disease-free survival,and overall survival rates were 97.1%,88.2%,85.3%,and 88.2%,respectively.The most common acute toxicities were grades 3–4 hematologic toxicities and stomatitis.Of the 24 patients who survived for more than 2 years,16(66.7%)and 15(62.5%)developed grades 1–2 xerostomia and ototoxicity,respectively.Two patients(8.3%)developed grade 3 ototoxicity;no grade 4 toxicities were observed.SIB-IMRT combined with chemotherapy achieves excellent long-term locoregional control in pediatric and adolescent NPC,with mild incidence of late toxicities.Distant metastasis is the predominant mode of failure.
文摘Objective: The aim of the work was to compare the dosimetric results that were obtained by using two treatment planning systems (TPS) Siemens KonRad version 2.2.23, Elekta XiO version 4.4 to perform a simultaneous integrated boost (SIB) for head and neck and central nervous system (CNS) cases in paediatric patients. Methods: The CT scan data for five paediatric patients, with head and neck and CNS tumors, were transferred into both of the TPSs. Clinical step-and-shoot intensity-modulated radiotherapy (IMRT) treatment plans were designed using 6 MV photon beam for delivery on a Siemens Oncor Accelerator with multileaf collimator MLC (82 leaf). Plans were optimized to achieve the same clinical objectives using the same beam energy, number and direction of beams. The analysis was based on isodose distributions, the dose volume histogram (DVH) for planning target volume (PTV) and the relevant organs at risk (OARs) as well as volume receiving 2 Gy and 5 Gy, also total number of segments, MU/segment, and the number of MU/cGy had been investigated. Treatment delivery time and conformation number were two other parameters in this study. Results: The segmentation using KonRad was more efficient, resulting in fewer segments (reduction between 13.2% and 48.3%), fewer MUs (reduction between 10.7% and 33%) and that reflected on treatment delivery times to be shorter by up to 8 min or 46%. In most of the cases KonRad had the highest volume receiving in excess of 2 and 5 Gy, and XiO showed the lowest. Also KonRad achieved slightly better conformality (0.76±0.054) than XiO (0.73±0.05) while XiO presented a higher modulation factor value (3.3 MU/cGy) than KonRad (2.4 MU/cGy). Conclusion: The KonRad treatment planning system was found to be superior to the XiO treatment planning system. This is true for the possible increase of radiation-induced secondary malignancies as well as for the local control.
