AIM:To evaluate impact of radiation therapy dose escalation through intensity modulated radiation therapy with simultaneous integrated boost(IMRT-SIB).METHODS:We retrospectively reviewed the patients who underwent fou...AIM:To evaluate impact of radiation therapy dose escalation through intensity modulated radiation therapy with simultaneous integrated boost(IMRT-SIB).METHODS:We retrospectively reviewed the patients who underwent four-dimensional-based IMRT-SIBbased neoadjuvant chemoradiation protocol.During the concurrent chemoradiation therapy,radiation therapy was through IMRT-SIB delivered in 28 consecutive daily fractions with total radiation doses of 56 Gy to tumor and 5040 Gy dose-painted to clinical tumor volume,with a regimen at the discretion of the treating medical oncologist.This was followed by surgical tumor resection.We analyzed pathological completion response(p CR) rates its relationship with overall survival and event-freesurvival.RESULTS:Seventeen patients underwent dose escalation with the IMRT-SIB protocol between 2007 and 2014 and their records were available for analysis.Among the IMRT-SIB-treated patients,the toxicity appeared mild,the most common side effects were grade 1-3 esophagitis(46%) and pneumonitis(11.7%).There were no cardiac events.The Ro resection rate was 94%(n = 16),the p CR rate was 47%(n = 8),and the postoperative morbidity was zero.There was one mediastinal failure found,one patient had local failure at the anastomosis site,and the majority of failures were distant in the lung or bone.The 3-year diseasefree survival and overall survival rates were 41%(n = 7) and 53%(n = 9),respectively.CONCLUSION:The dose escalation through IMRT-SIB in the chemoradiation regimen seems responsible for down-staging the distal esophageal with well-tolerated complications.展开更多
Objective This study aimed to compare and analyze the clinical efficacy and safety of late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy(IMRT) for cervical cancer complicated...Objective This study aimed to compare and analyze the clinical efficacy and safety of late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy(IMRT) for cervical cancer complicated with pelvic lymph node metastasis. Methods Sixty patients with cervical cancer complicated with pelvic lymph node metastasis who were admitted to our hospital from January 2013 to January 2015 were enrolled. The patients were randomly divided into the late-course dose-increasing IMRT group and the simultaneous integrated dose-increasing IMRT group, with 30 cases included in each group, respectively. All patients were concurrently treated with cisplatin. After treatment, the clinical outcomes of the two groups were compared. Results The remission rate of symptoms in the simultaneous integrated dose-increasing IMRT group was significantly higher than that in the late-course dose-increasing IMRT group(P < 0.05). The follow-up results showed that the overall survival time, progression-free survival time, and distant metastasis time of patients in the simultaneous integrated dose-increasing IMRT group were significantly longer than those in the late-course dose-increasing IMRT group(P < 0.05). The recurrent rate of lymph nodes in the radiation field in the simultaneous integrated dose-increasing IMRT group was significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in the incidence of cervical and vaginal recurrence and distant metastasis between the two groups(P > 0.05). The radiation doses of Dmax in the small intestine, D1 cc(the minimum dose to the 1 cc receiving the highest dose) in the bladder, and Dmax in the rectum in the simultaneous integrated dose-increasing IMRT group were significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in intestinal D2 cc(the minimum dose to the 2 cc receiving the highest dose) between the two groups(P > 0.05). The incidence of bone marrow suppression in the simultaneous integrated dose-increasing IMRT group was significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group.Conclusion The application of simultaneous integrated dose-increasing IMRT in the treatment of cervical cancer patients complicated with pelvic lymph node metastasis can significantly control tumor progression, improve the long-term survival time, and postpone distant metastasis time with high safety.展开更多
AIM:To establish the feasibility of simultaneous modulated accelerated radiation therapy(SMART) in esophageal cancer(EC).METHODS:Computed tomography(CT)datasets of 10patients with upper or middle thoracic squamous cel...AIM:To establish the feasibility of simultaneous modulated accelerated radiation therapy(SMART) in esophageal cancer(EC).METHODS:Computed tomography(CT)datasets of 10patients with upper or middle thoracic squamous cell EC undergoing chemoradiotherapy were used to generate SMART,conventionally-fractionated three-dimensional conformal radiotherapy(3DCRT)and intensity-modulated radiation therapy(cf-IMRT)plans,respectively.The gross target volume(GTV)of the esophagus,positive regional lymph nodes(LN),and suspected lymph nodes(LN±)were contoured for each patient.The clinical target volume(CTV)was delineated with 2-cm longitudinal and 0.5-to 1.0-cm radial margins with respect to the GTV and with 0.5-cm uniform margins for LN and LN(±).For the SMART plans,there were two planning target volumes(PTVs):PTV66=(GTV+LN)+0.5 cm and PTV54=CTV+0.5 cm.For the 3DCRT and cfIMRT plans,there was only a single PTV:PTV60=CTV+0.5 cm.The prescribed dose for the SMART plans was 66 Gy/30 F to PTV66 and 54 Gy/30 F to PTV54.The dose prescription to the PTV60 for both the 3DCRT and cf-IMRT plans was set to 60 Gy/30 F.All the plans were generated on the Eclipse 10.0 treatment planning system.Fulfillment of the dose criteria for the PTVs received the highest priority,followed by the spinal cord,heart,and lungs.The dose-volume histograms were compared.RESULTS:Clinically acceptable plans were achieved for all the SMART,cf-IMRT,and 3DCRT plans.Compared with the 3DCRT plans,the SMART plans increased the dose delivered to the primary tumor(66Gy vs 60 Gy),with improved sparing of normal tissues in all patients.The Dmax of the spinal cord,V20 of the lungs,and Dmean and V50 of the heart for the SMART and 3DCRT plans were as follows:38.5±2.0 vs 44.7±0.8(P=0.002),17.1±4.0 vs 25.8±5.0(P=0.000),14.4±7.5 vs 21.4±11.1(P=0.000),and 4.9±3.4vs 12.9±7.6(P=0.000),respectively.In contrast to the cf-IMRT plans,the SMART plans permitted a simultaneous dose escalation(6 Gy)to the primary tumor while demonstrating a significant trend of a lower irradiation dose to all organs at risk except the spinal cord,for which no significant difference was found.CONCLUSION:SMART offers the potential for a 6Gy simultaneous escalation in the irradiation dose delivered to the primary tumor of EC and improves the sparing of normal tissues.展开更多
文摘AIM:To evaluate impact of radiation therapy dose escalation through intensity modulated radiation therapy with simultaneous integrated boost(IMRT-SIB).METHODS:We retrospectively reviewed the patients who underwent four-dimensional-based IMRT-SIBbased neoadjuvant chemoradiation protocol.During the concurrent chemoradiation therapy,radiation therapy was through IMRT-SIB delivered in 28 consecutive daily fractions with total radiation doses of 56 Gy to tumor and 5040 Gy dose-painted to clinical tumor volume,with a regimen at the discretion of the treating medical oncologist.This was followed by surgical tumor resection.We analyzed pathological completion response(p CR) rates its relationship with overall survival and event-freesurvival.RESULTS:Seventeen patients underwent dose escalation with the IMRT-SIB protocol between 2007 and 2014 and their records were available for analysis.Among the IMRT-SIB-treated patients,the toxicity appeared mild,the most common side effects were grade 1-3 esophagitis(46%) and pneumonitis(11.7%).There were no cardiac events.The Ro resection rate was 94%(n = 16),the p CR rate was 47%(n = 8),and the postoperative morbidity was zero.There was one mediastinal failure found,one patient had local failure at the anastomosis site,and the majority of failures were distant in the lung or bone.The 3-year diseasefree survival and overall survival rates were 41%(n = 7) and 53%(n = 9),respectively.CONCLUSION:The dose escalation through IMRT-SIB in the chemoradiation regimen seems responsible for down-staging the distal esophageal with well-tolerated complications.
文摘Objective This study aimed to compare and analyze the clinical efficacy and safety of late-course and simultaneous integrated dose-increasing intensity-modulated radiation therapy(IMRT) for cervical cancer complicated with pelvic lymph node metastasis. Methods Sixty patients with cervical cancer complicated with pelvic lymph node metastasis who were admitted to our hospital from January 2013 to January 2015 were enrolled. The patients were randomly divided into the late-course dose-increasing IMRT group and the simultaneous integrated dose-increasing IMRT group, with 30 cases included in each group, respectively. All patients were concurrently treated with cisplatin. After treatment, the clinical outcomes of the two groups were compared. Results The remission rate of symptoms in the simultaneous integrated dose-increasing IMRT group was significantly higher than that in the late-course dose-increasing IMRT group(P < 0.05). The follow-up results showed that the overall survival time, progression-free survival time, and distant metastasis time of patients in the simultaneous integrated dose-increasing IMRT group were significantly longer than those in the late-course dose-increasing IMRT group(P < 0.05). The recurrent rate of lymph nodes in the radiation field in the simultaneous integrated dose-increasing IMRT group was significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in the incidence of cervical and vaginal recurrence and distant metastasis between the two groups(P > 0.05). The radiation doses of Dmax in the small intestine, D1 cc(the minimum dose to the 1 cc receiving the highest dose) in the bladder, and Dmax in the rectum in the simultaneous integrated dose-increasing IMRT group were significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group. There was no significant difference in intestinal D2 cc(the minimum dose to the 2 cc receiving the highest dose) between the two groups(P > 0.05). The incidence of bone marrow suppression in the simultaneous integrated dose-increasing IMRT group was significantly lower(P < 0.05) than in the late-course dose-increasing IMRT group.Conclusion The application of simultaneous integrated dose-increasing IMRT in the treatment of cervical cancer patients complicated with pelvic lymph node metastasis can significantly control tumor progression, improve the long-term survival time, and postpone distant metastasis time with high safety.
基金Supported by Shantou University Medical College Clinical Research Enhancement Initiative,and Research and Travel Grants from the Science and Technology Key Project of Shantou City,China,2012,No.2012-165-131
文摘AIM:To establish the feasibility of simultaneous modulated accelerated radiation therapy(SMART) in esophageal cancer(EC).METHODS:Computed tomography(CT)datasets of 10patients with upper or middle thoracic squamous cell EC undergoing chemoradiotherapy were used to generate SMART,conventionally-fractionated three-dimensional conformal radiotherapy(3DCRT)and intensity-modulated radiation therapy(cf-IMRT)plans,respectively.The gross target volume(GTV)of the esophagus,positive regional lymph nodes(LN),and suspected lymph nodes(LN±)were contoured for each patient.The clinical target volume(CTV)was delineated with 2-cm longitudinal and 0.5-to 1.0-cm radial margins with respect to the GTV and with 0.5-cm uniform margins for LN and LN(±).For the SMART plans,there were two planning target volumes(PTVs):PTV66=(GTV+LN)+0.5 cm and PTV54=CTV+0.5 cm.For the 3DCRT and cfIMRT plans,there was only a single PTV:PTV60=CTV+0.5 cm.The prescribed dose for the SMART plans was 66 Gy/30 F to PTV66 and 54 Gy/30 F to PTV54.The dose prescription to the PTV60 for both the 3DCRT and cf-IMRT plans was set to 60 Gy/30 F.All the plans were generated on the Eclipse 10.0 treatment planning system.Fulfillment of the dose criteria for the PTVs received the highest priority,followed by the spinal cord,heart,and lungs.The dose-volume histograms were compared.RESULTS:Clinically acceptable plans were achieved for all the SMART,cf-IMRT,and 3DCRT plans.Compared with the 3DCRT plans,the SMART plans increased the dose delivered to the primary tumor(66Gy vs 60 Gy),with improved sparing of normal tissues in all patients.The Dmax of the spinal cord,V20 of the lungs,and Dmean and V50 of the heart for the SMART and 3DCRT plans were as follows:38.5±2.0 vs 44.7±0.8(P=0.002),17.1±4.0 vs 25.8±5.0(P=0.000),14.4±7.5 vs 21.4±11.1(P=0.000),and 4.9±3.4vs 12.9±7.6(P=0.000),respectively.In contrast to the cf-IMRT plans,the SMART plans permitted a simultaneous dose escalation(6 Gy)to the primary tumor while demonstrating a significant trend of a lower irradiation dose to all organs at risk except the spinal cord,for which no significant difference was found.CONCLUSION:SMART offers the potential for a 6Gy simultaneous escalation in the irradiation dose delivered to the primary tumor of EC and improves the sparing of normal tissues.
