Top

Radiation Oncology

Published in:

Open Access 01-12-2013 | Research

Reduced lung dose during radiotherapy for thoracic esophageal carcinoma: VMAT combined with active breathing control for moderate DIBH

Authors: Guanzhong Gong, Ruozheng Wang, Yujie Guo, Deyin Zhai, Tonghai Liu, Jie Lu, Jinhu Chen, Chengxin Liu, Yong Yin

Published in: Radiation Oncology | Issue 1/2013

Abstract

Background

Lung radiation injury is a critical complication of radiotherapy (RT) for thoracic esophageal carcinoma (EC). Therefore, the goal of this study was to investigate the feasibility and dosimetric effects of reducing the lung tissue irradiation dose during RT for thoracic EC by applying volumetric modulated arc radiotherapy (VMAT) combined with active breathing control (ABC) for moderate deep inspiration breath-hold (mDIBH).

Methods

Fifteen patients with thoracic EC were randomly selected to undergo two series of computed tomography (CT) simulation scans with ABC used to achieve mDIBH (representing 80% of peak DIBH value) versus free breathing (FB). Gross tumor volumes were contoured on different CT images, and planning target volumes (PTVs) were obtained using different margins. For PTV_-FB, intensity-modulated radiotherapy (IMRT) was designed with seven fields, and VMAT included two whole arcs. For PTV_-DIBH, VMAT with three 135° arcs was applied, and the corresponding plans were named: IMRT_-FB, VMAT_-FB, and VMAT_-DIBH, respectively. Dosimetric differences between the different plans were compared.

Results

The heart volumes decreased by 19.85%, while total lung volume increased by 52.54% in mDIBH, compared to FB (p < 0.05). The mean conformality index values and homogeneity index values for VMAT_-DIBH (0.86, 1.07) were slightly worse than those for IMRT_-FB (0.90, 1.05) and VMAT_-FB (0.90, 1.06) (p > 0.05). Furthermore, compared to IMRT_-FB and VMAT_-FB, VMAT_-DIBH reduced the mean total lung dose by 18.64% and 17.84%, respectively (p < 0.05); moreover, the V₅, V₁₀, V₂₀, and V₃₀ values for IMRT_-FB and VMAT_-FB were reduced by 10.84% and 10.65% (p > 0.05), 12.5% and 20% (p < 0.05), 30.77% and 33.33% (p < 0.05), and 50.33% and 49.15% (p < 0.05), respectively. However, the heart dose-volume indices were similar between VMAT_-DIBH and VMAT_-FB which were lower than IMRT_-FB without being statistically significant (p > 0.05). The monitor units and treatment time of VMAT_-DIBH were also the lowest (p < 0.05).

Conclusions

VMAT combined with ABC to achieve mDIBH is a feasible approach for RT of thoracic EC. Furthermore, this method has the potential to effectively reduce lung dose in a shorter treatment time and with better targeting accuracy.

Siegel R, Naishadham D, Jemal A: Cancer statistics, 2012. CA Cancer J Clin 2012, 62: 10-29. 10.3322/caac.20138CrossRefPubMed

Shahbaz Sarwar CM, Luketich JD, Landreneau RJ, Abbas G: Esophageal cancer: an update. Int J Surg 2010, 8: 417-422. 10.1016/j.ijsu.2010.06.011CrossRefPubMed

Pantling AZ, Gossage JA, Mamidanna R, Newman G, Robinson A, Manifold DK, Hale PC: Outcomes from chemoradiotherapy for patients with esophageal cancer. Dis Esophagus 2011, 24: 172-176. 10.1111/j.1442-2050.2010.01121.xCrossRefPubMed

Zhang J, Peng F, Li N, Liu Y, Xu Y, Zhou L, Wang J, Zhu J, Huang M, Gong Y: Salvage concurrent radio-chemotherapy for post-operative local recurrence of squamous-cell esophageal cancer. Radiat Oncol 2012, 7: 93. 10.1186/1748-717X-7-93CrossRefPubMedPubMedCentral

Tu L, Sun L, Xu Y, Wang Y, Zhou L, Liu Y, Zhu J, Peng F, Wei Y, Gong Y: Paclitaxel and cisplatin combined with intensity-modulated radiotherapy for upper esophageal carcinoma. Radiat Oncol 2013, 8: 75. 10.1186/1748-717X-8-75CrossRefPubMedPubMedCentral

Fakhrian K, Gamisch N, Schuster T, Thamm R, Molls M, Geinitz H: Salvage radiotherapy in patients with recurrent esophageal carcinoma. Strahlenther Onkol 2012, 188: 136-142. 10.1007/s00066-011-0023-xCrossRefPubMed

Wang S, Liao Z, Wei X, Liu HH, Tucker SL, Hu C, Ajani JA, Phan A, Swisher SG, Mohan R, Cox JD, Komaki R: Association between systemic chemotherapy before chemoradiation and increased risk of treatment-related pneumonitis in esophageal cancer patients treated with definitive chemoradiotherapy. J Thorac Oncol 2008, 3: 277-282. 10.1097/JTO.0b013e3181653ca6CrossRefPubMed

Mizumoto M, Sugahara S, Nakayama H, Hashii H, Nakahara A, Terashima H, Okumura T, Tsuboi K, Tokuuye K, Sakurai H: Clinical results of proton-beam therapy for locoregionally advanced esophageal cancer. Strahlenther Onkol 2010, 186: 482-488. 10.1007/s00066-010-2079-4CrossRefPubMed

Vosmik M, Petera J, Sirak I, Hodek M, Paluska P, Dolezal J, Kopacova M: Technological advances in radiotherapy for esophageal cancer. World J Gastroenterol 2010, 16: 5555-5564. 10.3748/wjg.v16.i44.5555CrossRefPubMedPubMedCentral

10.

Benthuysen L, Hales L, Podgorsak MB: Volumetric modulated arc therapy vs. IMRT for the treatment of distal esophageal cancer. Med Dosim 2011, 36: 404-409. 10.1016/j.meddos.2010.09.009CrossRefPubMed

11.

Vivekanandan N, Sriram P, Kumar SA, Bhuvaneswari N, Saranya K: Volumetric modulated arc radiotherapy for esophageal cancer. Med Dosim 2012, 37: 108-113. 10.1016/j.meddos.2011.01.008CrossRefPubMed

12.

Martin S, Chen JZ, Rashid Dar A, Yartsev S: Dosimetric comparison of helical tomotherapy, RapidArc, and a novel IMRT & Arc technique for esophageal carcinoma. Radiother Oncol 2011, 101: 431-437. 10.1016/j.radonc.2011.08.030CrossRefPubMed

13.

Yin Y, Chen J, Xing L, Dong X, Liu T, Lu J, Yu J: Applications of IMAT in cervical esophageal cancer radiotherapy: a comparison with fixed-field IMRT in dosimetry and implementation. J Appl Clin Med Phys 2011, 12: 48-57.

14.

Wang PM, Hsu WC, Chung NN, Chang FL, Fogliata A, Cozzi L: Radiation treatment with volumetric modulated arc therapy of hepatocellular carcinoma patients. Early clinical outcome and toxicity profile from a retrospective analysis of 138 patients. Radiat Oncol 2012, 7: 207. 10.1186/1748-717X-7-207CrossRefPubMedPubMedCentral

15.

Richetti A, Fogliata A, Clivio A, Nicolini G, Pesce G, Salati E, Vanetti E, Cozzi L: Neo-adjuvant chemo-radiation of rectal cancer with volumetric modulated arc therapy: summary of technical and dosimetric features and early clinical experience. Radiat Oncol 2010, 5: 14. 10.1186/1748-717X-5-14CrossRefPubMedPubMedCentral

16.

Pesce GA, Clivio A, Cozzi L, Nicolini G, Richetti A, Salati E, Valli M, Vanetti E, Fogliata A: Early clinical experience of radiotherapy of prostate cancer with volumetric modulated arc therapy. Radiat Oncol 2010, 5: 54. 10.1186/1748-717X-5-54CrossRefPubMedPubMedCentral

17.

Wolff HA, Wagner DM, Christiansen H, Hess CF, Vorwerk H: Single fraction radiosurgery using Rapid Arc for treatment of intracranial targets. Radiat Oncol 2010, 5: 77. 10.1186/1748-717X-5-77CrossRefPubMedPubMedCentral

18.

Scorsetti M, Alongi F, Fogliata A, Pentimalli S, Navarria P, Lobefalo F, Garcia-Etienne C, Clivio A, Cozzi L, Mancosu P, Nicolini G, Vanetti E, Eboli M, Rossetti C, Rubino A, Sagona A, Arcangeli S, Gatzemeier W, Masci G, Torrisi R, Testori A, Alloisio M, Santoro A, Tinterri C: Phase I-II study of hypofractionated simultaneous integrated boost using volumetric modulated arc therapy for adjuvant radiation therapy in breast cancer patients: a report of feasibility and early toxicity results in the first 50 treatments. Radiat Oncol 2012, 7: 145. 10.1186/1748-717X-7-145CrossRefPubMedPubMedCentral

19.

Sriram P, Syamkumar SA, Kumar JS, Prabakar S, Dhanabalan R, Vivekanandan N: Adaptive volumetric modulated arc treatment planning for esophageal cancers using cone beam computed tomography. Phys Med 2012, 28: 327-332. 10.1016/j.ejmp.2011.10.006CrossRefPubMed

20.

Yamashita H, Kida S, Sakumi A, Haga A, Ito S, Onoe T, Okuma K, Ino K, Akahane M, Ohtomo K, Nakagawa K: Four-dimensional measurement of the displacement of internal fiducial markers during 320-multislice computed tomography scanning of thoracic esophageal cancer. Int J Radiat Oncol Biol Phys 2011, 79: 588-595. 10.1016/j.ijrobp.2010.03.045CrossRefPubMed

21.

Lorchel F, Dumas JL, Noël A, Wolf D, Bosset JF, Aletti P: Esophageal cancer: determination of internal target volume for conformal radiotherapy. Radiother Oncol 2006, 80: 327-332. 10.1016/j.radonc.2006.08.003CrossRefPubMed

22.

Wong JW, Sharpe MB, Jaffray DA, Kini VR, Robertson JM, Stromberg JS, Martinez AA: The use of active breathing control (ABC) to reduce margin for breathing motion. Int J Radiat Oncol Biol Phys 1999, 44: 911-919. 10.1016/S0360-3016(99)00056-5CrossRefPubMed

23.

Patel AA, Wolfgang JA, Niemierko A, Hong TS, Yock T, Choi NC: Implications of respiratory motion as measured by four-dimensional computed tomography for radiation treatment planning of esophageal cancer. Int J Radiat Oncol Biol Phys 2009, 74: 290-296. 10.1016/j.ijrobp.2008.12.060CrossRefPubMed

24.

Asakura H, Hashimoto T, Zenda S, Harada H, Hirakawa K, Mizumoto M, Furutani K, Hironaka S, Fuji H, Murayama S, Boku N, Nishimura T: Analysis of dose-volume histogram parameters for radiation pneumonitis after definitive concurrent chemoradiotherapy for esophageal cancer. Radiother Oncol 2010, 95: 240-244. 10.1016/j.radonc.2010.02.006CrossRefPubMed

25.

Cilla S, Macchia G, Digesù C, Deodato F, Romanella M, Ferrandina G, Padula GD, Picardi V, Scambia G, Piermattei A, Morganti AG: 3D-Conformal versus intensity-modulated postoperative radiotherapy of vaginal vault: a dosimetric comparison. Med Dosim 2010, 35: 135-142. 10.1016/j.meddos.2009.04.003CrossRefPubMed

26.

Blom Goldman U, Wennberg B, Svane G, Bylund H, Lind P: Reduction of radiation pneumonitis by V20-constraints in breast cancer. Radiat Oncol 2010, 5: 99. 10.1186/1748-717X-5-99CrossRefPubMed

27.

Vogelius IR, Bentzen SM: A literature-based meta-analysis of clinical risk factors for development of radiation induced pneumonitis. Acta Oncol 2012, 51: 975-983. 10.3109/0284186X.2012.718093CrossRefPubMedPubMedCentral

28.

Dang J, Li G, Ma L, Diao R, Zang S, Han C, Zhang S, Yao L: Predictors of grade ≥ 2 and grade ≥ 3 radiation pneumonitis in patients with locally advanced non-small cell lung cancer treated with three-dimensional conformal radiotherapy. Acta Oncol 2012, 52: 1175-1180.CrossRefPubMed

29.

Yang GY, McClosky SA, Khushalani NI: Principles of modern radiation techniques for esophageal and gastroesophageal junction cancers. Gastrointest Cancer Res 2009,3(2 Suppl):S6-S10.PubMedPubMedCentral

30.

Schallenkamp JM, Miller RC, Brinkmann DH, Foote T, Garces YI: Incidence of radiation pneumonitis after thoracic irradiation: dose-volume correlates. Int J Radiat Oncol Biol Phys 2007, 67: 410-416. 10.1016/j.ijrobp.2006.09.030CrossRefPubMed

31.

Wang SL, Liao Z, Vaporciyan AA, Tucker SL, Liu H, Wei X, Swisher S, Ajani JA, Cox JD, Komaki R: Investigation of clinical and dosimetric factors associated with postoperative pulmonary complications in esophageal cancer patients treated with concurrent chemoradiotherapy followed by surgery. Int J Radiat Oncol Biol Phys 2006, 64: 692-699. 10.1016/j.ijrobp.2005.08.002CrossRefPubMed

32.

Vogelius IS, Westerly DC, Cannon GM, Bentzen SM: Hypofractionation does not increase radiation pneumonitis risk with modern conformal radiation delivery techniques. Acta Oncol 2010, 49: 1052-1057. 10.3109/0284186X.2010.498835CrossRefPubMed

33.

Gong GZ, Yin Y, Xing LG, Guo YJ, Liu T, Chen J, Lu J, Ma C, Sun T, Bai T, Zhang G, Wang R: RapidArc combined with the active breathing coordinator provides an effective and accurate approach for the radiotherapy of hepatocellular carcinoma. Strahlenther Onkol 2012, 188: 262-268. 10.1007/s00066-011-0044-5CrossRefPubMed

34.

Guckenberger M, Richter A, Krieger T, Wilbert J, Baier K, Flentje M: Is a single arc sufficient in volumetric-modulated arc therapy (VMAT) for complex-shaped target volumes? Radiother Oncol 2009, 93: 259-265. 10.1016/j.radonc.2009.08.015CrossRefPubMed

35.

Paumier A, Ghalibafian M, Gilmore J, Beaudre A, Blanchard P, el Nemr M, Azoury F, al Hamokles H, Lefkopoulos D, Girinsky T: Dosimetric benefits of intensity-modulated radiotherapy combined with the deep-inspiration breath-hold technique in patients with mediastinal Hodgkin’s lymphoma. Int J Radiat Oncol Biol Phys 2012, 82: 1522-1527. 10.1016/j.ijrobp.2011.05.015CrossRefPubMed

36.

Liao Z, Cox JD, Komaki R: Radiochemotherapy of esophageal cancer. J Thorac Oncol 2007, 2: 553-568. 10.1097/01.JTO.0000275339.62831.5eCrossRefPubMed

37.

Pasler M, Wirtz H, Lutterbach J: Impact of gantry rotation time on plan quality and dosimetric verification–volumetric modulated arc therapy (VMAT) vs. intensity modulated radiotherapy (IMRT). Strahlenther Onkol 2011, 187: 812-819. 10.1007/s00066-011-2263-1CrossRefPubMed

38.

Wolf M, Zehentmayr F, Niyazi M, Ganswindt U, Haimerl W, Schmidt M, Hölzel D, Belka C: Long-term outcome of mitomycin C– and 5-FU-based primary radiochemotherapy for esophageal cancer. Strahlenther Onkol 2010, 186: 374-381. 10.1007/s00066-010-2137-yCrossRefPubMed

39.

Patonay P, Naszály A, Mayer A: Simultaneous radiochemotherapy and endoluminal HDR brachytherapy in esophageal cancer. Strahlenther Onkol 2007, 183: 94-98. 10.1007/s00066-007-1606-4CrossRefPubMed

Title: Reduced lung dose during radiotherapy for thoracic esophageal carcinoma: VMAT combined with active breathing control for moderate DIBH
Authors: Guanzhong Gong
Ruozheng Wang
Yujie Guo
Deyin Zhai
Tonghai Liu
Jie Lu
Jinhu Chen
Chengxin Liu
Yong Yin
Publication date: 01-12-2013
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2013
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-8-291

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Reduced lung dose during radiotherapy for thoracic esophageal carcinoma: VMAT combined with active breathing control for moderate DIBH

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2013

In vitro study of combined cilengitide and radiation treatment in breast cancer cell lines

Stereotactic body radiation therapy with concurrent full-dose gemcitabine for locally advanced pancreatic cancer: a pilot trial demonstrating safety

Patterns of failure in patients with locally advanced rectal cancer receiving pre-operative or post-operative chemoradiotherapy

A phase I study on combined therapy with proton-beam radiotherapy and in situ tumor vaccination for locally advanced recurrent hepatocellular carcinoma

Integration method of 3D MR spectroscopy into treatment planning system for glioblastoma IMRT dose painting with integrated simultaneous boost

FDG uptake heterogeneity in FIGO IIb cervical carcinoma does not predict pelvic lymph node involvement