Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Radiation Oncology
Published in: Radiation Oncology 1/2018

Open Access 01-12-2018 | Research

Efficacy of virtual block objects in reducing the lung dose in helical tomotherapy planning for cervical oesophageal cancer: a planning study

Authors: Makoto Ito, Hidetoshi Shimizu, Takahiro Aoyama, Hiroyuki Tachibana, Natsuo Tomita, Chiyoko Makita, Yutaro Koide, Daiki Kato, Tsuneo Ishiguchi, Takeshi Kodaira

Published in: Radiation Oncology | Issue 1/2018

Login to get access

Abstract

Background

Intensity-modulated radiotherapy is useful for cervical oesophageal carcinoma (CEC); however, increasing low-dose exposure to the lung may lead to radiation pneumonitis. Nevertheless, an irradiation technique that avoids the lungs has never been examined due to the high difficulty of dose optimization. In this study, we examined the efficacy of helical tomotherapy that can restrict beamlets passing virtual blocks during dose optimization computing (block plan) in reducing the lung dose.

Methods

Fifteen patients with CEC were analysed. The primary/nodal lesion and prophylactic nodal region with adequate margins were defined as the planning target volume (PTV)-60 Gy and PTV-48 Gy, respectively. Nineteen plans per patient were made and compared (total: 285 plans), including non-block and block plans with several shapes and sizes.

Results

The most appropriate block model was semi-circular, 8 cm outside of the tracheal bifurcation, with a significantly lower lung dose compared to that of non-block plans; the mean lung volumes receiving 5 Gy, 10 Gy, 20 Gy, and the mean lung dose were 31.3% vs. 48.0% (p <  0.001), 22.4% vs. 39.4% (p <  0.001), 13.2% vs. 16.0% (p = 0.028), and 7.1 Gy vs. 9.6 Gy (p <  0.001), respectively. Both the block and non-block plans were comparable in terms of the homogeneity and conformity indexes of PTV-60 Gy: 0.05 vs. 0.04 (p = 0.100) and 0.82 vs. 0.85 (p = 0.616), respectively. The maximum dose of the spinal cord planning risk volume increased slightly (49.4 Gy vs. 47.9 Gy, p = 0.002). There was no significant difference in the mean doses to the heart and the thyroid gland. Prolongation of the delivery time was less than 1 min (5.6 min vs. 4.9 min, p = 0.010).

Conclusions

The block plan for CEC could significantly reduce the lung dose, with acceptable increment in the spinal dose and a slightly prolonged delivery time.
Literature
1.
Tachimori Y, Ozawa S, Numasaki H, Fujishiro M, Matsubara H, Oyama T, Shinoda M, Toh Y, Udagawa H, Uno T. Registration Committee for Esophageal Cancer of the Japan esophageal S: comprehensive registry of esophageal Cancer in Japan, 2009. Esophagus. 2016;13:110–37.CrossRefPubMedPubMedCentral
2.
Zenda S, Kojima T, Kato K, Izumi S, Ozawa T, Kiyota N, Katada C, Tsushima T, Ito Y, Akimoto T, et al. Multicenter phase 2 study of Cisplatin and 5-fluorouracil with concurrent radiation therapy as an organ preservation approach in patients with Squamous cell carcinoma of the cervical esophagus. Int J Radiat Oncol Biol Phys. 2016;96:976–84.CrossRefPubMed
3.
McDowell LJ, Huang SH, Xu W, Che J, RKS W, Brierley J, Kim J, Cummings B, Waldron J, Bayley A, et al. Effect of intensity modulated radiation therapy with concurrent chemotherapy on survival for patients with cervical esophageal carcinoma. Int J Radiat Oncol Biol Phys. 2017;98:186–95.CrossRefPubMed
4.
Cao CN, Luo JW, Gao L, Xu GZ, Yi JL, Huang XD, Wang K, Zhang SP, Qu Y, Li SY, et al. Intensity-modulated radiotherapy for cervical esophageal squamous cell carcinoma: clinical outcomes and patterns of failure. Eur Arch Otorhinolaryngol. 2016;273:741–7.CrossRefPubMed
5.
Zhang P, Xi M, Zhao L, Qiu B, Liu H, Hu YH, Liu MZ. Clinical efficacy and failure pattern in patients with cervical esophageal cancer treated with definitive chemoradiotherapy. Radiother Oncol. 2015;116:257–61.CrossRefPubMed
6.
Fenkell L, Kaminsky I, Breen S, Huang S, Van Prooijen M, Ringash J. Dosimetric comparison of IMRT vs. 3D conformal radiotherapy in the treatment of cancer of the cervical esophagus. Radiother Oncol. 2008;89:287–91.CrossRefPubMed
7.
van Vulpen M, Field C, Raaijmakers CP, Parliament MB, Terhaard CH, MacKenzie MA, Scrimger R, Lagendijk JJ, Fallone BG. Comparing step-and-shoot IMRT with dynamic helical tomotherapy IMRT plans for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2005;62:1535–9.CrossRefPubMed
8.
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;12:3343.CrossRefPubMed
9.
Gao M, Li Q, Ning Z, Gu W, Huang J, Mu J, Pei H. Dosimetric comparison between step-shoot intensity-modulated radiotherapy and volumetric-modulated arc therapy for upper thoracic and cervical esophageal carcinoma. Med Dosim. 2016;41:131–5.CrossRefPubMed
10.
Ito M, Kodaira T, Tachibana H, Tomita N, Makita C, Koide Y, Kato D, Abe T, Muro K, Tajika M, et al. Clinical results of definitive chemoradiotherapy for cervical esophageal cancer: comparison of failure pattern and toxicities between intensity-modulated radiotherapy and 3-dimensional conformal radiotherapy. Head Neck. 2017;39:2406–15.CrossRefPubMed
11.
Shaikh T, Churilla TM, Monpara P, Scott WJ, Cohen SJ, Meyer JE. Risk of radiation pneumonitis in patients receiving taxane-based trimodality therapy for locally advanced esophageal cancer. Pract Radiat Oncol. 2016;6:388–94.CrossRefPubMedPubMedCentral
12.
Tanabe S, Myojin M, Shimizu S, Fujino M, Takahashi H, Shirato H, Ito YM, Ishikawa M, Hosokawa M. Dose-volume analysis for respiratory toxicity in intrathoracic esophageal cancer patients treated with definitive chemoradiotherapy using extended fields. J Radiat Res. 2013;54:1085–94.CrossRefPubMedPubMedCentral
13.
Nomura M, Kodaira T, Furutani K, Tachibana H, Tomita N, Goto Y. Predictive factors for radiation pneumonitis in oesophageal cancer patients treated with chemoradiotherapy without prophylactic nodal irradiation. Br J Radiol. 2012;85:813–8.CrossRefPubMedPubMedCentral
14.
Chang CH, Mok GS, Shueng PW, Yeh HP, Shiau AC, Tien HJ, Lin CT, Wu TH. Fan-shaped complete block on helical tomotherapy for esophageal cancer: a phantom study. Biomed Res Int. 2015;2015:959504.PubMedPubMedCentral
15.
16.
Society JE. Japanese classification of esophageal Cancer, 11th edition: part I. Esophagus. 2017;14(1):1–36.
17.
Binny D, Lancaster CM, Harris S, Sylvander SR. Effects of changing modulation and pitch parameters on tomotherapy delivery quality assurance plans. J Appl Clin Med Phys. 2015;16:5282.CrossRef
18.
Tsujino K, Hashimoto T, Shimada T, Yoden E, Fujii O, Ota Y, Satouchi M, Negoro S, Adachi S, Soejima T. Combined analysis of V20, VS5, pulmonary fibrosis score on baseline computed tomography, and patient age improves prediction of severe radiation pneumonitis after concurrent chemoradiotherapy for locally advanced non-small-cell lung cancer. J Thorac Oncol. 2014;9:983–90.CrossRefPubMed
19.
Paddick I. A simple scoring ratio to index the conformity of radiosurgical treatment plans. Technical note. J Neurosurg. 2000;93(Suppl 3):219–22.PubMed
20.
Das IJ, Andersen A, Chen ZJ, Dimofte A, Glatstein E, Hoisak J, Huang L, Langer MP, Lee C, Pacella M, et al. State of dose prescription and compliance to international standard (ICRU-83) in intensity modulated radiation therapy among academic institutions. Pract Radiat Oncol. 2017;7:e145–55.CrossRefPubMed
21.
Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2013;48:452–8.CrossRefPubMed
22.
Roeder F, Nicolay NH, Nguyen T, Saleh-Ebrahimi L, Askoxylakis V, Bostel T, Zwicker F, Debus J, Timke C, Huber PE. Intensity modulated radiotherapy (IMRT) with concurrent chemotherapy as definitive treatment of locally advanced esophageal cancer. Radiat Oncol. 2014;9:191.CrossRefPubMedPubMedCentral
23.
Lin SH, Wang L, Myles B, Thall PF, Hofstetter WL, Swisher SG, Ajani JA, Cox JD, Komaki R, Liao Z. Propensity score-based comparison of long-term outcomes with 3-dimensional conformal radiotherapy vs intensity-modulated radiotherapy for esophageal cancer. Int J Radiat Oncol Biol Phys. 2012;84:1078–85.CrossRefPubMedPubMedCentral
24.
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;101:431–7.CrossRefPubMed
25.
Yin L, Wu H, Gong J, Geng JH, Jiang F, Shi AH, Yu R, Li YH, Han SK, Xu B, Zhu GY. Volumetric-modulated arc therapy vs. c-IMRT in esophageal cancer: a treatment planning comparison. World J Gastroenterol. 2012;18:5266–75.CrossRefPubMedPubMedCentral
26.
Wang YC, Chen SW, Chien CR, Hsieh TC, Yu CY, Kuo YC, Yang SN, Kao CH, Liang JA. Radiotherapy for esophageal cancer using simultaneous integrated boost techniques: dosimetric comparison of helical TomoTherapy, volumetric-modulated arc therapy (RapidArc) and dynamic intensity-modulated radiotherapy. Technol Cancer Res Treat. 2013;12:485–91.CrossRefPubMed
27.
Lin JC, Tsai JT, Chang CC, Jen YM, Li MH, Liu WH. Comparing treatment plan in all locations of esophageal cancer: volumetric modulated arc therapy versus intensity-modulated radiotherapy. Medicine (Baltimore). 2015;94:e750.CrossRef
28.
Hirano S, Nagahara K, Moritani S, Kitamura M, Takagita S. Upper mediastinal node dissection for hypopharyngeal and cervical esophageal carcinomas. Ann Otol Rhinol Laryngol. 2007;116:290–6.CrossRefPubMed
29.
Yang H, Feng C, Cai BN, Yang J, Liu HX, Ma L. Comparison of three-dimensional conformal radiation therapy, intensity-modulated radiation therapy, and volumetric-modulated arc therapy in the treatment of cervical esophageal carcinoma. Dis Esophagus. 2017;30(2):1–8.PubMedCentral
30.
Franco P, Catuzzo P, Cante D, La Porta MR, Sciacero P, Girelli G, Casanova Borca V, Pasquino M, Numico G, Tofani S, et al. TomoDirect: an efficient means to deliver radiation at static angles with tomotherapy. Tumori. 2011;97:498–502.CrossRefPubMed
31.
Murai T, Shibamoto Y, Manabe Y, Murata R, Sugie C, Hayashi A, Ito H, Miyoshi Y. Intensity-modulated radiation therapy using static ports of tomotherapy (TomoDirect): comparison with the TomoHelical mode. Radiat Oncol. 2013;8:68.CrossRefPubMedPubMedCentral
Metadata
Title
Efficacy of virtual block objects in reducing the lung dose in helical tomotherapy planning for cervical oesophageal cancer: a planning study
Authors
Makoto Ito
Hidetoshi Shimizu
Takahiro Aoyama
Hiroyuki Tachibana
Natsuo Tomita
Chiyoko Makita
Yutaro Koide
Daiki Kato
Tsuneo Ishiguchi
Takeshi Kodaira
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2018
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-018-1012-3

Other articles of this Issue 1/2018

Radiation Oncology 1/2018 Go to the issue

Research

Evaluation of particle radiotherapy for the re-irradiation of recurrent intracranial meningioma

Research

Optimized radiotherapy to improve clinical outcomes for locally advanced lung cancer

Study protocol

ONE SHOT - single shot radiotherapy for localized prostate cancer: study protocol of a single arm, multicenter phase I/II trial

Research

Stereotactic ablative radiotherapy for ultra-central lung tumors: prioritize target coverage or organs at risk?

Research

Optimal collimator rotation based on the outline of multiple brain targets in VMAT

Research

Radiation-induced parotid changes in oropharyngeal cancer patients: the role of early functional imaging and patient−/treatment-related factors