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adaptive radiotherapy

G Guidi, N Maffei, B Meduri, E D'Angelo, G M Mistretta, P Ceroni, A Ciarmatori, A Bernabei, S Maggi, M Cardinali, V E Morabito, F Rosica, S Malara, A Savini, G Orlandi, C D'Ugo, F Bunkheila, M Bono, S Lappi, C Blasi, F Lohr, T Costi
PURPOSE: To predict patients who would benefit from adaptive radiotherapy (ART) and re-planning intervention based on machine learning from anatomical and dosimetric variations in a retrospective dataset. MATERIALS AND METHODS: 90 patients (pts) treated for head-neck cancer (H&N) formed a multicenter data-set. 41 H&N pts (45.6%) were considered for learning; 49 pts (54.4%) were used to test the tool. A homemade machine-learning classifier was developed to analyze volume and dose variations of parotid glands (PG)...
October 17, 2016: Physica Medica: PM
Irene Göllnitz, Johanna Inhestern, Thomas G Wendt, Jens Buentzel, Dirk Esser, Daniel Böger, Andreas H Mueller, Jörn-Uwe Piesold, Stefan Schultze-Mosgau, Ekkehard Eigendorff, Peter Schlattmann, Orlando Guntinas-Lichius
To examine the impact of comorbidity on overall survival (OS) in a population-based study of patients with head and neck cancer who were treated between 2009 and 2011. Data of 1094 patients with primary head and neck carcinomas without distant metastasis from the Thuringian cancer registries were evaluated concerning the influence of patient's characteristics and comorbidity on OS. Data on comorbidity prior to head and neck cancer diagnosis was adapted to the Charlson Comorbidity (CCI), age-adjusted CCI (ACCI), head and neck CCI (HNCCI), simplified comorbidity score (SCS), and to the Adult Comorbidity Evaluation-27 (ACE-27)...
October 11, 2016: Cancer Medicine
Y Luo, Y Qin, J Lang
PURPOSE: Limited data have been published regarding the effect of adaptive radiotherapy (ART) on clinical outcome in patients with nasopharyngeal carcinoma (NPC). We compared the long-term outcomes in patients with locally advanced NPC treated by adaptive intensity-modulated radiotherapy (IMRT) replanning versus IMRT. METHODS: 200 NPC patients with stage T3/T4 were included between October 2004 and November 2010. Patients in both treatment groups were matched using propensity score matching method at the ratio of 1:1...
October 7, 2016: Clinical & Translational Oncology
Guozi Yang, Dehai Yu, Wei Li, Yuguang Zhao, Xue Wen, Xinyue Liang, Xiaoying Zhang, Lei Zhou, Jifan Hu, Chao Niu, Huimin Tian, Fujun Han, Xiao Chen, Lihua Dong, Lu Cai, Jiuwei Cui
Low-dose radiation (LDR) induces hormesis and adaptive response in normal cells but not in cancer cells, suggesting its potential protection of normal tissue against damage induced by conventional radiotherapy. However, the underlying mechanisms are not well established. We addressed this in the present study by examining the role of the ataxia telangiectasia mutated (ATM) signaling pathway in response to LDR using A549 human lung adenocarcinoma cells and HBE135-E6E7 (HBE) normal lung epithelial cells. We found that LDR-activated ATM was the initiating event in hormesis and adaptive response to LDR in HBE cells...
September 30, 2016: Oncotarget
Hidehito Horinouchi
A number of promising new approaches for both local and systemic control of locally advanced non-small cell lung cancer have been examined in clinical trials, aimed at improving the patient survival. Development of better systemic therapies by adopting newer agents (such as epidermal growth factor receptor-tyrosine kinase inhibitors and immune checkpoint inhibitors) from advanced non-small cell lung cancer is mandatory. As for radiotherapy, adaptive radiotherapy and proton therapy are under investigation after the RTOG 0617 trial unexpectedly failed to show the efficacy of high-dose radiotherapy for Stage III disease...
October 4, 2016: Japanese Journal of Clinical Oncology
E Onjukka, J Uzan, C Baker, L Howard, A Nahum, I Syndikus
AIMS: For patients with high-risk, locally bulky prostate cancer, an intra-prostatic boost to tumour volumes (dose-painting) offers a risk-adapted dose escalation. We evaluated the feasibility of hypofractionated dose-painting radiotherapy and the associated toxicity. The possibility to streamline a radiobiologically optimised planning protocol was also investigated. MATERIALS AND METHODS: Twenty-eight patients were treated using a dose-painting approach; boost volumes were identified with functional magnetic resonance imaging scans...
September 29, 2016: Clinical Oncology: a Journal of the Royal College of Radiologists
Claudio Agostinelli, Andrea Gallamini, Luisa Stracqualursi, Patrizia Agati, Claudio Tripodo, Fabio Fuligni, Maria Teresa Sista, Stefano Fanti, Alberto Biggi, Umberto Vitolo, Luigi Rigacci, Francesco Merli, Caterina Patti, Alessandra Romano, Alessandro Levis, Livio Trentin, Caterina Stelitano, Anna Borra, Pier Paolo Piccaluga, Stephen Hamilton-Dutoit, Peter Kamper, Jan Maciej Zaucha, Bogdan Małkowski, Waldemar Kulikowski, Joanna Tajer, Edyta Subocz, Justyna Rybka, Christian Steidl, Alessandro Broccoli, Lisa Argnani, Randy D Gascoyne, Francesco d'Amore, Pier Luigi Zinzani, Stefano A Pileri
BACKGROUND: Early-interim fluorodeoxyglucose (FDG)-PET scan after two ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) chemotherapy courses (PET-2) represents the most effective predictor of treatment outcome in classical Hodgkin's lymphoma. We aimed to assess the predictive value of PET-2 combined with tissue biomarkers in neoplastic and microenvironmental cells for this disease. METHODS: We enrolled 208 patients with classical Hodgkin's lymphoma and treated with ABVD (training set), from Jan 1, 2002, to Dec 31, 2009, and validated the results in a fully matched independent cohort of 102 patients with classical Hodgkin's lymphoma (validation set), enrolled from Jan 1, 2008, to Dec 31, 2012...
October 2016: Lancet Haematology
Jayant S Vaidya, Frederik Wenz, Max Bulsara, Jeffrey S Tobias, David J Joseph, Christobel Saunders, Chris Brew-Graves, Ingrid Potyka, Stephen Morris, Hrisheekesh J Vaidya, Norman R Williams, Michael Baum
BACKGROUND: Based on our laboratory work and clinical trials we hypothesised that radiotherapy after lumpectomy for breast cancer could be restricted to the tumour bed. In collaboration with the industry we developed a new radiotherapy device and a new surgical operation for delivering single-dose radiation to the tumour bed - the tissues at highest risk of local recurrence. We named it TARGeted Intraoperative radioTherapy (TARGIT). From 1998 we confirmed its feasibility and safety in pilot studies...
September 2016: Health Technology Assessment: HTA
U Leiter, R Gutzmer, M Alter, C Ulrich, A S Lonsdorf, M M Sachse, U Hillen
Squamous cell carcinoma (SCC) of the skin accounts for 20 % of non-melanoma skin cancer and is one of the most frequent types of cancer in Caucasian populations. Diagnosis is based on the clinical features and should be histopathologically confirmed to adequately address the prognosis and treatment. Complete surgical excision with histopathological control of excision margins is the gold standard in the treatment of primary SCC. Sentinel lymph node biopsies (SLNB) can be considered in SCC with a tumor thickness of >6 mm but there is currently no evidence concerning prognostic and therapeutic effects...
September 28, 2016: Der Hautarzt; Zeitschrift Für Dermatologie, Venerologie, und Verwandte Gebiete
J Kriz, C Baues, R Engenhart-Cabillic, U Haverkamp, K Herfarth, P Lukas, H Schmidberger, S Marnitz-Schulze, M Fuchs, A Engert, H T Eich
INTRODUCTION: Field design changed substantially from extended-field RT (EF-RT) to involved-field RT (IF-RT) and now to involved-node RT (IN-RT) and involved-site RT (IS-RT) as well as treatment techniques in radiotherapy (RT) of Hodgkin's lymphoma (HL). The purpose of this article is to demonstrate the establishment of a quality assurance program (QAP) including modern RT techniques and field designs within the German Hodgkin Study Group (GHSG). METHODS: In the era of modern conformal RT, this QAP had to be fundamentally adapted and a new evaluation process has been intensively discussed by the radiotherapeutic expert panel of the GHSG...
September 27, 2016: Strahlentherapie und Onkologie: Organ der Deutschen Röntgengesellschaft ... [et Al]
Anne-Sophie Dolez, Azahara Alcantara, Romain Mouny
The Montévrain clinic wants to be a medical center oriented towards autonomy and recovery of patient autonomy, reintegration within the family, as well as social and professional reintegration. After studying the care offer and the population base in Seine et Marne, we wanted to get involved in order to improve the capacity of patients treated for breast cancer, suffering deconditioning, with or without joint limitation and functional impairment, with or without a mental deterioration. We studied the recommendations of the "plan cancer III", researched the tertiary phase of cancer treatment and studied literature about evaluation of the physical and mental condition...
September 2016: Annals of Physical and Rehabilitation Medicine
Bivas Biswas, Sameer Bakhshi
Ewing sarcoma family tumors (ESFT) are heterogeneous, aggressive group of disease with peak incidence in adolescent and young adults. The outcome has been improved dramatically from 10% with surgery and radiotherapy alone to 65%-70% now, in localized disease, with the introduction of chemotherapy. Chemotherapy regimen evolved from single agent to multiagent with effort of many cooperative clinical trials over decades. The usual treatment protocol include introduction of multi-agent chemotherapy in neoadjuvant setting to eradicate systemic disease with timely incorporation of surgery and/or radiotherapy as local treatment modality and further adjuvant chemotherapy to prevent recurrence...
September 18, 2016: World Journal of Orthopedics
Prabhjot Juneja, Vincent Caillet, Tom Shaw, Judith Martland, Jeremy T Booth
This study presents estimation of typical kV fluoroscopic imaging doses for image-guided real-time adaptive radiotherapy. For a cohort of 10 lung SABR patients the estimated imaging dose to ipsi-lateral lung with real-time adaptation is 9.9-15.1cGy, which is less than the extra lung dose from treatment with potentially larger ITV-based PTV approach.
September 20, 2016: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Fleur Huang, Amy Driga, Bronwen E LeGuerrier, Renée Schmitz, Debra M Hall-Lavoie, Xanthoula Kostaras, Karen P Chu, Edith Pituskin, Sharon M Watanabe, Alysa Fairchild
Caring for patients with incurable cancer presents unique challenges. Managing symptoms that evolve with changing clinical status and, at the same time, ensuring alignment with patient goals demands specific attention from clinicians. With care needs that often transcend traditional service provision boundaries, patients who seek palliation commonly interface with a team of providers that represents multiple disciplines across multiple settings. In this case study, we explore some of the dynamics of a cross-disciplinary approach to symptom management in an integrated outpatient radiotherapy service model...
September 20, 2016: Journal of Oncology Practice
Jeremy T Booth, Vincent Caillet, Nicholas Hardcastle, Ricky O'Brien, Kathryn Szymura, Charlene Crasta, Benjamin Harris, Carol Haddad, Thomas Eade, Paul J Keall
BACKGROUND AND PURPOSE: Real time adaptive radiotherapy that enables smaller irradiated volumes may reduce pulmonary toxicity. We report on the first patient treatment of electromagnetic-guided real time adaptive radiotherapy delivered with MLC tracking for lung stereotactic ablative body radiotherapy. MATERIALS AND METHODS: A clinical trial was developed to investigate the safety and feasibility of MLC tracking in lung. The first patient was an 80-year old man with a single left lower lobe lung metastasis to be treated with SABR to 48Gy in 4 fractions...
September 17, 2016: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Daniel Markel, Ives Levesque, Joe Larkin, Pierre Léger, Issam El Naqa
At present, there exists few openly available methods for evaluation of simultaneous segmentation and registration algorithms. These methods allow for a combination of both techniques to track the tumor in complex settings such as adaptive radiotherapy. We have produced a quality assurance platform for evaluating this specific subset of algorithms using a preserved porcine lung in such that it is multi-modality compatible: positron emission tomography (PET), computer tomography (CT) and magnetic resonance imaging (MRI)...
October 7, 2016: Physics in Medicine and Biology
Fatemeh Saberian, Archis Ghate, Minsun Kim
Hypoxia, that is, insufficient oxygen partial pressure, is a known cause of reduced radiosensitivity in solid tumors, and especially in head-and-neck tumors. It is thus believed to adversely affect the outcome of fractionated radiotherapy. Oxygen partial pressure varies spatially and temporally over the treatment course and exhibits inter-patient and intra-tumor variation. Emerging advances in non-invasive functional imaging offer the future possibility of adapting radiotherapy plans to this uncertain spatiotemporal evolution of hypoxia over the treatment course...
October 7, 2016: Physics in Medicine and Biology
Ditte Sloth Møller, Marianne Ingerslev Holt, Markus Alber, Marie Tvilum, Azza Ahmed Khalil, Marianne Marquard Knap, Lone Hoffmann
BACKGROUND AND PURPOSE: Advanced lung cancer patients experience anatomical changes during radiotherapy. Uncorrected, these may lead to lower tumor dose, but can be corrected for by adaptive radiotherapy (ART). MATERIAL AND METHODS: Anatomical changes in 233 patients were monitored online on cone-beam CT-scans used for daily soft-tissue matching. If systematic changes above the pre-defined trigger criteria were observed, a new CT-scan, delineations, and treatment plan were made, restoring the intended dose distribution...
September 16, 2016: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Lars König, Alexander Derksen, Nils Papenberg, Benjamin Haas
BACKGROUND: Deformable image registration (DIR) is a key component in many radiotherapy applications. However, often resulting deformations are not satisfying, since varying deformation properties of different anatomical regions are not considered. To improve the plausibility of DIR in adaptive radiotherapy in the male pelvic area, this work integrates a local rigidity deformation model into a DIR algorithm. METHODS: A DIR framework is extended by constraints, enforcing locally rigid deformation behavior for arbitrary delineated structures...
2016: Radiation Oncology
Claus Rödel, Ralf Hofheinz, Emmanouil Fokas
The monolithic approach to apply the same schedule of preoperative 5-fluorouracil (5-FU)- or capecitabine-based chemoradiotherapy (CRT) to all patients with clinically staged TNM stage II/III rectal cancer need to be questioned. Five randomized trials have been completed to determine if the addition of oxaliplatin to preoperative 5-FU/capecitabine-based CRT offers an advantage compared with single-agent CRT. In contrast to the German CAO/ARO/AIO-04 trial, results from the ACCORD 12, STAR-01, PETACC-6 and NSAPB R-04 trials failed to demonstrate a significant improvement of early or late efficacy endpoints with the addition of oxaliplatin...
August 2016: Best Practice & Research. Clinical Gastroenterology
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