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Erschienen in:

06.09.2018 | Short Communication

Heart-sparing volumetric modulated arc therapy for whole lung irradiation

verfasst von: Alexandros Papachristofilou, Anna-Lena Hottinger, Oliver Weinhold, Yasar-Kemal Avcu, Tobias Finazzi, Tamara Diesch, Ulrich Schratzenstaller

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 1/2019

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Abstract

Purpose

Whole lung irradiation (WLI) is indicated for subgroups of patients with lung metastases from Wilms’ tumor (nephroblastoma). WLI has traditionally been performed with an anterior/posterior field arrangement with poor potential for heart sparing; thus, new techniques are desirable to achieve a lower dose to the heart.

Materials and methods

We utilized volumetric modulated arc therapy (VMAT) for WLI with 18 Gy in a patient with metastatic nephroblastoma. The planning results were compared against a three-dimensional (3D) conformal plan.

Results

VMAT resulted in adequate target volume coverage with the prescribed dose. Mean heart dose was 10.2 Gy. The dose to organs at risk (OAR) was generally more favorable with VMAT when compared with a 3D-conformal radiotherapy plan.

Discussion

WLI with VMAT provides superior sparing of OARs and especially a considerably lower dose to the heart.
Literatur
1.
Zurück zum Zitat D’Angio GJ et al (1976) The treatment of Wilms’ tumor: results of the national Wilms’ tumor study. Cancer 38:633–646CrossRefPubMed D’Angio GJ et al (1976) The treatment of Wilms’ tumor: results of the national Wilms’ tumor study. Cancer 38:633–646CrossRefPubMed
4.
Zurück zum Zitat Sasso G, Greco N, Murino P, Sasso FS (2010) Late toxicity in Wilms tumor patients treated with radiotherapy at 15 years of median follow-up. J Pediatr Hematol Oncol 32:e264–7CrossRefPubMed Sasso G, Greco N, Murino P, Sasso FS (2010) Late toxicity in Wilms tumor patients treated with radiotherapy at 15 years of median follow-up. J Pediatr Hematol Oncol 32:e264–7CrossRefPubMed
5.
Zurück zum Zitat World Medical Association (2013) World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 310:2191–2194CrossRef World Medical Association (2013) World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 310:2191–2194CrossRef
6.
Zurück zum Zitat Verschuur A et al (2012) Treatment of pulmonary metastases in children with stage IV nephroblastoma with risk-based use of pulmonary radiotherapy. J Clin Oncol 30:3533–3539CrossRefPubMed Verschuur A et al (2012) Treatment of pulmonary metastases in children with stage IV nephroblastoma with risk-based use of pulmonary radiotherapy. J Clin Oncol 30:3533–3539CrossRefPubMed
7.
Zurück zum Zitat Gagliardi G et al (2010) Radiation dose-volume effects in the heart. Int J Radiat Oncol Biol Phys 76:77–85CrossRef Gagliardi G et al (2010) Radiation dose-volume effects in the heart. Int J Radiat Oncol Biol Phys 76:77–85CrossRef
8.
Zurück zum Zitat Darby SC et al (2013) Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 368:987–998CrossRefPubMed Darby SC et al (2013) Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 368:987–998CrossRefPubMed
9.
Zurück zum Zitat Corradini S et al (2018) Left-sided breast cancer and risks of secondary lung cancer and ischemic heart disease: effects of modern radiotherapy techniques. Strahlenther Onkol 194:196–205CrossRefPubMed Corradini S et al (2018) Left-sided breast cancer and risks of secondary lung cancer and ischemic heart disease: effects of modern radiotherapy techniques. Strahlenther Onkol 194:196–205CrossRefPubMed
10.
Zurück zum Zitat Sakka M, Kunzelmann L, Metzger M, Grabenbauer GG (2017) Cardiac dose-sparing effects of deep-inspiration breath-hold in left breast irradiation. Strahlenther Onkol 193:800–811CrossRefPubMed Sakka M, Kunzelmann L, Metzger M, Grabenbauer GG (2017) Cardiac dose-sparing effects of deep-inspiration breath-hold in left breast irradiation. Strahlenther Onkol 193:800–811CrossRefPubMed
11.
Zurück zum Zitat Pein F et al (2004) Cardiac abnormalities 15 years and more after adriamycin therapy in 229 childhood survivors of a solid tumour at the Institut Gustave Roussy. Br J Cancer 91:37–44CrossRefPubMedPubMedCentral Pein F et al (2004) Cardiac abnormalities 15 years and more after adriamycin therapy in 229 childhood survivors of a solid tumour at the Institut Gustave Roussy. Br J Cancer 91:37–44CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Tukenova M et al (2010) Role of cancer treatment in long-term overall and cardiovascular mortality after childhood cancer. J Clin Oncol 28:1308–1315CrossRefPubMed Tukenova M et al (2010) Role of cancer treatment in long-term overall and cardiovascular mortality after childhood cancer. J Clin Oncol 28:1308–1315CrossRefPubMed
13.
14.
Zurück zum Zitat Bölling T, Könemann S, Ernst I, Willich N (2008) Late effects of thoracic irradiation in children. Strahlenther Onkol 184:289–295CrossRefPubMed Bölling T, Könemann S, Ernst I, Willich N (2008) Late effects of thoracic irradiation in children. Strahlenther Onkol 184:289–295CrossRefPubMed
15.
Zurück zum Zitat Stam B et al (2017) Heart dose associated with overall survival in locally advanced NSCLC patients treated with hypofractionated chemoradiotherapy. Radiother Oncol 125:62–65CrossRefPubMed Stam B et al (2017) Heart dose associated with overall survival in locally advanced NSCLC patients treated with hypofractionated chemoradiotherapy. Radiother Oncol 125:62–65CrossRefPubMed
16.
Zurück zum Zitat Bradley JD et al (2015) Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): a randomised, two-by-two factorial p. Lancet Oncol 16:187–199CrossRefPubMedPubMedCentral Bradley JD et al (2015) Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): a randomised, two-by-two factorial p. Lancet Oncol 16:187–199CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Ogino I et al (2016) Symptomatische strahleninduzierte Herzerkrankung bei Langzeitüberlebenden nach Ösophaguskarzinom. Strahlenther Onkol 192:359–367CrossRefPubMed Ogino I et al (2016) Symptomatische strahleninduzierte Herzerkrankung bei Langzeitüberlebenden nach Ösophaguskarzinom. Strahlenther Onkol 192:359–367CrossRefPubMed
18.
Zurück zum Zitat Kalapurakal JA et al (2013) Cardiac-sparing whole lung IMRT in children with lung metastasis. Int J Radiat Oncol Biol Phys 85:761–767CrossRefPubMed Kalapurakal JA et al (2013) Cardiac-sparing whole lung IMRT in children with lung metastasis. Int J Radiat Oncol Biol Phys 85:761–767CrossRefPubMed
19.
Zurück zum Zitat Kalapurakal JA et al (2018) Final report of a prospective clinical trial of cardiac sparing whole-lung intensity modulated radiation therapy in patients with metastatic pediatric tumors. Int J Radiat Oncol Biol Phys 96:118–S119CrossRef Kalapurakal JA et al (2018) Final report of a prospective clinical trial of cardiac sparing whole-lung intensity modulated radiation therapy in patients with metastatic pediatric tumors. Int J Radiat Oncol Biol Phys 96:118–S119CrossRef
20.
Zurück zum Zitat Pallotta S et al (2015) Surface imaging, portal imaging, and skin marker set-up vs. CBCT for radiotherapy of the thorax and pelvis. Strahlenther Onkol 191:726–733CrossRefPubMed Pallotta S et al (2015) Surface imaging, portal imaging, and skin marker set-up vs. CBCT for radiotherapy of the thorax and pelvis. Strahlenther Onkol 191:726–733CrossRefPubMed
21.
Zurück zum Zitat Rösler P et al (2015) Hepatotoxicity after liver irradiation in children and adolescents: results from the RiSK. Strahlenther Onkol 191:413–420CrossRefPubMed Rösler P et al (2015) Hepatotoxicity after liver irradiation in children and adolescents: results from the RiSK. Strahlenther Onkol 191:413–420CrossRefPubMed
22.
Zurück zum Zitat Bhatia S et al (1996) Breast cancer and other second neoplasms after childhood Hodgkin’s disease. N Engl J Med 334:745–751CrossRefPubMed Bhatia S et al (1996) Breast cancer and other second neoplasms after childhood Hodgkin’s disease. N Engl J Med 334:745–751CrossRefPubMed
23.
Zurück zum Zitat Swerdlow AJ et al (2012) Breast cancer risk after supradiaphragmatic radiotherapy for Hodgkin’s lymphoma in England and Wales: a National Cohort Study. J Clin Oncol 30:2745–2752CrossRefPubMed Swerdlow AJ et al (2012) Breast cancer risk after supradiaphragmatic radiotherapy for Hodgkin’s lymphoma in England and Wales: a National Cohort Study. J Clin Oncol 30:2745–2752CrossRefPubMed
24.
Zurück zum Zitat Lohr F et al (2014) Novel radiotherapy techniques for involved-field and involved-node treatment of mediastinal Hodgkin lymphoma. Strahlenther Onkol 190:864–871CrossRefPubMed Lohr F et al (2014) Novel radiotherapy techniques for involved-field and involved-node treatment of mediastinal Hodgkin lymphoma. Strahlenther Onkol 190:864–871CrossRefPubMed
25.
Zurück zum Zitat Hall EJ, Wuu CS (2003) Radiation-induced second cancers: the impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys 56:83–88CrossRefPubMed Hall EJ, Wuu CS (2003) Radiation-induced second cancers: the impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys 56:83–88CrossRefPubMed
26.
Zurück zum Zitat Zelefsky MJ et al (2012) Secondary cancers after intensity-modulated radiotherapy, brachytherapy and radical prostatectomy for the treatment of prostate cancer: incidence and cause-specific survival outcomes according to the initial treatment intervention. BJU Int 110:1696–1701CrossRefPubMed Zelefsky MJ et al (2012) Secondary cancers after intensity-modulated radiotherapy, brachytherapy and radical prostatectomy for the treatment of prostate cancer: incidence and cause-specific survival outcomes according to the initial treatment intervention. BJU Int 110:1696–1701CrossRefPubMed
27.
Zurück zum Zitat Sakthivel V, Kadirampatti Mani G, Mani S, Boopathy R, Selvaraj J (2017) Estimating second malignancy risk in intensity-modulated radiotherapy and volumetric-modulated arc therapy using a mechanistic radiobiological model in radiotherapy for carcinoma of left breast. J Med Phys 42:234–240CrossRefPubMedPubMedCentral Sakthivel V, Kadirampatti Mani G, Mani S, Boopathy R, Selvaraj J (2017) Estimating second malignancy risk in intensity-modulated radiotherapy and volumetric-modulated arc therapy using a mechanistic radiobiological model in radiotherapy for carcinoma of left breast. J Med Phys 42:234–240CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat Chao PJ et al (2017) Propensity-score-matched evaluation of the incidence of radiation pneumonitis and secondary cancer risk for breast cancer patients treated with IMRT/VMAT. Sci Rep 7:1–9CrossRef Chao PJ et al (2017) Propensity-score-matched evaluation of the incidence of radiation pneumonitis and secondary cancer risk for breast cancer patients treated with IMRT/VMAT. Sci Rep 7:1–9CrossRef
29.
Zurück zum Zitat Zwahlen DR et al (2009) Effect of intensity-modulated pelvic radiotherapy on second cancer risk in the postoperative treatment of endometrial and cervical cancer. Int J Radiat Oncol Biol Phys 74:539–545CrossRefPubMed Zwahlen DR et al (2009) Effect of intensity-modulated pelvic radiotherapy on second cancer risk in the postoperative treatment of endometrial and cervical cancer. Int J Radiat Oncol Biol Phys 74:539–545CrossRefPubMed
31.
Zurück zum Zitat Gomarteli K et al (2017) Focus on the low-dose bath: no increased cancer risk after mediastinal VMAT versus AP/PA irradiation in a tumor-prone rat model. Int J Radiat Oncol Biol Phys 99:76–S77CrossRef Gomarteli K et al (2017) Focus on the low-dose bath: no increased cancer risk after mediastinal VMAT versus AP/PA irradiation in a tumor-prone rat model. Int J Radiat Oncol Biol Phys 99:76–S77CrossRef
Metadaten
Titel
Heart-sparing volumetric modulated arc therapy for whole lung irradiation
verfasst von
Alexandros Papachristofilou
Anna-Lena Hottinger
Oliver Weinhold
Yasar-Kemal Avcu
Tobias Finazzi
Tamara Diesch
Ulrich Schratzenstaller
Publikationsdatum
06.09.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
Strahlentherapie und Onkologie / Ausgabe 1/2019
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-018-1363-6

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