A pilot study of volumetric‐modulated arc therapy for malignant pleural mesothelioma

Li, Runxiao; Cao, Yong; Wang, Lan

doi:10.1120/jacmp.v17i2.5980

Cited by 10 publications

(6 citation statements)

References 16 publications

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“…Limited published benchmark data of treatment times for RT for MPM exist. Two prior publications report treatment delivery times of 5.0-5.4 min for VMAT for MPM, but direct comparison is limited in that the treatment volumes in those studies encompassed the entire hemithorax, a much larger treatment volume than in our study, which could independently lengthen treatment time (7,23). The beamon and treatment times observed compare favorably with those of patients treated for breast cancer (2.0±0.3 and 4.4±0.4 min, respectively) and gynecologic cancers (2.9±0.4 and 3.6±0.4 min, respectively) on Halcyon TM , while again recognizing the limitation of the differences in disease sites, setup details, and treatment volumes (17,18).…”

Section: Discussionmentioning

confidence: 75%

“…Volumetric-modulated arc therapy (VMAT), is a form of IMRT in which RT is delivered in continuous, dynamic arcs. While published reports of the use of VMAT in MPM are limited, it has been shown that VMAT can significantly improve MPM treatment homogeneity and conformity indices and shorten treatment delivery times as compared to fixed-field IMRT (7), with reasonable toxicity (8).…”

Section: Introductionmentioning

confidence: 99%

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Initial clinical experience treating patients with palliative radiotherapy for malignant pleural mesothelioma on the HalcyonTM linear accelerator

Barsky¹,

Kim²,

Maxwell³

et al. 2020

Ann Palliat Med

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Background: Radiation therapy (RT) can provide effective symptomatic palliation in patients with malignant pleural mesothelioma (MPM). Advances in RT technology, including intensity-modulated RT (IMRT) and volumetric-modulated arc therapy (VMAT), have improved treatment conformality, potentially improving the therapeutic ratio of RT. A novel 6-MV flattening-filter-free O-ring linear accelerator, Halcyon TM (Varian Medical Systems, Palo Alto, CA, USA), was built to provide such advanced therapies, while possibly reducing treatment time. Here, we report the initial clinical experience using Halcyon TM to deliver palliative RT for patients with MPM. Methods: We retrospectively assessed consecutive patients with MPM who received thoracic RT on Halcyon TM . Their electronic medical records were reviewed for clinical, RT planning, treatment timing, and image-guidance RT (IGRT) data.Results: Four patients with metastatic MPM received palliative RT on Halcyon TM between 1/2017-1/2020 for severe pain (50%), dysphagia (25%), or dyspnea (25%). Targets included a combination of pleura, chest wall, lung, hilum, and mediastinum, with patient-specific dose and fractionation regimens ranging from 20-45 Gy in 5-15 fractions, and 75% of patients receiving concurrent systemic therapy. Pre-specified target and organ-at-risk constraints were met for nearly all plans. At a median follow-up of 2.2 months (range, 1.6-7.1 months), all patients experienced either improved (75%) or stable (25%) tumor-related symptoms following palliative RT. The mean 3D vector couch correction was 0.67±0.15 cm. The mean beam-on, treatment (beam-on plus cone-beam computed tomography times), and approximated total room usage times were 1.6±0.2, 1.8±0.2, and 9.8±0.2 min, respectively. Grade 2 fatigue and cough occurred in 25% and 25% of patients, and no patients experienced Grade ≥3 toxicity. Conclusions: In this initial clinical experience treating patients with palliative RT for MPM on Halcyon TM , treatment provided symptom palliation and local control across multiple palliative scenarios, with minimal toxicity, acceptable dosimetry, and setup corrections and treatment times that compared favorably with other published experiences of MPM RT. Palliative RT on Halcyon TM can provide patients with MPM quick and safe tumor-related symptom relief, even in a frail, elderly population.

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Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Initial clinical experience treating patients with palliative radiotherapy for malignant pleural mesothelioma on the HalcyonTM linear accelerator

Barsky¹,

Kim²,

Maxwell³

et al. 2020

Ann Palliat Med

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“…And IMRT/VMAT/HT therapy are being used more commonly now than historically ( 8 ). For instance, several studies have shown that conventional static IMRT achieves better dose coverage and improved local control compared with 3DCRT ( 6 - 13 ) for MPM, while other studies have demonstrated that VMAT allows for even better dose conformality in a shorter delivery time compared with static IMRT, sparing potential organs at risk (OARs) during MPM radiotherapy ( 14 - 16 ). Moreover, several studies exploring the feasibility of prescription dose escalation using HT and VMAT have also been reported ( 17 - 21 ).…”

Section: Introductionmentioning

confidence: 99%

Dosimetric evaluation of helical tomotherapy and volumetric-modulated arc therapy for malignant pleural mesothelioma: a planning study for dose escalation

Zhang¹,

Lü²,

Jiang³

et al. 2021

Transl Cancer Res TCR

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Background To compare the dosimetric differences between helical tomotherapy (HT) and volumetric-modulated arc therapy (VMAT) treatment plans for inoperable malignant pleural mesothelioma (MPM). Methods Ten patients with inoperable MPM were retrospectively planned with the HT and VMAT techniques, and the dose-volume histogram (DVH)-based parameters of the planning target volume (PTV) and organs at risk (OARs) were compared. Results Compared with the VMAT plans, the target homogeneity index (HI) and conformity index (CI) of the HT plans were significantly better (HI: 1.04±0.01 vs. 1.11±0.03, CI: 0.80±0.07 vs. 0.71±0.12, respectively) (P<0.001, P=0.013, respectively). Regarding the OARs, including the ipsilateral lung, contralateral lung, heart, and spinal cord, the differences among the V30 (Vx: fraction of volume receiving >5, 10, 20, and 30 Gy, respectively) of the ipsilateral lung and V5, V10, and V20 of the contralateral lung were statistically significant (P=0.031, P=0.030, P=0.021, P=0.003, respectively). However, there was no significant differences between HT plans and VMAT plans, regarding the V5, V10 and V20 of the ipsilateral lung, V3 of the contralateral lung, V5 and Dmean of the heart, and Dmax of the cord. The treatment delivery time of the VMAT was significantly shorter than that of the HT (mean delivery time: 3.27±1.65 vs. 11.11±3.75 min, respectively) (P<0.001). Conclusions Compared to the VMAT plans, the HT plans not only demonstrated more optimal target coverage and conformity but also considerably reduced the dose-volume parameters of the OARs in both low-dose areas in contralateral lung and high-dose areas in ipsilateral lung and contralateral lung, which is correlated to radiation injury. However, the treatment delivery time of the HT plans was longer.

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“…The IMPRINT and SMART trials are examples of a possible and safe therapeutic benefit of RT within a multimodal approach 34 . However, owing to a lack of large clinical studies with definitive results, the role of RT largely remains within the settings of clinical trials and palliation 8 , 19 , 35 .…”

Section: Radiation Therapymentioning

confidence: 99%

Multimodality treatment of malignant pleural mesothelioma

Berzenji

Schil

2018

F1000Res

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Malignant pleural mesothelioma (MPM) is a rare disease of the pleura and is largely related to asbestos exposure. Despite recent advancements in technologies and a greater understanding of the disease, the prognosis of MPM remains poor; the median overall survival rate is about 6 to 9 months in untreated patients. The main therapeutic strategies for MPM are surgery, chemotherapy, and radiation therapy (RT). The two main surgical approaches for MPM are extrapleural pneumonectomy (EPP), in which the lung is removed en bloc, and pleurectomy/decortication, in which the lung stays in situ. Chemotherapy usually consists of a platinum-based chemotherapy, such as cisplatin, often combined with a folate antimetabolite, such as pemetrexed. More recently, immunotherapy has emerged as a possible therapeutic strategy for MPM. Evidence suggests that single-modality treatments are not an effective therapeutic approach for MPM. Therefore, researchers have started to explore different multimodality treatment approaches, in which often combinations of surgery, chemotherapy, immunotherapy, and RT are investigated. There is still no definitive answer to the question of which multimodality treatment combinations are most effective in improving the poor prognosis of MPM. Research into the effects of trimodality treatment approaches have found that radical approaches such as EPP and hemithoracic RT post-EPP are less effective than was previously assumed. In general, there are still a great number of unanswered questions and unknown factors regarding the ideal treatment approach for MPM. Hopefully, more research into multimodality therapy will provide insight into which combination of treatment modalities is most effective.

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A pilot study of volumetric‐modulated arc therapy for malignant pleural mesothelioma

Cited by 10 publications

References 16 publications

Initial clinical experience treating patients with palliative radiotherapy for malignant pleural mesothelioma on the HalcyonTM linear accelerator

Initial clinical experience treating patients with palliative radiotherapy for malignant pleural mesothelioma on the HalcyonTM linear accelerator

Dosimetric evaluation of helical tomotherapy and volumetric-modulated arc therapy for malignant pleural mesothelioma: a planning study for dose escalation

Multimodality treatment of malignant pleural mesothelioma

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