Cardiac-Sparing Whole Lung IMRT in Children With Lung Metastasis

Kalapurakal, John A.; Zhang, Yunkai; Kepka, A.; Zawislak, Brian; Sathiaseelan, V.; Rigsby, Cynthia K.; Gopalakrishnan, Mahesh

doi:10.1016/j.ijrobp.2012.05.036

Cited by 36 publications

(31 citation statements)

References 19 publications

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“…In addition to the low‐dose delivered with WLI, improved radiation techniques such as intensity‐modulated radiation therapy (IMRT) allows for more conformal radiation delivery with potential sparing of normal tissues such as the heart. A recent dosimetry study revealed lower cardiac doses when WLI was delivered with IMRT as compared to conventional techniques . Though we did not employ this technique in treating this patient, future studies examining the role for WLI in synovial sarcoma could use IMRT in an effort to reduce cardiac dose.…”

Section: Discussionmentioning

confidence: 89%

Whole‐lung irradiation in the treatment of metastatic synovial sarcoma

Gerber

Meyers

LaQuaglia

et al. 2014

Pediatric Blood & Cancer

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Whole-lung irradiation (WLI) is standard of care in the treatment of patients with rhabdomyosarcoma, Ewing sarcoma, and Wilms tumor and pulmonary metastases. However, it is not routinely utilized in the treatment of pulmonary metastases arising from other soft tissue sarcoma histologies. A patient presented with synovial sarcoma of his groin and punctate pulmonary metastases. After completion of multimodality treatment to his primary lesion, he received WLI. The patient is without evidence of disease at 3.8 years. This case demonstrates the need for further study of WLI in synovial sarcoma as it may improve outcomes in patients with this disease.

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Section: Discussionmentioning

confidence: 89%

Whole‐lung irradiation in the treatment of metastatic synovial sarcoma

Gerber

Meyers

LaQuaglia

et al. 2014

Pediatric Blood & Cancer

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“…Significant cardiac toxicity from WLI per se has not been described for any age group, but there is a preponderance of evidence associating RT with the heart with subsequent adverse cardiac events for both pediatric and adult cohorts [ 16 – 20 ]. For this reason, potential cardiac toxicity from WLI must be acknowledged, along with consideration of research and efforts to minimize cardiac dose such as the cardiac-sparing IMRT technique for WLI [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Whole Lung Irradiation in Adults with Metastatic Ewing Sarcoma: Practice Patterns and Implications for Treatment

Tanguturi¹,

George

Marcus

et al. 2015

Sarcoma

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Background. Whole lung irradiation (WLI) is a standard treatment component for children with metastatic Ewing Sarcoma (ES), but data on WLI for adults are sparse. Design. An email survey was sent to expert sarcoma-dedicated oncologists worldwide: An adult with excellent performance status presents with primary ES in the leg and multiple pulmonary metastases. The patient achieves complete radiographic response after chemotherapy and resection of the primary. Would you give bilateral WLI to (1) this adult patient?, (2) this patient if 20 years old (yo)?, (3) this patient if 45 yo?, or (4) this patient if 60 yo? Results. 38 experts responded, including 24 adult, 1 adolescent young adult, and 13 pediatric oncologists. 63%, 63%, 62%, and 50% of respondents offered WLI to the adult, 20-year-old, 45-year-old, and 60-year-old, respectively. Pediatric oncologists more likely endorsed WLI across all ages including the adult (P = 0.01), 20-year-old (P = 0.005), 45-year-old (P = 0.01), and 60-year-old (P = 0.08). There were no significant differences between medical and radiation oncologists or between European/Australian and American providers. Conclusions. Almost two-thirds of experts surveyed supported WLI for adults with metastatic ES up to age 45 and half supported WLI for a 60-year-old. Continued collaboration across adult and pediatric oncology is needed to define evidence-based strategies across the age spectrum.

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“…Heart dose-volume constraints for IMRT planning were derived from the Northwestern dosimetry study (22). For organs at risk dose (OARs), the maximum dose to the spinal cord, heart and liver should be <107%, <110% and <110% respectively of the prescribed dose.…”

Section: Methodsmentioning

confidence: 99%

“…Cardiac failure is an important late effect observed in childhood cancer survivors after WLI and doxorubicin (11-21). A dosimetry study has shown that WLI using IMRT has the potential to reduce radiation exposure to the heart while improving coverage to 4D lung volumes compared to standard antero-posterior (AP) techniques (22). This dosimetry report formed the basis of this novel NIH funded prospective multicenter clinical trial using cardiac sparing (CS) IMRT for WLI in children and young adults with lung metastasis.…”

mentioning

confidence: 99%