Dose–Volume Constraints fOr oRganS At risk In Radiotherapy (CORSAIR): An “All-in-One” Multicenter–Multidisciplinary Practical Summary

Bisello, S.; Cilla, Savino; Benini, Anna; Cardano, Raffaele; Nguyen, Nam Q.; Deodato, Francesco; Macchia, G.; Buwenge, M.; Cammelli, S.; Wondemagegnehu, Tigeneh; Uddin, Aaliya; Rizzo, Stefania; Bazzocchi, Alberto; Strigari, Lidia; Morganti, Alessio Giuseppe

doi:10.3390/curroncol29100552

Cited by 22 publications

(16 citation statements)

References 117 publications

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“…Further examination revealed no significant neurotoxicity. 8 Our case adds to this conclusion, indicating that SRS can treat recurrent EMPs. Moreover, this case also adds to the growing body of literature for CyberKnife’s therapeutic potential in the plasmacytoma domain broadly.…”

Section: Discussionsupporting

confidence: 64%

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CyberKnife stereotactic radiosurgery for extramedullary plasmacytoma in the external auditory canal: illustrative case

Patil,

Shaghaghian,

Yuan

et al. 2024

Journal of Neurosurgery: Case Lessons

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BACKGROUND Plasmacytoma, a rare plasma cell disorder, often presents as a solitary or multiple tumors within the bone marrow or soft tissues, typically associated with multiple myeloma. Extramedullary plasmacytomas (EMPs), particularly those located in the external auditory canal (EAC), are exceedingly rare and pose significant treatment challenges given their location, anatomical complexity, and high risk of recurrence. OBSERVATIONS The authors report the case of a 72-year-old male with a history of multiple myeloma, presenting with recurrent left EAC plasmacytoma. After initial conventional radiotherapy for the lesion, a recurrence was documented in 7 years. The patient subsequently underwent stereotactic radiosurgery, which proved successful, leading to complete resolution of the lesion without any long-term adverse effects or radiation-related complications over a 45-month period. LESSONS This case is a unique instance of utilizing stereotactic radiosurgery for recurrent EMP in the EAC, highlighting its potential as an effective approach in managing complex plasmacytomas.

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Section: Discussionsupporting

confidence: 64%

“… 7 Dosimetrically, the right cochlea was exposed to a mean dose of 2.39 Gy and maximum dose of 4.38 Gy based on the general dose-volume constraints guideline for organs at risk. 8 The volume of the right cochlea receiving more than 17.1 Gy, based on the three-fraction dose-constraints guideline, was 0 mL. 9 …”

Section: Illustrative Casementioning

confidence: 99%

CyberKnife stereotactic radiosurgery for extramedullary plasmacytoma in the external auditory canal: illustrative case

Patil,

Shaghaghian,

Yuan

et al. 2024

Journal of Neurosurgery: Case Lessons

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“…The differences between the optimized and initial calculated doses were statistically significant (paired t ‐test, p < 0.001). In addition, Table 6 shows that the reoptimized plans met the dose‐volume criteria for the other critical OARs, 19 with no significant deviations from the original plans (paired t ‐test, p > 0.05).…”

Section: Resultsmentioning

confidence: 96%

Multiscale spatial relationship‐based model for predicting bladder wall dose in pelvic radiotherapy

Gao,

Ge,

Gao

et al. 2023

J Applied Clin Med Phys

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PurposeThis research aimed to develop a prediction model to assess bladder wall dosimetry during radiotherapy for patients with pelvic tumors, thereby facilitating the refinement and evaluation of radiotherapy treatment plans to mitigate bladder toxicity.MethodsRadiotherapy treatment plans of 49 rectal cancer patients and 45 gynecologic cancer patients were collected, and multiple linear regression analyses were used to generate prediction models for bladder wall dose parameters (, ). These models were based on the multiscale spatial relationship between the planning target volume (PTV) and the bladder or bladder wall. The proportion of bladder or bladder wall volume overlapped by the different distance expansions of the PTV was used as an indicator of the multiscale spatial relationship. The accuracy of these models was verified in a cohort of 12 new patients, with further refinement of radiotherapy treatment plans using the predicted values as optimization parameters. Model accuracy was assessed using root mean square error (RMSE) and mean percentage error (MPE).ResultsModels derived from individual disease data outperformed those derived from combined datasets. Predicted bladder wall dose parameters were accurate, with the majority of initial calculated values for new patients falling within the 95% confidence interval of the model predictions. There was a robust correlation between the predicted and actual dose metrics, with a correlation coefficient of 0.943. Using the predicted values to optimize treatment plans significantly reduced bladder wall dose (p0.001), with bladder wall and decreasing by 2.27±0.80 Gy (5.8%±1.8%) and 2.96±2.05 cm3 (7.9%±5.4%), respectively.ConclusionThe formulated prediction model provides a valuable tool for predicting and minimizing bladder wall dose and for optimizing and evaluating radiotherapy treatment plans for pelvic tumor patients. This approach holds promise for reducing bladder toxicity and potentially improving patient outcomes.

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“…With regard to the oral cavity, the V30 Gy < 73% (limiting the D mean to uninvolved oral cavity) and lips should not exceed a D mean of 30 Gy [24,25]. Interestingly, the head, neck and skin GEC-ESTRO working group has recently issued some recommendations with regard to dose constraints, and found that ORN correlates with Total Physical Dose to Mandible 2cm3 ; in fact, patients receiving total physical doses greater than 61 Gy had a 20-fold increased risk of ORN [26].…”

Section: Discussionmentioning

confidence: 99%

Interventional Radiotherapy (Brachytherapy) for Nasal Vestibule: Novel Strategies to Prevent Side Effects

Fionda,

Bussu,

Placidi

et al. 2023

JCM

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Interventional radiotherapy (brachytherapy) has become the new therapeutic standard in the management of early stages nasal vestibule tumors; in fact it allows for high local control rates and low toxicity profiles. However, since more and more patients will receive interventional radiotherapy (brachytherapy) as primary treatment, it is desirable to implement novel strategies to reduce the dose to organs at risk with the future aim to result in further lowering long-term side effects. Materials and methods: We were able to identify two different strategies to reduce dose to the treatment volume, including the implantation technique (the implant can be interstitial, endocavitary or mixed and the catheters may be placed either using the Paris system rules or the anatomical approach) and the dose distribution within the implant (the most commonly used parameter to consider is the dose non-uniformity ratio). We subsequently propose two novel strategies to reduce dose to organs at risk, including the use of metal shields for fixed organs as in the case of the eyes and the use of a mouth swab to push away mobile organs, such in the case of the mandible. We used two different algorithms to verify the values namely the TG-43 and the TG-186. Results: We provided an accurate literature review regarding strategies to reduce toxicity to the treatment volume, underlining the pros and cons of all implantation techniques and about the use dose non-uniformity ratio. Regarding the innovative strategies to reduce the dose to organs at risk, we investigated the use of eye shielding and the use of swabs to push away the mandible by performing an innovative calculation using two different algorithms in a series of three consecutive patients. Our results show that the dose reduction, both in the case of the mandible and in the case of eye shielding, was statistically significant. Conclusion: Proper knowledge of the best implantation technique and dose non-uniformity ratio as highlighted by existing literature is mandatory in order to reduce toxicity within the treatment volume. With regard to the dose reduction to the organs at risk we have demonstrated that the use of eye shielding and mouth swab could play a pivotal role in clinical practice; in fact, they are effective at lowering the doses to the surrounding organs and do not require any change to the current clinical workflow.

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Dose–Volume Constraints fOr oRganS At risk In Radiotherapy (CORSAIR): An “All-in-One” Multicenter–Multidisciplinary Practical Summary

Cited by 22 publications

References 117 publications

CyberKnife stereotactic radiosurgery for extramedullary plasmacytoma in the external auditory canal: illustrative case

CyberKnife stereotactic radiosurgery for extramedullary plasmacytoma in the external auditory canal: illustrative case

Multiscale spatial relationship‐based model for predicting bladder wall dose in pelvic radiotherapy

Interventional Radiotherapy (Brachytherapy) for Nasal Vestibule: Novel Strategies to Prevent Side Effects

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