Evolution of radiation techniques in the treatment of mediastinal lymphoma: from 3D conformal radiotherapy (3DCRT) to intensity-modulated RT (IMRT) using helical tomotherapy (HT): a single-centre experience and review of the literature

Besson, N.; Pernin, V.; Zefkili, S.; Kirova, Youlia

doi:10.1259/bjr.20150409

Cited by 25 publications

(14 citation statements)

References 26 publications

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“…Our results are in line with a SEER-based study in patients with stages 1 and/or 2 DLBCL, which found that CVM rates were higher in patients treated without RT. 25 A possible explanation for these observations is that, according to clinical practice guidelines, 26 patients treated with RT receive 27 However, these results need to be interpreted with caution because our study follow-up period was shorter than other published data that found an association between radiation and increased CVM (3 years vs 19 years, respectively), 28 and we did not have information about site, dose, or field of RT treatment.…”

Section: Discussionmentioning

confidence: 73%

“…A possible explanation for these observations is that, according to clinical practice guidelines, patients treated with RT receive fewer chemotherapy cycles, which translates into a lower risk of chemotherapy‐related cardiotoxicity. Also, improvements in RT techniques have decreased the amount of incidental radiation to the heart, thereby reducing associated complications . However, these results need to be interpreted with caution because our study follow‐up period was shorter than other published data that found an association between radiation and increased CVM (3 years vs 19 years, respectively), and we did not have information about site, dose, or field of RT treatment.…”

Section: Discussionmentioning

confidence: 83%

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Cardiovascular mortality among patients with non‐Hodgkin lymphoma: Differences according to lymphoma subtype

Abuamsha

Kadri

Hernandez

2019

Hematological Oncology

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Survival rates of patients with non‐Hodgkin lymphoma (NHL) have improved over the last decade. However, cardiotoxicities remain important adverse consequences of treatment with chemotherapy and radiation, although the burden of cardiovascular mortality (CVM) in such patients remains unknown. We conducted a retrospective cohort study of patients greater than or equal to 20 years of age diagnosed with diffuse large B‐cell lymphoma (DLBCL), follicular lymphoma (FL), and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) between 2000 and 2013 using data extracted from the United States Surveillance, Epidemiology, and End Results (SEER) database. Our primary endpoint was CVM. The association between NHL and CVM was evaluated using multivariable Cox regression analysis after adjusting for other patient characteristics. We calculated standardized mortality ratios (SMRs) for CVM, comparing NHL patients with the general population. We identified 153 983 patients who met the inclusion criteria (69 329 with DLBCL, 48 650 with CLL/SLL, and 36 004 with FL). The median follow‐up was 37 months (interquartile range, 10‐78 months); the mean patient age was 66.24 (±14.69) years; 84 924 (55.2%) were men; 134 720 (87.5%) were White, and 131 912 (85.7%) did not receive radiation therapy. Overall, 9017 patients (5.8%) died from cardiovascular disease, and we found that NHL patients had a higher risk of CVM than the general population, after adjusting for age (SMR 15.2, 95% confidence interval: 14.89‐15.52). The rates of CVM were 5.1%, 8%, and 4.4% in patients with DLBCL, CLL/SLL, and FL, respectively. Furthermore, across all NHL subtypes, older age, higher stage at the time of diagnosis (particularly stage 4), male sex, and living in the south were associated with higher risks of CVM. Our data suggest that risk assessment and careful cardiac monitoring are recommended for NHL patients, particularly those with the CLL/SLL subtypes.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 83%

Cardiovascular mortality among patients with non‐Hodgkin lymphoma: Differences according to lymphoma subtype

Abuamsha

Kadri

Hernandez

2019

Hematological Oncology

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“…It has high imaging accuracy and automatically corrects positioning errors before radiotherapy, which makes the target area conformability and dose distribution more reasonable. TOMO integrates three-dimensional conformal radiation therapy, intensity-modulated radiation therapy, image-guided radiation therapy, dose-guided radiation therapy, adaptive radiation therapy, and other radiotherapy technologies in one, could be clinically used for a variety of tumors throughout the body, especially for frequently occurring tumors and tumors adjacent to important organs and tissues, which improves the accuracy of the target area while reducing the occurrence of complications (11,12). All patients in this study used TOMO to treat lung metastases, and this has a certain research value.…”

Section: Discussionmentioning

confidence: 99%

Survival and Prognostic Factors of 40 Patients with Pulmonary Oligometastases Treated with Tomotherapy Hypofractionated Radiotherapy

Chen

Zhang

et al. 2021

Preprint

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Background: With continued improvement in radiotherapy technology, hypofractionated radiotherapy has helped achieve good results in the local control and toxicity of pulmonary oligometastases. This study aimed to investigate the efficacy of radiotherapy and the prognostic factors that affect survival in patients with pulmonary oligometastases who undergo helical tomotherapy (TOMO) hypofractionated radiotherapy.Methods: Ninety pulmonary oligometastases in 40 patients (26 males, 14 females; median age 57 years) were retrospectively investigated and treated with hypofractionated radiotherapy in the Department of Oncology and Radiotherapy of the First Affiliated Hospital of Bengbu Medical College during 2018-2020. Their Karnofsky performance status (KPS) was ≥70 points. The primary endpoints were overall survival (OS), local control (LC), and progression-free survival (PFS), and we determine the related influencing factors.Results: The median gross tumor volume (GTV) and planning target volume (PTV) were 9.7 cm³ (range 1.1–287.0 cm³) and 56.9 cm³ (range 16.3–494.2 cm³), respectively, the median biological effective dose, α/β=10 (BED10), was 76.8 Gy (range 56-96 Gy), and four-dimensional computed tomography positioning was applied to 52.5% of the patients. All patients completed the treatment plan during a median follow-up of 16.1 months (range 4.9–33.3 months). The 1- and 2-year OS rates were 90.3% and 55.2%, respectively. The 1- and 2-year LC rates were 80.8% and 64.7%, respectively. The 1- and 2-year PFS rates were 47.3% and 28.4%, respectively. Univariate analysis revealed that colorectal primary (p=0.004), age >57 years (p=0.037), and number of organ metastases ≥2 (p=0.046) were associated with OS, whereas disease-free interval (DFI) ≤17.4 months (p=0.032), number of lung metastases≥2 (p=0.049), and PTV >56.9 cm³ (p=0.041) were associated with LC; and number of metastatic organs ≥2 (p=0.015) was independently associated with PFS. In multivariate analysis, colorectal cancer (p=0.010) and age >57 years (p=0.009) were significantly associated with OS. No > grade 3 toxic reaction.Conclusions: The median OS, LC, and PFS rates of TOMO hypofractionated radiotherapy for pulmonary oligometastases were 24.9, 25.9, and 11.8 months, respectively, showing that good survival rates and low toxicity could still be achieved using the medium dose.

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“…According to recent studies, RP is becoming less and less frequent, mainly due to technological advances in RT and the increasing knowledge of its etiology ( 26 , 27 ). However, it still remains as a complication that may interfere with quality of life in cancer patients.…”

Section: Discussionmentioning

confidence: 99%

<sup>18</sup>F-FDG PET/CT in Patients with Parenchymal Changes Attributed to Radiation Pneumonitis

Demirev

Kostadinova

Gabrovski

2018

Mirt

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Objectives:Radiation pneumonitis (RP) can be an adverse complication of radiotherapy (RT) and can limit the application of the already planned radiation dose. It is often associated with RT of lung carcinoma and is occasionally caused by radiation therapy of breast carcinoma and lymphomas located in the mediastinum. Positron emission tomography/computed tomography (PET/CT) emerges lately as a prospective modality for early diagnostics of RP. The aim of this study was to summarize the initial data from diagnostic application of PET/CT in patients suspicious of RP and to derive criteria, which can help differentiate RP from early recurrence of the disease and/or residual tumor.Methods:The current study included 23 patients who had metabolic (PET) and anatomical (CT) changes consistent with RP. We additionally defined metabolic activity (SUVmax) in the lung parenchyma of 20 patients without RT.Results:All patients had increased metabolic activity in the lung parenchyma involved in the irradiated area with a mean SUVmax 3.45 (ranging between 1 and 7.1). The control group had a physiological background metabolic activity-SUVmax 0.61 +/- 0.11.Conclusion:Metabolic changes in patients suspicious of RP involved diffusely increased metabolic activity coinciding with the anatomical changes in the irradiated area. Three out of 23 patients had a proven recurrence of the primary neoplastic process in the irradiated area. The metabolic changes in those patients involved an increase in metabolic activity at follow-up or lack of tendency towards normalization after chemotherapy, which implied the existence of viable tumor cells. Our initial experience in the diagnostic application of 18F-FDG PET/CT in patients suspicious of RP allows us to summarize the following: PET/CT is a reliable imaging modality in the diagnostics of RP. Through its sequential use, we can differentiate inflammatory changes related to RP from early recurrence of the primary neoplastic process.

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Evolution of radiation techniques in the treatment of mediastinal lymphoma: from 3D conformal radiotherapy (3DCRT) to intensity-modulated RT (IMRT) using helical tomotherapy (HT): a single-centre experience and review of the literature

Abstract: Improvement of radiation techniques for HL and NHL appears to improve the tolerance.

Cited by 25 publications

References 26 publications

Cardiovascular mortality among patients with non‐Hodgkin lymphoma: Differences according to lymphoma subtype

Cardiovascular mortality among patients with non‐Hodgkin lymphoma: Differences according to lymphoma subtype

Survival and Prognostic Factors of 40 Patients with Pulmonary Oligometastases Treated with Tomotherapy Hypofractionated Radiotherapy

<sup>18</sup>F-FDG PET/CT in Patients with Parenchymal Changes Attributed to Radiation Pneumonitis

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