Frailty—the missing constraint in radiotherapy treatment planning for older adults

Rodrigues, Darlene; Gonsalves, Daniela; Teixeira, Laetitia; López, Escarlata

doi:10.1007/s40520-022-02200-1

Cited by 5 publications

(2 citation statements)

References 50 publications

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“…Endometrial carcinoma is primarily observed in older adults; the median age at diagnosis is between 65 and 76 years. Aging is associated with changes in multiple organs and systems, such as the bone marrow and hematopoietic system, which lead to increased rates of health problems [1,24,25]. Bone marrow is the main hematopoietic organ; 51% of its active area is located in the lower spinal and pelvic region [26].…”

Section: Discussionmentioning

confidence: 99%

Ninety-degree angled collimator: a dosimetric study related to dynamic intensity-modulated radiotherapy in patients with endometrial carcinoma

Serarslan

Dastan

Aksu

et al. 2023

Preprint

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Background Our purpose was to ensure that the dose constraints of the organs at risk (OARs) were not exceeded while increasing the prescription dose to the planning target volume (PTV) from 45 Gy to 50.4 Gy with the dynamic intensity-modulated radiotherapy (IMRT) technique. While trying for this purpose, a new dynamic IMRT technique that named 90° angled collimated dynamic IMRT (A-IMRT) planning was developed by us. Methods This study was based on the computed tomography data sets of 20 patients with postoperatively diagnosed International Federation of Gynecology and Obstetrics stage 2 endometrial carcinoma. For each patient, conventional dynamic IMRT (C-IMRT, collimator angle of 0° at all gantry angles), A-IMRT (collimator angle of 90° at gantry angles of 110°, 180°, 215°, and 285°), and volumetric modulated arc therapy (VMAT) were planned. Planning techniques were compared with parameters used to evaluate PTV and OARs via dose-volume-histogram analysis using the paired two-tailed Wilcoxon’s signed-rank test; p < 0.05 was considered indicative of statistical significance. Results All plans achieved adequate dose coverage for PTV. Conformality was best obtained with VMAT, whereas homogeneity was best obtained with C-IMRT. The conformality of A-IMRT was inferior to the conformality of C-IMRT; A-IMRT had similar homogeneity to VMAT. The bone marrow dose constraint was exceeded in 4 (20%), 16 (80%), and 18 (90%) patients with VMAT, A-IMRT, and C-IMRT, respectively. The bladder dose constraint was exceeded in no patients with A-IMRT or VMAT, but it was exceeded in 19 (95%) patients with C-IMRT. Dose constraints of the rectum and bilateral femoral heads were exceeded in no patients with A-IMRT or VMAT, but they were exceeded in 20 (100%) patients with C-IMRT. The dose constraint of the bowel (for V40 as in the RTOG 0418 trial) was exceeded in 4 (20%), 5 (25%), and 8 (40%) patients with VMAT, A-IMRT, and C-IMRT, respectively. Conclusions OARs are better protected when external beam radiotherapy is applied to the pelvis at a dose of 50.4 Gy by turning the collimator angle to 90° at some gantry angles with the dynamic IMRT technique in the absence of VMAT.

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Section: Discussionmentioning

confidence: 99%

Ninety-degree angled collimator: a dosimetric study related to dynamic intensity-modulated radiotherapy in patients with endometrial carcinoma

Serarslan

Dastan

Aksu

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Endometrial carcinoma is primarily observed in older adults; the median age at diagnosis is between 65 and 76 years. Aging is associated with changes in multiple organs and systems, such as the bone marrow and hematopoietic system, which lead to increased rates of health problems [ 1 , 25 , 26 ]. Bone marrow is the main hematopoietic organ; 51% of its active area is located in the lower spinal and pelvic region [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Ninety-degree angled collimator: a dosimetric study related to dynamic intensity-modulated radiotherapy in patients with endometrial carcinoma

et al. 2023

View full text Add to dashboard Cite

Background Our purpose was to ensure that the dose constraints of the organs at risk (OARs) were not exceeded while increasing the prescription dose to the planning target volume (PTV) from 45 to 50.4 Gray (Gy) with the dynamic intensity-modulated radiotherapy (IMRT) technique. While trying for this purpose, a new dynamic IMRT technique named 90° angled collimated dynamic IMRT (A-IMRT) planning was developed by us. Methods This study was based on the computed tomography data sets of 20 patients with postoperatively diagnosed International Federation of Gynecology and Obstetrics stage 2 endometrial carcinoma. For each patient, conventional dynamic IMRT (C-IMRT, collimator angle of 0° at all gantry angles), A-IMRT (collimator angle of 90° at gantry angles of 110°, 180°, 215°, and 285°), and volumetric modulated arc therapy (VMAT) were planned. Planning techniques were compared with parameters used to evaluate PTV and OARs via dose-volume-histogram analysis using the paired two-tailed Wilcoxon’s signed-rank test; p < 0.05 was considered indicative of statistical significance. Results All plans achieved adequate dose coverage for PTV. Although the technique with the lowest mean conformality index was A-IMRT (0.76 ± 0.05) compared to both C-IMRT (0.79 ± 0.04, p = 0.000) and VMAT (0.83 ± 0.03, p = 0.000), it protected the OARs especially the bladder (V45 = 32.84 ± 2.03 vs. 44.21 ± 6.67, p = 0.000), rectum (V30 = 56.18 ± 2.05 vs. 73.80 ± 4.75, p = 0.000) and both femoral heads (V30 for right = 12.19 ± 1.34 vs. 21.42 ± 4.03, p = 0.000 and V30 for left = 12.58 ± 1.48 vs. 21.35 ± 4.16, p = 0.000) better than C-IMRT. While the dose constraints of the bladder, rectum and bilateral femoral heads were not exceeded in any patient with A-IMRT or VMAT, they were exceeded in 19 (95%), 20 (100%) and 20 (100%) patients with C-IMRT, respectively. Conclusions OARs are better protected when external beam radiotherapy is applied to the pelvis at a dose of 50.4 Gy by turning the collimator angle to 90° at some gantry angles with the dynamic IMRT technique in the absence of VMAT.

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Frailty from conceptualization to action: the biopsychosocial model of frailty and resilience

Polidori

Ferrucci

2023

Aging Clin Exp Res

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Frailty—the missing constraint in radiotherapy treatment planning for older adults

Cited by 5 publications

References 50 publications

Ninety-degree angled collimator: a dosimetric study related to dynamic intensity-modulated radiotherapy in patients with endometrial carcinoma

Ninety-degree angled collimator: a dosimetric study related to dynamic intensity-modulated radiotherapy in patients with endometrial carcinoma

Ninety-degree angled collimator: a dosimetric study related to dynamic intensity-modulated radiotherapy in patients with endometrial carcinoma

Frailty from conceptualization to action: the biopsychosocial model of frailty and resilience

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