Radiobiological Determination of Dose Escalation and Normal Tissue Toxicity in Definitive Chemoradiation Therapy for Esophageal Cancer

Warren, S.; Carrington, R.; Hurt, Chris; Crosby, T.; Hawkins, M.

doi:10.1016/j.ijrobp.2014.06.028

Cited by 33 publications

(41 citation statements)

References 31 publications

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“…The IMRTSIB approach was based upon better radiographic findings of the biological target through PET scanning prior to CRT. This approach provides a better outline of the biological tumor within a mass, and allows RT dose intensity increase by 10% to the biological activity of tumor, without increasing the overall treatment time and the dose to the surrounding organs at risk [16] . In the Cross study, although the improvement in overall survival is 14%, the improvement for adenocar cinoma is limited [7] .…”

Section: Discussionmentioning

confidence: 99%

Intensity modulated radiation therapy with simultaneous integrated boost based dose escalation on neoadjuvant chemoradiation therapy for locally advanced distal esophageal adenocarcinoma

Zeng¹,

Aguila²,

Patel³

et al. 2016

WJGO

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AIM:To evaluate impact of radiation therapy dose escalation through intensity modulated radiation therapy with simultaneous integrated boost (IMRT-SIB). METHODS:We retrospectively reviewed the patients who underwent four-dimensional-based IMRT-SIBbased neoadjuvant chemoradiation protocol. During the concurrent chemoradiation therapy, radiation therapy was through IMRT-SIB delivered in 28 consecutive daily fractions with total radiation doses of 56 Gy to tumor and 5040 Gy dose-painted to clinical tumor volume, with a regimen at the discretion of the treating medical oncologist. This was followed by surgical tumor resection. We analyzed pathological completion response (pCR) rates its relationship with overall survival and event-free RESULTS:Seventeen patients underwent dose escalation with the IMRT-SIB protocol between 2007 and 2014 and their records were available for analysis. Among the IMRT-SIB-treated patients, the toxicity appeared mild, the most common side effects were grade 1-3 esophagitis (46%) and pneumonitis (11.7%). There were no cardiac events. The Ro resection rate was 94% (n = 16), the pCR rate was 47% (n = 8), and the postoperative morbidity was zero. There was one mediastinal failure found, one patient had local failure at the anastomosis site, and the majority of failures were distant in the lung or bone. The 3-year diseasefree survival and overall survival rates were 41% (n = 7) and 53% (n = 9), respectively. CONCLUSION:The dose escalation through IMRT-SIB in the chemoradiation regimen seems responsible for down-staging the distal esophageal with well-tolerated complications. Core tip: There are more data supporting neoadjuvant chemoradiation for locally advanced esophageal cancer. The best regimen of neoadjuvant chemoradiation remains to be defined, current available data using threedimensional vs intensity modulated radiation therapy deliver modest dose to downstage the tumor. In this report, we reviewed our experience using dose escalation technique to Gross Tumor Volume with compromising dose to organ at risk, the high R0 resection rate results suggest the feasibility of using this approach for future prospective study.

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Section: Discussionmentioning

confidence: 99%

Intensity modulated radiation therapy with simultaneous integrated boost based dose escalation on neoadjuvant chemoradiation therapy for locally advanced distal esophageal adenocarcinoma

Zeng¹,

Aguila²,

Patel³

et al. 2016

WJGO

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Section: Application Of Tcp/ntcp For Plan Comparisonmentioning

confidence: 99%

“…Moreover, radiobiological studies on esophageal cancer show that SIB treatments with RapidArc leads to better results compared to a standard dose plan. Using the RapidArc technique, acceptable dose escalation was clinically achievable for most of patients with more than 18% gain in TCP and a slight acceptable increase in NTCP for both the heart and lung [36].The advantages and shortcomings of new dose delivery techniques such as IMRT and Helical tomotherapy (HT) have been discussed in terms of practical use and dosimetric benefits in the literature. Otherwise, biological comparisons of helical tomotherapy with IMRT could provide more information on the effectiveness of these treatment techniques.…”

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confidence: 99%

An Overview on the Clinical Application of Radiobiological Modeling in Radiation Therapy of Cancer

Mesbahi

Oladghaffari

2017

IJRRT

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Analyzing the dose distribution inside target volumes of cancer patients before radiation delivery and then selection of the biologically optimal dose distribution has been one of the crucial steps in recent treatment planning developments. Plan evaluation and optimization have been based on the physical dose distribution and dose-volume parameters for several decades. However, with the development of a. clinical radiobiology in both domains of tumor and normal tissue response to radiation, ii) existence of reliable clinical results, and b. emergence of new mathematical models in cancer biology and treatment, radiation scientists have been motivated to calculate tumor control probability (TCP) and normal tissue complication probability (NTCP) for modern complex clinical treatment plans. The prediction of clinical outcome in terms of TCP in radiation therapy and its development have been an interesting subject of investigations for several decades. Additionally, this process has provided new information on radiotherapy consequences such as increased local control rates and lower complications rates. It also has helped treatment teams to choose optimum plans for individual patients. In this overview, we will look into some of these studies and give emphasis on potential benefits of TCP/NTCP calculations in different areas of radiation therapy such as plan evaluation, and the uncertainties associated with dose delivery. Keywords: Radiation therapy; Treatment planning; Radiobiological modelling;Tumor control probability; Normal tissue complication probability An Overview on the Clinical Application of Radiobiological Modeling in Radiation Therapy of Cancer 2/7Copyright: ©2017 Mesbahi et al.The β i parameter denotes the repairable part of radiation damage which varies over the population of patients. Also i g shows the fraction of patients having as their radiosensitivity [4].There are several models for NTCP calculations using DVH, dosimetric data of each patient. [4] One of the most applied models is the Lyman-Kutcher-Burman (LKB) model [1]. The NTCP calculation in the LKB model is defined as:Where TD 50 (v) is the tolerance dose for a 50% complication probability caused by uniform irradiation to volume v, and where n is the volume exponent and m is a parameter that is inversely related to the steepness of the dose-response curve.The increasing number of publications on radiobiological modeling implies its progressive utilization in current clinical practice as well as in silico (computer) modelling research. Although, the main purpose of TCP/NTCP calculations has been to provide a surrogate tool for plan comparisons and optimum plan selection for a given treatment, there are many other investigations that have employed this approach to quantize the radiobiological consequences for different available modalities, and geometric errors, as well as comparing novel techniques for radiation therapy [2,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Moreover, several studies have ut...

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“…Recently, an increasing number of studies have demonstrated its feasibility, efficacy, and safety for the treatment of EC patients with the combination of IMRT and dose escalation techniques 11–13. However, to the best of our knowledge, only several studies investigated the potential benefits of dose-escalated IMRT (DE-IMRT) to offer a dose escalation to the primary tumor, and improve the sparing of normal tissues compared with non-escalated IMRT (NE-IMRT) for EC patients 14–16. Unfortunately, the studies failed to provide further information on esophageal toxicity, which is a common radiation-induced side effect in the treatment of EC patients 11,12,17,18…”

Section: Introductionmentioning

confidence: 99%

Radiobiological evaluation of simultaneously dose-escalated versus non-escalated intensity-modulated radiation therapy for patients with upper thoracic esophageal cancer

Huang

Guo

et al. 2017

OTT

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ObjectiveTo compare the radiobiological response between simultaneously dose-escalated and non-escalated intensity-modulated radiation therapy (DE-IMRT and NE-IMRT) for patients with upper thoracic esophageal cancer (UTEC) using radiobiological evaluation.MethodsComputed tomography simulation data sets for 25 patients pathologically diagnosed with primary UTEC were used in this study. DE-IMRT plan with an escalated dose of 64.8 Gy/28 fractions to the gross tumor volume (GTV) and involved lymph nodes from 25 patients pathologically diagnosed with primary UTEC, was compared to an NE-IMRT plan of 50.4 Gy/28 fractions. Dose-volume metrics, tumor control probability (TCP), and normal tissue complication probability for the lung and spinal cord were compared. In addition, the risk of acute esophageal toxicity (AET) and late esophageal toxicity (LET) were also analyzed.ResultsCompared with NE-IMRT plan, we found the DE-IMRT plan resulted in a 14.6 Gy dose escalation to the GTV. The tumor control was predicted to increase by 31.8%, 39.1%, and 40.9% for three independent TCP models. The predicted incidence of radiation pneumonitis was similar (3.9% versus 3.6%), and the estimated risk of radiation-induced spinal cord injury was extremely low (<0.13%) in both groups. Regarding the esophageal toxicities, the estimated grade ≥2 and grade ≥3 AET predicted by the Kwint model were increased by 2.5% and 3.8%. Grade ≥2 AET predicted using the Wijsman model was increased by 14.9%. The predicted incidence of LET was low (<0.51%) in both groups.ConclusionRadiobiological evaluation reveals that the DE-IMRT dosing strategy is feasible for patients with UTEC, with significant gains in tumor control and minor or clinically acceptable increases in radiation-induced toxicities.

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Radiobiological Determination of Dose Escalation and Normal Tissue Toxicity in Definitive Chemoradiation Therapy for Esophageal Cancer

Cited by 33 publications

References 31 publications

Intensity modulated radiation therapy with simultaneous integrated boost based dose escalation on neoadjuvant chemoradiation therapy for locally advanced distal esophageal adenocarcinoma

Intensity modulated radiation therapy with simultaneous integrated boost based dose escalation on neoadjuvant chemoradiation therapy for locally advanced distal esophageal adenocarcinoma

An Overview on the Clinical Application of Radiobiological Modeling in Radiation Therapy of Cancer

Radiobiological evaluation of simultaneously dose-escalated versus non-escalated intensity-modulated radiation therapy for patients with upper thoracic esophageal cancer

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