Radiothérapie postopératoire des sarcomes des tissus mous des extrémités. Étude dosimétrique préliminaire comparative de la radiothérapie conformationnelle avec la tomothérapie hélicoïdale

Donnay, L.; Dejean, C.; Amsellem, E.; Bourezgui, H.; Figueiredo, B. Henriques de; Duparc, A.; Caron, J.; Tournat, H.; Lagarde, Pauline; Stoeckle, Eberhard; Kantor, G.

doi:10.1016/j.canrad.2008.08.275

Cited by 7 publications

(3 citation statements)

References 23 publications

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“…Helical tomotherapy is an integrated system which offers the possibility of delivering helical IMRT and fan‐beam megavoltage computed tomography (MVCT) imaging, (2) and it can be used to treat a wide variety of disease sites such as head and neck, brain, pelvis, lung, and breast. Moreover, advantages have been reported for large volume treatments 3 , 4 …”

Section: Introductionmentioning

confidence: 99%

A retrospective tomotherapy image‐guidance study: analysis of more than 9,000 MVCT scans for ten different tumor sites

Sánchez-Rubio

Rodríguez-Romero

Castro

2014

J Applied Clin Med Phys

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The purpose of this study was to quantify the systematic and random errors for various disease sites when daily MVCT scans are acquired, and to analyze alternative off‐line verification protocols (OVP) with respect to the patient setup accuracy achieved. Alignment data from 389 patients (9,418 fractions) treated at ten different anatomic sites with daily image‐guidance (IG) on a helical tomotherapy unit were analyzed. Moreover, six OVP were retrospectively evaluated. For each OVP, the frequency of the residual setup errors and additional margins required were calculated for the treatment sessions without image guidance. The magnitude of the three‐dimensional vector displacement and its frequency were evaluated for all OVP. From daily IG, the main global systematic error was in the vertical direction (4.4–9.4 mm), and all rotations were negligible (less than 0.5°) for all anatomic sites. The lowest systematic and random errors were found for H&N and brain patients. All OVP were effective in reducing the mean systematic error to less than 1 mm and 0.2° in all directions and roll corrections for almost all treatment sites. The treatment margins needed to adapt the residual errors should be increased by 2–5 mm for brain and H&N, around 8 mm in the vertical direction for the other anatomic sites, and up to 19 mm in the longitudinal direction for abdomen patients. Almost 70% of the sessions presented a setup error of 3 mm for OVPs with an imaging frequency above 50%. Only for brain patients it would be feasible to apply an OVP because the residual setup error could be compensated for with a slight margin increase. However, daily imaging should be used for anatomic sites of difficult immobilization and/or large interfraction movement.PACS numbers: 87.55.‐x, 87.56.‐v

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Section: Introductionmentioning

confidence: 99%

A retrospective tomotherapy image‐guidance study: analysis of more than 9,000 MVCT scans for ten different tumor sites

Sánchez-Rubio

Rodríguez-Romero

Castro

2014

J Applied Clin Med Phys

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“…Les comparaisons avec d'autres techniques en RCMI sont en cours d'évaluation et peuvent montrer un avantage dosimétrique dans les formes les plus complexes [14,15] pour les irradiations abdominales complexes avec en particulier l'irradiation des tumeurs rétropéritonéales avec radiothérapie préopératoire à haut niveau de dose (PHRC en cours) ; pour les irradiations pelviennes (évaluations en cours à la fois pour les toxicités [18], pour l'apport de l'imagerie et des modifications du fractionnement [19]) ; pour les irradiations de paroi abdominale ou thoracique (mésothéliomes ou sarcomes) ; pour les sarcomes des extrémités quand une condition particulière est requise [20] ; enfin pour les tumeurs axiales et para-axiales qui peuvent constituer une alternative aux traitements par particules lourdes. Toutes ces évaluations sont évolutives avec les développements techniques en RCMI très rapides en cours.…”

Section: éValuation Dosimétriqueunclassified

Tomothérapie hélicoïdale : aspects techniques et applications cliniques

et al. 2010

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“…With helical IMRT as Tomotherapy © dose distributions often are even more conformal, longer volumes can be treated, and the treatment machine offers online MV-CT imaging for position verification. Early reports on Tomotherapy © for sarcomas reported excellent results as well as improved sparing of normal tissue [ 41 – 44 ]. For daily repositioning image-guidance as well as positioning devices are necessary.…”

Section: Introductionmentioning

confidence: 99%

Study of Preoperative Radiotherapy for Sarcomas of the Extremities with Intensity-Modulation, Image-Guidance and Small Safety-margins (PREMISS)

et al. 2015

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BackgroundThe aim of the trial is to demonstrate that with the use of modern IMRT/IGRT and reduction of safety margins postoperative wound complications can be reduced.Methods/ DesignThe trial is designed as a prospective, monocentric clinical phase II trial. The treatment is performed with helical IMRT on the Tomotherapy HiArt System© or with RapidArc© IMRT as available. All treatments are performed with 6 MV photons and daily online CT-based IGRT.A dose of 50 Gy in 2 Gy single fractions (5 fractions per week) is prescribed. Restaging including MRI of the primary tumor site as well as CT of the thorax/abdomen is planned 4 weeks after RT. PET-examinations or any other imaging can be performed as required clinically. In cases of R1 resection, brachytherapy is anticipated in the 2nd postoperative week. Brachytherapy catheters are implanted into the tumor bed depending on the size and location of the lesion. Surgery is planned 5–6 weeks after completion of neoadjuvant RT. All patients are seen for a first follow-up visit 2 weeks after wound healing is completed, thereafter every 3 months during the first 2 years. The endpoints of the study are evaluated in detail during the first (2 weeks) and second (3 months) follow-up. Functional outcome and QOL are documented prior to treatment and at year 1 and 2. Treatment response and efficacy will be scored according to the RECIST 1.1 criteria. A total patient number of 50 with an expected 20 % rate of wound complications were calculated for the study, which translates into a 95 % confidence interval of 10.0-33.7 % for wound complication rate in a binomial distribution.DiscussionThe present study protocol prospectively evaluates the use of IMRT/IGRT for neoadjuvant RT in patients with soft tissue sarcomas of the extremity with the primary endpoint wound complications, which is the major concern with this treatment sequence. Besides complications rates, local control rates and survival rates, as well as QOL, functional outcome and treatment response parameters (imaging and pathology) are part of the protocol. The data of the present PREMISS study will enhance the current literature and support the hypothesis that neoadjuvant RT with IMRT/IGRT offers an excellent risk-benefit ratio in this patient population.Trial registration NCT01552239

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Radiothérapie postopératoire des sarcomes des tissus mous des extrémités. Étude dosimétrique préliminaire comparative de la radiothérapie conformationnelle avec la tomothérapie hélicoïdale

Cited by 7 publications

References 23 publications

A retrospective tomotherapy image‐guidance study: analysis of more than 9,000 MVCT scans for ten different tumor sites

A retrospective tomotherapy image‐guidance study: analysis of more than 9,000 MVCT scans for ten different tumor sites

Tomothérapie hélicoïdale : aspects techniques et applications cliniques

Study of Preoperative Radiotherapy for Sarcomas of the Extremities with Intensity-Modulation, Image-Guidance and Small Safety-margins (PREMISS)

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