Tomotherapy in malignant mesothelioma: a planning study to establish dose constraints

Leitzen, Christina; Wilhelm-Buchstab, Timo; Stumpf, Sabina; Heimann, Muriel; Koch, David; Schmeel, Christopher; Simon, Birgit; Vornholt, Susanne; Garbe, Stephan; Röhner, Fred; Schoroth, Felix; Schild, Hans H.; Schüller, Heinrich; Müdder, Thomas

doi:10.1007/s00066-019-01458-1

Cited by 5 publications

(6 citation statements)

References 18 publications

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“…The beam-on time was kept below 15 min. The MLD of the contralateral lung was below 4 Gy, and the Dmean of the heart was 22.23 Gy ( 31 ). Kimura et al treated a total of 15 patients after EPP with VMAT.…”

Section: Discussionmentioning

confidence: 99%

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Dosimetric evaluation of helical tomotherapy and volumetric-modulated arc therapy for malignant pleural mesothelioma: a planning study for dose escalation

Zhang¹,

Lü²,

Jiang³

et al. 2021

Transl Cancer Res TCR

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Background To compare the dosimetric differences between helical tomotherapy (HT) and volumetric-modulated arc therapy (VMAT) treatment plans for inoperable malignant pleural mesothelioma (MPM). Methods Ten patients with inoperable MPM were retrospectively planned with the HT and VMAT techniques, and the dose-volume histogram (DVH)-based parameters of the planning target volume (PTV) and organs at risk (OARs) were compared. Results Compared with the VMAT plans, the target homogeneity index (HI) and conformity index (CI) of the HT plans were significantly better (HI: 1.04±0.01 vs. 1.11±0.03, CI: 0.80±0.07 vs. 0.71±0.12, respectively) (P<0.001, P=0.013, respectively). Regarding the OARs, including the ipsilateral lung, contralateral lung, heart, and spinal cord, the differences among the V30 (Vx: fraction of volume receiving >5, 10, 20, and 30 Gy, respectively) of the ipsilateral lung and V5, V10, and V20 of the contralateral lung were statistically significant (P=0.031, P=0.030, P=0.021, P=0.003, respectively). However, there was no significant differences between HT plans and VMAT plans, regarding the V5, V10 and V20 of the ipsilateral lung, V3 of the contralateral lung, V5 and Dmean of the heart, and Dmax of the cord. The treatment delivery time of the VMAT was significantly shorter than that of the HT (mean delivery time: 3.27±1.65 vs. 11.11±3.75 min, respectively) (P<0.001). Conclusions Compared to the VMAT plans, the HT plans not only demonstrated more optimal target coverage and conformity but also considerably reduced the dose-volume parameters of the OARs in both low-dose areas in contralateral lung and high-dose areas in ipsilateral lung and contralateral lung, which is correlated to radiation injury. However, the treatment delivery time of the HT plans was longer.

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Section: Discussionmentioning

confidence: 99%

“…For the VMAT plan, the V5, V10, and V20 of the ipsilateral lung were 100%, 100%, and 92%, respectively, while the V5, V10, and V20 were 67.8%, 51.4%, and 3.5%, respectively. The Dmean of the heart was 33.3 Gy, and the Dmax of the cord was 39.3 Gy ( 31 ). Both the Dmax and Dmean of the PTV1 and PTV2 favored the HT plan over the VMAT plan.…”

Section: Discussionmentioning

confidence: 99%

Dosimetric evaluation of helical tomotherapy and volumetric-modulated arc therapy for malignant pleural mesothelioma: a planning study for dose escalation

Zhang¹,

Lü²,

Jiang³

et al. 2021

Transl Cancer Res TCR

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“…[16][17][18] Helical tomotherapy (HT) and volumetric-modulated arc therapy (VMAT) are novel IMRT techniques. [19][20][21] Proton beam RT also achieves a more conformal target dose distribution due to the Bragg peak than photon RT. 22 In particular, the potential benefits of intensity-modulated proton therapy (IMPT) 23 enable an excellent dose distribution for AS.…”

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confidence: 99%

Dosimetric Comparison of Helical Tomotherapy, Volumetric-Modulated Arc Therapy, and Intensity-Modulated Proton Therapy for Angiosarcoma of the Scalp

Mizuno

Tomita

Takaoka³

et al. 2021

Technol Cancer Res Treat

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Objective: We compared radiotherapy plans among helical tomotherapy (HT), volumetric-modulated arc therapy (VMAT), and intensity-modulated proton therapy (IMPT) for angiosarcoma of the scalp (AS). Methods: We conducted a planning study for 19 patients with AS. The clinical target volume (CTV) 1 and CTV2 were defined as the gross tumor volume with a specific margin and total scalp, respectively. For HT and VMAT, the planning target volume (PTV) 1 and PTV2 were defined as CTV1 and CTV2 with 0.5-cm margins, respectively. For IMPT, robust optimization was used instead of a CTV-PTV margin (i.e. CTV robust). The targets of the HT and VMAT plans were the PTV, whereas the IMPT plans targeted the CTV robust. In total, 70 Gy and 56 Gy were prescribed as the D95% (i.e. dose to 95% volume) of PTV1 (or CTV1 robust) and PTV2 (or CTV2 robust), respectively, using the simultaneous integrated boost (SIB) technique. Other constraint goals were also defined for the target and organs at risk (OAR). Results: All dose constraint parameters for the target and OAR met the goals within the acceptable ranges for the 3 techniques. The coverage of the targets replaced by D95% and D98% were almost equivalent among the 3 techniques. The homogeneity index of PTV1 or CTV1 robust was equivalent among the 3 techniques, whereas that of PTV2 or CTV2 robust was significantly higher in the IMPT plans than in the other plans. IMPT reduced the Dmean of the brain and hippocampus by 49% to 95%, and the Dmax of the spinal cord, brainstem, and optic pathway by 70% to 92% compared with the other techniques. Conclusion: The 3 techniques with SIB methods provided sufficient coverage and satisfactory homogeneity for the targets, but IMPT achieved the best OAR sparing.

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“…In our study, ipsilateral D mean was found to be 38.1 Gy (25.6–54.4), and V20 was 89.4% (67.2–100). In a dosimetric study conducted by Leitzen et al, [ 18 ] ipsilateral lung tissue was also maximally preserved, with a D mean for V20 of 80–81% (70.5–89.3). In this study, it was emphasized that the contralateral dose should be kept as low as possible, but the planning system of HTT does not allow protecting both lungs and then optimizing the plan for one side at the same time.…”

Section: Discussionmentioning

confidence: 99%

Trimodality therapy of malignant pleural mesothelioma with helical tomotherapy

Özyurt¹

2023

North Clin Istanbul

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M PM is an aggressive tumor that originates from the pleural surfaces and associated with asbestos exposure [1]. In recent studies some tumor suppressor genes, such as BAF-1, have been identified as factors in mesothelioma carcinogenesis [2].MPM is divided into 3 histopathological subgroups by WHO, which differ from each other in terms of prognosis: epithelioid, sarcomatoid, and biphasic. Epithelioid is the most common histopathological type with the best prognostic features, with a median survival of 14 months. Survival times of biphasic and sarcomatoid types were reported as 10 and 4 months, respectively [3].MPM treatment includes different approaches such as surgery, radiotherapy, and chemotherapy. Two surgical approaches are available: gross tumor resection and radical removal of visible disease with tissues, or conservative approaches such as tissue sparing and debulking. Extra-pleural pneumonectomy (EPP) is a radical ap- ABSTRACT OBJECTIVE:The purpose of this study was to determine the efficacy and tolerability of hemithoracic radiotherapy implemented with helical tomotherapy (HTT) in malignant pleural mesothelioma (MPM) patients. METHODS:Between October 2018 and December 2020, data from 11 MPM patients who received trimodality therapy, including lung-sparing surgery (pleurectomy-decortication, P/D), adjuvant chemotherapy (cisplatin+ pemetrexed), and radiotherapy, were retrospectively reviewed. HTT was used to deliver a total of 30 Gy, 50-54 Gy or 59.4-60 Gy to R2 disease with 1.8-2 Gy daily doses. Descriptive data are presented in number (percentage) or median (minimum-maximum). The Kaplan-Meier method was used to calculate survival data. In patients with toxicities, the risk organ doses were compared using the Mann-Whitney U test. RESULTS:The median follow-up was 20.5 (12-30) months. Two-year local control, disease-free, and overall survival rates were 48.5%, 49%, and 77.9%, respectively. The median prescribed dose for planning target volume (PTV) was 50.4±8.7 (30-60) Gy. Mean dose (D mean ) of total lung was 19.9±6 (10.4-26) Gy; the V20 (%) of ipsilateral and contralateral lungs were 89.±11.2 (62.7-100) and 0.7±2.1 (0.49-5.9), respectively. Esophageal D mean and maximum doses (D max ) were found as 21. 7±8.4 (7.4-34) and 53.1±10.4 (25.4-64.4) Gy, respectively. V30 (%) and Dmean of heart were 22.3%±13.4% (3.9-47) and 21±5.7 (10.8-29.3) Gy, respectively. D max of medulla spinalis (MS) was 38.6± 1.3 (13.7-48) Gy. Grade 1-2 radiation pneumonitis (RP) developed in 4 (36.4%) and esophagitis in 2 (18.2%) patients. RP was found to be associated with MS and esophageal doses (p<0.05). Myelitis was diagnosed in 1 (9.1%) patient (MS D max : 29 Gy).CONCLUSION: HTT can be used as part of trimodality therapy for MPM patients with acceptable toxicities. MS and esophageal doses should be considered for radiation pneumonitis risk, and new dose constraints for these organs should be defined.

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Tomotherapy in malignant mesothelioma: a planning study to establish dose constraints

Cited by 5 publications

References 18 publications

Dosimetric evaluation of helical tomotherapy and volumetric-modulated arc therapy for malignant pleural mesothelioma: a planning study for dose escalation

Dosimetric evaluation of helical tomotherapy and volumetric-modulated arc therapy for malignant pleural mesothelioma: a planning study for dose escalation

Dosimetric Comparison of Helical Tomotherapy, Volumetric-Modulated Arc Therapy, and Intensity-Modulated Proton Therapy for Angiosarcoma of the Scalp

Trimodality therapy of malignant pleural mesothelioma with helical tomotherapy

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