Intensity-modulated Radiation Therapy for Lymph Node Oligo-recurrence.

BACKGROUND/AIM: This study aimed to evaluate the effect of intensity-modulated radiation therapy (IMRT) on the clinical outcomes of patients with lymph node (LN) oligo-recurrence and a controlled primary tumor. PATIENTS AND METHODS: We retrospectively reviewed the medical records of 21 patients diagnosed with LN oligo-recurrence who received IMRT with curative intent. Patients with tumor of various primary sites and histopathological types were included in this study. RESULTS: The 3-year overall survival (OS) and in-field progression-free survival (PFS) rates were 75% and 52%, respectively. Statistical analysis showed that lower dose to the gross tumor volume (GTV) and larger GTV were significantly associated with poorer OS; adenocarcinoma and lower dose to GTV were significantly associated with poorer in-field PFS. No patients experienced severe adverse events. CONCLUSION: IMRT may provide a safe and effective treatment for patients with LN oligo-recurrence. Tumor dose-escalation sparing normal tissue using IMRT technology may improve the OS and in-field PFS.

Intensity-modulated radiation therapy using TomoDirect for postoperative radiation of left-sided breast cancer including lymph node area: comparison with TomoHelical and three-dimensional conformal radiation therapy.

Intensity-modulated radiation therapy (IMRT) delivers an excellent dose distribution compared with conventional three-dimensional conformal radiation therapy (3D-CRT) for postoperative radiation including the lymph nodes in breast cancer patients. The TomoTherapy system, developed exclusively for IMRT, has two treatment modes: TomoDirect (TD) with a fixed gantry angle for beam delivery, and TomoHelical (TH) with rotational beam delivery. We compared the characteristics of TD with TH and 3D-CRT plans in the breast cancer patients. Ten consecutive women with left breast cancer received postoperative radiation therapy using TD including the chest wall/residual breast tissue and level II-III axial and supraclavicular lymph node area. Fifty percent of the planning target volume (PTV) was covered with at least 50 Gy in 25 fractions. TD, TH and 3D-CRT plans were created for each patient, with the same dosimetric constraints. TD and TH showed better dose distribution to the PTV than 3D-CRT. TD and 3D-CRT markedly suppressed low-dose spread to the lung compared with TH. Total lung V5 and V10 were significantly lower, while V20 was significantly higher in the TD and 3D-CRT plans. The mean total lung, heart and contralateral breast doses were significantly lower using TD compared with the other plans. Compared with 3D-CRT and TH, TD can provide better target dose distribution with optimal normal-organ sparing for postoperative radiation therapy including the chest wall/residual breast tissue and lymph node area in breast cancer patients. TD is thus a useful treatment modality in these patients.

Patient organ doses from megavoltage computed tomography delivery with a helical tomotherapy unit using a general treatment planning system.

The purpose of this study was to quantify actual patient organ doses from megavoltage computed tomography (MVCT) using an MVCT beam model of a helical tomotherapy unit in a general treatment planning system (TPS). Dosimetric parameters (percentage depth dose, lateral beam profile, and longitudinal beam profile) of the MVCT beam were measured using Gafchromic EBT3 films (ISP Corporation, Wayne, NJ, USA) and used for beam modeling in a Pinnacle3 TPS (Philips, Amsterdam, Netherlands); this TPS is widely used with linear accelerators. The created beam model was adjusted and validated by assessing point doses in a cylindrical phantom in static and helical beam plans with fine, normal and coarse pitches. Maximum doses delivered to important organs from MVCT delivery for five clinical cases were calculated using the created beam model. The difference (average ± one standard deviation for all evaluation points) between calculated and measured doses was -0.69 ± 1.20% in the static beam plan. In the helical beam plan, the differences were 1.83 ± 2.65%, 1.35 ± 5.94% and -0.66 ± 8.48% for fine, normal and coarse pitches, respectively. The average maximum additional dose to important organs from MVCT in clinical cases was 0.82% of the prescribed dose. In conclusion, we investigated a method for quantifying patient organ dose from MVCT delivery on helical tomotherapy using an MVCT beam model in a general TPS. This technique enables estimation of the patient-specific organ dose from MVCT delivery, without the need for additional equipment.

Clinical and dosimetric predictors of late rectal bleeding of prostate cancer after TomoTherapy intensity modulated radiation therapy.

INTRODUCTION: Rectal bleeding after radiotherapy impacts the quality of life of long-term surviving prostate cancer patients. We sought to identify factors associated with late rectal bleeding following intensity modulated radiation therapy (IMRT) using TomoTherapy for prostate cancer. METHODS: We retrospectively analysed 82 patients with localised prostate cancer treated with TomoTherapy. Most patients (95.1%) received neoadjuvant and concurrent hormone therapy. Forty-two patients (51.2%) graded as high risk using D'Amico's classification underwent radiotherapy involving the pelvic nodal area. Late bleeding complications were quantified using the Common Terminology Criteria for Adverse Events v4.0. Multiple clinical and dosimetric factors were considered with reference to rectal bleeding. RESULTS: The median follow-up period was 538 (range, 128-904) days. Grades 1, 2 and 3 rectal bleeding were observed in 14 (17.1%), four (4.9%) and one (1.2%) patient respectively. In multivariate analysis, the following factors were significantly associated with Grade ≥1 late rectal bleeding: volume, mean dose (P = 0.012) and rectal V30 (P = 0.025), V40 (P = 0.011), V50 (P = 0.017) and V60 (P = 0.036). When exclusively considering Grade 2-3 rectal bleeding, significant associations were observed with the use of anticoagulants or antiaggregates (P = 0.007), rectal V30 (P = 0.021) and V40 (P = 0.041) in univariate analysis. CONCLUSIONS: Our results suggested that the intermediate rectal dose-volume (V30-V60) was a significant predictor for mild to severe late rectal bleeding (Grade ≥1). Rectal dose-volumes >V70, which represented the volume of the highest doses, were not predictive in this study.

[Influence of position of ionization chamber and leaf-end on verification value in IMRT verification for prostate cancer].

In IMRT for prostate cancer, MU verification is performed by the actual measurement. We have experienced a remarkable improvement in results, once succeeding in finding out the more suitable and optimal evaluation dose point in some cases even though the deviation between a designed MU score and our actual record gained at the iso-center was more than 3%. In this study, we tried to demonstrate how much influence would be given to the point dose verification by the 3D arrangement between an ion chamber and tips of the MLC. The five cases in which the bias between each actual datum and planed MU score showed that about 3% were picked up and through these MLC configurations, 8 leaf-ends around the chamber were highlighted as the influential ones. After each distance from 4 pairs, a total of 8 leaves to the axis (the mid-line) of our ion chamber were mapped. The indexes (PlanLeafScores) were computed through these distances and segmental MU scores. The ratio of these scores and results obtained at the 12 sites within 1 cm from the iso-center were carried out by single regression analysis. In all cases the ratios of planed MU values to the actual ones tended to go down in inverse proportion to the increase in PlanLeafScores (r<-0.77, p<0.002). As the dimensional arrangement between the ion chamber and the edges of the MLC were thought to determine the result of the verification. PlanLeafScores will enable us to determine the optimal evaluation of the dose point.

[Development of a respiratory monitoring device for truncal stereotactic radiotherapy using an abdominal pressure-detecting system with Stereotactic Body Frame].

The Stereotactic Body Frame, which was devised as a fastening unit for the irradiation of various truncal lesions, has obtained a good reputation for its high-precision reproductivity. This device is accessorized with 'Diaphragm Control', which can reduce the respiratory movement of intra-thoracic organs. In this study, to investigate the possibility of a respiratory monitor using our device, we try to clarify the relationship between the pressure against the abdominal board of 'Diaphragm Control' and each constrained tidal respiratory movement. Our original software was programmed to detect and analyze these data with our personal computer from some ready-made highly sensitive pressure detectors. In any fundamental performance of this system, response time is less than 1 msec at 115,200 bps, minimum detectable weight is 420 g, linearity correlation between loading weight and pressure index value is seen from 1000 g to 6000 g loading, and reproducibility of measurement is evaluated by coefficient of variation (CV=0.95% at 3000 g loading). It has sufficient capability to be used as a respiratory monitoring device during radiation therapy. In an experiment with three volunteers, the results revealed a positive correlation between pressure index value and ventilation air volume by spirometer. The decision coefficients (R(2)) were 0.7717, 0.7995, and, 0.8684, respectively. Our original respiratory monitoring device can be used for quantitative respiratory suppression and unexpected breathing detection without loading additional stress on the patient.

[Technical considerations on the usage of a general-purpose flatbed image scanner when making a dose-density table].

The DD-System is a dose-distribution system for analyzing the film method with a general-purpose flatbed image scanner. By analyzing the analogue digital conversion(ADC)value of each pixel acquired by the DD-system, we examined the technical problems of measurement with the scanner when making a dose-density table. When film of uniform density was measured, the ADC values distributed normally. Deviation of the values at the same pixel point on another time was about one-ten thousandth of the average. Deviation of the values from the time the scanner was turned on was in the same range. Although it may be negligible, the values measured at a peripheral area on the flatbed deviated about 2SD from the average measured at the central area. Further, deviation of the value obtained with a shade covering the outside of the irradiation field from that taken without the shade was about one thousandth. These deviations are not negligible. In the case of making a dose-density table with a DD-System and a general-purpose flatbed image scanner, the film should be set in the center of the flatbed, and the sampling area should be selected from those areas where the ADC values are distributed normally. Then proper data can be obtained and more accurate tables can be made.

[Artifact of indicators equipped to stereotactic body frame scanned by 16-row MDCT can be resolved].

We found an artifact of the Stereotactic Body Frame's (SBF) indicators when we used diagnostic 16-row multi-detector computed tomography (MDCT) as a simulator. Stereotactic radiotherapy (SRT) requires the accuracy of each millimeter. However, a gap of 3 mm at the maximum along the Z axis was caused by this artifact. We assessed the characteristics and cause of this artifact and searched for an imaging parameter to reduce the artifact in SRT. It was considered that the artifact was formed mainly by a stair-step artifact and cone-beam artifact. We can acquired accuracy, 1 mm minimizing the beam width and pitch (10 mm/0.5625). However, exposure time was extended because minimum pitch was selected. The influence on dose calculation was negligible. We decided to use a default parameter for treatment planning, and this parameter for determining the isocenter. We found the MDCT parameters to get acceptable positional accuracy for SRT with SBF.