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Low dose volume of the lung in prediction of acute radiation pneumonitis

Lan WANG ; Xiaoning LI ; Dongjie Lü ; Chun HAN ; Yuqin ZHAO ; Chao GAO

Chinese Journal of Radiation Oncology.2010;19(4):296-300. doi:10.3760/cma.j.issn.1004-4221.2010.04.005

Objective To observe the incidence of radiation pneumonitis (RP) in patients with non-small cell lung cancer (NSCLC) or esophageal carcinoma treated by three-dimensional conformal radiation therapy (3DCRT), and investigate the predictive value of low dose volume of the lung on RP.Methods From Mar 2005 to Aug 2008, 161 patients with locally advanced NSCLC or esophageal carcinoma received 3DCRT. Fifty-three patients with NSCLC received radiotherapy of 60 Gy/30 -34 fx and concurrent chemotherapy of navelbine plus cisplatin (NP). Among the 108 patients with esophageal carcinoma with prescription doses ranging from 58 Gy/29 fx to 70 Gy/35 fx, 46 and 62 received 3DCRT alone or 3DCRT with concurrent chemotherapy of calcium folinate, 5-Fu and cisplatin (LFP), respectively. Univariate and multivariate analysis and receiver operating characteristics (ROC) curves were performed to assess the correlated factors of RP. Results The follow-up rate was 100%. The rate of RP was 57. 8% (93/161) for all patients, 94% (50/53,including 1 with Grade 4 and 1 with Grade 5) for patients with NSCLC, and 39.8% (43/108, none with Grade 4 and 5) for patients with esophageal carcinoma. The correlative factors included the sex, volume of gross tumor volume (GTV), mean lung dose (MLD), V5, V10, V15, V20, V25 and V30 of normal lung according to Spearman correlative analysis. Univariate analysis showed that all the 9 factors could predict RP. Only V5 and the volume of GTV were found independently associated with Grade 2 or more RP in multivariate analysis. ROC analysis indicated that the cut-off point of the curve was 55% with the area under ROC curve of 0. 684 (P = 0. 000). For the patients with lung V5 ≥ 55% and < 55% ,43% (36/84) and 18% (14/77) developed RP of Grade 2 or more, respectively. Conclusions Dosimetric parameters including MLD, normal tissue complication probability, and V5-V30 could predict RP. V5 may be the most valuable predictor. When V5 exceeds 55%, the probability of RP of grade 2 or more may increase notably. Besides the limitation of MLD, V20 and V30, the volume of low dose region should be also limited to a lower range during treatment planning.

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FDG PET or PET-CT versus MRI in detecting local residue or recurrence of nasopharyngeal carcinoma after radiotherapy: a meta-analysis

Guozeng XU ; Xiaodong ZHU ; Mingyao LI

Chinese Journal of Radiation Oncology.2010;19(5):391-395. doi:10.3760/cma.j.issn.1004-4221.2010.05.002

Objective To compare the value of 18 F-labeled deoxyglucose (FDG) PET or PET-CT with MRI in detecting local residue or recurrence of nasopharyngeal carcinoma after radiotherapy, by performing a meta-analysis of relevant trials.Methods A literature search was performed to English original articles about FDG PET or PET-CT and MRI in Medline, Embase and the Cochrane database from January 1995 to August 2009.The reference standard was histopathologic analysis and/or close clinical and imaging follow-up.Two reviewers searched articles and extracted data independently.Sensitivity, specificity,summary receiver operating characteristic curves (SROC), and the Q index for FDG PET or PET-CT and MRI were pooled, respectively.Results Seventeen studies about FDG PET or PET-CT and 10 studies about MRI were included in this meta-analysis.The pooled sensitivity of FDG PET or PET-CT and MRI were 0.935(95% CI= 0.901 -0.964) and 0.792 (95% CI= 0.731 -0.844), separately.The pooled specificity were 0.924 (95 % CI= 0.898 - 0.945) and 0.787 (95 % GI= 0.746 - 0.825), separately.Area under SROC curves of PET-CT or PET (0.966) was significantly larger than that of MRI (0.852) (z =2.29, P < 0.05).The Q * index estimates for PET-CT or PET (0.914) were significantly higher than for MRI (0.783)(z=2.94,P<0.05).Conclusions FDG-PET/PET-CT has higher accuracy than MRI in diagnosing local residue or recurrence of nasopharyngeal carcinoma after radiotherapy.

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Impact of implanted metal plates on radiation dose distribution in vivo

Ming LIU ; Xingde LI ; Qingguo NIU ; Fushan ZHAI

Chinese Journal of Radiation Oncology.2010;19(5):459-462. doi:10.3760/cma.j.issn.1004-4221.2010.05.024

Objective To investigate the impact of metal plate on radiation dose distribution in surrounding tissues in cadaver specimens.Methods Stainless steel plate, titanium plate, and muscle strip were implanted into the left thigh of a corpse, respectively.All the specimens were irradiated with 6 MV X-ray , SSD = 100 cm.The absorbed dose of surface was measured by thermoluminiscent elements.Results Surface dose distributions differed significantly among the three different materials (F = 57.35, P < 0.01),with the amounts of 1.18 Gy ± 0.04 Gy (stainless steel plate), 1.12 Gy ± 0.04 Gy (titanium plate) and 0.97 Gy ±0.03 Gy (muscle strip), respectively.The surface absorbed doses on incident plane of stainless steel plate and titanium plate were significantly increased by 21.65% and 15.46% respectively as compared with that of muscle strip.The absorbed doses on the exit surface of stainless steel plate, titanium plate and muscle strip were 0.87 Gy ± 0.03 Gy, 0.90 Gy ± 0.02 Gy and 0.95 Gy ± 0.04 Gy, respectively (F =13.37, P <0.01).The doses on the exit surface of stainless steel plate and titanium plate were significantly lowered by 8.42% and 5.26% when compared with that of muscle strip.Using treatment planning system,the differences between dose distribution with and without metal plate were compared.Within 1 cm away from the incident plate, there was an obvious increase in the absorbed dose, while the influence was less than 5% 1cm outside the surface.The effect of dose distribution on exit surface was less than 2%.Conclusions The influence of metal plate on the radiotherapy dose distribution is significant.The deviations ranges from 5% to 29%.Under the same condition, the impact of stainless steel plate is much more than that of titanium alloy plate.

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Influence of CT/MRI image fusing technique on target volume and dosimetrics of normal tissues in intensity modulated radiotherapy for prostate carcinoma

Zhaoyang WANG ; Weihu WANG ; Yexiong LI ; Yuan TIAN ; Zhihui HU ; Hui FANG ; Li LIU ; Jing JIN ; Yueping LIU ; Shulian WANG ; Yongwen SONG ; Xinfan LIU ; Zihao YU ; Hua WANG ; Qingfeng LIU ; Shunan QI

Chinese Journal of Radiation Oncology.2010;19(5):452-455. doi:10.3760/cma.j.issn.1004-4221.2010.05.020

Objective To explore the influence of computed tomography (CT) and magnetic resonance imaging (MRI) fusing technique on target volume and dosimetrics of normal tissues in intensity modulated radiotherapy (IMRT) for prostate carcinoma.Methods Ten patients with pathologically diagnosed moderate-high risk localized prostate carcinoma were enrolled in this study.CT and MRI images were collected.Same image slices of the prostate, seminal vesicles, rectum and bladder were anatomically delineated using image fusing software.Clinical target volume (CTV) was defined as the prostate plus seminal vesicles.IMRT treatment planning was designed basing on CT and MRI images, respectively.Differences of CTV volume and dose volume histogram of rectum and bladder between the two image groups were analyzed.Results The mean volume of CTV on CT and MRI images was 84.03 cm3 and 53.53 cm3,respectively (t =2.47,P=0.024).The V50, V60 and V70 of rectum were 30.28%, 19.13%, 9.53% on MRI and 37.03%, 24.99% and 14.55% on CT images, respectively, with significent difference (t =2.71,P=0.014 for V50; t =2.83,P=0.011 for V60; t=3.19,P=0.005 for V70).The maximal dose of bladder was 81.10 Gy on MRI and 82.45 Gy on CT, respectively(t=2.41,P=0.027).Conclusions By using image fusing technique, the mean volume of the prostate plus seminal vesicles delineated on MRI image is smaller as compared to CT image.The volume of the rectum receiving high irradiation dose can be reduced when MRI was used to delineate CTV compared to CT image.

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Application of IMAT versus fixed-gantry IMRT in cervical esophageal cancer : A comparison in dosimetry and implementation

Jinhu CHEN ; Yong YIN ; Tonghai LIU ; Xiaoling DONG ; Dongqing WANG ; Tao SUN ; Changsheng MA ; Xiutong LIN

Chinese Journal of Radiation Oncology.2010;19(5):429-433. doi:10.3760/cma.j.issn.1004-4221.2010.05.013

Objective To compare and analyze the characteristics of intensity-modulated arc therapy (IMAT) versus fixed-gantry intensity-modulated radiotherapy (IMRT) in the treatment of cervical esophageal cancer.Methods Ten patients treated in our radiotherapy center were selected for this study.Based on the identical CT and planning target volume (PTV), two IMAT plans were generated with Eclipse ver8.6 planning system.IMAT1 consisting of a single 359.8° rotation, and IMAT2 consisting of two coplanar 359.8° rotations.PTV were prescribed to 60 Gy in 30 fractions.Planning objectives for PTV,corresponding with the IMRT plans, were V98 larger than 97% and V110 no more than 15%.The maximum dose of spinal-cord was constrained below 45 Gy.One-way ANOVA were applied to dose-volume values for PTV and OAR from DVH.Results There were no significant differences between IMRT and IMAT in PTV D98, V98, CI or total-lung V5, V10, V30, V40, V50 and mean lung dose (all P > 0.05).However, the differences were significant in terms of D2, V110 and HI of PTV, V20 of the total-lung (all P<0.05).On the MU,IMRT = 1174.8 MU,IMAT1 =709.7 MU,and IMAT2 =803.8 MU (F =39.25,P =0.000).On the treatment time,IMRT= 14.9 min,IMAT1 = 1.9 min, and IMAT2 =2.66 min (F=45.14,P=0.000).Conclusions IMAT is equal to IMRT in dosimetric evaluation.Due to much less MU and delivery time,IMAT is an ideal technique in treating patients by reducing the uncomfortable influences which could effect the treatment.However, IMAT1 is slightly inferior to IMAT2.

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Impact of anatomical changes on dose distribution of intensity-modulated radiotherapy for nasopharyngeal carcinoma

Shaomin HUANG ; Xiaowu DENG ; Chong ZHAO ; Fei HAN ; Xingwang GAO ; Taixiang LU ; Shi WANG

Chinese Journal of Radiation Oncology.2010;19(5):404-408. doi:10.3760/cma.j.issn.1004-4221.2010.05.005

Objective To observe the physique and anatomy changes in patients with nasopharyngeal carcinoma (NPC) during intensity-modulated radiotherapy (IMRT), using repeated CT images and deformable registration technique, and analyze their impact on delivery dose distribution.Methods Ten NPC patients were randomly selected from those who had received IMRT treatment.Gross tumor volume of nasopharyn (GTVnx), GTV of metastastatic lymph node (GTVnd), clinical target volume (CTV) and normal tissue or organ (OAR) were re-contoured on the in-course repeated CT images using a kind of deformable registration and auto-segmentation software according to the original planning contouring.Changes in volume of treatment targets and organs at risk were evaluated and the trends were then analyzed.Dose distributions were recalculated with repeated CT images and compared to the original plans.Results The volume of GTVnx were decreased by 6.44%,10.23% and9.72%(F=1.34,P=0.278) in the 2-,4-and 6-week after IM RT comparing with before IM RT, with 6.59%, 30.98 % and 35.13 % (F = 9.22, P =0.000) in GTVnd, 0.73%, 1.86% and 1.41% (F=0.33,P=0.722) in CTV1, -1.78%, -6.47%and -9.34% (F =16.89 ,P =0.000) in CTV2, 13.96%, 32.97% and 37.77%(F=17.17,P=0.000)in the left parotid , and 3.56% , 29.57% and 35.63% (F = 13.49 , P = 0.000) in the right parotid.The mean dose change rate of GTVnx were -0.39%, 0.08% and 0.32% (F =0.15 ,P =0.860) in the 2-,4- and 6-week after IMRT comparing with planning faction dose, with 0.53%, 1.19% and 0.69% (F=0.81,P=0.455) in GTVnd, 1.95%, 2.70% and 3.78% (F=0.61,P=0.552) in the spinal cord,0.32%, 0.81% and 0.62% (F=0.03,P=0.975) in the brain stem, 4.50%, 4.66% and 7.20% (F=0.33,P=0.725) in the left parotid, 2.20%, 7.17% and 7.12% (F= 1.24,P=0.306) in the right parotid.Conclusions The GTVnd, CTV2 and parotids shrinks obviously along with the treatment times for NPC patients during IMRT.Although changes in fraction dose of GTV, CTV, spinal cord, stem and parotids are not significant, further study with larger samples is needed.

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Concurrent chemoradiotherapy versus radiotherapy alone for T3-4N0-1M0 and T1-4N2-3M0 nasopharyngeal carcinoma after induction chemotherapy

Peiyu HUANG ; Haiqiang MAI ; Xiang GUO ; Kajia CAO ; Ling GUO ; Manquan DENG ; Haoyuan MO ; Minghuang HONG

Chinese Journal of Radiation Oncology.2010;19(5):387-390. doi:10.3760/cma.j.issn.1004-4221.2010.05.001

Objective To compare the efficacy of concurrent chemoradiotherapy versus radiotherapy alone for T3-4 N0-1 M0 and T14 N2-3 M0 nasopharyngeal carcinoma (NPC) after induction chemotherapy.Methods From 2002 to 2005,400 patients with stage Ⅲ and Ⅳa NPC were randomly divided into 2 groups :induction chemotherapy followed by concurrent chemoradiotherapy group (IC/CCRT,201 patients),and induction chemotherapy followed by radiotherapy alone group (IC/RT, 199 patients).Subgroup analysis was conducted for 197 patients with stage T3-4N0-1M0 NPC and 203 with stage T1-4N2-3M0 NPC.Results The follow-up rate were 96.2%, with a median followg-up time of 3.9 years.For T3-4N0-1 M0 NPC patients in IC/CCRT group (104 patients) and IC/RT group (93 patients), the 3-year overall survival, disease-free survival, locoregional recurrence-free survival and distant metastasis-free survival rates were 84.0% and 85.9% (χ2=0.08,P =0.780) ,77.0% and 72.0% (χ2=0.44,P =0.510) ,89.5% and 92.3% (χ2=0.65 ,P = 0.420), and 84.9% and 77.0% (χ2= 1.59, P = 0.210), respectively; For T1-4 N2-3 M0 NPC patients in IC/CCRT group (97 patients) and IC/RT group (106 patients), the corresponding rates were 67.4% and 82.2% (χ2=3.48,P=0.060), 61.5% and 68.0% (χ2= 1.86,P=0.170), 86.2% and 87.0% (χ2=0.57 ,P =0.450) and 66.2% and 75.6% (χ2=2.07 ,P =0.150), respectively.Acute sideeffects were similar except more leucocytopenia in IC/CCRT group than IC/RT group.Conclusions Compared with IC/RT, IC/CCRT dose not improve the overall survival in patients with T3-4N0-1 M0 and T1-4 N2-3 M0 NPC.

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Comprehensive parameters in predicting radiation pneumonitis in advanced stage non-small-cell lung cancer treated with three-dimensional conformal or intensity-modulated radiation therapy

Lei HAN ; Bing LU ; Heyi FU ; Yinxiang HU ; Jiaying GAN ; Bingqing XU ; Gang WANG ; Na LIANG ; Huiqin LI

Chinese Journal of Radiation Oncology.2010;19(5):420-424. doi:10.3760/cma.j.issn.1004-4221.2010.05.010

Objective To analyze relation of comprehensive parameters of the dose-volume V5,V10 and V20 with radiation pneumonitis (RP) in patients with advanced stage non-small-cell lung cancer (NSCLC) treated with three-dimensional conformal (3DCRT) or intensity-modulated radiation therapy (IMRT).Methods Data of 90 patients with histologically proved NSCLC treated with 3DCRT or IMRT between November 2006 and July 2009 were collected.The median radiation dose of 70 Gy (range, 61 - 80 Gy) was delivered with late-course accelerated hyperfractionated radiotherapy (LAHRT).The V5 ,V10 ,V20,V30 and mean lung dose (MLD) were calculated from the dose-volume histogram system.The RP was evaluated according to the common toxicity criteria 3.0(CTC 3.0).Results The range of V5 ,V10 and V20 was 36% - 98%, 27% - 78% and 19% - 54%, respectively, with a median value of 66%, 48% and 31%, respectively.The RP of grade 1,2,3,4 and 5 was observed in 29,23,5,1 and 1 patients.The V5,V10 ,V20, contralateral V10, GTV,PTV, and numbers of fields were all significantly associated with RP of ≥grade 1 (χ2=2.04, 2.05, 2.01, 4.62, 6.50, 5.61, 5.61, and P= 0.044, 0.043, 0.047, 0.030,0.010,0.020,0.020).The V5, V10, V20, V30, and MLD were all significantly associated with RP of ≥ grade 2 (χ2= 2.05,2.20,2.96,4.96,5.20, and P = 0.040,0.030,0.000,0.030,0.020).In Logistic regression analysis, GTV was the only factor significantly associated with RP of ≥ grade 1 (χ2= 4.06, P =0.044).The V20 was the only factor significantly associated with RP of ≥grade 2(χ2=9.61,P=0.002).The RP of ≥grade 2 was significantly increased when V20 was more than 31%.The RP of ≥grade 2 was significantly increased when V20, V10 and V5 were more than 31%, 48% and 66%, respectively.The RP of ≥ grade 2 was significantly increased when V20 was more than 31% and V5 was more than 66%.Conclusions The comprehensive parameters combined with V5, V10 and V20 are effective in predicting RP.

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Value of overall treatment time on the effect of intensity-modulated radiotherapy for locally advanced nasopharyngeal carcinoma

Shengfa SU ; Taixiang LU ; Chong ZHAO ; Fei HAN ; Weiwei XIAO ; Jiaxin LI ; Chunyan CHEN

Chinese Journal of Radiation Oncology.2010;19(5):400-403. doi:10.3760/cma.j.issn.1004-4221.2010.05.004

Objective To investigat the prognostic value of overall treatment time (OTT) for locally advanced nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT).Methods From May 2001 to April 2007, 376 patients with locally advanced NPC treated with IMRT were retrospectively analyzed.All patients were divided into OTT≤45 days group and OTT >45 days group.The treatment outcomes between the two groups were analyzed.Results Between the groups with OTT≤45 days and OTT > 45 days, the 2-year local control rate (LCR) was 94.9% and 93.1% (χ2= 2.83, P > 0.05) for all patients, 96.3% and 98.7% (χ2=2.83, P>0.05) for patients with T3 disease, 92.2% and 83.1%(χ2= 6.30, P < 0.05) for T4, and 93.1% and 97.5% (χ2= 4.69, P = 0.030) when chemotherapy was concurrently administered.The 2-year LCR was 98%, 96% and 93% (χ2= 2.20, P = 0.531) for patients with treatment interruption before, within and after the 3rd week of IMRT, The Cox regression analysis found that OTT was an independent prognostic factor for LCR in T4 disease.The Linear regression showed that the 2-year LCR was decreased by 2.7% per day of delay.Between the groups with OTT≤45 days and OTT >45days, the 2-year estimated disease-specific survival (DSS), distant metastasis-free survival (DMFS) and overall survival (OS) were 84.1% vs.78.7% (χ2= 0.02, P = 0.881), 87.0% vs.86.1% (χ2= 0.85,P = 0.358), and 91.7% vs.92.2% (χ2= 0.06, P = 0.806), respectively.The further stratified analysis found that the DSS, DMFS and OS were similar between the two groups in T3 (83.7% vs.83.2%, χ2=0.07, P=0.798;86.6% vs.85.7%,χ2=0.02, P = 0.898 ; and 93.7% vs.94.8%,χ2=0.03, P=0.862) and T4 disease (81.4% vs.72.3%, χ2= 0.16, P = 0.687 ;82.6% vs.86.9%, χ2= 1.78, P =0.182;and 88.3% vs.87.5% ,χ2=0.60, P =0.438).In multivariate analysis, T-stage and N-stage were the independent prognostic factors for both DFS and OS, and N-stage was the independent prognostic factor for DMFS.Conclusions The prolongation of the overall treatment time decrease the local control of patients with T4 NPC.

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CT features of retropharyngeal lymph node metastasis and its prognostic value in nasopharyngeal carcinoma

Yanfeng ZHAO ; Xiaoyi WANG ; Jingwei LUO ; Dehong LUO ; Xuesong YAO ; Erni LI ; Lin LI ; Chunwu ZHOU

Chinese Journal of Radiation Oncology.2010;19(5):396-399. doi:10.3760/cma.j.issn.1004-4221.2010.05.003

Objective To investigate the charateristics and prognostic value of computed tomography (CT) of retropharyngeal lymphadenopathy (RLN) in nasopharyngeal carcinoma (NPC).Methods From 1991 to 2006, CT images were analyzed for 588 patients with histologically proven NPC treated with radiation therapy in our hospital.The survival rate was evaluated by Kaplan-Meier method.Results RLN metastases were presented in 392 patients, with unilateral side in 254 patients and bilateral sides in 138 patients.The 5-year distant metastasis-free survival (DMFS) rate of patients with and without RLN metastasis was 66.6% and78.6%(χ2 = 10.78,P=0.005) ,with 69.7% and 62.2%(χ2 =2.31,P=0.129) for patients with unilateral and bilateral sides involvement.The DMFS rate was similar between the mild and moderate enhancement of RLN (67.6% and 58.9% ,χ2=2.77,P =0.096).The survival rate of RLN with homogeneous density was better than heterogeneous density (71.5%, 53.3% and 32.5%,respectively, χ2= 10.51, P = 0.001, χ2= 24.28, P = 0.000).The survival rate of patients with well boarded RLN was better than those with ill boarded RLN and obviously adjacent tissue involvement (65.5%, 51.8%and 50.0% , χ2 =8.20,P=0.004, χ2 =5.31 ,P=0.021).Conclusions The prognosis is poor with RLN metastasis, lymph node enhancement, heterogeneous density in nodes and ill boarded RLN.

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