Practical Radiation Oncology

Our medical research library holds 5 studies published in Practical Radiation Oncology (2015–2020). Each entry links to the study's record on PubMed and, where there is one, to the publisher's page and a free full text. 5 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it.

About the journal

• Publisher: Elsevier
• Published: 2011 to the present, United States
• Language: English
• ISSN: 1879-8500 (print), 1879-8519 (electronic)
• Its record in the NLM Catalog

2020s

• Disease-Related Outcomes and Toxicities of Intensity Modulated Radiation Therapy After Lung-Sparing Pleurectomy for Malignant Pleural Mesothelioma: A Systematic Review. R. Patel, E.B. Ludmir, J.A. Miccio, et al. 2020;10(6):423-433. Systematic review PubMed · Publisher

  Abstract

  Purpose: This review explores the use of intensity modulated radiation therapy (IMRT) after lung-sparing surgery in malignant pleural mesothelioma (MPM). Because severe toxicities have been documented after radiation therapy for MPM, its use remains controversial, especially as modern surgical management has shifted toward lung-sparing pleurectomy/decortication. IMRT is an advanced technique that may allow for safer radiation therapy delivery, but there remains limited data (including no summative data) to support this notion.

  Methods And Materials: We performed a systematic review evaluating the safety and efficacy of post-pleurectomy IMRT (P-IMRT). A systematic review of PubMed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted for publications of all dates that specifically reported clinical outcomes and/or toxicities of P-IMRT in patients with MPM. Ten original studies were included in this review.

  Results: The incidence of grade 3 pneumonitis ranged from 0% to 16%, with all but 2 studies reporting rates below 9%. Grade 4 and 5 pneumonitis were observed in less than 1.5% of cases, except in one publication that used hypofractionated radiation therapy to doses >60 Gy. Crude local failure rates ranged from 19% to 60%, median progression free survival ranged from 12 to 16 months, and median overall survival ranged from 19 to 28 months.

  Conclusions: P-IMRT produces relatively few higher-grade toxicities and has reasonable disease-related outcomes, especially when delivered using conventionally fractionated regimens to doses of 45 to 54 Gy and exercising careful attention to dose constraints during treatment planning. IMRT can thus be considered in well-selected patients in whom adequate survival after pleurectomy is expected. These data also support the initiation of the phase III NRG-LU006 trial of extended pleurectomy/decortication and chemotherapy with or without IMRT.

  Copyright © 2020 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

2010s

• Dosimetric Correlates of Pulmonary Toxicity in Patients with Malignant Pleural Mesothelioma Receiving Radiation Therapy to the Intact Lungs. M.R. Thompson, V.A. Dumane, S.A. Lazarev, et al. 2019;9(3):e331-e337. PubMed · Publisher · Free full text

  Abstract

  Purpose: We aimed to determine dose-volume constraints that correlate with severe (grade ≥3) radiation pneumonitis (RP) in patients diagnosed with malignant pleural mesothelioma, treated using volumetric modulated arc therapy.

  Methods And Materials: Data from 40 patients with malignant pleural mesothelioma who underwent pleurectomy decortication and adjuvant radiation therapy at our institution between December 2010 and October 2016 were retrospectively analyzed. Dosimetric variables for the absolute volume and percentage volume of the ipsilateral lung, contralateral lung, and heart were recorded. Events of RP were assessed using the Common Terminology Criteria for Toxicity and Adverse Events, version 4.0. The statistical analysis with Wilcoxon rank-sum, Spearman rank correlation, and receiver operating characteristic curves was computed using MATLAB V9.1, RV3.4, and SAS V9.4.

  Results: Of the 40 patients, 26 patients (65%) were male. The median age at the time of diagnosis was 66.5 years (range, 44-84 years). The median prescription dose was 45 Gy (range, 30-54 Gy). Five patients (12.5%) had grade ≥3 RP. The incidence of grade≥ 3 RP showed a significant correlation (P < .05) with the absolute volume and percentage volume of the ipsilateral lung spared of ≥20 Gy (55 cc; 7%) and spared of ≥30 Gy (200 cc; 23%). Dosimetric variables of the contralateral lung, total lung, and heart did not show a correlation with incidence of grade ≥3 RP.

  Conclusions: In our cohort, sparing the ipsilateral lung of at least 55 cc of 20 Gy and 200 cc of 30 Gy correlated with a reduced incidence of severe (grade ≥3) RP.

  Copyright © 2019 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

• Fast, Low-Dose Megavoltage-Topogram Localization on TomoTherapy: Initial Clinical Experience With Mesothelioma Patients. X.S. Qi, L. Yang, P. Lee, et al. 2019;9(5):373-380. PubMed · Publisher

  Abstract

  Purpose: This study aimed to evaluate the potential of megavoltage-topogram (MV-topogram)-based alignment as an alternative to megavoltage computed tomography (MVCT) in reducing setup time and imaging dose for patients with malignant pleural mesothelioma who are receiving TomoTherapy.

  Methods And Materials: Twelve patients were enrolled in an ongoing institutional review board approved clinical trial at our institute. Patients were set up with a clinical protocol using red lasers. Anteroposterior (AP) and lateral (LAT) MV-topograms were acquired using gantry angles of 0°/90° with a 1 mm collimator opening, all multileaf collimator leaves open, a couch speed of 4 cm/s, and a 12.5-second scanning time. Routine MVCT scans were performed immediately afterward. The MV-topograms were reconstructed and enhanced using contrast-limited adaptive histogram equalization. Anteroposterior and LAT kilovoltage digital reconstructed topogram images were reconstructed based on TomoTherapy geometry from computed tomography simulation scans. Registrations between MV-topograms and kilovoltage-digital reconstructed topogram images were performed manually, and patients' daily shifts were recorded. Results were compared against the corresponding daily MVCT shifts. MV-topogram and MVCT doses were measured and recorded using an ion chamber on a cheese phantom with depths between 1 and 14 cm, as well as the times required to acquire the 2 image modalities.

  Results: The mean and standard deviation of shift discrepancies between MV-topogram and MVCT were 0.74 ± 2.08, -0.09 ± 4.46, and 0.45 ± 3.57 mm in the LAT, longitudinal, and vertical directions, respectively. The MVCT imaging doses measured were 14.74 to 26.92 times higher than the MV-topogram doses, depending on depth. On average, MV-topograms with a mean scan length of 50 cm achieved a 5-fold image acquisition time savings over MVCT, with a mean scan length of 38 cm.

  Conclusions: MV-topograms has the potential to provide alignment performance equivalent to that of MVCT for patients with mesothelioma, with a significant reduction in imaging dose and acquisition time.

  Copyright © 2019 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

• Early experience with intensity modulated proton therapy for lung-intact mesothelioma: A case series. H.Y. Pan, S. Jiang, J. Sutton, et al. 2015;5(4):e345-53. PubMed · Publisher

  Abstract

  Purpose: The purpose of this study was to describe our experience implementing intensity modulated proton therapy (IMPT) for lung-intact malignant pleural mesothelioma (MPM), including patient selection, treatment planning, dose verification, and process optimization.

  Methods And Materials: Seven patients with epithelioid MPM were reviewed; 6 underwent pleurectomy, whereas 1 had biopsy alone. Four patients received IMPT and 3 received intensity modulated radiation therapy. Treatment plans for the other modality were created for dosimetric comparisons. Quality assurance processes included dose verification and robustness analysis. Image-guided setup was performed with the first isocenter, and couch shifts were applied to reposition to the second isocenter.

  Results: Treatment with IMPT was well tolerated and completed without breaks. IMPT plans were designed with 2 isocenters, 4 beams, and ≤64 energy layers per beam. Dose verification processes were completed in 3 hours. Total daily treatment time was approximately 45 minutes (20 minutes for setup and 25 minutes for delivery). IMPT produced lower mean doses to the contralateral lung, heart, esophagus, liver, and ipsilateral kidney, with increased contralateral lung sparing when mediastinal boost was required for nodal disease.

  Conclusions: Our initial experience showed that IMPT was feasible for routine care of patients with lung-intact MPM.

  Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

• Tomotherapy improves local control and changes failure patterns in locally advanced malignant pleural mesothelioma. A.U. Kishan, R.B. Cameron, P.C. Wang, et al. 2015;5(6):366-73. PubMed · Publisher

  Abstract

  Purpose: The purpose of the study was to determine whether intensity modulated radiation therapy delivered via helical tomotherapy improves local control (LC) after pleurectomy/decortication (P/D) for malignant pleural mesothelioma compared with 3-dimensional conformal radiation therapy (3D-CRT).

  Methods And Materials: Forty-five consecutive patients were treated with adjuvant radiation to 45 Gy in 1.8 Gy fractions after P/D between 2006 and 2014; 23 received 3D-CRT, and 22 received tomotherapy. Kaplan-Meier analysis was used to calculate overall survival, time to in-field or local failure (LF), and time to out-of-field failure. The Student t test and Fisher exact test were used to detect between-group differences.

  Results: Median follow-up time was 19.4 months and 12.7 months for the 3D-CRT and tomotherapy groups, respectively. Eighty-two percent of patients had T3/T4 disease, and 64% had positive nodes; 17.4% and 41% of patients in the 3D-CRT and tomotherapy groups had nonepithelioid histology, respectively. Mean planning target volume dose, percentage of planning target volume receiving 100% of the prescription dose, and lung doses were significantly greater with tomotherapy (P < .05), but toxicity rates (including radiation pneumonitis rates) were equivalent. LC was significantly improved with tomotherapy on Kaplan-Meier analysis with outcomes censored at 2 years (P < .05); uncensored, this became a trend (P = .06). Median time to LF was 19 months with tomotherapy and 10.9 months in 3D-CRT (the latter interval being less than the median follow-up in the tomotherapy group). On univariate analysis, treatment modality was the only significant predictor of LC (P < .05). Isolated LF was significantly more frequent with 3D-CRT (P < .05). Conversely, isolated out-of-field failure was significantly more frequent with tomotherapy (P < .05). Overall survival and out-of-field control were not significantly different.

  Conclusion: Tomotherapy after P/D for malignant pleural mesothelioma is associated with improved target coverage that translates into improved LC compared with 3D-CRT. This is related to a change in failure patterns, with isolated LF being more common in the 3D-CRT group and isolated out-of-field failures predominating in the tomotherapy group.

  Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

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