Journal of Radiotherapy http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Volumetric Modulated Arc Radiotherapy for Early Stage Non-Small-Cell Lung Carcinoma: Is It Better Than the Conventional Static Beam Intensity Modulated Radiotherapy? Mon, 07 Apr 2014 06:57:09 +0000 http://www.hindawi.com/journals/jra/2014/164165/ This study compared the performance of volumetric modulated arc therapy (VMAT) techniques: single arc volumetric modulated arc therapy (SA-VMAT) and double arc volumetric modulated arc therapy (DA-VMAT) with the static beam conventional intensity modulated radiotherapy (C-IMRT) for non-small-cell lung carcinoma (NSCLC). Twelve stage I and II NSCLC patients were recruited and their planning CT with contoured planning target volume (PTV) and organs at risk (OARs) was used for planning. Using the same dose constraints and planning objectives, the C-IMRT, SA-VMAT, and DA-VMAT plans were optimized. C-IMRT consisted of 7 static beams, while SA-VMAT and DA-VMAT plans consisted of one and two full gantry rotations, respectively. No significant difference was found among the three techniques in target homogeneity and conformity. Mean lung dose in C-IMRT plan was significantly lower than that in DA-VMAT plan . The ability of OAR sparing was similar among the three techniques, with no significant difference in V20, V10, or V5 of normal lungs, spinal cord, and heart. Less MUs were required in SA-VMAT and DA-VMAT. Besides, SA-VMAT required the shortest beam on time among the three techniques. In treatment of early stage NSCLC, no significant dosimetric superiority was shown by the VMAT techniques over C-IMRT and DA-VMAT over SA-VMAT. Vincent Wing Cheung Wu, Man In Pun, Cho Pan Lam, To Wing Mok, and Wah Wai Mok Copyright © 2014 Vincent Wing Cheung Wu et al. All rights reserved. Assessing Response to Radiation Therapy Treatment of Bone Metastases: Short-Term Followup of Radiation Therapy Treatment of Bone Metastases with Diffusion-Weighted Magnetic Resonance Imaging Wed, 26 Mar 2014 07:30:12 +0000 http://www.hindawi.com/journals/jra/2014/698127/ This study examined the usefulness of diffusion-weighted (DW) Magnetic Resonance Imaging (MRI) in monitoring bone metastases response to radiation therapy in 15 oligometastatic patients. For each metastasis, both mean apparent diffusion coefficient (ADC) changes and high b-value DW metastasis/muscle signal intensity ratio (SIR) variations were evaluated at 30 ± 5 days and 60 ± 7 days after the end of treatment. On baseline DW-MRI, all bone metastases were hyperintense and had signal intensities higher than normal bone marrow on calculated ADC maps. At follow-up evaluations, 4 patterns of response were identified: (I) decreased high b-value DW SIR associated with increased mean ADC (83.3% of cases); (II) increased mean ADC with no change of high b-value DW SIR (10% of cases); (III) decreased both high b-value DW SIR and mean ADC (3.3% of cases); (IV) a reduction in mean ADC associated with an increase in high b-value DW SIR compared to pretreatment values (3.3% of cases). Patterns (I) and (II) suggested a good response to therapy; pattern (III) was classified as indeterminate, while pattern (IV) was suggestive of disease progression. This pattern approach may represent a useful tool in the differentiation between treatment-induced necrosis and highly cellular residual tumor. Salvatore Cappabianca, Raffaella Capasso, Fabrizio Urraro, Andrea Izzo, Antonio Raucci, Rossella Di Franco, and Antonio Rotondo Copyright © 2014 Salvatore Cappabianca et al. All rights reserved. Dosimetric Studies of Mixed Energy Intensity Modulated Radiation Therapy for Prostate Cancer Treatments Sun, 16 Mar 2014 00:00:00 +0000 http://www.hindawi.com/journals/jra/2014/760206/ Dosimetric studies of mixed field photon beam intensity modulated radiation therapy (IMRT) for prostate cancer using pencil beam (PB) and collapsed cone convolution (CCC) algorithms using Oncentra MasterPlan treatment planning system (v. 4.3) are investigated in this study. Three different plans were generated using 6 MV, 15 MV, and mixed beam (both 6 and 15 MV). Fifteen patients with two sets of plans were generated: one by using PB and the other by using CCC for the same planning parameters and constraints except the beam energy. For each patient’s plan of high energy photons, one set of photoneutron measurements using solid state neutron track detector (SSNTD) was taken for this study. Mean percentage of in the rectum is , , and for 6 MV, 15 MV, and mixed-energy plans, respectively. Mean percentage of in bladder is , and for 6 MV, 15 MV, and mixed-energy plans, respectively. Mixed fields neutron contribution at the beam entrance surface is 45.62% less than at 15 MV photon beam. Our result shows that, with negligible neutron contributions, mixed field IMRT has considerable dosimetric advantage. K. Abdul Haneefa, K. K. Shakir, A. Siddhartha, T. Siji Cyriac, M. M. Musthafa, and R. Ganapthi Raman Copyright © 2014 K. Abdul Haneefa et al. All rights reserved. Uterine Carcinosarcoma Confined to the Pelvis: A Retrospective Review and Outcome Analysis Tue, 11 Mar 2014 09:28:54 +0000 http://www.hindawi.com/journals/jra/2014/124149/ Objective. We compared the treatments of uterine carcinosarcoma at our institution and evaluated their impact on survival. Methods. A retrospective analysis was performed on 60 eligible patients with carcinosarcoma limited to the pelvis. Subjects were divided into four categories: surgery, surgery plus chemotherapy, surgery plus radiation therapy, and a combination of surgery, chemotherapy, and RT. The most commonly used chemotherapy was cisplatin and/or carboplatin and taxol. Radiotherapy included external beam radiation therapy (EBRT) alone or with high dose rate (HDR) brachytherapy or HDR brachytherapy alone. Survival probability data were computed using the Kaplan-Meier method. The differences between groups were compared using the log-rank test. Results. The combination of surgery and radiation therapy with or without chemotherapy is seen to improve overall survival (OS) compared to surgery alone and , resp.). Brachytherapy involving three HDR vaginal cylinder fractions shows an equally effective reduction in local recurrence compared to EBRT. Conclusion. Our study of a relatively large number of carcinosarcoma patients suggests that adjuvant radiation therapy improves OS compared to surgery alone. Brachytherapy with 3 HDR vaginal cylinder fractions is preferred because of its time-saving, better tolerance, low toxicity and equivalent OS, and local control compared to EBRT. Hualei Li, Mindi J. TenNapel, Amina Ahmed, Lilie Lin, Sudershan K. Bhatia, and Geraldine Jacobson Copyright © 2014 Hualei Li et al. All rights reserved. Pretreatment Patient Specific Quality Assurance and Gamma Index Variation Study in Gantry Dependent EPID Positions for IMRT Prostate Treatments Wed, 05 Mar 2014 12:37:16 +0000 http://www.hindawi.com/journals/jra/2014/325057/ Pretreatment quality assurance (QA) is a major concern in complex radiation therapy treatment plans like intensity modulated radiation therapy (IMRT). Present study considers the variations in gamma index for gantry dependent pretreatment verification and commonly practiced zero gantry angle verifications for ten prostate IMRT plans using two commercial medical linear accelerators (Varian 2300 CD, Varian Clinac iX). Two verification plans (the one with all fields at the actual treatment angles and one with all fields merged to 0 degree gantry angles) for all the patients were generated to obtain dose fluence mapping using amorphous silicon electronic portal imaging device (EPID). The gamma index was found depend on gantry angles but the difference between zero and the nonzero treatment angles is in the confidence level for clinical acceptance. The acceptance criteria of gamma method were always satisfied in both cases for two machines and are stable enough to execute the patient specific pretreatment quality assurance at 0 degree gantry angle for prostate IMRTs, where limited number of gantry angles are used. Siji Cyriac, M. M. Musthafa, R. Ganapathi Raman, K. Abdul Haneefa, and V. T. Hridya Copyright © 2014 Siji Cyriac et al. All rights reserved. Late Toxicities after Conventional Radiotherapy for Nasopharyngeal Carcinoma: Incidence and Risk Factors Mon, 10 Feb 2014 07:25:19 +0000 http://www.hindawi.com/journals/jra/2014/268340/ Background. To determine the incidence and analyze the factors affecting late toxicity for nasopharyngeal carcinoma patients treated with conventional radiotherapy. Patients and Methods. Retrospective analysis was performed on 239 NPC patients treated between 1993 and 2004 in our institution. One hundred and fifty-seven patients were treated with conventional fractionation (2 Gy per fraction, 5 fractions per week) and eighty-two patients with hyperfractionated radiotherapy (1.6 Gy per fraction twice a day, 5 days per week). One hundred fifty nine patients underwent neoadjuvant cisplatin based chemotherapy. Late toxicity was evaluated according to the RTOG/EORTC score. Results. Xerostomia was the most common related complication (98.7%). Neoadjuvant chemotherapy and hyperfractionated radiotherapy did not increase late toxicities. Multivariate analyses showed that radiation dose was a significant factor for hearing impairment, younger age for trismus, initial node status for neck fibrosis, and initial dental hygiene for dental complications. Female gender was associated with significantly higher incidence of trismus and hearing impairment. Conclusion. Conventional radiotherapy was associated with a high rate of late toxicities which affect patients’ quality of life. With the development of three-dimensional conformal radiotherapy and intensity modulated radiotherapy, a reduced incidence of radiation related complications could be expected. Wicem Siala, Wafa Mnejja, Fatma Elloumi, Abdelmoneem Ghorbel, Jameleddine Mnif, Mounir Frikha, and Jamel Daoud Copyright © 2014 Wicem Siala et al. All rights reserved. Dosimetric Comparison of Volumetric Modulated Arc Therapy, Static Field Intensity Modulated Radiation Therapy, and 3D Conformal Planning for the Treatment of a Right-Sided Reconstructed Chest Wall and Regional Nodal Case Tue, 04 Feb 2014 11:06:26 +0000 http://www.hindawi.com/journals/jra/2014/835179/ We compared 3D conformal planning, static field intensity modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT) to investigate the suitable treatment plan and delivery method for a right-sided reconstructed chest wall and nodal case. The dose prescribed for the reconstructed chest wall and regional nodes was 50.4 Gy. Plans were compared for target coverage and doses of the lungs, heart, contralateral breast, and healthy tissue. All plans achieved acceptable coverage of the target and IMNs. The best right lung sparing achieved with 3D was a V20 Gy of 31.09%. Compared to it, VMAT reduced the same by 10.85% and improved the CI and HI over 3D by 18.75% and 2%, respectively. The ipsilateral lung V5 Gy to V20 Gy decreased with VMAT over IMRT by as high as 17.1%. The contralateral lung V5 Gy was also lowered with VMAT compared to IMRT by 16.22%. The MU and treatment beams were lowered with VMAT over IMRT by 30% and 10, respectively, decreasing the treatment time by >50%. VMAT was the treatment plan and delivery method of choice for this case due to a combination of improved lung sparing and reduced treatment time without compromising target coverage. Vishruta A. Dumane, Margie A. Hunt, Sheryl Green, Yeh-Chi Lo, and Richard L. Bakst Copyright © 2014 Vishruta A. Dumane et al. All rights reserved. Implant R100 Predicts Rectal Bleeding in Prostate Cancer Patients Treated with IG-IMRT to 45 Gy and Pd-103 Implant Tue, 04 Feb 2014 09:45:38 +0000 http://www.hindawi.com/journals/jra/2014/130652/ Purpose. To define factors associated with rectal bleeding in patients treated with IG-IMRT followed by Pd-103 seed implant. Methods and Materials. We retrospectively reviewed 61 prostate adenocarcinoma patients from 2002 to 2008. The majority (85.2%) were of NCCN intermediate risk category. All received IG-IMRT to the prostate and seminal vesicles followed by Pd-103 implant delivering a mean D90 of 100.7 Gy. Six patients received 45 Gy to the pelvic nodes and 10 received androgen deprivation. Results. Ten patients (16.4%) developed rectal bleeding: 4 were CTCAE v.3 grade 1, 5 were grade 2, and 1 was grade 3. By univariate analysis, age, stage, Gleason sum, PSA, hormonal therapy, pelvic radiation, postoperative prostate volume, D9, V100, individual source activity, total implanted activity per cm3, and duration of interval before implant did not impact rectal bleeding. Implant R100 was higher in patients with rectal bleeding: on average, 0.885 versus 0.396 cm3, , odds ratio of 2.26 per .5 cm3 (95% CI, 1.16–4.82). A trend for significance was seen for prostate V200 and total implanted activity. Conclusion. Higher implant R100 was associated with development of rectal bleeding in patients receiving IG-IMRT to 45 Gy followed by Pd-103 implant. Minimizing implant R100 may reduce the rate of rectal bleeding in similar patients. Matthew Packard, Vladimir Valakh, and Russell Fuhrer Copyright © 2014 Matthew Packard et al. All rights reserved. 90Y-DOTA-CHS Microspheres for Live Radiomicrosphere Therapy: Preliminary In Vivo Lung Radiochemical Stability Studies Mon, 03 Feb 2014 12:45:22 +0000 http://www.hindawi.com/journals/jra/2014/941072/ Chitosan (CHS) is used to prepare microspheres of 31 ± 8 µm size. Surface modification with p-SCN-Bn-DOTA was performed. A maximum 90Y capacity was found to be 12.1 ± 4.4 µCi/particle. The best obtained labeling yield was 87.7 ± 0.6%. More than 90% in vitro stability was found. Particle in vitro degradation half-life in PBS was found to be greater than 21 days. In vivo studies with 90Y-DOTA-CHS showed more than 95% of the injected activity (decay corrected) in the lungs 24 hours after tail vein administration. 90Y-DOTA-CHS in vivo label stability was superior to resin microspheres. The addition of p-SCN-Bn-DOTA served as a radioprotectant for bone marrow as the 5% 90Y released, during the first 24 hours, was quickly eliminated via urine. Alejandro Amor-Coarasa, Andrew Milera, Denny Carvajal, Seza Gulec, and Anthony J. McGoron Copyright © 2014 Alejandro Amor-Coarasa et al. All rights reserved. Intensity-Modulated Radiotherapy with a Simultaneous Integrated Boost Combined with Chemotherapy in Stages III-IV Hypopharynx-Larynx Cancer: Treatment Compliance and Clinical Outcomes Thu, 30 Jan 2014 08:14:19 +0000 http://www.hindawi.com/journals/jra/2014/703764/ Objectives. Retrospective review of our experience using intensity-modulated radiotherapy with simultaneous integrated boost (SIB-IMRT) combined with chemotherapy as the primary treatment of locoregionally advanced larynx and hypopharynx cancers. Materials and Methods. Between September 2008 and June 2012, 60 patients (26 with larynx and 34 hypopharynx cancers) were treated. Our policy was to offer SIB-IMRT plus concurrent cisplatin to patients affected by larynx cancer stage T3N0-N1 and NCT with TPF (docetaxel/cisplatin/fluorouracil) followed by SIB-IMRT to patients with larynx cancer stage T2-4N2-3 or hypopharynx cancer T2-4N0-3. SIB-IMRT consisted in a total dose of 70.95 Gy (2.15 Gy/fraction, 5 fractions/week) to the gross primary and nodal disease and differentiated dosages for high risk and low risk nodal regions. Results. Complete remission was achieved in 53/60 (88%) of patients. At a median follow up of 31 months (range 9–67), the rate of overall survival and locoregional control with functional larynx at 3 years were 68% and 60%, respectively. T stage (T1–3 versus T4) resulted in being significant for predicting 3-year freedom from relapse (it was 69% and 35%, resp., for T1–T3 and T4 tumors; ), while site of primary disease (larynx versus hypopharynx) was not significant (). Conclusion. Our results indicated that combining SIB-IMRT with induction chemotherapy or concurrent chemotherapy is an effective treatment strategy for organ preservation in advanced larynx/hypopharynx cancer. Giovanni Franchin, Emanuela Vaccher, Renato Talamini, Carlo Gobitti, Emilio Minatel, Carlo Furlan, Giuseppe Grando, Annalisa Drigo, Mauro Gaetano Trovo, and Luigi Barzan Copyright © 2014 Giovanni Franchin et al. All rights reserved. Radiation Therapy Improves Survival Outcome in Pancreatic Adenocarcinoma: Comparison of a 15-Year Institutional Experience at the University of Nebraska Medical Center with SEER Data Mon, 27 Jan 2014 06:30:47 +0000 http://www.hindawi.com/journals/jra/2014/708317/ Objectives. We examined the role of radiation therapy (RT) in pancreatic adenocarcinoma (PA) treatment through a 15-year retrospective analysis of patients treated at University of Nebraska Medical Center (UNMC) as well as those from the SEER database. Methods. A total of 561 patients diagnosed with PA at UNMC between 1995 and 2011 and 60,587 patients diagnosed between 1995 and 2009 from the SEER were included. Examined prognostic factors for overall survival (OS) were age, gender, race, stage, year of diagnosis, and treatment with surgery, chemotherapy (CT), or RT. Time to death was plotted by Kaplan-Meier method. A Cox proportional hazards model was used to evaluate prognostic factors for OS. Results. The median OS was 7.3 and 5 months for patients from UNMC and the SEER database, respectively. A Cox model of patients from UNMC showed that RT was associated with improved OS (HR 0.77, ) after adjusting for factors including age, race, gender, stage, year of diagnosis, having surgery, or having CT. Cox analysis of patients from the SEER showed similar results (HR 0.65, ). Conclusions. RT confers an independent survival advantage in patients being treated for PA which is apparent both at UNMC and through SEER data. Michael J. Baine and Chi Lin Copyright © 2014 Michael J. Baine and Chi Lin. All rights reserved.