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Intensity modulated radiation therapy (IMRT) for the treatment of unicentric Castlemans disease: a case report and review of the use of radiotherapy in the literature.

Matthiesen C, Ramgopol R, Seavey J, Ahmad S, Herman T - Radiol Oncol (2012)

Bottom Line: A 47 year old female was found to have an intra-thoracic posterior UCD and was determined not to be a good surgical candidate.Neither disease progression nor late effects have occurred.The use of IMRT and planned treatment break was successful in the treatment of a case of UCD, and should be considered for other unresectable cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.

ABSTRACT

Background: Surgical resection is considered standard therapy for cases of resectable unicentric Castleman's disease (UCD). Unresectable cases of UCD do not have a consensus regarding the optimal treatment approach, but have utilized steroids, observation, chemotherapy, and radiotherapy. Here we discuss a patient presentation of UCD treated with an advanced radiotherapy technique, IMRT.

Case report: A 47 year old female was found to have an intra-thoracic posterior UCD and was determined not to be a good surgical candidate. She was referred for radiotherapy and was treated using IMRT to a total dose of 4320 cGy in 180 cGy fractions including a scheduled 10 day break. Following the break, the patient's treatment was replanned at which the initial treatment volume was reduced by 50.9% for the duration of the treatment course. Radiation Therapy Oncology Group (RTOG) grade III pneumonitis developed which was managed medically. Neither disease progression nor late effects have occurred.

Conclusions: The use of IMRT and planned treatment break was successful in the treatment of a case of UCD, and should be considered for other unresectable cases.

No MeSH data available.


Related in: MedlinePlus

DVH of initial IMRT treatment plan. Line colors as follows: Orange - Spinal Cord, Pink - Heart, Yellow - Total Lung, Green - Right Lung, Blue - Left Lung.
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f3-rado-46-03-265: DVH of initial IMRT treatment plan. Line colors as follows: Orange - Spinal Cord, Pink - Heart, Yellow - Total Lung, Green - Right Lung, Blue - Left Lung.

Mentions: Treatment simulation was performed in the supine position and immobilization via a vac-lock. Treatment planning was performed on Eclipse External Beam Planning 7.5.51 (Varian Medical Systems, Palo Alto CA). Given the midline, posterior location of the mass, IMRT was utilized to reduce the dose gradient and toxicity to the surrounding normal tissues. The gross tumor volume (GTV) was contoured and expanded 5 mm to create the planning target volume (PTV). The patient was treated to a total dose of 4320 cGy. RT was delivered in nine initial once daily fractions of 180 cGy to a total dose of 1620. She was then placed on a 10 day break followed by re-simulation and treatment planning. She then completed the total 4320 cGy dose prescription without interruption in 180 cGy once daily fractions. Radiation therapy (RT) beam arrangements are shown in Figure 2. The initial PTV volume was 235.7 cm3 and the re-CT PTV following treatment break was reduced to 120 cm3, a reduction of approximately 50.9%. Cumulative dose volume constraints allowed the mean total lung dose to be limited to 961 cGy and the 20% volume to be limited to 1706 cGy. The heart was limited to a mean dose of 939 cGy, and the expanded cord mean to 1163 cGy. Dose volume histograms of each plan (pre and post treatment break) and a cumulative plan sum are shown in Figures 3, 4, and 5. A summary of mean and max dose statistics is shown in Table 1. No acute side effects were noted during treatment.


Intensity modulated radiation therapy (IMRT) for the treatment of unicentric Castlemans disease: a case report and review of the use of radiotherapy in the literature.

Matthiesen C, Ramgopol R, Seavey J, Ahmad S, Herman T - Radiol Oncol (2012)

DVH of initial IMRT treatment plan. Line colors as follows: Orange - Spinal Cord, Pink - Heart, Yellow - Total Lung, Green - Right Lung, Blue - Left Lung.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3472945&req=5

f3-rado-46-03-265: DVH of initial IMRT treatment plan. Line colors as follows: Orange - Spinal Cord, Pink - Heart, Yellow - Total Lung, Green - Right Lung, Blue - Left Lung.
Mentions: Treatment simulation was performed in the supine position and immobilization via a vac-lock. Treatment planning was performed on Eclipse External Beam Planning 7.5.51 (Varian Medical Systems, Palo Alto CA). Given the midline, posterior location of the mass, IMRT was utilized to reduce the dose gradient and toxicity to the surrounding normal tissues. The gross tumor volume (GTV) was contoured and expanded 5 mm to create the planning target volume (PTV). The patient was treated to a total dose of 4320 cGy. RT was delivered in nine initial once daily fractions of 180 cGy to a total dose of 1620. She was then placed on a 10 day break followed by re-simulation and treatment planning. She then completed the total 4320 cGy dose prescription without interruption in 180 cGy once daily fractions. Radiation therapy (RT) beam arrangements are shown in Figure 2. The initial PTV volume was 235.7 cm3 and the re-CT PTV following treatment break was reduced to 120 cm3, a reduction of approximately 50.9%. Cumulative dose volume constraints allowed the mean total lung dose to be limited to 961 cGy and the 20% volume to be limited to 1706 cGy. The heart was limited to a mean dose of 939 cGy, and the expanded cord mean to 1163 cGy. Dose volume histograms of each plan (pre and post treatment break) and a cumulative plan sum are shown in Figures 3, 4, and 5. A summary of mean and max dose statistics is shown in Table 1. No acute side effects were noted during treatment.

Bottom Line: A 47 year old female was found to have an intra-thoracic posterior UCD and was determined not to be a good surgical candidate.Neither disease progression nor late effects have occurred.The use of IMRT and planned treatment break was successful in the treatment of a case of UCD, and should be considered for other unresectable cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.

ABSTRACT

Background: Surgical resection is considered standard therapy for cases of resectable unicentric Castleman's disease (UCD). Unresectable cases of UCD do not have a consensus regarding the optimal treatment approach, but have utilized steroids, observation, chemotherapy, and radiotherapy. Here we discuss a patient presentation of UCD treated with an advanced radiotherapy technique, IMRT.

Case report: A 47 year old female was found to have an intra-thoracic posterior UCD and was determined not to be a good surgical candidate. She was referred for radiotherapy and was treated using IMRT to a total dose of 4320 cGy in 180 cGy fractions including a scheduled 10 day break. Following the break, the patient's treatment was replanned at which the initial treatment volume was reduced by 50.9% for the duration of the treatment course. Radiation Therapy Oncology Group (RTOG) grade III pneumonitis developed which was managed medically. Neither disease progression nor late effects have occurred.

Conclusions: The use of IMRT and planned treatment break was successful in the treatment of a case of UCD, and should be considered for other unresectable cases.

No MeSH data available.


Related in: MedlinePlus