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Preliminary results of tomotherapy for treatment of inoperable recurrent non-small cell lung cancer at bronchial stump site after right pneumonectomy.

Jang HS, Moon SK - Contemp Oncol (Pozn) (2015)

Bottom Line: We prescribed 95% volume of the primary planning target volume (PTV) to a total dose of 69 Gy in 30 fractions, and 95% of the secondary PTV to a total dose of 54 Gy in 30 fractions with reduction of the 50% volume of the heart < 20 Gy.The 2-year OS was 39.1%.The relatively high dose tomotherapy alone for patients with a recurrent bronchial stump mass which was proximal to the heart demonstrated favorable clinical results without severe heart or pulmonary complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Medical College, Catholic University, St. Mary's Hospital, Seoul, South Korea.

ABSTRACT

Aim of the study: This study aimed to prospectively investigate the clinical outcomes of curative radical helical tomotherapy (HT) applied to recurrent non-small cell lung cancer (NSCLC) at the bronchial stump site after right pneumonectomy. After right pneumonectomy, the heart shifted right laterally. The chambers of the heart closed with a recurrent mass at the bronchial stump were the right atrium and left atrium due to right shifting of the heart. The unfavorable bronchial stump recurrent cancer-heart geometry due to a right shift of the heart might serve as a reliable predictor of cardiac morbidity for aggressive radiotherapy.

Material and methods: The 23 patients received HT for the recurrent NSCLC at the bronchial stump site after right pneumonectomy between 2008 and 2011. The median age of the patients was 65 years (range 56-74).

Results: We prescribed 95% volume of the primary planning target volume (PTV) to a total dose of 69 Gy in 30 fractions, and 95% of the secondary PTV to a total dose of 54 Gy in 30 fractions with reduction of the 50% volume of the heart < 20 Gy. The median conformal index in the 23 plans was 1.21. The mean fraction of primary PTV receiving more than 95% of the prescribed dose was 97.8%. The mean V45, V50, V60 of the heart were 10.5%, 6.5%, 0.2%, respectively. The median follow-up after tomotherapy was 19.86 months. Median survival was 20 months. The 2-year OS was 39.1%.

Conclusions: The relatively high dose tomotherapy alone for patients with a recurrent bronchial stump mass which was proximal to the heart demonstrated favorable clinical results without severe heart or pulmonary complications.

No MeSH data available.


Related in: MedlinePlus

Primary PTV (red line) and secondary PTV (blue line). The primary planning target volume (PTV) associated with the primary tumor gross tumor volume (GTV) had a 10 mm margin from the GTV. The CTV were defined by adding 8 mm margins around the GTV in this patient with adenocarcinoma. By taking tumor motion and setup uncertainty into consideration, the secondary PTV was defined by adding 10 mm margins around the CTV
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Figure 0001: Primary PTV (red line) and secondary PTV (blue line). The primary planning target volume (PTV) associated with the primary tumor gross tumor volume (GTV) had a 10 mm margin from the GTV. The CTV were defined by adding 8 mm margins around the GTV in this patient with adenocarcinoma. By taking tumor motion and setup uncertainty into consideration, the secondary PTV was defined by adding 10 mm margins around the CTV

Mentions: All the target delineation was performed in the Pinnacle treatment planning system (Philips Medical Systems, Bothell, WA). Afterwards, each patient's planning CT scan and the contours were transferred into the helical tomotherapy planning system (Tomotherapy Inc.) for treatment planning. The primary planning target volume (PTVp) associated with the primary tumor gross tumor volume (GTV) had a 10 mm margin from GTV (Fig. 1). The clinical target volume (CTV) was defined by adding 8 mm margins around the gross tumor volume (GTV). By taking tumor motion and setup uncertainty into consideration, the secondary planning target volume (PTVs) was defined by adding 10 mm margins around the CTV (Fig. 1). The lungs, esophagus, spinal cord, and heart were contoured for each patient. The major vessels, major airway and other additional structures were contoured only when they were adjacent to the GTV. Treatment plans were generated in the Tomotherapy Hi-Art planning system using 6 MV photons delivered without a flattening filter.


Preliminary results of tomotherapy for treatment of inoperable recurrent non-small cell lung cancer at bronchial stump site after right pneumonectomy.

Jang HS, Moon SK - Contemp Oncol (Pozn) (2015)

Primary PTV (red line) and secondary PTV (blue line). The primary planning target volume (PTV) associated with the primary tumor gross tumor volume (GTV) had a 10 mm margin from the GTV. The CTV were defined by adding 8 mm margins around the GTV in this patient with adenocarcinoma. By taking tumor motion and setup uncertainty into consideration, the secondary PTV was defined by adding 10 mm margins around the CTV
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4507888&req=5

Figure 0001: Primary PTV (red line) and secondary PTV (blue line). The primary planning target volume (PTV) associated with the primary tumor gross tumor volume (GTV) had a 10 mm margin from the GTV. The CTV were defined by adding 8 mm margins around the GTV in this patient with adenocarcinoma. By taking tumor motion and setup uncertainty into consideration, the secondary PTV was defined by adding 10 mm margins around the CTV
Mentions: All the target delineation was performed in the Pinnacle treatment planning system (Philips Medical Systems, Bothell, WA). Afterwards, each patient's planning CT scan and the contours were transferred into the helical tomotherapy planning system (Tomotherapy Inc.) for treatment planning. The primary planning target volume (PTVp) associated with the primary tumor gross tumor volume (GTV) had a 10 mm margin from GTV (Fig. 1). The clinical target volume (CTV) was defined by adding 8 mm margins around the gross tumor volume (GTV). By taking tumor motion and setup uncertainty into consideration, the secondary planning target volume (PTVs) was defined by adding 10 mm margins around the CTV (Fig. 1). The lungs, esophagus, spinal cord, and heart were contoured for each patient. The major vessels, major airway and other additional structures were contoured only when they were adjacent to the GTV. Treatment plans were generated in the Tomotherapy Hi-Art planning system using 6 MV photons delivered without a flattening filter.

Bottom Line: We prescribed 95% volume of the primary planning target volume (PTV) to a total dose of 69 Gy in 30 fractions, and 95% of the secondary PTV to a total dose of 54 Gy in 30 fractions with reduction of the 50% volume of the heart < 20 Gy.The 2-year OS was 39.1%.The relatively high dose tomotherapy alone for patients with a recurrent bronchial stump mass which was proximal to the heart demonstrated favorable clinical results without severe heart or pulmonary complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Medical College, Catholic University, St. Mary's Hospital, Seoul, South Korea.

ABSTRACT

Aim of the study: This study aimed to prospectively investigate the clinical outcomes of curative radical helical tomotherapy (HT) applied to recurrent non-small cell lung cancer (NSCLC) at the bronchial stump site after right pneumonectomy. After right pneumonectomy, the heart shifted right laterally. The chambers of the heart closed with a recurrent mass at the bronchial stump were the right atrium and left atrium due to right shifting of the heart. The unfavorable bronchial stump recurrent cancer-heart geometry due to a right shift of the heart might serve as a reliable predictor of cardiac morbidity for aggressive radiotherapy.

Material and methods: The 23 patients received HT for the recurrent NSCLC at the bronchial stump site after right pneumonectomy between 2008 and 2011. The median age of the patients was 65 years (range 56-74).

Results: We prescribed 95% volume of the primary planning target volume (PTV) to a total dose of 69 Gy in 30 fractions, and 95% of the secondary PTV to a total dose of 54 Gy in 30 fractions with reduction of the 50% volume of the heart < 20 Gy. The median conformal index in the 23 plans was 1.21. The mean fraction of primary PTV receiving more than 95% of the prescribed dose was 97.8%. The mean V45, V50, V60 of the heart were 10.5%, 6.5%, 0.2%, respectively. The median follow-up after tomotherapy was 19.86 months. Median survival was 20 months. The 2-year OS was 39.1%.

Conclusions: The relatively high dose tomotherapy alone for patients with a recurrent bronchial stump mass which was proximal to the heart demonstrated favorable clinical results without severe heart or pulmonary complications.

No MeSH data available.


Related in: MedlinePlus