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Effect of Different Radiotherapy Techniques on the Left Anterior Descending Coronary Artery Dose in Left-Sided Lung Cancer
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A. Konuk   , I.H. Suyusal , A.U. Karabey , G. Ozkan , B. Tirpanci , U. Diremsizoglu , O. Ari , A. Ucuncu kefeli , E.B. Sarper , M.G. Aksu |
| Department of Radiation Oncology, School of Medicine, Kocaeli University, Izmit 41001, Turkey , aykut.oguz.konuk@hotmail.com |
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Abstract: (269 Views) |
Background: This study aims to compare the radiation doses delivered to the heart and left anterior descending artery (LAD) when using Volumetric Modulated Arc Therapy (VMAT) and Intensity Modulated Radiotherapy (IMRT) for the treatment of left-sided lung cancer. Materials and Methods: We selected 29 stage III lung cancer patients for replanning. Step and shoot IMRT(S&S-IMRT), dynamic IMRT(D-IMRT), full arc VMAT (FA-VMAT) and two partial arc VMAT (2PA-VMAT) techniques were used in plan recreation for each patient. Difference between heart and LAD doses were investigated using dose volume histogram. Results: FA-VMAT technique resulted in lower LAD mean (Dmean) (1712.43 cGy, p < 0.001), LAD maximum (Dmax), LAD 2% (D2%) (3527.33 cGy, p = 0.003), LAD 0.1cc (D0.1cc) (3473.12 cGy, p=0.006) doses and percentage of LAD that received 15Gy (V15) (43.69%, p < 0.001). No statistical difference was observed between the two partial arc VMAT and full arc VMAT techniques in LAD doses. Comparing cardiac V10, V15, and heart mean doses (MHD), the 2PA-VMAT technique showed better organ protection than FA-VMAT, S&S IMRT, and D-IMRT.2PA-VMAT and FA-VMAT showed similar results in cardiac V5, V20, V25, V30, V40 and V45 values. When the median heart volume (567 cc) was used as a threshold, those with heart volume smaller than 567cc had statistically significant differences in LAD and heart doses in favor of 2PA-VMAT (p < 0.005). Conclusion: VMAT technique protects LAD and heart better than IMRT technique in left-sided lung cancer patients. |
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| Keywords: Radiotherapy, Lung cancer, Left Anterior Coronary Artery, Volumetric Modulated Arc Therapy, IMRT, Dose Comparison. |
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Type of Study: Original Research |
Subject:
Radiation Biology
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1. Cuzick J, Stewart H, Rutqvist L, et al. (1994) Cause specific mortality in long-term survivors of breast cancer who participated in trials of radiotherapy. J Clin Oncol, 12: 447-453. [ DOI:10.1200/JCO.1994.12.3.447] 2. Van Nimwegen FA, Schaapveld M, Cutter DJ, et al. (2016) Radiation dose-response relationship for risk of coronary heart disease in survivors of Hodgkin lymphoma. J Clin Oncol, 34: 235-243. [ DOI:10.1200/JCO.2015.63.4444] 3. Banfill K, Giuliani M, Aznar M, Franks K, McWilliam A, Schmitt M, Sun F, Vozenin MC, Faivre Finn C; IASLC Advanced Radiation Technology committee. (2021) Cardiac Toxicity of Thoracic Radiotherapy: Existing Evidence and Future Directions. J Thorac Oncol, 16(2): 216-227. [ DOI:10.1016/j.jtho.2020.11.002] 4. Bradley JD, Paulus R, Komaki R, Masters G, Blumenschein G, Schild S, et al. (2015) Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with Stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): A randomised, two-by-two factorial phase 3 study. The Lancet Oncology, 16(2): 187-199. [ DOI:10.1016/S1470-2045(14)71207-0] 5. Bradley JD, Hu C, Komaki RR, Masters GA, Blumenschein GR, Schild SE, Bogart JA, Forster KM, Magliocco AM, Kavadi VS, Narayan S, Iyengar P, Robinson CG, Wynn RB, Koprowski CD, Olson MR, Meng J, Paulus R, Curran WJ Jr, Choy H (2020) Long-Term Results of NRG Oncology RTOG 0617: Standard- Versus High-Dose Chemoradiotherapy with or Without Cetuximab for Unresectable Stage III Non-Small-Cell Lung Cancer. J Clin Oncol, 38(7): 706-714. DOI:10.1200/JCO.19.01162. Epub 2019 Dec 16. PMID: 31841363; PMCID: PMC7048161. [ DOI:10.1200/JCO.19.01162] 6. Furuse K, Fukuoka M, Kawahara M, Nishikawa H, Takada Y, Kudoh S, et al. (1999) Phase III study of concurrent versus sequential thoracic radiotherapy in combination with mitomycin, Vindesine, and cisplatin in unresectable stage III non-small-cell lung cancer. Journal of Clinical Oncology, 17(9). [ DOI:10.1200/JCO.1999.17.9.2692] 7. Aupérin A, Le Péchoux C, Rolland E, Curran WJ, Furuse K, Fournel P, et al. (2010) Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer. Journal of Clinical Oncology, 28(13): 2181-2190. [ DOI:10.1200/JCO.2009.26.2543] 8. Machtay M, Paulus R, Moughan J, Komaki R, Bradley J, Choy H, et al. (2012) Defining local-regional control and its importance in locally advanced non-small cell lung carcinoma. Journal of Thoracic Oncology, 7(4): 716-722. [ DOI:10.1097/JTO.0b013e3182429682] 9. Saglam Y, Bolukbasi Y, Alpan V, Topkan E, Selek U, Matthew B, et al. (2017) Hybrid arc could combine the benefits of IMRT and VMAT to deliver a fast, conformal, homogeneous treatment in non-small cell lung cancer without limitations of Low Dose Bath: A planning study. International Journal of Hematology and Oncology, 27(3): 161-170. [ DOI:10.4999/uhod.172064] 10. Murshed H, Liu HH, Liao Z, Barker JL, Wang X, Tucker SL, et al. (2004) Dose and volume reduction for normal lung using intensity-modulated radiotherapy for advanced-stage non-small-cell lung cancer. International Journal of Radiation OncologyBiologyPhysics, 58(4): 1258-1267. [ DOI:10.1016/j.ijrobp.2003.09.086] 11. Pasler M, Georg D, Bartelt S, Lutterbach J (2013) Node-positive left-sided breast cancer: Does VMAT improve treatment plan quality with respect to IMRT? Strahlentherapie und Onkologie, 189(5): 380-386. [ DOI:10.1007/s00066-012-0281-2] 12. Akcay M, Etiz D, Duruer K, Bozdogan O, Ozen A (2021) Dosimetric comparison of single-arc/partial-arc volumetric modulated arc therapy and intensity-modulated radiotherapy for peripheral and central lung cancer. Journal of Cancer Research and Therapeutics. DOI: 10.4103/jcrt.JCRT_221_19. [ DOI:10.4103/jcrt.JCRT_221_19] 13. Darby SC, McGale P, Taylor CW, Peto R (2005) Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer: prospective cohort study of about 300,000 women in US SEER cancer registries. Lancet Oncol, 6(8): 557-565. [ DOI:10.1016/S1470-2045(05)70251-5] 14. Sardar P, Kundu A, Chatterjee S, Nohria A, Nairooz R, Bangalore S, Mukherjee D, Aronow WS, Lavie CJ (2017) Long-term cardiovascular mortality after radiotherapy for breast cancer: a systematic review and meta-analysis. Clin Cardiol, 40(2): 73-81. [ DOI:10.1002/clc.22631] 15. Feng M, Moran JM, Koelling T (2011) Development and validation of a heart atlas to study cardiac exposure to radiation following treatment for breast cancer. Int J Radiat Oncol Biol, 79: 10-18. [ DOI:10.1016/j.ijrobp.2009.10.058] 16. Cao D, Holmes TW, Afghan MKN, Shepard DM (2007) Comparison of plan quality provided by intensity-modulated arc therapy and Helical Tomotherapy. International Journal of Radiation Oncology, Biology, Physics, 69(1): 240-250. [ DOI:10.1016/j.ijrobp.2007.04.073] 17. Boyle J, Ackerson B, Gu L, Kelsey CR (2017) Dosimetric advantages of intensity-modulated radiation therapy in locally advanced lung cancer. Adv Radiat Oncol, 2(1): 6-11. DOI: 10.1016/j.adro.2016.12.006. [ DOI:10.1016/j.adro.2016.12.006] 18. Scorsetti M, Navarria P, Mancosu P, Alongi F, Castiglioni S, Cavina R, et al. (2010) Large volume unresectable locally advanced non-small cell lung cancer: Acute toxicity and initial outcome results with Rapid Arc. Radiation Oncology, 5: 94. [ DOI:10.1186/1748-717X-5-94] 19. Jiang X, Li T, Liu Y, Zhou L, Xu Y, Zhou X, et al. (2011) Planning analysis for locally advanced lung cancer: Dosimetric and efficiency comparisons between intensity-modulated radiotherapy (IMRT), single-arc/partial-arc volumetric modulated arc therapy (SA/PA-VMAT). Radiation Oncology, 6: 140. [ DOI:10.1186/1748-717X-6-140] 20. Atkins KM, Bitterman DS, Chaunzwa TL, Kozono DE, Baldini EH, Aerts HJWL, et al. (2021) Mean heart dose is an inadequate surrogate for left anterior descending coronary artery dose and the risk of major adverse cardiac events in Lung Cancer Radiation therapy. International Journal of Radiation Oncology, Biology, Physics, 110(5): 1473-1479. [ DOI:10.1016/j.ijrobp.2021.03.005] 21. Atkins KM, Chaunzwa TL, Lamba N, et al. (2021) Association of left anterior descending coronary artery radiation dose with major adverse cardiac events and mortality in patients with non-small cell lung cancer. JAMA Oncol, 7: 206-219. [ DOI:10.1001/jamaoncol.2020.6332] 22. Suyusal IH, Konuk AO, Diremsizoglu U (2023) Dosimetric evaluation of adding left ventricle and left anterior descending coronary artery cardiac substructures to plan optimization in left lung cancer radiotherapy. Int. J. Radiat. Res., October 2023; 21(4): 627-632. [ DOI:10.61186/ijrr.21.4.627] 23. Speirs CK, DeWees TA, Rehman S, Molotievschi A, Velez MA, Mullen D, Fergus S, Trovo M, Bradley JD, Robinson CG (2017) Heart dose is an independent dosimetric predictor of overall survival in locally advanced non-small cell lung cancer. J Thorac Oncol, 12(2): 293-301. [ DOI:10.1016/j.jtho.2016.09.134] |
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Konuk A, Suyusal I, Karabey A, Ozkan G, Tirpanci B, Diremsizoglu U, et al . Effect of Different Radiotherapy Techniques on the Left Anterior Descending Coronary Artery Dose in Left-Sided Lung Cancer. Int J Radiat Res 2024; 22 (3) :617-623 URL: http://ijrr.com/article-1-5610-en.html
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