kV Cone-Beam CT-Based IGRT Tập 187 Số 5 - Trang 284-291 - 2011
Judit Boda-Heggemann, Frank Lohr, Frederik Wenz, Michael Flentje, Matthias Gückenberger
Heart toxicity from breast cancer radiotherapy Tập 195 Số 1 - Trang 1-12 - 2019
Marc D. Piroth, René Baumann, Wilfried Budach, Jürgen Dunst, Petra Feyer, Rainer Fietkau, Wulf Haase, Wolfgang Harms, Thomas Hehr, David Krug, A. Röser, Felix Sedlmayer, Rainer Souchon, Frederik Wenz, Rolf Sauer
Abstract
Background
Late cardiac toxicities caused by (particularly left-sided) breast radiotherapy (RT) are now recognized as rare but relevant sequelae, which has prompted research on risk structure identification and definition of threshold doses to heart subvolumes. The aim of the present review was to critically discuss the clinical evidence on late cardiac reactions based on dose-dependent outcome reports for mean heart doses as well as doses to cardiac substructures.
Methods
A literature review was performed to examine clinical evidence on radiation-induced heart toxicities. Mean heart doses and doses to cardiac substructures were focused upon based on dose-dependent outcome reports. Furthermore, an overview of radiation techniques for heart protection is given and non-radiotherapeutic aspects of cardiotoxicity in the multimodal setting of breast cancer treatment are discussed.
Results
Based on available findings, the DEGRO breast cancer expert panel recommends the following constraints: mean heart dose <2.5 Gy; DmeanLV (mean dose left ventricle) < 3 Gy; V5LV (volume of LV receiving ≥5 Gy) < 17%; V23LV (volume of LV receiving ≥23 Gy) < 5%; DmeanLAD (mean dose left descending artery) < 10 Gy; V30LAD (volume of LAD receiving ≥30 Gy) < 2%; V40LAD (volume of LAD receiving ≥40 Gy) < 1%.
Conclusion
In addition to mean heart dose, breast cancer RT treatment planning should also include constraints for cardiac subvolumes such as LV and LAD. The given constraints serve as a clinicians’ aid for ensuring adequate heart protection. The individual decision between sufficient protection of cardiac structures versus optimal target volume coverage remains in the physician’s hand. The risk of breast cancer-specific mortality and a patient’s cardiac risk factors must be individually weighed up against the risk of radiation-induced cardiotoxicity.
Osteoradionecrosis of the Mandible Tập 182 Số 5 - Trang 283-288 - 2006
Gabriela Studer, Stephan Studer, Roger A. Zwahlen, P Huguenin, Klaus W. Grätz, Urs M. Lütolf, Christoph Glanzmann
Helical Tomotherapy Tập 184 Số 1 - Trang 8-14 - 2008
Florian Sterzing, Kai Schubert, G. Sroka-Peréz, Jörn Kalz, Jürgen Debus, Klaus Herfarth
Integrated boost IMRT with FET-PET-adapted local dose escalation in glioblastomas Tập 188 Số 4 - Trang 334-339 - 2012
Marc D. Piroth, Michael Pinkawa, Richard Holý, Jens Klotz, S. Schaar, Gabriele Stoffels, Norbert Galldiks, Heinz H. Coenen, Hartmut Kaiser, Karl‐Josef Langen, Michael J. Eble
Sucralfate versus Mesalazine versus Hydrocortisone in the Prevention of Acute Radiation Proctitis during Conformal Radiotherapy for Prostate Carcinoma Tập 179 - Trang 464-470 - 2003
Giuseppe Sanguineti, Paola Franzone, Michela Marcenaro, Franca Foppiano, Vito Vitale
To assess whether the topical use of steroids or 5-aminosalicylic acid (5-ASA) is superior to sucralfate in preventing acute rectal toxicity during three-dimensional conformal radiotherapy (3DCRT) to 76 Gy.
Patients and Methods: Patients undergoing 3DCRT for prostate carcinoma at our institution were offered to be randomized to sucralfate 3 g in 15 ml suspension enema (Antepsin®), mesalazine 4 g gel enema (Enterasyn®), or hydrocortisone 100 mg foam enema (Colifoam®). Randomization was blind to the treating physician but not to the patient. Sucralfate was chosen as control arm. Topical treatment had to be performed once daily, starting on day 1 of 3DCRT. Acute rectal toxicity was scored weekly according to RTOG criteria. Time to occurrence of grade 2+ acute rectal toxicity was taken as endpoint.
Results: The trial was opened in August 1999, and after the first 24 patients had been treated, arm 2 was discontinued because of eight patients receiving mesalazine, seven actually developed acute rectal toxicity (five patients grade 3 and two patients grade 2). Until May 2001, 134 consecutive patients were randomly assigned to sucralfate (63 patients), mesalazine (eight patients) or hydrocortisone (63 patients). The cumulative incidence of acute rectal toxicity at the end of treatment by arm is 61.9 ± 6.1%, 87.5 ± 11.7%, and 52.4 ± 6.2% for arms 1, 2, and 3, respectively. The difference between the mesalazine group and the sucralfate group is highly significant (hazard ratio [HR] 2.5, 95% confidence interval [CI] 1.1–5.7; p = 0.03). At both uni- and multivariate analysis taking into account several patients and treatment covariates, the difference between hydrocortisone and sucralfate is not significant (HR 0.7, 95% CI 0.5–1.2; p = 0.2).
Conclusion: Topical mesalazine is contraindicated during radiotherapy. Hydrocortisone enema is not superior to sucralfate in preventing acute rectal toxicity.
Current and Future Strategies in Radiotherapy of Childhood Low-Grade Glioma of the Brain Tập 179 Số 9 - Trang 585-597 - 2003
Rolf Dieter Kortmann, Beate Timmermann, Roger Taylor, Giovanni Scarzello, Ludwig Plaßwilm, Frank Paulsen, Branislav Jeremić, Astrid Gnekow, Karin Dieckmann, Sylvia Kay, M. Bamberg
