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Article: Tissue dose estimation after extravasation of

Tylski, Perrine / Pina-Jomir, Géraldine / Bournaud-Salinas, Claire / Jalade, Patrice

2021 Volume 8, Issue 1, Page(s) 33

Abstract: Background: Extravasation of radiopharmaceuticals used for vectorized internal radiotherapy can lead to severe tissue damage (van der Pol et al., Eur J Nucl Med Mol Imaging 44:1234-1243, 2017). Clinical management of these extravasations requires the ... ...

Abstract	Background: Extravasation of radiopharmaceuticals used for vectorized internal radiotherapy can lead to severe tissue damage (van der Pol et al., Eur J Nucl Med Mol Imaging 44:1234-1243, 2017). Clinical management of these extravasations requires the preliminary estimation of the dose distribution in the extravasation area. Data are scarce regarding the dose estimation in the literature. This work presents a methodology for estimating the dose distribution after an extravasation occurred in September 2017, in the arm of a patient during a 7.4-GBq infusion of Lutathera ® (AAA). Methods: A local quantification procedure initially developed for renal dosimetry was used. A calibration factor was determined and verified by phantom study. Extravasation volume of interest and its variation in time were determined using 4 whole body (WB) planar acquisitions performed at 2 h (T Results: Volumes estimated using 3D threshold were V Conclusions: Rapid local dose estimation was permitted thanks to knowledge of the calibration factor determined previous to accidental extravasation. Lutathera® lymphatic drainage was quick in the arm (T
Language	English
Publishing date	2021-03-31
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2768912-8
ISSN	2197-7364
ISSN	2197-7364
DOI	10.1186/s40658-021-00378-3
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Article ; Online: A novel QA phantom based on scintillating fiber ribbons with implementation of 2D dose tomography for small-field radiotherapy.

Esteves, Josué / Pivot, Odran / Ribouton, Julien / Jalade, Patrice / Zouaoui, Abdelaali / Desbat, Laurent / Rit, Simon / Blanc, Frédéric / Haefeli, Guido / Hopchev, Plamen / Galvan, Jean-Marc / Lu, Guo-Neng / Pittet, Patrick

Medical physics

2022 Volume 50, Issue 1, Page(s) 619–632

Abstract: Purpose: To develop a novel instrument for real-time quality assurance (QA) procedures in radiotherapy. The system implements a scintillation-based phantom and associated signal acquisition and processing modules and aims to monitor two-dimensional (2D) ...

Abstract	Purpose: To develop a novel instrument for real-time quality assurance (QA) procedures in radiotherapy. The system implements a scintillation-based phantom and associated signal acquisition and processing modules and aims to monitor two-dimensional (2D) dose distributions of small fields. Materials and methods: For the proposed phantom, we have designed and realized a prototype implementing six high-resolution tissue-equivalent scintillating fiber ribbons stacked with in-plane 30° rotated orientations from each other. Each ribbon output is coupled to a silicon photodiode linear array (with an element pitch of 400 μm) to detect scintillating signal, which represents the projected irradiation profile perpendicular to the ribbon's orientation. For the system providing six acquired projected dose profiles at different orientations, we have developed a two-step signal processing method to perform 2D dose reconstruction. The first step is to determine irradiation field geometry parameters using a tomographic geometry approach, and the second one is to perform specific penumbra estimation. The QA system prototype has been tested on a Novalis TrueBeam STX with a 6-MV photon beam for small elliptic fields defined by 5- and 10-mm cone collimators and for 10 × 10- and 20 × 10-mm Results: The reconstructed 2D dose distributions have gamma index pass rates higher than 95% for all the tested configurations as compared with EBT3 film measurements with both 2%-DD/700-μm-DTA and 1%-DD/1-mm criteria. 2D global gamma analysis shows that the two-step and FBP radiation field reconstruction methods systematically outperform the SIRT approach. Moreover, higher gamma index success rates are obtained with the two-step method than with FBP in the case of the fields defined with the stereotactic cones. Conclusions: The proposed small-field QA system makes a use of six water-equivalent scintillating detectors (fiber ribbons) to acquire dose distribution. The developed two-step signal processing method performs tomographic 2D dose reconstruction. A system prototype has been built and tested using hospital facilities with small rectangular and elliptic fields. Testing results show 2D reconstructed dose distributions with high accuracy and resolution. Such a system could potentially be an alternative approach to film dosimetry for small-field QA, which is still widely used as reference in clinical practice.
MeSH term(s)	Radiometry ; Tomography ; Imaging, Three-Dimensional ; Phantoms, Imaging ; Water ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted
Chemical Substances	Water (059QF0KO0R)
Language	English
Publishing date	2022-09-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	188780-4
ISSN	2473-4209 ; 0094-2405
ISSN (online)	2473-4209
ISSN	0094-2405
DOI	10.1002/mp.15902
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Article ; Online: Fan-Beam Based Virtual Fluoroscopy for Navigated Catheterization in Interventional Radiology.

Guiral, Pierrick / Pittet, Patrick / Grondin, Yannick / Jalade, Patrice / Galvan, Jean-Marc / Lu, Guo-Neng / Desbat, Laurent / Cinquin, Philippe

Studies in health technology and informatics

2019 Volume 264, Page(s) 74–78

Abstract: Personalized medicine implies reducing invasiveness of therapeutic procedures. Although interventional radiology proved a very interesting alternative to surgical procedures, it still raises concerns due to the irradiation dose received by the medical ... ...

Abstract	Personalized medicine implies reducing invasiveness of therapeutic procedures. Although interventional radiology proved a very interesting alternative to surgical procedures, it still raises concerns due to the irradiation dose received by the medical team (and by the patient). We propose a novel concept allowing to reduce very significantly the irradiation dose during the phases where tools inserted in the patient have to be tracked with respect to previously acquired images. This implies inserting a miniaturized X-ray detector in the tip of the tools, and reducing the dose by a "rotating collimator". We demonstrate that real-time processing of the signals allows accurate localization of the tip of the tools, with a dose reduction of at least ten times.
MeSH term(s)	Catheterization ; Fluoroscopy ; Humans ; Radiation Dosage ; Radiology, Interventional/instrumentation ; User-Computer Interface
Language	English
Publishing date	2019-07-09
Publishing country	Netherlands
Document type	Journal Article
ISSN	1879-8365
ISSN (online)	1879-8365
DOI	10.3233/SHTI190186
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Article ; Online: Prospective evaluation of a specific technique of sexual function preservation in external beam radiotherapy for prostate cancer.

Samlali, Hamza / Udrescu, Corina / Lapierre, Ariane / Enachescu, Ciprian / Ruffion, Alain / Jalade, Patrice / Chapet, Olivier

The British journal of radiology

2017 Volume 90, Issue 1078, Page(s) 20160877

Abstract: Objective: Sexual preservation is an important issue in the treatment of localized prostate cancer. A technique of irradiation was developed to better preserve this function and has been evaluated.: Methods: Eleven patients, with no erectile ... ...

Abstract	Objective: Sexual preservation is an important issue in the treatment of localized prostate cancer. A technique of irradiation was developed to better preserve this function and has been evaluated. Methods: Eleven patients, with no erectile dysfunction (ED), were treated with daily IMRT-IGRT (total dose: 76-78 Gy). The pudendal arteries, penile bulb and cavernous body were delineated on the planning CT scan. The doses to these structures (with a 5 mm margin) were optimized to be as low as possible. The erectile function was documented using IIEF-5 scores at baseline, 6 months, 1 and 2 years. No ED was defined by an IIEF5 ≥ 20/25, a mild ED by an IIEF5 score of 17-19 and an important ED by a score <17. Results: The mean age was 68.4 years. At the median follow-up of 36 months, there was no biochemical relapse. Before RT, the mean IIEF5 score in all 11 patients was 23.4 (range, 20-25). At 6, 12, 18 and 24 months after RT, the mean IIEF scores were 21.2 (14-25), 21.3 (14-25), 21.8 (16-25) and 21.8 (16-25), respectively. At 2 years, 8 patients (72.7%) had no ED and 2 patients (18.2%) experienced a mild ED. The only patient with an important ED had a medical treatment and recovered a satisfactory IIEF score from 16 to 24. Conclusion: The results of this technique of optimisation for sexual preservation are encouraging. Despite a mean age close to 70 years at the time of treatment, 90.9% of the patients had no to mild ED at 2 years. This rate increases at 100% with medical treatment. Advances in knowledge: Dose optimization on sexual organs is possible and could decrease the ED rates.
MeSH term(s)	Aged ; Erectile Dysfunction/prevention & control ; Humans ; Male ; Middle Aged ; Prospective Studies ; Prostatic Neoplasms/radiotherapy ; Radiotherapy/methods
Language	English
Publishing date	2017-07-27
Publishing country	England
Document type	Journal Article
ZDB-ID	2982-8
ISSN	1748-880X ; 0007-1285
ISSN (online)	1748-880X
ISSN	0007-1285
DOI	10.1259/bjr.20160877
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Article ; Online: Prostate hypofractionated radiation therapy with injection of hyaluronic acid: acute toxicities in a phase 2 study.

Chapet, Olivier / Decullier, Evelyne / Bin, Sylvie / Faix, Antoine / Ruffion, Alain / Jalade, Patrice / Fenoglietto, Pascal / Udrescu, Corina / Enachescu, Ciprian / Azria, David

International journal of radiation oncology, biology, physics

2015 Volume 91, Issue 4, Page(s) 730–736

Abstract: Purpose: Hypofractionated radiation therapy (RT) in prostate cancer can be developed only if the risk of rectal toxicity is controlled. In a multicenter phase 2 trial, hypofractionated irradiation was combined with an injection of hyaluronic acid (HA) ... ...

Abstract	Purpose: Hypofractionated radiation therapy (RT) in prostate cancer can be developed only if the risk of rectal toxicity is controlled. In a multicenter phase 2 trial, hypofractionated irradiation was combined with an injection of hyaluronic acid (HA) to preserve the rectal wall. Tolerance of the injection and acute toxicity rates are reported. Methods and materials: The study was designed to assess late grade 2 toxicity rates. The results described here correspond to the secondary objectives. Acute toxicity was defined as occurring during RT or within 3 months after RT and graded according to the Common Terminology Criteria for Adverse Events version 4.0. HA tolerance was evaluated with a visual analog scale during the injection and 30 minutes after injection and then by use of the Common Terminology Criteria at each visit. Results: From 2010 to 2012, 36 patients with low-risk to intermediate-risk prostate cancer were included. The HA injection induced a mean pain score of 4.6/10 ± 2.3. Thirty minutes after the injection, 2 patients still reported pain (2/10 and 3/10), which persisted after the intervention. Thirty-three patients experienced at least 1 acute genitourinary toxicity and 20 patients at least 1 acute gastrointestinal toxicity. Grade 2 toxicities were reported for 19 patients with urinary obstruction, frequency, or both and for 1 patient with proctitis. No grade 3 or 4 toxicities were reported. At the 3-month visit, 4 patients described grade 2 obstruction or frequency, and no patients had any grade 2 gastrointestinal toxicities. Conclusions: The injection of HA makes it possible to deliver hypofractionated irradiation over 4 weeks with a dose per fraction of > 3 Gy, with limited acute rectal toxicity.
MeSH term(s)	Adenocarcinoma/radiotherapy ; Adult ; Aged ; Aged, 80 and over ; Dose Fractionation ; Fiducial Markers ; Gastrointestinal Tract/radiation effects ; Humans ; Hyaluronic Acid/administration & dosage ; Hyaluronic Acid/adverse effects ; Injections/adverse effects ; Male ; Middle Aged ; Pain Measurement/methods ; Prostate/pathology ; Prostate/radiation effects ; Prostatic Neoplasms/pathology ; Prostatic Neoplasms/radiotherapy ; Radiation Injuries/prevention & control ; Radiotherapy, Image-Guided ; Radiotherapy, Intensity-Modulated/adverse effects ; Radiotherapy, Intensity-Modulated/methods ; Rectum/radiation effects ; Urination Disorders/etiology ; Urogenital System/radiation effects ; Viscosupplements/administration & dosage ; Viscosupplements/adverse effects
Chemical Substances	Viscosupplements ; Hyaluronic Acid (9004-61-9)
Language	English
Publishing date	2015-03-15
Publishing country	United States
Document type	Clinical Trial, Phase II ; Journal Article ; Multicenter Study
ZDB-ID	197614-x
ISSN	1879-355X ; 0360-3016
ISSN (online)	1879-355X
ISSN	0360-3016
DOI	10.1016/j.ijrobp.2014.11.027
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Article ; Online: Evaluation of the respiratory prostate motion with four-dimensional computed tomography scan acquisitions using three implanted markers.

Udrescu, Corina / Jalade, Patrice / de Bari, Berardino / Michel-Amadry, Géraldine / Chapet, Olivier

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

2012 Volume 103, Issue 2, Page(s) 266–269

Abstract: Background and purpose: During the irradiation of the prostate cancer, it is crucial to take into account the possible displacements in defining the planning target volume. The objective of this study was to specifically analyze the respiratory-induced ... ...

Abstract	Background and purpose: During the irradiation of the prostate cancer, it is crucial to take into account the possible displacements in defining the planning target volume. The objective of this study was to specifically analyze the respiratory-induced prostate motion using a four-dimensional CT scan (4DCT). Materials and methods: Ten patients have been treated for prostate cancer in the supine position and with three implanted gold markers; they underwent a 4DCT using a GE LightSpeed16 CT scan (slice thickness 2.5mm). This acquisition was divided into 10 phases over the respiratory cycle using the Advantage4D software. For each phase, digitally-reconstructed radiographs (DRRs) were created at 0° and 90° with the view of the markers. The coordinates of each marker center were generated from the scan isocenter. The motion amplitude was: visually analyzed on the dynamic 4DCT sequences and then more precisely calculated by comparing the marker coordinates on the 10 scans. Results: There was not any difficulty in defining the coordinates of the markers on each series. No prostate motion was observed on a simple visual analysis of the dynamic 4DCT sequences. After a more specific analysis, using the coordinates of the fiducials on the 10 phases, the prostate motion remained below 1mm in all directions, except for the cranio-caudal, where it was undetectable (thereby below the slice thickness of 2.5mm). Conclusions: To our knowledge, this is the first study that evaluates the respiratory-induced prostate motion, using a 4DCT scan. Even if important prostate displacement can occur during the prostate treatment, because of the bladder or rectum filling, in the present study no respiratory-induced prostate motion was observed.
MeSH term(s)	Four-Dimensional Computed Tomography/methods ; Humans ; Male ; Motion ; Prone Position ; Prostate/diagnostic imaging ; Prostatic Neoplasms/radiotherapy ; Respiration ; Supine Position
Language	English
Publishing date	2012-05
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	605646-5
ISSN	1879-0887 ; 0167-8140
ISSN (online)	1879-0887
ISSN	0167-8140
DOI	10.1016/j.radonc.2012.03.016
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Article ; Online: Dosimetric implications of an injection of hyaluronic acid for preserving the rectal wall in prostate stereotactic body radiation therapy.

Chapet, Olivier / Udrescu, Corina / Tanguy, Ronan / Ruffion, Alain / Fenoglietto, Pascal / Sotton, Marie-Pierre / Devonec, Marian / Colombel, Marc / Jalade, Patrice / Azria, David

International journal of radiation oncology, biology, physics

2014 Volume 88, Issue 2, Page(s) 425–432

Abstract: Purpose: This study assessed the contribution of ahyaluronic acid (HA) injection between the rectum and the prostate to reducing the dose to the rectal wall in stereotactic body radiation therapy (SBRT).: Methods and materials: As part of a phase 2 ... ...

Abstract	Purpose: This study assessed the contribution of ahyaluronic acid (HA) injection between the rectum and the prostate to reducing the dose to the rectal wall in stereotactic body radiation therapy (SBRT). Methods and materials: As part of a phase 2 study of hypofractionated radiation therapy (62 Gy in 20 fractions), the patients received a transperineal injection of 10 cc HA between the rectum and the prostate. A dosimetric computed tomographic (CT) scan was systematically performed before (CT1) and after (CT2) the injection. Two 9-beam intensity modulated radiation therapy-SBRT plans were optimized for the first 10 patients on both CTs according to 2 dosage levels: 5 × 6.5 Gy (PlanA) and 5 × 8.5 Gy (PlanB). Rectal wall parameters were compared with a dose-volume histogram, and the prostate-rectum separation was measured at 7 levels of the prostate on the center line of the organ. Results: For both plans, the average volume of the rectal wall receiving the 90% isodose line (V90%) was reduced up to 90% after injection. There was no significant difference (P=.32) between doses received by the rectal wall on CT1 and CT2 at the base of the prostate. This variation became significant from the median plane to the apex of the prostate (P=.002). No significant differences were found between PlanA without HA and PlanB with HA for each level of the prostate (P=.77, at the isocenter of the prostate). Conclusions: HA injection significantly reduced the dose to the rectal wall and allowed a dose escalation from 6.5 Gy to 8.5 Gy without increasing the dose to the rectum. A phase 2 study is under way in our department to assess the rate of acute and late rectal toxicities when SBRT (5 × 8.5 Gy) is combined with an injection of HA.
MeSH term(s)	Dose Fractionation ; Humans ; Hyaluronic Acid/administration & dosage ; Male ; Organ Sparing Treatments/methods ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/pathology ; Prostatic Neoplasms/surgery ; Radiation Injuries/prevention & control ; Radiosurgery/adverse effects ; Radiosurgery/methods ; Radiotherapy Planning, Computer-Assisted/methods ; Radiotherapy, Intensity-Modulated/methods ; Rectum/diagnostic imaging ; Rectum/radiation effects ; Tomography, X-Ray Computed/methods ; Tumor Burden ; Viscosupplements/administration & dosage
Chemical Substances	Viscosupplements ; Hyaluronic Acid (9004-61-9)
Language	English
Publishing date	2014-02-01
Publishing country	United States
Document type	Clinical Trial, Phase II ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	197614-x
ISSN	1879-355X ; 0360-3016
ISSN (online)	1879-355X
ISSN	0360-3016
DOI	10.1016/j.ijrobp.2013.10.039
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Article ; Online: Prostate hypofractionated radiation therapy: injection of hyaluronic acid to better preserve the rectal wall.

Chapet, Olivier / Udrescu, Corina / Devonec, Marian / Tanguy, Ronan / Sotton, Marie-Pierre / Enachescu, Ciprian / Colombel, Marc / Azria, David / Jalade, Patrice / Ruffion, Alain

International journal of radiation oncology, biology, physics

2013 Volume 86, Issue 1, Page(s) 72–76

Abstract: Purpose: The aim of this study was to evaluate the contribution of an injection of hyaluronic acid (HA) between the rectum and the prostate for reducing the dose to the rectal wall in a hypofractionated irradiation for prostate cancer.: Methods and ... ...

Abstract	Purpose: The aim of this study was to evaluate the contribution of an injection of hyaluronic acid (HA) between the rectum and the prostate for reducing the dose to the rectal wall in a hypofractionated irradiation for prostate cancer. Methods and materials: In a phase 2 study, 10 cc of HA was injected between the rectum and prostate. For 16 patients, the same intensity modulated radiation therapy plan (62 Gy in 20 fractions) was optimized on 2 computed tomography scans: CT1 (before injection) and CT2 (after injection). Rectal parameters were compared: dose to 2.5 cc (D2.5), 5 cc (D5), 10 cc (D10), 15 cc (D15), and 20 cc (D20) of rectal wall and volume of rectum covered by the 90% isodose line (V90), 80% (V80), 70% (V70), 60% (V60), and 50% (V50). Results: The mean V90, V80, V70, V60, and V50 values were reduced by 73.8% (P<.0001), 55.7% (P=.0003), 43.0% (P=.007), 34% (P=.002), and 25% (P=.036), respectively. The average values of D2.5, D5, D10, D15, and D20 were reduced by 8.5 Gy (P<.0001), 12.3 Gy (P<.0001), 8.4 Gy (P=.005), 3.7 Gy (P=.026), and 1.2 Gy (P=.25), respectively. Conclusions: The injection of HA significantly limited radiation doses to the rectal wall.
MeSH term(s)	Dose Fractionation ; Fiducial Markers ; Humans ; Hyaluronic Acid/administration & dosage ; Injections/methods ; Magnetic Resonance Imaging/methods ; Male ; Organ Size ; Organ Sparing Treatments/methods ; Prostate/anatomy & histology ; Prostate/diagnostic imaging ; Prostatic Neoplasms/radiotherapy ; Radiation Injuries/prevention & control ; Radiation Tolerance ; Radiotherapy Planning, Computer-Assisted/methods ; Radiotherapy, Intensity-Modulated/methods ; Rectum/anatomy & histology ; Rectum/diagnostic imaging ; Rectum/radiation effects ; Tomography, X-Ray Computed ; Urinary Bladder/diagnostic imaging ; Viscosupplements/administration & dosage
Chemical Substances	Viscosupplements ; Hyaluronic Acid (9004-61-9)
Language	English
Publishing date	2013-05-01
Publishing country	United States
Document type	Clinical Trial, Phase II ; Journal Article
ZDB-ID	197614-x
ISSN	1879-355X ; 0360-3016
ISSN (online)	1879-355X
ISSN	0360-3016
DOI	10.1016/j.ijrobp.2012.11.027
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Article ; Online: Targeting head and neck cancer stem cells to overcome resistance to photon and carbon ion radiation.

Bertrand, Gérald / Maalouf, Mira / Boivin, Antony / Battiston-Montagne, Priscillia / Beuve, Michael / Levy, Antonin / Jalade, Patrice / Fournier, Claudia / Ardail, Dominique / Magné, Nicolas / Alphonse, Gersende / Rodriguez-Lafrasse, Claire

Stem cell reviews and reports

2013 Volume 10, Issue 1, Page(s) 114–126

Abstract: Although promising new radiation therapy techniques such as hadrontherapy are currently being evaluated in the treatment of head and neck malignancies, local control of head and neck squamous cell carcinoma (HNSCC) remains low. Here, we investigated the ... ...

Abstract	Although promising new radiation therapy techniques such as hadrontherapy are currently being evaluated in the treatment of head and neck malignancies, local control of head and neck squamous cell carcinoma (HNSCC) remains low. Here, we investigated the involvement of cancer stem-like cells (CSCs) in a radioresistant HNSCC cell line (SQ20B). Stem-like cells SQ20B/SidePopulation(SP)/CD44(+)/ALDH(high) were more resistant to both photon and carbon ion irradiation compared with non-CSCs. This was confirmed by a BrdU labeling experiment, which suggests that CSCs were able to proliferate and to induce tumorigenicity after irradiation. SQ20B/SP/CD44(+)/ALDH(high) were capable of an extended G2/M arrest phase in response to photon or carbon ion irradiation compared with non-CSCs. Moreover, our data strongly suggest that resistance of CSCs may result from an imbalance between exacerbated self-renewal and proliferative capacities and the decrease in apoptotic cell death triggering. In order to modulate these processes, two targeted pharmacological strategies were tested. Firstly, UCN-01, a checkpoint kinase (Chk1) inhibitor, induced the relapse of G2/M arrest and radiosensitization of SQ20B-CSCs. Secondly, all-trans retinoic acid (ATRA) resulted in an inhibition of ALDH activity, and induction of the differentiation and radiosensitization of SQ20B/SP/CD44(+)/ALDH(high) cells. The combination of ATRA and UCN-01 treatments with irradiation drastically decreased the surviving fraction at 2Gy of SQ20B-CSCs from 0.85 to 0.38 after photon irradiation, and from 0.45 to 0.21 in response to carbon ions. Taken together, our results suggest that the combination of UCN-01 and ATRA represent a promising pharmacological-targeted strategy that significantly sensitizes CSCs to photon or carbon ion radiation.
MeSH term(s)	Apoptosis/radiation effects ; Carbon/chemistry ; Cell Proliferation/radiation effects ; Cell Survival/radiation effects ; Flow Cytometry ; Head and Neck Neoplasms/pathology ; Head and Neck Neoplasms/radiotherapy ; Humans ; Ions/chemistry ; Neoplastic Stem Cells/pathology ; Neoplastic Stem Cells/radiation effects ; Photons ; Radiation Tolerance ; Tumor Cells, Cultured
Chemical Substances	Ions ; Carbon (7440-44-0)
Language	English
Publishing date	2013-08-17
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2495577-2
ISSN	2629-3277 ; 1558-6804 ; 1550-8943
ISSN (online)	2629-3277 ; 1558-6804
ISSN	1550-8943
DOI	10.1007/s12015-013-9467-y
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Article: Potential benefits of using non coplanar field and intensity modulated radiation therapy to preserve the heart in irradiation of lung tumors in the middle and lower lobes.

Chapet, Olivier / Khodri, Mustapha / Jalade, Patrice / N'guyen, Daniel / Flandin, Isabelle / D'hombres, Anne / Romestaing, Pascale / Mornex, Francoise

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

2006 Volume 80, Issue 3, Page(s) 333–340

Abstract: Purpose: Investigate whether the use of non coplanar fields and intensity modulated radiation therapy (IMRT) reduces the dose to the heart, in irradiation of middle and lower lung tumors.: Materials and methods: Four plans are compared on 10 CT scans: ...

Abstract	Purpose: Investigate whether the use of non coplanar fields and intensity modulated radiation therapy (IMRT) reduces the dose to the heart, in irradiation of middle and lower lung tumors. Materials and methods: Four plans are compared on 10 CT scans: (1) a reference plan, corresponding to coplanar plan of 3D conformal radiotherapy (3DCRT); (2) a 3DCRT(noncopl) plan, differing from reference plan by the change of one field in non coplanar fields; (3) an IMRT(copl) plan optimized on the same coplanar plan as reference plan; and (4) an IMRT(noncopl) plan optimized on the same non coplanar beams as 3DCRT(noncopl) plan. The equivalent uniform dose (EUD) for PTV was 74 Gy in 37 fractions. Results: In all plans, the 95% isodose surface covers at least 99% of the PTV with very similar conformity index values. A significant reduction in EUD, V30, V40 and V50 is observed for heart when either non coplanar fields or IMRT is used. IMRT also reduces the lung NTCP, V5, V13, V20 and V30 values and esophagus NTCP. Conclusion: Both the use of non coplanar fields and IMRT dramatically reduces the dose received by the heart. The largest benefit is seen when the two techniques are combined.
MeSH term(s)	Carcinoma, Non-Small-Cell Lung/diagnostic imaging ; Carcinoma, Non-Small-Cell Lung/radiotherapy ; Heart ; Humans ; Imaging, Three-Dimensional ; Lung Neoplasms/diagnostic imaging ; Lung Neoplasms/radiotherapy ; Radiation Dosage ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Conformal ; Radiotherapy, Intensity-Modulated ; Tomography, X-Ray Computed
Language	English
Publishing date	2006-09
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	605646-5
ISSN	1879-0887 ; 0167-8140
ISSN (online)	1879-0887
ISSN	0167-8140
DOI	10.1016/j.radonc.2006.07.009
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