ABSTRACT
PURPOSE: To evaluate the feasibility of using Helical Tomotherapy (HT) for post mastectomy left-sided breast cancer. METHODS AND MATERIALS: Treatment plans were generated for 5 post mastectomy left sided breast cancer patients treated at king Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia, comparing three-dimensional technique with the HT planning. The prescribed dose was 50 Gy in 25 fractions; the planning target volume (chest wall and nodal volumes) was contoured according to RTOG atlas and the heart, lungs, spinal cord and contralateral breast were contoured as Organs at Risks (OARs). RESULTS: Both plans achieved the planning criteria, however the HT plan increased the minimal dose to the PTV (78% vs. 45.4%, p=0.043), improving the dose conformity (0.76 vs. 0.38, p=0.034) and dose homogeneity (1.05 vs. 1.2, p=0.08), while a three-dimensional technique has better V20 of lung (15.8% vs. 22.6%, p=0.04), Mean Lung Dose (7.6Gy vs. 13.8Gy, p=0.043), contralateral breast dose (0.1 vs. 12.7, p=0.043) and comparable Mean Heart Dose (4.4Gy vs. 5.3Gy, p=0.136). CONCLUSION: Both plans achieved comparable target coverage and OARs sparing, however HT plans provided better dose conformity and homogeneity than did the three-dimensional plans at the cost of less sparing of the heart, left lung and contralateral breast for treatment of left-sided post mastectomy breast cancer.
Subject(s)
Radiotherapy Planning, Computer-Assisted/methods , Radiotherapy, Intensity-Modulated/methods , Unilateral Breast Neoplasms/radiotherapy , Adult , Cohort Studies , Disease-Free Survival , Dose-Response Relationship, Radiation , Female , Humans , Mastectomy, Segmental/methods , Middle Aged , Prognosis , Radiometry , Radiotherapy Dosage , Risk Assessment , Survival Analysis , Treatment Outcome , Unilateral Breast Neoplasms/mortality , Unilateral Breast Neoplasms/surgeryABSTRACT
PURPOSE: To evaluate the feasibility, efficacy and toxicity of stereotactic hypofractionated accurate radiotherapy (SHARP) for localized prostate cancer. METHODS AND MATERIALS: The current series of SHARP included six patients with localized prostate cancer treated with 36.25 Gy in 5 fractions by Cyber-knife. Non-coplanar conformal fields and daily stereotactic localization of implanted fiducials were used for treatment. Acute and Late Genitourinary (GU) and gastrointestinal (GI) toxicity were evaluated by Common Toxicity Criteria (CTC). Prostate-specific antigen (PSA) values and self-reported sexual function were recorded at 3 months interval at first two years then every 6 months thereafter. RESULTS: The median follow-up is 32 months. Acute toxicity Grade 1 (GU) noted in four cases and two cases were Grade II; Grade I (GI) was in five cases and one patient in Grade II; also with regards to late toxicity, Grade 1 (GU) and (GI) was present in all cases. No patient has experienced grade 3 or greater acute or late toxicity. Regarding sexual activity, three patients reported impotency before and after therapy and all of them have insulin dependent diabetes mellitus and ischemic heart disease; fourth patient has developed impotence and the other two patients developed no changes as before radiation. The mean basal PSA was 8 ng/ml and became 0.658 ng/ml. CONCLUSIONS: SHARP for localized prostate cancer is feasible with minimal acute or late toxicity. Dose escalation should be possible. MRI guided target volume delineation and intrafraction prostate motion tracking with real-time beam adjustment are critical for safe high dose per fraction prostate SBRT.
Subject(s)
Dose Fractionation, Radiation , Prostatic Neoplasms/radiotherapy , Stereotaxic Techniques , Humans , Male , Prostate-Specific Antigen/blood , Saudi Arabia , Treatment OutcomeABSTRACT
BACKGROUND: To test the feasibility of radiotherapy dose escalation using volumetric arc therapy (VMAT) and image-guided radiotherapy (IGRT) with concurrent chemotherapy in locally advanced cervix cancer (LACC) and compare this with whole-pelvis three-dimensional conformal radiation therapy (CRT) in terms of clinical toxicity. METHODS: Database was reviewed for all LACC patients treated during 2011 and 2012. Twenty patients who were treated with escalated dose of radiotherapy using VMAT were selected for analysis. A matched cohort of 40 patients who had 3DCRT between 2005 and 2008 was selected as control. Mean basal hemoglobin, average weekly hemoglobin, and maximal drop in hemoglobin were measured for both 3DCRT and VMAT groups and treatment toxicity scored according to RTOG criteria. Charts were also reviewed for other acute and late toxicities including the rate of compliance with prescribed treatment. RESULTS: Mean age was 46 (30-63) and 47 years (33-67), mean tumor size was 5.5 and 5 cm and blood transfusion rate was 55 and 45 % in CRT and VMAT groups, respectively. Hemoglobin toxicity (Grade I-II) was encountered in 97.5 and 90 % (p 0.0.3) while Grade I-III Leukopenia was 90 and 70 % (p 0.02), respectively. There was no Grade 3 or 4 GI or GU toxicity. CONCLUSION: VMAT/IGRT with dose escalation is feasible in LACC without excessive toxicity as compared to CRT "Box". We propose a randomized control trial of this novel approach of higher radiation dose and volume against the standard prescription based on CRT.
