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1.
Br J Radiol ; 93(1108): 20190792, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31939310

RESUMO

OBJECTIVES: To evaluate the feasibility and optimal restricted angle of the complete-directional-complete block (CDCB) technique in helical tomotherapy (HT) by including regional nodal irradiation (RNI) with the internal mammary node (IMN) in left-sided breast cancer. METHODS: Ten left-sided breast cancer patients treated with 50 Gy in 25 fractions were compared with five-field intensity-modulated radiation therapy (5F-IMRT) and six types of HT plans. In the HT plans, complete block (CB), organ-based directional block (OBDB) and CDCB with different restricted angles were used. RESULTS: The conformity index (CI) between the CDCB0,10,15,20 and 5F-IMRT groups was similar. Compared to CB, OBDB and 5F-IMRT, CDCB20 resulted in a decreased ipsilateral mean lung dose. The low-dose region (V5) of the ipsilateral lung in OBDB (84.0%) was the highest among all techniques (p < 0.001). The mean dose of the heart in CB was significantly reduced (by 11.5-22.4%) compared with other techniques. The V30 of the heart in CDCB20 (1.9%) was significantly lower than that of CB, OBDB and 5F-IMRT. Compared to the mean dose of the left anterior descending (LAD) artery of 5F-IMRT (27.0 Gy), CDCB0, CDCB10, CDCB15, CDCB20 and OBDB reduced the mean dose effectively by 31.7%, 38.3%, 39.6%, 42.0 and 56.2%, respectively. Considering the parameters of the organs-at-risk (OARs), CDCB10,15,20 had higher expectative values than the other techniques (p = 0.01). CONCLUSIONS: HT with the CDCB technique is feasible for treating left-sided breast cancer patients. The CDCB10-20 techniques not only achieved similar planning target volume coverage, homogeneity and dose conformity but also allowed better sparing of the heart and bilateral lungs. ADVANCES IN KNOWLEDGE: For left-sided breast cancer patients whose RNI field includes the IMN, heart avoidance is an important issue. The CDCB technique achieved good PTV coverage, homogeneity and dose conformity and allowed better sparing of the mean dose of the lung, the LAD artery, and the heart and reduced the V30 of the heart.


Assuntos
Coração/efeitos da radiação , Pulmão/efeitos da radiação , Irradiação Linfática/métodos , Órgãos em Risco/efeitos da radiação , Lesões por Radiação/prevenção & controle , Radioterapia de Intensidade Modulada/métodos , Neoplasias Unilaterais da Mama/radioterapia , Fracionamento da Dose de Radiação , Estudos de Viabilidade , Feminino , Humanos , Órgãos em Risco/diagnóstico por imagem , Planejamento da Radioterapia Assistida por Computador/métodos , Neoplasias Unilaterais da Mama/diagnóstico por imagem
2.
Onco Targets Ther ; 9: 3025-30, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27284253

RESUMO

Treatment for bilateral breast cancer with chest wall and abdominal skin invasion normally involves conventional radiotherapy (RT); however, conventional RT provides inadequate target volume coverage and excessive treatment of large volumes of normal tissue. Helical tomotherapy (HT) has the ability to deliver continuous craniocaudal irradiation that suppresses junction problems and provides good conformity of dose distribution. A 47-year-old female with stage IV bilateral breast cancer with chest wall and pectoralis major muscle invasion, lymphadenopathy, bilateral pleural effusion, and multiple bone metastases received chemotherapy and target therapy beginning in January 2014; 4 months after the initiation of chemotherapy, computed tomography revealed progression of chest and abdominal wall invasion. A total dose of 70.2 Gy was delivered to both breasts, the chest wall, the abdominal wall, and the bilateral supraclavicular nodal areas in 39 fractions via HT. The total planning target volume was 4,533.29 cm(3). The percent of lung volume receiving at least 20 Gy (V20) was 28%, 22%, and 25% for the right lung, left lung, and whole lung, respectively. The mean dose to the heart was 8.6 Gy. Follow-up computed tomography revealed complete response after the RT course. Grade 1 dysphagia, weight loss, grade 2 neutropenia, and grade 3 dermatitis were noted during the RT course. Pain score decreased from 6 to 1. No cardiac, pulmonary, liver, or intestinal toxicity developed during treatment or follow-up. Concurrent HT with or without systemic treatment could be a safe salvage therapy for chemorefractory locally advanced breast cancer patients with extensive cutaneous metastasis.

3.
Biomed Res Int ; 2015: 959504, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25767810

RESUMO

Radiation pneumonitis (RP) is a common complication for radiotherapy of esophageal cancer and is associated with the low dose irradiated lung volume. This study aims to reduce the mean lung dose (MLD) and the relative lung volume at 20 Gy (V 20) and at low dose region using various designs of the fan-shaped complete block (FSCB) in helical tomotherapy. Hypothetical esophageal tumor was delineated on an anthropomorphic phantom. The FSCB was defined as the fan-shaped radiation restricted area located in both lungs. Seven treatment plans were performed with nonblock design and FSCB with different fan angles, that is, from 90° to 140°, with increment of 10°. The homogeneous index, conformation number, MLD, and the relative lung volume receiving more than 5, 10, 15, and 20 Gy (V 5, V 10, V 15, and V 20) were determined for each treatment scheme. There was a substantial reduction in the MLD, V 5, V 10, V 15, and V 20 when using different types of FSCB as compared to the nonblock design. The reduction of V 20, V 15, V 10, and V 5 was 6.3%-8.6%, 16%-23%, 42%-57%, and 42%-66% for FSCB 90°-140°, respectively. The use of FSCB in helical tomotherapy is a promising method to reduce the MLD, V 20, and relative lung volume in low dose region, especially in V 5 and V 10 for esophageal cancer.


Assuntos
Neoplasias Esofágicas/radioterapia , Pulmão/patologia , Pulmão/efeitos da radiação , Pneumonite por Radiação/prevenção & controle , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Relação Dose-Resposta à Radiação , Humanos , Imagens de Fantasmas , Pneumonite por Radiação/patologia , Dosagem Radioterapêutica
4.
Biomed Res Int ; 2014: 741326, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25170514

RESUMO

PURPOSE: Limited-tomotherapy and hybrid-IMRT treatment techniques were compared for reductions in ipsilateral and contralateral lung, heart, and contralateral breast radiation doses. METHODS AND MATERIALS: Thirty consecutively treated left-sided early-stage breast cancer patients were scheduled for lTomo and hIMRT. For the hIMRT plan conventional tangential-field and four-field IMRT plans were combined with different weightings in the prescribed dose. For the lTomo plan a geometrically limited arc was designed for the beamlet entrance. A D p of 50.4 Gy in 28 fractions was used for the PTV. The dose coverage, homogeneity index, conformity index of the target, and the dose volumes of critical structures were compared. RESULTS: Both modalities presented similar target coverage. The homogeneity and conformity were improved for lTomo with P < 0.001 and P = 0.006, respectively. In the lTomo plan a concave dose distribution was generated with significant dose reductions in both high and low dose regions for ipsilateral lung and heart (P < 0.001). Conclusions. lTomo plan can have similar dose coverage and better homogeneity and conformity to the target. By properly designing the directionally and completely blocked structure, lTomo plan was developed successfully in reducing doses to the healthy tissues for early-stage left-sided breast cancer radiotherapy.


Assuntos
Neoplasias da Mama/radioterapia , Mama/efeitos da radiação , Radioterapia de Intensidade Modulada/métodos , Radioterapia/efeitos adversos , Neoplasias da Mama/patologia , Feminino , Coração/efeitos da radiação , Humanos , Pulmão/efeitos da radiação , Dosagem Radioterapêutica
5.
Biomed Res Int ; 2013: 108794, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23984313

RESUMO

An anthropomorphic phantom was used to investigate a treatment technique and analyze the dose distributions for helical irradiation of the total skin (HITS) by helical tomotherapy (HT). Hypothetical bolus of thicknesses of 0, 10, and 15 mm was added around the phantom body to account for the dose homogeneity and setup uncertainty. A central core structure was assigned as a "complete block" to force the dose tangential delivery. HITS technique with prescribed dose (D p ) of 36 Gy in 36 fractions was generated. The radiochromic EBT2 films were used for the dose measurements. The target region with 95.0% of the D p received by more than 95% of the PTV was obtained. The calculated mean doses for the organs at risk (OARs) were 4.69, 3.10, 3.20, and 2.94 Gy for the lung, heart, liver, and kidneys, respectively. The measurement doses on a phantom surface for a plan with 10 mm hypothetical bolus and bolus thicknesses of 0, 1, 2, and 3 mm are 89.5%, 111.4%, 116.9%, and 117.7% of D p , respectively. HITS can provide an accurate and uniform treatment dose in the skin with limited doses to OARs and is safe to replace a total skin electron beam regimen.


Assuntos
Elétrons , Imagens de Fantasmas , Fótons , Radioterapia de Intensidade Modulada/instrumentação , Radioterapia de Intensidade Modulada/métodos , Pele Artificial , Pele/efeitos da radiação , Relação Dose-Resposta à Radiação , Humanos , Especificidade de Órgãos/efeitos da radiação , Incerteza
6.
Radiology ; 252(3): 754-62, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19717754

RESUMO

PURPOSE: To develop a new glucuronide probe for micro-positron emission topography (PET) that can depict beta-glucuronidase (betaG)-expressing tumors in vivo. MATERIALS AND METHODS: All animal experiments were preapproved by the Institutional Animal Care and Use Committee. A betaG-specific probe was generated by labeling phenolphthalein glucuronide (PTH-G) with iodine 131 ((131)I) or (124)I. To test the specificity of the probe in vitro, (124)I-PTH-G was added to CT26 and betaG-expressing CT26 (CT26/betaG) cells. Mice bearing CT26 and CT26/betaG tumors (n = 6) were injected with (124)I-PTH-G and subjected to micro-PET imaging. A betaG-specific inhibitor D-saccharic acid 1,4-lactone monohydrate was used in vitro and in vivo to ascertain the specificity of the glucuronide probes. Finally, the biodistributions of the probes were determined in selected organs after injection of (131)I-PTH-G to mice bearing CT26 and CT26/betaG tumors (n = 14). Differences in the radioactivity in CT26 and CT26/betaG tumors were analyzed with the Wilcoxon signed rank test. RESULTS: (124)I-PTH-G was selectively converted to (124)I-PTH (phenolphthalein), which accumulated in CT26/betaG cells and tumors in vitro. The micro-PET images demonstrated enhanced activity in CT26/betaG tumors resulting from betaG-mediated conversion and trapping of the radioactive probes. Accumulation of radioactive signals was 3.6-, 3.4-, and 3.3-fold higher in the CT26/betaG tumors than in parental CT26 tumors at 1, 3, and 20 hours, respectively, after injection of the probe (for all the three time points, P < .05). CONCLUSION: Hydrophilic-hydrophobic conversion of (124)I-PTH-G probe can aid in imaging of betaG-expressing tumors in vivo.


Assuntos
Neoplasias do Colo/diagnóstico por imagem , Neoplasias do Colo/enzimologia , Glucuronidase/metabolismo , Animais , Linhagem Celular Tumoral , Feminino , Interações Hidrofóbicas e Hidrofílicas , Radioisótopos do Iodo , Camundongos , Camundongos Endogâmicos BALB C , Neoplasias Experimentais , Fenolftaleínas , Tomografia por Emissão de Pósitrons/métodos , Estatísticas não Paramétricas
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