Description: Publication date: Available online 29 December 2015 Source: Radiotherapy and Oncology Author(s): Francesca De Felice, Daniela Musio, Vincenzo Tombolini

Description: Publication date: Available online 29 December 2015 Source: Radiotherapy and Oncology Author(s): Jacob Christian Lindegaard, Mikkel Lænsø Madsen, Anders Traberg, Bjarne Meisner, Søren Kynde Nielsen, Kari Tanderup, Harald Spejlborg, Lars Ulrik Fokdal, Ole Nørrevang Intracavitary–interstitial applicators for MRI guided brachytherapy are becoming increasingly important in locally advanced cervical cancer. The 3D printing technology enables a versatile method for obtaining a high degree of individualisation of the implant. Our clinical workflow is presented and exemplified by a stage IVA cervical cancer with superior dose distribution.

Description: Publication date: Available online 29 December 2015 Source: Radiotherapy and Oncology Author(s): Jens Wölfelschneider, Thomas Friedrich, Robert Lüchtenborg, Klemens Zink, Michael Scholz, Lei Dong, Marco Durante, Christoph Bert Background and purpose Scanned particle beam therapy may result in over and under dosages within the target volume. This study quantifies how CTV dose coverage improves with number of fractions and fields. Materials and methods Based on 4DCTs of nine lung tumor patients, treatment plans were optimized separately for four different fields using an ITV approach. 4D RBE-weighted dose distributions were calculated for varying motion parameters and fraction numbers. The total RBE-weighted dose was determined for one and four-field application per fraction. DVHs were analyzed for the tumor and interpreted based on statistical modeling. Results Dose homogeneity within the CTV increased with the fraction number, but depends significantly on the tumor motion amplitude. For single-field schedules and amplitudes >6 mm, the dose coverage indices (V95 min = 90.7% and V107 max = 0.4%) differed to the stationary case even after 40 fractions. Target coverage for a four-field approach followed a proposed model and homogeneous dose distributions could be achieved 6-times faster than single-field treatments. Conclusions Fractionated delivery improves dose homogeneity in scanned ion beam therapy of moving targets. The achievable homogeneity depends mainly on tumor volume and motion amplitude. The outcome of multiple-field irradiations can be predicted based on single-field results and accelerates the achievement of homogeneous dose distributions.

Description: Publication date: Available online 29 December 2015 Source: Radiotherapy and Oncology Author(s): Emma B. Holliday, Nathan F. Dieckmann, Tasha L. McDonald, Arthur Y. Hung, Charles R. Thomas, Lisa J. Wood Background and purpose Mechanisms of fatigue reported during radiotherapy are poorly defined but may include inflammatory cytokines and/or sleep disturbances. This prospective, longitudinal, phase II study assessed fatigue, sleep, and serum cytokine levels during radiotherapy for early-stage prostate cancer (PCa). Material and methods Twenty-eight men undergoing radiotherapy for early-stage PCa wore an Actiwatch Score to record fatigue level, sleep time, onset latency, efficiency and wake after sleep onset. Serum levels of IL-1α, IL-1β, TNF-α, IL-6, IL-8, IL-10 and VEGF were measured weekly during radiotherapy. Patient reported quality of life (QOL) metrics were collected before and after treatment. Linear mixed effects models examined trajectories across treatment weeks. Results Fatigue increased across treatment weeks ( P 〈 .01), and fatigue was associated with decreased patient-reported QOL. Sleep efficiency increased across treatment weeks (rate of change over time = .29, P = .03), and sleep onset latency decreased (rate of change over time = .86, P = .06). IL-6 tended to increase during treatment ( P = 0.09), but none of the cytokine levels or sleep variables were significantly related to fatigue trajectories. Conclusions Despite increased sleep efficiency across treatment weeks, fatigue significantly increased. Although IL-6 increased during the course of radiotherapy, cytokines levels were not associated with fatigue scores or sleep disturbance. Further studies are needed to define the mechanisms for fatigue during radiotherapy.

Description: Publication date: Available online 29 December 2015 Source: Radiotherapy and Oncology Author(s): Barbara Stam, Heike Peulen, Maddalena M.G. Rossi, José S.A. Belderbos, Jan-Jakob Sonke Background and purpose Determination of a dose–effect relation for rib fractures in a large patient group has been limited by the time consuming manual delineation of ribs. Automatic segmentation could facilitate such an analysis. We determine the accuracy of automatic rib segmentation in the context of normal tissue complication probability modeling (NTCP). Materials and methods Forty-one patients with stage I/II non-small cell lung cancer treated with SBRT to 54 Gy in 3 fractions were selected. Using the 4DCT derived mid-ventilation planning CT, all ribs were manually contoured and automatically segmented. Accuracy of segmentation was assessed using volumetric, shape and dosimetric measures. Manual and automatic dosimetric parameters D x and EUD were tested for equivalence using the Two One-Sided T -test (TOST), and assessed for agreement using Bland–Altman analysis. NTCP models based on manual and automatic segmentation were compared. Results Automatic segmentation was comparable with the manual delineation in radial direction, but larger near the costal cartilage and vertebrae. Manual and automatic D x and EUD were significantly equivalent. The Bland–Altman analysis showed good agreement. The two NTCP models were very similar. Conclusions Automatic rib segmentation was significantly equivalent to manual delineation and can be used for NTCP modeling in a large patient group.

Description: Publication date: Available online 29 December 2015 Source: Radiotherapy and Oncology Author(s): Sahaja Acharya, Jacqueline Esthappan, Shahed Badiyan, Todd A. DeWees, Kari Tanderup, Julie K. Schwarz, Perry W. Grigsby Background and purpose High BMI is a reason for medical inoperability in patients with endometrial cancer in the United States. Definitive radiation is an alternative therapy for these patients; however, data on patterns of failure after definitive radiotherapy are lacking. We describe the patterns of failure after definitive treatment with 3-D image-based high dose rate (HDR) brachytherapy for medically inoperable endometrial cancer. Materials and methods Forty-three consecutive patients with endometrial cancer FIGO stages I–III were treated definitively with HDR brachytherapy with or without external beam radiation therapy. Cumulative incidence of failures was estimated and prognostic variables were identified Results Mean follow up was 29.7 months. Median BMI was 50.2 kg/m 2 (range: 25.1–104 kg/m 2 ). The two-year overall survival was 65.2%. The two-year cumulative incidence of pelvic and distant failures was 8.3% and 13.5%, respectively. Grade 3 disease was associated with a higher risk of all-failures (Hazard Ratio [HR]: 4.67, 95% CI: 1.04–20.9, p = 0.044). The incidence of acute Grade 3 GI/GU toxicities was 4.6%. Conclusions Pelvic failure at two years was less than 10%. Patients with grade 3 disease were more likely to experience disease failure and may warrant closer follow up.

Description: Publication date: Available online 29 December 2015 Source: Radiotherapy and Oncology Author(s): Karolien Verhoeven, Caroline Weltens, Vincent Remouchamps, Khalil Mahjoubi, Liv Veldeman, Benoit Lengelé, Eszter Hortobagyi, Carine Kirkove

Description: Publication date: Available online 24 December 2015 Source: Radiotherapy and Oncology Author(s): Marko Popovic, Srinivas Raman, Milica Milakovic, May Tsao, Edward Chow

Description: Publication date: Available online 21 December 2015 Source: Radiotherapy and Oncology Author(s): Rick L.M. Haas, Aisha B. Miah, Cécile LePechoux, Thomas F. DeLaney, Elizabeth H. Baldini, Kaled Alektiar, Brian O’Sullivan Introduction: This critical review aims to summarize published data on limb sparing surgery for extremity soft tissue sarcoma in combination with pre-operative radiotherapy (RT). Methods: This review is based on peer-reviewed publications using a PubMed search on the MeSH headings “soft tissue sarcoma” AND “preoperative radiotherapy”. Titles and abstracts screened for data including “fraction size AND/OR total dose AND/OR overall treatment time”, “chemotherapy”, “targeted agents AND/OR tyrosine kinase inhibitors”, are collated. Reference lists from some articles have been studied to obtain other pertinent articles. Additional abstracts presented at international sarcoma meetings have been included as well as information on relevant clinical trials available at the ClinicalTrials.gov website. Results: Data are presented for the conventional regimen of 50–50.4 Gy in 25–28 fractions in 5–6 of weeks preoperative external beam RT with respect to the regimen’s local control probability compared to surgery alone, as well as acute and late toxicities. The rationale and outcome data for hypofractionated and/or reduced dose regimens are discussed. Finally, combination schedules with conventional chemotherapy and/or targeted agents are summarized. Conclusion: Outside the setting of well-designed prospective clinical trials, the conventional 50 Gy in 5–6 week schedule should be considered as standard. However, current and future studies addressing alternative fraction size, total dose, overall treatment time and/or combination with chemotherapy or targeted agents may reveal regimens of equal or increased efficacy with reduced late morbidities.

Description: Publication date: Available online 21 December 2015 Source: Radiotherapy and Oncology Author(s): Karen Wong, Geoff P. Delaney, Michael B. Barton Background and purpose The recently updated optimal radiotherapy utilisation model estimated that 48.3% of all cancer patients should receive external beam radiotherapy at least once during their disease course. Adapting this model, we constructed an evidence-based model to estimate the optimal number of fractions for notifiable cancers in Australia to determine equipment and workload implications. Materials and methods The optimal number of fractions was calculated based on the frequency of specific clinical conditions where radiotherapy is indicated and the evidence-based recommended number of fractions for each condition. Sensitivity analysis was performed to assess the impact of variables on the model. Results Of the 27 cancer sites, the optimal number of fractions for the first course of radiotherapy ranged from 0 to 23.3 per cancer patient, and 1.5 to 29.1 per treatment course. Brain, prostate and head and neck cancers had the highest average number of fractions per course. Overall, the optimal number of fractions was 9.4 per cancer patient (range 8.7–10.0) and 19.4 per course (range 18.0–20.7). Conclusions These results provide valuable data for radiotherapy services planning and comparison with actual practice. The model can be easily adapted by inserting population-specific epidemiological data thus making it applicable to other jurisdictions.