Évaluation de la radiothérapie conformationnelle en inspiration profonde bloquée de type involved-node chez des patients atteints de maladie de Hodgkin localisée sus-diaphragmatiques.
Les patients ...atteints de maladie de Hodgkin localisées sus-diaphragmatiques et irradiés en inspiration profonde bloquée dans notre institution ont été rétrospectivement revus. Tous ont reçu une chimiothérapie avant la radiothérapie. Les volumes traités ont été déterminés selon le concept de la radiothérapie involved-node. La radiothérapie en inspiration profonde bloquée a été réalisée grâce un spiromètre dédié.
Vingt-sept patients atteints de maladie de Hodgkin, 17 de stades I–IIA et dix de stades I–IIB (dont une réfractaire après une première ligne de chimiothérapie), ont été traités de novembre 2004 à octobre 2010. L’âge médian était 27ans (extrêmes : 16–54). À part trois patients, tous ont reçu de trois à six cycles d’une chimiothérapie associant l’adriamycine, la bléomycine, la vinblastine et la dacarbazine. La dose médiane prescrite était 30,6Gy (extrêmes : 20–40). Les doses reçues par le cœur, les coronaires et les poumons étaient satisfaisantes. Le suivi était en médiane de 38 mois (extrêmes : 7–70), la survie sans progression à trois ans et la survie globale à trois ans étaient respectivement de 96 % (intervalle de confiance à 95 % : 79–99 %) et de 95 % (intervalle de confiance à 95 % : 75–99 %). Il y a eu une rechute : une récidive locale est survenue en plein champ d’irradiation, dans la tumeur médiastinale. Il n’y a eu qu’un cas de toxicité de grade 3 : une pneumopathie régressive sous corticothérapie.
L’irradiation involved-node, optimisée grâce à la technique en inspiration profonde bloquée, est efficace et peu toxique. Le suivi à long terme doit se poursuivre, notamment pour évaluer la toxicité cardiaque et coronarienne.
To assess the clinical outcome of the involved-node radiotherapy (INRT) concept with the use of deep-inspiration breath-hold (DIBH) technique in patients with localized supra-diaphragmatic Hodgkin lymphoma.
All were patients with stage I–II Hodgkin lymphoma and they were treated with chemotherapy prior to irradiation. Radiation treatments were delivered using the involved-node radiotherapy concept according to the European Organization for Research and Treatment of Cancer Guidelines and a spirometer dedicated to DIBH radiotherapy was used for every patient.
Twenty-seven patients with Hodgkin lymphoma (26 patients with primary Hodgkin lymphoma, one with refractory disease), treated from November 2004 to October 2010, were retrospectively analysed. The median age was 27 years (range 16 to 54). Seventeen (63%) patients had stage I–IIA and 10 (37%) had stage I–IIB disease. All patients received two to six cycles of adriamycin, bleomycin, vinblastine and dacarbazine. The median radiation dose to patients was 30,6Gy (range: 19,8–40). Protection of various organs at risk was satisfactory. Median follow-up, 3-year progression-free and 3-year overall survival were 38 months (range: 7–70), 96% (95%CI: 79–99%) and 95% (95%CI: 75–99%), respectively. Recurrence occurred in one patient (mediastinal in-field relapse). There was one grade 3 acute toxicity (transient pneumonitis).
Our results suggest that patients with localized Hodgkin lymphoma can be safely and efficiently treated using deep-inspiration breath technique and the involved-node radiotherapy concept. Longer follow-up is needed to assess late toxicity, especially for the heart and the coronary arteries.
We propose a novel method to detect the current state of the quasi-periodic system from image sequences which in turn will enable us to synchronize/gate the image sequences to obtain images of the ...organ system at similar configurations. The method uses the cumulated phase shift in the spectral domain of successive image frames as a measure of the net motion of objects in the scene. The proposed method is applicable to 2D and 3D time varying sequences and is not specific to the imaging modality. We demonstrate its effectiveness on X-Ray Angiographic and Cardiac and Liver Ultrasound sequences. Knowledge of the current (cardiac or respiratory) phase of the system, opens up the possibility for a purely image based cardiac and respiratory gating scheme for interventional and radiotherapy procedures.
Tumor motion due to respiration during radiation therapy for non-small cell lung cancer is a significant problem. This article reports on two techniques used to control tumor motion: respiratory ...gating and the deep inspiration breath hold technique. This technique was implemented in 40 patients without significant difficulties and there are encouraging clinical outcomes.
To investigate the dosimetric effect of intended beam interruption during volumetric modulated arc therapy (VMAT) with flattening filter free (FFF) beam for exploring the possibility of deep ...inspiration breath hold stereotactic body radiation therapy (SBRT). A total of ten SBRT plans with 6 and 10 MV FFF beams were retrospectively selected. All plans consisted of four partial arcs, except one plan with six partial arcs. We delivered the plans using a Varian Truebeam™ with three different scenarios; without interruption (0int), with one intentional interruption (1int), or with two intentional interruptions (2int), per each partial arc. The treatment log files were exported from the treatment console, and the variations in delivered MU were evaluated at the beam interruption angles. The dose distributions were also measured using a 3D cylindrical diode array detector, ArcCHECK™. The 2D global gamma evaluations were performed, compared to the planned dose distribution, with 3%/3 and 4%/2 mm passing criterion. The dose difference (DD) was also determined between uninterrupted and interrupted data with 3, 2, 1, and 0.5% of global maximum dose. The interruption caused a total increase of 0.14 ± 0.05% and 0.25 ± 0.08% of the total planned MU, ranging from 1746 to 3261 MU, at the interrupted angles in 1int and 2int, respectively. All global gamma passing rates satisfied our clinical threshold of 90%, and the differences of passing rates were less than 0.3% on average with both criterions. All measured 1int and 2int data were within 3% DD from 0int measured data. For 6 MV FFF beams, the average passing rate with 2, 1, and 0.5% DD were 99.9 ± 0.2%, 92.3 ± 12.0%, and 81.9 ± 24.9%, respectively, between 0int and 1int, and 99.8 ± 0.4%, 92.1%12.4%, and 80.7 ± 26.5%, respectively, between 0int and 2int. For 10 MV FFF beams, the average passing rate with 2, 1, and 0.5% DD were 100.0 ± 0.2%, 95.4 ± 9.4% and 87.0 ± 19.8%, respectively, between 0int and 1int, and 99.9 ± 0.3%, 95.4 ± 9.7%, and 87.2 ± 21.3% between 0int and 2int. The dosimetric impact of beam interruption was investigated with small field and high dose rate FFF-VMAT SBRT plans. The delivered dose distributions with up to 12 interruptions per plan were still clinically acceptable. Only minimal changes were observed in Gamma, DD, and log file analysis.
Aim: To investigate the influence of deep inspiration breath-hold on the oxygen tension of
in-vivo tumours measured using an Eppendorf pO
2histograph.
Materials and methods: Patients with accessible ...primary or metastatic tumours ≥2
cm diameter were entered into a protocol measuring tumour oxygenation with an Eppendorf pO
2histograph during normal breathing (NB) and deep inspiration breath-hold (DIBH). Change in oxygen tension was assessed using the Wilcoxon Signed Ranks test.
Results: Thirty patients were entered in to this protocol. The median maximum tumour dimension was 4
cm. The median of the median pO
2of these tumours was 18
mmHg. Tumours were assessed during NB and DIBH. Oxygen tension measurements along 1–3 pairs of tracks per tumour (median of 2) were obtained. The median number of measurements per track was 30 for NB and 29 for DIBH (range 17–59). In six tumours, the values during NB were significantly higher than during DIBH, whereas, for six other tumours, the relationship was the opposite; for the remaining 18 patients, no significant difference was observed.
Conclusion: These data show heterogeneity of tumour oxygenation seen with
in-situ tumours both at baseline and as a result of DIBH. No systematic change in the Eppendorf pO
2measurements was seen as a result of DIBH; however, the individual tumour responses to DIBH varied dramatically.
Nine cases of primary hepatocellular carcinoma were treated with 3D-conformal radiation therapy using computerized planning system. This technique permits the precise delivery of a high dose of ...radiation to the target while sparing most of the normal liver tissue. In order to decrease the effect of organ movement related to respiration, periodical irradiation was combined with the deep inspiration breath-hold technique. The radiation dose was equivalent to conventional radiation with a total dose of 50-70 Gy with 2 Gy, 5 times a week. Irradiation was given in 1-10 fractions which encompassed the target with 90 per cent isodose line. The patients tolerated the treatment procedure well without any complications inherent to the technique. The tumors were decreased in size, the pain symptom and abdominal discomfort were relieved for 3-20 months. This technique is an effective and safe treatment for palliation in hepatocellular carcinoma especially in locally advanced stages with large or multiple lesions. However, long term follow-up should be done to evaluate the late radiation effect and clinical outcome.
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