Cancers

Editorial

Jump to: Research, Review, Other

3 pages, 180 KiB

Open AccessEditorial

Radiation Therapy in Thoracic Tumors: Recent Trends and Current Issues

by Laura Cella and Giuseppe Palma

Cancers 2022, 14(11), 2706; https://doi.org/10.3390/cancers14112706 - 30 May 2022

Cited by 3 | Viewed by 1761

Abstract

Radiation therapy (RT) plays a fundamental role in the multidisciplinary treatment and management of thoracic cancers, and in particular, RT is the most used non-surgical treatment modality for lung cancer, which in turn is the most common type of thoracic malignancy [...] Full article

(This article belongs to the Special Issue Radiation Therapy in Thoracic Tumors: Recent Trends and Current Issues)

Research

Jump to: Editorial, Review, Other

12 pages, 899 KiB

Open AccessArticle

Impact of Blood Parameters and Normal Tissue Dose on Treatment Outcome in Esophageal Cancer Patients Undergoing Neoadjuvant Radiochemotherapy

by Rebecca Bütof, Laura Häberlein, Christina Jentsch, Jörg Kotzerke, Fabian Lohaus, Sebastian Makocki, Chiara Valentini, Jürgen Weitz, Steffen Löck and Esther G. C. Troost

Cancers 2022, 14(14), 3504; https://doi.org/10.3390/cancers14143504 - 19 Jul 2022

Cited by 1 | Viewed by 1477

Abstract

Despite technological advances, normal tissue sparing in photon beam irradiation is still challenging. Since in esophageal cancer this may inflict damage on the lungs, heart and bone marrow, possibly impacting on outcome, the aim of this study was to investigate the association of [...] Read more.

Despite technological advances, normal tissue sparing in photon beam irradiation is still challenging. Since in esophageal cancer this may inflict damage on the lungs, heart and bone marrow, possibly impacting on outcome, the aim of this study was to investigate the association of normal tissue dose and blood parameters on the survival of patients having undergone neoadjuvant radiochemotherapy (RCTx) followed by surgery. This retrospective study included 125 patients irradiated to 40–41.4 Gy with photons or protons combined with concurrent chemotherapy. On initial and restaging 18F-FDG-PET/CT, the lungs and heart were contoured as organs at risk for which standardized uptake values (SUV) were evaluated. The mean radiation dose (D_mean) to the lungs and heart, the volume of the lungs receiving at least 20 Gy (V_{20Gy_lung}) and various pre- and per-treatment blood parameters were included in the Cox regression analyses. Results: The median follow-up time was 19.8 months and median overall survival 37 months (95% confidence interval: 16–58.9 months). In multivariate analysis, higher radiation doses to the lungs and heart were statistically significantly associated with decreased overall survival (D_{mean_lung}: p < 0.001; V_{20Gy_lung}: p < 0.002; D_{mean_heart}: p = 0.005). Neither the 18F-FDG-PET nor blood parameters were predictive for overall survival. In patients with locally advanced esophageal cancer treated with RCTx, the radiation dose to the heart and lungs was significantly associated with overall survival. Full article

(This article belongs to the Special Issue Radiation Therapy in Thoracic Tumors: Recent Trends and Current Issues)

► Show Figures

Figure 1

14 pages, 14500 KiB

Open AccessArticle

Radiation-Induced Esophagitis in Non-Small-Cell Lung Cancer Patients: Voxel-Based Analysis and NTCP Modeling

by Serena Monti, Ting Xu, Radhe Mohan, Zhongxing Liao, Giuseppe Palma and Laura Cella

Cancers 2022, 14(7), 1833; https://doi.org/10.3390/cancers14071833 - 5 Apr 2022

Cited by 14 | Viewed by 3100

Abstract

The aim of our study is to characterize the risk of radiation-induced esophagitis (RE) in a cohort of Non-Small-Cell Lung Cancer (NSCLC) patients treated with concurrent chemotherapy and photon/proton therapy. For each patient, the RE was graded according to the CTCAE v.3. The [...] Read more.

The aim of our study is to characterize the risk of radiation-induced esophagitis (RE) in a cohort of Non-Small-Cell Lung Cancer (NSCLC) patients treated with concurrent chemotherapy and photon/proton therapy. For each patient, the RE was graded according to the CTCAE v.3. The esophageal dose-volume histograms (DVHs) were extracted. Voxel-based analyses (VBAs) were performed to assess the spatial patterns of the dose differences between patients with and without RE of grade ≥ 2. Two hierarchical NTCP models were developed by multivariable stepwise logistic regression based on non-dosimetric factors and on the DVH metrics for the whole esophagus and its anatomical subsites identified by the VBA. In the 173 analyzed patients, 76 (44%) developed RE of grade ≥ 2 at a median follow-up time of 31 days. The VBA identified regions of significant association between dose and RE in a region encompassing the thoracic esophagus. We developed two NTCP models, including the RT modality and a dosimetric factor: V_55Gy for the model related to the whole esophagus, and the mean dose for the model designed on the thoracic esophagus. The cross-validated performance showed good predictions for both models (ROC-AUC of 0.70 and 0.73, respectively). The only slight improvement provided by the analysis of the thoracic esophageal subsites might be due to the relevant sparing of cervical and lower thoracic esophagus in the analyzed cohort. Further studies on larger cohorts and a more heterogeneous set of dose distributions are needed to validate these preliminary findings and shed further light on the spatial patterns of RE development. Full article

(This article belongs to the Special Issue Radiation Therapy in Thoracic Tumors: Recent Trends and Current Issues)

► Show Figures

Figure 1

18 pages, 8572 KiB

Open AccessArticle

Substantial Sparing of Organs at Risk with Modern Proton Therapy in Lung Cancer, but Altered Breathing Patterns Can Jeopardize Target Coverage

by Camilla Grindeland Boer, Kristine Fjellanger, Inger Marie Sandvik, Maren Ugland, Grete May Engeseth and Liv Bolstad Hysing

Cancers 2022, 14(6), 1365; https://doi.org/10.3390/cancers14061365 - 8 Mar 2022

Cited by 6 | Viewed by 2437

Abstract

Enhancing treatment of locally advanced non-small cell lung cancer (LA-NSCLC) by using pencil beam scanning proton therapy (PBS-PT) is attractive, but little knowledge exists on the effects of uncertainties occurring between the planning (Plan) and the start of treatment (Start). In this prospective [...] Read more.

Enhancing treatment of locally advanced non-small cell lung cancer (LA-NSCLC) by using pencil beam scanning proton therapy (PBS-PT) is attractive, but little knowledge exists on the effects of uncertainties occurring between the planning (Plan) and the start of treatment (Start). In this prospective simulation study, we investigated the clinical potential for PBS-PT under the influence of such uncertainties. Imaging with 4DCT at Plan and Start was carried out for 15 patients that received state-of-the-art intensity-modulated radiotherapy (IMRT). Three PBS-PT plans were created per patient: 3D robust single-field uniform dose (SFUD), 3D robust intensity-modulated proton therapy (IMPT), and 4D robust IMPT (4DIMPT). These were exposed to setup and range uncertainties and breathing motion at Plan, and changes in breathing motion and anatomy at Start. Target coverage and dose-volume parameters relevant for toxicity were compared. The organ at risk sparing at Plan was greatest with IMPT, followed by 4DIMPT, SFUD and IMRT, and persisted at Start. All plans met the preset criteria for target robustness at Plan. At Start, three patients had a lack of CTV coverage with PBS-PT. In conclusion, the clinical potential for heart and lung toxicity reduction with PBS-PT was substantial and persistent. Altered breathing patterns between Plan and Start jeopardized target coverage for all PBS-PT techniques. Full article

(This article belongs to the Special Issue Radiation Therapy in Thoracic Tumors: Recent Trends and Current Issues)

► Show Figures

Figure 1

21 pages, 16913 KiB

Open AccessArticle

A Novel and Automated Approach to Classify Radiation Induced Lung Tissue Damage on CT Scans

by Adam Szmul, Edward Chandy, Catarina Veiga, Joseph Jacob, Alkisti Stavropoulou, David Landau, Crispin T. Hiley and Jamie R. McClelland

Cancers 2022, 14(5), 1341; https://doi.org/10.3390/cancers14051341 - 5 Mar 2022

Cited by 3 | Viewed by 2722

Abstract

Radiation-induced lung damage (RILD) is a common side effect of radiotherapy (RT). The ability to automatically segment, classify, and quantify different types of lung parenchymal change is essential to uncover underlying patterns of RILD and their evolution over time. A RILD dedicated tissue [...] Read more.

Radiation-induced lung damage (RILD) is a common side effect of radiotherapy (RT). The ability to automatically segment, classify, and quantify different types of lung parenchymal change is essential to uncover underlying patterns of RILD and their evolution over time. A RILD dedicated tissue classification system was developed to describe lung parenchymal tissue changes on a voxel-wise level. The classification system was automated for segmentation of five lung tissue classes on computed tomography (CT) scans that described incrementally increasing tissue density, ranging from normal lung (Class 1) to consolidation (Class 5). For ground truth data generation, we employed a two-stage data annotation approach, akin to active learning. Manual segmentation was used to train a stage one auto-segmentation method. These results were manually refined and used to train the stage two auto-segmentation algorithm. The stage two auto-segmentation algorithm was an ensemble of six 2D Unets using different loss functions and numbers of input channels. The development dataset used in this study consisted of 40 cases, each with a pre-radiotherapy, 3-, 6-, 12-, and 24-month follow-up CT scans (n = 200 CT scans). The method was assessed on a hold-out test dataset of 6 cases (n = 30 CT scans). The global Dice score coefficients (DSC) achieved for each tissue class were: Class (1) 99% and 98%, Class (2) 71% and 44%, Class (3) 56% and 26%, Class (4) 79% and 47%, and Class (5) 96% and 92%, for development and test subsets, respectively. The lowest values for the test subsets were caused by imaging artefacts or reflected subgroups that occurred infrequently and with smaller overall parenchymal volumes. We performed qualitative evaluation on the test dataset presenting manual and auto-segmentation to a blinded independent radiologist to rate them as ‘acceptable’, ‘minor disagreement’ or ‘major disagreement’. The auto-segmentation ratings were similar to the manual segmentation, both having approximately 90% of cases rated as acceptable. The proposed framework for auto-segmentation of different lung tissue classes produces acceptable results in the majority of cases and has the potential to facilitate future large studies of RILD. Full article

(This article belongs to the Special Issue Radiation Therapy in Thoracic Tumors: Recent Trends and Current Issues)

► Show Figures

Figure 1

17 pages, 1963 KiB

Open AccessArticle

Quantitative Analysis of Radiation-Associated Parenchymal Lung Change

by Edward Chandy, Adam Szmul, Alkisti Stavropoulou, Joseph Jacob, Catarina Veiga, David Landau, James Wilson, Sarah Gulliford, John D. Fenwick, Maria A. Hawkins, Crispin Hiley and Jamie R. McClelland

Cancers 2022, 14(4), 946; https://doi.org/10.3390/cancers14040946 - 14 Feb 2022

Cited by 4 | Viewed by 2579

Abstract

We present a novel classification system of the parenchymal features of radiation-induced lung damage (RILD). We developed a deep learning network to automate the delineation of five classes of parenchymal textures. We quantify the volumetric change in classes after radiotherapy in order to [...] Read more.

We present a novel classification system of the parenchymal features of radiation-induced lung damage (RILD). We developed a deep learning network to automate the delineation of five classes of parenchymal textures. We quantify the volumetric change in classes after radiotherapy in order to allow detailed, quantitative descriptions of the evolution of lung parenchyma up to 24 months after RT, and correlate these with radiotherapy dose and respiratory outcomes. Diagnostic CTs were available pre-RT, and at 3, 6, 12 and 24 months post-RT, for 46 subjects enrolled in a clinical trial of chemoradiotherapy for non-small cell lung cancer. All 230 CT scans were segmented using our network. The five parenchymal classes showed distinct temporal patterns. Moderate correlation was seen between change in tissue class volume and clinical and dosimetric parameters, e.g., the Pearson correlation coefficient was ≤0.49 between V30 and change in Class 2, and was 0.39 between change in Class 1 and decline in FVC. The effect of the local dose on tissue class revealed a strong dose-dependent relationship. Respiratory function measured by spirometry and MRC dyspnoea scores after radiotherapy correlated with the measured radiological RILD. We demonstrate the potential of using our approach to analyse and understand the morphological and functional evolution of RILD in greater detail than previously possible. Full article

(This article belongs to the Special Issue Radiation Therapy in Thoracic Tumors: Recent Trends and Current Issues)

► Show Figures

Figure 1

16 pages, 1316 KiB

Open AccessArticle

Relationship between Treatment Plan Dosimetry, Toxicity, and Survival following Intensity-Modulated Radiotherapy, with or without Chemotherapy, for Stage III Inoperable Non-Small Cell Lung Cancer

by Isabel F. Remmerts de Vries, Merle I. Ronden, Idris Bahce, Femke O. B. Spoelstra, Patricia F. De Haan, Cornelis J. A. Haasbeek, Birgit I. Lissenberg-Witte, Ben J. Slotman, Max Dahele and Wilko F. A. R. Verbakel

Cancers 2021, 13(23), 5923; https://doi.org/10.3390/cancers13235923 - 25 Nov 2021

Cited by 3 | Viewed by 2219

Abstract

Concurrent chemoradiotherapy (cCRT) is the preferred treatment for stage III NSCLC because surgery containing multimodality treatment is often not appropriate. Alternatives, often for less fit patients, include sequential CRT and RT alone. Many reports describing the relationship between overall survival (OS), toxicity, and [...] Read more.

Concurrent chemoradiotherapy (cCRT) is the preferred treatment for stage III NSCLC because surgery containing multimodality treatment is often not appropriate. Alternatives, often for less fit patients, include sequential CRT and RT alone. Many reports describing the relationship between overall survival (OS), toxicity, and dosimetry are based on clinical trials, with strict criteria for patient selection. We performed an institutional analysis to study the relationship between dosimetric parameters, toxicity, and OS in inoperable patients with stage III NSCLC treated with (hybrid) IMRT/VMAT-based techniques in routine clinical practice. Eligible patients had undergone treatment with radical intent using cCRT, sCRT, or RT alone, planned to a total dose ≥ 50 Gy delivered in ≥15 fractions. All analyses were performed for two patient groups, (1) cCRT (n = 64) and (2) sCRT/RT (n = 65). The toxicity rate differences between the two groups were not significant, and OS was 29 and 17 months, respectively. For sCRT/RT, no dosimetric factors were associated with OS, whereas for cCRT, PTV-volume, esophagus V50 Gy, and contralateral lung V5 Gy were associated. cCRT OS was significantly lower in patients with esophagitis ≥ G2. The overall rate of ≥G3 pneumonitis was low (3%), and the rate of high-grade esophagitis the OS in this real-world patient population was comparable to those reported in clinical trials. Based on this hypothesis-generating data, more aggressive esophageal sparing merits consideration. Institutional auditing and benchmarking of the planning strategy, dosimetry, and outcome have an important role to play in the continuous quality improvement process. Full article

(This article belongs to the Special Issue Radiation Therapy in Thoracic Tumors: Recent Trends and Current Issues)

► Show Figures

Figure 1

18 pages, 3226 KiB

Open AccessArticle

Enhancing Radiotherapy for Locally Advanced Non-Small Cell Lung Cancer Patients with iCE, a Novel System for Automated Multi-Criterial Treatment Planning Including Beam Angle Optimization

by Kristine Fjellanger, Liv Bolstad Hysing, Ben J. M. Heijmen, Helge Egil Seime Pettersen, Inger Marie Sandvik, Turid Husevåg Sulen, Sebastiaan Breedveld and Linda Rossi

Cancers 2021, 13(22), 5683; https://doi.org/10.3390/cancers13225683 - 13 Nov 2021

Cited by 10 | Viewed by 2871

Abstract

In this study, the novel iCE radiotherapy treatment planning system (TPS) for automated multi-criterial planning with integrated beam angle optimization (BAO) was developed, and applied to optimize organ at risk (OAR) sparing and systematically investigate the impact of beam angles on radiotherapy dose [...] Read more.

In this study, the novel iCE radiotherapy treatment planning system (TPS) for automated multi-criterial planning with integrated beam angle optimization (BAO) was developed, and applied to optimize organ at risk (OAR) sparing and systematically investigate the impact of beam angles on radiotherapy dose in locally advanced non-small cell lung cancer (LA-NSCLC). iCE consists of an in-house, sophisticated multi-criterial optimizer with integrated BAO, coupled to a broadly used commercial TPS. The in-house optimizer performs fluence map optimization to automatically generate an intensity-modulated radiotherapy (IMRT) plan with optimal beam angles for each patient. The obtained angles and dose-volume histograms are then used to automatically generate the final deliverable plan with the commercial TPS. For the majority of 26 LA-NSCLC patients, iCE achieved improved heart and esophagus sparing compared to the manually created clinical plans, with significant reductions in the median heart D_mean (8.1 vs. 9.0 Gy, p = 0.02) and esophagus D_mean (18.5 vs. 20.3 Gy, p = 0.02), and reductions of up to 6.7 Gy and 5.8 Gy for individual patients. iCE was superior to automated planning using manually selected beam angles. Differences in the OAR doses of iCE plans with 6 beams compared to 4 and 8 beams were statistically significant overall, but highly patient-specific. In conclusion, automated planning with integrated BAO can further enhance and individualize radiotherapy for LA-NSCLC. Full article

(This article belongs to the Special Issue Radiation Therapy in Thoracic Tumors: Recent Trends and Current Issues)

► Show Figures

Figure 1

12 pages, 1742 KiB

Open AccessArticle

Potential Morbidity Reduction for Lung Stereotactic Body Radiation Therapy Using Respiratory Gating

by Kim Melanie Kraus, Cristoforo Simonetto, Pavel Kundrát, Vanessa Waitz, Kai Joachim Borm and Stephanie Elisabeth Combs

Cancers 2021, 13(20), 5092; https://doi.org/10.3390/cancers13205092 - 12 Oct 2021

Cited by 4 | Viewed by 1983

Abstract

We investigated the potential of respiratory gating to mitigate the motion-caused misdosage in lung stereotactic body radiotherapy (SBRT). For fourteen patients with lung tumors, we investigated treatment plans for a gating window (GW) including three breathing phases around the maximum exhalation phase, GW40–60. [...] Read more.

We investigated the potential of respiratory gating to mitigate the motion-caused misdosage in lung stereotactic body radiotherapy (SBRT). For fourteen patients with lung tumors, we investigated treatment plans for a gating window (GW) including three breathing phases around the maximum exhalation phase, GW40–60. For a subset of six patients, we also assessed a preceding three-phase GW20–40 and six-phase GW20–70. We analyzed the target volume, lung, esophagus, and heart doses. Using normal tissue complication probability (NTCP) models, we estimated radiation pneumonitis and esophagitis risks. Compared to plans without gating, GW40–60 significantly reduced doses to organs at risk without impairing the tumor doses. On average, the mean lung dose decreased by 0.6 Gy (p < 0.001), treated lung V20Gy by 2.4% (p = 0.003), esophageal dose to 5cc by 2.0 Gy (p = 0.003), and maximum heart dose by 3.2 Gy (p = 0.009). The model-estimated mean risks of 11% for pneumonitis and 12% for esophagitis without gating decreased upon GW40–60 to 7% and 9%, respectively. For the highest-risk patient, gating reduced the pneumonitis risk from 43% to 32%. Gating is most beneficial for patients with high-toxicity risks. Pre-treatment toxicity risk assessment may help optimize patient selection for gating, as well as GW selection for individual patients. Full article

(This article belongs to the Special Issue Radiation Therapy in Thoracic Tumors: Recent Trends and Current Issues)

► Show Figures

Figure 1

17 pages, 9641 KiB

Open AccessArticle

Radiation Pneumonitis in Thoracic Cancer Patients: Multi-Center Voxel-Based Analysis

by Giuseppe Palma, Serena Monti, Roberto Pacelli, Zhongxing Liao, Joseph O. Deasy, Radhe Mohan and Laura Cella

Cancers 2021, 13(14), 3553; https://doi.org/10.3390/cancers13143553 - 15 Jul 2021

Cited by 19 | Viewed by 2444

Abstract

This study investigates the dose–response patterns associated with radiation pneumonitis (RP) in patients treated for thoracic malignancies with different radiation modalities. To this end, voxel-based analysis (VBA) empowered by a novel strategy for the characterization of spatial properties of dose maps was applied. [...] Read more.

This study investigates the dose–response patterns associated with radiation pneumonitis (RP) in patients treated for thoracic malignancies with different radiation modalities. To this end, voxel-based analysis (VBA) empowered by a novel strategy for the characterization of spatial properties of dose maps was applied. Data from 382 lung cancer and mediastinal lymphoma patients from three institutions treated with different radiation therapy (RT) techniques were analyzed. Each planning CT and biologically effective dose map (α/β = 3 Gy) was spatially normalized on a common anatomical reference. The VBA of local dose differences between patients with and without RP was performed and the clusters of voxels with dose differences that significantly correlated with RP at a p-level of 0.05 were generated accordingly. The robustness of VBA inference was evaluated by a novel characterization for spatial properties of dose maps based on probabilistic independent component analysis (PICA) and connectograms. This lays robust foundations to the obtained findings that the lower parts of the lungs and the heart play a prominent role in the development of RP. Connectograms showed that the dataset can support a radiobiological differentiation between the main heart and lung substructures. Full article

(This article belongs to the Special Issue Radiation Therapy in Thoracic Tumors: Recent Trends and Current Issues)

► Show Figures

Figure 1

Review

Jump to: Editorial, Research, Other

13 pages, 677 KiB

Open AccessReview

Current Situation of Proton Therapy for Hodgkin Lymphoma: From Expectations to Evidence

by Pierre Loap, Alfredo Mirandola, Ludovic De Marzi, Remi Dendale, Alberto Iannalfi, Viviana Vitolo, Amelia Barcellini, Andrea Riccardo Filippi, Barbara Alicja Jereczek-Fossa, Youlia Kirova and Ester Orlandi

Cancers 2021, 13(15), 3746; https://doi.org/10.3390/cancers13153746 - 26 Jul 2021

Cited by 15 | Viewed by 3270

Abstract

Consolidative radiation therapy (RT) is of prime importance for early-stage Hodgkin lymphoma (HL) management since it significantly increases progression-free survival (PFS). Nevertheless, first-generation techniques, relying on large irradiation fields, delivered significant radiation doses to critical organs-at-risk (OARs, such as the heart, to the [...] Read more.

Consolidative radiation therapy (RT) is of prime importance for early-stage Hodgkin lymphoma (HL) management since it significantly increases progression-free survival (PFS). Nevertheless, first-generation techniques, relying on large irradiation fields, delivered significant radiation doses to critical organs-at-risk (OARs, such as the heart, to the lung or the breasts) when treating mediastinal HL; consequently, secondary cancers, and cardiac and lung toxicity were substantially increased. Fortunately, HL RT has drastically evolved and, nowadays, state-of-the-art RT techniques efficiently spare critical organs-at-risks without altering local control or overall survival. Recently, proton therapy has been evaluated for mediastinal HL treatment, due to its possibility to significantly reduce integral dose to OARs, which is expected to limit second neoplasm risk and reduce late toxicity. Nevertheless, clinical experience for this recent technique is still limited worldwide. Based on current literature, this critical review aims to examine the current practice of proton therapy for mediastinal HL irradiation. Full article

(This article belongs to the Special Issue Radiation Therapy in Thoracic Tumors: Recent Trends and Current Issues)

► Show Figures

Figure 1

13 pages, 935 KiB

Open AccessReview

Development and Implementation of Proton Therapy for Hodgkin Lymphoma: Challenges and Perspectives

by Pierre Loap, Ludovic De Marzi, Alfredo Mirandola, Remi Dendale, Alberto Iannalfi, Viviana Vitolo, Amelia Barcellini, Andrea Riccardo Filippi, Barbara Alicja Jereczek-Fossa, Youlia Kirova and Ester Orlandi

Cancers 2021, 13(15), 3744; https://doi.org/10.3390/cancers13153744 - 26 Jul 2021

Cited by 14 | Viewed by 2625

Abstract

Consolidative radiation therapy for early-stage Hodgkin lymphoma (HL) improves progression-free survival. Unfortunately, first-generation techniques, relying on large irradiation fields, were associated with an increased risk of secondary cancers, and of cardiac and lung toxicity. Fortunately, the use of smaller target volumes combined with [...] Read more.

Consolidative radiation therapy for early-stage Hodgkin lymphoma (HL) improves progression-free survival. Unfortunately, first-generation techniques, relying on large irradiation fields, were associated with an increased risk of secondary cancers, and of cardiac and lung toxicity. Fortunately, the use of smaller target volumes combined with technological advances in treatment techniques currently allows efficient organs-at-risk sparing without altering tumoral control. Recently, proton therapy has been evaluated for mediastinal HL treatment due to its potential to significantly reduce the dose to organs-at-risk, such as cardiac substructures. This is expected to limit late radiation-induced toxicity and possibly, second-neoplasm risk, compared with last-generation intensity-modulated radiation therapy. However, the democratization of this new technique faces multiple issues. Determination of which patient may benefit the most from proton therapy is subject to intense debate. The development of new effective systemic chemotherapy and organizational, societal, and political considerations might represent impediments to the larger-scale implementation of HL proton therapy. Based on the current literature, this critical review aims to discuss current challenges and controversies that may impede the larger-scale implementation of mediastinal HL proton therapy. Full article

(This article belongs to the Special Issue Radiation Therapy in Thoracic Tumors: Recent Trends and Current Issues)

► Show Figures

Figure 1

Other

Jump to: Editorial, Research, Review

12 pages, 569 KiB

Open AccessEditor’s ChoiceSystematic Review

Systematic Review of Single-Fraction Stereotactic Body Radiation Therapy for Early Stage Non-Small-Cell Lung Cancer and Lung Oligometastases: How to Stop Worrying and Love One and Done

by Austin J. Bartl, Mary Mahoney, Mark W. Hennon, Sai Yendamuri, Gregory M. M. Videtic, Kevin L. Stephans, Shankar Siva, Mark K. Farrugia, Sung Jun Ma and Anurag K. Singh

Cancers 2022, 14(3), 790; https://doi.org/10.3390/cancers14030790 - 3 Feb 2022

Cited by 26 | Viewed by 3717

Abstract

Adoption of single-fraction lung stereotactic body radiation therapy (SBRT) for patients with medically inoperable early stage non-small-cell lung cancer (NSCLC) or oligometastatic lung disease, even during the coronavirus disease 2019 (COVID-19) pandemic, was limited despite encouraging phase II trial results. Barriers to using [...] Read more.

Adoption of single-fraction lung stereotactic body radiation therapy (SBRT) for patients with medically inoperable early stage non-small-cell lung cancer (NSCLC) or oligometastatic lung disease, even during the coronavirus disease 2019 (COVID-19) pandemic, was limited despite encouraging phase II trial results. Barriers to using single-fraction SBRT may include lack of familiarity with the regimen and lack of clarity about the expected toxicity. To address these concerns, we performed a systematic review of prospective literature on single-fraction SBRT for definitive treatment of early stage and oligometastatic lung cancer. A PubMed search of prospective studies in English on single-fraction lung SBRT was conducted. A systematic review was performed of the studies that reported clinical outcomes of single-fraction SBRT in the treatment of early stage non-small-cell lung cancer and lung oligometastases. The current prospective literature including nine trials supports the use of single-fraction SBRT in the definitive treatment of early stage peripheral NSCLC and lung oligometastases. Most studies cite local control rates of >90%, mild toxicity profiles, and favorable survival outcomes. Most toxicities reported were grade 1–2, with grade ≥3 toxicity in 0–17% of patients. Prospective trial results suggest potential consideration of utilizing single-fraction SBRT beyond the COVID-19 pandemic. Full article

(This article belongs to the Special Issue Radiation Therapy in Thoracic Tumors: Recent Trends and Current Issues)

► Show Figures

Figure 1

9 pages, 742 KiB

Open AccessBrief Report

Radiation-Induced Dyspnea in Lung Cancer Patients Treated with Stereotactic Body Radiation Therapy

by Laura Cella, Serena Monti, Maria Thor, Andreas Rimner, Joseph O. Deasy and Giuseppe Palma

Cancers 2021, 13(15), 3734; https://doi.org/10.3390/cancers13153734 - 25 Jul 2021

Cited by 9 | Viewed by 2714

Abstract

In this study, we investigated the prognostic factors for radiation-induced dyspnea after hypo-fractionated radiation therapy (RT) in 106 patients treated with Stereotactic Body RT for Non-Small-Cell Lung Cancer (NSCLC). The median prescription dose was 50 Gy (range: 40–54 Gy), delivered in a median [...] Read more.

In this study, we investigated the prognostic factors for radiation-induced dyspnea after hypo-fractionated radiation therapy (RT) in 106 patients treated with Stereotactic Body RT for Non-Small-Cell Lung Cancer (NSCLC). The median prescription dose was 50 Gy (range: 40–54 Gy), delivered in a median of four fractions (range: 3–12). Dyspnea within six months after SBRT was scored according to CTCAE v.4.0. Biologically Effective Dose (α/β = 3 Gy) volume histograms for lungs and heart were extracted. Dosimetric parameters along with patient-specific and treatment-related factors were analyzed, multivariable logistic regression method with Leave-One-Out (LOO) internal validation applied. Model performance was evaluated by the area under the receiver operating characteristic (ROC) curve (AUC) and calibration plot parameters. Fifty-seven patients (53.8%) out of 106 developed dyspnea of any grade after SBRT (25/57 grade ≥ 2 cases). A three-variable predictive model including patient comorbidity (COPD), heart volume and the relative lungs volume receiving more than 15 Gy was selected. The model displays an encouraging performance given by a training ROC-AUC = 0.71 [95%CI 0.61–0.80] and a LOO-ROC-AUC = 0.64 [95%CI 0.53–0.74]. Further modeling efforts are needed for dyspnea prediction in hypo-fractionated treatments in order to identify patients at high risk for developing lung toxicity more accurately. Full article

(This article belongs to the Special Issue Radiation Therapy in Thoracic Tumors: Recent Trends and Current Issues)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Radiation Therapy in Thoracic Tumors: Recent Trends and Current Issues

Share This Special Issue

Special Issue Editors

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Published Papers (14 papers)

Editorial

Research

Review

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI