scholarly journals Who benefited most from higher cumulative dose of cisplatin among patients with locally advanced nasopharyngeal carcinoma treated by intensity-modulated radiation therapy? A retrospective study of 527 cases

2017 ◽  
Vol 8 (14) ◽  
pp. 2836-2845 ◽  
Author(s):  
Xiaomin Ou ◽  
Tingting Xu ◽  
Xiayun He ◽  
Hongmei Ying ◽  
Chaosu Hu
Keyword(s):  
Radiation Therapy ◽  
Retrospective Study ◽  
Nasopharyngeal Carcinoma ◽  
Cumulative Dose ◽  
Locally Advanced ◽  
Intensity Modulated Radiation Therapy ◽  
Intensity Modulated

scholarly journals A knowledge-based intensity-modulated radiation therapy treatment planning technique for locally advanced nasopharyngeal carcinoma radiotherapy

2020 ◽  
Author(s):  
Penggang Bai ◽  
Xing Weng ◽  
Kerun Quan ◽  
Jihong Chen ◽  
Yitao Dai ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Nasopharyngeal Carcinoma ◽  
Treatment Planning ◽  
Locally Advanced ◽  
Intensity Modulated Radiation Therapy ◽  
Target Volume ◽  
Planning System ◽  
Intensity Modulated ◽  
Knowledge Based ◽  
Planning Technique

Abstract BackgroundTo investigate the feasibility of a knowledge-based automated intensity-modulated radiation therapy (IMRT) planning technique for locally advanced nasopharyngeal carcinoma (NPC) radiotherapy.Methods140 NPC patients treated with definitive radiation therapy with the step-and-shoot IMRT techniques were retrospectively selected and separated into a knowledge library (n=115) and a test library (n=25). For each patient in the knowledge library, the overlap volume histogram (OVH), target volume histogram (TVH) and dose objectives were extracted from the manually generated plan. 5-fold cross validation was performed to divide the patients in the knowledge library into 5 groups before validating one group by using the other 4 groups to train each neural network (NN) machine learning models. For patients in the test library, their OVH and TVH were then used by the trained models to predict a corresponding set of mean dose objectives, which were subsequently used to generate automated plans (APs) in Pinnacle planning system via an in-house developed automated scripting system. All APs were obtained after a single step of optimization. Manual plans (MPs) for the test patients were generated by an experienced medical physicist strictly following the established clinical protocols. The qualities of the APs and MPs were evaluated by an attending radiation oncologist. The dosimetric parameters for planning target volume (PTV) coverage and the organs-at-risk (OAR) sparing were also quantitatively measured and compared using Mann-Whitney U test and Bonferroni correction.ResultsAPs and MPs had the same rating for more than 80% of the patients (19 out of 25) in the test group. Both AP and MP achieved PTV coverage criteria for no less than 80% of the patients. For each OAR, the number of APs achieving its criterion was similar to that in the MPs. The AP approach improved planning efficiency by greatly reducing the planning duration to about 17% of the MP (9.85±1.13 min vs. 57.10±6.35 min).ConclusionA robust and effective knowledge-based IMRT treatment planning technique for locally advanced NPC is developed. Patient specific dose objectives can be predicted by trained NN models based on the individual’s OVH and clinical TVH goals. The automated planning scripts can use these dose objectives to efficiently generate APs with largely shortened planning time. These APs had comparable dosimetric qualities when compared to our clinic’s manual plans.

scholarly journals A knowledge-based intensity-modulated radiation therapy treatment planning technique for locally advanced nasopharyngeal carcinoma radiotherapy

2020 ◽  
Author(s):  
Penggang Bai ◽  
Xing Weng ◽  
Kerun Quan ◽  
Jihong Chen ◽  
Yitao Dai ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Nasopharyngeal Carcinoma ◽  
Treatment Planning ◽  
Locally Advanced ◽  
Intensity Modulated Radiation Therapy ◽  
Target Volume ◽  
Planning System ◽  
Intensity Modulated ◽  
Knowledge Based ◽  
Planning Technique

Abstract BackgroundTo investigate the feasibility of a knowledge-based automated intensity-modulated radiation therapy (IMRT) planning technique for locally advanced nasopharyngeal carcinoma (NPC) radiotherapy.Methods140 NPC patients treated with definitive radiation therapy with the step-and-shoot IMRT techniques were retrospectively selected and seperated into a knowledge library (n=115) and a test library (n=25). For each case, in the knowledge library, the patient’s overlap volume histogram (OVH), target volume histogram (TVH) and dose objectives were extracted from the manually generated plan to train a 3-layer neural network (NN) machine learning model. For patients in the test library, their OVH and TVH were then used by the trained model to predict a corresponding set of dose objectives, which were subsequently used to generate automated plans (APs) in Pinnacle planning system via an in-house developed automated scripting system. All APs were obtained after a single step of optimization. Manual plans (MPs) of the same test patients were generated by an experienced medical physicist strictly following the established clinical protocols. The qualities of the APs and MPs were evaluated by an attending radiation oncologist. The dosimetric parameters for planning target volume (PTV) coverage and the organs-at-risk (OAR) sparing were also quantitatively measured and compared.ResultsAPs and MPs had the same rating for more than 80% of the patients (19 out of 25) in the test group. For greater than 80% of the patients, both AP and MP achieved PTV coverage criteria. For each OAR, the number of APs achieving its criterion was similar to that in the MPs. The AP approach significantly improved planning efficiency by reducing the planning duration to about 17% of the MP (9.73±1.80 min vs. 57.10±6.35 min, P<0.001). ConclusionA robust and effective knowledge-based IMRT treatment planning technique for locally advanced NPC is developed. Patient specific dose objectives can be predicted by a trained NN model based on the individual’s OVH and clinical TVH goals. The automated planning scripts can use these dose objectives to efficiently generate APs with largely shortened planning time. These APs had comparable dosimetric qualities when compared to our clinic’s manual plans.

Higher dose per fraction and shorter overall treatment time using intensity-modulated radiation therapy versus conventional radiation therapy with concurrent carboplatin and 5-fluorouracil for locally advanced oropharyngeal carcinoma: A comparison of toxicity and efficacy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6038-6038 ◽  
Author(s):  
S. Clavel ◽  
D. Nguyen ◽  
P. Després ◽  
B. Fortin ◽  
G. Coulombe ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Retrospective Study ◽  
Treatment Time ◽  
Locally Advanced ◽  
Intensity Modulated Radiation Therapy ◽  
Disease Free Survival ◽  
Oropharyngeal Carcinoma ◽  
Overall Treatment Time ◽  
Intensity Modulated ◽  
Dose Per Fraction

6038 Background: The aim of this retrospective study was to compare toxicity and efficacy of two different radiotherapy regimens, the first one using intensity-modulated radiation therapy (IMRT) to that of conventional radiotherapy (CRT) in patients treated with concomitant chemotherapy for locally advanced oropharyngeal cancer. Methods: Between January 2000 and December 2007, 249 patients with stage III-IV squamous cell oropharyngeal carcinoma were treated at our institution with definitive concurrent chemoradiation using carboplatin 70 mg/m2/day for four days and 5-fluorouracil 600 mg/m2/day as a continuous infusion every 3 weeks. One hundred patients had 70 Gy in 33 fractions using IMRT (2.12 Gy per day) and 149 received CRT at 70 gy in 35 fractions (2 Gy per day), both administered five times a week. Toxicities were compared using Fisher's exact test. Overall survival (OS), disease-free survival (DFS), and locoregional control (LRC) were estimated using the Kaplan-Meier method and compared with the log-rank test. Results: Median follow-up was 33 months. Three year actuarial rates for OS, DFS, and LRC were 95.4 vs. 75.8% (p < 0.001), 89.3 vs. 71.6% (p < 0.001), and 92.4 vs. 85.3% (p = 0.050) for IMRT and CRT respectively. To minimize the effect of changes in treatment paradigm over time, analyses were performed for patients treated after January 2004 and still showed OS, DFS, and LRC differences. Comparison of toxicities demonstrated that IMRT was associated with fewer dermatitis than CRT (p < 0.01), but caused the same rates of mucositis, weight loss, enteral feeding, hospitalization and death during treatment. There was significantly less xerostomia at 24 and 36 months (p < 0.001) following the end of treatment with IMRT. Conclusions: In this retrospective study, higher dose per fraction and shorter overall treatment time using IMRT given concurrently with chemotherapy when compared to CRT is a safe regimen with better OS, DFS, LRC, and less long term xerostomia. Altered fractionation RT with chemotherapy seems to result in better outcome and future prospective trials are needed to confirm this hypothesis. No significant financial relationships to disclose.

scholarly journals Impact of Factors on Acute Radiation Oral Mucositis for Nasopharyngeal Carcinoma Patients Treated with Concurrent Intensity-Modulated Radiation Therapy and Chemoradiotherapy:A Retrospective Study

2021 ◽  
Author(s):  
Yan Yin ◽  
Shupei Qu ◽  
Haibiao Wu ◽  
Xia Liu ◽  
Qin Tong ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Platelet Count ◽  
Retrospective Study ◽  
Nasopharyngeal Carcinoma ◽  
Oral Mucositis ◽  
Hematological Parameters ◽  
Multivariate Logistic Regression Analysis ◽  
Intensity Modulated Radiation Therapy ◽  
Weekly Chemotherapy ◽  
Intensity Modulated

Abstract Background To retrospectively studied the medical records in the latest 4 years in order to investigate the occurrence and influencing factors of radiation-induced oral mucositis in patients with nasopharyngeal carcinoma treated with concurrent intensity-modulated radiation therapy and chemoradiotherapy. Methods Between January 2014 and December 2018, 262 patients with non-metastatic nasopharyngeal carcinoma treated with concurrent intensity-modulated radiation therapy and chemoradiotherapy were enrolled in the study.The patients' age,gender,body mass index,smoking,diabetes,clinical stage, hematological parameters before radiotherapy before radiotherapy(leukocyte count,erythrocyte count,hemoglobin level,platelet count,lymphocyte count, neutrophil count),PGTV, PCTV1, PCTV2, induction chemotherapy, concurrent chemotherapy interval(weekly or three-weekly chemotherapy) and the concurrent chemotherapeutic drugs (single cisplatin or single lobaplatin or docetaxel plus cisplatin regimen) were examined, and the associations of variables with oral mucositis were analyzed by multivariate logistic regression analysis. Results Only platelet count before radiotherapy is the risk factor for grade 2 and higher acute oral mucositis(p = 0.028) with an odds ratio of 1.005 (95% CI: 1.001–1.009).There was no difference in the risk of grade 2 and higher oral mucositis between the single platinum regimen and docetaxel plus cisplatin regimen.The study also found similar responses to oral mucositis between weekly regimen and three-weekly regimen. Conclusion The present retrospective study demonstrated that certain factor may predispose patients with with nasopharyngeal carcinoma treated with concurrent intensity-modulated radiation therapy and chemoradiotherapy to develop oral mucositis.

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