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Radiobiological Determination of Dose Escalation and Normal Tissue Toxicity in Definitive Chemoradiation Therapy for Esophageal Cancer()

PURPOSE: This study investigated the trade-off in tumor coverage and organ-at-risk sparing when applying dose escalation for concurrent chemoradiation therapy (CRT) of mid-esophageal cancer, using radiobiological modeling to estimate local control and normal tissue toxicity. METHODS AND MATERIALS: T...

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Autores principales: Warren, Samantha, Partridge, Mike, Carrington, Rhys, Hurt, Chris, Crosby, Thomas, Hawkins, Maria A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier, Inc 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4165721/
https://www.ncbi.nlm.nih.gov/pubmed/25304796
http://dx.doi.org/10.1016/j.ijrobp.2014.06.028
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author Warren, Samantha
Partridge, Mike
Carrington, Rhys
Hurt, Chris
Crosby, Thomas
Hawkins, Maria A.
author_facet Warren, Samantha
Partridge, Mike
Carrington, Rhys
Hurt, Chris
Crosby, Thomas
Hawkins, Maria A.
author_sort Warren, Samantha
collection PubMed
description PURPOSE: This study investigated the trade-off in tumor coverage and organ-at-risk sparing when applying dose escalation for concurrent chemoradiation therapy (CRT) of mid-esophageal cancer, using radiobiological modeling to estimate local control and normal tissue toxicity. METHODS AND MATERIALS: Twenty-one patients with mid-esophageal cancer were selected from the SCOPE1 database (International Standard Randomised Controlled Trials number 47718479), with a mean planning target volume (PTV) of 327 cm(3). A boost volume, PTV2 (GTV + 0.5 cm margin), was created. Radiobiological modeling of tumor control probability (TCP) estimated the dose required for a clinically significant (+20%) increase in local control as 62.5 Gy/25 fractions. A RapidArc (RA) plan with a simultaneously integrated boost (SIB) to PTV2 (RA(62.5)) was compared to a standard dose plan of 50 Gy/25 fractions (RA(50)). Dose-volume metrics and estimates of normal tissue complication probability (NTCP) for heart and lungs were compared. RESULTS: Clinically acceptable dose escalation was feasible for 16 of 21 patients, with significant gains (>18%) in tumor control from 38.2% (RA(50)) to 56.3% (RA(62.5)), and only a small increase in predicted toxicity: median heart NTCP 4.4% (RA(50)) versus 5.6% (RA(62.5)) P<.001 and median lung NTCP 6.5% (RA(50)) versus 7.5% (RA(62.5)) P<.001. CONCLUSIONS: Dose escalation to the GTV to improve local control is possible when overlap between PTV and organ-at-risk (<8% heart volume and <2.5% lung volume overlap for this study) generates only negligible increase in lung or heart toxicity. These predictions from radiobiological modeling should be tested in future clinical trials.
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spelling pubmed-41657212014-10-01 Radiobiological Determination of Dose Escalation and Normal Tissue Toxicity in Definitive Chemoradiation Therapy for Esophageal Cancer() Warren, Samantha Partridge, Mike Carrington, Rhys Hurt, Chris Crosby, Thomas Hawkins, Maria A. Int J Radiat Oncol Biol Phys Physics Contribution PURPOSE: This study investigated the trade-off in tumor coverage and organ-at-risk sparing when applying dose escalation for concurrent chemoradiation therapy (CRT) of mid-esophageal cancer, using radiobiological modeling to estimate local control and normal tissue toxicity. METHODS AND MATERIALS: Twenty-one patients with mid-esophageal cancer were selected from the SCOPE1 database (International Standard Randomised Controlled Trials number 47718479), with a mean planning target volume (PTV) of 327 cm(3). A boost volume, PTV2 (GTV + 0.5 cm margin), was created. Radiobiological modeling of tumor control probability (TCP) estimated the dose required for a clinically significant (+20%) increase in local control as 62.5 Gy/25 fractions. A RapidArc (RA) plan with a simultaneously integrated boost (SIB) to PTV2 (RA(62.5)) was compared to a standard dose plan of 50 Gy/25 fractions (RA(50)). Dose-volume metrics and estimates of normal tissue complication probability (NTCP) for heart and lungs were compared. RESULTS: Clinically acceptable dose escalation was feasible for 16 of 21 patients, with significant gains (>18%) in tumor control from 38.2% (RA(50)) to 56.3% (RA(62.5)), and only a small increase in predicted toxicity: median heart NTCP 4.4% (RA(50)) versus 5.6% (RA(62.5)) P<.001 and median lung NTCP 6.5% (RA(50)) versus 7.5% (RA(62.5)) P<.001. CONCLUSIONS: Dose escalation to the GTV to improve local control is possible when overlap between PTV and organ-at-risk (<8% heart volume and <2.5% lung volume overlap for this study) generates only negligible increase in lung or heart toxicity. These predictions from radiobiological modeling should be tested in future clinical trials. Elsevier, Inc 2014-10-01 /pmc/articles/PMC4165721/ /pubmed/25304796 http://dx.doi.org/10.1016/j.ijrobp.2014.06.028 Text en © 2014 The Authors https://creativecommons.org/licenses/by/3.0/This work is licensed under a Creative Commons Attribution 3.0 Unported License (https://creativecommons.org/licenses/by/3.0/) .
spellingShingle Physics Contribution
Warren, Samantha
Partridge, Mike
Carrington, Rhys
Hurt, Chris
Crosby, Thomas
Hawkins, Maria A.
Radiobiological Determination of Dose Escalation and Normal Tissue Toxicity in Definitive Chemoradiation Therapy for Esophageal Cancer()
title Radiobiological Determination of Dose Escalation and Normal Tissue Toxicity in Definitive Chemoradiation Therapy for Esophageal Cancer()
title_full Radiobiological Determination of Dose Escalation and Normal Tissue Toxicity in Definitive Chemoradiation Therapy for Esophageal Cancer()
title_fullStr Radiobiological Determination of Dose Escalation and Normal Tissue Toxicity in Definitive Chemoradiation Therapy for Esophageal Cancer()
title_full_unstemmed Radiobiological Determination of Dose Escalation and Normal Tissue Toxicity in Definitive Chemoradiation Therapy for Esophageal Cancer()
title_short Radiobiological Determination of Dose Escalation and Normal Tissue Toxicity in Definitive Chemoradiation Therapy for Esophageal Cancer()
title_sort radiobiological determination of dose escalation and normal tissue toxicity in definitive chemoradiation therapy for esophageal cancer()
topic Physics Contribution
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4165721/
https://www.ncbi.nlm.nih.gov/pubmed/25304796
http://dx.doi.org/10.1016/j.ijrobp.2014.06.028
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