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Technology in Cancer Research &... 2022The development of new techniques in radiotherapy (RT) provides a better planned target volume (PTV) dose distribution while further improving the protection of organs... (Review)
Review
The development of new techniques in radiotherapy (RT) provides a better planned target volume (PTV) dose distribution while further improving the protection of organs at risk (OARs). The study aims to present the dosimetric results of studies using hybrid techniques in whole-breast radiotherapy (WBRT). This systematic literature review was conducted by scanning the relevant literature in PubMed, Scopus, and Web of Science following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Among the parameters are dose values for PTV and OARs beam contribute ratios, the value of monitors, and treatment times for different RT techniques. Initially, 586 articles were identified; 196 duplicate articles were removed leaving 391 articles for screening. Three-hundred and thirty-seven irrelevant articles were excluded, leaving 54 studies assessed for eligibility. A total of 22 articles met the search criteria to evaluate dosimetric results of hybrid and other RT techniques in WBRT. According to the dosimetric data of the studies, hybrid intensity-modulated RT (H-IMRT) and hybrid volumetric-modulated arc therapy (H-VMAT) techniques give dosimetrically advantageous results in WBRT compared to other RT techniques. Hybrid techniques using appropriate beams contribute value and show great promise in improving dosimetric results in WBRT. However, there is a need for new studies showing the long-term clinical results of hybrid RT.
Topics: Humans; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Intensity-Modulated; Breast; Organs at Risk
PubMed: 36537067
DOI: 10.1177/15330338221143937 -
Cancer Biology & Therapy Dec 2023To investigate the impact of radiation dose on the efficacy of definitive chemoradiotherapy(dCCRT) in patients with locally advanced esophageal carcinoma. PubMed,... (Meta-Analysis)
Meta-Analysis
The impact of radiation dose on the efficacy of definitive chemoradiotherapy in patients with locally advanced esophageal carcinoma: a systematic review and meta-analysis.
To investigate the impact of radiation dose on the efficacy of definitive chemoradiotherapy(dCCRT) in patients with locally advanced esophageal carcinoma. PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Wanfang, and Chinese National Knowledge Infrastructure(CNKI) were searched for eligible studies. Studies that compared high-dose radiation(HD-RT) group with low-dose radiation(LD-RT) group using modern radiotherapy techniques for locally advanced esophageal carcinoma patients in dCCRT were identified. The hazard ratios (HR) for overall survival (OS), progression-free survival (PFS), and the odds ratios (OR) for clinical complete response (cCR), local-regional failure (LRF), distant metastasis (DM), and grade≥3 AEs. Meta-analysis was performed when relevant data were available. Eleven studies involving 1943 patients were included for analyses. The results showed that the HD-RT group had better OS (pooled HR 0.78 [0.70, 0.87], p < .00001), PFS (pooled HR 0.72 [0.55, 0.94], p = .01), cCR (OR 1.52 [1.13, 2.05], p = .005), and LRF (OR 0.60 [0.45, 0.80], p = .0004). In addition, there were no significant differences between the two groups in terms of DM (OR 1.43 [1.00, 2.04], p = .05), grade 3-5 radiation pneumonitis (OR 1.38 [0.71, 2.68], p = .35), grade 3-5 radiation esophagitis (OR 1.36 [0.88, 2.10], p = .17), grade 3-5 other esophageal toxicities(stenosis/fistula/hemorrhage) (OR 1.22 [0.75, 2.00], p = .43), and treatment-related death (OR 1.40 [0.73, 2.68], p = .31). High-dose radiotherapy in definitive CCRT for patients with locally advanced esophageal carcinoma is associated with improved PFS, OS, cCR, and LC with no increase of grade≥3AEs. Simultaneously, we await the preliminary and final results of several ongoing dose-escalation randomized trials. Furthermore, future studies should provide personalized radiotherapy doses for these patients.
Topics: Humans; Chemoradiotherapy; Esophageal Neoplasms; Carcinoma; Progression-Free Survival; Radiation Dosage
PubMed: 36519807
DOI: 10.1080/15384047.2022.2156246 -
Journal of Medical Imaging and... Mar 2023Previous non-randomised studies comparing dosimetric outcomes between advanced techniques such as IMRT and VMAT reported conflicting findings. We thus sought to perform... (Meta-Analysis)
Meta-Analysis Review
Dosimetric comparison between Intensity Modulated Radiation Therapy (IMRT) vs dual arc Volumetric Arc Therapy (VMAT) for nasopharyngeal cancer (NPC): Systematic review and meta-analysis.
BACKGROUND AND PURPOSE
Previous non-randomised studies comparing dosimetric outcomes between advanced techniques such as IMRT and VMAT reported conflicting findings. We thus sought to perform a systematic review and meta-analysis to consolidate the findings of these studies.
MATERIALS AND METHODS
We searched PUBMED and EMBASE for eligible studies from their time of inception to 10 March 2022. A random effects model was used to estimate the pooled mean differences (MDs) and their 95% confidence intervals(CIs) for target volume coverage, organ-at-risk(OAR) doses, monitor units(MUs) and treatment delivery times. We also performed a subgroup analysis to evaluate if different treatment planning systems (TPS) (Eclipse, Monaco and Pinnacle) used affected the pooled mean differences.
RESULTS
A total of 17 studies (383 patients) were eligible to be included. The pooled results showed that dual arc VMAT reduced D2% of PTV (MD=0.71Gy,95%CI=0.14-1.27,P=0.01), mean left cochlea dose (MD=2.6Gy,95%CI=0.03-5.16,P=0.05), mean right cochlea dose (MD=3.4Gy,95%CI=0.7-6.1,P=0.01), MUs (MD=554.9,95%CI=245.8-863.9,P=0.0004), treatment delivery times (MD=6.7mins,95%CI=4.5-8.9,P<0.0001) and integral dose (MD=0.97Gy,95%CI=0.28-1.67,P=0.006). None of the other indices were significantly better for the IMRT plans. The subgroup analysis showed that the integral dose was significantly lower only for Eclipse (MD=0.88Gy, 95%CI=0.14-1.63, P=0.02). The total MUs was significantly lower only for Eclipse (MD=1035.2, 95%CI=624.6-1445.9, P<0.0001) and Pinnacle (MD=293, 95%CI=15.6-570.5, P=0.04). Similarly, delivery time was also significantly lower only for Eclipse (MD=6.1mins, 95%CI=5.7-6.5, P<0.0001) and Pinnacle (MD=4.9mins, 95%CI=2.6-7.2, P<0.0001). The subgroup analysis however showed that target coverage was superior for the IMRT plans for both Pinnacle (MD=0.48Gy, 95%CI=0.31-0.66, P<0.0001) and Monaco (MD=0.12Gy, 95%CI=0.07-0.17, P<0.0001).
CONCLUSION
Dual-arc VMAT plans improved OAR doses, MUs and treatment times as compared to IMRT plans. The different TPS used may modify dosimetric outcomes.
Topics: Humans; Nasopharyngeal Neoplasms; Radiotherapy, Intensity-Modulated; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Radiometry
PubMed: 36456460
DOI: 10.1016/j.jmir.2022.10.195 -
Clinical Neuroradiology Jun 2023The introduction of the first whole-body CT scanner in 1974 marked the beginning of cross-sectional spine imaging. In the last decades, the technological advancement,... (Review)
Review
The introduction of the first whole-body CT scanner in 1974 marked the beginning of cross-sectional spine imaging. In the last decades, the technological advancement, increasing availability and clinical success of CT led to a rapidly growing number of CT examinations, also of the spine. After initially being primarily used for trauma evaluation, new indications continued to emerge, such as assessment of vertebral fractures or degenerative spine disease, preoperative and postoperative evaluation, or CT-guided interventions at the spine; however, improvements in patient management and clinical outcomes come along with higher radiation exposure, which increases the risk for secondary malignancies. Therefore, technical developments in CT acquisition and reconstruction must always include efforts to reduce the radiation dose. But how exactly can the dose be reduced? What amount of dose reduction can be achieved without compromising the clinical value of spinal CT examinations and what can be expected from the rising stars in CT technology: artificial intelligence and photon counting CT? In this article, we try to answer these questions by systematically reviewing dose reduction techniques with respect to the major clinical indications of spinal CT. Furthermore, we take a concise look on the dose reduction potential of future developments in CT hardware and software.
Topics: Humans; Artificial Intelligence; Cross-Sectional Studies; Radiation Dosage; Tomography, X-Ray Computed; Spine
PubMed: 36416936
DOI: 10.1007/s00062-022-01227-1 -
Radiation Oncology (London, England) Nov 2022This systematic review aims to synthesise the outcomes of different strategies of incorporating functional biological markers in the radiation therapy plans of patients... (Review)
Review
RATIONALE
This systematic review aims to synthesise the outcomes of different strategies of incorporating functional biological markers in the radiation therapy plans of patients with glioblastoma to support clinicians and further research.
METHODS
The systematic review protocol was registered on PROSPERO (CRD42021221021). A structured search for publications was performed following PRISMA guidelines. Quality assessment was performed using the Newcastle-Ottawa Scale. Study characteristics, intervention methodology and outcomes were extracted using Covidence. Data analysis focused on radiation therapy target volumes, toxicity, dose distributions, recurrence and survival mapped to functional image-guided radiotherapy interventions.
RESULTS
There were 5733 citations screened, with 53 citations (n = 32 studies) meeting review criteria. Studies compared standard radiation therapy planning volumes with functional image-derived volumes (n = 20 studies), treated radiation therapy volumes with recurrences (n = 15 studies), the impact on current standard target delineations (n = 9 studies), treated functional volumes and survival (n = 8 studies), functionally guided dose escalation (n = 8 studies), radiomics (n = 4 studies) and optimal organ at risk sparing (n = 3 studies). The approaches to target outlining and dose escalation were heterogeneous. The analysis indicated an improvement in median overall survival of over two months compared with a historical control group. Simultaneous-integrated-boost dose escalation of 72-76 Gy in 30 fractions appeared to have an acceptable toxicity profile when delivered with inverse planning to a volume smaller than 100 cm[Formula: see text].
CONCLUSION
There was significant heterogeneity between the approaches taken by different study groups when implementing functional image-guided radiotherapy. It is recommended that functional imaging data be incorporated into the gross tumour volume with appropriate technology-specific margins used to create the clinical target volume when designing radiation therapy plans for patients with glioblastoma.
Topics: Humans; Glioblastoma; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated; Radiotherapy Planning, Computer-Assisted; Functional Neuroimaging
PubMed: 36371225
DOI: 10.1186/s13014-022-02146-8 -
Frontiers in Oncology 2022Pain relief is one of the main objectives of radiotherapy for cancer patients with bone metastases. Stereotactic body radiotherapy (SBRT) enables precise delivery of a...
BACKGROUND
Pain relief is one of the main objectives of radiotherapy for cancer patients with bone metastases. Stereotactic body radiotherapy (SBRT) enables precise delivery of a higher dosage to the target area. Several trials have reported comparisons between SBRT and conventional radiotherapy (cRT) in patients with painful bone metastasis. However, the results of those investigations were inconsistent, and no systematic review or meta-analysis has been done till now.
METHODS
We systematically searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Clinicaltrials.gov up to May 1, 2022 for relevant studies. Patients with painful bone metastasis who received SBRT or cRT were included. The primary outcome was the patients' pain response rate at three months. The secondary outcomes included the rate of pain responders at one month and six months, oral morphine equivalent dose (OMED) use, and any adverse events. STATA software 12.0 was used for the statistical analysis.
RESULTS
We collected 533 patients' data from 4 randomized controlled trials (RCTs), there was a significant difference of pain response rate at 3 months between two groups (RR = 1.41, 95% CI: 1.12-1.77, = 0.0%, P = 0.003). However, no significant difference was found in pain response rate at 1 month (RR = 1.19, 95% CI: 0.91-1.54, = 31.5%, P = 0.201) and 6 months (RR = 1.25, 95% CI: 0.93-1.69, = 0.0%, P = 0.140). OMED consumption was not significantly different in patients treated with SBRT compared with control group (WMD = -1.11, 95% CI: -17.51-15.28, = 0.0%, P = 0.894). For safety outcome, no statistical difference was found between SBRT and cRT (RR = 0.72, 95% CI: 0.46-1.14, 20.1%, P = 0.162).
CONCLUSION
This study shows that for painful bone metastases, patients with SBRT experienced better pain relief 3 months after radiation than patients with cRT, and SBRT did not increase the incidence of adverse events.
SYSTEMATIC REVIEW REGISTRATION
https://inplasy.com/inplasy-2022-6-0099/, identifier INPLASY202260099.
PubMed: 36338685
DOI: 10.3389/fonc.2022.979201 -
European Journal of Clinical... Jan 2023Aspirin has been suggested to reduce the risk of cancer. However, previous studies have been inconsistent regarding the relationship between aspirin use and the risk of... (Meta-Analysis)
Meta-Analysis
PURPOSE
Aspirin has been suggested to reduce the risk of cancer. However, previous studies have been inconsistent regarding the relationship between aspirin use and the risk of occurrence of hepatocellular carcinoma (HCC). The purpose of this study was to assess the effect of aspirin on clinical outcomes in patients with HCC in a meta-analysis and to explore the possible dose-response relationship.
METHODS
A systematic literature search was conducted in 10 electronic databases and 4 registries. The combined hazard ratios (HRs) were calculated using a random-effects model with 95% confidence interval (CIs) to assess the effect of aspirin on the risk of HCC. Relevant subgroup analyses and sensitivity analyses were performed.
RESULTS
The results show that aspirin use correlated with lower incidence of HCC (HR: 0.75, 95% CI: 0.71-0.80), decreased risk of HCC recurrence (HR: 0.79, 95% CI: 0.65-0.96), and reduced mortality (HR: 0.72, 95% CI: 0.60-0.87). The results of the subgroup analysis showed that aspirin use was consistently associated with reduced incidence of HCC across different regions, study designs, and populations. A linear relationship was found for both dosage and duration of aspirin use. An increased of bleeding with aspirin use among patients was also observed (HR 1.10, 95% CI: 1.02-1.20).
CONCLUSIONS
This meta-analysis found that aspirin use was independently associated with a reduced risk of HCC incidence, recurrence, and death. Furthermore, aspirin use influenced HCC occurrence in a dose-dependent and duration-dependent manner. However, an increased risk of bleeding with aspirin use was noted.
Topics: Humans; Aspirin; Carcinoma, Hepatocellular; Incidence; Liver Neoplasms; Proportional Hazards Models
PubMed: 36334108
DOI: 10.1007/s00228-022-03414-y -
Radiotherapy and Oncology : Journal of... Dec 2022To systematically review all dosimetric studies investigating the impact of deep inspiration breath hold (DIBH) compared with free breathing (FB) in mediastinal lymphoma... (Review)
Review
PURPOSE
To systematically review all dosimetric studies investigating the impact of deep inspiration breath hold (DIBH) compared with free breathing (FB) in mediastinal lymphoma patients treated with proton therapy as compared to IMRT (intensity-modulated radiation therapy)-DIBH.
MATERIALS AND METHODS
We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline using the PubMed database to identify studies of mediastinal lymphoma patients with dosimetric comparisons of proton-FB and/or proton-DIBH with IMRT-DIBH. Parameters included mean heart (MHD), lung (MLD), and breast (MBD) doses, among other parameters. Case reports were excluded. Absolute differences in mean doses > 1 Gy between comparators were considered to be clinically meaningful.
RESULTS
As of April 2021, eight studies fit these criteria (n = 8), with the following comparisons: proton-FB vs IMRT-DIBH (n = 5), proton-DIBH vs proton-FB (n = 5), and proton-DIBH vs IMRT-DIBH (n = 8). When comparing proton-FB with IMRT-DIBH in 5 studies, MHD was reduced with proton-FB in 2 studies, was similar (<1 Gy difference) in 2 studies, and increased in 1 study. On the other hand, MLD and MBD were reduced with proton-FB in 3 and 4 studies, respectively. When comparing proton-DIBH with proton-FB, MHD and MLD were reduced with proton DIBH in 4 and 3 studies, respectively, while MBD remained similar. Compared with IMRT-DIBH in 8 studies, proton-DIBH reduced the MHD in 7 studies and was similar in 1 study. Furthermore, MLD and MBD were reduced with proton-DIBH in 8 and 6 studies respectively. Integral dose was similar between proton-FB and proton-DIBH, and both were substantially lower than IMRT-DIBH.
CONCLUSION
Accounting for heart, lung, breast, and integral dose, proton therapy (FB or DIBH) was superior to IMRT-DIBH. Proton-DIBH can lower dose to the lungs and heart even further compared with proton-FB, depending on disease location in the mediastinum, and organ-sparing and target coverage priorities.
Topics: Humans; Proton Therapy; Breath Holding; Organs at Risk; Radiotherapy Planning, Computer-Assisted; Protons; Mediastinal Neoplasms; Lymphoma; Heart; Radiotherapy Dosage; Unilateral Breast Neoplasms
PubMed: 36252635
DOI: 10.1016/j.radonc.2022.10.003 -
Expert Review of Anticancer Therapy Nov 2022Neoadjuvant chemoradiation (CRT) followed by total mesorectal excision is the current standard-of-care for locally advanced UICC II-III stage rectal cancer (LARC). A...
Impact of preoperative chemoradiation with higher dose intensity modulated radiotherapy on pathological complete response for locally advanced rectal cancer: a systematic review.
INTRODUCTION
Neoadjuvant chemoradiation (CRT) followed by total mesorectal excision is the current standard-of-care for locally advanced UICC II-III stage rectal cancer (LARC). A pathological complete response (pCR) correlates with survival. Improvements of pCR, including dose escalation, should be explored. The aim of this explorative analysis is to assess the impact on pCR of intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB).
AREAS COVERED
A literature search via PICO (Population, Intervention, Comparison, Outcome) in MEDLINE/PubMed and EMBASE and a systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Metanalysis) methodology were performed. Studies that reported pCR rate in patients with LARC in clinical stage T2N+M0 or cT3/4 N0/+M0 treated with preoperative CRT with SIB-IMRT/VMAT (Volumetric Modulated Arc Therapy) were included. Sixty-two studies were identified, but only eight clinical trials with a total of 311 patients were included . Median follow-up was 16-61 months. pCR reached the value of 38%. Good survival outcomes were observed with a mild toxicity profile.
EXPERT OPINION
Radiotherapy dose intensification in LARC showed a slight increase of pCR compared to historical studies. Prospective evaluations are necessary to define which patients would benefit most.
Topics: Humans; Radiotherapy, Intensity-Modulated; Radiotherapy Dosage; Chemoradiotherapy; Rectal Neoplasms; Neoadjuvant Therapy
PubMed: 36174658
DOI: 10.1080/14737140.2022.2130895 -
Radiation Protection Dosimetry Oct 2022A systematic search was conducted to explore the literature on the existing diagnostic reference level (DRL) of radiographic and computed tomography (CT) examinations in...
A systematic search was conducted to explore the literature on the existing diagnostic reference level (DRL) of radiographic and computed tomography (CT) examinations in Saudi Arabia. The search was performed using Web of Science, Scopus and EBSCO. The search identified 19 studies that reported DRL values for radiographic and CT examinations in Saudi Arabia. Six of those studies reported DRL values for projection radiography, and the remaining studies reported DRL values for CT examinations (n = 13). The entrance surface dose, volume CT dose index (CTDIvol) and dose-length product (DLP) were the most common methods used for establishing the DRLs. Variations were observed in the Saudi DRL values, and this is consistent with the DRL values reported in the literature. Educating and training radiographers to better understand dose minimizing techniques may result in lower patient doses and lower variances in DRL values.
Topics: Humans; Radiation Dosage; Diagnostic Reference Levels; Saudi Arabia; Reference Values; Tomography, X-Ray Computed
PubMed: 36125219
DOI: 10.1093/rpd/ncac183