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Predictive value of dose-volume histogram parameters for pericardial effusion after concurrent chemoradiotherapy for esophageal cancer
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I. J. Radiation Oncology
2144
● Biology ● Physics
Volume 60, Number 1, Supplement, 2004
Predictive Value of Dose-Volume Histogram Parameters for Pericardial Effusion After Concurrent Chemoradiotherapy for Esophageal Cancer
Y. Ito,1,2 S. Ishikura,2 S. Hirota,3 T. Soejima,4 K. Tsujino,3 E. Yoden,3 Y. Okamoto,4 K. Nihei,2 M. Onozawa2 Radiation Oncology Division, National Cancer Center Hospital, Tokyo, Japan, 2Radiation Oncology Division, National Cancer Center Hospital East, Kashiwa, Japan, 3Department of Radiology, Hyogo Medical Center for Adults, Hyogo, Japan, 4Division of Radiology, Kobe University Graduate School of Medicine, Hyogo, Japan 1
Purpose/Objective: Chemoradiotherapy (CRT) is a treatment option in patients with esophageal cancer, but late toxicities such as pericardial effusion have become a major concern in long-term survivors. This study investigated parameters that predict pericardial effusion using dose-volume histograms in esophageal cancer patients treated with CRT. Materials/Methods: Patients with newly diagnosed SCC of the thoracic esophagus and treated with definitive CRT in our institutions were recruited from our database based on the following criteria: clinical tumor-node-metastasis system stage I-IVA, complete responder, ⱖ12 months follow-up after the initiation of treatment, dose-volume histogram available. Chemotherapy included cisplatin and fluorouracil. The heart was delineated from the level of origin of brachiocephalic artery to the level of cardiac apex. Three-dimensional treatment planning was performed in all cases. Dose-volume histogram for the heart was generated and the parameters including cardiac volume, mean heart dose, max heart dose, percentage of cardiac volume irradiated to ⱖ 45 Gy (V45), classical normal tissue complication probability (NTCP) for pericardial effusion (n ⫽ 0.35, m ⫽ 0.10, TD50 ⫽ 48 Gy), and modified NTCP (n ⫽ 0.64, m ⫽ 0.13, TD50 ⫽ 48 Gy) were analyzed. Pericardial effusion was graded according to the National Cancer Institute-Common Toxicity Criteria version 2.0 and ⱖ grade 3 was considered severe. Univariate analyses were performed for patient- and treatment-related factors, and parameters in dose-volume histogram in relation to severe pericardial effusion. Results: Eighty-three patients were recruited, and their characteristics were as follows: median age, 64 years (range, 44 - 79 years); 70 males and 13 females; and 15 patients in stage I, 31 patients in stage II, 31 patients in stage III, and 6 patients in stage IVA. Radiotherapy was delivered at 1.8 –2.0 Gy fractions once daily to a total of 46 –70 Gy (median 60 Gy) and three patients were treated with a high-dose-rate intracavitary brachytherapy after CRT. With a median follow-up of 41 months (range, 13–104months), Grade 0, 1, 2, 3, 4 pericardial effusion were observed in 26 (31.3%), 35 (42.2%), 11 (13.3%), 8 (9.6%), and 3 (3.6%) patients, respectively. Median value of cardiac volume, mean heart dose, max heart dose, V45, classical NTCP, and modified NTCP were 756 cc (range, 531–1061 cc), 42.1 Gy (range, 17.0 –53.3 Gy), 63.4 Gy (range, 49.1– 81.5 Gy), 49.0% (range, 13.0 – 81.0%), 50.8% (range, 0.7–97.5%), and 25.4% (0.0 –90.5%), respectively. There was a significant difference between mean heart dose ⱖ 40 Gy and ⬍ 40 Gy (p ⫽ 0.037), and a trend between modified NTCP ⱖ 20% and ⬍ 20% (p ⫽ 0.065). Univariate analysis of patient- and treatment-related factors did not show any other significant predictors of severe pericardial effusion. Conclusions: The risk of severe pericardial effusion was significantly higher when the mean heart dose was ⱖ 40 Gy. Mean heart dose ⬍ 40 Gy may be used as dose constraint, but it must be confirmed prospectively in the future.
2145
Long-Term Results of Intraoperative Presacral Electron Boost Radiotherapy (IOERT) in Combination with Chemoradiation in Patients with Locally Advanced Rectal Cancer
R. C. Krempien,1 M. Roebel,1 S. Oertel,1 M. J. Eble,1 F. Roeder,1 M. Buechler,2 J. Debus,1 M. Treiber1 Radiation Oncology, University of Heidelberg, Heidelberg, Germany, 2Surgery, University of Heidelberg, Heidelberg, Germany
1
Purpose/Objective: To analyze long-term results of adjuvant presacral intraoperative electron radiation therapy (IOERT) boost in combination with chemoradiotherapy in locally advanced rectal cancer. Materials/Methods: From 1991 to 2000 156 patients with locally advanced rectal cancer were treated with pre- or postoperative combined chemoradiation and intraoperative electron boost irradiation (IOERT). All patients were operated using
I. J. Radiation Oncology
2144
● Biology ● Physics
Volume 60, Number 1, Supplement, 2004
Predictive Value of Dose-Volume Histogram Parameters for Pericardial Effusion After Concurrent Chemoradiotherapy for Esophageal Cancer
Y. Ito,1,2 S. Ishikura,2 S. Hirota,3 T. Soejima,4 K. Tsujino,3 E. Yoden,3 Y. Okamoto,4 K. Nihei,2 M. Onozawa2 Radiation Oncology Division, National Cancer Center Hospital, Tokyo, Japan, 2Radiation Oncology Division, National Cancer Center Hospital East, Kashiwa, Japan, 3Department of Radiology, Hyogo Medical Center for Adults, Hyogo, Japan, 4Division of Radiology, Kobe University Graduate School of Medicine, Hyogo, Japan 1
Purpose/Objective: Chemoradiotherapy (CRT) is a treatment option in patients with esophageal cancer, but late toxicities such as pericardial effusion have become a major concern in long-term survivors. This study investigated parameters that predict pericardial effusion using dose-volume histograms in esophageal cancer patients treated with CRT. Materials/Methods: Patients with newly diagnosed SCC of the thoracic esophagus and treated with definitive CRT in our institutions were recruited from our database based on the following criteria: clinical tumor-node-metastasis system stage I-IVA, complete responder, ⱖ12 months follow-up after the initiation of treatment, dose-volume histogram available. Chemotherapy included cisplatin and fluorouracil. The heart was delineated from the level of origin of brachiocephalic artery to the level of cardiac apex. Three-dimensional treatment planning was performed in all cases. Dose-volume histogram for the heart was generated and the parameters including cardiac volume, mean heart dose, max heart dose, percentage of cardiac volume irradiated to ⱖ 45 Gy (V45), classical normal tissue complication probability (NTCP) for pericardial effusion (n ⫽ 0.35, m ⫽ 0.10, TD50 ⫽ 48 Gy), and modified NTCP (n ⫽ 0.64, m ⫽ 0.13, TD50 ⫽ 48 Gy) were analyzed. Pericardial effusion was graded according to the National Cancer Institute-Common Toxicity Criteria version 2.0 and ⱖ grade 3 was considered severe. Univariate analyses were performed for patient- and treatment-related factors, and parameters in dose-volume histogram in relation to severe pericardial effusion. Results: Eighty-three patients were recruited, and their characteristics were as follows: median age, 64 years (range, 44 - 79 years); 70 males and 13 females; and 15 patients in stage I, 31 patients in stage II, 31 patients in stage III, and 6 patients in stage IVA. Radiotherapy was delivered at 1.8 –2.0 Gy fractions once daily to a total of 46 –70 Gy (median 60 Gy) and three patients were treated with a high-dose-rate intracavitary brachytherapy after CRT. With a median follow-up of 41 months (range, 13–104months), Grade 0, 1, 2, 3, 4 pericardial effusion were observed in 26 (31.3%), 35 (42.2%), 11 (13.3%), 8 (9.6%), and 3 (3.6%) patients, respectively. Median value of cardiac volume, mean heart dose, max heart dose, V45, classical NTCP, and modified NTCP were 756 cc (range, 531–1061 cc), 42.1 Gy (range, 17.0 –53.3 Gy), 63.4 Gy (range, 49.1– 81.5 Gy), 49.0% (range, 13.0 – 81.0%), 50.8% (range, 0.7–97.5%), and 25.4% (0.0 –90.5%), respectively. There was a significant difference between mean heart dose ⱖ 40 Gy and ⬍ 40 Gy (p ⫽ 0.037), and a trend between modified NTCP ⱖ 20% and ⬍ 20% (p ⫽ 0.065). Univariate analysis of patient- and treatment-related factors did not show any other significant predictors of severe pericardial effusion. Conclusions: The risk of severe pericardial effusion was significantly higher when the mean heart dose was ⱖ 40 Gy. Mean heart dose ⬍ 40 Gy may be used as dose constraint, but it must be confirmed prospectively in the future.
2145
Long-Term Results of Intraoperative Presacral Electron Boost Radiotherapy (IOERT) in Combination with Chemoradiation in Patients with Locally Advanced Rectal Cancer
R. C. Krempien,1 M. Roebel,1 S. Oertel,1 M. J. Eble,1 F. Roeder,1 M. Buechler,2 J. Debus,1 M. Treiber1 Radiation Oncology, University of Heidelberg, Heidelberg, Germany, 2Surgery, University of Heidelberg, Heidelberg, Germany
1
Purpose/Objective: To analyze long-term results of adjuvant presacral intraoperative electron radiation therapy (IOERT) boost in combination with chemoradiotherapy in locally advanced rectal cancer. Materials/Methods: From 1991 to 2000 156 patients with locally advanced rectal cancer were treated with pre- or postoperative combined chemoradiation and intraoperative electron boost irradiation (IOERT). All patients were operated using