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Radiation-induced biological changes of neural structures in the base of the skull tumours

Published online by Cambridge University Press:  18 January 2017


C. Gh. Buzea
Affiliation:
Regional Institute of Oncology, Iasi, Romania
C. Mirestean
Affiliation:
Regional Institute of Oncology, Iasi, Romania
Irina Butuc
Affiliation:
Regional Institute of Oncology, Iasi, Romania
A. Zara
Affiliation:
Regional Institute of Oncology, Iasi, Romania
D. T. Iancu
Affiliation:
‘Grigore T. Popa’, University of Medicine and Pharmacy, Iasi, Romania
Corresponding
E-mail address:

Abstract

Background and purpose

The aim of this paper is to compare neural induced changes in three-dimensional conformal radiotherapy (3D-CRT) versus intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) for nasopharyngeal cancers.

Materials and methods

Radiotherapy plans for 10 patients with nasopharyngeal cancer stages III and IV were prospectively developed for 3D-CRT, IMRT and VMAT using Varian Eclipse planning system. The same radiation therapist carried out all planning and the same clinical dosimetric constraints were used. Normal tissue complication probabilities were calculated.

Results

The mean planning target volume’s (PTVs) conformity index (CI) for 3D-CRT was 1·424, for IMRT 1·1, and for VMAT 1·081. The PTV homogeneity (HI) index was 0·204 for 3D-CRT, 0·124 for IMRT and 0·153 for VMAT. Normal tissue complication probabilities gave complex results for 3D-CRT, IMRT and VMAT and are analysed in detail in this paper. The mean monitor units were 95 (range 9–180) for 3D-CRT; 165 (range 52–277) for IMRT; and 331 (range 167–494) for VMAT (p<0·05).

Conclusions

VMAT is associated with similar dosimetric advantages as IMRT over 3D-CRT for nasopharyngeal cancer. VMAT is associated with faster delivery times and greater number of mean monitor units than IMRT. Brain radionecrosis severity and risk, in the past, have been underestimated. By improving the life expectancy of patients with nasopharyngeal cancer to ensure maintenance of the neural structures, recommended dose limits should be considered as a first degree priority (as the spinal cord, brainstem, etc.) when IMRT and VMAT plans are implemented.


Type
Original Articles
Copyright
© Cambridge University Press 2017 

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References

1. Sun, Y, Zhou, G, Qi, Z, Zhang, L et al. Radiation-induced temporal lobe injury after intensity modulated radiotherapy in nasopharyngeal carcinoma patients: a dose-volume-outcome analysis. BMC Cancer 2013; 13: 397.CrossRefGoogle ScholarPubMed
2. Dassarath, M, Yin, Z, Chen, J, Liu, H et al. Temporal lobe necrosis: a dwindling entity in a patient with nasopharyngeal cancer after radiation therapy. Head Neck Oncol 2011; 10: 38.Google Scholar
3. Gaya, A, Mahadevan, A. (eds)Stereotactic body radiotherapy. a practical guide. Future Oncol 2014; 10 (15): 23072310.Google Scholar
4. Chen, J, Dassarath, M, Yin, Z et al. Radiation induced temporal lobe necrosis in patients with nasopharyngeal carcinoma: a review of new avenues in its management. Radiat Oncol 2011; 30: 6128.Google Scholar
5. Gocheva, L. Radiation tolerance of spinal cord: doctrine, dogmas, data. Archf Oncol 2000; 8 (3): 131134.Google Scholar
6. Kirkpatrick, J P, Van der Kogel, A J, Schultheiss, T E et al. Radiation dose–volume effects in the spinal cord. Int J Radiat Oncol Biol Phys 2010; 76 (3 suppl): S42S49.CrossRefGoogle ScholarPubMed
7. Lim, D C, Gagnon, P J, Meranvil, S, Darryl, K, Linda, L, John, M H. Lhermitte’s sign developing after imrt for head and neck cancer. Int J Otolaryngol 2010; 2010: 14.CrossRefGoogle ScholarPubMed
8. Pak, D, Vineberg, K, Feng, F et al. Lhermitte’s syndrome after chemo-IMRT of head and neck cancer: incidence, doses, and potential mechanisms. Int J Radiat Oncol Biol Phys 2012; 83 (5): 15281533.CrossRefGoogle Scholar
9. Mayo, C, Yorke, E, Merchant, T E et al. Radiation associated brainstem injury. Int J Radiat Oncol Biol Phys 2010; 76 (3 suppl): S36S41.CrossRefGoogle ScholarPubMed
10. Lee, V, Leung, T, Kwong, D. Dosimetric predictors of radiation-induced acute nausea and vomiting in IMRT for nasopharyngeal cancer. Int J Radiat Oncol Biol Phys 2012; 84 (1): 176182.CrossRefGoogle ScholarPubMed
11. Ciura, K, McBurney, M, Nguyen, B et al. Effect of brain stem and dorsal vagus complex dosimetry on nausea and vomiting in head and neck intensity-modulated radiation therapy. Med Dosim 2011; 36 (1): 4145.CrossRefGoogle ScholarPubMed
12. Pow, E H, Kwong, D L, McMillan, A S et al. Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: Initial report on a randomized controlled clinical trial. Int J Radiat Oncol Biol Phys 2006; 66: 981991.CrossRefGoogle ScholarPubMed
13. Braam, P M, Terhaard, C H, Roesink, J M et al. Intensity-modulated radiotherapy significantly reduces xerostomia compared with conventional radiotherapy. Int J Radiat Oncol Biol Phys 2006; 66: 975980.CrossRefGoogle ScholarPubMed
14. Dijkema, T, Terhaard, C H, Roesink, J M et al. Large cohort dose volume response analysis of parotid gland function after radiotherapy: Intensity-modulated versus conventional radiotherapy. Int J Radiat Oncol Biol Phys 2008; 72 (4): 11011109.CrossRefGoogle ScholarPubMed
15 Eisbruch, A, Ship, J A, Dawson, L A et al. Salivary gland sparing and improved target irradiation by conformal and intensity modulated irradiation of head and neck cancer. World J Surg 2003; 27: 832837.CrossRefGoogle ScholarPubMed
16. Chui, C S, Chan, M F, Spirou, S et al. Delivery of intensity-modulated radiation therapy with a conventional multileaf collimator: comparison of dynamic and segmental methods. Med Phys 2001; 28: 24412449.CrossRefGoogle ScholarPubMed
17. Pirzkall, A, Carol, M P, Pickett, B et al. The effect of beam energy and number of fields on photon-based IMRT for deep-seated targets. Int J Radiat Oncol Biol Phys 2002; 53: 434442.CrossRefGoogle ScholarPubMed
18. Cameron, C. Sweeping-window arc therapy: and implementation of rotational IMRT with automatic beam-weight calculation. Phys Med Biol 2005; 50: 43174336.CrossRefGoogle ScholarPubMed
19. Earl, M A, Shepard, D M, Naqvi, S et al. Inverse planning for intensity-modulated arc therapy using direct aperture optimization. Phys Med Biol 2003; 48: 10751089.CrossRefGoogle ScholarPubMed
20. Yu, C X, Li, X A, Ma, L et al. Clinical implementation of intensity-modulated arc therapy. Int J Radiat Oncol Biol Phys 2002; 53: 453463.CrossRefGoogle ScholarPubMed
21. Otto, K. Volumetric modulated arc therapy: IMRT in a single gantry arc. Med Phys 2008; 35: 310317.CrossRefGoogle Scholar
22. Das, I J, Cheng, C W, Chopra, K L et al. Intensity-modulated radiation therapy dose prescription, recording, and delivery: patterns of variability among institutions and treatment planning systems. J Natl Cancer Inst 2008; 100: 300307.CrossRefGoogle ScholarPubMed
23. Galvin, J M, Ezzell, G, Eisbrauch, A et al. Implementing IMRT in clinical practice: a joint document of the American Society for Therapeutic Radiology and Oncology and the American Association of Physicists in Medicine. Int J Radiat Oncol Biol Phys 2004; 58 (5): 16161634.CrossRefGoogle Scholar
24. Chang, J H, Gehrke, C, Prabhakar, R et al. RADBIOMOD: a simple program for utilising biological modelling in radiotherapy plan evaluation. Physica Medica 2016; 32: 248254.CrossRefGoogle ScholarPubMed
25. Van Gestel, D, Van Den Weyngaert, D, Schrijvers, D. Intensity-modulated radiotherapy in patients with head and neck cancer: a European single-centre experience. Br J Radiol 2011; 84 (1000): 367374.CrossRefGoogle ScholarPubMed
26. Dobbs, J E, Barrett, A, Roques, T. Practical Radiotherapy Planning, 4th edition. Boca Raton, FL: CRC Press, 2009.Google Scholar
27. Paddick, I. A simple scoring ratio to index the conformity of radiosurgical treatment plans. Technical note. J Neurosurg 2000; 93 (suppl 3): 219222.Google ScholarPubMed
28. Gay, H A, Niemierko, A. A free program for calculating EUD-based NTCP and TCP in external beam radiotherapy. Phys Med 2007; 23: 115125.CrossRefGoogle ScholarPubMed
29. Lyman, J T. Complication probability as assessed from dose-volume histograms. Radiat Res 1985 1985; 104: S13S19.CrossRefGoogle Scholar
30. Burman, C, Kutcher, G J, Emami, B, Goitein, M. Fitting of normal tissue tolerance data to an analytic function. Int J Radiat Oncol Biol Phys 1991; 21: 123135.CrossRefGoogle Scholar
31. Niemierko, A. A generalized concept of equivalent uniform dose (EUD). Med Phys 1999; 26: 1100.Google Scholar
32. Nishimura, Y, Komaki, R. Intensity-Modulated Radiation Therapy, Clinical Evidence and Techniques. Tokio: Springer, 2015.Google Scholar
33. van der Kogel, A, Joiner, M. Basic Clinical Radiobiology, 4th edition. London: Hodder Arnold Publication, 2009.CrossRefGoogle Scholar
34. Dunlop, A, Welsh, L, McQuaid, D. Brain-sparing methods for IMRT of head and neck cancer. PLoS One 2015; 10 (3): e0120141.CrossRefGoogle ScholarPubMed
35. Rubin, P, Constine, L S, Marks, L B. ALERT Adverse Late Effects of Cancer Treatment: Volume 1: General Concepts and Specific Precepts, Volume 2: Normal Tissue Specific Sites and Systems. New York: Springer, 2014.Google Scholar
36. Lee, A W, Tung, S Y, Chan, A T et al. Preliminary results of a randomized study (NPC-9902 Trial) on therapeutic gain by concurrent chemotherapy and/or accelerated fractionation for locally advanced nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2006; 66: 142151.CrossRefGoogle ScholarPubMed
37. Lee, N, Harris, J, Garden, A S, Straube, W, Glisson, B et al Intensity-modulated radiation therapy with or without chemotherapy for nasopharyngeal carcinoma: radiation therapy oncology group phase II trial 0225, J Clin Oncol 2009; 27 (22): 3684–3690.Google Scholar
38. Wu, X, Gu, M, Zhou, G et al. Cognitive and neuropsychiatric impairment in cerebral radionecrosis patients after radiotherapy of nasopharyngeal carcinoma. BMC Neurol 2014; 14: 10.CrossRefGoogle ScholarPubMed
39. Cheung, M, Chan, A S, Law, S C et al. Cognitive function of patients with nasopharyngeal carcinoma with and without temporal lobe radionecrosis. Arch Neurol 2000; 57 (9): 13471352.CrossRefGoogle ScholarPubMed
40. Kam, M K M, Teo, P M L, Chau, R M C et al. Treatment of nasopharyngeal carcinoma with intensity-modulated radiotherapy: the Hong Kong experience. Int J Radiat Oncol Biol Phys 2004; 60: 14401450.CrossRefGoogle ScholarPubMed
41. Zeng, L, Tian, Y M, Sun, X M et al. Late toxicities after intensity-modulated radiotherapy for nasopharyngeal carcinoma: patient and treatment-related risk factors. Br J Cancer 2014; 110: 4954.CrossRefGoogle ScholarPubMed
42. Yeh, S A, Tang, Y, Lui, C C, Huang, Y J, Huang, E Y et al. Treatment outcomes and late complications of 849 patients with nasopharyngeal carcinoma treated with radiotherapy alone. Int J Radiat Oncol Biol Phys 2005; 62: 672679.CrossRefGoogle ScholarPubMed
43. Lee, A W, Ng, W T, Chan, L L et al. Evolution of treatment for nasopharyngeal cancer – success and setback in the intensity-modulated radiotherapy era. Radiother Oncol 2014; 110: 377384.CrossRefGoogle ScholarPubMed
44. Lee, P W, Hung, B K, Woo, E K, Tai, P T, Choi, D T. Effects of radiation therapy on neuropsychological functioning in patients with nasopharyngeal carcinoma. J Neurol Neurosurg Psychiatr 1989; 52: 488492.CrossRefGoogle ScholarPubMed
45. Takiar, V, Ma, D, Garden, A S et al. Disease control and toxicity outcomes for T4 carcinoma of the nasopharynx treated with intensity-modulated radiotherapy. Head Neck 2016; 38 (suppl 1): E925E933.CrossRefGoogle ScholarPubMed
46. Zheng, Y, Han, F, Xiao, W et al. Analysis of late toxicity in nasopharyngeal carcinoma patients treated with intensity modulated radiation therapy. Radiat Oncol 2015; 13: 1017.Google Scholar
47. Bortfeld, T, Schmidt-Ullrich, R, De Neve, W, Wazer, D E. Image-Guided IMRT. Berlin, Heidelberg: Springer, 2016.Google Scholar
48. Su, S F, Huang, Y, Xiao, W W et al. Clinical and dosimetric characteristics of temporal lobe injury following intensity modulated radiotherapy of nasopharyngeal carcinoma. Radiother Oncol 2012; 104 (3): 312316.CrossRefGoogle ScholarPubMed
49. Hall, E J, Wuu, C S. Radiation-induced second cancers: the impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys 2003; 56: 8388.CrossRefGoogle ScholarPubMed
50. Ruben, J D, Davis, S, Evans, C et al. The effect of intensity-modulated radiotherapy on radiation-induced second malignancies. Int J Radiat Oncol Biol Phys 2008; 70: 15301536.CrossRefGoogle ScholarPubMed
51. Hall, E J. Intensity-modulated radiation therapy, protons, and the risk of second cancers. Int J Radiat Oncol Biol Phys 2006; 65: 17.CrossRefGoogle ScholarPubMed
52. Davidson, M T, Blake, S J, Batchelar, D L, Cheung, P, Mah, K. Assessing the role of volumetric modulated arc therapy (VMAT) relative to IMRT and helical tomotherapy in the management of localized, locally advanced, and post-operative prostate cancer. Int J Radiat Oncol Biol Phys 2011; 80: 15501558.CrossRefGoogle ScholarPubMed

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