Cardiac-Sparing Whole Lung IMRT in Patients With Pediatric Tumors and Lung Metastasis: Final Report of a Prospective Multicenter Clinical Trial.
Cardiac-Sparing Whole Lung IMRT in Patients With Pediatric Tumors and Lung Metastasis: Final Report of a Prospective Multicenter Clinical Trial.
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儿科肿瘤患者和肺转移患者的心脏比较整个肺IMRT：一项前瞻性多中心临床试验的最终报告。
DOI：
10.1016/j.ijrobp.2018.08.034
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发表时间：
2019-01-01
期刊：
影响因子：
--
通讯作者：
Fitzgerald TJ
中科院分区：
文献类型：
--
作者：
Kalapurakal JA;Gopalakrishnan M;Walterhouse DO;Rigsby CK;Rademaker A;Helenowski I;Kessel S;Morano K;Laurie F;Ulin K;Esiashvili N;Katzenstein H;Marcus K;Followill DS;Wolden SL;Mahajan A;Fitzgerald TJ
对接受心脏保留（CS）全肺照射（WLI）的患者进行了一项前瞻性临床试验。3个试验目的是：1）证明采用真实的时间中心质量控制的CS IMRT的可行性; 2）确定使用IMRT的WLI与标准前后（AP）技术相比的剂量学优势; 3）确定所有患者在方案规定的至少2年随访后的急性耐受性和短期疗效。所有患者均接受了3D胸部CT扫描和使用标准门控设备进行的对比增强4D门控胸部CT扫描。CTV是整个双侧3D肺体积，ITV是双肺的4D最小强度投影。将ITV扩张1cm以获得PTV。治疗前集中审查所有靶体积、心脏轮廓和治疗计划。计算并比较AP和IMRT WLI计划中不同心脏体积（V）接受规定RT剂量的百分比（%）。目标20例患者在2年内累积。中位放疗剂量为15 Gy。所有患者均获得了真实的实时中心质量保证审查和计划预批准。调强适形放射治疗的WLI在所有患者中均可行。与标准AP WLI相比，CS IMRT导致整个心脏、心房、心室和冠状动脉的辐射剂量在统计学上显著降低。1例患儿在接受15 Gy的CS IMRT和375 mg/m2的阿霉素治疗后5.5年出现心功能不全和肺限制性病变，2年和3年肺转移无进展生存率分别为65%和52%。我们已经证明了使用CS IMRT进行WLI的可行性，并证实了先前报道的IMRT的优势，包括上级心脏保护和4D肺体积的上级剂量覆盖。需要进一步的研究来确定这种辐照技术的有效性和安全性。本研究通过前瞻性临床试验，探讨全肺调强放射治疗的可行性、剂量学优势及近期疗效。获得了真实的中心QA审查和预批准。心脏保留调强放射治疗在所有患者中均可行，与标准技术相比，显示出改善的4D肺剂量覆盖范围和心脏剂量的显著降低。1例患者在治疗后5年出现心脏和肺毒性。
A prospective clinical trial was conducted for patients undergoing cardiac sparing (CS) whole lung irradiation (WLI) using IMRT. The 3 trial aims were: 1) To demonstrate the feasibility of CS IMRT with real time central quality control; 2) To determine the dosimetric advantages of WLI using IMRT compared to standard antero-posterior (AP) techniques; and 3) To determine acute tolerance and short-term efficacy after a protocol mandated minimum 2 year follow up for all patients. All patients underwent a 3D chest CT scan and a contrast-enhanced 4D gated chest CT scan using a standard gating device. The CTV was the entire bilateral 3D lung volume and the ITV was the 4D minimum intensity projection of both lungs. The ITV was expanded by 1cm to get the PTV. All target volumes, cardiac contours and treatment plans were centrally reviewed before treatment. The different cardiac volumes (V) receiving percentages (%) of prescribed RT doses on AP and IMRT WLI plans were estimated and compared. The target 20 patients were accrued in 2 years. Median RT dose was 15Gy. Real time central Quality Assurance review and plan pre-approval was obtained for all patients. WLI using IMRT was feasible in all patients. Compared to standard AP WLI, CS IMRT resulted in statistically significant reduction in radiation doses to the whole heart, atria, ventricles and coronaries. One child developed cardiac dysfunction and pulmonary restrictive disease 5.5 years after CS IMRT (15Gy) and doxorubicin (375mg/m2).The 2 and 3 year lung metastasis progression free survival was 65% and 52% respectively. We have demonstrated the feasibility of WLI using CS IMRT and confirmed the previously reported advantages of IMRT including superior cardiac protection and superior dose coverage of 4D lung volumes. Further studies are required to establish the efficacy and safety of this irradiation technique. A prospective clinical trial was conducted to demonstrate the feasibility of whole lung IMRT, study its dosimetric advantages and assess the short term clinical outcomes in children with lung metastasis. Real time central QA review and pre-approval was obtained. Cardiac sparing IMRT was feasible in all patients and showed improved 4D lung dose coverage and significant reduction in cardiac doses compared to standard techniques. One patient developed cardiac and pulmonary toxicity 5 years after treatment.
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DOI：
10.1016/s0360-3016(96)00295-7
发表时间：
1996-11-01
影响因子：
7
作者：
King, V;Constine, LS;Rubin, P
通讯作者：
Rubin, P
影响因子：
5.7
作者：
Guldner, Laurence;Haddy, Nadia;de Vathaire, Florent
通讯作者：
de Vathaire, Florent
阿霉素治疗后229个幼儿园幸存者的心脏异常15年及以后，在古斯塔夫·鲁西斯研究院（Institut Gustave Roussy）。
影响因子：
8.8
作者：
Pein, F;Sakiroglu, O;Dahan, M;Lebidois, J;Merlet, P;Shamsaldin, A;Villain, E;de Vathaire, F;Sidi, D;Hartmann, O
通讯作者：
Hartmann, O
DOI：
10.1016/j.ijrobp.2011.12.034
发表时间：
2012-10-01
影响因子：
7
作者：
Hoppe, Bradford S.;Flampouri, Stella;Mendenhall, Nancy P.
通讯作者：
Mendenhall, Nancy P.
DOI：
10.1016/s0360-3016(99)00086-3
发表时间：
1999-06-01
影响因子：
7
作者：
Meisel, JA;Guthrie, KA;Green, DM
通讯作者：
Green, DM