Cardiac Sparing Whole Lung IMRT in Children and Young Adults with Lung Metastases

患有肺转移的儿童和年轻人的心脏保留全肺 IMRT

• 批准号: 8272529
• 负责人: John Andrew Kalapurakal
• 金额: $ 32.55万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-06-01 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8272529
• 关键词: Acute; Adoption; Aftercare; British; Cancer Survivor; Cardiac; Cardiac Death; Cardiovascular Diseases; Chest; Child; Child Care; Childhood Cancer Survivor Study; Clinical; Clinical Protocols; Clinical Research; Congestive Heart Failure; Data; Diagnosis; Dose; Enrollment; Ensure; Ewings sarcoma; Feedback; Frequencies; Goals; Heart; Heart Atrium; Hot Spot; Image; Incidence; Institutes; Intensity-Modulated Radiotherapy; Liver; Low Dose Radiation; Lung; Methods; Morbidity - disease rate; Myocardial Infarction; National Wilms' Tumor Study Group; Neoplasm Metastasis; Nephroblastoma; Normal tissue morphology; Organ; Patients; Quality Control; Radiation; Relapse; Relative Risks; Reporting; Research Personnel; Rhabdomyosarcoma; Risk; Second Primary Neoplasms; Survivors; Techniques; Thyroid Gland; Time; Universities; X-Ray Computed Tomography; base; chemotherapy; childhood cancer survivor; density; dosimetry; experience; improved; irradiation; lung volume; meetings; mortality; novel; quality assurance; standard of care; treatment planning; young adult

DESCRIPTION (provided by applicant): Whole lung Irradiation (WLI) (AP-PA technique) is considered the standard of care for most patients with lung metastases from Wilms tumor, Ewing Sarcoma and rhabdomyosarcoma. Several studies have shown increased cardiac complications after WLI and chemotherapy. The National Wilms Tumor Study Group (NWTSG) showed that the 20 year frequency of congestive heart failure (CHF) was 4.4% after diagnosis and 17.4% after treatment for relapsed Wilms tumor. The Childhood Cancer Survivor Study (CCSS) noted that cardiac exposure of > 15Gy increased the risk of CHF and myocardial infarction by 2-6 times compared to non- irradiated survivors. The Institute Gustave Roussy reported that the 20 year incidence of CHF was 18% after >3.7Gy to the heart and 9% for lower doses. A recent French-British cancer survivors study showed that the relative risk of cardiac deaths was 12.5 after 5 -14.9Gy and 25.1 for > 15Gy dose to the heart. Along with second malignancies, cardiovascular disease is the leading cause of morbidity and mortality >20 years after diagnosis in childhood cancer survivors (NWTSG and CCSS). In an effort to reduce the heart dose received during WLI, investigators from Northwestern University (NU) examined a new method of delivering WLI using cardiac-sparing whole lung IMRT (WL-IMRT). WL-IMRT and standard WLI (SLRT) treatment plans were performed on chest CT scans of 22 children and young adults using 3D lung volumes (10 patients) and 4D lung volumes (12 patients). Radiation doses to the lungs, heart chambers, thyroid gland and liver from WL- IMRT and SLRT plans were compared. WL-IMRT delivered significantly lower doses of radiation to both atria and ventricles compared to SLRT. There were two additional advantages for WL-IMRT: 1) significantly improved dose coverage of 4D lung volumes compared to SLRT that was performed with 3D lung volumes and 2) significantly improved dose conformality with fewer hot spots in the lungs compared to SLRT that was performed without lung density correction. The proposed multi-institutional clinical protocol will examine the clinical feasibility of WL-IMRT in 20 patients. The normal tissue contouring, IMRT technique, treatment planning and dosimetry analysis will be performed similar to that reported in the Northwestern experience. The Quality Assurance Review Center (QARC) will facilitate pre-treatment image-based central quality review of all treatment data and provide prompt feedback for implementation before beginning actual treatment. This will ensure a uniform approach to the application of this novel treatment. The goals of this study are to demonstrate the feasibility of delivering WL-IMRT and to prospectively determine its dosimetric advantages compared to SLRT. This study will also determine the short-term efficacy and acute tolerance of WL-IMRT. This clinical study is the first to examine the feasibility of WL-IMRT and it has the potential to promote the adoption of a new standard for care for children with lung metastases.

描述（由申请人提供）：全肺辐照（WLI）（AP-PA技术）被认为是大多数来自Wilms肿瘤，Ewing肉瘤和横纹肌肉瘤的肺转移患者的护理标准。 WLI和化学疗法后的多项研究表明，心脏并发症增加。国家威尔姆斯肿瘤研究组（NWTSG）表明，诊断后的20年充血性心力衰竭（CHF）为4.4％，在复发后Wilms肿瘤治疗后17.4％。儿童期癌症幸存者研究（CCSS）指出，与非辐射的幸存者相比，心脏暴露> 15GY> 15GY的风险增加了2-6倍。该研究所的古斯塔夫·鲁西斯（Gustave Roussy）报告说，心脏> 3.7 gy的瑞士法郎的发病率为18％，较低剂量的发病率为9％。最近的一项法国 - 英国癌症幸存者的研究表明，心脏死亡的相对风险为5 -14.9GY后的12.5，心脏> 15剂的剂量为25.1。与第二次恶性肿瘤一起，心血管疾病是诊断儿童癌症幸存者（NWTSG和CCSS）诊断后20年的发病率和死亡率的主要原因。为了减少WLI期间接受的心脏剂量，西北大学（NU）的研究人员研究了一种使用心脏比较的全肺IMRT（WL-IMRT）传递WLI的新方法。 WL-IMRT和标准WLI（SLRT）治疗计划是对22名儿童和年轻人的胸部CT扫描进行的，使用3D肺量（10例患者）和4D肺量（12例患者）。比较了WL-IMRT和SLRT计划的肺部，心脏腔，甲状腺和肝脏的辐射剂量。与SLRT相比，WL-IMRT向心房和心室的辐射剂量显着降低。 WL-IMRT还有两个其他优势：1）与使用3D肺量进行的SLRT相比，与SLRT进行的SLRT相比，4D肺部体积的剂量覆盖率显着改善，而2）与没有肺部密度矫正的SLRT相比，肺部的热点较少，肺部热点较少，剂量相结合较少。拟议的多机构临床方案将检查20例WL-IMRT的临床可行性。正常的组织轮廓，IMRT技术，治疗计划和剂量法分析将与西北经验中报道的类似。质量保证审查中心（QARC）将促进所有治疗数据的基于图像的中央质量审查，并在开始实际治疗之前迅速进行实施反馈。这将确保采用这种新颖处理的应用方法。这项研究的目标是证明提供WL-IMRT的可行性，并与SLRT相比确定其剂量学优势。这项研究还将确定WL-IMRT的短期疗效和急性耐受性。这项临床研究是第一个检查WL-IMRT可行性的一项，它有可能促进采用新标准为肺转移儿童的护理标准。

项目成果

Cardiac-Sparing Whole Lung IMRT in Patients With Pediatric Tumors and Lung Metastasis: Final Report of a Prospective Multicenter Clinical Trial.

• DOI: 10.1016/j.ijrobp.2018.08.034
• 发表时间: 2019-01-01
• 期刊: International journal of radiation oncology, biology, physics
• 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
• 通讯作者: Fitzgerald TJ