La radiothérapie par modulation d'intensité de la région para-aortique peut-elle résoudre les problèmes que pose l'épargne des organes à risque ?

peer reviewedBACKGROUND AND PURPOSE: The recent RTOG guidelines for future clinical developments in gynecologic malignancies included the investigation of dose escalation in the paraaortic (PO) region which is, however, very difficult to target due to the presence of critical organs such as kidneys, liver, spinal cord, and digestive structures. The aim of this study was to investigate intensity-modulated radiotherapy's (IMRT) possibilites of either increasing, in a safe way, the dose to 50-60 Gy in case of macroscopic disease or decreasing the dose to organs at risk (OR) when treatment is given in an adjuvant setting. MATERIAL AND METHODS: The dosimetric charts of 14 patients irradiated to the PO region at the Department of Radiation Oncology, University Hospital of Liege, Belgium, in 2000 were analyzed in order to compare six-field conformal external-beam radiotherapy (CEBR) and five-beam IMRT approaches. Both CEBR and IMRT investigations were planned to theoretically deliver 60 Gy to the PO region in the safest way possible. Dose-volume histograms (DVHs) were calculated for clinical target volume (CTV), planning target volume (PTV), and OR. Student's t-test was used to compare the paired DVH data issued from CEBR and IMRT planning. RESULTS: The IMRT approach allowed to cover the PTV at a higher level as compared to CEBR. Using IMRT, the maximal dose to the spinal cord was reduced from 42.5 Gy to 26.2 Gy in comparison with CEBR (p or= 20 Gy in the IMRT approach (p < 0.00001). Irradiation of digestive structures was not different, with < 25% receiving 35 Gy. Doses to the liver remained low regardless of the method used. CONCLUSION: At 60 Gy, IMRT is largely sparing the spinal cord and kidneys as compared to CEBR and represents an interesting approach not only for dose escalation up to 50-60 Gy (probably facilitating the radiochemotherapy approaches) but also in an adjuvant setting at lower doses. The dosimetric data of this study are in the same range as those published recently with a dynamic arc conformal approach

Clinical outcomes of 130 patients with primary and secondary lung tumors treated with Cyberknife robotic stereotactic body radiotherapy

Background: Authors report clinical outcomes of patients treated with robotic stereotactic body radiotherapy (SBRT) for primary, recurrent and metastatic lung lesions. Patients and methods: 130 patients with 160 lesions were treated with Cyberknife SBRT, including T1-3 primary lung cancers (54%), recurrent tumors (22%) and pulmonary metastases (24%). The mean biologically equivalent dose (BED10Gy) was 151 Gy (72–180 Gy). Median prescribed dose for peripheral and central lesions was 3x20 Gy and 3x15 Gy, respectively. Local control (LC), overall survival (OS), and cause-specific survival (CSS) rates, early and late toxicities are reported. Statistical analysis was performed to identify factors influencing local tumor control. Results: Median follow-up time was 21 months. In univariate analysis, higher dose was associated with better LC and a cut-off value was detected at BED10Gy ≤ 112.5 Gy, resulting in 1-, 2-, and 3-year actuarial LC rates of 93%, vs 73%, 80% vs 61%, and 63% vs 54%, for the high and low dose groups, respectively (p = 0.0061, HR = 0.384). In multivariate analysis, metastatic origin, histological confirmation and larger Planning Target Volume (PTV) were associated with higher risk of local failure. Actuarial OS and CSS rates at 1, 2, and 3 years were 85%, 74% and 62%, and 93%, 89% and 80%, respectively. Acute and late toxicities ≥ Gr 3 were observed in 3 (2%) and 6 patients (5%), respectively. Conclusions: Our favorable LC and survival rates after robotic SBRT, with low rates of severe toxicities, are coherent with the literature data in this mixed, non-selected study population

Clinical outcomes of 130 patients with primary and secondary lung tumors treated with Cyberknife robotic stereotactic body radiotherapy

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Orthanc - Lightweight, Scriptable DICOM Server for Medical Image Management in Radiotherapy

High-quality radiotherapy (RT) treatment planning requires the combination of information arising from multiple medical imaging modalities. For this reason, RT implies the setup and the management of complex flows of images between the various modalities and software of the hospital. Even though biomedical images are most commonly stored and transferred using the DICOM standard, it remains hard to automatize and optimize these clinical flows that are very specific to each hospital. This stems from the fact that programming the DICOM network protocol requires both a high level of familiarity with the DICOM standard as well as substantial experience in computer programming. This motivates the introduction of the Orthanc software in the medical practice to improve the RT imaging workflow

Orthanc - Lightweight, scriptable DICOM server for image management in radiotherapy departments

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Orthanc - A lightweight, RESTful DICOM server for healthcare and medical research

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Ai-je bien entendu ? Je peux me faire traiter autrement que par chirurgie pour mon schwannome de l’acoustique

peer reviewedL’histoire du schwannome du nerf acoustique (SV) montre un déplacement du «standard de traitement» de la microchirurgie vers la radiothérapie. Pour ce type de tumeurs bénignes, le traitement a pour but d’éviter les complications fonctionnelles et de préserver la capacité auditive. Après microchirurgie pour une lésion de moins de 25 mm, on observera que le nerf facial est indemne dans approximativement 60% des cas et que la fonctionnalité du VIII est préservée dans 15% des cas pour des SV de plus de 15 mm et, dans 50% des cas, pour des SV de moins de 15 mm. Les différents progrès techniques et informatiques dans le domaine de la radiothérapie permettent aujourd’hui d’obtenir un taux de contrôle tumoral variant de 92 à 98% avec une morbidité quasi inexistante au niveau du nerf facial (<2%). La capacité auditive est maintenue dans approximativement 70% des cas. Forts de ces chiffres, on peut estimer que la prise en charge de ce type de tumeurs bénignes doit se faire par radiothérapie

Cost-effectiveness of weekly adaptive radiotherapy versus standard IMRT in head and neck cancer alongside the ARTIX trial

International audienceBACKGROUND AND PURPOSE: We performed a cost-effectiveness analysis (CEA) comparing an adaptive radiotherapy (ART) strategy, based on weekly replanning, aiming to correct the parotid gland overdose during treatment and expecting therefore to decrease xerostomia, when compared to a standard IMRT. MATERIALS AND METHODS: We conducted the ARTIX trial, a randomized, parallel-group, multicentric study comparing a systematic weekly replanning ART to a standard IMRT. The primary endpoint was the frequency of xerostomia at 12 months, measured by stimulating salivary flow with paraffin. The CEA was designed alongside the ARTIX trial which was linked to the French national health data system (SNDS). For each patient, healthcare consumptions and costs were provided by the SNDS. The reference case analysis was based on the primary endpoint of the trial. Sensitivity and scenario analyses were performed. RESULTS: Of the 129 patients randomly assigned between 2013 and 2018, only 2 records were not linked to the SNDS, which provides a linkage proportion of 98.4%. All of the other 127 records were linked with good to very good robustness. On the intent-to-treat population at 12 months, mean total costs per patient were €41,564 (SD 23,624) and €33,063 (SD 16,886) for ART and standard IMRT arms, respectively (p = 0.033). Incremental cost effectiveness ratio (ICER) was €162,444 per xerostomia avoided. At 24 months, ICER was €194,521 per xerostomia avoided. For both progression-free and overall survival, ART was dominated by standard IMRT. CONCLUSION: The ART strategy was deemed to be not cost-effective compared with standard IMRT for patients with locally advanced oropharyngeal cancer