Pulmonary metastasis from renal synovial sarcoma treated by stereotactic body radiotherapy: A case report and review of the literature

Primary synovial sarcoma of kidney is an uncommon neoplasm, metastasizing most commonly to lung. Surgery and/or palliative chemotherapy for pulmonary metastases is commonly used to improve tumor control and survival. Stereotactic body radiotherapy (SBRT) is a relatively new approach to treat pulmonary metastasis, encouraged by the results of cranial and spinal stereotactic radiosurgery. The local control and toxicity profile of patients with pulmonary metastasis treated with SBRT are comparable to pulmonary metastatectomy. Furthermore, with advancement of imaging techniques, immobilization techniques, tumor-tracking techniques, and treatment planning and delivery system, SBRT can now be alternatively employed for the treatment of pulmonary metastasis as a comparable substitute to surgical resection

Dosimetric comparison of 3DCRT versus IMRT in whole breast irradiation of early stage breast cancer

Purpose: The counseling regarding the treatment option is an important objective in the management of early stages breast cancer. In this study, we attempt to compare and analyze the dosimetric aspects of 3DRT over IMRT in the whole breast radiotherapy.Methods and Materials:  Both right and left sided computed tomography simulations of 14 women with early stage breast cancer were used for our retrospective study to compare the 3DCRT and IMRT. The dose prescribed was 50 Gy in 25 fractions to the whole breast PTV. The PTV was defined by adding unequal margins to the directional safety margin status of each lumpectomy cavity (i.e., medial, lateral, superior, inferior and deep margins measured from the tumor front after the examination of the surgical specimen: 2, 1.5, and 1 cm for resection margins < 1 cm, 1-2 cm, and > 2cm, respectively). And than modified so that it was no longer closer than 3mm to the skin surface and was no deep than the lung –chest interface. The prescribed dose delivered in 5 fractions per week schedule. Treatment plans were compared for target minimum dose, maximum dose, mean dose, conformity index, heterogeneity index and doses to organs at risk were compared and analysed.Results: The target coverage was achieved with 90% prescription to the 95% of the PTV. Conformity to the PTV was significantly higher with 3DCRT technique than IMRT. 3DCRT technique seems better in sparing critical organs parameters like lung V20 and Mean, heart, V25, Maximum, both lungs V20, Mean and Dose to the Normal Healthy tissue.Conclusion: We conclude from our study that treatment technique selection for whole Breast irradiation is an important factor in sparing the adjacent normal structures and in determining the associated risk. 3DCRT produces better conformity and heterogeneity indices of the target volume, also reduces dose to OARs the 3DCRT reduces the risk of radiation induced heart diseases.......................................................Cite this article as:Ashraf M, Janardhan N, Bhavani P, Shivakumar R, Ibrahim S, Reddy PY, Surrendharen J, Sarangnathan B, Johnson B, Madhuri B, Dar RA. Dosimetric comparison of 3DCRT versus IMRT in whole breast irradiation of early stage breast cancer. Int J Cancer Ther Oncol 2014; 2(3):020318. DOI: 10.14319/ijcto.0203.1

Set-up uncertainties: Online correction with X-ray volume imaging

Aim: To determine interfractional three-dimensional set-up errors using X-ray volumetric imaging (XVI). Materials and Methods: Between December 2007 and August 2009, 125 patients were taken up for image-guided radiotherapy using online XVI. After matching of reference and acquired volume view images, set-up errors in three translation directions were recorded and corrected online before treatment each day. Mean displacements, population systematic (Σ), and random (σ) errors were calculated and analyzed using SPSS (v16) software. Optimum clinical target volume (CTV) to planning target volume (PTV) margin was calculated using Van Herk′s (2.5Σ + 0.7 σ) and Stroom′s (2Σ + 0.7 σ) formula. Results: Patients were grouped in 4 cohorts, namely brain, head and neck, thorax, and abdomen-pelvis. The mean vector displacement recorded were 0.18 cm, 0.15 cm, 0.36 cm, and 0.35 cm for brain, head and neck, thorax, and abdomen-pelvis, respectively. Analysis of individual mean set-up errors revealed good agreement with the proposed 0.3 cm isotropic margins for brain and 0.5 cm isotropic margins for head-neck. Similarly, 0.5 cm circumferential and 1 cm craniocaudal proposed margins were in agreement with thorax and abdomen-pelvic cases. Conclusion: The calculated mean displacements were well within CTV-PTV margin estimates of Van Herk (90% population coverage to minimum 95% prescribed dose) and Stroom (99% target volume coverage by 95% prescribed dose). Employing these individualized margins in a particular cohort ensure comparable target coverage as described in literature, which is further improved if XVI-aided set-up error detection and correction is used before treatment

Pulmonary metastasis from renal synovial sarcoma treated by stereotactic body radiotherapy: A case report and review of the literature

Primary synovial sarcoma of kidney is an uncommon neoplasm, metastasizing most commonly to lung. Surgery and/or palliative chemotherapy for pulmonary metastases is commonly used to improve tumor control and survival. Stereotactic body radiotherapy (SBRT) is a relatively new approach to treat pulmonary metastasis, encouraged by the results of cranial and spinal stereotactic radiosurgery. The local control and toxicity profile of patients with pulmonary metastasis treated with SBRT are comparable to pulmonary metastatectomy. Furthermore, with advancement of imaging techniques, immobilization techniques, tumor-tracking techniques, and treatment planning and delivery system, SBRT can now be alternatively employed for the treatment of pulmonary metastasis as a comparable substitute to surgical resection

Pulmonary metastasis from renal synovial sarcoma treated by stereotactic body radiotherapy: A case report and review of the literature

Primary synovial sarcoma of kidney is an uncommon neoplasm, metastasizing most commonly to lung. Surgery and/or palliative chemotherapy for pulmonary metastases is commonly used to improve tumor control and survival. Stereotactic body radiotherapy (SBRT) is a relatively new approach to treat pulmonary metastasis, encouraged by the results of cranial and spinal stereotactic radiosurgery. The local control and toxicity profile of patients with pulmonary metastasis treated with SBRT are comparable to pulmonary metastatectomy. Furthermore, with advancement of imaging techniques, immobilization techniques, tumor-tracking techniques, and treatment planning and delivery system, SBRT can now be alternatively employed for the treatment of pulmonary metastasis as a comparable substitute to surgical resection

Dosimetric comparison of 3DCRT versus IMRT in whole breast irradiation of early stage breast cancer

Purpose: The counseling regarding the treatment option is an important objective in the management of early stages breast cancer. In this study, we attempt to compare and analyze the dosimetric aspects of 3DRT over IMRT in the whole breast radiotherapy.Methods and Materials:  Both right and left sided computed tomography simulations of 14 women with early stage breast cancer were used for our retrospective study to compare the 3DCRT and IMRT. The dose prescribed was 50 Gy in 25 fractions to the whole breast PTV. The PTV was defined by adding unequal margins to the directional safety margin status of each lumpectomy cavity (i.e., medial, lateral, superior, inferior and deep margins measured from the tumor front after the examination of the surgical specimen: 2, 1.5, and 1 cm for resection margins &lt; 1 cm, 1-2 cm, and &gt; 2cm, respectively). And than modified so that it was no longer closer than 3mm to the skin surface and was no deep than the lung –chest interface. The prescribed dose delivered in 5 fractions per week schedule. Treatment plans were compared for target minimum dose, maximum dose, mean dose, conformity index, heterogeneity index and doses to organs at risk were compared and analysed.Results: The target coverage was achieved with 90% prescription to the 95% of the PTV. Conformity to the PTV was significantly higher with 3DCRT technique than IMRT. 3DCRT technique seems better in sparing critical organs parameters like lung V20 and Mean, heart, V25, Maximum, both lungs V20, Mean and Dose to the Normal Healthy tissue.Conclusion: We conclude from our study that treatment technique selection for whole Breast irradiation is an important factor in sparing the adjacent normal structures and in determining the associated risk. 3DCRT produces better conformity and heterogeneity indices of the target volume, also reduces dose to OARs the 3DCRT reduces the risk of radiation induced heart diseases.......................................................Cite this article as:Ashraf M, Janardhan N, Bhavani P, Shivakumar R, Ibrahim S, Reddy PY, Surrendharen J, Sarangnathan B, Johnson B, Madhuri B, Dar RA. Dosimetric comparison of 3DCRT versus IMRT in whole breast irradiation of early stage breast cancer. Int J Cancer Ther Oncol 2014; 2(3):020318. DOI: 10.14319/ijcto.0203.18</p