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Int J Radiat Oncol Biol Phys. 2019 Jan 1;103(1):28-37. doi: 10.1016/j.ijrobp.2018.08.034. Epub 2018 Aug 29.

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

Author information

1
Radiation Oncology, Northwestern University, Chicago, Illinois. Electronic address: j-kalapurakal@northwestern.edu.
2
Radiation Oncology, Northwestern University, Chicago, Illinois.
3
Pediatric Oncology and Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
4
Imaging and Radiation Oncology Core, Providence, Rhode Island.
5
Radiation Oncology, Emory University, Atlanta, Georgia.
6
Pediatric Oncology, Nemours Children's Clinic, Jacksonville, Florida.
7
Radiation Oncology, Harvard University, Boston, Massachusetts.
8
Imaging and Radiation Oncology Core, Houston, Texas.
9
Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
10
Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.

Abstract

PURPOSE:

A prospective clinical trial was conducted for patients undergoing cardiac sparing (CS) whole lung irradiation (WLI) using intensity modulated radiation therapy (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 with standard anteroposterior (AP) techniques; and (3) to determine acute tolerance and short-term efficacy after a protocol-mandated minimum 2-year follow-up for all patients.

METHODS AND MATERIALS:

All patients underwent a 3-dimensional chest computed tomography scan and a contrast-enhanced 4-dimensional (4D) gated chest computed tomography scan using a standard gating device. The clinical target volume was the entire bilateral 3-dimensional lung volume, and the internal target volume was the 4D minimum intensity projection of both lungs. The internal target volume was expanded by 1 cm to get the planning target volume. All target volumes, cardiac contours, and treatment plans were centrally reviewed before treatment. The different cardiac volumes receiving percentages of prescribed radiation therapy (RT) doses on AP and IMRT WLI plans were estimated and compared.

RESULTS:

The target 20 patients were accrued in 2 years. Median RT dose was 15 Gy. Real-time central quality assurance review and plan preapproval were obtained for all patients. WLI using IMRT was feasible in all patients. Compared with standard AP WLI, CS IMRT resulted in a 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 (15 Gy) and doxorubicin (375 mg/m2). The 2- and 3-year lung metastasis progression-free survival was 65% and 52%, respectively.

CONCLUSIONS:

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.

PMID:
30170102
PMCID:
PMC6391051
[Available on 2020-01-01]
DOI:
10.1016/j.ijrobp.2018.08.034
[Indexed for MEDLINE]

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