Standard vs conformal radiation therapy for adenocarcinoma of the prostate: no difference.

Objective: To compare results of treatment of adenocardinoma of the prostate using Standard (2D) vs Conformal (3D) treatment planning. Methods: The records of all patients with adenocarcinoma of the prostate treated curatively with radiation therapy alone from July 1991 to June 1994 were reviewed. Acute and late complications were scored by the RTOG criteria.

Influence of tumor volume on survival in patients irradiated for non-small-cell lung cancer.

Purpose: To investigate the importance of CT-defined total tumor volume (TTV) on overall survival (OS) in patients with unresectable or medically inoperable non-small-cell lung carcinoma (NSCLC).

Methods And Materials: Between 1991 and 1998, 150 evaluable patients with Stage I-IIIB NSCLC were treated with three-dimensionally planned conformal radiotherapy and curative intent at Duke University Medical Center. On the treatment-planning CT, the primary tumor and nodal volumes were identified and subsequently combined to form the TTV.

The time course of radiation therapy-induced reductions in regional perfusion: a prospective study with >5 years of follow-up.

Purpose: To assess the time-dependence of radiation therapy (RT)-induced reductions in regional lung perfusion, as measured by single photon emission computed tomography (SPECT) lung perfusion scans.

Methods And Materials: Between 1991 and 1999, 79 patients had SPECT lung perfusion scans before and serially after RT. Changes in regional perfusion were correlated with regional dose using 3D planning tools and image fusion (PLUNC-Plan UNC).

Radiation-induced pulmonary toxicity: a dose-volume histogram analysis in 201 patients with lung cancer.

Purpose: To relate lung dose-volume histogram-based factors to symptomatic radiation pneumonitis (RP) in patients with lung cancer undergoing 3-dimensional (3D) radiotherapy planning.

Methods And Materials: Between 1991 and 1999, 318 patients with lung cancer received external beam radiotherapy (RT) with 3D planning tools at Duke University Medical Center. One hundred seventeen patients were not evaluated for RP because of <6 months of follow-up, development of progressive intrathoracic disease making scoring of pulmonary symptoms difficult, or unretrievable 3D dosimetry data.

Relating radiation-induced regional lung injury to changes in pulmonary function tests.

Purpose: To determine whether the sum of radiotherapy (RT)-induced reductions in regional lung perfusion is quantitatively related to changes in global lung function as assessed by reductions in pulmonary function tests (PFTs).

Methods And Materials: Two hundred seven patients (70% with lung cancer) who received incidental partial lung irradiation underwent PFTs (forced expiratory volume in 1 s and diffusion capacity for carbon monoxide) before and repeatedly after RT as part of a prospective clinical study. Regional lung function was serially assessed before and after RT by single photon emission computed tomography perfusion scans.

Predicting the risk of symptomatic radiation-induced lung injury using both the physical and biologic parameters V(30) and transforming growth factor beta.

Purpose: To correlate the volume of lung irradiated with changes in plasma levels of the fibrogenic cytokine transforming growth factor beta (TGFbeta) during radiotherapy (RT), such that this information might be used to predict the development of symptomatic radiation-induced lung injury (SRILI).

Methods And Materials: The records of all patients with lung cancer treated with RT with curative intent from 1991 to 1997 on a series of prospective normal tissue injury studies were reviewed. A total of 103 patients were identified who met the following inclusion criteria: (1) newly diagnosed lung cancer of any histology treated with RT +/- chemotherapy with curative intent; (2) no evidence of distant metastases or malignant pleural effusion; (3) no thoracic surgery after lung RT; (4) no endobronchial brachytherapy; (5) follow-up time more than 6 months; (6) plasma TGFbeta1 measurements obtained before and at the end of RT.

A practical and easy method to locate the first three internal mammary lymph node-bearing areas.

Purpose: To assess the distance from a clinically recognized anatomic landmark to the different costocondral interspaces in female patients to facilitate the design of radiation fields intended to include specific internal mammary nodal areas.

Methods And Materials: The distance from the suprasternal notch (SSN) to the caudal portion of the first through fourth interspace was measured on a computer display of the chest skeleton of 65 female patients with left-sided breast cancer. The relationship between these distances and bone size (sternal length and standing height) was assessed via linear regression.

Cardiac perfusion changes in patients treated for breast cancer with radiation therapy and doxorubicin: preliminary results.

Purpose: To determine the incidence and dose dependence of regional cardiac perfusion abnormalities in patients with left-sided breast cancer treated with radiation therapy (RT) with and without doxorubicin (Dox).

Methods: Twenty patients with left-sided breast cancer underwent cardiac perfusion imaging using single photon emission computed tomography (SPECT) prechemotherapy, pre-RT, and 6 months post-RT. SPECT perfusion images were registered onto 3-dimensional (3D) RT dose distributions.

Can we predict radiation-induced changes in pulmonary function based on the sum of predicted regional dysfunction?

Purpose: To determine whether changes in whole-lung pulmonary function test (PFT) values are related to the sum of predicted radiation therapy (RT)-induced changes in regional lung perfusion.

Patients And Methods: Between 1991 and 1998, 96 patients (61% with lung cancer) who were receiving incidental partial lung irradiation were studied prospectively. The patients were assessed with pre- and post-RT PFTs (forced expiratory volume in one second [FEV1] and diffusion capacity for carbon monoxide [DLCO]) for at least a 6-month follow-up period, and patients were excluded if it was determined that intrathoracic recurrence had an impact on lung function.

Functional imaging of normal tissues with nuclear medicine: applications in radiotherapy.

Functional imaging techniques are gaining significant interest from radiation oncologists. Many now claim the need for physical and physiological information during both treatment planning and in the study of normal tissue injury. Toward this goal, the nuclear medicine functional imaging modalities, single-photon emission computed tomography and positron-emission computed tomography, have been used.

Routine 3D treatment planning: opportunities, challenges, and hazards.

Three-dimensional (3D) treatment planning refers to the use of software and hardware tools to design and implement more accurate and conformal radiation therapy. This is a major advance in oncology that should lead to the reduction of treatment-associated morbidity and facilitate safe dose escalation for many tumor sites. This technology affords the incorporation of physiologic and anatomic information into the treatment planning process, further enhancing our ability to improve the therapeutic ratio.

Variability of the depth of supraclavicular and axillary lymph nodes in patients with breast cancer: is a posterior axillary boost field necessary?

Purpose: To determine the variability of the depth of supraclavicular (SC) and axillary (AX) lymph nodes in patients undergoing radiation therapy for breast cancer and to relate this variability with the patient's anterior/posterior (A/P) diameter. The dosimetric consequences of the variability in depth are explored and related to the need for a posterior axillary boost field.

Method And Materials: In 49 patients undergoing treatment-planning computed tomography (CT) scanning in the treatment position, the maximum depth of the SC and AX lymph nodes was measured on CT images.

Radiation-induced pulmonary injury: symptomatic versus subclinical endpoints.

Purpose: To assess the relationship between radiation (RT)-induced pulmonary symptoms and subclinical changes in pulmonary functions tests (PFT) and radiographs.

Materials And Methods: A total of 184 patients irradiated between 1992 and 1998 were prospectively evaluated for RT-induced pulmonary symptoms, changes in computed tomography (CT) density, reductions in single photon emission CT (SPECT) perfusion, and changes in pulmonary functions tests (forced expiratory volume in 1 s [FEV1] and diffusion capacity to carbon monoxide [DLCO]). Comparisons between the evaluable patients with (N=34) and without (N=106) RT-induced pulmonary symptoms were made.

The role of lung perfusion imaging in predicting the direction of radiation-induced changes in pulmonary function tests.

Background: The aim of this study was to determine whether preradiation (pre-RT) single photon emission computed tomography (SPECT) lung perfusion scans can be used to predict RT-induced changes in pulmonary function tests (PFTs).

Methods: Ninety-four patients irradiated for thoracic tumors had pre-RT SPECT lung perfusion scans. The presence of SPECT hypoperfusion distal to a central mediastinal tumor was qualitatively assessed visually without knowledge of PFT changes.

Can angiotensin-converting enzyme inhibitors protect against symptomatic radiation pneumonitis?

This study was designed to determine whether patients taking angiotensin-converting enzyme (ACE) inhibitors while receiving radiation therapy for lung cancer are protected from developing symptomatic radiation pneumonitis. The records of 213 eligible patients receiving thoracic irradiation for lung cancer with curative intent at Duke University Medical Center from 1994-1997 were reviewed. Of the 213 patients, 26 (12.

The effect of pressure from the table top and patient position on pelvic organ location in patients with prostate cancer.

Purpose: To assess the impact of pressure from the table top and patient position on the relationship of the prostate, rectum, and bladder to the bony pelvis.

Methods And Materials: In 9 patients with prostate cancer (3 status postprostatectomy), computed tomography (CT) scans were obtained in four positions: supine with and without false table top under the buttocks, prone with and without false table top under the lower abdomen. In four patients, a fifth scan was obtained in the first position (supine with table top in place) to assess the impact of changes in bladder/rectal fullness over time.

A neural network to predict symptomatic lung injury.

A nonlinear neural network that simultaneously uses pre-radiotherapy (RT) biological and physical data was developed to predict symptomatic lung injury. The input data were pre-RT pulmonary function, three-dimensional treatment plan doses and demographics. The output was a single value between 0 (asymptomatic) and 1 (symptomatic) to predict the likelihood that a particular patient would become symptomatic.

The effect of patient-specific factors on radiation-induced regional lung injury.

Purpose: To assess the impact of patient-specific factors on radiation (RT)-induced reductions in regional lung perfusion.

Methods: Fifty patients (32 lung carcinoma, 7 Hodgkin's disease, 9 breast carcinoma and 2 other thoracic tumors) had pre-RT and > or = 24-week post-RT single photon emission computed tomography (SPECT) perfusion images to assess the dose dependence of RT-induced reductions in regional lung perfusion. The SPECT data were analyzed using a normalized and non-normalized approach.

Variability of the location of internal mammary vessels and glandular breast tissue in breast cancer patients undergoing routine CT-based treatment planning.

Purpose: To determine the variability of position of internal mammary vessels (IMV) and glandular breast tissue (GBT) in patients undergoing breast-conserving radiation therapy. To assess the frequency and magnitude of tangential field border shifts based on preradiation therapy (RT) computed tomography (CT) imaging in breast cancer patients.

Methods And Materials: Five hundred and ninety breast cancer patients irradiated between 9/94 and 3/98 underwent routine CT-based treatment planning.

Acute and late morbidity of using a breast positioning ring in women with large/pendulous breasts.

Purpose: To assess acute and late effects of radiation therapy in women with breast cancer treated with a breast positioning ring.

Materials And Methods: Fifty-six patients with large and/or pendulous breasts were irradiated using a breast positioning ring. The incidence of acute morbidity was correlated with patient weight and breast 'size'.

The effect of beam divergence on target coverage.

The well-known fact that radiation beams diverge is frequently not considered during the treatment planning process. Complacency with respect to beam divergence can, in some situations, lead to inappropriate field design. In this review, the potential problems arising from failure to adequately account for beam divergence in treatment planning are outlined, and commonly encountered clinical examples are illustrated.

Postmastectomy radiotherapy: toxicities and techniques to reduce them.

The role of locoregional radiation therapy after mastectomy is controversial. It reduces the risk of tumor relapse, improves breast cancer-specific survival and possibly overall survival, but has potential morbidity. This article reviews the technical aspects of postmastectomy radiation therapy and its associations with treatment-related morbidity.

Incorporation of functional status into dose-volume analysis.

The dose-volume histogram (DVH) has gained wide acceptance as a mechanism for reducing the voluminous data of a three-dimensional dose distribution into a two-dimensional graph. These graphs are often converted to a single figure of merit. This data reduction technique is used both for clinical treatment plan evaluation and as part of proposed systems for estimating control and complication probabilities.

Differences in gross target volumes on contrast vs. noncontrast CT scans utilized for conformal radiation therapy treatment planning for prostate carcinoma.

Purpose: To compare the gross target volumes (GTVs) (prostate and seminal vesicles) defined on noncontrast and contrast-enhanced computed tomography (CT) images used for three-dimensional conformal treatment planning (3DCRT).

Methods And Materials: From 1993 to 1996, 39 patients referred for radiation therapy for adenocarcinoma of the prostate underwent pretreatment pelvic CT scanning with and without intravenous (i.v.

Radiation pneumonitis as a function of mean lung dose: an analysis of pooled data of 540 patients.

Purpose: To determine the relation between the incidence of radiation pneumonitis and the three-dimensional dose distribution in the lung.

Methods And Materials: In five institutions, the incidence of radiation pneumonitis was evaluated in 540 patients. The patients were divided into two groups: a Lung group, consisting of 399 patients with lung cancer and 1 esophagus cancer patient and a Lymph.