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We calculated the maximum dose to 0.
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Brachial plexus contouring using deformable image registration. The purpose of this study was to identify a threshold radiation dose at which plexopathy becomes evident when that radiation is delivered using modern-day techniques to tumors in the superior dh, upper mediastinum, or supraclavicular regions.
Significant effect of adjuvant chemotherapy on survival in locally advanced non-small-cell lung carcinoma.
Treatment plans from those patients were de-archived from the tape backup system and restored into a research Pinnacle planning system Philips Healthcare. Dose-volume histogram data showing the median radiation dose of 10 patients manually contoured forming the training set dotted line compared to the automatically generate plexus contours using deformable image registration, prior to modification.
Our study had several limitations. Radiation-induced brachial plexus neuropathy in breast cancer patients. Journal of Clinical Oncology. Dvj DRR showing patient with a superior sulcus tumor with contours of the brachial plexus generated by deformable image registration followed by manual modification. The planned tumor volume PTV received 74 Gy.
III, IV and recurrent. Complication without a cure. Statistical tests were based on a two-sided significance level. Initial results of the phase II trial RTOG to evaluate the feasibility of dose escalation to 74 Gy with concurrent chemotherapy for unresectable NSCLC were encouraging; the median overall survival time, 24 months, compares dbh to that produced by the lower Gy dose used in RTOG [ 6 ]. B Digitally-reconstructed radiographs DRR showing manual contours green and computer-generated contours red.
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Please note 5116 during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal 51661. The inferior and lateral borders of the plexus terminated with the subclavian vascular bundle Fig.
This is a PDF file of an unedited manuscript that has been accepted for publication. Of these, 5 patients The suggested maximum of 66 GyfromEmami et al[ 10 ] caused few problems when the definitive dose for lung cancer was 60 Gy. Unfortunately, these are the very patient likely to justify dose escalation as they often have gross tumor pushing on the nerve, and perhaps the risk is justified because svh tumors will also result in further morbidity. Arya AminiB. A prospective randomized study of various irradiation doses and fractionation schedules in the treatment of inoperable non-oat-cell carcinoma of the lung.
The two curves were nearly superimposable. National Center for Biotechnology InformationU.
Evaluation of Brachial Plexus Dose The Pinnacle planning system was used to xvh the dose to xvh brachial plexus using the original treatment plan. As the recommended radiation dose for non-small evh lung cancer NSCLC increases, meeting dose constraints for critical structures like the brachial plexus becomes increasingly challenging, particularly for tumors in the superior sulcus.
Additional inclusion criteria were having at least 4 months of follow-up and having had either photon or proton therapy with 3D conformal or intensity-modulated radiation treatment planning, with or without concurrent chemotherapy. Among patients identified as having unresectable NSCLC treated with definitive chemoradiation, 90 had superior sulcus tumors or tumors involving the upper mediastinum or supraclavicular region and had received a dose of at least 55 Gy to 0.
Contouring the brachial plexus on CT scans continues to be challenging. Tolerance of normal tissue to therapeutic irradiation. At present, the maximum tolerated radiation dose for the brachial plexus remains a matter of debate. However, with current trials evaluating 74 Gy, the dose constraints for the brachial plexus need to be revisited, particularly because most of the literature on brachial plexus toxicity dgh from studies of head and neck or breast cancer.
This work was made possible through the generosity of the family of M. Results The median radiation dose to the brachial plexus was 70 Gy range The resultant displacement vector fields characterizing the individual registrations were then used to deform the atlas brachial plexus contours to obtain 10 individual segmentations for 5116 patient. Radiation-induced brachial plexopathy can be quite debilitating and is difficult to treat [ 7 ].
The maximum tolerated dose to the plexus continues to be debated; we have found this structure to be a dose-limiting factor in our phase III randomized comparison of protons versus photons for unresectable NSCLC. For lung cancers near the apical region, brachial plexopathy is a major concern for high-dose radiation therapy. Brachial plexopathy can present dvb a wide range of symptoms, often irreversibly, including numbness, pain, parasthesias, and motor impairment [ 8 ].
Our findings here, focusing specifically on patients treated for lung cancer, indicate that the median dose to the brachial plexus 516 be kept below 69 Gy, and the maximum dose to 2 evh 3 below 75 Gy,for patients with NSCLC.