Electrocardiogram-Gated Computed Tomography with Coronary Angiography for Cardiac Substructure Delineation and Sparing in Patients with Mediastinal Lymphomas Treated with Radiation Therapy.

Autor:	Lester SC; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota. Electronic address: lester.scott@mayo.edu., Taparra K; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota; Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota., Petersen MM; Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota., Funk RK; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Blanchard MJ; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Young PM; Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota., Herrmann J; Department of Cardiology, Mayo Clinic, Rochester, Minnesota., Hunzeker AE; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Schultz HL; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., McCollough C; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Tasson AM; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Leng S; Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota., Martenson JA; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Deisher AJ; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Whitaker TJ; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Williamson EE; Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota., Laack NN; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
Jazyk:	angličtina
Zdroj:	Practical radiation oncology [Pract Radiat Oncol] 2020 Mar - Apr; Vol. 10 (2), pp. 104-111. Date of Electronic Publication: 2019 Nov 26.
DOI:	10.1016/j.prro.2019.10.016
Abstrakt:	Purpose: (1) Demonstrate feasibility of electrocardiogram-gated computed tomography with coronary angiography (E-CTA) in treatment planning for mediastinal lymphoma and (2) assess whether inclusion of cardiac substructures in the radiation plan optimization (CSS optimization) results in increased cardiac substructure sparing. Methods and Materials: Patients with mediastinal lymphomas requiring radiation therapy were prospectively enrolled in an observational study. Patients completed a treatment planning computed tomography scan and E-CTA in the deep inspiration breath hold position. Avoidance structures (eg, coronary arteries and cardiac valves) were created in systole and diastole and then merged into a single planning organ-at-risk volume based on a cardiac substructure contouring atlas. In the photon cohort, 2 volumetric modulated arc therapy plans were created per patient with and without CSS optimization. Dosimetric endpoints were compared. Results: In the photon cohort, 7 patients were enrolled. For all 7 patients, the treating physician elected to use the CSS optimization plan. At the individual level, 2 patients had reductions of 10.8% and 16.2% of the right coronary artery receiving at least 15 Gy, and 1 had a reduction of 9.6% of the left anterior descending artery receiving 30 Gy. No other differences for coronary arteries were detected between 15 and 30 Gy. Conversely, 5 of 7 patients had >10% reductions in dose between 15 to 30 Gy to at least 1 cardiac valve. The greatest reduction was 22.8% of the aortic valve receiving at least 30 Gy for 1 patient. At the cohort level, the maximum, mean, and 5-Gy increment analyses were nominally similar between planning techniques for all cardiac substructures and the lungs. Conclusions: Cardiac substructure delineation using E-CTA was feasible, and inclusion in optimization led to modest improvements in sparing of radiosensitive cardiac substructures for some patients. (Copyright © 2019. Published by Elsevier Inc.)
Databáze:	MEDLINE
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