DVH 5161 PDF

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Gender, concurrent chemoradiation, and the presence of diabetes were not associated with risk of brachial plexopathy Table 2. Our results could be used as a guideline in future prospective trialswithhigh dose radiation therapy for unresectable lung cancer.

Brachial plexopathy was documented according to the Common 5611 Criteria for Adverse Events v4.

The suggested maximum of 66 GyfromEmami et al[ 10 ] caused few problems when the definitive dose for lung cancer was 60 Gy. Conclusions For lung cancers near the apical region, brachial plexopathy is a major concern for high-dose radiation therapy. Most studies since have recommended the maximum dose be kept under 66 Gy.

As a service to our customers we are providing this early version of the manuscript. Preliminary report by the Radiation Therapy Oncology Group. It is well known that peripheral nerves are sensitive to recurrent episodes of trauma, whether from tumor invasion or from surgical intervention [ 915 dfh multiple traumas might be expected to reduce the threshold for development of symptoms.

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The contours were drawn jointly by two thoracic radiation oncologists and one thoracic radiologist. The Mann-Whitney two-sample statistic or Wilcoxon rank-sum test was used to test the distribution of continuous variables according to plexopathy status. Dose escalation introduces challenges with regard to meeting dose constraints for proximal critical structures such as the brachial plexus. Other studies have also noted correlations between receipt of concurrent chemoradiotherapy or use of large radiation doses per fraction [ 1617 ]; these other findings suggest that use of twice-daily fractionation may reduce toxicity and may provide particular benefit in patients with plexopathy prior to treatment.

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Atlas of human anatomy. Please refer to the text for details. The median time to symptom onset was 6. Radiation-induced brachial plexopathy and hypofractionated regimens in adjuvant irradiation of patients with breast cancer–a review. 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 sulcus, upper mediastinum, or supraclavicular regions.

Maria Johnson | DVHS JV vs Irvington HS 47 – San Ramon CA | IMG_

Characteristics Value or No. Implementation and validation of a three-dimensional deformable registration algorithm for targeted prostate cancer radiotherapy. Auto-segmentation using deformable image registration followed by modification was found to be accurate for the majority of the dvy, with only slight modification needed, mostly based on aberrant arm position. In this study we found that dch before treatment was also associated with greater risk of toxicity after treatment.

The superior border of the plexus was initiated between the neural foramina at C4-C5 where the nerve was traced as it exited the foramina. This was corrected withminor modifications for each individual to ensure consistency. The resultant displacement vector fields characterizing the individual registrations were then used to deform the atlas brachial plexus contours to obtain dvhh individual segmentations for each patient.

The multi-atlas segmentation technique we used svh the potential to reduce inter-subject, inter-observer, or even intra-observer variability in contouring the brachial plexus. Statistical tests were based on a two-sided significance level. 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 dvg concurrent chemotherapy.

The median maximum doses to 0. Even with the differences in anatomy and positioning among patients, we noticed excellent correlation between the STAPLE fused contours and the manually generated contours, suggesting that STAPLE fusion of multiple individual segmentations can reduce variability and produce accurate contours. We used a multi-atlas segmentation method combined with deformable image registration to delineate the brachial plexuson the original planning CT scans and scoredplexopathy according to the Common Terminology Criteria for Adverse Events v4.

Only minor modifications were made mostly as a result of arm position for these structures. This may prove to be problematic for complying with dose constraints to structures like the brachial plexus. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Bar graphs representing the percent risk for brachial plexopathy according to a cutoff median dose of 69 Gy to the entire brachial plexus panel A and a 75 Gy dose cutoff to 2 cm 3 of the brachial plexus panel B.


The median radiation dose to the brachial plexus was 70 Gy range Using the clavicle and first rib as landmarks [ 11 ], we used bony anatomy and the subclavian bundle to draw the plexus distally. In this retrospective analysis, we compared dose-volume histogram information with the incidence of plexopathy to establish the maximum tolerated dose to the brachial plexus. The Pinnacle planning system was used to calculate the dose to the brachial plexus using the original treatment plan.

When patients were treated with proton therapy using Varian Eclipse treatment planning, DICOM-RT dose plans were first exported from Eclipse 1561 system and then converted and imported into Pinnacle planning system for dose calculation. 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 comes from studies of head and neck or breast cancer.

We calculated the maximum dose to 0. The contours created by dfh image registration provided a good approximate location of the brachial plexus. Schierle C, Winograd JM.


Lung cancer is the leading cause of cancer-related death worldwide, with approximately 1. At present, the maximum tolerated radiation dose for the brachial plexus remains a matter of debate.

To save time and improve the consistency of contouring, we applied a new multi-atlas segmentation method to automatically delineate brachial plexus contours as follows.