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In this study we found that plexopathy before treatment was also associated with greater risk of toxicity after treatment.
Brachial plexopathy was documented 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. OR, odds ratio; CI, confidence interval.
Also, the borders of the brachial plexus, unlike those of other organs can be difficult to 511. The contours were drawn jointly by two thoracic radiation oncologists and one thoracic radiologist.
As a service to our customers we are providing this early version of the manuscript.
Characteristics Value or No. Schematic diagram for auto-contouring the brachial plexus using multiple atlases. The median radiation dose to the brachial plexus was 70 Gy range These 10 images were then incorporated in the deformable registry program. Patients with brachial plexopathy before treatment due to tumor invasion or surgical intervention were considered to have plexopathy after radiation treatment only if the plexopathy had cleared and then returned without evidence of new tumor impingement.
Minor clinical symptoms with no medical intervention required were considered grade 1; moderate symptoms requiring pain medication with good response, grade 2; and severe symptoms, treated with multiple pain medications, including neuropathic drugs or steroid injections, with some or no improvement in symptoms, grade 3.
Atlas of human anatomy. Conclusions For lung cancers near the apical region, brachial plexopathy is a major concern for high-dose radiation therapy. 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. Evaluation of Brachial Plexus Dose The Pinnacle planning system was used to calculate the dose to the brachial plexus using the original treatment plan.
Brachial plexus contouring using deformable image registration.
The Mann-Whitney two-sample statistic or Wilcoxon rank-sum test was used to test the distribution of continuous variables according to plexopathy status. Validation of Deformable Image Registration Auto-segmentation using deformable dvn registration followed by modification was found to be accurate for the majority of the cases, with only slight modification needed, mostly based on aberrant arm position.
DVH / DVH / DVH – Celsa Messgeräte GmbH
Ten sets of atlas patients were registered to the new patient using deformable image registration DIR and the deformed atlas contours were fused to produce the final auto-segmented brachial plexus contours for the new patient. Brachial plexus lesions in patients with cancer: For these reasons, estimates of smaller point doses may not have been accurate enough to predict the development of plexopathy. Where no foramen was present, only the regions between the scalene muscles were contoured.
B Digitally-reconstructed radiographs DRR showing manual contours green and computer-generated contours red. Brachial plexopathy can present with a wide range of symptoms, often irreversibly, including numbness, pain, parasthesias, and motor impairment [ 8 ]. Treatment plans from those patients were de-archived from the tape backup system and restored into a research Pinnacle planning system Philips Healthcare.
Maria Johnson | DVHS JV vs Irvington HS 47 – San Ramon CA | IMG_
We also evaluated the contribution of other factors, such as having plexopathy before radiation, receipt of concurrent chemotherapy, and receipt of proton versus photon therapy, to the risk of developing brachial plexopathy. Open in a separate window. Deformable Image Registration 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.
Tel ; fax ; gro. 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 favorably to that produced by the lower Gy dose used in RTOG [ 6 ]. The inferior and lateral borders of the plexus terminated with the subclavian vascular bundle Fig. Abstract Purpose As the recommended radiation dose for non-small cell lung cancer NSCLC increases, meeting dose constraints for critical structures like the brachial plexus becomes increasingly challenging, particularly for tumors in the superior sulcus.
We further attempted to address the difficulties in consistently contouring this structure by using deformable image registration. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final 1561 form. The potential benefit of tumor control must be balanced dvn the risk of treatment-related side effects on a case-by-case basis.
The authors declare no conflicts of interest regarding the work presented here. Additional inclusion criteria were having at least 4 months of 55161 and having had either photon or proton therapy with 3D conformal or intensity-modulated radiation treatment planning, with or without concurrent chemotherapy. The multi-atlas segmentation technique we used has the potential to reduce inter-subject, inter-observer, or even intra-observer variability in contouring the brachial plexus.
P values of 0. The suggested maximum of 66 GyfromEmami et al[ 10 ] caused few problems when the definitive dose for lung cancer was 60 Gy.
Radiation-induced brachial plexopathy and hypofractionated regimens in adjuvant irradiation of patients with breast cancer–a review. A Axial CT scan delineating the brachial plexus based on physician consensus green and computer-generated contours 1561. Proc Am Soc Clin Oncol. Please refer to the text for details. We identified C5 through T1 roots, which served as the medial borders of the brachial plexus; ddvh plexus was contoured from medial to lateral using the scalene muscles as landmarks[ 11 ].
This overall framework is illustrated in Figure 2.