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The contours were drawn jointly by two thoracic radiation oncologists and one thoracic radiologist.
J Natl Cancer Inst. Our study had several limitations. Results The median radiation dose to the brachial plexus was 70 Gy range This patient later developed grade 2 toxicity. Balancing the benefit of local control with the risk of considerable toxicity is a particular challenge for tumorsof the superior sulcus or tumors with supraclavicular adenopathy. Lung cancer is the leading cause of cancer-related death worldwide, with approximately 1. Radiation-induced brachial plexopathy can be quite debilitating and is difficult to treat [ 7 ].
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. P values of 0.
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Interestingly, we found that doses to 0. Other significant risk factors were having plexopathy before treatment OR 4.
Significant effect of adjuvant chemotherapy on survival in locally advanced non-small-cell lung carcinoma. CA Cancer J Clin. 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.
This overall framework is illustrated in Figure 2. Radiation-induced brachial plexus neuropathy in breast cancer patients.
Evaluation of Brachial Plexus Dose The Pinnacle planning system was used to 516 the dose to the brachial plexus using the original treatment plan. Also, the borders of the brachial plexus, unlike those of other organs can be difficult to define.
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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. Brachial plexopathy was documented according to the Common Terminology Criteria for Adverse Events v4.
For these reasons, estimates of smaller point doses may not have been accurate enough to predict the development of plexopathy. However, radiation doses of that magnitude often result in local failure, which itself cancause brachial plexopathy. Statistical tests were based on a two-sided significance level. This may prove to be problematic for complying with dose constraints to structures like the brachial plexus.
OR, odds ratio; CI, confidence interval. Schierle C, Winograd JM. Arya AminiB. When patients were treated with proton therapy using Varian Eclipse treatment planning, DICOM-RT dose plans were first exported from Eclipse planning system and then converted and imported into Pinnacle planning system for dose calculation.
The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please refer to the text for details. 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.
Validation of Deformable Image Registration Auto-segmentation using deformable image 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. Also, changes in arm position can affect the visibility of the brachial plexus and can contribute to inaccuracies in deformable image registration.
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