title: Respiratory-gated bilateral pulmonary radiotherapy for Ewing's sarcoma and nephroblastoma in children and young adults: Dosimetric and clinical feasibility studies.
abstract: OBJECTIVE
  Bilateral pulmonary radiotherapy in children and young adults aims to reduce the recurrence of lung metastases. The radiation field includes liver tissue, which is sensitive to even low radiation doses. We investigated the feasibility of respiratory gating radiotherapy using voluntary deep inspiration breath hold and its toxicity in these patients.
  
  
  METHODS
  A retrospective clinical review was conducted for all patients who had undergone bilateral pulmonary radiotherapy, with or without deep inspiration breath hold, treated in our institution between October 1999 and May 2012. A dosimetric study was conducted on seven consecutive children using 4D-scan data on free-breathing and a SpiroDyn'RX-system-scan on deep inspiration breath hold. A radiation treatment of 20Gy was simulated.
  
  
  RESULTS
  Concerning the clinical study, seven patients of mean age 11.9 years (range: 4.9-21.1 years) were treated with free-breathing and ten patients of mean age 15.6 years (range: 8.6-19.7 years) were treated with deep inspiration breath hold for mainly Ewing sarcoma and nephroblastoma. Within six months of radiotherapy, all patients experienced mild liver toxicity (grade 1 or 2 altered levels of alanine/aspartate aminotransferase [n=8 of 9] or cholestasis [n=1 of 9]), which resolved completely with no difference between deep inspiration breath hold and free-breathing technique. Over a median follow-up of 2.6 years (range: 0.1-9.3 years), four patients died from disease progression (mean 1.5 years post-radiotherapy [range: 1.1-1.6 years]) and three experienced grade III-V lung toxicity. Concerning the dosimetric study, the irradiated liver volume was significantly lower with deep inspiration breath hold than free-breathing, for each isodose (V5: 73.80% versus 86.74%, P<0.05; V20: 5.70% versus 26.44%, P<0.05).
  
  
  CONCLUSIONS
  The dosimetric data of respiratory-gated bilateral pulmonary radiotherapy showed a significantly spare of normal liver tissue. Clinical data showed that this technique is feasible even in young children. However, no liver toxicity difference between deep inspiration breath hold and free-breathing was shown.
authors.affiliation: Department of radiation oncology, institut de cancérologie de l'Ouest René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France; Faculté de médecine, université de Nantes, 1, rue Gaston-Veil, 44000 Nantes, France; Centre de recherche en épidémiologie et santé publique (CESP), 114, rue Édouard-Vaillant, 94805 Villejuif, France; Inserm U1018, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Université Paris-Saclay, université Paris-Sud, 94807 Villejuif, France; Department of clinical research, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France. Electronic address: c.demoor@hotmail.fr.
authors.forename: C
authors.initials: C
authors.lastname: Demoor-Goldschmidt
authors.affiliation: Department of medical physics, institut de cancérologie de l'Ouest René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France.
authors.forename: S
authors.initials: S
authors.lastname: Chiavassa
authors.affiliation: Department of medical physics, institut de cancérologie de l'Ouest René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France.
authors.forename: S
authors.initials: S
authors.lastname: Josset
authors.affiliation: Department of radiation oncology, institut de cancérologie de l'Ouest René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France; Faculté de médecine, université de Nantes, 1, rue Gaston-Veil, 44000 Nantes, France.
authors.forename: M-A
authors.initials: MA
authors.lastname: Mahé
authors.affiliation: Department of radiation oncology, institut de cancérologie de l'Ouest René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France; Faculté de médecine, université de Nantes, 1, rue Gaston-Veil, 44000 Nantes, France.
authors.forename: S
authors.initials: S
authors.lastname: Supiot
mesh_terms: D000293:Adolescent; D001859:Bone Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008175:Lung Neoplasms / Q000517:prevention & control* / Q000532:radiotherapy* / Q000556:secondary; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control* / Q000532:radiotherapy*; D011829:Radiation Dosage; D011878:Radiotherapy / Q000379:methods; D012119:Respiration; D012189:Retrospective Studies; D012512:Sarcoma, Ewing / Q000517:prevention & control* / Q000532:radiotherapy* / Q000556:secondary; D009396:Wilms Tumor / Q000517:prevention & control* / Q000532:radiotherapy* / Q000556:secondary; D055815:Young Adult
keywords: Bilateral pulmonary irradiation; Ewing sarcoma; Hodgkin; Metastasis; Métastase; Nephroblastoma; Néphroblastome; Paediatrics; Pédiatrie; Radiotherapy; Radiothérapie; Radiothérapie pulmonaire bilatérale; Sarcome d’Ewing