{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T12:35:02Z","timestamp":1788957302370,"version":"build-2803163510"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"1105","license":[{"start":{"date-parts":[[2019,11,13]],"date-time":"2019-11-13T00:00:00Z","timestamp":1573603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,1,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives:<\/jats:title>\n                  <jats:p>Anatomic changes may occur during chemoradiation treatment for lung cancers, requiring adaptive replanning. Here we characterize these cases.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods:<\/jats:title>\n                  <jats:p>We retrospectively studied lung cancer cases that underwent resimulation and adaptive replanning during 1\/2016\u20133\/2019. We compared first and second CT-simulation regarding tumor location, timing of change, tumor volume, anatomical alteration and change in simulation technique. We also compared dosimetric parameters between the plans, recorded local control, and overall survival outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results:<\/jats:title>\n                  <jats:p>Out of 281 patients, 58 underwent replanning (20.6%). Histology included small cell (22.4%) and non-small cell (77.6%). Stage III was in 91.4%. Mean radiation dose of 59.4 Gray (Gy) (range 50-66Gy).<\/jats:p>\n                  <jats:p>Tumor location was peribronchial in 53.5%. Timing of replanning was in the first, second and final third of the treatment course in 26%, 43% and 31% respectively. Changes in gross tumor volume were observed in 74%; mean gross tumor volume was 276.7cc vs 192.7 cc (first vs second simulation, p = 0.001). Anatomical changes were identified in 35.4% including pleural fluid accumulation, atelectasis or pneumothorax alteration. Change in simulation technique was performed in 25.9%, including breath-hold or continuous positive airway pressure.<\/jats:p>\n                  <jats:p>Changes in dosimetric parameters when the same technique was used: lung V20Gy 26% (standard deviation, SD 7.6) vs 25.3% (SD 6.6) (p = 0.36), mean lung dose 15.1\u2009Gy (SD 3.7) vs 14.7Gy (SD 3.3) (p = 0.23), heart V40Gy 10.2% (SD13) vs 7.2% (SD 9.8) (p = 0.037). When simulation technique changed: lung V20Gy 30.8% (SD 8.2) vs 27.3% (SD 8) (p = 0.012), mean lung dose 17.3\u2009Gy (SD 4.4) vs 15.3\u2009Gy (SD 3.8) (p = 0.007), heart V40Gy 11.1% (SD 14.7) vs 6.5% (SD 6.7) (p = 0.014).<\/jats:p>\n                  <jats:p>2 year local control was 60.7% (95% confidence interval, 34.5\u201379.2%), and median overall survival was 19.7 months.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion:<\/jats:title>\n                  <jats:p>Adaptive replanning of radiation was performed in a fifth of locally advanced lung cancer patients. In most cases tumor volume decreased, or atelectasis resolved, causing mediastinal shifts, which, if unidentified and left uncorrected, may have led to local failure and increased toxicity. The heart V40Gy was reduced significantly in all cases, but significant reduction in lung doses was evident only if simulation technique was altered.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Advances in knowledge:<\/jats:title>\n                  <jats:p>In locally advanced lung cancer image-guidance with cone beam CT can detect significant mediastinal shifts and gross tumor volume changes that raise the need for adaptive replanning. Image guidance-triggered adaptive replanning should be added to the armament of advanced radiation treatment planning in locally advanced lung cancer.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1259\/bjr.20190743","type":"journal-article","created":{"date-parts":[[2019,10,31]],"date-time":"2019-10-31T12:59:22Z","timestamp":1572526762000},"source":"Crossref","is-referenced-by-count":22,"title":["Image-guidance triggered adaptive replanning of radiation therapy for locally advanced lung cancer: an evaluation of cases requiring plan adaptation"],"prefix":"10.1093","volume":"93","author":[{"given":"Sarit","family":"Appel","sequence":"first","affiliation":[{"name":"Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center affiliated to Tel Aviv University, Sackler faculty of medicine , Ramat Gan , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jair","family":"Bar","sequence":"additional","affiliation":[{"name":"Medical Oncology, Institute of Oncology, Chaim Sheba Medical Center, affiliated to Tel Aviv University, Sackler faculty of medicine , Ramat Gan , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dror","family":"Alezra","sequence":"additional","affiliation":[{"name":"Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center affiliated to Tel Aviv University, Sackler faculty of medicine , Ramat Gan , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maoz","family":"Ben-Ayun","sequence":"additional","affiliation":[{"name":"Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center affiliated to Tel Aviv University, Sackler faculty of medicine , Ramat Gan , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatiana","family":"Rabin-Alezra","sequence":"additional","affiliation":[{"name":"Radiation Oncology, Sourasky Medical Center , Tel Aviv , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nir","family":"Honig","sequence":"additional","affiliation":[{"name":"Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center affiliated to Tel Aviv University, Sackler faculty of medicine , Ramat Gan , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamar","family":"Katzman","sequence":"additional","affiliation":[{"name":"Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center affiliated to Tel Aviv University, Sackler faculty of medicine , Ramat Gan , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumit","family":"Chatterji","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Chaim Sheba Medical Center affiliated to Tel Aviv University, Sackler faculty of medicine, Israel , Ramat Gan , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zvi","family":"Symon","sequence":"additional","affiliation":[{"name":"Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center affiliated to Tel Aviv University, Sackler faculty of medicine , Ramat Gan , Israel"},{"name":"Sackler Faculty of Medicine, Tel Aviv University , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaacov Richard","family":"Lawrence","sequence":"additional","affiliation":[{"name":"Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center affiliated to Tel Aviv University, Sackler faculty of medicine , Ramat Gan , Israel"},{"name":"Sackler Faculty of Medicine, Tel Aviv University , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,11,13]]},"reference":[{"key":"2024050215101619500_b1","first-page":"1258","article-title":"Dose and volume reduction for normal lung using intensity-modulated radiotherapy for advanced-stage non-small-cell lung cancer. International Journal of radiation oncology, biology","volume":"58","author":"Murshed","year":"2004","journal-title":"Physics"},{"key":"2024050215101619500_b2","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.semradonc.2014.11.002","article-title":"Intensity-Modulated radiotherapy, not 3 dimensional conformal, is the preferred technique for treating locally advanced lung cancer","volume":"25","author":"Chang","year":"2015","journal-title":"Semin Radiat Oncol"},{"key":"2024050215101619500_b3","first-page":"1330","article-title":"Effect of image-guidance frequency on geometric accuracy and setup margins in radiotherapy for locally advanced lung cancer. International Journal of radiation oncology, biology","volume":"80","author":"Higgins","year":"2011","journal-title":"Physics"},{"key":"2024050215101619500_b4","first-page":"614","article-title":"Neo-Adjuvant chemo-radiation to 60 gray followed by surgery for locally advanced non-small cell lung cancer patients: evaluation of trimodality strategy","volume":"19","author":"Appel","year":"2017","journal-title":"Isr Med Assoc J"},{"key":"2024050215101619500_b5","doi-asserted-by":"crossref","first-page":"1584","DOI":"10.1378\/chest.120.5.1584","article-title":"Grading of tumor regression in non-small cell lung cancer : morphology and prognosis","volume":"120","author":"Junker","year":"2001","journal-title":"Chest"},{"key":"2024050215101619500_b6","first-page":"341","article-title":"Quantification of tumor volume changes during radiotherapy for non-small-cell lung cancer. International Journal of radiation oncology, biology","volume":"74","author":"Fox","year":"2009","journal-title":"Physics"},{"key":"2024050215101619500_b7","first-page":"901","article-title":"Potential of adaptive radiotherapy to escalate the radiation dose in combined radiochemotherapy for locally advanced non-small cell lung cancer. International Journal of radiation oncology, biology","volume":"79","author":"Guckenberger","year":"2011","journal-title":"Physics"},{"key":"2024050215101619500_b8","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s00066-015-0927-y","article-title":"Cone-Beam CT-guided radiotherapy in the management of lung cancer: diagnostic and therapeutic value","volume":"192","author":"Elsayad","year":"2016","journal-title":"Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft"},{"key":"2024050215101619500_b9","first-page":"391","article-title":"Continuous positive airway pressure for motion management in stereotactic body radiation therapy to the lung: a controlled pilot study. International Journal of radiation oncology, biology","volume":"93","author":"Goldstein","year":"2015","journal-title":"Physics"},{"key":"2024050215101619500_b10","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijrobp.2018.07.1414","article-title":"Cpap improves the anatomy and dosimetry of patients undergoing Breath-Hold motion management for thoracic SBRT","volume":"102","author":"Sadetskii","year":"2018","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"2024050215101619500_b11","doi-asserted-by":"crossref","DOI":"10.1259\/bjr.20130643","article-title":"Adaptive radiotherapy in lung cancer: dosimetric benefits and clinical outcome","volume":"87","author":"Kataria","year":"2014","journal-title":"Br J Radiol"},{"key":"2024050215101619500_b12","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1001\/jamaoncol.2017.0982","article-title":"Effect of Midtreatment PET\/CT-Adapted radiation therapy with concurrent chemotherapy in patients with locally advanced non-small-cell lung cancer: a phase 2 clinical trial","volume":"3","author":"Kong","year":"2017","journal-title":"JAMA Oncol"},{"key":"2024050215101619500_b13","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.radonc.2014.10.009","article-title":"Intra thoracic anatomical changes in lung cancer patients during the course of radiotherapy","volume":"113","author":"Kwint","year":"2014","journal-title":"Radiother Oncol"},{"key":"2024050215101619500_b14","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.tipsro.2018.09.004","article-title":"Case report: A novel model for educating radiation therapists in small countries: Case study of the \u201cTrain the Trainer\u201d initiative in Israel","volume":"8","author":"Katzman","year":"2018","journal-title":"Technical Innovations & Patient Support in Radiation Oncology"},{"key":"2024050215101619500_b15","first-page":"1086","article-title":"Volumetric image guidance using carina vs spine as registration landmarks for conventionally fractionated lung radiotherapy. International Journal of radiation oncology, biology","volume":"84","author":"Lavoie","year":"2012","journal-title":"Physics"},{"key":"2024050215101619500_b16","first-page":"210","article-title":"Interfraction displacement of primary tumor and involved lymph nodes relative to anatomic landmarks in image guided radiation therapy of locally advanced lung cancer. International Journal of radiation oncology, biology","volume":"88","author":"Jan","year":"2014","journal-title":"Physics"},{"key":"2024050215101619500_b17","first-page":"959","article-title":"Differential motion between mediastinal lymph nodes and primary tumor in radically irradiated lung cancer patients. 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