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Ayrancıoğlu O, Ayrancıoğlu C, Arıkan ŞC, Alıcıkuş LZA. Performance assessment of the surface-guided radiation therapy system: Varian Identify. Med Dosim 2024:S0958-3947(24)00001-3. [PMID: 38320884 DOI: 10.1016/j.meddos.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/23/2023] [Accepted: 01/02/2024] [Indexed: 02/08/2024]
Abstract
Image-guided radiotherapy (IGRT) systems using ionizing radiation may increase the risk of secondary cancer and normal tissue toxicity due to additional radiation exposure caused by large field sizes or repeated scans during X-ray imaging. As an alternative to these modalities, surface-guided radiotherapy (SGRT) systems which do not employ ionizing radiation have been developed. This study presents a comprehensive performance evaluation of the Varian Identify SGRT system by using an anthropomorphic Alderson Rando phantom in three different aspects: (a) the accuracy and reproducibility of the system in different regions of interest (ROI) for varying couch displacements, (b) the setup accuracy of the system for patient positioning based on different computed tomography (CT) slice thicknesses, and (c) the potential influence of obstructing SGRT cameras by the gantry on the system's overall accuracy and reproducibility. The accuracy and reproducibility of the SGRT system fell within 1 mm and 1°. Nevertheless, in certain situations, these values were observed to exceed prescribed limits. Consequently, concerning SGRT tolerance limits for treatment applications, careful consideration of ROIs and offset values of the system is crucial. We also recommend that patients should ideally be set up during 0° gantry rotation, and the on-board imaging (OBI) system should be retracted to prevent obstruction of the cameras. Additionally, reference CT images with a slice thickness of under 3 mm are recommended for this purpose.
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Affiliation(s)
- Oğuzhan Ayrancıoğlu
- Department of Radiation Oncology, İzmir Tınaztepe University Galen Hospital, Izmir, Turkey.
| | | | - Şerife Ceren Arıkan
- Department of Radiation Oncology, İzmir Tınaztepe University Galen Hospital, Izmir, Turkey
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Li X, Zhong X, Xu H, Wang J, Liu X, Wang Y, He L, Ma J, Li G, Liu L. Survival analysis of palliative radiotherapy in patients with HER-2+ metastatic breast cancer. Front Endocrinol (Lausanne) 2024; 14:1305429. [PMID: 38260126 PMCID: PMC10800428 DOI: 10.3389/fendo.2023.1305429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/08/2023] [Indexed: 01/24/2024] Open
Abstract
Background Whether radiotherapy can improve the long-term survival of HER-2+ metastatic breast cancer remains unclear. We launched this study to explore the effect of HER-2+ metastatic breast cancer patients through anti-HER-2 targeted therapy + radiotherapy. Methods 488 HER-2 + metastatic breast cancer patients who received anti-HER2 targeted ± local radiotherapy from March 2006 to September 2021 were retrospectively collected. Patients were divided into a radiotherapy group (n=207) and a non-radiotherapy group (n=281) based on whether they received radiotherapy or not. 1: 1 propensity matching analysis was used to determine two groups of patients with similar baselines. Results Before matching, the radiotherapy group (n=207) had a median overall survival (mOS) of 51.7 months (48.8-63.8), which was superior to the non-radiotherapy group's (n=281) mOS of 33.9 months (27.9-39.9) (P < 0.0001). Moreover, the radiotherapy group exhibited better 1-year (94.6% vs 83.9%), 3-year (70.8% vs 45.5%), and 5-year (43.3% vs 25.0%) survival rates compared to the control group. Propensity score matching analysis identified 135 pairs of baseline-matched patients. In the matched groups, the mOS was 57.2 (44.5-69.8) months in the radiotherapy group (n=135) and 34.1 (27.5-40.6) months in the non-radiotherapy group (n=135), showing a statistically significant difference (P < 0.0001). Additionally, the radiotherapy group demonstrated 1-, 3-, and 5-year survival rates of 93.2%, 71.5%, and 46.9%, respectively, while those in the non-radiotherapy group were 89.4%, 45.8%, and 22.2%, respectively. Multivariate Cox analysis revealed that the presence of brain metastasis, liver metastasis, and radiotherapy were identified as independent predictive factors significantly associated with OS. Conclusion In patients with HER-2 positive metastatic breast cancer, radiotherapy was associated with better survival benefits compared to those who did not receive radiotherapy.
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Affiliation(s)
- Xueting Li
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Oncology, 363 Hospital, Chengdu, Sichuan, China
| | - Xiaorong Zhong
- Department of Breast Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongyu Xu
- Department of Oncology, 363 Hospital, Chengdu, Sichuan, China
| | - Jun Wang
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xianguo Liu
- Department of Oncology, 363 Hospital, Chengdu, Sichuan, China
| | - Yang Wang
- Department of Oncology, 363 Hospital, Chengdu, Sichuan, China
| | - Liang He
- Department of Oncology, 363 Hospital, Chengdu, Sichuan, China
| | - Jiayu Ma
- Department of Oncology, 363 Hospital, Chengdu, Sichuan, China
| | - Guanghua Li
- Department of Oncology, 363 Hospital, Chengdu, Sichuan, China
| | - Lei Liu
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Peng H, Yang H, Lei J, Dai X, Cao P, Jin F, Luo H. Optimal fractionation and timing of weekly cone-beam CT in daily surface-guided radiotherapy for breast cancer. Radiat Oncol 2023; 18:112. [PMID: 37408037 DOI: 10.1186/s13014-023-02279-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/08/2023] [Indexed: 07/07/2023] Open
Abstract
PURPOSE Surface-guided radiotherapy (SGRT) has been demonstrated to be a promising supplement to cone-beam computed tomography (CBCT) in adjuvant breast cancer radiotherapy, but a rational combination mode is lacking in clinical practice. The aim of this study was to explore this mode and investigate its impact on the setup and dose accuracy. METHODS AND MATERIALS Daily SGRT and weekly CBCT images were acquired for 23 patients with breast cancer who received conventional fractionated radiotherapy after lumpectomy. Sixteen modes were acquired by randomly selecting one (CBCT1), two (CBCTij), three (CBCTijk), four (CBCTijkl), and five (CBCT12345) images from the CBCT images for fusion with the SGRT. The CTV-PTV margins, OAR doses, and dose coverage (V95%) of PTV and CTV was calculated based on SGRT setup errors with different regions of interest (ROIs). Dose correlations between these modalities were investigated using Pearson and Spearman's methods. Patient-specific parameters were recorded to assess their impact on dose. RESULTS The CTV-PTV margins decreased with increasing CBCT frequencies and were close to 5 mm for CBCTijkl and CBCT12345. For the ipsilateral breast ROI, SGRT errors were larger in the AP direction, and target doses were higher in all modes than in the whole breast ROI (P < 0.05). In the ipsilateral ROI, the target dose correlations between all modes increased with increasing CBCT time intervals, decreased, and then increased with increasing CBCT frequencies, with the inflection point being CBCT participation at week 5. The dose deviations in CBCT123, CBCT124, CBCT125, CBCTijkl, and CBCT12345 were minimal and did not differ significantly (P > 0.05). There was excellent agreement between CBCT124 and CBCT1234, and between (CBCTijkl, CBCT12345) and CBCT125 in determining the classification for the percentage of PTV deviation (Kappa = 0.704-0.901). In addition, there were weak correlations between the patient's Dips_b (ipsilateral breast diameter with bolus) and CTV doses in modes with CBCT participation at week 4 (R = 0.270 to 0.480). CONCLUSIONS Based on weekly CBCT, these modes with ipsilateral ROI and a combination of daily SGRT and a CBCT frequency of ≥ 3 were recommended, and CBCT was required at weeks 1 and 2 for CBCTijk.
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Affiliation(s)
- Haiyan Peng
- Departments of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Han Yang
- Departments of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Jinyan Lei
- Departments of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Xinyao Dai
- Departments of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Panpan Cao
- Departments of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Fu Jin
- Departments of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, People's Republic of China.
| | - Huanli Luo
- Departments of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, People's Republic of China.
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