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Augurio A, Macchia G, Caravatta L, Lucarelli M, Di Gugliemo F, Vinciguerra A, Seccia B, De Sanctis V, Autorino R, Delle Curti C, Meregalli S, Perrucci E, Raspanti D, Cerrotta A. Contouring of emerging organs-at-risk (OARS) of the female pelvis and interobserver variability: A study by the Italian association of radiotherapy and clinical oncology (AIRO). Clin Transl Radiat Oncol 2023; 43:100688. [PMID: 37854671 PMCID: PMC10579954 DOI: 10.1016/j.ctro.2023.100688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/30/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
Purpose To provide straightforward instructions for daily practice in delineating emerging organs-at-risk (OARs) of the female pelvis and to discuss the interobserver variability in a two-step multicenter study. Methods and materials A contouring atlas with anatomical boundaries for each emerging OAR was realized by radiation oncologists and radiologists who are experts in pelvic imaging, as per their knowledge and clinical practice. These contours were identified as quality benchmarks for the analysis subsequently carried out. Radiation oncologists not involved in setting the custom-built contouring atlas and interested in the treatment of gynecological cancer were invited to participate in this 2-step trial. In the first step all participants were supplied with a selected clinical case of locally advanced cervical cancer and had to identify emerging OARs (Levator ani muscle; Puborectalis muscle; Internal anal sphincter; External anal sphincter; Bladder base and trigone; Bladder neck; Iliac Bone Marrow; Lower Pelvis Bone Marrow; Lumbosacral Bone Marrow) based on their own personal knowledge of pelvic anatomy and experience. The suggested OARs and the contouring process were then presented at a subsequent webinar meeting with a contouring laboratory. Finally, in the second step, after the webinar meeting, each participant who had joined the study but was not involved in setting the benchmark received the custom-built contouring atlas with anatomical boundaries and was requested to delineate again the OARs using the tool provided. The Dice Similarity Coefficient (DSC) and the Jaccard Similarity Coefficient (JSC) were used to evaluate the spatial overlap accuracy of the different volume delineations and compared with the benchmark; the Hausdorff distance (HD) and the mean distance to agreement (MDA) to explore the distance between contours. All the results were reported as sample mean and standard deviation (SD). Results Fifteen radiation oncologists from different Institutions joined the study. The participants had a high agreement degree for pelvic bones sub-structures delineation according to DICE (IBM: 0.9 ± 0.02; LPBM: 0.91 ± 0.01). A moderate degree according to DICE was showed for ovaries (Right: 0.61 ± 0.16, Left: 0.72 ± 0.05), vagina (0.575 ± 0.13), bladder sub-structures (0.515 ± 0.08) and EAS (0.605 ± 0.05), whereas a low degree for the other sub-structures of the anal-rectal sphincter complex (LAM: 0.345 ± 0.07, PRM: 0.41 ± 0.10, and IAS: 0.4 ± 0.07). Conclusion This study found a moderate to low level of agreement in the delineation of the female pelvis emerging OARs, with a high degree of variability among observers. The development of delineation tools should be encouraged to improve the routine contouring of these OARs and increase the quality and consistency of radiotherapy planning.
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Affiliation(s)
- A. Augurio
- Department of Radiation Oncology, SS. Annunziata Hospital, Via Dei Vestini, 66100 Chieti, Italy
| | - G. Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 1, 86100 Campobasso, Italy
| | - L. Caravatta
- Department of Radiation Oncology, SS. Annunziata Hospital, Via Dei Vestini, 66100 Chieti, Italy
| | - M. Lucarelli
- Department od Radiotion Oncology, SS Annunziata Hospital, "G. D'Annunzio" University, Via dei Vestini, 66100 Chieti, Italy
| | - F. Di Gugliemo
- Department od Radiotion Oncology, SS Annunziata Hospital, "G. D'Annunzio" University, Via dei Vestini, 66100 Chieti, Italy
| | - A. Vinciguerra
- Department of Radiation Oncology, SS. Annunziata Hospital, Via Dei Vestini, 66100 Chieti, Italy
| | - B. Seccia
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D’Annunzio” University, Via Luigi Polacchi 11, 66100 Chieti, Italy
| | - V. De Sanctis
- Radiotherapy Oncology, Department of Medicine and Surgery and Translational Medicine, Sapienza University of Rome, S. Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - R. Autorino
- Oncological Radiotherapy Unit, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Via Giuseppe Moscati, 31, 00168 Rome, Italy
| | - C. Delle Curti
- Radioterapia Oncologica, Fondazione IRCS, Istituto Nazionale dei Tumori di Milano, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - S. Meregalli
- Radiotherapy Unit, Azienda Ospedaliera San Gerardo, Via G. B. Pergolesi, 33, 20900 Monza, Italy
| | - E. Perrucci
- Radiation Oncology Section, Perugia General Hospital, Piazzale Giorgio Menghini, 3, 06129 Perugia, Italy
| | - D. Raspanti
- Temasinergie S.p.A., Via Marcello Malpighi 120, Faenza, Italy
| | - A. Cerrotta
- Radioterapia Oncologica, Fondazione IRCS, Istituto Nazionale dei Tumori di Milano, Via Giacomo Venezian, 1, 20133 Milano, Italy
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Lao Y, Cao M, Yang Y, Kishan AU, Yang W, Wang Y, Sheng K. Bladder surface dose modeling in prostate cancer radiotherapy: An analysis of motion-induced variations and the cumulative dose across the treatment. Med Phys 2021; 48:8024-8036. [PMID: 34734414 DOI: 10.1002/mp.15326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/15/2021] [Accepted: 10/21/2021] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To introduce a novel surface-based dose mapping method to improve quantitative bladder dosimetric assessment in prostate cancer (PC) radiotherapy. METHODS Based on the planning and daily pre and postfraction MRIs of 12 PC patients, bladder surface models (SMs) were generated on manually delineated contours and regionally aligned via surface-based registration. Subsequently, bladder surface dose models (SDMs) were created using face-wise dose sampling. To determine the bladder intrafractional and interfractional motion and dose variation, we performed a pose analysis between pre and postfraction bladder SMs, as well as surface mapping for fractional SMs. Discrepancies between the received dose, accumulated from daily SDMs, and the planned dose were then assessed on the corresponding SDMs. Complementary to the surface dose mapping, dose surface histogram (DSH)-based comparisons were also performed. RESULTS The intrafraction pose analysis revealed a significant (p < 0.05) bladder expansion, as well as an anterior/superior drift during the treatment. The intrafraction motion substantially altered dose to mid-bladder body, but not the bladder surface areas distal to or contiguous with the target. A similar pattern of dose variations was also detected by interfraction comparisons. With surface registration to the common SM, the cumulative bladder dose significantly differs from the planned dose. The discrepancy is evident in the mid-posterior range that corresponds to a mid- to high-dose region. The received DSH significantly differs from the planned DSH after permutation correction (p = 0.0122), while the overall surface-based comparison after multiple comparison correction is nonsignificant (p = 0.0800). CONCLUSIONS We developed a novel surface-based intra and interdose mapping framework applied to a unique daily MR dataset for image-guided radiotherapy. The framework identified significant intrafraction bladder positional changes, localized the intra and interfraction variations, and quantified planned versus received dose differences on the bladder surface. The result indicates the importance of adopting the motion-integrated bladder SDM for bladder dose management.
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Affiliation(s)
- Yi Lao
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | - Minsong Cao
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | - Yingli Yang
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | - Wensha Yang
- Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA
| | - Yalin Wang
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, Arizona, USA
| | - Ke Sheng
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
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Takeda K, Umezawa R, Ishikawa Y, Yamamoto T, Takahashi N, Takeda K, Kadoya N, Matsushita H, Kawasaki Y, Mitsuzuka K, Ito A, Arai Y, Takai Y, Jingu K. Clinical predictors of severe late urinary toxicity after curative intensity-modulated radiation therapy for localized prostate cancer. JOURNAL OF RADIATION RESEARCH 2021:rrab074. [PMID: 34467400 DOI: 10.1093/jrr/rrab074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/17/2021] [Indexed: 06/13/2023]
Abstract
Intractable late urinary toxicity is a serious complication after radiotherapy for patients with localized prostate cancer (LPC). We assessed clinical factors correlated with severe late urinary toxicity in LPC treated with curative image-guided intensity-modulated radiation therapy (IMRT). A total of 452 patients with LPC treated with IMRT between 2002 and 2016 were retrospectively analyzed. Among them, 432 patients received androgen deprivation therapy (ADT). The median total irradiated doses were 80 (range, 76-80) Gy. Each daily dose was 2 Gy per fraction. The median follow-up was 83 (range, 4-210) months. Late urinary toxicity was scored according to the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 4.03. Grade 3 late urinary toxicity was observed in 27 patients. No cases with grade ≥ 4 late urinary toxicity were observed. The 5-, 10-, and 12.5-year grade 3 late urinary toxicity-free survival rates were 97%, 91.8% and 88.1%, respectively. Age, risk classification, total irradiated dose, ADT duration, antithrombotic therapy (AT), cardiovascular disease, hypertension (HT), diabetes mellitus (DM), dyslipidemia (DL), prior transurethral resection of the prostate (TURP) and prior high-intensity focused ultrasound (HIFU) were investigated for correlations with grade 3 late urinary toxicity. In univariate analysis, AT and prior HIFU and no other studied factors, were correlated with grade 3 late urinary toxicity. AT and prior HIFU appear to be predictive of grade 3 late urinary toxicity. Patients with LPC with these relevant clinical factors should be carefully followed up by sharing detailed information with the urology department.
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Affiliation(s)
- Ken Takeda
- Course of Radiological Technology, Health Sciences, Tohoku University School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Yojiro Ishikawa
- Department of Radiation Oncology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Kazuya Takeda
- Department of Radiation Oncology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Haruo Matsushita
- Department of Radiation Oncology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Yoshihide Kawasaki
- Department of Urology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Koji Mitsuzuka
- Department of Urology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Akihiro Ito
- Department of Urology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Yoichi Arai
- Department of Urology, Miyagi Cancer Center, 47-1, Medeshimashiotenodayama, Natori, 981-1293, Japan
| | - Yoshihiro Takai
- Southern Tohoku BNCT Research Center, 7-10, Yatsuyamada, Koriyama, 963-8052, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
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Ebert MA, Gulliford S, Acosta O, de Crevoisier R, McNutt T, Heemsbergen WD, Witte M, Palma G, Rancati T, Fiorino C. Spatial descriptions of radiotherapy dose: normal tissue complication models and statistical associations. Phys Med Biol 2021; 66:12TR01. [PMID: 34049304 DOI: 10.1088/1361-6560/ac0681] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/28/2021] [Indexed: 12/20/2022]
Abstract
For decades, dose-volume information for segmented anatomy has provided the essential data for correlating radiotherapy dosimetry with treatment-induced complications. Dose-volume information has formed the basis for modelling those associations via normal tissue complication probability (NTCP) models and for driving treatment planning. Limitations to this approach have been identified. Many studies have emerged demonstrating that the incorporation of information describing the spatial nature of the dose distribution, and potentially its correlation with anatomy, can provide more robust associations with toxicity and seed more general NTCP models. Such approaches are culminating in the application of computationally intensive processes such as machine learning and the application of neural networks. The opportunities these approaches have for individualising treatment, predicting toxicity and expanding the solution space for radiation therapy are substantial and have clearly widespread and disruptive potential. Impediments to reaching that potential include issues associated with data collection, model generalisation and validation. This review examines the role of spatial models of complication and summarises relevant published studies. Sources of data for these studies, appropriate statistical methodology frameworks for processing spatial dose information and extracting relevant features are described. Spatial complication modelling is consolidated as a pathway to guiding future developments towards effective, complication-free radiotherapy treatment.
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Affiliation(s)
- Martin A Ebert
- School of Physics, Mathematics and Computing, University of Western Australia, Crawley, Western Australia, Australia
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- 5D Clinics, Claremont, Western Australia, Australia
| | - Sarah Gulliford
- Department of Radiotherapy Physics, University College Hospitals London, United Kingdom
- Department of Medical Physics and Bioengineering, University College London, United Kingdom
| | - Oscar Acosta
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI-UMR 1099, F-35000 Rennes, France
| | | | - Todd McNutt
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | - Marnix Witte
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Giuseppe Palma
- Institute of Biostructures and Bioimaging, National Research Council, Napoli, Italy
| | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
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Vaginal dose-surface maps in cervical cancer brachytherapy: Methodology and preliminary results on correlation with morbidity. Brachytherapy 2021; 20:565-575. [PMID: 33741274 DOI: 10.1016/j.brachy.2021.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/28/2021] [Accepted: 02/07/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of the study was to develop a methodology for vaginal dose-surface maps (DSMs) in patients with cervix cancer and to investigate dose-surface histogram metrics as predictors for vaginal stenosis (St) and mucositis (Muc). METHODS AND MATERIALS Thirty-one patients with locally advanced cervix cancer with no vaginal St/Muc (CTCAE-v3) G ≥ 2 at baseline were analyzed. Patients were divided in four morbidity groups: 15 with St/Muc G0/1, 6 with St G ≥ 2, 4 with St/Muc G ≥ 2, and 6 with Muc G ≥ 2. Patients received external beam radiotherapy and 4-fraction intracavitary/interstitial high-dose-rate brachytherapy using tandem and ovoids. DSMs were generated from inner/outer vaginal surfaces. DSMs of external beam radiotherapy and brachytherapy (Gy EQD23) were added based on a system of homologous points, to generate cumulative DSMs. Dose-surface histogram/dose-volume histogram parameters, location of high/intermediate-dose regions, rectovaginal reference point, vaginal lateral 5 mm point doses, and vagina/implant dimensions were investigated for St and Muc prediction. Average/difference DSMs and one-way analysis of variance were used to compare between groups. RESULTS Best predictors of stenosis were D15-25cm2 and upper-vagina S65-120Gy(%). Cutoffs of ∼90 Gy EQD23 for D20cm2 and ∼80% for S65Gy to top 3 cm inner vaginal surface suitably discriminated for stenosis. Spatial dose location on average/difference DSMs showed significantly higher doses (by > 20 Gy, p < 0.001) over longer parts of the dorsolateral vagina and higher rectovaginal reference point doses for any G ≥ 2 morbidity, over the whole circumference of the upper vagina for G ≥ 2 stenosis. Dose-volume histogram parameters were dependent on vaginal wall thickness. An increase of wall thickness from 2 to 4 mm resulted in an increase of D2cm3 (D4cm3) of 16% (32%). CONCLUSIONS A novel method was developed to generate vaginal DSMs and spatial-dose metrics. DSMs were found to correlate with vaginal stenosis. The findings of this study are promising and should be further validated on a larger patient cohort, treated with different applicators.
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Spampinato S, Fokdal LU, Pötter R, Haie-Meder C, Lindegaard JC, Schmid MP, Sturdza A, Jürgenliemk-Schulz IM, Mahantshetty U, Segedin B, Bruheim K, Hoskin P, Rai B, Huang F, Cooper R, van der Steen-Banasik E, Van Limbergen E, Sundset M, Westerveld H, Nout RA, Jensen NBK, Kirisits C, Kirchheiner K, Tanderup K. Importance of the ICRU bladder point dose on incidence and persistence of urinary frequency and incontinence in locally advanced cervical cancer: An EMBRACE analysis. Radiother Oncol 2020; 158:300-308. [PMID: 33065183 DOI: 10.1016/j.radonc.2020.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/25/2020] [Accepted: 10/02/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To identify patient- and treatment-related risk factors and dose-effects for urinary frequency and incontinence in locally advanced cervical cancer (LACC) treated with radio(chemo)therapy and image-guided adaptive brachytherapy (IGABT). MATERIAL AND METHODS Physician-assessed (CTCAE) and patient-reported (EORTC) frequency and incontinence recorded in the EMBRACE-I study were analysed. Risk factors analysis was performed in patients without bladder infiltration and with baseline morbidity available. Cox regression was used for CTCAE grade (G) ≥ 3 and G ≥ 2 and for EORTC "very much" and "quite a bit" or worse. Logistic regression was used for late persistent morbidity defined when CTCAE G ≥ 1 or EORTC ≥ "quite a bit" were scored in at least half of follow-ups. RESULTS Longitudinal data on 1153 and 884 patients were available for CTCAE and EORTC analysis, respectively. Median follow-up was 48[3-120] months. Crude incidence rates of G≥2 were 13% and 11% for frequency and incontinence, respectively. Baseline morbidity and overweight-obesity were risk factors for both symptoms. Elderly patients were at higher risk for incontinence. Patients receiving conformal-radiotherapy were at higher risk for frequency. ICRU bladder point (ICRU-BP) dose was a stronger predictor for incontinence than bladder D2cm3. The 5-year actuarial estimate of G ≥ 2 incontinence increased from 11% to 20% with ICRU-BP doses > 75 Gy compared to ≤ 65 Gy. Frequency showed weaker associations with dose. CONCLUSION ICRU-BP dose, in addition to clinical parameters, is a risk factor for urinary incontinence and shows a dose-effect after radio(chemo)therapy and IGABT. ICRU-BP dose should be monitored during treatment planning alongside volumetric parameters. Frequency seems associated with larger irradiated volumes.
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Affiliation(s)
- Sofia Spampinato
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
| | - Lars U Fokdal
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Richard Pötter
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | | | | | - Maximilian P Schmid
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Alina Sturdza
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | | | | | - Barbara Segedin
- Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Kjersti Bruheim
- Department of Oncology, The Norwegian Radium Hospital - Oslo University Hospital, Oslo, Norway
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, United Kingdom
| | - Bhavana Rai
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Fleur Huang
- Department of Oncology, Cross Cancer Institute and University of Alberta, Edmonton, Canada
| | - Rachel Cooper
- Leeds Cancer Centre, St James's University Hospital, Leeds, United Kingdom
| | | | | | - Marit Sundset
- Clinic of Oncology and Women's Clinic, St. Olavs Hospital, Trondheim, Norway
| | - Henrike Westerveld
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
| | - Remi A Nout
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina B K Jensen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Kirisits
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Kathrin Kirchheiner
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Kari Tanderup
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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McWilliam A, Dootson C, Graham L, Banfill K, Abravan A, van Herk M. Dose surface maps of the heart can identify regions associated with worse survival for lung cancer patients treated with radiotherapy. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2020; 15:46-51. [PMID: 33458326 PMCID: PMC7807666 DOI: 10.1016/j.phro.2020.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 07/06/2020] [Accepted: 07/10/2020] [Indexed: 12/13/2022]
Abstract
Creation of a modified cylindrical coordinate system to map cardiac surface dose. Validation of mapping using internal anatomical sub-structures. Identification of surface regions were excess dose is associated with poorer survival.
Background and purpose For lung cancer patients treated with radiotherapy, radiation dose to the heart has been associated with overall survival, with volumetric dose statistics widely presented. However, critical cardiac structures are present on the hearts surface, where this approach may be sub-optimal. In this work we present a methodology for creating cardiac surface dose maps and identify regions where excess dose is associated with in worse overall survival. Material and methods A modified cylindrical coordinate system was implemented to map the cardiac surface dose for lung cancer patients. Validation was performed by mapping the cardiac chambers for 55 patients, fitting a point spread function (PSF) to the blurred edge. To account for this uncertainty, dose maps were blurred by a 2D-Gaussian with width described by the PSF. Permutation testing identified regions where excess dose was associated with worse patient survival. The 99th percentile of the max t-value then defined a cardiac surface region to extract dose, from each patient, to be analysed in a multivariable cox-proportional hazards survival model. Results Cardiac surface maps were created for 648 lung cancer patients. Cardiac surface dose maps were blurred with a 2D- Gaussian filter of size σφ = 4.3° and σy = 1.3units to account for mapping uncertainties. Permutation testing identified significant differences across the surface of the right atria, p < 0.001, at all timepoints. The median dose to the region defined by the 99th percentile of the maximum t-value was 18.5 Gy. Multivariable analysis showed the dose to this region was significantly associated with survival, hazard ratio 1.01 Gy−1, p = 0.03, controlling for confounding variables. Conclusions Cardiac surface mapping was successfully implemented and identified a region where excess dose was associated with worse patient survival. This region extended over the right atria, potentially suggesting an interaction with the hearts electrical conduction system.
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Affiliation(s)
- Alan McWilliam
- Division of Clinical Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK
| | - Chloe Dootson
- Department of Physics and Astronomy, The University of Manchester, UK
| | - Lewis Graham
- Department of Physics and Astronomy, The University of Manchester, UK
| | - Kathryn Banfill
- Division of Clinical Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK
| | - Azadeh Abravan
- Division of Clinical Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK
| | - Marcel van Herk
- Division of Clinical Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK
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Casares-Magaz O, Moiseenko V, Witte M, Rancati T, Muren LP. Towards spatial representations of dose distributions to predict risk of normal tissue morbidity after radiotherapy. Phys Imaging Radiat Oncol 2020; 15:105-107. [PMID: 33458334 PMCID: PMC7807547 DOI: 10.1016/j.phro.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Oscar Casares-Magaz
- Department of Medical Physics - Oncology, Aarhus University/Aarhus University Hospital, Aarhus, Denmark
| | - Vitali Moiseenko
- Department of Radiation Medicine and Applied Science, University of California San Diego, La Jolla, CA, United States
| | - Marnix Witte
- Cluster Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Ludvig P Muren
- Department of Medical Physics - Oncology, Aarhus University/Aarhus University Hospital, Aarhus, Denmark
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9
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Local dose analysis to predict acute and late urinary toxicities after prostate cancer radiotherapy: Assessment of cohort and method effects. Radiother Oncol 2020; 147:40-49. [DOI: 10.1016/j.radonc.2020.02.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/28/2020] [Accepted: 02/28/2020] [Indexed: 01/03/2023]
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10
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Spampinato S, Tanderup K, Marinovskij E, Axelsen S, Pedersen EM, Pötter R, Lindegaard JC, Fokdal L. MRI-based contouring of functional sub-structures of the lower urinary tract in gynaecological radiotherapy. Radiother Oncol 2020; 145:117-124. [DOI: 10.1016/j.radonc.2019.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/15/2019] [Accepted: 12/15/2019] [Indexed: 01/21/2023]
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Shimizu H, Sasaki K, Ito M, Aoyama T, Tachibana H, Tomita N, Makita C, Tanaka H, Koide Y, Iwata T, Kodaira T. Impact of treatment planning using a structure block function on the target and organ doses related to patient movement in cervical esophageal cancer: A phantom study. J Appl Clin Med Phys 2019; 20:75-83. [PMID: 30997729 PMCID: PMC6523256 DOI: 10.1002/acm2.12582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/06/2022] Open
Abstract
Helical tomotherapy (HT) can restrict beamlets passing through the virtual contour on computed tomography (CT) image in dose optimization, reducing the dose to organs at risk (OARs). Beamlet restriction limits the incident beamlet angles; thus, the proper planning target volume (PTV) margin may differ from that of the standard treatment plan without beamlet restriction, depending on the patient's movement during dose delivery. Dose distribution changes resulting from patient movement have not been described for treatment plans with beamlet restriction. This study quantified changes in dose distribution to the target and OARs when beamlet restriction is applied to cervical esophageal cancer treatment plan using HT by systematically shifting a phantom. Treatment plans for cervical esophageal cancers with and without beamlet restriction modes [directional block (DB) and nonblock (NB), respectively] were designed for CT images of the RANDO phantom. The PTV margin for the DB mode was set to be the same as that for the NB mode (5 mm). The CT image was intentionally shifted by ±1, ±2, and ±3 voxels in the left–right, anterior–posterior, and superior–inferior directions, and the dose distribution was recalculated for each position using the fluence for the NB or DB mode. When the phantom shift was within the same PTV margin as the NB mode, changes in doses to the targets, lungs, heart, and spinal cord in the DB mode were small as those in the NB mode. In conclusion, the virtual contour shape used in this study would provide safe delivery even with patient movement within the same PTV margin as for the NB mode.
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Affiliation(s)
- Hidetoshi Shimizu
- Department of Radiation Oncology Aichi Cancer Center Hospital Nagoya Aichi Japan
- Graduate School of Radiological Technology Gunma Prefectural College of Health Sciences Maebashi Gunma Japan
| | - Koji Sasaki
- Graduate School of Radiological Technology Gunma Prefectural College of Health Sciences Maebashi Gunma Japan
| | - Makoto Ito
- Department of Radiology Aichi Medical University Hospital Nagakute Aichi Japan
| | - Takahiro Aoyama
- Department of Radiation Oncology Aichi Cancer Center Hospital Nagoya Aichi Japan
| | - Hiroyuki Tachibana
- Department of Radiation Oncology Aichi Cancer Center Hospital Nagoya Aichi Japan
| | - Natsuo Tomita
- Department of Radiology Nagoya City University Hospital Nagoya Aichi Japan
| | - Chiyoko Makita
- Department of Radiation Oncology Gifu Prefectural General Medical Center Gifu City Gifu Japan
| | - Hiroshi Tanaka
- Department of Radiation Oncology Aichi Cancer Center Hospital Nagoya Aichi Japan
| | - Yutaro Koide
- Department of Radiation Oncology Aichi Cancer Center Hospital Nagoya Aichi Japan
| | - Tohru Iwata
- Department of Radiation Oncology Aichi Cancer Center Hospital Nagoya Aichi Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology Aichi Cancer Center Hospital Nagoya Aichi Japan
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12
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Lideståhl A, Mondlane G, Gubanski M, Lind PA, Siegbahn A. An in silico planning study comparing doses and estimated risk of toxicity in 3D-CRT, IMRT and proton beam therapy of patients with thymic tumours. Phys Med 2019; 60:120-126. [DOI: 10.1016/j.ejmp.2019.03.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 12/25/2022] Open
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13
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Spampinato S, Fokdal L, Marinovskij E, Axelsen S, Pedersen E, Pötter R, Lindegaard J, Tanderup K. Assessment of dose to functional sub-structures in the lower urinary tract in locally advanced cervical cancer radiotherapy. Phys Med 2019; 59:127-132. [DOI: 10.1016/j.ejmp.2019.01.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/27/2019] [Accepted: 01/30/2019] [Indexed: 01/21/2023] Open
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14
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Mylona E, Acosta O, Lizee T, Lafond C, Crehange G, Magné N, Chiavassa S, Supiot S, Ospina Arango JD, Campillo-Gimenez B, Castelli J, de Crevoisier R. Voxel-Based Analysis for Identification of Urethrovesical Subregions Predicting Urinary Toxicity After Prostate Cancer Radiation Therapy. Int J Radiat Oncol Biol Phys 2019; 104:343-354. [PMID: 30716523 DOI: 10.1016/j.ijrobp.2019.01.088] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 01/22/2019] [Accepted: 01/26/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE To apply a voxel-based analysis to identify urethrovesical symptom-related subregions (SRSs) associated with acute and late urinary toxicity in prostate cancer radiation therapy. METHODS AND MATERIALS Two hundred seventy-two patients with prostate cancer treated with intensity-modulated radiation therapy/image-guided radiation therapy were analyzed prospectively. Each patient's computed tomography imaging was spatially normalized to a common coordinate system via nonrigid registration. The obtained deformation fields were used to map the dose of each patient to the common coordinate system. A voxel-based statistical analysis was applied to generate 3-dimensional dose-volume maps for different urinary symptoms, allowing the identification of corresponding SRSs with statistically significant dose differences between patients with or without toxicity. Each SRS was propagated back to each individual's native space, and dose-volume histograms (DVHs) for the SRSs and the whole bladder were computed. Logistic and Cox regression were used to estimate the SRS's prediction capability compared with the whole bladder. RESULTS A local dose-effect relationship was found in the bladder and the urethra. SRSs were identified for 5 symptoms: acute incontinence in the urethra, acute retention in the bladder trigone, late retention and dysuria in the posterior part of the bladder, and late hematuria in the superior part of the bladder, with significant dose differences between patients with and without toxicity, ranging from 1.2 to 9.3 Gy. The doses to the SRSs were significantly predictive of toxicity, with maximum areas under the receiver operating characteristic curve of 0.73 for acute incontinence, 0.62 for acute retention, 0.70 for late retention, 0.81 for late dysuria, and 0.67 for late hematuria. The bladder DVH was predictive only for late retention, dysuria, and hematuria (area under the curve, 0.65-0.72). CONCLUSIONS The dose delivered to the urethra and the posterior and superior parts of the bladder was predictive of acute incontinence and retention and of late retention, dysuria, and hematuria. The dose to the whole bladder was moderately predictive.
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Affiliation(s)
- Eugenia Mylona
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, F-35000 Rennes, France
| | - Oscar Acosta
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, F-35000 Rennes, France
| | - Thibaut Lizee
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, F-35000 Rennes, France
| | - Caroline Lafond
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, F-35000 Rennes, France
| | - Gilles Crehange
- Department of Radiation Oncology, Centre Georges François Leclerc, Dijon, France
| | - Nicolas Magné
- Department of Radiation Oncology, Lucien Neuwirth Cancer Institute, St Priest en Jarez, France
| | - Sophie Chiavassa
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Saint Herblain, France
| | - Stéphane Supiot
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Saint Herblain, France
| | - Juan David Ospina Arango
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, F-35000 Rennes, France; Universidad Nacional de Colombia, Medellin, Colombia
| | | | - Joel Castelli
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, F-35000 Rennes, France
| | - Renaud de Crevoisier
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, F-35000 Rennes, France.
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15
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Development of a prediction model for late urinary incontinence, hematuria, pain and voiding frequency among irradiated prostate cancer patients. PLoS One 2018; 13:e0197757. [PMID: 30016325 PMCID: PMC6049922 DOI: 10.1371/journal.pone.0197757] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 05/08/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Incontinence, hematuria, voiding frequency and pain during voiding are possible side effects of radiotherapy among patients treated for prostate cancer. The objective of this study was to develop multivariable NTCP models for these side effects. MATERIAL AND METHODS This prospective cohort study was composed of 243 patients with localized or locally advanced prostate cancer (stage T1-3). Genito-urinary (GU) toxicity was assessed using a standardized follow-up program. The GU toxicity endpoints were scored using the Common Terminology Criteria for Adverse Events version 3.0 (CTCAE 3.0) scoring system. The full bladder and different anatomical subregions within the bladder were delineated. A least absolute shrinkage and selection operator (LASSO) logistic regression analysis was used to analyze dose volume effects on the four individual endpoints. RESULTS In the univariable analysis, urinary incontinence was significantly associated with dose distributions in the trigone (V55-V75, mean). Hematuria was significantly associated with the bladder wall dose (V40-V75, mean), bladder dose (V70-V75), cardiovascular disease and anticoagulants use. Pain during urinating was associated with the dose to the trigone (V50-V75, mean) and with trans transurethral resection of the prostate (TURP). In the final multivariable model urinary incontinence was associated with the mean dose of the trigone. Hematuria was associated with bladder wall dose (V75) and cardiovascular disease, while pain during urinating was associated with trigone dose (V75) and TURP. No significant associations were found for increase in voiding frequency. CONCLUSIONS Radiation-induced urinary side effects are associated with dose distributions to different organs as risk. Given the dose effect relationships found, decreasing the dose to the trigone and bladder wall may reduce the incidence of incontinence, pain during voiding and hematuria, respectively.
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16
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A case-control study using motion-inclusive spatial dose-volume metrics to account for genito-urinary toxicity following high-precision radiotherapy for prostate cancer. Phys Imaging Radiat Oncol 2018; 7:65-69. [PMID: 33458407 PMCID: PMC7807649 DOI: 10.1016/j.phro.2018.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/19/2018] [Accepted: 09/24/2018] [Indexed: 11/21/2022] Open
Abstract
Background and purpose Material and methods Results Conclusions
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17
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Understanding Urinary Toxicity after Radiotherapy for Prostate Cancer: First Steps Forward. TUMORI JOURNAL 2017; 103:395-404. [DOI: 10.5301/tj.5000681] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2017] [Indexed: 01/10/2023]
Abstract
One of the most relevant achievements of Professor Gianni Bonadonna was the implementation of the methodology of controlled clinical trials in medical oncology. It is valid for all cancer types, oncological disciplines and clinical endpoints, both survival and toxicity. This narrative review reports on the status of the current knowledge of the radiation-induced urinary syndrome after external-beam radiotherapy for prostate cancer. In recent years, the syndrome has been the object of large-scale prospective observational trials specifically devoted to investigating the association of patient and treatment features with acute/late urinary toxicity. The first results of these trials allow initial attempts at predictive modeling, which can serve as a basis for the optimization of patient selection and treatment planning.
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18
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Casares-Magaz O, Moiseenko V, Hopper A, Pettersson NJ, Thor M, Knopp R, Deasy JO, Muren LP, Einck J. Associations between volume changes and spatial dose metrics for the urinary bladder during local versus pelvic irradiation for prostate cancer. Acta Oncol 2017; 56:884-890. [PMID: 28401808 DOI: 10.1080/0284186x.2017.1312014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Inter-fractional variation in urinary bladder volumes during the course of radiotherapy (RT) for prostate cancer causes deviations between planned and delivered doses. This study compared planned versus daily cone-beam CT (CBCT)-based spatial bladder dose distributions, for prostate cancer patients receiving local prostate treatment (local treatment) versus prostate including pelvic lymph node irradiation (pelvic treatment). MATERIAL AND METHODS Twenty-seven patients (N = 15 local treatment; N = 12 pelvic treatment) were treated using daily image-guided RT (1.8 Gy@43-45 fx), adhering to a full bladder/empty rectum protocol. For each patient, 9-10 CBCTs were registered to the planning CT, using the clinically applied translations. The urinary bladder was manually segmented on each CBCT, 3 mm inner shells were generated, and semi and quadrant sectors were created using axial/coronal cuts. Planned and delivered DVH metrics were compared across patients and between the two groups of treatment (t-test, p < .05; Holm-Bonferroni correction). Associations between bladder volume variations and the dose-volume histograms (DVH) of the bladder and its sectors were evaluated (Spearman's rank correlation coefficient, rs). RESULTS Bladder volumes varied considerably during RT (coefficient of variation: 16-58%). The population-averaged planned and delivered DVH metrics were not significantly different at any dose level. Larger treatment bladder volumes resulted in increased absolute volume of the posterior/inferior bladder sector receiving intermediate-high doses, in both groups. The superior bladder sector received less dose with larger bladder volumes for local treatments (rs ± SD: -0.47 ± 0.32), but larger doses for pelvic treatments (rs ± SD: 0.74 ± 0.24). CONCLUSIONS Substantial bladder volume changes during the treatment course occurred even though patients were treated under a full bladder/daily image-guided protocol. Larger bladder volumes resulted in less bladder wall spared at the posterior-inferior sector, regardless the treatment received. Contrary, larger bladder volumes meant larger delivered doses to the superior bladder sector for pelvic RT but smaller doses for local treatments.
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Affiliation(s)
| | - Vitali Moiseenko
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Austin Hopper
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Niclas Johan Pettersson
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Maria Thor
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Rick Knopp
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Joseph O. Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Ludvig Paul Muren
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - John Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
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19
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Shelley LEA, Scaife JE, Romanchikova M, Harrison K, Forman JR, Bates AM, Noble DJ, Jena R, Parker MA, Sutcliffe MPF, Thomas SJ, Burnet NG. Delivered dose can be a better predictor of rectal toxicity than planned dose in prostate radiotherapy. Radiother Oncol 2017; 123:466-471. [PMID: 28460825 PMCID: PMC5486775 DOI: 10.1016/j.radonc.2017.04.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 01/23/2023]
Abstract
Background and purpose For the first time, delivered dose to the rectum has been calculated and accumulated throughout the course of prostate radiotherapy using megavoltage computed tomography (MVCT) image guidance scans. Dosimetric parameters were linked with toxicity to test the hypothesis that delivered dose is a stronger predictor of toxicity than planned dose. Material and methods Dose–surface maps (DSMs) of the rectal wall were automatically generated from daily MVCT scans for 109 patients within the VoxTox research programme. Accumulated-DSMs, representing total delivered dose, and planned-DSMs, from planning CT data, were parametrised using Equivalent Uniform Dose (EUD) and ‘DSM dose-width’, the lateral dimension of an ellipse fitted to a discrete isodose cluster. Associations with 6 toxicity endpoints were assessed using receiver operator characteristic curve analysis. Results For rectal bleeding, the area under the curve (AUC) was greater for accumulated dose than planned dose for DSM dose-widths up to 70 Gy. Accumulated 65 Gy DSM dose-width produced the strongest spatial correlation (AUC 0.664), while accumulated EUD generated the largest AUC overall (0.682). For proctitis, accumulated EUD was the only reportable predictor (AUC 0.673). Accumulated EUD was systematically lower than planned EUD. Conclusions Dosimetric parameters extracted from accumulated DSMs have demonstrated stronger correlations with rectal bleeding and proctitis, than planned DSMs.
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Affiliation(s)
- L E A Shelley
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Medical Physics and Clinical Engineering, Cambridge University Hospitals NHS Foundation Trust, United Kingdom; Department of Engineering, University of Cambridge, United Kingdom.
| | - J E Scaife
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Oncology, University of Cambridge, United Kingdom
| | - M Romanchikova
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Medical Physics and Clinical Engineering, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - K Harrison
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Cavendish Laboratory, University of Cambridge, United Kingdom
| | - J R Forman
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - A M Bates
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Oncology, University of Cambridge, United Kingdom
| | - D J Noble
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Oncology, University of Cambridge, United Kingdom
| | - R Jena
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Oncology, University of Cambridge, United Kingdom
| | - M A Parker
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Cavendish Laboratory, University of Cambridge, United Kingdom
| | - M P F Sutcliffe
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Engineering, University of Cambridge, United Kingdom
| | - S J Thomas
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Medical Physics and Clinical Engineering, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - N G Burnet
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Oncology, University of Cambridge, United Kingdom
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20
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Rios R, De Crevoisier R, Ospina JD, Commandeur F, Lafond C, Simon A, Haigron P, Espinosa J, Acosta O. Population model of bladder motion and deformation based on dominant eigenmodes and mixed-effects models in prostate cancer radiotherapy. Med Image Anal 2017; 38:133-149. [PMID: 28343079 DOI: 10.1016/j.media.2017.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 02/27/2017] [Accepted: 03/07/2017] [Indexed: 10/20/2022]
Abstract
In radiotherapy for prostate cancer irradiation of neighboring organs at risk may lead to undesirable side-effects. Given this setting, the bladder presents the largest inter-fraction shape variations hampering the computation of the actual delivered dose vs. planned dose. This paper proposes a population model, based on longitudinal data, able to estimate the probability of bladder presence during treatment, using only the planning computed tomography (CT) scan as input information. As in previously-proposed principal component analysis (PCA) population-based models, we have used the data to obtain the dominant eigenmodes that describe bladder geometric variations between fractions. However, we have used a longitudinal analysis along each mode in order to properly characterize patient's variance from the total population variance. We have proposed is a mixed-effects (ME) model in order to separate intra- and inter-patient variability, in an effort to control confounding cohort effects. Other than using PCA, bladder shapes are represented by using spherical harmonics (SPHARM) that additionally enables data compression without information lost. Based on training data from repeated CT scans, the ME model was thus implemented following dimensionality reduction by means of SPHARM and PCA. We have evaluated the model in a leave-one-out cross validation framework on the training data but also using independent data. Probability maps (PMs) were thus generated with several draws from the learnt model as predicted regions where the bladder will likely move and deform. These PMs were compared with the actual regions using metrics based on mutual information distance and misestimated voxels. The prediction was also compared with two previous population PCA-based models. The proposed model was able to reduce the uncertainties in the estimation of the probable region of bladder motion and deformation. This model can thus be used for tailoring radiotherapy treatments.
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Affiliation(s)
- Richard Rios
- INSERM, U1099, F-35000 Rennes, France; Université de Rennes 1, LTSI, F-35000 Rennes, France; Universidad Nacional de Colombia, Facultad de Minas, GAUNAL, Medellín, Colombia.
| | - Renaud De Crevoisier
- INSERM, U1099, F-35000 Rennes, France; Université de Rennes 1, LTSI, F-35000 Rennes, France; CRLCC Eugène Marquis, Département de Radiothérapie, F-35000 Rennes, France
| | - Juan D Ospina
- INSERM, U1099, F-35000 Rennes, France; Université de Rennes 1, LTSI, F-35000 Rennes, France
| | - Frederic Commandeur
- INSERM, U1099, F-35000 Rennes, France; Université de Rennes 1, LTSI, F-35000 Rennes, France
| | - Caroline Lafond
- CRLCC Eugène Marquis, Département de Radiothérapie, F-35000 Rennes, France
| | - Antoine Simon
- INSERM, U1099, F-35000 Rennes, France; Université de Rennes 1, LTSI, F-35000 Rennes, France
| | - Pascal Haigron
- INSERM, U1099, F-35000 Rennes, France; Université de Rennes 1, LTSI, F-35000 Rennes, France
| | - Jairo Espinosa
- Universidad Nacional de Colombia, Facultad de Minas, GAUNAL, Medellín, Colombia
| | - Oscar Acosta
- INSERM, U1099, F-35000 Rennes, France; Université de Rennes 1, LTSI, F-35000 Rennes, France
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21
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Improta I, Palorini F, Cozzarini C, Rancati T, Avuzzi B, Franco P, Degli Esposti C, Del Mastro E, Girelli G, Iotti C, Vavassori V, Valdagni R, Fiorino C. Bladder spatial-dose descriptors correlate with acute urinary toxicity after radiation therapy for prostate cancer. Phys Med 2016; 32:1681-1689. [DOI: 10.1016/j.ejmp.2016.08.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/16/2016] [Accepted: 08/17/2016] [Indexed: 12/13/2022] Open
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22
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The role of medical physics in prostate cancer radiation therapy. Phys Med 2016; 32:435-7. [PMID: 27095755 DOI: 10.1016/j.ejmp.2016.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 03/29/2016] [Accepted: 03/29/2016] [Indexed: 01/20/2023] Open
Abstract
Medical physics, both as a scientific discipline and clinical service, hugely contributed and still contributes to the advances in the radiotherapy of prostate cancer. The traditional translational role in developing and safely implementing new technology and methods for better optimizing, delivering and monitoring the treatment is rapidly expanding to include new fields such as quantitative morphological and functional imaging and the possibility of individually predicting outcome and toxicity. The pivotal position of medical physicists in treatment personalization probably represents the main challenge of current and next years and needs a gradual change of vision and training, without losing the traditional and fundamental role of physicists to guarantee a high quality of the treatment. The current focus issue is intended to cover traditional and new fields of investigation in prostate cancer radiation therapy with the aim to provide up-to-date reference material to medical physicists daily working to cure prostate cancer patients. The papers presented in this focus issue touch upon present and upcoming challenges that need to be met in order to further advance prostate cancer radiation therapy. We suggest that there is a smart future for medical physicists willing to perform research and innovate, while they continue to provide high-quality clinical service. However, physicists are increasingly expected to actively integrate their implicitly translational, flexible and high-level skills within multi-disciplinary teams including many clinical figures (first of all radiation oncologists) as well as scientists from other disciplines.
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