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Ninni S, Gallot-Lavallée T, Klein C, Longère B, Brigadeau F, Potelle C, Crop F, Rault E, Decoene C, Lacornerie T, Lals S, Kouakam C, Pontana F, Lacroix D, Klug D, Mirabel X. Stereotactic Radioablation for Ventricular Tachycardia in the Setting of Electrical Storm. Circ Arrhythm Electrophysiol 2022; 15:e010955. [PMID: 36074658 DOI: 10.1161/circep.122.010955] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stereotactic body radiotherapy (SBRT) has been reported as a safe and efficient therapy for treating refractory ventricular tachycardia (VT) despite optimal medical treatment and catheter ablation. However, data on the use of SBRT in patients with electrical storm (ES) is lacking. The aim of this study was to assess the clinical outcomes associated with SBRT in the context of ES. METHODS This retrospective study included patients who underwent SBRT in the context of ES from March 2020 to March 2021 in one tertiary center (CHU Lille). The target volume was delineated according to a predefined workflow. The efficacy was assessed with the following end points: sustained VT recurrence, VT reduced with antitachycardia pacing, and implantable cardioverter defibrillator shock. RESULTS Seventeen patients underwent SBRT to treat refractory VT in the context of ES (mean 67±12.8 age, 59% presenting ischemic heart disease, mean left ventricular ejection fraction: 33.7± 9.7%). Five patients presented with ES related to incessant VT. Among these 5 patients, the time to effectiveness ranged from 1 to 7 weeks after SBRT. In the 12 remaining patients, VT recurrences occurred in 7 patients during the first 6 weeks following SBRT. After a median 12.5 (10.5-17.8) months follow-up, a significant reduction of the VT burden was observed beyond 6 weeks (-91% [95% CI, 78-103]), P<0.0001). The incidence of implantable cardioverter defibrillator shock and antitachycardia pacing was 36% at 1 year. CONCLUSIONS SBRT is associated with a significant reduction of the VT burden in the event of an ES; however, prospective randomized control trials are needed. In patients without incessant VT, recurrences are observed in half of patients during the first 6 weeks. VT tolerance and implantable cardioverter defibrillator programming adjustments should be integrated as part of an action plan defined before SBRT for each patient.
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Affiliation(s)
- Sandro Ninni
- CHU Lille, Institut Cœur-Poumon, Service de Cardiologie (S.N., T.G.L., C.K., F.B., C.K., D.L., D.K.)
| | - Thomas Gallot-Lavallée
- CHU Lille, Institut Cœur-Poumon, Service de Cardiologie (S.N., T.G.L., C.K., F.B., C.K., D.L., D.K.)
| | - Cédric Klein
- CHU Lille, Institut Cœur-Poumon, Service de Cardiologie (S.N., T.G.L., C.K., F.B., C.K., D.L., D.K.)
| | - Benjamin Longère
- CHU Lille, Institut Cœur-Poumon, Service De Radiologie (B.L., F.P.)
| | - François Brigadeau
- CHU Lille, Institut Cœur-Poumon, Service de Cardiologie (S.N., T.G.L., C.K., F.B., C.K., D.L., D.K.)
| | | | - Frederik Crop
- University Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center (F.C., E.R., C.D., T.L., S.L.).,Medical Physics, Centre Oscar Lambret, Lille, France (F.C., E.R., C.D., T.L.)
| | - Erwann Rault
- University Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center (F.C., E.R., C.D., T.L., S.L.).,Medical Physics, Centre Oscar Lambret, Lille, France (F.C., E.R., C.D., T.L.)
| | - Camille Decoene
- University Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center (F.C., E.R., C.D., T.L., S.L.).,Medical Physics, Centre Oscar Lambret, Lille, France (F.C., E.R., C.D., T.L.)
| | - Thomas Lacornerie
- University Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center (F.C., E.R., C.D., T.L., S.L.).,Medical Physics, Centre Oscar Lambret, Lille, France (F.C., E.R., C.D., T.L.)
| | - Séverine Lals
- University Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center (F.C., E.R., C.D., T.L., S.L.)
| | - Claude Kouakam
- CHU Lille, Institut Cœur-Poumon, Service de Cardiologie (S.N., T.G.L., C.K., F.B., C.K., D.L., D.K.)
| | - François Pontana
- CHU Lille, Institut Cœur-Poumon, Service De Radiologie (B.L., F.P.)
| | - Dominique Lacroix
- CHU Lille, Institut Cœur-Poumon, Service de Cardiologie (S.N., T.G.L., C.K., F.B., C.K., D.L., D.K.)
| | - Didier Klug
- CHU Lille, Institut Cœur-Poumon, Service de Cardiologie (S.N., T.G.L., C.K., F.B., C.K., D.L., D.K.)
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Kolacio MŠ, Rajlić D, Radojčić M, Radojčić ĐS, Obajdin N, Debeljuh DD, Jurković S. Dosimetric accuracy of three dose calculation algorithms for radiation therapy of in situ non-small cell lung carcinoma. Rep Pract Oncol Radiother 2022; 27:86-96. [PMID: 35402037 PMCID: PMC8989458 DOI: 10.5603/rpor.a2022.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background Study determines differences in calculated dose distributions for non-small cell lung carcinoma (NSC LC) patients. NSC LC cases were investigated, being the most common lung cancer treated by radiotherapy in our clinical practice. Materials and methods A retrospective study of 15 NSCLC patient dose distributions originally calculated using standard superposition (SS) and recalculated using collapsed cone (CC ) and Monte Carlo (MC) based algorithm expressed as dose to medium in medium (MCDm) and dose to water in medium (MCDw,) was performed so that prescribed dose covers at least 99% of the gross target volume (GTV). Statistical analysis was performed for differences of conformity index (CI), heterogeneity index (HI), gradient index (GI), dose delivered to 2% of the volume (D2%), mean dose (Dmean) and percentage of volumes covered by prescribed dose (V70Gy). For organs at risk (OARs), Dmean and percentage of volume receiving 20 Gy and 5Gy (V20Gy, V5Gy) were analysed. Results Statistically significant difference for GTVs was observed between MCDw and SS algorithm in mean dose only. For planning target volumes (PTVs), statistically significant differences were observed in prescribed dose coverage for CC, MCDm and MCDw. The differences in mean CI value for the CC algorithm and mean HI value for MCDm and MCDw were statistically significant. There is a statistically significant difference in the number of MUs for MCDm and MCDw compared to SS. Conclusion All investigated algorithms succeed in managing the restrictive conditions of the clinical goals. This study shows the drawbacks of the CC algorithm compared to other algorithms used.
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Affiliation(s)
| | - David Rajlić
- Medical Physics Department, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Milan Radojčić
- Clinic for Radiotherapy and Oncology, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Đeni Smilović Radojčić
- Medical Physics Department, Clinical Hospital Center Rijeka, Rijeka, Croatia.,Department of Medical Physics and Biophysics, University of Rijeka Faculty of Medicine, Rijeka, Croatia
| | - Nevena Obajdin
- Medical Physics Department, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | - Dea Dundara Debeljuh
- Medical Physics Department, Clinical Hospital Center Rijeka, Rijeka, Croatia.,Department of Medical Physics and Biophysics, University of Rijeka Faculty of Medicine, Rijeka, Croatia.,Radiology Department, General Hospital Pula, Pula, Croatia
| | - Slaven Jurković
- Medical Physics Department, Clinical Hospital Center Rijeka, Rijeka, Croatia.,Department of Medical Physics and Biophysics, University of Rijeka Faculty of Medicine, Rijeka, Croatia
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3
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Zeverino M, Jia Y, Charosky L, Bourhis J, Bochud FO, Moeckli R. On the interplay effect for moving targets treated with the CyberKnife static tracking system. Phys Med 2021; 90:30-39. [PMID: 34530213 DOI: 10.1016/j.ejmp.2021.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To assess the interplay effect amplitude between different planned MU distributions and respiratory patterns in the CyberKnife system when treating moving targets with static tracking technique. METHODS Small- and Large-Respiratory Motions (SRM and LRM) differing in amplitude and frequency were simulated in a semi-anthropomorphic dynamic thorax phantom. The interplay effect was evaluated for both respiration motions in terms of GTV coverage and conformity for three plans designed with an increasing range of MU per beam (small, medium and large). Each plan was delivered three times changing the initial beam-on phase to assess the inter-fraction variation. Dose distributions were measured using radiochromic films placed in the GTV axial and sagittal planes. RESULTS Generally, SRM plans gave higher GTV coverage and were less dependent on beam-on phases than LRM plans. For SRM (LRM) plans, the GTV coverage ranged from 95.2% to 99.7% (85.9% to 99.8%). Maximum GTV coverage was found for large MU plans in SRM and for small MU plans in LRM. Minimum GTV coverage was found for medium MU plans for both SRM and LRM. For SRM plans, dose conformity decreased with increasing MU range while the variation was reduced for LRM plans. Large MU plans reduced the inter-fraction variation for SRM and LRM. CONCLUSIONS We confirmed the interplay effect between target motion and beam irradiation time for CyberKnife static tracking. Plans with large MU per beam improved the GTV coverage for small motion amplitude and the inter-fraction dose variation for large motion amplitude.
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Affiliation(s)
- Michele Zeverino
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Yihan Jia
- École polytechnique fédérale de Lausanne- EPFL, Lausanne, Switzerland
| | - Leo Charosky
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Jean Bourhis
- Radiation Oncology Department, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Francois O Bochud
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Raphael Moeckli
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.
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Komiyama T, Saito M, Kuriyama K, Marino K, Aoki S, Saito R, Muramatsu J, Maehata Y, Ze C, Akita T, Yamada T, Sano N, Yoshizawa K, Kazunari A, Hidekazu S, Ueda K, Vu N, Onishi H. Dose Prescription Methods in Stereotactic Body Radiotherapy for Small Peripheral Lung Tumors: Approaches Based on the Gross Tumor Volume Are Superior to Prescribing a Dose That Covers 95% of the Planning Target Volume. Technol Cancer Res Treat 2020; 19:1533033820974030. [PMID: 33272112 PMCID: PMC7720311 DOI: 10.1177/1533033820974030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose: We aimed to validate the usefulness of prescriptions based on gross tumor volume for stereotactic body radiotherapy for small peripheral lung tumors. Materials and Methods: Radiotherapy treatment planning data of 50 patients with small peripheral lung tumors (adenocarcinoma: 24, squamous cell carcinoma: 10, other: 1, unknown: 15) receiving breath-hold computed tomography-guided stereotactic body radiotherapy at our institution during 2013–2016 were analyzed. For each case, 3 dose prescription methods were applied: one based on 95% (PTVD95%) of the planning target volume, one based on 50% of the gross tumor volume (GTVD50%), and one based on 98% (GTVD98%) of the gross tumor volume. The maximum (GTVDmax), minimum (GTVDmin), and mean gross tumor volume dose (GTVDmean) and the dose covering 98% of the gross tumor volume were calculated to evaluate variations in the gross tumor volume dose. Results: Upon switching to GTVD50%, the variations in GTVDmax and GTVDmean decreased significantly, compared with variations observed for PTVD95% (p < 0.01), but the variation in GTVDmin increased significantly (p < 0.01). Upon switching to the GTVD98%, the variation in GTVDmean decreased significantly compared with that observed for PTVD95% (p < 0.01). Conclusion: Switching from prescriptions based on 95% of the planning target volume to those based on 98% of the gross tumor volume decreased variations among cases in the overall gross tumor volume dose. Overall, prescriptions based on 98% of the gross tumor volume appear to be more suitable than those based on 95% of the planning target volume in cases of small peripheral lung tumors treated with stereotactic body radiotherapy.
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Affiliation(s)
- Takafumi Komiyama
- Department of Radiology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Masahide Saito
- Department of Radiology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Kengo Kuriyama
- Department of Radiology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Kan Marino
- Department of Radiology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Shinichi Aoki
- Department of Radiology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Ryo Saito
- Department of Radiology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Juria Muramatsu
- Department of Radiology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Yoshiyasu Maehata
- Department of Radiology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Chen Ze
- Department of Radiology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Tomoko Akita
- Department of Radiology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Takashi Yamada
- Department of Radiology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Naoki Sano
- Department of Radiology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Kazuya Yoshizawa
- Department of Radiology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Ashizawa Kazunari
- Department of Radiology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Suzuki Hidekazu
- Department of Radiology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Koji Ueda
- Department of Radiology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Nam Vu
- Department of Radiology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
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Biston MC, Chiavassa S, Grégoire V, Thariat J, Lacornerie T. Time of PTV is ending, robust optimization comes next. Cancer Radiother 2020; 24:676-686. [PMID: 32861608 DOI: 10.1016/j.canrad.2020.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 12/25/2022]
Abstract
Continuous improvements have been made in the way to prescribe, record and report dose distributions since the therapeutic use of ionizing radiations. The international commission for radiation units and measurement (ICRU) has provided a common language for physicians and physicists to plan and evaluate their treatments. The PTV concept has been used for more than two decades but is becoming obsolete as the CTV-to-PTV margin creates a static dose cloud that does not properly recapitulate all planning vs. delivery uncertainties. The robust optimization concept has recently emerged to overcome the limitations of the PTV concept. This concept is integrated in the inverse planning process and minimizes deviations to planned dose distribution through integration of uncertainties in the planning objectives. It appears critical to account for the uncertainties that are specific to protons and should be accounted for to better exploit the clinical potential of proton therapy. It may also improve treatment quality particularly in hypofractionated photon plans of mobile tumors and more widely to photon radiotherapy. However, in contrast to the PTV concept, a posteriori evaluation of plan quality, called robust evaluation, using error-based scenarios is still warranted. Robust optimization metrics are warranted. These metrics are necessary to compare PTV-based photon and robustly optimized proton plans in general and in model-based NTCP approaches. Assessment of computational demand and approximations of robust optimization algorithms along with metrics to evaluate plan quality are needed but a step further to better prescribe radiotherapy may has been achieved.
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Affiliation(s)
- M-C Biston
- Department of Radiation Oncology, centre Léon-Bérard, 28, rue Laennec 69373 Lyon cedex 08, France; Creatis, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Lyon 1, Villeurbanne, France.
| | - S Chiavassa
- Department of Medical Physics, Institut de cancérologie de l'Ouest, Saint-Herblain, France
| | - V Grégoire
- Department of Radiation Oncology, centre Léon-Bérard, 28, rue Laennec 69373 Lyon cedex 08, France
| | - J Thariat
- Department of radiation oncology, centre François-Baclesse/ARCHADE, Laboratoire de physique corpusculaire IN2P3/ENSICAEN-UMR6534, Unicaen, Normandie Universite, Caen, France
| | - T Lacornerie
- Department of Medical Physics, centre Oscar-Lambret, Lille, France
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Leung RWK, Chan MKH, Chiang CL, Wong M, Blanck O. On the pitfalls of PTV in lung SBRT using type-B dose engine: an analysis of PTV and worst case scenario concepts for treatment plan optimization. Radiat Oncol 2020; 15:130. [PMID: 32471457 PMCID: PMC7260838 DOI: 10.1186/s13014-020-01573-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/17/2020] [Indexed: 11/30/2022] Open
Abstract
Background PTV concept is presumed to introduce excessive and inconsistent GTV dose in lung stereotactic body radiotherapy (SBRT). That GTV median dose prescription (D50) and robust optimization are viable PTV–free solution (ICRU 91 report) to harmonize the GTV dose was investigated by comparisons with PTV–based SBRT plans. Methods Thirteen SBRT plans were optimized for 54 Gy / 3 fractions and prescribed (i) to 95% of the PTV (D95) expanded 5 mm from the ITV on the averaged intensity project (AIP) CT, i.e., PTVITV, (ii) to D95 of PTV derived from the van Herk (VH)‘s margin recipe on the mid–ventilation (MidV)–CT, i.e., PTVVH, (iii) to ITV D98 by worst case scenario (WCS) optimization on AIP,i.e., WCSITV and (iv) to GTV D98 by WCS using all 4DCT images, i.e., WCSGTV. These plans were subsequently recalculated on all 4DCT images and deformably summed on the MidV–CT. The dose differences between these plans were compared for the GTV and selected normal organs by the Friedman tests while the variability was compared by the Levene’s tests. The phase–to–phase changes of GTV dose through the respiration were assessed as an indirect measure of the possible increase of photon fluence owing to the type–B dose engine. Finally, all plans were renormalized to GTV D50 and all the dosimetric analyses were repeated to assess the relative influences of the SBRT planning concept and prescription method on the variability of target dose. Results By coverage prescriptions (i) to (iv), significantly smaller chest wall volume receiving ≥30 Gy (CWV30) and normal lung ≥20 Gy (NLV20Gy) were achieved by WCSITV and WCSGTV compared to PTVITV and PTVVH (p > 0.05). These plans differed significantly in the recalculated and summed GTV D2, D50 and D98 (p < 0.05). The inter–patient variability of all GTV dose parameters is however equal between these plans (Levene’s tests; p > 0.05). Renormalizing these plans to GTV D50 reduces their differences in GTV D2, and D98 to insignificant level (p > 0.05) and their inter–patient variability of all GTV dose parameters. None of these plans showed significant differences in GTV D2, D50 and D98 between respiratory phases, nor their inter–phase variability is significant. Conclusion Inconsistent GTV dose is not unique to PTV concept but occurs to other PTV–free concept in lung SBRT. GTV D50 renormalization effectively harmonizes the target dose among patients and SBRT concepts of geometric uncertainty management.
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Affiliation(s)
| | - Mark Ka Heng Chan
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany. .,Department of Radiotherapy, University Hospital Essen, Kiel Campus, 24105, Kiel, Germany.
| | - Chi-Leung Chiang
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Matthew Wong
- Department of Clinical Oncology, TuenMun Hospital, Hong Kong, SAR, China
| | - Oliver Blanck
- Department of Radiotherapy, University Hospital Essen, Kiel Campus, 24105, Kiel, Germany
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de Jong EEC, Guckenberger M, Andratschke N, Dieckmann K, Hoogeman MS, Milder M, Møller DS, Nyeng TB, Tanadini-Lang S, Lartigau E, Lacornerie T, Senan S, Verbakel W, Verellen D, De Kerf G, Hurkmans C. Variation in current prescription practice of stereotactic body radiotherapy for peripherally located early stage non-small cell lung cancer: Recommendations for prescribing and recording according to the ACROP guideline and ICRU report 91. Radiother Oncol 2020; 142:217-223. [PMID: 31767472 DOI: 10.1016/j.radonc.2019.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/30/2019] [Accepted: 11/02/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE In 2017 the ACROP guideline on SBRT for peripherally located early stage NSCLC was published. Later that year ICRU-91 about prescribing, recording and reporting was published. The purpose of this study is to quantify the current variation in prescription practice in the institutions that contributed to the ACROP guideline and to establish the link between the ACROP and ICRU-91 recommendations. MATERIAL AND METHODS From each of the eight participating centres, 15 SBRT plans for stage I NSCLC were analyzed. Plans were generated following the institutional protocol, centres prescribed 3 × 13.5 Gy, 3 × 15 Gy, 3 × 17 Gy or 3 × 18 Gy. Dose parameters of the target volumes were reported as recommended by ICRU-91 and also converted to BED10Gy. RESULTS The intra-institutional variance in D98%, Dmean and D2% of the PTV and GTV/ITV is substantially smaller than the inter-institutional spread, indicating well protocollised planning procedures are followed. The median values per centre ranged from 56.1 Gy to 73.1 Gy (D2%), 50.4 Gy to 63.3 Gy (Dmean) and 40.5 Gy to 53.6 Gy (D98%) for the PTV and from 57.1 Gy to 73.6 Gy (D2%), 53.7 Gy to 68.7 Gy (Dmean) and 48.5 Gy to 62.3 Gy (D98%) for the GTV/ITV. Comparing the variance in PTV D98% with the variance in GTV Dmean per centre, using an F-test, shows that four centres have a larger variance in GTV Dmean, while one centre has a larger variance in PTV D98% (p values <0.01). This shows some centres focus on achieving a constant PTV coverage while others aim at a constant GTV coverage. CONCLUSION More detailed recommendations for dose planning and reporting of lung SBRT in line with ICRU-91 were formulated, including a minimum PTV D98% of 100 Gy BED10Gy and minimum GTV/ITV mean dose of 150 Gy BED10Gy and a D2% in the range of 60-70 Gy.
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Affiliation(s)
| | | | | | | | | | - Maaike Milder
- Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | | | | | | | | | | | - Suresh Senan
- Amsterdam University Medical Center, the Netherlands.
| | | | - Dirk Verellen
- Iridium Kankernetwerk, Antwerp University, Antwerp, Belgium.
| | - Geert De Kerf
- Iridium Kankernetwerk, Antwerp University, Antwerp, Belgium.
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Dosimetric Multicenter Planning Comparison Studies for Stereotactic Body Radiation Therapy: Methodology and Future Perspectives. Int J Radiat Oncol Biol Phys 2019; 106:403-412. [PMID: 31707124 DOI: 10.1016/j.ijrobp.2019.10.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/03/2019] [Accepted: 10/25/2019] [Indexed: 12/22/2022]
Abstract
In this review a summary of the published literature pertaining to the stereotactic body radiation therapy multiplanning comparison, data sharing strategies, and implementation of benchmark planning cases to improve the skills and knowledge of the participating centers was investigated. A total of 30 full-text articles were included. The studies were subdivided in 3 categories: multiplanning studies on dosimetric variability, planning harmonization before clinical trials, and technical and methodologic studies. The methodology used in the studies were critically analyzed to find common and original elements with the pros and cons. Multicenter planning studies have played a key role in improving treatment plan harmonization, treatment plan compliance, and even clinical practices. This review has highlighted that some fundamental steps should be taken to transform a simple treatment planning comparison study into a potential credentialing method for stereotactic body radiation therapy accreditation. In particular, prescription and general requirements should always be well defined; data analysis should be performed with independent dose volume histogram or dose calculations; quality score indices should be constructed; feedback and correction strategies should be provided; and a simple web-based collaboration platform should be used. The results reported clearly showed that a crowd-based replanning approach is a viable method for achieving harmonization and standardization of treatment planning among centers using different technologies.
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ICRU report 91 on prescribing, recording, and reporting of stereotactic treatments with small photon beams : Statement from the DEGRO/DGMP working group stereotactic radiotherapy and radiosurgery. Strahlenther Onkol 2019; 195:193-198. [PMID: 30649567 DOI: 10.1007/s00066-018-1416-x] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 12/13/2018] [Indexed: 12/14/2022]
Abstract
The International Commission on Radiation Units and Measurements (ICRU) report 91 with the title "prescribing, recording, and reporting of stereotactic treatments with small photon beams" was published in 2017. This extensive publication covers different relevant aspects of stereotactic radiotherapy such as small field dosimetry, accuracy requirements for volume definition and planning algorithms, and the precise application of treatment by means of image guidance. Finally, recommendations for prescribing, recording and reporting are given.
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10
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Bedford JL. Calculation of absorbed dose in radiotherapy by solution of the linear Boltzmann transport equations. Phys Med Biol 2019; 64:02TR01. [PMID: 30524016 DOI: 10.1088/1361-6560/aaf0e2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Over the last decade, dose calculations which solve the linear Boltzmann transport equations have been introduced into clinical practice and are now in widespread use. However, knowledge in the radiotherapy community concerning the details of their function is limited. This review gives a general description of the linear Boltzmann transport equations as applied to calculation of absorbed dose in clinical radiotherapy. The aim is to elucidate the principles of the method, rather than to describe a particular implementation. The literature on the performance of typical algorithms is then reviewed, in many cases with reference to Monte Carlo simulations. The review is completed with an overview of the emerging applications in the important area of MR-guided radiotherapy.
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Affiliation(s)
- James L Bedford
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5PT, United Kingdom
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Matsuoka T, Araki F, Ohno T, Sakata J, Tominaga H. Dependence of volume dose indices on dose calculation algorithms for VMAT-SBRT plans for peripheral lung tumor. Med Dosim 2018; 44:284-290. [PMID: 30455092 DOI: 10.1016/j.meddos.2018.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 10/20/2018] [Accepted: 10/23/2018] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to investigate the dependence of volume dose indices on dose calculation algorithms for volumetric modulated arc therapy (VMAT) for stereotactic body radiotherapy (SBRT) plans to treat peripheral lung tumors by comparing them with those of Monte Carlo (MC) calculations. VMAT-SBRT plans for peripheral lung tumors were created using the Eclipse treatment planning system (TPS) for 24 patients with nonsmall cell lung cancer. VMAT dose distributions for gross tumor volume (GTV), internal target volume (ITV), and planning target volume (PTV) were calculated using the analytical anisotropic algorithm (AAA), the Acuros XB (AXB) algorithm, and a MC algorithm. VMAT dose distributions of the 3 algorithms were compared using their volume dose indices from dose volume histograms (DVHs), a dose difference map, and 3-dimensional gamma analysis. The DVHs for GTV and ITV from AAA, AXB, and MC were in good agreement. The difference between the ITV and PTV volume dose indices from AAA and MC increased as D98, D95, D80, D50, and D2. In particular, the difference between D98 for PTV from AAA and MC was up to 48%. A >5% difference between D95 for PTV from AAA and MC was 11 patients, but only 2 patients for ITV. The volume dose indices for AXB were near those of MC. AAA tended to overestimate the PTV volume dose indices compared to AXB and MC. Thus, we propose that the volume dose indices for the ITV be used because they are independent of dose calculation algorithms.
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Affiliation(s)
- Takanori Matsuoka
- Graduate School of Health Sciences, Kumamoto University, Kumamoto, Japan
| | - Fujio Araki
- Department of Health Sciences, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
| | - Takeshi Ohno
- Department of Health Sciences, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Mancosu P, Nisbet A, Jornet N. Editorial: The role of medical physics in lung SBRT. Phys Med 2018; 45:205-206. [PMID: 29325801 DOI: 10.1016/j.ejmp.2018.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 12/24/2022] Open
Abstract
Stereotactic body radiation therapy (SBRT) has become a standard treatment for non-operable patients with early stage non-small cell lung cancer (NSCLC). In this context, medical physics community has largely helped in the starting and the growth of this technique. In fact, SBRT requires the convergence of many different features for delivering large doses in few fractions to small moving target in an heterogeneous medium. The special issue of last month, was focused on the different physics challenges in lung SBRT. Eleven reviews were presented, covering: imaging for treatment planning and for treatment assessment; dosimetry and planning optimization; treatment delivery possibilities; image guidance during delivery; radiobiology. The current cutting edge role of medical physics was reported. We aimed to give a complete overview of different aspects of lung SBRT that would be of interest to both physicists implementing this technique in their institutions and more experienced physicists that would be inspired to start research projects in areas that still need further developments. We also feel that the role that medical physicists have played in the development and safe implementation of SBRT, particularly in lung region, can be taken as an excellent example to be translated to other areas, not only in Radiation Oncology but also in other health sectors.
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Affiliation(s)
- Pietro Mancosu
- Medical Physics service, Radiotherapy department, Humanitas Cancer Center, Rozzano-Milan, Italy.
| | - Andrew Nisbet
- Department of Medical Physics, Royal Surrey County Hospital, United Kingdom; Department of Physics, Faculty of Engineering & Physical Sciences, University of Surrey, United Kingdom
| | - Núria Jornet
- Servei de Radiofísica i Radioprotecció, Hospital Sant Pau, Barcelona, Spain
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