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Yamashita K, Shimizu T, Miyabayashi K, Iwase T, Togasaki G, Hara R. Utility of a skin marker-less setup procedure using surface-guided imaging: a comparison with the traditional laser-based setup in extremity irradiation. Radiol Phys Technol 2024; 17:569-577. [PMID: 38668937 DOI: 10.1007/s12194-024-00806-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 05/27/2024]
Abstract
This study aimed to assess the feasibility of a skin marker-less patient setup using a surface-guided radiotherapy (SGRT) system for extremity radiotherapy. Twenty-five patients who underwent radiotherapy to the extremities were included in this retrospective study. The first group consisted of 10 patients and underwent a traditional setup procedure using skin marks and lasers. The second group comprised 15 patients and had a skin marker-less setup procedure that used an SGRT system only. To compare the two setup procedures for setup accuracy, the mean 3D vector shift magnitude was 0.9 mm for the traditional setup procedure and 0.5 mm for the skin marker-less setup procedure (p < 0.01). In addition, SGRT systems have been suggested to improve the accuracy and reproducibility of patient setups and consistently reduce interfractional setup errors. These results indicate that a skin marker-less patient setup procedure using an SGRT system is useful for extremity irradiation.
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Affiliation(s)
- Kei Yamashita
- Department of Radiation Oncology, Chiba Cancer Center, 666-2 Nitona-Chou, Chuo-ku, Chiba, 260-8717, Japan.
| | - Takayuki Shimizu
- Department of Radiation Oncology, Chiba Cancer Center, 666-2 Nitona-Chou, Chuo-ku, Chiba, 260-8717, Japan
| | - Kanae Miyabayashi
- Department of Radiation Oncology, Chiba Cancer Center, 666-2 Nitona-Chou, Chuo-ku, Chiba, 260-8717, Japan
| | - Tsutomu Iwase
- Department of Radiation Oncology, Chiba Cancer Center, 666-2 Nitona-Chou, Chuo-ku, Chiba, 260-8717, Japan
| | - Gentaro Togasaki
- Department of Radiation Oncology, Chiba Cancer Center, 666-2 Nitona-Chou, Chuo-ku, Chiba, 260-8717, Japan
| | - Ryusuke Hara
- Department of Radiation Oncology, Chiba Cancer Center, 666-2 Nitona-Chou, Chuo-ku, Chiba, 260-8717, Japan
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Liu M, Tang B, Orlandini LC, Li J, Wang X, Peng Q, Thwaites D. Potential dosimetric error in the adaptive workflow of a 1.5 T MR-Linac from patient movement relative to immobilisation systems. Phys Eng Sci Med 2024; 47:351-359. [PMID: 38227140 DOI: 10.1007/s13246-023-01369-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 12/10/2023] [Indexed: 01/17/2024]
Abstract
In magnetic resonance- (MR-) based adaptive workflows for an MR-linac, the treatment plan is optimized and recalculated online using the daily MR images. The Unity MR-linac is supplied with a patient positioning device (ppd) using pelvic and abdomen thermoplastic masks attached to a board with high-density components. This study highlights the dosimetric effect of using this in such workflows when there are relative patient-ppd displacements, as these are not visualized on MR imaging and the treatment planning system assumes the patient is fixed relative to the ppd. The online adapted plans of two example rectum cancer patients treated at a Unity MR-linac were perturbed by introducing relative patient-ppd displacements, and the effect was evaluated on plan dosimetry. Forty-eight perturbed clinical adapted plans were recalculated, based on online MR-based synthetic computed tomography, and compared with the original plans, using dose-volume histogram parameters and gamma analysis. The target volume covered by the prescribed dose ( D pre ) and by at least 107% of D pre varied up to - 1.87% and + 3.67%, respectively for 0.5 cm displacements, and to - 3.18% and + 4.96% for 2 cm displacements; whilst 2%-2 mm gamma analysis showed a median value of 92.9%. The use of a patient positioning system with high-density components in a Unity MR-based online adaptive treatment workflow can introduce unrecognized errors in plan dosimetry and it is recommended not to use such a device for such treatments, without modifying the device and the workflow, followed by careful clinical evaluation, or alternatively to use other immobilization methods.
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Affiliation(s)
- Min Liu
- Radiation Oncology Department, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Chengdu, China
- Institute of Nuclear Technology and Automation Engineering, Chengdu University of Technology, Chengdu, China
| | - Bin Tang
- Radiation Oncology Department, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Chengdu, China
| | - Lucia Clara Orlandini
- Radiation Oncology Department, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Chengdu, China
| | - Jie Li
- Radiation Oncology Department, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
- Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Chengdu, China.
- Radiotherapy Research Group, Leeds Institute of Medical Research, St James's Hospital and University of Leeds, Leeds, UK.
| | - Xianliang Wang
- Radiation Oncology Department, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
- Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Chengdu, China.
- Radiotherapy Research Group, Leeds Institute of Medical Research, St James's Hospital and University of Leeds, Leeds, UK.
| | - Qian Peng
- Radiation Oncology Department, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Chengdu, China
| | - David Thwaites
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia
- Sydney West Radiation Oncology Network, Crown Princess Mary Cancer Centre, Sydney, NSW, Australia
- Radiotherapy Research Group, Leeds Institute of Medical Research, St James's Hospital and University of Leeds, Leeds, UK
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Daly M, McDaid L, Nelder C, Chuter R, Choudhury A, McWilliam A, Radhakrishna G, Eccles C. Feasibility of abdominal fat quantification on MRI and impact on effectiveness of abdominal compression for radiotherapy motion management. Tech Innov Patient Support Radiat Oncol 2024; 29:100232. [PMID: 38269244 PMCID: PMC10805931 DOI: 10.1016/j.tipsro.2023.100232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 01/26/2024] Open
Abstract
The impact of fat on abdominal compression effectiveness in abdominal cancers was determined using magnetic resonance imaging (MRI). Visceral and subcutaneous fat were delineated on T2W 3D MRI, and motion change with compression was measured on 2D cine MRI. Results from 16 participants showed no correlation between fat percentage, body mass index (BMI), and motion change. Median BMI was 28.7 (SD, 4.9). Mean motion reduction was 7.8 mm (IQR, 5.0; p = 0.001) with compression. While no direct link was found between fat, BMI, and compression effectiveness, abdominal compression remains crucial for motion management in radiotherapy planning, providing dosimetric benefits.
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Affiliation(s)
- M. Daly
- Division of Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Northern Ireland, United Kingdom
| | - L. McDaid
- Department of Radiotherapy, The Christie NHSFT, Wilmslow Road, Manchester M20 4BX, Northern Ireland, United Kingdom
| | - C. Nelder
- Department of Radiotherapy, The Christie NHSFT, Wilmslow Road, Manchester M20 4BX, Northern Ireland, United Kingdom
| | - R. Chuter
- Division of Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Northern Ireland, United Kingdom
- Department of Medical Physics and Engineering, The Christie NHSFT, Wilmslow Road, Manchester M20 4BX, Northern Ireland, United Kingdom
| | - A. Choudhury
- Division of Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Northern Ireland, United Kingdom
- Department of Clinical Oncology, The Christie NHSFT, Wilmslow Road, Manchester M20 4BX, Northern Ireland, United Kingdom
| | - A. McWilliam
- Division of Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Northern Ireland, United Kingdom
- Department of Medical Physics and Engineering, The Christie NHSFT, Wilmslow Road, Manchester M20 4BX, Northern Ireland, United Kingdom
| | - G. Radhakrishna
- Department of Medical Physics and Engineering, The Christie NHSFT, Wilmslow Road, Manchester M20 4BX, Northern Ireland, United Kingdom
| | - C.L. Eccles
- Division of Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Northern Ireland, United Kingdom
- Department of Radiotherapy, The Christie NHSFT, Wilmslow Road, Manchester M20 4BX, Northern Ireland, United Kingdom
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Lv T, Xie C, Zhang Y, Liu Y, Zhang G, Qu B, Zhao W, Xu S. A qualitative study of improving megavoltage computed tomography image quality and maintaining dose accuracy using cycleGAN-based image synthesis. Med Phys 2024; 51:394-406. [PMID: 37475544 DOI: 10.1002/mp.16633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/18/2023] [Accepted: 07/02/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Due to inconsistent positioning, tumor shrinking, and weight loss during fractionated treatment, the initial plan was no longer appropriate after a few fractional treatments, and the patient will require adaptive helical tomotherapy (HT) to overcome the issue. Patients are scanned with megavoltage computed tomography (MVCT) before each fractional treatment, which is utilized for patient setup and provides information for dose reconstruction. However, the low contrast and high noise of MVCT make it challenging to delineate treatment targets and organs at risk (OAR). PURPOSE This study developed a deep-learning-based approach to generate high-quality synthetic kilovoltage computed tomography (skVCT) from MVCT and meet clinical dose requirements. METHODS Data from 41 head and neck cancer patients were collected; 25 (2995 slices) were used for training, and 16 (1898 slices) for testing. A cycle generative adversarial network (cycleGAN) based on attention gate and residual blocks was used to generate MVCT-based skVCT. For the 16 patients, kVCT-based plans were transferred to skVCT images and electron density profile-corrected MVCT images to recalculate the dose. The quantitative indices and clinically relevant dosimetric metrics, including the mean absolute error (MAE), structural similarity index measure (SSIM), peak signal-to-noise ratio (PSNR), gamma passing rates, and dose-volume-histogram (DVH) parameters (Dmax , Dmean , Dmin ), were used to assess the skVCT images. RESULTS The MAE, PSNR, and SSIM of MVCT were 109.6 ± 12.3 HU, 27.5 ± 1.1 dB, and 91.9% ± 1.7%, respectively, while those of skVCT were 60.6 ± 9.0 HU, 34.0 ± 1.9 dB, and 96.5% ± 1.1%. The image quality and contrast were enhanced, and the noise was reduced. The gamma passing rates improved from 98.31% ± 1.11% to 99.71% ± 0.20% (2 mm/2%) and 99.77% ± 0.18% to 99.98% ± 0.02% (3 mm/3%). No significant differences (p > 0.05) were observed in DVH parameters between kVCT and skVCT. CONCLUSION With training on a small data set (2995 slices), the model successfully generated skVCT with improved image quality, and the dose calculation accuracy was similar to that of MVCT. MVCT-based skVCT can increase treatment accuracy and offer the possibility of implementing adaptive radiotherapy.
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Affiliation(s)
- Tie Lv
- Beihang University, School of Physics, Beijing, China
- The First Medical Center of PLA General Hospital, Department of Radiation Oncology, Beijing, China
| | - Chuanbin Xie
- Beihang University, School of Physics, Beijing, China
- The First Medical Center of PLA General Hospital, Department of Radiation Oncology, Beijing, China
| | - Yihang Zhang
- Beihang University, School of Physics, Beijing, China
- The First Medical Center of PLA General Hospital, Department of Radiation Oncology, Beijing, China
| | - Yaoying Liu
- Beihang University, School of Physics, Beijing, China
- The First Medical Center of PLA General Hospital, Department of Radiation Oncology, Beijing, China
| | - Gaolong Zhang
- Beihang University, School of Physics, Beijing, China
| | - Baolin Qu
- The First Medical Center of PLA General Hospital, Department of Radiation Oncology, Beijing, China
| | - Wei Zhao
- Beihang University, School of Physics, Beijing, China
| | - Shouping Xu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Jain V, Soni TP, Singh DK, Patni N, Jakhotia N, Gupta AK, Gupta TC, Singhal H. A prospective study to assess and quantify the setup errors with cone-beam computed tomography in head-and-neck cancer image-guided radiotherapy treatment. J Cancer Res Ther 2023; 19:783-787. [PMID: 37470611 DOI: 10.4103/jcrt.jcrt_2006_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction This study was done to quantify the translational setup errors with cone-beam computed tomography (CBCT) in the image-guided radiation therapy (IGRT) treatment of head-and-neck cancer (HNC) patients. Aims The objective was to quantify the setup errors by CBCT. Methodology One hundred patients of HNC were enrolled from March 2020 to March 2021 for IGRT treatment. Pretreatment kV-CBCT images were obtained at the first 3 days of irradiations, and setup error corrections were done in the mediolateral (ML), superior-inferior (SI), and anterior-posterior (AP) directions. Subsequently, a weekly kV-CBCT was repeated for whole duration of radiotherapy for the next 6-7 weeks. Adequacy of planning target volume (PTV) margins was assessed by van Herk's formula. Results Total 630 CBCT scans of 100 patients were analyzed. Setup errors greater than 3 mm and 5 mm were seen in 11.4% and 0.31% of the patients, respectively. Systematic errors and random errors before correction in ML, SI, and AP directions were 0.10 cm, 0.11 cm, and 0.12 cm and 0.24 cm, 0.20 cm, and 0.21 cm, respectively. Systematic errors and random errors after correction in ML, SI, and AP directions were 0.06 cm, 0.07 cm, and 0.07 cm and 0.13 cm, 0.10 cm, and 0.12 cm, respectively. Conclusion CBCT at the first 3 fractions and then weekly during radiotherapy is effective to detect the setup errors. An isotropic PTV margin of 5 mm over clinical target volume is safe to account for setup errors, however, in the case of close organ at risk, or with IGRT, a PTV margin of 3 mm can be considered.
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Affiliation(s)
- Vidhi Jain
- Department of Radiation Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Tej Prakash Soni
- Department of Radiation Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Dinesh Kumar Singh
- Department of Radiation Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Nidhi Patni
- Department of Radiation Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Naresh Jakhotia
- Department of Radiation Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Anil Kumar Gupta
- Department of Surgical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Tara Chand Gupta
- Department of Medical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Harish Singhal
- Department of Clinical Trial, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
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Parchur AK, Lim S, Nasief H, Omari E, Zhang Y, Paulson E, Hall W, Erickson B, Li XA. Auto-detection of necessity for MRI-guided online adaptive replanning using a machine learning classifier. Med Phys 2023; 50:440-448. [PMID: 36227732 PMCID: PMC9868055 DOI: 10.1002/mp.16047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/23/2022] [Accepted: 10/08/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE MRI-guided adaptive radiation therapy (MRgART), particularly daily online adaptive replanning (OLAR) can substantially improve radiation therapy delivery, however, it can be labor-intensive and time-consuming. Currently, the decision to perform OLAR for a treatment fraction is determined subjectively. In this work, we develop a machine learning algorithm based on structural similarity index measure (SSIM) and change in entropy to quickly and objectively determine whether OLAR is necessary for a daily MRI set. METHODS A total of 109 daily MRI sets acquired on a 1.5T MR-Linac during MRgART for 22 pancreatic cancer patients each treated with five fractions were retrospectively analyzed. For each daily MRI set, OLAR and reposition (No-OLAR) plans were created and the superior plan with the daily fraction determined per clinical dose-volume criteria. SSIM and entropy maps were extracted from each daily MRI set, with respect to its reference (e.g., dry-run) MRI in the region enclosed by 50-100% isodose surfaces. A total of six common features were extracted from SSIM maps. Pearson's rank correlation coefficient was utilized to rule out redundant SSIM features. A t-test was used to determine significant SSIM features which were combined with the change in entropy to develop anensemble machine classifier with fivefold cross validation. The performance of the classifier was evaluated using the area under the curve (AUC) of the receiver operating characteristic curve. RESULTS A machine learning classifier model using two SSIM features (mean and full width at half maximum) and change in entropy was determined to be able to significantly discriminate between No-OLAR and OLAR groups. The obtained machine learning ensemble classifier can predict OLAR necessity with a cross validated AUC of 0.93. Misclassification was found primarily for No-OLAR cases with dosimetric plan quality closely comparable to the corresponding OLAR plans, thus, are not a major practical concern. CONCLUSION A machine learning classifier based on simple first-order image features, that is, SSIM features and change in entropy, was developed to determine when OLAR is necessary for a daily MRI set with practical acceptable prediction accuracy. This classifier may be implemented in the MRgART process to automatically and objectively determine if OLAR is required following daily MRI.
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Affiliation(s)
- Abdul K. Parchur
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, 53226 USA
| | - Sara Lim
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, 53226 USA
| | - Haidy Nasief
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, 53226 USA
| | - Eenas Omari
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, 53226 USA
| | - Ying Zhang
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, 53226 USA
| | - Eric Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, 53226 USA
| | - William Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, 53226 USA
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, 53226 USA
| | - X. Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, 53226 USA
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Daly M, McWilliam A, Radhakrishna G, Choudhury A, Eccles CL. Radiotherapy respiratory motion management in hepatobiliary and pancreatic malignancies: a systematic review of patient factors influencing effectiveness of motion reduction with abdominal compression. Acta Oncol 2022; 61:833-841. [PMID: 35611555 DOI: 10.1080/0284186x.2022.2073186] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/28/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The effectiveness of abdominal compression for motion management in hepatobiliary-pancreatic (HPB) radiotherapy has not been systematically evaluated. METHODS & MATERIALS A systematic review was carried out using PubMed/Medline, Cochrane Library, Web of Science, and CINAHL databases up to 1 July 2021. No date restrictions were applied. Additional searches were carried out using the University of Manchester digital library, Google Scholar and of retrieved papers' reference lists. Studies conducted evaluating respiratory motion utilising imaging with and without abdominal compression in the same patients available in English were included. Studies conducted in healthy volunteers or majority non-HPB sites, not providing descriptive motion statistics or patient characteristics before and after compression in the same patients or published without peer-review were excluded. A narrative synthesis was employed by tabulating retrieved studies and organising chronologically by abdominal compression device type to help identify patterns in the evidence. RESULTS The inclusion criteria were met by 6 studies with a total of 152 patients. Designs were a mix of retrospective and prospective quantitative designs with chronological, non-randomised recruitment. Abdominal compression reduced craniocaudal respiratory motion in the majority of patients, although in four studies there were increases seen in at least one direction. The influence of patient comorbidities on effectiveness of compression, and/or comfort with compression was not evaluated in any study. CONCLUSION Abdominal compression may not be appropriate for all patients, and benefit should be weighed with potential increase in motion or discomfort in patients with small initial motion (<5 mm). Patient factors including male sex, and high body mass index (BMI) were found to impact the effectiveness of compression, however with limited evidence. High-quality studies are warranted to fully assess the clinical impact of abdominal compression on treatment outcomes and toxicity prospective in comparison to other motion management strategies.
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Affiliation(s)
- Mairead Daly
- Division of Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, School of Medical Sciences, The University of Manchester, Manchester, United Kingdom
| | - Alan McWilliam
- Division of Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, School of Medical Sciences, The University of Manchester, Manchester, United Kingdom
- The Christie NHSFT, Manchester, United Kingdom
| | | | - Ananya Choudhury
- Division of Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, School of Medical Sciences, The University of Manchester, Manchester, United Kingdom
- The Christie NHSFT, Manchester, United Kingdom
| | - Cynthia L Eccles
- Division of Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, School of Medical Sciences, The University of Manchester, Manchester, United Kingdom
- The Christie NHSFT, Manchester, United Kingdom
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MR-guided adaptive versus ITV-based stereotactic body radiotherapy for hepatic metastases (MAESTRO): a randomized controlled phase II trial. Radiat Oncol 2022; 17:59. [PMID: 35346270 PMCID: PMC8958771 DOI: 10.1186/s13014-022-02033-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/14/2022] [Indexed: 12/22/2022] Open
Abstract
Background Stereotactic body radiotherapy (SBRT) is an established local treatment method for patients with hepatic oligometastasis or oligoprogression. Liver metastases often occur in close proximity to radiosensitive organs at risk (OARs). This limits the possibility to apply sufficiently high doses needed for optimal local control. Online MR-guided radiotherapy (oMRgRT) is expected to hold potential to improve hepatic SBRT by offering superior soft-tissue contrast for enhanced target identification as well as the benefit of gating and daily real-time adaptive treatment. The MAESTRO trial therefore aims to assess the potential advantages of adaptive, gated MR-guided SBRT compared to conventional SBRT at a standard linac using an ITV (internal target volume) approach. Methods This trial is conducted as a prospective, randomized, three-armed phase II study in 82 patients with hepatic metastases (solid malignant tumor, 1–3 hepatic metastases confirmed by magnetic resonance imaging (MRI), maximum diameter of each metastasis ≤ 5 cm (in case of 3 metastases: sum of diameters ≤ 12 cm), age ≥ 18 years, Karnofsky Performance Score ≥ 60%). If a biologically effective dose (BED) ≥ 100 Gy (α/β = 10 Gy) is feasible based on ITV-based planning, patients will be randomized to either MRgRT or ITV-based SBRT. If a lesion cannot be treated with a BED ≥ 100 Gy, the patient will be treated with MRgRT at the highest possible dose. Primary endpoint is the non-inferiority of MRgRT at the MRIdian Linac® system compared to ITV-based SBRT regarding hepatobiliary and gastrointestinal toxicity CTCAE III or higher. Secondary outcomes investigated are local, locoregional (intrahepatic) and distant tumor control, progression-free survival, overall survival, possible increase of BED using MRgRT if the BED is limited with ITV-based SBRT, treatment-related toxicity, quality of life, dosimetric parameters of radiotherapy plans as well as morphological and functional changes in MRI. Potential prognostic biomarkers will also be evaluated. Discussion MRgRT is known to be both highly cost- and labor-intensive. The MAESTRO trial aims to provide randomized, higher-level evidence for the dosimetric and possible consecutive clinical benefit of MR-guided, on-table adaptive and gated SBRT for dose escalation in critically located hepatic metastases adjacent to radiosensitive OARs. Trial registration The study has been prospectively registered on August 30th, 2021: Clinicaltrials.gov, “Magnetic Resonance-guided Adaptive Stereotactic Body Radiotherapy for Hepatic Metastases (MAESTRO)”, NCT05027711. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-022-02033-2.
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Mao W, Riess J, Kim J, Vance S, Chetty IJ, Movsas B, Kretzler A. Evaluation of auto-contouring and dose distributions for online adaptive radiation therapy of patients with locally advanced lung cancers. Pract Radiat Oncol 2022; 12:e329-e338. [DOI: 10.1016/j.prro.2021.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/14/2021] [Accepted: 12/26/2021] [Indexed: 11/28/2022]
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10
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Vaz SC, Adam JA, Bolton RCD, Vera P, van Elmpt W, Herrmann K, Hicks RJ, Lievens Y, Santos A, Schöder H, Dubray B, Visvikis D, Troost EGC, de Geus-Oei LF. Joint EANM/SNMMI/ESTRO practice recommendations for the use of 2-[ 18F]FDG PET/CT external beam radiation treatment planning in lung cancer V1.0. Eur J Nucl Med Mol Imaging 2022; 49:1386-1406. [PMID: 35022844 PMCID: PMC8921015 DOI: 10.1007/s00259-021-05624-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/15/2021] [Indexed: 12/16/2022]
Abstract
Purpose 2-[18F]FDG
PET/CT is of utmost importance for radiation treatment (RT) planning and response monitoring in lung cancer patients, in both non-small and small cell lung cancer (NSCLC and SCLC). This topic has been addressed in guidelines composed by experts within the field of radiation oncology. However, up to present, there is no procedural guideline on this subject, with involvement of the nuclear medicine societies. Methods A literature review was performed, followed by a discussion between a multidisciplinary team of experts in the different fields involved in the RT planning of lung cancer, in order to guide clinical management. The project was led by experts of the two nuclear medicine societies (EANM and SNMMI) and radiation oncology (ESTRO). Results and conclusion This guideline results from a joint and dynamic collaboration between the relevant disciplines for this topic. It provides a worldwide, state of the art, and multidisciplinary guide to 2-[18F]FDG PET/CT RT planning in NSCLC and SCLC. These practical recommendations describe applicable updates for existing clinical practices, highlight potential flaws, and provide solutions to overcome these as well. Finally, the recent developments considered for future application are also reviewed.
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Affiliation(s)
- Sofia C Vaz
- Nuclear Medicine Radiopharmacology, Champalimaud Centre for the Unkown, Champalimaud Foundation, Lisbon, Portugal.,Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Judit A Adam
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño (La Rioja), Spain
| | - Pierre Vera
- Henri Becquerel Cancer Center, QuantIF-LITIS EA 4108, Université de Rouen, Rouen, France
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany.
| | - Rodney J Hicks
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Yolande Lievens
- Radiation Oncology Department, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Andrea Santos
- Nuclear Medicine Department, CUF Descobertas Hospital, Lisbon, Portugal
| | - Heiko Schöder
- Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Bernard Dubray
- Department of Radiotherapy and Medical Physics, Centre Henri Becquerel, Rouen, France.,QuantIF-LITIS EA4108, University of Rouen, Rouen, France
| | | | - Esther G C Troost
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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11
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Lee D, Jeong SW, Kim SJ, Cho H, Park W, Han Y. Improvement of megavoltage computed tomography image quality for adaptive helical tomotherapy using cycleGAN-based image synthesis with small datasets. Med Phys 2021; 48:5593-5610. [PMID: 34418109 DOI: 10.1002/mp.15182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/20/2021] [Accepted: 07/30/2021] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Megavoltage computed tomography (MVCT) offers an opportunity for adaptive helical tomotherapy. However, high noise and reduced contrast in the MVCT images due to a decrease in the imaging dose to patients limits its usability. Therefore, we propose an algorithm to improve the image quality of MVCT. METHODS The proposed algorithm generates kilovoltage CT (kVCT)-like images from MVCT images using a cycle-consistency generative adversarial network (cycleGAN)-based image synthesis model. Data augmentation using an affine transformation was applied to the training data to overcome the lack of data diversity in the network training. The mean absolute error (MAE), root-mean-square error (RMSE), peak signal-to-noise ratio (PSNR), and structural similarity index measure (SSIM) were used to quantify the correction accuracy of the images generated by the proposed algorithm. The proposed method was validated by comparing the images generated with those obtained from conventional and deep learning-based image processing method through non-augmented datasets. RESULTS The average MAE, RMSE, PSNR, and SSIM values were 18.91 HU, 69.35 HU, 32.73 dB, and 95.48 using the proposed method, respectively, whereas cycleGAN with non-augmented data showed inferior results (19.88 HU, 70.55 HU, 32.62 dB, 95.19, respectively). The voxel values of the image obtained by the proposed method also indicated similar distributions to those of the kVCT image. The dose-volume histogram of the proposed method was also similar to that of electron density corrected MVCT. CONCLUSIONS The proposed algorithm generates synthetic kVCT images from MVCT images using cycleGAN with small patient datasets. The image quality achieved by the proposed method was correspondingly improved to the level of a kVCT image while maintaining the anatomical structure of an MVCT image. The evaluation of dosimetric effectiveness of the proposed method indicates the applicability of accurate treatment planning in adaptive radiation therapy.
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Affiliation(s)
- Dongyeon Lee
- Department of Radiation Convergence Engineering, Yonsei University, Wonju, Republic of Korea.,Department of Radiation Oncology, Samsung Medical Center, Seoul, Republic of Korea
| | - Sang Woon Jeong
- Department of Health Sciences and Technology, SAIHST,Sungkyunkwan University, Seoul, Republic of Korea.,Department of Radiation Oncology, Samsung Medical Center, Seoul, Republic of Korea
| | - Sung Jin Kim
- Department of Radiation Oncology, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyosung Cho
- Department of Radiation Convergence Engineering, Yonsei University, Wonju, Republic of Korea
| | - Won Park
- Department of Health Sciences and Technology, SAIHST,Sungkyunkwan University, Seoul, Republic of Korea.,Department of Radiation Oncology, Samsung Medical Center, Seoul, Republic of Korea
| | - Youngyih Han
- Department of Health Sciences and Technology, SAIHST,Sungkyunkwan University, Seoul, Republic of Korea.,Department of Radiation Oncology, Samsung Medical Center, Seoul, Republic of Korea
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12
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Li D, Wei S, Li T, Liu Y, Cai J, Ge H. Study of Spinal Cord Substructure Expansion Margin in Esophageal Cancer. Technol Cancer Res Treat 2021; 20:15330338211024559. [PMID: 34137317 PMCID: PMC8216358 DOI: 10.1177/15330338211024559] [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] [Indexed: 11/23/2022] Open
Abstract
Purpose: To analyze the setup errors and residual errors of different spinal cord parts in esophageal cancer patients and to explore the necessity of spinal cord segmental expansion. Methods and Materials: Sixty cases of esophageal cancer were included with 20 patients subdivided into the following groups: neck, chest and abdomen as per the treatment site. The patients underwent intensity modulated radiation therapy (IMRT) between 2017 and 2019. Thermoplastic mask or vacuum bag were utilized for immobilization of different groups. CTVision (Siemens CT-On-Rail system) was used to acquire pre-treatment CT, and 20 consecutive pre-treatment CT datasets were collected for data analysis for each case. Images were exported to MIM (MIM Software Inc.) for processing and data analysis. Dice coefficient, maximum Hausdorff distance and centroid coordinate values between the spinal cord contours in the pre-treatment CTs and the planning CT were calculated and extracted. The contour expansion margin value is calculated as MPRV = 1.3 ∑ total + 0.5 σ total, where ∑ total and σ total are the systematic and random error, respectively. Results: For neck, chest, abdominal segments of the spinal cord, the mean Dice coefficients (± SD) are 0.73 ± 0.06, 0.80 ± 0.06, 0.82 ± 0.06, the maximum Hausdorff distance residual error (± SD) are 4.46 ± 0.55, 3.49 ± 0.53, 3.46 ± 0.69 mm, and the mean centroid coordinate residual error (± SD) are 2.40 ± 0.53, 1.66 ± 0.47, 2.14 ± 0.95 mm, respectively. The calculated margin using residual centroid method in medial-lateral (ML), anterior-posterior (AP), and cranial-caudal (CC) direction of spinal cord in neck, chest, abdominal segments are 3.86, 5.37, 6.36 mm, 3.45, 3.83, 4.51 mm, 4.05, 4.83, 7.06 mm, respectively, and the calculated margin using residual Hausdorff method are 3.10, 5.33 and 6.15 mm, 3.30, 3.77, 4.61 mm, 3.35, 4.76, 6.87 mm, respectively. Conclusion: The setup errors and residual errors are different in each segment of the spinal cord. Different margins expansion should be applied to different segment of spinal cord.
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Affiliation(s)
- Dingjie Li
- Department of Radiation Oncology, 571884The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Shengtao Wei
- Department of Radiation Oncology, 571884The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Tian Li
- Department of Health Technology and Informatics, 26680The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Yang Liu
- Department of Radiation Oncology, 571884The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Jing Cai
- Department of Radiation Oncology, 571884The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China.,Department of Health Technology and Informatics, 26680The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Hong Ge
- Department of Radiation Oncology, 571884The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China
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13
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Tonneau M, Lacornerie T, Mirabel X, Pasquier D. [Stereotactic body radiotherapy for locally advanced pancreatic cancer: A systemic review]. Cancer Radiother 2021; 25:283-295. [PMID: 33423968 DOI: 10.1016/j.canrad.2020.08.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/02/2020] [Accepted: 08/06/2020] [Indexed: 01/11/2023]
Abstract
Stereotactic body radiation therapy (SBRT) for locally advanced pancreatic cancer (LAPC) is an emerging treatment option. Most studies showed local control of approximately 75% with no evidence of improved overall survival. Gastrointestinal toxicities could be significant, ranging up to 22% for acute toxicities≥grade 3+ and 44% for late toxicities≥grade 3+. Currently, no standardized guidelines for treatment and management scheme. We conducted a systemic review of published prospective and retrospective trials to evaluate the efficacy, safety, technical data, and discuss future directions.
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Affiliation(s)
- M Tonneau
- Département universitaire de radiothérapie, centre Oscar-Lambret, université de Lille, 3, rue Combemale, 59020 Lille cedex, France.
| | - T Lacornerie
- Service de physique médicale, centre Oscar-Lambret, 3, rue Combemale, 59020 Lille cedex, France
| | - X Mirabel
- Département universitaire de radiothérapie, centre Oscar-Lambret, université de Lille, 3, rue Combemale, 59020 Lille cedex, France
| | - D Pasquier
- Département universitaire de radiothérapie, centre Oscar-Lambret, université de Lille, 3, rue Combemale, 59020 Lille cedex, France; Centre de recherche en informatique, signal et automatique de Lille, UMR CNRS 9189, université de Lille, M3, avenue Carl-Gauss, 59650 Villeneuve-d'Ascq, France
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14
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Time Analysis of Online Adaptive Magnetic Resonance-Guided Radiation Therapy Workflow According to Anatomical Sites. Pract Radiat Oncol 2020; 11:e11-e21. [PMID: 32739438 DOI: 10.1016/j.prro.2020.07.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/26/2020] [Accepted: 07/18/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE To document time analysis of detailed workflow steps for the online adaptive magnetic resonance-guided radiation therapy treatments (MRgRT) with the ViewRay MRIdian system and to identify the barriers to and solutions for shorter treatment times. METHODS AND MATERIALS A total of 154 patients were treated with the ViewRay MRIdian system between September 2018 and October 2019. The time process of MRgRT workflow steps of 962 fractions for 166 treatment sites was analyzed in terms of patient and online adaptive treatment (ART) characteristics. RESULTS Overall, 774 of 962 fractions were treated with online ART, and 83.2% of adaptive fractions were completed in less than 60 minutes. Sixty-three percent, 50.3%, and 4.2% of fractions were completed in less than 50 minutes, 45 minutes, and 30 minutes, respectively. Eight-point-three percent and 3% of fractions were completed in more than 70 minutes and 80 minutes, respectively. The median time (tmed) for ART workflow steps were as follows: (1) setup tmed: 5.0 minutes, (2) low-resolution scanning tmed: 1 minute, (3) high-resolution scanning tmed: 3 minutes, (4) online contouring tmed: 9 minutes, (5) reoptimization with online quality assurance tmed: 5 minutes, (6) real targeting tmed: 3 minutes, (7) beam delivery with gating tmed: 17 minutes, and (8) net total treatment time tmed: 45 minutes. The shortest and longest tmean rates of net total treatment time were 41.59 minutes and 64.43 minutes for upper-lung-lobe-located thoracic tumors and ultracentrally located thoracic tumors, respectively. CONCLUSIONS To our knowledge, this is the first broad treatment-time analysis for online ART in the literature. Although treatment times are long due to human- and technology-related limitations, benefits offered by MRgRT might be clinically important. In the future, implementation of artificial intelligence segmentation, an increase in dose rate, and faster multileaf collimator and gantry speeds may lead to achieving shorter MRgRT treatments.
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15
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Pinzi V, Landoni V, Cattani F, Lazzari R, Jereczek-Fossa BA, Orecchia R. IMRT and brachytherapy comparison in gynaecological cancer treatment: thinking over dosimetry and radiobiology. Ecancermedicalscience 2019; 13:993. [PMID: 32010217 PMCID: PMC6974373 DOI: 10.3332/ecancer.2019.993] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Indexed: 12/29/2022] Open
Abstract
Background The role of radiotherapy and brachytherapy in the management of locally advanced cervical and endometrial cancer is well established. However, in some cases, intracavitary brachytherapy (ICBRT) is not recommended or cannot be carried out. We aimed to investigate whether external-beam irradiation delivered by means of intensity-modulated radiation therapy (IMRT) might replace ICBRT in gynaecological cancer when the standard ICBRT boost delivering cannot be administered for technical or clinical reasons. Materials and methods Fifteen already delivered treatments for gynaecological cancer patients were analysed. The treatments were performed through 3-dimensional conformal radiotherapy (3D-CRT) to the whole-pelvis up to the dose of 45–50.4 Gy followed by a boost dose administered with ICBRT in high-dose-rate or pulsed-dose-rate modality. For each patient, IMRT plans were elaborated to mimic the ICBRT. We analysed the ICBRT boost versus IMRT boost in terms of dosimetric and radiobiological aspects. Results Mean conformity index value calculated on boost volume was 0.73 for ICBRT and 0.97 for IMRT. Mean conformation number was 0.24 for ICBRT boost and 0.78 for IMRT boost. Mean normal tissue complication probability (NTCP) values for 3D-CRT plus ICBRT and for IMRT (pelvis plus boost) were, respectively, 28% and 5% for rectum; 1.5% and 0.1% for urinary bladder and 8.9% and 6.1% for bowel. Conclusions Our findings suggest that IMRT may represent a viable alternative in delivering the boost in patients diagnosed with gynaecological cancer not amenable to ICBRT.
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Affiliation(s)
- Valentina Pinzi
- Department of Neurosurgery, Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Valeria Landoni
- Laboratory of Medical Physics and Expert System, IRCCS Istituto Nazionale Tumori Regina Elena, 00128 Rome, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology IRCCS (IEO), 20141 Milan, Italy
| | - Roberta Lazzari
- Department of Radiation Oncology of IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiation Oncology of IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy.,Department of Oncology and Hemato-Oncology of University of Milan, 20122 Milan, Italy
| | - Roberto Orecchia
- Scientific Directory of IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
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16
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Jarema T, Aland T. Using the iterative kV CBCT reconstruction on the Varian Halcyon linear accelerator for radiation therapy planning for pelvis patients. Phys Med 2019; 68:112-116. [DOI: 10.1016/j.ejmp.2019.11.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/16/2019] [Accepted: 11/18/2019] [Indexed: 01/15/2023] Open
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17
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Prehabilitation for patient positioning: pelvic exercises assist in minimizing inter-fraction sacral slope variability during radiation therapy. Med Oncol 2019; 37:3. [PMID: 31713056 DOI: 10.1007/s12032-019-1322-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Abstract
Reproducible patient positioning is essential for precision in radiation therapy (RT) delivery. We tested the hypothesis that a structured daily pre-treatment stretching regimen is both feasible and effective for minimizing variability in positioning, as measured by sacral slope angles (SSA). Eight female subjects undergoing pelvic radiotherapy performed a structured daily hip exercise regimen (extension and external rotation) immediately prior to both simulation imaging and daily treatment, throughout their RT course. This exercising cohort was compared to a retrospective review of 20 subjects (17 women and 3 men) undergoing RT, who had usual care. SSA measurements from daily pre-treatment imaging were compared to SSA measurements from the simulation CT. The average variation in SSA among the intervention subjects was 0.91° (± 0.58°), with a range among subjects of 0.57°-1.27°. The average variation for the control subjects was 2.27° (± 1.43°), ranging 1.22°-5.09°. The difference between the two groups was statistically significant (p = 0.0001). There was a statistically significant SSA variation between groups at each week of treatment. There was no significant variation among the intervention subjects between week 1 and later weeks, whereas subjects in the control group demonstrated significant SSA variation between week 1 and later weeks. We demonstrated a significant decrease in the variability of SSA by implementing a simple pre-treatment exercise program, while control subjects exhibited increasing variation in SSA over the course of treatment. We conclude that there is a potential benefit of prehabilitation during pelvic RT; however, a larger randomized control trial is required to confirm the findings.Clinical Trial: This research project was approved by the University of Massachusetts Medical School IRB (IRB ID H00012353) on January 21, 2017. The study is listed on ClinicalTrials.gov, provided by the U.S. National Library of Medicine, found with identifier NCT03242538.
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18
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Schmid RK, Tai A, Klawikowski S, Straza M, Ramahi K, Li XA, Robbins JR. The Dosimetric Impact of Interfractional Organ-at-Risk Movement During Liver Stereotactic Body Radiation Therapy. Pract Radiat Oncol 2019; 9:e549-e558. [PMID: 31176791 DOI: 10.1016/j.prro.2019.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/07/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) is an effective therapy for treating liver malignancies. However, little is known about interfractional dose variations to adjacent organs at risk (OARs). We examine the effects of interfractional organ movement and setup variation on dose delivered to OARs in patients receiving liver SBRT. METHODS AND MATERIALS Thirty patients treated with liver SBRT were analyzed. Daily image guidance with diagnostic quality computed tomography-on-rails imaging was performed before each fraction. In phase 1, these daily images were used to delineate all OARs including the liver, heart, right kidney, esophagus, stomach, duodenum, and large bowel in 10 patients. In phase 2, only OARS in close proximity to the target were contoured in 20 additional patients. Dose distribution on each daily computed tomography was generated, and daily doses to each OAR were recorded and compared with clinical thresholds to determine whether a daily dose excess (DDE) occurred. RESULTS In phase 1, significant interfractional dose differences between planned and delivered dose to OARs were observed, but differences were rarely clinically significant, with just 1 DDE. In phase 2, multiple DDEs were recorded for OARs close to the target, mainly involving the stomach, heart, and esophagus. Tumors in the hilum and liver segments I, IV, and VIII were the most common locations for DDEs. On root cause analysis, 3 etiologies of DDE emerged: craniocaudal shift (69.2%), anatomic changes (28.2%), and anteroposterior shifts (2.6%). CONCLUSIONS OARs close to liver lesions may receive higher doses than expected during SBRT owing to interfractional variations in OARs relative to the target. These differences in planned versus expected dose can lead to toxicity. Efforts to better evaluate OARs with daily image guidance may help reduce risks. Application of adaptive replanning and improved and real-time image guidance could mitigate risks of toxicity, and further study into their applications is warranted.
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Affiliation(s)
- Ryan K Schmid
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - An Tai
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Slade Klawikowski
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael Straza
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Khalid Ramahi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jared R Robbins
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Radiation Oncology, University of Arizona College of Medicine, Tucson, Arizona.
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Kanzaki R, Araki F, Kawamura S. Image-guidance technique comparison on respiratory reproducibility and dose indexes for stereotactic body radiotherapy in lung tumor. Med Dosim 2019; 44:385-393. [PMID: 30857654 DOI: 10.1016/j.meddos.2019.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/19/2019] [Accepted: 02/13/2019] [Indexed: 11/17/2022]
Abstract
We investigated respiratory reproducibility from position errors of gold internal fiducial markers for breath-hold (BH) and real-time tumor tracking (RTT) techniques for stereotactic body radiotherapy in lung tumors. The relationship between position errors and dose indexes was checked for both techniques. The stereotactic body radiotherapy plan in lung tumors was planned for 29 patients. The tumor positioning was arranged using 1.5 mm diameter gold internal fiducial markers. First, CT images were acquired to analyze position errors of gold markers for BH and RTT techniques. The offset plans for both techniques were calculated by displacing the mean position errors. The dose indexes (D98, D95, D2, mean dose) in a planning target volume were evaluated from dose volume histograms for the original plan, BH, and RTT offset plans. The relationship between position errors and dose indexes was analyzed using the root mean square (RMS) for both techniques. For the BH, the RMS was 3.29 mm at the lower lobe. Similarly, it was 1.34 mm for the RTT. The difference for D98 by position error for BH was -7.0 ± 10.8% at the lower lobe and the difference of all dose indexes for the RTT was less than 1%. The D2 and mean dose for both techniques were nearly the same as those of the original plan. In conclusion, the adaptation of the BH technique should be ≤2 mm RMS. If the position error is >2 mm RMS, the RTT technique should be used instead of the BH technique.
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Affiliation(s)
- Ryuji Kanzaki
- Department of Radiological Technology, Yamaguchi University Hospital, Ube City, Yamaguchi, Japan; Graduate School of Health Sciences, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Fujio Araki
- Department of Health Sciences, Faculty of Life Sciences, Kumamoto University, Chuo-ku, Kumamoto, Japan.
| | - Shinji Kawamura
- Graduate School of Health Sciences, Teikyo University, Omuta, Fukuoka, Japan
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Zhou Y, Yuan J, Wong OL, Fung WWK, Cheng KF, Cheung KY, Yu SK. Assessment of positional reproducibility in the head and neck on a 1.5-T MR simulator for an offline MR-guided radiotherapy solution. Quant Imaging Med Surg 2018; 8:925-935. [PMID: 30505721 DOI: 10.21037/qims.2018.10.03] [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] [Indexed: 11/06/2022]
Abstract
Background Recently, a shuttle-based offline magnetic resonance-guided radiotherapy (MRgRT) approach was proposed. This study aims to evaluate the positional reproducibility in the immobilized head and neck using a 1.5-T MR-simulator (MR-sim) on healthy volunteers. Methods A total of 159 scans of 14 healthy volunteers were conducted on a 1.5-T MR-sim with thermoplastic mask immobilization. MR images with isotropic 1.053 mm3 voxel size were rigidly registered to the first scan based on fiducial, anatomical and gross positions. Mean and standard deviation of positional displacements in translation and rotation were assessed. Systematic error and random errors of positioning in the head and neck on the MR-sim were determined in the translation of, and in the rotation of roll, pitch and yaw. Results The systematic error (Σ) of translation in left-right (LR), anterior-posterior (AP) and superior-inferior (SI) direction was 0.57, 0.22 and 0.26 mm for fiducial displacement, 0.28, 0.10 and 0.52 mm for anatomical displacement, and 0.53, 0.22 and 0.49 mm for gross displacement, respectively. The random error (σ) in corresponding translation direction was 2.07, 0.54 and 1.32 mm for fiducial displacement, 1.34, 0.73 and 2.04 mm for anatomical displacement, and 2.24, 0.86 and 2.61 mm for gross displacement. The systematic error and random error of rotation were generally smaller than 1°. Conclusions Our results suggested that high gross positional reproducibility (<1 mm translational and <1° rotational systematic error) could be achieved on an MR-sim for the proposed offline MRgRT.
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Affiliation(s)
- Yihang Zhou
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Jing Yuan
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Oi Lei Wong
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Winky Wing Ki Fung
- Department of Radiotherapy, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Ka Fai Cheng
- Department of Radiotherapy, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Kin Yin Cheung
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Siu Ki Yu
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
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Mostafaei F, Tai A, Omari E, Song Y, Christian J, Paulson E, Hall W, Erickson B, Li XA. Variations of MRI-assessed peristaltic motions during radiation therapy. PLoS One 2018; 13:e0205917. [PMID: 30359413 PMCID: PMC6201905 DOI: 10.1371/journal.pone.0205917] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/03/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Understanding complex abdominal organ motion is essential for motion management in radiation therapy (RT) of abdominal tumors. This study investigates abdominal motion induced by respiration and peristalsis, during various time durations relevant to RT, using various CT and MRI techniques acquired under free breathing (FB) and breath hold (BH). METHODS A series of CT and MRI images acquired with various techniques under free breathing and/or breath hold from 37 randomly-selected pancreatic or liver cancer patients were analyzed to assess the motion in various time frames. These data include FB 4DCT from 15 patients (for motion in time duration of 5 sec), FB 2D cine-MRI from 4 patients (time duration of 1.7 min, 1 second acquisition time per slice), FB cine-MRI acquired using MR-Linac from 6 patients in various fractions (acquisition time is less than 0.6 seconds per slice), FB 4DMRI from 2 patients (time duration of 2 min), respiration-gated T2 with gating at the end expiration (time duration of 3-5 min), and BH T1 with multiphase dynamic contrast in acquisition times of 17 seconds for each of five phases (pre-contrast, arterial, venous, portal venous and delayed post-contrast) from 10 patients. Motions of various organs including gallbladder (GB) and liver were measured based on these MRI data. The GB motion includes both respiration and peristalsis, while liver motion is primarily respiration. By subtracting liver motion (respiration) from GB motion (respiration and peristalsis), the peristaltic motion, along with small residual motion, was obtained. RESULTS From cine-MRI, the residual motion beyond the respiratory motion was found to be up to 0.6 cm in superior-inferior (SI) and 0.55 cm in anterior-posterior (AP) directions. From 2D cine-MRI acquired by the MR-Linac, different peristaltic motions were found from different fractions for each patient. The peristaltic motion was found to vary between 0.3-1 cm. From BH T1 phase images, the average motions that were primarily due to peristalsis movements were found to be 1.2 cm in SI, 0.7 cm in AP, and 0.9 cm in left-right (LR) directions. The average motions assessed from 4DCT were 1.0 cm in SI and 0.3 cm in AP directions, which were generally smaller than the motions assessed from cine-MRI, i.e., 1.8 cm in SI and 0.6 cm in AP directions, for the same patients. However, average motions from 4DMRI, which are coming from respiratory were measured to be 1.5, 0.5, and 0.4 cm in SI, AP, and LR directions, respectively. CONCLUSION The abdominal motion due to peristalsis can be similar in magnitude to respiratory motion as assessed. These motions can be irregular and persistent throughout the imaging and RT delivery procedures, and should be considered together with respiratory motion during RT for abdominal tumors.
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Affiliation(s)
- Farshad Mostafaei
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - An Tai
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Eenas Omari
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Yingqiu Song
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Union Hospital Cancer Center, Huazhong University of Science and Technology, Wuhan, China
| | - James Christian
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Eric Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - William Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - X. Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- * E-mail:
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22
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Kashani R, Olsen JR. Magnetic Resonance Imaging for Target Delineation and Daily Treatment Modification. Semin Radiat Oncol 2018; 28:178-184. [DOI: 10.1016/j.semradonc.2018.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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23
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Gupta V, Wang Y, Méndez Romero A, Myronenko A, Jordan P, Maurer C, Heijmen B, Hoogeman M. Fast and robust adaptation of organs-at-risk delineations from planning scans to match daily anatomy in pre-treatment scans for online-adaptive radiotherapy of abdominal tumors. Radiother Oncol 2018. [DOI: 10.1016/j.radonc.2018.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Zhu J, Bai T, Gu J, Sun Z, Wei Y, Li B, Yin Y. Effects of megavoltage computed tomographic scan methodology on setup verification and adaptive dose calculation in helical TomoTherapy. Radiat Oncol 2018; 13:80. [PMID: 29699582 PMCID: PMC5921977 DOI: 10.1186/s13014-018-0989-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/02/2018] [Indexed: 11/26/2022] Open
Abstract
Background To evaluate the effect of pretreatment megavoltage computed tomographic (MVCT) scan methodology on setup verification and adaptive dose calculation in helical TomoTherapy. Methods Both anthropomorphic heterogeneous chest and pelvic phantoms were planned with virtual targets by TomoTherapy Physicist Station and were scanned with TomoTherapy megavoltage image-guided radiotherapy (IGRT) system consisted of six groups of options: three different acquisition pitches (APs) of ‘fine’, ‘normal’ and ‘coarse’ were implemented by multiplying 2 different corresponding reconstruction intervals (RIs). In order to mimic patient setup variations, each phantom was shifted 5 mm away manually in three orthogonal directions respectively. The effect of MVCT scan options was analyzed in image quality (CT number and noise), adaptive dose calculation deviations and positional correction variations. Results MVCT scanning time with pitch of ‘fine’ was approximately twice of ‘normal’ and 3 times more than ‘coarse’ setting, all which will not be affected by different RIs. MVCT with different APs delivered almost identical CT numbers and image noise inside 7 selected regions with various densities. DVH curves from adaptive dose calculation with serial MVCT images acquired by varied pitches overlapped together, where as there are no significant difference in all p values of intercept & slope of emulational spinal cord (p = 0.761 & 0.277), heart (p = 0.984 & 0.978), lungs (p = 0.992 & 0.980), soft tissue (p = 0.319 & 0.951) and bony structures (p = 0.960 & 0.929) between the most elaborated and the roughest serials of MVCT. Furthermore, gamma index analysis shown that, compared to the dose distribution calculated on MVCT of ‘fine’, only 0.2% or 1.1% of the points analyzed on MVCT of ‘normal’ or ‘coarse’ do not meet the defined gamma criterion. On chest phantom, all registration errors larger than 1 mm appeared at superior-inferior axis, which cannot be avoided with the smallest AP and RI. On pelvic phantom, craniocaudal errors are much smaller than chest, however, AP of ‘coarse’ presents larger registration errors which can be reduced from 2.90 mm to 0.22 mm by registration technique of ‘full image’. Conclusions AP of ‘coarse’ with RI of 6 mm is recommended in adaptive radiotherapy (ART) planning to provide craniocaudal longer and faster MVCT scan, while registration technique of ‘full image’ should be used to avoid large residual error. Considering the trade-off between IGRT and ART, AP of ‘normal’ with RI of 2 mm was highly recommended in daily practice. Electronic supplementary material The online version of this article (10.1186/s13014-018-0989-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jian Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, 440# Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China.
| | - Tong Bai
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, 440# Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China
| | - Jiabing Gu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, 440# Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China
| | - Ziwen Sun
- Medical Department, Affiliated Hospital of Shandong Academy of Medical Sciences, Jinan, 250031, People's Republic of China
| | - Yumei Wei
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, 440# Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China
| | - Baosheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, 440# Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China
| | - Yong Yin
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, 440# Jiyan Road, Jinan, 250117, Shandong Province, People's Republic of China.
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A service evaluation of on-line image-guided radiotherapy to lower extremity sarcoma: Investigating the workload implications of a 3 mm action level for image assessment and correction prior to delivery. Radiography (Lond) 2018; 24:142-145. [PMID: 29605111 DOI: 10.1016/j.radi.2017.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 11/13/2017] [Accepted: 11/26/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Although all systematic and random positional setup errors can be corrected for in entirety during on-line image-guided radiotherapy, the use of a specified action level, below which no correction occurs, is also an option. The following service evaluation aimed to investigate the use of this 3 mm action level for on-line image assessment and correction (online, systematic set-up error and weekly evaluation) for lower extremity sarcoma, and understand the impact on imaging frequency and patient positioning error within one cancer centre. METHODS All patients were immobilised using a thermoplastic shell attached to a plastic base and an individual moulded footrest. A retrospective analysis of 30 patients was performed. Patient setup and correctional data derived from cone beam CT analysis was retrieved. The timing, frequency and magnitude of corrections were evaluated. The population systematic and random error was derived. RESULTS 20% of patients had no systematic corrections over the duration of treatment, and 47% had one. The maximum number of systematic corrections per course of radiotherapy was 4, which occurred for 2 patients. 34% of episodes occurred within the first 5 fractions. All patients had at least one observed translational error during their treatment greater than 0.3 cm, and 80% of patients had at least one observed translational error during their treatment greater than 0.5 cm. The population systematic error was 0.14 cm, 0.10 cm, 0.14 cm and random error was 0.27 cm, 0.22 cm, 0.23 cm in the lateral, caudocranial and anteroposterial directions. The required Planning Target Volume margin for the study population was 0.55 cm, 0.41 cm and 0.50 cm in the lateral, caudocranial and anteroposterial directions. CONCLUSION The 3 mm action level for image assessment and correction prior to delivery reduced the imaging burden and focussed intervention on patients that exhibited greater positional variability. This strategy could be an efficient deployment of departmental resources if full daily correction of positional setup error is not possible.
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Klawikowski S, Tai A, Ates O, Ahunbay E, Li XA. A fast 4D IMRT/VMAT planning method based on segment aperture morphing. Med Phys 2018; 45:1594-1602. [DOI: 10.1002/mp.12778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/28/2017] [Accepted: 01/02/2018] [Indexed: 12/25/2022] Open
Affiliation(s)
- Slade Klawikowski
- Department of Radiation Oncology; The Medical College of Wisconsin; Milwaukee WI USA
| | - An Tai
- Department of Radiation Oncology; The Medical College of Wisconsin; Milwaukee WI USA
| | - Ozgur Ates
- Department of Radiation Oncology; The Medical College of Wisconsin; Milwaukee WI USA
| | - Ergun Ahunbay
- Department of Radiation Oncology; The Medical College of Wisconsin; Milwaukee WI USA
| | - X. Allen Li
- Department of Radiation Oncology; The Medical College of Wisconsin; Milwaukee WI USA
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MacManus M, Everitt S, Schimek-Jasch T, Li XA, Nestle U, Kong FMS. Anatomic, functional and molecular imaging in lung cancer precision radiation therapy: treatment response assessment and radiation therapy personalization. Transl Lung Cancer Res 2017; 6:670-688. [PMID: 29218270 DOI: 10.21037/tlcr.2017.09.05] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This article reviews key imaging modalities for lung cancer patients treated with radiation therapy (RT) and considers their actual or potential contributions to critical decision-making. An international group of researchers with expertise in imaging in lung cancer patients treated with RT considered the relevant literature on modalities, including computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET). These perspectives were coordinated to summarize the current status of imaging in lung cancer and flag developments with future implications. Although there are no useful randomized trials of different imaging modalities in lung cancer, multiple prospective studies indicate that management decisions are frequently impacted by the use of complementary imaging modalities, leading both to more appropriate treatments and better outcomes. This is especially true of 18F-fluoro-deoxyglucose (FDG)-PET/CT which is widely accepted to be the standard imaging modality for staging of lung cancer patients, for selection for potentially curative RT and for treatment planning. PET is also more accurate than CT for predicting survival after RT. PET imaging during RT is also correlated with survival and makes response-adapted therapies possible. PET tracers other than FDG have potential for imaging important biological process in tumors, including hypoxia and proliferation. MRI has superior accuracy in soft tissue imaging and the MRI Linac is a rapidly developing technology with great potential for online monitoring and modification of treatment. The role of imaging in RT-treated lung cancer patients is evolving rapidly and will allow increasing personalization of therapy according to the biology of both the tumor and dose limiting normal tissues.
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Affiliation(s)
- Michael MacManus
- Department of Radiation Oncology, Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia.,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - Sarah Everitt
- Department of Radiation Oncology, Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia.,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - Tanja Schimek-Jasch
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, WI, USA
| | - Ursula Nestle
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany
| | - Feng-Ming Spring Kong
- Indiana University Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
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Fast and robust online adaptive planning in stereotactic MR-guided adaptive radiation therapy (SMART) for pancreatic cancer. Radiother Oncol 2017; 125:439-444. [PMID: 28811038 DOI: 10.1016/j.radonc.2017.07.028] [Citation(s) in RCA: 228] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/23/2017] [Accepted: 07/27/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE To implement a robust and fast stereotactic MR-guided adaptive radiation therapy (SMART) online strategy in locally advanced pancreatic cancer (LAPC). MATERIAL AND METHODS SMART strategy for plan adaptation was implemented with the MRIdian system (ViewRay Inc.). At each fraction, OAR (re-)contouring is done within a distance of 3cm from the PTV surface. Online plan re-optimization is based on robust prediction of OAR dose and optimization objectives, obtained by building an artificial neural network (ANN). Proposed limited re-contouring strategy for plan adaptation (SMART3CM) is evaluated by comparing 50 previously delivered fractions against a standard (re-)planning method using full-scale OAR (re-)contouring (FULLOAR). Plan quality was assessed using PTV coverage (V95%, Dmean, D1cc) and institutional OAR constraints (e.g. V33Gy). RESULTS SMART3CM required a significant lower number of optimizations than FULLOAR (4 vs 18 on average) to generate a plan meeting all objectives and institutional OAR constraints. PTV coverage with both strategies was identical (mean V95%=89%). Adaptive plans with SMART3CM exhibited significant lower intermediate and high doses to all OARs than FULLOAR, which also failed in 36% of the cases to adhere to the V33Gy dose constraint. CONCLUSIONS SMART3CM approach for LAPC allows good OAR sparing and adequate target coverage while requiring only limited online (re-)contouring from clinicians.
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Omari EA, Erickson B, Ehlers C, Quiroz F, Noid G, Cooper DT, Lachaine M, Li XA. Preliminary results on the feasibility of using ultrasound to monitor intrafractional motion during radiation therapy for pancreatic cancer. Med Phys 2017; 43:5252. [PMID: 27587056 DOI: 10.1118/1.4960004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Substantial intrafraction organ motion during radiation therapy (RT) for pancreatic cancer is well recognized as a major limiting factor for accurate delivery of RT. The aim of this work is to determine the feasibility of monitoring the intrafractional motion of the pancreas or surrounding structures using ultrasound for RT delivery. METHODS Transabdominal ultrasound (TAUS) and 4DCT data were acquired on ten pancreatic cancer patients during radiation therapy process in a prospective study. In addition, TAUS and MRI were collected for five healthy volunteers. The portal vein (PV) and the head of the pancreas (HP) along with other structures were contoured on these images. Volume changes, distance between the HP and PV, and motion difference between the HP and PV were measured to examine whether PV can be used as a motion surrogate for HP. TAUS images were acquired and processed using a research version of the Clarity autoscan ultrasound system (CAUS). Motion monitoring was performed with the ultrasound probe mounted on an arm fixed to the couch. Video segments of the monitoring sessions were captured. RESULTS On TAUS, PV is better visualized than HP. The measured mean volume deviation for all patients for the HP and PV was 1.4 and 0.6 ml, respectively. The distance between the HP and PV was close to a constant with 0.22 mm mean deviation throughout the ten breathing phases. The mean of the absolute motion difference for all patients was 1.7 ± 0.8 mm in LR, 1.5 ± 0.5 mm in AP, and 2.3 ± 0.7 mm in SI, suggesting that the PV is a good surrogate for HP motion estimation. By using this surrogate, the HP motion tracking using TAUS was demonstrated. CONCLUSIONS Large intrafractional organ motion due to respiratory and/or bowel motion is a limiting factor in administering curative radiation doses to pancreatic tumors. The authors investigate the use of real-time ultrasound to track pancreas motion. Due to the poor visibility of the pancreas head on an ultrasound image, the portal vein is identified as a surrogate. The authors have demonstrated the feasibility of tracking HP motion through the localization of the PV using TAUS. This will potentially allow real-time tracking of intrafractional motion to justify small PTV-margins and to account for unusual motions, thus, improving normal tissue sparing.
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Affiliation(s)
- Eenas A Omari
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | - Christopher Ehlers
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | - Francisco Quiroz
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | - George Noid
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | | | | | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
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Mao W, Rozario T, Lu W, Gu X, Yan Y, Jia X, Sumer B, Schwartz DL. Online dosimetric evaluation of larynx SBRT: A pilot study to assess the necessity of adaptive replanning. J Appl Clin Med Phys 2016; 18:157-163. [PMID: 28291932 PMCID: PMC5689891 DOI: 10.1002/acm2.12019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 11/06/2016] [Indexed: 12/15/2022] Open
Abstract
Purpose We have initiated a multi‐institutional phase I trial of 5‐fraction stereotactic body radiotherapy (SBRT) for Stage III–IVa laryngeal cancer. We conducted this pilot dosimetric study to confirm potential utility of online adaptive replanning to preserve treatment quality. Methods We evaluated ten cases: five patients enrolled onto the current trial and five patients enrolled onto a separate phase I SBRT trial for early‐stage glottic larynx cancer. Baseline SBRT treatment plans were generated per protocol. Daily cone‐beam CT (CBCT) or diagnostic CT images were acquired prior to each treatment fraction. Simulation CT images and target volumes were deformably registered to daily volumetric images, the original SBRT plan was copied to the deformed images and contours, delivered dose distributions were re‐calculated on the deformed CT images. All of these were performed on a commercial treatment planning system. In‐house software was developed to propagate the delivered dose distribution back to reference CT images using the deformation information exported from the treatment planning system. Dosimetric differences were evaluated via dose‐volume histograms. Results We could evaluate dose within 10 minutes in all cases. Prescribed coverage to gross tumor volume (GTV) and clinical target volume (CTV) was uniformly preserved; however, intended prescription dose coverage of planning treatment volume (PTV) was lost in 53% of daily treatments (mean: 93.9%, range: 83.9–97.9%). Maximum bystander point dose limits to arytenoids, parotids, and spinal cord remained respected in all cases, although variances in carotid artery doses were observed in a minority of cases. Conclusions Although GTV and CTV SBRT dose coverage is preserved with in‐room three‐dimensional image guidance, PTV coverage can vary significantly from intended plans and dose to critical structures may exceed tolerances. Online adaptive treatment re‐planning is potentially necessary and clinically applicable to fully preserve treatment quality. Confirmatory trial accrual and analysis remains ongoing.
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Affiliation(s)
- Weihua Mao
- Department of Radiation Oncology, University of Texas Southwestern School of Medicine, Dallas, TX, USA.,Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI, USA
| | - Timothy Rozario
- Department of Radiation Oncology, University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Weiguo Lu
- Department of Radiation Oncology, University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Xuejun Gu
- Department of Radiation Oncology, University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Yulong Yan
- Department of Radiation Oncology, University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Xun Jia
- Department of Radiation Oncology, University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Baran Sumer
- Department of Otolaryngology, University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - David L Schwartz
- Department of Radiation Oncology, University of Texas Southwestern School of Medicine, Dallas, TX, USA
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Kaur I, Rawat S, Ahlawat P, Kakria A, Gupta G, Saxena U, Mishra MB. Dosimetric impact of setup errors in head and neck cancer patients treated by image-guided radiotherapy. J Med Phys 2016; 41:144-8. [PMID: 27217627 PMCID: PMC4871004 DOI: 10.4103/0971-6203.181640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
To assess and analyze the impact of setup uncertainties on target volume coverage and doses to organs at risk (OAR) in head and neck cancer (HNC) patients treated by image-guided radiotherapy (IGRT). Translational setup errors in 25 HNC patients were observed by kilovoltage cone beam computed tomography (kV CBCT). Two plans were generated. Plan one – the original plan which was the initially optimized and approved plan of the patient. All patients were treated according to their respective approved plans at a defined isocenter. Plan two – the plan sum which was the sum of all plans recalculated at a different isocenter according to setup errors in x, y, and z-direction. Plan sum was created to evaluate doses that would have been received by planning target volume (PTV) and OARs if setup errors were not corrected. These 2 plans were analyzed and compared in terms of target volume coverage and doses to OARs. A total 503 kV CBCT images were acquired for evaluation of setup errors in 25 HNC patients. The systematic (mean) and random errors (standard deviation) combined for 25 patients in x, y, and z directions were 0.15 cm, 0.21 cm, and 0.19 cm and 0.09 cm, 0.12 cm, and 0.09 cm, respectively. The study showed that there was a significant difference in PTV coverage between 2 plans. The doses to various OARs showed a nonsignificant increase in the plan sum. The correction of translational setup errors is essential for IGRT treatment in terms of delivery of planned optimal doses to target volume.
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Affiliation(s)
- Inderjit Kaur
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sheh Rawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Parveen Ahlawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Anjali Kakria
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Gourav Gupta
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Upasna Saxena
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Manindra Bhushan Mishra
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Image guided radiation therapy boost in combination with high-dose-rate intracavitary brachytherapy for the treatment of cervical cancer. J Contemp Brachytherapy 2016; 8:122-7. [PMID: 27257416 PMCID: PMC4873551 DOI: 10.5114/jcb.2016.59282] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/15/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose The purpose of this study was to demonstrate the dosimetric and clinical feasibility of image guided radiation therapy (IGRT) combined with high-dose-rate (HDR) intracavitary brachytherapy (ICBT) to improve dose distribution in cervical cancer treatment. Material and methods For 42 cervical cancer patients, magnetic resonance imaging (MRI) scans were acquired after completion of whole pelvic irradiation 45-46 Gy and 5 fractions of B + I (ICBT + IGRT) treatment were subsequently received. The high risk clinical target volume (HRCTV), intermediate risk clinical target volume (IRCTV), bladder, rectum, and sigmoid were contoured on the computed tomography (CT) scans. The total planning aim doses for HRCTV was D90% > 85 Gy, whilst constraints for rectum and sigmoid were D2cc < 75 Gy and D2cc < 90 Gy for bladder in terms of an equivalent dose in 2 Gy (EQD2) for external beam radiotherapy (EBRT) and brachytherapy boost. The IGRT plan was optimized on top of the ICBT dose distribution. A dosimetric comparison was made between B + I and optimized ICBT (O-ICBT) only. Results The mean D90% of HRCTV was comparable for B + I and O-ICBT (p = 0.82). For B + I plan, HRCTV D100%, IRCTV D100%, and IRCTV D90% were significantly increased by a mean of 10.52 Gy, 5.61 Gy, and 2.70 Gy, respectively (p < 0.01). The D2cc for bladder, rectum, and sigmoid were lower by a mean of 21.36, 6.78, and 10.65 Gy, respectively (p < 0.01). The mean rectum V60 Gy value over 42 patients was almost the same for both techniques but for bladder and sigmoid B + I had higher V60 Gy mean values as compared with the O-ICBT. Conclusions B + I can improve dose distribution in cervical cancer treatment; it could be useful for tumors extended beyond the reach of intracavitary/interstitial brachytherapy (IC/ISBT) or for centers that are inexperienced or ill-equipped with IC/ISBT techniques. Additional confirmatory prospective studies with larger numbers of patients and longer follow-up are required to validate the durability.
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Arthurs M, Gillham C, O'Shea E, McCrickard E, Leech M. Dosimetric comparison of 3-dimensional conformal radiation therapy and intensity modulated radiation therapy and impact of setup errors in lower limb sarcoma radiation therapy. Pract Radiat Oncol 2016; 6:119-25. [PMID: 26932232 DOI: 10.1016/j.prro.2015.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 03/19/2015] [Accepted: 03/30/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE This study compared dosimetric data between 3-dimensional conformal radiation therapy (3DCRT) and intensity modulated radiation therapy (IMRT) plans in a population of patients with lower limb sarcoma immobilized with an in-house device and quantified the impact of systematic and random errors on these techniques. The dosimetric effects of displacements on target coverage and organs at risk (OARs) were considered. METHODS AND MATERIALS Plans were created for 11 postoperative patients using both 3DCRT and IMRT. The techniques were compared dosimetrically. Population-based systematic and random errors were applied and the results compared with the initial plans. RESULTS Higher target D95, D2, D98, and D50 and the best homogeneity index resulted with IMRT compared with 3DCRT. Systematic errors increased target D2 in IMRT. Random errors decreased target homogeneity in IMRT. Maximum bone dose was higher in IMRT than in 3DCRT. Neither error type increased OAR dose for either technique. CONCLUSIONS IMRT could become the favored lower limb sarcoma radiation therapy technique because of superior target coverage and homogeneity. Offline imaging can adequately correct for systematic errors in these patients when an in-house immobilization device is used.
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Affiliation(s)
- Meadhbh Arthurs
- Applied Radiation Therapy Trinity Research Group, Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Ireland
| | | | - Evelyn O'Shea
- St. Luke's Radiation Oncology Network, Dublin, Ireland
| | | | - Michelle Leech
- Applied Radiation Therapy Trinity Research Group, Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Ireland.
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Saha A, Mallick I, Das P, Shrimali R, Achari R, Chatterjee S. Evaluating the Need for Daily Image Guidance in Head and Neck Cancers Treated with Helical Tomotherapy: A Retrospective Analysis of a Large Number of Daily Imaging-based Corrections. Clin Oncol (R Coll Radiol) 2016; 28:178-84. [DOI: 10.1016/j.clon.2015.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/25/2015] [Accepted: 10/26/2015] [Indexed: 10/22/2022]
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Jeong S, Lee JH, Chung MJ, Lee SW, Lee JW, Kang DG, Kim SH. Analysis of Geometric Shifts and Proper Setup-Margin in Prostate Cancer Patients Treated With Pelvic Intensity-Modulated Radiotherapy Using Endorectal Ballooning and Daily Enema for Prostate Immobilization. Medicine (Baltimore) 2016; 95:e2387. [PMID: 26765418 PMCID: PMC4718244 DOI: 10.1097/md.0000000000002387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
We evaluate geometric shifts of daily setup for evaluating the appropriateness of treatment and determining proper margins for the planning target volume (PTV) in prostate cancer patients.We analyzed 1200 sets of pretreatment megavoltage-CT scans that were acquired from 40 patients with intermediate to high-risk prostate cancer. They received whole pelvic intensity-modulated radiotherapy (IMRT). They underwent daily endorectal ballooning and enema to limit intrapelvic organ movement. The mean and standard deviation (SD) of daily translational shifts in right-to-left (X), anterior-to-posterior (Y), and superior-to-inferior (Z) were evaluated for systemic and random error.The mean ± SD of systemic error (Σ) in X, Y, Z, and roll was 2.21 ± 3.42 mm, -0.67 ± 2.27 mm, 1.05 ± 2.87 mm, and -0.43 ± 0.89°, respectively. The mean ± SD of random error (δ) was 1.95 ± 1.60 mm in X, 1.02 ± 0.50 mm in Y, 1.01 ± 0.48 mm in Z, and 0.37 ± 0.15° in roll. The calculated proper PTV margins that cover >95% of the target on average were 8.20 (X), 5.25 (Y), and 6.45 (Z) mm. Mean systemic geometrical shifts of IMRT were not statistically different in all transitional and three-dimensional shifts from early to late weeks. There was no grade 3 or higher gastrointestinal or genitourianry toxicity.The whole pelvic IMRT technique is a feasible and effective modality that limits intrapelvic organ motion and reduces setup uncertainties. Proper margins for the PTV can be determined by using geometric shifts data.
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Affiliation(s)
- Songmi Jeong
- From the Department of Radiation Oncology, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon (SJ, JHL, MJC, SWL, DGK, SHK); and Department of Radiation Oncology, Kyungpook National University Hospital, Daegu, Korea (JWL)
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Shimizu M, Sato T, Sawa Y, Terashima K, Yanou T, Ida R. [The Usefulness of Using Fiducial Marker in Proton Therapy for Locally Advanced Pancreatic Cancer]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2016; 72:1074-1083. [PMID: 27867166 DOI: 10.6009/jjrt.2016_jsrt_72.11.1074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Though the dosimetric criteria for the gastrointestinal tract were met, late gastrointestinal toxicity was seen in several cases. Therefore, we thought that it was caused by the positional variation of gastrointestine surrounding pancreatic cancer because of peristalsis. METHOD They were confirmed by CT image regularly. And we evaluated that how much the difference of matching methods for correcting the positional variation influenced dose distribution. RESULT The fiducial markers could follow the position of pancreatic cancer and the duodenum. But it could reproduce the dose distribution to pancreatic cancer and the duodenum. DISCUSSION In proton therapy, the reproducible improvement of the duodenum position did not make the dose of the duodenum same as planning dose because the matching of fiducial markers made the positional relations between beam compensator and the duodenum change. CONCLUSION The fiducial markers are useful for correcting the position of pancreatic cancer and the duodenum. But in proton therapy, it could not reproduce the dose distribution to pancreatic cancer and the duodenum.
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Affiliation(s)
- Masakazu Shimizu
- Department of Radiation Technology, Hyogo Ion Beam Medical Center
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CBCT image guidance in head and neck irradiation: the impact of daily and weekly imaging protocols. JOURNAL OF RADIOTHERAPY IN PRACTICE 2015. [DOI: 10.1017/s1460396915000266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractPurposeThis study evaluated the impact of a daily and weekly image-guided radiotherapy protocols in reducing setup errors and setting of appropriate margins in head and neck cancer patients.Materials and methodsInterfraction and systematic shifts for the hypothetical day 1–3 plus weekly imaging were extrapolated from daily imaging data from 31 patients (964 cone beam computed tomography (CBCT) scans). In addition, residual setup errors were calculated by taking the average shifts in each direction for each patient based on the first three shifts and were presumed to represent systematic setup error. The clinical target volume (CTV) to planning target volume (PTV) margins were calculated using van Herk formula and analysed for each protocol.ResultsThe mean interfraction shifts for daily imaging were 0·8, 0·3 and 0·5 mm in the S-I (superior-inferior), L-R (left-right) and A-P (anterior-posterior) direction, respectively. On the other hand the mean shifts for day 1–3 plus weekly imaging were 0·9, 1·8 and 0·5 mm in the S-I, L-R and A-P direction, respectively. The mean day 1–3 residual shifts were 1·5, 2·1 and 0·7 mm in the S-I, L-R and A-P direction, respectively. No significant difference was found in the mean setup error for the daily and hypothetical day 1–3 plus weekly protocol. However, the calculated CTV to PTV margins for the daily interfraction imaging data were 1·6, 3·8 and 1·4 mm in the S-I, L-R and A-P directions, respectively. Hypothetical day 1–3 plus weekly resulted in CTV–PTV margins of 5, 4·2 and 5 mm in the S-I, L-R and A-P direction.ConclusionsThe results of this study show that a daily CBCT protocol reduces setup errors and allows setup margin reduction in head and neck radiotherapy compared to a weekly imaging protocol.
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Wang J, Chen YY, Tai A, Chen XL, Huang SM, Yang C, Bao Y, Li NW, Deng XW, Zhao C, Chen M, Li XA. Sensorineural Hearing Loss after Combined Intensity Modulated Radiation Therapy and Cisplatin-Based Chemotherapy for Nasopharyngeal Carcinoma. Transl Oncol 2015; 8:456-62. [PMID: 26692526 PMCID: PMC4700287 DOI: 10.1016/j.tranon.2015.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/19/2015] [Accepted: 10/19/2015] [Indexed: 12/04/2022] Open
Abstract
PURPOSE The incidence of sensorineural hearing loss (SNHL) after treatment with combination of intensity-modulated radiation therapy (IMRT) and cisplatin-based chemotherapy in nasopharyngeal carcinoma (NPC) patients was evaluated, and relationships of SNHL with host factors, treatment-related factors, and radiation dosimetric parameters were investigated. METHODS Fifty-one NPC patients treated with IMRT from 2004 to 2009 were analyzed. All patients received neoadjuvant, concurrent, or adjuvant use of cisplatin. Pure tone audiometry was performed during the follow-up period with a median time of 60months, ranging from 28 to 84months. Correlation of SNHL at low frequencies (pure tone average, 0.5-2kHz) with a series of factors was analyzed. RESULTS Among 102 ears, 12.7% had low-frequency SNHL and 42.2% had high-frequency (4kHz) SNHL. The incidence of low-frequency SNHL was greater in patients with age>40, with T-stage 4, or who received cumulative cisplatin dose (CCD)>200mg/m(2) (P=.034, .011, and .003, respectively) and in ears with secretory otitis media (SOM) (P=.002). Several dosimetric parameters were found to be correlated with SNHL. Univariate analysis showed that the minimum radiation dose to 0.1ml highest dose volume (D0.1ml) of the cochlea was the best radiation-related predictive parameter. Multivariate analysis indicated that CCD, SOM, and D0.1ml of cochlea (P=.035, .012, and .022, respectively) were the factors associated with SNHL. CONCLUSION For NPC patients treated with IMRT and chemotherapy, the incidence of treatment-related SNHL was associated with CCD, D0.1ml of cochlea, and SOM.
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Affiliation(s)
- Jin Wang
- Departments of Radiation Oncology, Zhejiang Key Lab of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China; Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Yuan-Yuan Chen
- Departments of Radiation Oncology, Zhejiang Key Lab of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - An Tai
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Xue-Lin Chen
- Department of Nasopharyngeal Carcinoma, Cancer Center, Sun Yat-sen University Guangzhou, People's Republic of China
| | - Shao-Ming Huang
- Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Cungen Yang
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Yong Bao
- Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Ning-Wei Li
- Department of Nasopharyngeal Carcinoma, Cancer Center, Sun Yat-sen University Guangzhou, People's Republic of China
| | - Xiao-Wu Deng
- Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Chong Zhao
- Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China.
| | - Ming Chen
- Departments of Radiation Oncology, Zhejiang Key Lab of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China; Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China.
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI.
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Li XA, Chen X, Zhang Q, Kirsch DG, Petersen I, DeLaney TF, Freeman CR, Trotti A, Hitchcock Y, Bedi M, Haddock M, Salerno K, Dundas G, Wang D. Margin reduction from image guided radiation therapy for soft tissue sarcoma: Secondary analysis of Radiation Therapy Oncology Group 0630 results. Pract Radiat Oncol 2015; 6:e135-e140. [PMID: 26852173 DOI: 10.1016/j.prro.2015.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 11/04/2015] [Accepted: 11/12/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE Six imaging modalities were used in Radiation Therapy Oncology Group (RTOG) 0630, a study of image guided radiation therapy (IGRT) for primary soft tissue sarcomas of the extremity. We analyzed all daily patient-repositioning data collected in this trial to determine the impact of daily IGRT on clinical target volume-to-planning target volume (CTV-to-PTV) margin. METHODS AND MATERIALS Daily repositioning data, including shifts in right-left (RL), superior-inferior (SI), and anterior-posterior (AP) directions and rotations for 98 patients enrolled in RTOG 0630 from 18 institutions were analyzed. Patients were repositioned daily on the basis of bone anatomy by using pretreatment images, including kilovoltage orthogonal images (KVorth), megavoltage orthogonal images (MVorth), KV fan-beam computed tomography (KVCT), KV cone beam CT (KVCB), MV fan-beam CT (MVCT), and MV cone beam CT (MVCB). Means and standard deviations (SDs) for each shift and rotation were calculated for each patient and for each IGRT modality. The Student's t tests and F-tests were performed to analyze the differences in the means and SDs. Necessary CTV-to-PTV margins were estimated. RESULTS The repositioning shifts and day-to-day variations were large and generally similar for the 6 imaging modalities. Of the 2 most commonly used modalities, MVCT and KVorth, there were no statistically significant differences in the shifts and rotations (P = .15 and .59 for the RL and SI shifts, respectively; and P = .22 for rotation), except for shifts in AP direction (P = .002). The estimated CTV-to-PTV margins in the RL, SI, and AP directions would be 13.0, 10.4, and 11.7 mm from MVCT data, respectively, and 13.1, 8.6, and 10.8 mm from KVorth data, respectively, indicating that margins substantially larger than 5 mm used with daily IGRT would be required in the absence of IGRT. CONCLUSIONS The observed large daily repositioning errors and the large variations among institutions imply that daily IGRT is necessary for this tumor site, particularly in multi-institutional trials. Otherwise, a CTV-to-PTV margin of 1.5 cm is required to account for daily setup variations.
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Affiliation(s)
- X Allen Li
- Medical College of Wisconsin, Milwaukee, Wisconsin.
| | | | - Qiang Zhang
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | | | | | | | | - Andy Trotti
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - Meena Bedi
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | - George Dundas
- Cross Cancer Institute - University of Alberta, Edmonton, Alberta, Canada
| | - Dian Wang
- Rush University Medical Center, Chicago, Illinois
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Wang D, Abrams RA. Radiotherapy for soft tissue sarcoma: 50 years of change and improvement. Am Soc Clin Oncol Educ Book 2015:244-51. [PMID: 24857082 DOI: 10.14694/edbook_am.2014.34.244] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Radiotherapy for soft tissue sarcoma (STS) has advanced significantly over the past 50 years. This review focuses briefly on the period from 1964 to 1999 and more substantially on the changes of the past 15 years, such as IMRT and image-guided radiotherapy (IG-RT), especially when brought together (IG-IMRT) in the same planning and delivery process to treat localized STS. In particular, the introduction of IG-RT, target volume definitions for IG-RT, and review of recent clinical trials using IG-RT to treat localized STS in extremity will be reviewed. Finally, potential investigational agents combined with IG-RT to improve outcomes in patients with localized STS are discussed.
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Affiliation(s)
- Dian Wang
- From the Department of Radiation Oncology, Rush University Medical Center, Chicago, IL
| | - Ross A Abrams
- From the Department of Radiation Oncology, Rush University Medical Center, Chicago, IL
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Yao L, Zhu L, Wang J, Liu L, Zhou S, Jiang S, Cao Q, Qu A, Tian S. Positioning accuracy during VMAT of gynecologic malignancies and the resulting dosimetric impact by a 6-degree-of-freedom couch in combination with daily kilovoltage cone beam computed tomography. Radiat Oncol 2015; 10:104. [PMID: 25927659 PMCID: PMC4443556 DOI: 10.1186/s13014-015-0412-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 04/20/2015] [Indexed: 12/25/2022] Open
Abstract
Background To improve the delivery of radiotherapy in gynecologic malignancies and to minimize the irradiation of unaffected tissues by using daily kilovoltage cone beam computed tomography (kV-CBCT) to reduce setup errors. Methods Thirteen patients with gynecologic cancers were treated with postoperative volumetric-modulated arc therapy (VMAT). All patients had a planning CT scan and daily CBCT during treatment. Automatic bone anatomy matching was used to determine initial inter-fraction positioning error. Positional correction on a six-degrees-of-freedom (6DoF) couch was followed by a second scan to calculate the residual inter-fraction error, and a post-treatment scan assessed intra-fraction motion. The margins of the planning target volume (MPTV) were calculated from these setup variations and the effect of margin size on normal tissue sparing was evaluated. Results In total, 573 CBCT scans were acquired. Mean absolute pre-/post-correction errors were obtained in all six planes. With 6DoF couch correction, the MPTV accounting for intra-fraction errors was reduced by 3.8–5.6 mm. This permitted a reduction in the maximum dose to the small intestine, bladder and femoral head (P = 0.001, 0.035 and 0.032, respectively), the average dose to the rectum, small intestine, bladder and pelvic marrow (P = 0.003, 0.000, 0.001 and 0.000, respectively) and markedly reduced irradiated normal tissue volumes. Conclusions A 6DoF couch in combination with daily kV-CBCT can considerably improve positioning accuracy during VMAT treatment in gynecologic malignancies, reducing the MPTV. The reduced margin size permits improved normal tissue sparing and a smaller total irradiated volume.
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Affiliation(s)
- Lihong Yao
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - Lihong Zhu
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - Lu Liu
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - Shun Zhou
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - ShuKun Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - Qianqian Cao
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - Ang Qu
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - Suqing Tian
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
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Kessel KA, Jäger A, Habermehl D, Rüppell J, Bendl R, Debus J, Combs SE. Changes in Gross Tumor Volume and Organ Motion Analysis During Neoadjuvant Radiochemotherapy in Patients With Locally Advanced Pancreatic Cancer Using an In-House Analysis System. Technol Cancer Res Treat 2015; 15:348-54. [PMID: 25824268 DOI: 10.1177/1533034615577515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 02/14/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE During radiation treatment, movement of the target and organs at risks as well as tumor response can significantly influence dose distribution. This is highly relevant in patients with pancreatic cancer, where organs at risk lie in close proximity to the target. MATERIAL AND METHODS Data sets of 10 patients with locally advanced pancreatic cancer were evaluated. Gross tumor volume deformation was analyzed. Dose changes to organs at risk were determined with focus on kidneys both without adaptive radiotherapy compensation and with replanning based on weekly acquired computed tomography scans. RESULTS During irradiation, gross tumor volume changes between 0% and 26% and moves within a radius of 5 to 16 mm. Required maximal dose to organs at risk for kidneys can be met with the current practice of matching computed tomography scans during treatment and adjusting patient position accordingly. Comparison of the mean doses and V15, V20 volumes demonstrated that weekly replanning could bring a significant dose sparing of the left kidney. CONCLUSION Manual matching with focus on bony structures can lead to overall acceptable positioning of patients during treatment. Thus, tolerance doses of organs at risk, such as the kidneys, can be met. With adequate margins, normal tissue constraints to organs at risk can be kept as well. Adaptive radiotherapy approaches (in this case with weekly rescanning) reduced dose to organs at risk, which may be especially important for hypofractionated approaches.
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Affiliation(s)
- Kerstin A Kessel
- Department of Radiation Oncology, Technische Universität München (TUM), Munich, Germany
| | - Andreas Jäger
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany German Cancer Research Center (DKFZ), Department of Medical Physics in Radiation Oncology, Heidelberg, Germany
| | - Daniel Habermehl
- Department of Radiation Oncology, Technische Universität München (TUM), Munich, Germany
| | - Jan Rüppell
- German Cancer Research Center (DKFZ), Department of Medical Physics in Radiation Oncology, Heidelberg, Germany
| | - Rolf Bendl
- German Cancer Research Center (DKFZ), Department of Medical Physics in Radiation Oncology, Heidelberg, Germany Department of Medical Informatics, Heilbronn University, Heilbronn, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany German Cancer Research Center (DKFZ), Department of Medical Physics in Radiation Oncology, Heidelberg, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technische Universität München (TUM), Munich, Germany
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Soda I, Ishiyama H, Ono S, Takenaka K, Arai M, Arai T, Iwase H, Sekiguchi A, Kawakami S, Komori S, Onda T, Hayakawa K. Assessment of transposed ovarian movement: how much of a safety margin should be added during pelvic radiotherapy? JOURNAL OF RADIATION RESEARCH 2015; 56:354-9. [PMID: 25589505 PMCID: PMC4380061 DOI: 10.1093/jrr/rru116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 09/23/2014] [Accepted: 11/10/2014] [Indexed: 05/25/2023]
Abstract
The purpose of this study was to analyze transposed ovarian movement. Data from 27 patients who underwent ovarian transposition after surgical treatment for uterine cancer were retrospectively analyzed. Computed tomography (CT) images including transposed ovaries were superimposed on other CT images acquired at different times, and were matched on bony structures. Differences in ovarian position between the CT images were measured. The planning organ at risk volume (PRV) margins were calculated from the formula of the 90% reference intervals (RIs) and the 95% RI, which were defined as mean ± 1.65 standard deviation (SD) and mean ± 1.96 SD, respectively. The 90% RI in the cranial, caudal, anterior, posterior, left and right directions were 1.5, 1.5, 1.4, 1.0, 1.7 and 0.9 cm, respectively. The 95% RI in the corresponding directions were 1.5, 2.0, 1.7, 1.2, 1.9 and 1.2 cm, respectively. These data suggest that bilateral ovaries need a PRV margin of ∼2 cm in all directions. The present study suggests that a transposed ovary needs the same PRV margin as a normal ovary (∼2 cm). Even after transposition, ovaries should be kept away from the radiation field to take into consideration the degree of ovarian movement.
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Affiliation(s)
- Itaru Soda
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamihara, Kanagawa 252-0374, Japan
| | - Hiromichi Ishiyama
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamihara, Kanagawa 252-0374, Japan
| | - Shigemitsu Ono
- Department of Gynecology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamihara, Kanagawa 252-0374, Japan
| | - Kouji Takenaka
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamihara, Kanagawa 252-0374, Japan
| | - Masahide Arai
- Department of Gynecology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamihara, Kanagawa 252-0374, Japan
| | - Tsutomu Arai
- Department of Gynecology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamihara, Kanagawa 252-0374, Japan
| | - Haruko Iwase
- Department of Gynecology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamihara, Kanagawa 252-0374, Japan
| | - Akane Sekiguchi
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamihara, Kanagawa 252-0374, Japan
| | - Shogo Kawakami
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamihara, Kanagawa 252-0374, Japan
| | - Shouko Komori
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamihara, Kanagawa 252-0374, Japan
| | - Takashi Onda
- Department of Gynecology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamihara, Kanagawa 252-0374, Japan
| | - Kazushige Hayakawa
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamihara, Kanagawa 252-0374, Japan
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Kainz K, Firat S, Wilson JF, Schultz C, Siker M, Wang A, Olson D, Li XA. Comparing the quality of passively-scattered proton and photon tomotherapy plans for brain and head and neck disease sites. Phys Med Biol 2015; 60:2167-77. [PMID: 25683607 DOI: 10.1088/0031-9155/60/6/2167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We compare the quality of photon IMRT (helical tomotherapy) with classic proton plans for brain, head and neck tumors, in terms of target dose uniformity and conformity along with organ-at-risk (OAR) sparing. Plans were created for twelve target volumes among eight cases. All patients were originally planned and treated using helical tomotherapy. Proton plans were generated using a passively-scattered beam model with a maximum range of 32 g cm(-2) (225 MeV), range modulation in 0.5 g cm(-2) increments and range compensators with 4.8 mm milling tool diameters. All proton plans were limited to two to four beams. Plan quality was compared using uniformity index (UI), conformation number (CN) and a EUD-based plan quality index (fEUD). For 11 of the 12 targets, UI was improved for the proton plan; on average, UI was 1.05 for protons versus 1.08 for tomotherapy. For 7 of the 12 targets, the tomotherapy plan exhibited more favorable CN. For proximal OARs, the improved dose conformity to the target volume from tomotherapy led to a lower maximum dose. For distal OARs, the maximum dose was much lower for proton plans. For 6 of the 8 cases, near-total avoidance for distal OARs provided by protons leads to improved fEUD. However, if distal OARs are excluded in the fEUD calculation, the proton plans exhibit better fEUD in only 3 of the 8 cases. The distal OAR sparing and target dose uniformity are generally better with passive-scatter proton planning than with photon tomotherapy; proton therapy may be preferred if the clinician deems those attributes critical. However, tomotherapy may serve equally as well as protons for cases where superior target dose conformity from tomotherapy leads to plan quality nearly identical to or better than protons and for cases where distal OAR sparing is not concerning.
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Affiliation(s)
- Kristofer Kainz
- Department of Radiation Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin 53226, USA
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Dosimetric benefit of adaptive re-planning in pancreatic cancer stereotactic body radiotherapy. Med Dosim 2015; 40:318-24. [DOI: 10.1016/j.meddos.2015.04.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/28/2015] [Accepted: 04/07/2015] [Indexed: 02/06/2023]
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Kornerup JS, Brodin NP, Björk-Eriksson T, Birk Christensen C, Kiil-Berthelsen A, Aznar MC, Hollensen C, Markova E, Munck Af Rosenschöld P. PET/CT-guided treatment planning for paediatric cancer patients: a simulation study of proton and conventional photon therapy. Br J Radiol 2014; 88:20140586. [PMID: 25494657 DOI: 10.1259/bjr.20140586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the impact of including fluorine-18 fludeoxyglucose ((18)F-FDG) positron emission tomography (PET) scanning in the planning of paediatric radiotherapy (RT). METHODS Target volumes were first delineated without and subsequently re-delineated with access to (18)F-FDG PET scan information, on duplicate CT sets. RT plans were generated for three-dimensional conformal photon RT (3DCRT) and intensity-modulated proton therapy (IMPT). The results were evaluated by comparison of target volumes, target dose coverage parameters, normal tissue complication probability (NTCP) and estimated risk of secondary cancer (SC). RESULTS Considerable deviations between CT- and PET/CT-guided target volumes were seen in 3 out of the 11 patients studied. However, averaging over the whole cohort, CT or PET/CT guidance introduced no significant difference in the shape or size of the target volumes, target dose coverage, irradiated volumes, estimated NTCP or SC risk, neither for IMPT nor 3DCRT. CONCLUSION Our results imply that the inclusion of PET/CT scans in the RT planning process could have considerable impact for individual patients. There were no general trends of increasing or decreasing irradiated volumes, suggesting that the long-term morbidity of RT in childhood would on average remain largely unaffected. ADVANCES IN KNOWLEDGE (18)F-FDG PET-based RT planning does not systematically change NTCP or SC risk for paediatric cancer patients compared with CT only. 3 out of 11 patients had a distinct change of target volumes when PET-guided planning was introduced. Dice and mismatch metrics are not sufficient to assess the consequences of target volume differences in the context of RT.
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Affiliation(s)
- J S Kornerup
- 1 Section of Radiotherapy, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Utilization of intensity-modulated radiation therapy and image-guided radiation therapy in pancreatic cancer: is it beneficial? Semin Radiat Oncol 2014; 24:132-9. [PMID: 24635870 DOI: 10.1016/j.semradonc.2013.11.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The recent development of intensity-modulated radiation therapy (IMRT) and improvements in image-guided radiotherapy (IGRT) have provided considerable advances in the utilization of radiation therapy (RT) for the management of pancreatic cancer. IGRT allows for the reduction of treatment volumes, potentially less chance of a marginal miss, and quality assurance of gastrointestinal filling, while IMRT has been shown to reduce both sudden and late side effects compared with 3-dimensional conformal RT. Here, we review published data and provide essential recommendations on the utilization of IMRT and IGRT for the management of patients with pancreatic cancer.
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Liu F, Ahunbay E, Lawton C, Li XA. Assessment and management of interfractional variations in daily diagnostic-quality-CT guided prostate-bed irradiation after prostatectomy. Med Phys 2014; 41:031710. [PMID: 24593714 DOI: 10.1118/1.4866222] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To quantify interfractional anatomic variations and limitations of the current practice of image-guided radiation therapy (IGRT) for prostate-bed patients and to study dosimetric benefits of an online adaptive replanning scheme that addresses the interfractional variations. METHODS Contours for the targets and organs at risk (OARs) from daily diagnostic-quality CTs acquired with in-room CT (CTVision, Siemens) were generated by populating the planning contours using an autosegmentation tool based on deformable registration (ABAS, Elekta) with manual editing for ten prostate-bed patients treated with postoperative daily CT-guided IMRT. Dice similarity coefficient (DSC) obtained by maximizing the overlap of contours for a structure between the daily and plan contours was used to quantify the organ deformation between the plan and daily CTs. Three interfractional-variation-correction schemes, the current standard practice of IGRT repositioning, a previously developed online adaptive RT (ART), and the full reoptimization, were applied to these daily CTs and a number of dose-volume quantities for the targets and organs at risk were compared for their effectiveness to account for the interfractional variations. RESULTS Large interfractional organ deformations in prostate-bed irradiation were seen. The mean DSCs for CTV, rectum, and bladder were 86.6 ± 5.1% (range from 61% to 97%), 77.3% ± 7.4% (range from 55% to 90%), and 75.4% ± 11.2% (range from 46% to 96%), respectively. The fractional and cumulative dose-volume quantities for CTV and PTV: V100 (volume received at least 100% prescription dose), and rectum and bladder: V45Gy and V60Gy (volume received at least 45 or 60 Gy), were compared for the repositioning, adaptive, reoptimization, and original plans. The fractional and cumulative dosimetric results were nearly the same. The average cumulative CTV V100 were 88.0%, 98.4%, 99.2%, and 99.3% for the IGRT, ART, reoptimization, and original plans, respectively. The corresponding rectal V45Gy (V60Gy) were 58.7% (27.3%), 48.1% (20.7%), 43.8% (16.1%), and 44.9% (16.8%). The results for bladder were comparable among three schemes. Paired two-tailed Wilcoxon signed-rank tests were performed and it was found that ART and reoptimization provide better target coverage and better OAR sparing, especially rectum sparing. CONCLUSIONS The interfractional organ motions and deformations during prostate-bed irradiation are significant. The online adaptive replanning scheme is capable of effectively addressing the large organ deformation, resulting in cumulative doses equivalent to those originally planned.
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Affiliation(s)
- Feng Liu
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | - Ergun Ahunbay
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | - Colleen Lawton
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
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Sánchez-Rubio P, Rodríguez-Romero R, Castro-Tejero P. A retrospective tomotherapy image-guidance study: analysis of more than 9,000 MVCT scans for ten different tumor sites. J Appl Clin Med Phys 2014; 15:4663. [PMID: 25493505 PMCID: PMC5711128 DOI: 10.1120/jacmp.v15i6.4663] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 06/24/2014] [Accepted: 06/18/2014] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study was to quantify the systematic and random errors for various disease sites when daily MVCT scans are acquired, and to analyze alterna- tive off-line verification protocols (OVP) with respect to the patient setup accuracy achieved. Alignment data from 389 patients (9,418 fractions) treated at ten differ- ent anatomic sites with daily image-guidance (IG) on a helical tomotherapy unit were analyzed. Moreover, six OVP were retrospectively evaluated. For each OVP, the frequency of the residual setup errors and additional margins required were calculated for the treatment sessions without image guidance. The magnitude of the three-dimensional vector displacement and its frequency were evaluated for all OVP. From daily IG, the main global systematic error was in the vertical direction (4.4-9.4 mm), and all rotations were negligible (less than 0.5°) for all anatomic sites. The lowest systematic and random errors were found for H&N and brain patients. All OVP were effective in reducing the mean systematic error to less than 1 mm and 0.2° in all directions and roll corrections for almost all treatment sites. The treatment margins needed to adapt the residual errors should be increased by 2-5 mm for brain and H&N, around 8 mm in the vertical direction for the other anatomic sites, and up to 19 mm in the longitudinal direction for abdomen patients. Almost 70% of the sessions presented a setup error of 3 mm for OVPs with an imaging frequency above 50%. Only for brain patients it would be feasible to apply an OVP because the residual setup error could be compensated for with a slight margin increase. However, daily imaging should be used for anatomic sites of difficult immobilization and/or large interfraction movement.
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