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Peng H, Zhang J, Xu N, Zhou Y, Tan H, Ren T. Fan beam CT-guided online adaptive external radiotherapy of uterine cervical cancer: a dosimetric evaluation. BMC Cancer 2023; 23:588. [PMID: 37365516 DOI: 10.1186/s12885-023-11089-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023] Open
Abstract
PURPOSE To discuss the dosimetric advantages and reliability of the accurate delivery of online adaptive radiotherapy(online ART) for uterine cervical cancer(UCC). METHODS AND MATERIALS Six UCC patients were enrolled in this study. 95% of the planning target volume (PTV) reached 100% of the prescription dose (50.4 Gy/28fractions/6weeks) was required. The patients were scanned with uRT-Linac 506c KV-FBCT then the target volume (TV) and organs at risk (OARs) were delineated by doctors. The dosimeters designed and obtained a routine plan (Plan0). KV-FBCT was used for image guidance before subsequent fractional treatment. The online ART was processed after registration, which acquired a virtual nonadaptive radiotherapy plan (VPlan) and an adaptive plan (APlan). VPlan was the direct calculation of Plan0 on the fractional image, while APlan required adaptive optimization and calculation. In vivo dose monitoring and three-dimensional dose reconstruction were required during the implementation of APlan. RESULTS The inter-fractional volumes of the bladder and rectum changed greatly among the treatments. These changes influenced the primary gross tumor volume (GTVp) and the position deviation of GTVp and PTV and positively affected the prescription dose coverage of TV. GTVp decreased gradually along with dose accumulation. The Dmax, D98, D95, D50, and D2 of APlan were superior to those of VPlan in target dose distribution. APlan had good conformal index, homogeneity index and target coverage. The rectum V40 and Dmax, bladder V40, the small bowel V40 and Dmax of APlan were better than that of VPlan. The APlan's fractional mean γ passing rate was significantly higher than the international standard and the mean γ passing rate of all cases after the three-dimensional reconstruction was higher than 97.0%. CONCLUSION Online ART in external radiotherapy of UCC significantly improved the dose distribution and can become an ideal technology to achieve individualized precise radiotherapy.
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Affiliation(s)
- Haibo Peng
- Oncology Department, The First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China
- Key Clinical Specialty of Sichuan Province (Oncology Department), The First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China
- Clinical Medical School, Chengdu Medical College, Chengdu, 610500, China
| | - Jie Zhang
- Oncology Department, The First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China
- Key Clinical Specialty of Sichuan Province (Oncology Department), The First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China
- Clinical Medical School, Chengdu Medical College, Chengdu, 610500, China
| | - Ningyue Xu
- Oncology Department, The First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China
| | - Yangang Zhou
- Oncology Department, The First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China
| | - Huigang Tan
- Oncology Department, The First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China
| | - Tao Ren
- Oncology Department, The First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China.
- Key Clinical Specialty of Sichuan Province (Oncology Department), The First Affiliated Hospital of Chengdu Medical College, Chengdu, 610500, China.
- Clinical Medical School, Chengdu Medical College, Chengdu, 610500, China.
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Hypofractionated 192Ir source stereotactic ablative brachytherapy with coplanar template assistance in the primary treatment of peripheral lung cancer. J Contemp Brachytherapy 2019; 11:370-378. [PMID: 31523239 PMCID: PMC6737569 DOI: 10.5114/jcb.2019.87218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/23/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose In this study, we reported the safety and efficacy of hypofractionated 192Ir source stereotactic ablative brachytherapy (SABT) with coplanar template assistance for peripheral lung cancer, and compared the dosimetric parameters between SABT and stereotactic body radiotherapy (SBRT). Material and methods Thirty-three peripheral lung cancer patients, with the gross lung tumor volume (GTVL) < 5 cm in diameter were enrolled in this study. We assessed the safety and efficacy of SABT, and compared the dosimetric parameters between SABT and SBRT. Results Chest computed tomography (CT) of post-SABT revealed mild pneumothorax in 2 of 33 patients. Complete response (CR) plus partial response (PR) rate for GTVL at 6-month was 100%. Local control (LC) rate for GTVL at 1-year was 96.9%. For organs at risk (OARs), D1000 cm3, and D1500 cm3 for lung in 1, 3, and 5 fractions were not statistically different between SABT and SBRT (all p > 0.05); the remaining dosimetric parameters were significantly lower in SABT than in SBRT (all p < 0.01). Conclusions SABT can provide safe and effective treatment, and warrant generalization for peripheral lung cancer.
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Aznar MC, Warren S, Hoogeman M, Josipovic M. The impact of technology on the changing practice of lung SBRT. Phys Med 2018; 47:129-138. [PMID: 29331227 PMCID: PMC5883320 DOI: 10.1016/j.ejmp.2017.12.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 11/20/2017] [Accepted: 12/23/2017] [Indexed: 02/09/2023] Open
Abstract
Stereotactic body radiotherapy (SBRT) for lung tumours has been gaining wide acceptance in lung cancer. Here, we review the technological evolution of SBRT delivery in lung cancer, from the first treatments using the stereotactic body frame in the 1990's to modern developments in image guidance and motion management. Finally, we discuss the impact of current technological approaches on the requirements for quality assurance as well as future technological developments.
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Affiliation(s)
- Marianne Camille Aznar
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Institute for Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Niels Bohr Institute, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
| | - Samantha Warren
- Hall Edwards Radiotherapy Group, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mischa Hoogeman
- MC-Daniel den Hoed Cancer Center, Erasmus University, Rotterdam, Netherlands
| | - Mirjana Josipovic
- Niels Bohr Institute, Faculty of Science, University of Copenhagen, Copenhagen, Denmark; Department of Oncology, Section for Radiotherapy, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Moore K, Paterson C, Hicks J, Harrow S, McJury M. Stereotactic ablative body radiotherapy for non-small-cell lung cancer: setup reproducibility with novel arms-down immobilization. Br J Radiol 2016; 89:20160227. [PMID: 27706946 DOI: 10.1259/bjr.20160227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE A clinical evaluation of the intrafraction and interfraction setup accuracy of a novel thermoplastic mould immobilization device and patient position in early-stage lung cancer being treated with stereotactic radiotherapy at the Beatson West of Scotland Cancer Centre, Glasgow, UK. METHODS 35 patients were immobilized in a novel, arms-down position, with a four-point Klarity™ (Klarity Medical Products, Ohio, US) clear thermoplastic mould fixed to a SinMed (CIVCO Medical solutions, lowa, US) head and neck board. A knee support was also used for patient comfort and support. Pre- and post-treatment kilovoltage cone beam CT (CBCT) images were fused with the planning CT scan to determine intra- and interfraction motion. A total of 175 CBCT scans were analysed in the longitudinal, vertical and lateral directions. RESULTS The mean intrafraction errors were 0.05 ± 0.77 mm (lateral), 0.44 ± 1.2 mm (superior-inferior) and -1.44 ± 1.35 mm (anteroposterior), respectively. Mean composite three-dimensional displacement vector was 2.14 ± 1.2 mm. Interfraction errors were -0.66 ± 2.35 mm (lateral), -0.13 ± 3.11 mm (superior-inferior) and 0.00 ± 2.94 mm (anteroposterior), with three-dimensional vector 4.08 ± 2.73 mm. CONCLUSION Setup accuracy for lung image-guided stereotactic ablative radiotherapy using a unique immobilization device, where patients have arms by their sides, has been shown to be safe and favourably comparable to other published setup data where more complex and cumbersome devices were utilised. There was no arm toxicity reported and low arm doses. Advances in knowledge: We report on the accuracy of a novel patient immobilization device.
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Affiliation(s)
- Karen Moore
- 1 Department of Radiotherapy, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Claire Paterson
- 2 Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Jonathan Hicks
- 2 Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Stephen Harrow
- 2 Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Mark McJury
- 3 Radiotherapy Physics Section, Department of Clinical Physics and Bio-engineering, Beatson West of Scotland Cancer Centre, Glasgow, UK
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Sun Y, Ge H, Cheng S, Yang C, Zhu Q, Li D, Tian Y. Evaluation of interfractional variation of the centroid position and volume of internal target volume during stereotactic body radiotherapy of lung cancer using cone-beam computed tomography. J Appl Clin Med Phys 2016; 17:461-472. [PMID: 27074466 PMCID: PMC5874940 DOI: 10.1120/jacmp.v17i2.5835] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 02/14/2016] [Accepted: 11/04/2015] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study was to determine interfractional variation of the centroid position and volume of internal target volume (ITV) during stereotactic body radiation therapy (SBRT) of lung cancer. From January 2014 to August 2014, a total of 32 patients with 37 primary or metastatic lung tumors were enrolled in our study. All patients received SBRT treatment in 4-5 fractions to a median dose of 48 Gy. Both 3D CT and 4D CT scans were used for radiotherapy treatment planning. 3D CBCT was acquired prior to treatment delivery to verify patient positioning. A total of 163 3D CBCT images were available for evaluation. 3D CBCT scans acquired for verification were registered with simulation CT scans. The ITVs were contoured on all verification 3D CBCT scans and compared to the initial gross target volume (GTV) or ITV in treatment planning system. GTV was based on 3D CT while ITV was based on both 3D CT and 4D CT. To assess the interfractional variation of ITV centroid position, we used vertebrae body adja-cent to the tumor as reference point when performing the registration procedure. To eliminate the effect of time on tumor volume between simulation CT scan and the first fraction, the interfractional variation of ITV was evaluated from the first fraction to the last fraction. The overall 3D vector shift was 4.4 ± 2.5 mm (range: 0.4-13.8 mm). The interfractional variation of ITV centroid position in superior-inferior, anterior-posterior, and left-right directions were -0.7 ± 2.7 mm, -1.4 ± 3.4 mm, and -0.5 ± 2.2 mm, respectively. No significant difference was observed between three directions (p = 0.147). Large interfractional variations (≥ 5 mm) were observed in 12 fractions (9.3%) in superior-inferior direction, 24 fractions (18.6%) in anterior-posterior direction, and 5 fractions (3.9%) in left-right direction. No time trend of tumor volume change measured in 3D CBCT was detected during four fractions (p = 0.074). A significant (p = 0.010) time trend was detected when evaluating the time trend of ITV change during 5 fractions and diameter was found to be significantly correlated with the ITV change (p = 0.000). ITV did not show significant regression during SBRT treatment, but interfractional variation in the ITV centroid position was observed, especially in anterior-posterior direc-tion. An isotropic margin of 7 mm around ITV might be necessary for adequate coverage of interfractional variation of ITV centroid position, but only in case no soft tissue-based setup is performed during SBRT treatment.
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Affiliation(s)
- Yanan Sun
- The Affiliated Cancer Hospital of Zhengzhou University.
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Tominaga H, Araki F, Shimohigashi Y, Ishihara T, Kawasaki K, Kanetake N, Sakata J, Iwashita Y. Accuracy of positioning and irradiation targeting for multiple targets in intracranial image-guided radiation therapy: a phantom study. Phys Med Biol 2016; 59:7753-66. [PMID: 25419723 DOI: 10.1088/0031-9155/59/24/7753] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study investigated the accuracy of positioning and irradiation targeting for multiple off-isocenter targets in intracranial image-guided radiation therapy (IGRT). A phantom with nine circular targets was created to evaluate both accuracies. First, the central point of the isocenter target was positioned with a combination of an ExacTrac x-ray (ETX) and a 6D couch. The positioning accuracy was determined from the deviations of coordinates of the central point in each target obtained from the kV-cone beam computed tomography (kV-CBCT) for IGRT and the planning CT. Similarly, the irradiation targeting accuracy was evaluated from the deviations of the coordinates between the central point of each target and the central point of each multi-leaf collimator (MLC) field for multiple targets. Secondly, the 6D couch was intentionally rotated together with both roll and pitch angles of 0.5° and 1° at the isocenter and similarly the deviations were evaluated. The positioning accuracy for all targets was less than 1 mm after 6D positioning corrections. The irradiation targeting accuracy was up to 1.3 mm in the anteroposterior (AP) direction for a target 87 mm away from isocenter. For the 6D couch rotations with both roll and pitch angles of 0.5° and 1°, the positioning accuracy was up to 1.0 mm and 2.3 mm in the AP direction for the target 87 mm away from the isocenter, respectively. The irradiation targeting accuracy was up to 2.1 mm and 2.6 mm in the AP direction for the target 87 mm away from the isocenter, respectively. The off-isocenter irradiation targeting accuracy became worse than the positioning accuracy. Both off-isocenter accuracies worsened in proportion to rotation angles and the distance from the isocenter to the targets. It is necessary to examine the set-up margin for off-isocenter multiple targets at each institution because irradiation targeting accuracy is peculiar to the linac machine.
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Affiliation(s)
- Hirofumi Tominaga
- Kumamoto Radiosurgery Clinic, 7-90-2, Izumi, Chuo-ku, Japan. Graduate School of Health Sciences, Kumamoto University, 4-24-1, Kuhonji, Chuo-ku, Kumamoto, Japan
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Mayyas E, Wen N, Glide-Hurst C, Chin K, Cattaneo R, Movsas B, Ajlouni M, Chetty IJ. Analysis of CBCT-based image guidance for a large cohort of lung cancer patients treated with SABR. Biomed Phys Eng Express 2015. [DOI: 10.1088/2057-1976/1/3/035203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Xiang L, Zhang JW, Lin S, Luo HQ, Wen QL, He LJ, Shang CL, Ren PR, Yang HR, Pang HW, Yang B, He HL, Chen Y, Wu JB. Computed Tomography-Guided Interstitial High-Dose-Rate Brachytherapy in Combination With Regional Positive Lymph Node Intensity-Modulated Radiation Therapy in Locally Advanced Peripheral Non-Small Cell Lung Cancer: A Phase 1 Clinical Trial. Int J Radiat Oncol Biol Phys 2015; 92:1027-1034. [PMID: 26194678 DOI: 10.1016/j.ijrobp.2015.04.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 04/03/2015] [Accepted: 04/09/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the technical safety, adverse events, and efficacy of computed tomography (CT)-guided interstitial high-dose-rate (HDR) brachytherapy in combination with regional positive lymph node intensity modulated radiation therapy in patients with locally advanced peripheral non-small cell lung cancer (NSCLC). METHODS AND MATERIALS Twenty-six patients with histologically confirmed NSCLC were enrolled in a prospective, officially approved phase 1 trial. Primary tumors were treated with HDR brachytherapy. A single 30-Gy dose was delivered to the 90% isodose line of the gross lung tumor volume. A total dose of at least 70 Gy was administered to the 95% isodose line of the planning target volume of malignant lymph nodes using 6-MV X-rays. The patients received concurrent or sequential chemotherapy. We assessed treatment efficacy, adverse events, and radiation toxicity. RESULTS The median follow-up time was 28 months (range, 7-44 months). There were 3 cases of mild pneumothorax but no cases of hemothorax, dyspnea, or pyothorax after the procedure. Grade 3 or 4 acute hematologic toxicity was observed in 5 patients. During follow-up, mild fibrosis around the puncture point was observed on the CT scans of 2 patients, but both patients were asymptomatic. The overall response rates (complete and partial) for the primary mass and positive lymph nodes were 100% and 92.3%, respectively. The 1-year and 2-year overall survival (OS) rates were 90.9% and 67%, respectively, with a median OS of 22.5 months. CONCLUSION Our findings suggest that HDR brachytherapy is safe and feasible for peripheral locally advanced NSCLC, justifying a phase 2 clinical trial.
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Affiliation(s)
- Li Xiang
- Department of Oncology, Affiliated Hospital of Luzhou Medical College, Luzhou, China
| | - Jian-Wen Zhang
- Department of Oncology, Affiliated Hospital of Luzhou Medical College, Luzhou, China
| | - Sheng Lin
- Department of Oncology, Affiliated Hospital of Luzhou Medical College, Luzhou, China
| | - Hui-Qun Luo
- Department of Oncology, Affiliated Hospital of Luzhou Medical College, Luzhou, China
| | - Qing-Lian Wen
- Department of Oncology, Affiliated Hospital of Luzhou Medical College, Luzhou, China
| | - Li-Jia He
- Department of Oncology, Affiliated Hospital of Luzhou Medical College, Luzhou, China
| | - Chang-Ling Shang
- Department of Oncology, Affiliated Hospital of Luzhou Medical College, Luzhou, China
| | - Pei-Rong Ren
- Department of Oncology, Affiliated Hospital of Luzhou Medical College, Luzhou, China
| | - Hong-Ru Yang
- Department of Oncology, Affiliated Hospital of Luzhou Medical College, Luzhou, China
| | - Hao-Wen Pang
- Department of Oncology, Affiliated Hospital of Luzhou Medical College, Luzhou, China
| | - Bo Yang
- Department of Oncology, Affiliated Hospital of Luzhou Medical College, Luzhou, China
| | - Huai-Lin He
- Department of Oncology, Affiliated Hospital of Luzhou Medical College, Luzhou, China
| | - Yue Chen
- Department of Nuclear Medicine, Affiliated Hospital of Luzhou Medical College, Luzhou, China.
| | - Jing-Bo Wu
- Department of Oncology, Affiliated Hospital of Luzhou Medical College, Luzhou, China.
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Interfractional variations of tumor centroid position and tumor regression during stereotactic body radiotherapy for lung tumor. BIOMED RESEARCH INTERNATIONAL 2014; 2014:372738. [PMID: 25548770 PMCID: PMC4274869 DOI: 10.1155/2014/372738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 09/11/2014] [Accepted: 10/02/2014] [Indexed: 12/25/2022]
Abstract
Purpose. To determine interfractional changes of lung tumor centroid position and tumor regression during stereotactic body radiation therapy (SBRT). Methods and Materials. 34 patients were treated by SBRT in 4-5 fractions to a median dose of 50 Gy. The CT scans acquired for verification were registered with simulation CT scans. The gross target volume (GTV) was contoured on all verification CT scans and compared to the initial GTV in treatment plan system. Results. The mean (±standard deviation, SD) three-dimension vector shift was 5.2 ± 3.1 mm. The mean (±SD) interfractional variations of tumor centroid position were −0.7 ± 4.5 mm in anterior-posterior (AP) direction, 0.2 ± 3.1 mm in superior-inferior (SI) direction, and 0.4 ± 2.4 mm in right-left (RL) direction. Large interfractional variations (≥5 mm) were observed in 5 fractions (3.3%) in RL direction, 16 fractions (10.5%) in SI direction, and 36 fractions (23.5%) in AP direction. Tumor volume did not decrease significantly during lung SBRT. Conclusions. Small but insignificant tumor volume regression was observed during lung SBRT. While the mean interfractional variations of tumor centroid position were minimal in three directions, variations more than 5 mm account for approximately a third of all, indicating additional margin for PTV, especially in AP direction.
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Mampuya WA, Matsuo Y, Ueki N, Nakamura M, Mukumoto N, Nakamura A, Iizuka Y, Kishi T, Mizowaki T, Hiraoka M. The impact of abdominal compression on outcome in patients treated with stereotactic body radiotherapy for primary lung cancer. JOURNAL OF RADIATION RESEARCH 2014; 55:934-939. [PMID: 24801474 PMCID: PMC4202286 DOI: 10.1093/jrr/rru028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/27/2014] [Accepted: 03/27/2014] [Indexed: 06/03/2023]
Abstract
The aim of this study was to evaluate the impact of abdominal compression (AC) on outcome in patients treated with stereotactic body radiotherapy (SBRT) for primary lung cancer. We retrospectively reviewed data for 47 patients with histologically proven non-small cell lung cancer and lung tumour motion ≥ 8 mm treated with SBRT. Setup error was corrected based on bony structure. The differences in overall survival (OS), local control (LC) and disease-free survival (DFS) were evaluated to compare patients treated with AC (n = 22) and without AC (n = 25). The median follow-up was 42.6 months (range, 1.4-94.6 months). The differences in the 3-year OS, LC and DFS rate between the two groups were not statistically significant (P = 0.909, 0.209 and 0.639, respectively). However, the largest difference was observed in the LC rate, which was 82.5% (95% CI, 54.9-94.0%) for patients treated without AC and 65.4% (95% CI, 40.2-82.0%) for those treated with AC. After stratifying the patients into prognostic groups based on sex and T-stage, the LC difference increased in the group with an unfavourable prognosis. The present study suggests that AC might be associated with a worse LC rate after SBRT using a bony-structure-based set-up.
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Affiliation(s)
- Wambaka Ange Mampuya
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Nami Ueki
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Mitsuhiro Nakamura
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Nobutaka Mukumoto
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Akira Nakamura
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yusuke Iizuka
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takahiro Kishi
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Masahiro Hiraoka
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
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Ionizing radiation selectively reduces skin regulatory T cells and alters immune function. PLoS One 2014; 9:e100800. [PMID: 24959865 PMCID: PMC4069168 DOI: 10.1371/journal.pone.0100800] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 05/28/2014] [Indexed: 12/28/2022] Open
Abstract
The skin serves multiple functions that are critical for life. The protection from pathogens is achieved by a complicated interaction between aggressive effectors and controlling functions that limit damage. Inhomogeneous radiation with limited penetration is used in certain types of therapeutics and is experienced with exposure to solar particle events outside the protection of the Earth’s magnetic field. This study explores the effect of ionizing radiation on skin immune function. We demonstrate that radiation, both homogeneous and inhomogeneous, induces inflammation with resultant specific loss of regulatory T cells from the skin. This results in a hyper-responsive state with increased delayed type hypersensitivity in vivo and CD4+ T cell proliferation in vitro. The effects of inhomogeneous radiation to the skin of astronauts or as part of a therapeutic approach could result in an unexpected enhancement in skin immune function. The effects of this need to be considered in the design of radiation therapy protocols and in the development of countermeasures for extended space travel.
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Factors influencing intrafractional target shifts in lung stereotactic body radiation therapy. Pract Radiat Oncol 2014; 4:e45-51. [DOI: 10.1016/j.prro.2013.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 02/25/2013] [Accepted: 02/25/2013] [Indexed: 12/25/2022]
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Corradetti MN, Mitra N, Bonner Millar LP, Byun J, Wan F, Apisarnthanarax S, Christodouleas J, Anderson N, Simone CB, Teo BK, Rengan R. A moving target: Image guidance for stereotactic body radiation therapy for early-stage non-small cell lung cancer. Pract Radiat Oncol 2013; 3:307-15. [DOI: 10.1016/j.prro.2012.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/03/2012] [Accepted: 10/08/2012] [Indexed: 12/31/2022]
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Mampuya WA, Nakamura M, Matsuo Y, Ueki N, Iizuka Y, Fujimoto T, Yano S, Monzen H, Mizowaki T, Hiraoka M. Interfraction variation in lung tumor position with abdominal compression during stereotactic body radiotherapy. Med Phys 2013; 40:091718. [DOI: 10.1118/1.4819940] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Tominaga H, Araki F, Shimohigashi Y, Kanetake N, Tomiyama Y, Kawasaki K, Iwashita Y, Sakata J, Okuda T. [Dose impact of a carbon fiber couch for stereotactic body radiation therapy of lung tumors]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2013; 69:400-6. [PMID: 23609862 DOI: 10.6009/jjrt.2013_jsrt_69.4.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of this study was to measure the dose attenuation caused by a carbon fiber radiation therapy table (Imaging Couch Top; ICT, BrainLab) and to evaluate the dosimetric impact of ICT during stereotactic body radiation therapy (SBRT) in lung tumors. The dose attenuation of ICT was measured using an ionization chamber and modeled by means of a treatment planning system (TPS). SBRT was planned with and without ICT in a lung tumor phantom and ten cases of clinical lung tumors. The results were analyzed from isocenter doses and a dose-volume histogram (DVH): D95, Dmean, V20, V5, homogeneity index (HI), and conformity index (CI). The dose attenuation of the ICT modeled with TPS agreed to within ±1% of the actually measured values. The isocenter doses, D95 and Dmean with and without ICT showed differences of 4.1-5% for posterior single field and three fields in the phantom study, and differences of 0.6-2.4% for five fields and rotation in the phantom study and six fields in ten clinical cases. The dose impact of ICT was not significant for five or more fields in SBRT. It is thus possible to reduce the dose effect of ICT by modifying the beam angle and beam weight in the treatment plan.
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Westover KD, Timmerman R. Developments in stereotactic ablative radiotherapy for the treatment of early-stage lung cancer. Lung Cancer Manag 2013. [DOI: 10.2217/lmt.13.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Stereotactic ablative radiotherapy (SABR), also known as stereotactic body radiation therapy, has emerged as an effective treatment for inoperable early-stage non-small-cell lung cancer. SABR differs from conventional radiotherapy by virtue of its tight spatial tolerances and use of oligofractionated radiation. The modern technique is characterized by management of tumor motion, image guidance before each fraction and specialized radiation delivery techniques. The result is a highly conformal target dose with a sharp gradient that spares normal tissues with great accuracy. This enables delivery of very potent (ablative) doses, causing more rapid and durable responses than traditional radiation therapy treatment regimens can achieve. The established techniques, new developments and ongoing questions related to SABR for early-stage non-small-cell lung cancer are reviewed herein.
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Affiliation(s)
- Kenneth D Westover
- Department of Radiation Oncology, University of Texas, Southwestern Medical Center, Dallas, TX 75390-9183, USA.
| | - Robert Timmerman
- Department of Radiation Oncology, University of Texas, Southwestern Medical Center, Dallas, TX 75390-9183, USA
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Briere TM, Crane CH, Beddar S, Bhosale P, Mok H, Delclos ME, Krishnan S, Das P. Reproducibility and genital sparing with a vaginal dilator used for female anal cancer patients. Radiother Oncol 2012; 104:161-6. [DOI: 10.1016/j.radonc.2012.05.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 02/06/2012] [Accepted: 05/20/2012] [Indexed: 11/16/2022]
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Chung H, Court L, Lin SH, Kulkarni D, Balter P. Evaluation of dose variation to normal and critical structures for lung hypofractionated stereotactic body radiation therapy. Pract Radiat Oncol 2012; 2:e15-e21. [PMID: 24674129 DOI: 10.1016/j.prro.2012.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 01/02/2012] [Accepted: 01/05/2012] [Indexed: 11/18/2022]
Abstract
PURPOSE To quantify the dose received by normal and critical structures during lung stereotactic body radiation therapy (SBRT) when registered to tumor or bone. METHODS AND MATERIALS Sixteen patients with lung cancer receiving a total dose of 50 Gy in 4fractions for lung SBRT were retrospectively studied. Cone-beam computed tomography (CT) was performed for all fractions, and the images obtained were registered with planning CT with respect tosoft tissue for target localization. Isocenter shifts were determined for each fraction from differences between the bony and tumor alignments; doses were then recalculated based on the new isocenters and summed over all 4 fractions to compare against the planned normal and critical tissue dose. The normal and critical structures evaluated were total and ipsilateral lung, spinal cord, and esophagus. The first data collected were isocenter coordinate shifts in all 3 Cartesian coordinates for both tumor andbony alignments. The second were the dose differences to the normal and critical structures fromthe planned and recalculated doses for alignment based on the tumor. RESULTS The study showed that while the maximum isocenter coordinate shifts in any direction couldbe as much as 1.60 cm, the normal and critical structure dose variations between the original plans and the simulated plans showed almost no change. The mean volume of total lung that receivedat least 20Gy difference for total lung and ipsilateral lung were 0.01% and -0.04%, respectively. For the esophagus, spinal cord, and heart the maximum and mean dose differences were 0.25 Gy and -0.04 Gy, -0.08 Gy and -0.02 Gy, and 0.02 Gy and 0.05 Gy, respectively. CONCLUSIONS Target localization using daily cone-beam CT with soft tissue registration was appropriate for minimizing the dose to the normal and critical structures without the need to re-plan due to the changes in the tumor position. For tumors located close to a critical structure, daily cone-beam CT is recommended to determine the appropriate isocenter shifts.
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Affiliation(s)
- Heeteak Chung
- The University of Texas MD Anderson Cancer Center, Department of Radiation Physics, Houston, Texas.
| | - Laurence Court
- The University of Texas MD Anderson Cancer Center, Department of Radiation Physics, Houston, Texas
| | - Steven H Lin
- The University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, Texas
| | - Dhananjay Kulkarni
- The School of Public Health, The University of Texas Houston, School of Medicine, Houston, Texas
| | - Peter Balter
- The University of Texas MD Anderson Cancer Center, Department of Radiation Physics, Houston, Texas
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Josipovic M, Persson GF, Logadottir A, Smulders B, Westmann G, Bangsgaard JP. Translational and rotational intra- and inter-fractional errors in patient and target position during a short course of frameless stereotactic body radiotherapy. Acta Oncol 2012; 51:610-7. [PMID: 22263924 DOI: 10.3109/0284186x.2011.626448] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Implementation of cone beam computed tomography (CBCT) in frameless stereotactic body radiotherapy (SBRT) of lung tumours enables setup correction based on tumour position. The aim of this study was to compare setup accuracy with daily soft tissue matching to bony anatomy matching and evaluate intra- and inter-fractional translational and rotational errors in patient and target positions. MATERIAL AND METHODS Fifteen consecutive SBRT patients were included in the study. Vacuum cushions were used for immobilisation. SBRT plans were based on midventilation phase of four-dimensional (4D)-CT or three-dimensional (3D)-CT from PET/CT. Margins of 5 mm in the transversal plane and 10 mm in the cranio-caudal (CC) direction were applied. SBRT was delivered in three fractions within a week. At each fraction, CBCT was performed before and after the treatment. Setup accuracy comparison between soft tissue matching and bony anatomy matching was evaluated on pretreatment CBCTs. From differences in pre- and post-treatment CBCTs, we evaluated the extent of translational and rotational intra-fractional changes in patient position, tumour position and tumour baseline shift. All image registration was rigid with six degrees of freedom. RESULTS The median 3D difference between patient position based on bony anatomy matching and soft tissue matching was 3.0 mm (0-8.3 mm). The median 3D intra-fractional change in patient position was 1.4 mm (0-12.2 mm) and 2.2 mm (0-13.2 mm) in tumour position. The median 3D intra-fractional baseline shift was 2.2 mm (0-4.7 mm). With correction of translational errors, the remaining systematic and random errors were approximately 1°. CONCLUSION . Soft tissue tumour matching improved precision of treatment delivery in frameless SBRT of lung tumours compared to image guidance using bone matching. The intra-fractional displacement of the target position was affected by both translational and rotational changes in tumour baseline position relative to the bony anatomy and by changes in patient position.
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Affiliation(s)
- Mirjana Josipovic
- Department of Radiation Oncology, Rigshospitalet, Copenhagen, Denmark.
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Bujold A, Craig T, Jaffray D, Dawson LA. Image-guided radiotherapy: has it influenced patient outcomes? Semin Radiat Oncol 2012; 22:50-61. [PMID: 22177878 DOI: 10.1016/j.semradonc.2011.09.001] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Cancer control and toxicity outcomes are the mainstay of evidence-based medicine in radiation oncology. However, radiotherapy is an intricate therapy involving numerous processes that need to be executed appropriately in order for the therapy to be delivered successfully. The use of image-guided radiation therapy (IGRT), referring to imaging occurring in the radiation therapy room with per-patient adjustments, can increase the agreement between the planned and the actual dose delivered. However, the absence of direct evidence regarding the clinical benefit of IGRT has been a criticism. Here, we dissect the role of IGRT in the radiotherapy (RT) process and emphasize its role in improving the quality of the intervention. The literature is reviewed to collect evidence that supports that higher-quality dose delivery enabled by IGRT results in higher clinical control rates, reduced toxicity, and new treatment options for patients that previously were without viable options.
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Affiliation(s)
- Alexis Bujold
- Département de Radio-Oncologie Clinique-Enseignement-Recherche, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Canada.
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Cone-Beam CT-Based Delineation of Stereotactic Lung Targets: The Influence of Image Modality and Target Size on Interobserver Variability. Int J Radiat Oncol Biol Phys 2012; 82:e265-72. [DOI: 10.1016/j.ijrobp.2011.03.042] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 02/28/2011] [Accepted: 03/05/2011] [Indexed: 11/19/2022]
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