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Colen J, Nguyen C, Liyanage SW, Aliotta E, Chen J, Alonso C, Romano K, Peach S, Showalter T, Read P, Larner J, Wijesooriya K. Predicting radiation-induced immune suppression in lung cancer patients treated with stereotactic body radiation therapy. Med Phys 2024. [PMID: 38837261 DOI: 10.1002/mp.17181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/14/2024] [Accepted: 04/21/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Stereotactic body radiation therapy (SBRT) is known to modulate the immune system and contribute to the generation of anti-tumor T cells and stimulate T cell infiltration into tumors. Radiation-induced immune suppression (RIIS) is a side effect of radiation therapy that can decrease immunological function by killing naive T cells as well as SBRT-induced newly created effector T cells, suppressing the immune response to tumors and increasing susceptibility to infections. PURPOSE RIIS varies substantially among patients and it is currently unclear what drives this variability. Models that can accurately predict RIIS in near real time based on treatment plan characteristics would allow treatment planners to maintain current protocol specific dosimetric criteria while minimizing immune suppression. In this paper, we present an algorithm to predict RIIS based on a model of circulating blood using early stage lung cancer patients treated with SBRT. METHODS This Python-based algorithm uses DICOM data for radiation therapy treatment plans, dose maps, patient CT data sets, and organ delineations to stochastically simulate blood flow and predict the doses absorbed by circulating lymphocytes. These absorbed doses are used to predict the fraction of lymphocytes killed by a given treatment plan. Finally, the time dependence of absolute lymphocyte count (ALC) following SBRT is modeled using longitudinal blood data up to a year after treatment. This model was developed and evaluated on a cohort of 64 patients with 10-fold cross validation. RESULTS Our algorithm predicted post-treatment ALC with an average error of0.24 ± 0.21 × 10 9 $0.24 \pm 0.21 \times {10}^9$ cells/L with 89% of the patients having a prediction error below 0.5 × 109 cells/L. The accuracy was consistent across a wide range of clinical and treatment variables. Our model is able to predict post-treatment ALC < 0.8 (grade 2 lymphopenia), with a sensitivity of 81% and a specificity of 98%. This model has a ∼38-s end-to-end prediction time of post treatment ALC. CONCLUSION Our model performed well in predicting RIIS in patients treated using lung SBRT. With near-real time model prediction time, it has the capability to be interfaced with treatment planning systems to prospectively reduce immune cell toxicity while maintaining national SBRT conformity and plan quality criteria.
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Affiliation(s)
- Jonathan Colen
- University of Virginia, Department of Physics, Charlottesville, Virginia, USA
- Old Dominion University, Joint Institute on Advanced Computing for Environmental Studies, Norfolk, Virginia, USA
- Hampton Roads Biomedical Research Consortium, Portsmouth, Virginia, USA
| | - Cam Nguyen
- University of Virginia, Department of Physics, Charlottesville, Virginia, USA
| | - Seth W Liyanage
- Stanford University, Department of Mechanical Engineering, Stanford, California, USA
| | - Eric Aliotta
- University of Virginia, Department of Radiation Oncology, Charlottesville, Virginia, USA
| | - Joe Chen
- University of Virginia, Department of Radiation Oncology, Charlottesville, Virginia, USA
| | - Clayton Alonso
- University of Virginia, Department of Radiation Oncology, Charlottesville, Virginia, USA
| | - Kara Romano
- University of Virginia, Department of Radiation Oncology, Charlottesville, Virginia, USA
| | - Sean Peach
- University of Virginia, Department of Radiation Oncology, Charlottesville, Virginia, USA
| | - Timothy Showalter
- University of Virginia, Department of Radiation Oncology, Charlottesville, Virginia, USA
| | - Paul Read
- University of Virginia, Department of Radiation Oncology, Charlottesville, Virginia, USA
| | - James Larner
- University of Virginia, Department of Radiation Oncology, Charlottesville, Virginia, USA
| | - Krishni Wijesooriya
- University of Virginia, Department of Physics, Charlottesville, Virginia, USA
- University of Virginia, Department of Radiation Oncology, Charlottesville, Virginia, USA
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Liu CW, Kolano AM, Gray T, Stephans KL, Videtic GMM, Farr JB, Xia P. Cyclotron and linear accelerator generated scanning proton beams for lung cancer SBRT: Interplay effects and mitigations. Med Phys 2024; 51:3985-3994. [PMID: 38683935 DOI: 10.1002/mp.17082] [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: 02/15/2024] [Accepted: 03/23/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Pencil beam scanning (PBS) proton therapy for moving targets is known to be impacted by interplay effects between the scanning beam and organ motion. While respiratory motion in the thoracic region is the major cause for organ motion, interplay effects depend on the delivery characteristics of proton accelerators. PURPOSE To evaluate the impact of different types of PBS proton accelerators and spot sizes on interplay effects, mitigations, and plan quality for Stereotactic Body Radiation Therapy (SBRT) treatment of non-small cell lung cancer (NSCLC). METHODS Twenty NSCLC patients treated with photon SBRT were selected to represent varying tumor volumes and respiratory motion amplitudes (median: 0.6 cm with abdominal compression) for this retrospective study. For each patient, plans were created using: (1) cyclotron-generated proton beams (CPB) with spot sizes of σ = 2.7-7.0 mm; (2) linear accelerator proton beams (LPB) (σ = 2.9-5.5 mm); and (3) linear accelerator proton minibeams (LPMB) (σ = 0.9-3.9 mm). The energy switching time is one second for CPB, and 0.005 s for LPMB and LPB. Plans were robustly optimized on the gross tumor volume (GTV) using each individual phase of four-dimensional computed tomography (4DCT) scans. Initially, single-field optimization (SFO) plans were evaluated; if the plan quality did not meet the dosimetric requirement, multi-field optimization (MFO) was used. MFO plans were created for all patients for comparisons. For each patient, all plans were normalized to have the same dose received by 99% of the GTV. Interplay effects were evaluated by computing the dose on 10 breathing phases, based on the spot distribution. Volumetric repainting (VR) was performed 2-6 times for each plan. We compared volume receiving 100% of the prescribed dose (V100%RX) of the GTV, and normal lung V20Gy. RESULTS Twelve of 20 plans can be optimized sufficiently with SFO. SFO plans were less sensitive to the interplay effect compared to MFO plans in terms of target coverage for both LPB and LPMB. The following comparisons showed results utilizing the MFO technique. In the interplay evaluation without repainting, the mean V100%RX of the GTV were 99.42 ± 0.6%, 97.52 ± 3.9%, and 94.49 ± 7.3% for CPB, LPB, and LPMB plans, respectively. Following VR (2 × for CPB; 3 × for LPB; 5 × for LPMB), V100%RX of the GTV were improved (on average) by 0.13%, 1.84%, and 4.63%, respectively, achieving the acceptance criteria of V100%RX > 95%. Because of fast energy switch in linear accelerator proton machines, the delivery time for VR plans was the lowest for LPB plans, while delivery time for LPMB was on average 1 min longer than CPB plans. The advantage of small spot machines was better sparing in normal lung V20Gy, even when VR was applied. CONCLUSION In the absence of repainting, proton machines with large spot sizes generated more robust plans against interplay effects. The number of VR increased with decreasing spot sizes to achieve the acceptance criteria. VR improved the plan robustness against interplay effects for modalities with small spot sizes and fast energy changes, preserving the low dose sparing aspect of the LPMB, even when motion is included.
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Affiliation(s)
- Chieh-Wen Liu
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anna M Kolano
- Applications of Detectors and Accelerators to Medicine (ADAM) SA, Meyrin, Switzerland
- Advanced Oncotherapy (AVO) plc, London, UK
| | - Tara Gray
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kevin L Stephans
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gregory M M Videtic
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jonathan B Farr
- Applications of Detectors and Accelerators to Medicine (ADAM) SA, Meyrin, Switzerland
- Advanced Oncotherapy (AVO) plc, London, UK
| | - Ping Xia
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Wang H, Bai X, Wang Y, Lu Y, Wang B. An integrated solution of deep reinforcement learning for automatic IMRT treatment planning in non-small-cell lung cancer. Front Oncol 2023; 13:1124458. [PMID: 36816929 PMCID: PMC9936236 DOI: 10.3389/fonc.2023.1124458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
Purpose To develop and evaluate an integrated solution for automatic intensity-modulated radiation therapy (IMRT) planning in non-small-cell lung cancer (NSCLC) cases. Methods A novel algorithm named as multi-objectives adjustment policy network (MOAPN) was proposed and trained to learn how to adjust multiple optimization objectives in commercial Eclipse treatment planning system (TPS), based on the multi-agent deep reinforcement learning (DRL) scheme. Furthermore, a three-dimensional (3D) dose prediction module was developed to generate the patient-specific initial optimization objectives to reduce the overall exploration space during MOAPN training. 114 previously treated NSCLC cases suitable for stereotactic body radiotherapy (SBRT) were selected from the clinical database. 87 cases were used for the model training, and the remaining 27 cases for evaluating the feasibility and effectiveness of MOAPN in automatic treatment planning. Results For all tested cases, the average number of adjustment steps was 21 ± 5.9 (mean ± 1 standard deviation). Compared with the MOAPN initial plans, the actual dose of chest wall, spinal cord, heart, lung (affected side), esophagus and bronchus in the MOAPN final plans reduced by 14.5%, 11.6%, 4.7%, 16.7%, 1.6% and 7.7%, respectively. The dose result of OARs in the MOAPN final plans was similar to those in the clinical plans. The complete automatic treatment plan for a new case was generated based on the integrated solution, with about 5-6 min. Conclusion We successfully developed an integrated solution for automatic treatment planning. Using the 3D dose prediction module to obtain the patient-specific optimization objectives, MOAPN formed action-value policy can simultaneously adjust multiple objectives to obtain a high-quality plan in a shorter time. This integrated solution contributes to improving the efficiency of the overall planning workflow and reducing the variation of plan quality in different regions and treatment centers. Although improvement is warranted, this proof-of-concept study has demonstrated the feasibility of this integrated solution in automatic treatment planning based on the Eclipse TPS.
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Duan Y, Lin Y, Wang H, Kang B, Feng A, Ma K, Chen H, Huang Y, Gu H, Shao Y, Zhou T, Kong Q, Xu Z. How Does the Gradient Measure of the Lung SBRT Treatment Plan Depend on the Tumor Volume and Shape? Front Oncol 2021; 11:781302. [PMID: 34869034 PMCID: PMC8636139 DOI: 10.3389/fonc.2021.781302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose Gradient measure (GM) is a critical index related to normal tissue sparing in radiosurgery. This study aims to describe the dependence of GM on target volume and target shape for lung stereotactic body radiation therapy (SBRT) treatment plans. Methods A total of 307 peripheral and 119 central lung SBRT treatment plans were enrolled for this study. A least-squares regression was used for data analysis. First, the equations with different functional forms were established to determine the dependence of GM on a univariaty (VP or Sp) and bivariaty (VP and Sp), respectively. Then, the correlation coefficients and p-values of variables for all equations were compared and analyzed to determine the dependence of GM on PTV volume (VP) and sphericity (Sp). Results The power equations had the highest coefficient of determination (R2) in the dependence results of GM on univariate VP. The equations were GM = 0.674 V P 0.178 and GM = 0.660 V P 0.185 for peripheral and central lesions, respectively. On the other hand, the R2 of all functional forms were less than 0.25 when the relationship of GM versus univariate Sp was analyzed. Similarly, the power equation also obtained the highest R2 in bivariaty VP and Sp analysis, whether for central or peripheral. However, the R2 of the bivariate equations were not improved compared with those of univariate equations. Moreover, the p-values of the variable Sp were greater than 0.05. Conclusions The GM of the lung SBRT plan is shape-independent and volume-dependent. The dependence of GM on PTV volume for peripheral and central lung cancer can be described by two different power equations. The results of this study can be used as a potential tool to assist dosimetric quality control during the radiosurgery process.
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Affiliation(s)
- Yanhua Duan
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yang Lin
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Bodong Kang
- Pekoe Team, MIM Software Inc., Cleveland, OH, United States
| | - Aihui Feng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Kui Ma
- Clinical Helpdesk, Varian Medical Systems, Beijing, China
| | - Hua Chen
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Huang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hengle Gu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Shao
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Tao Zhou
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Qing Kong
- Institute of Modern Physics, Fudan University, Shanghai, China
| | - Zhiyong Xu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Q. M. Reis C, Little B, Lee MacDonald R, Syme A, Thomas CG, Robar JL. SBRT of ventricular tachycardia using 4pi optimized trajectories. J Appl Clin Med Phys 2021; 22:72-86. [PMID: 34679247 PMCID: PMC8664144 DOI: 10.1002/acm2.13454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/05/2021] [Accepted: 10/03/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To investigate the possible advantages of using 4pi-optimized arc trajectories in stereotactic body radiation therapy of ventricular tachycardia (VT-SBRT) to minimize exposure of healthy tissues. METHODS AND MATERIALS Thorax computed tomography (CT) data for 15 patients were used for contouring organs at risk (OARs) and defining realistic planning target volumes (PTVs). A conventional trajectory plan, defined as two full coplanar arcs was compared to an optimized-trajectory plan provided by a 4pi algorithm that penalizes geometric overlap of PTV and OARs in the beam's-eye-view. A single fraction of 25 Gy was prescribed to the PTV in both plans and a comparison of dose sparing to OARs was performed based on comparisons of maximum, mean, and median dose. RESULTS A significant average reduction in maximum dose was observed for esophagus (18%), spinal cord (26%), and trachea (22%) when using 4pi-optimized trajectories. Mean doses were also found to decrease for esophagus (19%), spinal cord (33%), skin (18%), liver (59%), lungs (19%), trachea (43%), aorta (11%), inferior vena cava (25%), superior vena cava (33%), and pulmonary trunk (26%). A median dose reduction was observed for esophagus (40%), spinal cord (48%), skin (36%), liver (72%), lungs (41%), stomach (45%), trachea (53%), aorta (45%), superior vena cava (38%), pulmonary veins (32%), and pulmonary trunk (39%). No significant difference was observed for maximum dose (p = 0.650) and homogeneity index (p = 0.156) for the PTV. Average values of conformity number were 0.86 ± 0.05 and 0.77 ± 0.09 for the conventional and 4pi optimized plans respectively. CONCLUSIONS 4pi optimized trajectories provided significant reduction to mean and median doses to cardiac structures close to the target but did not decrease maximum dose. Significant improvement in maximum, mean and median doses for noncardiac OARs makes 4pi optimized trajectories a suitable delivery technique for treating VT.
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Affiliation(s)
- Cristiano Q. M. Reis
- Department of Radiation OncologyDalhousie UniversityHalifaxNova ScotiaCanada
- Department of Medical PhysicsScotia Health Authority, NovaHalifaxNova ScotiaCanada
- Department of Physics and Atmospheric ScienceDalhousie UniversityHalifaxNova ScotiaCanada
- Department of Radiation Oncology, London Regional Cancer ProgramLondon Health Sciences Centre790 Commissioners Road EastLondonONN6A 4L6Canada
| | - Brian Little
- Department of Radiation OncologyDalhousie UniversityHalifaxNova ScotiaCanada
- Department of Medical PhysicsScotia Health Authority, NovaHalifaxNova ScotiaCanada
- Department of Physics and Atmospheric ScienceDalhousie UniversityHalifaxNova ScotiaCanada
- Adaptiiv Medical Technologies Inc405‐1344 Summer Street Halifax, NS B3H 0A8Canada
| | - Robert Lee MacDonald
- Department of Radiation OncologyDalhousie UniversityHalifaxNova ScotiaCanada
- Department of Medical PhysicsScotia Health Authority, NovaHalifaxNova ScotiaCanada
- Department of Physics and Atmospheric ScienceDalhousie UniversityHalifaxNova ScotiaCanada
| | - Alasdair Syme
- Department of Radiation OncologyDalhousie UniversityHalifaxNova ScotiaCanada
- Department of Medical PhysicsScotia Health Authority, NovaHalifaxNova ScotiaCanada
- Department of Physics and Atmospheric ScienceDalhousie UniversityHalifaxNova ScotiaCanada
- Beatrice Hunter Cancer Research InstituteHalifaxNova ScotiaCanada
| | - Christopher G. Thomas
- Department of Radiation OncologyDalhousie UniversityHalifaxNova ScotiaCanada
- Department of Medical PhysicsScotia Health Authority, NovaHalifaxNova ScotiaCanada
- Department of Physics and Atmospheric ScienceDalhousie UniversityHalifaxNova ScotiaCanada
- Beatrice Hunter Cancer Research InstituteHalifaxNova ScotiaCanada
- Department of RadiologyDalhousie UniversityHalifaxNova ScotiaCanada
| | - James L. Robar
- Department of Radiation OncologyDalhousie UniversityHalifaxNova ScotiaCanada
- Department of Medical PhysicsScotia Health Authority, NovaHalifaxNova ScotiaCanada
- Department of Physics and Atmospheric ScienceDalhousie UniversityHalifaxNova ScotiaCanada
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Dosimetric evaluation of SBRT treatment plans of non-central lung tumours: clinical experience. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s146039692000103x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectives:Lung cancer is the most commonly diagnosed cancer in Canada and the leading cause of cancer-related mortality in both men and women in North America. Surgery is usually the primary treatment option for early-stage non-small cell lung cancer (NSCLC). However, for patients who may not be suitable candidates for surgery, stereotactic body radiation therapy (SBRT) is an alternative method of treatment. SBRT has proven to be an effective technique for treating NSCLC patients by focally administering high radiation dose to the tumour with acceptable risk of toxicity to surrounding healthy tissues. The goal of this comprehensive retrospective dosimetric study is to compare the dosimetric parameters between three-dimensional conformal radiation therapy (3DCRT) and volumetric-modulated arc therapy (VMAT) lung SBRT treatment plans for two prescription doses.Methods:We retrospectively analysed and compared lung SBRT treatment plans of 263 patients treated with either a 3DCRT non-coplanar or with 2–3 VMAT arcs technique at 48 Gy in 4 fractions (48 Gy/4) or 50 Gy in 5 fractions (50 Gy/5) prescribed to the planning target volume (PTV), typically encompassing the 80% isodose volume. All patients were treated on either a Varian 21EX or TrueBeam linear accelerator using 6-MV or 10-MV photon beams.Results:The mean PTV V95% and V100% for treatment plans at 48 Gy/4 are 99·4 ± 0·6% and 96·0 ± 1·0%, respectively, for 3DCRT and 99·7 ± 0·4% and 96·4 ± 3·4%, respectively, for VMAT. The corresponding mean PTV V95% and V100% at 50 Gy/5 are 99·0 ± 1·4% and 95·5 ± 2·5% for 3DCRT and 99·5 ± 0·8% and 96·1 ± 1·6% for VMAT. The CIRI and HI5/95 for the PTV at 48 Gy/4 are 1·1 ± 0·1 and 1·2 ± 0·0 for 3DCRT and 1·0 ± 0·1 and 1·2 ± 0·0 for VMAT. The corresponding CIRI and HI5/95 at 50 Gy/5 are 1·1 ± 0·1 and 1·3 ± 0·1 for 3DCRT and 1·0 ± 0·1 and 1·2 ± 0·0 for VMAT. The mean R50% and D2cm at 48 Gy/4 are 5·0 ± 0·8 and 61·2 ± 7·0% for 3DCRT and 4·9 ± 0·8 and 57·8 ± 7·9% for VMAT. The corresponding R50% and D2cm at 50 Gy/5 are 4·7 ± 0·5 and 65·5 ± 9·4% for 3DCRT and 4·7 ± 0·7 and 60·0 ± 7·2% for VMAT.Conclusion:The use of 3DCRT or VMAT technique for lung SBRT is an efficient and reliable method for achieving dose conformity, rapid dose fall-off and minimising doses to the organs at risk. The VMAT technique resulted in improved dose conformity, rapid dose fall-off from the PTV compared to 3DCRT, although the magnitude may not be clinically significant.
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Duan Y, Gan W, Wang H, Chen H, Gu H, Shao Y, Feng A, Ying Y, Fu X, Zhang C, Xu Z, Jeff Yue N. On the optimal number of dose-limiting shells in the SBRT auto-planning design for peripheral lung cancer. J Appl Clin Med Phys 2020; 21:134-142. [PMID: 32700823 PMCID: PMC7497906 DOI: 10.1002/acm2.12983] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/14/2020] [Accepted: 06/22/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The number of dose-limiting shells in the optimization process is one of the key factors determining the quality of stereotactic body radiotherapy (SBRT) auto-planning in the Pinnacle treatment planning system (TPS). This study attempted to derive the optimal number of shells by evaluating the auto-plans designed with different number of shells for peripheral lung cancer patients treated with SBRT. METHODS Identical treatment technique, optimization process, constraints, and dose calculation algorithm in the Pinnacle TPS were retrospectively applied to 50 peripheral lung cancer patients who underwent SBRT in our center. For each of the patients, auto-plans were optimized based on two shells, three shells, four shells, five shells, six shells, seven shells, eight shells, respectively. The optimal number of shells for the SBRT auto-planning was derived through the evaluations and comparisons of various dosimetric parameters of planning target volume (PTV) and organs at risk (OARs), monitor units (MU), and optimization time of the plans. RESULTS The conformity index (CI) and the gradient index (GI) of PTV, the maximum dose outside the 2 cm of PTV (D2cm ), Dmax of spinal cord (SCmax ), the percentage of volume of total lung excluding ITV receiving 20 Gy (V20) and 10 Gy (V10), and the mean lung dose (MLD) were improved when the number of shell increased, but the improvement became not significant as the number of shell reached six. The monitor units (MUs) varied little among different plans where no statistical differences were found. However, as the number of shell increased, the auto-plan optimization time increased significantly. CONCLUSIONS It appears that for peripheral lung SBRT plan using six shells can yield satisfactory plan quality with acceptable beam MUs and optimization time in the Pinnacle TPS.
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Affiliation(s)
- Yanhua Duan
- Department of Radiation OncologyShanghai Chest HospitalShanghai Jiao Tong UniversityShanghaiChina
| | - Wutian Gan
- Shcool of Physics and TechnologyUniversity of WuhanWuhanChina
| | - Hao Wang
- Department of Radiation OncologyShanghai Chest HospitalShanghai Jiao Tong UniversityShanghaiChina
| | - Hua Chen
- Department of Radiation OncologyShanghai Chest HospitalShanghai Jiao Tong UniversityShanghaiChina
| | - Hengle Gu
- Department of Radiation OncologyShanghai Chest HospitalShanghai Jiao Tong UniversityShanghaiChina
| | - Yan Shao
- Department of Radiation OncologyShanghai Chest HospitalShanghai Jiao Tong UniversityShanghaiChina
| | - Aihui Feng
- Department of Radiation OncologyShanghai Chest HospitalShanghai Jiao Tong UniversityShanghaiChina
| | - Yanchen Ying
- Department of Radiation OncologyShanghai Chest HospitalShanghai Jiao Tong UniversityShanghaiChina
| | - Xiaolong Fu
- Department of Radiation OncologyShanghai Chest HospitalShanghai Jiao Tong UniversityShanghaiChina
| | - Chenchen Zhang
- Department of Radiation OncologyShanghai Chest HospitalShanghai Jiao Tong UniversityShanghaiChina
| | - Zhiyong Xu
- Department of Radiation OncologyShanghai Chest HospitalShanghai Jiao Tong UniversityShanghaiChina
| | - Ning Jeff Yue
- Department of Radiation OncologyRutgers Cancer Institute of New JerseyRutgers UniversityNew BrunswickNJUSA
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Xue J, Emami B, Grimm J, Kubicek GJ, Asbell SO, Lanciano R, Welsh JS, Peng L, Quon H, Laub W, Gui C, Spoleti N, Das IJ, Goldman HW, Redmond KJ, Kleinberg LR, Brady LW. Clinical evidence for dose tolerance of the central nervous system in hypofractionated radiotherapy. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s13566-018-0367-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Ritter TA, Matuszak M, Chetty IJ, Mayo CS, Wu J, Iyengar P, Weldon M, Robinson C, Xiao Y, Timmerman RD. Application of Critical Volume-Dose Constraints for Stereotactic Body Radiation Therapy in NRG Radiation Therapy Trials. Int J Radiat Oncol Biol Phys 2018; 98:34-36. [PMID: 28587050 DOI: 10.1016/j.ijrobp.2017.01.204] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/10/2017] [Accepted: 01/17/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Timothy A Ritter
- Department of Radiation Oncology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; NRG Radiation Oncology Committee and/or NRG Medical Physics Subcommittee.
| | - Martha Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; NRG Radiation Oncology Committee and/or NRG Medical Physics Subcommittee
| | - Indrin J Chetty
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan; NRG Radiation Oncology Committee and/or NRG Medical Physics Subcommittee
| | - Charles S Mayo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; NRG Radiation Oncology Committee and/or NRG Medical Physics Subcommittee
| | - Jackie Wu
- Department of Radiation Oncology, Duke University, Durham, North Carolina; NRG Radiation Oncology Committee and/or NRG Medical Physics Subcommittee
| | - Puneeth Iyengar
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas; NRG Radiation Oncology Committee and/or NRG Medical Physics Subcommittee
| | - Michael Weldon
- Department of Radiation Oncology, The Ohio State University, Columbus, Ohio; NRG Radiation Oncology Committee and/or NRG Medical Physics Subcommittee
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University, St. Louis, Missouri; NRG Radiation Oncology Committee and/or NRG Medical Physics Subcommittee
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania; NRG Radiation Oncology Committee and/or NRG Medical Physics Subcommittee
| | - Robert D Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas; NRG Radiation Oncology Committee and/or NRG Medical Physics Subcommittee
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Amin NP, Nalichowski A, Campbell S, Hyder J, Spink R, Konski AA, Dominello M. Helical Therapy is Safe for Lung Stereotactic Body Radiation Therapy Despite Limitations in Achieving Sharp Dose Gradients. Technol Cancer Res Treat 2017; 16:1173-1178. [PMID: 29332448 PMCID: PMC5762086 DOI: 10.1177/1533034617740265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/15/2017] [Accepted: 09/29/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE We observed that many of our helical therapy lung stereotactic body radiation therapy plans did not meet the Radiation Therapy Oncology Group (RTOG) recommended R50% (volume of 50% of the prescription dose/planning target volume), which characterizes the steepness of dose fall off. We hypothesized that despite not meeting R50%, helical therapy lung stereotactic body radiation therapy plans would confer similar local control and minimal side effects as previously reported using nonhelical treatment platforms. MATERIALS AND METHODS We report a retrospective review of all consecutive patients treated off-protocol with stereotactic body radiation therapy for peripheral lung lesions from 2008 to 2013 utilizing helical therapy. Seventy-four patients (81 lesions and 79 plans) were treated with doses ranging from 48 to 60 Gy in 3 to 5 fractions prescribed to the edge of the planning target volume. RESULTS Forty-eight (61%) plans had major deviation from R50%. Only 1 (<1%) plan had a major deviation from the R100%. All plans had > 95% planning target volume coverage by prescription dose, 7(8.6%) plans with 121% to 133% maximum dose, and lung V20 Gy <10% in 70 (89%) plans. With a median follow-up of 4.7 years (95% confidence interval: 4.1-5.3), local control for all patients at 1, 2, and 5 years was 94.6%, 83.4%, and 74%, respectively. For patients with primary stage I-II lung cancer (n = 46), the 1, 2, and 5-year local control: 97.2%, 94.2%, and 86.9%; RC: 97.6%, 82.5%, and 69.5%; and DM: 3%, 16%, and 33.4%, respectively. Patients treated for lung metastases (n = 26) had worse local control at 1, 2, and 5 years: 94.4%, 69.3%, and 55.5%, respectively. Side effects were rare with 2 (3%) patients reporting chest wall pain and 6 (8%) patients experiencing radiation pneumonitis, including 1 patient who had grade 5 radiation pneumonitis. CONCLUSIONS Helical therapy delivers a safe and effective lung stereotactic body radiation therapy plan, despite not being able to meet RTOG's recommended R50 conformality constraint.
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Affiliation(s)
- Neha P. Amin
- Department of Radiation Oncology, University of Maryland, Baltimore, MD, USA
| | - Adrian Nalichowski
- Division of Radiation Oncology, Department of Oncology, Wayne State University, Detroit, MI, USA
| | - Shauna Campbell
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Jal Hyder
- Division of Radiation Oncology, Department of Oncology, Wayne State University, Detroit, MI, USA
| | - Robyn Spink
- Department of Radiation Oncology, Genesis Healthcare System, Zanesville, OH, USA
| | - Andre A. Konski
- Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Michael Dominello
- Division of Radiation Oncology, Department of Oncology, Wayne State University, Detroit, MI, USA
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Block AM, Patel R, Surucu M, Harkenrider MM, Roeske JC. Evaluation of a template-based algorithm for markerless lung tumour localization on single- and dual-energy kilovoltage images. Br J Radiol 2016; 89:20160648. [PMID: 27730838 PMCID: PMC5604930 DOI: 10.1259/bjr.20160648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/04/2016] [Accepted: 10/10/2016] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate a template-based matching algorithm on single-energy (SE) and dual-energy (DE) radiographs for markerless localization of lung tumours. METHODS A total of 74 images from 17 patients with Stages IA-IV lung cancer were considered. At the time of radiotherapy treatment, gated end-expiration SE radiographs were obtained at 60 and 120 kVp at different gantry angles (33° anterior and 41° oblique), from which soft-tissue-enhanced DE images were created. A template-based matching algorithm was used to localize individual tumours on both SE and DE radiographs. Tumour centroid co-ordinates obtained from the template-matching software on both SE and DE images were compared with co-ordinates defined by physicians. RESULTS The template-based matching algorithm was able to successfully localize the gross tumor volume within 5 mm on 70% (52/74) of the SE images vs 91% (66/74) of the DE images (p < 0.01). The mean vector differences between the co-ordinates of the template matched by the algorithm and the co-ordinates of the physician-defined ground truth were 3.2 ± 2.8 mm for SE images vs 2.3 ± 1.7 mm for DE images (p = 0.03). CONCLUSION Template-based matching on DE images was more accurate and precise than using SE images. Advances in knowledge: This represents, to the authors' knowledge, the largest study evaluating template matching on clinical SE and DE images, considering not only anterior gantry angles but also oblique angles, suggesting a novel lung tumour matching technique using DE subtraction that is reliable, accurate and precise.
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Affiliation(s)
- Alec M Block
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, USA
| | - Rakesh Patel
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, USA
| | - Murat Surucu
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, USA
| | - Matthew M Harkenrider
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, USA
| | - John C Roeske
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL, USA
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12
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Vieillevigne L, Bessieres S, Ouali M, Lanaspeze C. Dosimetric comparison of flattened and unflattened beams for stereotactic body radiation therapy: Impact of the size of the PTV on dynamic conformal arc and volumetric modulated arc therapy. Phys Med 2016; 32:1405-1414. [DOI: 10.1016/j.ejmp.2016.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/15/2016] [Accepted: 10/05/2016] [Indexed: 12/31/2022] Open
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13
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Alite F, Stang K, Balasubramanian N, Adams W, Shaikh MP, Small C, Sethi A, Nagda S, Emami B, Harkenrider MM. Local control dependence on consecutive vs. nonconsecutive fractionation in lung stereotactic body radiation therapy. Radiother Oncol 2016; 121:9-14. [DOI: 10.1016/j.radonc.2016.07.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 07/26/2016] [Accepted: 07/31/2016] [Indexed: 11/26/2022]
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14
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Kim J, Wu Q, Zhao B, Wen N, Ajlouni M, Movsas B, Chetty IJ. To gate or not to gate - dosimetric evaluation comparing Gated vs. ITV-based methodologies in stereotactic ablative body radiotherapy (SABR) treatment of lung cancer. Radiat Oncol 2016; 11:125. [PMID: 27659780 PMCID: PMC5034438 DOI: 10.1186/s13014-016-0699-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/10/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To compare retrospectively generated gated plans to conventional internal target volume (ITV)-based plans and to evaluate whether gated radiotherapy provides clinically relevant dosimetric improvements to organs-at-risk (OARs). METHODS Evaluation was performed of 150 stereotactic ablative radiotherapy treatment plans delivered to 128 early-stage (T1-T3 (<5 cm)) NSCLC patients. To generate gated plans, original ITV-based plans were re-optimized and re-calculated on the end-exhale phase and using gated planning target volumes (PTV). Gated and ITV-based plans were produced for 3 × 18 Gy and 4 × 12 Gy fractionation regimens. Dose differences between gated and ITV-based plans were analyzed as a function of both three-dimensional motion and tumor volume. OARs were analyzed using RTOG and AAPM dose constraints. RESULTS Differences between gated and ITV-based plans for all OAR indices were largest for the 3 × 18 Gy regimen. For this regimen, MLD differences calculated by subtracting the gated values from the ITV-based values (ITV vs. Gated) were 0.10 ± 0.56 Gy for peripheral island (N = 57), 0.16 ± 0.64 Gy for peripheral lung-wall seated (N = 57), and 0.10 ± 0.64 Gy for central tumors (N = 36). Variations in V20 were similarly low, with the greatest differences occurring in peripheral tumors (0.20 ± 1.17 %). Additionally, average differences (in 2Gy-equivalence) between ITV and gated lung indices fell well below clinical tolerance values for all fractionation regimens, with no clinically meaningful differences observed from the 4 × 12 Gy regimen and rarely for the 3 × 18 Gy regimen (<2 % of cases). Dosimetric differences between gated and ITV-based methods did generally increase with increasing tumor motion and decreasing tumor volume. Dose to ribs and bronchial tree were slightly higher in gated plans compared to ITV-based plans and slightly lower for esophagus, heart, spinal cord, and trachea. CONCLUSIONS Analysis of 150 SABR-based lung cancer treatment plans did not show a substantial benefit for the gating regimen when compared to ITV-based treatment plans. Small benefits were observed only for the largest tumor motion (exceeding 2 cm) and the high dose treatment regimen (3 × 18 Gy), though these benefits did not appear to be clinically relevant.
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Affiliation(s)
- Joshua Kim
- Department of Radiation Oncology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202 USA
| | - Qixue Wu
- Department of Radiation Oncology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202 USA
| | - Bo Zhao
- Department of Radiation Oncology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202 USA
| | - Ning Wen
- Department of Radiation Oncology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202 USA
| | - Munther Ajlouni
- Department of Radiation Oncology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202 USA
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202 USA
| | - Indrin J. Chetty
- Department of Radiation Oncology, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202 USA
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Abstract
Pulmonary metastases are common in patients with cancer for which surgery is considered a standard approach in appropriately selected patients. A number of patients are not candidates for surgery due to a medical comorbidities or the extent of surgery required. For these patients, noninvasive or minimally invasive approaches to ablate pulmonary metastases are potential treatment strategies. This article summarizes the rationale and outcomes for non-surgical treatment approaches, including radiotherapy, radiofrequency and microwave ablation, for pulmonary metastases.
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Affiliation(s)
- Matthew J Boyer
- Department of Radiation Oncology, Duke University, Box 3085 DUMC, Durham, NC 27710, USA
| | - Umberto Ricardi
- Department of Oncology, University of Turin, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - David Ball
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 2 St Andrews Pl, Melbourne, Victoria 3002, Australia; The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Joseph K Salama
- Department of Radiation Oncology, Duke University, Box 3085 DUMC, Durham, NC 27710, USA.
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16
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Ko YE, Cho B, Kim SS, Song SY, Choi EK, Ahn SD, Yi B. Improving Delivery Accuracy of Stereotactic Body Radiotherapy to a Moving Tumor Using Simplified Volumetric Modulated Arc Therapy. PLoS One 2016; 11:e0158053. [PMID: 27333199 PMCID: PMC4917108 DOI: 10.1371/journal.pone.0158053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 06/09/2016] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To develop a simplified volumetric modulated arc therapy (VMAT) technique for more accurate dose delivery in thoracic stereotactic body radiation therapy (SBRT). METHODS AND MATERIALS For each of the 22 lung SBRT cases treated with respiratory-gated VMAT, a dose rate modulated arc therapy (DrMAT) plan was retrospectively generated. A dynamic conformal arc therapy plan with 33 adjoining coplanar arcs was designed and their beam weights were optimized by an inverse planning process. All sub-arc beams were converted into a series of control points with varying MLC segment and dose rates and merged into an arc beam for a DrMAT plan. The plan quality of original VMAT and DrMAT was compared in terms of target coverage, compactness of dose distribution, and dose sparing of organs at risk. To assess the delivery accuracy, the VMAT and DrMAT plans were delivered to a motion phantom programmed with the corresponding patients' respiratory signal; results were compared using film dosimetry with gamma analysis. RESULTS The plan quality of DrMAT was equivalent to that of VMAT in terms of target coverage, dose compactness, and dose sparing for the normal lung. In dose sparing for other critical organs, DrMAT was less effective than VMAT for the spinal cord, heart, and esophagus while being well within the limits specified by the Radiation Therapy Oncology Group. Delivery accuracy of DrMAT to a moving target was similar to that of VMAT using a gamma criterion of 2%/2mm but was significantly better using a 2%/1mm criterion, implying the superiority of DrMAT over VMAT in SBRT for thoracic/abdominal tumors with respiratory movement. CONCLUSION We developed a DrMAT technique for SBRT that produces plans of a quality similar to that achieved with VMAT but with better delivery accuracy. This technique is well-suited for small tumors with motion uncertainty.
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Affiliation(s)
- Young Eun Ko
- Department of Radiation Oncology, Ulsan University Hospital, Ulsan, Korea
| | - Byungchul Cho
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su Ssan Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Si Yeol Song
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Kyung Choi
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Do Ahn
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byongyong Yi
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
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Treatment of Peripheral Non-Small Cell Lung Carcinoma with Stereotactic Body Radiation Therapy. J Thorac Oncol 2016; 10:1261-1267. [PMID: 26291009 DOI: 10.1097/jto.0000000000000610] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Stereotactic body radiation therapy (SBRT) is an effective and well-tolerated noninvasive treatment for medically inoperable patients with peripheral non-small cell lung carcinoma. The term "peripheral" refers to lesions that lie 2 cm or more from the mediastinum and proximal bronchial tree and was instituted based on results from a specific dose and fractionation schedule. Improvements in immobilization, respiratory motion management, and image guidance have allowed for SBRT's highly conformal and accurate delivery of large radiation doses per fraction. Results from prospective and retrospective studies suggest that lung SBRT has superior outcomes when compared with conventionally fractionated treatments and is comparable with surgical resection. Investigations into the optimal SBRT dosing regimen for peripheral lesions are ongoing, with recent trials suggesting comparable efficacy between single and multiple fraction schedules. Chest wall toxicity after peripheral treatment is common, but it usually resolves with conservative management. Pneumonitis is less often observed after treatment of peripheral lesions, and changes in pulmonary function tests are minimal. Studies in the frail and elderly suggest that neither baseline pulmonary function tests nor age should preclude treatment. Recent technical developments have reduced delivery time and resulted in more conformal treatments. This review is on behalf of the IASLC Advanced Radiation Technology Committee.
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18
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Nuyttens JJ, Moiseenko V, McLaughlin M, Jain S, Herbert S, Grimm J. Esophageal Dose Tolerance in Patients Treated With Stereotactic Body Radiation Therapy. Semin Radiat Oncol 2016; 26:120-8. [DOI: 10.1016/j.semradonc.2015.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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Ruben J, Seeley A, Panettieri V, Ackerly T. Variation in Lung Tumour Breathing Motion between Planning Four-dimensional Computed Tomography and Stereotactic Ablative Radiotherapy Delivery and its Dosimetric Implications: Any Role for Four-dimensional Set-up Verification? Clin Oncol (R Coll Radiol) 2016; 28:21-7. [DOI: 10.1016/j.clon.2015.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 07/06/2015] [Accepted: 08/25/2015] [Indexed: 12/13/2022]
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20
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Ming X, Feng Y, Liu H, Zhang Y, Zhou L, Deng J. Cardiac Exposure in the Dynamic Conformal Arc Therapy, Intensity-Modulated Radiotherapy and Volumetric Modulated Arc Therapy of Lung Cancer. PLoS One 2015; 10:e0144211. [PMID: 26630566 PMCID: PMC4667972 DOI: 10.1371/journal.pone.0144211] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 11/13/2015] [Indexed: 02/05/2023] Open
Abstract
Purpose To retrospectively evaluate the cardiac exposure in three cohorts of lung cancer patients treated with dynamic conformal arc therapy (DCAT), intensity-modulated radiotherapy (IMRT), or volumetric modulated arc therapy (VMAT) at our institution in the past seven years. Methods and Materials A total of 140 lung cancer patients were included in this institutional review board approved study: 25 treated with DCAT, 70 with IMRT and 45 with VMAT. All plans were generated in a same commercial treatment planning system and have been clinically accepted and delivered. The dose distribution to the heart and the effects of tumor laterality, the irradiated heart volume and the beam-to-heart distance on the cardiac exposure were investigated. Results The mean dose to the heart among all 140 plans was 4.5 Gy. Specifically, the heart received on average 2.3, 5.2 and 4.6 Gy in the DCAT, IMRT and VMAT plans, respectively. The mean heart doses for the left and right lung tumors were 4.1 and 4.8 Gy, respectively. No patients died with evidence of cardiac disease. Three patients (2%) with preexisting cardiac condition developed cardiac disease after treatment. Furthermore, the cardiac exposure was found to increase linearly with the irradiated heart volume while decreasing exponentially with the beam-to-heart distance. Conclusions Compared to old technologies for lung cancer treatment, modern radiotherapy treatment modalities demonstrated better heart sparing. But the heart dose in lung cancer radiotherapy is still higher than that in the radiotherapy of breast cancer and Hodgkin’s disease where cardiac complications have been extensively studied. With strong correlations of mean heart dose with beam-to-heart distance and irradiated heart volume, cautions should be exercised to avoid long-term cardiac toxicity in the lung cancer patients undergoing radiotherapy.
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Affiliation(s)
- Xin Ming
- Department of Biomedical Engineering, Tianjin University, Tianjin, China
- Department of Therapeutic Radiology, Yale University, New Haven, CT, United States of America
| | - Yuanming Feng
- Department of Biomedical Engineering, Tianjin University, Tianjin, China
| | - Huan Liu
- Department of Therapeutic Radiology, Yale-New Haven Hospital, New Haven, CT, United States of America
| | - Ying Zhang
- Department of Biomedical Engineering, Tianjin University, Tianjin, China
- Department of Therapeutic Radiology, Yale University, New Haven, CT, United States of America
| | - Li Zhou
- Center for Radiation Physics and Technology, West China Hospital Cancer Center, Sichuan University, Chengdu, China
| | - Jun Deng
- Department of Therapeutic Radiology, Yale University, New Haven, CT, United States of America
- Department of Therapeutic Radiology, Yale-New Haven Hospital, New Haven, CT, United States of America
- * E-mail:
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21
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Siva S, Kirby K, Caine H, Pham D, Kron T, Te Marvelde L, Whalley D, Stevens MJ, Foroudi F, MacManus M, Ball D, Eade T. Comparison of Single-fraction and Multi-fraction Stereotactic Radiotherapy for Patients with 18F-fluorodeoxyglucose Positron Emission Tomography-staged Pulmonary Oligometastases. Clin Oncol (R Coll Radiol) 2015; 27:353-61. [PMID: 25698068 DOI: 10.1016/j.clon.2015.01.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 11/17/2014] [Accepted: 11/24/2014] [Indexed: 01/12/2023]
Abstract
AIM To compare outcomes of single-fraction and multi-fraction stereotactic ablative body radiotherapy (SABR) for pulmonary metastases. MATERIALS AND METHODS A retrospective review from two academic institutions of patients with one to three pulmonary metastases staged with (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scans. For single-fraction SABR, 26 Gy was prescribed for peripheral targets and 18 Gy for central targets. In the multi-fraction cohort, 48 Gy/4 or 50 Gy/5 was prescribed for peripheral targets and 50 Gy/5 was prescribed for central targets. Three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) plans were delivered using heterogeneity corrections. Conformity indices at an intermediate dose (R50%) and at a high dose (R100%) were used to assess a relationship with the planning target volume (PTV). Overall survival, local and distant progression and toxicity rates were analysed from the date of treatment completion. RESULTS Between February 2010 and June 2013, 65 patients with 85 pulmonary metastases were reviewed. The median follow-up was 2.1 years. Metastases most commonly originated from colorectal cancer (31%), followed by non-small cell lung cancer (25%). 3D-CRT was used in 52 targets, IMRT in 21 and VMAT in 12. 3D-CRT showed a lower median R50% (P=0.01), but a higher median R100% than IMRT/VMAT (P=0.04). The R50% index was inversely correlated to the PTV with all techniques (P=0.01). Overall survival at 1 and 2 years in all patients was 93% (95% confidence interval 87-100%) and 71% (95% confidence interval 58-86%), respectively. The 2 year freedom from local and distant progression was 93% (95% confidence interval 86-100%) and 38% (95% confidence interval 27-55%), respectively. There were no significant differences between overall survival (P=0 .14), time to distant progression (P=0.06) or toxicity rates (P=0.75) between single- and multi-fraction cohorts. CONCLUSION We report comparable local control, overall survival and toxicity rates between single-fraction and multi-fraction SABR treatments in patients with FDG-PET-staged pulmonary oligometastases. We propose a guideline for R50% conformity incorporating 3D-CRT/IMRT/VMAT techniques with heterogeneity corrected planning algorithms.
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Affiliation(s)
- S Siva
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia; Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Australia.
| | - K Kirby
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - H Caine
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Sydney, Australia
| | - D Pham
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - T Kron
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - L Te Marvelde
- Department of Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - D Whalley
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Sydney, Australia
| | - M J Stevens
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Sydney, Australia
| | - F Foroudi
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia; Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - M MacManus
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia; Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - D Ball
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia; Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - T Eade
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Sydney, Australia
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22
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Nuyttens JJ, van der Voort van Zyp NC, Verhoef C, Maat A, van Klaveren RJ, van der Holt B, Aerts J, Hoogeman M. Stereotactic Body Radiation Therapy for Oligometastases to the Lung: A Phase 2 Study. Int J Radiat Oncol Biol Phys 2015; 91:337-43. [DOI: 10.1016/j.ijrobp.2014.10.021] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 09/30/2014] [Accepted: 10/10/2014] [Indexed: 12/18/2022]
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Abstract
Extracranial stereotactic body radiotherapy (SBRT) has been developed and refined over the last 25 years as a means to precisely deliver ablative doses of hypofractionated radiotherapy to small targets located outside of the cranial vault. SBRT has armed the radiation oncologist with a therapeutic approach that allows for intensification of both dose delivered and fractionation regimen employed. As a consequence, tumor control rates have improved to levels that previously have been associated only with surgical resection. Several prospective phase I and II studies have evaluated the use of SBRT for non-small cell lung cancer (NSCLC), liver tumors, and spinal metastases. This article will give an overview of SBRT and evidence for its use in the most common sites of disease for which it is employed today.
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Affiliation(s)
- Laura Kollar
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA.
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA; SCCA Proton Therapy, a ProCure Center, Seattle, WA
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Ahmed KA, Correa CR, Dilling TJ, Rao NG, Shridhar R, Trotti AM, Wilder RB, Caudell JJ. Altered fractionation schedules in radiation treatment: a review. Semin Oncol 2014; 41:730-50. [PMID: 25499633 DOI: 10.1053/j.seminoncol.2014.09.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Conventionally fractionated radiotherapy is delivered in 1.8- to 2.0-Gy fractions. With increases in understanding of radiation and tumor biology, various alterations of radiotherapy schedules have been tested in clinical trials and are now regarded by some as standard treatment options. Hyperfractionation is delivered through a greater number of smaller treatment doses. Accelerated fractionation decreases the amount of time over which radiotherapy is delivered typically by increasing the number of treatments per day. Hypofractionation decreases the number of fractions delivered by increasing daily treatment doses. Furthermore, many of these schedules have been tested with concurrent chemotherapy regimens. In this review, we summarize the major clinical studies that have been conducted on altered fractionation in various disease sites.
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Affiliation(s)
- Kamran A Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Candace R Correa
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Thomas J Dilling
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Nikhil G Rao
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Ravi Shridhar
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Andy M Trotti
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Richard B Wilder
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Jimmy J Caudell
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
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Ritter TA, Owen D, Brooks CM, Stenmark MH. Treatment planning for SBRT using automated field delivery: A case study. Med Dosim 2014; 40:44-6. [PMID: 25241356 DOI: 10.1016/j.meddos.2014.07.005] [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: 05/07/2014] [Revised: 07/19/2014] [Accepted: 07/31/2014] [Indexed: 11/29/2022]
Abstract
Stereotactic body radiation therapy (SBRT) treatment planning and delivery can be accomplished using a variety of techniques that achieve highly conformal dose distributions. Herein, we describe a template-based automated treatment field approach that enables rapid delivery of more than 20 coplanar fields. A case study is presented to demonstrate how modest adaptations to traditional SBRT planning can be implemented to take clinical advantage of this technology. Treatment was planned for a left-sided lung lesion adjacent to the chest wall using 25 coplanar treatment fields spaced at 11° intervals. The plan spares the contralateral lung and is in compliance with the conformality standards set forth in Radiation Therapy and Oncology Group protocol 0915, and the dose tolerances found in the report of the American Association of Physicists in Medicine Task Group 101. Using a standard template, treatment planning was accomplished in less than 20 minutes, and each 10Gy fraction was delivered in approximately 5.4 minutes. For those centers equipped with linear accelerators capable of automated treatment field delivery, the use of more than 20 coplanar fields is a viable SBRT planning approach and yields excellent conformality and quality combined with rapid planning and treatment delivery. Although the case study discusses a laterally located lung lesion, this technique can be applied to centrally located tumors with similar results.
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Affiliation(s)
- Timothy A Ritter
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI.
| | - Dawn Owen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI
| | - Cassandra M Brooks
- Department of Radiation Oncology, Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI
| | - Matthew H Stenmark
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI
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30 Gy or 34 Gy? Comparing 2 single-fraction SBRT dose schedules for stage I medically inoperable non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2014; 90:203-8. [PMID: 25015198 DOI: 10.1016/j.ijrobp.2014.05.017] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 05/12/2014] [Accepted: 05/14/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE To review outcomes of 2 single-fraction lung stereotactic body radiation therapy (SBRT) schedules used for medically inoperable early stage lung cancer. METHODS AND MATERIALS Patients in our institution have been treated on and off protocols using single-fraction SBRT (30 Gy and 34 Gy, respectively). All patients had node-negative lung cancer measuring ≤5 cm and lying ≥2 cm beyond the trachea-bronchial tree and were treated on a Novalis/BrainLAB system with the ExactTrac positioning system for daily image guidance. RESULTS For the interval from 2009 to 2012, 80 patients with 82 lesions were treated with single-fraction lung SBRT. Fifty-five patients (69%) and 25 patients (31%) received 30 Gy and 34 Gy, respectively. In a comparison of 30 Gy and 34 Gy cohorts, patient and tumor characteristics were balanced and median follow-up in months was 18.7 and 17.8, respectively. The average heterogeneity-corrected mean doses to the target were 33.75 Gy and 37.94 Gy for the 30-Gy and 34-Gy prescriptions, respectively. Comparing 30-Gy and 34-Gy cohorts, 92.7% and 84.0% of patients, respectively, experienced no toxicity (P was not significant), and had neither grade 3 nor higher toxicities. For the 30-Gy and 34-Gy patients, rates of 1-year local failure, overall survival, and lung cancer-specific mortality were 2.0% versus 13.8%, 75.0% versus 64.0%, and 2. 1% versus 16.0%, respectively (P values for differences were not significant). CONCLUSIONS This is the largest single-fraction lung SBRT series yet reported. and it confirms the safety, efficacy, and minimal toxicity of this schedule for inoperable early stage lung cancer.
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Mou B, Beltran CJ, Park SS, Olivier KR, Furutani KM. Feasibility of proton transmission-beam stereotactic ablative radiotherapy versus photon stereotactic ablative radiotherapy for lung tumors: a dosimetric and feasibility study. PLoS One 2014; 9:e98621. [PMID: 24887068 PMCID: PMC4041776 DOI: 10.1371/journal.pone.0098621] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 05/06/2014] [Indexed: 12/25/2022] Open
Abstract
Stereotactic ablative radiotherapy is being increasingly adopted in the treatment of lung tumors. The use of proton beam therapy can further reduce dose to normal structures. However, uncertainty exists in proton-based treatment plans, including range uncertainties, large sensitivity to position uncertainty, and calculation of dose deposition in heterogeneous areas. This study investigated the feasibility of proton transmission beams, i.e. without the Bragg peak, to treat lung tumors with stereotactic ablative radiotherapy. We compared three representative treatment plans using proton transmission beams versus conformal static-gantry photon beams. It was found that proton treatment plans using transmission beams passing through the patient were feasible and demonstrated lower dose to normal structures and markedly reduced treatment times than photon plans. This is the first study to demonstrate the feasibility of proton-based stereotactic ablative radiotherapy planning for lung tumors using proton transmission beams alone. Further research using this novel approach for proton-based planning is warranted.
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Affiliation(s)
- Benjamin Mou
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Chris J. Beltran
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Sean S. Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Kenneth R. Olivier
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Keith M. Furutani
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, United States of America
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