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Muren LP. Physics and Imaging in Radiation Oncology comes of age. Phys Imaging Radiat Oncol 2024; 29:100559. [PMID: 38434208 PMCID: PMC10906384 DOI: 10.1016/j.phro.2024.100559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Affiliation(s)
- Ludvig P Muren
- Physics and Imaging in Radiation Oncology, Danish Centre for Particle Therapy, Aarhus University Hospital / Aarhus University, Aarhus, Denmark
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Alborghetti L, Castriconi R, Sosa Marrero C, Tudda A, Ubeira-Gabellini MG, Broggi S, Pascau J, Cubero L, Cozzarini C, De Crevoisier R, Rancati T, Acosta O, Fiorino C. Selective sparing of bladder and rectum sub-regions in radiotherapy of prostate cancer combining knowledge-based automatic planning and multicriteria optimization. Phys Imaging Radiat Oncol 2023; 28:100488. [PMID: 37694264 PMCID: PMC10482897 DOI: 10.1016/j.phro.2023.100488] [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: 04/13/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/12/2023] Open
Abstract
Background and Purpose The association between dose to selected bladder and rectum symptom-related sub-regions (SRS) and late toxicity after prostate cancer radiotherapy has been evidenced by voxel-wise analyses. The aim of the current study was to explore the feasibility of combining knowledge-based (KB) and multi-criteria optimization (MCO) to spare SRSs without compromising planning target volume (PTV) dose delivery, including pelvic-node irradiation. Materials and Methods Forty-five previously treated patients (74.2 Gy/28fr) were selected and SRSs (in the bladder, associated with late dysuria/hematuria/retention; in the rectum, associated with bleeding) were generated using deformable registration. A KB model was used to obtain clinically suitable plans (KB-plan). KB-plans were further optimized using MCO, aiming to reduce dose to the SRSs while safeguarding target dose coverage, homogeneity and avoiding worsening dose volume histograms of the whole bladder, rectum and other organs at risk. The resulting MCO-generated plans were examined to identify the best-compromise plan (KB + MCO-plan). Results The mean SRS dose decreased in almost all patients for each SRS. D1% also decreased in the large majority, less frequently for dysuria/bleeding SRS. Mean differences were statistically significant (p < 0.05) and ranged between 1.3 and 2.2 Gy with maximum reduction of mean dose up to 3-5 Gy for the four SRSs. The better sparing of SRSs was obtained without compromising PTVs coverage. Conclusions Selectively sparing SRSs without compromising PTV coverage is feasible and has the potential to reduce toxicities in prostate cancer radiotherapy. Further investigation to better quantify the expected risk reduction of late toxicities is warranted.
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Affiliation(s)
- Lisa Alborghetti
- IRCCS San Raffaele Scientific Institute, Medical Physics, Milano, Italy
| | | | - Carlos Sosa Marrero
- CLCC Eugène Marquis, INSERM, LTSI—UMR1099, F-35000, Univ Rennes, Rennes, France
| | - Alessia Tudda
- IRCCS San Raffaele Scientific Institute, Medical Physics, Milano, Italy
| | | | - Sara Broggi
- IRCCS San Raffaele Scientific Institute, Medical Physics, Milano, Italy
| | - Javier Pascau
- Universidad Carlos III de Madrid, Bioengineering Department, Madrid, Spain
| | - Lucia Cubero
- Universidad Carlos III de Madrid, Bioengineering Department, Madrid, Spain
| | - Cesare Cozzarini
- IRCCS San Raffaele Scientific Institute, Radiotherapy, Milano, Italy
| | | | - Tiziana Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Progetto Prostata, Milano, Italy
| | - Oscar Acosta
- CLCC Eugène Marquis, INSERM, LTSI—UMR1099, F-35000, Univ Rennes, Rennes, France
| | - Claudio Fiorino
- IRCCS San Raffaele Scientific Institute, Medical Physics, Milano, Italy
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Li Kuan Ong A, Knight K, Panettieri V, Dimmock M, Kit Loong Tuan J, Qi Tan H, Wright C. Predictors for late genitourinary toxicity in men receiving radiotherapy for high-risk prostate cancer using planned and accumulated dose. Phys Imaging Radiat Oncol 2023; 25:100421. [PMID: 36817981 PMCID: PMC9932727 DOI: 10.1016/j.phro.2023.100421] [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: 10/15/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023] Open
Abstract
Background and purpose Significant deviations between bladder dose planned (DP) and dose accumulated (DA) have been reported in patients receiving radiotherapy for prostate cancer. This study aimed to construct multivariate analysis (MVA) models to predict the risk of late genitourinary (GU) toxicity with clinical and DP or DA as dose-volume (DV) variables. Materials and methods Bladder DA obtained from 150 patients were compared with DP. MVA models were built from significant clinical and DV variables (p < 0.05) at univariate analysis. Previously developed dose-based-region-of-interest (DB-ROI) metrics using expanded ring structures from the prostate were included. Goodness-of-fit test and calibration plots were generated to determine model performance. Internal validation was accomplished using Bootstrapping. Results Intermediate-high DA (V30-65 Gy and DB-ROI-20-50 mm) for bladder increased compared to DP. However, at the very high dose region, DA (D0.003 cc, V75 Gy, and DB-ROI-5-10 mm) were significantly lower. In MVA, single variable models were generated with odds ratio (OR) < 1. DB-ROI-50 mm was predictive of Grade ≥ 1 GU toxicity for DA and DP (DA and DP; OR: 0.96, p: 0.04) and achieved an area under the receiver operating curve (AUC) of > 0.6. Prostate volume (OR: 0.87, p: 0.01) was significant in predicting Grade 2 GU toxicity with a high AUC of 0.81. Conclusions Higher DA (V30-65 Gy) received by the bladder were not translated to higher late GU toxicity. DB-ROIs demonstrated higher predictive power than standard DV metrics in associating Grade ≥ 1 toxicity. Smaller prostate volumes have a minor protective effect on late Grade 2 GU toxicity.
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Affiliation(s)
- Ashley Li Kuan Ong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore,Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, VIC, Australia,Corresponding author at: Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Kellie Knight
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, VIC, Australia
| | - Vanessa Panettieri
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, VIC, Australia,Central Clinical School, Monash University, Melbourne, VIC, Australia,Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Mathew Dimmock
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, VIC, Australia,School of Allied Health Professions, Keele University, Staffordshire, UK
| | | | - Hong Qi Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Caroline Wright
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, VIC, Australia
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Muren LP, Redalen KR, Thorwarth D. Five years, 20 volumes and 300 publications of Physics and Imaging in Radiation Oncology. Phys Imaging Radiat Oncol 2022; 21:123-125. [PMID: 35265751 PMCID: PMC8899405 DOI: 10.1016/j.phro.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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van Sörnsen de Koste JR, van Vliet CC, Schneiders FL, Bruynzeel AME, Slotman BJ, Palacios MA, Senan S. Renal atrophy following gated delivery of stereotactic ablative radiotherapy to adrenal metastases. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2021; 20:1-4. [PMID: 34604552 PMCID: PMC8473532 DOI: 10.1016/j.phro.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/22/2022]
Abstract
Stereotactic ablative radiotherapy (SABR) planning for adrenal metastases aims to minimize doses to the adjacent kidney. Renal dose constraints for SABR delivery are not well defined. In 20 patients who underwent MR-guided breath-hold SABR in five daily fractions of 8–10 Gy, ipsilateral renal volumes receiving ≥20 Gy best correlated with loss of renal volumes, with median renal volume reduction being 6% (range: 3%-11%, 10th-90th percentiles). Organ function did not deteriorate in 18 patients, who had post treatment renal function tests available. This suggests that the ipsilateral renal volume receiving 20 Gy can be used as partial organ dose constraint for SABR to targets in the upper abdomen.
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Affiliation(s)
- John R van Sörnsen de Koste
- Department of Radiation Oncology, Amsterdam University Medical Centers, location VUmc, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Claire C van Vliet
- Department of Radiation Oncology, Amsterdam University Medical Centers, location VUmc, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Famke L Schneiders
- Department of Radiation Oncology, Amsterdam University Medical Centers, location VUmc, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Anna M E Bruynzeel
- Department of Radiation Oncology, Amsterdam University Medical Centers, location VUmc, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Berend J Slotman
- Department of Radiation Oncology, Amsterdam University Medical Centers, location VUmc, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Miguel A Palacios
- Department of Radiation Oncology, Amsterdam University Medical Centers, location VUmc, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, location VUmc, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Pedersen J, Liang X, Casares-Magaz O, Bryant C, Mendenhall N, Li Z, Muren LP. Multivariate normal tissue complication probability models for rectal and bladder morbidity in prostate cancer patients treated with proton therapy. Radiother Oncol 2020; 153:279-288. [PMID: 33096166 DOI: 10.1016/j.radonc.2020.10.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Normal tissue complication probability (NTCP) models applied for model-based patient selection to proton therapy (PT) have usually been derived using dose/volume histogram (DVH) parameters from photon-based radiotherapy. This study aimed to derive PT-specific multivariate NTCP models that also accounted for the spatial dose distribution (rectum only) as well as non-dose/volume related factors. MATERIALS AND METHODS The study included rectum and bladder DVHs, 2D rectal dose maps and relevant patient/treatment characteristics from 1151 prostate cancer cases treated with PT. Prospectively scored Grade 2 late rectal bleeding (CTCAE v3.0, also procedural interventions separately) (n = 156 (15%)) and Grade 3+ GU morbidity (n = 51 (4%)) were entered into a multivariate logistic regression analysis. Model evaluation included assessment of the area under the receiver operating characteristic curve (AUC). RESULTS Anticoagulant use was a dominant predictor, chosen in four of the six rectum models and in the bladder model. Age was a dominant predictor in all procedural only rectum models while prostate volume, bladder D5% and V75Gy were predictors in the bladder model. The selection frequency of the dose/volume predictors varied widely, where the percentage of the anterior rectum surface receiving >=75 Gy was the most robust. AUC values ranged from 0.58 to 0.70 across all models, with no clear difference between the DVH- and spatial-based models for the rectum. CONCLUSION Anticoagulant use and age were the most prominent predictors in the NTCP models. V75Gy of the rectal wall and the bladder was a predictor in the DVH-based models of the rectum and bladder respectively.
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Affiliation(s)
- Jesper Pedersen
- Danish Centre for Particle Therapy, Aarhus University Hospital/Aarhus University, Denmark.
| | - Xiaoying Liang
- University of Florida Health Proton Therapy Institute, Jacksonville, USA
| | - Oscar Casares-Magaz
- Danish Centre for Particle Therapy, Aarhus University Hospital/Aarhus University, Denmark
| | - Curtis Bryant
- University of Florida Health Proton Therapy Institute, Jacksonville, USA
| | - Nancy Mendenhall
- University of Florida Health Proton Therapy Institute, Jacksonville, USA
| | - Zuofeng Li
- University of Florida Health Proton Therapy Institute, Jacksonville, USA
| | - Ludvig P Muren
- Danish Centre for Particle Therapy, Aarhus University Hospital/Aarhus University, Denmark
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