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Niyazi M, Andratschke N, Bendszus M, Chalmers AJ, Erridge SC, Galldiks N, Lagerwaard FJ, Navarria P, Munck Af Rosenschöld P, Ricardi U, van den Bent MJ, Weller M, Belka C, Minniti G. ESTRO-EANO guideline on target delineation and radiotherapy details for glioblastoma. Radiother Oncol 2023; 184:109663. [PMID: 37059335 DOI: 10.1016/j.radonc.2023.109663] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND AND PURPOSE Target delineation in glioblastoma is still a matter of extensive research and debate. This guideline aims to update the existing joint European consensus on delineation of the clinical target volume (CTV) in adult glioblastoma patients. MATERIAL AND METHODS The ESTRO Guidelines Committee identified 14 European experts in close interaction with the ESTRO clinical committee and EANO who discussed and analysed the body of evidence concerning contemporary glioblastoma target delineation, then took part in a two-step modified Delphi process to address open questions. RESULTS Several key issues were identified and are discussed including i) pre-treatment steps and immobilisation, ii) target delineation and the use of standard and novel imaging techniques, and iii) technical aspects of treatment including planning techniques and fractionation. Based on the EORTC recommendation focusing on the resection cavity and residual enhancing regions on T1-sequences with the addition of a reduced 15 mm margin, special situations are presented with corresponding potential adaptations depending on the specific clinical situation. CONCLUSIONS The EORTC consensus recommends a single clinical target volume definition based on postoperative contrast-enhanced T1 abnormalities, using isotropic margins without the need to cone down. A PTV margin based on the individual mask system and IGRT procedures available is advised; this should usually be no greater than 3 mm when using IGRT.
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Affiliation(s)
- Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Munich, Germany.
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Sara C Erridge
- Edinburgh Centre for Neuro-Oncology, University of Edinburgh, Western General Hospital, Edinburgh, EH4 1EU, UK
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany; Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany; Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
| | - Frank J Lagerwaard
- Department of Radiation Oncology, Amsterdam UMC location Vrije Universiteit Amsterdam, The Netherlands
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Department, IRCCS, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Per Munck Af Rosenschöld
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, and Lund University, Lund, Sweden
| | | | | | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Giuseppe Minniti
- Dept. of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy; IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
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Task synergies in neurovascular surgery: Image-guided navigation using a thermoplastic facial mask for the resection of a symptomatic occult to MRI brain microarteriovenous malformation. J Neuroradiol 2023; 50:237-240. [PMID: 36030925 DOI: 10.1016/j.neurad.2022.08.002] [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: 04/11/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/22/2022]
Abstract
Due to the size of microarteriovenous malformations (mAVM), its precise angioarchitecture description often requires a supraselective DSA and detecting the nidus during microsurgical resection is challenging. An accurate intraoperative navigation system is desirable but available softwares which can combine DSA and MRI are not always available. The authors present here a technical note describing the use of a stereotactic thermoplastic mask with a fiducial box to guide the resection of a mAVM.
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Han EY, Wang H, Briere TM, Yeboa DN, Boursianis T, Kalaitzakis G, Pappas E, Castillo P, Yang J. Brain stereotactic radiosurgery using MR-guided online adaptive planning for daily setup variation: An end-to-end test. J Appl Clin Med Phys 2022; 23:e13518. [PMID: 34994101 PMCID: PMC8906207 DOI: 10.1002/acm2.13518] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/02/2021] [Accepted: 12/09/2021] [Indexed: 11/21/2022] Open
Abstract
Online magnetic resonance (MR)‐guided radiotherapy is expected to benefit brain stereotactic radiosurgery (SRS) due to superior soft tissue contrast and capability of daily adaptive planning. The purpose of this study was to investigate daily adaptive plan quality with setup variations and to perform an end‐to‐end test for brain SRS with multiple metastases treated with a 1.5‐Tesla MR‐Linac (MRL). The RTsafe PseudoPatient Prime brain phantom was used with a delineation insert that includes two predefined structures mimicking gadolinium contrast‐enhanced brain lesions. Daily adaptive plans were generated using six preset and six random setup variations. Two adaptive plans per daily MR image were generated using the adapt‐to‐position (ATP) and adapt‐to‐shape (ATS) workflows. An adaptive patient plan was generated on a diagnostic MR image with simulated translational and rotational daily setup variation and was compared with the reference plan. All adaptive plans were compared with the reference plan using the target coverage, Paddick conformity index, gradient index (GI), Brain V12 or V20, optimization time and total monitor units. Target doses were measured as an end‐to‐end test with two ionization chambers inserted into the phantom. With preset translational variations, V12 from the ATS plan was 17% lower than that of the ATP plan. With a larger daily setup variation, GI and V12 of the ATS plan were 10% and 16% lower than those of the ATP plan, respectively. Compared to the ATP plans, the plan quality index of the ATS plans was more consistent with the reference plan, and within 5% in both phantom and patient plans. The differences between the measured and planned target doses were within 1% for both treatment workflows. Treating brain SRS using an MRL is feasible and could achieve satisfactory dosimetric goals. Setup uncertainties could be accounted for using online plan adaptation. The ATS workflow achieved better dosimetric results than the ATP workflow at the cost of longer optimization time.
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Affiliation(s)
- Eun Young Han
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - He Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tina Marie Briere
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Debra Nana Yeboa
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | | | - Evangelos Pappas
- Department of Biomedical Sciences, Radiology and Radiotherapy Sector, University of West Attica, Athens, Greece
| | - Pamela Castillo
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Sun J, Kong L, Chen Z, You D, Mao J, Guan X, Wu X, Sheng Y. Clinical Implementation of a 6D Treatment Chair for Fixed Ion Beam Lines. Front Oncol 2021; 11:694749. [PMID: 34249751 PMCID: PMC8260974 DOI: 10.3389/fonc.2021.694749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose To verify the practicality and safety of a treatment chair with six degrees of freedom (6DTC) through demonstrating the efficacy of the workflow in clinical settings and analyzing the obtained technical data, including intra-fraction patient movement during the use of the 6DTC. Materials and Methods A clinical study was designed and conducted to test the clinical treatment workflow and the safety of the 6DTC. Based on the demonstrated dosimetric advantages, fifteen patients with head and neck tumors were selected and treated with the 6DTC. The positional error at the first beam position (PE-B1) and the second beam position (PE-B2) were analyzed and compared with the results from daily quality assurance (QA) procedures of the 6DTC and imaging system performed each day before clinical treatment. The intra-fraction patient movement was derived from the total patient alignment positional error and the QA data based on a Gaussian distribution formulism. Results The QA results showed sub-millimeter mechanical accuracy of the 6DTC over the course of the clinical study. For 150 patient treatment fractions, the mean deviations between PE-B1 and PE-B2 were 0.13mm (SD 0.88mm), 0.25mm (SD 1.17mm), -0.57mm (SD 0.85mm), 0.02° (SD 0.35°), 0.00° (SD 0.37°), and -0.02° (SD 0.37°) in the x, y, z (translational), and u, v, w (rotational) directions, respectively. The calculated intra-fraction patient movement was -0.08mm (SD 0.56mm), 0.71mm (SD 1.12mm), -0.52mm (SD 0.84mm), 0.10° (SD 0.32°), 0.09° (SD 0.36°), and -0.04° (SD 0.36°) in the x, y, z, u, v, w directions, respectively. Conclusions The performance stability of the 6DTC was satisfactory. The position accuracy and intra-fraction patient movement in an upright posture with the 6DTC were verified and found adequate for clinical implementation.
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Affiliation(s)
- Jiayao Sun
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Lin Kong
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Zhi Chen
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Dan You
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Jingfang Mao
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Xiyin Guan
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Xiaodong Wu
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Yinxiangzi Sheng
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
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A novel rabbit fixator made of a thermoplastic mask for awake imaging experiments. Sci Rep 2021; 11:1546. [PMID: 33452449 PMCID: PMC7810717 DOI: 10.1038/s41598-021-81358-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 01/05/2021] [Indexed: 12/21/2022] Open
Abstract
This study aimed to develop and validate a novel rabbit fixator made from a thermoplastic mask for awake imaging experiments. When heated in a hot-water bath at 65–70 °C for 2–5 min, the thermoplastic mask became soft and could be molded to fit over the entire body of an anesthetized rabbit (4 ml of 3% pentobarbital sodium solution by intramuscular injection). Twenty rabbits were randomly divided into fixator (n = 10) and anesthesia (n = 10) groups. The animals’ vital signs, stress hormones (cortisol and adrenaline), and subjective image quality scores for the computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI) scanning were measured and compared. Phantom CT, MRI and PET studies were performed to assess the performance with and without the thermoplastic mask by using image agents at different concentrations or with different radioactivity. The respiration rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), peripheral capillary oxygen saturation (SpO2) and body temperature (T) decreased after anesthesia (all P < 0.05) but did not significantly decrease after fixation (all P > 0.05). The heart rate (HR), cortisol and adrenaline did not significantly decrease after either anesthesia or fixation (all P > 0.05). The subjective image quality scores for the CT and MRI images of the head, thorax, liver, kidney, intestines and pelvis and the subjective image quality scores for the PET images did not significantly differ between the two groups (all P > 0.05). For all examined organs except the muscle, 18F-FDG metabolism was lower after fixation than after anesthesia, and was almost identical of liver between two groups. The phantom study showed that the CT values, standard uptake values and MR T2 signal values did not differ significantly with or without the mask (all P > 0.05). A novel rabbit fixator created using a thermoplastic mask could be used to obtain high-quality images for different imaging modalities in an awake and near-physiological state.
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Mangesius J, Seppi T, Weigel R, Arnold CR, Vasiljevic D, Goebel G, Lukas P, Ganswindt U, Nevinny-Stickel M. Intrafractional 6D head movement increases with time of mask fixation during stereotactic intracranial RT-sessions. Radiat Oncol 2019; 14:231. [PMID: 31852497 PMCID: PMC6921566 DOI: 10.1186/s13014-019-1425-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/22/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The present study investigates the intrafractional accuracy of a frameless thermoplastic mask used for head immobilization during stereotactic radiotherapy. Non-invasive masks cannot completely prohibit head movements. Previous studies attempted to estimate the magnitude of intrafractional inaccuracy by means of pre- and postfractional measurements only. However, this might not be sufficient to accurately map also intrafractional head movements. MATERIALS AND METHODS Intrafractional deviation of mask-fixed head positions was measured in five patients during a total of 94 fractions by means of close-meshed repeated ExacTrac measurements (every 1.4 min) conducted during the entire treatment session. A median of six (range: 4 to 11) measurements were recorded per fraction, delivering a dataset of 453 measurements. RESULTS Random errors (SD) for the x, y and z axes were 0.27 mm, 0.29 mm and 0.29 mm, respectively. Median 3D deviation was 0.29 mm. Of all 3D intrafractional motions, 5.5 and 0.4% exceeded 1 mm and 2 mm, respectively. A moderate correlation between treatment duration and mean 3D displacement was determined (rs = 0.45). Mean 3D deviation increased from 0.21 mm (SD = 0.26 mm) in the first 2 min to a maximum of 0.53 mm (SD = 0.31 mm) after 10 min of treatment time. CONCLUSION Pre- and post-treatment measurement is not sufficient to adequately determine the range of intrafractional head motion. Thermoplastic masks provide both reliable interfractional and intrafractional immobilization for image-guided stereotactic hypofractionated radiotherapy. Greater positioning accuracy may be obtained by reducing treatment duration (< 6 min) and applying intrafractional correction. TRIAL REGISTRATION Clinicaltrials.gov, NCT03896555, Registered 01 April 2019 - retrospectively registered.
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Affiliation(s)
- Julian Mangesius
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Thomas Seppi
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Rocco Weigel
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Christoph Reinhold Arnold
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Danijela Vasiljevic
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Lukas
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Ute Ganswindt
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Meinhard Nevinny-Stickel
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
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Sarkar B, Munshi A, Ganesh T, Manikandan A, Krishnankutty S, Chitral L, Pradhan A, Kalyan Mohanti B. Technical Note: Rotational positional error corrected intrafraction set-up margins in stereotactic radiotherapy: A spatial assessment for coplanar and noncoplanar geometry. Med Phys 2019; 46:4749-4754. [PMID: 31495931 DOI: 10.1002/mp.13810] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/26/2019] [Accepted: 08/26/2019] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The aim of this study is to calculate setup margin based on six-dimensional (6D) corrected residual positional errors from kV cone beam computed tomography (CBCT) and from intrafraction projection kV imaging in coplanar and in noncoplanar couch positions in stereotactic radiotherapy. METHODS Six dimensional positional corrections were carried out before patient treatments, using a robotic couch and CBCT matching. A CBCT and stereoscopic ExacTrac image were acquired post-table position correction. Further, a series of intrafraction ExacTrac images were obtained for the variable couch position. Translational and rotational errors were identified as lateral (X), longitudinal (Y), vertical (Z); roll (Ɵ°), pitch (Φ°) and yaw (Ψ°). A total of 699 intrafraction image sets (361 coplanar and 338 noncoplanar) for 51 SRS/SRT patients were analysed. Rotational errors were corrected in terms of translational coordinates. Residual set-up margins were calculated from CBCT shifts. ExacTrac shifts give residual + intrafraction setup margins as a function of coplanar and noncoplanar couch positions. RESULTS The average residual positional error obtained from CBCT in X, Y, Z, Ɵ, Φ, Ψ were 0.1 ± 0.4 mm, 0.0 ± 0.6 mm, 0.0 ± 0.5 mm, 0.2 ± 0.8°, 0.1 ± 0.6° and -0.1 ± 0.7° respectively. For ExacTrac, the shits were -0.5 ± 0.9 mm, -0.0 ± 1mm, -0.6 ± 1.0mm, 0.4 ± 0.9°, -0.2 ± 0.6°, and -0.0 ± 0.8°. CBCT calculated linear setup margins in X, Y, Z direction were 0.5, 1.2, and 1 mm respectively. ExacTrac yielded coplanar and noncoplanar linear setup margins were 1.2, 1.3, 1.5, 1.4, 1.5, and 2.1 mm respectively. CONCLUSION CBCT-based gross residual set-up margin is equal to 1 mm. ExacTrac calculated residual plus intrafraction setup margin falls within a 2 mm range; attributed to intrafraction patient movement, table position inaccuracies, and poor image fusion in noncoplanar geometry. There could be variations in the required additional margin between centers and between machines, which require further studies.
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Affiliation(s)
- Biplab Sarkar
- Department of Radiation Oncology, Manipal Hospitals, Dwarka, New Delhi, 110070, India
| | - Anusheel Munshi
- Department of Radiation Oncology, Manipal Hospitals, Dwarka, New Delhi, 110070, India
| | - Tharmarnadar Ganesh
- Department of Radiation Oncology, Manipal Hospitals, Dwarka, New Delhi, 110070, India
| | - Arjunan Manikandan
- Department of Medical Physics, Apollo Proton Cancer Centre, Chennai, 600096, Tamil Nadu, India
| | - Saneg Krishnankutty
- Department of Radiation Oncology, Fortis Memorial Research Institute, Gurgaon, 122002, Haryana, India
| | - Latika Chitral
- Department of Radiation Oncology, Manipal Hospitals, Dwarka, New Delhi, 110070, India
| | - Anirudh Pradhan
- Department of Mathematics, Institute of Applied Sciences & Humanities, GLA University, Mathura, 281406, Uttar Pradesh, India
| | - Bidhu Kalyan Mohanti
- Department of Radiation Oncology, Manipal Hospitals, Dwarka, New Delhi, 110070, India
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8
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Jeon SH, Kim JH. Positional uncertainties of cervical and upper thoracic spine in stereotactic body radiotherapy with thermoplastic mask immobilization. Radiat Oncol J 2018; 36:122-128. [PMID: 29983032 PMCID: PMC6074070 DOI: 10.3857/roj.2017.00591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/07/2018] [Indexed: 01/19/2023] Open
Abstract
Purpose To investigate positional uncertainty and its correlation with clinical parameters in spine stereotactic body radiotherapy (SBRT) using thermoplastic mask (TM) immobilization. Materials and Methods A total of 21 patients who underwent spine SBRT for cervical or upper thoracic spinal lesions were retrospectively analyzed. All patients were treated with image guidance using cone beam computed tomography (CBCT) and 4 degrees-of-freedom (DoF) positional correction. Initial, pre-treatment, and post-treatment CBCTs were analyzed. Setup error (SE), pre-treatment residual error (preRE), post-treatment residual error (postRE), intrafraction motion before treatment (IM1), and intrafraction motion during treatment (IM2) were determined from 6 DoF manual rigid registration. Results The three-dimensional (3D) magnitudes of translational uncertainties (mean ± 2 standard deviation) were 3.7±3.5 mm (SE), 0.9±0.9 mm (preRE), 1.2±1.5 mm (postRE), 1.4±2.4 mm (IM1), and 0.9±1.0 mm (IM2), and average angular differences were 1.1°±1.2° (SE), 0.9°±1.1° (preRE), 0.9°±1.1° (postRE), 0.6°±0.9° (IM1), and 0.5°±0.5° (IM2). The 3D magnitude of SE, preRE, postRE, IM1, and IM2 exceeded 2 mm in 18, 0, 3, 3, and 1 patients, respectively. No association were found between all positional uncertainties and body mass index, pain score, and treatment location (p > 0.05, Mann-Whitney test). There was a tendency of intrafraction motion to increase with overall treatment time; however, the correlation was not statistically significant (p > 0.05, Spearman rank correlation test). Conclusion In spine SBRT using TM immobilization, CBCT and 4 DoF alignment correction, a minimum residual translational uncertainty was 2 mm. Shortening overall treatment time and 6 DoF positional correction may further reduce positional uncertainties.
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Affiliation(s)
- Seung Hyuck Jeon
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
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Rubinstein AE, Ingram WS, Anderson BM, Gay SS, Fave XJ, Ger RB, McCarroll RE, Owens CA, Netherton TJ, Kisling KD, Court LE, Yang J, Li Y, Lee J, Mackin DS, Cardenas CE. Cost-effective immobilization for whole brain radiation therapy. J Appl Clin Med Phys 2017; 18:116-122. [PMID: 28585732 PMCID: PMC5874864 DOI: 10.1002/acm2.12101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/24/2017] [Accepted: 04/05/2017] [Indexed: 11/23/2022] Open
Abstract
To investigate the inter‐ and intra‐fraction motion associated with the use of a low‐cost tape immobilization technique as an alternative to thermoplastic immobilization masks for whole‐brain treatments. The results of this study may be of interest to clinical staff with severely limited resources (e.g., in low‐income countries) and also when treating patients who cannot tolerate standard immobilization masks. Setup reproducibility of eight healthy volunteers was assessed for two different immobilization techniques. (a) One strip of tape was placed across the volunteer's forehead and attached to the sides of the treatment table. (b) A second strip was added to the first, under the chin, and secured to the table above the volunteer's head. After initial positioning, anterior and lateral photographs were acquired. Volunteers were positioned five times with each technique to allow calculation of inter‐fraction reproducibility measurements. To estimate intra‐fraction reproducibility, 5‐minute anterior and lateral videos were taken for each technique per volunteer. An in‐house software was used to analyze the photos and videos to assess setup reproducibility. The maximum intra‐fraction displacement for all volunteers was 2.8 mm. Intra‐fraction motion increased with time on table. The maximum inter‐fraction range of positions for all volunteers was 5.4 mm. The magnitude of inter‐fraction and intra‐fraction motion found using the “1‐strip” and “2‐strip” tape immobilization techniques was comparable to motion restrictions provided by a thermoplastic mask for whole‐brain radiotherapy. The results suggest that tape‐based immobilization techniques represent an economical and useful alternative to the thermoplastic mask.
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Affiliation(s)
- Ashley E Rubinstein
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - W Scott Ingram
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Brian M Anderson
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Skylar S Gay
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xenia J Fave
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Rachel B Ger
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Rachel E McCarroll
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Constance A Owens
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Tucker J Netherton
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Kelly D Kisling
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Laurence E Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Yuting Li
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
| | - Joonsang Lee
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dennis S Mackin
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos E Cardenas
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Graduate School of Biomedical Sciences, The University of Texas Health Sciences Center, Houston, TX, USA
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Tiong A, Lao L, MacKean J, Goonetilleke M, Kron T. Faculty of Radiation Oncology Position Paper on the use of Image-Guided Radiation Therapy. J Med Imaging Radiat Oncol 2016; 60:772-780. [PMID: 27122102 DOI: 10.1111/1754-9485.12463] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/17/2016] [Indexed: 12/26/2022]
Abstract
The development of technology such as intensity-modulated radiotherapy (IMRT), volumetric arc therapy (VMAT) and stereotactic ablative body radiotherapy (SABR) has resulted in highly conformal radiotherapy treatments. While such technology has allowed for improved dose delivery, it has also meant that improved accuracy in the treatment room is required. Image-guided radiotherapy (IGRT), the use of imaging prior to or during treatment delivery, has been shown to improve the accuracy of treatment delivery and in some circumstances, clinical outcomes. Allied with the adoption of highly conformal treatments, there is a need for stringent quality assurance processes in a multidisciplinary environment. In 2015, the Royal Australian and New Zealand College of Radiologist (RANZCR) updated its position paper on IGRT. The draft document was distributed through the membership of the Faculty of Radiation Oncology (FRO) for review and the final version was endorsed by the board of FRO. This article describes issues that radiotherapy departments throughout Australia and New Zealand should consider. It outlines the role of IGRT and reviews current clinical evidence supporting the benefit of IGRT in genitourinary, head and neck, and lung cancers. It also highlights important international publications which provide guidance on implementation and quality assurances for IGRT. A set of key recommendations are provided to guide safe and effective IGRT implementation and practice in the Australian and New Zealander context.
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Affiliation(s)
- Albert Tiong
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Louis Lao
- Department of Radiation Oncology, Auckland City Hospital, Auckland, New Zealand.,Auckland Radiation Oncology, Auckland, New Zealand.,University of Auckland, Auckland, New Zealand
| | - James MacKean
- Genesis Cancer Care Queensland, Brisbane, Queensland, Australia
| | - Madhavi Goonetilleke
- Department of Radiation Oncology, Townsville Cancer Centre, Townsville, Queensland, Australia
| | - Tomas Kron
- Department of Medical Physics, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
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Frameless LINAC-based stereotactic radiation therapy to brain metastasis resection cavity without whole-brain radiation therapy: A systematic review. Pract Radiat Oncol 2016; 6:324-330. [PMID: 26922701 DOI: 10.1016/j.prro.2016.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 12/24/2015] [Accepted: 01/03/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE The aim of this systematic review was to summarize the findings from the published data of frameless stereotactic radiation therapy (RT) to the resection cavity delivered with nonrobotic linear accelerator in patients with brain metastases. METHODS The studies cited in this systematic review were identified through a search of the PubMed database, using the search terms: "stereotactic [Title/Abstract]" and "Brain [Title/Abstract]," and "Metas* [Title/Abstract]." The search was unlimited to language and publication year. RESULTS A total of 9 studies were included in our review. Stereotactic RT to the resection cavity appears to provide excellent local control rates that are comparable to framed stereotactic RT. There are various factors that influence local control. Distant intracranial control rates are poor with the use of postoperative stereotactic RT compared with local treatment (surgery or stereotactic RT) plus whole-brain RT. CONCLUSIONS Stereotactic RT to the resection cavity appears to provide good local control rates and poor distant intracranial control. Postoperative treatment should be discussed by a multidisciplinary team and tailored to each case individually.
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Niyazi M, Brada M, Chalmers AJ, Combs SE, Erridge SC, Fiorentino A, Grosu AL, Lagerwaard FJ, Minniti G, Mirimanoff RO, Ricardi U, Short SC, Weber DC, Belka C. ESTRO-ACROP guideline “target delineation of glioblastomas”. Radiother Oncol 2016; 118:35-42. [DOI: 10.1016/j.radonc.2015.12.003] [Citation(s) in RCA: 201] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 12/13/2015] [Indexed: 11/26/2022]
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