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Wong YM, Koh CWY, Lew KS, Chua CGA, Yeap PL, Zhang ET, Ong ALK, Tuan JKL, Ng BF, Lew WS, Lee JCL, Tan HQ. Deformable anthropomorphic pelvis phantom for dose accumulation verification. Phys Med Biol 2024; 69:12NT01. [PMID: 38821109 DOI: 10.1088/1361-6560/ad52e4] [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: 02/25/2024] [Accepted: 05/31/2024] [Indexed: 06/02/2024]
Abstract
Objective.The validation of deformable image registration (DIR) for contour propagation is often done using contour-based metrics. Meanwhile, dose accumulation requires evaluation of voxel mapping accuracy, which might not be accurately represented by contour-based metrics. By fabricating a deformable anthropomorphic pelvis phantom, we aim to (1) quantify the voxel mapping accuracy for various deformation scenarios, in high- and low-contrast regions, and (2) identify any correlation between dice similarity coefficient (DSC), a commonly used contour-based metric, and the voxel mapping accuracy for each organ.Approach. Four organs, i.e. pelvic bone, prostate, bladder and rectum (PBR), were 3D printed using PLA and a Polyjet digital material, and assembled. The latter three were implanted with glass bead and CT markers within or on their surfaces. Four deformation scenarios were simulated by varying the bladder and rectum volumes. For each scenario, nine DIRs with different parameters were performed on RayStation v10B. The voxel mapping accuracy was quantified by finding the discrepancy between true and mapped marker positions, termed the target registration error (TRE). Pearson correlation test was done between the DSC and mean TRE for each organ.Main results. For the first time, we fabricated a deformable phantom purely from 3D printing, which successfully reproduced realistic anatomical deformations. Overall, the voxel mapping accuracy dropped with increasing deformation magnitude, but improved when more organs were used to guide the DIR or limit the registration region. DSC was found to be a good indicator of voxel mapping accuracy for prostate and rectum, but a comparatively poorer one for bladder. DSC > 0.85/0.90 was established as the threshold of mean TRE ⩽ 0.3 cm for rectum/prostate. For bladder, extra metrics in addition to DSC should be considered.Significance. This work presented a 3D printed phantom, which enabled quantification of voxel mapping accuracy and evaluation of correlation between DSC and voxel mapping accuracy.
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Affiliation(s)
- Yun Ming Wong
- Division of Physics and Applied Physics, Nanyang Technological University, Singapore, Singapore
| | - Calvin Wei Yang Koh
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Ai3 Lab, National Cancer Centre Singapore, Singapore, Singapore
| | - Kah Seng Lew
- Division of Physics and Applied Physics, Nanyang Technological University, Singapore, Singapore
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Clifford Ghee Ann Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Ai3 Lab, National Cancer Centre Singapore, Singapore, Singapore
| | - Ping Lin Yeap
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Ee Teng Zhang
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
- Singapore Centre for 3D Printing, Nanyang Technological University, Singapore, Singapore
| | - Ashley Li Kuan Ong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Ai3 Lab, National Cancer Centre Singapore, Singapore, Singapore
| | - Jeffrey Kit Loong Tuan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Ai3 Lab, National Cancer Centre Singapore, Singapore, Singapore
| | - Bing Feng Ng
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Wen Siang Lew
- Division of Physics and Applied Physics, Nanyang Technological University, Singapore, Singapore
| | - James Cheow Lei Lee
- Division of Physics and Applied Physics, Nanyang Technological University, Singapore, Singapore
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Hong Qi Tan
- Division of Physics and Applied Physics, Nanyang Technological University, Singapore, Singapore
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
- Ai3 Lab, National Cancer Centre Singapore, Singapore, Singapore
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Nagata K, Janik EA, Gutti JR. Rectal volume is correlated with interfractional positional shifts of the prostate gland in dogs receiving radiation therapy. Vet Radiol Ultrasound 2024. [PMID: 38734934 DOI: 10.1111/vru.13381] [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: 12/05/2023] [Revised: 02/23/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Variability in prostate gland positioning during RT for prostate tumors is a recognized challenge in both human and veterinary oncology. This retrospective study investigates the interfractional variability in prostate gland positioning in relation to rectal and bladder volumes in dogs undergoing radiation therapy (RT) for prostate tumors. The study tracked 10 dogs undergoing five RT sessions from February 2016 to November 2021, delivering a total of 25 Gy each. Each dog underwent CT scans for treatment simulation, and cone-beam CT (CBCT) images were acquired before each RT. The focus was to analyze the positional shifts of the prostate gland concerning the volumes of the rectum and urinary bladder. The pelvic bones were used as the point of reference. The rectal and bladder volumes were measured before each RT, and shifts in the prostate gland position were calculated by comparing coordinates from planning CT and treatment session images. Findings revealed significant correlations between prostate positional shifts in the dorsal-ventral (repeated measures correlation coefficient of -0.58 [range 00.75-00.33]; P < .001) and cranial-caudal directions (repeated measures correlation coefficient [95%CI] 0.56 [range 0.31-0.74]; P < .001) and rectal volume, while no significant relationship was observed with bladder volume. Shifts in the lateral direction were not correlated with either organ's volume. This study highlights the importance of considering rectal volume in canine prostate tumor RT to minimize positional uncertainties. Maintaining consistent rectal volume may enhance the precision of prostate targeting, potentially influencing the safety of RT.
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Affiliation(s)
- Koichi Nagata
- Department of Small Animal Medicine & Surgery, The University of Georgia College of Veterinary Medicine, Athens, Georgia, USA
| | - Emily A Janik
- Department of Small Animal Medicine & Surgery, The University of Georgia College of Veterinary Medicine, Athens, Georgia, USA
| | - Jishnu Rao Gutti
- Department of Small Animal Clinical Sciences, The University of Florida College of Veterinary Medicine, Gainesville, Florida, USA
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Nugent K, O'Neill B, Brennan V, Lynch J, Higgins M, Dunne M, Skourou C. Quantification of organ motion in male and female patients undergoing long course radiotherapy for rectal cancer in the supine position. Adv Radiat Oncol 2022; 8:101109. [DOI: 10.1016/j.adro.2022.101109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022] Open
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Emergence of MR-Linac in Radiation Oncology: Successes and Challenges of Riding on the MRgRT Bandwagon. J Clin Med 2022; 11:jcm11175136. [PMID: 36079065 PMCID: PMC9456673 DOI: 10.3390/jcm11175136] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 12/05/2022] Open
Abstract
The special issue of JCM on “Advances of MRI in Radiation Oncology” provides a unique forum for scientific literature related to MR imaging in radiation oncology. This issue covered many aspects, such as MR technology, motion management, economics, soft-tissue–air interface issues, and disease sites such as the pancreas, spine, sarcoma, prostate, head and neck, and rectum from both camps—the Unity and MRIdian systems. This paper provides additional information on the success and challenges of the two systems. A challenging aspect of this technology is low throughput and the monumental task of education and training that hinders its use for the majority of therapy centers. Additionally, the cost of this technology is too high for most institutions, and hence widespread use is still limited. This article highlights some of the difficulties and how to resolve them.
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Drabble J, Das P, George B, Camilleri P, Morris A. Based on 0.35 T magnetic resonance-guided radiotherapy, what are the nonisotropic PTV margins required for conventional prostate radiotherapy? Med Dosim 2022; 47:334-341. [PMID: 35907693 DOI: 10.1016/j.meddos.2022.06.004] [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: 12/25/2021] [Revised: 05/31/2022] [Accepted: 06/23/2022] [Indexed: 10/16/2022]
Abstract
This study aims to calculate planning target volume (PTV) margins for the prostate and seminal vesicles (SVs) from the use of magnetic resonance-guided radiation therapy (MRgRT). And whether nonisotropic PTV margins are beneficial for these structures. Organ motion is linked to the displacement of the prostate and SVs. From the use of MRgRT, the nearby organs at risk (OAR) can be visualized both inter- and intrafraction. This study looked to determine if there is a correlation between interfractional OAR changes and displacements to the prostate and SVs. Inter- and intrafractional data from 20 consecutive prostate cancer patients treated using extreme hypofractionated 0.35 T MRgRT indicated prostate and SV motion during treatment. Tracking points (TPs) on 2D sagittal cine-MRI enabled assessment of this intrafractional motion. To determine a correlation between rectal changes and target displacements, the rectal diameter (RD) changes were compared against the displacement differences (DDs) at the prostate and SVs. Eighty percent of patients required intrafractional imaging corrections during radiotherapy, including 16/100 fractions due to rectal volume increases and 24/100 fractions due to bladder volume increases. The frequency of ≥3 mm intrafraction displacement was considerably greater in TPs in the SV than in the prostate. A moderate positive correlation (R2 = 0.417) was shown between RD changes and DDs at the level of the prostate and SVs. The PTV margins required for 90% of the patient cohort for prostate and SVs are nonuniform in different directions, and the margin is larger for SVs. Organ motion contributed toward prostate and SV displacements and showed the importance of a robust bladder and rectal-filling protocol.
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Affiliation(s)
| | | | - Ben George
- GenesisCare UK, radiotherapy, Oxford, England.
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Zhang Y, Zhang X, Li J, Zeng L, Wang X, Wu X, Li Y, Li X, Zhong R. Analysis of the Influence of Peripheral Anatomical Changes for CBCT-Guided Prostate Cancer Radiotherapy. Technol Cancer Res Treat 2021; 20:15330338211016370. [PMID: 33982618 PMCID: PMC8127575 DOI: 10.1177/15330338211016370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose: To analyze the influence of the bladder and rectum filling and the body contour changes on the prostate target dose. Methods: A total of 190 cone-beam CT (CBCT) image data sets from 16 patients with prostate cancer were used in this study. Dose reconstruction was performed on the virtual CT generated by the deformable planning CT. Then, the effects of the bladder filling, rectal filling, and the patient’s body contour changes of the PCTV1 (the prostate area, B1) and PCTV2 (the seminal vesicle area, B2) on the target dose were analyzed. Correlation analysis was performed for the ratio of bladder and rectal volume variation and the variation of the bladder and rectal dose. Results: The mean Dice coefficients of B1, B2, bladder, and rectum were 0.979, 0.975, 0.888 and 0.827, respectively, and the mean Hausdorff distances were 0.633, 1.505, 2.075, and 1.533, respectively. With the maximum volume variations of 142.04 ml for the bladder and 40.50 ml for the rectum, the changes of V100, V95, D2, and D98 were 1.739 ± 1.762 (%), 0.066 ± 0.169 (%), 0.562 ± 0.442 (%), and 0.496 ± 0.479 (%) in PCTV1 and 1.686 ± 1.051 (%), 0.240 ± 0.215 (%), 1.123 ± 0.925 (%), and 0.924 ± 0.662 (%) in PCTV2, respectively. With a 10% increase in the volume of the bladder and rectum, the V75, V70, and V65 of rectum increased at 0.73 (%), 0.71 (%), and 1.18 (%), and the V75, V70, and V65 of bladder changed at −0.21 (%), −0.32 (%), and −0.39 (%), respectively. Conclusion: Significant correlations were observed between the volume variation and the dose variation of the bladder and rectum. However, when a bladder and rectal filling protocol was adopted, the target dose coverage can be effectively ensured based on CBCT guidance to correct the prostate target position.
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Affiliation(s)
- Yingjie Zhang
- Division of Radiation Physics, Department of Radiotherapy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Xiangbin Zhang
- Division of Radiation Physics, Department of Radiotherapy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Jing Li
- Division of Radiation Physics, Department of Radiotherapy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Liang Zeng
- Institute of Radiation Medicine, Fudan University, Shanghai, P.R. China
| | - Xuetao Wang
- Division of Radiation Physics, Department of Radiotherapy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Xiaohong Wu
- Department of Oncology, The Affiliated Hospital of Panzhihua University, Panzhihua, P.R. China
| | - Yan Li
- Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Cancer Hospital Affiliate to School of Medicine, UESTC, Chengdu, P.R. China
| | - Xiaoyu Li
- Division of Radiation Physics, Department of Radiotherapy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Renming Zhong
- Division of Radiation Physics, Department of Radiotherapy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, P.R. China
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Axford A, Dikaios N, Roberts DA, Clark CH, Evans PM. An end-to-end assessment on the accuracy of adaptive radiotherapy in an MR-linac. Phys Med Biol 2021; 66:055021. [PMID: 33503604 DOI: 10.1088/1361-6560/abe053] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To develop and demonstrate an end-to-end assessment procedure for adaptive radiotherapy (ART) within an MR-guided system. METHODS AND MATERIALS A 3D printed pelvic phantom was designed and constructed for use in this study. The phantom was put through the complete radiotherapy treatment chain, with planned internal changes made to model prostate translations and shape changes, allowing an investigation into three ART techniques commonly used. Absolute dosimetry measurements were made within the phantom using both gafchromic film and alanine. Comparisons between treatment planning system (TPS) calculations and measured dose values were made using the gamma evaluation with criteria of 3 mm/3% and 2 mm/2%. RESULTS Gamma analysis evaluations for each type of treatment plan adaptation investigated showed a very high agreement with pass rates for each experiment ranging from 98.10% to 99.70% and 92.60% to 97.55%, for criteria of 3%/3 mm and 2%/2 mm respectively. These pass rates were consistent for both shape and position changes. Alanine measurements further supported the results, showing an average difference of 1.98% from the TPS. CONCLUSION The end-to-end assessment procedure provided demanding challenges for treatment plan adaptations to demonstrate the capabilities and achieved high consistency in all findings.
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Affiliation(s)
- A Axford
- The Centre for Vision Speech and Signal Processing (CVSSP), University of Surrey, Guildford, Surrey, United Kingdom. Metrology for Medical Physics (MEMPHYS), National Physical Laboratory, Teddington, United Kingdom
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Jarema T, Aland T. Using the iterative kV CBCT reconstruction on the Varian Halcyon linear accelerator for radiation therapy planning for pelvis patients. Phys Med 2019; 68:112-116. [DOI: 10.1016/j.ejmp.2019.11.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/16/2019] [Accepted: 11/18/2019] [Indexed: 01/15/2023] Open
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Miura H, Ozawa S, Doi Y, Nakao M, Ohnishi K, Kenjo M, Nagata Y. Automatic gas detection in prostate cancer patients during image-guided radiation therapy using a deep convolutional neural network. Phys Med 2019; 64:24-28. [PMID: 31515026 DOI: 10.1016/j.ejmp.2019.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/04/2019] [Accepted: 06/17/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The detection of intestinal/rectal gas is very important during image-guided radiation therapy (IGRT) of prostate cancer patients because intestinal/rectal gas increases the inter- and intra-fractional prostate motion. We propose a deep convolutional neural network (DCNN) to detect intestinal/rectal gas in the pelvic region. MATERIAL AND METHODS We selected 300 anterior-posterior kilo-voltage (kV) X-ray images from 30 prostate cancer patients. Thirty images were randomly chosen for a test set, and the remaining 270 images used as the training set. The intestinal/rectal gas was manually delineated on kV X-ray images and segmented. The training images were augmented by applying artificial shifts and fed into a DCNN. The network models were trained to keep the quality of the output image close to the quality of the input image by pooling and upsampling. The training set was used to adjust the parameters of the DCNN, and the test set was used to assess the performance of the model. The performance of the DCNN was evaluated using a fivefold cross-validation procedure. The dice similarity coefficient (DSC) was calculated to evaluate the detection accuracy between the manual contour and auto-segmentation. RESULTS The DCNN was trained within approximately 17 min with a time step of 20 s/epoch. The training and validation accuracy of the models after 50epochs were 0.94 and 0.85, respectively. The average ± standard deviation of the DSC for 30 test images was 0.85 ± 0.08. CONCLUSIONS The proposed DCNN method can automatically detect the intestinal/rectal gas in kV images with good accuracy.
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Affiliation(s)
- Hideharu Miura
- Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan; Department of Radiation Oncology, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, Japan.
| | - Shuichi Ozawa
- Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan; Department of Radiation Oncology, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, Japan
| | - Yoshiko Doi
- Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan; Department of Radiation Oncology, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, Japan
| | - Minoru Nakao
- Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan; Department of Radiation Oncology, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, Japan
| | - Keiichi Ohnishi
- Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan
| | - Masahiro Kenjo
- Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan; Department of Radiation Oncology, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, Japan
| | - Yasushi Nagata
- Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan; Department of Radiation Oncology, Institute of Biomedical & Health Science, Hiroshima University, Hiroshima, Japan
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Nathoo D, Loblaw A, Davidson M, Musunuru HB, Khojaste A, Ravi A. A Feasibility Study on the Role of Ultrasound Imaging of Bladder Volume as a Method to Improve Concordance of Bladder Filling Status on Treatment with Simulation. J Med Imaging Radiat Sci 2018; 49:277-285. [PMID: 32074054 DOI: 10.1016/j.jmir.2018.04.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 04/12/2018] [Accepted: 04/20/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Accurate positioning of the prostate is of paramount importance to ensure optimal target coverage and normal tissue sparing in stereotactic ablative body radiation when large doses per fraction are delivered with tight margins around the prostate. Bladder and rectal filling play an important part in controlling the accuracy of a patient's setup and therefore the overall toxicities and outcomes. The aim of this study was to establish the value of characterizing patients' bladder filling kinetics at the time of simulation with ultrasound scans so that a predictive model can be used to ensure that a bladder volume at treatment would match at simulation. METHODS A prospective trial was conducted in unfavorable risk prostate cancer patients to evaluate the utility of ultrasound bladder monitoring. Thirty patients (n = 30) were enrolled in this study. Patients were required to void before simulation and then were given 500 mL of fluids to drink. Ultrasound measurements of the bladder were documented at 15-minute intervals for up to four measurements before simulation. On treatment, bladder volumes were measured at a single time point; typically, half an hour after the patient voided and consumed 500 mL of fluids. The kinetic model was then used to predict the optimal time to set up the patient for treatment such that the bladder volume at treatment would match the volume at simulation. Every patient had a cone beam computed tomography scan before each fraction to ensure accurate patient positioning before dose delivery. Bladder volumes at treatment were measured and compared with those at simulation on the cone beam computed tomography data sets using MIMVISTA software. RESULTS Of 30 patients, 26 were analyzed. The comparison of the bladder contours at treatment compared to simulation yielded a DICE coefficient (similarity) of 0.76 ± 0.11. The largest variation in bladder size was seen in the anterior-posterior direction. CONCLUSIONS This study demonstrated that ultrasound monitoring of the bladder status was a valuable tool in ensuring reproducible bladder filling on treatment. The bladder kinetic model indicated the general time required to achieve optimal bladder filling was 60 minutes after voiding and drinking 500 mL of water.
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Affiliation(s)
- Dilshad Nathoo
- Department of Radiation Therapy, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrew Loblaw
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Davidson
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Hima Bindu Musunuru
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Amir Khojaste
- Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ananth Ravi
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Dang A, Kupelian PA, Cao M, Agazaryan N, Kishan AU. Image-guided radiotherapy for prostate cancer. Transl Androl Urol 2018; 7:308-320. [PMID: 30050792 PMCID: PMC6043755 DOI: 10.21037/tau.2017.12.37] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Intensity-modulated radiotherapy (IMRT) has become the standard radiotherapy technology utilized for the treatment of prostate cancer, as it permits the delivery of highly conformal radiation dose distributions. Image-guided radiotherapy (IGRT) is an essential companion to IMRT that allows the treatment team to account for daily changes in target anatomy and positioning. In the present review, we will discuss the different sources of geometric uncertainty and review the rationale behind using IGRT in the treatment of prostate cancer. We will then describe commonly employed IGRT techniques and review their benefits and drawbacks. Additionally, we will review the evidence suggesting a potential clinical benefit to utilizing IGRT.
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Affiliation(s)
- Audrey Dang
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Patrick A Kupelian
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Minsong Cao
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Nzhde Agazaryan
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Amar U Kishan
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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12
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McPartlin AJ, Li XA, Kershaw LE, Heide U, Kerkmeijer L, Lawton C, Mahmood U, Pos F, van As N, van Herk M, Vesprini D, van der Voort van Zyp J, Tree A, Choudhury A. MRI-guided prostate adaptive radiotherapy - A systematic review. Radiother Oncol 2016; 119:371-80. [PMID: 27162159 DOI: 10.1016/j.radonc.2016.04.014] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/08/2016] [Accepted: 04/09/2016] [Indexed: 11/29/2022]
Abstract
Dose escalated radiotherapy improves outcomes for men with prostate cancer. A plateau for benefit from dose escalation using EBRT may not have been reached for some patients with higher risk disease. The use of increasingly conformal techniques, such as step and shoot IMRT or more recently VMAT, has allowed treatment intensification to be achieved whilst minimising associated increases in toxicity to surrounding normal structures. To support further safe dose escalation, the uncertainties in the treatment target position will need be minimised using optimal planning and image-guided radiotherapy (IGRT). In particular the increasing usage of profoundly hypo-fractionated stereotactic therapy is predicated on the ability to confidently direct treatment precisely to the intended target for the duration of each treatment. This article reviews published studies on the influences of varies types of motion on daily prostate position and how these may be mitigated to improve IGRT in future. In particular the role that MRI has played in the generation of data is discussed and the potential role of the MR-Linac in next-generation IGRT is discussed.
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Affiliation(s)
- A J McPartlin
- The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, UK
| | - X A Li
- Medical College of Wisconsin, USA
| | - L E Kershaw
- The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, UK
| | - U Heide
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, The Netherlands
| | - L Kerkmeijer
- University Medical Center Utrecht, The Netherlands
| | - C Lawton
- Medical College of Wisconsin, USA
| | - U Mahmood
- MD Anderson Cancer Center, Houston, USA
| | - F Pos
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, The Netherlands
| | - N van As
- Royal Marsden Hospital, UK; Institute of Cancer Research, UK
| | - M van Herk
- The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, UK
| | - D Vesprini
- Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | | | - A Tree
- Royal Marsden Hospital, UK
| | - A Choudhury
- The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, UK.
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Kole TP, Nichols RC, Lei S, Wu B, Huh SN, Morris CG, Lee S, Tong M, Mendenhall NP, Dritschilo A, Collins SP. A dosimetric comparison of ultra-hypofractionated passively scattered proton radiotherapy and stereotactic body radiotherapy (SBRT) in the definitive treatment of localized prostate cancer. Acta Oncol 2015; 54:825-31. [PMID: 25227898 DOI: 10.3109/0284186x.2014.953260] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND We compared target and normal tissue dosimetric indices between ultra-hypofractionated passively scattered proton radiotherapy and stereotactic body radiotherapy (SBRT) in the definitive treatment of localized prostate cancer. MATERIAL AND METHODS Ten patients were treated definitively for localized prostate cancer with SBRT to a dose of 36.25 Gy in 5 fractions prescribed to a volume encompassing the prostate only. Dose-volume constraints were applied to the rectum, bladder, penile bulb, femoral heads, and prostatic and membranous urethra. Three-field passively scattered proton plans were retrospectively generated using target volumes from the same patients. Dosimetric indices were compared between the SBRT and proton plans using the Wilcoxon signed rank test. RESULTS All dose constraints were achieved using both ultra-hypofractionated passively scattered proton and SBRT planning. Proton plans demonstrated significant improvement over SBRT in mean dose delivered to the penile bulb (5.2 CGE vs. 11.4 Gy; p=0.002), rectum (6.7 CGE vs. 10.6 Gy; p=0.002), and membranous urethra (32.2 CGE vs. 34.4 Gy; p=0.006) with improved target homogeneity resulting in a significant reduction in hot spots and volumes of tissue exposed to low doses of radiation. Compared to proton planning, SBRT planning resulted in significant improvement in target conformality with a mean index of 1.17 versus 1.72 (p=0.002), resulting in a dose reduction to the volume of bladder receiving more than 90% of the PD (V32.6, 7.5% vs. 15.9%; p=0.01) and mean dose to the left (7.1 Gy vs. 10.4 CGE; p=0.004) and right (4.0 Gy vs. 10.9 CGE; p=0.01) femoral heads. CONCLUSION Target and normal tissue dose constraints for ultra-hypofractionated definitive radiotherapy of localized prostate cancer are readily achieved using both CK SBRT and passively scattered proton-based therapy suggesting feasibility of either modality.
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Joh DY, Chen LN, Porter G, Bhagat A, Sood S, Kim JS, Moures R, Yung T, Lei S, Collins BT, Ju AW, Suy S, Carroll J, Lynch JH, Dritschilo A, Collins SP. Proctitis following stereotactic body radiation therapy for prostate cancer. Radiat Oncol 2014; 9:277. [PMID: 25497602 PMCID: PMC4272823 DOI: 10.1186/s13014-014-0277-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 11/26/2014] [Indexed: 11/26/2022] Open
Abstract
Background Proctitis after radiation therapy for prostate cancer remains an ongoing clinical challenge and critical quality of life issue. SBRT could minimize rectal toxicity by reducing the volume of rectum receiving high radiation doses and offers the potential radiobiologic benefits of hypofractionation. This study sought to evaluate the incidence and severity of proctitis following SBRT for prostate cancer. Methods Between February 2008 and July 2011, 269 men with clinically localized prostate cancer were treated definitively with SBRT monotherapy at Georgetown University Hospital. All patients were treated to 35-36.25Gy in 5 fractions delivered with the CyberKnife Radiosurgical System (Accuray). Rectal bleeding was recorded and scored using the CTCAE v.4. Telangiectasias were graded using the Vienna Rectoscopy Score (VRS). Proctitis was assessed via the Bowel domain of the Expanded Prostate Index Composite (EPIC)-26 at baseline and at 1, 3, 6, 9, 12, 18 and 24 months post-SBRT. Results The median age was 69 years with a median prostate volume of 39 cc. The median follow-up was 3.9 years with a minimum follow-up of two years. The 2-year actuarial incidence of late rectal bleeding ≥ grade 2 was 1.5%. Endoscopy revealed VRS Grade 2 rectal telangiectasias in 11% of patients. All proctitis symptoms increased at one month post-SBRT but returned to near-baseline with longer follow-up. The most bothersome symptoms were bowel urgency and frequency. At one month post-SBRT, 11.2% and 8.5% of patients reported a moderate to big problem with bowel urgency and frequency, respectively. The EPIC bowel summary scores declined transiently at 1 month and experienced a second, more protracted decline between 6 months and 18 months before returning to near-baseline at two years post-SBRT. Prior to treatment, 4.1% of men felt their bowel function was a moderate to big problem which increased to 11.5% one month post-SBRT but returned to near-baseline at two years post-SBRT. Conclusions In this single institution cohort, the rate and severity of proctitis observed following SBRT is low. QOL decreased on follow-up; however, our results compare favorably to those reported for patients treated with alternative radiation modalities. Future prospective randomized studies are needed to confirm these observations.
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Affiliation(s)
- Daniel Y Joh
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - Leonard N Chen
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - Gerald Porter
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - Aditi Bhagat
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - Sumit Sood
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - Joy S Kim
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - Rudy Moures
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - Thomas Yung
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - Brian T Collins
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - Andrew W Ju
- Department of Radiation Oncology, East Carolina University, Greenville, NC, 27834, USA.
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - John Carroll
- Department of Gastroenterology, Georgetown University Hospital, Washington, DC, 20007, USA.
| | - John H Lynch
- Department of Urology, Georgetown University Hospital, Washington, DC, 20007, USA.
| | - Anatoly Dritschilo
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
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Acquah G, Gustavsson M, Doudoo C, Agbeve R, Schiestl B. Clinical use of electronic portal imaging to analyse tumor motion variation during a 3D-conformal prostate cancer radiotherapy using online target verification and implanted markers. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2014. [DOI: 10.14319/ijcto.0204.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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16
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Scaife J, Harrison K, Romanchikova M, Parker A, Sutcliffe M, Bond S, Thomas S, Freeman S, Jena R, Bates A, Burnet N. Random variation in rectal position during radiotherapy for prostate cancer is two to three times greater than that predicted from prostate motion. Br J Radiol 2014; 87:20140343. [PMID: 25138155 PMCID: PMC4170867 DOI: 10.1259/bjr.20140343] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: Radiotherapy for prostate cancer does not explicitly take into account daily variation in the position of the rectum. It is important to accurately assess accumulated dose (DA) to the rectum in order to understand the relationship between dose and toxicity. The primary objective of this work was to quantify systematic (Σ) and random (σ) variation in the position of the rectum during a course of prostate radiotherapy. Methods: The rectum was manually outlined on the kilo-voltage planning scan and 37 daily mega-voltage image guidance scans for 10 participants recruited to the VoxTox study. The femoral heads were used to produce a fixed point to which all rectal contours were referenced. Results: Σ [standard deviation (SD) of means] between planning and treatment was 4.2 mm in the anteroposterior (AP) direction and 1.3 mm left–right (LR). σ (root mean square of SDs) was 5.2 mm AP and 2.7 mm LR. Superior–inferior variation was less than one slice above and below the planning position. Conclusion: Our results for Σ are in line with published data for prostate motion. σ, however, was approximately twice as great as that seen for prostate motion. This suggests that DA may differ from planned dose in some patients treated with radiotherapy for prostate cancer. Advances in knowledge: This work is the first to use daily imaging to quantify Σ and σ of the rectum in prostate cancer. σ was found to be greater than published data, providing strong rationale for further investigation of individual DA.
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Affiliation(s)
- J Scaife
- 1 Department of Oncology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
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17
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M. den Harder A, H. van Gils C, N.T.J. Kotte A, van Vulpen M, M. Lips I. Effect of magnesium oxide on interfraction prostate motion and rectal filling in prostate cancer radiotherapy. Strahlenther Onkol 2014; 190:758-61. [DOI: 10.1007/s00066-014-0660-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 03/19/2014] [Indexed: 12/30/2022]
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18
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Acquah G. The use of gold markers and electronic portal imaging for radiotherapy verification in prostate cancer patients: Sweden Ghana Medical Centre experience. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2014. [DOI: 10.14319/ijcto.0201.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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19
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Nakamura N, Hatanaka S, Takahashi O, Mizuno N, Endo H, Tamaki S, Shikama N, Ogita M, Kawamori J, Sekiguchi K. Gas in the rectum tends to reduce during radical external beam radiotherapy for localised prostate cancer. J Med Imaging Radiat Oncol 2013; 58:253-6. [DOI: 10.1111/1754-9485.12141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 10/31/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Naoki Nakamura
- Department of Radiation Oncology; St. Luke's International Hospital; Tokyo Japan
| | - Shogo Hatanaka
- Department of Radiation Oncology; Kanagawa Cancer Center; Yokohama Japan
| | - Osamu Takahashi
- Division of General Internal Medicine; Department of Medicine; St. Luke's International Hospital; Tokyo Japan
| | - Norifumi Mizuno
- Department of Radiation Oncology; St. Luke's International Hospital; Tokyo Japan
| | - Haruna Endo
- Department of Radiation Oncology; St. Luke's International Hospital; Tokyo Japan
| | - Seiichi Tamaki
- Department of Radiation Oncology; St. Luke's International Hospital; Tokyo Japan
- Department of Physics; Rikkyo University; Tokyo Japan
| | - Naoto Shikama
- Department of Radiation Oncology; Saitama Medical University International Medical Center; Hidaka Japan
| | - Mami Ogita
- Department of Radiation Oncology; St. Luke's International Hospital; Tokyo Japan
| | - Jiro Kawamori
- Department of Radiation Oncology; St. Luke's International Hospital; Tokyo Japan
| | - Kenji Sekiguchi
- Department of Radiation Oncology; St. Luke's International Hospital; Tokyo Japan
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Bhattasali O, Chen LN, Tong M, Lei S, Collins BT, Krishnan P, Kalhorn C, Lynch JH, Suy S, Dritschilo A, Dawson NA, Collins SP. Rationale for stereotactic body radiation therapy in treating patients with oligometastatic hormone-naïve prostate cancer. Front Oncol 2013; 3:293. [PMID: 24350058 PMCID: PMC3847811 DOI: 10.3389/fonc.2013.00293] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 11/18/2013] [Indexed: 12/31/2022] Open
Abstract
Despite advances in treatment for metastatic prostate cancer, patients eventually progress to castrate-resistant disease and ultimately succumb to their cancer. Androgen deprivation therapy (ADT) is the standard treatment for metastatic prostate cancer and has been shown to improve median time to progression and median survival time. Research suggests that castrate-resistant clones may be present early in the disease process prior to the initiation of ADT. These clones are not susceptible to ADT and may even flourish when androgen-responsive clones are depleted. Stereotactic body radiation therapy (SBRT) is a safe and efficacious method of treating clinically localized prostate cancer and metastases. In patients with a limited number of metastatic sites, SBRT may have a role in eliminating castrate-resistant clones and possibly delaying progression to castrate-resistant disease.
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Affiliation(s)
- Onita Bhattasali
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Leonard N. Chen
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Michael Tong
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Brian T. Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Pranay Krishnan
- Department of Radiology, Georgetown University Hospital, Washington, DC, USA
| | - Christopher Kalhorn
- Department of Neurosurgery, Georgetown University Medical Center, Washington, DC, USA
| | - John H. Lynch
- Department of Urology, Georgetown University Hospital, Washington, DC, USA
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Anatoly Dritschilo
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Nancy A. Dawson
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Sean P. Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
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21
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Yahya S, Zarkar A, Southgate E, Nightingale P, Webster G. Which bowel preparation is best? Comparison of a high-fibre diet leaflet, daily microenema and no preparation in prostate cancer patients treated with radical radiotherapy to assess the effect on planned target volume shifts due to rectal distension. Br J Radiol 2013; 86:20130457. [PMID: 23995876 PMCID: PMC3830438 DOI: 10.1259/bjr.20130457] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 08/26/2013] [Accepted: 08/28/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We evaluated and compared a high-fibre diet leaflet, daily microenema and no preparation to establish how best to achieve consistent bowel preparation in prostate cancer patients being treated with radical radiotherapy. METHODS 3 cohorts of 10 patients had different dietary interventions: no bowel preparation, high-fibre diet information leaflet and daily microenemas. The available cone beam CT (CBCT) scans of each patient were used to quantify interfractional changes in rectal distension (measured using average cross-sectional area-CSA), prostate shifts relative to bony anatomy compared with that at CT planning scan and rates of geometric miss (i.e. shifts of ≥5 mm). 85 CBCT scans were available in the pre-leaflet cohort, 89 scans in the post-leaflet, and 89 scans in the post-enema group. RESULTS Mean rectal CSA in the post-enema group was reduced compared with both pre-leaflet (p=0.010) and post-leaflet values (p=0.031). The magnitude of observed mean prostate shifts was significantly reduced in the post-enema group compared with the pre-leaflet group (p=0.014). The proportion of scans showing geometric miss (i.e. shift >5 mm) in the post-enema group (31%) was significantly lower than in the pre-leaflet (62%, p<0.001) or post-leaflet groups (56%, p<0.001). CONCLUSION This study indicates microenema to be an effective measure to achieve reduction in rectal CSA, prostate shift and reduce geometric miss of ≥5 mm. A further prospective randomised study is advocated to validate the results. ADVANCES IN KNOWLEDGE The use of microenema is effective in reducing prostate shift and rectal CSA, consequently decreasing the incidence of geographical miss.
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Affiliation(s)
- S Yahya
- Hall-Edwards Radiotherapy Research Group, The Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
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22
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Parr K. Nutritional Management In Prostate Cancer. Nutr Cancer 2013. [DOI: 10.1002/9781118788707.ch18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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23
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Knight K. Patient positioning and treatment instructions used during radiation therapy of the prostate: results of an Australian and New Zealand survey. ACTA ACUST UNITED AC 2013. [DOI: 10.1002/j.2051-3909.2005.tb00023.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kellie Knight
- Peter MacCallum Cancer Centre; Moorabbin Victoria 3189 Australia
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24
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Sood S, Ju AW, Wang H, Lei S, Uhm S, Zhang G, Suy S, Carroll J, Lynch J, Dritschilo A, Collins SP. Rectal endoscopy findings following stereotactic body radiation therapy for clinically localized prostate cancer. Radiat Oncol 2013; 8:197. [PMID: 23937800 PMCID: PMC3751769 DOI: 10.1186/1748-717x-8-197] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 08/02/2013] [Indexed: 11/12/2022] Open
Abstract
Background Treating prostate cancer with SBRT could potentially minimize radiation proctitis by reducing high-dose rectal irradiation. In addition, it offers the potential radiobiologic benefits of hypofractionation. This study reports the endoscopic changes and the associated clinical rectal toxicity in these patients. Methods We reviewed the records of patients treated from 2008–2011 for localized prostate cancer who had rectal endoscopy following SBRT. SBRT was delivered either as primary treatment in 5 fractions of 7–7.25 Gy, or as an initial boost in 3 fractions of 6.5 Gy followed by conventionally fractionated radiotherapy to 45–50.4 Gy. Endoscopic changes were graded using the Vienna Rectoscopy Score (VRS). Rectal toxicity was graded via CTCAEv.4. Rectal quality of life (QOL) was assessed via the bowel domain of the EPIC-26 questionnaire. Results Fifty-one patients with a median 23 months follow-up were analyzed. Thirty-five patients completed SBRT monotherapy and 16 patients received SBRT as a boost to conventionally fractionated IMRT. The median interval from SBRT to rectal endoscopy was 13 months. Endoscopy revealed VRS Grade 1–2 telangiectasias for 10 patients and VRS Grade 1–2 mucosal edema for 12 patients. No rectal ulcerations, strictures or necrosis were observed. Grade 1–2 late rectal bleeding occurred in 10 patients. There were no CTCAEv.4 Grade ≥3 toxicities. Mean EPIC bowel scores decreased from a baseline value of 96.9 to 82.3 at 1-month, but subsequently increased to 91.0 at 24 months. Conclusions In this cohort that is skewed towards patients with rectal complaints, the rate and severity of endoscopic changes following SBRT is low. Rectal toxicity and QOL were comparable to patients treated with other radiation modalities. Prospective trials examining the endoscopic outcomes following SBRT for prostate cancer are needed for confirmation of the findings of this study. Trial registration The Georgetown Institutional Review Board has approved this retrospective study (IRB 2009–510).
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Chen YJ, Suh S, Nelson RA, Liu A, Pezner RD, Wong JY. Setup Variations in Radiotherapy of Anal Cancer: Advantages of Target Volume Reduction Using Image-Guided Radiation Treatment. Int J Radiat Oncol Biol Phys 2012; 84:289-95. [DOI: 10.1016/j.ijrobp.2011.10.068] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 10/26/2011] [Accepted: 10/28/2011] [Indexed: 10/14/2022]
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26
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Wen N, Glide-Hurst C, Nurushev T, Xing L, Kim J, Zhong H, Liu D, Liu M, Burmeister J, Movsas B, Chetty IJ. Evaluation of the deformation and corresponding dosimetric implications in prostate cancer treatment. Phys Med Biol 2012; 57:5361-79. [PMID: 22863976 DOI: 10.1088/0031-9155/57/17/5361] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The cone-beam computed tomography (CBCT) imaging modality is an integral component of image-guided adaptive radiation therapy (IGART), which uses patient-specific dynamic/temporal information for potential treatment plan modification. In this study, an offline process for the integral component IGART framework has been implemented that consists of deformable image registration (DIR) and its validation, dose reconstruction, dose accumulation and dose verification. This study compares the differences between planned and estimated delivered doses under an IGART framework of five patients undergoing prostate cancer radiation therapy. The dose calculation accuracy on CBCT was verified by measurements made in a Rando pelvic phantom. The accuracy of DIR on patient image sets was evaluated in three ways: landmark matching with fiducial markers, visual image evaluation and unbalanced energy (UE); UE has been previously demonstrated to be a feasible method for the validation of DIR accuracy at a voxel level. The dose calculated on each CBCT image set was reconstructed and accumulated over all fractions to reflect the 'actual dose' delivered to the patient. The deformably accumulated (delivered) plans were then compared to the original (static) plans to evaluate tumor and normal tissue dose discrepancies. The results support the utility of adaptive planning, which can be used to fully elucidate the dosimetric impact based on the simulated delivered dose to achieve the desired tumor control and normal tissue sparing, which may be of particular importance in the context of hypofractionated radiotherapy regimens.
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Affiliation(s)
- Ning Wen
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI 48202, USA.
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Lei S, Piel N, Oermann EK, Chen V, Ju AW, Dahal KN, Hanscom HN, Kim JS, Yu X, Zhang G, Collins BT, Jha R, Dritschilo A, Suy S, Collins SP. Six-Dimensional Correction of Intra-Fractional Prostate Motion with CyberKnife Stereotactic Body Radiation Therapy. Front Oncol 2011; 1:48. [PMID: 22655248 PMCID: PMC3356099 DOI: 10.3389/fonc.2011.00048] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 11/14/2011] [Indexed: 11/13/2022] Open
Abstract
Large fraction radiation therapy offers a shorter course of treatment and radiobiological advantages for prostate cancer treatment. The CyberKnife is an attractive technology for delivering large fraction doses based on the ability to deliver highly conformal radiation therapy to moving targets. In addition to intra-fractional translational motion (left-right, superior-inferior, and anterior-posterior), prostate rotation (pitch, roll, and yaw) can increase geographical miss risk. We describe our experience with six-dimensional (6D) intra-fraction prostate motion correction using CyberKnife stereotactic body radiation therapy (SBRT). Eighty-eight patients were treated by SBRT alone or with supplemental external radiation therapy. Trans-perineal placement of four gold fiducials within the prostate accommodated X-ray guided prostate localization and beam adjustment. Fiducial separation and non-overlapping positioning permitted the orthogonal imaging required for 6D tracking. Fiducial placement accuracy was assessed using the CyberKnife fiducial extraction algorithm. Acute toxicities were assessed using Common Toxicity Criteria v3. There were no Grade 3, or higher, complications and acute morbidity was minimal. Ninety-eight percent of patients completed treatment employing 6D prostate motion tracking with intra-fractional beam correction. Suboptimal fiducial placement limited treatment to 3D tracking in two patients. Our experience may guide others in performing 6D correction of prostate motion with CyberKnife SBRT.
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Affiliation(s)
- Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital Washington, DC, USA
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Hypofractionated Versus Conventionally Fractionated Radiotherapy for Prostate Carcinoma: Final Results of Phase III Randomized Trial. Int J Radiat Oncol Biol Phys 2011; 81:1271-8. [PMID: 20934277 DOI: 10.1016/j.ijrobp.2010.07.1984] [Citation(s) in RCA: 176] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 06/28/2010] [Accepted: 07/22/2010] [Indexed: 12/30/2022]
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29
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Can diet combined with treatment scheduling achieve consistency of rectal filling in patients receiving radiotherapy to the prostate? Radiother Oncol 2011; 101:471-8. [DOI: 10.1016/j.radonc.2011.08.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 08/04/2011] [Accepted: 08/05/2011] [Indexed: 11/22/2022]
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30
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Uncertainties and CTV to PTV margins quantitative assessment using cone-beam CT technique in clinical application for prostate, and head and neck irradiation tumours. Clin Transl Oncol 2011; 13:819-25. [DOI: 10.1007/s12094-011-0740-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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31
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Cambria R, Jereczek-Fossa BA, Zerini D, Cattani F, Serafini F, Luraschi R, Pedroli G, Orecchia R. Physical and clinical implications of radiotherapy treatment of prostate cancer using a full bladder protocol. Strahlenther Onkol 2011; 187:799-805. [PMID: 22127358 DOI: 10.1007/s00066-011-2259-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 06/16/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the dosimetric and clinical implication when applying the full bladder protocol for the treatment of the localized prostate cancer (PCA). PATIENTS AND METHODS A total of 26 consecutive patients were selected for the present study. Patients underwent two series of CT scans: the day of the simulation and after 40 Gy. Each series consisted of two consecutive scans: (1) full bladder (FB) and (2) empty bladder (EB). The contouring of clinical target volumes (CTVs) and organs at risk (OAR) were compared to evaluate organ motion. Treatment plans were compared by dose distribution and dose-volume histograms (DVH). RESULTS CTV shifts were negligible in the laterolateral and superior-inferior directions (the maximum shift was 1.85 mm). Larger shifts were recorded in the anterior-posterior direction (95% CI, 0.83-4.41 mm). From the dosimetric point of view, shifts are negligible: the minimum dose to the CTV was 98.5% (median; 95%CI, 95-99%). The potential advantage for GU toxicity in applying the FB treatment protocol was measured: the ratio between full and empty bladder dose-volume points (selected from our protocol) is below 0.61, excluding the higher dose region where DVHs converge. CONCLUSION Having a FB during radiotherapy does not affect treatment effectiveness, on the contrary it helps achieve a more favorable DVH and lower GU toxicities.
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Affiliation(s)
- Raffaella Cambria
- Department of Medical Physics, Istituto Europeo di Oncologia, Milan, Italy.
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Yeung TPC, Yartsev S, Rodrigues G, Bauman G. Evaluation of image-guidance strategies with helical tomotherapy for localised prostate cancer. J Med Imaging Radiat Oncol 2011; 55:220-8. [PMID: 21501414 DOI: 10.1111/j.1754-9485.2011.02255.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Set-up accuracy of different image-guidance (IG) protocols using reduced imaging frequency was compared with daily IG. Anatomical characteristics were investigated for their potential to help select the suitable IG protocols for individual patients. METHODS Set-up corrections from 26 prostate cancer patients treated with daily IG on helical tomotherapy were used to simulate IG protocols with reduced imaging frequency, where average set-up corrections from a subset of initial IG sessions were used for subsequent fractions with no IG. Residual set-up error, the difference between the average set-up correction and the actual correction required, was used to evaluate the accuracy of each protocol. Adaptive treatment margins required to encompass these errors were calculated. Body mass index and daily bladder and rectum cross-sectional areas (CSAs) were measured, and their correlations with set-up corrections were evaluated. We also investigated the use of reduced imaging schedules to estimate changes in bladder and rectum CSAs. RESULTS As expected, residual set-up errors and adaptive treatment margins were effectively reduced with frequent imaging. For the majority of patients (81%), 10 IG sessions were sufficient to reduce residual set-up errors to within the adaptive treatment margins. Daily IG was more suitable than using a reduced IG protocol for a minority of patients (19%) with residual set-up errors that consistently exceeded the margins for >10% of fractions. These patients could be identified with 10 imaging sessions via the analysis of anatomical variations. CONCLUSIONS The accuracy of modified IG protocols should be validated in the context of institutional practice regarding patient set-up and bowel/bladder preparation.
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Affiliation(s)
- Timothy P C Yeung
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
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Brierley JD, Dawson LA, Sampson E, Bayley A, Scott S, Moseley JL, Craig T, Cummings B, Dinniwell R, Kim JJ, Ringash J, Wong R, Brock KK. Rectal Motion in Patients Receiving Preoperative Radiotherapy for Carcinoma of the Rectum. Int J Radiat Oncol Biol Phys 2011; 80:97-102. [DOI: 10.1016/j.ijrobp.2010.01.042] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 01/09/2010] [Accepted: 01/16/2010] [Indexed: 11/26/2022]
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Murphy MJ, Adler JR, Bodduluri M, Dooley J, Forster K, Hai J, Le Q, Luxton G, Martin D, Poen J. Image-Guided Radiosurgery for the Spine and Pancreas. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/10929080009148895] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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CTV to PTV margins for prostate irradiation. Three-dimensional quantitative assessment of interfraction uncertainties using portal imaging and serial CT scans. Clin Transl Oncol 2009; 11:615-21. [DOI: 10.1007/s12094-009-0413-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zhu X, Bourland JD, Yuan Y, Zhuang T, O'Daniel J, Thongphiew D, Wu QJ, Das SK, Yoo S, Yin FF. Tradeoffs of integrating real-time tracking into IGRT for prostate cancer treatment. Phys Med Biol 2009; 54:N393-401. [PMID: 19661570 DOI: 10.1088/0031-9155/54/17/n03] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study investigated the integration of the Calypso real-time tracking system, based on implanted ferromagnetic transponders and a detector array, into the current process for image-guided radiation treatment (IGRT) of prostate cancer at our institution. The current IGRT process includes magnetic resonance imaging (MRI) for prostate delineation, CT simulation for treatment planning, daily on-board kV and CBCT imaging for target alignment, and MRI/MRS for post-treatment assessment. This study assesses (1) magnetic-field-induced displacement and radio-frequency (RF)-induced heating of transponders during MRI at 1.5 T and 3 T, and (2) image artifacts caused by transponders and the detector array in phantom and patient cases with the different imaging systems. A tissue-equivalent phantom mimicking prostate tissue stiffness was constructed and implanted with three operational transponders prior to phantom solidification. The measurements show that the Calypso system is safe with all the imaging systems. Transponder position displacements due to the MR field are minimal (<1.0 mm) for both 1.5 T and 3 T MRI scanners, and the temperature variation due to MRI RF heating is <0.2 degrees C. The visibility of transponders and bony anatomy was not affected on the OBI kV and CT images. Image quality degradation caused by the detector antenna array is observed in the CBCT image. Image artifacts are most significant with the gradient echo sequence in the MR images, producing null signals surrounding the transponders with radii approximately 1.5 cm and length approximately 4 cm. Thus, Calypso transponders can preclude the use of MRI/MRS in post-treatment assessment. Modifications of the clinical flow are required to accommodate and minimize the substantial MRI artifacts induced by the Calypso transponders.
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Affiliation(s)
- X Zhu
- Department of Radiation Oncology, Duke University, Durham, NC, USA.
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Microscopic Gold Particle-Based Fiducial Markers for Proton Therapy of Prostate Cancer. Int J Radiat Oncol Biol Phys 2009; 74:1609-16. [DOI: 10.1016/j.ijrobp.2009.02.076] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 02/04/2009] [Accepted: 02/19/2009] [Indexed: 10/20/2022]
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Dawson NA, Collins SP. Novel treatment methods for localized prostate cancer: hypofractionated robotic radiation therapy and adjuvant chemotherapy. Expert Rev Anticancer Ther 2009; 9:953-62. [PMID: 19589034 DOI: 10.1586/era.09.53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The standard localized therapies for prostate cancer include external-beam radiation therapy, brachytherapy and radical prostatectomy. There are several novel approaches in development aimed at improving local disease control and survival, and reducing post-treatment complications. In low-to-intermediate-risk patients, new radiation approaches are being explored to include hypofractionated robotic radiation therapy. For high-risk patients, the focus is on multimodality approaches, especially the addition of chemotherapy. Recent developments in radiation therapy and adjuvant chemotherapy are the focus of this review.
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Affiliation(s)
- Nancy A Dawson
- Lombardi Comprehensive Cancer Center, Georgetown University, 3800 Reservoir Road, NW, Washington, DC 20007, USA.
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Mc Parland NA. kV-Cone Beam CT as an IGRT Tool in the Treatment of Early Stage Prostate Cancer: A Literature Review. J Med Imaging Radiat Sci 2009; 40:9-14. [PMID: 31051791 DOI: 10.1016/j.jmir.2008.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 11/30/2008] [Accepted: 12/04/2008] [Indexed: 11/29/2022]
Abstract
Image-guided radiation therapy (IGRT) is an important quality assurance measure that can be used in tandem with conformal radiation therapy treatment. Cone beam computed tomography (CBCT) is a sophisticated IGRT technology that has recently been introduced to the clinical setting. Cone beam equipment includes kilovoltage (kV) CBCT that produces online, high-quality, three-dimensional images of the prostate gland. Interfractional displacements of the prostate can be quantified and adjustments made using kV-CBCT so that daily RT can be accurately delivered. In addition, the volumetric nature of CBCT allows deformations of the prostate gland and surrounding anatomy to be accounted for using adaptive radiation therapy strategies. This article provides an introduction to the main IGRT tools that can be used in parallel with conformal radiation therapy of prostate cancer. A literature review is performed to describe the major IGRT approaches; however, the focus will remain primarily on the technical and clinical applications of kV-CBCT. Important considerations including patient dose, resource implications, and possible changes to the radiation therapist's scope of practice are also discussed.
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Affiliation(s)
- Neil A Mc Parland
- Radiation Therapy, British Columbia Cancer Agency, Vancouver Center, BC.
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40
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Fu W, Yang Y, Yue NJ, Heron DE, Huq MS. A cone beam CT-guided online plan modification technique to correct interfractional anatomic changes for prostate cancer IMRT treatment. Phys Med Biol 2009; 54:1691-703. [DOI: 10.1088/0031-9155/54/6/019] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Evaluating the relationships between rectal normal tissue complication probability and the portion of seminal vesicles included in the clinical target volume in intensity-modulated radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 2009; 73:334-40. [PMID: 19147014 DOI: 10.1016/j.ijrobp.2008.09.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 09/11/2008] [Accepted: 09/23/2008] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare dose-volume consequences of the inclusion of various portions of the seminal vesicles (SVs) in the clinical target volume (CTV) in intensity-modulated radiotherapy (IMRT) for patients with prostate cancer. METHODS AND MATERIALS For 10 patients with prostate cancer, three matched IMRT plans were generated, including 1 cm, 2 cm, or the entire SVs (SV1, SV2, or SVtotal, respectively) in the CTV. Prescription dose (79.2 Gy) and IMRT planning were according to the high-dose arm of the Radiation Therapy Oncology Group (RTOG) 0126 protocol. We compared plans for percentage of rectal volume receiving minimum doses of 60-80 Gy and for rectal normal tissue complication probability (NTCP[R]). RESULTS There was a detectable increase in rectal dose in SV2 and SVtotal compared with SV1. The magnitude of difference between plans was modest in the high-dose range. In 2 patients, there was underdosing of the planning target volume (PTV) because of constraints on rectal dose in the SVtotal plans. All other plans were compliant with RTOG 0126 protocol requirements. Mean NTCP increased from 14% to 17% and 18% for SV1, SV2, and SV total, respectively. The NTCP correlated with the size of PTV-rectum volume overlap (Pearson's r = 0.86; p < 0.0001), but not with SV volume. CONCLUSIONS Doubling (1 to 2 cm) or comprehensively increasing (1 cm to full SVs) SV volume included in the CTV for patients with prostate IMRT is achievable in the majority of cases without exceeding RTOG dose-volume limits or underdosing the PTV and results in only a moderate increase in NTCP.
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Knight K, Touma N, Zhu L, Duchesne GM, Cox J. Implementation of daily image-guided radiation therapy using an in-room CT scanner for prostate cancer isocentre localization. J Med Imaging Radiat Oncol 2009; 53:132-8. [DOI: 10.1111/j.1754-9485.2009.02048.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Peng C, Kainz K, Lawton C, Li XA. A Comparison of daily megavoltage CT and ultrasound image guided radiation therapy for prostate cancer. Med Phys 2008; 35:5619-28. [DOI: 10.1118/1.3013550] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Faria SL, Souhami L, Joshua B, Vuong T, Freeman CR. Reporting Late Rectal Toxicity in Prostate Cancer Patients Treated With Curative Radiation Treatment. Int J Radiat Oncol Biol Phys 2008; 72:777-81. [DOI: 10.1016/j.ijrobp.2008.02.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2007] [Revised: 12/21/2007] [Accepted: 02/01/2008] [Indexed: 11/30/2022]
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Metwaly M, Awaad AM, El-Sayed ESM, Sallam ASM. Comparison of intensity-modulated radiotherapy and forward-planning dynamic arc therapy techniques for prostate cancer. J Appl Clin Med Phys 2008; 9:37-56. [PMID: 19020481 PMCID: PMC5722358 DOI: 10.1120/jacmp.v9i4.2783] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Revised: 02/03/2008] [Accepted: 07/18/2008] [Indexed: 12/05/2022] Open
Abstract
We compare an inverse‐planning intensity‐modulated radiotherapy (IMRT) technique with three previously published forward‐planning dynamic arc therapy techniques and a newly implemented technique for treatment of prostate only. The three previously published dynamic arc techniques are dynamic arc therapy (DAT), two‐axis dynamic arc therapy (2A‐DAT), and modified dynamic arc therapy (M‐DAT). The newly implemented technique is the bilateral wedged dynamic arc (BW‐DAT). In all dynamic arcs, the multileaf collimator is moving during rotation to fit the prostate, except that, in 2A‐DAT, it is fitting two separate symmetrical rhombi including the prostate. The rectum is shielded during rotation only in the cases of M‐DAT and BW‐DAT. The results obtained indicate that the BW‐DAT, M‐DAT, and DAT techniques provide the intended dose coverage of the prescribed dose to the planning target volume (PTV)—that is, 95% of the PTV is covered by 100% of the dose. The maximum dose to a 3‐cm margin of healthy tissue that surrounds the PTV is lower by 2.5% in the case of IMRT than in both BW‐DAT and M‐DAT, but it is lower by 5.0% than that in both DAT and 2A‐DAT. The maximum dose to the rest of the healthy tissue in the case of BW‐DAT is 33.2Gy±2.2Gy. This dose covers percentage healthy body volumes of 8%±3.2% with IMRT, 4%±1.5% with DAT, and 6%±1.2% with both 2A‐DAT and M‐DAT. Also, this dose is much lower than the accepted maximum dose (52 Gy) to the femoral heads and necks according to Report 62 from the International Commission on Radiation Units and Measurements. Accordingly, it would be possible to neglect delineation of the femoral heads and necks as organs at risk in cases of BW‐DAT. Doses to 15%, 25%, 35%, and 50% (D15%, D25%, D35%, and D50%) of the rectum volume in the case of BW‐DAT were 43.5Gy±8.6Gy, 24.2Gy±8.7Gy, 13.2Gy±4.2Gy, and 5.7Gy±2.1Gy respectively. The D15% of rectum in the case of IMRT was lower than that in BW‐DAT, M‐DAT, 2A‐DAT, and DAT by 7.3%, 10.3%, 33.0%, and 17.6% of the prescribed dose (78 Gy in 39 fractions) respectively. The D25%, D35%, and D50% of the rectum volume in the cases of IMRT and DAT were comparable (with a maximum variation of 4.5%); they were similarly comparable in the cases of M‐DAT and BW‐DAT (with maximum variation of 1.5%). These same doses in BW‐DAT were lower than those in IMRT by 8.7%, 10.6%, and 6.2% respectively, but they were quite lower than those in 2A‐DAT, because the average variation was 41.6% (with a maximum of 44.0%). The D15%, D25%, D35%, and D50% of the bladder volume in the case of BW‐DAT were 33.2Gy±10.9Gy, 17.4Gy±7.9Gy, 6.5Gy±4.3Gy, and 4.2Gy±3.5Gy respectively. The D15% and D25% of the bladder in the cases of IMRT, M‐DAT, and BW‐DAT were comparable (with a maximum variation of 2.2% and 3.6% respectively), and the mean values of each dose were lower in DAT by 14.3% and 11.7% respectively. However, the values of D35% and D50% in the four techniques were comparable, with maximum variations of 5.1% and 2.7% respectively. The D15%, D25%, D35%, and D50% of the bladder in the case of DAT were lower than those in 2A‐DAT by 20.1%, 26.9%, 16.0%, and 2.7% respectively. Ion chamber measurements showed good agreement between the calculated and measured isocentric doses (maximum deviation: 3.2%). Accuracy of the dose distribution calculation for BW‐DAT was evaluated by film dosimetry using a gamma index, allowing 3% dose variation and 3 mm distance to agreement as the individual acceptance criteria. We found that fewer than 6.5% of the pixels in the dose distributions of the scanned and calculated area of 10×10 cm failed the acceptance criteria. We conclude that, in addition to simplicity of the dose calculation, the BW‐DAT technique provides the intended concave dose distribution for treatment of the prostate only. Compared with IMRT, it produces better dose protection to the most of the rectum volume and to the healthy tissue outside the treatment volume. Also, as compared with the other forward planning dynamic arc techniques, it gives the most favorable isodose distributions to the prostate and rectum. PACS number: 87.53.Tf
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Affiliation(s)
- Mohamed Metwaly
- Radiation Physics Department, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Awaad Mousa Awaad
- Radiotherapy Department, Oncology and Hematology Hospital, Maadi Armed Forces Medical Compound, Faculty of Science, Ain Shams University, Cairo, Egypt
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Ogino I, Uemura H, Inoue T, Kubota Y, Nomura K, Okamoto N. Reduction of Prostate Motion by Removal of Gas in Rectum During Radiotherapy. Int J Radiat Oncol Biol Phys 2008; 72:456-66. [DOI: 10.1016/j.ijrobp.2008.01.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Revised: 12/15/2007] [Accepted: 01/05/2008] [Indexed: 11/27/2022]
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Frank SJ, Dong L, Kudchadker RJ, De Crevoisier R, Lee AK, Cheung R, Choi S, O'Daniel J, Tucker SL, Wang H, Kuban DA. Quantification of Prostate and Seminal Vesicle Interfraction Variation During IMRT. Int J Radiat Oncol Biol Phys 2008; 71:813-20. [DOI: 10.1016/j.ijrobp.2007.10.028] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 10/16/2007] [Accepted: 10/16/2007] [Indexed: 10/22/2022]
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Yeoh EK, Holloway RH, Fraser RJ, Botten R, Di Matteo A, Moore JW, Schoeman MN, Bartholomeusz DL. Anorectal function after three- versus two-dimensional radiation therapy for carcinoma of the prostate. Int J Radiat Oncol Biol Phys 2008; 73:46-52. [PMID: 18571336 DOI: 10.1016/j.ijrobp.2008.03.058] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 02/27/2008] [Accepted: 03/20/2008] [Indexed: 11/15/2022]
Abstract
PURPOSE To compare the effects of (three-dimensional) 3D vs. two-dimensional (2D) radiation therapy (RT) for carcinoma of the prostate on the prevalence and pathophysiology of anorectal dysfunction. METHODS AND MATERIALS Anorectal symptoms, motility, sensory function, and anal sphincter morphology were evaluated before and up to 2 years after randomly assigned hypofractionated vs. conventionally fractionated RT in 67 patients (median age, 69 years; range, 54-82 years) with localized prostate carcinoma, using either a 3D (n = 29) or 2D (n = 38) treatment technique. RESULTS Anorectal symptoms increased 4 to 6 weeks after RT and persisted in both patient groups. At 2 years, abnormalities included increased stool frequency (55% vs. 53%, p = NS), urgency of defecation (72% vs. 47%, p < 0.05), fecal incontinence (28% vs. 26%, p = NS), and rectal bleeding (38% and 42%, p = NS). Anorectal motility and sensory function deteriorated after RT in both groups with reductions in basal anal pressures, anal pressures in response to squeeze, rectal compliance, and rectal volumes associated with the desire to defecate. External but not internal sphincter thickness changed in the treatment groups although in different directions. However no differences in motility or sensory function were detected between the groups. Baseline anorectal motility but not treatment technique and the hypofracionated schedule were of independent prognostic significance for anorectal motor dysfunction and rectal bleeding respectively at 2 years. CONCLUSION The prevalence and pathophysiology of anorectal dysfunction 2 years after RT for prostate carcinoma was largely independent of the treatment techniques used in this study.
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Affiliation(s)
- Eric K Yeoh
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide SA, Australia
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Stanley S, Griffiths S, Sydes MR, Moore AR, Syndikus I, Dearnaley DP. Accuracy and reproducibility of conformal radiotherapy using data from a randomised controlled trial of conformal radiotherapy in prostate cancer (MRC RT01, ISRCTN47772397). Clin Oncol (R Coll Radiol) 2008; 20:582-90. [PMID: 18565744 PMCID: PMC2568874 DOI: 10.1016/j.clon.2008.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 04/08/2008] [Accepted: 04/10/2008] [Indexed: 11/24/2022]
Abstract
Aims The MRC RT01 trial used conformal radiotherapy to the prostate, a method that reduces the volume of normal tissue treated by 40–50%. Because of the risk of geographical miss, the trial used portal imaging to examine whether treatment delivery was within the required accuracy. Material and methods In total, 843 patients were randomly assigned to receive 64 Gy in 32 fractions over 6.5 weeks or 74 Gy in 37 fractions over 7.5 weeks. Field displacements and corrections were recorded for all imaged fractions. Displacement trends and their association with time, disease and treatment set-up characteristics were examined using univariate and multivariate analyses. A Radiographer Trial Implementation Group (RTIG) was set up to inform the quality assurance process and to promote the development of best practice. Results Treatment isocentre positioning was within 5 mm in every direction on 6238 (83%) of the 7535 fractions imaged. In total, 532 (81%) of 695 included patients had at least one ≥ 3mm displacement and 415 (63%) had at least one ≥ 5mm displacement. Univariate, multivariate and stepwise models of ≥ 5mm displacements showed an increased likelihood of displacement in weeks 1 and 2 with low melting point alloy (LMPA) blocks compared with multileaf collimators, film verification compared with electronic portal imaging (EPI) and increased number of fractions imaged. Except for LMPA, this was also seen for ≥ 5mm displacements in weeks 3–6. Conclusions Accurate conformal treatment was delivered. The use of EPI was associated with increased reported accuracy. The RTIG was a crucial part of the quality assurance process.
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Affiliation(s)
- S Stanley
- St James's Institute of Oncology, Leeds, UK.
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An assessment of interfractional uterine and cervical motion: implications for radiotherapy target volume definition in gynaecological cancer. Radiother Oncol 2008; 88:250-7. [PMID: 18538873 DOI: 10.1016/j.radonc.2008.04.016] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2007] [Revised: 04/20/2008] [Accepted: 04/26/2008] [Indexed: 11/22/2022]
Abstract
PURPOSE To assess interfractional movement of the uterus and cervix in patients with gynaecological cancer to aid selection of the internal margin for radiotherapy target volumes. METHODS AND MATERIALS Thirty-three patients with gynaecological cancer had an MRI scan performed on two consecutive days. The two sets of T2-weighted axial images were co-registered, and the uterus and cervix outlined on each scan. Points were identified on the anterior uterine body (Point U), posterior cervix (Point C) and upper vagina (Point V). The displacement of each point in the antero-posterior (AP), superior-inferior (SI) and lateral directions between the two scans was measured. The changes in point position and uterine body angle were correlated with bladder volume and rectal diameter. RESULTS The mean difference (+/-1 SD) in Point U position was 7 mm (+/-9.0) in the AP direction, 7.1 mm (+/-6.8) SI and 0.8 mm (+/-1.3) laterally. Mean Point C displacement was 4.1 mm (+/-4.4) SI, 2.7 mm (+/-2.8) AP, 0.3 (+/-0.8) laterally, and Point V was 2.6 mm (+/-3.0) AP and 0.3 mm (+/-1.0) laterally. There was correlation for uterine SI movement in relation to bladder filling, and for cervical and vaginal AP movement in relation to rectal filling. CONCLUSION Large movements of the uterus can occur, particularly in the superior-inferior and anterior-posterior directions, but cervical displacement is less marked. Rectal filling may affect cervical position, while bladder filling has more impact on uterine body position, highlighting the need for specific instructions on bladder and rectal filling for treatment. We propose an asymmetrical margin with CTV-PTV expansion of the uterus, cervix and upper vagina of 15 mm AP, 15 mm SI and 7 mm laterally and expansion of the nodal regions and parametria by 7 mm in all directions.
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