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Tryggestad E, Li H, Rong Y. 4DCT is long overdue for improvement. J Appl Clin Med Phys 2023; 24:e13933. [PMID: 36866617 PMCID: PMC10113694 DOI: 10.1002/acm2.13933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 03/04/2023] Open
Affiliation(s)
- Erik Tryggestad
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Heng Li
- Department of Radiation Oncology, John Hopkins University, Baltimore, Maryland, USA
| | - Yi Rong
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
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Chuter R, Glassborow E, Speight R, Clarke M, Murray L, Radhakrishna G, Lavin V, Aspin L, Aldred M, Gregory S, Richardson J, Handley J. A treatment planning comparison of photon stereotactic ablative radiotherapy and proton beam therapy for the re-irradiation of pelvic cancer recurrence. Phys Imaging Radiat Oncol 2022; 21:78-83. [PMID: 35243036 PMCID: PMC8881531 DOI: 10.1016/j.phro.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patients who experience a pelvic cancer recurrence in or near a region that received initial radiotherapy, typically have few options for treatment. Organs at risk (OAR) have often reached their dose constraint limits leaving minimal dose remaining for standard re-irradiation (reRT). However, photon based stereotactic ablative radiotherapy (SABR) has been utilised for reRT with promising initial results although meeting OAR constraints can be challenging. Proton beam therapy (PBT) could offer an advantage. MATERIALS AND METHODS SABR plans used for treatment for ten pelvic reRT patients were dosimetrically compared to PBT plans retrospectively planned using the same CT and contour data. PBT plans were created to match the CTV dose coverage of SABR treatment plans with V100% ≥95%. An 'as low as reasonably achievable' approach was taken to OAR tolerances with consideration of OAR dose from the initial radiation (using equivalent dose in 2 Gy fractions). RESULTS Dosimetric comparison of relevant OAR statistics showed a decrease in OAR dose using PBT over SABR in all patients, with equivalent target coverage. The largest statistically significant reduction was seen for the colon D0.5 cm3 with a median reduction from 13.1 Gy to 5.9 Gy. There were statistically significant dose reductions in the median dose to small bowel, sacral plexus and cauda equina. CONCLUSION PBT has the potential for significant dose reductions for OARs in the pelvic reRT setting compared to SABR. However, it remains unclear if the magnitude of these OAR dose reductions will translate into clinical benefit.
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Affiliation(s)
- R. Chuter
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Heath, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - E. Glassborow
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - R. Speight
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M. Clarke
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - L. Murray
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - G. Radhakrishna
- Clinical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - V. Lavin
- Clinical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - L. Aspin
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Aldred
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S Gregory
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J. Richardson
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Heath, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - J. Handley
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
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Ruggieri R, Naccarato S, Stavrev P, Stavreva N, Fersino S, Giaj Levra N, Mazzola R, Mancosu P, Scorsetti M, Alongi F. Volumetric-modulated arc stereotactic body radiotherapy for prostate cancer: dosimetric impact of an increased near-maximum target dose and of a rectal spacer. Br J Radiol 2015; 88:20140736. [PMID: 26235142 DOI: 10.1259/bjr.20140736] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE In volumetric-modulated arc therapy (VMAT) prostate stereotactic body radiotherapy (SBRT), dose coverage of the planning target volume (PTV) becomes challenging when the sparing of rectum, bladder and urethra is strictly pursued. Our current 35-Gy-in-five-fraction plans only assure 33.2 Gy to ≥95% PTV ([Formula: see text] ≥ 95%). Looking for an improved [Formula: see text], increased near-maximum target dose (D2%) and prostate-rectum spacer insertion were tested. METHODS For 11 patients, two VMAT plans, with D2% ≤ 37.5 Gy (Hom) or D2% ≤ 40.2 Gy (Het), on each of two CT studies, before or after spacer insertion, were computed. All plans assured [Formula: see text] ≥95%, and <1 cm(3) of rectum, bladder and urethra receiving ≥35 Gy. By hypothesis testing, several dose-volume metrics for target coverage and rectal sparing were compared across the four groups of plans. The impact of spacer insertion on the fractions of rectum receiving more than 18, 28 and 32 Gy ([Formula: see text]) was further tested by linear correlation analysis. RESULTS By hypothesis testing, the increased D2% was associated with improvements in target coverage, whereas spacer insertion was associated with improvements in both target coverage and rectal [Formula: see text]. By linear correlation analysis, spacer insertion was related to the reductions in rectal [Formula: see text] for X ≥ 28 Gy. CONCLUSION A slightly increased D2% or the use of spacer insertion was each able to improve [Formula: see text]. Their combined use assured [Formula: see text] ≥ 98% to all our patients. Spacer insertion was further causative for improvements in rectal sparing. ADVANCES IN KNOWLEDGE For VMAT plans in prostate SBRT, the distinct dosimetric usefulness of increased D2% and of the use of spacer insertion were validated in terms of target coverage and rectal sparing.
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Affiliation(s)
- Ruggero Ruggieri
- 1 Radiation Oncology, Ospedale Sacro Cuore Don Calabria, Verona, Italy
| | | | - Pavel Stavrev
- 1 Radiation Oncology, Ospedale Sacro Cuore Don Calabria, Verona, Italy
| | - Nadejda Stavreva
- 1 Radiation Oncology, Ospedale Sacro Cuore Don Calabria, Verona, Italy
| | - Sergio Fersino
- 1 Radiation Oncology, Ospedale Sacro Cuore Don Calabria, Verona, Italy
| | | | - Rosario Mazzola
- 1 Radiation Oncology, Ospedale Sacro Cuore Don Calabria, Verona, Italy
| | - Pietro Mancosu
- 2 Radiotherapy and Radiosurgery Department, IRCCS Istituto Clinico Humanitas, Milan, Italy
| | - Marta Scorsetti
- 2 Radiotherapy and Radiosurgery Department, IRCCS Istituto Clinico Humanitas, Milan, Italy
| | - Filippo Alongi
- 1 Radiation Oncology, Ospedale Sacro Cuore Don Calabria, Verona, Italy
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Foster WK, Osei E, Barnett R. Margin selection to compensate for loss of target dose coverage due to target motion during external-beam radiation therapy of the lung. J Appl Clin Med Phys 2015; 16:5089. [PMID: 25679166 PMCID: PMC5689985 DOI: 10.1120/jacmp.v16i1.5089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 10/17/2014] [Accepted: 10/07/2014] [Indexed: 12/25/2022] Open
Abstract
The aim of this study is to provide guidelines for the selection of external‐beam radiation therapy target margins to compensate for target motion in the lung during treatment planning. A convolution model was employed to predict the effect of target motion on the delivered dose distribution. The accuracy of the model was confirmed with radiochromic film measurements in both static and dynamic phantom modes. 502 unique patient breathing traces were recorded and used to simulate the effect of target motion on a dose distribution. A 1D probability density function (PDF) representing the position of the target throughout the breathing cycle was generated from each breathing trace obtained during 4D CT. Changes in the target D95 (the minimum dose received by 95% of the treatment target) due to target motion were analyzed and shown to correlate with the standard deviation of the PDF. Furthermore, the amount of target D95 recovered per millimeter of increased field width was also shown to correlate with the standard deviation of the PDF. The sensitivity of changes in dose coverage with respect to target size was also determined. Margin selection recommendations that can be used to compensate for loss of target D95 were generated based on the simulation results. These results are discussed in the context of clinical plans. We conclude that, for PDF standard deviations less than 0.4 cm with target sizes greater than 5 cm, little or no additional margins are required. Targets which are smaller than 5 cm with PDF standard deviations larger than 0.4 cm are most susceptible to loss of coverage. The largest additional required margin in this study was determined to be 8 mm. PACS numbers: 87.53.Bn, 87.53.Kn, 87.55.D‐, 87.55.Gh
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Wu J, Betzing C, He TT, Fuss M, D'Souza WD. Dosimetric comparison of patient setup strategies in stereotactic body radiation therapy for lung cancer. Med Phys 2013; 40:051709. [PMID: 23635257 DOI: 10.1118/1.4801926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE In this work, the authors retrospectively compared the accumulated dose over the treatment course for stereotactic body radiation therapy (SBRT) of lung cancer for three patient setup strategies. METHODS Ten patients who underwent lung SBRT were selected for this study. At each fraction, patients were immobilized using a vacuum cushion and were CT scanned. Treatment plans were performed on the simulation CT. The planning target volume (PTV) was created by adding a 5-mm uniform margin to the internal target volume derived from the 4DCT. All plans were normalized such that 99% of the PTV received 60 Gy. The plan parameters were copied onto the daily CT images for dose recalculation under three setup scenarios: skin marker, bony structure, and soft tissue based alignments. The accumulated dose was calculated by summing the dose at each fraction along the trajectory of a voxel over the treatment course through deformable image registration of each CT with the planning CT. The accumulated doses were analyzed for the comparison of setup accuracy. RESULTS The tumor volume receiving 60 Gy was 91.7 ± 17.9%, 74.1 ± 39.1%, and 99.6 ± 1.3% for setup using skin marks, bony structures, and soft tissue, respectively. The isodose line covering 100% of the GTV was 55.5 ± 7.1, 42.1 ± 16.0, and 64.3 ± 7.1 Gy, respectively. The corresponding average biologically effective dose of the tumor was 237.3 ± 29.4, 207.4 ± 61.2, and 258.3 ± 17.7 Gy, respectively. The differences in lung biologically effective dose, mean dose, and V20 between the setup scenarios were insignificant. CONCLUSIONS The authors' results suggest that skin marks and bony structure are insufficient for aligning patients in lung SBRT. Soft tissue based alignment is needed to match the prescribed dose delivered to the tumors.
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Affiliation(s)
- Jianzhou Wu
- Radiation Oncology, Swedish Cancer Institute, Seattle, Washington 98104, USA.
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Tryggestad E, Flammang A, Hales R, Herman J, Lee J, McNutt T, Roland T, Shea SM, Wong J. 4D tumor centroid tracking using orthogonal 2D dynamic MRI: Implications for radiotherapy planning. Med Phys 2013; 40:091712. [DOI: 10.1118/1.4818656] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Roland T, Hales R, McNutt T, Wong J, Simari P, Tryggestad E. A method for deriving a 4D-interpolated balanced planning target for mobile tumor radiotherapy. Med Phys 2011; 39:195-205. [DOI: 10.1118/1.3666774] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Richter A, Wilbert J, Flentje M. Dosimetric evaluation of intrafractional tumor motion by means of a robot driven phantom. Med Phys 2011; 38:5280-9. [DOI: 10.1118/1.3633890] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Cuijpers JP, Verbakel WF, Slotman BJ, Senan S. A novel simple approach for incorporation of respiratory motion in stereotactic treatments of lung tumors. Radiother Oncol 2010; 97:443-8. [PMID: 21047693 DOI: 10.1016/j.radonc.2010.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 06/10/2010] [Accepted: 06/22/2010] [Indexed: 12/17/2022]
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