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Sakata Y, Umene K, Asaka S, Hirai R, Ishikawa H, Mori S. Real-time nonstandard-shaped gold fiducial marker tracking on x-ray fluoroscopic images for prostate radiotherapy. Phys Med Biol 2024; 69:025007. [PMID: 38091621 DOI: 10.1088/1361-6560/ad154a] [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: 06/15/2023] [Accepted: 12/13/2023] [Indexed: 01/09/2024]
Abstract
Objective.The prostate moves in accordance with the movement of surrounding organs. Tumor position can change by ≥3 mm during radiotherapy. Given the difficulties of visualizing the prostate fluoroscopically, fiducial markers are generally implanted into the prostate to monitor its motion during treatment. Recently, internally motion guidance methods of the prostate using a 99.5% gold/0.5% iron flexible notched wire fiducial marker (Gold Anchor® , Naslund Medical AB, Huddinge, Sweden), which requires a 22 gauge needle, has been used. However, because the notched wire can retain its linear shape, acquire a spiral shape, or roll into an irregular ball, detecting it on fluoroscopic images in real-time incurs higher computation costs.Approach.We developed a fiducial tracking algorithm to achieve real-time computation. The marker is detected on the first image frame using a shape filter that employs inter-class variance for the marker likelihood calculated by the filter, focusing on the large difference in densities between the marker and its surroundings. After the second frame, the marker is tracked by adding to the shape filter the similarity to the template cropped from the area around the marker position detected in the first frame. We retrospectively evaluated the algorithm's marker tracking accuracy for ten prostate cases, analyzing two fractions in each case.Main results.Tracking positional accuracy averaged over all patients was 0.13 ± 0.04 mm (mean ± standard deviation, Euclidean distance) and 0.25 ± 0.09 mm (95th percentile). Computation time was 2.82 ± 0.20 ms/frame averaged over all frames.Significance.Our algorithm successfully and stably tracked irregularly-shaped markers in real time.
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Affiliation(s)
- Yukinobu Sakata
- Corporate Research & Development Center, Toshiba Corporation, Kanagawa, Japan
| | - Kenta Umene
- Corporate Research & Development Center, Toshiba Corporation, Kanagawa, Japan
| | - Saori Asaka
- Corporate Research & Development Center, Toshiba Corporation, Kanagawa, Japan
| | - Ryusuke Hirai
- Corporate Research & Development Center, Toshiba Corporation, Kanagawa, Japan
| | - Hitoshi Ishikawa
- QST hospital, National Institutes for Quantum Science and Technology, Inage-ku, Chiba 263-8555, Japan
| | - Shinichiro Mori
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
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Kim J, Sung J, Lee SJ, Cho KS, Chung BH, Yang D, Kim J, Kim JW. Optimal planning target margin for prostate radiotherapy based on interfractional and intrafractional variability assessment during 1.5T MRI-guided radiotherapy. Front Oncol 2023; 13:1337626. [PMID: 38173837 PMCID: PMC10761547 DOI: 10.3389/fonc.2023.1337626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction We analyzed daily pre-treatment- (PRE) and real-time motion monitoring- (MM) MRI scans of patients receiving definitive prostate radiotherapy (RT) with 1.5 T MRI guidance to assess interfractional and intrafractional variability of the prostate and suggest optimal planning target volume (PTV) margin. Materials and methods Rigid registration between PRE-MRI and planning CT images based on the pelvic bone and prostate anatomy were performed. Interfractional setup margin (SM) and interobserver variability (IO) were assessed by comparing the centroid values of prostate contours delineated on PRE-MRIs. MM-MRIs were used for internal margin (IM) assessment, and PTV margin was calculated using the van Herk formula. Results We delineated 400 prostate contours on PRE-MRI images. SM was 0.57 ± 0.42, 2.45 ± 1.98, and 2.28 ± 2.08 mm in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions, respectively, after bone localization and 0.76 ± 0.57, 1.89 ± 1.60, and 2.02 ± 1.79 mm in the LR, AP, and SI directions, respectively, after prostate localization. IO was 1.06 ± 0.58, 2.32 ± 1.08, and 3.30 ± 1.85 mm in the LR, AP, and SI directions, respectively, after bone localization and 1.11 ± 0.55, 2.13 ± 1.07, and 3.53 ± 1.65 mm in the LR, AP, and SI directions, respectively, after prostate localization. Average IM was 2.12 ± 0.86, 2.24 ± 1.07, and 2.84 ± 0.88 mm in the LR, AP, and SI directions, respectively. Calculated PTV margin was 2.21, 5.16, and 5.40 mm in the LR, AP, and SI directions, respectively. Conclusions Movements in the SI direction were the largest source of variability in definitive prostate RT, and interobserver variability was a non-negligible source of margin. The optimal PTV margin should also consider the internal margin.
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Affiliation(s)
- Jina Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jiwon Sung
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seo Jin Lee
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kang Su Cho
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Ha Chung
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dongjoon Yang
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jihun Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Won Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Khanmohammadi S, Golzarian J, Akhlaghpoor S. CT-guided Transgluteal Prostate Fiducial Marker Insertion for Localized Radiation Therapy. Cardiovasc Intervent Radiol 2023; 46:1409-1413. [PMID: 37640950 DOI: 10.1007/s00270-023-03539-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE To Evaluate the safety and technical success of transgluteal CT-guided fiducial marker implantation into the prostate as an alternative method to transperineal and transrectal approaches. MATERIAL AND METHODS We retrospectively identified all patients who had undergone CT-guided transgluteal fiducial marker insertion between 2020 and 2022. Four patients with confirmed prostate cancer were identified. One radiologist performed all procedures via a bilateral transgluteal approach under the guidance of real-time CT-fluoroscopy. Twenty cm long pre-waxed 18G guiding needles, preloaded with smooth gold fiducial markers, were used to implant markers. Technical success was defined as the successful placement of the fiducial markers into the planned positions. RESULTS The mean age of patients was 70 years. The mean procedure time was 19.25 (SD: 6.75) min, and the mean total dose length product (DLP) was 801.75 (SD: 291.17) mGycm, which is compatible with the 12 mSv estimated effective dose. All procedures were technically successful (100%). All patients tolerated the procedure and did not require any analgesia for pain, and there were no requests to stop or pause the procedure. Only one patient reported hematuria one day after the procedure, which required no treatment. CONCLUSION Transgluteal CT-guided fiducial marker implantation into the prostate is an alternative method to transperineal and transrectal approaches. In this technique, the risk of septic complications is minor, and general anesthesia is not required. Thus, transgluteal CT-guided marker insertion is a feasible and well-tolerated method for image-guided radiation therapy (IGRT) in patients with prostate cancer.
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Affiliation(s)
- Shaghayegh Khanmohammadi
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Jafar Golzarian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Shahram Akhlaghpoor
- Department of Radiology, Pardis Noor Medical Imaging Center, No 5, 25th Street, Sa'adat abad street, Tehran, Iran.
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Ogawa S, Yasui K, Hayashi N, Saito Y, Hayashi S. Impact of Dose Perturbations Around Brachytherapy Seeds in External-Beam Radiotherapy Planning: A Fundamental and Clinical Validation Using Treatment Planning System-Based Monte Carlo Simulations. Cureus 2023; 15:e48041. [PMID: 38046495 PMCID: PMC10689119 DOI: 10.7759/cureus.48041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
Background This study evaluates dose perturbations caused by nonradioactive seeds in clinical cases by employing treatment planning system-based Monte Carlo (TPS-MC) simulation. Methodology We investigated dose perturbation using a water-equivalent phantom and 20 clinical cases of prostate cancer (10 cases with seeds and 10 cases without seeds) treated at Fujita Health University Hospital, Japan. First, dose calculations for a simple geometry were performed using the RayStation MC algorithm for a water-equivalent phantom with and without a seed. TPS-independent Monte Carlo (full-MC) simulations and film measurements were conducted to verify the accuracy of TPS-MC simulation. Subsequently, dose calculations using TPS-MC were performed on CT images of clinical cases of prostate cancer with and without seeds, and the dose distributions were compared. Results In clinical cases, dose calculations using MC simulations revealed hotspots around the seeds. However, the size of the hotspot was not correlated with the number of seeds. The maximum difference in dose perturbation between TPS-MC simulations and film measurements was 3.9%, whereas that between TPS-MC simulations and full-MC simulations was 3.7%. The dose error of TPS-MC was negligible for multiple beams or rotational irradiation. Conclusions Hotspots were observed in dose calculations using TPS-MC performed on CT images of clinical cases with seeds. The dose calculation accuracy around the seeds using TPS-MC simulations was comparable to that of film measurements and full-MC simulations, with differences within 3.9%. Although the clinical impact of hotspots occurring around the seeds is minimal, utilizing MC simulations on TPSs can be beneficial to verify their presence.
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Affiliation(s)
- Shuta Ogawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, JPN
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
| | - Keisuke Yasui
- School of Medical Sciences, Fujita Health University, Toyoake, JPN
| | - Naoki Hayashi
- School of Medical Sciences, Fujita Health University, Toyoake, JPN
| | - Yasunori Saito
- Division of Radiology, Fujita Health University Hospital, Toyoake, JPN
- School of Medical Sciences, Fujita Health University, Toyoake, JPN
| | - Shinya Hayashi
- Department of Radiation Oncology, Fujita Health University School of Medicine, Toyoake, JPN
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Mahdavi A, Mofid B, Taghizadeh-Hesary F. Intra-prostatic gold fiducial marker insertion for image-guided radiotherapy (IGRT): five-year experience on 795 patients. BMC Med Imaging 2023; 23:79. [PMID: 37308834 DOI: 10.1186/s12880-023-01036-z] [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: 03/22/2023] [Accepted: 05/29/2023] [Indexed: 06/14/2023] Open
Abstract
INTRODUCTION Prostate cancer is the second most commonly diagnosed cancer in males. The use of intra-prostatic fiducial markers (FM) for image-guided radiotherapy (IGRT) has become widespread due to their accuracy, relatively safe use, low cost, and reproducibility. FM provides a tool to monitor prostate position and volume changes. Many studies reported low to moderate rates of complications following FM implantation. In the current study, we present our five years' experience regarding the insertion technique, technical success, and rates of complication and migration of intraprostatic insertion of FM gold marker. METHODS From January 2018 to January 2023, 795 patients with prostate cancer candidate for IGRT (with or without a history of radical prostatectomy) enrolled in this study. We used three fiducial markers (3*0.6 mm) inserted through an 18-gauge Chiba needle under transrectal ultrasonography (TRUS) guidance. The patients were observed for complications up to seven days after the procedure. Besides, the rate of marker migration was recorded. RESULTS All procedures were completed successfully, and all patients tolerated the procedure well with minimal discomfort. The rate of sepsis after the procedure was 1%, and transient urinary obstruction was 1.6%. Only two patients experienced marker migration shortly after insertion, and no fiducial migration was reported throughout radiotherapy. No other major complication was recorded. DISCUSSION TRUS-guided intraprostatic FM implantation is technically feasible, safe, and well-tolerated in most patients. The FM migration can seldom occur, with negligible effects. This study can provide convincing evidence that TRUS-guided intra-prostatic FM insertion is an appropriate choice for IGRT.
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Affiliation(s)
- Ali Mahdavi
- Department of Radiology, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahram Mofid
- Department of Radiation Oncology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, 1985717443, Iran.
| | - Farzad Taghizadeh-Hesary
- ENT and Head and Neck Research Center and Department, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Department of Radiation Oncology, Iran University of Medical Sciences, Tehran, Iran.
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Reynaud T, Ben Aicha I, Carignan D, Pelchat C, Fiset C, Foster W, Martin AG, Vigneault E. Infection after prostatic transrectal fiducial marker implantation for image guided radiation therapy. Cancer Radiother 2023; 27:214-218. [PMID: 37080858 DOI: 10.1016/j.canrad.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 04/22/2023]
Abstract
PURPOSE The aim of this retrospective study is to assess the risk of infection after transrectal ultrasound-guided fiducial marker insertion for image-guided radiotherapy of prostate cancer. MATERIAL AND METHODS Between January 2016 and December 2020, 829 patients scheduled for intensity-modulated radiotherapy for prostate cancer had an intraprostatic fiducial marker transrectal implantation under ultrasound guidance by radiation-oncologists specialized in brachytherapy. Patients received standard oral prophylactic antibiotic with quinolone. If Gram negative bacteria resistant to quinolone were detected at the time of the prostate cancer biopsies, the antibioprophylaxis regimen was modified accordingly. The resistance to quinolone screening test was not repeated before fiducial marker insertion. Infectious complications were assessed with questionnaires at the time of CT-planning and medical record reviewed. Toxicity was evaluated according to CTCAE v5.0. RESULTS The median time between fiducial marker implantation and evaluation was 10 days (range: 0-165 days). Four patients (0.48%) developed urinary tract infection related to the procedure, mostly with Gram-negative bacteria resistant to quinolone (75%). Three had a grade 2 infection, and one patient experienced a grade 3 urosepsis. The quinolone-resistance status was known for two patients (one positive and one negative) and was unknown for the other two patients prior to fiducial marker implantation. CONCLUSION Intraprostatic transrectal fiducial marker implantation for image-guided radiotherapy is well tolerated with a low rate of infection. With such a low rate of infection, there is no need to repeat the search of Gram-negative bacteria resistant to quinolone before fiducial marker implantation if it was done at the time of prostate biopsies. Optimal antibioprophylaxis should be adapted to the known status of Gram-negative bacteria resistant to quinolone.
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Affiliation(s)
- T Reynaud
- Département de radio-oncologie et Centre de recherche CHU de Québec-université Laval, centre intégré de cancérologie, 2260, boulevard Henri-Bourassa, Québec, QC G1G 5X1, Canada; CHU de Québec-université Laval, Research Centre, Québec, Canada; CHU de Saint-Etienne, Department of radiotherapy, Saint-Priest-en-Jarez, France
| | - I Ben Aicha
- Département de radio-oncologie et Centre de recherche CHU de Québec-université Laval, centre intégré de cancérologie, 2260, boulevard Henri-Bourassa, Québec, QC G1G 5X1, Canada; CHU de Québec-université Laval, Research Centre, Québec, Canada
| | - D Carignan
- CHU de Québec-université Laval, Research Centre, Québec, Canada
| | - C Pelchat
- Département de radio-oncologie et Centre de recherche CHU de Québec-université Laval, centre intégré de cancérologie, 2260, boulevard Henri-Bourassa, Québec, QC G1G 5X1, Canada
| | - C Fiset
- Département de radio-oncologie et Centre de recherche CHU de Québec-université Laval, centre intégré de cancérologie, 2260, boulevard Henri-Bourassa, Québec, QC G1G 5X1, Canada
| | - W Foster
- Département de radio-oncologie et Centre de recherche CHU de Québec-université Laval, centre intégré de cancérologie, 2260, boulevard Henri-Bourassa, Québec, QC G1G 5X1, Canada
| | - A-G Martin
- Département de radio-oncologie et Centre de recherche CHU de Québec-université Laval, centre intégré de cancérologie, 2260, boulevard Henri-Bourassa, Québec, QC G1G 5X1, Canada; CHU de Québec-université Laval, Research Centre, Québec, Canada
| | - E Vigneault
- Département de radio-oncologie et Centre de recherche CHU de Québec-université Laval, centre intégré de cancérologie, 2260, boulevard Henri-Bourassa, Québec, QC G1G 5X1, Canada; CHU de Québec-université Laval, Research Centre, Québec, Canada.
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Bryant JM, Weygand J, Keit E, Cruz-Chamorro R, Sandoval ML, Oraiqat IM, Andreozzi J, Redler G, Latifi K, Feygelman V, Rosenberg SA. Stereotactic Magnetic Resonance-Guided Adaptive and Non-Adaptive Radiotherapy on Combination MR-Linear Accelerators: Current Practice and Future Directions. Cancers (Basel) 2023; 15:2081. [PMID: 37046741 PMCID: PMC10093051 DOI: 10.3390/cancers15072081] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Stereotactic body radiotherapy (SBRT) is an effective radiation therapy technique that has allowed for shorter treatment courses, as compared to conventionally dosed radiation therapy. As its name implies, SBRT relies on daily image guidance to ensure that each fraction targets a tumor, instead of healthy tissue. Magnetic resonance imaging (MRI) offers improved soft-tissue visualization, allowing for better tumor and normal tissue delineation. MR-guided RT (MRgRT) has traditionally been defined by the use of offline MRI to aid in defining the RT volumes during the initial planning stages in order to ensure accurate tumor targeting while sparing critical normal tissues. However, the ViewRay MRIdian and Elekta Unity have improved upon and revolutionized the MRgRT by creating a combined MRI and linear accelerator (MRL), allowing MRgRT to incorporate online MRI in RT. MRL-based MR-guided SBRT (MRgSBRT) represents a novel solution to deliver higher doses to larger volumes of gross disease, regardless of the proximity of at-risk organs due to the (1) superior soft-tissue visualization for patient positioning, (2) real-time continuous intrafraction assessment of internal structures, and (3) daily online adaptive replanning. Stereotactic MR-guided adaptive radiation therapy (SMART) has enabled the safe delivery of ablative doses to tumors adjacent to radiosensitive tissues throughout the body. Although it is still a relatively new RT technique, SMART has demonstrated significant opportunities to improve disease control and reduce toxicity. In this review, we included the current clinical applications and the active prospective trials related to SMART. We highlighted the most impactful clinical studies at various tumor sites. In addition, we explored how MRL-based multiparametric MRI could potentially synergize with SMART to significantly change the current treatment paradigm and to improve personalized cancer care.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Stephen A. Rosenberg
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; (J.M.B.)
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Björeland U, Notstam K, Fransson P, Söderkvist K, Beckman L, Jonsson J, Nyholm T, Widmark A, Thellenberg Karlsson C. Hyaluronic acid spacer in prostate cancer radiotherapy: dosimetric effects, spacer stability and long-term toxicity and PRO in a phase II study. Radiat Oncol 2023; 18:1. [PMID: 36593460 PMCID: PMC9809044 DOI: 10.1186/s13014-022-02197-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/30/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Perirectal spacers may be beneficial to reduce rectal side effects from radiotherapy (RT). Here, we present the impact of a hyaluronic acid (HA) perirectal spacer on rectal dose as well as spacer stability, long-term gastrointestinal (GI) and genitourinary (GU) toxicity and patient-reported outcome (PRO). METHODS In this phase II study 81 patients with low- and intermediate-risk prostate cancer received transrectal injections with HA before external beam RT (78 Gy in 39 fractions). The HA spacer was evaluated with MRI four times; before (MR0) and after HA-injection (MR1), at the middle (MR2) and at the end (MR3) of RT. GI and GU toxicity was assessed by physician for up to five years according to the RTOG scale. PROs were collected using the Swedish National Prostate Cancer Registry and Prostate cancer symptom scale questionnaires. RESULTS There was a significant reduction in rectal V70% (54.6 Gy) and V90% (70.2 Gy) between MR0 and MR1, as well as between MR0 to MR2 and MR3. From MR1 to MR2/MR3, HA thickness decreased with 28%/32% and CTV-rectum space with 19%/17% in the middle level. The cumulative late grade ≥ 2 GI toxicity at 5 years was 5% and the proportion of PRO moderate or severe overall bowel problems at 5 years follow-up was 12%. Cumulative late grade ≥ 2 GU toxicity at 5 years was 12% and moderate or severe overall urinary problems at 5 years were 10%. CONCLUSION We show that the HA spacer reduced rectal dose and long-term toxicity.
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Affiliation(s)
- Ulrika Björeland
- grid.12650.300000 0001 1034 3451Department of Radiation Sciences, Radiation Physics, Umeå University, 901 87 Umeå, Sweden
| | - Kristina Notstam
- grid.12650.300000 0001 1034 3451Department of Radiation Sciences, Oncology, Umeå University, 901 87 Umeå, Sweden
| | - Per Fransson
- grid.12650.300000 0001 1034 3451Department of Nursing, Umeå University, 901 87 Umeå, Sweden
| | - Karin Söderkvist
- grid.12650.300000 0001 1034 3451Department of Radiation Sciences, Oncology, Umeå University, 901 87 Umeå, Sweden
| | - Lars Beckman
- grid.12650.300000 0001 1034 3451Department of Radiation Sciences, Oncology, Umeå University, 901 87 Umeå, Sweden
| | - Joakim Jonsson
- grid.12650.300000 0001 1034 3451Department of Radiation Sciences, Radiation Physics, Umeå University, 901 87 Umeå, Sweden
| | - Tufve Nyholm
- grid.12650.300000 0001 1034 3451Department of Radiation Sciences, Radiation Physics, Umeå University, 901 87 Umeå, Sweden
| | - Anders Widmark
- grid.12650.300000 0001 1034 3451Department of Radiation Sciences, Oncology, Umeå University, 901 87 Umeå, Sweden
| | - Camilla Thellenberg Karlsson
- grid.12650.300000 0001 1034 3451Department of Radiation Sciences, Oncology, Umeå University, 901 87 Umeå, Sweden
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Hall WA, Kishan AU, Hall E, Nagar H, Vesprini D, Paulson E, Van der Heide UA, Lawton CAF, Kerkmeijer LGW, Tree AC. Adaptive magnetic resonance image guided radiation for intact localized prostate cancer how to optimally test a rapidly emerging technology. Front Oncol 2022; 12:962897. [PMID: 36132128 PMCID: PMC9484536 DOI: 10.3389/fonc.2022.962897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Prostate cancer is a common malignancy for which radiation therapy (RT) provides an excellent management option with high rates of control and low toxicity. Historically RT has been given with CT based image guidance. Recently, magnetic resonance (MR) imaging capabilities have been successfully integrated with RT delivery platforms, presenting an appealing, yet complex, expensive, and time-consuming method of adapting and guiding RT. The precise benefits of MR guidance for localized prostate cancer are unclear. We sought to summarize optimal strategies to test the benefits of MR guidance specifically in localized prostate cancer. Methods A group of radiation oncologists, physicists, and statisticians were identified to collectively address this topic. Participants had a history of treating prostate cancer patients with the two commercially available MRI-guided RT devices. Participants also had a clinical focus on randomized trials in localized prostate cancer. The goal was to review both ongoing trials and present a conceptual focus on MRI-guided RT specifically in the definitive treatment of prostate cancer, along with developing and proposing novel trials for future consideration. Trial hypotheses, endpoints, and areas for improvement in localized prostate cancer that specifically leverage MR guided technology are presented. Results Multiple prospective trials were found that explored the potential of adaptive MRI-guided radiotherapy in the definitive treatment of prostate cancer. Different primary areas of improvement that MR guidance may offer in prostate cancer were summarized. Eight clinical trial design strategies are presented that summarize options for clinical trials testing the potential benefits of MRI-guided RT. Conclusions The number and scope of trials evaluating MRI-guided RT for localized prostate cancer is limited. Yet multiple promising opportunities to test this technology and potentially improve outcomes for men with prostate cancer undergoing definitive RT exist. Attention, in the form of multi-institutional randomized trials, is needed.
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Affiliation(s)
- William A. Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Amar U. Kishan
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Emma Hall
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Himanshu Nagar
- Depart of Radiation Oncology, Weill Cornell Medicine, Department of Radiation Oncology, New York, NY, United States
| | - Danny Vesprini
- Department of Radiation Oncology, Sunnybrook Hospital, University of Toronto, Toronto, ON, Canada
| | - Eric Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Uulke A. Van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Colleen A. F. Lawton
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Linda G. W. Kerkmeijer
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Alison C. Tree
- The Royal Marsden NHS Foundation Trust, and the Institute of Cancer Research, Sutton, United Kingdom
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AI-based optimization for US-guided radiation therapy of the prostate. Int J Comput Assist Radiol Surg 2022; 17:2023-2032. [PMID: 35593988 PMCID: PMC9515059 DOI: 10.1007/s11548-022-02664-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/26/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Fast volumetric ultrasound presents an interesting modality for continuous and real-time intra-fractional target tracking in radiation therapy of lesions in the abdomen. However, the placement of the ultrasound probe close to the target structures leads to blocking some beam directions. METHODS To handle the combinatorial complexity of searching for the ultrasound-robot pose and the subset of optimal treatment beams, we combine CNN-based candidate beam selection with simulated annealing for setup optimization of the ultrasound robot, and linear optimization for treatment plan optimization into an AI-based approach. For 50 prostate cases previously treated with the CyberKnife, we study setup and treatment plan optimization when including robotic ultrasound guidance. RESULTS The CNN-based search substantially outperforms previous randomized heuristics, increasing coverage from 93.66 to 97.20% on average. Moreover, in some cases the total MU was also reduced, particularly for smaller target volumes. Results after AI-based optimization are similar for treatment plans with and without beam blocking due to ultrasound guidance. CONCLUSIONS AI-based optimization allows for fast and effective search for configurations for robotic ultrasound-guided radiation therapy. The negative impact of the ultrasound robot on the plan quality can successfully be mitigated resulting only in minor differences.
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Precisely translating computed tomography diagnosis accuracy into therapeutic intervention by a carbon-iodine conjugated polymer. Nat Commun 2022; 13:2625. [PMID: 35551194 PMCID: PMC9098856 DOI: 10.1038/s41467-022-30263-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/23/2022] [Indexed: 12/24/2022] Open
Abstract
X-ray computed tomography (CT) has an important role in precision medicine. However, CT contrast agents with high efficiency and the ability to translate diagnostic accuracy into therapeutic intervention are scarce. Here, poly(diiododiacetylene) (PIDA), a conjugated polymer composed of only carbon and iodine atoms, is reported as an efficient CT contrast agent to bridge CT diagnostic imaging with therapeutic intervention. PIDA has a high iodine payload (>84 wt%), and the aggregation of nanofibrous PIDA can further amplify CT intensity and has improved geometrical and positional stability in vivo. Moreover, with a conjugated backbone, PIDA is in deep blue color, making it dually visible by both CT imaging and the naked eyes. The performance of PIDA in CT-guided preoperative planning and visualization-guided surgery is validated using orthotopic xenograft rat models. In addition, PIDA excels clinical fiducial markers of imaging-guided radiotherapy in efficiency and biocompatibility, and exhibits successful guidance of robotic radiotherapy on Beagles, demonstrating clinical potential to translate CT diagnosis accuracy into therapeutic intervention for precision medicine.
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12
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Grimwood A, Thomas K, Kember S, Aldis G, Lawes R, Brigden B, Francis J, Henegan E, Kerner M, Delacroix L, Gordon A, Tree A, Harris EJ, McNair HA. Factors affecting accuracy and precision in ultrasound guided radiotherapy. Phys Imaging Radiat Oncol 2021; 18:68-77. [PMID: 34258411 PMCID: PMC8254201 DOI: 10.1016/j.phro.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Transperineal ultrasound (TPUS) is used clinically for directly assessing prostate motion. Factors affecting accuracy and precision in TPUS motion estimation must be assessed to realise its full potential. METHODS AND MATERIALS Patients were imaged using volumetric TPUS during the Clarity-Pro trial (NCT02388308). Prostate motion was measured online at patient set-up and offline by experienced observers. Cone beam CT with markers was used as a comparator and observer performance was also quantified. The influence of different clinical factors was examined to establish specific recommendations towards efficacious ultrasound guided radiotherapy. RESULTS From 330 fractions in 22 patients, offline observer random errors were 1.5 mm, 1.3 mm, 1.9 mm (left-right, superior-inferior, anteroposterior respectively). Errors increased in fractions exhibiting poor image quality to 3.3 mm, 3.3 mm and 6.8 mm. Poor image quality was associated with inconsistent probe placement, large anatomical changes and unfavourable imaging conditions within the patient. Online matching exhibited increased observer errors of: 3.2 mm, 2.9 mm and 4.7 mm. Four patients exhibited large systematic residual errors, of which three had poor quality images. Patient habitus showed no correlation with observer error, residual error, or image quality. CONCLUSIONS TPUS offers the unique potential to directly assess inter- and intra-fraction motion on conventional linacs. Inconsistent image quality, inexperienced operators and the pressures of the clinical environment may degrade precision and accuracy. Experienced operators are essential and cross-centre standards for training and QA should be established that build upon current guidance. Greater use of automation technologies may further minimise uncertainties.
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Affiliation(s)
- Alexander Grimwood
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
- Joint Department of Physics, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Karen Thomas
- Department of Statistics and Computing, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Sally Kember
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Georgina Aldis
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Rebekah Lawes
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Beverley Brigden
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Jane Francis
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Emer Henegan
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Melanie Kerner
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Louise Delacroix
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Alexandra Gordon
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Alison Tree
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Emma J. Harris
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
- Joint Department of Physics, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
| | - Helen A. McNair
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy Department, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
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Ohta K, Ogino H, Iwata H, Hashimoto S, Hattori Y, Nakajima K, Yamada M, Shimohira M, Mizoe JE, Shibamoto Y. Feasibility of transrectal and transperineal fiducial marker placement for prostate cancer before proton therapy. Jpn J Clin Oncol 2021; 51:258-263. [PMID: 33029639 DOI: 10.1093/jjco/hyaa172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/25/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To compare the feasibility of transrectal and transperineal fiducial marker placement for prostate cancer before proton therapy. MATERIALS AND METHODS From 2013 to 2015, the first 40 prostate cancer patients that were scheduled for proton therapy underwent transrectal fiducial marker placement, and the next 40 patients underwent transperineal fiducial marker placement (the first series). Technical and clinical success and pain scores were evaluated. In the second series (n = 280), the transrectal or transperineal approach was selected depending on the presence/absence of comorbidities, such as blood coagulation abnormalities. Seven patients refused to undergo the procedure. Thus, the total number of patients across both series was 353 (262 and 91 underwent the transrectal and transperineal approach, respectively). Technical and clinical success, complications, marker migration and the distance between the two markers were evaluated. RESULTS In the first series, the technical and clinical success rates were 100% in both groups. The transrectal group exhibited lower pain scores than the transperineal group. The overall technical success rates of the transrectal and transperineal groups were 100% (262/262) and 99% (90/91), respectively (P > 0.05). The overall clinical success rate was 100% in both groups, and there were no major complications in either group. The migration rates of the two groups did not differ significantly. The mean distance between the two markers was 25.6 ± 7.1 mm (mean ± standard deviation) in the transrectal group and 31.9 ± 5.2 mm in the transperineal group (P < 0.05). CONCLUSION Both the transrectal and transperineal fiducial marker placement methods are feasible and safe.
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Affiliation(s)
- Kengo Ohta
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya
| | - Hiroyuki Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya
| | - Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya
| | - Shingo Hashimoto
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya
| | - Yukiko Hattori
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya
| | - Koichiro Nakajima
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya
| | - Maho Yamada
- Department of Radiation Oncology, Nagoya City West Medical Center, Nagoya, Japan
| | - Masashi Shimohira
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya
| | - Jun-Etsu Mizoe
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya
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14
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Yan M, Gouveia AG, Cury FL, Moideen N, Bratti VF, Patrocinio H, Berlin A, Mendez LC, Moraes FY. Practical considerations for prostate hypofractionation in the developing world. Nat Rev Urol 2021; 18:669-685. [PMID: 34389825 PMCID: PMC8361822 DOI: 10.1038/s41585-021-00498-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 02/06/2023]
Abstract
External beam radiotherapy is an effective curative treatment option for localized prostate cancer, the most common cancer in men worldwide. However, conventionally fractionated courses of curative external beam radiotherapy are usually 8-9 weeks long, resulting in a substantial burden to patients and the health-care system. This problem is exacerbated in low-income and middle-income countries where health-care resources might be scarce and patient funds limited. Trials have shown a clinical equipoise between hypofractionated schedules of radiotherapy and conventionally fractionated treatments, with the advantage of drastically shortening treatment durations with the use of hypofractionation. The hypofractionated schedules are supported by modern consensus guidelines for implementation in clinical practice. Furthermore, several economic evaluations have shown improved cost effectiveness of hypofractionated therapy compared with conventional schedules. However, these techniques demand complex infrastructure and advanced personnel training. Thus, a number of practical considerations must be borne in mind when implementing hypofractionation in low-income and middle-income countries, but the potential gain in the treatment of this patient population is substantial.
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Affiliation(s)
- Michael Yan
- grid.410356.50000 0004 1936 8331Division of Radiation Oncology, Cancer Centre of Southeastern Ontario, Queen’s University, Kingston, Canada
| | - Andre G. Gouveia
- Department of Radiation Oncology, Americas Centro de Oncologia Integrado, Rio de Janeiro, Brazil
| | - Fabio L. Cury
- grid.14709.3b0000 0004 1936 8649Department of Radiation Oncology, Cedars Cancer Centre, McGill University, Montreal, Canada
| | - Nikitha Moideen
- grid.410356.50000 0004 1936 8331Division of Radiation Oncology, Cancer Centre of Southeastern Ontario, Queen’s University, Kingston, Canada
| | - Vanessa F. Bratti
- grid.410356.50000 0004 1936 8331Queen’s University School of Medicine, Department of Public Health Sciences, Kingston, Canada
| | - Horacio Patrocinio
- grid.14709.3b0000 0004 1936 8649Department of Medical Physics, Cedars Cancer Centre, McGill University, Montreal, Canada
| | - Alejandro Berlin
- grid.17063.330000 0001 2157 2938Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Lucas C. Mendez
- grid.39381.300000 0004 1936 8884Department of Radiation Oncology, London Regional Cancer Program, Western University, London, Canada
| | - Fabio Y. Moraes
- grid.410356.50000 0004 1936 8331Division of Radiation Oncology, Cancer Centre of Southeastern Ontario, Queen’s University, Kingston, Canada
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15
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Hansen AE, Henriksen JR, Jølck RI, Fliedner FP, Bruun LM, Scherman J, Jensen AI, Munck af Rosenschöld P, Moorman L, Kurbegovic S, de Blanck SR, Larsen KR, Clementsen PF, Christensen AN, Clausen MH, Wang W, Kempen P, Christensen M, Viby NE, Persson G, Larsen R, Conradsen K, McEvoy FJ, Kjaer A, Eriksen T, Andresen TL. Multimodal soft tissue markers for bridging high-resolution diagnostic imaging with therapeutic intervention. SCIENCE ADVANCES 2020; 6:eabb5353. [PMID: 32875113 PMCID: PMC7438096 DOI: 10.1126/sciadv.abb5353] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/07/2020] [Indexed: 05/11/2023]
Abstract
Diagnostic imaging often outperforms the surgeon's ability to identify small structures during therapeutic procedures. Smart soft tissue markers that translate the sensitivity of diagnostic imaging into optimal therapeutic intervention are therefore highly warranted. This paper presents a unique adaptable liquid soft tissue marker system based on functionalized carbohydrates (Carbo-gel). The liquid state of these markers allows for high-precision placement under image guidance using thin needles. Based on step-by-step modifications, the image features and mechanical properties of markers can be optimized to bridge diagnostic imaging and specific therapeutic interventions. The performance of Carbo-gel is demonstrated for markers that (i) have radiographic, magnetic resonance, and ultrasound visibility; (ii) are palpable and visible; and (iii) are localizable by near-infrared fluorescence and radio guidance. The study demonstrates encouraging proof of concept for the liquid marker system as a well-tolerated multimodal imaging marker that can improve image-guided radiotherapy and surgical interventions, including robotic surgery.
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Affiliation(s)
- Anders E. Hansen
- DTU Health Technology, Section for Biotherapeutic Engineering and Drug Targeting, Center for Nanomedicine and Theranostics, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Jonas R. Henriksen
- DTU Health Technology, Section for Biotherapeutic Engineering and Drug Targeting, Center for Nanomedicine and Theranostics, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Rasmus I. Jølck
- DTU Health Technology, Section for Biotherapeutic Engineering and Drug Targeting, Center for Nanomedicine and Theranostics, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Frederikke P. Fliedner
- Dept. of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Dept. of Biomedical Sciences, Copenhagen University Hospital (Rigshospitalet) and University of Copenhagen, Copenhagen, DK-2200, Denmark
| | - Linda M. Bruun
- DTU Health Technology, Section for Biotherapeutic Engineering and Drug Targeting, Center for Nanomedicine and Theranostics, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Jonas Scherman
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund SE-222 42, Sweden
| | - Andreas I. Jensen
- DTU Health Technology, The Hevesy Laboratory, Technical University of Denmark, Roskilde DK-4000, Denmark
| | - Per. Munck af Rosenschöld
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund SE-222 42, Sweden
| | - Lilah Moorman
- Department of Veterinary Clinical and Animal Sciences, University of Copenhagen, Frederiksberg DK-1870, Denmark
| | - Sorel Kurbegovic
- Dept. of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Dept. of Biomedical Sciences, Copenhagen University Hospital (Rigshospitalet) and University of Copenhagen, Copenhagen, DK-2200, Denmark
| | - Steen R. de Blanck
- Department of Oncology, Copenhagen University Hospital (Rigshospitalet), Copenhagen DK-2100, Denmark
| | - Klaus R. Larsen
- Department of Respiratory Medicine, Copenhagen University Hospital (Bispebjerg and Frederiksberg Hospital), Copenhagen DK-2400, Denmark
| | - Paul F. Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, DK-2100, Denmark
| | - Anders N. Christensen
- DTU Compute, Section for Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Mads H. Clausen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen DK-2100, Denmark
| | - Wenbo Wang
- DTU Health Technology, Section for Biotherapeutic Engineering and Drug Targeting, Center for Nanomedicine and Theranostics, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Paul Kempen
- DTU Health Technology, Section for Biotherapeutic Engineering and Drug Targeting, Center for Nanomedicine and Theranostics, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Merete Christensen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen DK-2100, Denmark
| | - Niels-Erik Viby
- Department of Cardiothoracic Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen DK-2100, Denmark
| | - Gitte Persson
- Department of Oncology, Herlev-Gentofte Hospital, Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen DK-2200, Denmark
| | - Rasmus Larsen
- DTU Compute, Section for Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Knut Conradsen
- DTU Compute, Section for Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
| | - Fintan J. McEvoy
- Department of Veterinary Clinical and Animal Sciences, University of Copenhagen, Frederiksberg DK-1870, Denmark
| | - Andreas Kjaer
- Dept. of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Dept. of Biomedical Sciences, Copenhagen University Hospital (Rigshospitalet) and University of Copenhagen, Copenhagen, DK-2200, Denmark
| | - Thomas Eriksen
- Department of Veterinary Clinical and Animal Sciences, University of Copenhagen, Frederiksberg DK-1870, Denmark
| | - Thomas L. Andresen
- DTU Health Technology, Section for Biotherapeutic Engineering and Drug Targeting, Center for Nanomedicine and Theranostics, Technical University of Denmark, Kgs. Lyngby DK-2800, Denmark
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Iocolano M, Blacksburg S, Carpenter T, Repka M, Carbone S, Demircioglu G, Miccio M, Katz A, Haas J. Prostate Fiducial Marker Placement in Patients on Anticoagulation: Feasibility Prior to Prostate SBRT. Front Oncol 2020; 10:203. [PMID: 32175274 PMCID: PMC7056879 DOI: 10.3389/fonc.2020.00203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/06/2020] [Indexed: 12/17/2022] Open
Abstract
Background and Purpose: Fiducial marker placement is required in patients undergoing robotic-based Stereotactic Body Radiotherapy (SBRT) or image-guided radiation therapy (IGRT) for prostate cancer. Many patients take antiplatelet or anticoagulant medication due to other medical comorbidities. They are often required to temporarily discontinue these medications prior to invasive medical procedures as they are prone to bleed. Some patients are unable to discontinue therapy due to an elevated risk of thromboembolic events. The purpose of this study is to report this institution's experience placing fiducial markers in prostate cancer patients who are on chronic antiplatelet or anticoagulant medication. Materials and Methods: From August 2015-March 2019 57 patients on chronic antiplatelet or anticoagulation therapy who were not cleared to stop these medications underwent transrectal ultrasound guided (TRUS) fiducial marker placement for SBRT/IGRT. All patients were monitored by a registered nurse during the procedure for prolonged bleeding that required staff to hold pressure to the area with a 4 × 4 gauze until it resolved. All patients were also called the following day to assess for ongoing bleeding events. Treatment planning CT scan confirmed the ideal geometry of the marker placement. Results: All 57 patients on antiplatelet or anticoagulant medication who underwent fiducial marker placement were discharged home the same day of the procedure. Four patients experienced persistent bleeding that required a nurse to hold prolonged pressure to the area. No patient experienced significant bleeding the following day or any untoward cardiovascular event. Conclusions: This series suggests the use of antiplatelet or anticoagulant medication is not an absolute contraindication to fiducial marker placement in patients undergoing SBRT or IGRT for prostate cancer. These patients should be closely monitored after the procedure for bleeding complications. Practitioners may consider the patient's medical comorbidities, risk factors for thromboembolism, and overall functional status as there is no standardized protocol for discontinuing anticoagulant or antiplatelet therapy for fiducial marker placement.
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Affiliation(s)
- Michelle Iocolano
- Department of Radiation Oncology, NYU Winthrop Hospital, Mineola, NY, United States.,Stony Brook University School of Medicine, Stony Brook, NY, United States
| | - Seth Blacksburg
- Department of Radiation Oncology, NYU Winthrop Hospital, Mineola, NY, United States
| | - Todd Carpenter
- Department of Radiation Oncology, NYU Winthrop Hospital, Mineola, NY, United States
| | - Michael Repka
- Department of Radiation Oncology, NYU Winthrop Hospital, Mineola, NY, United States
| | - Susan Carbone
- Department of Radiation Oncology, NYU Winthrop Hospital, Mineola, NY, United States
| | - Gizem Demircioglu
- Department of Radiation Oncology, NYU Winthrop Hospital, Mineola, NY, United States
| | - Maryann Miccio
- Department of Radiation Oncology, NYU Winthrop Hospital, Mineola, NY, United States
| | - Aaron Katz
- Department of Urology, NYU Winthrop Hospital, Mineola, NY, United States
| | - Jonathan Haas
- Department of Radiation Oncology, NYU Winthrop Hospital, Mineola, NY, United States
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17
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Alexander SE, Kinsella J, McNair HA, Tree AC. National survey of fiducial marker insertion for prostate image guided radiotherapy. Radiography (Lond) 2018; 24:275-282. [PMID: 30292494 DOI: 10.1016/j.radi.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/29/2018] [Accepted: 06/15/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION In the United Kingdom fiducial marker IGRT is the second most common verification method employed in radical prostate radiotherapy yet little evidence exists to support centres introducing or developing this practice. We developed a survey to elicit current fiducial marker practices adopted in the UK, to recommend standardisation of practice. METHODS A 16 question survey was distributed across UK Radiotherapy centres via promotion at the British Uro-Oncology Group Conference, 2016. Included were questions relating to workforce planning, patient preparation, insertion procedure and verification methods. The survey was open from September 2016 to January 2017. RESULTS Results from 15 centres routinely inserting fiducial markers for prostate IGRT are presented. Eleven professional groups insert fiducial markers across the UK. Fourteen centres insert fiducial markers trans-rectally; one trans-perineally. Centres adopting a trans-rectal approach administer prophylactic ciprofloxacin as a single agent or combined with gentamicin or metronidazole; poor agreement between regimes presented. One centre has introduced targeted antibiotic prophylaxis. Five brands of fiducial markers are utilised nationally. Fourteen centres standardly insert three single fiducial markers, two common configurations emerged. Coupled fiducial markers are routinely implanted by one centre. All centres delay at least one week between fiducial marker insertion and planning CT; seven centres wait two weeks. The most common fiducial verification method is two-dimensional, paired kilo Voltage imaging. CONCLUSION Variation in fiducial marker practice across the UK is considerable. Standardisation is required to support centres and healthcare professionals developing this service. Seven recommendations, to unify practice, have been proposed based on survey results and literature.
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Affiliation(s)
| | - J Kinsella
- The Royal Marsden NHS Foundation Trust, UK.
| | - H A McNair
- The Royal Marsden NHS Foundation Trust, UK; The Institute of Cancer Research, UK.
| | - A C Tree
- The Royal Marsden NHS Foundation Trust, UK; The Institute of Cancer Research, UK.
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18
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Castellanos E, Wersäll P, Tilikidis A, Andersson AH. Low Infection Rate After Transrectal Implantation of Gold Anchor ™ Fiducial Markers in Prostate Cancer Patients After Non-broad-spectrum Antibiotic Prophylaxis. Cureus 2018; 10:e3526. [PMID: 30648061 PMCID: PMC6318111 DOI: 10.7759/cureus.3526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/30/2018] [Indexed: 02/05/2023] Open
Abstract
Background In 621 consecutive prostate cancer patients, the frequency of urinary tract infections (UTI) and marker loss was evaluated. They prophylactically received a single dose of non-broad-spectrum antibiotics and transrectal implantation of three thin needle fiducial markers, Gold Anchor ™ (GA). Methods The occurrence of UTIs, sepsis, hospitalization due to infection, and marker loss after implantation was assessed from the medical records containing notes from physicians and nurses from the day of implantation to the end of 29 fractions. Results UTIs occurred in two (0.3%) of the 621 patients. Neither sepsis nor hospitalization was noted. Loss/drop-out of three markers was noted among 1,863 markers implanted. Conclusion The use of thin needles for the implantation of fiducials appears to reduce the rate of infection despite the use of a single dose of non-broad-spectrum antibiotics as prophylaxis. The marker construct appears to provide stability in the tissues.
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Affiliation(s)
- Enrique Castellanos
- Radiation Oncology, Karolinska University Hospital and Karolinska Institute, Stockholm, SWE
| | - Peter Wersäll
- Radiation Oncology, Karolinska University Hospital and Karolinska Institute, Stockholm, SWE
| | - Aris Tilikidis
- Medical Physics, Karolinska University Hospital and Karolinska Institute, Stockholm, SWE
| | - Arja H Andersson
- Radiation Oncology, Karolinska University Hospital and Karolinska Institute, Stockholm, SWE
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19
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Wang WJ, Chiou JF, Huang Y. Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy. J Vis Exp 2018. [PMID: 29806826 DOI: 10.3791/57050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The prognosis of patients with metastatic cancers has improved in the past decades due to effective chemotherapy and oligometastatic surgery. For inoperable patients, local ablation therapies, such as stereotactic body radiotherapy (SBRT), can provide effective local tumor control with minimal toxicity. Because of its high precision and accuracy, SBRT delivers a higher radiation dose per fraction, is more effective, and targets smaller irradiation volumes than does conventional radiotherapy. In addition, steep dose gradients from target lesions to surrounding normal tissues are achieved using SBRT; thus, SBRT provides more effective tumor control and exhibits fewer side effects than conventional radiotherapy. The use of SBRT is prevalent for treating intracranial lesions (known as stereotactic radiosurgery); however, it is now also used for treating spinal and adrenal metastases. Because of advancements in image-guided assistance and respiratory motion management, several studies have investigated the use of SBRT for treating lung or liver tumors, which move as a patient breathes. The results of these studies have suggested that SBRT favorably controls tumors in the case of moving lesions. Four-dimensional computed tomography (4D-CT) with an abdominal compressor (AC) is clinically convenient for effective respiratory motion management. Because this method is noninvasive and allows free breathing, its use reduces complications. Furthermore, patients consider this method convenient. Moreover, it is considered more efficient than other methods of respiratory motion management by physicians and therapists. The use of 4D-CT with an AC for treating pulmonary lesions has also been widely investigated, and the technique is gaining acceptance for treating hepatic lesions. However, the protocols for using 4D-CT with an AC for treating hepatic lesions are different from those used for treating pulmonary lesions. In this article, we describe a new protocol for SBRT with 4D-CT and an AC for treating liver metastases.
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Affiliation(s)
- Wei-Jun Wang
- Department of Radiation Oncology, Taipei Medical University Hospital; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University
| | - Jeng-Fong Chiou
- Department of Radiation Oncology, Taipei Medical University Hospital; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University; Taipei Cancer Center, Taipei Medical University
| | - Yaoru Huang
- Department of Radiation Oncology, Taipei Medical University Hospital; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University; Graduate Institute of Biomedical Materials & Tissue Engineering, College of Biomedical Engineering, Taipei Medical University;
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20
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Xia W, Breen SL. Image registration assessment in radiotherapy image guidance based on control chart monitoring. J Med Imaging (Bellingham) 2018; 5:021221. [PMID: 29564368 DOI: 10.1117/1.jmi.5.2.021221] [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: 08/28/2017] [Accepted: 02/01/2018] [Indexed: 11/14/2022] Open
Abstract
Image guidance with cone beam computed tomography in radiotherapy can guarantee the precision and accuracy of patient positioning prior to treatment delivery. During the image guidance process, operators need to take great effort to evaluate the image guidance quality before correcting a patient's position. This work proposes an image registration assessment method based on control chart monitoring to reduce the effort taken by the operator. According to the control chart plotted by daily registration scores of each patient, the proposed method can quickly detect both alignment errors and image quality inconsistency. Therefore, the proposed method can provide a clear guideline for the operators to identify unacceptable image quality and unacceptable image registration with minimal effort. Experimental results demonstrate that by using control charts from a clinical database of 10 patients undergoing prostate radiotherapy, the proposed method can quickly identify out-of-control signals and find special cause of out-of-control registration events.
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Affiliation(s)
- Wenyao Xia
- University Health Network, Princess Margaret Cancer Centre, Department of Radiation Physics, Toronto, Ontario, Canada.,Western University, Robarts Research Institute, London, Ontario, Canada
| | - Stephen L Breen
- University Health Network, Princess Margaret Cancer Centre, Department of Radiation Physics, Toronto, Ontario, Canada.,University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada
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21
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The dosimetric impact of manual adjustments following automated registration in prostate image-guided radiotherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2018. [DOI: 10.1017/s1460396917000516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractAimAlthough manual adjustment of automatic cone beam computed tomography (CBCT) matching may improve the target coverage in certain points of interest, concerns exist that this may lead to dosimetric uncertainties which would negate the theoretical benefit of this approach. The objective of this study is to evaluate the dosimetric impact of manual adjustments made after automatic bony registration on CBCT in prostate patients.MethodsA total of 50 CBCT datasets of ten high-risk prostate cancer patients were randomly chosen. Each CBCT dataset was registered three times. Method (A): Automatic registration, Method (M1): Manual adjustment carried out by two experienced radiation therapists, Method (M2): Manual adjustment carried out by different radiation therapists with varying levels of experience. The clinical target volume (CTV), planning target volume (PTV), the bladder and the rectum were subsequently contoured on each CBCT dataset by a radiation oncologist blinded to the registration methods. The absolute difference of various dosimetric parameters were then analysed and compared with the original planning doses. A comparison of the three matching methods employed was also carried out.ResultsThere was a statistically significant difference in the magnitude of move taken in the inferior superior direction between M1 and M2 method. There were no significant differences observed in any of the dosimetric parameters examined in relation to the rectum, bladder or CTV. The only significant difference observed was the volume of PTV covered by the prescription isodose (95%) which was statistically significant lower in method A compared with both M1 and M2. There was no difference observed between M1 and M2 methods. The mean duration of the automated registration and subsequent analysis was 64 seconds compared with 91 seconds for automated registrations which included the additional manual adjustment.FindingsCBCT-based manual adjustments of automated bony-based registrations during the image-guided radiotherapy verification of prostate cancer patients can improve PTV coverage without impacting negatively on the doses received by the organs at risk. This strategy is associated with a small increase in overall treatment time.
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22
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The Use of Ultrasound Imaging in the External Beam Radiotherapy Workflow of Prostate Cancer Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7569590. [PMID: 29619375 PMCID: PMC5829356 DOI: 10.1155/2018/7569590] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/13/2017] [Accepted: 12/28/2017] [Indexed: 12/16/2022]
Abstract
External beam radiotherapy (EBRT) is one of the curative treatment options for prostate cancer patients. The aim of this treatment option is to irradiate tumor tissue, while sparing normal tissue as much as possible. Frequent imaging during the course of the treatment (image guided radiotherapy) allows for determination of the location and shape of the prostate (target) and of the organs at risk. This information is used to increase accuracy in radiation dose delivery resulting in better tumor control and lower toxicity. Ultrasound imaging is harmless for the patient, it is cost-effective, and it allows for real-time volumetric organ tracking. For these reasons, it is an ideal technique for image guidance during EBRT workflows. Review papers have been published in which the use of ultrasound imaging in EBRT workflows for different cancer sites (prostate, breast, etc.) was extensively covered. This new review paper aims at providing the readers with an update on the current status for prostate cancer ultrasound guided EBRT treatments.
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23
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Han Y, Oakley E, Shafirstein G, Rabin Y, Kara LB. Reconstruction of a Deformed Tumor Based on Fiducial Marker Registration: A Computational Feasibility Study. Technol Cancer Res Treat 2018; 17:1533034618766792. [PMID: 29658392 PMCID: PMC5909864 DOI: 10.1177/1533034618766792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Interstitial photodynamic therapy has shown promising results in the treatment of locally advanced head and neck cancer. In this therapy, systemic administration of a light-sensitive drug is followed by insertion of multiple laser fibers to illuminate the tumor and its margins. Image-based pretreatment planning is employed in order to deliver a sufficient light dose to the complex locally advanced head-and-neck cancer anatomy, in order to meet clinical requirements. Unfortunately, the tumor may deform between pretreatment imaging for the purpose of planning and intraoperative imaging when the plan is executed. Tumor deformation may result from the mechanical forces applied by the light fibers and variation of the patient’s posture. Pretreatment planning is frequently done with the assistance of computed tomography or magnetic resonance imaging in an outpatient suite, while treatment monitoring and control typically uses ultrasound imaging due to considerations of costs and availability in the operation room. This article presents a computational method designed to bridge the gap between the 2 imaging events by taking a tumor geometry, reconstructed during preplanning, and by following the displacement of fiducial markers, which are initially placed during the preplanning procedure. The deformed tumor shape is predicted by solving an inverse problem, seeking for the forces that would have resulted in the corresponding fiducial marker displacements. The computational method is studied on spheres of variable sizes and demonstrated on computed tomography reconstructed locally advanced head and neck cancer model. Results of this study demonstrate an average error of less than 1 mm in predicting the deformed tumor shape, where 1 mm is typically the order of uncertainty in distance measurements using magnetic resonance imaging or computed tomography imaging and high-quality ultrasound imaging. This study further demonstrates that the deformed shape can be calculated in a few seconds, making the proposed method clinically relevant.
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Affiliation(s)
- Ye Han
- 1 Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Emily Oakley
- 2 Photodynamic Therapy Center, Department of Cell Stress Biology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Gal Shafirstein
- 2 Photodynamic Therapy Center, Department of Cell Stress Biology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Yoed Rabin
- 1 Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Levent Burak Kara
- 1 Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
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Tanaka O, Komeda H, Hirose S, Taniguchi T, Ono K, Matsuo M. Visibility of an iron-containing fiducial marker in magnetic resonance imaging for high-precision external beam prostate radiotherapy. Asia Pac J Clin Oncol 2017; 14:e405-e411. [DOI: 10.1111/ajco.12830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 10/30/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Osamu Tanaka
- Department of Radiation Oncology; Murakami Memorial Hospital; 3-23 Hashimoto-cho Gifu City Gifu Japan
| | - Hisao Komeda
- Department of Urology; Gifu Municipal Hospital; Gifu City Gifu Japan
| | - Shigeki Hirose
- Division of Radiation Service; Gifu Municipal Hospital; Gifu City Gifu Japan
| | - Takuya Taniguchi
- Department of Radiation Oncology; Murakami Memorial Hospital; 3-23 Hashimoto-cho Gifu City Gifu Japan
| | - Kousei Ono
- Department of Radiation Oncology; Murakami Memorial Hospital; 3-23 Hashimoto-cho Gifu City Gifu Japan
| | - Masayuki Matsuo
- Department of Radiology; Gifu University School of Medicine; Gifu City Gifu Japan
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25
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Tanaka O, Nishigaki Y, Hayashi H, Iida T, Yokoyama T, Takenaka E, Yama E, Tomita E. The advantage of iron-containing fiducial markers placed with a thin needle for radiotherapy of liver cancer in terms of visualization on MRI: an initial experience of Gold Anchor. Radiol Case Rep 2017; 12:416-421. [PMID: 28491201 PMCID: PMC5417757 DOI: 10.1016/j.radcr.2017.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 02/05/2017] [Accepted: 03/06/2017] [Indexed: 12/27/2022] Open
Abstract
Radiotherapy for liver malignancy is increasing due to advances in radiotherapy technique. Visualization of the tumor as well as fiducial markers is essential. To see if improved visibility exists on computed tomography (CT) and magnetic resonance imaging (MRI), we evaluated an iron-containing fiducial marker. A patient with hepatocellular carcinoma and a patient with cholangiocarcinoma were enrolled. Pain caused by placement of marker and the best MRI sequence for visualization of both the fiducial marker as well as the liver tumor on MRI was evaluated. CT was obtained in 2.5-mm thickness, and MRIs were obtained in eight sequences (ie, T2-weighted image). 22G preloaded needles were used for marker placement in both patients; this caused little pain during placement under local anesthesia with xylocaine. No complication occurred in either patient. Both markers and tumors were well visualized by the same MRI sequence. The iron-containing fiducial marker is safe and useful for detecting fiducial markers in the liver and for registration using CT and MRI.
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Affiliation(s)
- Osamu Tanaka
- Department of Radiation Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu 500-8513, Japan
| | - Yoichi Nishigaki
- Department of Hepatology, Gifu Municipal Hospital, Gifu City, Gifu, Japan
| | - Hideki Hayashi
- Department of Hepatology, Gifu Municipal Hospital, Gifu City, Gifu, Japan
| | - Takayoshi Iida
- Department of Radiation Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu 500-8513, Japan
| | - Takamasa Yokoyama
- Department of Radiation Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu 500-8513, Japan
| | - Eiji Takenaka
- Department of Radiation Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu 500-8513, Japan
| | - Eiichi Yama
- Department of Radiation Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu 500-8513, Japan
| | - Eiichi Tomita
- Department of Hepatology, Gifu Municipal Hospital, Gifu City, Gifu, Japan
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26
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Transperineal gold marker implantation for image-guided external beam radiotherapy of prostate cancer. Strahlenther Onkol 2017; 193:452-458. [DOI: 10.1007/s00066-017-1104-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/16/2017] [Indexed: 12/28/2022]
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27
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Maiorano G, Mele E, Frassanito MC, Restini E, Athanassiou A, Pompa PP. Ultra-efficient, widely tunable gold nanoparticle-based fiducial markers for X-ray imaging. NANOSCALE 2016; 8:18921-18927. [PMID: 27812579 DOI: 10.1039/c6nr07021c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We show the development of a new class of highly efficient, biocompatible fiducial markers for X-ray imaging and radiosurgery, based on polymer shells encapsulating engineered gold nanoparticle (AuNP) suspensions. Our smart fabrication strategy enables wide tunability of the fiducial size, shape, and X-ray attenuation performance, up to record values >20 000 Hounsfield units (HU), i.e. comparable to or even higher than bulk gold. We show that the NP fiducials allow for superior imaging both in vitro and in vivo (yet requiring 2 orders of magnitude less material), with strong stability over time and the absence of classical "streak artifacts" of standard bulk fiducials. NP fiducials were probed in vivo, showing exceptional contrast efficiency, even after 2 weeks post-implant in mice.
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Affiliation(s)
- G Maiorano
- Nanobiointeractions & Nanodiagnostics, Istituto Italiano di Tecnologia (IIT), Via Morego 30, 16163, Genoa, Italy.
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O'Neill AGM, Jain S, Hounsell AR, O'Sullivan JM. Fiducial marker guided prostate radiotherapy: a review. Br J Radiol 2016; 89:20160296. [PMID: 27585736 PMCID: PMC5604907 DOI: 10.1259/bjr.20160296] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 12/30/2022] Open
Abstract
Image-guided radiotherapy (IGRT) is an essential tool in the accurate delivery of modern radiotherapy techniques. Prostate radiotherapy positioned using skin marks or bony anatomy may be adequate for delivering a relatively homogeneous whole-pelvic radiotherapy dose, but these surrogates are not reliable when using reduced margins, dose escalation or hypofractionated stereotactic radiotherapy. Fiducial markers (FMs) for prostate IGRT have been in use since the 1990s. They require surgical implantation and provide a surrogate for the position of the prostate gland. A variety of FMs are available and they can be used in a number of ways. This review aimed to establish the evidence for using prostate FMs in terms of feasibility, implantation procedures, types of FMs used, FM migration, imaging modalities used and the clinical impact of FMs. A search strategy was defined and a literature search was carried out in Medline. Inclusion and exclusion criteria were applied, which resulted in 50 articles being included in this review. The evidence demonstrates that FMs provide a more accurate surrogate for the position of the prostate than either external skin marks or bony anatomy. A combination of FM alignment and soft-tissue analysis is currently the most effective and widely available approach to ensuring accuracy in prostate IGRT. FM implantation is safe and well tolerated. FM migration is possible but minimal. Standardization of all techniques and procedures in relation to the use of prostate FMs is required. Finally, a clinical trial investigating a non-surgical alternative to prostate FMs is introduced.
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Affiliation(s)
- Angela G M O'Neill
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, UK
- Northern Ireland Cancer Centre, Belfast Health & Social Care Trust, Belfast, UK
| | - Suneil Jain
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, UK
- Northern Ireland Cancer Centre, Belfast Health & Social Care Trust, Belfast, UK
| | - Alan R Hounsell
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, UK
- Northern Ireland Cancer Centre, Belfast Health & Social Care Trust, Belfast, UK
| | - Joe M O'Sullivan
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, UK
- Northern Ireland Cancer Centre, Belfast Health & Social Care Trust, Belfast, UK
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29
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Cordoba A, Pasquier D, Nickers P, Lacornerie T, Lartigau É. [Intraprostatic fiducials in stereotactic radiotherapy for prostate cancer]. Cancer Radiother 2016; 20:815-819. [PMID: 27793529 DOI: 10.1016/j.canrad.2016.07.097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/20/2016] [Accepted: 07/20/2016] [Indexed: 01/20/2023]
Abstract
PURPOSE Image-guided radiotherapy for prostate cancer is widely used in radiotherapy departments. Intraprostatic gold fiducial markers are used to visualize prostate position and motion before and during treatment. The aim of this report is to describe our experience of implanting intraprostatic fiducial markers under local anesthesia before hypofractionated stereotactic radiotherapy for prostate cancer and to assess its tolerance and reproducibility. PATIENTS AND METHODS Over a 6 and a half year period, 226 patients with prostate cancer received a stereotactic radiotherapy using the CyberKnife® system (Accuray) in our institution. Eighteen patients were treated for recurrence after prostatectomy; these patients were excluded from the study. Among the 208 remaining patients, 94 patients (45.2%) received stereotactic radiotherapy as a boost after external beam radiotherapy (three fractions of 6Gy); 36 patients (17.3%) were had a re-irradiation (six fractions of 6Gy) and 78 patients (37.5%) had a exclusive stereotactic radiotherapy (68 patients received five fractions of 7.25Gy and 11 patients five fractions of 6.25Gy). Four markers were implanted in all patients using transrectal ultrasound; the procedure was performed under local anesthesia, using transperineal access. The four fiducial markers were implanted in two strands with two fiducial each one, 1cm apart. In order to follow the recommendations of the image-guided radiotherapy system, the two strands of the two markers were located on the same plane in the middle of the prostate, at least 2cm apart from the midline. After insertion, correct positioning of fiducials markers was verified by X-ray. Dosimetry scanning was performed after the implantation procedure; prostate position tracking was possible before and during treatment through the kilovoltage incorporated system of the robotic accelerator. Clinical data, X-ray verification and dosimetry scanner have been retrospectively reviewed for all patients. RESULTS The tolerance to procedure was excellent; only four patients (1.8%) described pain related to implant. No urinary side effects were reported. Median time from fiducial implantation to dosimetry scanner was 16 days (4-113 days). Four fiducials were found within the prostate at dosimetry scanner in 181 patients and three in 27 remaining patients. All intraprostatic fiducials were used to track the prostate gland before and during treatment. CONCLUSIONS Intraprostatic fiducial markers implantation is a safe and reproducible procedure that allows us to have reliable prostate information before and during stereotactic radiotherapy.
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Affiliation(s)
- A Cordoba
- Département universitaire de radiothérapie, centre de lutte contre le cancer Oscar-Lambret, 3, rue Fréderic-Combemale, 59020 Lille cedex, France; Site de recherche intégrée sur le cancer (Siric) OncoLille, 3, rue Fréderic-Combemale, 59020 Lille cedex, France; Université de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France.
| | - D Pasquier
- Département universitaire de radiothérapie, centre de lutte contre le cancer Oscar-Lambret, 3, rue Fréderic-Combemale, 59020 Lille cedex, France; Site de recherche intégrée sur le cancer (Siric) OncoLille, 3, rue Fréderic-Combemale, 59020 Lille cedex, France; Université de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - P Nickers
- Département universitaire de radiothérapie, centre de lutte contre le cancer Oscar-Lambret, 3, rue Fréderic-Combemale, 59020 Lille cedex, France; Site de recherche intégrée sur le cancer (Siric) OncoLille, 3, rue Fréderic-Combemale, 59020 Lille cedex, France; Université de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - T Lacornerie
- Département universitaire de radiothérapie, centre de lutte contre le cancer Oscar-Lambret, 3, rue Fréderic-Combemale, 59020 Lille cedex, France; Site de recherche intégrée sur le cancer (Siric) OncoLille, 3, rue Fréderic-Combemale, 59020 Lille cedex, France; Université de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - É Lartigau
- Département universitaire de radiothérapie, centre de lutte contre le cancer Oscar-Lambret, 3, rue Fréderic-Combemale, 59020 Lille cedex, France; Site de recherche intégrée sur le cancer (Siric) OncoLille, 3, rue Fréderic-Combemale, 59020 Lille cedex, France; Université de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
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30
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Yildirim BA, Onal C, Dolek Y. Is it essential to use fiducial markers during cone-beam CT-based radiotherapy for prostate cancer patients? Jpn J Radiol 2016; 35:3-9. [PMID: 27730453 DOI: 10.1007/s11604-016-0590-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 09/29/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare soft-tissue cone-beam computed tomography (CBCT-P) and fiducial marker (CBCT-FM)-based image guided radiotherapy in prostate cancer patients. MATERIALS AND METHODS Sixteen prostate cancer patients were treated with volumetric modulated arc therapy. Manual alignment using CBCT-P and CBCT-FM was performed for each patient. Couch shifts were calculated and compared between methods in the left-right (x), superior-inferior (y), and anterior-posterior (z) directions. RESULTS CBCT-P and CBCT-FM alignments were compared using 252 scans from the 16 patients. Mean displacement from zero was 2.4 ± 1.3, 1.7 ± 1.2, and 1.8 ± 1.1 mm for CBCT-P and 2.3 ± 1.3, 1.7 ± 1.1 and 1.8 ± 1.1 mm for CBCT-FM in the x, y and z directions, respectively. There was no difference in median displacement between CBCT-P and CBCT-FM; however, there was a significant positive correlation between CBCT-P- and CBCT-FM-based displacements in the x (r = 0.881; p < 0.001), y (r = 0.789; p < 0.001) and z (r = 0.856; p < 0.001) directions by linear regression analysis. Systematic deviations within each group were <1 mm; however, random and systematic errors were similar in the x and y directions but larger in the z direction. CONCLUSION Our study demonstrated that CBCT-FM was not superior to CBCT-P for image-guided radiotherapy in prostate cancer patients.
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Affiliation(s)
- Berna A Yildirim
- Department of Radiation Oncology, Baskent University Faculty of Medicine, 01120, Adana, Turkey
| | - Cem Onal
- Department of Radiation Oncology, Baskent University Faculty of Medicine, 01120, Adana, Turkey.
| | - Yemliha Dolek
- Department of Radiation Oncology, Baskent University Faculty of Medicine, 01120, Adana, Turkey
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31
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De Bari B, Arcangeli S, Ciardo D, Mazzola R, Alongi F, Russi EG, Santoni R, Magrini SM, Jereczek-Fossa BA. Extreme hypofractionation for early prostate cancer: Biology meets technology. Cancer Treat Rev 2016; 50:48-60. [PMID: 27631875 DOI: 10.1016/j.ctrv.2016.08.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/11/2016] [Accepted: 08/16/2016] [Indexed: 02/07/2023]
Abstract
The aim of this review is to present the available radiobiological, technical and clinical data about extreme hypofractionation in primary prostate cancer radiotherapy. The interest in this technique is based on the favourable radiobiological characteristics of prostate cancer and supported by advantageous logistic aspects deriving from short overall treatment time. The clinical validity of short-term treatment schedule is proven by a body of non-randomised studies, using both isocentric (LINAC-based) or non-isocentric (CyberKnife®-based) stereotactic body irradiation techniques. Twenty clinical studies, each enrolling more than 40 patients for a total of 1874 treated patients, were revised in terms of technological setting, toxicity, outcome and quality of life assessment. The implemented strategies for the tracking of the prostate and the sparing of the rectal wall have been investigated with particular attention. The urinary toxicity after prostate stereotactic body irradiation seems slightly more pronounced as compared to rectal adverse events, and this is more evident for late occurring events, but no worse as respect to conventional fractionation schemes. As far as the rate of severe acute toxicity is concerned, in all the available studies the treatment was globally well tolerated. While awaiting long-term data on efficacy and toxicity, the analysed studies suggest that the outcome profile of this approach, alongside the patient convenience and reduced costs, is promising. Forty-eight ongoing clinical trials are also presented as a preview of the expectation from the near future.
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Affiliation(s)
- Berardino De Bari
- Division of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Stefano Arcangeli
- Division of Radiation Oncology, San Camillo-Forlanini Hospitals, Rome, Italy
| | - Delia Ciardo
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.
| | - Rosario Mazzola
- Division of Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy
| | - Filippo Alongi
- Division of Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy
| | - Elvio G Russi
- S.C. di Radioterapia Oncologica, Azienda ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Riccardo Santoni
- Università di Roma, Tor Vergata, U.O.C. di Radioterapia, Policlinico Tor Vergata, Roma, Italy
| | - Stefano M Magrini
- Istituto del Radio "O. Alberti", Spedali Civili, Università di Brescia, Brescia, Italy
| | - Barbara A Jereczek-Fossa
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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Ng SP, Tran T, Moloney P, Sale C, Mathlum M, Ong G, Lynch R. Synchronous prostate and rectal adenocarcinomas irradiation utilising volumetric modulated arc therapy. J Med Radiat Sci 2016; 62:286-91. [PMID: 27512575 PMCID: PMC4968563 DOI: 10.1002/jmrs.143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 11/24/2022] Open
Abstract
Cases of synchronous prostate and colorectal adenocarcinomas have been sporadically reported. There are case reports on patients with synchronous prostate and rectal cancers treated with external beam radiotherapy alone or combined with high‐dose rate brachytherapy boost to the prostate. Here, we illustrate a patient with synchronous prostate and rectal cancers treated using the volumetric arc therapy (VMAT) technique. The patient was treated with radical radiotherapy to 50.4 Gy in 28 fractions to the pelvis, incorporating the involved internal iliac node and the prostate. A boost of 24 Gy in 12 fractions was delivered to the prostate only, using VMAT. Treatment‐related toxicities and follow‐up prostate‐specific antigen and carcinoembryonic antigen were collected for data analysis. At 12 months, the patient achieved complete response for both rectal and prostate cancers without significant treatment‐related toxicities.
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Affiliation(s)
- Sweet Ping Ng
- Department of Radiation Oncology Andrew Love Cancer Centre Barwon Health Geelong Australia; Peter MacCallum Cancer Centre Melbourne Australia
| | - Thu Tran
- Department of Radiation Oncology Andrew Love Cancer Centre Barwon Health Geelong Australia
| | - Philip Moloney
- Department of Radiation Oncology Andrew Love Cancer Centre Barwon Health Geelong Australia
| | - Charlotte Sale
- Department of Radiation Oncology Andrew Love Cancer Centre Barwon Health Geelong Australia
| | - Maitham Mathlum
- Department of Radiation Oncology Andrew Love Cancer Centre Barwon Health Geelong Australia
| | - Grace Ong
- Department of Radiation Oncology Andrew Love Cancer Centre Barwon Health Geelong Australia; Peter MacCallum Cancer Centre Melbourne Australia
| | - Rod Lynch
- Department of Radiation Oncology Andrew Love Cancer Centre Barwon Health Geelong Australia
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Saad A, Goldstein J, Lawrence YR, Weiss I, Saad R, Spieler B, Symon Z. Transperineal implantation of gold fiducial markers (gold seeds) for prostate image-guided radiation therapy: a feasible technique associated with a low risk of complications. J Med Radiat Sci 2016; 62:261-6. [PMID: 27512572 PMCID: PMC4968561 DOI: 10.1002/jmrs.122] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 06/21/2015] [Accepted: 06/24/2015] [Indexed: 12/12/2022] Open
Abstract
Introduction The purpose is to describe the method, safety and efficacy of transperineal gold seed placement for image‐guided radiation therapy. Methods An ethics committee approved database was used to review records of consecutive patients from October 2008 through December 2013, who underwent transperineal implantation of three gold markers into the prostate using staged local anaesthesia and transrectal ultrasound. Seeds were counted on radiographs from CT simulation, first treatment and last treatment. Retention and use of at least three markers for kV/kV matching was considered a successful implant. A visual analogue scale (VAS) pain assessment was performed. SAS was used for data analysis. Results Fiducial marker placement was successful for kV/kV matching in 556/581 patients (95.7%). The procedure was aborted due to pain in two patients. Additional sedation during the procedure was required in two patients. Complications include urinary infections (2 patients, <0.5%) and transient haematuria (2 patients, <0.5%). There were no recorded calls requesting additional pain medication or delays in radiation due to complications. The number of seeds identified at simulation: 4 (2 patients), 3 (554 patients), 2 (21 patients), 1 (1 patient), 0 (1 patient). One patient with three seeds and two patients with <2 seeds had cone beam CT instead of kV/kV imaging for image guidance. No seeds were lost after simulation. The mean visual analogue pain score associated with transperineal gold seed insertion met patients' expectations (respectively 4.1 vs. 4.4 P = 0.19). Conclusion Outpatient transperineal insertion of fiducials avoids the rectum, is effective, convenient, well tolerated and has few side effects.
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Affiliation(s)
- Akram Saad
- Department of Radiation Oncology Chaim Sheba Medical Center Tel Hashomer, Ramat Gan Israel
| | - Jeffrey Goldstein
- Department of Radiation Oncology Chaim Sheba Medical Center Tel Hashomer, Ramat Gan Israel
| | - Yaacov Richard Lawrence
- Department of Radiation Oncology Chaim Sheba Medical Center Tel Hashomer, Ramat GanIsrael; Sackler School Of Medicine Tel Aviv University Tel Aviv Israel
| | - Ilana Weiss
- Department of Radiation Oncology Chaim Sheba Medical Center Tel Hashomer, Ramat Gan Israel
| | - Rasha Saad
- Department of Radiation Oncology Chaim Sheba Medical Center Tel Hashomer, Ramat Gan Israel
| | - Benjamin Spieler
- Department of Radiation Oncology Chaim Sheba Medical Center Tel Hashomer, Ramat Gan Israel
| | - Zvi Symon
- Department of Radiation Oncology Chaim Sheba Medical Center Tel Hashomer, Ramat GanIsrael; Sackler School Of Medicine Tel Aviv University Tel Aviv Israel
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Loh J, Baker K, Sridharan S, Greer P, Wratten C, Capp A, Gallagher S, Martin J. Infections after fiducial marker implantation for prostate radiotherapy: are we underestimating the risks? Radiat Oncol 2015; 10:38. [PMID: 25890179 PMCID: PMC4333155 DOI: 10.1186/s13014-015-0347-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 02/01/2015] [Indexed: 11/16/2022] Open
Abstract
Background The use of gold fiducial markers (FM) for prostate image-guided radiotherapy (IGRT) is standard practice. Published literature suggests low rates of serious infection following this procedure of 0-1.3%, but this may be an underestimate. We aim to report on the infection incidence and severity associated with the use of transrectally implanted intraprostatic gold FM. Methods Three hundred and fifty-nine patients who underwent transrectal FM insertion between January 2012 and December 2013 were assessed retrospectively via a self-reported questionnaire. All had standard oral fluoroquinolone antibiotic prophylaxis. The patients were asked about infective symptoms and the treatment received including antibiotics and/or related hospital admissions. Potential infective events were confirmed through medical records. Results 285 patients (79.4%) completed the questionnaire. 77 (27.0%) patients experienced increased urinary frequency and dysuria, and 33 patients (11.6%) reported episodes of chills and fevers after the procedure. 22 patients (7.7%) reported receiving antibiotics for urinary infection and eight patients (2.8%) reported hospital admission for urosepsis related to the procedure. Conclusion The overall rate of symptomatic infection with FM implantation in this study is 7.7%, with one third requiring hospital admission. This exceeds the reported rates in other FM implantation series, but is in keeping with the larger prostate biopsy literature. Given the higher than expected complication rate, a risk-adaptive approach may be helpful. Where higher accuracy is important such as stereotactic prostate radiotherapy, the benefits of FM may still outweigh the risks. For others, a non-invasive approach for prostate IGRT such as cone-beam CT could be considered. Electronic supplementary material The online version of this article (doi:10.1186/s13014-015-0347-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jasmin Loh
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Edith St, Waratah, NSW, 2298, Australia.
| | - Katie Baker
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.
| | - Swetha Sridharan
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Edith St, Waratah, NSW, 2298, Australia.
| | - Peter Greer
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Edith St, Waratah, NSW, 2298, Australia. .,Medical Physics Research Group, School of Mathematical and Physical Sciences, Faculty of Science & IT, The University of Newcastle & Centre for Clinical Radiation Research, Calvary Mater Newcastle, Waratah, NSW, Australia.
| | - Chris Wratten
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Edith St, Waratah, NSW, 2298, Australia.
| | - Anne Capp
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Edith St, Waratah, NSW, 2298, Australia.
| | - Sarah Gallagher
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Edith St, Waratah, NSW, 2298, Australia.
| | - Jarad Martin
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Edith St, Waratah, NSW, 2298, Australia.
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Zaorsky NG, Hurwitz MD, Dicker AP, Showalter TN, Den RB. Is robotic arm stereotactic body radiation therapy “virtual high dose ratebrachytherapy” for prostate cancer? An analysis of comparative effectiveness using published data [corrected]. Expert Rev Med Devices 2014; 12:317-27. [PMID: 25540018 DOI: 10.1586/17434440.2015.994606] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
High-dose rate brachytherapy (HDR-BT) monotherapy and robotic arm (i.e., CyberKnife) stereotactic body radiation therapy (SBRT) are emerging technologies that have become popular treatment options for prostate cancer. Proponents of both HDR-BT monotherapy and robotic arm SBRT claim that these modalities are as efficacious as intensity-modulated radiation therapy in treating prostate cancer. Moreover, proponents of robotic arm SBRT believe it is more effective than HDR-BT monotherapy because SBRT is non-invasive, touting it as 'virtual HDR-BT.' We perform a comparative effective analysis of the two technologies. The tumor control rates and toxicities of HDR-BT monotherapy and robotic arm SBRT are promising. However, at present, it would be inappropriate to state that HDR-BT monotherapy and robotic arm SBRT are as efficacious or effective as other treatment modalities for prostate cancer, which have stronger foundations of evidence. Studies reporting on these technologies have relatively short follow-up time, few patients and are largely retrospective.
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Mendenhall WM, Costa JA, Williams CR, Harris SE, Mandia SE, Hoppe BS, Henderson RH, Bryant CM, Nichols RC, Mendenhall NP. Bacterial Urinary Tract Infection after Fiducial Marker Placement or Prostate Biopsy. Int J Part Ther 2014. [DOI: 10.14338/ijpt-14-00010.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Fiducial marker implantation in prostate radiation therapy: complication rates and technique. Cancer Radiother 2014; 18:736-9. [PMID: 25451675 DOI: 10.1016/j.canrad.2014.07.160] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/02/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aims to report the complication rate from the transrectal ultrasound-guided implantation of gold seed markers in prostate radiotherapy, as well as describing the technique used. MATERIALS AND METHODS Between May 2010 and December 2012, 169 patients with localized prostate cancer had an intraprostatic fiducial marker implantation under transrectal ultrasound guidance. The procedure included prophylactic antibiotic therapy, fleet enema, implantation performed by trained radiation oncologists at our center prior to image-guided radiotherapy. Toxicity occurring between implantation and subsequent radiotherapy start date was assessed. The following parameters were analyzed via medical chart review: antibiotic therapy, anticoagulant interruption, bleeding, pain, prostate volume, number of markers implanted, post-implantation complications and delay before starting radiotherapy. RESULTS Of the 169 men, 119 (70.4%) underwent insertion of 4 fiducial markers and the other 50 (29.6%) had 3. The procedure was well-tolerated. There was no interruption of the implantation with regards to pain or hemorrhage. No grade 3 or 4 complications were observed. Seed migration rate was 0.32%, for the migration of 2 markers on 626 implanted. Mean prostate volume was 38 cm(3) (range: 10-150 cm(3)). Two patients (1.18%) developed a urinary tract infection following the procedure: prostate volume of 25 and 65 cm(3), four gold seed markers implanted, urinary tract infection resistant to prophylactic antibiotherapy, and treated with antibiotics specific to their infection as determined on urine culture. CONCLUSION Transrectal fiducial marker implantation for image-guided radiotherapy in prostate cancer is a well-tolerated procedure without major associated complications.
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Gill S, Dang K, Fox C, Bressel M, Kron T, Bergen N, Ferris N, Owen R, Chander S, Tai KH, Foroudi F. Seminal vesicle intrafraction motion analysed with cinematic magnetic resonance imaging. Radiat Oncol 2014; 9:174. [PMID: 25106679 PMCID: PMC4251603 DOI: 10.1186/1748-717x-9-174] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 07/12/2014] [Indexed: 11/10/2022] Open
Abstract
PURPOSE This study analyses seminal vesicle displacement relative to the prostate and in relation to treatment time. METHOD A group of eleven patients undergoing prostate cancer radiotherapy were imaged with a continuous 3 T cine-MRI in the standard treatment setup position. Four images were recorded every 4 seconds for 15 minutes in the sagittal plane and every 6.5 seconds for 12 minutes in the coronal plane. The prostate gland and seminal vesicles were contoured on each MRI image. The coordinates of the centroid of the prostate and seminal vesicles on each image was analysed for displacement against time. Displacements between the 2.5 percentile and 97.5 percentile (i.e. the 2.5% trimmed range) for prostate and seminal vesicle centroid displacements were measured for 3, 5, 10 and 15 minutes time intervals in the anterior-posterior (AP), left-right (LR) and superior-inferior (SI) directions. Real time prostate and seminal vesicle displacement was compared for individual patients. RESULTS The 2.5% trimmed range for 3, 5, 10 and 15 minutes for the seminal vesicle centroids in the SI direction measured 4.7 mm; 5.8 mm; 6.5 mm and 7.2 mm respectively. In the AP direction, it was 4.0 mm, 4.5 mm, 6.5 mm, and 7.0 mm. In the LR direction for 3, 5 and 10 minutes; for the left seminal vesicle, it was 2.7 mm, 2.8 mm, 3.4 mm and for the right seminal vesicle, it was 3.4 mm, 3.3 mm, and 3.4 mm. The correlation between the real-time prostate and seminal vesicle displacement varied substantially between patients indicating that the relationship between prostate displacement and seminal vesicles displacement is patient specific with the majority of the patients not having a strong relationship. CONCLUSION Our study shows that seminal vesicle motion increases with treatment time, and that the prostate and seminal vesicle centroids do not move in unison in real time, and that an additional margin is required for independent seminal vesicle motion if treatment localisation is to the prostate.
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Affiliation(s)
- Suki Gill
- />Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- />Department of Pathology, University of Melbourne, Melbourne, Australia
| | - Kim Dang
- />Radiation Therapy Services, Peter MacCallum Cancer Centre, Locked Bag 1; A’ Beckett Street, Melbourne, Australia
| | - Chris Fox
- />Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Mathias Bressel
- />Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Tomas Kron
- />Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Noelene Bergen
- />Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nick Ferris
- />Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Rebecca Owen
- />Radiation Therapy Services, Peter MacCallum Cancer Centre, Locked Bag 1; A’ Beckett Street, Melbourne, Australia
| | - Sarat Chander
- />Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- />Department of Pathology, University of Melbourne, Melbourne, Australia
| | - Keen Hun Tai
- />Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- />Department of Pathology, University of Melbourne, Melbourne, Australia
| | - Farshad Foroudi
- />Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- />Department of Pathology, University of Melbourne, Melbourne, Australia
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Kably I, Bordegaray M, Shah K, Salsamendi J, Narayanan G. Single-Center Experience in Prostate Fiducial Marker Placement: Technique and Midterm Follow-up. J Vasc Interv Radiol 2014; 25:1125-1132.e1. [DOI: 10.1016/j.jvir.2014.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 03/13/2014] [Accepted: 03/15/2014] [Indexed: 10/25/2022] Open
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Deegan T, Owen R, Holt T, Fielding A, Biggs J, Parfitt M, Coates A, Roberts L. Assessment of cone beam CT registration for prostate radiation therapy: fiducial marker and soft tissue methods. J Med Imaging Radiat Oncol 2014; 59:91-8. [PMID: 24953244 DOI: 10.1111/1754-9485.12197] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/24/2014] [Indexed: 12/11/2022]
Abstract
INTRODUCTION This investigation aimed to assess the consistency and accuracy of radiation therapists (RTs) performing cone beam computed tomography (CBCT) alignment to fiducial markers (FMs) (CBCTFM ) and the soft tissue prostate (CBCTST ). METHODS Six patients receiving prostate radiation therapy underwent daily CBCTs. Manual alignment of CBCTFM and CBCTST was performed by three RTs. Inter-observer agreement was assessed using a modified Bland-Altman analysis for each alignment method. Clinically acceptable 95% limits of agreement with the mean (LoAmean ) were defined as ±2.0 mm for CBCTFM and ±3.0 mm for CBCTST . Differences between CBCTST alignment and the observer-averaged CBCTFM (AvCBCTFM ) alignment were analysed. Clinically acceptable 95% LoA were defined as ±3.0 mm for the comparison of CBCTST and AvCBCTFM . RESULTS CBCTFM and CBCTST alignments were performed for 185 images. The CBCTFM 95% LoAmean were within ±2.0 mm in all planes. CBCTST 95% LoAmean were within ±3.0 mm in all planes. Comparison of CBCTST with AvCBCTFM resulted in 95% LoA of -4.9 to 2.6, -1.6 to 2.5 and -4.7 to 1.9 mm in the superior-inferior, left-right and anterior-posterior planes, respectively. CONCLUSIONS Significant differences were found between soft tissue alignment and the predicted FM position. FMs are useful in reducing inter-observer variability compared with soft tissue alignment. Consideration needs to be given to margin design when using soft tissue matching due to increased inter-observer variability. This study highlights some of the complexities of soft tissue guidance for prostate radiation therapy.
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Affiliation(s)
- Timothy Deegan
- Radiation Therapy Services, Radiation Oncology Mater Centre, Brisbane, Queensland, Australia; Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
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