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Yakkanti RR, Mohile NV, Cohen-Levy WB, Haziza S, Lavelle MJ, Bellam KG, Quinnan SM. Perioperative management of acetabular and pelvic fractures: evidence-based recommendations. Arch Orthop Trauma Surg 2023; 143:1311-1321. [PMID: 34854977 DOI: 10.1007/s00402-021-04278-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/24/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE The American Academy of Orthopaedic Surgeons does not currently provide clinical practice guidelines for management of PAF. Accordingly, this article aims to review and consolidate the relevant historical and recent literature in important topics pertaining to perioperative management of PAF. METHODS A thorough literature review using PubMed, Cochrane and Embase databases was performed to assess preoperative, intraoperative and postoperative management of PAF fracture. Topics reviewed included: time from injury to definitive fixation, the role of inferior vena cava filters (IVCF), tranexamic acid (TXA) use, intraopoperative cell salvage, incisional negative pressure wound therapy (NPWT), intraoperative antibiotic powder use, heterotopic ossification prophylaxis, and pre- and postoperative venous thromboembolism (VTE) prophylaxis. RESULTS A total of 126 articles pertaining to the preoperative, intraoperative and postoperative management of PAF were reviewed. Articles reviewed by topic include 13 articles pertaining to time to fixation, 23 on IVCF use, 14 on VTE prophylaxis, 20 on TXA use, 10 on cell salvage, 10 on iNPWT 14 on intraoperative antibiotic powder and 20 on HO prophylaxis. An additional eight articles were reviewed to describe background information. Five articles provided information for two or more treatment modalities and were therefore included in multiple categories when tabulating the number of articles reviewed per topic. CONCLUSION The literature supports the use of radiation therapy for HO prophylaxis, early (< 5 days from injury) surgical intervention and the routine use of intraoperative TXA. The literature does not support the routine use of iNPWT or IVCF. There is inadequate information to make a recommendation regarding the use of cell salvage and wound infiltration with antibiotic powder. While the routine use of chemical VTE prophylaxis is recommended, there is insufficient evidence to recommend the optimal agent and duration of therapy.
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Affiliation(s)
- Ramakanth R Yakkanti
- Department of Orthopaedic Surgery, University of Miami University Hospital, West Wing, 1321 NW 14th st, Suite 306, Miami, FL, 33125, USA
| | - Neil V Mohile
- Department of Orthopaedic Surgery, University of Miami University Hospital, West Wing, 1321 NW 14th st, Suite 306, Miami, FL, 33125, USA
| | | | - Sagie Haziza
- Department of Orthopaedic Surgery, University of Miami University Hospital, West Wing, 1321 NW 14th st, Suite 306, Miami, FL, 33125, USA.
| | - Matthew J Lavelle
- Department of Orthopaedic Surgery, University of Miami University Hospital, West Wing, 1321 NW 14th st, Suite 306, Miami, FL, 33125, USA
| | - Krishna G Bellam
- Warren Alpert Medical School at Brown University, Providence, RI, USA
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Radiation Proctitis: The Potential Role of Hyaluronic Acid in the Prevention and Restoration of Any Damage to the Rectal Mucosa among Prostate Cancer Patients Submitted to Curative External Beam Radiotherapy. GASTROENTEROLOGY INSIGHTS 2021. [DOI: 10.3390/gastroent12040043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim: To evaluate if hyaluronic acid reduces proctitis episodes with respect to corticosteroids in prostate cancer patients submitted to radical or adjuvant radiotherapy. Methods: A consecutive series of eligible patients received hyaluronic acid enemas as supportive care (experimental group, from January 2013 to June 2015). A historical group (control group), treated from October 2011 to December 2012, received beclomethasone dipropionate suppositories. We registered each patient’s data regarding acute and chronic proctitis. All patients were treated with static-intensity-modulated radiotherapy coupled to a daily set-up verification with orthogonal anterior–posterior/lateral X-ray pairs. Results: A total of 269 patients, 175 in the experimental group and 94 in the control group, was evaluated; 2 Gy/day (up to a total median dose of 80 Gy) and 2.7 Gy/day (up to a total median dose of 67.5 Gy) fractionation schemes were used for 216 and 53 patients, respectively. All patients had a good tolerance to radiotherapy, reporting no G3 or greater proctitis. No significant difference was reported concerning the total rate of proctitis between the two groups but only with respect to its grade: a higher G2 rate within the control group. There was no correlation between daily dose fractionation and toxicity grade. Conclusions: Hyaluronic acid enemas might be effective in reducing the severity of radiation proctitis.
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Brand DH, Brüningk SC, Wilkins A, Fernandez K, Naismith O, Gao A, Syndikus I, Dearnaley DP, Tree AC, van As N, Hall E, Gulliford S. Estimates of Alpha/Beta (α/β) Ratios for Individual Late Rectal Toxicity Endpoints: An Analysis of the CHHiP Trial. Int J Radiat Oncol Biol Phys 2021; 110:596-608. [PMID: 33412260 PMCID: PMC8129972 DOI: 10.1016/j.ijrobp.2020.12.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/10/2020] [Accepted: 12/24/2020] [Indexed: 12/04/2022]
Abstract
PURPOSE Changes in fraction size of external beam radiation therapy exert nonlinear effects on subsequent toxicity. Commonly described by the linear-quadratic model, fraction size sensitivity of normal tissues is expressed by the α/β ratio. We sought to study individual α/β ratios for different late rectal effects after prostate external beam radiation therapy. METHODS AND MATERIALS The CHHiP trial (ISRCTN97182923) randomized men with nonmetastatic prostate cancer 1:1:1 to 74 Gy/37 fractions (Fr), 60 Gy/20 Fr, or 57 Gy/19 Fr. Patients in the study had full dosimetric data and zero baseline toxicity. Toxicity scales were amalgamated to 6 bowel endpoints: bleeding, diarrhea, pain, proctitis, sphincter control, and stricture. Lyman-Kutcher-Burman models with or without equivalent dose in 2 Gy/Fr correction were log-likelihood fitted by endpoint, estimating α/β ratios. The α/β ratio estimate sensitivity was assessed using sequential inclusion of dose modifying factors (DMFs): age, diabetes, hypertension, inflammatory bowel or diverticular disease (IBD/diverticular), and hemorrhoids. 95% confidence intervals (CIs) were bootstrapped. Likelihood ratio testing of 632 estimator log-likelihoods compared the models. RESULTS Late rectal α/β ratio estimates (without DMF) ranged from bleeding (G1 + α/β = 1.6 Gy; 95% CI, 0.9-2.5 Gy) to sphincter control (G1 + α/β = 3.1 Gy; 95% CI, 1.4-9.1 Gy). Bowel pain modelled poorly (α/β, 3.6 Gy; 95% CI, 0.0-840 Gy). Inclusion of IBD/diverticular disease as a DMF significantly improved fits for stool frequency G2+ (P = .00041) and proctitis G1+ (P = .00046). However, the α/β ratios were similar in these no-DMF versus DMF models for both stool frequency G2+ (α/β 2.7 Gy vs 2.5 Gy) and proctitis G1+ (α/β 2.7 Gy vs 2.6 Gy). Frequency-weighted averaging of endpoint α/β ratios produced: G1 + α/β ratio = 2.4 Gy; G2 + α/β ratio = 2.3 Gy. CONCLUSIONS We estimated α/β ratios for several common late adverse effects of rectal radiation therapy. When comparing dose-fractionation schedules, we suggest using late a rectal α/β ratio ≤ 3 Gy.
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Affiliation(s)
- Douglas H Brand
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom; Urology Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom.
| | - Sarah C Brüningk
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
| | - Anna Wilkins
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom; Urology Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom; Tumour Cell Biology Laboratory, The Francis Crick Institute, London, United Kingdom
| | - Katie Fernandez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Olivia Naismith
- Radiotherapy Trials QA Group, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Annie Gao
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom; Urology Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Isabel Syndikus
- Radiotherapy Department, Clatterbridge Cancer Centre, United Kingdom
| | - David P Dearnaley
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom; Urology Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alison C Tree
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom; Urology Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Nicholas van As
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom; Urology Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Sarah Gulliford
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom; Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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4
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Varnava M, Sumida I, Oda M, Kurosu K, Isohashi F, Seo Y, Otani K, Ogawa K. Dosimetric comparison between volumetric modulated arc therapy planning techniques for prostate cancer in the presence of intrafractional organ deformation. JOURNAL OF RADIATION RESEARCH 2021; 62:309-318. [PMID: 33341880 PMCID: PMC7948894 DOI: 10.1093/jrr/rraa123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/24/2020] [Accepted: 09/30/2020] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to compare single-arc (SA) and double-arc (DA) treatment plans, which are planning techniques often used in prostate cancer volumetric modulated arc therapy (VMAT), in the presence of intrafractional deformation (ID) to determine which technique is superior in terms of target dose coverage and sparing of the organs at risk (OARs). SA and DA plans were created for 27 patients with localized prostate cancer. ID was introduced to the clinical target volume (CTV), rectum and bladder to obtain blurred dose distributions using an in-house software. ID was based on the motion probability function of each structure voxel and the intrafractional motion of the respective organs. From the resultant blurred dose distributions of SA and DA plans, various parameters, including the tumor control probability, normal tissue complication probability, homogeneity index, conformity index, modulation complexity score for VMAT, dose-volume indices and monitor units (MUs), were evaluated to compare the two techniques. Statistical analysis showed that most CTV and rectum parameters were significantly larger for SA plans than for DA plans (P < 0.05). Furthermore, SA plans had fewer MUs and were less complex (P < 0.05). The significant differences observed had no clinical significance, indicating that both plans are comparable in terms of target and OAR dosimetry when ID is considered. The use of SA plans is recommended for prostate cancer VMAT because they can be delivered in shorter treatment times than DA plans, and therefore benefit the patients.
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Affiliation(s)
- Maria Varnava
- Corresponding author. Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka, 565-0871, Japan. Tel: +81-6-6879-3482; Fax: +81-6-6879-3489;
| | - Iori Sumida
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Michio Oda
- Department of Medical Technology, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Keita Kurosu
- Department of Medical Technology, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Fumiaki Isohashi
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yuji Seo
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Keisuke Otani
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamadaoka, Suita, Osaka, 565-0871, Japan
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5
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Shelley LEA, Sutcliffe MPF, Thomas SJ, Noble DJ, Romanchikova M, Harrison K, Bates AM, Burnet NG, Jena R. Associations between voxel-level accumulated dose and rectal toxicity in prostate radiotherapy. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2020; 14:87-94. [PMID: 32582869 PMCID: PMC7301619 DOI: 10.1016/j.phro.2020.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/25/2022]
Abstract
Background and Purpose Associations between dose and rectal toxicity in prostate radiotherapy are generally poorly understood. Evaluating spatial dose distributions to the rectal wall (RW) may lead to improvements in dose-toxicity modelling by incorporating geometric information, masked by dose-volume histograms. Furthermore, predictive power may be strengthened by incorporating the effects of interfraction motion into delivered dose calculations.Here we interrogate 3D dose distributions for patients with and without toxicity to identify rectal subregions at risk (SRR), and compare the discriminatory ability of planned and delivered dose. Material and Methods Daily delivered dose to the rectum was calculated using image guidance scans, and accumulated at the voxel level using biomechanical finite element modelling. SRRs were statistically determined for rectal bleeding, proctitis, faecal incontinence and stool frequency from a training set (n = 139), and tested on a validation set (n = 47). Results SRR patterns differed per endpoint. Analysing dose to SRRs improved discriminative ability with respect to the full RW for three of four endpoints. Training set AUC and OR analysis produced stronger toxicity associations from accumulated dose than planned dose. For rectal bleeding in particular, accumulated dose to the SRR (AUC 0.76) improved upon dose-toxicity associations derived from planned dose to the RW (AUC 0.63). However, validation results could not be considered significant. Conclusions Voxel-level analysis of dose to the RW revealed SRRs associated with rectal toxicity, suggesting non-homogeneous intra-organ radiosensitivity. Incorporating spatial features of accumulated delivered dose improved dose-toxicity associations. This may be an important tool for adaptive radiotherapy in the future.
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Affiliation(s)
- Leila E A Shelley
- Cancer Research UK VoxTox Research Group, Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.,Edinburgh Cancer Centre, Western General Hospital, Edinburgh EH4 2XU, United Kingdom.,Department of Engineering, University of Cambridge, Trumpington St, Cambridge CB21PZ, United Kingdom
| | - Michael P F Sutcliffe
- Cancer Research UK VoxTox Research Group, Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.,Department of Engineering, University of Cambridge, Trumpington St, Cambridge CB21PZ, United Kingdom
| | - Simon J Thomas
- Cancer Research UK VoxTox Research Group, Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.,Department of Medical Physics and Clinical Engineering, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
| | - David J Noble
- Cancer Research UK VoxTox Research Group, Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.,Department of Oncology, University of Cambridge, Cambridge Biomedical Campus, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom
| | - Marina Romanchikova
- Cancer Research UK VoxTox Research Group, Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.,National Physical Laboratory, Teddington TW11 0JE, United Kingdom
| | - Karl Harrison
- Cancer Research UK VoxTox Research Group, Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.,Cavendish Laboratory, University of Cambridge, J J Thomson Avenue, Cambridge CB3 0HE, United Kingdom
| | - Amy M Bates
- Cancer Research UK VoxTox Research Group, Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.,Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
| | - Neil G Burnet
- Cancer Research UK VoxTox Research Group, Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.,University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, United Kingdom
| | - Raj Jena
- Cancer Research UK VoxTox Research Group, Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.,Department of Oncology, University of Cambridge, Cambridge Biomedical Campus, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom
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6
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Christiansen RL, Dysager L, Bertelsen AS, Hansen O, Brink C, Bernchou U. Accuracy of automatic deformable structure propagation for high-field MRI guided prostate radiotherapy. Radiat Oncol 2020; 15:32. [PMID: 32033574 PMCID: PMC7007657 DOI: 10.1186/s13014-020-1482-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/30/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In this study we have evaluated the accuracy of automatic, deformable structure propagation from planning CT and MR scans for daily online plan adaptation for MR linac (MRL) treatment, which is an important element to minimize re-planning time and reduce the risk of misrepresenting the target due to this time pressure. METHODS For 12 high-risk prostate cancer patients treated to the prostate and pelvic lymph nodes, target structures and organs at risk were delineated on both planning MR and CT scans and propagated using deformable registration to three T2 weighted MR scans acquired during the treatment course. Generated structures were evaluated against manual delineations on the repeated scans using intra-observer variation obtained on the planning MR as ground truth. RESULTS MR-to-MR propagated structures had significant less median surface distance and larger Dice similarity index compared to CT-MR propagation. The MR-MR propagation uncertainty was similar in magnitude to the intra-observer variation. Visual inspection of the deformed structures revealed that small anatomical differences between organs in source and destination image sets were generally well accounted for while large differences were not. CONCLUSION Both CT and MR based propagations require manual editing, but the current results show that MR-to-MR propagated structures require fewer corrections for high risk prostate cancer patients treated at a high-field MRL.
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Affiliation(s)
- Rasmus Lübeck Christiansen
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19 3. Sal, 5000, Odense C, Denmark.
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Kløvervænget 19, Indgang 85, Pavillion, Stuen, 5000, Odense C, Denmark.
| | - Lars Dysager
- Department of Oncology, Odense University Hospital, Kløvervænget 19 Indgang 85 Pavillion, 1. sal, 5000, Odense C, Denmark
| | - Anders Smedegaard Bertelsen
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Kløvervænget 19, Indgang 85, Pavillion, Stuen, 5000, Odense C, Denmark
| | - Olfred Hansen
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19 3. Sal, 5000, Odense C, Denmark
- Department of Oncology, Odense University Hospital, Kløvervænget 19 Indgang 85 Pavillion, 1. sal, 5000, Odense C, Denmark
| | - Carsten Brink
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19 3. Sal, 5000, Odense C, Denmark
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Kløvervænget 19, Indgang 85, Pavillion, Stuen, 5000, Odense C, Denmark
| | - Uffe Bernchou
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19 3. Sal, 5000, Odense C, Denmark
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Kløvervænget 19, Indgang 85, Pavillion, Stuen, 5000, Odense C, Denmark
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7
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Lam NFD, Rivens I, Giles SL, Harris E, deSouza NM, ter Haar G. Prediction of pelvic tumour coverage by magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) from referral imaging. Int J Hyperthermia 2020; 37:1033-1045. [PMID: 32873089 PMCID: PMC8352374 DOI: 10.1080/02656736.2020.1812736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Patient suitability for magnetic resonance-guided high intensity focused ultrasound (MRgHIFU) ablation of pelvic tumors is initially evaluated clinically for treatment feasibility using referral images, acquired using standard supine diagnostic imaging, followed by MR screening of potential patients lying on the MRgHIFU couch in a 'best-guess' treatment position. Existing evaluation methods result in ≥40% of referred patients being screened out because of tumor non-targetability. We hypothesize that this process could be improved by development of a novel algorithm for predicting tumor coverage from referral imaging. METHODS The algorithm was developed from volunteer images and tested with patient data. MR images were acquired for five healthy volunteers and five patients with recurrent gynaecological cancer. Subjects were MR imaged supine and in oblique-supine-decubitus MRgHIFU treatment positions. Body outline and bones were segmented for all subjects, with organs-at-risk and tumors also segmented for patients. Supine images were aligned with treatment images to simulate a treatment dataset. Target coverage (of patient tumors and volunteer intra-pelvic soft tissue), i.e. the volume reachable by the MRgHIFU focus, was quantified. Target coverage predicted from supine imaging was compared to that from treatment imaging. RESULTS Mean (±standard deviation) absolute difference between supine-predicted and treatment-predicted coverage for 5 volunteers was 9 ± 6% (range: 2-22%) and for 4 patients, was 12 ± 7% (range: 4-21%), excluding a patient with poor acoustic coupling (coverage difference was 53%). CONCLUSION Prediction of MRgHIFU target coverage from referral imaging appears feasible, facilitating further development of automated evaluation of patient suitability for MRgHIFU.
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Affiliation(s)
| | - Ian Rivens
- Joint Department of Physics, The Institute of Cancer Research, London, UK
| | - Sharon L. Giles
- The CRUK Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Emma Harris
- Joint Department of Physics, The Institute of Cancer Research, London, UK
| | - Nandita M. deSouza
- The CRUK Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Gail ter Haar
- Joint Department of Physics, The Institute of Cancer Research, London, UK
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8
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Fuchs F, Habl G, Devečka M, Kampfer S, Combs SE, Kessel KA. Interfraction variation and dosimetric changes during image-guided radiation therapy in prostate cancer patients. Radiat Oncol J 2019; 37:127-133. [PMID: 31137087 PMCID: PMC6610012 DOI: 10.3857/roj.2018.00514] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/15/2019] [Indexed: 11/09/2022] Open
Abstract
Purpose The aim of this study was to identify volume changes and dose variations of rectum and bladder during radiation therapy in prostate cancer (PC) patients. Materials and Methods We analyzed 20 patients with PC treated with helical tomotherapy. Daily image guidance was performed. We re-contoured the entire bladder and rectum including its contents as well as the organ walls on megavoltage computed tomography once a week. Dose variations were analyzed by means of Dmedian, Dmean, Dmax, V10 to V75, as well as the organs at risk (OAR) volume. Further, we investigated the correlation between volume changes and changes in Dmean of OAR. Results During treatment, the rectal volume ranged from 62% to 223% of its initial volume, the bladder volume from 22% to 375%. The average Dmean ranged from 87% to 118% for the rectum and 58% to 160% for the bladder. The Pearson correlation coefficients between volume changes and corresponding changes in Dmean were -0.82 for the bladder and 0.52 for the rectum. The comparison of the dose wall histogram (DWH) and the dose volume histogram (DVH) showed that the DVH underestimates the percentage of the rectal and bladder volume exposed to the high dose region. Conclusion Relevant variations in the volume of OAR and corresponding dose variations can be observed. For the bladder, an increase in the volume generally leads to lower doses; for the rectum, the correlation is weaker. Having demonstrated remarkable differences in the dose distribution of the DWH and the DVH, the use of DWHs should be considered.
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Affiliation(s)
- Frederik Fuchs
- Department of Radiation Oncology, Technical University of Munich (TUM), Germany
| | - Gregor Habl
- Department of Radiation Oncology, Technical University of Munich (TUM), Germany
| | - Michal Devečka
- Department of Radiation Oncology, Technical University of Munich (TUM), Germany
| | - Severin Kampfer
- Department of Radiation Oncology, Technical University of Munich (TUM), Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Germany.,Institute of Radiation Medicine, Department of Radiation Sciences, Helmholtz Zentrum München, Neuherberg, Germany
| | - Kerstin A Kessel
- Department of Radiation Oncology, Technical University of Munich (TUM), Germany.,Institute of Radiation Medicine, Department of Radiation Sciences, Helmholtz Zentrum München, Neuherberg, Germany
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9
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Shelley LEA, Sutcliffe MPF, Harrison K, Scaife JE, Parker MA, Romanchikova M, Thomas SJ, Jena R, Burnet NG. Autosegmentation of the rectum on megavoltage image guidance scans. Biomed Phys Eng Express 2019; 5:025006. [PMID: 31057946 PMCID: PMC6466640 DOI: 10.1088/2057-1976/aaf1db] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/07/2018] [Accepted: 11/19/2018] [Indexed: 11/12/2022]
Abstract
Autosegmentation of image guidance (IG) scans is crucial for streamlining and optimising delivered dose calculation in radiotherapy. By accounting for interfraction motion, daily delivered dose can be accumulated and incorporated into automated systems for adaptive radiotherapy. Autosegmentation of IG scans is challenging due to poorer image quality than typical planning kilovoltage computed tomography (kVCT) systems, and the resulting reduction of soft tissue contrast in regions such as the pelvis makes organ boundaries less distinguishable. Current autosegmentation solutions generally involve propagation of planning contours to the IG scan by deformable image registration (DIR). Here, we present a novel approach for primary autosegmentation of the rectum on megavoltage IG scans acquired during prostate radiotherapy, based on the Chan-Vese algorithm. Pre-processing steps such as Hounsfield unit/intensity scaling, identifying search regions, dealing with air, and handling the prostate, are detailed. Post-processing features include identification of implausible contours (nominally those affected by muscle or air), 3D self-checking, smoothing, and interpolation. In cases where the algorithm struggles, the best estimate on a given slice may revert to the propagated kVCT rectal contour. Algorithm parameters were optimised systematically for a training cohort of 26 scans, and tested on a validation cohort of 30 scans, from 10 patients. Manual intervention was not required. Comparing Chan-Vese autocontours with contours manually segmented by an experienced clinical oncologist achieved a mean Dice Similarity Coefficient of 0.78 (SE < 0.011). This was comparable with DIR methods for kVCT and CBCT published in the literature. The autosegmentation system was developed within the VoxTox Research Programme for accumulation of delivered dose to the rectum in prostate radiotherapy, but may have applicability to further anatomical sites and imaging modalities.
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Affiliation(s)
- L E A Shelley
- University of Cambridge, Department of Engineering, Cambridge, United Kingdom
- Addenbrooke's Hospital, Department of Medical Physics and Clinical Engineering, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
| | - M P F Sutcliffe
- University of Cambridge, Department of Engineering, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
| | - K Harrison
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
- University of Cambridge, Cavendish Laboratory, Cambridge, United Kingdom
| | - J E Scaife
- Gloucestershire Oncology Centre, Cheltenham General Hospital, Cheltenham, United Kingdom
| | - M A Parker
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
- University of Cambridge, Cavendish Laboratory, Cambridge, United Kingdom
| | - M Romanchikova
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
- National Physical Laboratory, Teddington, United Kingdom
| | - S J Thomas
- Addenbrooke's Hospital, Department of Medical Physics and Clinical Engineering, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
| | - R Jena
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
- Addenbrooke's Hospital, Oncology Centre, Cambridge, United Kingdom
| | - N G Burnet
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
- University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
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10
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Maspero M, Tyyger MD, Tijssen RH, Seevinck PR, Intven MP, van den Berg CA. Feasibility of magnetic resonance imaging-only rectum radiotherapy with a commercial synthetic computed tomography generation solution. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2018; 7:58-64. [PMID: 33458406 PMCID: PMC7807733 DOI: 10.1016/j.phro.2018.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/15/2018] [Accepted: 09/20/2018] [Indexed: 12/14/2022]
Abstract
Background and purpose Synthetic computed tomography (sCT) images enable magnetic resonance (MR)-based dose calculations. This work investigated whether a commercially available sCT generation solution was suitable for accurate dose calculations and position verification on patients with rectal cancer. Material and methods For twenty rectal cancer patients computed tomography (CT) images were rigidly registered to sCT images. Clinical volumetric modulated arc therapy plans were recalculated on registered CT and sCT images. Dose deviations were determined through gamma and voxelwise analysis. The impact on position verification was investigated by identifying differences in translations and rotation between cone-beam CT (CBCT) to CT and CBCT to sCT registrations. Results Across twenty patients, within a threshold of 90% of the prescription dose, a gamma analysis (2%, 2 mm) mean pass rate of 95.2 ± 4.0% (±1σ) and mean dose deviation of −0.3 ± 0.2% of prescription dose were obtained. The mean difference of translations and rotations over ten patients (76 CBCTs) was <1 mm and <0.5° in all directions. In the sole posterior-anterior direction a mean systematic shift of 0.7 ± 0.6 mm was found. Conclusions Accurate MR-based dose calculations using a commercial sCT generation method were clinically feasible for treatment of rectal cancer patients. The accuracy of position verification was clinically acceptable. However, before clinical implementation future investigations will be performed to determine the origin of the systematic shift.
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Affiliation(s)
- Matteo Maspero
- Department of Radiotherapy, Universitair Medisch Centrum Utrecht, The Netherlands
- Center for Image Sciences, Universitair Medisch Centrum Utrecht, The Netherlands
- Corresponding author at: Department of Radiotherapy, Universitair Medisch Centrum Utrecht, Heidelberglaan 1003584 CX, Utrecht, The Netherlands.
| | - Marcus D. Tyyger
- Department of Radiotherapy, Universitair Medisch Centrum Utrecht, The Netherlands
- Leeds Teaching Hospital, Department of Medical Physics and Engineering, Leeds, United Kingdom
| | - Rob H.N. Tijssen
- Department of Radiotherapy, Universitair Medisch Centrum Utrecht, The Netherlands
| | - Peter R. Seevinck
- Center for Image Sciences, Universitair Medisch Centrum Utrecht, The Netherlands
- Image Science Institute, Universitair Medisch Centrum Utrecht, The Netherlands
| | - Martijn P.W. Intven
- Department of Radiotherapy, Universitair Medisch Centrum Utrecht, The Netherlands
| | - Cornelis A.T. van den Berg
- Department of Radiotherapy, Universitair Medisch Centrum Utrecht, The Netherlands
- Center for Image Sciences, Universitair Medisch Centrum Utrecht, The Netherlands
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11
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Collery A, Forde E. Daily Rectal Dose-volume Histogram Variation in Prostate Intensity-modulated Radiation Therapy: Is It Clinically Significant in the Era of Image Guidance? J Med Imaging Radiat Sci 2017; 48:346-351. [DOI: 10.1016/j.jmir.2017.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 03/23/2017] [Accepted: 04/20/2017] [Indexed: 12/25/2022]
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12
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Shelley LEA, Scaife JE, Romanchikova M, Harrison K, Forman JR, Bates AM, Noble DJ, Jena R, Parker MA, Sutcliffe MPF, Thomas SJ, Burnet NG. Delivered dose can be a better predictor of rectal toxicity than planned dose in prostate radiotherapy. Radiother Oncol 2017; 123:466-471. [PMID: 28460825 PMCID: PMC5486775 DOI: 10.1016/j.radonc.2017.04.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 01/23/2023]
Abstract
Background and purpose For the first time, delivered dose to the rectum has been calculated and accumulated throughout the course of prostate radiotherapy using megavoltage computed tomography (MVCT) image guidance scans. Dosimetric parameters were linked with toxicity to test the hypothesis that delivered dose is a stronger predictor of toxicity than planned dose. Material and methods Dose–surface maps (DSMs) of the rectal wall were automatically generated from daily MVCT scans for 109 patients within the VoxTox research programme. Accumulated-DSMs, representing total delivered dose, and planned-DSMs, from planning CT data, were parametrised using Equivalent Uniform Dose (EUD) and ‘DSM dose-width’, the lateral dimension of an ellipse fitted to a discrete isodose cluster. Associations with 6 toxicity endpoints were assessed using receiver operator characteristic curve analysis. Results For rectal bleeding, the area under the curve (AUC) was greater for accumulated dose than planned dose for DSM dose-widths up to 70 Gy. Accumulated 65 Gy DSM dose-width produced the strongest spatial correlation (AUC 0.664), while accumulated EUD generated the largest AUC overall (0.682). For proctitis, accumulated EUD was the only reportable predictor (AUC 0.673). Accumulated EUD was systematically lower than planned EUD. Conclusions Dosimetric parameters extracted from accumulated DSMs have demonstrated stronger correlations with rectal bleeding and proctitis, than planned DSMs.
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Affiliation(s)
- L E A Shelley
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Medical Physics and Clinical Engineering, Cambridge University Hospitals NHS Foundation Trust, United Kingdom; Department of Engineering, University of Cambridge, United Kingdom.
| | - J E Scaife
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Oncology, University of Cambridge, United Kingdom
| | - M Romanchikova
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Medical Physics and Clinical Engineering, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - K Harrison
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Cavendish Laboratory, University of Cambridge, United Kingdom
| | - J R Forman
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - A M Bates
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Oncology, University of Cambridge, United Kingdom
| | - D J Noble
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Oncology, University of Cambridge, United Kingdom
| | - R Jena
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Oncology, University of Cambridge, United Kingdom
| | - M A Parker
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Cavendish Laboratory, University of Cambridge, United Kingdom
| | - M P F Sutcliffe
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Engineering, University of Cambridge, United Kingdom
| | - S J Thomas
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Medical Physics and Clinical Engineering, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - N G Burnet
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Oncology, University of Cambridge, United Kingdom
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13
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Sumida I, Yamaguchi H, Das IJ, Anetai Y, Kizaki H, Aboshi K, Tsujii M, Yamada Y, Tamari K, Seo Y, Isohashi F, Yoshioka Y, Ogawa K. Robust plan optimization using edge-enhanced intensity for intrafraction organ deformation in prostate intensity-modulated radiation therapy. PLoS One 2017; 12:e0173643. [PMID: 28282417 PMCID: PMC5345858 DOI: 10.1371/journal.pone.0173643] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 02/23/2017] [Indexed: 11/18/2022] Open
Abstract
This study evaluated a method for prostate intensity-modulated radiation therapy (IMRT) based on edge-enhanced (EE) intensity in the presence of intrafraction organ deformation using the data of 37 patients treated with step-and-shoot IMRT. On the assumption that the patient setup error was already accounted for by image guidance, only organ deformation over the treatment course was considered. Once the clinical target volume (CTV), rectum, and bladder were delineated and assigned dose constraints for dose optimization, each voxel in the CTV derived from the DICOM RT-dose grid could have a stochastic dose from the different voxel location according to the probability density function as an organ deformation. The stochastic dose for the CTV was calculated as the mean dose at the location through changing the voxel location randomly 1000 times. In the EE approach, the underdose region in the CTV was delineated and optimized with higher dose constraints that resulted in an edge-enhanced intensity beam to the CTV. This was compared to a planning target volume (PTV) margin (PM) approach in which a CTV to PTV margin equivalent to the magnitude of organ deformation was added to obtain an optimized dose distribution. The total monitor units, number of segments, and conformity index were compared between the two approaches, and the dose based on the organ deformation of the CTV, rectum, and bladder was evaluated. The total monitor units, number of segments, and conformity index were significantly lower with the EE approach than with the PM approach, while maintaining the dose coverage to the CTV with organ deformation. The dose to the rectum and bladder were significantly reduced in the EE approach compared with the PM approach. We conclude that the EE approach is superior to the PM with regard to intrafraction organ deformation.
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Affiliation(s)
- Iori Sumida
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- * E-mail:
| | - Hajime Yamaguchi
- Department of Radiation Oncology, NTT West Osaka hospital, Tennoji-ku, Osaka, Japan
| | - Indra J. Das
- Department of Radiation Oncology, New York University Langone Medical Center, New York, New York, United States of America
| | - Yusuke Anetai
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hisao Kizaki
- Department of Radiation Oncology, NTT West Osaka hospital, Tennoji-ku, Osaka, Japan
| | - Keiko Aboshi
- Department of Radiation Oncology, NTT West Osaka hospital, Tennoji-ku, Osaka, Japan
| | - Mari Tsujii
- Department of Radiation Oncology, NTT West Osaka hospital, Tennoji-ku, Osaka, Japan
| | - Yuji Yamada
- Department of Radiation Oncology, NTT West Osaka hospital, Tennoji-ku, Osaka, Japan
| | - Keisuke Tamari
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yuji Seo
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Fumiaki Isohashi
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yasuo Yoshioka
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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14
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Thomas SJ, Romanchikova M, Harrison K, Parker MA, Bates AM, Scaife JE, Sutcliffe MPF, Burnet NG. Recalculation of dose for each fraction of treatment on TomoTherapy. Br J Radiol 2016; 89:20150770. [PMID: 26728661 PMCID: PMC4986496 DOI: 10.1259/bjr.20150770] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: The VoxTox study, linking delivered dose to toxicity requires recalculation of typically 20–37 fractions per patient, for nearly 2000 patients. This requires a non-interactive interface permitting batch calculation with multiple computers. Methods: Data are extracted from the TomoTherapy® archive and processed using the computational task-management system GANGA. Doses are calculated for each fraction of radiotherapy using the daily megavoltage (MV) CT images. The calculated dose cube is saved as a digital imaging and communications in medicine RTDOSE object, which can then be read by utilities that calculate dose–volume histograms or dose surface maps. The rectum is delineated on daily MV images using an implementation of the Chan–Vese algorithm. Results: On a cluster of up to 117 central processing units, dose cubes for all fractions of 151 patients took 12 days to calculate. Outlining the rectum on all slices and fractions on 151 patients took 7 h. We also present results of the Hounsfield unit (HU) calibration of TomoTherapy MV images, measured over an 8-year period, showing that the HU calibration has become less variable over time, with no large changes observed after 2011. Conclusion: We have developed a system for automatic dose recalculation of TomoTherapy dose distributions. This does not tie up the clinically needed planning system but can be run on a cluster of independent machines, enabling recalculation of delivered dose without user intervention. Advances in knowledge: The use of a task management system for automation of dose calculation and outlining enables work to be scaled up to the level required for large studies.
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Affiliation(s)
- Simon J Thomas
- 1 Cambridge University Hospitals NHS Foundation Trust, Department of Medical Physics and Clinical Engineering, Addenbrooke's Hospital, Cambridge, UK.,2 Cancer Research UK VoxTox Research Group, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Marina Romanchikova
- 1 Cambridge University Hospitals NHS Foundation Trust, Department of Medical Physics and Clinical Engineering, Addenbrooke's Hospital, Cambridge, UK.,2 Cancer Research UK VoxTox Research Group, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Karl Harrison
- 2 Cancer Research UK VoxTox Research Group, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,3 Cavendish Laboratory, Department of Physics, University of Cambridge, Cambridge, UK
| | - Michael A Parker
- 2 Cancer Research UK VoxTox Research Group, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,3 Cavendish Laboratory, Department of Physics, University of Cambridge, Cambridge, UK
| | - Amy M Bates
- 2 Cancer Research UK VoxTox Research Group, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,4 Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Jessica E Scaife
- 2 Cancer Research UK VoxTox Research Group, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,5 Department of Oncology, University of Cambridge, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - Michael P F Sutcliffe
- 2 Cancer Research UK VoxTox Research Group, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,6 Department of Engineering, University of Cambridge, Cambridge, UK
| | - Neil G Burnet
- 2 Cancer Research UK VoxTox Research Group, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,5 Department of Oncology, University of Cambridge, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
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15
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Palacio‐Torralba J, Jiménez Aguilar E, Good DW, Hammer S, McNeill SA, Stewart GD, Reuben RL, Chen Y. Patient specific modeling of palpation-based prostate cancer diagnosis: effects of pelvic cavity anatomy and intrabladder pressure. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2016; 32:e02734. [PMID: 26190813 PMCID: PMC4975704 DOI: 10.1002/cnm.2734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 04/20/2015] [Accepted: 06/08/2015] [Indexed: 06/04/2023]
Abstract
Computational modeling has become a successful tool for scientific advances including understanding the behavior of biological and biomedical systems as well as improving clinical practice. In most cases, only general models are used without taking into account patient-specific features. However, patient specificity has proven to be crucial in guiding clinical practice because of disastrous consequences that can arise should the model be inaccurate. This paper proposes a framework for the computational modeling applied to the example of the male pelvic cavity for the purpose of prostate cancer diagnostics using palpation. The effects of patient specific structural features on palpation response are studied in three selected patients with very different pathophysiological conditions whose pelvic cavities are reconstructed from MRI scans. In particular, the role of intrabladder pressure in the outcome of digital rectal examination is investigated with the objective of providing guidelines to practitioners to enhance the effectiveness of diagnosis. Furthermore, the presence of the pelvic bone in the model is assessed to determine the pathophysiological conditions in which it has to be modeled. The conclusions and suggestions of this work have potential use not only in clinical practice and also for biomechanical modeling where structural patient-specificity needs to be considered. © 2015 The Authors. International Journal for Numerical Methods in Biomedical Engineering published by John Wiley & Sons Ltd.
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Affiliation(s)
- Javier Palacio‐Torralba
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical SciencesHeriot‐Watt UniversityEdinburghEH14 4ASUK
| | | | - Daniel W. Good
- Edinburgh Urological Cancer Group, Division of Pathology Laboratories, Institute of Genetics and Molecular MedicineUniversity of Edinburgh, Western General HospitalCrewe Road SouthEdinburghEH4 2XUUK
| | - Steven Hammer
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical SciencesHeriot‐Watt UniversityEdinburghEH14 4ASUK
| | - S. Alan McNeill
- Edinburgh Urological Cancer Group, Division of Pathology Laboratories, Institute of Genetics and Molecular MedicineUniversity of Edinburgh, Western General HospitalCrewe Road SouthEdinburghEH4 2XUUK
- Department of Urology, NHS LothianWestern General HospitalCrewe Road SouthEdinburghEH4 2XUUK
| | - Grant D. Stewart
- Edinburgh Urological Cancer Group, Division of Pathology Laboratories, Institute of Genetics and Molecular MedicineUniversity of Edinburgh, Western General HospitalCrewe Road SouthEdinburghEH4 2XUUK
- Department of Urology, NHS LothianWestern General HospitalCrewe Road SouthEdinburghEH4 2XUUK
| | - Robert L. Reuben
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical SciencesHeriot‐Watt UniversityEdinburghEH14 4ASUK
| | - Yuhang Chen
- Institute of Mechanical, Process and Energy Engineering, School of Engineering and Physical SciencesHeriot‐Watt UniversityEdinburghEH14 4ASUK
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16
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Barnett GC, Kerns SL, Noble DJ, Dunning AM, West CML, Burnet NG. Incorporating Genetic Biomarkers into Predictive Models of Normal Tissue Toxicity. Clin Oncol (R Coll Radiol) 2015; 27:579-87. [PMID: 26166774 DOI: 10.1016/j.clon.2015.06.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 06/08/2015] [Accepted: 06/12/2015] [Indexed: 12/25/2022]
Abstract
There is considerable variation in the level of toxicity patients experience for a given dose of radiotherapy, which is associated with differences in underlying individual normal tissue radiosensitivity. A number of syndromes have a large effect on clinical radiosensitivity, but these are rare. Among non-syndromic patients, variation is less extreme, but equivalent to a ±20% variation in dose. Thus, if individual normal tissue radiosensitivity could be measured, it should be possible to optimise schedules for individual patients. Early investigations of in vitro cellular radiosensitivity supported a link with tissue response, but individual studies were equivocal. A lymphocyte apoptosis assay has potential, and is currently under prospective validation. The investigation of underlying genetic variation also has potential. Although early candidate gene studies were inconclusive, more recent genome-wide association studies are revealing definite associations between genotype and toxicity and highlighting the potential for future genetic testing. Genetic testing and individualised dose prescriptions could reduce toxicity in radiosensitive patients, and permit isotoxic dose escalation to increase local control in radioresistant individuals. The approach could improve outcomes for half the patients requiring radical radiotherapy. As a number of patient- and treatment-related factors also affect the risk of toxicity for a given dose, genetic testing data will need to be incorporated into models that combine patient, treatment and genetic data.
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Affiliation(s)
- G C Barnett
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - S L Kerns
- Rubin Center for Cancer Survivorship, Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - D J Noble
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A M Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - C M L West
- Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital, Manchester, UK
| | - N G Burnet
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
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17
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Scaife JE, Thomas SJ, Harrison K, Romanchikova M, Sutcliffe MPF, Forman JR, Bates AM, Jena R, Parker MA, Burnet NG. Accumulated dose to the rectum, measured using dose-volume histograms and dose-surface maps, is different from planned dose in all patients treated with radiotherapy for prostate cancer. Br J Radiol 2015. [PMID: 26204919 PMCID: PMC4730972 DOI: 10.1259/bjr.20150243] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We sought to calculate accumulated dose (DA) to the rectum in patients treated with radiotherapy for prostate cancer. We were particularly interested in whether dose-surface maps (DSMs) provide additional information to dose-volume histograms (DVHs). METHODS Manual rectal contours were obtained for kilovoltage and daily megavoltage CT scans for 10 participants from the VoxTox study (380 scans). Daily delivered dose recalculation was performed using a ray-tracing algorithm. Delivered DVHs were summated to create accumulated DVHs. The rectum was considered as a cylinder, cut and unfolded to produce daily delivered DSMs; these were summated to produce accumulated DSMs. RESULTS Accumulated dose-volumes were different from planned in all participants. For one participant, all DA levels were higher and all volumes were larger than planned. For four participants, all DA levels were lower and all volumes were smaller than planned. For each of these four participants, ≥1% of pixels on the accumulated DSM received ≥5 Gy more than had been planned. CONCLUSION Differences between accumulated and planned dose-volumes were seen in all participants. DSMs were able to identify differences between DA and planned dose that could not be appreciated from the DVHs. Further work is needed to extract the dose data embedded in the DSMs. These will be correlated with toxicity as part of the VoxTox Programme. ADVANCES IN KNOWLEDGE DSMs are able to identify differences between DA and planned dose that cannot be appreciated from DVHs alone and should be incorporated into future studies investigating links between DA and toxicity.
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Affiliation(s)
- Jessica E Scaife
- 1 Cancer Research UK VoxTox Research Group, Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,2 Department of Oncology, University of Cambridge, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - Simon J Thomas
- 1 Cancer Research UK VoxTox Research Group, Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,3 Medical Physics Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Karl Harrison
- 1 Cancer Research UK VoxTox Research Group, Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,4 Department of Physics, University of Cambridge, Cavendish Laboratory, Cambridge, UK
| | - Marina Romanchikova
- 1 Cancer Research UK VoxTox Research Group, Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,3 Medical Physics Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Michael P F Sutcliffe
- 1 Cancer Research UK VoxTox Research Group, Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,5 Department of Engineering, University of Cambridge, Cambridge, UK
| | - Julia R Forman
- 1 Cancer Research UK VoxTox Research Group, Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,6 Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Amy M Bates
- 1 Cancer Research UK VoxTox Research Group, Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,2 Department of Oncology, University of Cambridge, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - Raj Jena
- 1 Cancer Research UK VoxTox Research Group, Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,2 Department of Oncology, University of Cambridge, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - M Andrew Parker
- 1 Cancer Research UK VoxTox Research Group, Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,4 Department of Physics, University of Cambridge, Cavendish Laboratory, Cambridge, UK
| | - Neil G Burnet
- 1 Cancer Research UK VoxTox Research Group, Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,2 Department of Oncology, University of Cambridge, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
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18
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Scaife JE, Barnett GC, Noble DJ, Jena R, Thomas SJ, West CML, Burnet NG. Exploiting biological and physical determinants of radiotherapy toxicity to individualize treatment. Br J Radiol 2015; 88:20150172. [PMID: 26084351 PMCID: PMC4628540 DOI: 10.1259/bjr.20150172] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/07/2015] [Accepted: 05/21/2015] [Indexed: 12/16/2022] Open
Abstract
The recent advances in radiation delivery can improve tumour control probability (TCP) and reduce treatment-related toxicity. The use of intensity-modulated radiotherapy (IMRT) in particular can reduce normal tissue toxicity, an objective in its own right, and can allow safe dose escalation in selected cases. Ideally, IMRT should be combined with image guidance to verify the position of the target, since patients, target and organs at risk can move day to day. Daily image guidance scans can be used to identify the position of normal tissue structures and potentially to compute the daily delivered dose. Fundamentally, it is still the tolerance of the normal tissues that limits radiotherapy (RT) dose and therefore tumour control. However, the dose-response relationships for both tumour and normal tissues are relatively steep, meaning that small dose differences can translate into clinically relevant improvements. Differences exist between individuals in the severity of toxicity experienced for a given dose of RT. Some of this difference may be the result of differences between the planned dose and the accumulated dose (DA). However, some may be owing to intrinsic differences in radiosensitivity of the normal tissues between individuals. This field has been developing rapidly, with the demonstration of definite associations between genetic polymorphisms and variation in toxicity recently described. It might be possible to identify more resistant patients who would be suitable for dose escalation, as well as more sensitive patients for whom toxicity could be reduced or avoided. Daily differences in delivered dose have been investigated within the VoxTox research programme, using the rectum as an example organ at risk. In patients with prostate cancer receiving curative RT, considerable daily variation in rectal position and dose can be demonstrated, although the median position matches the planning scan well. Overall, in 10 patients, the mean difference between planned and accumulated rectal equivalent uniform doses was -2.7 Gy (5%), and a dose reduction was seen in 7 of the 10 cases. If dose escalation was performed to take rectal dose back to the planned level, this should increase the mean TCP (as biochemical progression-free survival) by 5%. Combining radiogenomics with individual estimates of DA might identify almost half of patients undergoing radical RT who might benefit from either dose escalation, suggesting improved tumour cure or reduced toxicity or both.
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Affiliation(s)
- J E Scaife
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
- Cancer Research UK VoxTox Research Group, University of Cambridge Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - G C Barnett
- Cancer Research UK VoxTox Research Group, University of Cambridge Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D J Noble
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - R Jena
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
- Cancer Research UK VoxTox Research Group, University of Cambridge Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - S J Thomas
- Cancer Research UK VoxTox Research Group, University of Cambridge Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
- Medical Physics Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - C M L West
- Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital, Manchester, UK
| | - N G Burnet
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
- Cancer Research UK VoxTox Research Group, University of Cambridge Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
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