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Douglas R, Olanrewaju A, Mumme R, Zhang L, Beadle BM, Court LE. Evaluating automatically generated normal tissue contours for safe use in head and neck and cervical cancer treatment planning. J Appl Clin Med Phys 2024:e14338. [PMID: 38610118 DOI: 10.1002/acm2.14338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 03/05/2024] [Accepted: 03/15/2024] [Indexed: 04/14/2024] Open
Abstract
PURPOSE Volumetric-modulated arc therapy (VMAT) is a widely accepted treatment method for head and neck (HN) and cervical cancers; however, creating contours and plan optimization for VMAT plans is a time-consuming process. Our group has created an automated treatment planning tool, the Radiation Planning Assistant (RPA), that uses deep learning models to generate organs at risk (OARs), planning structures and automates plan optimization. This study quantitatively evaluates the quality of contours generated by the RPA tool. METHODS For patients with HN (54) and cervical (39) cancers, we retrospectively generated autoplans using the RPA. Autoplans were generated using deep-learning and RapidPlan models developed in-house. The autoplans were, then, applied to the original, physician-drawn contours, which were used as a ground truth (GT) to compare with the autocontours (RPA). Using a "two one-sided tests" (TOST) procedure, we evaluated whether the autocontour normal tissue dose was equivalent to that of the ground truth by a margin, δ, that we determined based on clinical judgement. We also calculated the number of plans that met established clinically accepted dosimetric criteria. RESULTS For HN plans, 91.8% and 91.7% of structures met dosimetric criteria for automatic and manual contours, respectively; for cervical plans, 95.6% and 95.7% of structures met dosimetric criteria for automatic and manual contours, respectively. Autocontours were equivalent to the ground truth for 71% and 75% of common DVH metrics for the HN and cervix, respectively. CONCLUSIONS This study shows that dosimetrically equivalent normal tissue contours can be created for HN and cervical cancers using deep learning techniques. In general, differences between the contours did not affect the passing or failing of clinical dose tolerances.
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Affiliation(s)
- Raphael Douglas
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Adenike Olanrewaju
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Raymond Mumme
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lifei Zhang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Laurence Edward Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Court LE, Aggarwal A, Jhingran A, Naidoo K, Netherton T, Olanrewaju A, Peterson C, Parkes J, Simonds H, Trauernicht C, Zhang L, Beadle BM. Artificial Intelligence-Based Radiotherapy Contouring and Planning to Improve Global Access to Cancer Care. JCO Glob Oncol 2024; 10:e2300376. [PMID: 38484191 PMCID: PMC10954080 DOI: 10.1200/go.23.00376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/22/2023] [Accepted: 01/22/2024] [Indexed: 03/19/2024] Open
Abstract
PURPOSE Increased automation has been identified as one approach to improving global cancer care. The Radiation Planning Assistant (RPA) is a web-based tool offering automated radiotherapy (RT) contouring and planning to low-resource clinics. In this study, the RPA workflow and clinical acceptability were assessed by physicians around the world. METHODS The RPA output for 75 cases was reviewed by at least three physicians; 31 radiation oncologists at 16 institutions in six countries on five continents reviewed RPA contours and plans for clinical acceptability using a 5-point Likert scale. RESULTS For cervical cancer, RPA plans using bony landmarks were scored as usable as-is in 81% (with minor edits 93%); using soft tissue contours, plans were scored as usable as-is in 79% (with minor edits 96%). For postmastectomy breast cancer, RPA plans were scored as usable as-is in 44% (with minor edits 91%). For whole-brain treatment, RPA plans were scored as usable as-is in 67% (with minor edits 99%). For head/neck cancer, the normal tissue autocontours were acceptable as-is in 89% (with minor edits 97%). The clinical target volumes (CTVs) were acceptable as-is in 40% (with minor edits 93%). The volumetric-modulated arc therapy (VMAT) plans were acceptable as-is in 87% (with minor edits 96%). For cervical cancer, the normal tissue autocontours were acceptable as-is in 92% (with minor edits 99%). The CTVs for cervical cancer were scored as acceptable as-is in 83% (with minor edits 92%). The VMAT plans for cervical cancer were acceptable as-is in 99% (with minor edits 100%). CONCLUSION The RPA, a web-based tool designed to improve access to high-quality RT in low-resource settings, has high rates of clinical acceptability by practicing clinicians around the world. It has significant potential for successful implementation in low-resource clinics.
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Affiliation(s)
| | - Ajay Aggarwal
- Guy's and St Thomas Hospitals, London, United Kingdom
| | - Anuja Jhingran
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | | | - Lifei Zhang
- University of Texas MD Anderson Cancer Center, Houston, TX
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3
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Mohamed AS, Martin GV, Ng SP, Takiar V, Beadle BM, Zafereo M, Garden AS, Frank SJ, David Fuller C, Brandon Gunn G, Morrison WH, Rosenthal DI, Reddy J, Moreno A, Lee A, Phan J. Patterns of failure for recurrent head and neck squamous cell carcinoma treated with salvage surgery and postoperative IMRT reirradiation. Clin Transl Radiat Oncol 2024; 44:100700. [PMID: 38058404 PMCID: PMC10695834 DOI: 10.1016/j.ctro.2023.100700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/21/2023] [Accepted: 11/05/2023] [Indexed: 12/08/2023] Open
Abstract
Purpose/Objectives The purpose of this study was to evaluate patterns of locoregional recurrence (LRR) after surgical salvage and adjuvant reirradiation with IMRT for recurrent head and neck squamous cell cancer (HNSCC). Materials/Methods Patterns of LRR for 61 patients treated consecutively between 2003 and 2014 who received post-operative IMRT reirradiation to ≥ 60 Gy for recurrent HNSCC were determined by 2 methods: 1) physician classification via visual comparison of post-radiotherapy imaging to reirradiation plans; and 2) using deformable image registration (DIR). Those without evaluable CT planning image data were excluded. All recurrences were verified by biopsy or radiological progression. Failures were defined as in-field, marginal, or out-of-field. Logistic regression analyses were performed to identify predictors for LRR. Results A total of 55 patients were eligible for analysis and 23 (42 %) had documented LRR after reirradiation. Location of recurrent disease prior to salvage surgery (lymphatic vs. mucosal) was the most significant predictor of LRR after post-operative reirradiation with salvage rate of 67 % for lymphatic vs. 33 % for mucosal sites (p = 0.037). Physician classification of LRR yielded 14 (61 %) in-field failures, 3 (13 %) marginal failures, and 6 (26 %) out-of-field failures, while DIR yielded 10 (44 %) in-field failures, 4 (17 %) marginal failures, and 9 (39 %) out-of-field failures. Most failures (57 %) occurred within the original site of recurrence or first echelon lymphatic drainage. Of patients who had a free flap placed during salvage surgery, 56 % of failures occurred within 1 cm of the surgical flap. Conclusion Our study highlights the role of DIR in enhancing the accuracy and consistency of POF analysis. Compared to traditional visual inspection, DIR reduces interobserver variability and provides more nuanced insights into dose-specific and spatial parameters of locoregional recurrences. Additionally, the study identifies the location of the initial recurrence as a key predictor of subsequent locoregional recurrence after salvage surgery and re-IMRT.
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Affiliation(s)
- Abdallah S.R. Mohamed
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
- Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Geoffrey V. Martin
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Sweet Ping Ng
- Department of Radiation Oncology, Austin Health, Melbourne, Australia
| | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinnati, OH, USA
| | - Beth M. Beadle
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Adam S. Garden
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Steven J. Frank
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - C. David Fuller
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - G. Brandon Gunn
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - William H. Morrison
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - David I. Rosenthal
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jay Reddy
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Amy Moreno
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Anna Lee
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jack Phan
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
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4
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Wu TC, No HJ, Rahimy E, Kishan AU, Steinberg ML, Raldow AC, Beadle BM. Performance Analysis of a Radiation Oncology Educational Podcast. J Am Coll Radiol 2024; 21:186-191. [PMID: 37516159 DOI: 10.1016/j.jacr.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE Asynchronous podcast education is a popular supplementary tool, with up to 88% of medical residents reporting its use. Radiation oncology podcasts remain scarce. The authors analyzed the early performance, listenership, and engagement of the first education-specific radiation oncology medical podcast. METHODS Episode data and listener demographics were gathered from Spotify and Apple Podcasts. Episodes were case based, categorized by disease subsite, and reviewed by a board-certified radiation oncologist. Listenership was defined by the number of plays per day (ppd) on unique devices, averaged up to 60 days from publication. Episode engagement was defined as a percentage of plays on unique devices playing >40% of an episode within a single session. Quantitative end points included episode engagement and listenership. Pearson's correlation coefficient calculations were used for analysis. RESULTS From July 2022 to March 2023, 20 total episodes had 13,078 total plays over 227 days. The median episode length was 13.8 min (range, 9.2-20.1 min). Listener demographics were as follows: 54.4% men, 44.0% women, 1.3% not specified, and 0.3% nonbinary, with ages 18 to 22 (1%), 23 to 27 (13%), 28 to 34 (58%), 35 to 44 (22%), 45 to 59 (4%), and ≥60 (2%) years. Episodes were played in 53 countries, with the most plays in North America (71.5%), followed by Asia (10.2%), Europe (8.2%), Oceania (8.0%), Africa (1.5%), and South America (0.5%). There was a 585.2% increase in listenership since initiation, with median growth of 46.0% per month. Median listenership and engagement were 11.3 ppd (interquartile range, 10.3-13.8 ppd) and 81.4% (interquartile range, 72.0%-84.2%) for all episodes, respectively. A significant negative relationship between episode length and engagement was observed (r[20] = -0.51, P = .02). There was no statistically significant relationship between ppd and episode length (r[20] = -0.19, P = .42). CONCLUSIONS The significant rise in listenership, high episode engagement, and large international audience support a previously unmet need in radiation oncology medical education that may be supplemented by podcasts.
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Affiliation(s)
- Trudy C Wu
- Resident Physician, Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California.
| | - Hyunsoo J No
- Resident Physician, Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Elham Rahimy
- Assistant Professor, Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Amar U Kishan
- Associate Professor, Vice-Chair of Clinical and Translational Research, Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
| | - Michael L Steinberg
- Professor, Chairman, Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
| | - Ann C Raldow
- Associate Professor, Program Director, Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
| | - Beth M Beadle
- Professor, Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
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Gay SS, Cardenas CE, Nguyen C, Netherton TJ, Yu C, Zhao Y, Skett S, Patel T, Adjogatse D, Guerrero Urbano T, Naidoo K, Beadle BM, Yang J, Aggarwal A, Court LE. Fully-automated, CT-only GTV contouring for palliative head and neck radiotherapy. Sci Rep 2023; 13:21797. [PMID: 38066074 PMCID: PMC10709623 DOI: 10.1038/s41598-023-48944-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
Planning for palliative radiotherapy is performed without the advantage of MR or PET imaging in many clinics. Here, we investigated CT-only GTV delineation for palliative treatment of head and neck cancer. Two multi-institutional datasets of palliative-intent treatment plans were retrospectively acquired: a set of 102 non-contrast-enhanced CTs and a set of 96 contrast-enhanced CTs. The nnU-Net auto-segmentation network was chosen for its strength in medical image segmentation, and five approaches separately trained: (1) heuristic-cropped, non-contrast images with a single GTV channel, (2) cropping around a manually-placed point in the tumor center for non-contrast images with a single GTV channel, (3) contrast-enhanced images with a single GTV channel, (4) contrast-enhanced images with separate primary and nodal GTV channels, and (5) contrast-enhanced images along with synthetic MR images with separate primary and nodal GTV channels. Median Dice similarity coefficient ranged from 0.6 to 0.7, surface Dice from 0.30 to 0.56, and 95th Hausdorff distance from 14.7 to 19.7 mm across the five approaches. Only surface Dice exhibited statistically-significant difference across these five approaches using a two-tailed Wilcoxon Rank-Sum test (p ≤ 0.05). Our CT-only results met or exceeded published values for head and neck GTV autocontouring using multi-modality images. However, significant edits would be necessary before clinical use in palliative radiotherapy.
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Affiliation(s)
- Skylar S Gay
- Unit 1472, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX, USA.
| | - Carlos E Cardenas
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Callistus Nguyen
- Unit 1472, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Tucker J Netherton
- Unit 1472, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Cenji Yu
- Unit 1472, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Yao Zhao
- Unit 1472, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX, USA
| | | | | | | | | | | | | | - Jinzhong Yang
- Unit 1472, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | | | - Laurence E Court
- Unit 1472, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
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Takiar V, Beadle BM. In Regard to Razavian et al. Int J Radiat Oncol Biol Phys 2023; 117:1298-1299. [PMID: 37980145 DOI: 10.1016/j.ijrobp.2023.08.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/24/2023] [Indexed: 11/20/2023]
Affiliation(s)
- Vinita Takiar
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - Beth M Beadle
- Department of Radiation Oncology - Radiation Therapy, Stanford University, Palo Alto, California
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7
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Gay SS, Kisling KD, Anderson BM, Zhang L, Rhee DJ, Nguyen C, Netherton T, Yang J, Brock K, Jhingran A, Simonds H, Klopp A, Beadle BM, Court LE, Cardenas CE. Identifying the optimal deep learning architecture and parameters for automatic beam aperture definition in 3D radiotherapy. J Appl Clin Med Phys 2023; 24:e14131. [PMID: 37670488 PMCID: PMC10691634 DOI: 10.1002/acm2.14131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/08/2023] [Accepted: 08/07/2023] [Indexed: 09/07/2023] Open
Abstract
PURPOSE Two-dimensional radiotherapy is often used to treat cervical cancer in low- and middle-income countries, but treatment planning can be challenging and time-consuming. Neural networks offer the potential to greatly decrease planning time through automation, but the impact of the wide range of hyperparameters to be set during training on model accuracy has not been exhaustively investigated. In the current study, we evaluated the effect of several convolutional neural network architectures and hyperparameters on 2D radiotherapy treatment field delineation. METHODS Six commonly used deep learning architectures were trained to delineate four-field box apertures on digitally reconstructed radiographs for cervical cancer radiotherapy. A comprehensive search of optimal hyperparameters for all models was conducted by varying the initial learning rate, image normalization methods, and (when appropriate) convolutional kernel size, the number of learnable parameters via network depth and the number of feature maps per convolution, and nonlinear activation functions. This yielded over 1700 unique models, which were all trained until performance converged and then tested on a separate dataset. RESULTS Of all hyperparameters, the choice of initial learning rate was most consistently significant for improved performance on the test set, with all top-performing models using learning rates of 0.0001. The optimal image normalization was not consistent across architectures. High overlap (mean Dice similarity coefficient = 0.98) and surface distance agreement (mean surface distance < 2 mm) were achieved between the treatment field apertures for all architectures using the identified best hyperparameters. Overlap Dice similarity coefficient (DSC) and distance metrics (mean surface distance and Hausdorff distance) indicated that DeepLabv3+ and D-LinkNet architectures were least sensitive to initial hyperparameter selection. CONCLUSION DeepLabv3+ and D-LinkNet are most robust to initial hyperparameter selection. Learning rate, nonlinear activation function, and kernel size are also important hyperparameters for improving performance.
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Affiliation(s)
- Skylar S. Gay
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | | | | | - Lifei Zhang
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Dong Joo Rhee
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Callistus Nguyen
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Tucker Netherton
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Jinzhong Yang
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Kristy Brock
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of Imaging PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Anuja Jhingran
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Hannah Simonds
- University Hospitals Plymouth NHS TrustPlymouthUnited Kingdom
| | - Ann Klopp
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Beth M. Beadle
- Department of Radiation OncologyStanford UniversityPalo AltoCaliforniaUSA
| | - Laurence E. Court
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Carlos E. Cardenas
- Department of Radiation OncologyThe University of Alabama at BirminghamBirminghamAlabamaUSA
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Chen Y, Yu L, Wang JY, Panjwani N, Obeid JP, Liu W, Liu L, Kovalchuk N, Gensheimer MF, Vitzthum LK, Beadle BM, Chang DT, Le QT, Han B, Xing L. Adaptive Region-Specific Loss for Improved Medical Image Segmentation. IEEE Trans Pattern Anal Mach Intell 2023; 45:13408-13421. [PMID: 37363838 DOI: 10.1109/tpami.2023.3289667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Defining the loss function is an important part of neural network design and critically determines the success of deep learning modeling. A significant shortcoming of the conventional loss functions is that they weight all regions in the input image volume equally, despite the fact that the system is known to be heterogeneous (i.e., some regions can achieve high prediction performance more easily than others). Here, we introduce a region-specific loss to lift the implicit assumption of homogeneous weighting for better learning. We divide the entire volume into multiple sub-regions, each with an individualized loss constructed for optimal local performance. Effectively, this scheme imposes higher weightings on the sub-regions that are more difficult to segment, and vice versa. Furthermore, the regional false positive and false negative errors are computed for each input image during a training step and the regional penalty is adjusted accordingly to enhance the overall accuracy of the prediction. Using different public and in-house medical image datasets, we demonstrate that the proposed regionally adaptive loss paradigm outperforms conventional methods in the multi-organ segmentations, without any modification to the neural network architecture or additional data preparation.
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Court LE, Aggarwal A, Burger H, Cardenas C, Chung C, Douglas R, du Toit M, Jhingran A, Mumme R, Muya S, Naidoo K, Ndumbalo J, Netherton T, Nguyen C, Olanrewaju A, Parkes J, Shaw W, Trauernicht C, Xu M, Yang J, Zhang L, Simonds H, Beadle BM. Radiation Planning Assistant - A Web-based Tool to Support High-quality Radiotherapy in Clinics with Limited Resources. J Vis Exp 2023. [PMID: 37870317 DOI: 10.3791/65504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
Access to radiotherapy worldwide is limited. The Radiation Planning Assistant (RPA) is a fully automated, web-based tool that is being developed to offer fully automated radiotherapy treatment planning tools to clinics with limited resources. The goal is to help clinical teams scale their efforts, thus reaching more patients with cancer. The user connects to the RPA via a webpage, completes a Service Request (prescription and information about the radiotherapy targets), and uploads the patient's CT image set. The RPA offers two approaches to automated planning. In one-step planning, the system uses the Service Request and CT scan to automatically generate the necessary contours and treatment plan. In two-step planning, the user reviews and edits the automatically generated contours before the RPA continues to generate a volume-modulated arc therapy plan. The final plan is downloaded from the RPA website and imported into the user's local treatment planning system, where the dose is recalculated for the locally commissioned linac; if necessary, the plan is edited prior to approval for clinical use.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Melody Xu
- University of California-San Francisco
| | | | - Lifei Zhang
- The University of Texas MD Anderson Cancer Center
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10
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Wu TC, No HJ, Rahimy E, Raldow A, Beadle BM. Performance Metric Analysis of a Radiation Oncology Educational Podcast. Int J Radiat Oncol Biol Phys 2023; 117:e555. [PMID: 37785705 DOI: 10.1016/j.ijrobp.2023.06.1866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Asynchronous podcast education is a popular supplementary tool with up to 88% of medical residents reporting its use, and is perceived by faculty to have high educational value with convenience and connection to broader medical communities.1,2 Radiation oncology (RO) podcasts remain scarce compared to other specialties, and ones focused exclusively on education are largely absent. We analyze the early performance, listenership, and engagement of the first RO medical education podcast. MATERIALS/METHODS Episode data and listener demographics were gathered from Spotify and iTunes. Episode engagement was defined as a percentage of plays on unique devices playing >40% of an episode within a single session. Listenership was defined by the number of plays per day (ppd) on unique devices, averaged over 60 days from publication date. Episodes were case based, categorized by disease subsite, and reviewed by a board-certified radiation oncologist. Quantitative endpoints included episode engagement and listenership. Qualitative comments were not solicited but received through email and Twitter. Pearson's correlation coefficient calculations were used for analysis. RESULTS Eighteen total episodes had 8,517 total plays since July 2022 over 176 days. Median episode length was 13.8 minutes (range 9.2-20.1). Popular listening platforms included iTunes (53.5%) and Spotify (34.0%). Listener demographics included 59.4% male, 39.6% female, and 1.0% other, ranging from age 23-27 (14%), 28-34 (65%), 35-44 (14%), 45-59 (4%), and 60+ (1%). ATB was played in 48 countries, with the most listeners in North America (74.6%) followed by Asia (7.8%), Europe (7.6%), Australia (7.0%), Africa (2.0%), and South America (0.4%). There was a 464% increase in listenership since publication with median growth of 63.3% per month. Median listenership and engagement were 9.2 ppd (IQR, 7.7-9.9) and 77.8% (IQR, 68.1-81.2) for all episodes, respectively. Among 8 topics, head and neck (HN) episodes had the highest mean listenership with 17.8 ppd, followed by genitourinary (GU, 10.8) and lung (10.5). GU episodes had the highest mean engagement at 84.6%, followed by lung (82.3) and sarcoma (81.2). Dosimetry had the lowest listenership and engagement at 5.9 ppd and 63.1%, respectively. A significant negative relationship between episode length and engagement was observed, (r(18) = -0.469, p = 0.05). There was no statistically significant relationship between ppd and episode length, (r(18) = -0.303, p = 0.22). CONCLUSION Evidenced by its significant rise in listenership, high listener engagement, and large international audience, there were previously unmet needs for RO medical education that may be supplemented by podcasts. HN episodes were most popular with GU exhibiting highest engagement. Longer episode length correlated with a significant decrease in engagement but no effect on popularity.
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Affiliation(s)
- T C Wu
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - H J No
- University of Vermont, Burlington, VT
| | - E Rahimy
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - A Raldow
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - B M Beadle
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
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Dai X, Yang Y, Liu W, Niedermayer TR, Kovalchuk N, Gensheimer MF, Beadle BM, Le QT, Xing L. Reinforcement Learning Powered Station Parameter Optimized Radiation Therapy (SPORT): A Novel Treatment Planning and Beam Delivery Technique. Int J Radiat Oncol Biol Phys 2023; 117:e658. [PMID: 37785951 DOI: 10.1016/j.ijrobp.2023.06.2091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Conventional intensity modulated radiation therapy (IMRT) with a typical 5-20 fixed beams often does not provide sufficient angular sampling required for conformal dose shaping, whereas current volumetric modulated arc therapy (VMAT) discretizes the angular space into equally spaced control points without considering the differential need for intensity modulation of different angles, leading to undersampling at some angles while oversampling at some other angles. Our goal is to develop a node or station parameter optimized radiation therapy (SPORT) strategy with simultaneously optimized angular sampling and beam modulation by leveraging state-of-the-art reinforcement learning and the unique capability of modern digital LINACs in dose delivery through programmable nodal points. MATERIALS/METHODS We developed a SPORT optimization framework, in which, the process of programming control points (or station parameters) was formulated as a stochastic dynamic programming problem, which was solved by a reinforcement learning-based algorithm. On-policy reinforcement learning method, namely, state-action-reward-state-action (SARSA) was integrated with deep convolutional neural network to predict station parameters by utilizing the patient's anatomical structures meanwhile considering the delivery capability of a typical digital LINAC machine. Here, the deep convolutional neural network estimated the state-action value by using the quality of the plan with current station parameters when a next potential station parameter was selected. The state-action value was then updated by SARSA learning. The quality of the plan was quantified by dosimetry constraints. The model was assessed by a retrospective study on a cohort of patients underwent head-and-neck radiation therapy. Dosimetric analysis and delivery efficiency comparisons were used to evaluate the performance of the proposed framework. RESULTS Our model was used to generate 16 plans unseen in the original training set. All the plans predicted by our model achieved better dose distributions without violating clinical planning constraints. Moreover, instead of using 4 full standard arcs in the original clinically used plans obtained via manual optimization, the predicted plans only used one full standard arc (about 178 control points) plus boost from a few sub-arcs (less than 30 degrees of gantry angles), which significantly improved the efficiency of the beam delivery. We are in the process of integrating the sub-arcs into the full arc by considering the programmable capability of modern LINACs. CONCLUSION We demonstrated that a machine learning-based SPORT framework capable of optimizing the spatial sampling and beam modulation simultaneously for modern radiation therapy. The framework not only significantly improves the quality and efficiency of beam delivery, but also has the potential to be incorporated into current clinical workflow to improve the efficiency of dose planning and delivery.
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Affiliation(s)
- X Dai
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Y Yang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - W Liu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - T R Niedermayer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - N Kovalchuk
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - M F Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - B M Beadle
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Q T Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - L Xing
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
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Yang Y, Wang JY, Dong P, Kovalchuk N, Gensheimer MF, Beadle BM, Bagshaw HP, Buyyounouski MK, Le QT, Xing L. Clinical Implementation of an Automated IMRT/VMAT Treatment Planning Tool. Int J Radiat Oncol Biol Phys 2023; 117:e739-e740. [PMID: 37786147 DOI: 10.1016/j.ijrobp.2023.06.2272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To create an in-house automated treatment planning tool for IMRT/VMAT treatments and evaluate the dosimetric plan quality against manually generated plans. MATERIALS/METHODS A scripting application programming interface is employed to interact with a commercial treatment planning system (TPS) to implement automatic plan evaluation and update optimization parameters by mimicking the human planning process. The automated planning performs in an iterative fashion until reaching an acceptable tradeoff among target coverage/dose homogeneity and sparing of critical organs at risk. In each iteration, the dose constraints, priorities, and optimization structures for are automatically updated based on the results of the current iteration. Twenty previously treated plans (10 prostate and 10 head and neck), were preliminarily used to evaluate the performance of the automated planning tool. The differences in target and organ-at-risk metrics from the manually generated clinical plans were analyzed using paired t-test to evaluate clinical acceptability of tour automated planning tool. The current in-house-developed automated planning solution is able to create plans for different disease sites, including head & neck, prostate, pelvis, and lung. So far, the VMAT plans for more than 150 different cases have been generated with the tool. The results for these were also evaluated. RESULTS Compared to the manually generated clinical head and neck plans, all auto plans achieved PTV D95% coverage and critical organs at risk sparing without statistically significant change in average global Dmax (107.4% for manual vs 107.3% for automated plans). The auto-planning solution provided reduced maximum doses to brainstem and spinal cord (average reductions with standard deviations of 5.1 ± 2.6 Gy and 2.9 ± 1.4 Gy, respectively, all p <0.03), reduced average mean doses to contralateral parotid, ipsilateral parotid, contralateral submandibular gland, pharynx, esophagus, cochleae (reductions of 2.2 ± 2.9 Gy, 4.8 ± 4.7 Gy, 3.6 ± 5.2 Gy, 2.0 ± 7.1 Gy, 3.9 ± 2.6 Gy, 3.8 ± 5.0 Gy, respectively, all p < 0.045). Similar results were observed for the prostate plans. With the same PTV coverage and without statistically significant change in average global Dmax (106.5% for manual vs 106.8% for automated plans), the automated solution provided superior sparing for both bladder and rectum. Bladder V75, V70, V65 were reduced by 0.6% ± 2.1%, 0.8% ± 2.5%, and 0.9% ± 2.9% (all p <0.04), respectively. Rectum V75, V70, V65, V60 were reduced by 1.0% ± 2.3%, 1.2% ± 2.8%, 1.3% ± 3.2%, 1.6% ± 3.6% (all p < 0.01), respectively. CONCLUSION Our automated treatment planning solution is capable of efficiently generating VMAT plans for different disease sites with superior dosimetric indices compared to manually generated plans. Our tool is integrated within a commercial TPS platform, so it has the advantage of seamless adoption into the standard workflow to improve plan quality and treatment planning efficiency in our clinic.
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Affiliation(s)
- Y Yang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - J Y Wang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - P Dong
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - N Kovalchuk
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - M F Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - B M Beadle
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - H P Bagshaw
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - M K Buyyounouski
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Q T Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - L Xing
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
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Wang JY, Chen Y, Pham D, Lewis J, Beadle BM, Gensheimer MF, Le QT, Gu X, Xing L. Prospective Clinical Adoption of Artificial Intelligence for Organ Contouring in Head and Neck Radiation Treatment Planning. Int J Radiat Oncol Biol Phys 2023; 117:e490-e491. [PMID: 37785549 DOI: 10.1016/j.ijrobp.2023.06.1721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Patients that undergo head and neck (H&N) radiation therapy (RT) require laborious delineation of organs-at-risk (OARs) on computed tomography (CT) scans in a treatment planning system (TPS) to minimize radiation to normal tissue. This task can be completed rapidly and accurately with recently developed artificial intelligence-based semantic segmentation models. The current study aims to deploy and evaluate a strategy for improving clinical practice with this technology. MATERIALS/METHODS Deep learning models were trained and tested with CT scans and OAR contours from previous H&N RT cases at our clinic. Two medical physicists vetted the models and selected a 2.5D U-Net for further implementation. The model was embedded in a dedicated server at the hospital, programmed to read H&N CT scans staged for import into the TPS, generate auto-contours, and write them into a TPS-compatible format made available alongside the scan. In the pilot implementation, the auto-contouring service was utilized for more than 60 cases, prospectively. The auto-contours were quantitatively evaluated against the treatment-approved contours to determine how much modification was performed by the clinical team. RESULTS The 2.5D U-Net selected for clinical integration segments 21 OARs in less than 3 minutes per scan. Across all the prospective cases, the mean Dice score and mean 95th percentile Hausdorff distance (mm) between the auto-contour and treatment-approved contour for each of the 21 OARs were as follows, respectively: brainstem (0.93, 1.94), optic chiasm (0.70, 2.96), left cochlea (0.69, 2.37), right cochlea (0.68, 2.44), esophagus (0.88, 2.46), left globe (0.93, 1.50), right globe (0.93, 1.63), glottis (0.91, 2.13), larynx (0.93, 2.76), mandible (0.90, 4.86), left optic nerve (0.78, 1.64), right optic nerve (0.82, 1.65), oral cavity (0.86, 8.46), left parotid gland (0.91, 2.78), right parotid gland (0.91, 2.39), pharynx (0.85, 2.39), spinal cord (0.87, 2.27), left submandibular gland (0.85, 3.46), right submandibular gland (0.83, 3.69), left temporal lobe (0.94, 2.20), and right temporal lobe (0.95, 2.09). The auto-contours for the optic chiasm, optic nerves, cochleas, and submandibular glands differed substantially from the final contours, a finding corroborated by the clinical team; the rest were clinically acceptable with minor or no edits necessary. CONCLUSION The proposed strategy provides a sophisticated starting point for treatment planning that has garnered overall favorable feedback from the participating radiation oncologists and dosimetrists. Consequently, the technique is being extended to other treatment sites.
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Affiliation(s)
- J Y Wang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Y Chen
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - D Pham
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - J Lewis
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - B M Beadle
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - M F Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Q T Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - X Gu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - L Xing
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
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Beadle BM, Chan AW. The Potential of Adaptive Radiotherapy for Patients With Head and Neck Cancer-Too Much or Not Enough? JAMA Oncol 2023; 9:1064-1065. [PMID: 37261837 DOI: 10.1001/jamaoncol.2023.1306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Beth M Beadle
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Annie W Chan
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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15
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Court L, Aggarwal A, Burger H, Cardenas C, Chung C, Douglas R, du Toit M, Jaffray D, Jhingran A, Mejia M, Mumme R, Muya S, Naidoo K, Ndumbalo J, Nealon K, Netherton T, Nguyen C, Olanrewaju N, Parkes J, Shaw W, Trauernicht C, Xu M, Yang J, Zhang L, Simonds H, Beadle BM. Addressing the Global Expertise Gap in Radiation Oncology: The Radiation Planning Assistant. JCO Glob Oncol 2023; 9:e2200431. [PMID: 37471671 PMCID: PMC10581646 DOI: 10.1200/go.22.00431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/08/2023] [Accepted: 04/24/2023] [Indexed: 07/22/2023] Open
Abstract
PURPOSE Automation, including the use of artificial intelligence, has been identified as a possible opportunity to help reduce the gap in access and quality for radiotherapy and other aspects of cancer care. The Radiation Planning Assistant (RPA) project was conceived in 2015 (and funded in 2016) to use automated contouring and treatment planning algorithms to support the efforts of oncologists in low- and middle-income countries, allowing them to scale their efforts and treat more patients safely and efficiently (to increase access). DESIGN In this review, we discuss the development of the RPA, with a particular focus on clinical acceptability and safety/risk across jurisdictions as these are important indicators for the successful future deployment of the RPA to increase radiotherapy availability and ameliorate global disparities in access to radiation oncology. RESULTS RPA tools will be offered through a webpage, where users can upload computed tomography data sets and download automatically generated contours and treatment plans. All interfaces have been designed to maximize ease of use and minimize risk. The current version of the RPA includes automated contouring and planning for head and neck cancer, cervical cancer, breast cancer, and metastases to the brain. CONCLUSION The RPA has been designed to bring high-quality treatment planning to more patients across the world, and it may encourage greater investment in treatment devices and other aspects of cancer treatment.
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Affiliation(s)
- Laurence Court
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ajay Aggarwal
- Guy's and St Thomas' Hospital, London, United Kingdom
| | - Hester Burger
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | | | - Christine Chung
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Raphael Douglas
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Monique du Toit
- Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - David Jaffray
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anuja Jhingran
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Mejia
- Benavides Cancer Institute, University of Santo Tomas, Manila, Philippines
| | - Raymond Mumme
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Komeela Naidoo
- Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | | | - Kelly Nealon
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Niki Olanrewaju
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeannette Parkes
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Willie Shaw
- University of the Free State, Bloemfontein, South Africa
| | | | - Melody Xu
- University of California San Francisco, San Francisco, CA
| | - Jinzhong Yang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lifei Zhang
- The University of Texas MD Anderson Cancer Center, Houston, TX
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16
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Gronberg MP, Beadle BM, Garden AS, Skinner H, Gay S, Netherton T, Cao W, Cardenas CE, Chung C, Fuentes DT, Fuller CD, Howell RM, Jhingran A, Lim TY, Marquez B, Mumme R, Olanrewaju AM, Peterson CB, Vazquez I, Whitaker TJ, Wooten Z, Yang M, Court LE. Deep Learning-Based Dose Prediction for Automated, Individualized Quality Assurance of Head and Neck Radiation Therapy Plans. Pract Radiat Oncol 2023; 13:e282-e291. [PMID: 36697347 DOI: 10.1016/j.prro.2022.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE This study aimed to use deep learning-based dose prediction to assess head and neck (HN) plan quality and identify suboptimal plans. METHODS AND MATERIALS A total of 245 volumetric modulated arc therapy HN plans were created using RapidPlan knowledge-based planning (KBP). A subset of 112 high-quality plans was selected under the supervision of an HN radiation oncologist. We trained a 3D Dense Dilated U-Net architecture to predict 3-dimensional dose distributions using 3-fold cross-validation on 90 plans. Model inputs included computed tomography images, target prescriptions, and contours for targets and organs at risk (OARs). The model's performance was assessed on the remaining 22 test plans. We then tested the application of the dose prediction model for automated review of plan quality. Dose distributions were predicted on 14 clinical plans. The predicted versus clinical OAR dose metrics were compared to flag OARs with suboptimal normal tissue sparing using a 2 Gy dose difference or 3% dose-volume threshold. OAR flags were compared with manual flags by 3 HN radiation oncologists. RESULTS The predicted dose distributions were of comparable quality to the KBP plans. The differences between the predicted and KBP-planned D1%,D95%, and D99% across the targets were within -2.53% ± 1.34%, -0.42% ± 1.27%, and -0.12% ± 1.97%, respectively, and the OAR mean and maximum doses were within -0.33 ± 1.40 Gy and -0.96 ± 2.08 Gy, respectively. For the plan quality assessment study, radiation oncologists flagged 47 OARs for possible plan improvement. There was high interphysician variability; 83% of physician-flagged OARs were flagged by only one of 3 physicians. The comparative dose prediction model flagged 63 OARs, including 30 of 47 physician-flagged OARs. CONCLUSIONS Deep learning can predict high-quality dose distributions, which can be used as comparative dose distributions for automated, individualized assessment of HN plan quality.
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Affiliation(s)
- Mary P Gronberg
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas.
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Heath Skinner
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Skylar Gay
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
| | - Tucker Netherton
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
| | - Wenhua Cao
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carlos E Cardenas
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Christine Chung
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David T Fuentes
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas; Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clifton D Fuller
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rebecca M Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tze Yee Lim
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
| | - Barbara Marquez
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
| | - Raymond Mumme
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adenike M Olanrewaju
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christine B Peterson
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ivan Vazquez
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas J Whitaker
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
| | - Zachary Wooten
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Statistics, Rice University, Houston, Texas
| | - Ming Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
| | - Laurence E Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
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Beadle BM, Bauman JE. Expert opinion: Reconsidering How It Begins: Response to Gray Zone Article About Head and Neck Cancer in a Young Pregnant Woman. Int J Radiat Oncol Biol Phys 2023; 115:263-264. [PMID: 36152970 DOI: 10.1016/j.ijrobp.2022.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Beth M Beadle
- Department of Radiation Oncology, Stanford University, Stanford, California.
| | - Julie E Bauman
- Department of Medicine, George Washington University, Washington, District of Columbia
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18
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Baniel CC, Klebaner D, Beadle BM, Ponce SEB, Takiar V, Gibbs IC, Soltys SG, Bagshaw HP, Chang DT, Le QT, Pollom EL. Reflections on the 2021 Accreditation Council for Graduate Medical Education and American Board of Radiology Family and Medical Leave of Absence Policies: An Opportunity to Increase Structural Support for Physicians. Int J Radiat Oncol Biol Phys 2023; 115:19-22. [PMID: 36526381 DOI: 10.1016/j.ijrobp.2022.07.1837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Claire C Baniel
- Department of Radiation Oncology, Stanford University, Stanford, California.
| | - Daniella Klebaner
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Sara E Beltrán Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - Iris C Gibbs
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Hilary P Bagshaw
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Daniel T Chang
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford University, Stanford, California
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Soto L, Nesbit S, Ramsey M, Gensheimer MF, Le QT, Beadle BM, Lui NS. Improving lung cancer screening rates among patients with head and neck cancer in a radiation oncology clinic. J Thorac Dis 2022; 14:4633-4640. [PMID: 36647458 PMCID: PMC9840013 DOI: 10.21037/jtd-22-787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/21/2022] [Indexed: 12/27/2022]
Abstract
Background The United States Preventive Services Task Force (USPSTF) recommends lung cancer screening via annual low dose computed tomography (LDCT) for high risk patients. Despite the strong evidence of a mortality benefit from several randomized clinical trials, rates of lung cancer screening remain low. We plan to assess how screening guidelines are implemented in a radiation oncology clinic for patients with head and neck cancer. Methods A single institution, retrospective chart review was used to identify patients with head and neck cancer seen in a radiation oncology clinic who were potentially eligible for lung cancer screening under the current USPSTF guidelines. Patients who were potentially screening-eligible were enrolled in a phone survey to assess their knowledge about lung cancer screening and willingness to be screened. Results Of the 184 patients with head and neck cancer seen in the clinic, 8 (4%) patients were eligible for lung cancer screening under the previous USPSTF recommendations, including 1 (0.5%) patient already being screened. One patient (0.5%) became eligible under the expanded guidelines. All 184 patients had smoking history documented. Of the 87 current or former smokers, there were 24 (28%) who did not have pack-years documented; of the 82 former smokers, there were 8 (10%) who did not have quit date documented. Among the 16 phone survey participants (response rate: 70%) only 6 (38%) were aware there is a way to screen for lung cancer and 12 (75%) patients would be interested in screening if they are found to be eligible. Conclusions These findings highlight a potential opportunity to increase rates of lung cancer screening among patients with head and neck cancer by both enhancing provider awareness as well as patient education at the community level.
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Affiliation(s)
- Lina Soto
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Shannon Nesbit
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Meghan Ramsey
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Quynh Thu Le
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Beth M. Beadle
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Natalie S. Lui
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Miller JA, Moradi F, Sundaram V, Liang R, Zhang C, Nguyen NK, Akhtar F, Liu Y, Ren Y, Harandi N, Weng Y, Pollom EL, Colevas AD, Divi V, Holsinger FC, Beadle BM, Le QT, Gensheimer MF. Posttreatment FDG-PET/CT Hopkins criteria predict locoregional recurrence after definitive radiotherapy for oropharyngeal squamous cell carcinoma. Head Neck 2022; 44:2491-2504. [PMID: 35920790 DOI: 10.1002/hed.27160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/16/2022] [Accepted: 07/15/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Metabolic response assessment for oropharyngeal squamous cell carcinoma (OPSCC) aids in identifying locoregional persistence/recurrence (LRR). The Hopkins Criteria are a standardized qualitative response assessment system using posttreatment FDG-PET/CT. METHODS We conducted a retrospective cohort study of patients with node-positive OPSCC treated with definitive (chemo)radiotherapy. We assessed Hopkins Criteria performance for LRR, then developed and validated a competing-risks model. RESULTS Between 2004 and 2018, 259 patients were included with median follow-up of 43 months. The Hopkins Criteria sensitivity, specificity, negative predictive value, and accuracy were 68%, 88%, 95%, and 85%. The 36-month cumulative incidence of LRR was greater with positive scores (45% vs. 5%, HR 12.60, p < 0.001). PET/CTs performed ≤10 weeks after radiotherapy were associated with a four-fold increase in pathologically negative biopsies/surgeries (36% vs. 9%, p = 0.03). The AUC for LRR was 0.89 using a model integrating the Hopkins score. CONCLUSIONS The Hopkins Criteria predict LRR with high accuracy for OPSCC response assessment.
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Affiliation(s)
- Jacob A Miller
- Department of Radiation Oncology, Stanford Hospital and Clinics, Stanford, California, USA
| | - Farshad Moradi
- Division of Nuclear Medicine, Department of Radiology, Stanford Hospital and Clinics, Stanford, California, USA
| | - Vandana Sundaram
- Quantitative Sciences Unit, Stanford University, Stanford, California, USA
| | - Rachel Liang
- Department of Radiation Oncology, Stanford Hospital and Clinics, Stanford, California, USA
| | - Carrie Zhang
- Department of Radiation Oncology, Stanford Hospital and Clinics, Stanford, California, USA
| | - Ngan Kim Nguyen
- Department of Radiation Oncology, Stanford Hospital and Clinics, Stanford, California, USA
| | - Faisal Akhtar
- Department of Radiation Oncology, Stanford Hospital and Clinics, Stanford, California, USA
| | - Yuhan Liu
- Quantitative Sciences Unit, Stanford University, Stanford, California, USA
| | - Yulan Ren
- Department of Radiation Oncology, Stanford Hospital and Clinics, Stanford, California, USA
| | - Nima Harandi
- Department of Radiation Oncology, Stanford Hospital and Clinics, Stanford, California, USA
| | - Yingjie Weng
- Quantitative Sciences Unit, Stanford University, Stanford, California, USA
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford Hospital and Clinics, Stanford, California, USA
| | | | - Vasu Divi
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Floyd Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford Hospital and Clinics, Stanford, California, USA
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford Hospital and Clinics, Stanford, California, USA
| | - Michael F Gensheimer
- Department of Radiation Oncology, Stanford Hospital and Clinics, Stanford, California, USA
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21
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Rhee DJ, Jhingran A, Huang K, Netherton TJ, Fakie N, White I, Sherriff A, Cardenas CE, Zhang L, Prajapati S, Kry SF, Beadle BM, Shaw W, O'Reilly F, Parkes J, Burger H, Trauernicht C, Simonds H, Court LE. Clinical acceptability of fully automated external beam radiotherapy for cervical cancer with three different beam delivery techniques. Med Phys 2022; 49:5742-5751. [PMID: 35866442 PMCID: PMC9474595 DOI: 10.1002/mp.15868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 06/16/2022] [Accepted: 07/12/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To fully automate CT‐based cervical cancer radiotherapy by automating contouring and planning for three different treatment techniques. Methods We automated three different radiotherapy planning techniques for locally advanced cervical cancer: 2D 4‐field‐box (4‐field‐box), 3D conformal radiotherapy (3D‐CRT), and volumetric modulated arc therapy (VMAT). These auto‐planning algorithms were combined with a previously developed auto‐contouring system. To improve the quality of the 4‐field‐box and 3D‐CRT plans, we used an in‐house, field‐in‐field (FIF) automation program. Thirty‐five plans were generated for each technique on CT scans from multiple institutions and evaluated by five experienced radiation oncologists from three different countries. Every plan was reviewed by two of the five radiation oncologists and scored using a 5‐point Likert scale. Results Overall, 87%, 99%, and 94% of the automatically generated plans were found to be clinically acceptable without modification for the 4‐field‐box, 3D‐CRT, and VMAT plans, respectively. Some customizations of the FIF configuration were necessary on the basis of radiation oncologist preference. Additionally, in some cases, it was necessary to renormalize the plan after it was generated to satisfy radiation oncologist preference. Conclusion Approximately, 90% of the automatically generated plans were clinically acceptable for all three planning techniques. This fully automated planning system has been implemented into the radiation planning assistant for further testing in resource‐constrained radiotherapy departments in low‐ and middle‐income countries.
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Affiliation(s)
- Dong Joo Rhee
- The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas, USA.,Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kai Huang
- The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas, USA.,Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tucker J Netherton
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nazia Fakie
- Division of Radiation Oncology and Medical Physics, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Ingrid White
- Radiotherapy Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Alicia Sherriff
- Department of Oncology, University of the Free State, Bloemfontein, South Africa
| | - Carlos E Cardenas
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lifei Zhang
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Surendra Prajapati
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen F Kry
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - William Shaw
- Department of Medical Physics (G68), University of the Free State, Bloemfontein, South Africa
| | - Frederika O'Reilly
- Department of Medical Physics (G68), University of the Free State, Bloemfontein, South Africa
| | - Jeannette Parkes
- Division of Radiation Oncology and Medical Physics, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Hester Burger
- Division of Radiation Oncology and Medical Physics, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Chris Trauernicht
- Division of Medical Physics, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Hannah Simonds
- Division of Radiation Oncology, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Laurence E Court
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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22
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Douglas RJ, Olanrewaju A, Zhang L, Beadle BM, Court LE. Assessing the practicality of using a single knowledge‐based planning model for multiple linac vendors. J Appl Clin Med Phys 2022; 23:e13704. [PMID: 35791594 PMCID: PMC9359004 DOI: 10.1002/acm2.13704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 05/18/2022] [Accepted: 05/31/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose Knowledge‐based planning (KBP) has been shown to be an effective tool in quality control for intensity‐modulated radiation therapy treatment planning and generating high‐quality plans. Previous studies have evaluated its ability to create consistent plans across institutions and between planners within the same institution as well as its use as teaching tool for inexperienced planners. This study evaluates whether planning quality is consistent when using a KBP model to plan across different treatment machines. Materials and methods This study used a RapidPlan model (Varian Medical Systems) provided by the vendor, to which we added additional planning objectives, maximum dose limits, and planning structures, such that a clinically acceptable plan is achieved in a single optimization. This model was used to generate and optimize volumetric‐modulated arc therapy plans for a cohort of 50 patients treated for head‐neck cancer. Plans were generated using the following treatment machines: Varian 2100, Elekta Versa HD, and Varian Halcyon. A noninferiority testing methodology was used to evaluate the hypothesis that normal and target metrics in our autoplans were no worse than a set of clinically‐acceptable baseline plans by a margin of 1.8 Gy or 3% dose‐volume. The quality of these plans were also compared through the use of common clinical dose‐volume histogram criteria. Results The Versa HD met our noninferiority criteria for 23 of 34 normal and target metrics; while the Halcyon and Varian 2100 machines met our criteria for 24 of 34 and 26 of 34 metrics, respectively. The experimental plans tended to have less volume coverage for prescription dose planning target volume and larger hotspot volumes. However, comparable plans were generated across different treatment machines. Conclusions These results support the use of a head‐neck RapidPlan models in centralized planning workflows that support clinics with different linac models/vendors, although some fine‐tuning for targets may be necessary.
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Affiliation(s)
- Raphael J. Douglas
- Department of Radiation Physics The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Adenike Olanrewaju
- Department of Radiation Physics The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Lifei Zhang
- Department of Radiation Physics The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Beth M. Beadle
- Department of Radiation Oncology Stanford University Palo Alto California USA
| | - Laurence E. Court
- Department of Radiation Physics The University of Texas MD Anderson Cancer Center Houston Texas USA
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23
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McDowell L, Chua MLK, Beadle BM, Ma DJ, Mierzwa M, Thomson DJ, Margalit DN. A Bit More Here and a Little Less There: The Trials (and Tribulations) of Adjuvant and Neoadjuvant Head and Neck Studies in 2021. Int J Radiat Oncol Biol Phys 2022; 113:243-251. [PMID: 35569469 DOI: 10.1016/j.ijrobp.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 11/28/2022]
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24
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Rhee DJ, Akinfenwa CPA, Rigaud B, Jhingran A, Cardenas CE, Zhang L, Prajapati S, Kry SF, Brock KK, Beadle BM, Shaw W, O'Reilly F, Parkes J, Burger H, Fakie N, Trauernicht C, Simonds H, Court LE. Automatic contouring QA method using a deep learning-based autocontouring system. J Appl Clin Med Phys 2022; 23:e13647. [PMID: 35580067 PMCID: PMC9359039 DOI: 10.1002/acm2.13647] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/27/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose To determine the most accurate similarity metric when using an independent system to verify automatically generated contours. Methods A reference autocontouring system (primary system to create clinical contours) and a verification autocontouring system (secondary system to test the primary contours) were used to generate a pair of 6 female pelvic structures (UteroCervix [uterus + cervix], CTVn [nodal clinical target volume (CTV)], PAN [para‐aortic lymph nodes], bladder, rectum, and kidneys) on 49 CT scans from our institution and 38 from other institutions. Additionally, clinically acceptable and unacceptable contours were manually generated using the 49 internal CT scans. Eleven similarity metrics (volumetric Dice similarity coefficient (DSC), Hausdorff distance, 95% Hausdorff distance, mean surface distance, and surface DSC with tolerances from 1 to 10 mm) were calculated between the reference and the verification autocontours, and between the manually generated and the verification autocontours. A support vector machine (SVM) was used to determine the threshold that separates clinically acceptable and unacceptable contours for each structure. The 11 metrics were investigated individually and in certain combinations. Linear, radial basis function, sigmoid, and polynomial kernels were tested using the combinations of metrics as inputs for the SVM. Results The highest contouring error detection accuracies were 0.91 for the UteroCervix, 0.90 for the CTVn, 0.89 for the PAN, 0.92 for the bladder, 0.95 for the rectum, and 0.97 for the kidneys and were achieved using surface DSCs with a thickness of 1, 2, or 3 mm. The linear kernel was the most accurate and consistent when a combination of metrics was used as an input for the SVM. However, the best model accuracy from the combinations of metrics was not better than the best model accuracy from a surface DSC as an input. Conclusions We distinguished clinically acceptable contours from clinically unacceptable contours with an accuracy higher than 0.9 for the targets and critical structures in patients with cervical cancer; the most accurate similarity metric was surface DSC with a thickness of 1, 2, or 3 mm.
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Affiliation(s)
- Dong Joo Rhee
- The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas, USA.,Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Bastien Rigaud
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carlos E Cardenas
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lifei Zhang
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Surendra Prajapati
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen F Kry
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kristy K Brock
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - William Shaw
- Department of Medical Physics (G68), University of the Free State, Bloemfontein, South Africa
| | - Frederika O'Reilly
- Department of Medical Physics (G68), University of the Free State, Bloemfontein, South Africa
| | - Jeannette Parkes
- Division of Radiation Oncology and Medical Physics, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Hester Burger
- Division of Radiation Oncology and Medical Physics, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Nazia Fakie
- Division of Radiation Oncology and Medical Physics, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Chris Trauernicht
- Division of Medical Physics, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Hannah Simonds
- Division of Radiation Oncology, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Laurence E Court
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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25
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McGinnis GJ, Ning MS, Beadle BM, Joubert N, Shaw W, Trauernich C, Simonds H, Grover S, Cardenas CE, Court LE, Smith GL. Barriers and Facilitators of Implementing Automated Radiotherapy Planning: A Multisite Survey of Low- and Middle-Income Country Radiation Oncology Providers. JCO Glob Oncol 2022; 8:e2100431. [PMID: 35537104 PMCID: PMC9126530 DOI: 10.1200/go.21.00431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/18/2022] [Accepted: 03/30/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Global access to radiotherapy (RT) is inequitable, with obstacles to implementing modern technologies in low- and middle- income countries (LMICs). The Radiation Planning Assistant (RPA) is a web-based automated RT planning software package intended to increase accessibility of high-quality RT planning. We surveyed LMIC RT providers to identify barriers and facilitators of future RPA deployment and uptake. METHODS RT providers underwent a pilot RPA teaching session in sub-Saharan Africa (Botswana, South Africa, and Tanzania) and Central America (Guatemala). Thirty providers (30 of 33, 90.9% response rate) participated in a postsession survey. RESULTS Respondents included physicians (n = 10, 33%), physicists (n = 9, 30%), dosimetrists (n = 8, 27%), residents/registrars (n = 1, 3.3%), radiation therapists (n = 1, 3.3%), and administrators (n = 1, 3.3%). Overall, 86.7% expressed interest in RPA; more respondents expected that RPA would be usable in 2 years (80%) compared with now (60%). Anticipated barriers were lack of reliable internet (80%), potential subscription fees (60%), and need for functionality in additional disease sites (48%). Expected facilitators included decreased workload (80%), decreased planning time (72%), and ability to treat more patients (64%). Forty-four percent anticipated that RPA would help transition from 2-dimensional to 3-dimensional techniques and 48% from 3-dimensional to intensity-modulated radiation treatment. Of a maximum acceptability/feasibility score of 60, physicians (45.6, standard deviation [SD] = 7.5) and dosimetrists (44.3, SD = 9.1) had lower scores than the mean for all respondents (48.3, SD = 7.7) although variation in scores by roles was not significantly different (P = .21). CONCLUSION These data provide an early assessment and create an initial framework to identify stakeholder needs and establish priorities to address barriers and promote facilitators of RPA deployment and uptake across global sites, as well as to tailor to needs in LMICs.
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Affiliation(s)
- Gwendolyn J. McGinnis
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Matthew S. Ning
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Beth M. Beadle
- Department of Radiation Oncology, Stanford University, Palo Alto, CA
| | - Nanette Joubert
- Division of Medical Physics, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - William Shaw
- Department of Medical Physics (G68), University of the Free State, Bloemfontein, South Africa
| | - Christoph Trauernich
- Division of Medical Physics, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Hannah Simonds
- Division of Radiation Oncology, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Surbhi Grover
- School of Medicine, University of Botswana, Gaborone, Botswana
- Princess Marina Hospital, Gaborone, Botswana
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Botswana University of Pennsylvania Partnership, Gaborone, Botswana
| | - Carlos E. Cardenas
- Department of Radiation Physics, The University of Alabama at Birmingham, Birmingham, AL
| | - Laurence E. Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Grace L. Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
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26
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Ward MC, Koyfman SA, Bakst RL, Margalit DN, Beadle BM, Beitler JJ, Chang SSW, Cooper JS, Galloway TJ, Ridge JA, Robbins JR, Sacco AG, Tsai CJ, Yom SS, Siddiqui F. Retreatment of Recurrent or Second Primary Head and Neck Cancer After Prior Radiation: Executive Summary of the American Radium Society® (ARS) Appropriate Use Criteria (AUC): Expert Panel on Radiation Oncology - Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2022; 113:759-786. [PMID: 35398456 DOI: 10.1016/j.ijrobp.2022.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/16/2022] [Accepted: 03/28/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Re-treatment of recurrent or second primary head and neck cancers occurring in a previously irradiated field is complex. Few guidelines exist to support practice. METHODS We performed an updated literature search of peer-reviewed journals in a systematic fashion. Search terms, key questions, and associated clinical case variants were formed by panel consensus. The literature search informed the committee during a blinded vote on the appropriateness of treatment options via the modified Delphi method. RESULTS The final number of citations retained for review was 274. These informed five key questions, which focused on patient selection, adjuvant re-irradiation, definitive re-irradiation, stereotactic body radiation (SBRT), and re-irradiation to treat non-squamous cancer. Results of the consensus voting are presented along with discussion of the most current evidence. CONCLUSIONS This provides updated evidence-based recommendations and guidelines for the re-treatment of recurrent or second primary cancer of the head and neck.
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Affiliation(s)
- Matthew C Ward
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina; Southeast Radiation Oncology Group, Charlotte, North Carolina.
| | | | | | - Danielle N Margalit
- Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Beth M Beadle
- Stanford University School of Medicine, Palo Alto, California
| | | | | | | | | | - John A Ridge
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jared R Robbins
- University of Arizona College of Medicine Tucson, Tucson, Arizona
| | - Assuntina G Sacco
- University of California San Diego Moores Cancer Center, La Jolla, California
| | - C Jillian Tsai
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sue S Yom
- University of California, San Francisco, California
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27
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Miller JA, Beadle BM, Gensheimer MF, Le QT. De-escalating elective nodal irradiation for nasopharyngeal carcinoma. Lancet Oncol 2022; 23:441-443. [DOI: 10.1016/s1470-2045(22)00096-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/28/2022]
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28
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Soo J, Jin MC, Beadle BM, Holsinger FC, Finegersh A. Circulating tumor DNA in head and neck cancer: Early successes and future promise. Cancer 2022; 128:2061-2063. [PMID: 35298053 DOI: 10.1002/cncr.34189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/13/2022] [Indexed: 12/12/2022]
Abstract
LAY SUMMARY The genetic components (DNA) of human papillomavirus-related throat cancer (in the oropharynx) might be measured after surgery to help to predict whether treatment has been successful.
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Affiliation(s)
- Joanne Soo
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Palo Alto, California
| | - Michael C Jin
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Palo Alto, California
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
| | - F Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Palo Alto, California
| | - Andrey Finegersh
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Palo Alto, California
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29
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Molkentine DP, Molkentine JM, Bridges KA, Valdecanas DR, Dhawan A, Bahri R, Hefner AJ, Kumar M, Yang L, Abdelhakiem M, Pifer PM, Sandulache V, Sheth A, Beadle BM, Thames HD, Mason KA, Pickering CR, Meyn RE, Skinner HD. p16 Represses DNA Damage Repair via a Novel Ubiquitin-Dependent Signaling Cascade. Cancer Res 2022; 82:916-928. [PMID: 34965932 PMCID: PMC9136619 DOI: 10.1158/0008-5472.can-21-2101] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/07/2021] [Accepted: 12/27/2021] [Indexed: 01/07/2023]
Abstract
Squamous cell carcinoma driven by human papillomavirus (HPV) is more sensitive to DNA-damaging therapies than its HPV-negative counterpart. Here, we show that p16, the clinically used surrogate for HPV positivity, renders cells more sensitive to radiotherapy via a ubiquitin-dependent signaling pathway, linking high levels of this protein to increased activity of the transcription factor SP1, increased HUWE1 transcription, and degradation of ubiquitin-specific protease 7 (USP7) and TRIP12. Activation of this pathway in HPV-positive disease led to decreased homologous recombination and improved response to radiotherapy, a phenomenon that can be recapitulated in HPV-negative disease using USP7 inhibitors in clinical development. This p16-driven axis induced sensitivity to PARP inhibition and potentially leads to "BRCAness" in head and neck squamous cell carcinoma (HNSCC) cells. Thus, these findings support a functional role for p16 in HPV-positive tumors in driving response to DNA damage, which can be exploited to improve outcomes in both patients with HPV-positive and HPV-negative HNSCC. SIGNIFICANCE In HPV-positive tumors, a previously undiscovered pathway directly links p16 to DNA damage repair and sensitivity to radiotherapy via a clinically relevant and pharmacologically targetable ubiquitin-mediated degradation pathway.
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Affiliation(s)
- David P. Molkentine
- Department of Radiation Oncology, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Jessica M. Molkentine
- Department of Radiation Oncology, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Kathleen A. Bridges
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David R. Valdecanas
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Annika Dhawan
- Department of Radiation Oncology, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Reshub Bahri
- Department of Radiation Oncology, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Andrew J. Hefner
- Department of Radiation Oncology, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Manish Kumar
- Department of Biochemistry, AIMS, Bilaspur, Himachal Pradesh, India
| | - Liangpeng Yang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mohamed Abdelhakiem
- Department of Radiation Oncology, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Phillip M. Pifer
- Department of Radiation Oncology, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Vlad Sandulache
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston Texas
| | - Aakash Sheth
- Department of Internal Medicine, Baylor College of Medicine, Houston Texas
| | - Beth M. Beadle
- Department of Radiation Oncology, Stanford University, Stanford California
| | - Howard D. Thames
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kathryn A. Mason
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Curtis R. Pickering
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Raymond E. Meyn
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Heath D. Skinner
- Department of Radiation Oncology, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
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Peterson SK, Basen-Engquist K, Demark-Wahnefried W, Prokhorov AV, Shinn EH, Martch SL, Beadle BM, Garden AS, Farcas E, Brandon Gunn G, Fuller CD, Morrison WH, Rosenthal DI, Phan J, Eng C, Cinciripini PM, Karam-Hage MA, Camero Garcia M, Patrick K. Feasibility of Mobile and Sensor Technology for Remote Monitoring in Cancer Care and Prevention. AMIA Annu Symp Proc 2022; 2021:979-988. [PMID: 35308916 PMCID: PMC8861680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objectives. Remote monitoring (RM) of health-related outcomes may optimize cancer care and prevention outside of clinic settings. CYCORE is a software-based system for collection and analyses of sensor and mobile data. We evaluated CYCORE's feasibility in studies assessing: (1) physical functioning in colorectal cancer (CRC) patients; (2) swallowing exercise adherence in head and neck cancer (HNC) patients during radiation therapy; and (3) tobacco use in cancer survivors post-tobacco treatment (TTP). Methods. Participants completed RM: for CRC, blood pressure, activity, GPS; for HNC, video of swallowing exercises; for TTP, expired carbon monoxide. Patient-reported outcomes were assessed daily. Results. For CRC, HNC and TTP, respectively, 50, 37, and 50 participants achieved 96%, 84%, 96% completion rates. Also, 91-100% rated ease and self-efficacy as highly favorable, 72-100% gave equivalent ratings for overall satisfaction, 72-93% had low/no data privacy concerns. Conclusion. RM was highly feasible and acceptable for patients across diverse use cases.
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Affiliation(s)
- Susan K Peterson
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | | | | | - Eileen H Shinn
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Beth M Beadle
- Stanford University Medical Center, Stanford, California, USA
| | - Adam S Garden
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Emilia Farcas
- University of California-San Diego, The Qualcomm Institute/Calit2, San Diego, California, USA
| | - G Brandon Gunn
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Clifton D Fuller
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - David I Rosenthal
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jack Phan
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cathy Eng
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | | | | | | | - Kevin Patrick
- University of California-San Diego, The Qualcomm Institute/Calit2, San Diego, California, USA
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31
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Kumar M, Molkentine D, Molkentine J, Bridges K, Xie T, Yang L, Hefner A, Gao M, Bahri R, Dhawan A, Frederick MJ, Seth S, Abdelhakiem M, Beadle BM, Johnson F, Wang J, Shen L, Heffernan T, Sheth A, Ferris RL, Myers JN, Pickering CR, Skinner HD. Inhibition of histone acetyltransferase function radiosensitizes CREBBP/EP300 mutants via repression of homologous recombination, potentially targeting a gain of function. Nat Commun 2021; 12:6340. [PMID: 34732714 PMCID: PMC8566594 DOI: 10.1038/s41467-021-26570-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 10/12/2021] [Indexed: 12/24/2022] Open
Abstract
Despite radiation forming the curative backbone of over 50% of malignancies, there are no genomically-driven radiosensitizers for clinical use. Herein we perform in vivo shRNA screening to identify targets generally associated with radiation response as well as those exhibiting a genomic dependency. This identifies the histone acetyltransferases CREBBP/EP300 as a target for radiosensitization in combination with radiation in cognate mutant tumors. Further in vitro and in vivo studies confirm this phenomenon to be due to repression of homologous recombination following DNA damage and reproducible using chemical inhibition of histone acetyltransferase (HAT), but not bromodomain function. Selected mutations in CREBBP lead to a hyperacetylated state that increases CBP and BRCA1 acetylation, representing a gain of function targeted by HAT inhibition. Additionally, mutations in CREBBP/EP300 are associated with recurrence following radiation in squamous cell carcinoma cohorts. These findings provide both a mechanism of resistance and the potential for genomically-driven treatment.
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Affiliation(s)
- Manish Kumar
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Bilaspur, Himachal Pradesh, India
| | - David Molkentine
- Department of Radiation Oncology, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Jessica Molkentine
- Department of Radiation Oncology, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Kathleen Bridges
- Department of Experimental Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Tongxin Xie
- Department of Head and Neck Surgery, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Liangpeng Yang
- Department of Experimental Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew Hefner
- Department of Radiation Oncology, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Meng Gao
- Department of Head and Neck Surgery, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Reshub Bahri
- Department of Radiation Oncology, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Annika Dhawan
- Department of Radiation Oncology, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Mitchell J Frederick
- Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Sahil Seth
- TRACTION Platform, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Mohamed Abdelhakiem
- Department of Radiation Oncology, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Faye Johnson
- Department of Thoracic and Head and Neck Medical Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
- The University of Texas Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Jing Wang
- The University of Texas Graduate School of Biomedical Sciences, Houston, TX, USA
- Department of Biostatistics, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Li Shen
- Department of Biostatistics, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Timothy Heffernan
- TRACTION Platform, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Aakash Sheth
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Jeffrey N Myers
- Department of Head and Neck Surgery, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
- The University of Texas Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Curtis R Pickering
- Department of Head and Neck Surgery, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
- The University of Texas Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Heath D Skinner
- Department of Radiation Oncology, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
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Mierzwa M, Beadle BM, Chua MLK, Ma DJ, Thomson DJ, Margalit DN. Something for Everyone From Low-Risk to High-Risk: 5 Recent Studies to Improve Treatment and Surveillance for All Patients With Squamous Cell Carcinoma of the Head and Neck. Int J Radiat Oncol Biol Phys 2021; 111:1-8. [PMID: 34348102 DOI: 10.1016/j.ijrobp.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Melvin L K Chua
- Divisions of Radiation Oncology and Medical Sciences, National Cancer Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | | | - David J Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Danielle N Margalit
- Brigham & Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
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Xiang M, Holsinger FC, Gensheimer MF, Divi V, Pollom EL, Colevas AD, Le QT, Beadle BM. Postoperative Observation Versus Radiotherapy for Pathologic N1 Oral Cavity Squamous Cell Carcinoma. Am J Clin Oncol 2021; 44:99-104. [PMID: 33417322 DOI: 10.1097/coc.0000000000000792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the benefit of postoperative radiotherapy (PORT) for low-volume (pN1) nodal disease after resection of oral cavity squamous cell carcinoma. MATERIALS AND METHODS The National Cancer Database was queried for adults with nonmetastatic squamous cell carcinoma of the oral cavity treated by surgical resection with pathologic stage T1-2 N0-2 (American Joint Committee on Cancer 7th edition) and with the maximal exclusion of standard indications for PORT. Overall survival was compared within pN1 for observation versus PORT and then compared for pN1 versus pN0 and versus pN2 stratified by receipt of observation or PORT. Multivariable Cox regression was used to adjust for potential confounders between PORT and survival, including comorbidity and age. RESULTS Overall 5017 pN0, 530 pN1, and 253 pN2 patients were identified, of whom 9%, 35%, and 64% received PORT, respectively. Within the pN1 cohort, PORT was associated with improved survival versus observation (adjusted hazard ratio, 0.66; 95% confidence interval, 0.46-0.97; P=0.03). Among observed patients, the prognosis of pN1 was equivalent to pN2 and inferior to pN0; in contrast, among patients treated with PORT, the prognosis of pN1 was equivalent to pN0 and superior to pN2. Without PORT, pN1 remained an adverse risk factor relative to pN0 regardless of the depth of invasion, lymph node size, lymph node location, and extent of lymph node dissection. CONCLUSIONS PORT was associated with a survival benefit compared with observation. Notably, pN1 was an adverse risk factor relative to pN0 if, and only if, patients did not receive PORT, suggesting pN1 by itself may be an indication for PORT.
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Affiliation(s)
- Michael Xiang
- Department of Radiation Oncology, University of California, Los Angeles
- Palo Alto Veterans Affairs Hospital, Palo Alto, CA
| | | | | | - Vasu Divi
- Department of Otolaryngology, Division of Head and Neck Surgery
| | - Erqi L Pollom
- Department of Radiation Oncology
- Palo Alto Veterans Affairs Hospital, Palo Alto, CA
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Olanrewaju A, Court LE, Zhang L, Naidoo K, Burger H, Dalvie S, Wetter J, Parkes J, Trauernicht CJ, McCarroll RE, Cardenas C, Peterson CB, Benson KRK, du Toit M, van Reenen R, Beadle BM. Clinical Acceptability of Automated Radiation Treatment Planning for Head and Neck Cancer Using the Radiation Planning Assistant. Pract Radiat Oncol 2021; 11:177-184. [PMID: 33640315 DOI: 10.1016/j.prro.2020.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/25/2020] [Accepted: 12/08/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Radiation treatment planning for head and neck cancer is a complex process with much variability; automated treatment planning is a promising option to improve plan quality and efficiency. This study compared radiation plans generated from a fully automated radiation treatment planning system to plans generated manually that had been clinically approved and delivered. METHODS AND MATERIALS The study cohort consisted of 50 patients treated by a specialized head and neck cancer team at a tertiary care center. An automated radiation treatment planning system, the Radiation Planning Assistant, was used to create autoplans for all patients using their original, approved contours. Common dose-volume histogram (DVH) criteria were used to compare the quality of autoplans to the clinical plans. Fourteen radiation oncologists, each from a different institution, then reviewed and compared the autoplans and clinical plans in a blinded fashion. RESULTS Autoplans and clinical plans were very similar with regard to DVH metrics for coverage and critical structure constraints. Physician reviewers found both the clinical plans and autoplans acceptable for use; overall, 78% of the clinical plans and 88% of the autoplans were found to be usable as is (without any edits). When asked to choose which plan would be preferred for approval, 27% of physician reviewers selected the clinical plan, 47% selected the autoplan, 25% said both were equivalent, and 0% said neither. Hence, overall, 72% of physician reviewers believed the autoplan or either the clinical or autoplan was preferable. CONCLUSIONS Automated radiation treatment planning creates consistent, clinically acceptable treatment plans that meet DVH criteria and are found to be appropriate on physician review.
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Affiliation(s)
- Adenike Olanrewaju
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Laurence E Court
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lifei Zhang
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Komeela Naidoo
- Department of Radiation Oncology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Hester Burger
- Department of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Sameera Dalvie
- Department of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Julie Wetter
- Department of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Jeannette Parkes
- Department of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Christoph J Trauernicht
- Department of Radiation Oncology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Rachel E McCarroll
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carlos Cardenas
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christine B Peterson
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kathryn R K Benson
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Monique du Toit
- Department of Radiation Oncology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Ricus van Reenen
- Department of Radiation Oncology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford University, Stanford, California.
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Margalit DN, Sacco AG, Cooper JS, Ridge JA, Bakst RL, Beadle BM, Beitler JJ, Chang SS, Chen AM, Galloway TJ, Koyfman SA, Mita C, Robbins JR, Tsai CJ, Truong MT, Yom SS, Siddiqui F. Systematic review of postoperative therapy for resected squamous cell carcinoma of the head and neck: Executive summary of the American Radium Society appropriate use criteria. Head Neck 2021; 43:367-391. [PMID: 33098180 PMCID: PMC7756212 DOI: 10.1002/hed.26490] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The aims of this systematic review are to (a) evaluate the current literature on the impact of postoperative therapy for resected squamous cell carcinoma of the head and neck (SCCHN) on oncologic and non-oncologic outcomes and (b) identify the optimal evidence-based postoperative therapy recommendations for commonly encountered clinical scenarios. METHODS An analysis of the medical literature from peer-reviewed journals was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. Prospective studies and methodology-based systematic reviews and meta-analyses of postoperative therapy for SCCHN were identified by searching Medline (OVID) and EMBASE (Elsevier) using controlled vocabulary terms (ie, National Library of Medicine Medical Subject Headings [MeSH], EMTREE). Study screening and selection was performed with Covidence software and full-text review. The RAND/UCLA appropriateness method was used by the expert panel to rate the appropriate use of postoperative therapy, and the modified Delphi method was used to come to consensus. RESULTS A total of 5660 studies were identified and screened using the title and abstract, leading to 201 studies assessed for relevance using full-text review. After limitation to the eligibility criteria, 101 studies from 1977 to 2020 were identified, including 77 with oncologic endpoints and 24 with function and quality of life endpoints. All studies reported staging prior to the implementation of American Joint Committee on Cancer (AJCC-8). CONCLUSIONS Prospective clinical studies and systematic reviews identified through the PRISMA systematic review provided good evidence for consensus statements regarding the appropriate use of postoperative therapy for resected SCCHN. Further research is needed in domains where consensus by the expert panel could not be achieved for the appropriateness of specific postoperative therapeutic interventions.
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Affiliation(s)
- Danielle N. Margalit
- Dana‐Farber/Brigham & Women's Cancer Center, Harvard Medical SchoolBostonMassachusettsUSA
| | | | | | | | | | - Beth M. Beadle
- Stanford University School of MedicineStanfordCaliforniaUSA
| | | | | | | | | | | | - Carol Mita
- Countway Library, Harvard Medical SchoolBostonMassachusettsUSA
| | | | | | - Minh T. Truong
- Boston University School of MedicineBostonMassachusettsUSA
| | - Sue S. Yom
- University of CaliforniaSan FranciscoCaliforniaUSA
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Tsai CJ, Galloway TJ, Margalit DN, Bakst RL, Beadle BM, Beitler JJ, Chang S, Chen A, Cooper J, Koyfman SA, Ridge JA, Robbins J, Truong MT, Yom SS, Siddiqui F. Ipsilateral radiation for squamous cell carcinoma of the tonsil: American Radium Society appropriate use criteria executive summary. Head Neck 2021; 43:392-406. [PMID: 33068064 PMCID: PMC9128573 DOI: 10.1002/hed.26492] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND We conducted the current systemic review to provide up-to-date literature summary and optimal evidence-based recommendations for ipsilateral radiation for squamous cell carcinoma of the tonsil. METHODS We performed literature search of peer-reviewed journals through PubMed. The search strategy and subject-specific keywords were developed based on the expert panel's consensus. Articles published from January 2000 to May 2020 with full text available on PubMed and restricted to the English language and human subjects were included. Several prespecified search terms were used to identify relevant publications and additional evidence published since the initial American College of Radiology Appropriateness Criteria Ipsilateral Tonsil Radiation recommendation was finalized in 2012. The full bibliographies of identified articles were reviewed and irrelevant studies were removed. RESULTS The initial search and review returned 46 citations. The authors added three citations from bibliographies, websites, or books not found in the literature search. Of the 49 citations, 30 citations were retained for further detailed review, and 14 of them were added to the evidence table. Articles were removed from the bibliography if they were not relevant or generalizable to the topic, or focused on unknown primary disease. Several commonly encountered clinical case variants were created and panelists anonymously rated each treatment recommendation. The results were reviewed and disagreements discussed. CONCLUSIONS The panel provided updated evidence and recommendations for ipsilateral radiation for squamous cell carcinoma of the tonsil in the setting of primary radiation-based therapy and postoperative adjuvant radiotherapy. This committee did not reach agreements for some case variants due to a lack of strong evidence supporting specific treatment decisions, indicating a further need for research in these topics.
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Affiliation(s)
- C Jillian Tsai
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Danielle N Margalit
- Dana Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard L Bakst
- Mount Sinai Icahn School of Medicine, New York, New York, USA
| | - Beth M Beadle
- Stanford University School of Medicine, Stanford, California, USA
| | | | - Steven Chang
- Henry Ford Cancer Institute, Detroit, Michigan, USA
| | - Allen Chen
- University of California, Irvine, California, USA
| | - Jay Cooper
- Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - John A Ridge
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Jared Robbins
- University of Arizona Cancer Center, Phoenix, Arizona, USA
| | - Minh Tam Truong
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Sue S Yom
- University of California San Francisco, San Francisco, California, USA
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37
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Xiang M, Gensheimer MF, Pollom EL, Holsinger FC, Colevas AD, Le QT, Beadle BM. Prolongation of definitive head and neck cancer radiotherapy: Survival impact and predisposing factors. Radiother Oncol 2020; 156:201-208. [PMID: 33383061 DOI: 10.1016/j.radonc.2020.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE To quantify the survival impact of prolongation of definitive radiotherapy (RT) for head and neck cancer in a national, modern cohort, and to identify predictive factors for prolongation. MATERIALS AND METHODS The National Cancer Database was queried for adults with non-metastatic cancer of the nasopharynx, oropharynx, larynx, or hypopharynx diagnosed 2004-2015, treated with definitive RT to 66-70 Gy in 30-35 fractions at 2-2.2 Gy per fraction. Multivariable Cox regression and propensity score matching were used to model the survival impact of RT prolongation, adjusting for potential confounders such as age and comorbidity. Predictors of RT prolongation were identified using multivariable multinomial logistic regression. RESULTS In total, 36,367 patients were identified. As a continuous variable, RT prolongation increased the relative hazard of death by 2% per day (P < .0001). In the matched cohorts, patients with short (4-8 days) or long prolongation (>8 days) had lower absolute 4-year overall survival by 4% and 12%, respectively (P < .0001), while prolongation of 1-3 days was not significantly adverse. Major predictors of increased risk of prolongation were administration of systemic therapy, baseline comorbidity, lack of private insurance, and tumor/nodal stage. Conversely, higher facility volume was significantly protective, with a 55% lower risk of long prolongation within the topmost quartile (>11.5 patients/year). CONCLUSION RT prolongation, especially >8 days, is significantly deleterious. Systemic therapy and facility volume were major predictors. Early identification of patients at increased risk of treatment interruptions may facilitate implementation of preventive measures.
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Affiliation(s)
- Michael Xiang
- Radiation Oncology, University of California, Los Angeles, United States; Palo Alto Veterans Affairs Hospital, United States
| | | | - Erqi L Pollom
- Radiation Oncology, Stanford University, United States; Palo Alto Veterans Affairs Hospital, United States
| | | | | | - Quynh-Thu Le
- Radiation Oncology, Stanford University, United States
| | - Beth M Beadle
- Radiation Oncology, Stanford University, United States.
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Netherton TJ, Cardenas CE, Rhee DJ, Court LE, Beadle BM. The Emergence of Artificial Intelligence within Radiation Oncology Treatment Planning. Oncology 2020; 99:124-134. [PMID: 33352552 DOI: 10.1159/000512172] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The future of artificial intelligence (AI) heralds unprecedented change for the field of radiation oncology. Commercial vendors and academic institutions have created AI tools for radiation oncology, but such tools have not yet been widely adopted into clinical practice. In addition, numerous discussions have prompted careful thoughts about AI's impact upon the future landscape of radiation oncology: How can we preserve innovation, creativity, and patient safety? When will AI-based tools be widely adopted into the clinic? Will the need for clinical staff be reduced? How will these devices and tools be developed and regulated? SUMMARY In this work, we examine how deep learning, a rapidly emerging subset of AI, fits into the broader historical context of advancements made in radiation oncology and medical physics. In addition, we examine a representative set of deep learning-based tools that are being made available for use in external beam radiotherapy treatment planning and how these deep learning-based tools and other AI-based tools will impact members of the radiation treatment planning team. Key Messages: Compared to past transformative innovations explored in this article, such as the Monte Carlo method or intensity-modulated radiotherapy, the development and adoption of deep learning-based tools is occurring at faster rates and promises to transform practices of the radiation treatment planning team. However, accessibility to these tools will be determined by each clinic's access to the internet, web-based solutions, or high-performance computing hardware. As seen by the trends exhibited by many technologies, high dependence on new technology can result in harm should the product fail in an unexpected manner, be misused by the operator, or if the mitigation to an expected failure is not adequate. Thus, the need for developers and researchers to rigorously validate deep learning-based tools, for users to understand how to operate tools appropriately, and for professional bodies to develop guidelines for their use and maintenance is essential. Given that members of the radiation treatment planning team perform many tasks that are automatable, the use of deep learning-based tools, in combination with other automated treatment planning tools, may refocus tasks performed by the treatment planning team and may potentially reduce resource-related burdens for clinics with limited resources.
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Affiliation(s)
- Tucker J Netherton
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA, .,The University of Texas MD Anderson Graduate School of Biomedical Science, Houston, Texas, USA,
| | - Carlos E Cardenas
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dong Joo Rhee
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,The University of Texas MD Anderson Graduate School of Biomedical Science, Houston, Texas, USA
| | - Laurence E Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Beth M Beadle
- Department of Radiation Oncology and Radiation Therapy, Stanford University, Stanford, California, USA
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Cardenas CE, Beadle BM, Garden AS, Skinner HD, Yang J, Rhee DJ, McCarroll RE, Netherton TJ, Gay SS, Zhang L, Court LE. Generating High-Quality Lymph Node Clinical Target Volumes for Head and Neck Cancer Radiation Therapy Using a Fully Automated Deep Learning-Based Approach. Int J Radiat Oncol Biol Phys 2020; 109:801-812. [PMID: 33068690 PMCID: PMC9472456 DOI: 10.1016/j.ijrobp.2020.10.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/12/2020] [Accepted: 10/06/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To develop a deep learning model that generates consistent, high-quality lymph node clinical target volumes (CTV) contours for head and neck cancer (HNC) patients, as an integral part of a fully automated radiation treatment planning workflow. METHODS AND MATERIALS Computed tomography (CT) scans from 71 HNC patients were retrospectively collected and split into training (n = 51), cross-validation (n = 10), and test (n = 10) data sets. All had target volume delineations covering lymph node levels Ia through V (Ia-V), Ib through V (Ib-V), II through IV (II-IV), and retropharyngeal (RP) nodes, which were previously approved by a radiation oncologist specializing in HNC. Volumes of interest (VOIs) about nodal levels were automatically identified using computer vision techniques. The VOI (cropped CT image) and approved contours were used to train a U-Net autosegmentation model. Each lymph node level was trained independently, with model parameters optimized by assessing performance on the cross-validation data set. Once optimal model parameters were identified, overlap and distance metrics were calculated between ground truth and autosegmentations on the test set. Lastly, this final model was used on 32 additional patient scans (not included in original 71 cases) and autosegmentations visually rated by 3 radiation oncologists as being "clinically acceptable without requiring edits," "requiring minor edits," or "requiring major edits." RESULTS When comparing ground truths to autosegmentations on the test data set, median Dice Similarity Coefficients were 0.90, 0.90, 0.89, and 0.81, and median mean surface distance values were 1.0 mm, 1.0 mm, 1.1 mm, and 1.3 mm for node levels Ia-V, Ib-V, II-IV, and RP nodes, respectively. Qualitative scoring varied among physicians. Overall, 99% of autosegmented target volumes were either scored as being clinically acceptable or requiring minor edits (ie, stylistic recommendations, <2 minutes). CONCLUSIONS We developed a fully automated artificial intelligence approach to autodelineate nodal CTVs for patients with intact HNC. Most autosegmentations were found to be clinically acceptable after qualitative review when considering recommended stylistic edits. This promising work automatically delineates nodal CTVs in a robust and consistent manner; this approach can be implemented in ongoing efforts for fully automated radiation treatment planning.
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Affiliation(s)
- Carlos E Cardenas
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | - Adam S Garden
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Heath D Skinner
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jinzhong Yang
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dong Joo Rhee
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rachel E McCarroll
- Department of Radiation Oncology, University of Maryland Medical System, Baltimore, Maryland
| | - Tucker J Netherton
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Skylar S Gay
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lifei Zhang
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Laurence E Court
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
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Kisling K, Cardenas C, Anderson BM, Zhang L, Jhingran A, Simonds H, Balter P, Howell RM, Schmeler K, Beadle BM, Court L. Automatic Verification of Beam Apertures for Cervical Cancer Radiation Therapy. Pract Radiat Oncol 2020; 10:e415-e424. [PMID: 32450365 PMCID: PMC8133770 DOI: 10.1016/j.prro.2020.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 03/16/2020] [Accepted: 05/03/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Automated tools can help identify radiation treatment plans of unacceptable quality. To this end, we developed a quality verification technique to automatically verify the clinical acceptability of beam apertures for 4-field box treatments of patients with cervical cancer. By comparing the beam apertures to be used for treatment with a secondary set of beam apertures developed automatically, this quality verification technique can flag beam apertures that may need to be edited to be acceptable for treatment. METHODS AND MATERIALS The automated methodology for creating verification beam apertures uses a deep learning model trained on beam apertures and digitally reconstructed radiographs from 255 clinically acceptable planned treatments (as rated by physicians). These verification apertures were then compared with the treatment apertures using spatial comparison metrics to detect unacceptable treatment apertures. We tested the quality verification technique on beam apertures from 80 treatment plans. Each plan was rated by physicians, where 57 were rated clinically acceptable and 23 were rated clinically unacceptable. RESULTS Using various comparison metrics (the mean surface distance, Hausdorff distance, and Dice similarity coefficient) for the 2 sets of beam apertures, we found that treatment beam apertures rated acceptable had significantly better agreement with the verification beam apertures than those rated unacceptable (P < .01). Upon receiver operating characteristic analysis, we found the area under the curve for all metrics to be 0.89 to 0.95, which demonstrated the high sensitivity and specificity of our quality verification technique. CONCLUSIONS We found that our technique of automatically verifying the beam aperture is an effective tool for flagging potentially unacceptable beam apertures during the treatment plan review process. Accordingly, we will clinically deploy this quality verification technique as part of a fully automated treatment planning tool and automated plan quality assurance program.
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Affiliation(s)
- Kelly Kisling
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carlos Cardenas
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brian M Anderson
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lifei Zhang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hannah Simonds
- Division of Radiation Oncology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Peter Balter
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rebecca M Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kathleen Schmeler
- Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Beth M Beadle
- Department of Radiation Oncology - Radiation Therapy, Stanford University, Stanford, California
| | - Laurence Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Xiang M, Colevas AD, Holsinger FC, Le QTX, Beadle BM. Survival After Definitive Chemoradiotherapy With Concurrent Cisplatin or Carboplatin for Head and Neck Cancer. J Natl Compr Canc Netw 2020; 17:1065-1073. [PMID: 31487677 DOI: 10.6004/jnccn.2019.7297] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/15/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND For definitive chemoradiotherapy (chemoRT) of head and neck squamous cell carcinoma (HNSCC), cisplatin is the preferred concurrent agent, with superiority over cetuximab for HPV-associated oropharyngeal squamous carcinoma recently shown in 2 randomized trials (RTOG 1016 and De-ESCALaTE). Patients who are not candidates for cisplatin may be treated with carboplatin instead, but its comparative efficacy is unclear. We analyzed nationwide patterns of care and cancer-specific outcomes after cisplatin- versus carboplatin-based chemoRT. PATIENTS AND METHODS Patients with locoregionally advanced (stages III-IVB according to the 6th and 7th editions of the AJCC Cancer Staging Manual) squamous cell carcinoma of the oropharynx, larynx, or hypopharynx who received definitive radiotherapy (RT) were identified in the linked SEER-Medicare database. The concurrent chemotherapy regimen was determined through corresponding Medicare claims. Death caused by HNSCC (cancer-specific mortality [CSM]) was analyzed with competing risks. Propensity score analysis and multivariable Fine-Gray regression were used to adjust for baseline differences, including age and comorbidity. RESULTS We identified 807 patients who received cisplatin-based chemoRT and 342 who received carboplatin-based chemoRT. Most carboplatin recipients (68%) had combination chemotherapy, predominantly with paclitaxel. Carboplatin- and cisplatin-based chemoRT had similar incidences of death attributable to HNSCC (3-year CSM, 29% vs 26%; P=.19), which persisted in propensity score-matched analysis. In addition, no significant difference in overall survival was seen in the matched cohorts. ChemoRT with either cisplatin or carboplatin was superior to RT alone and RT with concurrent cetuximab. In the multivariable model, the adjusted hazard ratio of CSM for carboplatin relative to cisplatin was 1.01 (95% CI, 0.79-1.28; P=.94). CONCLUSIONS Definitive carboplatin-based chemoRT was equivalent to cisplatin-based therapy and superior to RT alone and RT with concurrent cetuximab. In light of recent results of the RTOG 1016 and De-ESCALaTE trials, our findings suggest that carboplatin-based regimens warrant prospective investigation as an alternative to cisplatin for patients who are not cisplatin candidates.
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Affiliation(s)
| | | | - F Christopher Holsinger
- Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University, Stanford, California
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Kisling K, Zhang L, Simonds H, Fakie N, Yang J, McCarroll R, Balter P, Burger H, Bogler O, Howell R, Schmeler K, Mejia M, Beadle BM, Jhingran A, Court L. Fully Automatic Treatment Planning for External-Beam Radiation Therapy of Locally Advanced Cervical Cancer: A Tool for Low-Resource Clinics. J Glob Oncol 2020; 5:1-9. [PMID: 30629457 PMCID: PMC6426517 DOI: 10.1200/jgo.18.00107] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The purpose of this study was to validate a fully automatic treatment planning system for conventional radiotherapy of cervical cancer. This system was developed to mitigate staff shortages in low-resource clinics. Methods In collaboration with hospitals in South Africa and the United States, we have developed the Radiation Planning Assistant (RPA), which includes algorithms for automating every step of planning: delineating the body contour, detecting the marked isocenter, designing the treatment-beam apertures, and optimizing the beam weights to minimize dose heterogeneity. First, we validated the RPA retrospectively on 150 planning computed tomography (CT) scans. We then tested it remotely on 14 planning CT scans at two South African hospitals. Finally, automatically planned treatment beams were clinically deployed at our institution. Results The automatically and manually delineated body contours agreed well (median mean surface distance, 0.6 mm; range, 0.4 to 1.9 mm). The automatically and manually detected marked isocenters agreed well (mean difference, 1.1 mm; range, 0.1 to 2.9 mm). In validating the automatically designed beam apertures, two physicians, one from our institution and one from a South African partner institution, rated 91% and 88% of plans acceptable for treatment, respectively. The use of automatically optimized beam weights reduced the maximum dose significantly (median, −1.9%; P < .001). Of the 14 plans from South Africa, 100% were rated clinically acceptable. Automatically planned treatment beams have been used for 24 patients with cervical cancer by physicians at our institution, with edits as needed, and its use is ongoing. Conclusion We found that fully automatic treatment planning is effective for cervical cancer radiotherapy and may provide a reliable option for low-resource clinics. Prospective studies are ongoing in the United States and are planned with partner clinics.
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Affiliation(s)
- Kelly Kisling
- Kelly Kisling, Lifei Zhang, Jinzhong Yang, Rachel McCarroll, Peter Balter, Rebecca Howell, Kathleen Schmeler, Anuja Jhingran, and Laurence Court, The University of Texas MD Anderson Cancer Center, Houston, TX; Hannah Simonds, Stellenbosch University and Tygerberg Hospital; Nazia Fakie and Hester Burger, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Oliver Bogler, The University of New Mexico School of Medicine, Albuquerque, NM; Mike Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines; Beth M. Beadle, Stanford University, Stanford, CA
| | - Lifei Zhang
- Kelly Kisling, Lifei Zhang, Jinzhong Yang, Rachel McCarroll, Peter Balter, Rebecca Howell, Kathleen Schmeler, Anuja Jhingran, and Laurence Court, The University of Texas MD Anderson Cancer Center, Houston, TX; Hannah Simonds, Stellenbosch University and Tygerberg Hospital; Nazia Fakie and Hester Burger, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Oliver Bogler, The University of New Mexico School of Medicine, Albuquerque, NM; Mike Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines; Beth M. Beadle, Stanford University, Stanford, CA
| | - Hannah Simonds
- Kelly Kisling, Lifei Zhang, Jinzhong Yang, Rachel McCarroll, Peter Balter, Rebecca Howell, Kathleen Schmeler, Anuja Jhingran, and Laurence Court, The University of Texas MD Anderson Cancer Center, Houston, TX; Hannah Simonds, Stellenbosch University and Tygerberg Hospital; Nazia Fakie and Hester Burger, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Oliver Bogler, The University of New Mexico School of Medicine, Albuquerque, NM; Mike Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines; Beth M. Beadle, Stanford University, Stanford, CA
| | - Nazia Fakie
- Kelly Kisling, Lifei Zhang, Jinzhong Yang, Rachel McCarroll, Peter Balter, Rebecca Howell, Kathleen Schmeler, Anuja Jhingran, and Laurence Court, The University of Texas MD Anderson Cancer Center, Houston, TX; Hannah Simonds, Stellenbosch University and Tygerberg Hospital; Nazia Fakie and Hester Burger, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Oliver Bogler, The University of New Mexico School of Medicine, Albuquerque, NM; Mike Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines; Beth M. Beadle, Stanford University, Stanford, CA
| | - Jinzhong Yang
- Kelly Kisling, Lifei Zhang, Jinzhong Yang, Rachel McCarroll, Peter Balter, Rebecca Howell, Kathleen Schmeler, Anuja Jhingran, and Laurence Court, The University of Texas MD Anderson Cancer Center, Houston, TX; Hannah Simonds, Stellenbosch University and Tygerberg Hospital; Nazia Fakie and Hester Burger, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Oliver Bogler, The University of New Mexico School of Medicine, Albuquerque, NM; Mike Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines; Beth M. Beadle, Stanford University, Stanford, CA
| | - Rachel McCarroll
- Kelly Kisling, Lifei Zhang, Jinzhong Yang, Rachel McCarroll, Peter Balter, Rebecca Howell, Kathleen Schmeler, Anuja Jhingran, and Laurence Court, The University of Texas MD Anderson Cancer Center, Houston, TX; Hannah Simonds, Stellenbosch University and Tygerberg Hospital; Nazia Fakie and Hester Burger, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Oliver Bogler, The University of New Mexico School of Medicine, Albuquerque, NM; Mike Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines; Beth M. Beadle, Stanford University, Stanford, CA
| | - Peter Balter
- Kelly Kisling, Lifei Zhang, Jinzhong Yang, Rachel McCarroll, Peter Balter, Rebecca Howell, Kathleen Schmeler, Anuja Jhingran, and Laurence Court, The University of Texas MD Anderson Cancer Center, Houston, TX; Hannah Simonds, Stellenbosch University and Tygerberg Hospital; Nazia Fakie and Hester Burger, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Oliver Bogler, The University of New Mexico School of Medicine, Albuquerque, NM; Mike Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines; Beth M. Beadle, Stanford University, Stanford, CA
| | - Hester Burger
- Kelly Kisling, Lifei Zhang, Jinzhong Yang, Rachel McCarroll, Peter Balter, Rebecca Howell, Kathleen Schmeler, Anuja Jhingran, and Laurence Court, The University of Texas MD Anderson Cancer Center, Houston, TX; Hannah Simonds, Stellenbosch University and Tygerberg Hospital; Nazia Fakie and Hester Burger, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Oliver Bogler, The University of New Mexico School of Medicine, Albuquerque, NM; Mike Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines; Beth M. Beadle, Stanford University, Stanford, CA
| | - Oliver Bogler
- Kelly Kisling, Lifei Zhang, Jinzhong Yang, Rachel McCarroll, Peter Balter, Rebecca Howell, Kathleen Schmeler, Anuja Jhingran, and Laurence Court, The University of Texas MD Anderson Cancer Center, Houston, TX; Hannah Simonds, Stellenbosch University and Tygerberg Hospital; Nazia Fakie and Hester Burger, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Oliver Bogler, The University of New Mexico School of Medicine, Albuquerque, NM; Mike Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines; Beth M. Beadle, Stanford University, Stanford, CA
| | - Rebecca Howell
- Kelly Kisling, Lifei Zhang, Jinzhong Yang, Rachel McCarroll, Peter Balter, Rebecca Howell, Kathleen Schmeler, Anuja Jhingran, and Laurence Court, The University of Texas MD Anderson Cancer Center, Houston, TX; Hannah Simonds, Stellenbosch University and Tygerberg Hospital; Nazia Fakie and Hester Burger, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Oliver Bogler, The University of New Mexico School of Medicine, Albuquerque, NM; Mike Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines; Beth M. Beadle, Stanford University, Stanford, CA
| | - Kathleen Schmeler
- Kelly Kisling, Lifei Zhang, Jinzhong Yang, Rachel McCarroll, Peter Balter, Rebecca Howell, Kathleen Schmeler, Anuja Jhingran, and Laurence Court, The University of Texas MD Anderson Cancer Center, Houston, TX; Hannah Simonds, Stellenbosch University and Tygerberg Hospital; Nazia Fakie and Hester Burger, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Oliver Bogler, The University of New Mexico School of Medicine, Albuquerque, NM; Mike Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines; Beth M. Beadle, Stanford University, Stanford, CA
| | - Mike Mejia
- Kelly Kisling, Lifei Zhang, Jinzhong Yang, Rachel McCarroll, Peter Balter, Rebecca Howell, Kathleen Schmeler, Anuja Jhingran, and Laurence Court, The University of Texas MD Anderson Cancer Center, Houston, TX; Hannah Simonds, Stellenbosch University and Tygerberg Hospital; Nazia Fakie and Hester Burger, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Oliver Bogler, The University of New Mexico School of Medicine, Albuquerque, NM; Mike Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines; Beth M. Beadle, Stanford University, Stanford, CA
| | - Beth M Beadle
- Kelly Kisling, Lifei Zhang, Jinzhong Yang, Rachel McCarroll, Peter Balter, Rebecca Howell, Kathleen Schmeler, Anuja Jhingran, and Laurence Court, The University of Texas MD Anderson Cancer Center, Houston, TX; Hannah Simonds, Stellenbosch University and Tygerberg Hospital; Nazia Fakie and Hester Burger, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Oliver Bogler, The University of New Mexico School of Medicine, Albuquerque, NM; Mike Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines; Beth M. Beadle, Stanford University, Stanford, CA
| | - Anuja Jhingran
- Kelly Kisling, Lifei Zhang, Jinzhong Yang, Rachel McCarroll, Peter Balter, Rebecca Howell, Kathleen Schmeler, Anuja Jhingran, and Laurence Court, The University of Texas MD Anderson Cancer Center, Houston, TX; Hannah Simonds, Stellenbosch University and Tygerberg Hospital; Nazia Fakie and Hester Burger, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Oliver Bogler, The University of New Mexico School of Medicine, Albuquerque, NM; Mike Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines; Beth M. Beadle, Stanford University, Stanford, CA
| | - Laurence Court
- Kelly Kisling, Lifei Zhang, Jinzhong Yang, Rachel McCarroll, Peter Balter, Rebecca Howell, Kathleen Schmeler, Anuja Jhingran, and Laurence Court, The University of Texas MD Anderson Cancer Center, Houston, TX; Hannah Simonds, Stellenbosch University and Tygerberg Hospital; Nazia Fakie and Hester Burger, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Oliver Bogler, The University of New Mexico School of Medicine, Albuquerque, NM; Mike Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines; Beth M. Beadle, Stanford University, Stanford, CA
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Pollom EL, Sandhu N, Frank J, Miller JA, Obeid JP, Kastelowitz N, Panjwani N, Soltys SG, Bagshaw HP, Donaldson SS, Horst K, Beadle BM, Chang DT, Gibbs I. Continuing Medical Student Education During the Coronavirus Disease 2019 (COVID-19) Pandemic: Development of a Virtual Radiation Oncology Clerkship. Adv Radiat Oncol 2020; 5:732-736. [PMID: 32775783 PMCID: PMC7237939 DOI: 10.1016/j.adro.2020.05.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 11/04/2022] Open
Abstract
Purpose Our institution cancelled all in-person clerkships owing to the coronavirus disease 2019 pandemic. In response, we designed a virtual radiation oncology medical student clerkship. Methods and Materials We convened an advisory panel to design a virtual clerkship curriculum. We implemented clerkship activities using a cloud-based learning management system, video web conferencing systems, and a telemedicine portal. Students completed assessments pre- and postclerkship to provide data to improve future versions of the clerkship. Results The virtual clerkship spans 2 weeks and is graded pass or fail. Students attend interactive didactic sessions during the first week and participate in virtual clinic and give talks to the department during the second week. Didactic sessions include lectures, case-based discussions, treatment planning seminars, and material adapted from the Radiation Oncology Education Collaborative Study Group curriculum. Students also attend virtual departmental quality assurance rounds, cancer center seminars, and multidisciplinary tumor boards. The enrollment cap was met during the first virtual clerkship period (April 27 through May 8, 2020), with a total of 12 students enrolling. Conclusions Our virtual clerkship can increase student exposure and engagement in radiation oncology. Data on clerkship outcomes are forthcoming.
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Affiliation(s)
- Erqi L Pollom
- Stanford School of Medicine, Palo Alto, Stanford, California
| | - Navjot Sandhu
- Stanford School of Medicine, Palo Alto, Stanford, California
| | - Jessica Frank
- Stanford School of Medicine, Palo Alto, Stanford, California
| | - Jacob A Miller
- Stanford School of Medicine, Palo Alto, Stanford, California
| | | | | | - Neil Panjwani
- Stanford School of Medicine, Palo Alto, Stanford, California
| | - Scott G Soltys
- Stanford School of Medicine, Palo Alto, Stanford, California
| | | | | | - Kathleen Horst
- Stanford School of Medicine, Palo Alto, Stanford, California
| | - Beth M Beadle
- Stanford School of Medicine, Palo Alto, Stanford, California
| | - Daniel T Chang
- Stanford School of Medicine, Palo Alto, Stanford, California
| | - Iris Gibbs
- Stanford School of Medicine, Palo Alto, Stanford, California
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Putora PM, Baudis M, Beadle BM, El Naqa I, Giordano FA, Nicolay NH. Oncology Informatics: Status Quo and Outlook. Oncology 2020; 98:329-331. [PMID: 32408309 DOI: 10.1159/000507586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 11/19/2022]
Abstract
Oncology has undergone rapid progress, with emerging developments in areas including cancer stem cells, molecularly targeted therapies, genomic analyses, and individually tailored immunotherapy. These advances have expanded the tools available in the fight against cancer. Some of these have seen broad media coverage resulting in justified public attention. However, these achievements have only been possible due to rapid developments in the expanding field of biomedical informatics and information technology (IT). Artificial intelligence, radiomics, electronic health records, and electronic patient-reported outcome measures (ePROMS) are only a few of the developments enabling further progress in oncology. The promising impact of IT in oncology will only become reality through a multidisciplinary approach to the complex challenges ahead.
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Affiliation(s)
- Paul Martin Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland, .,Department of Radiation Oncology, University of Bern, Bern, Switzerland,
| | - Michael Baudis
- Department of Molecular Life Sciences and Swiss Institute of Bioinformatics, University of Zurich, Zurich, Switzerland
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Issam El Naqa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Frank A Giordano
- Department of Radiation Oncology, University of Bonn, Bonn, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany.,German Cancer Consortium Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
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Jin MC, Harris JP, Sabolch AN, Gensheimer M, Le QT, Beadle BM, Pollom EL. Proton radiotherapy and treatment delay in head and neck squamous cell carcinoma. Laryngoscope 2019; 130:E598-E604. [PMID: 31837165 DOI: 10.1002/lary.28458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/12/2019] [Accepted: 11/16/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE For patients with head and neck squamous cell carcinoma (HNSCC), delays in the initiation of radiotherapy (RT) have been closely associated with worse outcomes. We sought to investigate whether RT modality (proton vs. photon) is associated with differences in the time to initiation of RT. METHODS The National Cancer Database was queried for patients diagnosed with nonmetastatic HNSCC between 2004 and 2015 who received either proton or photon RT as part of their initial treatment. Wilcoxon rank-sum and chi-square tests were used to compare continuous and categorical variables, respectively. Multivariable logistic regression was used to determine the association between use of proton RT and delayed RT initiation. RESULTS A total of 175,088 patients with HNSCC receiving either photon or proton RT were identified. Patients receiving proton RT were more likely to be white, reside in higher income areas, and have private insurance. Proton RT was associated with delayed RT initiation compared to photon RT (median 59 days vs. 45, P < 0.001). Receipt of proton therapy was independently associated with RT initiation beyond 6 weeks after diagnosis (adjusted OR [aOR, definitive RT] = 1.69; 95% confidence interval [CI] 1.26-2.30) or surgery (aOR [adjuvant RT] = 4.08; 95% CI 2.64-6.62). In the context of adjuvant proton RT, increases in treatment delay were associated with worse overall survival (weeks, adjusted hazard ratio = 1.099, 95% CI 1.011-1.194). CONCLUSION Use of proton therapy is associated with delayed RT in both the definitive and adjuvant settings for patients with HNSCC and could be associated with poorer outcomes. LEVEL OF EVIDENCE 2b Laryngoscope, 122:0000-0000, 2019 Laryngoscope, 130:E598-E604, 2020.
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Affiliation(s)
- Michael C Jin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford
| | - Jeremy P Harris
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford.,Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Aaron N Sabolch
- The Center for Health Research and the Department of Radiation Oncology, Kaiser Permanente, Portland, Oregon, U.S.A
| | - Michael Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford.,Palo Alto Veterans Affairs Health Care System, Palo Alto, California
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McCarroll RE, Beadle BM, Balter PA, Burger H, Cardenas CE, Dalvie S, Followill DS, Kisling KD, Mejia M, Naidoo K, Nelson CL, Peterson CB, Vorster K, Wetter J, Zhang L, Court LE, Yang J. Retrospective Validation and Clinical Implementation of Automated Contouring of Organs at Risk in the Head and Neck: A Step Toward Automated Radiation Treatment Planning for Low- and Middle-Income Countries. J Glob Oncol 2019; 4:1-11. [PMID: 30110221 PMCID: PMC6223488 DOI: 10.1200/jgo.18.00055] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose We assessed automated contouring of normal structures for patients with head-and-neck cancer (HNC) using a multiatlas deformable-image-registration algorithm to better provide a fully automated radiation treatment planning solution for low- and middle-income countries, provide quantitative analysis, and determine acceptability worldwide. Methods Autocontours of eight normal structures (brain, brainstem, cochleae, eyes, lungs, mandible, parotid glands, and spinal cord) from 128 patients with HNC were retrospectively scored by a dedicated HNC radiation oncologist. Contours from a 10-patient subset were evaluated by five additional radiation oncologists from international partner institutions, and interphysician variability was assessed. Quantitative agreement of autocontours with independently physician-drawn structures was assessed using the Dice similarity coefficient and mean surface and Hausdorff distances. Automated contouring was then implemented clinically and has been used for 166 patients, and contours were quantitatively compared with the physician-edited autocontours using the same metrics. Results Retrospectively, 87% of normal structure contours were rated as acceptable for use in dose-volume-histogram–based planning without edit. Upon clinical implementation, 50% of contours were not edited for use in treatment planning. The mean (± standard deviation) Dice similarity coefficient of autocontours compared with physician-edited autocontours for parotid glands (0.92 ± 0.10), brainstem (0.95 ± 0.09), and spinal cord (0.92 ± 0.12) indicate that only minor edits were performed. The average mean surface and Hausdorff distances for all structures were less than 0.15 mm and 1.8 mm, respectively. Conclusion Automated contouring of normal structures generates reliable contours that require only minimal editing, as judged by retrospective ratings from multiple international centers and clinical integration. Autocontours are acceptable for treatment planning with no or, at most, minor edits, suggesting that automated contouring is feasible for clinical use and in the ongoing development of automated radiation treatment planning algorithms.
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Affiliation(s)
- Rachel E McCarroll
- Rachel E. McCarroll, Peter A. Balter, Carlos E. Cardenas, David S. Followill, Kelly D. Kisling, Christopher L. Nelson, Christine B. Peterson, Lifei Zhang, Laurence E. Court, and Jinzhong Yang, The University of Texas MD Anderson Cancer Center, Houston, TX; Beth M. Beadle, Stanford University, Stanford, CA; Hester Burger, Sameera Dalvie, and Julie Wetter, Groote Schuur Hospital and University of Cape Town; Komeela Naidoo, Stellenbosch University and Tygerberg Hospital, Cape Town; Karin Vorster, University of the Free State, Bloemfontein, South Africa; and Michael Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - Beth M Beadle
- Rachel E. McCarroll, Peter A. Balter, Carlos E. Cardenas, David S. Followill, Kelly D. Kisling, Christopher L. Nelson, Christine B. Peterson, Lifei Zhang, Laurence E. Court, and Jinzhong Yang, The University of Texas MD Anderson Cancer Center, Houston, TX; Beth M. Beadle, Stanford University, Stanford, CA; Hester Burger, Sameera Dalvie, and Julie Wetter, Groote Schuur Hospital and University of Cape Town; Komeela Naidoo, Stellenbosch University and Tygerberg Hospital, Cape Town; Karin Vorster, University of the Free State, Bloemfontein, South Africa; and Michael Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - Peter A Balter
- Rachel E. McCarroll, Peter A. Balter, Carlos E. Cardenas, David S. Followill, Kelly D. Kisling, Christopher L. Nelson, Christine B. Peterson, Lifei Zhang, Laurence E. Court, and Jinzhong Yang, The University of Texas MD Anderson Cancer Center, Houston, TX; Beth M. Beadle, Stanford University, Stanford, CA; Hester Burger, Sameera Dalvie, and Julie Wetter, Groote Schuur Hospital and University of Cape Town; Komeela Naidoo, Stellenbosch University and Tygerberg Hospital, Cape Town; Karin Vorster, University of the Free State, Bloemfontein, South Africa; and Michael Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - Hester Burger
- Rachel E. McCarroll, Peter A. Balter, Carlos E. Cardenas, David S. Followill, Kelly D. Kisling, Christopher L. Nelson, Christine B. Peterson, Lifei Zhang, Laurence E. Court, and Jinzhong Yang, The University of Texas MD Anderson Cancer Center, Houston, TX; Beth M. Beadle, Stanford University, Stanford, CA; Hester Burger, Sameera Dalvie, and Julie Wetter, Groote Schuur Hospital and University of Cape Town; Komeela Naidoo, Stellenbosch University and Tygerberg Hospital, Cape Town; Karin Vorster, University of the Free State, Bloemfontein, South Africa; and Michael Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - Carlos E Cardenas
- Rachel E. McCarroll, Peter A. Balter, Carlos E. Cardenas, David S. Followill, Kelly D. Kisling, Christopher L. Nelson, Christine B. Peterson, Lifei Zhang, Laurence E. Court, and Jinzhong Yang, The University of Texas MD Anderson Cancer Center, Houston, TX; Beth M. Beadle, Stanford University, Stanford, CA; Hester Burger, Sameera Dalvie, and Julie Wetter, Groote Schuur Hospital and University of Cape Town; Komeela Naidoo, Stellenbosch University and Tygerberg Hospital, Cape Town; Karin Vorster, University of the Free State, Bloemfontein, South Africa; and Michael Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - Sameera Dalvie
- Rachel E. McCarroll, Peter A. Balter, Carlos E. Cardenas, David S. Followill, Kelly D. Kisling, Christopher L. Nelson, Christine B. Peterson, Lifei Zhang, Laurence E. Court, and Jinzhong Yang, The University of Texas MD Anderson Cancer Center, Houston, TX; Beth M. Beadle, Stanford University, Stanford, CA; Hester Burger, Sameera Dalvie, and Julie Wetter, Groote Schuur Hospital and University of Cape Town; Komeela Naidoo, Stellenbosch University and Tygerberg Hospital, Cape Town; Karin Vorster, University of the Free State, Bloemfontein, South Africa; and Michael Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - David S Followill
- Rachel E. McCarroll, Peter A. Balter, Carlos E. Cardenas, David S. Followill, Kelly D. Kisling, Christopher L. Nelson, Christine B. Peterson, Lifei Zhang, Laurence E. Court, and Jinzhong Yang, The University of Texas MD Anderson Cancer Center, Houston, TX; Beth M. Beadle, Stanford University, Stanford, CA; Hester Burger, Sameera Dalvie, and Julie Wetter, Groote Schuur Hospital and University of Cape Town; Komeela Naidoo, Stellenbosch University and Tygerberg Hospital, Cape Town; Karin Vorster, University of the Free State, Bloemfontein, South Africa; and Michael Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - Kelly D Kisling
- Rachel E. McCarroll, Peter A. Balter, Carlos E. Cardenas, David S. Followill, Kelly D. Kisling, Christopher L. Nelson, Christine B. Peterson, Lifei Zhang, Laurence E. Court, and Jinzhong Yang, The University of Texas MD Anderson Cancer Center, Houston, TX; Beth M. Beadle, Stanford University, Stanford, CA; Hester Burger, Sameera Dalvie, and Julie Wetter, Groote Schuur Hospital and University of Cape Town; Komeela Naidoo, Stellenbosch University and Tygerberg Hospital, Cape Town; Karin Vorster, University of the Free State, Bloemfontein, South Africa; and Michael Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - Michael Mejia
- Rachel E. McCarroll, Peter A. Balter, Carlos E. Cardenas, David S. Followill, Kelly D. Kisling, Christopher L. Nelson, Christine B. Peterson, Lifei Zhang, Laurence E. Court, and Jinzhong Yang, The University of Texas MD Anderson Cancer Center, Houston, TX; Beth M. Beadle, Stanford University, Stanford, CA; Hester Burger, Sameera Dalvie, and Julie Wetter, Groote Schuur Hospital and University of Cape Town; Komeela Naidoo, Stellenbosch University and Tygerberg Hospital, Cape Town; Karin Vorster, University of the Free State, Bloemfontein, South Africa; and Michael Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - Komeela Naidoo
- Rachel E. McCarroll, Peter A. Balter, Carlos E. Cardenas, David S. Followill, Kelly D. Kisling, Christopher L. Nelson, Christine B. Peterson, Lifei Zhang, Laurence E. Court, and Jinzhong Yang, The University of Texas MD Anderson Cancer Center, Houston, TX; Beth M. Beadle, Stanford University, Stanford, CA; Hester Burger, Sameera Dalvie, and Julie Wetter, Groote Schuur Hospital and University of Cape Town; Komeela Naidoo, Stellenbosch University and Tygerberg Hospital, Cape Town; Karin Vorster, University of the Free State, Bloemfontein, South Africa; and Michael Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - Chris L Nelson
- Rachel E. McCarroll, Peter A. Balter, Carlos E. Cardenas, David S. Followill, Kelly D. Kisling, Christopher L. Nelson, Christine B. Peterson, Lifei Zhang, Laurence E. Court, and Jinzhong Yang, The University of Texas MD Anderson Cancer Center, Houston, TX; Beth M. Beadle, Stanford University, Stanford, CA; Hester Burger, Sameera Dalvie, and Julie Wetter, Groote Schuur Hospital and University of Cape Town; Komeela Naidoo, Stellenbosch University and Tygerberg Hospital, Cape Town; Karin Vorster, University of the Free State, Bloemfontein, South Africa; and Michael Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - Christine B Peterson
- Rachel E. McCarroll, Peter A. Balter, Carlos E. Cardenas, David S. Followill, Kelly D. Kisling, Christopher L. Nelson, Christine B. Peterson, Lifei Zhang, Laurence E. Court, and Jinzhong Yang, The University of Texas MD Anderson Cancer Center, Houston, TX; Beth M. Beadle, Stanford University, Stanford, CA; Hester Burger, Sameera Dalvie, and Julie Wetter, Groote Schuur Hospital and University of Cape Town; Komeela Naidoo, Stellenbosch University and Tygerberg Hospital, Cape Town; Karin Vorster, University of the Free State, Bloemfontein, South Africa; and Michael Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - Karin Vorster
- Rachel E. McCarroll, Peter A. Balter, Carlos E. Cardenas, David S. Followill, Kelly D. Kisling, Christopher L. Nelson, Christine B. Peterson, Lifei Zhang, Laurence E. Court, and Jinzhong Yang, The University of Texas MD Anderson Cancer Center, Houston, TX; Beth M. Beadle, Stanford University, Stanford, CA; Hester Burger, Sameera Dalvie, and Julie Wetter, Groote Schuur Hospital and University of Cape Town; Komeela Naidoo, Stellenbosch University and Tygerberg Hospital, Cape Town; Karin Vorster, University of the Free State, Bloemfontein, South Africa; and Michael Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - Julie Wetter
- Rachel E. McCarroll, Peter A. Balter, Carlos E. Cardenas, David S. Followill, Kelly D. Kisling, Christopher L. Nelson, Christine B. Peterson, Lifei Zhang, Laurence E. Court, and Jinzhong Yang, The University of Texas MD Anderson Cancer Center, Houston, TX; Beth M. Beadle, Stanford University, Stanford, CA; Hester Burger, Sameera Dalvie, and Julie Wetter, Groote Schuur Hospital and University of Cape Town; Komeela Naidoo, Stellenbosch University and Tygerberg Hospital, Cape Town; Karin Vorster, University of the Free State, Bloemfontein, South Africa; and Michael Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - Lifei Zhang
- Rachel E. McCarroll, Peter A. Balter, Carlos E. Cardenas, David S. Followill, Kelly D. Kisling, Christopher L. Nelson, Christine B. Peterson, Lifei Zhang, Laurence E. Court, and Jinzhong Yang, The University of Texas MD Anderson Cancer Center, Houston, TX; Beth M. Beadle, Stanford University, Stanford, CA; Hester Burger, Sameera Dalvie, and Julie Wetter, Groote Schuur Hospital and University of Cape Town; Komeela Naidoo, Stellenbosch University and Tygerberg Hospital, Cape Town; Karin Vorster, University of the Free State, Bloemfontein, South Africa; and Michael Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - Laurence E Court
- Rachel E. McCarroll, Peter A. Balter, Carlos E. Cardenas, David S. Followill, Kelly D. Kisling, Christopher L. Nelson, Christine B. Peterson, Lifei Zhang, Laurence E. Court, and Jinzhong Yang, The University of Texas MD Anderson Cancer Center, Houston, TX; Beth M. Beadle, Stanford University, Stanford, CA; Hester Burger, Sameera Dalvie, and Julie Wetter, Groote Schuur Hospital and University of Cape Town; Komeela Naidoo, Stellenbosch University and Tygerberg Hospital, Cape Town; Karin Vorster, University of the Free State, Bloemfontein, South Africa; and Michael Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
| | - Jinzhong Yang
- Rachel E. McCarroll, Peter A. Balter, Carlos E. Cardenas, David S. Followill, Kelly D. Kisling, Christopher L. Nelson, Christine B. Peterson, Lifei Zhang, Laurence E. Court, and Jinzhong Yang, The University of Texas MD Anderson Cancer Center, Houston, TX; Beth M. Beadle, Stanford University, Stanford, CA; Hester Burger, Sameera Dalvie, and Julie Wetter, Groote Schuur Hospital and University of Cape Town; Komeela Naidoo, Stellenbosch University and Tygerberg Hospital, Cape Town; Karin Vorster, University of the Free State, Bloemfontein, South Africa; and Michael Mejia, University of Santo Tomas Hospital, Benavides Cancer Institute, Manila, Philippines
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Rhee DJ, Cardenas CE, Elhalawani H, McCarroll R, Zhang L, Yang J, Garden AS, Peterson CB, Beadle BM, Court LE. Automatic detection of contouring errors using convolutional neural networks. Med Phys 2019; 46:5086-5097. [PMID: 31505046 PMCID: PMC6842055 DOI: 10.1002/mp.13814] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To develop a head and neck normal structures autocontouring tool that could be used to automatically detect the errors in autocontours from a clinically validated autocontouring tool. METHODS An autocontouring tool based on convolutional neural networks (CNN) was developed for 16 normal structures of the head and neck and tested to identify the contour errors from a clinically validated multiatlas-based autocontouring system (MACS). The computed tomography (CT) scans and clinical contours from 3495 patients were semiautomatically curated and used to train and validate the CNN-based autocontouring tool. The final accuracy of the tool was evaluated by calculating the Sørensen-Dice similarity coefficients (DSC) and Hausdorff distances between the automatically generated contours and physician-drawn contours on 174 internal and 24 external CT scans. Lastly, the CNN-based tool was evaluated on 60 patients' CT scans to investigate the possibility to detect contouring failures. The contouring failures on these patients were classified as either minor or major errors. The criteria to detect contouring errors were determined by analyzing the DSC between the CNN- and MACS-based contours under two independent scenarios: (a) contours with minor errors are clinically acceptable and (b) contours with minor errors are clinically unacceptable. RESULTS The average DSC and Hausdorff distance of our CNN-based tool was 98.4%/1.23 cm for brain, 89.1%/0.42 cm for eyes, 86.8%/1.28 cm for mandible, 86.4%/0.88 cm for brainstem, 83.4%/0.71 cm for spinal cord, 82.7%/1.37 cm for parotids, 80.7%/1.08 cm for esophagus, 71.7%/0.39 cm for lenses, 68.6%/0.72 for optic nerves, 66.4%/0.46 cm for cochleas, and 40.7%/0.96 cm for optic chiasm. With the error detection tool, the proportions of the clinically unacceptable MACS contours that were correctly detected were 0.99/0.80 on average except for the optic chiasm, when contours with minor errors are clinically acceptable/unacceptable, respectively. The proportions of the clinically acceptable MACS contours that were correctly detected were 0.81/0.60 on average except for the optic chiasm, when contours with minor errors are clinically acceptable/unacceptable, respectively. CONCLUSION Our CNN-based autocontouring tool performed well on both the publically available and the internal datasets. Furthermore, our results show that CNN-based algorithms are able to identify ill-defined contours from a clinically validated and used multiatlas-based autocontouring tool. Therefore, our CNN-based tool can effectively perform automatic verification of MACS contours.
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Affiliation(s)
- Dong Joo Rhee
- The University of Texas Graduate School of Biomedical Sciences at HoustonHoustonTX77030USA
- Department of Radiation PhysicsDivision of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTX77030USA
| | - Carlos E. Cardenas
- Department of Radiation PhysicsDivision of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTX77030USA
| | - Hesham Elhalawani
- Department of Radiation OncologyDivision of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTX77030USA
| | - Rachel McCarroll
- Department of Radiation OncologyThe University of Maryland Medical SystemBaltimoreMD21201USA
| | - Lifei Zhang
- Department of Radiation PhysicsDivision of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTX77030USA
| | - Jinzhong Yang
- Department of Radiation PhysicsDivision of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTX77030USA
| | - Adam S. Garden
- Department of Radiation OncologyDivision of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTX77030USA
| | - Christine B. Peterson
- Department of BiostatisticsDivision of Basic SciencesThe University of Texas MD Anderson Cancer CenterHoustonTX77030USA
| | - Beth M. Beadle
- Department of Radiation OncologyStanford University School of MedicineStanfordCA94305USA
| | - Laurence E. Court
- Department of Radiation PhysicsDivision of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTX77030USA
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Affiliation(s)
- Beth M Beadle
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Carryn M Anderson
- Department of Radiation Oncology, University of Iowa Hospital and Clinics, Iowa City, Iowa.
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Liu S, Bush KK, Bertini J, Fu Y, Lewis JM, Pham DJ, Yang Y, Niedermayr TR, Skinner L, Xing L, Beadle BM, Hsu A, Kovalchuk N. Optimizing efficiency and safety in external beam radiotherapy using automated plan check (APC) tool and six sigma methodology. J Appl Clin Med Phys 2019; 20:56-64. [PMID: 31423729 PMCID: PMC6698761 DOI: 10.1002/acm2.12678] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/20/2019] [Accepted: 06/11/2019] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To develop and implement an automated plan check (APC) tool using a Six Sigma methodology with the aim of improving safety and efficiency in external beam radiotherapy. METHODS The Six Sigma define-measure-analyze-improve-control (DMAIC) framework was used by measuring defects stemming from treatment planning that were reported to the departmental incidence learning system (ILS). The common error pathways observed in the reported data were combined with our departmental physics plan check list, and AAPM TG-275 identified items. Prioritized by risk priority number (RPN) and severity values, the check items were added to the APC tool developed using Varian Eclipse Scripting Application Programming Interface (ESAPI). At 9 months post-APC implementation, the tool encompassed 89 check items, and its effectiveness was evaluated by comparing RPN values and rates of reported errors. To test the efficiency gains, physics plan check time and reported error rate were prospectively compared for 20 treatment plans. RESULTS The APC tool was successfully implemented for external beam plan checking. FMEA RPN ranking re-evaluation at 9 months post-APC demonstrated a statistically significant average decrease in RPN values from 129.2 to 83.7 (P < .05). After the introduction of APC, the average frequency of reported treatment-planning errors was reduced from 16.1% to 4.1%. For high-severity errors, the reduction was 82.7% for prescription/plan mismatches and 84.4% for incorrect shift note. The process shifted from 4σ to 5σ quality for isocenter-shift errors. The efficiency study showed a statistically significant decrease in plan check time (10.1 ± 7.3 min, P = .005) and decrease in errors propagating to physics plan check (80%). CONCLUSIONS Incorporation of APC tool has significantly reduced the error rate. The DMAIC framework can provide an iterative and robust workflow to improve the efficiency and quality of treatment planning procedure enabling a safer radiotherapy process.
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Affiliation(s)
- Shi Liu
- Department of Radiation OncologyStanford UniversityStanfordCAUSA
| | - Karl K. Bush
- Department of Radiation OncologyStanford UniversityStanfordCAUSA
| | | | - Yabo Fu
- Department of Radiation OncologyWashington University School of MedicineSt. LouisMOUSA
| | | | - Daniel J. Pham
- Department of Radiation OncologyStanford UniversityStanfordCAUSA
| | - Yong Yang
- Department of Radiation OncologyStanford UniversityStanfordCAUSA
| | | | - Lawrie Skinner
- Department of Radiation OncologyStanford UniversityStanfordCAUSA
| | - Lei Xing
- Department of Radiation OncologyStanford UniversityStanfordCAUSA
| | - Beth M. Beadle
- Department of Radiation OncologyStanford UniversityStanfordCAUSA
| | - Annie Hsu
- Department of Radiation OncologyStanford UniversityStanfordCAUSA
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Kisling K, Zhang L, Shaitelman SF, Anderson D, Thebe T, Yang J, Balter PA, Howell RM, Jhingran A, Schmeler K, Simonds H, du Toit M, Trauernicht C, Burger H, Botha K, Joubert N, Beadle BM, Court L. Automated treatment planning of postmastectomy radiotherapy. Med Phys 2019; 46:3767-3775. [PMID: 31077593 PMCID: PMC6739169 DOI: 10.1002/mp.13586] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/01/2019] [Accepted: 05/05/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Breast cancer is the most common cancer in women globally and radiation therapy is a cornerstone of its treatment. However, there is an enormous shortage of radiotherapy staff, especially in low‐ and middle‐income countries. This shortage could be ameliorated through increased automation in the radiation treatment planning process, which may reduce the workload on radiotherapy staff and improve efficiency in preparing radiotherapy treatments for patients. To this end, we sought to create an automated treatment planning tool for postmastectomy radiotherapy (PMRT). Methods Algorithms to automate every step of PMRT planning were developed and integrated into a commercial treatment planning system. The only required inputs for automated PMRT planning are a planning computed tomography scan, a plan directive, and selection of the inferior border of the tangential fields. With no other human input, the planning tool automatically creates a treatment plan and presents it for review. The major automated steps are (a) segmentation of relevant structures (targets, normal tissues, and other planning structures), (b) setup of the beams (tangential fields matched with a supraclavicular field), and (c) optimization of the dose distribution by using a mix of high‐ and low‐energy photon beams and field‐in‐field modulation for the tangential fields. This automated PMRT planning tool was tested with ten computed tomography scans of patients with breast cancer who had received irradiation of the left chest wall. These plans were assessed quantitatively using their dose distributions and were reviewed by two physicians who rated them on a three‐tiered scale: use as is, minor changes, or major changes. The accuracy of the automated segmentation of the heart and ipsilateral lung was also assessed. Finally, a plan quality verification tool was tested to alert the user to any possible deviations in the quality of the automatically created treatment plans. Results The automatically created PMRT plans met the acceptable dose objectives, including target coverage, maximum plan dose, and dose to organs at risk, for all but one patient for whom the heart objectives were exceeded. Physicians accepted 50% of the treatment plans as is and required only minor changes for the remaining 50%, which included the one patient whose plan had a high heart dose. Furthermore, the automatically segmented contours of the heart and ipsilateral lung agreed well with manually edited contours. Finally, the automated plan quality verification tool detected 92% of the changes requested by physicians in this review. Conclusions We developed a new tool for automatically planning PMRT for breast cancer, including irradiation of the chest wall and ipsilateral lymph nodes (supraclavicular and level III axillary). In this initial testing, we found that the plans created by this tool are clinically viable, and the tool can alert the user to possible deviations in plan quality. The next step is to subject this tool to prospective testing, in which automatically planned treatments will be compared with manually planned treatments.
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Affiliation(s)
- Kelly Kisling
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Lifei Zhang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Simona F Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - David Anderson
- Department of Radiation Oncology, University of Cape Town and Groote Schuur Hospital, Cape Town, 8000, South Africa
| | - Tselane Thebe
- Department of Radiation Oncology, University of Cape Town and Groote Schuur Hospital, Cape Town, 8000, South Africa
| | - Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Peter A Balter
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Rebecca M Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Kathleen Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Hannah Simonds
- Division of Radiation Oncology, Stellenbosch University and Tygerberg Hospital, Cape Town, 7505, South Africa
| | - Monique du Toit
- Division of Medical Physics, Stellenbosch University and Tygerberg Hospital, Cape Town, 7505, South Africa
| | - Christoph Trauernicht
- Division of Medical Physics, Stellenbosch University and Tygerberg Hospital, Cape Town, 7505, South Africa
| | - Hester Burger
- Division of Medical Physics, University of Cape Town and Groote Schuur Hospital, Cape Town, 8000, South Africa
| | - Kobus Botha
- Division of Medical Physics, University of Cape Town and Groote Schuur Hospital, Cape Town, 8000, South Africa
| | - Nanette Joubert
- Division of Medical Physics, University of Cape Town and Groote Schuur Hospital, Cape Town, 8000, South Africa
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford University, Stanford, CA, 94305, USA
| | - Laurence Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
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