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Warren M, Barrett A, Bhalla N, Brada M, Chuter R, Cobben D, Eccles CL, Hart C, Ibrahim E, McClelland J, Rea M, Turtle L, Fenwick JD. Sorting lung tumor volumes from 4D-MRI data using an automatic tumor-based signal reduces stitching artifacts. J Appl Clin Med Phys 2024; 25:e14262. [PMID: 38234116 PMCID: PMC11005973 DOI: 10.1002/acm2.14262] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/30/2023] [Accepted: 12/18/2023] [Indexed: 01/19/2024] Open
Abstract
PURPOSE To investigate whether a novel signal derived from tumor motion allows more precise sorting of 4D-magnetic resonance (4D-MR) image data than do signals based on normal anatomy, reducing levels of stitching artifacts within sorted lung tumor volumes. METHODS (4D-MRI) scans were collected for 10 lung cancer patients using a 2D T2-weighted single-shot turbo spin echo sequence, obtaining 25 repeat frames per image slice. For each slice, a tumor-motion signal was generated using the first principal component of movement in the tumor neighborhood (TumorPC1). Signals were also generated from displacements of the diaphragm (DIA) and upper and lower chest wall (UCW/LCW) and from slice body area changes (BA). Pearson r coefficients of correlations between observed tumor movement and respiratory signals were determined. TumorPC1, DIA, and UCW signals were used to compile image stacks showing each patient's tumor volume in a respiratory phase. Unsorted image stacks were also built for comparison. For each image stack, the presence of stitching artifacts was assessed by measuring the roughness of the compiled tumor surface according to a roughness metric (Rg). Statistical differences in weighted means of Rg between any two signals were determined using an exact permutation test. RESULTS The TumorPC1 signal was most strongly correlated with superior-inferior tumor motion, and had significantly higher Pearson r values (median 0.86) than those determined for correlations of UCW, LCW, and BA with superior-inferior tumor motion (p < 0.05). Weighted means of ratios of Rg values in TumorPC1 image stacks to those in unsorted, UCW, and DIA stacks were 0.67, 0.69, and 0.71, all significantly favoring TumorPC1 (p = 0.02-0.05). For other pairs of signals, weighted mean ratios did not differ significantly from one. CONCLUSION Tumor volumes were smoother in 3D image stacks compiled using the first principal component of tumor motion than in stacks compiled with signals based on normal anatomy.
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Affiliation(s)
- Mark Warren
- School of Health Sciences, Institute of Population HealthUniversity of LiverpoolLiverpoolUK
| | | | - Neeraj Bhalla
- The Clatterbridge Cancer Centre NHS Foundation TrustLiverpoolUK
| | - Michael Brada
- Molecular & Clinical Cancer Medicine, Institute of Institute of Systems, Molecular and Integrative BiologyUniversity of LiverpoolLiverpoolUK
| | - Robert Chuter
- Christie Medical Physics and EngineeringThe Christie NHS Foundation TrustManchesterUK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - David Cobben
- The Clatterbridge Cancer Centre NHS Foundation TrustLiverpoolUK
- Department of Health Data Science, Institute of Population HealthUniversity of LiverpoolLiverpoolUK
| | - Cynthia L. Eccles
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- RadiotherapyThe Christie NHS Foundation TrustManchesterUK
| | - Clare Hart
- The Clatterbridge Cancer Centre NHS Foundation TrustLiverpoolUK
| | - Ehab Ibrahim
- The Clatterbridge Cancer Centre NHS Foundation TrustLiverpoolUK
| | - Jamie McClelland
- Department of Medical Physics and BioengineeringUniversity College LondonLondonUK
| | - Marc Rea
- The Clatterbridge Cancer Centre NHS Foundation TrustLiverpoolUK
| | - Louise Turtle
- The Clatterbridge Cancer Centre NHS Foundation TrustLiverpoolUK
| | - John D. Fenwick
- Department of Medical Physics and BioengineeringUniversity College LondonLondonUK
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Eccles CL, Dubec M, Cobben D, van Herk M, McDaid L, Nelder C, Whiteside L, Davies LSC, McHugh L, Bridge J, Fendallamaro P, Chuter R, Hoskin P, Huddart RA, Choudhury A. Single Institution Preliminary Evaluation of a National Study for the Development of Daily Online Magnetic Resonance Image Guided Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e663. [PMID: 37785963 DOI: 10.1016/j.ijrobp.2023.06.2101] [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) A 4-stage non-comparative prospective feasibility study to assess and develop imaging protocols for MRIgRT was opened at the first two centers using MR Linac technology in the UK. The primary aims of this study were to determine a) the acceptability of MR images for target and organ at risk delineation and registration; b) inter/intra observer registration and delineation variation. This work reports on the initial results from a single center. MATERIALS/METHODS In June 2019, following ethical and regulatory approvals the 2nd UK centre began study recruitment as follows: Stage A: non-patient volunteer imaging to determine sequence suitability for normal tissue in 6 anatomical sites (head & neck (H&N), chest wall/breast, lung/esophagus, abdomen, male and female pelvis). Volunteers were recruited in cohorts of 3 participants per region, and image quality was assessed by 3 independent observers using a visual guidance assessment tool (VGA). Stage B: the most suitable sequences defined in stage A used to assess the visibility of targets/normal tissues in patient volunteers using the same methods as in stage A. Stage C: patient volunteers were imaged using sequences selected from stage B to determine inter and intra observer segmentation and registration variation. Stage D recruitment of patient and non-patient volunteers for further image develop and refinement of MRIgRT workflows. All participants completed experience questionnaires to optimize workflows. Participants were asked to undergo 1-12 imaging sessions, lasting no more than 60. RESULTS To date 151 participants (61 non-patients; 90 patients) have undergone 231 imaging sessions. From stage B, vendor provided, in-workflow sequences have been agreed from 47 completed VGAs by prioritizing high scores in either the tumor (e.g., lung) or organs at risk (e.g., cervix). T2w 3D sequences scored best in cervix, pancreas, prostate, bladder, liver, soft-tissue metastases and rectal cancers; T1w 3D sequences for H&N, and patient a specific approach for lung. No suitable sequences have been selected for partial breast. Research sequences (e.g., diffusion weighted or motion corrected imaging) have been agreed or are in development in stages C & D for H&N, cervix, bladder and prostate cancers. The mean interobserver (n = 8) vector variation in 5 H&N patients was largest (3.6mm) using T1-CT boney registrations and smallest (2.1mm) using T1-T1 soft-tissue registrations (mean observer match confidence 3.7/5). Analyses using MR to CT, MR to MR and CT to CT registrations in lung, pancreas, cervix, bladder, and prostate have also been completed. Interobserver delineation studies are on-going. CONCLUSION Using a 4-stage non-comparative prospective feasibility study has facilitated clinical implementation MRIgRT of multiple treatment sites at our institution.
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Affiliation(s)
- C L Eccles
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - M Dubec
- University of Manchester, Manchester, United Kingdom
| | - D Cobben
- The Clatterbridge Cancer Centre NHS, Liverpool, United Kingdom
| | - M van Herk
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - L McDaid
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - C Nelder
- The Christie NHS, Manchester, United Kingdom
| | - L Whiteside
- The Christie NHS FT, Manchester, United Kingdom
| | | | - L McHugh
- The Christie NHS FT, Manchester, United Kingdom
| | - J Bridge
- The Christie NHS FT, Manchester, United Kingdom
| | | | - R Chuter
- The Christie NHS Foundation, Manchester, United Kingdom
| | - P Hoskin
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - R A Huddart
- The Institute of Cancer Research, Division of Radiotherapy and Imaging, London, United Kingdom
| | - A Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK, Manchester, United Kingdom
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Huang HT, Nix MG, Brand DH, Cobben D, Hiley CT, Fenwick JD, Hawkins MA. Dose-Response Analysis Describes Particularly Rapid Repopulation of Non-Small Cell Lung Cancer during Concurrent Chemoradiotherapy. Cancers (Basel) 2022; 14:4869. [PMID: 36230791 PMCID: PMC9563948 DOI: 10.3390/cancers14194869] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Purpose: We analysed overall survival (OS) rates following radiotherapy (RT) and chemo-RT of locally-advanced non-small cell lung cancer (LA-NSCLC) to investigate whether tumour repopulation varies with treatment-type, and to further characterise the low α/β ratio found in a previous study. (2) Materials and methods: Our dataset comprised 2-year OS rates for 4866 NSCLC patients (90.5% stage IIIA/B) belonging to 51 cohorts treated with definitive RT, sequential chemo-RT (sCRT) or concurrent chemo-RT (cCRT) given in doses-per-fraction ≤3 Gy over 16-60 days. Progressively more detailed dose-response models were fitted, beginning with a probit model, adding chemotherapy effects and survival-limiting toxicity, and allowing tumour repopulation and α/β to vary with treatment-type and stage. Models were fitted using the maximum-likelihood technique, then assessed via the Akaike information criterion and cross-validation. (3) Results: The most detailed model performed best, with repopulation offsetting 1.47 Gy/day (95% confidence interval, CI: 0.36, 2.57 Gy/day) for cCRT but only 0.30 Gy/day (95% CI: 0.18, 0.47 Gy/day) for RT/sCRT. The overall fitted tumour α/β ratio was 3.0 Gy (95% CI: 1.6, 5.6 Gy). (4) Conclusion: The fitted repopulation rates indicate that cCRT schedule durations should be shortened to the minimum in which prescribed doses can be tolerated. The low α/β ratio suggests hypofractionation should be efficacious.
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Affiliation(s)
- Huei-Tyng Huang
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
| | - Michael G. Nix
- Department of Medical Physics and Engineering, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Foundation Trust, Leeds LS9 7TF, UK
| | - Douglas H. Brand
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
- University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
| | - David Cobben
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool CH63 4JY, UK
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool L69 3GF, UK
| | - Crispin T. Hiley
- University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, London WC1E 6AG, UK
| | - John D. Fenwick
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool CH63 4JY, UK
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool L69 7BE, UK
| | - Maria A. Hawkins
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
- University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
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Clough A, Pitt E, Nelder C, Benson R, McDaid L, Whiteside L, Davies L, Parker J, Awofisoye T, Freear L, Berresford J, Marchant T, McPartlin A, Crockett C, Salem A, Cobben D, Eccles C. OC-0420 Considerations for the clinical implementation of MRI-guided ART for H&N and lung cancers. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02556-7] [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] [Indexed: 10/18/2022]
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Piddock K, Nautiyal H, Ahmed M, Barron M, Bhalla N, Cook T, Cubbin S, Davis G, Dobson R, Escriu C, Ghoz H, Hart C, Johnston M, McManus C, Montasem A, Sohl H, Rose S, Tippett V, Wong H, Cobben D. Frailty, comorbidity and cardiovascular risk assessment in older patients with lung cancer. Lung Cancer 2022. [DOI: 10.1016/s0169-5002(22)00134-9] [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] [Indexed: 10/19/2022]
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Amugongo L, Osorio EV, Green A, Cobben D, van Herk M, McWilliam A. Impact of registration uncertainties on the prediction of early tumour response to radiotherapy in NSCLC patients. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00120-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Amugongo LM, Osorio EV, Green A, Cobben D, van Herk M, McWilliam A. Early prediction of tumour-response to radiotherapy in NSCLC patients. Phys Med Biol 2021; 66. [PMID: 34644691 DOI: 10.1088/1361-6560/ac2f88] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/13/2021] [Indexed: 12/25/2022]
Abstract
Objective. In this study we developed an automatic method to predict tumour volume and shape in weeks 3 and 4 of radiotherapy (RT), using cone-beam computed tomography (CBCT) scans acquired up to week 2, allowing identification of large tumour changes.Approach. 240 non-small cell lung cancer (NSCLC) patients, treated with 55 Gy in 20 fractions, were collected. CBCTs were rigidly registered to the planning CT. Intensity values were extracted in each voxel of the planning target volume across all CBCT images from days 1, 2, 3, 7 and 14. For each patient and in each voxel, four regression models were fitted to voxel intensity; applying linear, Gaussian, quadratic and cubic methods. These models predicted the intensity value for each voxel in weeks 3 and 4, and the tumour volume found by thresholding. Each model was evaluated by computing the root mean square error in pixel value and structural similarity index metric (SSIM) for all patients. Finally, the sensitivity and specificity to predict a 30% change in volume were calculated for each model.Main results. The linear, Gaussian, quadratic and cubic models achieved a comparable similarity score, the average SSIM for all patients was 0.94, 0.94, 0.90, 0.83 in week 3, respectively. At week 3, a sensitivity of 84%, 53%, 90% and 88%, and specificity of 99%, 100%, 91% and 42% were observed for the linear, Gaussian, quadratic and cubic models respectively. Overall, the linear model performed best at predicting those patients that will benefit from RT adaptation. The linear model identified 21% and 23% of patients in our cohort with more than 30% tumour volume reduction to benefit from treatment adaptation in weeks 3 and 4 respectively.Significance. We have shown that it is feasible to predict the shape and volume of NSCLC tumours from routine CBCTs and effectively identify patients who will respond to treatment early.
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Affiliation(s)
- Lameck Mbangula Amugongo
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom.,Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Eliana Vasquez Osorio
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom.,Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Andrew Green
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom.,Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - David Cobben
- The Clatterbridge Cancer Centre NHS Foundation Trust, United Kingdom
| | - Marcel van Herk
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom.,Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Alan McWilliam
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom.,Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
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Amugongo LM, Green A, Cobben D, van Herk M, McWilliam A, Osorio EV. Identification of modes of tumor regression in non-small cell lung cancer patients during radiotherapy. Med Phys 2021; 49:370-381. [PMID: 34724228 DOI: 10.1002/mp.15320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 02/07/2021] [Revised: 09/18/2021] [Accepted: 10/19/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Observed gross tumor volume (GTV) shrinkage during radiotherapy (RT) raises the question of whether to adapt treatment to changes observed on the acquired images. In the literature, two modes of tumor regression have been described: elastic and non-elastic. These modes of tumor regression will affect the safety of treatment adaptation. This study applies a novel approach, using routine cone-beam computed tomography (CBCT) and deformable image registration to automatically distinguish between elastic and non-elastic tumor regression. METHODS In this retrospective study, 150 locally advanced non-small cell lung cancer patients treated with 55 Gray of radiotherapy were included. First, the two modes of tumor regression were simulated. For each mode of tumor regression, one timepoint was simulated. Based on the results of simulated data, the approach used for analysis in real patients was developed. CBCTs were non-rigidly registered to the baseline CBCT using a cubic B-spline algorithm, NiftyReg. Next, the Jacobian determinants were computed from the deformation vector fields. To capture local volume changes, 10 Jacobian values were sampled perpendicular to the surface of the GTV, across the lung-tumor boundary. From the simulated data, we can distinguish elastic from non-elastic tumor regression by comparing the Jacobian values samples between 5 and 12.5 mm inside and 5 and 12.5 mm outside the planning GTV. Finally, morphometric results were compared between tumors of different histologies. RESULTS Most patients (92.3%) in our cohort showed stable disease in the first week of treatment and non-elastic shrinkage in the later weeks of treatment. At week 2, 125 patients (88%) showed stable disease, three patients (2.1%) disease progression, and 11 patients (8%) regression. By treatment completion, 91 patients (64%) had stable disease, one patient (0.7%) progression and 46 patients (32%) regression. A slight difference in the mode of tumor change was observed between tumors of different histologies. CONCLUSION Our novel approach shows that it may be possible to automatically quantify and identify global changes in lung cancer patients during RT, using routine CBCT images. Our results show that different regions of the tumor change in different ways. Therefore, careful consideration should be taken when adapting RT.
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Affiliation(s)
- Lameck Mbangula Amugongo
- Division of Cancer Sciences, University of Manchester, Manchester, UK.,Department of Radiotherapy Related Research, the Christie NHS Foundation Trust, Manchester, UK
| | - Andrew Green
- Division of Cancer Sciences, University of Manchester, Manchester, UK.,Department of Radiotherapy Related Research, the Christie NHS Foundation Trust, Manchester, UK
| | - David Cobben
- The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Hospital, Birkenhead, UK
| | - Marcel van Herk
- Division of Cancer Sciences, University of Manchester, Manchester, UK.,Department of Radiotherapy Related Research, the Christie NHS Foundation Trust, Manchester, UK
| | - Alan McWilliam
- Division of Cancer Sciences, University of Manchester, Manchester, UK.,Department of Radiotherapy Related Research, the Christie NHS Foundation Trust, Manchester, UK
| | - Eliana Vasquez Osorio
- Division of Cancer Sciences, University of Manchester, Manchester, UK.,Department of Radiotherapy Related Research, the Christie NHS Foundation Trust, Manchester, UK
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Brown S, Beasley M, Aznar MC, Belderbos J, Chuter R, Cobben D, Faivre-Finn C, Franks K, Henry A, Murray L, Price G, van Herk M. The Impact of Intra-thoracic Anatomical Changes upon the Delivery of Lung Stereotactic Ablative Radiotherapy. Clin Oncol (R Coll Radiol) 2021; 33:e413-e421. [PMID: 34001380 DOI: 10.1016/j.clon.2021.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/23/2021] [Revised: 03/29/2021] [Accepted: 04/21/2021] [Indexed: 12/25/2022]
Abstract
AIMS So far, the impact of intra-thoracic anatomical changes (ITACs) on patients treated with stereotactic ablative radiotherapy (SABR) for early-stage non-small cell lung cancer is unknown. Studying these is important, as ITACs have the potential to impact the workflow and reduce treatment quality. The aim of this study was to assess and categorise ITACs, as detected on cone beam computed tomography scans (CBCT), and their subsequent impact upon treatment in lung cancer patients treated with SABR. MATERIALS AND METHODS CBCTs from 100 patients treated with SABR for early non-small cell lung cancer were retrospectively reviewed. The presence of the following ITACs was assessed: atelectasis, infiltrative change, pleural effusion, baseline shift and gross tumour volume (GTV) increase and decrease. ITACs were graded using a traffic light protocol. This was adapted from a tool previously developed to assesses potential target undercoverage or organ at risk overdose. The frequency of physics or clinician review was noted. A linear mixed effects model was used to assess the relationship between ITAC grade and set-up time (time from first CBCT to beam delivery). RESULTS ITACs were observed in 22% of patients. Twenty-one per cent of these were categorised as 'red', implying a risk of underdosage to the GTV. Most were 'yellow' (51%), indicating little impact upon planning target volume coverage of the GTV. Physics or clinician review was required in 10% of all treatment fractions overall. Three patients needed their treatment replanned. The mixed effect model analysis showed that ITACs cause a significant prolongation of set-up time (Χ2(3) = 9.22, P = 0.02). CONCLUSION Most ITACs were minor, but associated with unplanned physics or clinician review, representing a potentially significant resource burden. ITACs also had a significant impact upon set-up time, with consequences for the wider workflow and intra-fraction motion. Detailed guidance on the management of ITACs is needed to provide support for therapeutic radiographers delivering lung SABR.
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Affiliation(s)
- S Brown
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Gloucestershire Oncology Centre, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK.
| | - M Beasley
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M C Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - J Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - R Chuter
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - D Cobben
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - C Faivre-Finn
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - K Franks
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Henry
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - L Murray
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - G Price
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - M van Herk
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Dubec M, Brown S, Chuter R, Hales R, Whiteside L, Rodgers J, Parker J, Eccles CL, van Herk M, Faivre-Finn C, Cobben D. MRI and CBCT for lymph node identification and registration in patients with NSCLC undergoing radical radiotherapy. Radiother Oncol 2021; 159:112-118. [PMID: 33775713 DOI: 10.1016/j.radonc.2021.03.015] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 02/26/2021] [Accepted: 03/08/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE This study compared MRI to CBCT for the identification and registration of lymph nodes (LN) in patients with locally advanced (LA)-NSCLC, to assess the suitability of targeting LNs in future MR-image guided radiotherapy (MRgRT) workflows. METHOD Radiotherapy radiographers carried out Visual Grading Analysis (VGA) assessment of image quality, LN registration and graded their confidence in registration for each of the 24 LNs on CBCT and two MR sequences, MR1 (T2w Turbo Spin Echo) and MR2 (T1w DIXON water only image). RESULTS Pre-registration image quality assessment revealed MR1 and MR2 as significantly superior to CBCT in terms of image quality (p ≤ 0.01). No significant differences were noted in interobserver variability for LN registration between CBCT, MR1 and MR2. Observers were more confident in their MR registrations compared to their CBCT based LN registrations (p ≤ 0.02). SUMMARY Interobserver setup correction variability was not found to be significantly different between CBCT and MR. Image quality and registration confidence were found to be superior for MRI sequences. This is a promising step towards MR-guided radiotherapy for the treatment of LA-NSCLC.
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Affiliation(s)
- Michael Dubec
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK.
| | - Sean Brown
- Gloucestershire Oncology Centre, Cheltenham General Hospital, Cheltenham, UK
| | - Robert Chuter
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Rosie Hales
- Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK
| | - Lee Whiteside
- Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK
| | - John Rodgers
- Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK
| | - Jacqui Parker
- Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK
| | - Cynthia L Eccles
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK
| | - Marcel van Herk
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - David Cobben
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
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Crockett C, Chuter R, Cobben D, Dubec M, Green O, Hackett S, McDonald F, Robinson C, Samson P, Shiarli AM, Straza M, Verhoeff J, Vlacich G, Werner-Wasik M, Faivre-Finn C. Magnetic resonance-guided radiotherapy (MRgRT) for patients with lung cancer. Lung Cancer 2021. [DOI: 10.1016/s0169-5002(21)00347-0] [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] [Indexed: 10/21/2022]
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Tang C, Mistry H, Bayman N, Chan C, Cobben D, Faivre-Finn C, Harris M, Kennedy J, Pemberton L, Price G, Sheikh H, Woolf D, Coote J, Salem A. Outcomes of curative-intent radiotherapy in non-small cell lung cancer (NSCLC) patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). Radiother Oncol 2021; 160:78-81. [PMID: 33901563 DOI: 10.1016/j.radonc.2021.04.014] [Citation(s) in RCA: 3] [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: 07/30/2020] [Revised: 03/29/2021] [Accepted: 04/16/2021] [Indexed: 12/25/2022]
Abstract
Outcomes of non-small cell lung cancer (NSCLC) patients with chronic obstructive pulmonary disease (COPD n = 587) and interstitial lung disease (ILD n = 34) treated with curative-intent radiotherapy were retrospectively investigated. Presence of ILD but not decreased forced expiratory volume in 1-second correlated with poor overall survival. Increased breathlessness and oxygen requirements after radiotherapy were observed in severe/very severe COPD and ILD.
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Affiliation(s)
- Celion Tang
- Division of Medical Education, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Hitesh Mistry
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Neil Bayman
- Department Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Clara Chan
- Department Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - David Cobben
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Department Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Department Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Margaret Harris
- Department Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jason Kennedy
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Laura Pemberton
- Department Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Gareth Price
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Department Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Hamid Sheikh
- Department Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - David Woolf
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Department Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Joanna Coote
- Department Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Ahmed Salem
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Department Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom.
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Crockett CB, Samson P, Chuter R, Dubec M, Faivre-Finn C, Green OL, Hackett SL, McDonald F, Robinson C, Shiarli AM, Straza MW, Verhoeff JJC, Werner-Wasik M, Vlacich G, Cobben D. Initial Clinical Experience of MR-Guided Radiotherapy for Non-Small Cell Lung Cancer. Front Oncol 2021; 11:617681. [PMID: 33777759 PMCID: PMC7988221 DOI: 10.3389/fonc.2021.617681] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023] Open
Abstract
Curative-intent radiotherapy plays an integral role in the treatment of lung cancer and therefore improving its therapeutic index is vital. MR guided radiotherapy (MRgRT) systems are the latest technological advance which may help with achieving this aim. The majority of MRgRT treatments delivered to date have been stereotactic body radiation therapy (SBRT) based and include the treatment of (ultra-) central tumors. However, there is a move to also implement MRgRT as curative-intent treatment for patients with inoperable locally advanced NSCLC. This paper presents the initial clinical experience of using the two commercially available systems to date: the ViewRay MRIdian and Elekta Unity. The challenges and potential solutions associated with MRgRT in lung cancer will also be highlighted.
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Affiliation(s)
- Cathryn B. Crockett
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Pamela Samson
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, United States
| | - Robert Chuter
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Michael Dubec
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Olga L. Green
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, United States
| | - Sara L. Hackett
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Fiona McDonald
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, United States
| | - Anna-Maria Shiarli
- Department of Radiotherapy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Michael W. Straza
- Department of Radiation Oncology, Froedtert and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Joost J. C. Verhoeff
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, United States
| | - Gregory Vlacich
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, United States
| | - David Cobben
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
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Amugongo L, Vasquez Osorio E, Green A, Cobben D, Van Herk M, McWilliam A. PO-1569: Early prediction of tumour-response to radiotherapy in NSCLC patients. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01587-5] [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] [Indexed: 11/25/2022]
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15
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Brown S, Dubec M, Chuter R, Eccles C, Hales R, Parker J, Rodgers J, Whiteside L, Van Herk M, Finn CF, Cobben D. PD-0673: MRI vs CBCT image guidance when treating lymph nodes in patients with locally advanced (LA)-NSCLC. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00695-2] [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] [Indexed: 11/17/2022]
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16
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Amugongo LM, Osorio EV, Green A, Cobben D, van Herk M, McWilliam A. Identification of patterns of tumour change measured on CBCT images in NSCLC patients during radiotherapy. Phys Med Biol 2020; 65:215001. [PMID: 32693397 DOI: 10.1088/1361-6560/aba7d3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this study, we propose a novel approach to investigate changes in the visible tumour and surrounding tissues with the aim of identifying patterns of tumour change during radiotherapy (RT) without segmentation on the follow-up images. On-treatment cone-beam computed tomography (CBCT) images of 240 non-small cell lung cancer (NSCLC) patients who received 55 Gy of RT were included. CBCTs were automatically aligned onto planning computed tomography (planning CT) scan using a two-step rigid registration process. To explore density changes across the lung-tumour boundary, eight shells confined to the shape of the gross tumour volume (GTV) were created. The shells extended 6 mm inside and outside of the GTV border, and each shell is 1.5 mm thick. After applying intensity correction on CBCTs, the mean intensity was extracted from each shell across all CBCTs. Thereafter, linear fits were created, indicating density change over time in each shell during treatment. The slopes of all eight shells were clustered to explore patterns in the slopes that show how tumours change. Seven clusters were obtained, 97% of the patients were clustered into three groups. After visual inspection, we found that these clusters represented patients with little or no density change, progression and regression. For the three groups, the survival curves were not significantly different between the groups, p-value = 0.51. However, the results show that definite patterns of tumour change exist, suggesting that it may be possible to identify patterns of tumour changes from on-treatment CBCT images.
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Affiliation(s)
- Lameck Mbangula Amugongo
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom. Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
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Pluyter JR, Jacobs I, Langereis S, Cobben D, Williams S, Curfs J, van den Borne B. Looking through the eyes of the multidisciplinary team: the design and clinical evaluation of a decision support system for lung cancer care. Transl Lung Cancer Res 2020; 9:1422-1432. [PMID: 32953514 PMCID: PMC7481580 DOI: 10.21037/tlcr-19-441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 12/24/2022]
Abstract
Background Decision-making in lung cancer is complex due to a rapidly increasing amount of diagnostic data and treatment options. The need for timely and accurate diagnosis and delivery of care demands high-quality multidisciplinary team (MDT) collaboration and coordination. Clinical decision support systems (CDSSs) can potentially support MDTs in constructing a shared mental model of a patient case. This enables the team to assess the strength and completeness of collected diagnostic data, stratification for the right personalized therapy driven by clinical stage and other treatment-influencing factors, and adapt care management strategies when needed. Current CDSSs often have a suboptimal fit into the decision-making workflow, which hampers their impact in clinical practice. Methods A CDSS for multidisciplinary decision-making in lung cancer was designed to support the abovementioned goals through presentation of relevant clinical data in line with existing mental model structures of the MDT members. The CDSS was tested in a simulated multidisciplinary tumor board meeting for primary diagnosis and treatment selection, based on de-identified primary lung cancer cases (n=8). Decision course analysis, eye-tracking data and questionnaires were used to assess the impact of the CDSS on constructing shared mental models to improve the decision-making process and outcome. Results The CDSS supported the team in their self-correcting capacity for accurate diagnosis and TNM classification. It enabled cross-validation of diagnostic findings, surfaced discordance between diagnostic tests and facilitated cancer staging according the diagnostic evidence, as well as spotting contra-indications for personalized treatment selection. Conclusions This study shows the potential of CDSS on clinical decision making, when these systems are properly designed in line with clinical thinking. The presented setup enables assessment of the impact of CDSS design on clinical decision making and optimization of CDSSs to maximize their effect on decision quality and confidence.
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Affiliation(s)
- Jon R Pluyter
- Philips Experience Design, High Tech Campus 33, Eindhoven, The Netherlands
| | - Igor Jacobs
- Department of Oncology Solutions, Philips Research Europe, High Tech Campus 34, Eindhoven, The Netherlands
| | - Sander Langereis
- Department of Oncology Solutions, Philips Research Europe, High Tech Campus 34, Eindhoven, The Netherlands
| | - David Cobben
- Department of Radiotherapy Related Research, University of Manchester-The Christie National Health Trust, Manchester, UK
| | - Sharon Williams
- Philips Experience Design, High Tech Campus 33, Eindhoven, The Netherlands
| | - Jeannine Curfs
- Department of Pulmonary Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Ben van den Borne
- Department of Pulmonary Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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Beech A, Faivre-Finn C, Bayman N, Blackhall F, Califano R, Chan C, Cobben D, Coote J, Cove-Smith L, Harris M, Hughes S, Martimarti F, Pemberton L, Salem A, Summers Y, Taylor P, Wang X, Woolf D, Sheikh H. Pneumocystis jirovecii pneumonia (PJP) prophylaxis in lung cancer patients receiving radical radiotherapy (RT) ± chemotherapy (CTRT): audit of the first UK departmental guideline. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30113-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Coote J, Tang C, Salem A, Bayman N, Chan C, Cobben D, Faivre-Finn C, Harris M, Hudson A, Pemberton L, Sheikh H, Woolf D. Outcomes of curative-intent radiotherapy in patients with severe COPD or lung fibrosis. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30103-3] [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] [Indexed: 10/25/2022]
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20
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Shiarli AM, Brown S, Cobben D, Wetscherek A, Dubec M, Herbert T, Smith G, Lawes R, Barnes H, Faivre-Finn C, McDonald F. MRI image acquisition on the MR-Linac for patients with locally advanced lung cancer (LALC). Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30111-2] [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] [Indexed: 10/25/2022]
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21
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Antico M, Prinsen P, Fracassi A, Isola A, Cobben D, Fontanarosa D. Comparison between Conventional IMRT Planning and a Novel Real-Time Adaptive Planning Strategy in Hypofractionated Regimes for Prostate Cancer: A Proof-of-Concept Planning Study. Healthcare (Basel) 2019; 7:healthcare7040153. [PMID: 31810236 PMCID: PMC6956044 DOI: 10.3390/healthcare7040153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/11/2019] [Accepted: 11/29/2019] [Indexed: 11/30/2022] Open
Abstract
In prostate cancer external beam radiation therapy (EBRT), intra-fraction prostate drifts may compromise the treatment efficacy by underdosing the target and/or overdosing the organs at risk. In this study, a recently developed real-time adaptive planning strategy for intensity-modulated radiation therapy (IMRT) for prostate cancer was evaluated in hypofractionated regimes against traditional treatment planning based on a treatment volume margin expansion. The proposed workflow makes use of a “library of plans” corresponding to possible intra-fraction prostate positions. During delivery, at each beam end, the plan prepared for the position of the prostate closest to the current one is selected and the corresponding beam delivered. This adaptive planning strategy was compared with the traditional approach on a clinical prostate cancer case where different prostate shift magnitudes were considered. Five, six and fifteen fraction hypofractionated schemes were considered for each of these scenarios. When shifts larger than the treatment margin were present, using the traditional approach the seminal vesicles were underdosed by 3–4% of the prescribed dose. The adaptive approach instead allowed for correct target dose coverage and lowered the dose on the rectum for each dosimetric endpoint on average by 3–4% in all the fractionation schemes. Standard intensity-modulated radiation therapy planning did not always guarantee a correct dose distribution on the seminal vesicles and the rectum. The adaptive planning strategy proposed resulted insensitive to the intra-fraction prostate drifts, produced a dose distribution in agreement with the dosimetric requirements in every case analysed and significantly lowered the dose on the rectum.
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Affiliation(s)
- Maria Antico
- Philips Research, 5656 AE Eindhoven, The Netherlands; (M.A.); (P.P.); (A.F.); (A.I.)
- Delft University of Technology, 2628 CD Delft, The Netherlands
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia
- School of Electrical Engineering and Computer Science, Queensland University of Technology, Gardens Point Campus, 2 George St, Brisbane, QLD 4000, Australia
| | - Peter Prinsen
- Philips Research, 5656 AE Eindhoven, The Netherlands; (M.A.); (P.P.); (A.F.); (A.I.)
| | - Alice Fracassi
- Philips Research, 5656 AE Eindhoven, The Netherlands; (M.A.); (P.P.); (A.F.); (A.I.)
- University of Rome Tor Vergata, 00133 Rome, Italy
| | - Alfonso Isola
- Philips Research, 5656 AE Eindhoven, The Netherlands; (M.A.); (P.P.); (A.F.); (A.I.)
| | - David Cobben
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
- Department of Radiotherapy Related Research, University of Manchester, Manchester M13 9PL, UK
- The Christie National Health Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Davide Fontanarosa
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia
- School of Clinical Sciences, Queensland University of Technology, Gardens Point Campus, 2 George St, Brisbane, QLD 4000, Australia
- Correspondence: ; Tel.: +61-(0)4-03862724
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Ackermann C, Fornacon-Wood I, Tay R, Manoharan P, Price G, Lindsay C, Faivre-Finn C, Blackhall F, Cobben D. P1.04-44 Radiomics for Predicting Response to First-Line Anti-PD1 Therapy in Advanced NSCLC. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.947] [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] [Indexed: 10/25/2022]
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23
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Behrouzi R, Bayman N, Harris M, Salem A, Hudson A, Chan C, Faivre-Finn C, Cobben D, Sheikh H, Coote J, Pemberton L, Woolf D. P2.17-02 Survival in Performance Status 3 Non-Small Cell Lung Cancer Patients Receiving Radical Radiotherapy. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1913] [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] [Indexed: 10/25/2022]
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24
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Cobben D, Bainbridge H, Belderbos J, Cheung P, Dubec M, Gomez D, Gore E, Knowles E, Lalezari F, Oelfke U, Sonke J, Tijssen R, Van Es C, Van Herk M, Wetscherek A, McDonald F, Faivre-Finn C. EP-1346 A framework for systematic clinical evaluation of the MR-linac for treatment of lung cancer patients. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31766-9] [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] [Indexed: 11/29/2022]
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25
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Dubec M, Brown S, Chuter R, McWilliam A, Cobben D, Faivre-Finn C, Van Herk M. EP-1986 Comparison of automatic OAR contour propagation from CT to MR lung images. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32406-5] [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] [Indexed: 10/26/2022]
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26
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Osorio EV, McCallum H, Iqbal S, Bedair A, McWilliam A, Price G, Byrne J, Cobben D. EP-1369 Heart delineations based on 3DCT, AVG and MIP scans: are they representative of the total motion? Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31789-x] [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] [Indexed: 11/27/2022]
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27
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Vasquez Osorio E, Brewster F, McWilliam A, Scaife A, Banfill K, Abravan A, Cobben D, Faivre-Finn C, Van Herk M. OC-0404 Dose to vascular calcifications is predictive for overall survival in lung cancer patients. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30824-2] [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] [Indexed: 11/30/2022]
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Lewis T, Kennedy J, Price G, Mee T, Kirkby K, Kirkby N, Woolf D, Bayman N, Chan C, Coote J, Faivre-Finn C, Harris M, Hudson A, Pemberton L, Salem A, Sheikh H, Mistry H, Cobben D. PO-0775 Palliative lung radiotherapy: audit of prescribing practice and survival analysis. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31195-8] [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] [Indexed: 11/28/2022]
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Antico M, Prinsen P, Cellini F, Fracassi A, Isola AA, Cobben D, Fontanarosa D. Real-time adaptive planning method for radiotherapy treatment delivery for prostate cancer patients, based on a library of plans accounting for possible anatomy configuration changes. PLoS One 2019; 14:e0213002. [PMID: 30818345 PMCID: PMC6394960 DOI: 10.1371/journal.pone.0213002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/13/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE In prostate cancer treatment with external beam radiation therapy (EBRT), prostate motion and internal changes in tissue distribution can lead to a decrease in plan quality. In most currently used planning methods, the uncertainties due to prostate motion are compensated by irradiating a larger treatment volume. However, this could cause underdosage of the treatment volume and overdosage of the organs at risk (OARs). To reduce this problem, in this proof of principle study we developed and evaluated a novel adaptive planning method. The strategy proposed corrects the dose delivered by each beam according to the actual position of the target in order to produce a final dose distribution dosimetrically as similar as possible to the prescribed one. MATERIAL AND METHODS Our adaptive planning method was tested on a phantom case and on a clinical case. For the first, a pilot study was performed on an in-silico pelvic phantom. A "library" of intensity modulated RT (IMRT) plans corresponding to possible positions of the prostate during a treatment fraction was generated at planning stage. Then a 3D random walk model was used to simulate possible displacements of the prostate during the treatment fraction. At treatment stage, at the end of each beam, based on the current position of the target, the beam from the library of plans, which could reproduce the best approximation of the prescribed dose distribution, was selected and delivered. In the clinical case, the same approach was used on two prostate cancer patients: for the first a tissue deformation was simulated in-silico and for the second a cone beam CT (CBCT) taken during the treatment was used to simulate an intra-fraction change. Then, dosimetric comparisons with the standard treatment plan and, for the second patient, also with an isocenter shift correction, were performed. RESULTS For the phantom case, the plan generated using the adaptive planning method was able to meet all the dosimetric requirements and to correct for a misdosage of 13% of the dose prescription on the prostate. For the first clinical case, the standard planning method caused underdosage of the seminal vesicles, respectively by 5% and 4% of the prescribed dose, when the position changes for the target were correctly taken into account. The proposed adaptive planning method corrected any possible missed target coverage, reducing at the same time the dose on the OARs. For the second clinical case, both with the standard planning strategy and with the isocenter shift correction target coverage was significantly worsened (in particular uniformity) and some organs exceeded some toxicity objectives. While with our approach, the most uniform coverage for the target was produced and systematically the lowest toxicity values for the organs at risk were achieved. CONCLUSIONS In our proof of principle study, the adaptive planning method performed better than the standard planning and the isocenter shift methods for prostate EBRT. It improved the coverage of the treatment volumes and lowered the dose to the OARs. This planning method is particularly promising for hypofractionated IMRT treatments in which a higher precision and control on dose deposition are needed. Further studies will be performed to test more extensively the proposed adaptive planning method and to evaluate it at a full clinical level.
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Affiliation(s)
- Maria Antico
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
- Delft University of Technology, Delft, The Netherlands
- Philips Research, Oncology Solutions Department, Eindhoven, The Netherlands
| | - Peter Prinsen
- Philips Research, Oncology Solutions Department, Eindhoven, The Netherlands
| | - Francesco Cellini
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Istituto di Radiologia, Fondazione Policlinico A. Gemelli, IRCCS—Università Cattolica Sacro Cuore, Roma, Italia
| | - Alice Fracassi
- Philips Research, Oncology Solutions Department, Eindhoven, The Netherlands
- University of Rome Tor Vergata, Rome, Italy
| | - Alfonso A. Isola
- Philips Research, Oncology Solutions Department, Eindhoven, The Netherlands
| | - David Cobben
- North West Cancer Centre, Altnagelvin Hospital, Derry-Londonderry, Northern Ireland
- The University of Manchester, Division of Cancer Studies, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Clinical Oncology, Manchester, United Kingdom
| | - Davide Fontanarosa
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
- School of Clinical Sciences, Queensland University of Technology, Gardens Point Campus, Brisbane, QLD, Australia
- * E-mail:
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Cobben D, Bainbridge H, Belderbos J, Cheung P, Dubec M, Gomez D, Gore E, Knowles E, Lalezari F, Oelfke U, Sonke J, Tijssen R, Van Es C, Van Herk M, Wetscherek A, Mcdonald F, Faivre-Finn C. A framework for systematic clinical evaluation of technical innovations in lung cancer patients treated on the MR-linac (MRL). Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30184-9] [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] [Indexed: 11/26/2022]
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31
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Lewis T, Kennedy J, Price G, Mee T, Woolf D, Bayman N, Chan C, Coote J, Faivre-Finn C, Harris M, Hudson A, Pemberton L, Salem A, Sheikh H, Mistry H, Cobben D. Palliative lung radiotherapy at the Christie: audit of prescribing practice and survival analysis. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30240-5] [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] [Indexed: 11/28/2022]
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32
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Cobben D, Bainbridge H, Belderbos J, Cheung P, Dubec M, Gomez D, Gore E, Knowles E, Lalezari F, Oelfke U, Sonke J, Tijssen R, Van Es C, Van Herk M, Wetscherek A, Mcdonald F, Faivre-Finn C. P3.01-26 A Framework for Systematic Clinical Evaluation of Technical Innovations in Lung Cancer Patients Treated on the MR-Linac (MRL). J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1586] [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] [Indexed: 10/28/2022]
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33
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Dubec M, Brown S, Salem A, Cobben D, Van Herk M, Faivre-Finn C. P2.01-27 MR, CT and Cone-Beam CT for Lymph Node Visualisation in Locally-Advanced Lung Cancer. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1081] [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] [Indexed: 10/28/2022]
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34
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Vasquez Osorio E, Brewster F, Cobben D, Faivre-Finn C, Scaife A, Van Herk M, McWilliam A. OA01.03 Interaction Between Dose and Calcifications Is a Predictor for Overall Survival in Lung Cancer Patients Receiving Radiotherapy. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.235] [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] [Indexed: 11/15/2022]
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35
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Vasquez Osorio E, Mccallum H, Iqbal S, Bedair A, McWilliam A, Price G, Byrne J, Cobben D. P2.17-08 Heart Motion in Lung Radiotherapy: How Representative Are Delineations Based on 3DCT, Average and Maximum Projection Scans? J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1534] [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] [Indexed: 11/28/2022]
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36
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Osorio EV, Brewster F, Cobben D, Finn CF, Scaife A, van Herk M, McWilliam A. [OA129] Calcifications in lung cancer patients: can they be used as surrogate for overall survival predictions? Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.06.201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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37
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Vasquez Osorio E, Aznar M, McWilliam A, Cobben D, Green A, Van Herk M. PO-0906: Robust breast VMAT plan optimisation accounting for breast swelling and positional changes. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31216-7] [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] [Indexed: 10/14/2022]
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