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Keane M, Weitkamp N, Madani I, Day J, Dal Bello R, Zamburlini M, Schiess A, Moreira A, Perryck S, Tomuschat K, Spencer M, Tanadini-Lang S, Guckenberger M, Brown M. Randomized self-controlled study comparing open-face vs. closed immobilization masks in fractionated cranial radiotherapy. Radiother Oncol 2024; 196:110314. [PMID: 38677329 DOI: 10.1016/j.radonc.2024.110314] [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: 11/05/2023] [Revised: 04/01/2024] [Accepted: 04/21/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE To compare patient discomfort and immobilisation performance of open-face and closed immobilization masks in cranial radiotherapy. MATERIAL AND METHODS This was a single-center randomized self-controlled clinical trial. At CT simulation, an open-face and closed mask was made for each patient and treatment plans with identical dose prescription were generated for each mask. Patients were randomised to start treatment with an open-face or closed mask. Masks were switched halfway through the treatment course; every patient was their own control. Patients self-reported discomfort, anxiety and pain using the visual analogue scale (VAS). Inter- and intrafraction set-up variability was measured with planar kV imaging and a surface guided radiotherapy (SGRT) system for the open-face masks. RESULTS 30 patients with primary or metastatic brain tumors were randomized - 29 completed radiotherapy to a median total dose of 54 Gy (range 30-60 Gy). Mean discomfort VAS score was significantly lower with open-face masks (0.5, standard deviation 1.0) vs. closed masks (3.3, standard deviation 2.9), P < 0.0001. Anxiety and pain VAS scores were significantly lower with open-face masks (P < 0.0001). Closed masks caused more discomfort in infraorbital (P < 0.001) and maxillary (P = 0.02) areas. Two patients and 27 patients preferred closed or open-face masks, respectively. Interfraction longitudinal shifts and roll and yaw rotations were significantly smaller and lateral shifts were significantly larger with closed masks in combination with the laser system (P < 0.05) compared to open masks in combination with a SGRT system. Intrafraction variability did not differ between the masks. CONCLUSIONS Open-face masks are associated with decreased patient discomfort without compromising patient positioning and immobilisation accuracy.
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Affiliation(s)
- Michèle Keane
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Nienke Weitkamp
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Indira Madani
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Jonathan Day
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Riccardo Dal Bello
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Mariangela Zamburlini
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Antonia Schiess
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Amanda Moreira
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Sophie Perryck
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Katja Tomuschat
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Marilyn Spencer
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Michelle Brown
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland.
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Guckenberger M, Billiet C, Schnell D, Franzese C, Spałek M, Rogers S, Stelmes JJ, Aebersold DM, Hemmatazad H, Zimmermann F, Zimmer J, Zilli T, Bruni A, Baumert BG, Nägler F, Gut P, Förster R, Madani I. Dose-intensified stereotactic body radiotherapy for painful vertebral metastases: A randomized phase 3 trial. Cancer 2024. [PMID: 38581694 DOI: 10.1002/cncr.35310] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/25/2024] [Accepted: 03/12/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND The purpose of this randomised study was to determine whether dose-intensified stereotactic body radiotherapy (SBRT) for painful vertebral metastases results in increased rates of pain improvement compared with conventional external beam radiotherapy (cEBRT) (control) 6 months after treatment. METHODS This randomized, controlled phase 3 trial was conducted between November 2016 and January 2023, when it was stopped early. Patients were eligible if they were aged 18 years or older; had one or two painful, stable, or potentially unstable vertebral metastases; and had a life expectancy of 1 year or longer according to the investigator's estimates. Patients received 48.5 grays (Gy) in 10 fractions (with epidural involvement) or 40 Gy in five fractions (without epidural involvement) in the SBRT group and 30 Gy in 10 fractions or 20 Gy in five fractions in the cEBRT group, respectively. The primary end point was an improvement in the pain score at the treated site by at least 2 points (on a visual analog scale from 0 to 10 points) at 6-month follow-up. Data were analyzed on an intention-to-treat and per-protocol basis. RESULTS Of 214 patients who were screened for eligibility, 63 were randomized 1:1 between SBRT (33 patients with 36 metastases) and cEBRT (30 patients with 31 metastases). The median age of all patients was 66 years, and 40 patients were men (63.5%). In the intention-to-treat analysis, the 6-month proportion of patients who had metastases with pain reduction by 2 or more points was significantly higher in the SBRT group versus the control group (69.4% vs. 41.9%, respectively; two-sided p = .02). Changes in opioid medication intake relative to baseline were nonsignificant between the groups. No differences were observed in vertebral compression fracture or adverse event rates between the groups. CONCLUSIONS Dose-intensified SBRT improved pain score more effectively than cEBRT at 6 months.
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Affiliation(s)
- Matthias Guckenberger
- University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | | | | | - Ciro Franzese
- Humanitas University, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Mateusz Spałek
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Jean-Jacques Stelmes
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Luxemburg Health Directorate, Luxemburg, Luxemburg
| | - Daniel M Aebersold
- Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Hossein Hemmatazad
- Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | | | - Jörg Zimmer
- Städtisches Klinikum Dresden, Dresden, Germany
| | - Thomas Zilli
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Geneva University Hospital, Geneva, Switzerland
| | | | | | | | | | - Robert Förster
- University Hospital Zurich, Zurich, Switzerland
- Kantonsspital Winterthur, Winterthur, Switzerland
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De Bruycker A, De Neve W, Daisne JF, Vercauteren T, De Gersem W, Olteanu L, Berwouts D, Deheneffe S, Madani I, Goethals I, Duprez F. Disease Control and Late Toxicity in Adaptive Dose Painting by Numbers Versus Nonadaptive Radiation Therapy for Head and Neck Cancer: A Randomized Controlled Phase 2 Trial. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00025-7. [PMID: 38387811 DOI: 10.1016/j.ijrobp.2024.01.012] [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] [Received: 11/07/2022] [Revised: 12/03/2023] [Accepted: 01/02/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE Local recurrence remains the main cause of death in stage III-IV nonmetastatic head and neck cancer (HNC), with relapse-prone regions within high 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET)-signal gross tumor volume. We investigated if dose escalation within this subvolume combined with a 3-phase treatment adaptation could increase local (LC) and regional (RC) control at equal or minimized radiation-induced toxicity, by comparing adaptive 18F-FDG-PET voxel intensity-based dose painting by numbers (A-DPBN) with nonadaptive standard intensity modulated radiation therapy (S-IMRT). METHODS AND MATERIALS This 2-center randomized controlled phase 2 trial assigned (1:1) patients to receive A-DPBN or S-IMRT (+/-chemotherapy). Eligibility: nonmetastatic HNC of oral cavity, oro-/hypopharynx, or larynx, needing radio(chemo)therapy; T1-4N0-3 (exception: T1-2N0 glottic); KPS ≥ 70; ≥18 years; and informed consent. PRIMARY OUTCOMES 1-year LC and RC. The dose prescription for A-DPBN was intercurrently adapted in 2 steps to an absolute dose-volume limit (≤1.75 cm3 can receive >84 Gy and normalized isoeffective dose >96 Gy) as a safety measure during the study course after 4/7 A-DPBN patients developed ≥G3 mucosal ulcers. RESULTS Ninety-five patients were randomized (A-DPBN, 47; S-IMRT, 48). Median follow-up was 31 months (IQR, 14-48 months); 29 patients died (17 of cancer progression). A-DPBN resulted in superior LC compared with S-IMRT, with 1- and 2-year LC of 91% and 88% versus 78% and 75%, respectively (hazard ratio, 3.13; 95% CI, 1.13-8.71; P = .021). RC and overall survival were comparable between arms, as was overall grade (G) ≥3 late toxicity (36% vs 20%; P = .1). More ≥G3 late mucosal ulcers were observed in active smokers (29% vs 3%; P = .005) and alcohol users (33% vs 13%; P = .02), independent of treatment arm. Similarly, in the A-DPBN arm, significantly more patients who smoked at diagnosis developed ≥G3 (46% vs 12%; P = .005) and ≥G4 (29% vs 8%; P = .048) mucosal ulcers. One arterial blowout occurred after a G5 mucosal toxicity. CONCLUSIONS A-DPBN resulted in superior 1- and 2-year LC for HNC compared with S-IMRT. This supports further exploration in multicenter phase 3 trials. It will, however, be challenging to recruit a substantial patient sample for such trials, as concerns have arisen regarding the association of late mucosal ulcers when escalating the dose in continuing smokers.
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Affiliation(s)
- Aurélie De Bruycker
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
| | - Wilfried De Neve
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Jean-François Daisne
- Department of Radiation Oncology, Université Catholique de Louvain, CHU-UCL-Namur, Namur, Belgium; Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium; Department of Oncology, Leuven Cancer Institute (LKI), Catholic University of Leuven, Leuven, Belgium
| | - Tom Vercauteren
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Werner De Gersem
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Luiza Olteanu
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Dieter Berwouts
- Department of Nuclear Medicine, AZ Maria-Middelares, AZ Jan Palfijn, Ghent, Belgium
| | - Stéphanie Deheneffe
- Department of Radiation Oncology, Université Catholique de Louvain, CHU-UCL-Namur, Namur, Belgium
| | - Indira Madani
- Department of Radiation Oncology, University Hospital of Zurich, Zurich, Switzerland
| | - Ingeborg Goethals
- Faculty of Medicine and Health Sciences, Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Fréderic Duprez
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
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Madani I, Sahgal A, Erler D, Stish BJ, Olivier KR, Park SS, Eppinga WSC, Seravalli E, Redmond KJ, Cao Y, Siva S, Chang D, Nguyen TK, O'Neil M, Guckenberger M. STEREOTACTIC BODY RADIATION THERAPY FOR METASTASES IN LONG BONES. Int J Radiat Oncol Biol Phys 2022; 114:738-746. [PMID: 35850362 DOI: 10.1016/j.ijrobp.2022.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 04/05/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the cumulative incidence of fracture and local failure and associated risk factors after stereotactic body radiotherapy (SBRT) for long bone metastases. MATERIAL AND METHODS Data from 111 patients with 114 metastases in the femur, humerus and tibia treated with SBRT in 7 international centers between October 2011 and February 2021 were retrospectively reviewed and analyzed using a competing risk regression model. RESULTS The median follow-up was 21 months (range 6-91 months). All but one patient had a Karnofsky performance status ≥70. There were 84 femur (73.7%), 26 humerus (22.8%) and 4 tibia (3.5%) metastases from prostate (45 [39.5%]), breast (22 [19.3%]), lung (15 [13.2%]), kidney (13 [11.4%]) and other (19 [16.6%]) malignancies. Oligometastases accounted for 74.8% of metastases and 28.1% were osteolytic. The most common total doses were 30-50 Gy in 5 daily fractions (50.9%). Eight fractures (5 in the femur, 2 in the tibia and 1 in the humerus) were observed with a median time to fracture of 12 months (range 0.8-33 months). In 6/8 patients, fracture was not associated with local failure. The cumulative incidence of fracture was 3.5%, 6.1% and 9.8% at 1, 2 and 3 years, respectively. The cumulative incidence of local failure (9/110 metastases with imaging follow-up) was 5.7%, 7.2% and 13.5% at 1, 2 and 3 years, respectively. On multivariate analysis, extraosseous disease extension was significantly associated with fracture (P=0.001; subhazard ratio [SHR] 10.8; 95% CI 2.8-41.9) and local failure (P=0.02; SHR 7.9; 95% CI 1.4-44.7). CONCLUSION SBRT for metastases in long bones achieved high rates of durable local metastasis control without an increased risk of fracture. Similar to spine SBRT, patients with extraosseous disease extension are at higher risk of local failure and fracture.
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Affiliation(s)
- Indira Madani
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Arjun Sahgal
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Darby Erler
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | | | | | - W S C Eppinga
- University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Kristin J Redmond
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Yilin Cao
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Shankar Siva
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - David Chang
- Peter MacCallum Cancer Centre, Melbourne, Australia
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Vercauteren T, De Bruycker A, Duprez F, Daisne J, Olteanu A, Deheneffe S, Berwouts D, De Neve W, Madani I, Paelinck L, Speleers B, Goethals I, De Gersem W. OC-0129 Adaptive Dose Painting vs standard IMRT in a randomized phase II trial: a dosimetric analysis. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02505-1] [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] [Indexed: 11/28/2022]
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Madani I, Guckenberger M, Erler D, Stish B, Olivier K, Park S, Eppinga W, Seravalli E, Redmond K, Cao Y, Siva S, Chang D, Nguyen T, O’Neil M, Sahgal A. MO-0713 Stereotactic Body Radiotherapy for Long Bone Metastases: An International Multicenter Analysis. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02411-2] [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: 11/25/2022]
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Guckenberger M, Mantel F, Sweeney RA, Hawkins M, Belderbos J, Ahmed M, Andratschke N, Madani I, Flentje M. Long-Term Results of Dose-Intensified Fractionated Stereotactic Body Radiation Therapy (SBRT) for Painful Spinal Metastases. Int J Radiat Oncol Biol Phys 2021; 110:348-357. [PMID: 33412262 DOI: 10.1016/j.ijrobp.2020.12.045] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 12/16/2020] [Accepted: 12/22/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To report long-term outcome of fractionated stereotactic body radiation therapy (SBRT) for painful spinal metastases. METHODS AND MATERIALS This prospective, single-arm, multicenter phase 2 clinical trial enrolled 57 patients with 63 painful, unirradiated spinal metastases between March 2012 and July 2015. Patients were treated with 48.5 Gy in 10 SBRT fractions (long life expectancy [Mizumoto score ≤4]) or 35 Gy in 5 SBRT fractions (intermediate life expectancy [Mizumoto score 5-9]). Pain response was defined as pain improvement of a minimum of 2 points on a visual analog scale, and net pain relief was defined as the sum of time with pain response (complete and partial) divided by the overall follow-up time. RESULTS All 57 patients received treatment per protocol; 32 and 25 patients were treated with 10- and 5-fraction SBRT, respectively. The median follow-up of living patients was 60 months (range, 33-74 months). Of evaluable patients, 82% had complete or partial pain response (responders) at 3 months' follow-up (primary endpoint), and pain response remained stable over 5 years. Net pain relief was 74% (95% CI, 65%-80%). Overall survival rates of 1, 3, and 5 years were 59.6% (95% CI, 47%-72%), 33.3% (95% CI, 21%-46%), and 21% (95% CI, 10%-32%), respectively. Freedom from local spinal-metastasis progression was 82% at the last imaging follow-up. Late grade-3 toxicity was limited to pain in 2 patients (nonresponders). There were no cases of myelopathy. SBRT resulted in long-term improvements of all dimensions of the 5-level EuroQol 5-Dimension Questionnaire except anxiety/depression. CONCLUSIONS Fractionated SBRT achieved durable pain response and improved quality of life at minimum late toxicity.
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Affiliation(s)
- Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany.
| | - Frederick Mantel
- Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Reinhart A Sweeney
- Department of Radiation Oncology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany
| | - Maria Hawkins
- Medical Physics and Biomedical Engineering, University College London, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - José Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Merina Ahmed
- Department of Radiation Therapy, Royal Marsden NHS Foundation Trust/Institute of Cancer Research, Sutton, United Kingdom
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Indira Madani
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Flentje
- Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany
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Apolle R, Appold S, Bijl HP, Blanchard P, Bussink J, Faivre-Finn C, Khalifa J, Laprie A, Lievens Y, Madani I, Ruffier A, de Ruysscher D, van Elmpt W, Troost EGC. Inter-observer variability in target delineation increases during adaptive treatment of head-and-neck and lung cancer. Acta Oncol 2019; 58:1378-1385. [PMID: 31271079 DOI: 10.1080/0284186x.2019.1629017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: Inter-observer variability (IOV) in target volume delineation is a well-documented source of geometric uncertainty in radiotherapy. Such variability has not yet been explored in the context of adaptive re-delineation based on imaging data acquired during treatment. We compared IOV in the pre- and mid-treatment setting using expert primary gross tumour volume (GTV) and clinical target volume (CTV) delineations in locoregionally advanced head-and-neck squamous cell carcinoma (HNSCC) and (non-)small cell lung cancer [(N)SCLC]. Material and methods: Five and six observers participated in the HNSCC and (N)SCLC arm, respectively, and provided delineations for five cases each. Imaging data consisted of CT studies partly complemented by FDG-PET and was provided in two separate phases for pre- and mid-treatment. Global delineation compatibility was assessed with a volume overlap metric (the Generalised Conformity Index), while local extremes of IOV were identified through the standard deviation of surface distances from observer delineations to a median consensus delineation. Details of delineation procedures, in particular, GTV to CTV expansion and adaptation strategies, were collected through a questionnaire. Results: Volume overlap analysis revealed a worsening of IOV in all but one case per disease site, which failed to reach significance in this small sample (p-value range .063-.125). Changes in agreement were propagated from GTV to CTV delineations, but correlation could not be formally demonstrated. Surface distance based analysis identified longitudinal target extent as a pervasive source of disagreement for HNSCC. High variability in (N)SCLC was often associated with tumours abutting consolidated lung tissue or potentially invading the mediastinum. Adaptation practices were variable between observers with fewer than half stating that they consistently adapted pre-treatment delineations during treatment. Conclusion: IOV in target volume delineation increases during treatment, where a disparity in institutional adaptation practices adds to the conventional causes of IOV. Consensus guidelines are urgently needed.
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Affiliation(s)
- Rudi Apolle
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology – OncoRay, Dresden, Germany
| | - Steffen Appold
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Henk P. Bijl
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Pierre Blanchard
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Johan Bussink
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Corinne Faivre-Finn
- The Christie NHS Foundation Trust, Division of Cancer Science, The University of Manchester, Manchester, UK
| | - Jonathan Khalifa
- Department of Radiotherapy, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Anne Laprie
- Department of Radiotherapy, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Yolande Lievens
- Radiation Oncology Department, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Indira Madani
- Department of Radiation Oncology, University Hospital Zürich, Zürich, Switzerland
| | - Amandine Ruffier
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Dirk de Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Esther G. C. Troost
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology – OncoRay, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center DKFZ, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany
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Apolle R, Bijl H, Blanchard P, Laprie A, Madani I, Ruffier A, Van Elmpt W, Troost E. EP-1184 Target volume delineation for adaptive treatment in HNSCC is highly variable among experts. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31604-4] [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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Guckenberger M, Sweeney R, Hawkins M, Belderbos J, Andratschke N, Ahmed M, Madani I, Mantel F, Steigerwald S, Flentje M. PV-0475: Stereotactic Body Radiation Therapy For Painful Spinal Metastases - Results Of A Phase 2 Study. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30785-0] [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: 11/15/2022]
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Guckenberger M, Sweeney RA, Hawkins M, Belderbos J, Andratschke N, Ahmed M, Madani I, Mantel F, Steigerwald S, Flentje M. Dose-intensified hypofractionated stereotactic body radiation therapy for painful spinal metastases: Results of a phase 2 study. Cancer 2018; 124:2001-2009. [DOI: 10.1002/cncr.31294] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 12/11/2017] [Accepted: 01/05/2018] [Indexed: 11/11/2022]
Affiliation(s)
| | - Reinhart A. Sweeney
- Department of Radiation Oncology; Leopoldina Hospital Schweinfurt; Schweinfurt Germany
| | - Maria Hawkins
- Cancer Research UK/Medical Research Council Oxford Institute for Radiation Oncology, Gray Laboratories; University of Oxford; Oxford United Kingdom
| | - Jose Belderbos
- Department of Radiation Oncology; Netherlands Cancer Institute; Amsterdam the Netherlands
| | - Nicolaus Andratschke
- Department of Radiation Oncology; University Hospital Zurich; Zurich Switzerland
| | - Merina Ahmed
- Department of Radiotherapy; Royal Marsden NHS Foundation Trust/Institute of Cancer Research; Sutton United Kingdom
| | - Indira Madani
- Department of Radiation Oncology; University Hospital Zurich; Zurich Switzerland
| | - Frederick Mantel
- Department of Radiation Oncology; University Hospital Würzburg; Würzburg Germany
| | - Sabrina Steigerwald
- Department of Radiation Oncology; University Hospital Würzburg; Würzburg Germany
| | - Michael Flentje
- Department of Radiation Oncology; University Hospital Würzburg; Würzburg Germany
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Berwouts D, Madani I, Duprez F, Olteanu AL, Vercauteren T, Boterberg T, Deron P, Bonte K, Huvenne W, De Neve W, Goethals I. Long-term outcome of 18 F-fluorodeoxyglucose-positron emission tomography-guided dose painting for head and neck cancer: Matched case-control study. Head Neck 2017; 39:2264-2275. [PMID: 28833829 DOI: 10.1002/hed.24892] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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: 03/28/2017] [Accepted: 06/16/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study was to report the long-term outcome of 18 F-fluorodeoxyglucose-positron emission tomography (18 F-FDG-PET)-guided dose painting for head and neck cancer in comparison to conventional intensity-modulated radiotherapy (IMRT) in a matched case-control study. METHODS Seventy-two patients with nonmetastatic head and neck cancer treated with dose painting were compared with 72 control patients matched on tumor site and T classification. Either 18 F-FDG-PET-guided dose painting by contour (DPBC) or voxel intensity-based dose painting by number (DPBN) was performed; control patients underwent standard IMRT. A total median dose to the dose-painted target was 70.2-85.9 Gy/30-32 fractions versus 69.1 Gy/32 fractions with conventional IMRT. In 31 patients, dose painting was adapted to per-treatment changes in the tumor and organs-at-risk (OAR). RESULTS Median follow-up in living dose-painting and control patients was 87.7 months (range 56.1-119.3) and 64.8 months (range 46.3-83.4), respectively. Five-year local control rates in the dose-painting patients were 82.3% against 73.6% in the control (P = .36); in patients treated to normalized isoeffective doses >91 Gy (NID2Gy) local control reached 85.7% at 5 years against 73.6% in the control group (P =.39). There was no difference in regional (P = .82) and distant control (P = .78). Five-year overall and disease-specific survival rates were 36.3% versus 38.1% (P = .50) and 56.5% versus 51.7% (P = .72), respectively. A half of the dose-painting patients developed acute grade ≥3 dysphagia (P = .004). Late grade 4 mucosal ulcers at the site of dose escalation in 9 of 72 patients was the most common severe toxicity with dose painting versus 3 of 72 patients with conventional IMRT (P = .11). Patients in the dose-painting group had increased rates of acute and late dysphagia (P = .004 and P = .005). CONCLUSION Dose-painting strategies can be used to increase dose to specific tumor subvolumes. Five-year local, regional, and distant control rates are comparable with patients treated with conventional IMRT. Volume and intensity of dose escalation should be further tailored, given the possible increase in severe acute and chronic toxicity. Adapting treatment and decreasing dose to the swallowing structures might contribute to lower toxicity rates when applied in smaller tumor volumes. Whether adaptive DPBN can significantly improve outcomes is currently being investigated in a novel clinical trial.
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Affiliation(s)
- Dieter Berwouts
- Department of Radiotherapy and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium.,Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Indira Madani
- Department of Radiotherapy and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium.,Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Frédéric Duprez
- Department of Radiotherapy and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - AnaMaria Luiza Olteanu
- Department of Radiotherapy and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - Tom Vercauteren
- Department of Radiotherapy and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - Tom Boterberg
- Department of Radiotherapy and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - Philippe Deron
- Department of Head, Neck and Maxillo-Facial Surgery, Ghent University Hospital, Ghent, Belgium
| | - Katrien Bonte
- Department of Head, Neck and Maxillo-Facial Surgery, Ghent University Hospital, Ghent, Belgium
| | - Wouter Huvenne
- Department of Head, Neck and Maxillo-Facial Surgery, Ghent University Hospital, Ghent, Belgium
| | - Wilfried De Neve
- Department of Radiotherapy and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - Ingeborg Goethals
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
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Berwouts D, De Wolf K, De Neve W, Olteanu LA, Lambert B, Speleers B, Goethals I, Madani I, Ost P. Variations in target volume definition and dose to normal tissue using anatomic versus biological imaging ( 18 F-FDG-PET) in the treatment of bone metastases: results from a 3-arm randomized phase II trial. J Med Imaging Radiat Oncol 2016; 61:124-132. [PMID: 27527354 DOI: 10.1111/1754-9485.12507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/17/2015] [Accepted: 07/08/2016] [Indexed: 12/25/2022]
Abstract
INTRODUCTION To report the impact on target volume delineation and dose to normal tissue using anatomic versus biological imaging (18 F-FDG-PET) for bone metastases. METHODS Patients with uncomplicated painful bone metastases were randomized (1:1:1) and blinded to receive either 8 Gy in a single fraction with conventionally planned radiotherapy (ConvRT-8 Gy) or 8 Gy in a single fraction with dose-painting-by-numbers (DPBN) dose range between 6 and 10 Gy) (DPBN-8 Gy) or 16 Gy in a single fraction with DPBN (dose range between 14 and 18 Gy) (DPBN-16 Gy). The primary endpoint was overall pain response at 1 month. Volumes of the gross tumour volume (GTV) - both biological (GTVPET ) and anatomical (GTVCT ) -, planning target volume (PTV), dose to the normal tissue and maximum standardized-uptake values (SUVMAX ) were analysed (secondary endpoint). RESULTS Sixty-three percent of the GTVCT volume did not show 18 F-FDG-uptake. On average, 20% of the GTVPET volume was outside GTVCT . The volume of normal tissue receiving 4 Gy, 6 Gy and 8 Gy was at least 3×, 6× and 13× smaller in DPBN-8 Gy compared to ConvRT-8 Gy and DPBN-16 Gy (P < 0.05). CONCLUSION Positron emitting tomography-information potentially changes the target volume for bone metastases. DPBN between 6 and 10 Gy significantly decreases dose to the normal tissue compared to conventional radiotherapy.
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Affiliation(s)
- Dieter Berwouts
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.,Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Katrien De Wolf
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - Wilfried De Neve
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - Luiza Am Olteanu
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - Bieke Lambert
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Bruno Speleers
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - Ingeborg Goethals
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Indira Madani
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - Piet Ost
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
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Berwouts D, Olteanu LAM, Speleers B, Duprez F, Madani I, Vercauteren T, De Neve W, De Gersem W. Intensity modulated arc therapy implementation in a three phase adaptive (18)F-FDG-PET voxel intensity-based planning strategy for head-and-neck cancer. Radiat Oncol 2016; 11:52. [PMID: 27039294 PMCID: PMC4818905 DOI: 10.1186/s13014-016-0629-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 12/17/2015] [Accepted: 03/28/2016] [Indexed: 12/15/2022] Open
Abstract
Background This study investigates the implementation of a new intensity modulated arc therapy (IMAT) class solution in comparison to a 6-static beam step-and-shoot intensity modulated radiotherapy (s-IMRT) for three-phase adaptive 18F-FDG-PET-voxel-based dose-painting-by-numbers (DPBN) for head-and-neck cancer. Methods We developed 18F-FDG-PET-voxel intensity-based IMAT employing multiple arcs and compared it to clinically used s-IMRT DPBN. Three IMAT plans using 18F-FDG-PET/CT acquired before treatment (phase I), after 8 fractions (phase II) and CT acquired after 18 fractions (phase III) were generated for each of 10 patients treated with 3 s-IMRT plans based on the same image sets. Based on deformable image registration (ABAS, version 0.41, Elekta CMS Software, Maryland Heights, MO), doses of the 3 plans were summed on the pretreatment CT using validated in-house developed software. Dosimetric indices in targets and organs-at-risk (OARs), biologic conformity of treatment plans set at ≤5 %, treatment quality and efficiency were compared between IMAT and s-IMRT for the whole group and for individual patients. Results Doses to most organs-at-risk (OARs) were significantly better in IMAT plans, while target levels were similar for both types of plans. On average, IMAT ipsilateral and contralateral parotid mean doses were 14.0 % (p = 0.001) and 12.7 % (p < 0.001) lower, respectively. Pharyngeal constrictors D50% levels were similar or reduced with up to 54.9 % for IMAT compared to s-IMRT for individual patient cases. IMAT significantly improved biologic conformity by 2.1 % for treatment phases I and II. 3D phantom measurements reported an agreement of ≥95 % for 3 % and 3 mm criteria for both treatment modalities. IMAT delivery time was significantly shortened on average by 41.1 %. Conclusions IMAT implementation significantly improved the biologic conformity as compared to s-IMRT in adaptive dose-escalated DPBN treatments. The better OAR sparing and faster delivery highly improved the treatment efficiency. Electronic supplementary material The online version of this article (doi:10.1186/s13014-016-0629-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dieter Berwouts
- Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. .,Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium.
| | - Luiza Ana Maria Olteanu
- Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | | | - Frédéric Duprez
- Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Indira Madani
- Ghent University, Ghent, Belgium.,Zürich University Hospital, Zürich, Switzerland
| | - Tom Vercauteren
- Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Wilfried De Neve
- Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.,Ghent University, Ghent, Belgium
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Berwouts D, Swimberghe M, Duprez F, Boterberg T, Bonte K, Deron P, De Gersem W, De Neve W, Madani I. Intensity-modulated radiotherapy for early-stage glottic cancer. Head Neck 2015; 38 Suppl 1:E179-84. [PMID: 25537856 DOI: 10.1002/hed.23967] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study was to report on treatment outcome of intensity-modulated radiotherapy (IMRT) for early-stage (cT1-2 cN0 M0) squamous cell carcinoma of the glottis, as compared with patients treated with conventional radiotherapy. METHODS Between November 2007 and December 2011, 40 consecutive patients were treated with IMRT with daily cone-beam CT position verification. The median prescription to the planning target volume (PTV) was 63 Gy/28 fractions and 67.5 Gy/30 fractions for T1 and T2 tumors, respectively. The historical control comprised 81 consecutive patients treated with conventional radiotherapy to total doses of 66 Gy/33 fractions (66 patients) and 70 Gy/35 fractions (15 patients) for T1 and T2 tumors, respectively. RESULTS The median follow-up of living patients was 3.8 years (range, 1.0-5.0 years) in the IMRT group and 9.0 years, (range, 5.2-12.7 years) in the conventional group. Five-year actuarial local control was equal compared to the conventional group: 83% versus 74% (p = .64). Five-year actuarial ultimate local control was 100% in the IMRT group and 95% in the conventional group (p = .17). Five-year actuarial overall and disease-specific survival was 85% after IMRT versus 65% after conventional radiotherapy (p = .15) and 97% versus 89% (p = .31), respectively. Incidence and severity of acute dermatitis was significantly less during IMRT than in the control group (p < .001). Two patients receiving IMRT had late grade 3 hoarseness. CONCLUSION IMRT is as efficient as conventional radiotherapy in terms of disease control and overall survival. It has the potential to reduce toxicity as compared to conventional radiotherapy. © 2015 Wiley Periodicals, Inc. Head Neck 38: E179-E184, 2016.
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Affiliation(s)
- Dieter Berwouts
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | | | - Fréderic Duprez
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - Tom Boterberg
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - Katrien Bonte
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
| | - Philippe Deron
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
| | - Werner De Gersem
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - Wilfried De Neve
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - Indira Madani
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
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Berwouts D, De Wolf K, Lambert B, Bultijnck R, De Neve W, De Lobel L, Jans L, Goetghebeur E, Speleers B, Olteanu LA, Madani I, Goethals I, Ost P. Biological 18[F]-FDG-PET image-guided dose painting by numbers for painful uncomplicated bone metastases: A 3-arm randomized phase II trial. Radiother Oncol 2015; 115:272-8. [DOI: 10.1016/j.radonc.2015.04.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 03/17/2015] [Accepted: 04/22/2015] [Indexed: 12/25/2022]
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Madani I, Lomax AJ, Albertini F, Trnková P, Weber DC. Dose-painting intensity-modulated proton therapy for intermediate- and high-risk meningioma. Radiat Oncol 2015; 10:72. [PMID: 25890217 PMCID: PMC4404662 DOI: 10.1186/s13014-015-0384-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 11/19/2014] [Accepted: 03/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Newly diagnosed WHO grade II-III or any WHO grade recurrent meningioma exhibit an aggressive behavior and thus are considered as high- or intermediate risk tumors. Given the unsatisfactory rates of disease control and survival after primary or adjuvant radiation therapy, optimization of treatment strategies is needed. We investigated the potential of dose-painting intensity-modulated proton beam-therapy (IMPT) for intermediate- and high-risk meningioma. MATERIAL AND METHODS Imaging data from five patients undergoing proton beam-therapy were used. The dose-painting target was defined using [68]Ga-[1,4,7,10-tetraazacyclododecane tetraacetic acid]- d-Phe(1),Tyr(3)-octreotate ([68]Ga-DOTATATE)-positron emission tomography (PET) in target delineation. IMPT and photon intensity-modulated radiation therapy (IMRT) treatment plans were generated for each patient using an in-house developed treatment planning system (TPS) supporting spot-scanning technology and a commercial TPS, respectively. Doses of 66 Gy (2.2 Gy/fraction) and 54 Gy (1.8 Gy/fraction) were prescribed to the PET-based planning target volume (PTVPET) and the union of PET- and anatomical imaging-based PTV, respectively, in 30 fractions, using simultaneous integrated boost. RESULTS Dose coverage of the PTVsPET was equally good or slightly better in IMPT plans: dose inhomogeneity was 10 ± 3% in the IMPT plans vs. 13 ± 1% in the IMRT plans (p = 0.33). The brain Dmean and brainstem D50 were small in the IMPT plans: 26.5 ± 1.5 Gy(RBE) and 0.002 ± 0.0 Gy(RBE), respectively, vs. 29.5 ± 1.5 Gy (p = 0.001) and 7.5 ± 11.1 Gy (p = 0.02) for the IMRT plans, respectively. The doses delivered to the optic structures were also decreased with IMPT. CONCLUSIONS Dose-painting IMPT is technically feasible using currently available planning tools and resulted in dose conformity of the dose-painted target comparable to IMRT with a significant reduction of radiation dose delivered to the brain, brainstem and optic apparatus. Dose escalation with IMPT may improve tumor control and decrease radiation-induced toxicity.
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Affiliation(s)
- Indira Madani
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland. .,Ghent University, Ghent, Belgium.
| | - Antony J Lomax
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland.
| | | | - Petra Trnková
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland.
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland. .,Department of Radiation Oncology, University Hospital of Zürich, Zürich, Switzerland.
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Berwouts D, Duprez F, Olteanu A, De Gersem W, Vercauteren T, Boterberg T, Deron P, Bonte K, De Neve W, Madani I. PO-087: Long-term outcome of 18F-FDG-PET-guided dose painting for head-and-neck cancer: matched case-controlled study. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)34847-7] [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: 11/27/2022]
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Duprez F, Berwouts D, Madani I, Bonte K, Boterberg T, De Gersem W, Deron P, Huvenne W, De Neve W. High-dose reirradiation with intensity-modulated radiotherapy for recurrent head-and-neck cancer: disease control, survival and toxicity. Radiother Oncol 2014; 111:388-92. [PMID: 24998706 DOI: 10.1016/j.radonc.2014.04.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [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: 10/02/2013] [Revised: 04/14/2014] [Accepted: 04/22/2014] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate disease control, survival and severe late toxicity after high-dose fractionated reirradiation using intensity-modulated radiotherapy (IMRT) for recurrent head-and-neck cancer. MATERIALS AND METHODS Sixty consecutive patients were reirradiated with IMRT between 1997 and 2011. The median prescribed dose was 70 Gy in 35 daily fractions until 2004 and 69.12 Gy in 32 daily fractions thereafter. The median cumulative dose was 132 Gy. Sixty-seven percent of patients had non-metastatic stage IV disease. Surgery prior to reirradiation and concomitant systemic therapy was performed in 13 (22%) and 20 (33%) patients, respectively. RESULTS Median follow-up in living patients was 18.5 months. Actuarial 1-, 2- and 5-year locoregional control was 64%, 48% and 32%, respectively. Median overall (OS) and disease-free survival was 9.6 and 6.7 months, respectively. Actuarial 1-, 2- and 5-year OS was 44%, 32% and 22%, respectively. Seventeen (27%) and 2 (3%) patients had grade 3 and 4 acute toxicity, respectively. Cumulative incidence of late grade≥3 toxicity was 23%, 27% and 66% at 1, 2 and 5 years, respectively. In 4 patients, death was attributed to toxicity: fatal bleeding (n=2), aspiration pneumonia (n=1) and skin necrosis (n=1). CONCLUSIONS High-dose fractionated reirradiation with IMRT offers 5-year disease control and OS in recurrent head-and-neck cancer for 1/3 and 1/4 patients, respectively. Severe late toxicity after 1-2 and 5 years occurs in 1/4 and 2/3 patients, respectively.
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Affiliation(s)
| | | | | | - Katrien Bonte
- Department of Head & Neck Surgery, Ghent University Hospital, Belgium
| | | | | | - Philippe Deron
- Department of Head & Neck Surgery, Ghent University Hospital, Belgium
| | - Wouter Huvenne
- Department of Head & Neck Surgery, Ghent University Hospital, Belgium
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Olteanu LAM, Berwouts D, Madani I, De Gersem W, Vercauteren T, Duprez F, De Neve W. Comparative dosimetry of three-phase adaptive and non-adaptive dose-painting IMRT for head-and-neck cancer. Radiother Oncol 2014; 111:348-53. [PMID: 24746575 DOI: 10.1016/j.radonc.2014.02.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [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: 04/23/2013] [Revised: 01/28/2014] [Accepted: 02/21/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE The anatomical changes, which occur during the radiotherapy treatment for head-and-neck cancer, may compromise the effectiveness of the treatment. This study compares dosimetrical effects of adaptive (ART) and non-adaptive (RT) dose-painted radiotherapy. MATERIALS AND METHODS For 10 patients, three treatment phases were preceded by a planning PET/CT scan. In ART, phases II and III were planned using PET/CT2 and PET/CT3, respectively. In RT, phases II and III were planned on PET/CT1 and recalculated on PET/CT2 and PET/CT3. Deformable image co-registration was used to sum the dose distributions and to propagate regions-of-interest (ROIs) drawn on PET/CT1 to PET/CT2, PET/CT3 and a last-treatment-day CT-scan. RESULTS Re-adjusted dose-painting ART provided higher minimum and lower maximum doses in target ROIs in comparison to RT. On average, ART reduced the parotids' median dose and swallowing structures mean dose by 4.6-7.1% (p>0.05) and 3% (p=0.06), respectively. Dose differences for targets were from -1.6% to 6.6% and for organs-at-risk from -7.1% to 7.1%. Analysis of individual patient data showed large improvements of ROI dose/volume metrics by ART, reaching a 24.4% minimum-dose increase in the elective neck planning target volume and 21.1% median-dose decrease in swallowing structures. CONCLUSION Compared to RT, ART readjusts dose-painting, increases minimum and decreases maximum doses in target volumes and improves dose/volume metrics of organs-at-risk. The results favored the adaptive strategy, but also revealed considerable heterogeneity in patient-specific benefit. Reporting population-average effects underestimates the patient-specific benefits of ART.
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Affiliation(s)
| | - Dieter Berwouts
- Department of Radiotherapy, Ghent University Hospital, Belgium
| | - Indira Madani
- Department of Radiotherapy, Ghent University Hospital, Belgium
| | | | - Tom Vercauteren
- Department of Radiotherapy, Ghent University Hospital, Belgium
| | - Fréderic Duprez
- Department of Radiotherapy, Ghent University Hospital, Belgium
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Madani I, Duprez F, Berwouts D, De Gersem W, Olteanu A, Vercauteren T, De Neve W. SP-0033: Adaptive dose painting early experiences. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30138-9] [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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Duprez F, Berwouts D, Madani I, Boterberg T, De Neve W. PO-0657: Late dysphagia, xerostomia, neck fibrosis and toxic death after IMRT for head and neck cancer. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30775-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Nuyts S, Lambrecht M, Duprez F, Daisne JF, Van Gestel D, Van den Weyngaert D, Platteaux N, Geussens Y, Voordeckers M, Madani I, De Neve W. Reduction of the dose to the elective neck in head and neck squamous cell carcinoma, a randomized clinical trial using intensity modulated radiotherapy (IMRT). Dosimetrical analysis and effect on acute toxicity. Radiother Oncol 2013; 109:323-9. [PMID: 23953410 DOI: 10.1016/j.radonc.2013.06.044] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [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: 03/14/2013] [Revised: 06/13/2013] [Accepted: 06/21/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE A randomized trial was initiated to investigate whether a reduction of the dose to the elective nodal sites and the swallowing apparatus delivered by IMRT would result in a reduction of acute and late side effects without compromising tumor control. The aim of this paper is to report on dosimetrical analysis and acute toxicity. MATERIALS & METHODS Two-hundred patients were randomized. In the standard arm, elective nodal volumes (PTVelect) were irradiated up to an equivalent dose of 50Gy. In the experimental arm an equivalent dose of 40Gy was prescribed to the PTVelect. The dose to the swallowing apparatus was kept as low as possible without compromising therapeutic PTV (PTVther) coverage. RESULTS No significant difference was seen between both arms concerning PTVther coverage. The median D95 of the PTVelect was significantly lower in the experimental arm (39.5 vs 49.8Gy; p<0.001). Concerning the organs at risk, the dose to swallowing structures and spinal cord was significantly reduced. There was no significant difference in acute toxicity. Three months after radiotherapy there was significantly less grade ⩾3 dysphagia in the experimental arm (2% vs 11%; p=0.03). With a median follow-up of 6months no significant differences were observed in locoregional control, disease free survival or overall survival. CONCLUSIONS Using IMRT we were able to significantly reduce the dose to the PTVelect and several organs at risk without compromising PTVther coverage. This resulted in a significant reduction of severe dysphagia 3months after radiotherapy. Further follow-up is necessary to investigate whether these observations translate into a benefit on late treatment related dysphagia without affecting treatment outcome.
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Affiliation(s)
- Sandra Nuyts
- Department of Experimental Radiotherapy KU Leuven, Campus Gasthuisberg, Belgium.
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Vercauteren T, De Gersem W, Olteanu LAM, Madani I, Duprez F, Berwouts D, Speleers B, De Neve W. Deformation field validation and inversion applied to adaptive radiation therapy. Phys Med Biol 2013; 58:5269-86. [DOI: 10.1088/0031-9155/58/15/5269] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Mulliez T, Speleers B, Madani I, De Gersem W, Veldeman L, De Neve W. Whole breast radiotherapy in prone and supine position: is there a place for multi-beam IMRT? Radiat Oncol 2013; 8:151. [PMID: 23800109 PMCID: PMC3702403 DOI: 10.1186/1748-717x-8-151] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [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] [Received: 01/28/2013] [Accepted: 06/18/2013] [Indexed: 11/10/2022] Open
Abstract
Background Early stage breast cancer patients are long-term survivors and finding techniques that may lower acute and late radiotherapy-induced toxicity is crucial. We compared dosimetry of wedged tangential fields (W-TF), tangential field intensity-modulated radiotherapy (TF-IMRT) and multi-beam IMRT (MB-IMRT) in prone and supine positions for whole-breast irradiation (WBI). Methods MB-IMRT, TF-IMRT and W-TF treatment plans in prone and supine positions were generated for 18 unselected breast cancer patients. The median prescription dose to the optimized planning target volume (PTVoptim) was 50 Gy in 25 fractions. Dose-volume parameters and indices of conformity were calculated for the PTVoptim and organs-at-risk. Results Prone MB-IMRT achieved (p<0.01) the best dose homogeneity compared to WTF in the prone position and WTF and MB-IMRT in the supine position. Prone IMRT scored better for all dose indices. MB-IMRT lowered lung and heart dose (p<0.05) in supine position, however the lowest ipsilateral lung doses (p<0.001) were in prone position. In left-sided breast cancer patients population averages for heart sparing by radiation dose was better in prone position; though non-significant. For patients with a PTVoptim volume ≥600 cc heart dose was consistently lower in prone position; while for patients with smaller breasts heart dose metrics were comparable or worse compared to supine MB-IMRT. Doses to the contralateral breast were similar regardless of position or technique. Dosimetry of prone MB-IMRT and prone TF-IMRT differed slightly. Conclusions MB-IMRT is the treatment of choice in supine position. Prone IMRT is superior to any supine treatment for right-sided breast cancer patients and left-sided breast cancer patients with larger breasts by obtaining better conformity indices, target dose distribution and sparing of the organs-at-risk. The influence of treatment techniques in prone position is less pronounced; moreover dosimetric differences between TF-IMRT and MB-IMRT are rather small.
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Affiliation(s)
- Thomas Mulliez
- Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, Ghent 9000, Belgium.
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Berwouts D, Olteanu LAM, Duprez F, Vercauteren T, De Gersem W, De Neve W, Van de Wiele C, Madani I. Three-phase adaptive dose-painting-by-numbers for head-and-neck cancer: initial results of the phase I clinical trial. Radiother Oncol 2013; 107:310-6. [PMID: 23647760 DOI: 10.1016/j.radonc.2013.04.002] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [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: 09/25/2012] [Revised: 03/12/2013] [Accepted: 04/01/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate feasibility of using deformable image co-registration in three-phase adaptive dose-painting-by-numbers (DPBN) for head-and-neck cancer and to report dosimetrical data and preliminary clinical results. MATERIAL AND METHODS Between November 2010 and October 2011, 10 patients with non-metastatic head-and-neck cancer enrolled in this phase I clinical trial where treatment was adapted every ten fractions. Each patient was treated with three DPBN plans based on: a pretreatment 18[F]-FDG-PET scan (phase I: fractions 1-10), a per-treatment 18[F]-FDG-PET/CT scan acquired after 8 fractions (phase II: fractions 11-20) and a per-treatment 18[F]-FDG-PET/CT scan acquired after 18 fractions (phase III: fractions 21-30). A median prescription dose to the dose-painted target was 70.2 Gy (fractions 1-30) and to elective neck was 40 Gy (fractions 1-20). Deformable image co-registration was used for automatic region-of-interest propagation and dose summation of the three treatment plans. RESULTS All patients (all men, median age 68, range 48-74 years) completed treatment without any break or acute G≥4 toxicity. Target volume reductions (mean (range)) between pre-treatment CT and CT on the last day of treatment were 72.3% (57.9-98.4) and 46.3% (11.0-73.1) for GTV and PTV(high_dose), respectively. Acute G3 toxicity was limited to dysphagia in 3/10 patients and mucositis in 2/10 patients; none of the patients lost ≥20% weight. At median follow-up of 13, range 7-22 months, 9 patients did not have evidence of disease. CONCLUSIONS Three-phase adaptive 18[F]-FDG-PET-guided dose painting by numbers using currently available tools is feasible. Irradiation of smaller target volumes might have contributed to mild acute toxicity with no measurable decrease in tumor response.
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Affiliation(s)
- Dieter Berwouts
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
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De Ruyck K, Duprez F, Werbrouck J, Sabbe N, Sofie DL, Boterberg T, Madani I, Thas O, Wilfried DN, Thierens H. A predictive model for dysphagia following IMRT for head and neck cancer: introduction of the EMLasso technique. Radiother Oncol 2013; 107:295-9. [PMID: 23618501 DOI: 10.1016/j.radonc.2013.03.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [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: 02/23/2012] [Revised: 02/22/2013] [Accepted: 03/29/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE Design a model for prediction of acute dysphagia following intensity-modulated radiotherapy (IMRT) for head and neck cancer. Illustrate the use of the EMLasso technique for model selection. MATERIAL AND METHODS Radiation-induced dysphagia was scored using CTCAE v.3.0 in 189 head and neck cancer patients. Clinical data (gender, age, nicotine and alcohol use, diabetes, tumor location), treatment parameters (chemotherapy, surgery involving the primary tumor, lymph node dissection, overall treatment time), dosimetric parameters (doses delivered to pharyngeal constrictor (PC) muscles and esophagus) and 19 genetic polymorphisms were used in model building. The predicting model was achieved by EMLasso, i.e. an EM algorithm to account for missing values, applied to penalized logistic regression, which allows for variable selection by tuning the penalization parameter through crossvalidation on AUC, thus avoiding overfitting. RESULTS Fifty-three patients (28%) developed acute ≥ grade 3 dysphagia. The final model has an AUC of 0.71 and contains concurrent chemotherapy, D2 to the superior PC and the rs3213245 (XRCC1) polymorphism. The model's false negative rate and false positive rate in the optimal operation point on the ROC curve are 21% and 49%, respectively. CONCLUSIONS This study demonstrated the utility of the EMLasso technique for model selection in predictive radiogenetics.
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Affiliation(s)
- Kim De Ruyck
- Department of Basic Medical Sciences, Ghent University, Belgium.
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Nuyts S, Lambrecht M, Duprez F, Daisne J, Van den Weyngaert D, Platteaux N, Geussens Y, Voordeckers M, Madani I. OC-0141: Reduction of the dose to the elective CTV in HNSCC using IMRT. Dosimetrical analysis and effect on acute toxicity. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)32447-6] [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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Duprez F, Madani I, De Potter B, Boterberg T, De Neve W. Systematic Review of Dose–Volume Correlates for Structures Related to Late Swallowing Disturbances After Radiotherapy for Head and Neck Cancer. Dysphagia 2013; 28:337-49. [DOI: 10.1007/s00455-013-9452-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 01/23/2013] [Indexed: 11/28/2022]
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Olteanu LA, Madani I, De Neve W, Vercauteren T, De Gersem W. Evaluation of Deformable Image Coregistration in Adaptive Dose Painting by Numbers for Head-and-Neck Cancer. Int J Radiat Oncol Biol Phys 2012; 83:696-703. [DOI: 10.1016/j.ijrobp.2011.07.037] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 07/08/2011] [Accepted: 07/19/2011] [Indexed: 10/14/2022]
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De Ruyck K, Duprez F, Werbrouck J, Sabbe N, De Langhe S, Boterberg T, Madani I, Thas O, De Neve W, Thierens H. OC-0505 A PREDICTIVE MODEL FOR DYSPHAGIA DURING IMRT IN HEAD AND NECK CANCER : INTRODUCTION OF THE EMLASSO TECHNIQUE. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70844-7] [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: 10/28/2022]
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Madani I, Duprez F, Berwouts D, Olteanu L, Vercauteren T, De Gersem W, De Neve W. PO-0710 PRELIMINARY RESULTS OF A PHASE CLINICAL I TRIAL ON ADAPTIVE DOSE-PAINTING BY NUMBERS FOR HEAD-AND-NECK CANCER. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71043-5] [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: 11/16/2022]
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Abstract
During the last 2 decades, intensity-modulated radiation therapy (IMRT) became a standard technique despite its drawbacks of volume delineation, planning, robustness of delivery, challenging quality assurance, and cost as compared with non-IMRT. The theoretic advantages of IMRT dose distributions are generally accepted, but the clinical advantages remain debatable because of the lack of clinical assessment of the effort that is required to overshadow the disadvantages. Rational IMRT use requires a positive advantage/drawback balance. Only 5 randomized clinical trials (RCTs), 3 in the breast and 2 in the head and neck, which compare IMRT with non-IMRT (2-dimensional technique in four fifths of the trials), have been published (as of March 2011), and all had toxicity as the primary endpoint. More than 50 clinical trials compared results of IMRT-treated patients with a non-IMRT group, mostly historical controls. RCTs systematically showed a lower toxicity in IMRT-treated patients, and the non-RCTs confirmed these findings. Toxicity reduction, counterbalancing the drawbacks of IMRT, was convincing for breast and head and neck IMRT. For other tumor sites, the arguments favoring IMRT are weaker because of the inability to control bias outside the randomized setting. For anticancer efficacy endpoints, like survival, disease-specific survival, or locoregional control, the balance between advantages and drawbacks is fraught with uncertainties because of the absence of robust clinical data.
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Affiliation(s)
- Wilfried De Neve
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
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Madani I, Duprez F, Boterberg T, Van de Wiele C, Bonte K, Deron P, Gersem WD, Coghe M, Neve WD. Maximum tolerated dose in a phase I trial on adaptive dose painting by numbers for head and neck cancer. Radiother Oncol 2011; 101:351-5. [DOI: 10.1016/j.radonc.2011.06.020] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 06/01/2011] [Accepted: 06/10/2011] [Indexed: 01/13/2023]
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Duprez F, Madani I, Morbée L, Bonte K, Deron P, Domján V, Boterberg T, De Gersem W, De Neve W. IMRT for sinonasal tumors minimizes severe late ocular toxicity and preserves disease control and survival. Int J Radiat Oncol Biol Phys 2011; 83:252-9. [PMID: 22027259 DOI: 10.1016/j.ijrobp.2011.06.1977] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 06/15/2011] [Accepted: 06/17/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE To report late ocular (primary endpoint) and other toxicity, disease control, and survival (secondary endpoints) after intensity-modulated radiotherapy (IMRT) for sinonasal tumors. METHODS AND MATERIALS Between 1998 and 2009, 130 patients with nonmetastatic sinonasal tumors were treated with IMRT at Ghent University Hospital. Prescription doses were 70 Gy (n = 117) and 60-66 Gy (n = 13) at 2 Gy per fraction over 6-7 weeks. Most patients had adenocarcinoma (n = 82) and squamous cell carcinoma (n = 23). One hundred and one (101) patients were treated postoperatively. Of 17 patients with recurrent tumors, 9 were reirradiated. T-stages were T1-2 (n = 39), T3 (n = 21), T4a (n = 38), and T4b (n = 22). Esthesioneuroblastoma was staged as Kadish A, B, and C in 1, 3, and 6 cases, respectively. RESULTS Median follow-up was 52, range 15-121 months. There was no radiation-induced blindness in 86 patients available for late toxicity assessment (≥6 month follow-up). We observed late Grade 3 tearing in 10 patients, which reduced to Grade 1-2 in 5 patients and Grade 3 visual impairment because of radiation-induced ipsilateral retinopathy and neovascular glaucoma in 1 patient. There was no severe dry eye syndrome. The worst grade of late ocular toxicity was Grade 3 (n = 11), Grade 2 (n = 31), Grade 1 (n = 33), and Grade 0 (n = 11). Brain necrosis and osteoradionecrosis occurred in 6 and 1 patients, respectively. Actuarial 5-year local control and overall survival were 59% and 52%, respectively. On multivariate analysis local control was negatively affected by cribriform plate and brain invasion (p = 0.044 and 0.029, respectively) and absence of surgery (p = 0.009); overall survival was negatively affected by cribriform plate and orbit invasion (p = 0.04 and <0.001, respectively) and absence of surgery (p = 0.001). CONCLUSIONS IMRT for sinonasal tumors allowed delivering high doses to targets at minimized ocular toxicity, while maintaining disease control and survival. Avoidance of severe dry eye syndrome and radiation-induced blindness suggests IMRT as a standard treatment for sinonasal tumors.
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Affiliation(s)
- Fréderic Duprez
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
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Berwouts D, Olteanu A, De Neve W, Vercauteren T, De Gersem W, Madani I. SU-E-J-49: Evaluation of Deformable Image Co-Registration in Adaptive Dose Painting by Numbers for Head and Neck Cancer. Med Phys 2011. [DOI: 10.1118/1.3611817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Speleers B, Madani I, de Gersem W, de Neve W. 188 oral DOSE PAINTING BY NUMBERS FOR HEAD AND NECK CANCER: 18F-FDG-PET-VOXEL INTENSITY-BASED VMAT VERSUS 18F-FDGPET-VOXEL INTENSITY-BASED IMRT. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70310-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Olteanu A, Madani I, de Gersem W, Vercauteren T, de Neve W. 1190 poster EVALUATION OF DEFORMABLE IMAGE CO-REGISTRATION IN ADAPTIVE IMRT FOR HEAD AND NECK CANCER. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)71312-3] [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: 10/18/2022]
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Madani I, Duprez F, De Gersem W, Coghe M, De Neve W. Phase I Trial on Adaptive Dose Painting by Numbers for Head and Neck Cancer: What is the Maximum Tolerated Dose? Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Duprez F, De Neve W, De Gersem W, Coghe M, Madani I. Adaptive dose painting by numbers for head-and-neck cancer. Int J Radiat Oncol Biol Phys 2010; 80:1045-55. [PMID: 20643512 DOI: 10.1016/j.ijrobp.2010.03.028] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Revised: 03/05/2010] [Accepted: 03/17/2010] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate the feasibility of adaptive intensity-modulated radiation therapy (IMRT) using dose painting by numbers (DPBN) for head-and-neck cancer. METHODS AND MATERIALS Each patient's treatment used three separate treatment plans: fractions 1-10 used a DPBN ([(18)-F]fluoro-2-deoxy-D-glucose positron emission tomography [(18)F-FDG-PET]) voxel intensity-based IMRT plan based on a pretreatment (18)F-FDG-PET/computed tomography (CT) scan; fractions 11-20 used a DPBN plan based on a (18)F-FDG-PET/CT scan acquired after the eighth fraction; and fractions 21-32 used a conventional (uniform dose) IMRT plan. In a Phase I trial, two dose prescription levels were tested: a median dose of 80.9 Gy to the high-dose clinical target volume (CTV(high_dose)) (dose level I) and a median dose of 85.9 Gy to the gross tumor volume (GTV) (dose level II). Between February 2007 and August 2009, 7 patients at dose level I and 14 patients at dose level II were enrolled. RESULTS All patients finished treatment without a break, and no Grade 4 acute toxicity was observed. Treatment adaptation (i.e., plans based on the second (18)F-FDG-PET/CT scan) reduced the volumes for the GTV (41%, p = 0.01), CTV(high_dose) (18%, p = 0.01), high-dose planning target volume (14%, p = 0.02), and parotids (9-12%, p < 0.05). Because the GTV was much smaller than the CTV(high_dose) and target adaptation, further dose escalation at dose level II resulted in less severe toxicity than that observed at dose level I. CONCLUSION To our knowledge, this represents the first clinical study that combines adaptive treatments with dose painting by numbers. Treatment as described above is feasible.
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Affiliation(s)
- Fréderic Duprez
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
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Duprez F, Bonte K, De Neve W, Boterberg T, De Gersem W, Madani I. Regional relapse after intensity-modulated radiotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys 2010; 79:450-8. [PMID: 20381266 DOI: 10.1016/j.ijrobp.2009.10.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [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: 07/31/2009] [Revised: 09/15/2009] [Accepted: 10/29/2009] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the regional relapse rate in the elective neck using intensity-modulated radiotherapy (IMRT) for head-and-neck cancer. METHODS AND MATERIALS We retrospectively analyzed the data from 285 patients treated with IMRT between 2000 and 2008. The median dose prescription to the primary tumor and involved lymph nodes was 69 Gy in 32 fractions. The elective neck was treated simultaneously according to Protocol 1 (multiple dose prescription levels of 56-69 Gy; 2-Gy normalized isoeffective dose, 51-70 Gy; 222 patients) or Protocol 2 (one dose prescription level of 56 Gy; 2-Gy normalized isoeffective dose, 51 Gy; 63 patients). Primary surgery or lymph node dissection was performed before IMRT in 72 (25%) and 157 (55%) patients, respectively. Also, 92 patients (32%) received concomitant chemotherapy. The median follow-up of living patients was 27.4 months (range, 0.3-99). RESULTS Regional, local, and distant relapse were observed in 16 (5.6%), 35 (12.3%), and 47 (16.5%) patients, respectively. The 2- and 5-year rate of regional relapse was 7% and 10%, respectively, with a trend favoring Protocol 2 (p = 0.06). Seven isolated regional relapses were detected at a median follow-up of 7.3 months in patients treated with Protocol 1 and none in those treated with Protocol 2. Percutaneous gastrostomy was required more frequently in patients who received Protocol 1 (p = 0.079). CONCLUSION Isolated regional relapse is rare after IMRT for head-and-neck cancer. Elective neck node doses >51 Gy for a 2-Gy normalized isoeffective dose do not seem to improve regional control.
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Affiliation(s)
- Fréderic Duprez
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
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Duprez F, Madani I, Bonte K, Boterberg T, Vakaet L, Derie C, De Gersem W, De Neve W. Intensity-modulated radiotherapy for recurrent and second primary head and neck cancer in previously irradiated territory. Radiother Oncol 2009; 93:563-9. [PMID: 19919885 DOI: 10.1016/j.radonc.2009.10.012] [Citation(s) in RCA: 60] [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: 01/29/2009] [Revised: 10/13/2009] [Accepted: 10/22/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate re-irradiation using IMRT for recurrent and second primary head and neck cancer in previously irradiated territory. MATERIALS AND METHODS Between 1997 and 2008, 84 patients with recurrent and second primary head and neck cancer were treated with IMRT to a median dose of 69 Gy. Median time interval between initial radiotherapy and re-irradiation was 49.5 (5.2-298.3) months. Salvage surgery preceded re-irradiation in 19 patients; 17 patients received concurrent chemotherapy. RESULTS Median follow-up of living patients was 19.8 (1.9-76.1) months. Five-year locoregional control and overall survival were 40% and 20%, respectively. Five-year disease-specific survival and disease-free survival were 29% and 15%, respectively. Stage T4 (p=0.015), time interval between initial treatment and re-irradiation (p=0.011) and hypopharyngeal cancer (p=0.013) were independent prognostic factors for worse overall survival in multivariate analysis. Twenty-six and 11 patients developed Grade 3 acute and late toxicity, respectively. No Grade 5 acute toxicity was encountered. There were 2 fatal vascular ruptures during follow-up. CONCLUSIONS High-dose IMRT for recurrent and second primary head and neck cancer in previously irradiated territory leads to approximately 20% long-term survival in a non-selected patient population. Identification of patients who would benefit most of curative IMRT is warranted.
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Affiliation(s)
- Fréderic Duprez
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
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Mareel M, Oliveira MJ, Madani I. Cancer invasion and metastasis: interacting ecosystems. Virchows Arch 2009; 454:599-622. [DOI: 10.1007/s00428-009-0784-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Accepted: 04/30/2009] [Indexed: 12/16/2022]
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Kersemans V, Vergote V, de Gelder V, Madani I, Thierens H, De Neve W, Mertens J, Slegers G, Burvenich C, Peremans K, De Spiegeleer B. The use of [123I]-2-iodo-L-phenylalanine as an early radiotherapy evaluation tool: in vitro R1M rabdomyosarcoma cell and in vivo mouse experiments. Cancer Biother Radiopharm 2008; 23:192-201. [PMID: 18454688 DOI: 10.1089/cbr.2007.0362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED This study was performed to determine whether [123I]-2-iodo-L-phenylalanine single-photon emission computed tomography (SPECT) can be used to monitor the tumor response to radiotherapy in an early phase. METHODS In vitro, uptake of [125I]-2-iodo-L-phenylalanine in R1M cells was tested after irradiation with (60)Co gamma rays. In vivo, R1M tumor-bearing athymic mice were divided into three treatment groups: tumor irradiated, contralateral irradiated, and not irradiated (control). [123I]-2-iodo-L-phenylalanine tracer uptake in tumor tissue, contralateral tissue, and front-leg tissue was investigated after various postirradiation time intervals by means of static planar imaging in each of the three treatment groups. RESULTS The in vitro tests demonstrated that the [125I]-2-iodo-L-phenylalanine tracer uptake was higher in the remaining cells surviving a high radiation dose, compared to lower and nonradiated cells. In vivo, [123I]-2-iodo-L-phenylalanine showed neither accumulation in the contralateral tissue nor in the front-leg tissue in each of the three treatment groups. Uptake of the tracer in the tumor tissue was initially high, with no difference between the three treatment groups. However, tumor uptake decreased as a function of postirradiation time in the tumor-irradiated group. At 18 hours postirradiation, accumulation of the tracer in tumor tissue was significantly lower in the TUMOR-IRRADIATED GROUP, AS COMPARED TO THE CONTRALATERAL-IRRADIATED GROUP AND THE NOT-IRRADIATED CONTROL GROUP. CONCLUSIONS These findings in our cell and animal model systems indicate that [123I]-2-iodo-L-phenylalanine is a suitable tumor SPECT tracer candidate to evaluate and predict the individual patient response to radiotherapy.
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Affiliation(s)
- Veerle Kersemans
- Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
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Veldeman L, Madani I, Hulstaert F, De Meerleer G, Mareel M, De Neve W. Evidence behind use of intensity-modulated radiotherapy: a systematic review of comparative clinical studies. Lancet Oncol 2008; 9:367-75. [PMID: 18374290 DOI: 10.1016/s1470-2045(08)70098-6] [Citation(s) in RCA: 240] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Since its introduction more than a decade ago, intensity-modulated radiotherapy (IMRT) has spread to most radiotherapy departments worldwide for a wide range of indications. The technique has been rapidly implemented, despite an incomplete understanding of its advantages and weaknesses, the challenges of IMRT planning, delivery, and quality assurance, and the substantially increased cost compared with non-IMRT. Many publications discuss the theoretical advantages of IMRT dose distributions. However, the key question is whether the use of IMRT can be exploited to obtain a clinically relevant advantage over non-modulated external-beam radiation techniques. To investigate which level of evidence supports the routine use of IMRT for various disease sites, we did a review of clinical studies that reported on overall survival, disease-specific survival, quality of life, treatment-induced toxicity, or surrogate endpoints. This review shows evidence of reduced toxicity for various tumour sites by use of IMRT. The findings regarding local control and overall survival are generally inconclusive.
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Affiliation(s)
- Liv Veldeman
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
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Abstract
Radiation-induced lung injury (RILI) is the most common, dose-limiting complication of thoracic radio- and radiochemotherapy. Unfortunately, predicting which patients will suffer from this complication is extremely difficult. Ideally, individual phenotype- and genotype-based risk profiles should be able to identify patients who are resistant to RILI and who could benefit from dose escalation in chemoradiotherapy. This could result in better local control and overall survival. We review the risk predictors that are currently in clinical use--dosimetric parameters of radiotherapy such as normal tissue complication probability, mean lung dose, V20 and V30--as well as biomarkers that might individualize risk profiles. These biomarkers comprise a variety of proinflammatory and profibrotic cytokines and molecules including transforming growth factor beta1 that are implicated in development and persistence of RILI. Dosimetric parameters of radiotherapy show a low negative predictive value of 60% to 80%. Depending on the studied molecule, negative predictive value of biomarkers is approximately 50%. The predictive power of biomarkers might be increased if they are coupled with radiogenomics, e.g., genotyping analysis of single nucleotide polymorphisms in transforming growth factor beta1, transforming growth factor beta1 pathway genes, and other cytokines. Genetic variability and the complexity of RILI and its underlying molecular mechanisms make identification of biological risk predictors challenging. Further investigations are needed to develop more effective risk predictors of RILI.
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Affiliation(s)
- Indira Madani
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
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Madani I, Duthoy W, Derie C, De Gersem W, Boterberg T, Saerens M, Jacobs F, Grégoire V, Lonneux M, Vakaet L, Vanderstraeten B, Bauters W, Bonte K, Thierens H, De Neve W. Positron emission tomography-guided, focal-dose escalation using intensity-modulated radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 2007; 68:126-35. [PMID: 17448871 DOI: 10.1016/j.ijrobp.2006.12.070] [Citation(s) in RCA: 174] [Impact Index Per Article: 10.2] [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: 08/28/2006] [Revised: 11/08/2006] [Accepted: 12/01/2006] [Indexed: 02/08/2023]
Abstract
PURPOSE To assess the feasibility of intensity-modulated radiotherapy (IMRT) using positron emission tomography (PET)-guided dose escalation, and to determine the maximum tolerated dose in head and neck cancer. METHODS AND MATERIALS A Phase I clinical trial was designed to escalate the dose limited to the [(18)-F]fluoro-2-deoxy-D-glucose positron emission tomography ((18)F-FDG-PET)-delineated subvolume within the gross tumor volume. Positron emission tomography scanning was performed in the treatment position. Intensity-modulated radiotherapy with an upfront simultaneously integrated boost was employed. Two dose levels were planned: 25 Gy (level I) and 30 Gy (level II), delivered in 10 fractions. Standard IMRT was applied for the remaining 22 fractions of 2.16 Gy. RESULTS Between 2003 and 2005, 41 patients were enrolled, with 23 at dose level I, and 18 at dose level II; 39 patients completed the planned therapy. The median follow-up for surviving patients was 14 months. Two cases of dose-limiting toxicity occurred at dose level I (Grade 4 dermitis and Grade 4 dysphagia). One treatment-related death at dose level II halted the study. Complete response was observed in 18 of 21 (86%) and 13 of 16 (81%) evaluated patients at dose levels I and II (p < 0.7), respectively, with actuarial 1-year local control at 85% and 87% (p = n.s.), and 1-year overall survival at 82% and 54% (p = 0.06), at dose levels I and II, respectively. In 4 of 9 patients, the site of relapse was in the boosted (18)F-FDG-PET-delineated region. CONCLUSIONS For head and neck cancer, PET-guided dose escalation appears to be well-tolerated. The maximum tolerated dose was not reached at the investigated dose levels.
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Affiliation(s)
- Indira Madani
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
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Madani I, Vanderstraeten B, Bral S, Coghe M, De Gersem W, De Wagter C, Thierens H, De Neve W. Comparison of 6MV and 18MV photons for IMRT treatment of lung cancer. Radiother Oncol 2007; 82:63-9. [PMID: 17182143 DOI: 10.1016/j.radonc.2006.11.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [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: 03/31/2006] [Revised: 11/11/2006] [Accepted: 11/24/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE To compare 6 MV and 18 MV photon intensity modulated radiotherapy (IMRT) for non-small cell lung cancer. MATERIALS AND METHODS Doses for a cohort of 10 patients, typical for our department, were computed with a commercially available convolution/superposition (CS) algorithm. Final dose computation was also performed with a dedicated IMRT Monte Carlo dose engine (MCDE). RESULTS CS plans showed higher D(95%) (Gy) for the GTV (68.13 vs 67.36, p=0.004) and CTV (67.23 vs 66.87, p=0.028) with 18 than with 6 MV photons. MCDE computations demonstrated higher doses with 6 MV than 18 MV in D(95%) for the PTV (64.62 vs 63.64, p=0.009), PTV(optim) (65.48 vs 64.83, p=0.014) and CTV (66.22 vs 65.64, p=0.027). Dose inhomogeneity was lower with 18 than with 6 MV photons for GTV (0.08 vs 0.09, p=0.007) and CTV (0.10 vs 0.11, p=0.045) in CS but not MCDE plans. 6 MV photons significantly (D(33%); p=0.045) spared the esophagus in MCDE plans. Observed dose differences between lower and higher energy IMRT plans were dependent on the individual patient. CONCLUSIONS Selection of photon energy depends on priority ranking of endpoints and individual patients. In the absence of highly accurate dose computation algorithms such as CS and MCDE, 6 MV photons may be the prudent choice.
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Affiliation(s)
- Indira Madani
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
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Vanderstraeten B, Reynaert N, Paelinck L, Madani I, De Wagter C, De Gersem W, De Neve W, Thierens H. Accuracy of patient dose calculation for lung IMRT: A comparison of Monte Carlo, convolution/superposition, and pencil beam computations. Med Phys 2006; 33:3149-58. [PMID: 17022207 DOI: 10.1118/1.2241992] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.9] [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: 11/07/2022] Open
Abstract
The accuracy of dose computation within the lungs depends strongly on the performance of the calculation algorithm in regions of electronic disequilibrium that arise near tissue inhomogeneities with large density variations. There is a lack of data evaluating the performance of highly developed analytical dose calculation algorithms compared to Monte Carlo computations in a clinical setting. We compared full Monte Carlo calculations (performed by our Monte Carlo dose engine MCDE) with two different commercial convolution/superposition (CS) implementations (Pinnacle-CS and Helax-TMS's collapsed cone model Helax-CC) and one pencil beam algorithm (Helax-TMS's pencil beam model Helax-PB) for 10 intensity modulated radiation therapy (IMRT) lung cancer patients. Treatment plans were created for two photon beam qualities (6 and 18 MV). For each dose calculation algorithm, patient, and beam quality, the following set of clinically relevant dose-volume values was reported: (i) minimal, median, and maximal dose (Dmin, D50, and Dmax) for the gross tumor and planning target volumes (GTV and PTV); (ii) the volume of the lungs (excluding the GTV) receiving at least 20 and 30 Gy (V20 and V30) and the mean lung dose; (iii) the 33rd percentile dose (D33) and Dmax delivered to the heart and the expanded esophagus; and (iv) Dmax for the expanded spinal cord. Statistical analysis was performed by means of one-way analysis of variance for repeated measurements and Tukey pairwise comparison of means. Pinnacle-CS showed an excellent agreement with MCDE within the target structures, whereas the best correspondence for the organs at risk (OARs) was found between Helax-CC and MCDE. Results from Helax-PB were unsatisfying for both targets and OARs. Additionally, individual patient results were analyzed. Within the target structures, deviations above 5% were found in one patient for the comparison of MCDE and Helax-CC, while all differences between MCDE and Pinnacle-CS were below 5%. For both Pinnacle-CS and Helax-CC, deviations from MCDE above 5% were found within the OARs: within the lungs for two (6 MV) and six (18 MV) patients for Pinnacle-CS, and within other OARs for two patients for Helax-CC (for Dmax of the heart and D33 of the expanded esophagus) but only for 6 MV. For one patient, all four algorithms were used to recompute the dose after replacing all computed tomography voxels within the patient's skin contour by water. This made all differences above 5% between MCDE and the other dose calculation algorithms disappear. Thus, the observed deviations mainly arose from differences in particle transport modeling within the lungs, and the commissioning of the algorithms was adequately performed (or the commissioning was less important for this type of treatment). In conclusion, not one pair of the dose calculation algorithms we investigated could provide results that were consistent within 5% for all 10 patients for the set of clinically relevant dose-volume indices studied. As the results from both CS algorithms differed significantly, care should be taken when evaluating treatment plans as the choice of dose calculation algorithm may influence clinical results. Full Monte Carlo provides a great benchmarking tool for evaluating the performance of other algorithms for patient dose computations.
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Affiliation(s)
- Barbara Vanderstraeten
- Department of Medical Physics, Ghent University, Proeftuinstraat 86, 9000 Ghent, Belgium.
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