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Al-Mamgani A, Kessels R, Gouw ZA, Navran A, Mohan V, van de Kamer JB, Sonke JJ, Vogel WV. Adaptive FDG-PET/CT guided dose escalation in head and neck squamous cell carcinoma: Late toxicity and oncologic outcomes (The ADMIRE study). Clin Transl Radiat Oncol 2023; 43:100676. [PMID: 37753461 PMCID: PMC10518442 DOI: 10.1016/j.ctro.2023.100676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
Purpose To report on the late toxicity and local control (LC) of head and neck cancer patients treated with adaptive FDG-PET/CT response-guided radiotherapy (ADMIRE) with dose escalation (NCT03376386). Materials and methods Between December 2017 and April 2019, 20 patients with stage II-IV squamous cell carcinoma of the larynx, hypopharynx or oropharynx were treated within the ADMIRE study where FDG-PET/CT response-guided (Week 2&4) dose escalation was applied (total dose 70-78 Gy). Cisplatin or cetuximab was added to radiotherapy in case of T3-4 and/or N2c disease. To compare the LC and late toxicity of the study population, we used an external control group (n = 67) consisting of all eligible patients for the study (but not participated). These patients were treated in our institution during the same period with the current standard of 70 Gy radiotherapy. To reduce the effect of confounding, logistic regression analyses was done using stabilized inverse probability of treatment weighting (SIPTW). Results After median follow-up of 40 and 43 months for the ADMIRE and control groups, the 3-year LC-rates were 74% and 78%, respectively (adjusted HR after SIPTW 0.80, 95 %CI 0.25-2.52, p = 0.70). The incidences of any late G3 toxicity were 35% and 18%, respectively. The adjusted OR for any late G3 toxicity was 5.09 (95 %CI 1.64-15.8, p = 0.005), for any late G ≥ 2 toxicity was 3.67 (95 %CI 1.2-11.7, p = 0.02), for persistent laryngeal edema was 10.95 (95% CI 2.71-44.29, p = 0.001), for persistent mucosal ulcers was 4.67 (95% CI 1.23-17.7, p = 0.023), and for late G3 radionecrosis was 15.69 (95 %CI 2.43-101.39, p = 0.004). Conclusion Given the comparable LC rates with increased late toxicity in the ADMIRE group, selection criteria for future adaptive dose escalation trials (preferably randomized) need to be refined to include only patients at higher risk of local failure and/or lower risk of severe late toxicity.
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Affiliation(s)
- Abrahim Al-Mamgani
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rob Kessels
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Zeno A.R. Gouw
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Arash Navran
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Vineet Mohan
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeroen B. van de Kamer
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wouter V. Vogel
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Heeling E, van de Kamer JB, Methorst M, Bruining A, van de Meent M, Vrancken Peeters MJTFD, Lok CAR, van der Ploeg IMC. The Safe Use of 125I-Seeds as a Localization Technique in Breast Cancer during Pregnancy. Cancers (Basel) 2023; 15:3229. [PMID: 37370839 DOI: 10.3390/cancers15123229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Some aspects of the treatment protocol for breast cancer during pregnancy (PrBC) have not been thoroughly studied. This study provides clarity regarding the safety of the use of 125I-seeds as a localization technique for breast-conserving surgery in patients with PrBC. METHODS To calculate the exposure to the fetus of one 125I-seed implanted in a breast tumor, we developed a model accounting for the decaying 125I-source, time to surgery, and the declining distance between the 125I-seed and the fetus. The primary outcome was the maximum cumulative fetal dose of radiation at consecutive gestational ages (GA). RESULTS The cumulative fetal dose remains below 1 mSv if a single 125I-seed is implanted at a GA of 26 weeks. After a GA of 26 weeks, the fetal dose can be at a maximum of 11.6 mSv. If surgery takes place within two weeks of implantation from a GA of 26 weeks, and one week above a GA of 32 weeks, the dose remains below 1 mSv. CONCLUSION The use of 125I-seeds is safe in PrBC. The maximum fetal exposure remains well below the threshold of 100 mSv, and therefore, does not lead to an increased risk of fetal tissue damage. Still, we propose keeping the fetal dose as low as possible, preferably below 1 mSv.
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Affiliation(s)
- Eva Heeling
- Department of Surgical Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Jeroen B van de Kamer
- Department of Radiation Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Michelle Methorst
- Department of Gynaecologic Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Annemarie Bruining
- Department of Radiology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Mette van de Meent
- Department of Obstetrics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | | | - Christianne A R Lok
- Department of Gynaecologic Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Iris M C van der Ploeg
- Department of Surgical Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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McDonald F, Belka C, Hurkmans C, Alicja Jereczek-Fossa B, Poortmans P, van de Kamer JB, Azizaj E, Franco P. Introducing the ESTRO Guidelines Committee, driving force for the new generation of ESTRO guidelines. Radiother Oncol 2023:109724. [PMID: 37244357 DOI: 10.1016/j.radonc.2023.109724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 05/29/2023]
Affiliation(s)
- Fiona McDonald
- Lung Unit, Royal Marsden Hospital, London, United Kingdom; Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich; German Cancer Consortium (DKTK), partner site Munich; Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Jeroen B van de Kamer
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Eralda Azizaj
- European Society for Radiotherapy and Oncology, Brussels, Belgium
| | - Pierfrancesco Franco
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, Novara, Italy; Department of Radiation Oncology, 'Maggiore della Carità' University Hospital, Novara, Italy.
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Langendijk JA, Hoebers FJP, de Jong MA, Doornaert P, Terhaard CHJ, Steenbakkers RJHM, Hamming-Vrieze O, van de Kamer JB, Verbakel WFAR, Keskin-Cambay F, Reitsma JB, van der Schaaf A, Boersma LJ, Schuit E. National Protocol for Model-Based Selection for Proton Therapy in Head and Neck Cancer. Int J Part Ther 2021; 8:354-365. [PMID: 34285961 PMCID: PMC8270079 DOI: 10.14338/ijpt-20-00089.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/08/2021] [Indexed: 11/21/2022] Open
Abstract
In the Netherlands, the model-based approach is used to identify patients with head and neck cancer who may benefit most from proton therapy in terms of prevention of late radiation-induced side effects in comparison with photon therapy. To this purpose, a National Indication Protocol Proton therapy for Head and Neck Cancer patients (NIPP-HNC) was developed, which has been approved by the health care authorities. When patients qualify according to the guidelines of the NIPP-HNC, proton therapy is fully reimbursed. This article describes the procedures that were followed to develop this NIPP-HNC and provides all necessary information to introduce model-based selection for patients with head and neck cancer into routine clinical practice.
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Affiliation(s)
- Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Frank J P Hoebers
- Department of Radiation Oncology (MAASTRO clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, the Netherlands
| | - Martin A de Jong
- Department of Radiation Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Patricia Doornaert
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Chris H J Terhaard
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Roel J H M Steenbakkers
- Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Olga Hamming-Vrieze
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jeroen B van de Kamer
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Wilko F A R Verbakel
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, the Netherlands
| | - Fatma Keskin-Cambay
- Department of Radiation Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Johannes B Reitsma
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Arjen van der Schaaf
- Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Liesbeth J Boersma
- Department of Radiation Oncology (MAASTRO clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, the Netherlands
| | - Ewoud Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Vieira B, Demirtas D, van de Kamer JB, Hans EW, Jongste W, van Harten W. Radiotherapy treatment scheduling: Implementing operations research into clinical practice. PLoS One 2021; 16:e0247428. [PMID: 33606831 PMCID: PMC7894882 DOI: 10.1371/journal.pone.0247428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/05/2021] [Indexed: 12/24/2022] Open
Abstract
Background Every week, radiotherapy centers face the complex task of scheduling hundreds of treatment sessions amongst the available linear accelerators. With the increase in cancer patient numbers, manually creating a feasible and efficient schedule has shown to be a difficult, time-consuming task. Although operations research models have been increasingly reported upon to optimize patient care logistics, there is almost no scientific evidence of implementation in practice. Methods A mathematical operations research model was adapted to generate radiotherapy treatment schedules in two Dutch centers. The model was iteratively adjusted to fulfill the technical and medical constraints of each center until a valid model was attained. Patient data was collected for the planning horizon of one week, and the feasibility of the obtained schedules was verified by the staff of each center. The resulting optimized solutions are compared with the ones manually developed in practice. Results The weekly schedule was improved in both centers by decreasing the average standard deviation between sessions’ starting times from 103.0 to 50.4 minutes (51%) in one center, and the number of gaps in the schedule from 18 to 5 (72%) in the other. The number of patients requiring linac switching between sessions has also decreased from 71 to 0 patients in one center, and from 43 to 2 in the other. The automated process required 5 minutes and 1.5 hours of computation time to find an optimal weekly patient schedule, respectively, as opposed to approximately 1.5 days when performed manually for both centers. Conclusions The practical application of a theoretical operations research model for radiotherapy treatment scheduling has provided radiotherapy planners a feasible, high-quality schedule in an automated way. Iterative model adaptations performed in small steps, early engagement of stakeholders, and constant communication proved to facilitate the implementation of operations research models into clinical practice.
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Affiliation(s)
- Bruno Vieira
- Department of Radiation Oncology, Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, The Netherlands
| | - Derya Demirtas
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, The Netherlands
- Faculty of Behavioural Management and Social Sciences, Department Industrial Engineering and Business Information Systems, University of Twente, Enschede, The Netherlands
| | - Jeroen B. van de Kamer
- Department of Radiation Oncology, Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Erwin W. Hans
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, The Netherlands
- Faculty of Behavioural Management and Social Sciences, Department Industrial Engineering and Business Information Systems, University of Twente, Enschede, The Netherlands
| | | | - Wim van Harten
- Department of Radiation Oncology, Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Health Technology and Services Research, School of Governance and Management, University of Twente, Enschede, The Netherlands
- * E-mail:
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6
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Gouw ZA, La Fontaine MD, Vogel WV, van de Kamer JB, Sonke JJ, Al-Mamgani A. Single-Center Prospective Trial Investigating the Feasibility of Serial FDG-PET Guided Adaptive Radiation Therapy for Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2020; 108:960-968. [DOI: 10.1016/j.ijrobp.2020.04.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 12/17/2022]
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7
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Vieira B, Demirtas D, van de Kamer JB, Hans EW, Rousseau LM, Lahrichi N, van Harten WH. Radiotherapy treatment scheduling considering time window preferences. Health Care Manag Sci 2020; 23:520-534. [PMID: 32594285 PMCID: PMC7676074 DOI: 10.1007/s10729-020-09510-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 06/10/2020] [Indexed: 11/26/2022]
Abstract
External-beam radiotherapy treatments are delivered by a linear accelerator (linac) in a series of high-energy radiation sessions over multiple days. With the increase in the incidence of cancer and the use of radiotherapy (RT), the problem of automatically scheduling RT sessions while satisfying patient preferences regarding the time of their appointments becomes increasingly relevant. While most literature focuses on timeliness of treatments, several Dutch RT centers have expressed their need to include patient preferences when scheduling appointments for irradiation sessions. In this study, we propose a mixed-integer linear programming (MILP) model that solves the problem of scheduling and sequencing RT sessions considering time window preferences given by patients. The MILP model alone is able to solve the problem to optimality, scheduling all sessions within the desired window, in reasonable time for small size instances up to 66 patients and 2 linacs per week. For larger centers, we propose a heuristic method that pre-assigns patients to linacs to decompose the problem in subproblems (clusters of linacs) before using the MILP model to solve the subproblems to optimality in a sequential manner. We test our methodology using real-world data from a large Dutch RT center (8 linacs). Results show that, combining the heuristic with the MILP model, the problem can be solved in reasonable computation time with as few as 2.8% of the sessions being scheduled outside the desired time window.
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Affiliation(s)
- Bruno Vieira
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .,Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, The Netherlands.
| | - Derya Demirtas
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, The Netherlands.,Department of Industrial Engineering and Business Information Systems, Faculty of Behavioural Management and Social Sciences, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Jeroen B van de Kamer
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Erwin W Hans
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, The Netherlands.,Department of Industrial Engineering and Business Information Systems, Faculty of Behavioural Management and Social Sciences, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Louis-Martin Rousseau
- Mathematics and Industrial Engineering, Polytechnique Montreal, 2900 Edouard Montpetit Blvd, Montreal, Quebec, H3T 1J4, Canada
| | - Nadia Lahrichi
- Mathematics and Industrial Engineering, Polytechnique Montreal, 2900 Edouard Montpetit Blvd, Montreal, Quebec, H3T 1J4, Canada
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Rijnstate General Hospital, Arnhem, The Netherlands
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Konert T, Everitt S, La Fontaine MD, van de Kamer JB, MacManus MP, Vogel WV, Callahan J, Sonke JJ. Robust, independent and relevant prognostic 18F-fluorodeoxyglucose positron emission tomography radiomics features in non-small cell lung cancer: Are there any? PLoS One 2020; 15:e0228793. [PMID: 32097418 PMCID: PMC7041813 DOI: 10.1371/journal.pone.0228793] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 01/22/2020] [Indexed: 12/14/2022] Open
Abstract
In locally advanced lung cancer, established baseline clinical variables show limited prognostic accuracy and 18F-fluorodeoxyglucose positron emission tomography (FDG PET) radiomics features may increase accuracy for optimal treatment selection. Their robustness and added value relative to current clinical factors are unknown. Hence, we identify robust and independent PET radiomics features that may have complementary value in predicting survival endpoints. A 4D PET dataset (n = 70) was used for assessing the repeatability (Bland-Altman analysis) and independence of PET radiomics features (Spearman rank: |ρ|<0.5). Two 3D PET datasets combined (n = 252) were used for training and validation of an elastic net regularized generalized logistic regression model (GLM) based on a selection of clinical and robust independent PET radiomics features (GLMall). The fitted model performance was externally validated (n = 40). The performance of GLMall (measured with area under the receiver operating characteristic curve, AUC) was highest in predicting 2-year overall survival (0.66±0.07). No significant improvement was observed for GLMall compared to a model containing only PET radiomics features or only clinical variables for any clinical endpoint. External validation of GLMall led to AUC values no higher than 0.55 for any clinical endpoint. In this study, robust independent FDG PET radiomics features did not have complementary value in predicting survival endpoints in lung cancer patients. Improving risk stratification and clinical decision making based on clinical variables and PET radiomics features has still been proven difficult in locally advanced lung cancer patients.
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Affiliation(s)
- Tom Konert
- Nuclear Medicine Department, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sarah Everitt
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Matthew D. La Fontaine
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeroen B. van de Kamer
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michael P. MacManus
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Wouter V. Vogel
- Nuclear Medicine Department, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jason Callahan
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- * E-mail:
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van Beek S, Jonker M, Hamming-Vrieze O, Al-Mamgani A, Navran A, Remeijer P, van de Kamer JB. Protocolised way to cope with anatomical changes in head & neck cancer during the course of radiotherapy. Tech Innov Patient Support Radiat Oncol 2019; 12:34-40. [PMID: 32095553 PMCID: PMC7033784 DOI: 10.1016/j.tipsro.2019.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/14/2019] [Accepted: 11/01/2019] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION During a course of radiotherapy for head-and-neck-cancer (HNC), non-rigid anatomical changes can be observed on daily Cone Beam CT (CBCT). To objectify responses to these changes, we use a decision support system (traffic light protocol). Action levels orange and red may lead to re-planning. The purpose of this study was to evaluate how often re-planning was done for non-rigid anatomical changes, which anatomical changes led to re-planning and in which subgroups of patients treatment adaptation was deemed necessary. MATERIALS AND METHODS A consecutive series of 388 HNC patients were retrospectively selected using the digital log of CBCT scans. The logs were analyzed for the number of new plans on an original planning CT scan (O-pCT) or a new pCT scan (N-pCT). Reasons for re-planning were categorized into: target volume increase/decrease, body contour decrease/increase and local shift of target volume. Subgroup analysis was performed to investigate relative differences of re-planning between treatment modalities. RESULTS For 33 patients the treatment plan was adapted due to anatomical changes, resulting in 37 new plans in total. Re-planning on a N-pCT with complete re-delineation was done 22 times. In fifteen cases a new plan was created after adjustment of contours on the O-pCT. Main reasons for re-planning were target volume increase, body contour decrease and local shifts of target volume. Most re-planning (23%) was seen in patients treated with chemoradiotherapy. CONCLUSION Visual detection of anatomical changes on CBCT during treatment of HNC, results in re-planning in 1 out of 10 patients.
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Verbakel WF, Doornaert PA, Raaijmakers CP, Bos LJ, Essers M, van de Kamer JB, Dahele M, Terhaard CH, Kaanders JH. Targeted Intervention to Improve the Quality of Head and Neck Radiation Therapy Treatment Planning in the Netherlands: Short and Long-Term Impact. Int J Radiat Oncol Biol Phys 2019; 105:514-524. [DOI: 10.1016/j.ijrobp.2019.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/20/2019] [Accepted: 07/04/2019] [Indexed: 12/18/2022]
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Vieira B, Demirtas D, B van de Kamer J, Hans EW, van Harten W. Improving workflow control in radiotherapy using discrete-event simulation. BMC Med Inform Decis Mak 2019; 19:199. [PMID: 31651304 PMCID: PMC6814107 DOI: 10.1186/s12911-019-0910-0] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 09/06/2019] [Indexed: 11/22/2022] Open
Abstract
Background In radiotherapy, minimizing the time between referral and start of treatment (waiting time) is important to possibly mitigate tumor growth and avoid psychological distress in cancer patients. Radiotherapy pre-treatment workflow is driven by the scheduling of the first irradiation session, which is usually set right after consultation (pull strategy) or can alternatively be set after the pre-treatment workflow has been completed (push strategy). The objective of this study is to assess the impact of using pull and push strategies and explore alternative interventions for improving timeliness in radiotherapy. Methods Discrete-event simulation is used to model the patient flow of a large radiotherapy department of a Dutch hospital. A staff survey, interviews with managers, and historical data from 2017 are used to generate model inputs, in which fluctuations in patient inflow and resource availability are considered. Results A hybrid (40% pull / 60% push) strategy representing the current practice (baseline case) leads to 12% lower average waiting times and 48% fewer first appointment rebooks when compared to a full pull strategy, which in turn leads to 41% fewer patients breaching the waiting time targets. An additional scenario analysis performed on the baseline case showed that spreading consultation slots evenly throughout the week can provide a 21% reduction in waiting times. Conclusions A 100% pull strategy allows for more patients starting treatment within the waiting time targets than a hybrid strategy, in spite of slightly longer waiting times and more first appointment rebooks. Our algorithm can be used by radiotherapy policy makers to identify the optimal balance between push and pull strategies to ensure timely treatments while providing patient-centered care adapted to their specific conditions.
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Affiliation(s)
- Bruno Vieira
- Department of Radiation Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands. .,Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, The Netherlands.
| | - Derya Demirtas
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, The Netherlands.,Department of Industrial Engineering and Business Information Systems, Faculty of Behavioural Management and Social Sciences, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Jeroen B van de Kamer
- Department of Radiation Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
| | - Erwin W Hans
- Center for Healthcare Operations Improvement and Research (CHOIR), University of Twente, Enschede, The Netherlands.,Department of Industrial Engineering and Business Information Systems, Faculty of Behavioural Management and Social Sciences, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Wim van Harten
- Department of Radiation Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands.,Department of Health Technology and Services Research, School of Governance and Management, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands.,Rijnstate General Hospital, Arnhem, The Netherlands
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Gouw ZAR, La Fontaine MD, van Kranen S, van de Kamer JB, Vogel WV, van Werkhoven E, Sonke JJ, Al-Mamgani A. The Prognostic Value of Baseline 18F-FDG PET/CT in Human Papillomavirus–Positive Versus Human Papillomavirus–Negative Patients With Oropharyngeal Cancer. Clin Nucl Med 2019; 44:e323-e328. [DOI: 10.1097/rlu.0000000000002531] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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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Valstar MH, Owers EC, Al-Mamgani A, Smeele LE, van de Kamer JB, Sonke JJ, Vogel WV. Prostate-specific membrane antigen positron emission tomography/computed tomography as a potential tool to assess and guide salivary gland irradiation. Phys Imaging Radiat Oncol 2019; 9:65-68. [PMID: 33458427 PMCID: PMC7807566 DOI: 10.1016/j.phro.2019.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 02/15/2019] [Accepted: 02/19/2019] [Indexed: 11/28/2022]
Abstract
PSMA PET/CT allows visualisation of salivary glands with good spatial and contrast resolution. Evaluable glands include minor and less well-known gland locations. PSMA PET/CT can visualise damage to salivary glands from external beam radiotherapy. PSMA PET/CT has the potential to guide optimisation of radiotherapy to the head and neck. The potential benefit of PSMA PET/CT is to avoid salivary gland toxicity and preserve quality of life.
Evaluation of salivary gland damage after head and neck radiotherapy (RT) is difficult with current tools, such as subjective patient-reported outcome measures. We demonstrate the use of prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) as an objective non-invasive tool to visualize damage to salivary glands resulting from RT. In three clinical cases, the PSMA-ligand distribution correlates to the RT dose distribution including intra-gland dose gradients and matches patient-reported toxicity, suggesting a dose-response relation. These findings support further exploration of PSMA PET/CT to guide and evaluate RT, with the ultimate aim to reduce salivary gland toxicity.
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Affiliation(s)
- Matthijs H Valstar
- Department of Head and Neck Oncology and Surgery, Antoni van Leeuwenhoek The Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Emilia C Owers
- Department of Nuclear Medicine, Antoni van Leeuwenhoek The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, Antoni van Leeuwenhoek The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ludwig E Smeele
- Department of Head and Neck Oncology and Surgery, Antoni van Leeuwenhoek The Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Jeroen B van de Kamer
- Department of Radiation Oncology, Antoni van Leeuwenhoek The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, Antoni van Leeuwenhoek The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Wouter V Vogel
- Department of Nuclear Medicine, Antoni van Leeuwenhoek The Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Radiation Oncology, Antoni van Leeuwenhoek The Netherlands Cancer Institute, Amsterdam, the Netherlands
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Konert T, van de Kamer JB, Sonke JJ, Vogel WV. The developing role of FDG PET imaging for prognostication and radiotherapy target volume delineation in non-small cell lung cancer. J Thorac Dis 2018; 10:S2508-S2521. [PMID: 30206495 DOI: 10.21037/jtd.2018.07.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Advancements in functional imaging technology have allowed new possibilities in contouring of target volumes, monitoring therapy, and predicting treatment outcome in non-small cell lung cancer (NSCLC). Consequently, the role of 18F-fluorodeoxyglucose positron emission tomography (FDG PET) has expanded in the last decades from a stand-alone diagnostic tool to a versatile instrument integrated with computed tomography (CT), with a prominent role in lung cancer radiotherapy. This review outlines the most recent literature on developments in FDG PET imaging for prognostication and radiotherapy target volume delineation (TVD) in NSCLC. We also describe the challenges facing the clinical implementation of these developments and present new ideas for future research.
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Affiliation(s)
- Tom Konert
- Nuclear Medicine Department, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeroen B van de Kamer
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wouter V Vogel
- Nuclear Medicine Department, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Dube S, van de Kamer JB, Rong Y. Globalism versus Nationalism in Medical Physics. J Appl Clin Med Phys 2017; 18:5-8. [PMID: 28504412 PMCID: PMC5689855 DOI: 10.1002/acm2.12097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 01/20/2017] [Accepted: 04/12/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Scott Dube
- Department of Radiation Oncology; Morton Plant Hospital; Clearwater FL USA
| | - Jeroen B. van de Kamer
- Department of Radiation Oncology; Netherlands Cancer Institute; Antoni van Leeuwenhoek; Amsterdam The Netherlands
| | - Yi Rong
- Department of Radiation Oncology; University of California Davis Comprehensive Cancer Center; Sacramento CA USA
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Mans A, Schuring D, Arends MP, Vugts CAJM, Wolthaus JWH, Lotz HT, Admiraal M, Louwe RJW, Öllers MC, van de Kamer JB. The NCS code of practice for the quality assurance and control for volumetric modulated arc therapy. Phys Med Biol 2016; 61:7221-7235. [PMID: 27649474 DOI: 10.1088/0031-9155/61/19/7221] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In 2010, the NCS (Netherlands Commission on Radiation Dosimetry) installed a subcommittee to develop guidelines for quality assurance and control for volumetric modulated arc therapy (VMAT) treatments. The report (published in 2015) has been written by Dutch medical physicists and has therefore, inevitably, a Dutch focus. This paper is a condensed version of these guidelines, the full report in English is freely available from the NCS website www.radiationdosimetry.org. After describing the transition from IMRT to VMAT, the paper addresses machine quality assurance (QA) and treatment planning system (TPS) commissioning for VMAT. The final section discusses patient specific QA issues such as the use of class solutions, measurement devices and dose evaluation methods.
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Affiliation(s)
- Anton Mans
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Kruis MF, van de Kamer JB, Vogel WV, Belderbos JS, Sonke JJ, van Herk M. Clinical evaluation of respiration-induced attenuation uncertainties in pulmonary 3D PET/CT. EJNMMI Phys 2015; 2:4. [PMID: 26501806 PMCID: PMC4545225 DOI: 10.1186/s40658-014-0107-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 12/30/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In contemporary positron emission tomography (PET)/computed tomography (CT) scanners, PET attenuation correction is performed by means of a CT-based attenuation map. Respiratory motion can however induce offsets between the PET and CT data. Studies have demonstrated that these offsets can cause errors in quantitative PET measures. The purpose of this study is to quantify the effects of respiration-induced CT differences on the attenuation correction of pulmonary 18-fluordeoxyglucose (FDG) 3D PET/CT in a patient population and to investigate contributing factors. METHODS For 32 lung cancer patients, 3D-CT, 4D-PET and 4D-CT data were acquired. The 4D FDG PET data were attenuation corrected (AC) using a free-breathing 3D-CT (3D-AC), the end-inspiration CT (EI-AC), the end-expiration CT (EE-AC) or phase-by-phase (P-AC). After reconstruction and AC, the 4D-PET data were averaged. In the 4Davg data, we measured maximum tumour standardised uptake value (SUV)max in the tumour, SUVmean in a lung volume of interest (VOI) and average SUV (SUVmean) in a muscle VOI. On the 4D-CT, we measured the lung volume differences and CT number changes between inhale and exhale in the lung VOI. RESULTS Compared to P-AC, we found -2.3% (range -9.7% to 1.2%) lower tumour SUVmax in EI-AC and 2.0% (range -0.9% to 9.5%) higher SUVmax in EE-AC. No differences in the muscle SUV were found. The use of 3D-AC led to respiration-induced SUVmax differences up to 20% compared to the use of P-AC. SUVmean differences in the lung VOI between EI-AC and EE-AC correlated to average CT differences in this region (ρ = 0.83). SUVmax differences in the tumour correlated to the volume changes of the lungs (ρ = -0.55) and the motion amplitude of the tumour (ρ = 0.53), both as measured on the 4D-CT. CONCLUSIONS Respiration-induced CT variations in clinical data can in extreme cases lead to SUV effects larger than 10% on PET attenuation correction. These differences were case specific and correlated to differences in CT number in the lungs.
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Affiliation(s)
- Matthijs F Kruis
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Jeroen B van de Kamer
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Wouter V Vogel
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .,Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - José Sa Belderbos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Marcel van Herk
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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Kruis MF, van de Kamer JB, Belderbos JSA, Sonke JJ, van Herk M. 4D CT amplitude binning for the generation of a time-averaged 3D mid-position CT scan. Phys Med Biol 2014; 59:5517-29. [PMID: 25170633 DOI: 10.1088/0031-9155/59/18/5517] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The purpose of this study was to develop a method to use amplitude binned 4D-CT (A-4D-CT) data for the construction of mid-position CT data and to compare the results with data created from phase-binned 4D-CT (P-4D-CT) data. For the latter purpose we have developed two measures which describe the regularity of the 4D data and we have tried to correlate these measures with the regularity of the external respiration signal. 4D-CT data was acquired for 27 patients on a combined PET-CT scanner. The 4D data were reconstructed twice, using phase and amplitude binning. The 4D frames of each dataset were registered using a quadrature-based optical flow method. After registration the deformation vector field was repositioned to the mid-position. Since amplitude-binned 4D data does not provide temporal information, we corrected the mid-position for the occupancy of the bins. We quantified the differences between the two mid-position datasets in terms of tumour offset and amplitude differences. Furthermore, we measured the standard deviation of the image intensity over the respiration after registration (σregistration) and the regularity of the deformation vector field (Delta J) to quantify the quality of the 4D-CT data. These measures were correlated to the regularity of the external respiration signal (σsignal).The two irregularity measures, Delta J and σregistration, were dependent on each other (p<0.0001, R2=0.80 for P-4D-CT, R2=0.74 for A-4D-CT). For all datasets amplitude binning resulted in lower Delta J and σregistration and large decreases led to visible quality improvements in the mid-position data. The quantity of artefact decrease was correlated to the irregularity of the external respiratory signal.The average tumour offset between the phase and amplitude binned mid-position without occupancy correction was 0.42 mm in the caudal direction (10.6% of the amplitude). After correction this was reduced to 0.16 mm in caudal direction (4.1% of the amplitude). Similar relative offsets were found at the diaphragm. We have devised a method to use amplitude binned 4D-CT to construct motion model and generate a mid-position planning CT for radiotherapy treatment purposes. We have decimated the systematic offset of this mid-position model with a motion model derived from P-4D-CT. We found that the A-4D-CT led to a decrease of local artefacts and that this decrease was correlated to the irregularity of the external respiration signal.
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Affiliation(s)
- Matthijs F Kruis
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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van Dijk IWEM, van Os RM, van de Kamer JB, Franken NAP, van der Pal HJH, Koning CCE, Caron HN, Ronckers CM, Kremer LCM. The use of equivalent radiation dose in the evaluation of late effects after childhood cancer treatment. J Cancer Surviv 2014; 8:638-46. [DOI: 10.1007/s11764-014-0373-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 05/28/2014] [Indexed: 12/25/2022]
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Kruis MF, van de Kamer JB, Sonke JJ, Jansen EP, van Herk M. Registration accuracy and image quality of time averaged mid-position CT scans for liver SBRT. Radiother Oncol 2013; 109:404-8. [DOI: 10.1016/j.radonc.2013.08.047] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 08/26/2013] [Accepted: 08/31/2013] [Indexed: 10/26/2022]
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Kruis MF, van de Kamer JB, Houweling AC, Sonke JJ, Belderbos JS, van Herk M. PET Motion Compensation for Radiation Therapy Using a CT-Based Mid-Position Motion Model: Methodology and Clinical Evaluation. Int J Radiat Oncol Biol Phys 2013; 87:394-400. [DOI: 10.1016/j.ijrobp.2013.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 06/04/2013] [Accepted: 06/07/2013] [Indexed: 10/26/2022]
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22
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Houweling AC, Wolf AL, Vogel WV, Hamming-Vrieze O, van Vliet-Vroegindeweij C, van de Kamer JB, van der Heide UA. FDG-PET and diffusion-weighted MRI in head-and-neck cancer patients: implications for dose painting. Radiother Oncol 2013; 106:250-4. [PMID: 23395065 DOI: 10.1016/j.radonc.2013.01.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 11/14/2012] [Accepted: 01/06/2013] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study was to investigate if FDG-PET and DWI identify the same or different targets for dose escalation in the GTV of HN cancer patients. Additionally, the dose coverage of DWI-targets in an FDG-PET-based dose painting plan was analyzed. MATERIALS AND METHODS Eighteen HN cancer patients underwent FDG-PET and DWI exams, which were converted to standardized uptake value (SUV)- and apparent diffusion coefficient (ADC)-maps. The correspondence between the two imaging modalities was determined on a voxel-level using Spearman's correlation coefficient (ρ). Dose painting plans were optimized based on the 50% isocontour of the maximum SUV ( SUV(50%max)). Dose coverage was analyzed in three different SUV- and three different ADC-targets using the mean dose and the near-minimum and near-maximum doses. RESULTS The average maximum SUV was 13.9 and the mean ADC was 1.17 · 10(-3) mm(2)/s. The average ρ between SUV and ADC was -0.2 (range: -0.6 to 0.4). The ADC-targets were only partly overlapping the SUV(50%max)-target and the dose parameters were significantly smaller in the ADC-targets compared to the SUV(50%max)-target. CONCLUSIONS FDG-PET and DWI contain different information, resulting in different targets. Further information about failure patterns and dose relations can be obtained by adding DWI to currently ongoing dose painting trials.
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Affiliation(s)
- Antonetta C Houweling
- Department of Radiotherapy, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Haverkort MA, van de Kamer JB, Pieters BR, Koning CC, van Herk M, van Tienhoven G. Adaptive margin radiotherapy for patients with prostate carcinoma: What’s the benefit? Radiother Oncol 2012; 105:203-6. [DOI: 10.1016/j.radonc.2012.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 10/04/2012] [Accepted: 10/11/2012] [Indexed: 10/27/2022]
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Chai X, van Herk M, van de Kamer JB, Hulshof MCCM, Remeijer P, Lotz HT, Bel A. Finite element based bladder modeling for image-guided radiotherapy of bladder cancer. Med Phys 2010; 38:142-50. [DOI: 10.1118/1.3523624] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [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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van Rooijen DC, Pool R, van de Kamer JB, Hulshof MCCM, Koning CCE, Bel A. Independent position correction on tumor and lymph nodes; consequences for bladder cancer irradiation with two combined IMRT plans. Radiat Oncol 2010; 5:53. [PMID: 20550672 PMCID: PMC2893191 DOI: 10.1186/1748-717x-5-53] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 06/15/2010] [Indexed: 11/22/2022] Open
Abstract
Background The application of lipiodol injections as markers around bladder tumors combined with the use of CBCT for image guidance enables daily on-line position correction based on the position of the bladder tumor. However, this might introduce the risk of underdosing the pelvic lymph nodes. In this study several correction strategies were compared. Methods For this study set-up errors and tumor displacements for ten complete treatments were generated; both were based on the data of 10 bladder cancer patients. Besides, two IMRT plans were made for 20 patients, one for the elective field and a boost plan for the tumor. For each patient 10 complete treatments were simulated. For each treatment the dose was calculated without position correction (option 1), correction on bony anatomy (option 2), on tumor only (option 3) and separately on bone for the elective field (option 4). For each method we analyzed the D99% for the tumor, bladder and lymph nodes and the V95% for the small intestines, rectum, healthy part of the bladder and femoral heads. Results CTV coverage was significantly lower with options 1 and 2. With option 3 the tumor coverage was not significantly different from the treatment plan. The ΔD99% (D99%, option n - D99%, treatment plan) for option 4 was small, but significant. For the lymph nodes the results from option 1 differed not significantly from the treatment plan. The median ΔD99% of the other options were small, but significant. ΔD99% for PTVbladder was small for options 1, 2 and 4, but decreased up to -8.5 Gy when option 3 was applied. Option 4 is the only method where the difference with the treatment plan never exceeds 2 Gy. The V95% for the rectum, femoral heads and small intestines was small in the treatment plan and this remained so after applying the correction options, indicating that no additional hot spots occurred. Conclusions Applying independent position correction on bone for the elective field and on tumor for the boost separately gives on average the best target coverage, without introducing additional hot spots in the healthy tissue.
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Chai X, van Herk M, van de Kamer JB, Remeijer P, Bex A, Betgen A, De Reijke TM, Hulshof MC, Pos FJ, Bel A. Behavior of Lipiodol Markers During Image Guided Radiotherapy of Bladder Cancer. Int J Radiat Oncol Biol Phys 2010; 77:309-14. [DOI: 10.1016/j.ijrobp.2009.08.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Revised: 08/06/2009] [Accepted: 08/13/2009] [Indexed: 11/28/2022]
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van Rooijen DC, van de Kamer JB, Pool R, Hulshof MCCM, Koning CCE, Bel A. The effect of on-line position correction on the dose distribution in focal radiotherapy for bladder cancer. Radiat Oncol 2009; 4:38. [PMID: 19775479 PMCID: PMC2759947 DOI: 10.1186/1748-717x-4-38] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [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: 07/21/2009] [Accepted: 09/24/2009] [Indexed: 12/25/2022] Open
Abstract
Background The purpose of this study was to determine the dosimetric effect of on-line position correction for bladder tumor irradiation and to find methods to predict and handle this effect. Methods For 25 patients with unifocal bladder cancer intensity modulated radiotherapy (IMRT) with 5 beams was planned. The requirement for each plan was that 99% of the target volume received 95% of the prescribed dose. Tumor displacements from -2.0 cm to 2.0 cm in each dimension were simulated, using 0.5 cm increments, resulting in 729 simulations per patient. We assumed that on-line correction for the tumor was applied perfectly. We determined the correlation between the change in D99% and the change in path length, which is defined here as the distance from the skin to the isocenter for each beam. In addition the margin needed to avoid underdosage was determined and the probability that an underdosage occurs in a real treatment was calculated. Results Adjustments for tumor displacement with perfect on-line position correction resulted in an altered dose distribution. The altered fraction dose to the target varied from 91.9% to 100.4% of the prescribed dose. The mean D99% (± SD) was 95.8% ± 1.0%. There was a modest linear correlation between the difference in D99% and the change in path length of the beams after correction (R2 = 0.590). The median probability that a systematic underdosage occurs in a real treatment was 0.23% (range: 0 - 24.5%). A margin of 2 mm reduced that probability to < 0.001% in all patients. Conclusion On-line position correction does result in an altered target coverage, due to changes in average path length after position correction. An extra margin can be added to prevent underdosage.
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van Herten YR, van de Kamer JB, van Wieringen N, Pieters BR, Bel A. Dosimetric evaluation of prostate rotations and their correction by couch rotations. Radiother Oncol 2008; 88:156-62. [DOI: 10.1016/j.radonc.2008.03.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Revised: 03/14/2008] [Accepted: 03/16/2008] [Indexed: 11/25/2022]
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Pieters BR, van de Kamer JB, van Herten YR, van Wieringen N, D’Olieslager GM, van der Heide UA, Koning CC. Comparison of biologically equivalent dose–volume parameters for the treatment of prostate cancer with concomitant boost IMRT versus IMRT combined with brachytherapy. Radiother Oncol 2008; 88:46-52. [DOI: 10.1016/j.radonc.2008.02.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 01/23/2008] [Accepted: 02/25/2008] [Indexed: 10/22/2022]
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Hulshof MCCM, van Andel G, Bel A, Gangel P, van de Kamer JB. Intravesical markers for delineation of target volume during external focal irradiation of bladder carcinomas. Radiother Oncol 2007; 84:49-51. [PMID: 17561295 DOI: 10.1016/j.radonc.2007.05.017] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Accepted: 05/16/2007] [Indexed: 11/27/2022]
Abstract
A clip forceps was developed which can insert markers at the border of a bladder tumour through a rigid cystoscope. This technique proved to be simple and safe and is of help for delineation of the target volume during CT simulation for focal boost irradiation of bladder cancer.
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van Vulpen M, Raaymakers BW, de Leeuw AAC, van de Kamer JB, van Moorselaar RJA, Hobbelink MGG, Battermann JJ, Lagendijk JJW. Prostate perfusion in patients with locally advanced prostate carcinoma treated with different hyperthermia techniques. J Urol 2002; 168:1597-602. [PMID: 12352464 DOI: 10.1016/s0022-5347(05)64527-2] [Citation(s) in RCA: 31] [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] [Indexed: 11/18/2022]
Abstract
PURPOSE We determined prostate perfusion in 18 patients with locally advanced prostate carcinoma treated with a combination of external beam irradiation and regional (10) or interstitial (8) hyperthermia. MATERIALS AND METHODS Perfusion values were calculated from temperature elevations due to constant applied power and from transient temperature measurements after a change in applied power. Student's t test was used for comparing perfusion values with time and in the 2 groups. RESULTS At the start of regional hyperthermia treatment mean estimated perfusion plus or minus standard deviation was 10 +/- 8 ml./100 gm. per minute. At the end of treatment mean perfusion was increased to 14 +/- 2 ml./100 gm. per minute (p <0.01). Achieved thermal parameters were a mean temperature of at least 40.3C +/- 0.6C in 90% of the prostate, 40.9C +/- 0.6C in 50% and a mean maximum temperature of 41.6C +/- 0.6C. At the end of interstitial hyperthermia treatment estimated mean perfusion was 47 +/- 5 ml./100 gm. per minute, which was significantly different compared with the end of regional hyperthermia (p < 0(-7) ). Mean temperature was at least 39.4C +/- 0.9C in 90% of the prostate and 41.8C +/- 1.6C in 50%, while mean maximum temperature was 53.1C +/- 6.3C. Systemic temperature increased during regional hyperthermia up to 38.6C, whereas during interstitial hyperthermia body temperature was not elevated. CONCLUSIONS During interstitial hyperthermia perfusion values are higher than during regional hyperthermia. Hyperthermia causes increased prostate perfusion.
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Affiliation(s)
- Marco van Vulpen
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
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van Vulpen M, Raaymakers BW, de Leeuw AAC, van de Kamer JB, van Moorselaar RJA, Hobbelink MGG, Battermann JJ, Lagendijk JJW. Prostate perfusion in patients with locally advanced prostate carcinoma treated with different hyperthermia techniques. J Urol 2002; 168:1597-602. [PMID: 12352464 DOI: 10.1097/01.ju.0000030155.67888.5b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We determined prostate perfusion in 18 patients with locally advanced prostate carcinoma treated with a combination of external beam irradiation and regional (10) or interstitial (8) hyperthermia. MATERIALS AND METHODS Perfusion values were calculated from temperature elevations due to constant applied power and from transient temperature measurements after a change in applied power. Student's t test was used for comparing perfusion values with time and in the 2 groups. RESULTS At the start of regional hyperthermia treatment mean estimated perfusion plus or minus standard deviation was 10 +/- 8 ml./100 gm. per minute. At the end of treatment mean perfusion was increased to 14 +/- 2 ml./100 gm. per minute (p <0.01). Achieved thermal parameters were a mean temperature of at least 40.3C +/- 0.6C in 90% of the prostate, 40.9C +/- 0.6C in 50% and a mean maximum temperature of 41.6C +/- 0.6C. At the end of interstitial hyperthermia treatment estimated mean perfusion was 47 +/- 5 ml./100 gm. per minute, which was significantly different compared with the end of regional hyperthermia (p < 0(-7) ). Mean temperature was at least 39.4C +/- 0.9C in 90% of the prostate and 41.8C +/- 1.6C in 50%, while mean maximum temperature was 53.1C +/- 6.3C. Systemic temperature increased during regional hyperthermia up to 38.6C, whereas during interstitial hyperthermia body temperature was not elevated. CONCLUSIONS During interstitial hyperthermia perfusion values are higher than during regional hyperthermia. Hyperthermia causes increased prostate perfusion.
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Affiliation(s)
- Marco van Vulpen
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
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