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Jung H, Yoon J, Dona Lemus O, Tanny S, Zhou Y, Milano M, Usuki K, Hardy S, Zheng D. Dosimetric evaluation of LINAC-based single-isocenter multi-target multi-fraction stereotactic radiosurgery with more than 20 targets: comparing MME, HyperArc, and RapidArc. Radiat Oncol 2024; 19:19. [PMID: 38326813 PMCID: PMC10848506 DOI: 10.1186/s13014-024-02416-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/31/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND To compare the dosimetric quality of three widely used techniques for LINAC-based single-isocenter multi-target multi-fraction stereotactic radiosurgery (fSRS) with more than 20 targets: dynamic conformal arc (DCA) in BrainLAB Multiple Metastases Elements (MME) module and volumetric modulated arc therapy (VMAT) using RapidArc (RA) and HyperArc (HA) in Varian Eclipse. METHODS Ten patients who received single-isocenter fSRS with 20-37 targets were retrospectively replanned using MME, RA, and HA. Various dosimetric parameters, such as conformity index (CI), Paddick CI, gradient index (GI), normal brain dose exposures, maximum organ-at-risk (OAR) doses, and beam-on times were extracted and compared among the three techniques. Wilcoxon signed-rank test was used for statistical analysis. RESULTS All plans achieved the prescribed dose coverage goal of at least 95% of the planning target volume (PTV). HA plans showed superior conformity compared to RA and MME plans. MME plans showed superior GI compared to RA and HA plans. RA plans resulted in significantly higher low and intermediate dose exposure to normal brain compared to HA and MME plans, especially for lower doses of ≥ 8Gy and ≥ 5Gy. No significant differences were observed in the maximum dose to OARs among the three techniques. The beam-on time of MME plans was about two times longer than RA and HA plans. CONCLUSIONS HA plans achieved the best conformity, while MME plans achieved the best dose fall-off for LINAC-based single-isocenter multi-target multi-fraction SRS with more than 20 targets. The choice of the optimal technique should consider the trade-offs between dosimetric quality, beam-on time, and planning effort.
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Affiliation(s)
- Hyunuk Jung
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA.
| | - Jihyung Yoon
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA
| | - Olga Dona Lemus
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA
| | - Sean Tanny
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA
| | - Yuwei Zhou
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA
| | - Michael Milano
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA
| | - Kenneth Usuki
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA
| | - Sara Hardy
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA
| | - Dandan Zheng
- Department of Radiation Oncology, University of Rochester, Rochester, NY, USA
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Garrett MD, Li F, Lemus OD, Lavrova E, Savacool M, Price MJ, Kachnic LA, Horowitz DP, Chin C. Impact of Adapted Radiotherapy Schedules on Bowel Sparing in Node-Positive Cervical Cancer. Pract Radiat Oncol 2023; 13:e184-e191. [PMID: 36539155 DOI: 10.1016/j.prro.2022.11.012] [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: 08/08/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Definitive radiation therapy (RT) for locally advanced node-positive cervical cancer confers significant toxicity to pelvic organs including the small bowel. Gross nodal disease exhibits significant shrinkage during RT, and yet conventional RT does not account for this change. We evaluated the reduction in absorbed bowel dose using various adaptive RT schedules. METHODS AND MATERIALS We obtained 130 evaluable scans (computed tomography simulation and 25 cone beam computed tomography scans per patient) of 5 patients who had received definitive external beam RT for lymph node positive cervical cancer daily over 5 weeks. Using a single universal volumetric modulated arc therapy plan with predefined optimization priorities, we created adapted RT plans in 4 schedules: Daily, Weekly, Twice, and NoAdapt (mimicking conventional nonadapted RT). The in silico (computer modeled) patients were treated to 45 Gy to primary cervical disease with a simultaneous integrated boost to 55 Gy to involved lymph nodes. We evaluated dose metrics including D2cc, D15cc, and V45 to determine the impact of adapted RT schedules on bowel sparing. Statistical tests included the Student t test, analysis of variance, and the Spearman rank correlation. RESULTS The quantity of reduced bowel dose was significantly associated with the chosen planning schedule in all evaluated metrics and was proportional to the frequency of adaptive RT with significant moderate-to-strong monotonicity. Both D2cc and D15cc were reduced an average of 2.7 Gy using daily replanning compared with a nonadapted approach. A minimally adapted strategy of only 2 replans also confers a significant dosimetric benefit over a nonadapted approach. Reduced standard deviations of D2cc and V45 bowel doses over the treatment courses were significantly associated with the choice of planning schedule with strong monotonicity. CONCLUSIONS All adaptive RT schedules evaluated confer significant dosimetric advantages in bowel sparing over a conventional nonadapted technique, with greater sparing seen with more frequent replanning schedules. These findings warrant future trials of adaptive RT for pelvic malignancies.
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Affiliation(s)
- Matthew D Garrett
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Fiona Li
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Olga Dona Lemus
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Elizaveta Lavrova
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Michelle Savacool
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Michael J Price
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Lisa A Kachnic
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - David P Horowitz
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Christine Chin
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York.
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Royba E, Repin M, Balajee AS, Shuryak I, Pampou S, Karan C, Wang YF, Lemus OD, Obaid R, Deoli N, Wuu CS, Brenner DJ, Garty G. Validation of a High-Throughput Dicentric Chromosome Assay Using Complex Radiation Exposures. Radiat Res 2023; 199:1-16. [PMID: 35994701 PMCID: PMC9947868 DOI: 10.1667/rade-22-00007.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 10/24/2022] [Indexed: 01/12/2023]
Abstract
Validation of biodosimetry assays is routinely performed using primarily orthovoltage irradiators at a conventional dose rate of approximately 1 Gy/min. However, incidental/ accidental exposures caused by nuclear weapons can be more complex. The aim of this work was to simulate the DNA damage effects mimicking those caused by the detonation of a several kilotons improvised nuclear device (IND). For this, we modeled complex exposures to: 1. a mixed (photons + IND-neutrons) field and 2. different dose rates that may come from the blast, nuclear fallout, or ground deposition of radionuclides (ground shine). Additionally, we assessed whether myeloid cytokines affect the precision of radiation dose estimation by modulating the frequency of dicentric chromosomes. To mimic different exposure scenarios, several irradiation systems were used. In a mixed field study, human blood samples were exposed to a photon field enriched with neutrons (ranging from 10% to 37%) from a source that mimics Hiroshima's A-bomb's energy spectrum (0.2-9 MeV). Using statistical analysis, we assessed whether photons and neutrons act in an additive or synergistic way to form dicentrics. For the dose rates study, human blood was exposed to photons or electrons at dose rates ranging from low (where the dose was spread over 32 h) to extremely high (where the dose was delivered in a fraction of a microsecond). Potential effects of cytokine treatment on biodosimetry dose predictions were analyzed in irradiated blood subjected to Neupogen or Neulasta for 24 or 48 h at the concentration recommended to forestall manifestation of an acute radiation syndrome in bomb survivors. All measurements were performed using a robotic station, the Rapid Automated Biodosimetry Tool II, programmed to culture lymphocytes and score dicentrics in multiwell plates (the RABiT-II DCA). In agreement with classical concepts of radiation biology, the RABiT-II DCA calibration curves suggested that the frequency of dicentrics depends on the type of radiation and is modulated by changes in the dose rate. The resulting dose-response curves suggested an intermediate dicentric yields and additive effects of photons and IND-neutrons in the mixed field. At ultra-high dose rate (600 Gy/s), affected lymphocytes exhibited significantly fewer dicentrics (P < 0.004, t test). In contrast, we did not find the dose-response modification effects of radiomitigators on the yields of dicentrics (Bonferroni corrected P > 0.006, ANOVA test). This result suggests no bias in the dose predictions should be expected after emergency cytokine treatment initiated up to 48 h prior to blood collection for dicentric analysis.
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Affiliation(s)
- Ekaterina Royba
- Center for Radiological Research, Columbia University Irving Medical Center, New York, New York
| | - Mikhail Repin
- Center for Radiological Research, Columbia University Irving Medical Center, New York, New York
| | - Adayabalam S. Balajee
- Radiation Emergency Assistance Center/Training Site (REAC/TS), Cytogenetic Biodosimetry Laboratory (CBL), Oak Ridge Institute for Science and Education, Oak Ridge Associated Universities, Oak Ridge, Tennessee
| | - Igor Shuryak
- Center for Radiological Research, Columbia University Irving Medical Center, New York, New York
| | - Sergey Pampou
- Columbia Genome Center High-Throughput Screening facility, Columbia University Irving Medical Center, New York, New York
| | - Charles Karan
- Columbia Genome Center High-Throughput Screening facility, Columbia University Irving Medical Center, New York, New York
| | - Yi-Fang Wang
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Olga Dona Lemus
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Razib Obaid
- Radiological Research Accelerator facility, Columbia University Irving Medical Center, Irvington, New York
- Currently at Stanford Linear Accelerator Center National Accelerator Laboratory, Menlo Park, California
| | - Naresh Deoli
- Radiological Research Accelerator facility, Columbia University Irving Medical Center, Irvington, New York
| | - Cheng-Shie Wuu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - David J. Brenner
- Center for Radiological Research, Columbia University Irving Medical Center, New York, New York
| | - Guy Garty
- Center for Radiological Research, Columbia University Irving Medical Center, New York, New York
- Radiological Research Accelerator facility, Columbia University Irving Medical Center, Irvington, New York
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Xu AY, Wang YF, Wang TJC, Cheng SK, Elliston CD, Savacool MK, Dona Lemus O, Sisti MB, Wuu CS. Performance of the cone beam computed tomography-based patient positioning system on the Gamma Knife Icon™. Med Phys 2019; 46:4333-4339. [PMID: 31359438 DOI: 10.1002/mp.13740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/17/2019] [Accepted: 07/20/2019] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Cone beam computed tomography (CBCT) imaging has been implemented on the Leksell Gamma Knife® Icon™ for assessing patient positioning in mask-based Gamma Knife radiosurgery. The purpose of this study was to evaluate the performance of the CBCT-based patient positioning system as a tool for frameless Gamma Knife radiosurgery. METHODS Daily quality assurance (QA) CBCT precision test results from a 12-month period were analyzed for the geometric accuracy and the stability of the imager. The performance of the image acquisition module and the image registration algorithm was evaluated using an anthropomorphic head phantom (CIRS Inc., Norfolk, VA) and a XYZR axis manual positioning stage (TOAUTO Inc., Guangdong, China). The head phantom was fixed on a mask adaptor and manually translated in the X, Y, Z directions or rotated around the X, Y, Z axes in the range of ±10 mm or ±10º. A CBCT scan was performed after each manual position setup followed by an image registration to the reference scan. To assess the overall setup uncertainties in fractionated treatment, two cylindrical Presage phantoms (Heuris Inc., Skillman, NJ) of 15 cm diameter and 10 cm height were irradiated with identical prescription dose and shot placement following standard mask-based treatment workflow according to two different fraction schedules: a single fraction treatment of 7.5 Gy and a 5-fraction treatment with 1.5 Gy per fraction. RESULTS The averaged vector deviations of the four marks from their preset values are 0.087, 0.085, 0.095, and 0.079 mm from the 212 daily QA tests. The averaged displacements in the X, Y, Z coordinates and the pitch, yaw, roll angles from the image registration tests are 0.23, 0.27, 0.14, 0.32º, 0.19º, 0.31º from the manual setup. The corresponding maximum differences are 0.41, 0.33, 0.29 mm, 0.45º, 0.31º, and 0.43º, respectively. Compared to the treatment plan using the 2% & 1 mm criteria, the averaged 2D Gamma passing rate is 98.25% for the measured dose distribution from the Presage phantom with 1-fraction irradiation and 95.12% for the 5-fraction irradiation. The averaged Gamma passing rates are 99.53% and 98.16% for the 1-fraction and 5-fraction irradiations using the 2% & 2 mm criteria. CONCLUSIONS The CBCT imager and the image registration algorithm can reproduce phantom position with <0.5 mm/0.5º uncertainty. A systematic contribution from the interfraction phantom repositioning procedure was observed in the Gamma analysis over the irradiated volumes of two end-to-end test phantoms.
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Affiliation(s)
- Andy Y Xu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, USA
| | - Yi-Fang Wang
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, USA
| | - Tony J C Wang
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, USA
| | - Simon K Cheng
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, USA
| | - Carl D Elliston
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, USA
| | - Michelle K Savacool
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, USA
| | - Olga Dona Lemus
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael B Sisti
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Cheng-Shie Wuu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, USA
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