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Schuring D, Westendorp H, van der Bijl E, Bol GH, Crijns W, Delor A, Jourani Y, Ong CL, Penninkhof J, Kierkels R, Verbakel W, van de Water T, van de Kamer JB. The NCS code of practice for the quality assurance of treatment planning systems (NCS-35). Phys Med Biol 2023; 68:205017. [PMID: 37748504 DOI: 10.1088/1361-6560/acfd06] [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: 06/01/2023] [Accepted: 09/25/2023] [Indexed: 09/27/2023]
Abstract
A subcommittee of the Netherlands Commission on Radiation Dosimetry (NCS) was initiated in 2018 with the task to update and extend a previous publication (NCS-15) on the quality assurance of treatment planning systems (TPS) (Bruinviset al2005). The field of treatment planning has changed considerably since 2005. Whereas the focus of the previous report was more on the technical aspects of the TPS, the scope of this report is broader with a focus on a department wide implementation of the TPS. New sections about education, automated planning, information technology (IT) and updates are therefore added. Although the scope is photon therapy, large parts of this report will also apply to all other treatment modalities. This paper is a condensed version of these guidelines; the full version of the report in English is freely available from the NCS website (http://radiationdosimetry.org/ncs/publications). The paper starts with the scope of this report in relation to earlier reports on this subject. Next, general aspects of the commissioning process are addressed, like e.g. project management, education, and safety. It then focusses more on technical aspects such as beam commissioning and patient modeling, dose representation, dose calculation and (automated) plan optimisation. The final chapters deal with IT-related subjects and scripting, and the process of updating or upgrading the TPS.
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Affiliation(s)
- D Schuring
- Radiotherapiegroep, Radiation Oncology department, Arnhem/Deventer, The Netherlands
| | - H Westendorp
- Isala Hospital, Oncology department, Zwolle, The Netherlands
| | - E van der Bijl
- Radboud University Medical Center, Radiation Oncology department, Nijmegen, The Netherlands
| | - G H Bol
- University Medical Center Utrecht, Radiotherapy department, Utrecht, The Netherlands
| | - W Crijns
- KU Leuven-UZ Leuven, Oncology department, Radiation Oncology, Leuven, Belgium
| | - A Delor
- Institut Roi Albert II, Cliniques universitaires Saint-Luc, Radiation Oncology department, Brussels, Belgium
| | - Y Jourani
- Institut Jules Bordet-Université Libre de Bruxelles, Medical Physics department, Brussels, Belgium
| | - C Loon Ong
- Haga Hospital, Radiation Oncology department, The Hague, The Netherlands
| | - J Penninkhof
- Erasmus MC Cancer Institute-University Medical Center Rotterdam, Radiation Oncology department, Rotterdam, The Netherlands
| | - R Kierkels
- Radiotherapiegroep, Radiation Oncology department, Arnhem/Deventer, The Netherlands
| | - W Verbakel
- Amsterdam University Medical Centers-location VUmc, Radiation Oncology Department, Amsterdam, The Netherlands
| | - T van de Water
- Radiotherapeutic Institute Friesland, Leeuwarden, The Netherlands
| | - J B van de Kamer
- The Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
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Güneş AM, van Rooij W, Gulshad S, Slotman B, Dahele M, Verbakel W. Impact of imperfection in medical imaging data on deep learning-based segmentation performance: An experimental study using synthesized data. Med Phys 2023; 50:6421-6432. [PMID: 37118976 DOI: 10.1002/mp.16437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 02/20/2023] [Accepted: 03/12/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Clinical data used to train deep learning models are often not clean data. They can contain imperfections in both the imaging data and the corresponding segmentations. PURPOSE This study investigates the influence of data imperfections on the performance of deep learning models for parotid gland segmentation. This was done in a controlled manner by using synthesized data. The insights this study provides may be used to make deep learning models better and more reliable. METHODS The data were synthesized by using the clinical segmentations, creating a pseudo ground-truth in the process. Three kinds of imperfections were simulated: incorrect segmentations, low image contrast, and artifacts in the imaging data. The severity of each imperfection was varied in five levels. Models resulting from training sets from each of the five levels were cross-evaluated with test sets from each of the five levels. RESULTS Using synthesized data led to almost perfect parotid gland segmentation when no error was added. Lowering the quality of the parotid gland segmentations used for training substantially lowered the model performance. Additionally, lowering the image quality of the training data by decreasing the contrast or introducing artifacts made the resulting models more robust to data containing those respective kinds of data imperfection. CONCLUSION This study demonstrated the importance of good-quality segmentations for deep learning training and it shows that using low-quality imaging data for training can enhance the robustness of the resulting models.
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Affiliation(s)
| | - Ward van Rooij
- Department of Radiation Oncology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sadaf Gulshad
- Faculty of Science, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - Ben Slotman
- Department of Radiation Oncology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Max Dahele
- Department of Radiation Oncology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wilko Verbakel
- Department of Radiation Oncology, Amsterdam UMC, Amsterdam, The Netherlands
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Verbakel W. SP-0372 Only the basics, leave it to the companies. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03962-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mueller M, Poulsen P, Hansen R, Verbakel W, Berbeco R, Ferguson D, Mori S, Ren L, Roeske JC, Wang L, Zhang P, Keall P. The markerless lung target tracking AAPM Grand Challenge (MATCH) results. Med Phys 2022; 49:1161-1180. [PMID: 34913495 PMCID: PMC8828678 DOI: 10.1002/mp.15418] [Citation(s) in RCA: 5] [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: 08/05/2021] [Revised: 11/16/2021] [Accepted: 12/06/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Lung stereotactic ablative body radiotherapy (SABR) is a radiation therapy success story with level 1 evidence demonstrating its efficacy. To provide real-time respiratory motion management for lung SABR, several commercial and preclinical markerless lung target tracking (MLTT) approaches have been developed. However, these approaches have yet to be benchmarked using a common measurement methodology. This knowledge gap motivated the MArkerless lung target Tracking CHallenge (MATCH). The aim was to localize lung targets accurately and precisely in a retrospective in silico study and a prospective experimental study. METHODS MATCH was an American Association of Physicists in Medicine sponsored Grand Challenge. Common materials for the in silico and experimental studies were the experiment setup including an anthropomorphic thorax phantom with two targets within the lungs, and a lung SABR planning protocol. The phantom was moved rigidly with patient-measured lung target motion traces, which also acted as ground truth motion. In the retrospective in silico study a volumetric modulated arc therapy treatment was simulated and a dataset consisting of treatment planning data and intra-treatment kilovoltage (kV) and megavoltage (MV) images for four blinded lung motion traces was provided to the participants. The participants used their MLTT approach to localize the moving target based on the dataset. In the experimental study, the participants received the phantom experiment setup and five patient-measured lung motion traces. The participants used their MLTT approach to localize the moving target during an experimental SABR phantom treatment. The challenge was open to any participant, and participants could complete either one or both parts of the challenge. For both the in silico and experimental studies the MLTT results were analyzed and ranked using the prospectively defined metric of the percentage of the tracked target position being within 2 mm of the ground truth. RESULTS A total of 30 institutions registered and 15 result submissions were received, four for the in silico study and 11 for the experimental study. The participating MLTT approaches were: Accuray CyberKnife (2), Accuray Radixact (2), BrainLab Vero, C-RAD, and preclinical MLTT (5) on a conventional linear accelerator (Varian TrueBeam). For the in silico study the percentage of the 3D tracking error within 2 mm ranged from 50% to 92%. For the experimental study, the percentage of the 3D tracking error within 2 mm ranged from 39% to 96%. CONCLUSIONS A common methodology for measuring the accuracy of MLTT approaches has been developed and used to benchmark preclinical and commercial approaches retrospectively and prospectively. Several MLTT approaches were able to track the target with sub-millimeter accuracy and precision. The study outcome paves the way for broader clinical implementation of MLTT. MATCH is live, with datasets and analysis software being available online at https://www.aapm.org/GrandChallenge/MATCH/ to support future research.
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Affiliation(s)
- Marco Mueller
- Corresponding author; Room 221, ACRF Image X institute, 1 Central Ave, Eveleigh NSW 2015, Australia; +61 2 8627 1106,
| | - Per Poulsen
- Danish Center for Particle Therapy and Department of Oncology, Aarhus University Hospital, Aarhus 8200, Denmark
| | - Rune Hansen
- Department of Medical Physics, Aarhus University Hospital, Aarhus 8200, Denmark
| | - Wilko Verbakel
- Amsterdam University Medical Centers, location VUmc, Amsterdam 1081 HV, Netherlands
| | - Ross Berbeco
- Department of Radiation Oncology, Brigham and Women’s Hospital, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA 02215, USA
| | | | - Shinichiro Mori
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba 263-0024, Japan
| | - Lei Ren
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA
| | - John C. Roeske
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Lei Wang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Pengpeng Zhang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center New York, NY, USA
| | - Paul Keall
- ACRF Image X Institute, The University of Sydney, Sydney, NSW 2015, Australia
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Van De Water S, Dahele M, Slotman B, Verbakel W. FLASH in the Clinic Track (Oral Presentations) FLASH PROTON THERAPY FOR WHOLE BREAST IRRADIATION: EXPLORING MACHINE REQUIREMENTS. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01469-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Remmerts De Vries I, Ronden M, Bahce I, Dahele M, Spoelstra F, De Haan P, Haasbeek C, Lissenberg-Witte B, Slotman B, Verbakel W. P29.04 Treatment Plan Parameters and Toxicity Following Chemoradiotherapy and High-Dose Radiotherapy in Stage III Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.399] [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: 10/20/2022]
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Remmerts de Vries IF, Dahele M, Mostafavi H, Slotman B, Verbakel W. Markerless 3D tumor tracking during single-fraction free-breathing 10MV flattening-filter-free stereotactic lung radiotherapy. Radiother Oncol 2021; 164:6-12. [PMID: 34506828 DOI: 10.1016/j.radonc.2021.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Positional verification during single fraction lung SBRT could increase confidence and reduce the chance of geographic miss. As planar 2DkV imaging during VMAT irradiation is already available on current linear accelerators, markerless tracking based on these images could offer widely available and low-cost verification. We evaluated treatment delivery data and template matching and triangulation for 3D-positional verification during free-breathing, single fraction (34 Gy), 10 MV flattening-filter-free VMAT lung SBRT. METHODS AND MATERIALS Tumor tracking based on kV imaging at 7 frames/second was performed during irradiation in 6 consecutive patients (7 lesions). Tumor characteristics, tracking ability, comparison of tracking displacements with CBCT-based shifts, tumor position relative to the PTV margin, and treatment times are reported. RESULTS For all 7 lesions combined, 3D tumor position could be determined for, on average, 71% (51-84%) of the total irradiation time. Visually estimated tracked and automated match +/- manually-corrected CBCT-derived displacements generally agreed within 1 mm. During the tracked period, the longitudinal, lateral and vertical position of the tumor was within a 5 mm/3 mm PTV margin 95.5/85.3% of the time. The PTV was derived from the ITV including all tumor motion. The total time from first set-up imaging to end of the last arc was 18.3-31.4 min (mean = 23.4, SD = 4.1). CONCLUSION 3D positional verification during irradiation of small lung targets with limited motion, was feasible. However, tumor position could not be determined for on average 29% of the time. Improvements are needed. Margin reduction may be feasible. Imaging and delivery of a single 34 Gy fraction was fast.
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Affiliation(s)
- I F Remmerts de Vries
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands.
| | - Max Dahele
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | - Ben Slotman
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Wilko Verbakel
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
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Mueller M, Poulsen P, Verbakel W, Berbeco R, Ferguson D, Wang L, Ren L, Mori S, Roeske J, Zhang P, Keall P. OC-0357 The MArkerless Lung target Tracking CHallenge (MATCH). Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06872-9] [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: 11/28/2022]
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Remmerts de Vries I, Dahele M, Mostafavi H, Slotman B, Verbakel W. PO-1765 Markerless 3D tumor tracking during single-fraction free-breathing flattening-filter-free lung SBRT. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08216-5] [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: 11/29/2022]
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Jourani Y, Delor A, Crijns W, Bol G, Kierkels R, Ong C, Penninkhof J, van der Bijl E, van de Water T, Verbakel W, Schuring D, Westendorp R, van de Kamer J. PH-0547 Quality assurance of Treatment Planning Systems: upgrading the NCS report 15. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07357-6] [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: 10/20/2022]
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van Marlen P, Dahele M, Folkerts M, Abel E, Slotman BJ, Verbakel W. Ultra-High Dose Rate Transmission Beam Proton Therapy for Conventionally Fractionated Head and Neck Cancer: Treatment Planning and Dose Rate Distributions. Cancers (Basel) 2021; 13:cancers13081859. [PMID: 33924627 PMCID: PMC8070061 DOI: 10.3390/cancers13081859] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/02/2021] [Accepted: 04/11/2021] [Indexed: 12/02/2022] Open
Abstract
Simple Summary Standard intensity-modulated proton therapy (IMPT) places the Bragg-peak in the target. However, it is also possible to use high energy proton transmission beams (TBs), where the Bragg-peak is placed outside the patient, irradiating with the beam section proximal to the Bragg-peak. TBs use only one energy, increase robustness, are insensitive to density changes and have sharper penumbras. TBs can also be delivered at ultra-high dose-rates (UHDRs, e.g., ≥40 Gy/s), which is one of the requirements for the FLASH-effect. The aim of this work was twofold: (1) comparison of TB-plan quality to IMPT and photon volumetric-modulated arc therapy (VMAT) for conventionally fractionated head-and-neck cancer; (2) analysis of TB-plan UHDR-metrics. We showed that TB-plan quality was comparable to IMPT for contoured organs at risk and better than VMAT. Any potential FLASH-effect would only further improve plan quality. TB plans can also be delivered quickly, which might facilitate higher patient through-put and enhance patient comfort. Abstract Transmission beam (TB) proton therapy (PT) uses single, high energy beams with Bragg-peak behind the target, sharp penumbras and simplified planning/delivery. TB facilitates ultra-high dose-rates (UHDRs, e.g., ≥40 Gy/s), which is a requirement for the FLASH-effect. We investigated (1) plan quality for conventionally-fractionated head-and-neck cancer treatment using spot-scanning proton TBs, intensity-modulated PT (IMPT) and photon volumetric-modulated arc therapy (VMAT); (2) UHDR-metrics. VMAT, 3-field IMPT and 10-field TB-plans, delivering 70/54.25 Gy in 35 fractions to boost/elective volumes, were compared (n = 10 patients). To increase spot peak dose-rates (SPDRs), TB-plans were split into three subplans, with varying spot monitor units and different gantry currents. Average TB-plan organs-at-risk (OAR) sparing was comparable to IMPT: mean oral cavity/body dose were 4.1/2.5 Gy higher (9.3/2.0 Gy lower than VMAT); most other OAR mean doses differed by <2 Gy. Average percentage of dose delivered at UHDRs was 46%/12% for split/non-split TB-plans and mean dose-averaged dose-rate 46/21 Gy/s. Average total beam-on irradiation time was 1.9/3.8 s for split/non-split plans and overall time including scanning 8.9/7.6 s. Conventionally-fractionated proton TB-plans achieved comparable OAR-sparing to IMPT and better than VMAT, with total beam-on irradiation times <10s. If a FLASH-effect can be demonstrated at conventional dose/fraction, this would further improve plan quality and TB-protons would be a suitable delivery system.
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Affiliation(s)
- Patricia van Marlen
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, 1118, 1081 HV Amsterdam, The Netherlands; (M.D.); (B.J.S.); (W.V.)
- Correspondence:
| | - Max Dahele
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, 1118, 1081 HV Amsterdam, The Netherlands; (M.D.); (B.J.S.); (W.V.)
| | - Michael Folkerts
- Varian Medical Systems, 3120 Hansen Way, Palo Alto, CA 94304, USA; (M.F.); (E.A.)
| | - Eric Abel
- Varian Medical Systems, 3120 Hansen Way, Palo Alto, CA 94304, USA; (M.F.); (E.A.)
| | - Ben J. Slotman
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, 1118, 1081 HV Amsterdam, The Netherlands; (M.D.); (B.J.S.); (W.V.)
| | - Wilko Verbakel
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, 1118, 1081 HV Amsterdam, The Netherlands; (M.D.); (B.J.S.); (W.V.)
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Ronden M, Bahce I, Hashemi S, Paul M, De Haan P, Becker A, Spoelstra F, Dahele M, Dickhoff C, Tiemessen M, Van Diepen D, Tarasevych S, Looysen E, Van Den Brink KM, Haasbeek N, Daniels J, Van Laren M, Roeleveld R, Alberts B, De Fraiture D, Veltman J, Verbakel W, Senan S. P18.02 Factors Influencing Multi-Disciplinary Tumor Board Recommendations in Stage III Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hansen CR, Crijns W, Hussein M, Rossi L, Gallego P, Verbakel W, Unkelbach J, Thwaites D, Heijmen B. Response to the Letter to the Editor "Application of the RATING score: In regards to Hansen et al.". Radiother Oncol 2021; 158:311. [PMID: 33493499 DOI: 10.1016/j.radonc.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Christian Rønn Hansen
- Laboratory of Radiation Physics, Odense University Hospital, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Institute of Medical Physics, School of Physics, University of Sydney, Australia; Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark
| | - Wouter Crijns
- Department Oncology - Laboratory of Experimental Radiotherapy, KU Leuven, Belgium; Radiation Oncology, UZ Leuven, Belgium
| | - Mohammad Hussein
- Metrology for Medical Physics Centre, National Physical Laboratory, Teddington, UK
| | - Linda Rossi
- Erasmus MC Cancer Institute, Radiation Oncology, Rotterdam, The Netherlands
| | - Pedro Gallego
- Servei de Radiofísica I Radioprotecció, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Jan Unkelbach
- Radiation Oncology Department, University Hospital Zurich, Switzerland
| | - David Thwaites
- Institute of Medical Physics, School of Physics, University of Sydney, Australia
| | - Ben Heijmen
- Erasmus MC Cancer Institute, Radiation Oncology, Rotterdam, The Netherlands
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Van Marlen P, Dahele M, Folkerts M, Abel E, Slotman B, Verbakel W. OC-0580: Bringing FLASH to the clinic: treatment planning considerations for ultrahigh dose-rate proton beams. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00602-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Van Rooij W, Dahele M, Nijhuis H, Slotman B, Verbakel W. OC-0346: Strategies to improve deep learning-based salivary gland segmentation. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00370-4] [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: 10/22/2022]
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Verbakel W. SP-0731: Physics treatment planning and delivery issues for FLASH Radiotherapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00753-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nijhuis H, Van Rooij W, Gregoire V, Overgaard J, Slotman B, Verbakel W, Dahele M. PH-0607: Investigating the potential of deep learning for quality assurance of organ-at-risk contours. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00629-0] [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: 11/17/2022]
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Remmerts De Vries I, Ronden M, De Haan P, Spoelstra F, Haasbeek N, Dahele M, Bahce I, Senan S, Verbakel W. PO-1877: Survival and dosimetric parameters in stage III NSCLC patients undergoing radical chemoradiotherapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01895-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hansen CR, Crijns W, Hussein M, Rossi L, Gallego P, Verbakel W, Unkelbach J, Thwaites D, Heijmen B. Radiotherapy Treatment plannINg study Guidelines (RATING): A framework for setting up and reporting on scientific treatment planning studies. Radiother Oncol 2020; 153:67-78. [PMID: 32976873 DOI: 10.1016/j.radonc.2020.09.033] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/04/2020] [Accepted: 09/11/2020] [Indexed: 12/26/2022]
Abstract
Radiotherapy treatment planning studies contribute significantly to advances and improvements in radiation treatment of cancer patients. They are a pivotal step to support and facilitate the introduction of novel techniques into clinical practice, or as a first step before clinical trials can be carried out. There have been numerous examples published in the literature that demonstrated the feasibility of such techniques as IMRT, VMAT, IMPT, or that compared different treatment methods (e.g. non-coplanar vs coplanar treatment), or investigated planning approaches (e.g. automated planning). However, for a planning study to generate trustworthy new knowledge and give confidence in applying its findings, then its design, execution and reporting all need to meet high scientific standards. This paper provides a 'quality framework' of recommendations and guidelines that can contribute to the quality of planning studies and resulting publications. Throughout the text, questions are posed and, if applicable to a specific study and if met, they can be answered positively in the provided 'RATING' score sheet. A normalised weighted-sum score can then be calculated from the answers as a quality indicator. The score sheet can also be used to suggest how the quality might be improved, e.g. by focussing on questions with high weight, or by encouraging consideration of aspects given insufficient attention. Whilst the overall aim of this framework and scoring system is to improve the scientific quality of treatment planning studies and papers, it might also be used by reviewers and journal editors to help to evaluate scientific manuscripts reporting planning studies.
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Affiliation(s)
- Christian Rønn Hansen
- Laboratory of Radiation Physics, Odense University Hospital, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Institute of Medical Physics, School of Physics, University of Sydney, Sydney, Australia; Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark.
| | - Wouter Crijns
- Department Oncology - Laboratory of Experimental Radiotherapy, KU Leuven, Belgium; Radiation Oncology, UZ Leuven, Belgium
| | - Mohammad Hussein
- Metrology for Medical Physics Centre, National Physical Laboratory, Teddington, UK
| | - Linda Rossi
- Erasmus MC Cancer Institute, Radiation Oncology, Rotterdam, The Netherlands
| | - Pedro Gallego
- Servei de Radiofísica I Radioprotecció, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Jan Unkelbach
- Radiation Oncology Department, University Hospital Zurich, Switzerland
| | - David Thwaites
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, Australia
| | - Ben Heijmen
- Erasmus MC Cancer Institute, Radiation Oncology, Rotterdam, The Netherlands
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de Jong EEC, Guckenberger M, Andratschke N, Dieckmann K, Hoogeman MS, Milder M, Møller DS, Nyeng TB, Tanadini-Lang S, Lartigau E, Lacornerie T, Senan S, Verbakel W, Verellen D, De Kerf G, Hurkmans C. Variation in current prescription practice of stereotactic body radiotherapy for peripherally located early stage non-small cell lung cancer: Recommendations for prescribing and recording according to the ACROP guideline and ICRU report 91. Radiother Oncol 2020; 142:217-223. [PMID: 31767472 DOI: 10.1016/j.radonc.2019.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 05/13/2019] [Revised: 10/30/2019] [Accepted: 11/02/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE In 2017 the ACROP guideline on SBRT for peripherally located early stage NSCLC was published. Later that year ICRU-91 about prescribing, recording and reporting was published. The purpose of this study is to quantify the current variation in prescription practice in the institutions that contributed to the ACROP guideline and to establish the link between the ACROP and ICRU-91 recommendations. MATERIAL AND METHODS From each of the eight participating centres, 15 SBRT plans for stage I NSCLC were analyzed. Plans were generated following the institutional protocol, centres prescribed 3 × 13.5 Gy, 3 × 15 Gy, 3 × 17 Gy or 3 × 18 Gy. Dose parameters of the target volumes were reported as recommended by ICRU-91 and also converted to BED10Gy. RESULTS The intra-institutional variance in D98%, Dmean and D2% of the PTV and GTV/ITV is substantially smaller than the inter-institutional spread, indicating well protocollised planning procedures are followed. The median values per centre ranged from 56.1 Gy to 73.1 Gy (D2%), 50.4 Gy to 63.3 Gy (Dmean) and 40.5 Gy to 53.6 Gy (D98%) for the PTV and from 57.1 Gy to 73.6 Gy (D2%), 53.7 Gy to 68.7 Gy (Dmean) and 48.5 Gy to 62.3 Gy (D98%) for the GTV/ITV. Comparing the variance in PTV D98% with the variance in GTV Dmean per centre, using an F-test, shows that four centres have a larger variance in GTV Dmean, while one centre has a larger variance in PTV D98% (p values <0.01). This shows some centres focus on achieving a constant PTV coverage while others aim at a constant GTV coverage. CONCLUSION More detailed recommendations for dose planning and reporting of lung SBRT in line with ICRU-91 were formulated, including a minimum PTV D98% of 100 Gy BED10Gy and minimum GTV/ITV mean dose of 150 Gy BED10Gy and a D2% in the range of 60-70 Gy.
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Affiliation(s)
| | | | | | | | | | - Maaike Milder
- Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | | | | | | | | | | | - Suresh Senan
- Amsterdam University Medical Center, the Netherlands.
| | | | - Dirk Verellen
- Iridium Kankernetwerk, Antwerp University, Antwerp, Belgium.
| | - Geert De Kerf
- Iridium Kankernetwerk, Antwerp University, Antwerp, Belgium.
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Van Rooij W, Ribeiro Brandao H, Delaney A, Slotman B, Verbakel W, Dahele M. PO-1010 Clinical evaluation of deep learning delineation of head and neck OARs. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31430-6] [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: 11/24/2022]
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De Jong E, Guckenberger M, Andratschke N, Dieckmann K, Hoogeman M, Milder M, Moller DS, Nyeng TB, Tanadini-Lang S, Lartigau E, Lacornerie T, Romero AM, Verbakel W, Verellen D, De Kerf G, Hurkmans C. PV-103 Linking ACROP guidelines to ICRU91: a multicentre study in lung SBRT on prescription and reporting. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30523-7] [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: 10/26/2022]
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Dubouloz A, Rouzaud M, Tsvang L, Verbakel W, Björkqvist M, Linthout N, Lencart J, Pérez-Moreno JM, Ozen Z, Escude L, Zilli T, Miralbell R. Urethra-sparing stereotactic body radiotherapy for prostate cancer: how much can the rectal wall dose be reduced with or without an endorectal balloon? Radiat Oncol 2018; 13:114. [PMID: 29921291 PMCID: PMC6008922 DOI: 10.1186/s13014-018-1059-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 02/07/2018] [Accepted: 06/13/2018] [Indexed: 11/20/2022] Open
Abstract
Background This is a dosimetric comparative study intended to establish appropriate low-to-intermediate dose-constraints for the rectal wall (Rwall) in the context of a randomized phase-II trial on urethra-sparing stereotactic body radiotherapy (SBRT) for prostate cancer. The effect of plan optimization on low-to-intermediate Rwall dose and the potential benefit of an endorectal balloon (ERB) are investigated. Methods Ten prostate cancer patients, simulated with and without an ERB, were planned to receive 36.25Gy (7.25Gyx5) to the planning treatment volume (PTV) and 32.5Gy to the urethral planning risk volume (uPRV). Reference plans with and without the ERB, optimized with respect to PTV and uPRV coverage objectives and the organs at risk dose constraints, were further optimized using a standardized stepwise approach to push down dose constraints to the Rwall in the low to intermediate range in five sequential steps to obtain paired plans with and without ERB (Vm1 to Vm5). Homogeneity index for the PTV and the uPRV, and the Dice similarity coefficient (DSC) for the PTV were analyzed. Dosimetric parameters for Rwall including the median dose and the dose received by 10 to 60% of the Rwall, bladder wall (Bwall) and femoral heads (FHeads) were compared. The monitor units (MU) per plan were recorded. Results Vm4 reduced by half D30%, D40%, D50%, and Dmed for Rwall and decreased by a third D60% while HIPTV, HIuPRV and DSC remained stable with and without ERB compared to Vmref. HIPTV worsened at Vm5 both with and without ERB. No statistical differences were observed between paired plans on Rwall, Bwall except a higher D2% for Fheads with and without an ERB. Conclusions Further optimization to the Rwall in the context of urethra sparing prostate SBRT is feasible without compromising the dose homogeneity to the target. Independent of the use or not of an ERB, low-to-intermediate doses to the Rwall can be significantly reduced using a four-step sequential optimization approach.
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Affiliation(s)
- Angèle Dubouloz
- Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland. .,Radiation Oncology Department, Geneva University Hospital, CH-1211, 14, Geneva, Switzerland.
| | - Michel Rouzaud
- Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Lev Tsvang
- Department of Radiation Oncology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat Gan, Israel
| | - Wilko Verbakel
- Department of Radiation Oncology, VU medical center, De Boelelaan 1117, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Mikko Björkqvist
- Department of Oncology and Radiotherapy, Turku University Hospital, PO Box 52, 20521, Turku, Finland.,Department of Medical Physics, Turku University Hospital, PO Box 52, 20521, Turku, Finland
| | - Nadine Linthout
- Onze-Lieve-Vrouw Ziekenhuis, Moorselbaan 164, 9300, Aalst, Belgium
| | - Joana Lencart
- Serviço de Radioterapia Externa, Instituto Portugues de Oncologia, Rua Dr Antonio Bernardino de Almeida, 4200-072, Porto, Portugal
| | - Juan María Pérez-Moreno
- Servicio de Oncología Radioterápica, Centro Integral Oncológico "Clara Campal", Hospital Universitario Madrid Sanchinarro, C/ Oña 10, 28050, Madrid, Spain
| | - Zeynep Ozen
- Neolife Medical Center, Nisbetiye Mah. Yucel Sokak, No: 6 Besiktas, 34340, Istanbul, Turkey
| | - Lluís Escude
- Servei de Radiooncologia, Institut Oncològic Teknon, C/ Vilana 12, 08022, Barcelona, Spain
| | - Thomas Zilli
- Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Raymond Miralbell
- Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland.,Servei de Radiooncologia, Institut Oncològic Teknon, C/ Vilana 12, 08022, Barcelona, Spain
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Hazelaar C, Dahele M, Mostafavi H, van der Weide L, Slotman B, Verbakel W. Markerless positional verification using template matching and triangulation of kV images acquired during irradiation for lung tumors treated in breath-hold. ACTA ACUST UNITED AC 2018; 63:115005. [DOI: 10.1088/1361-6560/aac1a9] [Citation(s) in RCA: 20] [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] [Indexed: 12/25/2022]
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Delaney A, Dong L, Mascia A, Zou W, Zhang Y, Yin L, Hrbacek J, Lomax A, Slotman B, Dahele M, Verbakel W. OC-0304: Using a single knowledge-based proton planning model to create automated plans for different centers. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30614-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Delaney A, Dahele M, Slotman B, Verbakel W. EP-1963: Is accurate contouring necessary for salivary and swallowing structure-sparing radiotherapy? Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32272-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Tol J, Dahele M, Gregoire V, Overgaard J, Slotman B, Verbakel W. OC-0609: Patient specific plan QA for clinical trial EORTC 1219 using Knowledge-Based Planning. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30919-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Duijm M, Tekatli H, Oomen-de Hoop E, Verbakel W, Schillemans W, Slotman B, Senan S, Nuyttens J. PV-0038: Esophagus toxicity after stereotactic radiotherapy of central lung tumor: NTCP modelling. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30348-7] [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: 11/26/2022]
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Tekatli H, Duijm M, Oomen-de Hoop E, Verbakel W, Schillemans W, Slotman B, Nuyttens J, Senan S. PO-0746: NTCP modelling of pulmonary toxicity after stereotactic radiotherapy for central lung tumors. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31056-9] [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: 11/30/2022]
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Tekatli H, Duijm M, Oomen-de Hoop E, Verbakel W, Schillemans W, Slotman BJ, Nuyttens JJ, Senan S. Normal Tissue Complication Probability Modeling of Pulmonary Toxicity After Stereotactic and Hypofractionated Radiation Therapy for Central Lung Tumors. Int J Radiat Oncol Biol Phys 2017; 100:738-747. [PMID: 29413285 DOI: 10.1016/j.ijrobp.2017.11.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 10/23/2017] [Accepted: 11/13/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate clinical pulmonary and radiographic bronchial toxicity after stereotactic ablative radiation therapy and hypofractionated radiation therapy for central lung tumors, and perform normal tissue complication probability modeling and multivariable analyses to identify predictors for toxicity. METHODS AND MATERIALS A pooled analysis was performed of patients with a central lung tumor treated using ≤12 fractions at 2 centers between 2006 and 2015. Airways were manually contoured on planning computed tomography scans, and doses were recalculated to an equivalent dose of 2 Gy per fraction with an α/β ratio of 3. Grade ≥3 (≥G3) clinical pulmonary toxicity was evaluated by 2 or more physicians. Radiographic toxicity was defined as a stenosis or an occlusion with or without atelectasis using follow-up computed tomography scans. Logistic regression analyses were used for statistical analyses. RESULTS A total of 585 bronchial structures were studied in 195 patients who were mainly treated using 5 or 8 fractions (60%). Median patient survival was 27.9 months (95% confidence interval 22.3-33.6 months). Clinical ≥G3 toxicity was observed in 24 patients (12%) and radiographic bronchial toxicity in 55 patients (28%), both mainly manifesting ≤12 months after treatment. All analyzed dosimetric parameters correlated with clinical and lobar bronchial radiographic toxicity, with V130Gy,EQD having the highest odds ratio. Normal tissue complication probability modeling showed a volume dependency for the development of both clinical and radiographic toxicity. On multivariate analyses, significant predictors for ≥G3 toxicity were a planning target volume overlapping the trachea or main stem bronchus (P = .005), chronic obstructive pulmonary disease (P = .034), and the total V130Gy,EQD (P = .012). Radiographic bronchial toxicity did not significantly correlate with clinical toxicity (P = .663). CONCLUSIONS We identified patient and dosimetric factors associated with clinical and radiographic toxicity after high-dose radiation therapy for central lung tumors. Additional data from prospective studies are needed to validate these findings.
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Affiliation(s)
- H Tekatli
- Department of Radiation Oncology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
| | - M Duijm
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - E Oomen-de Hoop
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - W Verbakel
- Department of Radiation Oncology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - W Schillemans
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - B J Slotman
- Department of Radiation Oncology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - J J Nuyttens
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - S Senan
- Department of Radiation Oncology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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Sahgal A, Ruschin M, Ma L, Verbakel W, Larson D, Brown PD. Stereotactic radiosurgery alone for multiple brain metastases? A review of clinical and technical issues. Neuro Oncol 2017; 19:ii2-ii15. [PMID: 28380635 DOI: 10.1093/neuonc/nox001] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Over the past three decades several randomized trials have enabled evidence-based practice for patients presenting with limited brain metastases. These trials have focused on the role of surgery or stereotactic radiosurgery (SRS) with or without whole brain radiation therapy (WBRT). As a result, it is clear that local control should be optimized with surgery or SRS in patients with optimal prognostic factors presenting with up to 4 brain metastases. The routine use of adjuvant WBRT remains debatable, as although greater distant brain control rates are observed, there is no impact on survival, and modern outcomes suggest adverse effects from WBRT on patient cognition and quality of life. With dramatic technologic advances in radiation oncology facilitating the adoption of SRS into mainstream practice, the optimal management of patients with multiple brain metastases is now being put forward. Practice is evolving to SRS alone in these patients despite a lack of level 1 evidence to support a clinical departure from WBRT. The purpose of this review is to summarize the current state of the evidence for patients presenting with limited and multiple metastases, and to present an in-depth analysis of the technology and dosimetric issues specific to the treatment of multiple metastases.
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Affiliation(s)
- Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mark Ruschin
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Lijun Ma
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Wilko Verbakel
- Department of Radiation Oncology, VU University Medical Center, Amsterdam,The Netherlands
| | - David Larson
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
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Hazelaar C, Dahele M, Slotman B, Verbakel W. OC-0300: Proof of tumor position during SBRT delivery using (limited-arc) CBCT imaging. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30742-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kuijper I, Dahele M, Delaney A, Slotman B, Verbakel W. EP-1832: Selecting head and neck cancer patients for proton therapy: the influence of dosimetric thresholds. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)32267-3] [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: 11/25/2022]
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Dahele M, Slotman B, Verbakel W. Stereotactic body radiotherapy for spine and bony pelvis using flattening filter free volumetric modulated arc therapy, 6D cone-beam CT and simple positioning techniques: Treatment time and patient stability. Acta Oncol 2016; 55:795-8. [PMID: 27029341 DOI: 10.3109/0284186x.2015.1119885] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Max Dahele
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Ben Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Wilko Verbakel
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
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Tol J, Doornaert P, Dahele M, Slotman B, Verbakel W. PO-0843: Dosimetric evaluation of 10 years of treatment planning improvements in head and neck cancer. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32093-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hazelaar C, Dahele M, Slotman B, Verbakel W. OC-0213: Towards on-line sub-mm and sub-second positional verification during stereotactic spine radiotherapy. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31462-1] [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: 11/16/2022]
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Verbakel W, Raaijmakers C, Bos L, Essers M, Terhaard C, Kaanders J, Doornaert P. PO-0943: Dutch national head and neck plan comparison significantly improved treatment planning quality. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32193-4] [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: 10/21/2022]
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Delaney A, Tol J, Dahele M, Cuijpers J, Slotman B, Verbakel W. PO-0838: Impact of dosimetric outliers on the performance of a knowledge-based planning system. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32088-6] [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: 11/28/2022]
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Tekatli H, Senan S, Dahele M, Slotman B, Verbakel W. PO-0691: SABR for central lung tumors: plan quality and long-term clinical outcomes. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31941-7] [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: 10/21/2022]
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Tekatli H, Tetar S, Warner A, Palma D, Verbakel W, Nguyen T, Spoelstra F, Gaede S, Slotman B, Senan S. 197PD: Identifying dosimetric predictors of toxicity in multiple lung tumors treated with stereotactic ablative radiotherapy (SABR). J Thorac Oncol 2016. [DOI: 10.1016/s1556-0864(16)30306-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tekatli H, Haasbeek N, Dahele M, De Haan P, Verbakel W, Bongers E, Hashemi S, Nossent E, Spoelstra F, de Langen AJ, Slotman B, Senan S. Outcomes of Hypofractionated High-Dose Radiotherapy in Poor-Risk Patients with "Ultracentral" Non-Small Cell Lung Cancer. J Thorac Oncol 2016; 11:1081-9. [PMID: 27013408 DOI: 10.1016/j.jtho.2016.03.008] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/11/2016] [Accepted: 03/12/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION We defined "ultracentral" lung tumors as centrally located non-small cell lung cancers with planning target volumes overlapping the trachea or main bronchi. Increased toxicity has been reported after both conventional and stereotactic radiotherapy for such lesions. We studied outcomes after 12 fractions of 5 Gy (BED10 = 90 Gy, heterogeneous dose distribution) to ultracentral tumors in patients unfit for surgery or conventional chemoradiotherapy. METHODS Clinical outcomes and dosimetric details were analyzed in 47 consecutive patients with single primary or recurrent ultracentral non-small cell lung cancer treated between 2010 and 2015. Those irradiated previously or with metastasis to sites other than the brain and adrenal glands were excluded. Treatments were delivered using volumetric modulated arc therapy. RESULTS The median age was 77.5 years, 49% of patients had a World Health Organization performance score of 2 or higher, and the median planning target volume was 104.5cm(3) (range 17.7-508.5). At a median follow-up of 29.3 months, median overall survival was 15.9 months, and 3-year survival was 20.1%. No isolated local recurrences were observed. Grade 3 or higher toxicity was recorded in 38% of patients, with 21% scored as having a "possible" (n = 2) or "likely" (n = 8) treatment-related death between 5.2 and 18.2 months after treatment. Fatal pulmonary hemorrhage was observed in 15% of patients. CONCLUSIONS Unfit patients with ultracentral tumors who were treated using this scheme had a high local control and a median survival of 15.9 months. Despite manifestation of rates of a fatal lung bleeding comparable to those seen with conventional radiotherapy for endobronchial tumors, the overall rate of G5 toxicity is of potential concern. Additional work is needed to identify tumor and treatment factors related to hemorrhage.
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Affiliation(s)
- Hilâl Tekatli
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Niels Haasbeek
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Max Dahele
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Patricia De Haan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Wilko Verbakel
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Eva Bongers
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Sayed Hashemi
- Department of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
| | - Esther Nossent
- Department of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
| | - Femke Spoelstra
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Adrianus J de Langen
- Department of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
| | - Ben Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
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Matuszak M, Moran J, Xiao Y, Mayo C, Bosch W, Popple R, Marks L, Wu Q, Molineu A, Miller R, Yock T, McNutt T, Brown N, Purdie T, Yorke E, Santanam L, Gabriel P, Michalski J, Moore J, Richardson S, Siochi R, Napalitano M, Ulin K, Fitzgerald T, Feng M, Verbakel W, Siddiqui S, Morgas T, Martel M, Archambault Y, Ladra M, Lansing B, Ruo R, Fogliata-Cozzi A, Hurkmans C. SU-E-P-22: AAPM Task Group 263 Tackling Standardization of Nomenclature for Radiation Therapy. Med Phys 2015. [DOI: 10.1118/1.4923956] [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] [Indexed: 11/07/2022] Open
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44
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Dubouloz A, Tsvang L, Verbakel W, Björkqvist M, Linthout N, Linero D, Rouzaud M, Lencart J, Pérez-Moreno J, Ozen Z, Escude L. EP-1453: Urethra-sparing prostatic SBRT: extreme dosimetric optimization on rectal wall using an endorectal balloon. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41445-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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45
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van Sornsen de Koste J, Dahele M, Senan S, Slotman B, Verbakel W. Markerless Tracking of Lung Tumors on Continuous kV Images. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2416] [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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46
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Blom G, Verbakel W, Dahele M, Slotman B, Senan S. VMAT Planning for Large Volume Stage III Lung Cancer. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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47
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Kool L, Bruggeman A, Van Hofwegen F, Jeulink M, Verbakel W. PD-0312: Flattening Filter Free for head and neck and prostate irradiation. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30417-5] [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: 11/26/2022]
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Mayo C, Verbakel W, Wu Q, Xiao Y, Ge Y. TH-C-500-01: Collaborative Knowledge Modeling and Integration for Radiation Therapy Planning. Med Phys 2013. [DOI: 10.1118/1.4815757] [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: 11/07/2022] Open
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49
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Bakri B, Verbakel W, Slotman B, Dahele M. Cone-beam computed tomography imaging in stereotactic body radiotherapy allows for more than target localization. J Radiosurg SBRT 2013; 2:141-145. [PMID: 29296353 PMCID: PMC5658886] [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] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 10/17/2012] [Indexed: 06/07/2023]
Abstract
Image-guidance plays a crucial role in positioning the target during stereotactic body radiotherapy (SBRT). Despite current limitations, on-line kilo-voltage cone-beam computed tomography (CBCT) also has the potential to identify changes in target volume geometry and the location of important organs at risk. These capabilities could be enhanced by further technical improvements in CBCT, including image quality.
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Affiliation(s)
- Bonnie Bakri
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Wilko Verbakel
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
| | - Ben Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Max Dahele
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
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Dahele M, Verbakel W, Cuijpers J, Slotman B, Senan S. An analysis of patient positioning during stereotactic lung radiotherapy performed without rigid external immobilization. Radiother Oncol 2012; 104:28-32. [DOI: 10.1016/j.radonc.2012.03.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 03/25/2012] [Accepted: 03/26/2012] [Indexed: 12/31/2022]
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