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Wheeler PA, West NS, Powis R, Maggs R, Chu M, Pearson RA, Willis N, Kurec B, Reed KL, Lewis DG, Staffurth J, Spezi E, Millin AE. Multi-institutional evaluation of a Pareto navigation guided automated radiotherapy planning solution for prostate cancer. Radiat Oncol 2024; 19:45. [PMID: 38589961 PMCID: PMC11003074 DOI: 10.1186/s13014-024-02404-x] [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: 12/06/2022] [Accepted: 01/15/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Current automated planning solutions are calibrated using trial and error or machine learning on historical datasets. Neither method allows for the intuitive exploration of differing trade-off options during calibration, which may aid in ensuring automated solutions align with clinical preference. Pareto navigation provides this functionality and offers a potential calibration alternative. The purpose of this study was to validate an automated radiotherapy planning solution with a novel multi-dimensional Pareto navigation calibration interface across two external institutions for prostate cancer. METHODS The implemented 'Pareto Guided Automated Planning' (PGAP) methodology was developed in RayStation using scripting and consisted of a Pareto navigation calibration interface built upon a 'Protocol Based Automatic Iterative Optimisation' planning framework. 30 previous patients were randomly selected by each institution (IA and IB), 10 for calibration and 20 for validation. Utilising the Pareto navigation interface automated protocols were calibrated to the institutions' clinical preferences. A single automated plan (VMATAuto) was generated for each validation patient with plan quality compared against the previously treated clinical plan (VMATClinical) both quantitatively, using a range of DVH metrics, and qualitatively through blind review at the external institution. RESULTS PGAP led to marked improvements across the majority of rectal dose metrics, with Dmean reduced by 3.7 Gy and 1.8 Gy for IA and IB respectively (p < 0.001). For bladder, results were mixed with low and intermediate dose metrics reduced for IB but increased for IA. Differences, whilst statistically significant (p < 0.05) were small and not considered clinically relevant. The reduction in rectum dose was not at the expense of PTV coverage (D98% was generally improved with VMATAuto), but was somewhat detrimental to PTV conformality. The prioritisation of rectum over conformality was however aligned with preferences expressed during calibration and was a key driver in both institutions demonstrating a clear preference towards VMATAuto, with 31/40 considered superior to VMATClinical upon blind review. CONCLUSIONS PGAP enabled intuitive adaptation of automated protocols to an institution's planning aims and yielded plans more congruent with the institution's clinical preference than the locally produced manual clinical plans.
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Affiliation(s)
- Philip A Wheeler
- Radiotherapy Physics Department, Velindre Cancer Centre, CF14 2TL, Cardiff, Wales, UK.
| | - Nicholas S West
- Northern Centre for Cancer Care, Cancer Services and Clinical Haematology, Newcastle upon Tyne, UK
| | - Richard Powis
- Worcester Oncology Centre, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Rhydian Maggs
- Radiotherapy Physics Department, Velindre Cancer Centre, CF14 2TL, Cardiff, Wales, UK
| | - Michael Chu
- Radiotherapy Physics Department, Velindre Cancer Centre, CF14 2TL, Cardiff, Wales, UK
| | - Rachel A Pearson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Nick Willis
- Northern Centre for Cancer Care, Cancer Services and Clinical Haematology, Newcastle upon Tyne, UK
| | - Bartlomiej Kurec
- Worcester Oncology Centre, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Katie L Reed
- Worcester Oncology Centre, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - David G Lewis
- Radiotherapy Physics Department, Velindre Cancer Centre, CF14 2TL, Cardiff, Wales, UK
| | - John Staffurth
- School of Medicine, Cardiff University, Cardiff, Wales, UK
- Velindre Cancer Centre, Medical Directorate, Cardiff, Wales, UK
| | - Emiliano Spezi
- School of Engineering, Cardiff University, Cardiff, Wales, UK
| | - Anthony E Millin
- Radiotherapy Physics Department, Velindre Cancer Centre, CF14 2TL, Cardiff, Wales, UK
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Le Bao V, Haworth A, Dowling J, Walker A, Arumugam S, Jameson M, Chlap P, Wiltshire K, Keats S, Cloak K, Sidhom M, Kneebone A, Holloway L. Evaluating the relationship between contouring variability and modelled treatment outcome for prostate bed radiotherapy. Phys Med Biol 2024; 69:085008. [PMID: 38471173 DOI: 10.1088/1361-6560/ad3325] [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: 10/19/2023] [Accepted: 03/12/2024] [Indexed: 03/14/2024]
Abstract
Objectives.Contouring similarity metrics are often used in studies of inter-observer variation and automatic segmentation but do not provide an assessment of clinical impact. This study focused on post-prostatectomy radiotherapy and aimed to (1) identify if there is a relationship between variations in commonly used contouring similarity metrics and resulting dosimetry and (2) identify the variation in clinical target volume (CTV) contouring that significantly impacts dosimetry.Approach.The study retrospectively analysed CT scans of 10 patients from the TROG 08.03 RAVES trial. The CTV, rectum, and bladder were contoured independently by three experienced observers. Using these contours reference simultaneous truth and performance level estimation (STAPLE) volumes were established. Additional CTVs were generated using an atlas algorithm based on a single benchmark case with 42 manual contours. Volumetric-modulated arc therapy (VMAT) treatment plans were generated for the observer, atlas, and reference volumes. The dosimetry was evaluated using radiobiological metrics. Correlations between contouring similarity and dosimetry metrics were calculated using Spearman coefficient (Γ). To access impact of variations in planning target volume (PTV) margin, the STAPLE PTV was uniformly contracted and expanded, with plans created for each PTV volume. STAPLE dose-volume histograms (DVHs) were exported for plans generated based on the contracted/expanded volumes, and dose-volume metrics assessed.Mainresults. The study found no strong correlations between the considered similarity metrics and modelled outcomes. Moderate correlations (0.5 <Γ< 0.7) were observed for Dice similarity coefficient, Jaccard, and mean distance to agreement metrics and rectum toxicities. The observations of this study indicate a tendency for variations in CTV contraction/expansion below 5 mm to result in minor dosimetric impacts.Significance. Contouring similarity metrics must be used with caution when interpreting them as indicators of treatment plan variation. For post-prostatectomy VMAT patients, this work showed variations in contours with an expansion/contraction of less than 5 mm did not lead to notable dosimetric differences, this should be explored in a larger dataset to assess generalisability.
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Affiliation(s)
- Viet Le Bao
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Annette Haworth
- Institute of Medical Physics, School of Physics, University of Sydney, Australia
| | - Jason Dowling
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Amy Walker
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Sankar Arumugam
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
| | - Michael Jameson
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia
- GenesisCare, Sydney, NSW, Australia
| | - Phillip Chlap
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
| | - Kirsty Wiltshire
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - Sarah Keats
- Ingham Institute for Applied Medical Research, Sydney, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
| | - Kirrily Cloak
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
| | - Mark Sidhom
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
| | | | - Lois Holloway
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- Institute of Medical Physics, School of Physics, University of Sydney, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
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Davis TM, Luca K, Sudmeier LJ, Buchwald ZS, Khan MK, Yang X, Schreibmann E, Zhang J, Roper J. Total scalp irradiation: A study comparing multiple types of bolus and VMAT optimization techniques. J Appl Clin Med Phys 2024; 25:e14260. [PMID: 38243628 PMCID: PMC11005987 DOI: 10.1002/acm2.14260] [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: 09/11/2023] [Revised: 11/13/2023] [Accepted: 12/19/2023] [Indexed: 01/21/2024] Open
Abstract
PURPOSE To investigate bolus design and VMAT optimization settings for total scalp irradiation. METHODS Three silicone bolus designs (flat, hat, and custom) from .decimal were evaluated for adherence to five anthropomorphic head phantoms. Flat bolus was cut from a silicone sheet. Generic hat bolus resembles an elongated swim cap while custom bolus is manufactured by injecting silicone into a 3D printed mold. Bolus placement time was recorded. Air gaps between bolus and scalp were quantified on CT images. The dosimetric effect of air gaps on target coverage was evaluated in a treatment planning study where the scalp was planned to 60 Gy in 30 fractions. A noncoplanar VMAT technique based on gEUD penalties was investigated that explored the full range of gEUD alpha values to determine which settings achieve sufficient target coverage while minimizing brain dose. ANOVA and the t-test were used to evaluate statistically significant differences (threshold = 0.05). RESULTS The flat bolus took 32 ± 5.9 min to construct and place, which was significantly longer (p < 0.001) compared with 0.67 ± 0.2 min for the generic hat bolus or 0.53 ± 0.10 min for the custom bolus. The air gap volumes were 38 ± 9.3 cc, 32 ± 14 cc, and 17 ± 7.0 cc for the flat, hat, and custom boluses, respectively. While the air gap differences between the flat and custom boluses were significant (p = 0.011), there were no significant dosimetric differences in PTV coverage at V57Gy or V60Gy. In the VMAT optimization study, a gEUD alpha of 2 was found to minimize the mean brain dose. CONCLUSIONS Two challenging aspects of total scalp irradiation were investigated: bolus design and plan optimization. Results from this study show opportunities to shorten bolus fabrication time during simulation and create high quality treatment plans using a straightforward VMAT template with simple optimization settings.
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Affiliation(s)
- Tanisha M. Davis
- Medical Dosimetry ProgramSouthern Illinois UniversityCarbondaleIllinoisUSA
- Department of Radiation OncologyEmory UniversityAtlantaGeorgiaUSA
| | - Kirk Luca
- Department of Radiation OncologyEmory UniversityAtlantaGeorgiaUSA
| | - Lisa J. Sudmeier
- Department of Radiation OncologyEmory UniversityAtlantaGeorgiaUSA
| | | | - Mohammad K. Khan
- Department of Radiation OncologyEmory UniversityAtlantaGeorgiaUSA
| | - Xiaofeng Yang
- Department of Radiation OncologyEmory UniversityAtlantaGeorgiaUSA
| | | | - Jiahan Zhang
- Department of Radiation OncologyEmory UniversityAtlantaGeorgiaUSA
| | - Justin Roper
- Department of Radiation OncologyEmory UniversityAtlantaGeorgiaUSA
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Brekner MC, Imhoff D, Rödel C, Filmann N, Licher J, Ramm U, Köhn J. Stereotactic body radiotherapy with volumetric intensity-modulated arc therapy and flattening filter-free beams: dosimetric considerations. Strahlenther Onkol 2024; 200:346-357. [PMID: 38092967 DOI: 10.1007/s00066-023-02181-8] [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: 07/27/2023] [Accepted: 11/01/2023] [Indexed: 03/27/2024]
Abstract
PURPOSE The present study comparatively evaluates the impact of energy-matched flattening filter-free (FFF) photon beams with different energy levels on the physical-dosimetric quality of lung and liver stereotactic body radiotherapy (SBRT) treatment plans. METHODS For this purpose, 54 different lung and liver lesions from 44 patients who had already received SBRT combined with volumetric modulated arc therapy (VMAT) were included in this retrospective planning study. Planning computed tomography scans already available were used for the renewed planning with 6 MV, 6 MV-FFF, 10 MV, and 10 MV-FFF under constant planning objectives. The treatment delivery data, dosimetric distributions, and dose-volume histograms as well as parameters such as the conformity index and gradient indices were the basis for the evaluation and comparison of treatment plans. RESULTS A significant reduction of beam-on time (BOT) was achieved due to the high dose rates of FFF beams. In addition, we showed that for FFF beams compared to flattened beams of the same energy level, smaller planning target volumes (PTV) require fewer monitor units (MU) than larger PTVs. An equal to slightly superior target volume coverage and sparing of healthy tissue as well as organs at risk in both lung and liver lesions were found. Significant differences were seen mainly in the medium to lower dose range. CONCLUSION We found that FFF beams together with VMAT represent an excellent combination for SBRT of lung or liver lesions with shortest BOT for 10 MV-FFF but significant dose savings for 6 MV-FFF in lung lesions.
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Affiliation(s)
- Mark Christoph Brekner
- Department of Radiation Oncology, University Hospital, Johann Wolfgang Goethe University Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany.
| | - Detlef Imhoff
- Department of Radiation Oncology, University Hospital, Johann Wolfgang Goethe University Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Claus Rödel
- Department of Radiation Oncology, University Hospital, Johann Wolfgang Goethe University Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Natalie Filmann
- Institute for Biostatistics and Mathematical Modeling, University Hospital, Goethe University, 60590, Frankfurt, Germany
| | - Jörg Licher
- Department of Radiation Oncology, University Hospital, Johann Wolfgang Goethe University Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Ulla Ramm
- Department of Radiation Oncology, University Hospital, Johann Wolfgang Goethe University Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Janett Köhn
- Department of Radiation Oncology, University Hospital, Johann Wolfgang Goethe University Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany
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Zhang H, Zhang B, Lasio G, Chen S, Nasehi Tehrani J. Assessing quality assurance of multi-leaf collimator using the structural similarity index. J Appl Clin Med Phys 2024; 25:e14288. [PMID: 38345201 PMCID: PMC11005984 DOI: 10.1002/acm2.14288] [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: 07/31/2023] [Revised: 12/11/2023] [Accepted: 01/22/2024] [Indexed: 04/11/2024] Open
Abstract
PURPOSE This study aims to evaluate the viability of utilizing the Structural Similarity Index (SSI*) as an innovative imaging metric for quality assurance (QA) of the multi-leaf collimator (MLC). Additionally, we compared the results obtained through SSI* with those derived from a conventional Gamma index test for three types of Varian machines (Trilogy, Truebeam, and Edge) over a 12-week period of MLC QA in our clinic. METHOD To assess sensitivity to MLC positioning errors, we designed a 1 cm slit on the reference MLC, subsequently shifted by 0.5-5 mm on the target MLC. For evaluating sensitivity to output error, we irradiated five 25 cm × 25 cm open fields on the portal image with varying Monitor Units (MUs) of 96-100. We compared SSI* and Gamma index tests using three linear accelerator (LINAC) machines: Varian Trilogy, Truebeam, and Edge, with MLC leaf widths of 1, 0.5, and 0.25 mm. Weekly QA included VMAT and static field modes, with Picket fence test images acquired. Mechanical uncertainties related to the LINAC head, electronic portal imaging device (EPID), and MLC during gantry rotation and leaf motion were monitored. RESULTS The Gamma index test started detecting the MLC shift at a threshold of 4 mm, whereas the SSI* metric showed sensitivity to shifts as small as 2 mm. Moreover, the Gamma index test identified dose changes at 95MUs, indicating a 5% dose difference based on the distance to agreement (DTA)/dose difference (DD) criteria of 1 mm/3%. In contrast, the SSI* metric alerted to dose differences starting from 97MUs, corresponding to a 3% dose difference. The Gamma index test passed all measurements conducted on each machine. However, the SSI* metric rejected all measurements from the Edge and Trilogy machines and two from the Truebeam. CONCLUSIONS Our findings demonstrate that the SSI* exhibits greater sensitivity than the Gamma index test in detecting MLC positioning errors and dose changes between static and VMAT modes. The SSI* metric outperformed the Gamma index test regarding sensitivity across these parameters.
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Affiliation(s)
- Hong Zhang
- Departments of Radiation OncologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Baoshe Zhang
- Departments of Radiation OncologyMedical SchoolUniversity of MarylandBaltimoreMarylandUSA
| | - Giovanni Lasio
- Departments of Radiation OncologyMedical SchoolUniversity of MarylandBaltimoreMarylandUSA
| | - Shifeng Chen
- Departments of Radiation OncologyMedical SchoolUniversity of MarylandBaltimoreMarylandUSA
| | - Joubin Nasehi Tehrani
- Departments of Radiation OncologyMedical SchoolUniversity of MarylandBaltimoreMarylandUSA
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Huang K, Chung C, Ludmir EB, Zhang L, Owens CA, Vega JGL, Duryea J, Zhao Y, Chen X, Fuentes D, Cardenas CE, Briere TM, Beddar S, Court LE, Das P. Automatic end-to-end VMAT treatment planning for rectal cancers. J Appl Clin Med Phys 2024; 25:e14259. [PMID: 38317597 PMCID: PMC11005975 DOI: 10.1002/acm2.14259] [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: 09/01/2023] [Revised: 09/01/2023] [Accepted: 11/16/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The treatment planning process from segmentation to producing a deliverable plan is time-consuming and labor-intensive. Existing solutions automate the segmentation and planning processes individually. The feasibility of combining auto-segmentation and auto-planning for volumetric modulated arc therapy (VMAT) for rectal cancers in an end-to-end process is not clear. PURPOSE To create and clinically evaluate a complete end-to-end process for auto-segmentation and auto-planning of VMAT for rectal cancer requiring only the gross tumor volume contour and a CT scan as inputs. METHODS Patient scans and data were retrospectively selected from our institutional records for patients treated for malignant neoplasm of the rectum. We trained, validated, and tested deep learning auto-segmentation models using nnU-Net architecture for clinical target volume (CTV), bowel bag, large bowel, small bowel, total bowel, femurs, bladder, bone marrow, and female and male genitalia. For the CTV, we identified 174 patients with clinically drawn CTVs. We used data for 18 patients for all structures other than the CTV. The structures were contoured under the guidance of and reviewed by a gastrointestinal (GI) radiation oncologist. The predicted results for CTV in 35 patients and organs at risk (OAR) in six patients were scored by the GI radiation oncologist using a five-point Likert scale. For auto-planning, a RapidPlan knowledge-based planning solution was modeled for VMAT delivery with a prescription of 25 Gy in five fractions. The model was trained and tested on 20 and 34 patients, respectively. The resulting plans were scored by two GI radiation oncologists using a five-point Likert scale. Finally, the end-to-end pipeline was evaluated on 16 patients, and the resulting plans were scored by two GI radiation oncologists. RESULTS In 31 of 35 patients, CTV contours were clinically acceptable without necessary modifications. The CTV achieved a Dice similarity coefficient of 0.85 (±0.05) and 95% Hausdorff distance of 15.25 (±5.59) mm. All OAR contours were clinically acceptable without edits, except for large and small bowel which were challenging to differentiate. However, contours for total, large, and small bowel were clinically acceptable. The two physicians accepted 100% and 91% of the auto-plans. For the end-to-end pipeline, the two physicians accepted 88% and 62% of the auto-plans. CONCLUSIONS This study demonstrated that the VMAT treatment planning technique for rectal cancer can be automated to generate clinically acceptable and safe plans with minimal human interventions.
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Affiliation(s)
- Kai Huang
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical SciencesHoustonTexasUSA
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Christine Chung
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Ethan B. Ludmir
- Department of Gastrointestinal Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Lifei Zhang
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Constance A. Owens
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical SciencesHoustonTexasUSA
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Jean Gumma‐De La Vega
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Jack Duryea
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Yao Zhao
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical SciencesHoustonTexasUSA
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Xinru Chen
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical SciencesHoustonTexasUSA
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - David Fuentes
- Department of Imaging PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Carlos E. Cardenas
- Department of Radiation OncologyThe University of Alabama at BirminghamBirminghamAlabamaUSA
| | - Tina Marie Briere
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Sam Beddar
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Laurence E. Court
- Department of Radiation PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Prajnan Das
- Department of Gastrointestinal Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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Bertholet J, Mackeprang PH, Loebner HA, Mueller S, Guyer G, Frei D, Volken W, Elicin O, Aebersold DM, Fix MK, Manser P. Organs-at-risk dose and normal tissue complication probability with dynamic trajectory radiotherapy (DTRT) for head and neck cancer. Radiother Oncol 2024; 195:110237. [PMID: 38513960 DOI: 10.1016/j.radonc.2024.110237] [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: 12/12/2023] [Revised: 03/07/2024] [Accepted: 03/18/2024] [Indexed: 03/23/2024]
Abstract
We compared dynamic trajectory radiotherapy (DTRT) to state-of-the-art volumetric modulated arc therapy (VMAT) for 46 head and neck cancer cases. DTRT had lower dose to salivary glands and swallowing structure, resulting in lower predicted xerostomia and dysphagia compared to VMAT. DTRT is deliverable on C-arm linacs with high dosimetric accuracy.
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Affiliation(s)
- Jenny Bertholet
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
| | - Paul-Henry Mackeprang
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Hannes A Loebner
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Silvan Mueller
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Gian Guyer
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Daniel Frei
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Werner Volken
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Olgun Elicin
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Daniel M Aebersold
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Michael K Fix
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Peter Manser
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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Huijskens S, Granton P, Fremeijer K, van Wanrooij C, Offereins-van Harten K, Schouwenaars-van den Beemd S, Hoogeman MS, Sattler MGA, Penninkhof J. Clinical practicality and patient performance for surface-guided automated VMAT gating for DIBH breast cancer radiotherapy. Radiother Oncol 2024; 195:110229. [PMID: 38492672 DOI: 10.1016/j.radonc.2024.110229] [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: 12/22/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND AND PURPOSE To evaluate the performance of automated surface-guided gating for left-sided breast cancer with DIBH and VMAT. MATERIALS AND METHODS Patients treated in the first year after introduction of DIBH with VMAT were retrospectively considered for analysis. With automated surface-guided gating the beam automatically switches on/off, if the surface region of interest moved in/out the gating tolerance (±3 mm, ±3°). Patients were coached to hold their breath as long as comfortably possible. Depending on the patient's preference, patients received audio instructions during treatment delivery. Real-time positional variations of the breast/chest wall surface with respect to the reference surface were collected, for all three orthogonal directions. The durations and number of DIBHs needed to complete dose delivery, and DIBH position variations were determined. To evaluate an optimal gating window threshold, smaller tolerances of ±2.5 mm, ±2.0 mm, and ±1.5 mm were simulated. RESULTS 525 fractions from 33 patients showed that median DIBH duration was 51 s (range: 30-121 s), and median 4 DIBHs per fraction were needed to complete VMAT dose delivery. Median intra-DIBH stability and intrafractional DIBH reproducibility approximated 1.0 mm in each direction. No large differences were found between patients who preferred to perform the DIBH procedure with (n = 21) and without audio-coaching (n = 12). Simulations demonstrated that gating window tolerances could be reduced from ±3.0 mm to ±2.0 mm, without affecting beam-on status. CONCLUSION Independent of the use of audio-coaching, this study demonstrates that automated surface-guided gating with DIBH and VMAT proved highly efficient. Patients' DIBH performance far exceeded our expectations compared to earlier experiences and literature. Furthermore, gating window tolerances could be reduced.
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Affiliation(s)
- Sophie Huijskens
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands.
| | - Patrick Granton
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
| | - Kimm Fremeijer
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
| | - Cynthia van Wanrooij
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
| | - Kirsten Offereins-van Harten
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
| | | | - Mischa S Hoogeman
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
| | - Margriet G A Sattler
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
| | - Joan Penninkhof
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
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Sreejeev AT, Joseph D, Krishnan AS, Pasricha R, Gupta S, Ahuja R, Sharma N, Sikdar D, Raut S, Sasi A, Gupta M. Weekly assessment of volumetric and dosimetric changes during volumetric modulated arc therapy of locally advanced head and neck carcinoma: Implications for adaptive radiation therapy-A prospective study. Head Neck 2024. [PMID: 38436506 DOI: 10.1002/hed.27710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Chemoradiation in head and neck carcinoma (HNC) shows significant anatomical resulting in erroneous dose deposition in the target or the organ at risk (OAR). Adaptive radiotherapy (ART) can overcome this. Timing of significant target and OAR changes with dosimetric impact; thus, most suitable time and frequency of ART is unclear. METHODS This dosimetric study used prospective weekly non-contrast CT scans in 12 HNC patients (78 scans). OARs and TVs were manually contoured after registration with simulation scan. Dose overlay done on each scan without reoptimization. Dosimetric and volumetric variations assessed. RESULTS Commonest site was oropharynx. Gross Tumor Volume (GTV) reduced from 47.5 ± 19.2 to 17.8 ± 10.7 cc. Nodal GTV reduced from 15.7 ± 18.8 to 4.7 ± 7.1 cc. Parotid showed mean volume loss of 35%. T stage moderately correlated with GTV regression. CONCLUSION Maximum GTV changes occurred after 3 weeks. Best time to do single fixed interval ART would be by the end of 3 weeks.
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Affiliation(s)
| | - Deepa Joseph
- Department of Radiation Oncology, AIIMS, Rishikesh, India
| | - Ajay S Krishnan
- Department of Radiation Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre, Varanasi, India
| | | | - Sweety Gupta
- Department of Radiation Oncology, AIIMS, Rishikesh, India
| | - Rachit Ahuja
- Department of Radiation Oncology, Shri Mahant Indiresh Hospital, Dehradun, India
| | - Nidhi Sharma
- Department of Radiation Oncology, AIIMS, Rishikesh, India
| | | | - Sagar Raut
- Department of Radiation Oncology, AIIMS, Rishikesh, India
| | | | - Manoj Gupta
- Department of Radiation Oncology, AIIMS, Rishikesh, India
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10
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Yamashita M, Ohira S, Tanabe H, Kokubo M, Koizumi M. Correlation Between Dosimetric Parameters and Local Control in Definitive Radiotherapy for Head and Neck Cancers. In Vivo 2024; 38:819-825. [PMID: 38418123 PMCID: PMC10905467 DOI: 10.21873/invivo.13506] [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: 11/02/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND/AIM Radiotherapy (RT) outcomes are generally reported based on stage, patient background, and concomitant chemotherapy. This study aimed to investigate the effects of the prescribed dose to gross tumor volume (GTV) and the calculation algorithm on local control in definitive RT for head and neck (H&N) cancers using follow-up images after RT. PATIENTS AND METHODS This study included 154 patients with H&N cancers treated by Volumetric Modulated Arc Therapy at the Kobe City Medical Center General Hospital. Patients were classified into those receiving definitive RT (70 Gy of irradiation) and those not receiving it. Follow-up images were used to categorize the patients into the responders and non-responders groups. In the non-responders group, follow-up images were imported into the treatment planning system, and the contours of the residual or recurrent areas (local failure) were extracted and fused with computed tomography-simulated images for treatment planning. Dose evaluation parameters included maximum dose, dose administered to 1% of the volume, dose administered to 50% of the volume, dose administered to 99% of the volume (D99%), and minimum dose (Dmin) administered to the GTV. The doses to the GTV were compared between responders and non-responders. RESULTS D99% exhibited significant differences between local failure and responders and between local failure and non-responders. Dmin showed significant differences between responders and non-responders and between responders and local failure. CONCLUSION This study emphasizes the importance of verifying dose distribution in all slices of treatment planning, highlighting the need for precise assessment of the dose to the GTV in head and neck cancers.
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Affiliation(s)
- Mikiko Yamashita
- Department of Radiological Technology, Kobe City Medical Center General Hospital, Hyogo, Japan;
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shingo Ohira
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Comprehensive Radiation Oncology, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Tanabe
- Department of Radiological Technology, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Masaki Kokubo
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Masahiko Koizumi
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
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11
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Prokofev I, Salim N. Off-isocentric VMAT technique for breast cancer: Effective dose reduction to organs at risk and its applicability based on patient anatomy. J Appl Clin Med Phys 2024; 25:e14237. [PMID: 38207110 DOI: 10.1002/acm2.14237] [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: 11/03/2023] [Revised: 11/10/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE This study aims to explore the off-isocentric volumetric modulated arc therapy (offVMAT) technique for breast cancer and determine its applicability based on patient anatomical parameters. METHODS We retrospectively analyzed 44 breast cancer patients with varied lymph node involvement using different arc designs. Off-isocentric techniques were benchmarked against previously published arc techniques: classic arcs (clVMAT), tangential arcs (tVMAT), and split arcs (spVMAT). During optimization, target coverage was made for all plans as close as possible to the criteria D99% > 95% and Dmax < 110% of the prescribed dose. A novel patient categorization, based on anatomical parameters (auxiliary structures) rather than lymph node involvement, is introduced. This categorization considers the volume of ipsilateral organs at risk (OARs) adjacent to the target. A binary regression model was developed on these anatomical parameters. It predicts the likelihood of offVMAT (P[offVMAT]) achieving better criteria. RESULTS Using the regression model, patients were divided into two groups: P(offVMAT) > 0.5 and P(offVMAT) < 0.5. For the P(offVMAT) > 0.5 group, most tVMAT plans are unable to achieve the clinical objectives. Comparing offVMAT with spVMAT, offVMAT exhibited better dose parameters for the heart (V20, V10, and D2 are 7.1, 2.4, and 1.5 times lower respectively), ipsilateral lung (V20, V10, V5 and the mean dose are 1.4, 1.3, 1.2, and 1.2 times lower respectively). The average doses to the contralateral side are consistent. In the P(offVMAT) < 0.5 group, the tVMAT technique showed increased doses at medium and high levels, yet reduced doses in contralateral OARs compared to spVMAT and offVMAT. spVMAT showed lower doses in the contralateral lung relative to the offVMAT technique, while clVMAT trailed in both groups. Validation of the model yielded a 90% accuracy rate. CONCLUSIONS The new off-isocentric breast planning technique effectively reduces doses to ipsilateral OARs, maintaining acceptable contralateral mean doses. This technique has an advantage over other techniques for patients with intricate anatomies. It is evaluated using anatomical parameters, which are also used to build binary regression model, which shows the dependence of anatomical parameters on whether offVMAT is preferred for individual patients. Also, such anatomical parameters provide a more objective and precise comparison between different planning techniques.
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Affiliation(s)
- Igor Prokofev
- Department of Radiotherapy, European Medical Center, Moscow, Russia
| | - Nidal Salim
- Department of Radiotherapy, European Medical Center, Moscow, Russia
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12
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Yau T, Kempe J, Gaede S. A four-dimensional dynamic conformal arc approach for real-time tumor tracking: A retrospective treatment planning study. J Appl Clin Med Phys 2024; 25:e14224. [PMID: 38146134 DOI: 10.1002/acm2.14224] [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: 03/27/2023] [Revised: 10/10/2023] [Accepted: 11/15/2023] [Indexed: 12/27/2023] Open
Abstract
PURPOSE For many thoracic tumors, patient respiration can introduce a significant amount of variability in tumor position that must be accounted for during radiotherapy. Of all existing techniques, real-time dynamic tumor tracking (DTT) represents the most ideal motion management strategy but can be limited by the treatment delivery technique. Our objective was to analyze the dosimetric performance of a dynamic conformal arc (DCA) approach to tumor tracking on standard linear accelerators that may offer similar dosimetric benefit, but with less complexity compared to intensity-modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT). METHODS Ten patients who previously received free-breathing VMAT for lung cancer were retrospectively analyzed. Patient 4D-CT and respiratory traces were simultaneously acquired prior to treatment and re-planned with DCA and VMAT using the Eclipse v15.6 Treatment Planning System with gated, deep inspiration breath hold (DIBH), and motion encompassment techniques taken into consideration, generating seven new plans per patient. DTT with DCA was simulated using an in-house MATLAB script to parse the radiation dose into each phase of the 4D-CT based on the patient's respiratory trace. Dose distributions were normalized to the same prescription and analyzed using dose volume histograms (DVHs). DVH metrics were assessed using ANOVA with subsequent paired t-tests. RESULTS The DCA-based DTT plans outperformed or showed comparable performance in their DVH metrics compared to all other combinations of treatment techniques while using motion management in normal lung sparing (p < 0.05). Normal lung sparing was not significantly different when comparing DCA-based DTT to gated and DIBH VMAT (p > 0.05), while both outperformed the corresponding DCA plans (p < 0.05). Simulated treatment times using DCA-based DTT were significantly shorter than both gating and DIBH plans (p < 0.05). CONCLUSIONS A DCA-based DTT technique showed significant advantages over conventional motion encompassment treatments in lung cancer radiotherapy, with comparable performance to stricter techniques like gating and DIBH while conferring greater time-saving benefits.
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Affiliation(s)
- Timothy Yau
- Department of Medical Biophysics, University of Western Ontario, London, Canada
- London Health Sciences Centre, London, Canada
| | - Jeff Kempe
- London Health Sciences Centre, London, Canada
| | - Stewart Gaede
- Department of Medical Biophysics, University of Western Ontario, London, Canada
- London Health Sciences Centre, London, Canada
- Lawson Health Research Institute, London, Canada
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13
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Brooks FMD, Glenn MC, Hernandez V, Saez J, Mehrens H, Pollard-Larkin JM, Howell RM, Peterson CB, Nelson CL, Clark CH, Kry SF. A radiotherapy community data-driven approach to determine which complexity metrics best predict the impact of atypical TPS beam modeling on clinical dose calculation accuracy. J Appl Clin Med Phys 2024:e14318. [PMID: 38427776 DOI: 10.1002/acm2.14318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/20/2023] [Accepted: 01/25/2024] [Indexed: 03/03/2024] Open
Abstract
PURPOSE To quantify the impact of treatment planning system beam model parameters, based on the actual spread in radiotherapy community data, on clinical treatment plans and determine which complexity metrics best describe the impact beam modeling errors have on dose accuracy. METHODS Ten beam modeling parameters for a Varian accelerator were modified in RayStation to match radiotherapy community data at the 2.5, 25, 50, 75, and 97.5 percentile levels. These modifications were evaluated on 25 patient cases, including prostate, non-small cell lung, H&N, brain, and mesothelioma, generating 1,000 plan perturbations. Differences in the mean planned dose to clinical target volumes (CTV) and organs at risk (OAR) were evaluated with respect to the planned dose using the reference (50th-percentile) parameter values. Correlation between CTV dose differences, and 18 different complexity metrics were evaluated using linear regression; R-squared values were used to determine the best metric. RESULTS Perturbations to MLC offset and transmission parameters demonstrated the greatest changes in dose: up to 5.7% in CTVs and 16.7% for OARs. More complex clinical plans showed greater dose perturbation with atypical beam model parameters. The mean MLC Gap and Tongue & Groove index (TGi) complexity metrics best described the impact of TPS beam modeling variations on clinical dose delivery across all anatomical sites; similar, though not identical, trends between complexity and dose perturbation were observed among all sites. CONCLUSION Extreme values for MLC offset and MLC transmission beam modeling parameters were found to most substantially impact the dose distribution of clinical plans and careful attention should be given to these beam modeling parameters. The mean MLC Gap and TGi complexity metrics were best suited to identifying clinical plans most sensitive to beam modeling errors; this could help provide focus for clinical QA in identifying unacceptable plans.
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Affiliation(s)
- Fre'Etta Mae Dayo Brooks
- University of Texas MD Anderson UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mallory Carson Glenn
- University of Texas MD Anderson UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Victor Hernandez
- Department of Medical Physics, Hospital Sant Joan de Reus, IISPV, Tarragona, Spain
| | - Jordi Saez
- Department of Radiation Oncology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Hunter Mehrens
- University of Texas MD Anderson UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Julianne Marie Pollard-Larkin
- University of Texas MD Anderson UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rebecca Maureen Howell
- University of Texas MD Anderson UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christine Burns Peterson
- University of Texas MD Anderson UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christopher Lee Nelson
- University of Texas MD Anderson UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Catharine Helen Clark
- Department of Radiotherapy Physics, University College London Hospital London, London, UK
- Department of Medical Physics and Bioengineering, University College London, London, UK
- Medical Physics Department, National Physical Laboratory, Teddington, UK
| | - Stephen Frasier Kry
- University of Texas MD Anderson UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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14
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Murugan P, Manickam R, Rajamanickam T, Muthu S, Dinesan C, Murali A, Appunu K. Evaluation of improvements in plan quality with Photon Optimizer v16.1 for single brain lesion SRS treatment. Rep Pract Oncol Radiother 2024; 28:801-808. [PMID: 38515825 PMCID: PMC10954267 DOI: 10.5603/rpor.98742] [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: 11/22/2022] [Accepted: 12/29/2023] [Indexed: 03/23/2024] Open
Abstract
Background The purpose of this study is to compare the performance of the Photon Optimizer (PO) version 16.1 algorithm with its earlier version PO v13.6 and with Progressive Resolution Optimizer (PRO) version 13.6 algorithms. Materials and methods 20 patients with single brain lesions treated with the stereotactic radiosurgery (SRS) technique were retrospectively selected for this study. Initially, for all patients volumetric modulated arc therapy (VMAT) SRS plans were generated with the PRO v 13.6 algorithm. Then, all the plans were re-generated with two versions 13.6 and 16.1 of PO algorithm using the same setup and dose-volume optimization objectives as that of PRO with a similar planning approach. The quality of the generated plans was analysed using ICRU 91 plan evaluation parameters and also using dice similarity co-efficient (DSC), centre of mass distance (CMD) between target and prescription isodose line, Monitor units (MU) and brain-gross tumor volume (GTV) 12 Gy volume. Paired Student t-test was used for statistical analysis with 0.05 as a significant value. Results PO v16.1 improved all the dosimetric parameters studied compared to PO 13.6, the difference is statistically significant for all the parameters (p < 0.05), except for median dose and brain-GTV 12 Gy volume. PO v16.1 also showed statistically significant improvement for all the dosimetric parameters evaluated, except DSC and conformity index (CI), compared to PRO v13.6. Conclusion The PO v16.1 generated plans are dosimetrically superior to PO v13.6 and PRO v13.6 in terms of target dose coverage and dose gradient with lesser beam modulation and plan complexity for single brain lesion SRS.
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Affiliation(s)
- Perumal Murugan
- Radiation Oncology Department, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
| | - Ravikumar Manickam
- Radiation Oncology Department, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
| | - Tamilarasan Rajamanickam
- Radiation Oncology Department, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
| | - Sivakumar Muthu
- Radiation Oncology Department, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
| | - C Dinesan
- Radiation Oncology Department, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
| | - Abishake Murali
- Radiation Oncology Department, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
| | - Karthik Appunu
- Radiation Oncology Department, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
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15
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Okamoto H, Wakita A, Tani K, Kito S, Kurooka M, Kodama T, Tohyama N, Fujita Y, Nakamura S, Iijima K, Chiba T, Nakayama H, Murata M, Goka T, Igaki H. Plan complexity metrics for head and neck VMAT competition plans. Med Dosim 2024:S0958-3947(24)00009-8. [PMID: 38368182 DOI: 10.1016/j.meddos.2024.01.007] [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: 09/06/2023] [Revised: 12/22/2023] [Accepted: 01/24/2024] [Indexed: 02/19/2024]
Abstract
Previous plan competitions have largely focused on dose metric assessments. However, whether the submitted plans were realistic and reasonable from a quality assurance (QA) perspective remains unclear. This study aimed to investigate the relationship between aperture-based plan complexity metrics (PCM) in volumetric modulated arc therapy (VMAT) competition plans and clinical treatment plans verified through patient-specific QA (PSQA). In addition, the association of PCMs with plan quality was examined. A head and neck (HN) plan competition was held for Japanese institutions from June 2019 to July 2019, in which 210 competition plans were submitted. Dose distribution quality was quantified based on dose-volume histogram (DVH) metrics by calculating the dose distribution plan score (DDPS). Differences in PCMs between the two VMAT treatment plan groups (HN plan competitions held in Japan and clinically accepted HN VMAT plans through PSQA) were investigated. The mean (± standard deviation) DDPS for the 98 HN competition plans was 158.5 ± 20.6 (maximum DDPS: 200). DDPS showed a weak correlation with PCMs with a maximum r of 0.45 for monitor unit (MU); its correlation with some PCMs was "very weak." Significant differences were found in some PCMs between plans with the highest 20% DDPSs and the remaining plans. The clinical VMAT and competition plans revealed similar distributions for some PCMs. Deviations in PCMs for the two groups were comparable, indicating considerable variability among planners regarding planning skills. The plan complexity for HN VMAT competition plans increased for high-quality plans, as shown by the dose distribution. Direct comparison of PCMs between competition plans and clinically accepted plans showed that the submitted HN VMAT competition plans were realistic and reasonable from the QA perspective. This evaluation may provide a set of criteria for evaluating plan quality in plan competitions.
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Affiliation(s)
- Hiroyuki Okamoto
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan.
| | - Akihisa Wakita
- Division of Medical Physics, EuroMediTech Co., LTD., 2-20-4 higashigotanda, shinagawa-ku Tokyo, 141-0022, Japan
| | - Kensuke Tani
- Division of Medical Physics, EuroMediTech Co., LTD., 2-20-4 higashigotanda, shinagawa-ku Tokyo, 141-0022, Japan
| | - Satoshi Kito
- Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku Tokyo,113-8677, Japan
| | - Masahiko Kurooka
- Department of Radiation Therapy, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Takumi Kodama
- Department of Radiation Oncology, Saitama Cancer Center, 780 Ooazakomuro, Inamachi, Kitaadachi-gun Saitama 362-0806, Japan
| | - Naoki Tohyama
- Division of Medical Physics, Tokyo Bay Makuhari Clinic for Advanced Imaging, Cancer Screening, and High-Precision Radiotherapy, 1-17 Toyosuna, Mihama-ku Chiba, Chiba, 261-0024, Japan
| | - Yukio Fujita
- Department of Radiation Sciences, Komazawa University, 1-23-1, komazawa, setagaya-ku Tokyo, 154-8525, Japan
| | - Satoshi Nakamura
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
| | - Kotaro Iijima
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
| | - Takahito Chiba
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
| | - Hiroki Nakayama
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
| | - Miyuki Murata
- Department of Radiological Technology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
| | - Tomonori Goka
- Department of Radiological Technology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku Tokyo, 104-0045, Japan
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Ferrer C, Huertas C, Ocanto A, García D, Plaza R, Mínguez C, de la Monja P, Escribano A, Pérez A, Sáez M. Evolution of dosimetric treatment planning for pediatric total lymphoid irradiation (TLI): a single-institution experience. Rep Pract Oncol Radiother 2024; 28:772-783. [PMID: 38515822 PMCID: PMC10954272 DOI: 10.5603/rpor.98734] [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: 12/16/2022] [Accepted: 12/20/2023] [Indexed: 03/23/2024] Open
Abstract
Background Total lymphoid irradiation (TLI) is a conditioning regimen in allogeneic hematopoietic stem cell transplantation (allo-HSCT) which may reduce long-term toxicities attributed to other techniques, such as total body irradiation (TBI). At our institution, TLI treatments were first planned with the three-dimensional conformal radiation therapy (3D-CRT) technique and later with volumetric modulated arc therapy (VMAT). With the recent availability of a basic helical tomotherapy (HT), the possible dosimetric gain of the latter for TLI is studied. Materials and methods 22 pediatric patients were planned for VMAT and HT, prescribed to 8 Gy in 4 fractions. VMAT was planned with template based on a single cost function, using the Monaco treatment planning system (TPS). HT plans were planned using Accuray Precision TPS for a basic HT without the dynamic jaws feature or VOLO-Ultra algorithm. Plan quality was analyzed based on four quality indices, mean and maximum doses to planning target volume (PTV) and organs at risk (OARs), dose gradient and integral doses. Differences were analyzed with Wilcoxon signed-rank test. Results HT plans resulted in improved conformity (CI) and homogeneity indices (HI) (p < 0.05) but less steep dose gradient (p = 0.181). VMAT plans created larger areas with high doses within the PTV, while comparable doses to OARs, except mainly for the spinal marrow, for which a reduction of 37.7% in D2% was obtained (p < 0.05). Integral dose for non-tumor tissue was 11.3% lower with the VMAT template (p < 0.05). Conclusion HT achieves better conformity and homogeneity even without its more advanced features. Nevertheless, the VMAT template achieves dosimetric results close to those of HT, both with similar clinical outcome.
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Affiliation(s)
- Carlos Ferrer
- Medical Physics and Radiation Protection Department, H.U. La Paz, Madrid, Spain
| | - Concepción Huertas
- Medical Physics and Radiation Protection Department, H.U. La Paz, Madrid, Spain
| | | | - David García
- Medical Physics and Radiation Protection Department, H.U. La Paz, Madrid, Spain
| | - Rodrigo Plaza
- Medical Physics and Radiation Protection Department, H.U. La Paz, Madrid, Spain
| | - Cristina Mínguez
- Medical Physics and Radiation Protection Department, H.U. La Paz, Madrid, Spain
| | | | - Anne Escribano
- Radiation Oncology Department, H.U. La Paz, Madrid, Spain
| | - Antonio Pérez
- Pediatric Hemato-Oncology Department, H.U. La Paz, Madrid, Spain
| | - Moisés Sáez
- Medical Physics and Radiation Protection Department, H.U. La Paz, Madrid, Spain
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17
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Ono T, Hirashima H, Adachi T, Iramina H, Fujimoto T, Uto M, Nakamura M, Mizowaki T. Influence of dose calculation algorithms on the helical diode array using volumetric-modulated arc therapy for small targets. J Appl Clin Med Phys 2024:e14307. [PMID: 38363044 DOI: 10.1002/acm2.14307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/26/2023] [Accepted: 02/06/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND For patient-specific quality assurance (PSQA) for small targets, the dose resolution can change depending on the characteristics of the dose calculation algorithms. PURPOSE This study aimed to evaluate the influence of the dose calculation algorithms Acuros XB (AXB), anisotropic analytical algorithm (AAA), photon Monte Carlo (pMC), and collapsed cone (CC) on a helical diode array using volumetric-modulated arc therapy (VMAT) for small targets. MATERIALS AND METHODS ArcCHECK detectors were inserted with a physical depth of 2.9 cm from the surface. To evaluate the influence of the dose calculation algorithms for small targets, rectangular fields of 2×100, 5×100, 10×100, 20×100, 50×100, and 100×100 mm2 were irradiated and measured using ArcCHECK with TrueBeam STx. A total of 20 VMAT plans for small targets, including the clinical sites of 19 brain metastases and one spine, were also evaluated. The gamma passing rates (GPRs) were evaluated for the rectangular fields and the 20 VMAT plans using AXB, AAA, pMC, and CC. RESULTS For rectangular fields of 2×100 and 5×100 mm2 , the GPR at 3%/2 mm of AXB was < 50% because AXB resulted in a coarser dose resolution with narrow beams. For field sizes > 10×100 mm2, the GPR at 3%/2 mm was > 88.1% and comparable for all dose calculation algorithms. For the 20 VMAT plans, the GPRs at 3%/2 mm were 79.1 ± 15.7%, 93.2 ± 5.8%, 94.9 ± 4.1%, and 94.5 ± 4.1% for AXB, AAA, pMC, and CC, respectively. CONCLUSION The behavior of the dose distribution on the helical diode array differed depending on the dose calculation algorithm for small targets. Measurements using ArcCHECK for VMAT with small targets can have lower GPRs owing to the coarse dose resolution of AXB around the detector area.
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Affiliation(s)
- Tomohiro Ono
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hideaki Hirashima
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takanori Adachi
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiraku Iramina
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takahiro Fujimoto
- Division of Clinical Radiology Service, Kyoto University Hospital, Kyoto, Japan
| | - Megumi Uto
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mitsuhiro Nakamura
- Department of Advanced Medical Physics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Mankinen M, Virén T, Seppälä J, Koivumäki T. Interfractional variation in whole-breast VMAT irradiation: a dosimetric study with complementary SGRT and CBCT patient setup. Radiat Oncol 2024; 19:21. [PMID: 38347554 PMCID: PMC10863193 DOI: 10.1186/s13014-024-02418-5] [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: 09/04/2023] [Accepted: 02/05/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The dosimetric effect of setup uncertainty and tissue deformations in left-sided whole-breast irradiation with complementary surface-guided radiotherapy (SGRT) and cone-beam computed tomography (CBCT) setup was evaluated. METHOD Treatment courses of 40.05 Gy prescribed dose in 15 fractions were simulated for 29 patients by calculating the dose on deformed CT images, that were based on daily CBCT images, and deforming and accumulating the dose onto the planning CT image. Variability in clinical target volume (CTV) position and shape was assessed as the 95% Hausdorff distance (HD95) between the planning CTV and deformed CTV structures. DVH metrics were evaluated between the planned and simulated cumulative dose distributions using two treatment techniques: tangential volumetric modulated arc therapy (tVMAT) and conventional 3D-conformal radiotherapy (3D-CRT). RESULTS Based on the HD95 values, the variations in CTV shape and position were enclosed by the 5 mm CTV-PTV margin in 85% of treatment fractions using complementary CBCT and SGRT setup. A residual error of 8.6 mm was observed between the initial SGRT setup and CBCT setup. The median CTV V95% coverage was 98.1% (range 93.1-99.8%) with tVMAT and 98.2% (range 84.5-99.7%) with 3D-CRT techniques with CBCT setup. With the initial SGRT-only setup, the corresponding coverages were 96.3% (range 92.6-99.4%) and 96.6% (range 84.2-99.4%), respectively. However, a considerable bias in vertical residual error between initial SGRT setup and CBCT setup was observed. Clinically relevant changes between the planned and cumulative doses to organs-at-risk (OARs) were not observed. CONCLUSIONS The CTV-to-PTV margin should not be reduced below 5 mm even with daily CBCT setup. Both tVMAT and 3D-CRT techniques were robust in terms of dose coverage to the target and OARs. Based on the shifts between setup methods, CBCT setup is recommended as a complementary method with SGRT.
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Affiliation(s)
- M Mankinen
- Deparment of Physics, University of Jyväskylä (JYU), Survontie 9 C, 40014, Jyväskylä, Finland.
- Deparment of Medical Physics, Hospital Nova of Central Finland, Wellbeing Services County of Central Finland, Jyväskylä, Finland.
| | - T Virén
- Center of Oncology, Kuopio University Hospital (KUH), The Wellbeing Services Country of North Savo, Kuopio, Finland
| | - J Seppälä
- Center of Oncology, Kuopio University Hospital (KUH), The Wellbeing Services Country of North Savo, Kuopio, Finland
| | - T Koivumäki
- Deparment of Physics, University of Jyväskylä (JYU), Survontie 9 C, 40014, Jyväskylä, Finland
- Deparment of Medical Physics, Hospital Nova of Central Finland, Wellbeing Services County of Central Finland, Jyväskylä, Finland
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19
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Dibs K, Gogineni E, Jhawar SM, Baliga S, Grecula JC, Mitchell DL, Palmer J, Haglund K, Andraos TY, Zoller W, Ewing A, Bonomi M, Bhateja P, Tinoco G, Liebner D, Rocco JW, Old M, Gamez ME, Chakravarti A, Konieczkowski DJ, Blakaj DM. Scalp Irradiation with 3D-Milled Bolus: Initial Dosimetric and Clinical Experience. Cancers (Basel) 2024; 16:688. [PMID: 38398079 PMCID: PMC10887235 DOI: 10.3390/cancers16040688] [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: 01/09/2024] [Revised: 01/31/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND AND PURPOSE A bolus is required when treating scalp lesions with photon radiation therapy. Traditional bolus materials face several issues, including air gaps and setup difficulty due to irregular, convex scalp geometry. A 3D-milled bolus is custom-formed to match individual patient anatomy, allowing improved dose coverage and homogeneity. Here, we describe the creation process of a 3D-milled bolus and report the outcomes for patients with scalp malignancies treated with Volumetric Modulated Arc Therapy (VMAT) utilizing a 3D-milled bolus. MATERIALS AND METHODS Twenty-two patients treated from 2016 to 2022 using a 3D-milled bolus and VMAT were included. Histologies included squamous cell carcinoma (n = 14, 64%) and angiosarcoma (n = 8, 36%). A total of 7 (32%) patients were treated in the intact and 15 (68%) in the postoperative setting. The median prescription dose was 66.0 Gy (range: 60.0-69.96). RESULTS The target included the entire scalp for 8 (36%) patients; in the remaining 14 (64%), the median ratio of planning target volume to scalp volume was 35% (range: 25-90%). The median dose homogeneity index was 1.07 (range: 1.03-1.15). Six (27%) patients experienced acute grade 3 dermatitis and one (5%) patient experienced late grade 3 skin ulceration. With a median follow-up of 21.4 months (range: 4.0-75.4), the 18-month rates of locoregional control and overall survival were 75% and 79%, respectively. CONCLUSIONS To our knowledge, this is the first study to report the clinical outcomes for patients with scalp malignancies treated with the combination of VMAT and a 3D-milled bolus. This technique resulted in favorable clinical outcomes and an acceptable toxicity profile in comparison with historic controls and warrants further investigation in a larger prospective study.
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Affiliation(s)
- Khaled Dibs
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Emile Gogineni
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Sachin M. Jhawar
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Sujith Baliga
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - John C. Grecula
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Darrion L. Mitchell
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Joshua Palmer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Karl Haglund
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Therese Youssef Andraos
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Wesley Zoller
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Ashlee Ewing
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Marcelo Bonomi
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (M.B.); (P.B.); (G.T.); (D.L.)
| | - Priyanka Bhateja
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (M.B.); (P.B.); (G.T.); (D.L.)
| | - Gabriel Tinoco
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (M.B.); (P.B.); (G.T.); (D.L.)
| | - David Liebner
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (M.B.); (P.B.); (G.T.); (D.L.)
| | - James W. Rocco
- Department of Otolaryngology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (J.W.R.); (M.O.)
| | - Matthew Old
- Department of Otolaryngology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (J.W.R.); (M.O.)
| | - Mauricio E. Gamez
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA;
| | - Arnab Chakravarti
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - David J. Konieczkowski
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
| | - Dukagjin M. Blakaj
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W. 10th Ave., Columbus, OH 43210, USA; (K.D.); (E.G.); (S.M.J.); (S.B.); (J.C.G.); (D.L.M.); (J.P.); (K.H.); (T.Y.A.); (W.Z.); (A.E.); (A.C.); (D.J.K.)
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20
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Bedford JL. Inverse planning of lung radiotherapy with photon and proton beams using a discrete ordinates Boltzmann solver. Phys Med Biol 2024; 69:035021. [PMID: 38198720 DOI: 10.1088/1361-6560/ad1cf7] [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: 09/05/2023] [Accepted: 01/10/2024] [Indexed: 01/12/2024]
Abstract
Objective. A discrete ordinates Boltzmann solver has recently been developed for use as a fast and accurate dose engine for calculation of photon and proton beams. The purpose of this study is to apply the algorithm to the inverse planning process for photons and protons and to evaluate the impact that this has on the quality of the final solution.Approach.The method was implemented into an iterative least-squares inverse planning optimiser, with the Boltzmann solver used every 20 iterations over the total of 100 iterations. Elemental dose distributions for the intensity modulation and the dose changes at the intermediate iterations were calculated by a convolution algorithm for photons and a simple analytical model for protons. The method was evaluated for 12 patients in the heterogeneous tissue environment encountered in radiotherapy of lung tumours. Photon arc and proton arc treatments were considered in this study. The results were compared with those for use of the Boltzmann solver solely at the end of inverse planning or not at all.Main results.Application of the Boltzmann solver at the end of inverse planning shows the dose heterogeneity in the planning target volume to be greater than calculated by convolution and empirical methods, with the median root-mean-square dose deviation increasing from 3.7 to 5.3 for photons and from 1.9 to 3.4 for proton arcs. Use of discrete ordinates throughout inverse planning enables homogeneity of target coverage to be maintained throughout, the median root-mean-square dose deviation being 3.6 for photons and 2.3 for protons. Dose to critical structures is similar with discrete ordinates and conventional methods. Time for inverse planning with discrete ordinates takes around 1-2 h using a contemporary computing environment.Significance.By incorporating the Boltzmann solver into an iterative least squares inverse planning optimiser, accurate dose calculation in a heterogeneous medium is obtained throughout inverse planning, with the result that the final dose distribution is of the highest quality.
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Affiliation(s)
- James L Bedford
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5PT, United Kingdom
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21
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Enomoto H, Fujita Y, Matsumoto S, Nakajima Y, Nagai M, Tonari A, Ebara T. Dosimetric impact of MLC positional errors on dose distribution in IMRT. J Appl Clin Med Phys 2024; 25:e14158. [PMID: 37722769 PMCID: PMC10860456 DOI: 10.1002/acm2.14158] [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: 11/14/2022] [Revised: 08/07/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023] Open
Abstract
Optimizing the positional accuracy of multileaf collimators (MLC) for radiotherapy is important for dose accuracy and for reducing doses delivered to normal tissues. This study investigates dose sensitivity variations and complexity metrics of MLC positional error in volumetric modulated arc therapy and determines the acceptable ranges of MLC positional accuracy in several clinical situations. Treatment plans were generated for four treatment sites (prostate cancer, lung cancer, spinal, and brain metastases) using different treatment planning systems (TPSs) and fraction sizes. Each treatment plan introduced 0.25-2.0 mm systematic or random MLC leaf bank errors. The generalized equivalent uniform dose (gEUD) sensitivity and complexity metrics (MU/Gy and plan irregularity) were calculated, and the correlation coefficients were assessed. Furthermore, the required tolerances for MLC positional accuracy control were calculated. The gEUD sensitivity showed the highest dependence of systematic positional error on the treatment site, followed by TPS and fraction size. The gEUD sensitivities were 6.7, 4.5, 2.5, and 1.7%/mm for Monaco and 8.9, 6.2, 3.4, and 2.3%/mm (spinal metastasis, lung cancer, prostate cancer, and brain metastasis, respectively) for RayStation. The gEUD sensitivity was strongly correlated with the complexity metrics (r = 0.88-0.93). The minimum allowable positional error for MLC was 0.63, 0.34, 1.02, and 0.28 mm (prostate, lung, brain, and spinal metastasis, respectively). The acceptable range of MLC positional accuracy depends on the treatment site, and an appropriate tolerance should be set for each treatment site with reference to the complexity metric. It is expected to enable easier and more detailed MLC positional accuracy control than before by reducing dose errors to patients at the treatment planning stage and by controlling MLC quality based on complexity metrics, such as MU/Gy.
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Affiliation(s)
- Hiromi Enomoto
- Department of RadiologyKyorin University HospitalMitakaTokyoJapan
- Department of Radiological SciencesKomazawa UniversitySetagayaTokyoJapan
| | - Yukio Fujita
- Department of Radiological SciencesKomazawa UniversitySetagayaTokyoJapan
| | - Saki Matsumoto
- Department of RadiologyKyorin University HospitalMitakaTokyoJapan
| | - Yujiro Nakajima
- Department of Radiological SciencesKomazawa UniversitySetagayaTokyoJapan
| | - Miyuki Nagai
- Department of Radiation OncologyKyorin UniversityMitakaTokyoJapan
| | - Ayako Tonari
- Department of Radiation OncologyKyorin UniversityMitakaTokyoJapan
- Department of Medical Radiological TechnologyFaculty of Health SciencesKyorin UniversityMitakaTokyoJapan
| | - Takeshi Ebara
- Department of Radiation OncologyKyorin UniversityMitakaTokyoJapan
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22
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Noblet C, Maunet M, Duthy M, Coste F, Moreau M. A TPS integrated machine learning tool for predicting patient-specific quality assurance outcomes in volumetric-modulated arc therapy. Phys Med 2024; 118:103208. [PMID: 38211462 DOI: 10.1016/j.ejmp.2024.103208] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/28/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024] Open
Abstract
PURPOSE Machine learning (ML) models have been demonstrated to be beneficial for optimizing the workload of patient-specific quality assurance (PSQA). Implementing them in clinical routine frequently requires third-party applications beyond the treatment planning system (TPS), slowing down the workflow. To address this issue, a PSQA outcomes predictive model was carefully selected and validated before being fully integrated into the TPS. MATERIALS AND METHODS Nine ML algorithms were evaluated using cross-validation. The learning database was built by calculating complexity metrics (CM) and binarizing PSQA results into "pass"/"fail" classes for 1767 VMAT arcs. The predictive performance was evaluated using area under the ROC curve (AUROC), sensitivity, and specificity. The ML model was integrated into the TPS via a C# script. Script-guided reoptimization impact on PSQA and dosimetric results was evaluated on ten VMAT plans with "fail"-predicted arcs. Workload reduction potential was also assessed. RESULTS The selected model exhibited an AUROC of 0.88, with a sensitivity and specificity exceeding 50 % and 90 %, respectively. The script-guided reoptimization of the ten evaluated plans led to an average improvement of 1.4 ± 0.9 percentage points in PSQA results, while preserving the quality of the dose distribution. A yearly savings of about 140 h with the use of the script was estimated. CONCLUSIONS The proposed script is a valuable complementary tool for PSQA measurement. It was efficiently integrated into the clinical workflow to enhance PSQA outcomes and reduce PSQA workload by decreasing the risk of failing QA and thereby, the need for repeated replanning and measurements.
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Affiliation(s)
- Caroline Noblet
- Department of Medical Physics, Clinique Mutualiste de l'Estuaire, Cité Sanitaire, Saint-Nazaire, France.
| | - Mathis Maunet
- Department of Medical Physics, Clinique Mutualiste de l'Estuaire, Cité Sanitaire, Saint-Nazaire, France
| | - Marie Duthy
- Department of Medical Physics, Clinique Mutualiste de l'Estuaire, Cité Sanitaire, Saint-Nazaire, France
| | - Frédéric Coste
- Department of Medical Physics, Clinique Mutualiste de l'Estuaire, Cité Sanitaire, Saint-Nazaire, France
| | - Matthieu Moreau
- Department of Medical Physics, Clinique Mutualiste de l'Estuaire, Cité Sanitaire, Saint-Nazaire, France
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Misa J, McCarthy S, Clair WS, Pokhrel D. Stereotactic radiotherapy of intracranial tumor beds on a ring-mounted Halcyon LINAC. J Appl Clin Med Phys 2024:e14281. [PMID: 38277473 DOI: 10.1002/acm2.14281] [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: 09/21/2023] [Revised: 12/21/2023] [Accepted: 01/03/2024] [Indexed: 01/28/2024] Open
Abstract
PURPOSE This study sought to evaluate the feasibility and efficacy of the Halcyon Ring Delivery System (RDS) for delivering stereotactic radiotherapy (SRT) treatments for intracranial tumors beds. METHODS Ten previously treated brain SRT patients for 30 Gy in five fractions with non-coplanar HyperArc plans on TrueBeam (6MV-FFF) were replanned on Halcyon (6MV-FFF) using the same number of arcs and Eclipse's AcurosXB dose engine. Plan quality evaluation metrics per SRT protocol included: PTV coverage, GTV dose (minimum and mean), target conformity indices (CI), heterogeneity index (HI), gradient index (GI), maximum dose 2 cm away from the PTV (D2cm ), and doses to organs-at-risk (OAR). Additionally, patient-specific quality assurance (QA) results and beam-on-time (BOT) were analyzed. RESULTS The Halcyon RDS provided highly conformal SRT plans for intracranial tumor beds with similar dose to target. When benchmarked against clinically delivered HyperArc plans, target coverage, CI(s) and HI were statistically similar. The Halcyon plans saw no statistical difference in maximum OAR doses to the brainstem, spinal cord, and cochlea. Due to the machine's coplanar geometry, the Halcyon plans showed a decrease in optic pathway dose (0.75 Gy vs. 2.08 Gy, p = 0.029). Overall, Halcyon's coplanar geometry resulted in a larger GI (3.33 vs. 2.72, p = 0.008) and a larger D2cm (39.59% vs. 29.07%, p < 0.001). In this cohort, multiple cases had the PTV and the optic pathway in the same axial plane. In one such instance, the PTV was <2 cm away from the optic pathway but even at this close proximity OAR, Halcyon still adequately spared the optic pathway. Additionally, the Halcyon's geometry provided slightly larger amount of normal brain dose receiving 24.4 Gy (8.99 cc vs. 7.36 cc) and 28.8 Gy (2.9 cc vs. 2.5 cc), although statistically insignificant. The Halcyon plans achieved similar delivery accuracy, quantified by patient-specific QA results evaluated with a 2%/2 mm gamma criteria (99.42% vs. 99.70%). For both plans, independent Monte Carlo second checks calculation agreed within 1%. Average Halcyon BOT was slightly higher by 0.35 min (p = 0.045), however, due to the one-step patient set-up and verification overall estimated treatment times on Halcyon were lower compared to HyperArc treatments (7.61 min vs. 10.26 min, p < 0.001). CONCLUSIONS When benchmarked against clinically delivered HyperArc treatments, the Halcyon brain SRT plans provided similar plan quality and delivery accuracy but achieved faster overall treatment times. We have started treating select brain SRT patients on the Halcyon RDS for patients having tumor beds greater than 1 cm in diameter with the closest OAR distance of greater than 2 cm away from the target. We recommend other clinics to consider commissioning SRT treatments on their Halcyon systems-allowing including remote Halcyon-only clinics to provide exceptionally high-quality therapeutic brain SRT treatments to an otherwise underserved patient cohort.
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Affiliation(s)
- Joshua Misa
- Medical Physics Graduate Program, Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Shane McCarthy
- Medical Physics Graduate Program, Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - William St Clair
- Medical Physics Graduate Program, Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Damodar Pokhrel
- Medical Physics Graduate Program, Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky, USA
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24
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Jingu K, Ito K, Sato K, Umezawa R, Yamamoto T, Takahashi N, Suzuki Y, Kishida K, Omata S, Harada H, Seki Y, Chiba N, Kadoya N. VMAT with DIBH in hypofractionated radiotherapy for left-sided breast cancer after breast-conserving surgery: results of a non-inferiority clinical study. J Radiat Res 2024; 65:87-91. [PMID: 38091980 PMCID: PMC10803169 DOI: 10.1093/jrr/rrad096] [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] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/27/2023] [Accepted: 11/12/2023] [Indexed: 01/24/2024]
Abstract
The purpose of this study was to show the safety of volumetric modulated arc therapy (VMAT) with deep inspiration breath-hold (DIBH) in hypofractionated radiotherapy for left-sided breast cancer after breast-conserving surgery in a clinical setting. Twenty-five Japanese women, aged 20-59 years, who were enrolled in this prospective non-inferiority study received VMAT under the condition of DIBH with 42.4 Gy/16 fractions for whole-breast irradiation (WBI) ± boost irradiation for the tumor bed to show the non-inferiority of VMAT with DIBH to conventional fractionated WBI with free breathing. The primary endpoint was the rate of occurrence of radiation dermatitis of Grade 3 or higher or pneumonitis of Grade 2 or higher within 6 months after the start of radiotherapy. This study was registered with UMIN00004321. All of the enrolled patients completed the planned radiotherapy without interruption. The evaluation of adverse events showed that three patients (12.0%) had Grade 2 radiation dermatitis. There was no other Grade 2 adverse event and there was no patient with an adverse event of Grade 3 or higher. Those results confirmed our hypothesis that the experimental treatment method is non-inferior compared with our historical results. There was no patient with locoregional recurrence or metastases. In conclusion, VMAT under the condition of DIBH in hypofractionated radiotherapy for left-sided breast cancer after breast-conserving surgery can be performed safely in a clinical setting.
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Affiliation(s)
- Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai 980-8574, Japan
| | - Kengo Ito
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai 980-8574, Japan
| | - Kiyokazu Sato
- Division of Radiation Technology, Tohoku University Hospital, 1-1 Seiryo-chou, Aoba-ku, Sendai 980-8574, Japan
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai 980-8574, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai 980-8574, Japan
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai 980-8574, Japan
| | - Yu Suzuki
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai 980-8574, Japan
| | - Keita Kishida
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai 980-8574, Japan
| | - So Omata
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai 980-8574, Japan
| | - Hinako Harada
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai 980-8574, Japan
| | - Yasuhiro Seki
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai 980-8574, Japan
| | - Nanae Chiba
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai 980-8574, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai 980-8574, Japan
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Bonaccorsi SG, Tessonnier T, Hoeltgen L, Meixner E, Harrabi S, Hörner-Rieber J, Haberer T, Abdollahi A, Debus J, Mairani A. Exploring Helium Ions' Potential for Post-Mastectomy Left-Sided Breast Cancer Radiotherapy. Cancers (Basel) 2024; 16:410. [PMID: 38254899 PMCID: PMC10814201 DOI: 10.3390/cancers16020410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/04/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Proton therapy presents a promising modality for treating left-sided breast cancer due to its unique dose distribution. Helium ions provide increased conformality thanks to a reduced lateral scattering. Consequently, the potential clinical benefit of both techniques was explored. An explorative treatment planning study involving ten patients, previously treated with VMAT (Volumetric Modulated Arc Therapy) for 50 Gy in 25 fractions for locally advanced, node-positive breast cancer, was carried out using proton pencil beam therapy with a fixed relative biological effectiveness (RBE) of 1.1 and helium therapy with a variable RBE described by the mMKM (modified microdosimetric kinetic model). Results indicated that target coverage was improved with particle therapy for both the clinical target volume and especially the internal mammary lymph nodes compared to VMAT. Median dose value analysis revealed that proton and helium plans provided lower dose on the left anterior descending artery (LAD), heart, lungs and right breast than VMAT. Notably, helium therapy exhibited improved ipsilateral lung sparing over protons. Employing NTCP models as available in the literature, helium therapy showed a lower probability of grade ≤ 2 radiation pneumonitis (22% for photons, 5% for protons and 2% for helium ions), while both proton and helium ions reduce the probability of major coronary events with respect to VMAT.
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Affiliation(s)
| | - Thomas Tessonnier
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, 69120 Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Line Hoeltgen
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Eva Meixner
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Semi Harrabi
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Thomas Haberer
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Amir Abdollahi
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, 69120 Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Jürgen Debus
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Andrea Mairani
- Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, 69120 Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany
- Centro Nazionale di Adroterapia Oncologica (CNAO), 27100 Pavia, Italy
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Khosla D, Kapoor R, Dey T, Kataria V, Singh R, Kumar D, Oinam AS, Gupta R, Rana SS, Shah J, Singh H, Irrinki S, Madan R. Simultaneous Integrated Boost (SIB) Versus Sequential Boost in Anal Cancer Patients: A Single-Center Experience. J Gastrointest Cancer 2024:10.1007/s12029-024-01019-5. [PMID: 38236375 DOI: 10.1007/s12029-024-01019-5] [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] [Accepted: 01/10/2024] [Indexed: 01/19/2024]
Abstract
PURPOSE Concurrent chemoradiation is the standard of care for the treatment of anal cancer. Radiation can be delivered by sequential or simultaneous integrated boost (SIB) approach. The present study was conducted to compare the treatment outcomes and toxicity profile of patients with anal cancer treated with sequential boost and SIB approach. METHODS A single-institution retrospective analysis of patients with squamous cell carcinoma of the anal canal treated between 2019 and 2022 with radical chemoradiation was performed. The sequential boost schedule consisted of 45 Gy in 25 fractions (1.8 Gy daily) to the gross tumor, nodes, and elective nodal volume, followed by a 9 Gy in five fractions boost to the gross disease. Patients receiving SIB were treated as per RTOG 0529 protocol. In both the groups, patients were treated with volumetric modulated arc therapy (VMAT). The two groups were compared in terms of overall survival (OS), colostomy-free survival (CFS), relapse-free survival (RFS), and acute toxicity profile. p-values < 0.05 were considered statistically significant. RESULTS The patient and disease characteristics in both treatment arms were comparable. The only difference was a significantly longer overall treatment time of ≥ 50 days in the sequential arm (77.8% vs 43.8%, p = 0.04). The median follow-up was 18 months. The 2-year CFS was 80% in sequential vs 87.5% at 2 years for the SIB arm, 2-year OS 83.3% vs 58.6%, and 2-year RFS was 38.9% vs 41.7%, respectively. A total of 14 (77.8%) in sequential and 8 (50%) in the SIB arm had disease relapse. On univariate analysis, the involved pelvic lymph node significantly affected OS (HR 10.45, p = 0.03) while inguinal lymph node involvement adversely affected RFS (HR 6.16, p = 0.02). The most common acute toxicity was radiation-induced dermatitis, 15 (83.4%; 5 grade II, 10 grade III) in sequential vs 7 (43.8%; 3 each grade II and III) in the SIB group followed by hematological (61.1% vs 68.75%). However, the incidence of overall acute toxicities was significantly less in the SIB arm (p = 0.006). CONCLUSION Our study showed that concurrent chemoradiation with the SIB-VMAT approach is well tolerated in patients of anal carcinoma and resulted in lesser treatment interruptions and comparable outcomes as compared to the sequential approach. Our results warrant further evaluation in a prospective study.
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Affiliation(s)
- Divya Khosla
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rakesh Kapoor
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Treshita Dey
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Vaishali Kataria
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ranjit Singh
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Divyesh Kumar
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arun Singh Oinam
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajesh Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Surinder Singh Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Jimil Shah
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Harjeet Singh
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Santhosh Irrinki
- Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Renu Madan
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Hadj Henni A, Arhoun I, Boussetta A, Daou W, Marque A. Enhancing dosimetric practices through knowledge-based predictive models: a case study on VMAT prostate irradiation. Front Oncol 2024; 14:1320002. [PMID: 38304869 PMCID: PMC10832012 DOI: 10.3389/fonc.2024.1320002] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/05/2024] [Indexed: 02/03/2024] Open
Abstract
Introduction Acquisition of dosimetric knowledge by radiation therapy planners is a protracted and complex process. This study delves into the impact of empirical predictive models based on the knowledge-based planning (KBP) methodology, aimed at detecting suboptimal results and homogenizing and improving existing practices for prostate cancer. Moreover, the dosimetric effect of implementing these models into routine clinical practice was also assessed. Materials and methods Based on the KBP method, we analyzed 25 prostate treatment plans performed using VMAT by expert operators, aiming to correlate dose indicators with patient geometry. The D a v g C a v ( G y ) , V 45 G y C a v ( c c ) , and V 15 G y C a v ( c c ) of the peritoneal cavity and the V 60 G y ( % ) and V 70 G y ( % ) of the rectum and bladder were linked to geometric characteristics such as the distance from the planning target volume (PTV) to the organs at risk (OAR), the volume of the OAR, or the overlap between the PTV and the OAR. In the second phase, the KBP was used in routine clinical practice in a prospective cohort of 25 patients and compared with the 41 patient plans calculated before implementing the tool. Results Using linear regression, we identified strong geometric predictive factors for the peritoneal cavity, rectum, and bladder (R 2 > 0.8), with an average prescribed dose of 97.8%, covering 95% of the target volume. The use of the model led to a significant dose reduction ( Δ ) for all evaluated OARs. This trend was most notable for Δ V 15 G y C a v = - 171.5 cc ( p = 0.003 ) . Significant reductions were also obtained in average doses to the rectum and bladder, Δ D a v g R e c t = - 2.3 G y ( p = 0.040 ) , and Δ D a v g V e s s = - 3.3 G y ( p = 0.039 ) respectively. Based on this model, we reduced the number of plans with OAR constraints above the clinical recommendations from 19% to 8%. Conclusions The KBP methodology established a robust and personalized predictive model for dose estimation to organs at risk in prostate cancer. Implementing the model resulted in improved sparing of these organs. Notably, it yields a solid foundation for harmonizing dosimetric practices, alerting us to suboptimal results, and improving our knowledge.
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Affiliation(s)
- Ahmed Hadj Henni
- Radiation Oncology Department, Centre Frederic Joliot, Rouen, France
| | - Ilias Arhoun
- Radiation Oncology Department, Centre Frederic Joliot, Rouen, France
| | | | - Walid Daou
- Mohammed VI Polytechnic University, Ben Guerir, Morocco
| | - Alexandre Marque
- Radiation Oncology Department, Centre Frederic Joliot, Rouen, France
- Oncology Department, Clinique Saint Hilaire, Rouen, France
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Konstantinou E, Varveris A, Solomou G, Antoniadis C, Tolia M, Mazonakis M. Radiation Dose to Critical Cardiac Structures from Three-Dimensional Conformal Radiation Therapy (3D-CRT), Intensity-Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy ( VMAT) Techniques for Left-Sided Breast Cancer. J Pers Med 2024; 14:63. [PMID: 38248764 PMCID: PMC10817491 DOI: 10.3390/jpm14010063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 01/23/2024] Open
Abstract
A comparison of the radiation exposure to the left anterior descending artery (LAD) and left ventricle (LV) was performed for twenty-three left breast cancer patients. For each participant, two tangential fields 3D-CRT, two- and seven-field IMRT and two and four partial arcs VMAT plans were created. Dose constraints for CTV, ipsilateral lung and heart were followed. The V40Gy, V30Gy, Dav of LAD and V23Gy, V5Gy, Dav of LV were calculated and extracted from the plans. Parametric and non-parametric tests were applied to compare the parameters derived from the five treatment techniques. All generated plans fulfilled the dose constraints. The Dav ranges of the LAD and LV from all examined techniques were 11.77-14.73 Gy and 5.37-6.40 Gy, respectively. The V40Gy and V30Gy ranges of the LAD were 2.90-12.91% and 10.80-18.51%, respectively. The V23Gy and V5Gy of the LV were 4.29-7.43% and 18.24-30.05%, respectively. The VMAT plans and seven-field IMRT significantly reduced the V40Gy, V30Gy of LAD and V23Gy of LV compared with the two-field treatments (p < 0.05). However, 3D-CRT plans provided statistically lower values for V5Gy of LV over the other techniques (p < 0.05). The presented results provide a detailed dataset of the radiation burden of two critical cardiac structures from five radiotherapy techniques.
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Affiliation(s)
- Evgenia Konstantinou
- Department of Medical Physics, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Antonis Varveris
- Department of Radiotherapy and Oncology, University General Hospital of Heraklion, 71110 Heraklion, Greece
| | - Georgia Solomou
- Department of Medical Physics, University General Hospital of Heraklion, 71110 Heraklion, Greece
| | - Chrysostomos Antoniadis
- Department of Radiotherapy and Oncology, University General Hospital of Heraklion, 71110 Heraklion, Greece
| | - Maria Tolia
- Department of Radiotherapy and Oncology, University General Hospital of Heraklion, 71110 Heraklion, Greece
| | - Michalis Mazonakis
- Department of Medical Physics, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
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Claessens M, De Kerf G, Vanreusel V, Mollaert I, Hernandez V, Saez J, Jornet N, Verellen D. Multi-institutional generalizability of a plan complexity machine learning model for predicting pre-treatment quality assurance results in radiotherapy. Phys Imaging Radiat Oncol 2024; 29:100525. [PMID: 38204910 PMCID: PMC10776441 DOI: 10.1016/j.phro.2023.100525] [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: 07/27/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024] Open
Abstract
Background and purpose Treatment plans in radiotherapy are subject to measurement-based pre-treatment verifications. In this study, plan complexity metrics (PCMs) were calculated per beam and used as input features to develop a predictive model. The aim of this study was to determine the robustness against differences in machine type and institutional-specific quality assurance (QA). Material and methods A number of 567 beams were collected, where 477 passed and 90 failed the pre-treatment QA. Treatment plans of different anatomical regions were included. One type of linear accelerator was represented. For all beams, 16 PCMs were calculated. A random forest classifier was trained to distinct between acceptable and non-acceptable beams. The model was validated on other datasets to investigate its robustness. Firstly, plans for another machine type from the same institution were evaluated. Secondly, an inter-institutional validation was conducted on three datasets from different centres with their associated QA. Results Intra-institutionally, the PCMs beam modulation, mean MLC gap, Q1 gap, and Modulation Complexity Score were the most informative to detect failing beams. Eighty-tree percent of the failed beams (15/18) were detected correctly. The model could not detect over-modulated beams of another machine type. Inter-institutionally, the model performance reached higher accuracy for centres with comparable equipment both for treatment and QA as the local institute. Conclusions The study demonstrates that the robustness decreases when major differences appear in the QA platform or in planning strategies, but that it is feasible to extrapolate institutional-specific trained models between centres with similar clinical practice. Predictive models should be developed for each machine type.
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Affiliation(s)
- Michaël Claessens
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk (Antwerp), Belgium
- Centre for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Antwerp, Belgium
| | - Geert De Kerf
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk (Antwerp), Belgium
| | - Verdi Vanreusel
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk (Antwerp), Belgium
- Centre for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Antwerp, Belgium
- Research in Dosimetric Applications (RDA), SCK CEN, Mol (Antwerp), Belgium
| | - Isabelle Mollaert
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk (Antwerp), Belgium
| | - Victor Hernandez
- Department of Medical Physics, Hospital Sant Joan de Reus, IISPV, 43204 Tarragona, Spain
| | - Jordi Saez
- Department of Radiation Oncology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Núria Jornet
- Servei de Radiofísica i Radioprotecció, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Dirk Verellen
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk (Antwerp), Belgium
- Centre for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Antwerp, Belgium
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Yoshimura N, Fujiwara M, Igeta M, Suzuki H, Kunimoto R, Terada T, Shinoda Y, Nakamura M, Fukutake J, Takaki H, Yamakado K. Risk Factors Causing Hypothyroidism in Patients With Head and Neck Cancer After Radiotherapy Using SIB- VMAT. Anticancer Res 2024; 44:323-329. [PMID: 38159971 DOI: 10.21873/anticanres.16815] [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: 11/14/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND/AIM We evaluated the incidence of radiation-induced hypothyroidism and its risk factors in patients with head and neck cancer who underwent radiotherapy using simultaneous integrated boost-volumetric-modulated arc therapy (SIB-VMAT). PATIENTS AND METHODS This retrospective study included 86 patients who received definitive radiotherapy using SIB-VMAT for head and neck cancer. The incidence of ≥ grade 2 hypothyroidism was evaluated. We also evaluated the relationships between hypothyroidism development and clinical factors and thyroid dose-volume parameters. RESULTS During a median follow-up period of 17 months (range=3-65 months), 31 patients (36.0%, 31/86) developed grade 2 hypothyroidism requiring hormone replacement therapy. No patients experienced ≥ grade 3 hypothyroidism. The cumulative incidences of hypothyroidism at 1 and 2 years after radiation therapy were 24.5% and 38.7%, respectively, with a median onset time of 10.0 months (range=3.0-35.0 months). Thyroid volume (p=0.003), volume of the thyroid spared at 60 Gy (VS60; cut-off value, 5.16 ml; p=0.009), VS70 (cut-off value, 8.0 ml; p=0.007), VS60 equivalent dose in 2 Gy fraction (EQD2; cut-off value, 7.78 ml; p=0.001), and VS70EQD2 (cut-off value, 10.59 ml; p=0.008) were significantly associated with the development of radiation-induced hypothyroidism. CONCLUSION Radiation-induced hypothyroidism is not rare in patients with head and neck cancer undergoing radiotherapy using SIB-VMAT. Radiation dose-volume parameters detected in this study may be useful indicators to prevent this complication.
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Affiliation(s)
| | | | - Masataka Igeta
- Department of Biostatistics, Hyogo Medical University, Hyogo, Japan
| | - Hitomi Suzuki
- Department of Radiology, Hyogo Medical University, Hyogo, Japan
| | - Ryo Kunimoto
- Department of Radiology, Hyogo Medical University, Hyogo, Japan
| | - Tomonori Terada
- Department of Otolaryngology-Head and Neck Surgery, Hyogo Medical University, Hyogo, Japan
| | - Yuichiro Shinoda
- Department of Otolaryngology-Head and Neck Surgery, Hyogo Medical University, Hyogo, Japan
| | - Masataka Nakamura
- Department of Otolaryngology-Head and Neck Surgery, Hyogo Medical University, Hyogo, Japan
| | - Junko Fukutake
- Department of Otolaryngology-Head and Neck Surgery, Hyogo Medical University, Hyogo, Japan
| | - Haruyuki Takaki
- Department of Radiology, Hyogo Medical University, Hyogo, Japan
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Ayuthaya IIN, Sanghangthum T, Oonsiri P, Oonsiri S, Keawsamur M, Ruangchan S, Vannavijit C, Kanphet J, Kingkaew S, Vimolnoch M, Tawonwong T, Plangpleng N. Multi-planner validation of RapidPlan knowledge-based model for volumetric modulated arc therapy in prostate cancer. J Appl Clin Med Phys 2024; 25:e14223. [PMID: 38009569 PMCID: PMC10795433 DOI: 10.1002/acm2.14223] [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: 05/23/2023] [Revised: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE To investigate the performance of a model-based optimization process for volumetric modulated arc therapy (VMAT) applied to prostate cancer patients with the multi-planner. METHODS AND MATERIALS The 120 prostate plans for VMAT treatment were entered into the database system of the RapidPlan (RP) knowledge-based treatment planning. The treatment planning data for each plan was used to create and train the RP model. Twelve prostate cancer cases were selected and were used for planning by a manual of 12 planners based on the clinical protocol for dose constraints. Then, the treatment plans for each patient were compared with the RP model plans and analyzed with Wilcoxon tests. RESULTS On average, the RP models can estimate comparable doses among all planner plans and clinical plans for the PTV, which Dmax , D95% , D98% , HI, and CI were used to evaluate. For the normal organ doses of the bladder, rectum, penile bulb, and femoral head, all RP model plans showed comparable or better dose sparing than all planner plans and clinical plans. Moreover, the average planning time of the RP model was faster than manual plans by about two times. The RP model can significantly reduce the variation dose of the normal organs compared with the manual plans among the planners. CONCLUSION The automated plans of the RP model might benefit from further fine-tuning of the dose constraints of the normal organs, although both procedure plans are acceptable and fulfill the clinical protocol goals so that the RP model can enhance the efficacy and quality of plans.
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Affiliation(s)
- Isra Israngkul Na Ayuthaya
- Division of Radiation OncologyDepartment of RadiologyKing Chulalongkorn Memorial HospitalBangkokThailand
| | - Taweap Sanghangthum
- Division of Radiation OncologyDepartment of RadiologyFaculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Puntiwa Oonsiri
- Division of Radiation OncologyDepartment of RadiologyKing Chulalongkorn Memorial HospitalBangkokThailand
| | - Sornjarod Oonsiri
- Division of Radiation OncologyDepartment of RadiologyKing Chulalongkorn Memorial HospitalBangkokThailand
| | - Mintra Keawsamur
- Division of Radiation OncologyDepartment of RadiologyKing Chulalongkorn Memorial HospitalBangkokThailand
| | - Sirinya Ruangchan
- Division of Radiation OncologyDepartment of RadiologyKing Chulalongkorn Memorial HospitalBangkokThailand
| | - Chulee Vannavijit
- Division of Radiation OncologyDepartment of RadiologyKing Chulalongkorn Memorial HospitalBangkokThailand
| | - Jaruek Kanphet
- Division of Radiation OncologyDepartment of RadiologyKing Chulalongkorn Memorial HospitalBangkokThailand
| | - Sakda Kingkaew
- Division of Radiation OncologyDepartment of RadiologyKing Chulalongkorn Memorial HospitalBangkokThailand
| | - Mananchaya Vimolnoch
- Division of Radiation OncologyDepartment of RadiologyKing Chulalongkorn Memorial HospitalBangkokThailand
| | - Tanawat Tawonwong
- Division of Radiation OncologyDepartment of RadiologyKing Chulalongkorn Memorial HospitalBangkokThailand
| | - Nuttha Plangpleng
- Division of Radiation OncologyDepartment of RadiologyKing Chulalongkorn Memorial HospitalBangkokThailand
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Seravalli E, Willemsen-Bosman M, Zoetelief A, Roosenboom S, Harderwijk T, Krikke L, Bol G, Kotte A, Huijboom E, van Loon K, Hoeben B. Treatment robustness of total body irradiation with volumetric modulated arc therapy. Phys Imaging Radiat Oncol 2024; 29:100537. [PMID: 38292651 PMCID: PMC10827537 DOI: 10.1016/j.phro.2024.100537] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 02/01/2024] Open
Abstract
This study evaluated the robustness of multi-isocenter Volumetric Modulated Arc Therapy Total Body Irradiation dose distribution in the overlapping region between the head-first and feet-first computed tomography scans, considering the longitudinal isocenter shifts recorded during treatment delivery. For 15 out of 22 patients, the dose distribution in the overlapping region fulfilled all three the robustness criteria. The overlapping region dose distribution of the remaining 7 cases fulfilled two robustness criteria. The dose distribution was found to be robust against daily recorded longitudinal isocenter shifts, as a consequence of the patient position verification procedure, of up to 16 mm.
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Affiliation(s)
- Enrica Seravalli
- University Medical Center Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands
| | - Mirjam Willemsen-Bosman
- University Medical Center Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands
| | - Annelies Zoetelief
- University Medical Center Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands
| | - Sanne Roosenboom
- University Medical Center Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands
| | - Tessa Harderwijk
- University Medical Center Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands
| | - Lean Krikke
- University Medical Center Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands
| | - Gijsbert Bol
- University Medical Center Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands
| | - Alexis Kotte
- University Medical Center Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands
| | - Eline Huijboom
- University Medical Center Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands
| | - Karel van Loon
- University Medical Center Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands
| | - Bianca Hoeben
- University Medical Center Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands
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Kim H, Lee JW, Hong S. Feasibility of Customized Thermoplastic Patient-Specific Helmet Bolus for Scalp Irradiation Using Volumetric-Modulated Arc Therapy Planning. Technol Cancer Res Treat 2024; 23:15330338241241898. [PMID: 38557213 PMCID: PMC10983790 DOI: 10.1177/15330338241241898] [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: 11/05/2023] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction: In this study, we sought to develop a thermoplastic patient-specific helmet bolus that could deliver a uniform therapeutic dose to the target and minimize the dose to the normal brain during whole-scalp treatment with a humanoid head phantom. Methods: The bolus material was a commercial thermoplastic used for patient immobilization, and the holes in the netting were filled with melted paraffin. We compared volumetric-modulated arc therapy treatment plans with and without the bolus for quantitative dose distribution analysis. We analyzed the dose distribution in the region of interest to compare dose differences between target and normal organs. For quantitative analysis of treatment dose, OSLD chips were attached at the vertex (VX), posterior occipital (PO), right (RT), and left temporal (LT) locations. Results: The average dose in the clinical target volume was 6553.8 cGy (99.3%) with bolus and 5874 cGy (89%) without bolus, differing by more than 10% from the prescribed dose (6600 cGy) to the scalp target. For the normal brain, it was 3747.8 cGy (56.8%) with bolus and 5484.6 cGy (83.1%) without bolus. These results show that while the dose to the treatment target decreased, the average dose to the normal brain, which is mostly inside the treatment target, increased by more than 25%. With the bolus, the OSLD measured dose was 102.5 ± 1.2% for VX and 101.5 ± 1.9%, 95.9 ± 1.9%, and 81.8 ± 2.1% for PO, RT, and LT, respectively. In addition, the average dose in the treatment plan was 102%, 101%, 93.6%, and 80.7% for VX, PO, RT, and LT. When no bolus was administered, 59.6 ± 2.4%, 112.6 ± 1.8%, 47.1 ± 1.6%, and 53.1 ± 2.3% were assessed as OSLD doses for VX, PO, RT, and LT, respectively. Conclusion: This study proposed a method to fabricate patient-specific boluses that are highly reproducible, accessible, and easy to fabricate for radiotherapy to the entire scalp and can effectively spare normal tissue while delivering sufficient surface dose.
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Affiliation(s)
- Heesoo Kim
- Konkuk University, Seoul, Republic of Korea
- Yonsei Cancer Center, Seoul, Republic of Korea
| | - Jeong-Woo Lee
- Konkuk University, Seoul, Republic of Korea
- Konkuk University Medical Center, Seoul, Republic of Korea
| | - Semie Hong
- Konkuk University, Seoul, Republic of Korea
- Konkuk University Medical Center, Seoul, Republic of Korea
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Alaimo R, Ippolito E, Falconi R, Perrone Congedi F, Sciommari C, Silipigni S, Pellegrini R, Carnevale A, Greco C, Fiore M, D’Angelillo RM, Ramella S. Breast Volume Is a Predictor of Higher Heart Dose in Whole-Breast Supine Free-Breathing Volumetric-Modulated Arc Therapy Planning. Curr Oncol 2023; 30:10530-10538. [PMID: 38132402 PMCID: PMC10742666 DOI: 10.3390/curroncol30120768] [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: 11/23/2023] [Revised: 11/23/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
In breast cancer volumetric-modulated arc therapy (VMAT) planning, the rotation of the gantry around the target implies a greater dose spreading to the whole heart, compared to tangential-field standard treatment. A consecutive cohort of 121 breast cancer patients treated with the VMAT technique was investigated. The correlation of breast volume, heart volume and lung volume with mean heart dose (mHD) and mean and maximum LAD dose (mLAD dose, MLAD dose) was tested, and a subsequent a linear regression analysis was carried out. VMAT treatment plans from 56 left breast cancer and 65 right breast cancer patients were analyzed. For right-sided patients, breast volume was significantly correlated with mHD, mLAD and MLAD dose, while for left-sided patients, breast volume was significantly correlated with mHD and mLAD, while heart volume and lung volume were correlated with mHD, mLAD and MLAD dose. Breast volume was the only predictor of increased heart and LAD dose (p ≤ 0.001) for right-sided patients. In left-sided patients, heart and lung were also predictors of increased mHD (p = 0.005, p ≤ 0.001) and mean LAD dose (p = 0.009, p ≤ 0.001). In this study, we observed an increase in heart and LAD doses in larger-breasted patients treated with VMAT planning. In right-sided patients, breast volume was shown to be the only predictor of increased heart dose and LAD dose.
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Affiliation(s)
- Rita Alaimo
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
| | - Edy Ippolito
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
- Department of Radiation Oncology (Medicine and Surgery), Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Rita Falconi
- Medical Physics Unit, S. Filippo Neri Hospital, ASL Roma 1, 00135 Rome, Italy;
| | - Francesca Perrone Congedi
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
| | - Cecilia Sciommari
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
| | - Sonia Silipigni
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
| | | | - Alessia Carnevale
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
| | - Carlo Greco
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
- Department of Radiation Oncology (Medicine and Surgery), Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Michele Fiore
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
- Department of Radiation Oncology (Medicine and Surgery), Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | | | - Sara Ramella
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
- Department of Radiation Oncology (Medicine and Surgery), Università Campus Bio-Medico di Roma, 00128 Rome, Italy
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Akdeniz Y, Ispir B. Whole-brain radiotherapy with hippocampus sparing and simultaneous integrated boost to metastases: A plan quality comparison study between Ethos, HyperArc, VMAT and Tomotherapy. Med Dosim 2023:S0958-3947(23)00112-7. [PMID: 38101995 DOI: 10.1016/j.meddos.2023.11.004] [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: 08/13/2023] [Accepted: 11/10/2023] [Indexed: 12/17/2023]
Abstract
This study provides a concise and structured overview of a dosimetric comparison study conducted to assess the feasibility and effectiveness of 4 advanced radiotherapy techniques in treating brain metastases with hippocampus sparing and simultaneous integrated boost (HS-WBRT+SIB). Eleven patients with brain metastases previously treated with radiotherapy were included in the study. Planning CT scans with 2 mm slice thickness and MR imaging were used for contouring and dose prescription. The bilateral hippocampus and other organs at risk (OARs) were automatically contoured, and hippocampal avoidance regions (HAR) were defined as a 7 mm 3D expansion around the hippocampus. Gross tumor volume for each metastasis (GTVmet) and planning target volume for metastases (PTVmet) were delineated. The whole-brain CTV (CTVWB) and planning target volume for whole brain (PTVWB) were defined accordingly. Treatment planning and optimization were conducted using state-of-the-art radiotherapy techniques: Ethos, HyperArc, VMAT, and Tomotherapy. Tomotherapy achieved the highest D98% for PTVmet, indicating the best metastasis coverage. HyperArc plans showed the highest D98% for PTVWB, suggesting superior whole-brain coverage. Tomotherapy demonstrated significantly lower D98%, D2%, and Dmean values for the hippocampus, indicating its superiority in sparing the hippocampus. VMAT resulted in the lowest D2% values for the eyes, optic nerves, brainstem, and hypophysis, showing the best sparing of these critical structures. Tomotherapy consistently achieved lower Dmean values for parotids, oral cavity, and lips compared to the other techniques. The dosimetric comparison revealed distinct strengths and weaknesses for each radiotherapy technique. Tomotherapy excelled in sparing the hippocampus, while VMAT showed promise in sparing OARs. HyperArc plans demonstrated the best overall whole-brain coverage. These findings should guide clinicians in selecting the most suitable technique based on patient characteristics and institutional resources.
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Affiliation(s)
- Yucel Akdeniz
- Radiation Oncology Department, Acıbadem Adana Hospital, Adana, Turkey.
| | - Burcin Ispir
- Radiation Oncology Department, Acıbadem Ataşehir Hospital, İstanbul, Turkey
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Ferenczi Ö, Major T, Fröhlich G, Béla D, Tódor S, Polgár C, Akiyama H, Bukovszky B, Takácsi-Nagy Z. Dosimetric comparison of postoperative interstitial high-dose-rate brachytherapy and modern external beam radiotherapy modalities in tongue and floor of the mouth tumours in terms of doses to critical organs. Radiol Oncol 2023; 57:516-523. [PMID: 38038418 PMCID: PMC10690754 DOI: 10.2478/raon-2023-0050] [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: 05/19/2023] [Accepted: 08/23/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND The aim of the study was to dosimetrically compare interstitial high-dose-rate (HDR) brachytherapy (BT) and modern external beam radiotherapy modalities, as volumetric modulated arc therapy (VMAT) and stereotactic radiotherapy with Cyberknife (CK) of tumours of the tongue and floor of the mouth in terms of dose to the critical organs. PATIENTS AND METHODS In National Institute of Oncology, Budapest, between March 2013 and August 2022 twenty patients (11 male/9 female) with stage T1-3N0M0 tongue (n = 14) and floor of mouth (n = 6) tumours received postoperative radiotherapy because of close/positive surgical margin and/or lymphovascular and/or perineural invasion. High-dose-rate interstitial brachytherapy applying flexible plastic catheters with a total dose of 15 × 3 Gy was used for treatment. In addition to BT plans VMAT and stereotactic CK plans were also made in all cases, using the same fractionation scheme and dose prescription. As for the organs at risk, the doses to the mandible, the ipsilateral and the contralateral salivary glands were compared. RESULTS The mean volume of the planning target volume (PTV) was 12.5 cm3, 26.5 cm3 and 17.5 cm3 in BT, VMAT and CK techniques, respectively, due to different safety margin protocols. The dose to the mandible was the most favourable with BT, as for the salivary glands (parotid and submandibular) the CK technique resulted in the lowest dose. The highest dose to the critical organs was observed with the VMAT technique. The mean values of D2cm3 and D0.1cm3 for the critical organs were as follows for BT, VMAT and CK plans: 47.4% and 73.9%, 92.2% and 101.8%, 68.4% and 92.3% for the mandible, 4.8% and 6.7%, 7.3% and 13.8%, 2.3% and 5.1% for the ipsilateral parotid gland, 3.5% and 4.9%, 6.8% and 10.9%, 1.5% and 3.3% for the contralateral parotid gland, 7.3% and 9.4%, 9.0% and 14.3%, 3.6% and 5.6% for the contralateral submandibular gland. CONCLUSIONS The present results confirm that BT, despite being an invasive technique, is dosimetrically clearly beneficial in the treatment of oral cavity tumours and is a modality worth considering when applying radiotherapy, not only as definitive treatment, but also postoperatively. The use of the CK in the head and neck region requires further investigation.
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Affiliation(s)
- Örs Ferenczi
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Tibor Major
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
- Department of Oncology, Semmelweis University, Budapest, Hungary
- National Tumour Biology Laboratory, National Institute of Oncology, Budapest, Hungary
| | - Georgina Fröhlich
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
- Eötvös Loránd University, Faculty of Science, Budapest, Hungary
| | - Dalma Béla
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Szabolcs Tódor
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Csaba Polgár
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
- Department of Oncology, Semmelweis University, Budapest, Hungary
- National Tumour Biology Laboratory, National Institute of Oncology, Budapest, Hungary
| | - Hironori Akiyama
- Department of Oral Radiology, Osaka Dental University, Osaka, Japan
| | - Botond Bukovszky
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
- Department of Oncology, Semmelweis University, Budapest, Hungary
- Department of Oral Diagnostics, Semmelweis University, Budapest, Hungary
| | - Zoltán Takácsi-Nagy
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
- Department of Oncology, Semmelweis University, Budapest, Hungary
- National Tumour Biology Laboratory, National Institute of Oncology, Budapest, Hungary
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Hernández KVD, Unterkirhers S, Schneider U. Quality assessment of automatically planned O-Ring linac SBRT plans for pelvic lymph node metastases, finding the optimal minimum target size by comparison with robotic SBRT. J Appl Clin Med Phys 2023; 24:e14143. [PMID: 37738649 PMCID: PMC10691630 DOI: 10.1002/acm2.14143] [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: 02/20/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/24/2023] Open
Abstract
PURPOSE The purpose of this study is to assess the quality of automatic planned O-Ring Halcyon linac SBRT plans for pelvic lymph node metastases and to establish an absolute PTV volume threshold as a plan quality prediction criterion. Compliance of the plans to institutional SBRT plan evaluation criteria and differences in plan quality and treatment delivery times between Halcyon Linac and CyberKnife robotic SBRT were evaluated. METHODS Twenty-one CyberKnife treatment plans were replanned for Halcyon. Prescription doses range was 26-40 Gy in mean three fractions. The mean/median planning target volume was 4.0/3.6 cm3 . Institutional criteria for the plan evaluation were: New Conformity Index (NCI), Conformity Index (CI), Modified Gradient Index (MGI), selectivity index reciprocal (PIV/TVPIV ), and the target coverage by prescription isodose (%PIV). Statistical analysis based on the receiver operating characteristic (ROC) curve was used to determine a plan quality predictor threshold of the PTV volume. Comparative analysis of normal tissue complication probabilities (NTCP) was used to assess the risk of toxicity in healthy tissues. RESULTS Seventy-one percent (n = 15)/95% (n = 20) of Halcyon and 81% (n = 17)/100% (n = 21) of CK plans fulfilled all ideal/tolerance criteria. For PTVs above a found optimal threshold of 2.6 cm3 (71%, n = 15), no statistically significant difference was observed between the CI, NCI, PIV/TVPIV , and MGI indexes of both groups, while the coverage (%PIV) was statistically but not clinically significantly different between cohorts. Significantly shorter delivery times are expected with Halcyon. No significant differences in NTCP were observed. CONCLUSION All but one automatically optimized Halcyon treatment plans demonstrated ideal or acceptable performance. PTV threshold of 2.6 cm3 can be used as decision criteria in clinical settings. The results of our study demonstrated the promising performance of the Halcyon for pelvic SBRT, although plan-specific QA is required to verify machine performance during plan delivery.
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Affiliation(s)
| | | | - Uwe Schneider
- Science FacultyUniversity of ZürichZürichSwitzerland
- Medical PhysicsRadiotherapy HirslandenZürichSwitzerland
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Funderud M, Hoem IS, Guleng MAD, Eidem M, Almberg SS, Alsaker MD, Ståhl-Kornerup J, Frengen J, Marthinsen ABL. Script-based automatic radiotherapy planning for cervical cancer. Acta Oncol 2023; 62:1798-1807. [PMID: 37881003 DOI: 10.1080/0284186x.2023.2267171] [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: 05/31/2023] [Accepted: 10/01/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND This study aimed to develop fully automated script-based radiotherapy treatment plans for cervical cancer patients, and evaluate them against clinically accepted plans, as validation before clinical implementation. MATERIAL AND METHODS In this retrospective planning study, treatment plans for 25 locally advanced cervical cancer (LACC) patients with up to three dose levels were included. Fully automated plans were created using an in-house developed Python script in RayStation, and compared to clinically accepted manually made plans. Quantitatively, relevant dose statistics were compared, and average dose volume histograms (DVHs) were analyzed. Qualitatively, a blinded plan comparison was conducted between the clinical and automatic plans. The accuracy of treatment plan delivery was verified with the Delta4 Phantom+. RESULTS The quantitative evaluation showed that target coverage was acceptable for all the automatic and clinical plans. The automatic plans were significantly more conformal than the clinical plans; median of 1.03 vs. 1.12. Mean doses to almost all organs at risk (OARs) were reduced in the automatic plans, with a median reduction of between 0.6 Gy and 1.9 Gy. In the blinded plan comparison, the automatic plans were the preferred plans or of equal quality as the clinical plans in 99% of the cases. In addition, plan delivery was excellent, with a mean gamma passing rate of 99.8%. Complete script-based plans were generated in 30-45 min; about four to ten times faster than manually made plans. CONCLUSION The automatic plans had acceptable target coverage, lower doses to almost all OARs, more conformal dose distributions, and were predominantly preferred by the clinicians. Based on these results, our institution has implemented the script for clinical use.
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Affiliation(s)
- Marit Funderud
- Department of Radiotherapy, St. Olavs Hospital, Trondheim, Norway
| | - Ingvild Straumsheim Hoem
- Department of Radiotherapy, St. Olavs Hospital, Trondheim, Norway
- Department of Physics, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | - Monika Eidem
- Department of Radiotherapy, St. Olavs Hospital, Trondheim, Norway
| | | | | | | | - Jomar Frengen
- Department of Radiotherapy, St. Olavs Hospital, Trondheim, Norway
| | - Anne Beate Langeland Marthinsen
- Department of Radiotherapy, St. Olavs Hospital, Trondheim, Norway
- Department of Physics, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Saito M, Komiyama T, Marino K, Aoki S, Akita T, Matsuda M, Sano N, Suzuki H, Koji U, Nemoto H, Onishi H. Dosimetric comparison of five different radiotherapy treatment planning approaches for locally advanced non-small cell lung cancer with sequential plan changes. Thorac Cancer 2023; 14:3445-3452. [PMID: 37846145 PMCID: PMC10719662 DOI: 10.1111/1759-7714.15137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/24/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The purpose of this study was to compare the dosimetric characteristics of five different treatment planning techniques for locally advanced non-small cell lung cancer (LA-NSCLC) with sequential plan changes. METHODS A total of 13 stage III NSCLC patients were enrolled in this study. These patients had both computed tomography (CT) images for initial and boost treatment plans. The latter CT images were taken if tumor shrinkage was observed after 2 weeks of treatment. The prescription dose was 60 Gy/30 Fr (initial: 40 Gy/20 Fr, and boost: 20 Gy/10 Fr). Five techniques (forward-planed 3-dimensional conformal radiotherapy [F-3DCRT] on both CT images, inverse-planned 3DCRT [I-3DCRT] on both CT images, volumetric modulated arc therapy [VMAT] on both CT images, F-3DCRT on initial CT plus VMAT on boost CT [bVMAT], and hybrid of fixed intensity-modulated radiotherapy [IMRT] beams and VMAT beams on both CT images [hybrid]) were recalculated for all patients. The accumulated doses between initial and boost plans were compared among all treatment techniques. RESULTS The conformity indexes (CI) of the planning target volume (PTV) of the five planning techniques were 0.34 ± 0.10, 0.57 ± 0.10, 0.86 ± 0.08, 0.61 ± 0.12, and 0.83 ± 0.11 for F-3DCRT, I-3DCRT, VMAT, bVMAT, and hybrid, respectively. In the same manner, lung volumes receiving >20 Gy (V20Gy ) were 21.05 ± 10.56%, 20.86 ± 6.45, 19.50 ± 7.38%, 19.98 ± 10.04%, and 17.74 ± 7.86%. There was significant improvement about CI and V20Gy for hybrid compared with F-3DCRT (p < 0.05). CONCLUSION The IMRT/VMAT hybrid technique for LA-NSCLC patients improved target CI and reduced lung doses. Furthermore, if IMRT was not available initially, starting with 3DCRT might be beneficial as demonstrated in the bVMAT procedure of this study.
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Affiliation(s)
- Masahide Saito
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | | | - Kan Marino
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Shinichi Aoki
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Tomoko Akita
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Masaki Matsuda
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Naoki Sano
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Hidekazu Suzuki
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Ueda Koji
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Hikaru Nemoto
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Hiroshi Onishi
- Department of RadiologyUniversity of YamanashiYamanashiJapan
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Yoganathan SA, Ahmed S, Paloor S, Torfeh T, Aouadi S, Al-Hammadi N, Hammoud R. Virtual pretreatment patient-specific quality assurance of volumetric modulated arc therapy using deep learning. Med Phys 2023; 50:7891-7903. [PMID: 37379068 DOI: 10.1002/mp.16567] [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: 01/11/2023] [Revised: 05/16/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Automatic patient-specific quality assurance (PSQA) is recently explored using artificial intelligence approaches, and several studies reported the development of machine learning models for predicting the gamma pass rate (GPR) index only. PURPOSE To develop a novel deep learning approach using a generative adversarial network (GAN) to predict the synthetic measured fluence. METHODS AND MATERIALS A novel training method called "dual training," which involves the training of the encoder and decoder separately, was proposed and evaluated for cycle GAN (cycle-GAN) and conditional GAN (c-GAN). A total of 164 VMAT treatment plans, including 344 arcs (training data: 262, validation data: 30, and testing data: 52) from various treatment sites, were selected for prediction model development. For each patient, portal-dose-image-prediction fluence from TPS was used as input, and measured fluence from EPID was used as output/response for model training. Predicted GPR was derived by comparing the TPS fluence with the synthetic measured fluence generated by the DL models using gamma evaluation of criteria 2%/2 mm. The performance of dual training was compared against the traditional single-training approach. In addition, we also developed a separate classification model specifically designed to detect automatically three types of errors (rotational, translational, and MU-scale) in the synthetic EPID-measured fluence. RESULTS Overall, the dual training improved the prediction accuracy of both cycle-GAN and c-GAN. Predicted GPR results of single training were within 3% for 71.2% and 78.8% of test cases for cycle-GAN and c-GAN, respectively. Moreover, similar results for dual training were 82.7% and 88.5% for cycle-GAN and c-GAN, respectively. The error detection model showed high classification accuracy (>98%) for detecting errors related to rotational and translational errors. However, it struggled to differentiate the fluences with "MU scale error" from "error-free" fluences. CONCLUSION We developed a method to automatically generate the synthetic measured fluence and identify errors within them. The proposed dual training improved the PSQA prediction accuracy of both the GAN models, with c-GAN demonstrating superior performance over the cycle-GAN. Our results indicate that the c-GAN with dual training approach combined with error detection model, can accurately generate the synthetic measured fluence for VMAT PSQA and identify the errors. This approach has the potential to pave the way for virtual patient-specific QA of VMAT treatments.
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Affiliation(s)
- S A Yoganathan
- Department of Radiation Oncology, National Center for Cancer Care & Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Sharib Ahmed
- Department of Radiation Oncology, National Center for Cancer Care & Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Satheesh Paloor
- Department of Radiation Oncology, National Center for Cancer Care & Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Tarraf Torfeh
- Department of Radiation Oncology, National Center for Cancer Care & Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Souha Aouadi
- Department of Radiation Oncology, National Center for Cancer Care & Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Noora Al-Hammadi
- Department of Radiation Oncology, National Center for Cancer Care & Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Rabih Hammoud
- Department of Radiation Oncology, National Center for Cancer Care & Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
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Yang B, Liang Y, He S, Liu Y, Zhang K, Qiu J. Dosimetric comparison of coplanar and noncoplanar volumetric modulated arc therapy for hippocampal-sparing whole-brain radiation therapy. Med Dosim 2023:S0958-3947(23)00073-0. [PMID: 38016886 DOI: 10.1016/j.meddos.2023.08.010] [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: 04/04/2023] [Revised: 06/21/2023] [Accepted: 08/24/2023] [Indexed: 11/30/2023]
Abstract
Whole brain radiation therapy with hippocampal-sparing (HS-WBRT) is a novel treatment of brain metastases, which can relieve symptoms reduce recurrence in the central nervous system, and spare the hippocampus without compromising target coverage. This study aims to find out the superior combination of the treatment planning system and linear accelerator between Eclipse (version 15.6) with TrueBeam and uRT-TPOIS (vision R001.4) with uRT-linac 506c in HS-WBRT. The coplanar and noncoplanar volumetric modulated arc therapy (VMAT) for HS-WBRT plans were evaluated and compared on both combinations, respectively. Twenty patients for HS-WBRT were retrospectively selected at Peking Union Medical College Hospital (PUMCH) from 2021 to 2022. The coplanar and noncoplanar HS-WBRT treatment plans were designed by Eclipse and uRT-TPOIS referring to RTOG 0933 dose criteria, and their dosimetry parameters were compared. In addition, the plan complexity, monitor units, and beam-on time were recorded for Eclipse plans delivered on TrueBeam and uRT-TPOIS plans delivered on uRT-linac 506c. The results demonstrated that the dosimetric criteria of 4 types of HS-WBRT plans could meet the requirements of RTOG 0933. In terms of target coverage, dosimetric indexes of Eclipse plans and uRT-TPOIS plans were comparable, and the former is slightly better. As for metrics of organs-at-risk protection, coplanar and noncoplanar plans conducted by uRT-TPOIS were greatly superior to those by Eclipse. For coplanar and noncoplanar plans designed by the same treatment planning system, most of the dosimetric indexes had no significant difference. The monitor units of uRT-TPOIS plans was higher than that of Eclipse plans, but the modulation complexity of them were close, and uRT-TPOIS with uRT-linac 506c significantly reduced beam-on-time consumption by 9% on average for coplanar plans and 26% for noncoplanar plans compared to Eclipse with TrueBeam. This study firstly compared the coplanar and noncoplanar HS-WBRT treatment plans between Eclipse with TrueBeam and uRT-TPOIS with uRT-linac 506c in terms of dosimetry indexes, modulation complexity, and time consumption. It is shown that the radiation treatment solution of uRT-TPOIS with uRT-linac 506c is comparable with Eclipse with TrueBeam in terms of planning design, and significantly reduced the delivery time, which can be applied in clinical practice and promoted as a treatment format.
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Affiliation(s)
- Bo Yang
- Department of Radiation Oncology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Yongguang Liang
- Department of Radiation Oncology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Shumeng He
- United Imaging Research Institute of Intelligent Imaging, Beijing, 100094, China
| | - Yinglong Liu
- United Imaging Research Institute of Innovative Medical Equipment, Shenzhen, 518045, China
| | - Kang Zhang
- Shanghai United Imaging Healthcare Co., Ltd., Shanghai, 201807, China
| | - Jie Qiu
- Department of Radiation Oncology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China.
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Sundaram V, Khanna D, Mohandass P, Vasudeva T. Comparison of Progressive Resolution Optimizer and Photon Optimizer algorithms in RapidArc delivery for head and neck SIB treatments. Rep Pract Oncol Radiother 2023; 28:623-635. [PMID: 38179289 PMCID: PMC10764045 DOI: 10.5603/rpor.97431] [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: 06/30/2023] [Accepted: 09/05/2023] [Indexed: 01/06/2024] Open
Abstract
Background The aim of this study is to analyze and verify characterization of two different algorithms using simultaneous integrated boost (SIB) in head and neck (H&N) plans. Materials and methods In our study 15 patients were selected, who received radiation therapy by using Eclipse volumetric modulated arc therapy (VMAT) Progressive Resolution Optimizer (PRO) algorithm 15.1. The same cases were re-optimized using a Photon Optimizer (PO) algorithm 15.6.A total of 30 treatment plans (15 PRO-VMAT plans and 15 PO-VMAT plans) were produced in the present study. All plans were created using double full arcs, keeping the identical constraints, cost functions and optimization time. Plan evaluation was done using planning target volume (PTV) parameters (D98%, D95%, D50%, D2% mean dose and V105%), homogeneity index (HI), conformity index (CI), Monitor unit (MU) per degree with control points (CP), organ at risk (OAR) doses and gamma verification (Portal dosimetry and ArcCHECK) values were evaluated. Treatment was delivered in Varian Truebeam 2.5, energy 6 MV with Millennium 120 multileaf collimator (MLC). Results The PTV coverage (D95%) for PRO and PO were 98.7 ± 0.8 Gy, 98.8 ± 0.9 Gy, HI were 0.09 ± 0.02 and 0.09 ± 0.02, CI were 0.98 ± 0.01 and 0.99 ± 0.01. Monitor units (MU) for PRO and PO were 647.5 ± 137.9, 655.2 ± 138.4. The Portal dose results were [3%, 3mm (%) & 1 %, 1 mm (%)] for PO and PRO 100 ± 0.1, 95.1 ± 1.4 and 100 ± 0.1, 95.2 ± 1.3. For ArcCHECK were 99.9 ± 0.1, 94.7 ± 3.0 and 99.9 ± 0.1, 93.5 ± 3.9, respectively. Conclusion Results showed that PTV coverage and OAR doses were comparable. For individual patients CI and HI of PO showed slightly higher values than PRO. MUs for PO were slightly increased as compared to PRO. MU per degree with each individual control points generated by PO showed a high degree of modulation compared to PRO. Hence, new PO optimizer can produce a comparable degree of plan while using the same PRO objectives.
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Affiliation(s)
- Venugopal Sundaram
- Department of Applied Physics, Karunya Institute of Technology and Sciences, Coimbatore, Tamilnadu, India
- Department of Radiation Oncology, Meherbai Tata Memorial Hospital, Jamshedpur, Jharkhand, India
| | - D Khanna
- Department of Applied Physics, Karunya Institute of Technology and Sciences, Coimbatore, Tamilnadu, India
| | - P Mohandass
- Department of Radiation Oncology, Fortis Hospital, Mohali, Punjab, India
| | - Titiksha Vasudeva
- Department of Radiation Oncology, Meherbai Tata Memorial Hospital, Jamshedpur, Jharkhand, India
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Vandewinckele L, Reynders T, Weltens C, Maes F, Crijns W. Deep learning based MLC aperture and monitor unit prediction as a warm start for breast VMAT optimisation. Phys Med Biol 2023; 68:225013. [PMID: 37903442 DOI: 10.1088/1361-6560/ad07f6] [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: 06/30/2023] [Accepted: 10/30/2023] [Indexed: 11/01/2023]
Abstract
Objective. Automated treatment planning today is focussed on non-exact, two-step procedures. Firstly, dose-volume histograms (DVHs) or 3D dose distributions are predicted from the patient anatomy. Secondly, these are converted in multi-leaf collimator (MLC) apertures and monitor units (MUs) using a generic optimisation to obtain the final treatment plan. In contrast, we present a method to predict volumetric modulated arc therapy (VMAT) MLC apertures and MUs directly from patient anatomy using deep learning. The predicted plan is then provided as initialisation to the optimiser for fine-tuning.Approach. 148 patients (training: 101; validation: 23; test: 24), treated for right breast cancer, are replanned to obtain a homogeneous database of 3-arc VMAT plans (PTVBreast: 45.57 Gy; PTVBoost: 55.86 Gy) according to the clinical protocol, using RapidPlanTMwith automatic optimisation and extended convergence mode (clinical workflow). Projections of the CT and contours are created along the beam's eye view of all control points and given as input to a U-net type convolutional neural networks (CNN). The output are the MLC aperture and MU for all control points, from which a DICOM RTplan is built. This is imported and further optimised in the treatment planning system using automatic optimisation without convergence mode, with clinical PTV objectives and organs-at-risk (OAR) objectives based on the DVHs calculated from the imported plan (CNN workflow).Main results. Mean dose differences between the clinical and CNN workflow over the test set are 0.2 ± 0.5 Gy atD95%and 0.6 ± 0.4 Gy atD0.035ccof PTVBreastand -0.4 ± 0.3 Gy atD95%and 0.7 ± 0.3 Gy atD0.035ccof PTVBoost. For the OAR, they are -0.2 ± 0.2 Gy forDmean,heartand 0.04 ± 0.8 Gy forDmean,ipsilateral lung. The mean computation time is 60 and 25 min respectively.Significance. VMAT optimisation can be initialised by MLC apertures and MUs, directly predicted from patient anatomy using a CNN, reducing planning time with more than half while maintaining clinically acceptable plans. This procedure puts the planner in a supervising role over an AI-based treatment planning workflow.
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Affiliation(s)
- L Vandewinckele
- Department of Oncology, Laboratory of Experimental Radiotherapy, KU Leuven, Belgium
- Department of Radiation Oncology, UZ Leuven, Belgium
| | - T Reynders
- Department of Radiation Oncology, UZ Leuven, Belgium
| | - C Weltens
- Department of Oncology, Laboratory of Experimental Radiotherapy, KU Leuven, Belgium
- Department of Radiation Oncology, UZ Leuven, Belgium
| | - F Maes
- Department ESAT/PSI, KU Leuven, Belgium
- Medical Imaging Research Center, UZ Leuven, Belgium
| | - W Crijns
- Department of Oncology, Laboratory of Experimental Radiotherapy, KU Leuven, Belgium
- Department of Radiation Oncology, UZ Leuven, Belgium
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Krauss RF, Balik S, Cirino ET, Hadley A, Hariharan N, Holmes SM, Kielar K, Lavvafi H, McCullough K, Palefsky S, Sawyer JP, Smith K, Tracy J, Winter JD, Wingreen NE. AAPM Medical Physics Practice Guideline 8.b: Linear accelerator performance tests. J Appl Clin Med Phys 2023; 24:e14160. [PMID: 37793084 PMCID: PMC10647991 DOI: 10.1002/acm2.14160] [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: 05/11/2023] [Revised: 06/23/2023] [Accepted: 08/24/2023] [Indexed: 10/06/2023] Open
Abstract
The purpose of this guideline is to provide a list of critical performance tests to assist the Qualified Medical Physicist (QMP) in establishing and maintaining a safe and effective quality assurance (QA) program. The performance tests on a linear accelerator (linac) should be selected to fit the clinical patterns of use of the accelerator and care should be given to perform tests which are relevant to detecting errors related to the specific use of the accelerator. Current recommendations for linac QA were reviewed to determine any changes required to those tests highlighted by the original report as well as considering new components of the treatment process that have become common since its publication. Recommendations are made on the acquisition of reference data, routine establishment of machine isocenter, basing performance tests on clinical use of the linac, working with vendors to establish QA tests and performing tests after maintenance and upgrades. The recommended tests proposed in this guideline were chosen based on consensus of the guideline's committee after assessing necessary changes from the previous report. The tests are grouped together by class of test (e.g., dosimetry, mechanical, etc.) and clinical parameter tested. Implementation notes are included for each test so that the QMP can understand the overall goal of each test. This guideline will assist the QMP in developing a comprehensive QA program for linacs in the external beam radiation therapy setting. The committee sought to prioritize tests by their implication on quality and patient safety. The QMP is ultimately responsible for implementing appropriate tests. In the spirit of the report from American Association of Physicists in Medicine Task Group 100, individual institutions are encouraged to analyze the risks involved in their own clinical practice and determine which performance tests are relevant in their own radiotherapy clinics.
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Affiliation(s)
| | - Salim Balik
- University of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Austin Hadley
- Anchorage Radiation Oncology CenterAnchorageAlaskaUSA
| | | | | | | | | | | | | | | | - Koren Smith
- UMass Chan Medical School/IROC Rhode Island QA CenterLincolnRhode IslandUSA
| | | | - Jeff D. Winter
- Department of Medical PhysicsPrincess Margaret Cancer CentreTorontoOntarioCanada
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Mione C, Casile M, Moreau J, Miroir J, Molnar I, Chautard E, Bernadach M, Kossai M, Saroul N, Martin F, Pham-Dang N, Lapeyre M, Biau J. Outcomes among oropharyngeal and oral cavity cancer patients treated with postoperative volumetric modulated arctherapy. Front Oncol 2023; 13:1272856. [PMID: 38023128 PMCID: PMC10644788 DOI: 10.3389/fonc.2023.1272856] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Background Presently, there are few published reports on postoperative radiation therapy for oropharyngeal and oral cavity cancers treated with IMRT/VMAT technique. This study aimed to assess the oncological outcomes of this population treated with postoperative VMAT in our institution, with a focus on loco-regional patterns of failure. Material and methods Between 2011 and 2019, 167 patients were included (40% of oropharyngeal cancers, and 60% of oral cavity cancers). The median age was 60 years. There was 64.2% of stage IV cancers. All patients had both T and N surgery. 34% had a R1 margin, 42% had perineural invasion. 72% had a positive neck dissection and 42% extranodal extension (ENE). All patients were treated with VMAT with simultaneous integrated boost with three dose levels: 66Gy in case of R1 margin and/or ENE, 59.4-60Gy on the tumor bed, and 54Gy on the prophylactic areas. Concomittant cisplatin was administrated concomitantly when feasible in case of R1 and/or ENE. Results The 1- and 2-year loco-regional control rates were 88.6% and 85.6% respectively. Higher tumor stage (T3/T4), the presence of PNI, and time from surgery >45 days were significant predictive factors of worse loco-regional control in multivariate analysis (p=0.02, p=0.04, and p=0.02). There were 17 local recurrences: 11 (64%) were considered as infield, 4 (24%) as marginal, and 2 (12%) as outfield. There were 9 regional recurrences only, 8 (89%) were considered as infield, and 1 (11%) as outfield. The 1- and 2-year disease-free survival (DFS) rates were 78.9% and 71.8% respectively. The 1- and 2-year overall survival (OS) rates were 88.6% and 80% respectively. Higher tumor stage (T3/T4) and the presence of ENE were the two prognostic factors significantly associated with worse DFS and OS in multivariate analysis. Conclusion Our outcomes for postoperative VMAT for oral cavity and oropharyngeal cancers are encouraging, with high rates of loco-regional control. However, the management of ENE still seems challenging.
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Affiliation(s)
- Cécile Mione
- Department of Radiation Therapy, Centre Jean Perrin, Clermont-Ferrand, France
| | - Mélanie Casile
- INSERM U1240 IMoST, University of Clermont Auvergne, Clermont-Ferrand, France
- UMR 501, Clinical Investigation Centre, Clermont-Ferrand, France
- Department of Clinical Research, Clinical Search and Innovation, Centre Jean Perrin, Clermont-Ferrand, France
| | - Juliette Moreau
- Department of Radiation Therapy, Centre Jean Perrin, Clermont-Ferrand, France
| | - Jessica Miroir
- Department of Radiation Therapy, Centre Jean Perrin, Clermont-Ferrand, France
| | - Ioana Molnar
- INSERM U1240 IMoST, University of Clermont Auvergne, Clermont-Ferrand, France
- UMR 501, Clinical Investigation Centre, Clermont-Ferrand, France
- Department of Clinical Research, Clinical Search and Innovation, Centre Jean Perrin, Clermont-Ferrand, France
| | - Emmanuel Chautard
- Department of Radiation Therapy, Centre Jean Perrin, Clermont-Ferrand, France
- INSERM U1240 IMoST, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Maureen Bernadach
- UMR 501, Clinical Investigation Centre, Clermont-Ferrand, France
- Department of Clinical Research, Clinical Search and Innovation, Centre Jean Perrin, Clermont-Ferrand, France
- Medical Oncology Department, Jean Perrin Center, Clermont-Ferrand, France
| | - Myriam Kossai
- INSERM U1240 IMoST, University of Clermont Auvergne, Clermont-Ferrand, France
- Department of Pathology and Molecular Pathology, Centre Jean Perrin, Clermont-Ferrand, France
| | - Nicolas Saroul
- Department of Otolaryngology-Head and Neck Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - F. Martin
- Department of Radiation Therapy, Centre Jean Perrin, Clermont-Ferrand, France
| | - Nathalie Pham-Dang
- Department of Maxillo-Facial Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Michel Lapeyre
- Department of Radiation Therapy, Centre Jean Perrin, Clermont-Ferrand, France
| | - Julian Biau
- Department of Radiation Therapy, Centre Jean Perrin, Clermont-Ferrand, France
- INSERM U1240 IMoST, University of Clermont Auvergne, Clermont-Ferrand, France
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Marrazzo L, Redapi L, Pellegrini R, Voet P, Meattini I, Arilli C, Calusi S, Casati M, Chilà D, Compagnucci A, Talamonti C, Zani M, Livi L, Pallotta S. Fully automated volumetric modulated arc therapy technique for radiation therapy of locally advanced breast cancer. Radiat Oncol 2023; 18:176. [PMID: 37904150 PMCID: PMC10617151 DOI: 10.1186/s13014-023-02364-8] [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: 08/30/2023] [Accepted: 10/17/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND This study aimed to evaluate an a-priori multicriteria plan optimization algorithm (mCycle) for locally advanced breast cancer radiation therapy (RT) by comparing automatically generated VMAT (Volumetric Modulated Arc Therapy) plans (AP-VMAT) with manual clinical Helical Tomotherapy (HT) plans. METHODS The study included 25 patients who received postoperative RT using HT. The patient cohort had diverse target selections, including both left and right breast/chest wall (CW) and III-IV node, with or without internal mammary node (IMN) and Simultaneous Integrated Boost (SIB). The Planning Target Volume (PTV) was obtained by applying a 5 mm isotropic expansion to the CTV (Clinical Target Volume), with a 5 mm clip from the skin. Comparisons of dosimetric parameters and delivery/planning times were conducted. Dosimetric verification of the AP-VMAT plans was performed. RESULTS The study showed statistically significant improvements in AP-VMAT plans compared to HT for OARs (Organs At Risk) mean dose, except for the heart and ipsilateral lung. No significant differences in V95% were observed for PTV breast/CW and PTV III-IV, while increased coverage (higher V95%) was seen for PTV IMN in AP-VMAT plans. HT plans exhibited smaller values of PTV V105% for breast/CW and III-IV, with no differences in PTV IMN and boost. HT had an average (± standard deviation) delivery time of (17 ± 8) minutes, while AP-VMAT took (3 ± 1) minutes. The average γ passing rate for AP-VMAT plans was 97%±1%. Planning times reduced from an average of 6 h for HT to about 2 min for AP-VMAT. CONCLUSIONS Comparing AP-VMAT plans with clinical HT plans showed similar or improved quality. The implementation of mCycle demonstrated successful automation of the planning process for VMAT treatment of locally advanced breast cancer, significantly reducing workload.
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Affiliation(s)
- Livia Marrazzo
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
- Medical Physics Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Laura Redapi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- Medical Physics Unit, Azienda USL Toscana Centro, Pistoia-Prato, Italy
| | - Roberto Pellegrini
- Medical Affairs & Research Clinical Liaison, Elekta AB, Stockholm, Sweden
| | - Peter Voet
- Medical Affairs & Research Clinical Liaison, Elekta AB, Stockholm, Sweden
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Chiara Arilli
- Medical Physics Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Silvia Calusi
- Medical Physics Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marta Casati
- Medical Physics Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Deborah Chilà
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | | | - Cinzia Talamonti
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- Medical Physics Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Margherita Zani
- Medical Physics Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Stefania Pallotta
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- Medical Physics Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Pokhrel D, Misa J, McCarthy S, Yang ES. Two novel stereotactic radiotherapy methods for locally advanced, previously irradiated head and neck cancers patients. Med Dosim 2023:S0958-3947(23)00079-1. [PMID: 37867087 DOI: 10.1016/j.meddos.2023.09.003] [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: 07/21/2023] [Revised: 09/08/2023] [Accepted: 09/22/2023] [Indexed: 10/24/2023]
Abstract
To determine the feasibility and utility of conebeam CT-guided stereotactic radiotherapy for locally recurrent, previously irradiated head and neck cancer (HNC) patients on the Halcyon, a ring delivery system (RDS). This research aims to quantify plan quality, treatment delivery accuracy, and overall efficacy by comparing against novel clinical TrueBeam HyperArc method. Ten recurrent HNC patients who were treated at our institution on TrueBeam (6MV-FFF) for 3 to 40 Gy in 3 to 5 fractions with noncoplanar HyperArc plans were re-planned on Halcyon (6MV-FFF). These plans were re-planned with the same Acuros-based dose engine. Additionally, we used site-specific full/partial coplanar VMAT arcs. PTV coverage, mean dose to GTV, maximum dose to organs-at-risk (OAR), beam-on time (BOT), and quality assurance (QA) results were investigated and compared. Halcyon provided highly conformal HNC SRT plans with slightly superior mean PTVD99 coverage (96.7% vs 95.5%, p = 0.071), and slightly lower mean GTV dose (37.8 Gy vs 38.2 Gy, p = 0.241) when compared to the HyperArc plans. Differences in plan conformality and maximum dose to OARs were statistically insignificant. Due to Halcyon's coplanar geometry, D2cm was significantly higher (p = 0.001) but Halcyon did result in a reduced normal brain dose by 1 Gy on average and up to 5.2 Gy in some cases. Halcyon provided similar patient-specific QA pass rates with a 2%/2mm gamma criteria (98.2% vs 98.5%) and independent in-house Monte Carlo second check results (97.7% vs 98.2%), suggesting identical treatment delivery accuracy. Halcyon plans resulted in slightly longer beam-on time (3.16 vs 2.30 minutes, p = 0.010), however door-to-door patient time is expected to be <10 minutes. Compared to clinical TrueBeam HyperArc, Halcyon SRT plans provided similar plan quality and treatment delivery accuracy with a potentially faster overall treatment using fully automated patient setup and verification. Rapid delivery of recurrent HNC SRT may reduce intrafraction motion errors while also improving patient compliance and comfort. To provide high-quality of HNC SRT similar to HyperArc, we recommend Halcyon users consider commissioning this novel method. This method will be useful for remote and underserved patient cohorts including Halcyon-only clinics as well.
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Affiliation(s)
- Damodar Pokhrel
- Department of Radiation Medicine, Medical Physics Graduate Program, Markey Cancer Center, University of Kentucky College of Medicine, Lexington, KY 40536, USA.
| | - Josh Misa
- Department of Radiation Medicine, Medical Physics Graduate Program, Markey Cancer Center, University of Kentucky College of Medicine, Lexington, KY 40536, USA
| | - Shane McCarthy
- Department of Radiation Medicine, Medical Physics Graduate Program, Markey Cancer Center, University of Kentucky College of Medicine, Lexington, KY 40536, USA
| | - Eddy S Yang
- Department of Radiation Medicine, Medical Physics Graduate Program, Markey Cancer Center, University of Kentucky College of Medicine, Lexington, KY 40536, USA
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Pant A, Miri N, Bhagroo S, Mathews JA, Nazareth DP. Monitor unit verification for Varian TrueBeam VMAT plans using Monte Carlo calculations and phase space data. J Appl Clin Med Phys 2023; 24:e14063. [PMID: 37469244 PMCID: PMC10562028 DOI: 10.1002/acm2.14063] [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: 11/04/2022] [Revised: 04/29/2023] [Accepted: 05/15/2023] [Indexed: 07/21/2023] Open
Abstract
To use the open-source Monte Carlo (MC) software calculations for TPS monitor unit verification of VMAT plans, delivered with the Varian TrueBeam linear accelerator, and compare the results with a commercial software product, following the guidelines set in AAPM Task Group 219. The TrueBeam is modeled in EGSnrc using the Varian-provided phase-space files. Thirteen VMAT TrueBeam treatment plans representing various anatomical regions were evaluated, comprising 37 treatment arcs. VMAT plans simulations were performed on a computing cluster, using 107 -109 particle histories per arc. Point dose differences at five reference points per arc were compared between Eclipse, MC, and the commercial software, MUCheck. MC simulation with 5 × 107 histories per arc offered good agreement with Eclipse and a reasonable average calculation time of 9-18 min per full plan. The average absolute difference was 3.0%, with only 22% of all points exceeding the 5% action limit. In contrast, the MUCheck average absolute difference was 8.4%, with 60% of points exceeding the 5% dose difference. Lung plans were particularly problematic for MUCheck, with an average absolute difference of approximately 16%. Our EGSnrc-based MC framework can be used for the MU verification of VMAT plans calculated for the Varian TrueBeam; furthermore, our phase space approach can be adapted to other treatment devices by using appropriate phase space files. The use of 5 × 107 histories consistently satisfied the 5% action limit across all plan types for the majority of points, performing significantly better than a commercial MU verification system, MUCheck. As faster processors and cloud computing facilities become even more widely available, this approach can be readily implemented in clinical settings.
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Affiliation(s)
- Ankit Pant
- Department of Radiation MedicineRoswell Park Comprehensive Cancer CenterBuffaloNew YorkUSA
- Medical Physics ProgramUniversity at Buffalo (SUNY)BuffaloNew YorkUSA
| | - Narges Miri
- Department of Radiation MedicineRoswell Park Comprehensive Cancer CenterBuffaloNew YorkUSA
| | - Stephen Bhagroo
- Department of Radiation OncologyHuntsman Cancer InstituteSalt Lake CityUtahUSA
| | | | - Daryl P. Nazareth
- Department of Radiation MedicineRoswell Park Comprehensive Cancer CenterBuffaloNew YorkUSA
- Medical Physics ProgramUniversity at Buffalo (SUNY)BuffaloNew YorkUSA
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Frengen J, Vikström J, Mjaaland I, Funderud M, Almberg SS, Dybvik KI, Hjelstuen MHB. Locoregional breast radiotherapy including IMN: optimizing the dose distribution using an automated non-coplanar VMAT-technique. Acta Oncol 2023; 62:1169-1177. [PMID: 37812070 DOI: 10.1080/0284186x.2023.2264488] [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: 05/03/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Volumetric Modulated Arc Therapy (VMAT) offers better conformity, homogeneity and sparing of the heart and ipsilateral lung for locoregional radiotherapy in left-sided breast cancer compared to three-dimensional conformal radiotherapy (3D-CRT). However, conventional coplanar VMAT (cVMAT) can result in higher doses to the normal tissue on the contralateral side. This study investigates a non-coplanar VMAT-technique (ncVMAT) to mitigate this issue. MATERIAL AND METHODS CT series of 20 left sided breast cancer patients were included for planning of locoregional breast radiotherapy including internal mammary nodes (IMN). Three treatment plans; 3D-CRT, cVMAT and ncVMAT, were generated for each patient with a prescription dose of 40.05 Gy in 15 fractions. Both VMAT-techniques consisted of a single arc in the axial plane, while ncVMAT included an additional arc in the sagittal plane. All plans were optimized to cover the clinical target volume (CTV) by 38.05 Gy for the breast and 36.05 Gy for lymph nodes, with as low as possible dose to organs at risk. RESULTS Full CTV coverage was achieved for all plans. Both cVMAT and ncVMAT delivered more conformal and homogeneous target doses than 3D-CRT. Doses to the heart and ipsilateral lung were significantly lower with ncVMAT compared to both cVMAT and 3D-CRT. ncVMAT reduced doses to both the contralateral breast and lung compared to cVMAT and achieved levels similar to 3D-CRT for the contralateral breast and moderately higher doses for the contralateral lung. Delivery of high doses (>30 Gy) to the contralateral side was completely avoided with ncVMAT, contrary to the results for cVMAT and 3D-CRT. CONCLUSION ncVMAT reduced doses to the heart and ipsilateral lung as compared to both cVMAT and 3D-CRT. All contralateral dose metrics were reduced with the novel ncVMAT technique compared to cVMAT, and the mean contralateral breast doses were similar to 3D-CRT.
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Affiliation(s)
- Jomar Frengen
- Department of Radiotherapy, Cancer Clinic, St. Olavs Hospital, Trondheim, Norway
| | - Johan Vikström
- Department of Radiotherapy, Stavanger University Hospital, Stavanger, Norway
| | - Ingvil Mjaaland
- Department of Radiotherapy, Stavanger University Hospital, Stavanger, Norway
| | - Marit Funderud
- Department of Radiotherapy, Cancer Clinic, St. Olavs Hospital, Trondheim, Norway
| | - Sigrun Saur Almberg
- Department of Radiotherapy, Cancer Clinic, St. Olavs Hospital, Trondheim, Norway
| | - Kjell Ivar Dybvik
- Department of Radiotherapy, Stavanger University Hospital, Stavanger, Norway
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Kamer S, Yilmaz Susluer S, Balci Okcanoglu T, Kayabasi C, Ozmen Yelken B, Hoca S, Tavlayan E, Olacak N, Anacak Y, Olukman M, Gunduz C. Evaluation of the effect of intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc radiotherapy ( VMAT) techniques on survival response in cell lines with a new radiobiological modeling. Cancer Med 2023; 12:19874-19888. [PMID: 37754559 PMCID: PMC10587949 DOI: 10.1002/cam4.6593] [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: 05/05/2023] [Revised: 08/18/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The optimal radiobiological model, which assesses the biological effects of novel radiotherapy techniques that concurrently modify multiple physical factors, has not yet been defined. This study aimed to investigate the impact of intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) on cellular response in head and neck cancer and melanoma models. METHODS Clonogenic analysis, DNA double-strand break analysis, apoptosis, and cell cycle analysis were performed on cancer stem cell models, cancer models, and normal tissue cell models to assess radiation sensitivity. RESULTS The segmented radiation approach used in IMRT applications enhanced radiosensitivity and cytotoxicity in the cancer models, while changes in dose rate had varying effects on cytotoxicity depending on the tumor cell type. VMAT increased cellular resistance, favoring treatment outcomes. CONCLUSIONS The biological processes were influenced differently by dose rate, IMRT, and VMAT depending on the tumor cell type. The selection of the most appropriate technique is crucial in representing new radiotherapy approaches. The obtained data can serve as a model to address clinical questions in daily practice. The integration of non-standard outcomes with standard applications should be considered in clinical settings.
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Affiliation(s)
- Serra Kamer
- Department of Radiation OncologyEge University Medical FacultyIzmirTurkey
| | | | | | - Cagla Kayabasi
- Department of Medical BiologyEge University Medical FacultyIzmirTurkey
| | | | - Sinan Hoca
- Department of Radiation OncologyEge University Medical FacultyIzmirTurkey
| | - Emin Tavlayan
- Department of Radiation OncologyEge University Medical FacultyIzmirTurkey
| | - Nezahat Olacak
- Department of Radiation OncologyEge University Medical FacultyIzmirTurkey
| | - Yavuz Anacak
- Department of Radiation OncologyEge University Medical FacultyIzmirTurkey
| | - Murat Olukman
- Department of PharmacologyEge University Medical FacultyIzmirTurkey
| | - Cumhur Gunduz
- Department of Medical BiologyEge University Medical FacultyIzmirTurkey
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