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Lassen-Ramshad Y, Seiersen K, Gleeson I, Mahajan A, Sehested A, Toussaint L, Safwat A, Joergensen M, Agerbaek M, Paulino AC, Ajithkumar T. Influence of radiotherapy technique on incidental dose to the whole ventricular system in focal irradiation of nongerminomatous germcell tumours. Acta Oncol 2023:1-5. [PMID: 37171106 DOI: 10.1080/0284186x.2023.2211713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
| | - Klaus Seiersen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Ian Gleeson
- Department of Medical Physics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Astrid Sehested
- Department of Pediatrics and Adolescent Medicine, Rigshospital, Copenhagen, Denmark
| | - Laura Toussaint
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Akmal Safwat
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Mads Agerbaek
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Arnold C Paulino
- Department of Radiation Oncology, the University of Texas MD, Anderson Cancer Center, Houston, TX, USA
| | - Thankamma Ajithkumar
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Gleeson I, Bolger N, Chun H, Hutchinson K, Klodowska M, Mehrer J, Toomey M. Implementation of automated personalised breast radiotherapy planning techniques with scripting in Raystation. Br J Radiol 2023; 96:20220707. [PMID: 36728760 PMCID: PMC10078863 DOI: 10.1259/bjr.20220707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Implement scripted automatic breast planning (AP) for breast techniques within Raystation. METHODS Manual plans (MPs) were re-planned and compared with AP plans for whole breast (WB), partial breast (PB), hybrid volumetric modulated arc therapy simultaneous integrated boost (VMAT SIB) and VMAT nodal plans. RESULTS WB AP plans took 7 min comparing well to MP. One WB AP failed a mandatory dose constraint. Small statistically significant differences showed improved coverage for AP at expense of slightly hotter plans, however absolute differences were small (mean differences < 1% or D 0.5cc<0.2 Gy). PB AP plans took 9 min, showing improved coverage (V 24.7Gy97.6 vs 96.4 %). One PB AP case failed a mandatory constraint. Other dosimetric differences were non-significant. SIB AP plans took 14 min with one case failing a mandatory constraint with minor differences compared with MP except larger V 42.8Gy (3 vs 1.5 %) and more MU. VMAT AP plans took 12 min and were hotter for PTVp_4000 but had higher nodal coverage. Contra_Lung V 2.5Gy was higher (8.8 %) than MP plans (6.5 %). CONCLUSION Automatic planning of modern breast techniques has been successfully introduced using a commercial planning system. AP plans are very similar to MP, requiring little manual interaction for most cases with significant timesaving potential. ADVANCES IN KNOWLEDGE Scripted breast plans produced within minutes for WB, PB, SIB and VMAT. Successfully introduced into large busy department. Plans similar to manual plans, requiring little manual interaction.
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Affiliation(s)
- Ian Gleeson
- Department of Medical Physics, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK
| | - Niall Bolger
- Department of Medical Physics, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK
| | - Harmony Chun
- Department of Medical Physics, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK
| | - Katie Hutchinson
- Department of Medical Physics, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK
| | - Magdalena Klodowska
- Department of Medical Physics, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK
| | - Jennifer Mehrer
- Department of Medical Physics, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK
| | - Marian Toomey
- Department of Medical Physics, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK
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Ryan JT, Nakayama M, Gleeson I, Mannion L, Geso M, Kelly J, Ng SP, Hardcastle N. Functional brain imaging interventions for radiation therapy planning in patients with glioblastoma: a systematic review. Radiat Oncol 2022; 17:178. [PMID: 36371225 PMCID: PMC9653002 DOI: 10.1186/s13014-022-02146-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 10/14/2022] [Indexed: 11/15/2022] Open
Abstract
RATIONALE This systematic review aims to synthesise the outcomes of different strategies of incorporating functional biological markers in the radiation therapy plans of patients with glioblastoma to support clinicians and further research. METHODS The systematic review protocol was registered on PROSPERO (CRD42021221021). A structured search for publications was performed following PRISMA guidelines. Quality assessment was performed using the Newcastle-Ottawa Scale. Study characteristics, intervention methodology and outcomes were extracted using Covidence. Data analysis focused on radiation therapy target volumes, toxicity, dose distributions, recurrence and survival mapped to functional image-guided radiotherapy interventions. RESULTS There were 5733 citations screened, with 53 citations (n = 32 studies) meeting review criteria. Studies compared standard radiation therapy planning volumes with functional image-derived volumes (n = 20 studies), treated radiation therapy volumes with recurrences (n = 15 studies), the impact on current standard target delineations (n = 9 studies), treated functional volumes and survival (n = 8 studies), functionally guided dose escalation (n = 8 studies), radiomics (n = 4 studies) and optimal organ at risk sparing (n = 3 studies). The approaches to target outlining and dose escalation were heterogeneous. The analysis indicated an improvement in median overall survival of over two months compared with a historical control group. Simultaneous-integrated-boost dose escalation of 72-76 Gy in 30 fractions appeared to have an acceptable toxicity profile when delivered with inverse planning to a volume smaller than 100 cm[Formula: see text]. CONCLUSION There was significant heterogeneity between the approaches taken by different study groups when implementing functional image-guided radiotherapy. It is recommended that functional imaging data be incorporated into the gross tumour volume with appropriate technology-specific margins used to create the clinical target volume when designing radiation therapy plans for patients with glioblastoma.
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Affiliation(s)
- John T Ryan
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Melbourne, Australia
- Medical Radiations Department, School of Health and Biomedical Sciences, STEM College, RMIT University Bundoora, Melbourne, Australia
| | - Masao Nakayama
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuou-ku, Kobe, Japan
| | - Ian Gleeson
- Cancer Research UK RadNet Cambridge, Medical Physics, NHS Foundation Trust, Addenbrookes Hospital, Cambridge, CB2 0QQ UK
| | - Liam Mannion
- Division of Midwifery and Radiography, School of Health Sciences, University of London, Northampton Square, London, UK
| | - Moshi Geso
- Medical Radiations Department, School of Health and Biomedical Sciences, STEM College, RMIT University Bundoora, Melbourne, Australia
| | - Jennifer Kelly
- Medical Radiations Department, School of Health and Biomedical Sciences, STEM College, RMIT University Bundoora, Melbourne, Australia
| | - Sweet Ping Ng
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, 145 Studley Rd, Heidelberg, Melbourne, Australia
| | - Nicholas Hardcastle
- Department of Physical Sciences, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Australia
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Gleeson I. Comparing the robustness of different skin flash approaches using wide tangents, manual flash VMAT, and simulated organ motion robust optimization VMAT in breast and nodal radiotherapy. Med Dosim 2022; 47:264-272. [DOI: 10.1016/j.meddos.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/24/2022] [Accepted: 04/11/2022] [Indexed: 11/25/2022]
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Padden-Modi M, Spivak Y, Gleeson I, Robinson A, Thippu Jayaprakash K. PO-1242 Clinical, pathological and dosimetric factors influencing outcomes in NSCLC treated with SABR. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03206-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gleeson I, Toomey M, Hutchinson K, Chantler H. PH-0043 Robustness of Wide Tangents and VMAT through simulations and CBCT delivered dose in breast cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07225-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gleeson I. PO-1499: Incidental dose to obturator nodes in prostate radiotherapy trials CHHiP, PROFIT and PIVOTALboost. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01517-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gleeson I. A comparison of a moderately hypofractionated IMRT planning technique used in a randomised UK external beam radiotherapy trial with an in-house technique for localised prostate cancer. Rep Pract Oncol Radiother 2020; 25:360-366. [PMID: 32256220 DOI: 10.1016/j.rpor.2020.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/26/2019] [Accepted: 03/10/2020] [Indexed: 11/18/2022] Open
Abstract
AIM To compare the radiotherapy technique used in a randomised trial with VMAT and an in-house technique for prostate cancer. BACKGROUND Techniques are evolving with volumetric modulated arc therapy (VMAT) commonly used. The CHHiP trial used a 3 PTV forward planned IMRT technique (FP_CH). Our centre has adopted a simpler two PTV technique with locally calculated margins. MATERIALS AND METHODS 25 patients treated with FP_CH to 60 Gy in 20 fractions were re-planned with VMAT (VMAT_CH) and a two PTV protocol (VMAT_60/52 and VMAT_60/48). Target coverage, conformity index (CI), homogeneity index (HI), monitor units (MU) and dose to the rectum, bladder, hips and penile bulb were compared. RESULTS PTV coverage was high for all techniques. VMAT_CH plans had better CI than FP_CH (p ≤ 0.05). VMAT_60/52/48 plans had better CI than VMAT_CH. FP_CH had better HI and fewer MU than VMAT (p ≤ 0.05). More favourable rectum doses were found for VMAT _CH than FP_CH (V48.6, V52.8, V57, p ≤ 0.05) with less difference for bladder (p ≥ 0.05). Comparing VMAT_CH to VMAT_60/52/48 showed little differences for the bladder and rectum but VMAT_CH had larger penile bulb doses (V40.8, V48.6, mean, D2, p ≤ 0.05). Femoral head doses (V40.8) were similarly low for all techniques (p = ≥ 0.05). CONCLUSION VMAT produced more conformal plans with smaller rectum doses compared to FP_CH albeit worse HI and more MU. VMAT_60/52 and VMAT_60/48 plans had similar rectal and bladder doses to VMAT_CH but better CI and penile bulb doses which may reduce toxicity.
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Affiliation(s)
- Ian Gleeson
- Department of Medical Physics, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
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Gleeson I, Rose C, Spurrell J. Dosimetric comparison of helical tomotherapy and VMAT for anal cancer: A single institutional experience. Med Dosim 2019; 44:e32-e38. [PMID: 30639142 DOI: 10.1016/j.meddos.2018.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 08/21/2018] [Revised: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 11/17/2022]
Abstract
To compare the dosimetric results of helical tomotherapy (HT) and volumetric arc therapy (VMAT) in the treatment of anal cancer. Plans were created for 20 (n = 20) patients treated for anal cancer using HT and 2 arc VMAT. Dosimetric comparison was assessed for doses to targets and organs at risk (small bowel, bladder, external genitalia, and femoral heads). Delivery time and dosimetric verification results were also compared. HT showed a higher V95% for both primary and nodal targets (V95% increase by 0.5% to 1.3%; p = ≤0.05). No differences were seen in V105%, V107%, or V110 % between techniques. HT provided better sparing of the small bowel for dose levels V30, V35, and V40 (p = 0.005, 0.001, and 0.030), but was similar at higher doses. Similarly HT provided better bladder dose at V35 only (p = 0.020). Doses to femoral heads and genitalia were similar. Delivery time was higher for the HT plans (4.58 ± 1.1 min) than VMAT (3.13 ± 0.2 minutes) (p = 0.011). Dose verification results were 99.5 ± 0.9% and 100 ± 0% (HT, n = 6) vs 95.0 ± 3.1% and 99.2 ± 0.8% (VMAT, n = 20) for global gamma criteria 3%/3 mm and 4%/4 mm, respectively. Both HT and VMAT produced high quality plans that frequently met most of the dose objectives apart from genitalia V20, V40, bladder V35, and V50. Although absolute dose differences were small, the PTV V95%, small bowel V30, V35, and V40 and bladder V35 were statistically better in the HT plans. VMAT provided a shorter delivery time by 1.45 minutes; however, our HT plans were more likely to pass tighter plan dose verification criteria than VMAT.
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Affiliation(s)
- Ian Gleeson
- Department of Medical Physics, Addenbrooke's Hospital, Cambridge, CB20QQ, UK.
| | - Christopher Rose
- Department of Medical Physics, Addenbrooke's Hospital, Cambridge, CB20QQ, UK.
| | - Joshua Spurrell
- Department of Medical Physics, Addenbrooke's Hospital, Cambridge, CB20QQ, UK.
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Lassen-Ramshad Y, Seiersen K, Gleeson I, Mahajan A, Paulino A, Ajithkumar T. RONC-11. EVALUATION OF DIFFERENT RADIOTHERAPY TECHNIQUES ON INCIDENTAL RADIATION DOSES TO THE WHOLE VENTRICULAR SYSTEM DURING FOCAL IRRADIATION FOR NON GERMINOMATOUS GERM CELL TUMOURS AFTER CHEMOTHERAPY. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Klaus Seiersen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Ian Gleeson
- Department of Oncology, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochesterm MN, USA
| | - Arnold Paulino
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
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Noble DJ, Ajithkumar T, Lambert J, Gleeson I, Williams MV, Jefferies SJ. Highly Conformal Craniospinal Radiotherapy Techniques Can Underdose the Cranial Clinical Target Volume if Leptomeningeal Extension through Skull Base Exit Foramina is not Contoured. Clin Oncol (R Coll Radiol) 2017; 29:439-447. [PMID: 28318880 PMCID: PMC5479365 DOI: 10.1016/j.clon.2017.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/13/2017] [Accepted: 02/14/2017] [Indexed: 01/03/2023]
Abstract
AIMS Craniospinal irradiation (CSI) remains a crucial treatment for patients with medulloblastoma. There is uncertainty about how to manage meningeal surfaces and cerebrospinal fluid (CSF) that follows cranial nerves exiting skull base foramina. The purpose of this study was to assess plan quality and dose coverage of posterior cranial fossa foramina with both photon and proton therapy. MATERIALS AND METHODS We analysed the radiotherapy plans of seven patients treated with CSI for medulloblastoma and primitive neuro-ectodermal tumours and three with ependymoma (total n = 10). Four had been treated with a field-based technique and six with TomoTherapy™. The internal acoustic meatus (IAM), jugular foramen (JF) and hypoglossal canal (HC) were contoured and added to the original treatment clinical target volume (Plan_CTV) to create a Test_CTV. This was grown to a test planning target volume (Test_PTV) for comparison with a Plan_PTV. Using Plan_CTV and Plan_PTV, proton plans were generated for all 10 cases. The following dosimetry data were recorded: conformity (dice similarity coefficient) and homogeneity index (D2 - D98/D50) as well as median and maximum dose (D2%) to Plan_PTV, V95% and minimum dose (D99.9%) to Plan_CTV and Test_CTV and Plan_PTV and Test_PTV, V95% and minimum dose (D98%) to foramina PTVs. RESULTS Proton and TomoTherapy™ plans were more conformal (0.87, 0.86) and homogeneous (0.07, 0.04) than field-photon plans (0.79, 0.17). However, field-photon plans covered the IAM, JF and HC PTVs better than proton plans (P = 0.002, 0.004, 0.003, respectively). TomoTherapy™ plans covered the IAM and JF better than proton plans (P = 0.000, 0.002, respectively) but the result for the HC was not significant. Adding foramen CTVs/PTVs made no difference for field plans. The mean Dmin dropped 3.4% from Plan_PTV to Test_PTV for TomoTherapy™ (not significant) and 14.8% for protons (P = 0.001). CONCLUSIONS Highly conformal CSI techniques may underdose meninges and CSF in the dural reflections of posterior fossa cranial nerves unless these structures are specifically included in the CTV.
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Affiliation(s)
- D J Noble
- Cancer Research UK VoxTox Research Group, Department of Oncology, University of Cambridge, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK; Department of Oncology, Cambridge University Hospital's NHS Foundation Trust, Cambridge, UK.
| | - T Ajithkumar
- Department of Oncology, Cambridge University Hospital's NHS Foundation Trust, Cambridge, UK
| | - J Lambert
- West German Proton Therapy Centre Essen, Essen, Germany
| | - I Gleeson
- Medical Physics Department, Cambridge University Hospital's NHS Foundation Trust, Cambridge, UK
| | - M V Williams
- Department of Oncology, Cambridge University Hospital's NHS Foundation Trust, Cambridge, UK
| | - S J Jefferies
- Department of Oncology, Cambridge University Hospital's NHS Foundation Trust, Cambridge, UK
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