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Gkika E, Kostyszyn D, Fechter T, Moustakis C, Ernst F, Boda-Heggemann J, Sarria G, Dieckmann K, Dobiasch S, Duma MN, Eberle F, Kroeger K, Häussler B, Izaguirre V, Jazmati D, Lautenschläger S, Lohaus F, Mantel F, Menzel J, Pachmann S, Pavic M, Radlanski K, Riesterer O, Gerum S, Röder F, Willner J, Barczyk S, Imhoff D, Blanck O, Wittig A, Guckenberger M, Grosu AL, Brunner TB. Interobserver agreement on definition of the target volume in stereotactic radiotherapy for pancreatic adenocarcinoma using different imaging modalities. Strahlenther Onkol 2023; 199:973-981. [PMID: 37268767 PMCID: PMC10598103 DOI: 10.1007/s00066-023-02085-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/11/2023] [Indexed: 06/04/2023]
Abstract
PURPOSE The aim of this study was to evaluate interobserver agreement (IOA) on target volume definition for pancreatic cancer (PACA) within the Radiosurgery and Stereotactic Radiotherapy Working Group of the German Society of Radiation Oncology (DEGRO) and to identify the influence of imaging modalities on the definition of the target volumes. METHODS Two cases of locally advanced PACA and one local recurrence were selected from a large SBRT database. Delineation was based on either a planning 4D CT with or without (w/wo) IV contrast, w/wo PET/CT, and w/wo diagnostic MRI. Novel compared to other studies, a combination of four metrics was used to integrate several aspects of target volume segmentation: the Dice coefficient (DSC), the Hausdorff distance (HD), the probabilistic distance (PBD), and the volumetric similarity (VS). RESULTS For all three GTVs, the median DSC was 0.75 (range 0.17-0.95), the median HD 15 (range 3.22-67.11) mm, the median PBD 0.33 (range 0.06-4.86), and the median VS was 0.88 (range 0.31-1). For ITVs and PTVs the results were similar. When comparing the imaging modalities for delineation, the best agreement for the GTV was achieved using PET/CT, and for the ITV and PTV using 4D PET/CT, in treatment position with abdominal compression. CONCLUSION Overall, there was good GTV agreement (DSC). Combined metrics appeared to allow a more valid detection of interobserver variation. For SBRT, either 4D PET/CT or 3D PET/CT in treatment position with abdominal compression leads to better agreement and should be considered as a very useful imaging modality for the definition of treatment volumes in pancreatic SBRT. Contouring does not appear to be the weakest link in the treatment planning chain of SBRT for PACA.
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Affiliation(s)
- E Gkika
- Department of Radiation Oncology, University Medical Center Freiburg, Robert Koch Str 3, Freiburg, Germany.
| | - D Kostyszyn
- Department of Radiation Oncology, University Medical Center Freiburg, Robert Koch Str 3, Freiburg, Germany
| | - T Fechter
- Department of Radiation Oncology, University Medical Center Freiburg, Robert Koch Str 3, Freiburg, Germany
| | - C Moustakis
- Department of Radiation Oncology, University Medical Center Muenster, Muenster, Germany
| | - F Ernst
- Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck, Germany
| | - J Boda-Heggemann
- Department of Radiation Oncology, Faculty of Medicine Mannheim, Department of Radiation Oncology, University of Heidelberg, Mannheim, Germany
| | - G Sarria
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - K Dieckmann
- Department of Radiation Oncology, University Departments of the MedUni Vienna, Vienna General Hospital, Vienna, Austria
| | - S Dobiasch
- Department of Radiation Oncology, Klinikum Rechts der Isar, TU Munich, Munich, Germany
| | - M N Duma
- Department of Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller University, Jena, Germany
| | - F Eberle
- Department of Radiation Oncology, University Hospital Marburg, Marburg, Germany
| | - K Kroeger
- Department of Radiation Oncology, University Medical Center Muenster, Muenster, Germany
| | - B Häussler
- Radiation Oncology Dr. Häussler/Dr. Schorer, Munich, Germany
| | - V Izaguirre
- Department of Radiation Oncology, University Hospital Halle, Halle, Germany
| | - D Jazmati
- Proton Therapy Centre, University Hospital Essen, Essen, Germany
| | - S Lautenschläger
- Department of Radiation Oncology, University Hospital, Marburg, Germany
| | - F Lohaus
- Department of Radiation Oncology, University Hospital Dresden, Dresden, Germany
| | - F Mantel
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - J Menzel
- Department of Radiation Oncology, University Hospital Hannover, Hannover, Germany
| | - S Pachmann
- Department of Radiation Oncology, Weilheim Clinic, Weilheim, Germany
| | - M Pavic
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - K Radlanski
- Department of Radiation Oncology, Charite, University Hospital Berlin, Berlin, Germany
| | - O Riesterer
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - S Gerum
- Department of Radiation Oncology, University Clinic, Paracelsus Medical University (PMU), Salzburg, Austria
| | - F Röder
- Department of Radiation Oncology, University Clinic, Paracelsus Medical University (PMU), Salzburg, Austria
| | - J Willner
- Department of Radiation Oncology, University Hospital Bayreuth, Bayreuth, Germany
| | - S Barczyk
- Center for Radiation Oncology, Belegklinik am St. Agnes-Hospital, Bocholt, Germany
| | - D Imhoff
- Department of Radiation Oncology, Saphir Radiosurgery, University Hospital Frankfurt, Frankfurt, Germany
| | - O Blanck
- Saphir Radiosurgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A Wittig
- Department of Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller University, Jena, Germany
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anca-L Grosu
- Department of Radiation Oncology, University Medical Center Freiburg, Robert Koch Str 3, Freiburg, Germany
| | - T B Brunner
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, Graz, Austria
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Buergy D, Würschmidt F, Gkika E, Hörner-Rieber J, Knippen S, Gerum S, Balermpas P, Henkenberens C, Voglhuber T, Kornhuber C, Barczyk S, Röper B, Rashid A, Blanck O, Wittig A, Herold HU, Brunner TB, Sweeney RA, Kahl KH, Ciernik FI, Ottinger A, Izaguirre V, Putz F, König L, Hoffmann M, Combs SE, Guckenberger M, Boda-Heggemann J. Stereotactic Body Radiotherapy of adrenal metastases - A dose-finding study. Int J Cancer 2022; 151:412-421. [PMID: 35383919 DOI: 10.1002/ijc.34017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/22/2022] [Accepted: 03/08/2022] [Indexed: 11/12/2022]
Abstract
Optimal doses for the treatment of adrenal metastases with stereotactic radiotherapy (SBRT) are unknown. We aimed to identify dose-volume cut-points associated with decreased local recurrence rates (LRR). A multicenter database of patients with adrenal metastases of any histology treated with SBRT (biologically effective dose, BED10 ≥ 50Gy, ≤ 12 fractions) was analyzed. Details on dose-volume parameters were required (planning target volume: PTV-D98%, PTV-D50%, PTV-D2%; gross tumor volume: GTV-D50%, GTV-mean). Cut-points for LRR were optimized using the R maxstat package. 196 patients with 218 lesions were included, the largest histopathological subgroup was adenocarcinoma (n = 101). Cut-point optimization resulted in significant cut-points for PTV-D50% (BED10: 73.2Gy; p = 0.003), GTV-D50% (BED10: 74.2Gy; p = 0.006), GTV-mean (BED10: 73.0Gy; p = 0.007), and PTV-D2% (BED10: 78.0Gy; p = 0.02) but not for the PTV-D98% (p = 0.06). Differences in LRR were clinically relevant (LRR ≥ doubled for cut-points that were not achieved). Further dose-escalation was not associated with further improved LRR. PTV-D50%, GTV-D50%, and GTV-mean cut-points were also associated with significantly improved LRR in the adenocarcinoma subgroup. Separate dose optimizations indicated a lower cut-point for the PTV-D50% (BED10: 69.1Gy) in adenocarcinoma lesions, other values were similar (< 2% difference). Associations of cut-points with overall survival (OS) and progression-free survival were not significant but durable freedom from local recurrence was associated with OS in a landmark model (p < 0.001). To achieve a significant improvement of LRR for adrenal SBRT, a moderate escalation of PTV-D50% BED10 > 73.2Gy (adenocarcinoma: 69.1Gy) should be considered. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Daniel Buergy
- Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Klinik für Strahlentherapie und Radioonkologie, Mannheim, Deutschland
| | | | - Eleni Gkika
- Universitätsklinikum Freiburg, Strahlenheilkunde, Freiburg, Deutschland
| | - Juliane Hörner-Rieber
- Universitätsklinikum Heidelberg, Klinik für Radioonkologie und Strahlentherapie, Heidelberg, Deutschland
| | - Stefan Knippen
- Universitätsklinikum Jena, Klinik für Strahlentherapie und Radioonkologie, Jena, Deutschland.,Universitätsklinikum Erlangen, Strahlenklinik, Erlangen, Deutschland
| | - Sabine Gerum
- Radioonkologie LMU München, Strahlentherapie und Radioonkologie, München, Deutschland.,Klinik für Radiotherapie und Radioonkologie, Paracelsus Universität Salzburg, Landeskrankenhaus, Salzburg, Österreich
| | - Panagiotis Balermpas
- Universitätsspital Zürich, Universität Zürich, Klinik für Radio-Onkologie, Zürich, Schweiz
| | - Christoph Henkenberens
- Medizinische Hochschule Hannover, Klinik für Strahlentherapie und Spezielle Onkologie, Hannover, Deutschland
| | - Theresa Voglhuber
- Technische Universität München (TUM), Department of Radiation Oncology, Ismaninger Straße 22, Munich
| | - Christine Kornhuber
- Universitätsklinikum Halle (Saale), Klinik für Strahlentherapie, Halle (Saale), Deutschland
| | - Steffen Barczyk
- Zentrum für Strahlentherapie und Radioonkologie, Belegklinik am St. Agnes-Hospital, Bocholt, Deutschland
| | - Barbara Röper
- DIE RADIOLOGIE, MVZ Strahlentherapie Bogenhausen - Harlaching - Neuperlach, München, Deutschland
| | - Ali Rashid
- MediClin Robert Janker Klinik, Klinik für Strahlentherapie und Radioonkologie, Bonn, Deutschland
| | - Oliver Blanck
- Universitätsklinikum Schleswig-Holstein, Klinik für Strahlentherapie, Kiel, Deutschland
| | - Andrea Wittig
- Universitätsklinikum Jena, Klinik für Strahlentherapie und Radioonkologie, Jena, Deutschland
| | - Hans-Ulrich Herold
- Cyberknife Centrum Mitteldeutschland GmbH, Institut für Radiochirurgie und Präzisionsbestrahlung, Erfurt, Deutschland
| | - Thomas B Brunner
- Universitätsklinikum Magdeburg, Klinik für Strahlentherapie, Magdeburg, Deutschland
| | - Reinhart A Sweeney
- Leopoldina Krankenhaus Schweinfurt, Klinik für Strahlentherapie, Schweinfurt, Deutschland
| | - Klaus Henning Kahl
- Universitätsklinikum Augsburg, Klinik für Strahlentherapie und Radioonkologie, Augsburg, Deutschland
| | - F Ilja Ciernik
- Städtisches Klinikum Dessau, Klinik für Strahlentherapie und Radioonkologie, Dessau, Deutschland
| | - Annette Ottinger
- Klinikum Darmstadt GmbH, Institut für Radioonkologie und Strahlentherapie, Darmstadt, Deutschland
| | - Victor Izaguirre
- Universitätsklinikum Halle (Saale), Klinik für Strahlentherapie, Halle (Saale), Deutschland
| | - Florian Putz
- Universitätsklinikum Erlangen, Strahlenklinik, Erlangen, Deutschland
| | - Laila König
- Universitätsklinikum Heidelberg, Klinik für Radioonkologie und Strahlentherapie, Heidelberg, Deutschland
| | - Michael Hoffmann
- Radioonkologie LMU München, Strahlentherapie und Radioonkologie, München, Deutschland
| | - Stephanie E Combs
- Technische Universität München (TUM), Department of Radiation Oncology, Ismaninger Straße 22, Munich.,Helmholtz Zentrum München (HMGU), Ingolstädter Landstraße 1, Neuherberg, Deutschland.,Deutsches Zentrum für Translationale Krebsforschung (DKTK) Partner Site Munich
| | - Matthias Guckenberger
- Universitätsspital Zürich, Universität Zürich, Klinik für Radio-Onkologie, Zürich, Schweiz
| | - Judit Boda-Heggemann
- Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Klinik für Strahlentherapie und Radioonkologie, Mannheim, Deutschland
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3
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Buergy D, Würschmidt F, Gkika E, Hörner-Rieber J, Knippen S, Gerum S, Balermpas P, Henkenberens C, Voglhuber T, Kornhuber C, Barczyk S, Röper B, Rashid A, Blanck O, Wittig A, Herold HU, Brunner TB, Klement RJ, Kahl KH, Ciernik IF, Ottinger A, Izaguirre V, Putz F, König L, Hoffmann M, Combs SE, Guckenberger M, Boda-Heggemann J. Stereotactic or conformal radiotherapy for adrenal metastases: Patient characteristics and outcomes in a multicenter analysis. Int J Cancer 2021; 149:358-370. [PMID: 33682927 DOI: 10.1002/ijc.33546] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 01/17/2023]
Abstract
To report outcome (freedom from local progression [FFLP], overall survival [OS] and toxicity) after stereotactic, palliative or highly conformal fractionated (>12) radiotherapy (SBRT, Pall-RT, 3DCRT/IMRT) for adrenal metastases in a retrospective multicenter cohort within the framework of the German Society for Radiation Oncology (DEGRO). Adrenal metastases treated with SBRT (≤12 fractions, biologically effective dose [BED10] ≥ 50 Gy), 3DCRT/IMRT (>12 fractions, BED10 ≥ 50 Gy) or Pall-RT (BED10 < 50 Gy) were eligible for this analysis. In addition to unadjusted FFLP (Kaplan-Meier/log-rank), we calculated the competing-risk-adjusted local recurrence rate (CRA-LRR). Three hundred twenty-six patients with 366 metastases were included by 21 centers (median follow-up: 11.7 months). Treatment was SBRT, 3DCRT/IMRT and Pall-RT in 260, 27 and 79 cases, respectively. Most frequent primary tumors were non-small-cell lung cancer (NSCLC; 52.5%), SCLC (16.3%) and melanoma (6.7%). Unadjusted FFLP was higher after SBRT vs Pall-RT (P = .026) while numerical differences in CRA-LRR between groups did not reach statistical significance (1-year CRA-LRR: 13.8%, 17.4% and 27.7%). OS was longer after SBRT vs other groups (P < .05) and increased in patients with locally controlled metastases in a landmark analysis (P < .0001). Toxicity was mostly mild; notably, four cases of adrenal insufficiency occurred, two of which were likely caused by immunotherapy or tumor progression. Radiotherapy for adrenal metastases was associated with a mild toxicity profile in all groups and a favorable 1-year CRA-LRR after SBRT or 3DCRT/IMRT. One-year FFLP was associated with longer OS. Dose-response analyses for the dataset are underway.
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Affiliation(s)
- Daniel Buergy
- Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Klinik für Strahlentherapie und Radioonkologie, Mannheim, Germany
| | | | - Eleni Gkika
- Universitätsklinikum Freiburg, Strahlenheilkunde, Freiburg, Germany
| | - Juliane Hörner-Rieber
- Universitätsklinikum Heidelberg, Klinik für Radioonkologie und Strahlentherapie, Heidelberg, Germany
| | - Stefan Knippen
- Universitätsklinikum Jena, Klinik für Strahlentherapie und Radioonkologie, Jena, Germany.,Universitätsklinikum Erlangen, Strahlenklinik, Erlangen, Germany
| | - Sabine Gerum
- Radioonkologie LMU München, Strahlentherapie und Radioonkologie, Munich, Germany.,Klinik für Radiotherapie und Radioonkologie, Paracelsus Universität Salzburg, Landeskrankenhaus, Salzburg, Austria
| | - Panagiotis Balermpas
- Universitätsspital Zürich, Universität Zürich, Klinik für Radio-Onkologie, Zürich, Switzerland
| | - Christoph Henkenberens
- Medizinische Hochschule Hannover, Klinik für Strahlentherapie und Spezielle Onkologie, Hannover, Germany
| | - Theresa Voglhuber
- Technische Universität München (TUM), Department of Radiation Oncology, Munich, Germany
| | - Christine Kornhuber
- Universitätsklinikum Halle (Saale), Klinik für Strahlentherapie, Halle (Saale), Germany
| | - Steffen Barczyk
- Zentrum für Strahlentherapie und Radioonkologie, Belegklinik am St. Agnes-Hospital, Bocholt, Germany
| | - Barbara Röper
- Gemeinschaftspraxis für Strahlentherapie, Bogenhausen - Harlaching - Neuperlach, Munich, Germany
| | - Ali Rashid
- MediClin Robert Janker Klinik, Klinik für Strahlentherapie und Radioonkologie, Bonn, Germany
| | - Oliver Blanck
- Universitätsklinikum Schleswig-Holstein, Klinik für Strahlentherapie, Kiel, Germany
| | - Andrea Wittig
- Universitätsklinikum Jena, Klinik für Strahlentherapie und Radioonkologie, Jena, Germany
| | - Hans-Ulrich Herold
- Cyberknife Centrum Mitteldeutschland GmbH, Institut für Radiochirurgie und Präzisionsbestrahlung, Erfurt, Germany
| | - Thomas B Brunner
- Universitätsklinikum Magdeburg, Klinik für Strahlentherapie, Magdeburg, Germany
| | - Rainer J Klement
- Universitätsspital Zürich, Universität Zürich, Klinik für Radio-Onkologie, Zürich, Switzerland.,Leopoldina Krankenhaus Schweinfurt, Klinik für Strahlentherapie, Schweinfurt, Germany
| | - Klaus Henning Kahl
- Universitätsklinikum Augsburg, Klinik für Strahlentherapie und Radioonkologie, Augsburg, Germany
| | - Ilja F Ciernik
- Städtisches Klinikum Dessau, Klinik für Strahlentherapie und Radioonkologie, Dessau, Germany
| | - Annette Ottinger
- Klinikum Darmstadt GmbH, Institut für Radioonkologie und Strahlentherapie, Darmstadt, Germany
| | - Victor Izaguirre
- Universitätsklinikum Halle (Saale), Klinik für Strahlentherapie, Halle (Saale), Germany
| | - Florian Putz
- Universitätsklinikum Erlangen, Strahlenklinik, Erlangen, Germany
| | - Laila König
- Universitätsklinikum Heidelberg, Klinik für Radioonkologie und Strahlentherapie, Heidelberg, Germany
| | - Michael Hoffmann
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Klinikum der Universität München, LMU, Munich, Germany
| | - Stephanie E Combs
- Technische Universität München (TUM), Department of Radiation Oncology, Munich, Germany.,Helmholtz Zentrum München (HMGU), Neuherberg, Germany.,Deutsches Zentrum für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Matthias Guckenberger
- Universitätsspital Zürich, Universität Zürich, Klinik für Radio-Onkologie, Zürich, Switzerland
| | - Judit Boda-Heggemann
- Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Klinik für Strahlentherapie und Radioonkologie, Mannheim, Germany
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Stützer K, Jakobi A, Bandurska-Luque A, Barczyk S, Arnsmeyer C, Löck S, Richter C. Potential proton and photon dose degradation in advanced head and neck cancer patients by intratherapy changes. J Appl Clin Med Phys 2017; 18:104-113. [PMID: 28921843 PMCID: PMC5689930 DOI: 10.1002/acm2.12189] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/28/2017] [Accepted: 08/21/2017] [Indexed: 12/25/2022] Open
Abstract
Purpose Evaluation of dose degradation by anatomic changes for head‐and‐neck cancer (HNC) intensity‐modulated proton therapy (IMPT) relative to intensity‐modulated photon therapy (IMRT) and identification of potential indicators for IMPT treatment plan adaptation. Methods For 31 advanced HNC datasets, IMPT and IMRT plans were recalculated on a computed tomography scan (CT) taken after about 4 weeks of therapy. Dose parameter changes were determined for the organs at risk (OARs) spinal cord, brain stem, parotid glands, brachial plexus, and mandible, for the clinical target volume (CTV) and the healthy tissue outside planning target volume (PTV). Correlation of dose degradation with target volume changes and quality of rigid CT matching was investigated. Results Recalculated IMPT dose distributions showed stronger degradation than the IMRT doses. OAR analysis revealed significant changes in parotid median dose (IMPT) and near maximum dose (D1ml) of spinal cord (IMPT, IMRT) and mandible (IMPT). OAR dose parameters remained lower in IMPT cases. CTV coverage (V95%) and overdose (V107%) deteriorated for IMPT plans to (93.4 ± 5.4)% and (10.6 ± 12.5)%, while those for IMRT plans remained acceptable. Recalculated plans showed similarly decreased PTV conformity, but considerable hotspots, also outside the PTV, emerged in IMPT cases. Lower CT matching quality was significantly correlated with loss of PTV conformity (IMPT, IMRT), CTV homogeneity and coverage (IMPT). Target shrinkage correlated with increased dose in brachial plexus (IMRT, IMPT), hotspot generation outside the PTV (IMPT) and lower PTV conformity (IMRT). Conclusions The study underlines the necessity of precise positioning and monitoring of anatomy changes, especially in IMPT which might require adaptation more often. Since OAR doses remained typically below constraints, IMPT plan adaptation will be indicated by target dose degradations.
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Affiliation(s)
- Kristin Stützer
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Fetscherstr. 74, PF 41, 01307, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Bautzner Landstr. 400, 01328, Dresden, Germany
| | - Annika Jakobi
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Fetscherstr. 74, PF 41, 01307, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Bautzner Landstr. 400, 01328, Dresden, Germany.,Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Anna Bandurska-Luque
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Fetscherstr. 74, PF 41, 01307, Dresden, Germany.,Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Steffen Barczyk
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Fetscherstr. 74, PF 41, 01307, Dresden, Germany.,Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Carolin Arnsmeyer
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Fetscherstr. 74, PF 41, 01307, Dresden, Germany
| | - Steffen Löck
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Fetscherstr. 74, PF 41, 01307, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Bautzner Landstr. 400, 01328, Dresden, Germany
| | - Christian Richter
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Fetscherstr. 74, PF 41, 01307, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Bautzner Landstr. 400, 01328, Dresden, Germany.,Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.,German Cancer Consortium (DKTK), partner site Dresden, Germany and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69192, Heidelberg, Germany
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5
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Stützer K, Haase R, Lohaus F, Barczyk S, Exner F, Löck S, Rühaak J, Lassen-Schmidt B, Corr D, Richter C. Evaluation of a deformable registration algorithm for subsequent lung computed tomography imaging during radiochemotherapy. Med Phys 2017; 43:5028. [PMID: 27587033 DOI: 10.1118/1.4960366] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Rating both a lung segmentation algorithm and a deformable image registration (DIR) algorithm for subsequent lung computed tomography (CT) images by different evaluation techniques. Furthermore, investigating the relative performance and the correlation of the different evaluation techniques to address their potential value in a clinical setting. METHODS Two to seven subsequent CT images (69 in total) of 15 lung cancer patients were acquired prior, during, and after radiochemotherapy. Automated lung segmentations were compared to manually adapted contours. DIR between the first and all following CT images was performed with a fast algorithm specialized for lung tissue registration, requiring the lung segmentation as input. DIR results were evaluated based on landmark distances, lung contour metrics, and vector field inconsistencies in different subvolumes defined by eroding the lung contour. Correlations between the results from the three methods were evaluated. RESULTS Automated lung contour segmentation was satisfactory in 18 cases (26%), failed in 6 cases (9%), and required manual correction in 45 cases (66%). Initial and corrected contours had large overlap but showed strong local deviations. Landmark-based DIR evaluation revealed high accuracy compared to CT resolution with an average error of 2.9 mm. Contour metrics of deformed contours were largely satisfactory. The median vector length of inconsistency vector fields was 0.9 mm in the lung volume and slightly smaller for the eroded volumes. There was no clear correlation between the three evaluation approaches. CONCLUSIONS Automatic lung segmentation remains challenging but can assist the manual delineation process. Proven by three techniques, the inspected DIR algorithm delivers reliable results for the lung CT data sets acquired at different time points. Clinical application of DIR demands a fast DIR evaluation to identify unacceptable results, for instance, by combining different automated DIR evaluation methods.
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Affiliation(s)
- Kristin Stützer
- OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstr. 74, PF 41, Dresden 01307, Germany
| | - Robert Haase
- OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstr. 74, PF 41, Dresden 01307, Germany
| | - Fabian Lohaus
- OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstr. 74, PF 41, Dresden 01307, Germany; Department of Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden 01307, Germany; German Cancer Consortium (DKTK), Dresden 01307, Germany; and German Cancer Research Center (DKFZ), Heidelberg 69121, Germany
| | - Steffen Barczyk
- OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstr. 74, PF 41, Dresden 01307, Germany and Department of Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden 01307, Germany
| | - Florian Exner
- OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstr. 74, PF 41, Dresden 01307, Germany
| | - Steffen Löck
- OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstr. 74, PF 41, Dresden 01307, Germany; Department of Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden 01307, Germany; German Cancer Consortium (DKTK), Dresden 01307, Germany; German Cancer Research Center (DKFZ), Heidelberg 69121, Germany; and Institute of Radiooncology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden 01328, Germany
| | - Jan Rühaak
- Fraunhofer MEVIS, Institute for Medical Image Computing, Maria-Goeppert-Straße 3, Lübeck 23562, Germany
| | - Bianca Lassen-Schmidt
- Fraunhofer MEVIS, Institute for Medical Image Computing, Universitätsallee 29, Bremen 28359, Germany
| | - Dörte Corr
- Fraunhofer MEVIS, Institute for Medical Image Computing, Universitätsallee 29, Bremen 28359, Germany
| | - Christian Richter
- OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstr. 74, PF 41, Dresden 01307, Germany; Department of Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden 01307, Germany; German Cancer Consortium (DKTK), Dresden 01307, Germany; German Cancer Research Center (DKFZ), Heidelberg 69121, Germany; and Institute of Radiooncology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden 01328, Germany
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Priegnitz M, Barczyk S, Nenoff L, Golnik C, Keitz I, Werner T, Mein S, Smeets J, Vander Stappen F, Janssens G, Hotoiu L, Fiedler F, Prieels D, Enghardt W, Pausch G, Richter C. Towards clinical application: prompt gamma imaging of passively scattered proton fields with a knife-edge slit camera. Phys Med Biol 2016; 61:7881-7905. [PMID: 27779120 DOI: 10.1088/0031-9155/61/22/7881] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Prompt γ-ray imaging with a knife-edge shaped slit camera provides the possibility of verifying proton beam range in tumor therapy. Dedicated experiments regarding the characterization of the camera system have been performed previously. Now, we aim at implementing the prototype into clinical application of monitoring patient treatments. Focused on this goal of translation into clinical operation, we systematically addressed remaining challenges and questions. We developed a robust energy calibration routine and corresponding quality assurance protocols. Furthermore, with dedicated experiments, we determined the positioning precision of the system to 1.1 mm (2σ). For the first time, we demonstrated the application of the slit camera, which was intentionally developed for pencil beam scanning, to double scattered proton beams. Systematic experiments with increasing complexity were performed. It was possible to visualize proton range shifts of 2-5 mm with the camera system in phantom experiments in passive scattered fields. Moreover, prompt γ-ray profiles for single iso-energy layers were acquired by synchronizing time resolved measurements to the rotation of the range modulator wheel of the treatment system. Thus, a mapping of the acquired profiles to different anatomical regions along the beam path is feasible and additional information on the source of potential range shifts can be obtained. With the work presented here, we show that an application of the slit camera in clinical treatments is possible and of potential benefit.
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Affiliation(s)
- M Priegnitz
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiation Physics, Bautzner Landstraße 400, 01328 Dresden, Germany
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Santiago A, Barczyk S, Jelen U, Engenhart-Cabillic R, Wittig A. Challenges in radiobiological modeling: can we decide between LQ and LQ-L models based on reviewed clinical NSCLC treatment outcome data? Radiat Oncol 2016; 11:67. [PMID: 27154064 PMCID: PMC4859978 DOI: 10.1186/s13014-016-0643-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/27/2016] [Indexed: 01/31/2023] Open
Abstract
Aim To study the dose-response of stage I non-small-cell lung cancer (NSCLC) in terms of long-term local tumor control (LC) after conventional and hypofractionated photon radiotherapy, modeled with the linear-quadratic (LQ) and linear-quadratic-linear (LQ-L) approaches and to estimate the clinical α/β ratio within the LQ frame. Material and methods We identified studies of curative radiotherapy as single treatment through MedLine search reporting 3-year LC as primary outcome of interest. Logistic models coupled with the biologically effective dose (BED) at isocenter and PTV edge according to both the LQ and LQ-L models with α/β = 10 Gy were fitted. Additionally, α/β was estimated from direct LQ fits. Results Thirty one studies were included reporting outcome of 2319 patients. The LQ-L fit yielded a significant value of 11.0 ± 5.2 Gy for the dose threshold (Dt) for BED10 at the isocenter. The LQ and LQ-L fits did not differ substantially. Concerning the estimation of α/β, the value obtained from the direct LQ fit for the complete fractionation range was 3.9 [68 % CI: 2.2–9.0] Gy (p > 0.05). Conclusion Both LQ and LQ-L fits can model local tumor control after conventionally and hypofractionated irradiation and are robust methods for predicting clinical effects. The observed dose-effect for local control in NSCLC is weaker at high doses due to data dispersion. For BED10 values of 100–150 Gy in ≥3 fractions, the differences in isoeffects predicted by both models can be neglected. Electronic supplementary material The online version of this article (doi:10.1186/s13014-016-0643-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alina Santiago
- Department of Radiotherapy and Radiation Oncology, University Hospital Giessen and Marburg, Philipps-University Marburg, Baldingerstrasse, Marburg, 35043, Germany.
| | - Steffen Barczyk
- Department of Radiotherapy and Radiation Oncology, University Hospital Giessen and Marburg, Philipps-University Marburg, Baldingerstrasse, Marburg, 35043, Germany.,Present address: Gemeinschaftspraxis Strahlentherapie am St. Agnes Hospital, Bocholt, Germany
| | - Urszula Jelen
- Department of Radiotherapy and Radiation Oncology, University Hospital Giessen and Marburg, Philipps-University Marburg, Baldingerstrasse, Marburg, 35043, Germany.,Present address: Marburger Ionenstrahl-Therapiezentrum MIT, Marburg, Germany
| | - Rita Engenhart-Cabillic
- Department of Radiotherapy and Radiation Oncology, University Hospital Giessen and Marburg, Philipps-University Marburg, Baldingerstrasse, Marburg, 35043, Germany
| | - Andrea Wittig
- Department of Radiotherapy and Radiation Oncology, University Hospital Giessen and Marburg, Philipps-University Marburg, Baldingerstrasse, Marburg, 35043, Germany
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Priegnitz M, Barczyk S, Keitz I, Mein S, Stappen F, Janssens G, Hotoiu L, Smeets J, Fiedler F, Prieels D, Enghardt W, Pausch G, Richter C. Prompt gamma imaging of passively shaped proton fields with a knife-edge slit camera. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)30177-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Richter C, Pausch G, Barczyk S, Priegnitz M, Keitz I, Thiele J, Smeets J, Vander Stappen F, Bombelli L, Fiorini C, Hotoiu L, Perali I, Prieels D, Enghardt W, Baumann M. First clinical application of a prompt gamma based in vivo proton range verification using a knife-edge slit camera. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)30184-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Richter C, Pausch G, Barczyk S, Priegnitz M, Keitz I, Thiele J, Smeets J, Stappen FV, Bombelli L, Fiorini C, Hotoiu L, Perali I, Prieels D, Enghardt W, Baumann M. First clinical application of a prompt gamma based in vivo proton range verification system. Radiother Oncol 2016; 118:232-7. [DOI: 10.1016/j.radonc.2016.01.004] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/13/2015] [Accepted: 01/05/2016] [Indexed: 12/25/2022]
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