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Galofaro E, Malizia C, Ammendolia I, Galuppi A, Guido A, Ntreta M, Siepe G, Tolento G, Veraldi A, Scirocco E, Arcelli A, Buwenge M, Ferioli M, Zamagni A, Strigari L, Cammelli S, Morganti AG. COVID-19 Pandemic-Adapted Radiotherapy Guidelines: Are They Really Followed? Curr Oncol 2021; 28:3323-3330. [PMID: 34590595 PMCID: PMC8482258 DOI: 10.3390/curroncol28050288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In our department, we provided guidelines to the radiation oncologists (ROs) regarding the omission, delay, or shortening of radiotherapy (RT). The purpose was to reduce the patients' exposure to the hospital environment and to minimize the departmental overcrowding. The aim was to evaluate the ROs' compliance to these guidelines. METHODS ROs were asked to fill out a data collection form during patients' first visits in May and June 2020. The collected data included the ROs' age and gender, patient age and residence, RT purpose, treated tumor, the dose and fractionation that would have been prescribed, and RT changes. The chi-square test and binomial logistic regression were used to analyze the correlation between the treatment prescription and the collected parameters. RESULTS One hundred and twenty-six out of 205 prescribed treatments were included in this analysis. Treatment was modified in 61.1% of cases. More specifically, the treatment was omitted, delayed, or shortened in 7.9, 15.9, and 37.3% of patients, respectively. The number of delivered fractions was reduced by 27.9%. A statistically significant correlation (p = 0.028) between younger patients' age and lower treatment modifications rate was recorded. CONCLUSION Our analysis showed a reasonably high compliance of ROs to the pandemic-adapted guidelines. The adopted strategy was effective in reducing the number of admissions to our department.
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Affiliation(s)
- Elena Galofaro
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
- Correspondence: ; Tel.: +39-3409328999
| | - Claudio Malizia
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Ilario Ammendolia
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
| | - Andrea Galuppi
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
| | - Alessandra Guido
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
| | - Maria Ntreta
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
| | - Giambattista Siepe
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
| | - Giorgio Tolento
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
| | - Antonio Veraldi
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
| | - Erica Scirocco
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
| | - Alessandra Arcelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
| | - Milly Buwenge
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
| | - Martina Ferioli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
| | - Alice Zamagni
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
| | - Lidia Strigari
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Silvia Cammelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
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752
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Naessig M, Hernandez S, Astorga NR, McCulloch J, Saenz D, Myers P, Rasmussen K, Stathakis S, Ha CS, Papanikolaou N, Ford J, Kirby N. A customizable aluminum compensator system for total body irradiation. J Appl Clin Med Phys 2021; 22:36-44. [PMID: 34432944 PMCID: PMC8504611 DOI: 10.1002/acm2.13393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/15/2021] [Accepted: 07/28/2021] [Indexed: 11/08/2022] Open
Abstract
Purpose To develop a simplified aluminum compensator system for total body irradiation (TBI) that is easy to assemble and modify in a short period of time for customized patient treatments. Methods The compensator is composed of a combination of 0.3 cm thick aluminum bars, two aluminum T‐tracks, spacers, and metal bolts. The system is mounted onto a plexiglass block tray. The design consists of 11 fixed sectors spanning from the patient's head to feet. The outermost sectors utilize 7.6 cm wide aluminum bars, while the remaining sectors use 2.5 cm wide aluminum bars. There is a magnification factor of 5 from the compensator to the patient treatment plane. Each bar of aluminum is interconnected at each adjacent sector with a tongue and groove arrangement and fastened to the T‐track using a metal washer, bolt, and nut. Inter‐bar leakage of the compensator was tested using a water tank and diode. End‐to‐end measurements were performed with an ion chamber in a solid water phantom and also with a RANDO phantom using internal and external optically stimulated luminescent detectors (OSLDs). In‐vivo patient measurements from the first 20 patients treated with this aluminum compensator were compared to those from 20 patients treated with our previously used lead compensator system. Results The compensator assembly time was reduced to 20–30 min compared to the 2–4 h it would take with the previous lead design. All end‐to‐end measurements were within 10% of that expected. The median absolute in‐vivo error for the aluminum compensator was 3.7%, with 93.8% of measurements being within 10% of that expected. The median error for the lead compensator system was 5.3%, with 85.1% being within 10% of that expected. Conclusion This design has become the standard compensator at our clinic. It allows for quick assembly and customization along with meeting the Task Group 29 recommendations for dose uniformity.
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Affiliation(s)
- Madison Naessig
- Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Department of Nuclear Engineering, Texas A&M University, College Station, Texas, USA
| | - Soleil Hernandez
- Department of Nuclear Engineering, Texas A&M University, College Station, Texas, USA
| | - Nestor Rodrigo Astorga
- Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - James McCulloch
- Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Daniel Saenz
- Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Pamela Myers
- Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Karl Rasmussen
- Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Sotirios Stathakis
- Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Chul S Ha
- Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Niko Papanikolaou
- Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - John Ford
- Department of Nuclear Engineering, Texas A&M University, College Station, Texas, USA
| | - Neil Kirby
- Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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753
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Dzul S, Ninia J, Jang H, Kim S, Dominello M. Predictors of Acute Radiation Dermatitis and Esophagitis in African American Patients Receiving Whole Breast Radiotherapy. Pract Radiat Oncol 2021; 12:52-59. [PMID: 34710629 DOI: 10.1016/j.prro.2021.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE/OBJECTIVES Adjuvant whole breast radiotherapy following breast conserving surgery is standard of care in the management of early stage breast cancer. Two of the most common acute toxicities of breast radiotherapy are radiation esophagitis (RE) and radiation dermatitis (RD). African Americans are at higher risk for experiencing treatment-related toxicity and are often under-represented in clinical trials. METHODS An institutional database was developed to include all African American patients with history of breast cancer or DCIS undergoing adjuvant radiotherapy at a single institution from 2013-2019. Records were reviewed to identify patient age, BMI, radiation dose, prone vs supine position, inclusion of boost, and inclusion of regional nodal irradiation (RNI). Radiation treatment plans were reviewed to identify breast size as well as dosimetric parameters to the breast and esophagus. Medical records were reviewed to identify which patients were prescribed silvadene or mylanta-lidocaine during or immediately following their course of radiotherapy which was used as a surrogate for Grade 2 or higher dermatitis (G2RD) and esophagitis (G2RE), respectively. RESULTS 272 patients were included in the final analysis. On univariable analysis, morbidly obese patients were more likely to develop G2RD while hypofractionated radiotherapy was associated with lower rates of G2RD. On multivariable analysis, increasing breast volume was associated with higher rates of G2RD. For the subset of patients receiving RNI, 19% of patients experienced G2RE with the best predictor on multivariable analysis being Dmean to the esophagus. CONCLUSION Radiation dermatitis and esophagitis are common toxicities in African American patients undergoing adjuvant breast radiotherapy. Breast size, irrespective of patient's BMI, was associated with worse rate of dermatitis. Prone position and hypofractionated radiation reduced rates of G2RD. Dmean to the esophagus was the dosimetric parameter best correlating with G2RE. These results may be used to help select patients are at higher risk for G2 or higher toxicity during radiotherapy.
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Affiliation(s)
- Stephen Dzul
- Wayne State University School of Medicine, Detroit, MI.
| | - James Ninia
- Wayne State University School of Medicine, Detroit, MI
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754
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Taylor A, Shuttleworth P. Supporting the development of the research and clinical trials therapeutic radiographers workforce: The RaCTTR survey. Radiography (Lond) 2021; 27 Suppl 1:S20-S27. [PMID: 34420887 DOI: 10.1016/j.radi.2021.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The Research and Clinical Trials Therapeutic Radiographers network is a College of Radiographers Specialist Interest Group. It was established to develop and facilitate a support network for therapeutic radiographers working in roles which involve the delivery of radiotherapy clinical trials. Its establishment highlighted the challenges faced by therapeutic radiographers employed in these roles. Consequently, the authors sought to formally capture the working landscape of this subsection of the radiographic workforce, aiming to ascertain any potential barriers to professional development and the increase of clinical trials activity by 15% mandated by NHS England. METHODS A Qualtrics survey was designed, pilot tested and distributed to the sixty-two radiotherapy departments across England and the devolved nations. Departments were questioned on the size, structure and the scope of practice of their radiotherapy research and clinical trials team members. FINDINGS Thirty-nine complete responses were received, providing a response rate of 62%, with each region of the UK represented in the survey. The findings demonstrated issues related to the number of posts affecting capacity, contract status jeopardising the security and effectiveness of their role and the activities specific to research and clinical trials being 'bolted on' to existing roles. Although advanced practice was being undertaken by around a third of this workforce the findings established several barriers including individual/teams' capacity and a perceived lack of support for therapeutic radiographers to progress in clinical trials roles. CONCLUSION The findings illustrate several important implications which if not addressed may not only hinder UK radiotherapy departments to achieve the national increase of 15% of clinical trial activity over the next three years but also restrict the growth in size and scope of professional practice of the workforce. IMPLICATIONS FOR PRACTICE The research and clinical trials workforce need to adopt a collaborative approach to profile raising and establish a standardised professional scope of practice to support growth and recognition of their role.
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Affiliation(s)
- A Taylor
- Weston Park Cancer Centre, Whitham Road, Sheffield, S10 2SJ, United Kingdom.
| | - P Shuttleworth
- Weston Park Cancer Centre, Whitham Road, Sheffield, S10 2SJ, United Kingdom
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755
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Mah D, Yorke E, Zemanaj E, Han Z, Liu H, George J, Lambiase J, Czmielewski C, Lovelock DM, Rimner A, Shepherd AF. A Planning Comparison of IMRT vs. Pencil Beam Scanning for Deep Inspiration Breath Hold Lung Cancers. Med Dosim 2021; 47:26-31. [PMID: 34426041 DOI: 10.1016/j.meddos.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/09/2021] [Accepted: 07/20/2021] [Indexed: 12/25/2022]
Abstract
Deep inspiration breath hold (DIBH) has dosimetric advantages for lung cancer patients treated with external beam therapy, but is difficult for many patients to perform. Proton therapy permits sparing of the downstream organs at risk (OAR). We compared conventionally fractionated proton (p) and photon(x) plans on both free breathing (FB) and DIBH planning CTs to determine the effect of DIBH with proton therapy. We evaluated 24 plans from 6 lung cancer patients treated with photon DIBH on a prospective protocol. All patients were re-planned using pencil beam scanning (PBS) proton therapy. New plans were generated for FB datasets with both modalities. All plans were renormalized to 60 Gy. We evaluated dosimetric parameters for heart, lung and esophagus. We also compared FBp to DIBHx parameters to quantify how FBp plans compare to DIBHx plans. Significant differences were found for lung metrics V20 and mean lung dose between FB and DIBH plans regardless of treatment modality. Furthermore, lung metrics for FBp were comparable or superior to DIBHx, suggesting that FB protons may be a viable alternative for those patients that cannot perform DIBH with IMRT. The heart dose metrics were significantly different for the 5 out of 6 patients where the PTV overlapped the heart as DIBH moved heart out of the high dose volume. Heart dose metrics were further reduced by proton therapy. DIBH offers similar relative advantages for lung sparing for PBS as it does for IMRT but the magnitude of the DIBH related gains in OAR sparing were smaller for PBS than IMRT. FBp plans offer similar or better lung and heart sparing compared to DIBHx plans. For IMRT patients who have difficulty performing DIBH, FB protons may offer an alternative.
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Affiliation(s)
- Dennis Mah
- Department of Medical Physics, ProCure Proton Therapy Center, Somerset NJ 08873, USA.
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Entela Zemanaj
- Department of Medical Physics, ProCure Proton Therapy Center, Somerset NJ 08873, USA
| | - Zhiqiang Han
- Department of Medical Physics, ProCure Proton Therapy Center, Somerset NJ 08873, USA
| | - Haoyang Liu
- Department of Medical Physics, ProCure Proton Therapy Center, Somerset NJ 08873, USA
| | - Jobin George
- Department of Medical Physics, ProCure Proton Therapy Center, Somerset NJ 08873, USA
| | - Jason Lambiase
- Department of Medical Physics, ProCure Proton Therapy Center, Somerset NJ 08873, USA
| | - Christian Czmielewski
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - D Michael Lovelock
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Annemarie F Shepherd
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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756
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Guven DC, Aksun MS, Cakir IY, Kilickap S, Kertmen N. The association of BMI and sarcopenia with survival in patients with glioblastoma multiforme. Future Oncol 2021; 17:4405-4413. [PMID: 34409854 DOI: 10.2217/fon-2021-0681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background: The association between obesity and sarcopenia (via temporal muscle thickness) with overall survival (OS) has been evaluated in several glioblastoma multiforme studies, however, the data are inconclusive. Methods: The authors conducted meta-analyses via the generic inverse-variance method with a random-effects model. Results: In the pooled analysis of five studies, including 973 patients, patients with lower temporal muscle thickness had significantly decreased OS (HR: 1.62, 95% CI: 1.16-2.28, p = 0.005). The pooled analysis of five studies, including 2131 patients, demonstrated decreased OS in patients with lower BMI compared with patients with obesity (HR: 1.45, 95% CI: 1.12-1.88, p = 0.005). Conclusion: Readily available body composition parameters could be used for prognosis prediction and to aid in treatment decisions in patients with glioblastoma multiforme.
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Affiliation(s)
| | - Melek Seren Aksun
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Ibrahim Yahya Cakir
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Saadettin Kilickap
- Hacettepe University Cancer Institute, Ankara 06100, Turkey.,Department of Medical Oncology, Istinye University, Istanbul 34010, Turkey
| | - Neyran Kertmen
- Hacettepe University Cancer Institute, Ankara 06100, Turkey
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757
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Borghi L, Bonazza F, Lamiani G, Musetti A, Manari T, Filosa M, Quattropani MC, Lenzo V, Freda MF, Lemmo D, Saita E, Cattivelli R, Castelnuovo G, Vegni E, Franceschini C. Dreaming during lockdown: a quali-quantitative analysis of the Italian population dreams during the first COVID-19 pandemic wave. RESEARCH IN PSYCHOTHERAPY (MILANO) 2021; 24:547. [PMID: 34568113 PMCID: PMC8451213 DOI: 10.4081/ripppo.2021.547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/29/2021] [Indexed: 12/02/2022]
Abstract
This study aims to explore the emotional experiences related to the lockdown during the first pandemic wave, analysing the dreams of the Italian population. Through an online survey spread throughout the country, participants completed the Depression Anxiety Stress Scale-21 (DASS-21), the Resilience Scale (RS) and were asked to narrate a dream they had during the lockdown. The dreams were qualitatively analysed through the thematic content analysis. Logistic regression analyses were then conducted to verify the relationship among the categories that emerged and between these categories and the DASS-21 and RS scores. In the dreams 8 categories were identified (Places, Characters, Relationships, Actions, Danger, Death, Processes, and Emotions) composed of specific sub-categories, which seem to compose a sort of narrative structure of the dream. Some sub-categories were found to be predictor of depression and resilience or with exposure to COVID-19. Dreams can be a valid tool both to understand the experiences of the population during the pandemic and to evaluate those at risk of developing distress in clinical practice.
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Affiliation(s)
- Lidia Borghi
- Psicologia Clinica, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano
| | - Federica Bonazza
- Psicologia Clinica, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano
| | - Giulia Lamiani
- Psicologia Clinica, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano
| | - Alessandro Musetti
- Dipartimento di Discipline Umanistiche, Sociali e delle Imprese culturali, Università di Parma, Parma
| | - Tommaso Manari
- Dipartimento di Discipline Umanistiche, Sociali e delle Imprese culturali, Università di Parma, Parma
| | - Maria Filosa
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma
| | | | - Vittorio Lenzo
- Dipartimento di Scienze della Società e della Formazione d’Area Mediterranea, Università per Stranieri ‘Dante Alighieri’ di Reggio Calabria
| | | | - Daniela Lemmo
- Dipartimento di Scienze Umanistiche, Università Federico II, Napoli
| | - Emanuela Saita
- Dipartimento di Psicologia, Università Cattolica di Milano, Milano
| | - Roberto Cattivelli
- Dipartimento di Psicologia, Università Cattolica di Milano, Milano
- Istituto Auxologico Italiano IRCCS, Laboratorio di Ricerca Psicologica, Milano, Italy
| | - Gianluca Castelnuovo
- Dipartimento di Psicologia, Università Cattolica di Milano, Milano
- Istituto Auxologico Italiano IRCCS, Laboratorio di Ricerca Psicologica, Milano, Italy
| | - Elena Vegni
- Psicologia Clinica, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano
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758
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De Meerleer G, Berghen C, Briganti A, Vulsteke C, Murray J, Joniau S, Leliveld AM, Cozzarini C, Decaestecker K, Rans K, Fonteyne V, De Hertogh O, Bossi A. Elective nodal radiotherapy in prostate cancer. Lancet Oncol 2021; 22:e348-e357. [PMID: 34339655 DOI: 10.1016/s1470-2045(21)00242-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/02/2021] [Accepted: 04/15/2021] [Indexed: 12/18/2022]
Abstract
In patients with prostate cancer who have a high risk of pelvic nodal disease, the use of elective whole pelvis radiotherapy is still controversial. Two large, randomised, controlled trials (RTOG 9413 and GETUG-01) did not show a benefit of elective whole pelvis radiotherapy over prostate-only radiotherapy. In 2020, the POP-RT trial established the role of elective whole pelvis radiotherapy in patients who have more than a 35% risk of lymph node invasion (known as the Roach formula). POP-RT stressed the importance of patient selection. In patients with cN1 (clinically node positive) disease or pN1 (pathologically node positive) disease, the addition of whole pelvis radiotherapy to androgen deprivation therapy significantly improved survival compared with androgen deprivation therapy alone, as shown in large, retrospective studies. This patient population might increase in the future because use of the more sensitive prostate-specific membrane antigen PET-CT will become the standard staging procedure. Additionally, the SPORTT trial suggested a benefit of whole pelvis radiotherapy in biochemical recurrence-free survival in the salvage setting. A correct definition of the upper field border, which should include the bifurcation of the abdominal aorta, is key in the use of pelvic radiotherapy. As a result of using modern radiotherapy technology, severe late urinary and intestinal toxic effects are rare and do not seem to increase compared with prostate-only radiotherapy.
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Affiliation(s)
- Gert De Meerleer
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium.
| | - Charlien Berghen
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Alberto Briganti
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Christof Vulsteke
- Department of Medical Oncology, Maria Middelares Hospital, Gent, Belgium
| | - Julia Murray
- Department of Radiation Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Anne M Leliveld
- Department of Urology, University Medical Centre Groningen, Groningen, Netherlands
| | - Cesare Cozzarini
- Department of Radiation Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Kato Rans
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Valerie Fonteyne
- Department of Radiotherapy and Experimental Cancer Research, Gent University Hospital, Gent, Belgium
| | - Olivier De Hertogh
- Department of Radiotherapy, Centre Hospitalier Régional de Verviers, Verviers, Belgium
| | - Alberto Bossi
- Department of Radiation Oncology, Gustave Roussy Institute, Paris, France
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759
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Apilan AG, Mothersill C. Targeted and Non-Targeted Mechanisms for Killing Hypoxic Tumour Cells-Are There New Avenues for Treatment? Int J Mol Sci 2021; 22:ijms22168651. [PMID: 34445354 PMCID: PMC8395506 DOI: 10.3390/ijms22168651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose: A major issue in radiotherapy is the relative resistance of hypoxic cells to radiation. Historic approaches to this problem include the use of oxygen mimetic compounds to sensitize tumour cells, which were unsuccessful. This review looks at modern approaches aimed at increasing the efficacy of targeting and radiosensitizing hypoxic tumour microenvironments relative to normal tissues and asks the question of whether non-targeted effects in radiobiology may provide a new “target”. Novel techniques involve the integration of recent technological advancements such as nanotechnology, cell manipulation, and medical imaging. Particularly, the major areas of research discussed in this review include tumour hypoxia imaging through PET imaging to guide carbogen breathing, gold nanoparticles, macrophage-mediated drug delivery systems used for hypoxia-activate prodrugs, and autophagy inhibitors. Furthermore, this review outlines several features of these methods, including the mechanisms of action to induce radiosensitization, the increased accuracy in targeting hypoxic tumour microenvironments relative to normal tissue, preclinical/clinical trials, and future considerations. Conclusions: This review suggests that the four novel tumour hypoxia therapeutics demonstrate compelling evidence that these techniques can serve as powerful tools to increase targeting efficacy and radiosensitizing hypoxic tumour microenvironments relative to normal tissue. Each technique uses a different way to manipulate the therapeutic ratio, which we have labelled “oxygenate, target, use, and digest”. In addition, by focusing on emerging non-targeted and out-of-field effects, new umbrella targets are identified, which instead of sensitizing hypoxic cells, seek to reduce the radiosensitivity of normal tissues.
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760
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Eckl M, Sarria GR, Springer S, Willam M, Ruder AM, Steil V, Ehmann M, Wenz F, Fleckenstein J. Dosimetric benefits of daily treatment plan adaptation for prostate cancer stereotactic body radiotherapy. Radiat Oncol 2021; 16:145. [PMID: 34348765 PMCID: PMC8335467 DOI: 10.1186/s13014-021-01872-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/27/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Hypofractionation is increasingly being applied in radiotherapy for prostate cancer, requiring higher accuracy of daily treatment deliveries than in conventional image-guided radiotherapy (IGRT). Different adaptive radiotherapy (ART) strategies were evaluated with regard to dosimetric benefits. METHODS Treatments plans for 32 patients were retrospectively generated and analyzed according to the PACE-C trial treatment scheme (40 Gy in 5 fractions). Using a previously trained cycle-generative adversarial network algorithm, synthetic CT (sCT) were generated out of five daily cone-beam CT. Dose calculation on sCT was performed for four different adaptation approaches: IGRT without adaptation, adaptation via segment aperture morphing (SAM) and segment weight optimization (ART1) or additional shape optimization (ART2) as well as a full re-optimization (ART3). Dose distributions were evaluated regarding dose-volume parameters and a penalty score. RESULTS Compared to the IGRT approach, the ART1, ART2 and ART3 approaches substantially reduced the V37Gy(bladder) and V36Gy(rectum) from a mean of 7.4cm3 and 2.0cm3 to (5.9cm3, 6.1cm3, 5.2cm3) as well as to (1.4cm3, 1.4cm3, 1.0cm3), respectively. Plan adaptation required on average 2.6 min for the ART1 approach and yielded doses to the rectum being insignificantly different from the ART2 approach. Based on an accumulation over the total patient collective, a penalty score revealed dosimetric violations reduced by 79.2%, 75.7% and 93.2% through adaptation. CONCLUSION Treatment plan adaptation was demonstrated to adequately restore relevant dose criteria on a daily basis. While for SAM adaptation approaches dosimetric benefits were realized through ensuring sufficient target coverage, a full re-optimization mainly improved OAR sparing which helps to guide the decision of when to apply which adaptation strategy.
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Affiliation(s)
- Miriam Eckl
- Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Sandra Springer
- Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Marvin Willam
- Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Arne M Ruder
- Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Volker Steil
- Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Michael Ehmann
- Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Frederik Wenz
- University Medical Center Freiburg, University of Freiburg, Freiburg im Breisgau, Germany
| | - Jens Fleckenstein
- Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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761
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Rassiah P, Esiashvili N, Olch AJ, Hua CH, Ulin K, Molineu A, Marcus K, Gopalakrishnan M, Pillai S, Kovalchuk N, Liu A, Niyazov G, Peñagarícano JA, Cheung F, Olson AC, Wu CC, Malhotra H, MacEwan IJ, Faught J, Breneman JC, Followill DS, FitzGerald TJ, Kalapurakal JA. Practice patterns of pediatric total body irradiation techniques: A Children's Oncology Group survey. Int J Radiat Oncol Biol Phys 2021; 111:1155-1164. [PMID: 34352289 DOI: 10.1016/j.ijrobp.2021.07.1715] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/30/2021] [Accepted: 07/28/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE The aim of this study was to examine current practice patterns in pediatric total body irradiation (TBI) techniques among xxx member institutions. METHODS AND MATERIALS Between Nov 2019 and Feb 2020 a questionnaire, containing 52 questions related to the technical aspects of TBI was sent to medical physicists at 152 xxx institutions. The questions were designed to obtain technical information on commonly used TBI treatment techniques. Another set of 9 questions related to the clinical management of patients undergoing TBI was sent to 152 xxx member radiation oncologists at the same institutions. RESULTS Twelve institutions were excluded because TBI was not performed in their institutions. A total of 88 physicists from 88 institutions (63% response rate) and 96 radiation oncologists from 96 institutions responded (69% response rate). The AP/PA technique was the most common (49 institutions - 56%); 44 institutions (50%) used the lateral technique and 14 institutions (16%) used volumetric modulated arc therapy (VMAT)/Tomotherapy. Mid-plane dose rates of 6-15 cGy/min were most commonly used. The most common specification for lung dose was the mid lung dose for both AP/PA (71%) and lateral (63%) techniques. All physician responders agreed with the need to refine current TBI techniques and 79% supported the investigation of new TBI techniques to further lower the lung dose. CONCLUSION There is no consistency in the practice patterns, methods for dose measurement and reporting of TBI doses among xxx institutions. The lack of a standardization precludes meaningful correlation between TBI doses and clinical outcomes including disease control and normal tissue toxicity. The xxx radiation oncology discipline is currently undertaking several steps to standardize the practice and dose reporting of pediatric TBI using detailed questionnaires and phantom-based credentialing for all xxx centers.
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Affiliation(s)
- P Rassiah
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT.
| | - N Esiashvili
- Department of Radiation Oncology, Emory University, Atlanta, GA
| | - A J Olch
- Department of Radiation Oncology, University of Southern California and Children's Hospital of Los Angeles, Los Angeles, CA
| | - C H Hua
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - K Ulin
- Imaging and Radiation Oncology Core, Rhode Island QA Center, University of Massachusetts Medical School, Lincoln, RI
| | - A Molineu
- Imaging and Radiation Oncology Core, Houston QA Center, MD Anderson Cancer Center, Houston, TX
| | - K Marcus
- Department of Radiation Oncology, Harvard Medical School, Boston, MA
| | - M Gopalakrishnan
- Department of Radiation Oncology, Northwestern University, Chicago, IL
| | - S Pillai
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR
| | - N Kovalchuk
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - A Liu
- Department of Radiation Oncology, City of Hope, Los Angeles, CA
| | - G Niyazov
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J A Peñagarícano
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - F Cheung
- Medical Physics division, Princess Margaret Cancer Center, Toronto, Canada
| | - A C Olson
- Department of Radiation Oncology, Children's Hospital of Pittsburgh, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine Pittsburgh, PA
| | - C C Wu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY
| | - H Malhotra
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - I J MacEwan
- Department of Radiation Medicine and Applied Sciences, UC San Diego, La Jolla, CA
| | - J Faught
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - J C Breneman
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH
| | - D S Followill
- Imaging and Radiation Oncology Core, Houston QA Center, MD Anderson Cancer Center, Houston, TX
| | - T J FitzGerald
- Department of Radiation Oncology, University of Massachusetts, Worcester, MA
| | - J A Kalapurakal
- Department of Radiation Oncology, Northwestern University, Chicago, IL
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762
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Chakraborty S, Chatterjee S. Adjuvant radiation therapy in breast cancer: Recent advances & Indian data. Indian J Med Res 2021; 154:189-198. [PMID: 35295008 PMCID: PMC9131773 DOI: 10.4103/ijmr.ijmr_565_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Breast cancer is the most common cancer among women in India, and adjuvant radiotherapy is an integral part of curative treatment in most patients. The recent decades have witnessed several advances in radiation therapy delivery. Several advances in radiation oncology have been identified which include technological advances, change in fractionation used, use of cardiac-sparing radiotherapy as well as efforts to personalize radiotherapy using accelerated partial breast irradiation or avoidance of radiotherapy in certain subpopulations. Indian data are available in most areas which have been summarized. However, increasing emphasis on research in these areas is needed so that effectiveness and safety in our setting can be established. Advances in breast cancer radiotherapy have resulted in improved outcomes. Data published from India suggest that these improved outcomes can be replicated in patients when appropriate treatment protocols are followed.
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Affiliation(s)
- Santam Chakraborty
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Sanjoy Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India,For correspondence: Dr Sanjoy Chatterjee, Department of Radiation Oncology, Tata Medical Center, Kolkata 700 160, West Bengal, India e-mail:
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763
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Slevin F, Beasley M, Zhong J, Hudson E, Speight R, Lilley J, Murray LJ, Henry AM. A feasibility study of hyoscine butylbromide (buscopan) to improve image quality of cone beam computed tomography during abdominal/pelvic Stereotactic Ablative Radiotherapy. BJR Open 2021; 3:20210045. [PMID: 34381954 PMCID: PMC8328082 DOI: 10.1259/bjro.20210045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Cone beam computed tomography (CBCT) is used for image guidance of stereotactic ablative radiotherapy (SABR), but it is susceptible to bowel motion artefacts. This trial evaluated the impact of hyoscine butylbromide (buscopan) on CBCT image quality and its feasibility within a radiotherapy workflow. METHODS A single-centre feasibility trial (ISRCTN24362767) was performed in patients treated with SABR for abdominal/pelvic oligorecurrence. Buscopan was administered to separate cohorts by intramuscular (IM) or intravenous (i.v.) injection on alternate fractions, providing within-patient control data. 4-point Likert scales were used to assess overall image quality (ranging from excellent to impossible to use) and bowel motion artefact (ranging from none to severe). Feasibility was determined by patient/radiographer questionnaires and toxicity assessment. Descriptive statistics are presented. RESULTS 16 patients were treated (8 by IM and 8 by i.v. buscopan). The percentage of images of excellent quality with/without buscopan was 47 vs 29% for IM buscopan and 65 vs 40% for i.v. buscopan. The percentage of images with no bowel motion artefact with/without buscopan was 24.6 vs 8.9% for IM buscopan and 25.8 vs 7% for i.v. buscopan. Four patients (25%) reported dry mouth. 14 patients (93%) would accept buscopan as routine. 11 radiographers (92%) reported no delay in treatments. CONCLUSIONS A trend towards improved image quality/reduced bowel motion artefact was observed with IM/i.v. buscopan. Buscopan was well tolerated with limited impact on workflow. ADVANCES IN KNOWLEDGE This is the first trial of buscopan within a radiotherapy workflow. It demonstrated a trend to improved image quality and feasibility of use.
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Affiliation(s)
| | - Matthew Beasley
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, UK
| | | | - Eleanor Hudson
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Richard Speight
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, UK
| | - John Lilley
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, UK
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764
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Feasibility of ablative stereotactic body radiation therapy of pancreas cancer patients on a 1.5 Tesla magnetic resonance-linac system using abdominal compression. Phys Imaging Radiat Oncol 2021; 19:53-59. [PMID: 34307919 PMCID: PMC8295846 DOI: 10.1016/j.phro.2021.07.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 01/18/2023] Open
Abstract
Background and Purpose Stereotactic body radiation therapy delivered using MR-guided radiotherapy (MRgRT) and automatic breathold gating has shown to improve overall survival for locally advanced pancreatic cancer (LAPC) patients. The goal of our study was to evaluate feasibility of treating LAPC patients using abdominal compression (AC) and impact of potential intrafraction motion on planned dose on a 1.5T MR-linac. Methods & Materials Ten LAPC patients were treated with MRgRT to 50 Gy in 5 fractions with daily online plan adaptation and AC. Three orthogonal plane cine MRI were acquired to assess stability of AC pressure in minimizing tumor motion. Three sets of T2w MR scans, pre-treatment (MRIpre), verification (MRIver) and post-treatment (MRIpost) MRI, were acquired for every fraction. A total of 150 MRIs and doses were evaluated. Impact of intrafraction organ motion was evaluated by propagating pre-treatment plan and structures to MRIver and MRIpost, editing contours and recalculating doses. Gross tumor volume (GTV) coverage and organs-at-risk (OARs) doses were evaluated on MRIver and MRIpost. Results Median total treatment time was 75.5 (49–132) minutes. Median tumor motion in AC for all fractions was 1.7 (0.7–7), 2.1 (0.6–6.3) and 4.1 (1.4–10.0) mm in anterior-posterior, left–right and superior-inferior direction. Median GTV V50Gy was 78.7%. Median D5cm3 stomach_duodenum was 24.2 (18.4–29.3) Gy on MRIver and 24.2 (18.3–30.5) Gy on MRIpost. Median D5cm3 small bowel was 24.3 (18.2–32.8) Gy on MRIver and 24.4 (16.0–33.6) Gy on MRIpost. Conclusion Dose-volume constraints for OARs were exceeded for some fractions on MRIver and MRIpost. Longer follow up is needed to see the dosimetric impact of intrafraction motion on gastrointestinal toxicity.
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765
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Feasibility of Conebeam CT-based online adaptive radiotherapy for neoadjuvant treatment of rectal cancer. Radiat Oncol 2021; 16:136. [PMID: 34301300 PMCID: PMC8305875 DOI: 10.1186/s13014-021-01866-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background Online adaptive radiotherapy has the potential to reduce toxicity for patients treated for rectal cancer because smaller planning target volumes (PTV) margins around the entire clinical target volume (CTV) are required. The aim of this study is to describe the first clinical experience of a Conebeam CT (CBCT)-based online adaptive workflow for rectal cancer, evaluating timing of different steps in the workflow, plan quality, target coverage and patient compliance. Methods Twelve consecutive patients eligible for 5 × 5 Gy pre-operative radiotherapy were treated on a ring-based linear accelerator with a multidisciplinary team present at the treatment machine for each fraction. The accelerator is operated using an integrated software platform for both treatment planning and delivery. In all directions for all CTVs a PTV margin of 5 mm was used, except for the cranial/caudal borders of the total CTV where a margin of 8 mm was applied. A reference plan was generated based on a single planning CT. After aligning the patient the online adaptive procedure started with acquisition of a CBCT. The planning CT scan was registered to the CBCT using deformable registration and a synthetic CT scan was generated. With the support of artificial intelligence, structure guided deformation and the synthetic CT scan contours were adapted by the system to match the anatomy on the CBCT. If necessary, these contours were adjusted before a new plan was generated. A second and third CBCT were acquired to validate the new plan with respect to CTV coverage just before and after treatment delivery, respectively. Treatment was delivered using volumetric modulated arc treatment (VMAT). All steps in this process were defined and timed. Results On average the timeslot needed at the treatment machine was 34 min. The process of acquiring a CBCT, evaluating and adjusting the contours, creating the new plan and verifying the CTV on the CBCT scan took on average 20 min. Including delivery and post treatment verification this was 26 min. Manual adjustments of the target volumes were necessary in 50% of fractions. Plan quality, target coverage and patient compliance were excellent. Conclusions First clinical experience with CBCT-based online adaptive radiotherapy shows it is feasible for rectal cancer. Trial registration Medical Research Involving Human Subjects Act (WMO) does not apply to this study and was retrospectively approved by the Medical Ethics review Committee of the Academic Medical Center (W21_087 # 21.097; Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands). Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01866-7.
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766
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Donati CM, Nardi E, Galietta E, Alfieri ML, Siepe G, Zamagni A, Buwenge M, Macchia G, Deodato F, Cilla S, Strigari L, Cammelli S, Cellini F, Morganti AG. An Intensive Educational Intervention Significantly Improves the Adoption of Single Fractionation Radiotherapy in Uncomplicated Bone Metastases. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2021; 15:11795549211027148. [PMID: 34366683 PMCID: PMC8312156 DOI: 10.1177/11795549211027148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/01/2021] [Indexed: 11/17/2022]
Abstract
Introduction: An education strategy was employed in our department to increase the rate of patients with uncomplicated painful bone metastases undergoing single fractionation radiotherapy (SFRT). The purpose of this report is to analyze the results of this strategy over a 5 year period. Materials and Methods: In January 2015, two meetings were organized in our department. In the first, data from an audit on the current SFRT rate were shown. In the second, evidence of SFRT efficacy in the relief of pain from uncomplicated bone metastases was presented. In addition, during the weekly discussion of clinical cases, the opportunity to use the SFRT was systematically recalled. Using our institutional database, all patients treated with radiotherapy for uncomplicated painful bone metastases in the period between 2014 (year considered as a reference) and 2019 were retrieved. Data regarding treatment date (year), radiotherapy fractionation, and tumor, patients, and radiation oncologists characteristics were collected. Results: A total of 627 patients were included in the analysis. The rate of patients undergoing SFRT increased from 4.0% in 2014 to 63.5% in 2019 (p < 0.001). At multivariable analysis, the delivery of SFRT was significantly correlated with older patients age (>80 years), lung cancer as the primary tumor, treatment prescribed by a radiation oncologist dedicated to palliative treatments, and treatment date (2014 vs 2015–2019). Conclusions: This retrospective single-center analysis showed that a simple but intensive and prolonged departmental education strategy can increase the rate of patients treated with SFRT by nearly 16 times.
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Affiliation(s)
- Costanza M Donati
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic, and Specialty Medicine-DIMES, Alma Mater Studiorum Bologna University; Bologna, Italy
| | - Elena Nardi
- Medical Statistics, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Erika Galietta
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic, and Specialty Medicine-DIMES, Alma Mater Studiorum Bologna University; Bologna, Italy
| | - Maria L Alfieri
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic, and Specialty Medicine-DIMES, Alma Mater Studiorum Bologna University; Bologna, Italy
| | - Giambattista Siepe
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alice Zamagni
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic, and Specialty Medicine-DIMES, Alma Mater Studiorum Bologna University; Bologna, Italy
| | - Milly Buwenge
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic, and Specialty Medicine-DIMES, Alma Mater Studiorum Bologna University; Bologna, Italy
| | - Gabriella Macchia
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy.,Radiation Oncology Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Francesco Deodato
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy.,Radiation Oncology Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Lidia Strigari
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Silvia Cammelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic, and Specialty Medicine-DIMES, Alma Mater Studiorum Bologna University; Bologna, Italy
| | - Francesco Cellini
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy.,Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Roma, Italy
| | - Alessio G Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic, and Specialty Medicine-DIMES, Alma Mater Studiorum Bologna University; Bologna, Italy
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767
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Unmet Needs and Quality of Life of Cancer Patients and Their Families: Actor-Partner Interdependence Modeling. Healthcare (Basel) 2021; 9:healthcare9070874. [PMID: 34356252 PMCID: PMC8305838 DOI: 10.3390/healthcare9070874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 02/04/2023] Open
Abstract
Unmet needs and quality of life (QOL) are important nursing issues for both patients and their families. However, studies into their direct association, considering the dyadic relationship between them, have not been done. We investigated the associations using the actor–partner interdependence modeling for dyadic data. Data were collected from 115 patient–family dyads at a tertiary teaching hospital. The study variables were assessed using the questionnaires and clinical data. To analyze patient–family dyad data, the actor–partner interdependence modeling and structural equation modeling were used. The cancer patients and their families experienced diverse and high levels of unmet needs that affected their quality of life, both physically and mentally. The cancer patients’ unmet needs decreased their physical and mental quality of life, while those of their families had a negative impact on their own physical and mental quality of life. However, the cancer patients’ unmet needs did not have partner effects on their families’ quality of life, and vice versa. Therefore, unmet needs played important roles in their QOL taking into dyadic relationships in the model. The results suggest that nursing intervention programs to meet the needs of both patients and their families are required to improve their quality of life.
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768
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Low-dose Splenic Irradiation in Conjunction With Ruxolitinib to Provide Symptomatic Relief in Heavily Treated, Advanced Stage Myelofibrosis: A Case Series From a UK Tertiary Referral Center. Hemasphere 2021; 5:e611. [PMID: 34235403 PMCID: PMC8240780 DOI: 10.1097/hs9.0000000000000611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/27/2021] [Indexed: 12/03/2022] Open
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769
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Shelley CE, Barraclough LH, Nelder CL, Otter SJ, Stewart AJ. Adaptive Radiotherapy in the Management of Cervical Cancer: Review of Strategies and Clinical Implementation. Clin Oncol (R Coll Radiol) 2021; 33:579-590. [PMID: 34247890 DOI: 10.1016/j.clon.2021.06.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/19/2021] [Accepted: 06/11/2021] [Indexed: 02/08/2023]
Abstract
The complex and varied motion of the cervix-uterus target during external beam radiotherapy (EBRT) underscores the clinical benefits afforded by adaptive radiotherapy (ART) techniques. These gains have already been realised in the implementation of image-guided adaptive brachytherapy, where adapting to anatomy at each fraction has seen improvements in clinical outcomes and a reduction in treatment toxicity. With regards to EBRT, multiple adaptive strategies have been implemented, including a personalised internal target volume, offline replanning and a plan of the day approach. With technological advances, there is now the ability for real-time online ART using both magnetic resonance imaging and computed tomography-guided imaging. However, multiple challenges remain in the widespread dissemination of ART. This review investigates the ART strategies and their clinical implementation in EBRT delivery for cervical cancer.
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Affiliation(s)
- C E Shelley
- Department of Clinical Oncology, St. Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK.
| | - L H Barraclough
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - C L Nelder
- Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK
| | - S J Otter
- Department of Clinical Oncology, St. Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK
| | - A J Stewart
- Department of Clinical Oncology, St. Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK; University of Surrey, Guildford, UK
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770
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Kilian-Meneghin J, Ma T, Kumaraswamy L. Impact of prostate focused alignment on planned pelvic lymph node dose. J Appl Clin Med Phys 2021; 22:27-35. [PMID: 34231945 PMCID: PMC8292696 DOI: 10.1002/acm2.13092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 09/13/2019] [Accepted: 10/06/2019] [Indexed: 11/11/2022] Open
Abstract
Purpose Prostate patients with positive lymph node margins receive an initial course of 45 Gy to the planning target volume (PTV) comprised of prostate, seminal vesicles, and lymph nodes with a 1‐cm margin. The prostate is localized via implanted fiducial markers before each fraction is delivered using portal‐imaging. However, the pelvic lymph nodes are affixed to the bony anatomy and are not mobile in concert with the prostate. The aim of this study was to determine whether a significant difference in pelvic lymph node coverage exists between planned and delivered external beam therapy treatments for these patients. Methods The recorded prostate motions were gathered for 19 patients; conjointly the pelvic lymph node motions were determined by manual registration of the bony anatomy in the kV‐images. The difference between the prostate and the bony anatomy coordinates was input into Eclipse as field shifts to represent the deviation in planned vs delivered pelvic lymph node coverage. Results Structure volume at V(100) was recorded for each patient for two structures: summed pelvic lymph nodes (LN CTV) and pelvic lymph nodes +1 cm margin (LN PTV) to express their contribution to the PTV. For the LN PTV, the average difference between the planned coverage and calculated delivered coverage was 3.5%, with a paired t‐test value of P = 0.005. Based upon bony anatomy registration, 26% of patients received less than 95% dose coverage using V(100) criteria for LN PTV. Dose value differences between the two plans at minimum were 6.96 ± 6.23 Gy, at mean were 0.54 ± 0.40 Gy, and at maximum were 0.10 ± 0.29 Gy. For the LN CTV, the average difference between the planned coverage and calculated delivered coverage was 1%, with a paired t‐test value of P = 0.53. Conclusions The results indicate a significant difference exists between the planned coverage and calculated delivered coverage for the LN PTV. There was no significant difference found for the LN CTV. We conclude that lymph node motion must be considered with the prostate motion when aligning patients before each fraction.
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Affiliation(s)
| | - Tianjun Ma
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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771
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Nasser NJ, Klein J, Fenig E, Agbarya A. Automatic localization of the prostatic urethra for image guided radiation therapy. Tech Innov Patient Support Radiat Oncol 2021; 19:1-6. [PMID: 34189284 PMCID: PMC8215297 DOI: 10.1016/j.tipsro.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/27/2021] [Accepted: 05/27/2021] [Indexed: 11/28/2022] Open
Abstract
Prostatic urethra can be used for image guided radiation for prostate cancer. Computer “finds” the urethra by digital subtraction of scans with / without contrast. Urethra segmentation used to setup the patient and position prostate as in simulation. A catheter with continuous aerated gel flow is used to detect the urethra under US.
Treatment of prostate cancer with radiation therapy (RT) requires image guided RT (IGRT) to focus the radiation on the target volumes while minimizing doses to organs at risk. Here we describe a urinary catheter that allows imaging of the prostatic urethra and uses it for automatic localization of the prostate for IGRT. The catheter has a contrast lumen that can be empty or full with contrast. Computerized tomography is performed twice, with contrast lumen empty and full, allowing urethral autosegmentation using digital subtraction. Under ultrasound, continuous urethral visualization is possible by pumping aerated gel in- and out of the contrast lumen.
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Affiliation(s)
- Nicola J Nasser
- Department of Radiation Oncology, University of Maryland School of Medicine, Maryland Proton Treatment Center, Baltimore, MD, USA
| | - Jonathan Klein
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eyal Fenig
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Abed Agbarya
- Institute of Oncology, Bnai Zion Medical Center, Haifa, Israel
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772
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Field M, Hardcastle N, Jameson M, Aherne N, Holloway L. Machine learning applications in radiation oncology. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2021; 19:13-24. [PMID: 34307915 PMCID: PMC8295850 DOI: 10.1016/j.phro.2021.05.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 05/19/2021] [Accepted: 05/22/2021] [Indexed: 12/23/2022]
Abstract
Machine learning technology has a growing impact on radiation oncology with an increasing presence in research and industry. The prevalence of diverse data including 3D imaging and the 3D radiation dose delivery presents potential for future automation and scope for treatment improvements for cancer patients. Harnessing this potential requires standardization of tools and data, and focused collaboration between fields of expertise. The rapid advancement of radiation oncology treatment technologies presents opportunities for machine learning integration with investments targeted towards data quality, data extraction, software, and engagement with clinical expertise. In this review, we provide an overview of machine learning concepts before reviewing advances in applying machine learning to radiation oncology and integrating these techniques into the radiation oncology workflows. Several key areas are outlined in the radiation oncology workflow where machine learning has been applied and where it can have a significant impact in terms of efficiency, consistency in treatment and overall treatment outcomes. This review highlights that machine learning has key early applications in radiation oncology due to the repetitive nature of many tasks that also currently have human review. Standardized data management of routinely collected imaging and radiation dose data are also highlighted as enabling engagement in research utilizing machine learning and the ability integrate these technologies into clinical workflow to benefit patients. Physicists need to be part of the conversation to facilitate this technical integration.
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Affiliation(s)
- Matthew Field
- South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Nicholas Hardcastle
- Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Michael Jameson
- GenesisCare, Alexandria, NSW, Australia.,St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Australia
| | - Noel Aherne
- Mid North Coast Cancer Institute, NSW, Australia.,Rural Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Lois Holloway
- South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,Cancer Therapy Centre, Liverpool Hospital, Sydney, NSW, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
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773
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Bertholet J, Aznar MC, Garibaldi C, Thwaites D, Gershkevitsh E, Thorwarth D, Verellen D, Heijmen B, Hurkmans C, Muren L, Redalen KR, Siebert FA, Schwarz M, Van Elmpt W, Georg D, Jornet N, Clark CH. Professional practice changes in radiotherapy physics during the COVID-19 pandemic. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2021; 19:25-32. [PMID: 34179522 PMCID: PMC8216850 DOI: 10.1016/j.phro.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/29/2021] [Accepted: 06/12/2021] [Indexed: 11/11/2022]
Abstract
The experience of 433 medical physicists during COVID-19 was analysed. Changes in clinical practice had an impact on treatment planning and quality assurance tasks. The effects of the changes were perceived differently by management vs clinical medical physicists. There is a clear willingness to learn from this experience.
Background and purpose The COVID-19 pandemic has imposed changes in radiotherapy (RT) departments worldwide. Medical physicists (MPs) are key healthcare professionals in maintaining safe and effective RT. This study reports on MPs experience during the first pandemic peak and explores the consequences on their work. Methods A 39-question survey on changes in departmental and clinical practice and on the impact for the future was sent to the global MP community. A total of 433 responses were analysed by professional role and by country clustered on the daily infection numbers. Results The impact of COVID-19 was bigger in countries with high daily infection rate. The majority of MPs worked in alternation at home/on-site. Among practice changes, implementation and/or increased use of hypofractionation was the most common (47% of the respondents). Sixteen percent of respondents modified patient-specific quality assurance (QA), 21% reduced machine QA, and 25% moved machine QA to weekends/evenings. The perception of trust in leadership and team unity was reversed between management MPs (towards increased trust and unity) and clinical MPs (towards a decrease). Changes such as home-working and increased use of hypofractionation were welcomed. However, some MPs were concerned about pressure to keep negative changes (e.g. weekend work). Conclusion COVID-19 affected MPs through changes in practice and QA procedures but also in terms of trust in leadership and team unity. Some changes were welcomed but others caused worries for the future. This report forms the basis, from a medical physics perspective, to evaluate long-lasting changes within a multi-disciplinary setting.
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Affiliation(s)
- Jenny Bertholet
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Division of Medical Radiation Physics, Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Corresponding author.
| | - Marianne C. Aznar
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Cristina Garibaldi
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Unit of Radiation Research, IEO European Institute of Oncology, IRCCS, Milano, Italy
| | - David Thwaites
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, Australia
- Medical Physics, Leeds Institute of Cancer and Pathology, School of Medicine, Leeds University, Leeds, UK
| | - Eduard Gershkevitsh
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- North Estonia Medical Centre, Tallinn, Estonia
| | - Daniela Thorwarth
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Germany
| | - Dirk Verellen
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Iridium Network, Antwerp University (Faculty of Medicine and Health Sciences), Antwerp, Belgium
| | - Ben Heijmen
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands
| | - Coen Hurkmans
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Catharina Hospital, Department of Radiation Oncology, Eindhoven, The Netherlands
| | - Ludvig Muren
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Kathrine Røe Redalen
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Frank-André Siebert
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Clinic of Radiotherapy, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - Marco Schwarz
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Proton Therapy Department, Trento Hospital, TIFPA-INFN, Trento, Italy
| | - Wouter Van Elmpt
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Dietmar Georg
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Division Medical Radiation Physics, Department of Radiation Oncology, Medical University of Vienna, AKH Wien, Austria
| | - Nuria Jornet
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Servei de Radiofísica i Radioprotecció, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Catharine H. Clark
- European Society for Radiotherapy and Oncology (ESTRO), Physics Committee, Brussels, Belgium
- Department of Radiotherapy Physics, University College London Hospital, UK
- Department of Medical Physics and Bioengineering, University College London, UK
- National Physical Laboratory, London, UK
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774
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Kang SK, An HJ, Jin H, Kim JI, Chie EK, Park JM, Lee JS. Synthetic CT generation from weakly paired MR images using cycle-consistent GAN for MR-guided radiotherapy. Biomed Eng Lett 2021; 11:263-271. [PMID: 34350052 DOI: 10.1007/s13534-021-00195-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/01/2021] [Accepted: 06/11/2021] [Indexed: 12/22/2022] Open
Abstract
Although MR-guided radiotherapy (MRgRT) is advancing rapidly, generating accurate synthetic CT (sCT) from MRI is still challenging. Previous approaches using deep neural networks require large dataset of precisely co-registered CT and MRI pairs that are difficult to obtain due to respiration and peristalsis. Here, we propose a method to generate sCT based on deep learning training with weakly paired CT and MR images acquired from an MRgRT system using a cycle-consistent GAN (CycleGAN) framework that allows the unpaired image-to-image translation in abdomen and thorax. Data from 90 cancer patients who underwent MRgRT were retrospectively used. CT images of the patients were aligned to the corresponding MR images using deformable registration, and the deformed CT (dCT) and MRI pairs were used for network training and testing. The 2.5D CycleGAN was constructed to generate sCT from the MRI input. To improve the sCT generation performance, a perceptual loss that explores the discrepancy between high-dimensional representations of images extracted from a well-trained classifier was incorporated into the CycleGAN. The CycleGAN with perceptual loss outperformed the U-net in terms of errors and similarities between sCT and dCT, and dose estimation for treatment planning of thorax, and abdomen. The sCT generated using CycleGAN produced virtually identical dose distribution maps and dose-volume histograms compared to dCT. CycleGAN with perceptual loss outperformed U-net in sCT generation when trained with weakly paired dCT-MRI for MRgRT. The proposed method will be useful to increase the treatment accuracy of MR-only or MR-guided adaptive radiotherapy. Supplementary Information The online version contains supplementary material available at 10.1007/s13534-021-00195-8.
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Affiliation(s)
- Seung Kwan Kang
- Department of Biomedical Sciences and Nuclear Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080 South Korea.,Institute of Radiation Medicine, Medical Research Center, Seoul National University College of Medicine, Seoul, 03080 South Korea
| | - Hyun Joon An
- Department of Radiation Oncology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 South Korea
| | - Hyeongmin Jin
- Department of Radiation Oncology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 South Korea
| | - Jung-In Kim
- Department of Radiation Oncology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 South Korea.,Institute of Radiation Medicine, Medical Research Center, Seoul National University College of Medicine, Seoul, 03080 South Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 South Korea.,Institute of Radiation Medicine, Medical Research Center, Seoul National University College of Medicine, Seoul, 03080 South Korea
| | - Jong Min Park
- Department of Radiation Oncology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 South Korea.,Institute of Radiation Medicine, Medical Research Center, Seoul National University College of Medicine, Seoul, 03080 South Korea
| | - Jae Sung Lee
- Department of Biomedical Sciences and Nuclear Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080 South Korea.,Department of Nuclear Medicine, Seoul National University Hospital, Seoul, 03080 South Korea.,Institute of Radiation Medicine, Medical Research Center, Seoul National University College of Medicine, Seoul, 03080 South Korea
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775
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Cleland S, Chan P, Chua B, Crowe SB, Dawes J, Kenny L, Lin C, Obereigner E, Peet SC, Trapp JV, Poroa T, Kairn T. Dosimetric evaluation of a patient-specific 3D-printed oral positioning stent for head-and-neck radiotherapy. Phys Eng Sci Med 2021; 44:887-899. [PMID: 34110611 DOI: 10.1007/s13246-021-01025-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/03/2021] [Indexed: 12/21/2022]
Abstract
As head-and-neck radiotherapy treatments become more complex and sophisticated, and the need to control and stabilise the positioning of intra-oral anatomy becomes more important, leading the increasing use of oral positioning stents during head-and-neck radiotherapy simulation and delivery. As an alternative to the established practice of creating oral positioning stents using wax, this study investigated the use of a 3D printing technique. An Ender 5 3D printer (Creality 3D, Shenzhen, China) was used, with PLA+ "food-safe" polylactic acid filament (3D Fillies, Dandenong South, Australia), to produce a low-density 3D printed duplicate of a conventional wax stent. The physical and dosimetric effects of the two stents were evaluated using radiochromic film in a solid head phantom that was modified to include flexible parts. The Varian Eclipse treatment planning system (Varian Medical Systems, Palo Alto, USA) was used to calculate the dose from two different head-and-neck treatment plans for the phantom with each of the two stents. Examination of the resulting four dose distributions showed that both stents effectively pushed sensitive oral tissues away from the treatment targets, even though most of the phantom was solid. Film measurements confirmed the accuracy of the dose calculations from the treatment planning system, despite the steep density gradients in the treated volume, and demonstrated that the 3D print could be a suitable replacement for the wax stent. This study demonstrated a useful method for dosimetrically testing novel oral positioning stents. We recommend the development of flexible phantoms for future studies.
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Affiliation(s)
- Susannah Cleland
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Queensland University of Technology, Brisbane, QLD, 4001, Australia.,Herston Bifabrication Institute, Metro North Hospital and Health Service, Herston, QLD, 4029, Australia.,Radiation Oncology Princess Alexandra Hospital Raymond Terrace, South Brisbane, QLD, 4101, Australia
| | - Philip Chan
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,University of Queensland, Brisbane, QLD, 4072, Australia
| | - Benjamin Chua
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,University of Queensland, Brisbane, QLD, 4072, Australia
| | - Scott B Crowe
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Queensland University of Technology, Brisbane, QLD, 4001, Australia.,Herston Bifabrication Institute, Metro North Hospital and Health Service, Herston, QLD, 4029, Australia.,University of Queensland, Brisbane, QLD, 4072, Australia
| | - Jodi Dawes
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Lizbeth Kenny
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,University of Queensland, Brisbane, QLD, 4072, Australia
| | - Charles Lin
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,University of Queensland, Brisbane, QLD, 4072, Australia
| | - Elise Obereigner
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Herston Bifabrication Institute, Metro North Hospital and Health Service, Herston, QLD, 4029, Australia
| | - Samuel C Peet
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Queensland University of Technology, Brisbane, QLD, 4001, Australia
| | - Jamie V Trapp
- Queensland University of Technology, Brisbane, QLD, 4001, Australia
| | - Tania Poroa
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Herston Bifabrication Institute, Metro North Hospital and Health Service, Herston, QLD, 4029, Australia
| | - Tanya Kairn
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia. .,Queensland University of Technology, Brisbane, QLD, 4001, Australia. .,Herston Bifabrication Institute, Metro North Hospital and Health Service, Herston, QLD, 4029, Australia. .,University of Queensland, Brisbane, QLD, 4072, Australia.
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776
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Votta C, Cusumano D, Boldrini L, Dinapoli N, Placidi L, Turco G, Antonelli MV, Pollutri V, Romano A, Indovina L, Valentini V. Delivery of online adaptive magnetic resonance guided radiotherapy based on isodose boundaries. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2021; 18:78-81. [PMID: 34258412 PMCID: PMC8254198 DOI: 10.1016/j.phro.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 05/14/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022]
Abstract
Magnetic Resonance-guided Radiotherapy (MRgRT) allows direct monitoring of treated volumes. The aim of this study was to investigate the feasibility of a new gating strategy consisting in using an isodose as boundary. Forty-four patients treated for thoracic and abdominal lesions using MRgRT were enrolled. The accuracy of the new strategy was compared to the conventional one in terms of area improvement available for gating without compromising target coverage. A mean increase of 24% for lung, 15% for liver and 11% for pancreas was observed, demonstrating how the new method can be useful in challenging situations with low dose conformality.
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777
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Wong J, Huang V, Giambattista JA, Teke T, Kolbeck C, Giambattista J, Atrchian S. Training and Validation of Deep Learning-Based Auto-Segmentation Models for Lung Stereotactic Ablative Radiotherapy Using Retrospective Radiotherapy Planning Contours. Front Oncol 2021; 11:626499. [PMID: 34164335 PMCID: PMC8215371 DOI: 10.3389/fonc.2021.626499] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 05/14/2021] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Deep learning-based auto-segmented contour (DC) models require high quality data for their development, and previous studies have typically used prospectively produced contours, which can be resource intensive and time consuming to obtain. The aim of this study was to investigate the feasibility of using retrospective peer-reviewed radiotherapy planning contours in the training and evaluation of DC models for lung stereotactic ablative radiotherapy (SABR). METHODS Using commercial deep learning-based auto-segmentation software, DC models for lung SABR organs at risk (OAR) and gross tumor volume (GTV) were trained using a deep convolutional neural network and a median of 105 contours per structure model obtained from 160 publicly available CT scans and 50 peer-reviewed SABR planning 4D-CT scans from center A. DCs were generated for 50 additional planning CT scans from center A and 50 from center B, and compared with the clinical contours (CC) using the Dice Similarity Coefficient (DSC) and 95% Hausdorff distance (HD). RESULTS Comparing DCs to CCs, the mean DSC and 95% HD were 0.93 and 2.85mm for aorta, 0.81 and 3.32mm for esophagus, 0.95 and 5.09mm for heart, 0.98 and 2.99mm for bilateral lung, 0.52 and 7.08mm for bilateral brachial plexus, 0.82 and 4.23mm for proximal bronchial tree, 0.90 and 1.62mm for spinal cord, 0.91 and 2.27mm for trachea, and 0.71 and 5.23mm for GTV. DC to CC comparisons of center A and center B were similar for all OAR structures. CONCLUSIONS The DCs developed with retrospective peer-reviewed treatment contours approximated CCs for the majority of OARs, including on an external dataset. DCs for structures with more variability tended to be less accurate and likely require using a larger number of training cases or novel training approaches to improve performance. Developing DC models from existing radiotherapy planning contours appears feasible and warrants further clinical workflow testing.
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Affiliation(s)
- Jordan Wong
- Radiation Oncology, British Columbia Cancer – Vancouver, Vancouver, BC, Canada
| | - Vicky Huang
- Medical Physics, British Columbia Cancer – Fraser Valley, Surrey, BC, Canada
| | - Joshua A. Giambattista
- Radiation Oncology, Saskatchewan Cancer Agency, Regina, SK, Canada
- Limbus AI Inc, Regina, SK, Canada
| | - Tony Teke
- Medical Physics/Radiation Oncology, British Columbia Cancer – Kelowna, Kelowna, BC, Canada
| | | | | | - Siavash Atrchian
- Medical Physics/Radiation Oncology, British Columbia Cancer – Kelowna, Kelowna, BC, Canada
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778
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Mihai AM, Armstrong PJ, Hickey D, Milano MT, Dunne M, Healy K, Thirion P, Heron DE, ElBeltagi N, Armstrong JG. Late Toxicity and Long-Term Local Control in Patients With Ultra-Central Lung Tumours Treated by Intensity-Modulated Radiotherapy-Based Stereotactic Ablative Body Radiotherapy With Homogenous Dose Prescription. Clin Oncol (R Coll Radiol) 2021; 33:627-637. [PMID: 34092462 DOI: 10.1016/j.clon.2021.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/21/2021] [Accepted: 05/13/2021] [Indexed: 12/14/2022]
Abstract
AIMS To report late toxicity and long-term outcomes of intensity-modulated radiotherapy (IMRT)-based stereotactic ablative body radiotherapy (SABR) in patients with ultra-central lung tumours. MATERIALS AND METHODS This is a single-institution retrospective analysis of patients treated with SABR for ultra-central tumours between May 2008 and April 2016. Ultra-central location was defined as tumour (GTV) abutting or involving trachea, main or lobar bronchi. Respiratory motion management and static-field dynamic-IMRT were used, with dose prescribed homogeneously (maximum <120%). Descriptive analysis, Kaplan-Meier method, log-rank test and Cox regression were used to assess outcomes. RESULTS Sixty-five per cent of patients had inoperable primary non-small cell lung cancer and 35% had lung oligometastases. The median age was 72 (range 34-85) years. The median gross tumour volume and planning target volume (PTV) were 19.6 (range 1.7-203.3) cm3 and 57.4 (range 7.7-426.6) cm3, respectively. The most commonly used dose fractionation was 60 Gy in eight fractions (n = 51, 87.8%). Median BED10 for D98%PTV and D2%PTV were 102.6 Gy and 115.06 Gy, respectively. With a median follow-up of 26.5 (range 3.2-100.5) months, fatal haemoptysis occurred in five patients (8.7%), of which two were directly attributable to SABR. A statistically significant difference was identified between median BED3 for 4 cm3 of airway, for patients who developed haemoptysis versus those who did not (147.4 versus 47.2 Gy, P = 0.005). At the last known follow-up, 50 patients (87.7%) were without local recurrence. Freedom from local progression at 2 and 4 years was 92 and 79.8%, respectively. The median overall survival was 34.3 (95% confidence interval 6.1-61.6) months. Overall survival at 2 and 4 years was 55.1 and 41.2%, respectively. CONCLUSION In patients with high-risk ultra-central lung tumours, IMRT-based SABR with homogenous dose prescription achieves high local control, similar to that reported for peripheral tumours. Although fatal haemoptysis occurred in 8.7% of patients, a direct causality with SABR was evident in only 3%. Larger studies are warranted to ascertain factors associated with outcomes, especially toxicity, and identify patients who would probably benefit from this treatment.
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Affiliation(s)
- A M Mihai
- Department of Radiotherapy, Beacon Hospital, Dublin, Ireland.
| | - P J Armstrong
- University College Dublin School of Medicine, Dublin, Ireland
| | - D Hickey
- Department of Radiotherapy, Beacon Hospital, Dublin, Ireland
| | - M T Milano
- University of Rochester, Rochester, NY, USA
| | - M Dunne
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - K Healy
- University College Dublin School of Medicine, Dublin, Ireland
| | - P Thirion
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - D E Heron
- Bon Secours Mercy Health, Cincinnati, OH, USA
| | - N ElBeltagi
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - J G Armstrong
- Department of Radiotherapy, Beacon Hospital, Dublin, Ireland
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779
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Kong V, Hansen VN, Hafeez S. Image-guided Adaptive Radiotherapy for Bladder Cancer. Clin Oncol (R Coll Radiol) 2021; 33:350-368. [PMID: 33972024 DOI: 10.1016/j.clon.2021.03.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022]
Abstract
Technological advancement has facilitated patient-specific radiotherapy in bladder cancer. This has been made possible by developments in image-guided radiotherapy (IGRT). Particularly transformative has been the integration of volumetric imaging into the workflow. The ability to visualise the bladder target using cone beam computed tomography and magnetic resonance imaging initially assisted with determining the magnitude of inter- and intra-fraction target change. It has led to greater confidence in ascertaining true anatomy at each fraction. The increased certainty of dose delivered to the bladder has permitted the safe reduction of planning target volume margins. IGRT has therefore improved target coverage with a reduction in integral dose to the surrounding tissue. Use of IGRT to feed back into plan and dose delivery optimisation according to the anatomy of the day has enabled adaptive radiotherapy bladder solutions. Here we undertake a review of the stepwise developments underpinning IGRT and adaptive radiotherapy strategies for external beam bladder cancer radiotherapy. We present the evidence in accordance with the framework for systematic clinical evaluation of technical innovations in radiation oncology (R-IDEAL).
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Affiliation(s)
- V Kong
- Radiation Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - V N Hansen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - S Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK.
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780
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Corradini S, Alongi F, Andratschke N, Azria D, Bohoudi O, Boldrini L, Bruynzeel A, Hörner-Rieber J, Jürgenliemk-Schulz I, Lagerwaard F, McNair H, Raaymakers B, Schytte T, Tree A, Valentini V, Wilke L, Zips D, Belka C. ESTRO-ACROP recommendations on the clinical implementation of hybrid MR-linac systems in radiation oncology. Radiother Oncol 2021; 159:146-154. [PMID: 33775715 DOI: 10.1016/j.radonc.2021.03.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/17/2021] [Indexed: 01/11/2023]
Abstract
Online magnetic resonance-guided radiotherapy (oMRgRT) represents one of the most innovative applications of current image-guided radiation therapy (IGRT). The revolutionary concept of oMRgRT systems is the ability to acquire MR images for adaptive treatment planning and also online imaging during treatment delivery. The daily adaptive planning strategies allow to improve targeting accuracy while avoiding critical structures. This ESTRO-ACROP recommendation aims to provide an overview of available systems and guidance for best practice in the implementation phase of hybrid MR-linac systems. Unlike the implementation of other radiotherapy techniques, oMRgRT adds the MR environment to the daily practice of radiotherapy, which might be a new experience for many centers. New issues and challenges that need to be thoroughly explored before starting clinical treatments will be highlighted.
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Affiliation(s)
- Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Germany.
| | - Filippo Alongi
- Department of Advanced Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy, University of Brescia, Italy
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Switzerland
| | - David Azria
- Department of Radiation Oncology, University Federation of Radiation Oncology Montpellier-Nîmes, ICM, Montpellier Cancer Institute, University of Montpellier, INSERM U1194, France
| | - Omar Bohoudi
- Department of Radiation Oncology, Amsterdam University Medical Center, location de Boelelaan, The Netherlands
| | - Luca Boldrini
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
| | - Anna Bruynzeel
- Department of Radiation Oncology, Amsterdam University Medical Center, location de Boelelaan, The Netherlands
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany, Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Frank Lagerwaard
- Department of Radiation Oncology, Amsterdam University Medical Center, location de Boelelaan, The Netherlands
| | - Helen McNair
- The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, United Kingdom
| | - Bas Raaymakers
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
| | - Tine Schytte
- Department of Oncology, Odense University Hospital, Odense, Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Alison Tree
- The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, United Kingdom
| | - Vincenzo Valentini
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy
| | - Lotte Wilke
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Switzerland
| | - Daniel Zips
- Department of Radiation Oncology, University of Tübingen, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Germany
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781
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Victor Mugabe K. Barriers and facilitators to the adoption of artificial intelligence in radiation oncology: A New Zealand study. Tech Innov Patient Support Radiat Oncol 2021; 18:16-21. [PMID: 33981867 PMCID: PMC8085695 DOI: 10.1016/j.tipsro.2021.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/08/2021] [Accepted: 03/30/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Advances in computing capabilities and automated data collection have led to an increase in the use of Artificial Intelligence (AI) in radiation therapy. This has implications to workflow and workforce planning in radiation oncology departments. A survey was conducted in New Zealand to determine the likelihood of departments adopting AI into their practice. Survey responses were used to determine barriers and facilitators to the adoption of AI. MATERIALS AND METHODS An online electronic survey was sent to all ten radiation therapy centres in New Zealand. The survey was sent to radiation oncologists, medical physicists and senior radiation therapists involved in treatment planning. Descriptive analysis, factor analysis, analysis of variance and hierarchical multiple regression were used to analyse the data. RESULTS AI usage was low across the country and there was middling expertise. Most respondents found AI had a lot of perceived benefits. On the whole, respondents reported a high likelihood to adopt AI. There were significant differences on the Expertise factor between the staff groupsp = 0.016 with radiation therapists reporting more expertise than oncologists. Innovation factors (Perceived Benefit) on their own accounted for over 51 % of total variance and was the biggest predictor of likelihood to adopt AI ( p < 0.001 ) . Organisational factors (Expertise) was a moderate predictor ( p < 0.059 ) . CONCLUSION The survey results have been used to investigate the barriers and facilitators to the adoption of AI. These results demonstrate that respondents are likely to adopt AI in their practice. Perceived benefits were a facilitator as high scores were correlated with high likelihood of adoption of AI. Low expertise on the other hand was a barrier to adoption as the low scores were linked to lower likelihood of adoption.
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Affiliation(s)
- Koki Victor Mugabe
- Waikato Hospital, Regional Cancer Centre Selwyn Street Level 1 Lomas Street Hamilton, Waikato 3240 New Zealand
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782
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Pang EPP, Knight K, Leung RW, Wang MLC, Chan JWS, Low GK, Seah IKL, Atan MAB, Chai JYH, Ng GC, Yang TC, Tuan JKL. Technical considerations for positioning and placement of a transperineal ultrasound probe during prostate radiotherapy. J Med Radiat Sci 2021; 68:196-202. [PMID: 33017863 PMCID: PMC8168066 DOI: 10.1002/jmrs.439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/07/2020] [Accepted: 09/14/2020] [Indexed: 01/01/2023] Open
Abstract
This technical evaluation aims to provide practice 'how to' guidelines for radiation therapists (RTs) when positioning a transperineal ultrasound (TPUS) probe during prostate radiotherapy. Recommendations and practical tips will be provided for the best practice in TPUS-guided workflow to obtain optimal ultrasound images for accurate interpretation and registration of the prostate gland. This will assist the RTs in making consistent and accurate clinical decision in an ultrasound-guided radiotherapy workflow for prostate treatment. The implementation process and the associated successes and challenges will also be described to assist institutions who may be investigating the potential of implementing this system.
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Affiliation(s)
- Eric Pei Ping Pang
- Division of Radiation OncologyNational Cancer Centre SingaporeSingaporeSingapore
- Faculty of Medicine, Nursing and Health SciencesDepartment of Medical Imaging & Radiation SciencesMonash UniversityClaytonVICAustralia
| | - Kellie Knight
- Faculty of Medicine, Nursing and Health SciencesDepartment of Medical Imaging & Radiation SciencesMonash UniversityClaytonVICAustralia
| | | | - Michael Lian Chek Wang
- Division of Radiation OncologyNational Cancer Centre SingaporeSingaporeSingapore
- Duke‐NUS Graduate Medical SchoolSingaporeSingapore
| | - Jason Wei Siang Chan
- Division of Radiation OncologyNational Cancer Centre SingaporeSingaporeSingapore
| | - Gee Keng Low
- Division of Radiation OncologyNational Cancer Centre SingaporeSingaporeSingapore
| | - Irene Kai Ling Seah
- Division of Radiation OncologyNational Cancer Centre SingaporeSingaporeSingapore
| | | | - Jairia Yih Huei Chai
- Division of Radiation OncologyNational Cancer Centre SingaporeSingaporeSingapore
| | - Grace Chuk‐Kwan Ng
- Department of Clinical OncologyTuen Mun HospitalTuen Mun, New TerritoriesHong Kong
| | | | - Jeffrey Kit Loong Tuan
- Division of Radiation OncologyNational Cancer Centre SingaporeSingaporeSingapore
- Duke‐NUS Graduate Medical SchoolSingaporeSingapore
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783
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Ong A, Knight K, Panettieri V, Dimmock M, Tuan JKL, Tan HQ, Master Z, Wright C. Development of an automated radiotherapy dose accumulation workflow for locally advanced high-risk prostate cancer - A technical report. J Med Radiat Sci 2021; 68:203-210. [PMID: 33058720 PMCID: PMC8168070 DOI: 10.1002/jmrs.442] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 11/23/2022] Open
Abstract
An automated dose accumulation and contour propagation workflow using daily cone beam computed tomography (CBCTs) images for prostate cases that require pelvic lymph nodes irradiation (PLNs) was developed. This workflow was constructed using MIM® software with the intention to provide accurate dose transformations for plans with two different isocentres, whereby two sequential treatment phases were prescribed. The pre-processing steps for data extractions from treatment plans, CBCTs, determination of couch shift information and management of missing CBCTs are described. To ensure that the imported translational couch shifts were in the correct orientation and readable in MIM, phantom commissioning was performed. For dose transformation, rigid registration with corrected setup shifts and scaled fractional dose was performed for pCT to daily CBCTs, which were then deformed onto CBCT1 . Fractional dose summation resulted in the final accumulated dose for the patient allowing differences in dosimetry between the planned and accumulated dose to be analysed. Contour propagations of the prostate, bladder and rectum were performed within the same workflow. Transformed contours were then deformed onto daily CBCTs to generate trending reports for analysis, including Dice Similarity Coefficient (DSC) and Mean Distance to Agreement (MDA). Results obtained from phantom commissioning (DSC = 0.96, MDA = 0.89 mm) and geometrical analysis of the propagated contours for twenty patients; prostate (DSC: 0.9 ± 0.0, MDA: 1.0 ± 0.3 mm), rectum (DSC: 0.8 ± 0.1, mm, MDA: 1.7 ± 0.6 mm) and bladder (DSC: 0.8 ± 0.1, MDA: 2.8 ± 1.0 mm) were within clinically accepted tolerances for both DSC (>0.8) and MDA (< 0.3 mm). The developed workflow is being performed on a larger patient cohort for predictive model building, with the goal of correlating observed toxicity with the actual accumulated dose received by the patient.
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Affiliation(s)
- Ashley Ong
- Department of Radiation TherapyNational Cancer CentreSingapore
- Department of Medical Imaging and Radiation SciencesMonash UniversityClaytonAustralia
| | - Kellie Knight
- Department of Medical Imaging and Radiation SciencesMonash UniversityClaytonAustralia
| | - Vanessa Panettieri
- Department of Medical Imaging and Radiation SciencesMonash UniversityClaytonAustralia
- Alfred Health Radiation OncologyAlfred HospitalMelbourneAustralia
| | - Matthew Dimmock
- Department of Medical Imaging and Radiation SciencesMonash UniversityClaytonAustralia
| | | | - Hong Qi Tan
- Department of Radiation TherapyNational Cancer CentreSingapore
| | - Zubin Master
- Department of Radiation TherapyNational Cancer CentreSingapore
| | - Caroline Wright
- Department of Medical Imaging and Radiation SciencesMonash UniversityClaytonAustralia
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784
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Kim TH, Heo SY, Oh GW, Heo SJ, Jung WK. Applications of Marine Organism-Derived Polydeoxyribonucleotide: Its Potential in Biomedical Engineering. Mar Drugs 2021; 19:296. [PMID: 34067499 PMCID: PMC8224764 DOI: 10.3390/md19060296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 12/18/2022] Open
Abstract
Polydeoxyribonucleotides (PDRNs) are a family of DNA-derived drugs with a molecular weight ranging from 50 to 1500 kDa, which are mainly extracted from the sperm cells of salmon trout or chum salmon. Many pre-clinical and clinical studies have demonstrated the wound healing and anti-inflammatory properties of PDRN, which are mediated by the activation of adenosine A2A receptor and salvage pathways, in addition to promoting osteoblast activity, collagen synthesis, and angiogenesis. In fact, PDRN is already marketed due to its therapeutic properties against various wound healing- and inflammation-related diseases. Therefore, this review assessed the most recent trends in marine organism-derived PDRN using the Google Scholar search engine. Further, we summarized the current applications and pharmacological properties of PDRN to serve as a reference for the development of novel PDRN-based technologies.
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Affiliation(s)
- Tae-Hee Kim
- Department of Biomedical Engineering and New-Senior Healthcare Innovation Center (BK21 Plus), Pukyong National University, Busan 48513, Korea;
| | - Seong-Yeong Heo
- Research Center for Marine Integrated Bionics Technology, Pukyong National University, Busan 48513, Korea; (S.-Y.H.); (G.-W.O.)
| | - Gun-Woo Oh
- Research Center for Marine Integrated Bionics Technology, Pukyong National University, Busan 48513, Korea; (S.-Y.H.); (G.-W.O.)
| | - Soo-Jin Heo
- Jeju Marine Research Center, Korea Institute of Ocean Science & Technology (KIOST), Jeju 63349, Korea
- Department of Marine Biology, Korea University of Science and Technology, Deajeon 34113, Korea
| | - Won-Kyo Jung
- Department of Biomedical Engineering and New-Senior Healthcare Innovation Center (BK21 Plus), Pukyong National University, Busan 48513, Korea;
- Research Center for Marine Integrated Bionics Technology, Pukyong National University, Busan 48513, Korea; (S.-Y.H.); (G.-W.O.)
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785
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Oelofse I, van Staden J, Coetzee N, Steyn J. Quality management in radiotherapy: A 9-year review of incident reporting within a multifacility organisation. SOUTH AFRICAN JOURNAL OF ONCOLOGY 2021. [DOI: 10.4102/sajo.v5i0.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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786
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Abreu AMD, Fraga DRDS, Giergowicz BB, Figueiró RB, Waterkemper R. Effectiveness of nursing interventions in preventing and treating radiotherapy side effects in cancer patients: a systematic review. Rev Esc Enferm USP 2021; 55:e03697. [PMID: 33978137 DOI: 10.1590/s1980-220x2019026303697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 03/10/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To synthesize the best available evidence on the effectiveness of nursing interventions in radiotherapy patient care and to summarize the evidence on the experience and acceptability of interventions reported by health professionals involved in the prevention and treatment of side effects. METHOD A mixed-method systematic review. Quantitative and qualitative studies are presented. RESULTS Twelve studies published between 2013 and 2017 were included. Most interventions found focused on skin care, oral care, nausea and vomiting and nursing consultation. In accordance with high level of evidence and recommendation grade of the studies, the use of Calendula officinalis and thyme honey were considered effective for preventing and treating radiodermatitis and mucositis, respectively. CONCLUSION The quality of evidence of nursing interventions is weak. Although there are studies with a strong design and a high level of evidence, publication of nursing interventions is not enough and does not present a high quality to support practice to plan an effective patient-centered care.
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Affiliation(s)
- Aline Moraes de Abreu
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Bruna Bastos Giergowicz
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Roberta Waterkemper
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Porto Alegre, RS, Brazil
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787
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Placidi L, Nardini M, Cusumano D, Boldrini L, Chiloiro G, Romano A, Votta C, Antonelli MV, Valentini V, Indovina L. VMAT-like plans for magnetic resonance guided radiotherapy: Addressing unmet needs. Phys Med 2021; 85:72-78. [PMID: 33979726 DOI: 10.1016/j.ejmp.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/29/2021] [Accepted: 05/03/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE VMAT delivery technique is currently not applicable to Magnetic Resonance-guided radiotherapy (MRgRT) hybrid systems. Aim of this study is to evaluate an innovative VMAT-like (VML) delivery technique. MATERIAL AND METHODS First, planning and dosimetric evaluation of the MRgRT VML treatment have been performed on 10 different disease sites and the results have been compared with the corresponding IMRT plans. Then, in the second phase, 10 of the most dosimetrically challenging locally advanced pancreas treatment plans have been retrospectively re-planned using the VML approach to explore the potentiality of this new delivery technique. Finally, VML robustness was evaluated and compared with the IMRT plans, considering a lateral positioning error of ± 5 mm. RESULTS In phase one, all VML plans were within constraint for all OARs. When PTV coverage is considered, in the 50% of the cases VML PTV coverage is equal or higher than in IMRT plan. In the remaining 50%, the highest target under coverage difference in comparison with IMRT plan is -1.71%. The mean and maximum treatment time differences (VML-IMRT) is 0.2 min and 3.1 min respectively. In phase two, the treatment time variation (VML-IMRT), shows a mean, maximum and minimum variations of 1.3, 4.6 and -0.6 min respectively. All VML plans have a better target coverage if compared with IMRT plans, keeping in any case the OARs constraints within tolerance. VML doesn't increase plan robustness. CONCLUSION VMAT-like treatment approach appeared to be an efficient planning solution and it was decided to clinically implement it in daily practice, especially in the frame of hypo fractionated treatments.
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Affiliation(s)
- L Placidi
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Nardini
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - D Cusumano
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy.
| | - L Boldrini
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy
| | - G Chiloiro
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy
| | - A Romano
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy
| | - C Votta
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy
| | - M V Antonelli
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy
| | - V Valentini
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Indovina
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy
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788
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Dudzisz-Śledź M, Bylina E, Teterycz P, Rutkowski P. Treatment of Metastatic Gastrointestinal Stromal Tumors (GIST): A Focus on Older Patients. Drugs Aging 2021; 38:375-396. [PMID: 33651369 PMCID: PMC8096750 DOI: 10.1007/s40266-021-00841-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/24/2022]
Abstract
Gastrointestinal stromal tumors (GIST) originating in the Cajal cells are the most common mesenchymal neoplasms of the gastrointestinal tract. The median age of patients with this diagnosis is 65 years, and over 20% of cases affect people over the age of 70 years. The effectiveness and tolerability of systemic treatment with tyrosine kinase inhibitors in older patients with GIST seem to be similar to that in younger patients, but some studies have shown that treatment of older patients is suboptimal. Disability, frailty, comorbidities, and concomitant medications may influence treatment decisions, and toxicities also more often lead to treatment discontinuation. The known safety profile and oral administration route of the tyrosine kinase inhibitors used in GIST may allow maximization of treatment and the best efficacy, especially in older patients. This review summarizes the efficacy data for the systemic treatment of GIST, including data for older patients and from real-world experiences, if available and significant. The reported safety data and general rules for toxicity management, including appropriate patient selection and the need for careful monitoring during treatment, are also discussed.
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Affiliation(s)
- Monika Dudzisz-Śledź
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, 02-781, Warsaw, Poland.
| | - Elżbieta Bylina
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, 02-781, Warsaw, Poland
| | - Paweł Teterycz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, 02-781, Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, 02-781, Warsaw, Poland
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789
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Durie E, Nicholson E, Anthias C, Dunne EM, Potter M, Ethell M, Messiou C, Brennan J, Eagle S, Talbot J, Smyth G, Ingram W, Saran F, Mandeville HC. Determining the incidence of interstitial pneumonitis and chronic kidney disease following full intensity haemopoetic stem cell transplant conditioned using a forward-planned intensity modulated total body irradiation technique. Radiother Oncol 2021; 158:97-103. [PMID: 33636231 DOI: 10.1016/j.radonc.2021.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 02/01/2021] [Accepted: 02/15/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE/OBJECTIVE Total body irradiation (TBI) remains a key component of conditioning for allogeneic haemopoietic stem cell transplant (HSCT), with interstitial pneumonitis (IP) and chronic kidney disease (CKD) important late sequelae. We undertook a retrospective service evaluation of TBI patients treated with a forward-planned intensity modulated radiotherapy technique (FP IMRT). MATERIAL/METHODS 74 adult patients were identified; all received step and shoot FP IMRT TBI, 14.4 Gy in 8 fractions over 4 days. Mean doses to the lungs and kidneys were 12-12.5 Gy. Toxicities were defined as per CTCAE v4.0: IP as multilobar infiltrates on CT with symptoms of dyspnoea, and renal dysfunction as an Estimated Glomerular Filtration rate (eGFR) < 60 ml/min/1.73 m2 for > 3 months. Secondary endpoints were overall survival (OS), progression free survival (PFS), cumulative incidence of non-relapse mortality (NRM), relapse risk and of acute and chronic GvHD. RESULTS Patients received treatment for the following diagnosis: ALL/LBL (n = 37); AML (n = 33), CML-BC (n = 2) and High grade NHL (n = 2). The rate of IP due to any cause was 30%; positive microbiological evidence in 73% (16 /22). Idiopathic IP was seen in 8%, with only 4% (n = 3) having IP Grade ≥ 3. Two (4%) of 52 long term survivors developed CKD, one with thrombotic microangiopathy. 4 year NRM was 16% (CI 11-32%); no treatment related deaths in matched sibling or umbilical cord blood HSCT. CONCLUSION FP IMRT TBI, reducing dose to the lungs and kidneys, has lower rates of idiopathic IP and CKD compared to the literature. This technique is safe and effective conditioning for full intensity HSCT.
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Affiliation(s)
- Emily Durie
- Department of Radiotherapy, The Royal Marsden Hospital, Sutton, United Kingdom
| | - Emma Nicholson
- Haemato-Oncology Unit, The Royal Marsden Hospital, Sutton, United Kingdom
| | - Chloe Anthias
- Haemato-Oncology Unit, The Royal Marsden Hospital, Sutton, United Kingdom
| | - Emma M Dunne
- Department of Radiotherapy, The Royal Marsden Hospital, Sutton, United Kingdom
| | - Mike Potter
- Haemato-Oncology Unit, The Royal Marsden Hospital, Sutton, United Kingdom
| | - Mark Ethell
- Haemato-Oncology Unit, The Royal Marsden Hospital, Sutton, United Kingdom
| | - Christina Messiou
- Radiology Department, The Royal Marsden Hospital, Sutton, United Kingdom
| | - Joy Brennan
- Haemato-Oncology Unit, The Royal Marsden Hospital, Sutton, United Kingdom
| | - Sally Eagle
- Department of Radiotherapy, The Royal Marsden Hospital, Sutton, United Kingdom
| | - James Talbot
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Gregory Smyth
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Westley Ingram
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Frank Saran
- Department of Radiotherapy, Auckland City Hospital, New Zealand
| | - Henry C Mandeville
- Department of Radiotherapy, The Royal Marsden Hospital, Sutton, United Kingdom; The Institute of Cancer Research, Sutton, United Kingdom.
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790
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Yamaguchi S, Sato E, Ieko Y, Ariga H, Yoshioka K. Development of a dose-rate dosimeter for x-ray CT scanner using silicon x-ray diode. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2021; 92:053103. [PMID: 34243345 DOI: 10.1063/5.0047546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/02/2021] [Indexed: 06/13/2023]
Abstract
In an x-ray diagnosis, it is important to evaluate the entrance dose rate, as the dose rate of exposure becomes highest in that position. To investigate the effect of the entrance dose rate of x-ray CT scanners, a dose-rate dosimeter comprising a silicon x-ray diode (Si-XD), a CMOS dual operational amplifier, resistors, capacitors, and a mini-substrate measuring 20 × 17 mm2 were developed. The Si-XD is desirable for measuring the changing entrance dose rate, as it enables the reduction of the response time, dimensions, and cost of the dosimeter. The dosimeter was connected to a microcomputer (mbed), and the output voltages from the dosimeter were measured using an analog-digital converter in the mbed. The output voltages were proportional to the tube currents at a constant tube voltage of 100 kV using an industrial x-ray tube, and the calibrated dose rates corresponded well to those obtained using a commercially available semiconductor dosimeter. However, owing to the energy dependence of the dosimeter, the calibrated dose rate was ∼10% higher than that of a commercially available semiconductor dosimeter at the lower tube voltage. In the angular dependence of the dosimeter, the flatness measured from 60° to 120° was ∼103% in this study. A fundamental study for measuring the dose-rate variations with rotation was performed. The results showed a different profile than the angular dependence due to the distance from the source and the complex factors of the scattered radiation.
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Affiliation(s)
- Satoshi Yamaguchi
- Department of Radiology, School of Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan
| | - Eiichi Sato
- Department of Physics, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Iwate 028-3694, Japan
| | - Yoshiro Ieko
- Department of Radiation Oncology, Iwate Medical University Hospital, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan
| | - Hisanori Ariga
- Department of Radiation Oncology, Iwate Medical University Hospital, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan
| | - Kunihiro Yoshioka
- Department of Radiation Oncology, Iwate Medical University Hospital, Iwate Medical University, 2-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan
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791
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Khullar K, Dhawan ST, Nosher J, Jabbour SK. Fiducial marker migration following computed tomography-guided placement in the liver: a case report. AME Case Rep 2021; 5:15. [PMID: 33912804 DOI: 10.21037/acr-20-153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/06/2021] [Indexed: 12/12/2022]
Abstract
Radiation therapy for liver tumors has been shown to provide a local control and overall survival benefit in patients with primary or oligometastatic liver tumors. However, accurate delineation of the target volume in intraabdominal tumors can be limited by diaphragmatic motion. In addition to image guidance during radiation therapy, computed tomography (CT)-guided fiducial marker placement can improve the accuracy of radiation treatment and optimize tumor control. Fiducial marker placement is often indicated in stereotactic body radiation therapy (SBRT) due to the ablative doses used as well as in proton therapy given that these markers are clearly visible on orthogonal kV image guidance and studies have suggested that their placement in liver tumors offers improved local control. However, fiducial marker migration is a rare risk associated with fiducial placement for which literature remains scarce. We report two separate cases of fiducial marker migrations from the liver into the inferior vena cava and right atrium which occurred following CT-guided placement without any resultant toxicity. Imaging using contrast-enhanced or volume navigation ultrasound techniques during fiducial marker deployment may mitigate the risk of fiducial marker migration and potential end-organ injury. Alternative techniques for motion management such as inspiratory or expiratory breath hold or use of residual lipiodol on imaging in patients who have undergone transarterial chemoembolization (TACE) should be considered as well to avoid potential complications from fiducial marker placement.
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Affiliation(s)
- Karishma Khullar
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | | | - John Nosher
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
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792
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Keijnemans K, Borman PTS, van Lier ALHMW, Verhoeff JJC, Raaymakers BW, Fast MF. Simultaneous multi-slice accelerated 4D-MRI for radiotherapy guidance. Phys Med Biol 2021; 66. [PMID: 33827065 DOI: 10.1088/1361-6560/abf591] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/07/2021] [Indexed: 12/25/2022]
Abstract
4D-MRI is becoming increasingly important for daily guidance of thoracic and abdominal radiotherapy. This study exploits the simultaneous multi-slice (SMS) technique to accelerate the acquisition of a balanced turbo field echo (bTFE) and a turbo spin echo (TSE) coronal 4D-MRI sequence performed on 1.5 T MRI scanners. SMS single-shot bTFE and TSE sequences were developed to acquire a stack of 52 coronal 2D images over 30 dynamics. Simultaneously excited slices were separated by half the field of view. Slices intersecting with the liver-lung interface were used as navigator slices. For each navigator slice location, an end-exhale dynamic was automatically identified, and used to derive the self-sorting signal by rigidly registering the remaining dynamics. Navigator slices were sorted into 10 amplitude bins, and the temporal relationship of simultaneously excited slices was used to generate sorted 4D-MRIs for 12 healthy volunteers. The self-sorting signal was validated using anin vivopeak-to-peak motion analysis. The smoothness of the liver-lung interface was quantified by comparing to sagittal cine images acquired directly after the SMS-4D-MRI sequence. To ensure compatibility with the MR-linac radiotherapy workflow, the 4D-MRIs were transformed into 3D mid-position (MidP) images using deformable image registration. Consistency of the deformable vector fields was quantified in terms of the distance discordance metric (DDM) in the body. The SMS-4D-TSE sequence was additionally acquired for 3 lung cancer patients to investigate tumor visibility. SMS-4D-MRI acquisition and processing took approximately 7 min. 4D-MRI reconstruction was possible for 26 out of 27 acquired datasets. Missing data in the sorted 4D-MRIs varied from 4%-26% for the volunteers and varied from 8%-24% for the patients. Peak-to-peak (SD) amplitudes analysis agreed within 1.8 (1.1) mm and 0.9 (0.4) mm between the sorted 4D-MRIs and the self-sorting signals of the volunteers and patients, respectively. Liver-lung interface smoothness was found to be in the range of 0.6-3.1 mm for volunteers. The percentage of DDM values smaller than 2 mm was in the range of 85%-89% and 86%-92% for the volunteers and patients, respectively. Lung tumors were clearly visibility in the SMS-4D-TSE images and MidP images. Two fast SMS-accelerated 4D-MRI sequences were developed resulting in T2/T1or T2weighted contrast. The SMS-4D-MRIs and derived 3D MidP-MRIs yielded anatomically plausible images and good tumor visibility. SMS-4D-MRI is therefore a strong candidate to be used for treatment simulation and daily guidance of thoracic and abdominal MR-guided radiotherapy.
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Affiliation(s)
- K Keijnemans
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - P T S Borman
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - A L H M W van Lier
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - J J C Verhoeff
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - B W Raaymakers
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - M F Fast
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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793
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Grilo AM, Santos B, Baptista I, Monsanto F. Exploring the cancer patients' experiences during external radiotherapy: A systematic review and thematic synthesis of qualitative and quantitative evidence. Eur J Oncol Nurs 2021; 52:101965. [PMID: 34023669 DOI: 10.1016/j.ejon.2021.101965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 03/28/2021] [Accepted: 04/14/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the subjective experience of adult cancer patients undergoing external radiotherapy and provide evidence for better practices in radiotherapy services. METHODS A systematic review was performed according to the PRISMA Statement Guidelines. Qualitative and mixed studies were identified through five electronic databases (CINAHL, PsychINFO, Medline, Scopus and Web of Science), between March and April 2020, using defined criteria. Methodological quality assessment was conducted, and the data integrated into a thematic synthesis. RESULTS Of the 886 studies identified, 13 met our inclusion criteria. Patients experiences were described into four main themes: (1) Time, (2) Physical Environment, (3) Treatment Concerns and (4) Radiotherapy Team. Time refers to waiting time and treatment time; Physical Environment states temperature in the treatment room and equipment; Treatment Concerns included side effects, daily activities, positioning and immobilization and treatment preparation (e.g., bladder filling); radiotherapy team comprised patients support; response to patients needs and recognized team. The generating analytical phase of thematic analysis allowed us to recognize that the effectiveness of the radiotherapy team operates as a facilitator of the patients' experience. In contrast, time in the waiting room, the treatment preparation when is required, and the positioning and immobilization, specifically for the neck and head patients, act as barriers. CONCLUSION Four distinct themes were identified to be positively and negatively associated with patients' experience during external radiotherapy. The evidence provides valuable recommendations to improved radiotherapy services organization, as well as to the delivery of more patient-centred care adjusted to the concerns and needs of patients.
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Affiliation(s)
- Ana Monteiro Grilo
- H&TRC-Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal; CICPsi - Research Center for Psychological Science, Faculty of Psychology, University of Lisbon, Portugal.
| | - Bárbara Santos
- Medical Imaging and RT Degree, Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal.
| | - Inês Baptista
- Medical Imaging and RT Degree, Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal.
| | - Fátima Monsanto
- H&TRC-Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal.
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794
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Delta radiomics for rectal cancer response prediction using low field magnetic resonance guided radiotherapy: an external validation. Phys Med 2021; 84:186-191. [PMID: 33901863 DOI: 10.1016/j.ejmp.2021.03.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/20/2021] [Accepted: 03/29/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION A recent study performed on 16 locally advanced rectal cancer (LARC) patients treated using magnetic resonance guided radiotherapy (MRgRT) has identified two delta radiomics features as predictors of clinical complete response (cCR) after neoadjuvant radio-chemotherapy (nCRT). This study aims to validate these features (ΔLleast and Δglnu) on an external larger dataset, expanding the analysis also for pathological complete response (pCR) prediction. METHODS A total of 43 LARC patients were enrolled: Gross Tumour Volume (GTV) was delineated on T2/T1* MR images acquired during MRgRT and the two delta features were calculated. Receiver Operating Characteristic (ROC) curve analysis was performed on the 16 cases of the original study and the best cut-off value was identified. The performance of ΔLleast and Δglnu was evaluated at the best cut-off value. RESULTS On the original dataset of 16 patients, ΔLleast reported an AUC of 0.81 for cCR and 0.93 for pCR, while Δglnu 0.72 and 0.54 respectively. The best cut-off values of ΔLleast was 0.73 for both outcomes, while Δglnu reported 0.54 for cCR and 0.93 for pCR. At the external validation, ΔLleast showed an accuracy of 81% for cCR and 79% for pCR, while Δglnu reported 63% for cCR and 40% for pCR. CONCLUSION The accuracy of ΔLleast in predicting cCR and pCR is significantly higher than those obtained considering Δglnu, but inferior if compared with other image-based biomarker, such as the early-regression index. Studies with larger cohorts of patients are recommended to further investigate the role of delta radiomic features in MRgRT.
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795
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Banegas-Luna AJ, Peña-García J, Iftene A, Guadagni F, Ferroni P, Scarpato N, Zanzotto FM, Bueno-Crespo A, Pérez-Sánchez H. Towards the Interpretability of Machine Learning Predictions for Medical Applications Targeting Personalised Therapies: A Cancer Case Survey. Int J Mol Sci 2021; 22:4394. [PMID: 33922356 PMCID: PMC8122817 DOI: 10.3390/ijms22094394] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 12/18/2022] Open
Abstract
Artificial Intelligence is providing astonishing results, with medicine being one of its favourite playgrounds. Machine Learning and, in particular, Deep Neural Networks are behind this revolution. Among the most challenging targets of interest in medicine are cancer diagnosis and therapies but, to start this revolution, software tools need to be adapted to cover the new requirements. In this sense, learning tools are becoming a commodity but, to be able to assist doctors on a daily basis, it is essential to fully understand how models can be interpreted. In this survey, we analyse current machine learning models and other in-silico tools as applied to medicine-specifically, to cancer research-and we discuss their interpretability, performance and the input data they are fed with. Artificial neural networks (ANN), logistic regression (LR) and support vector machines (SVM) have been observed to be the preferred models. In addition, convolutional neural networks (CNNs), supported by the rapid development of graphic processing units (GPUs) and high-performance computing (HPC) infrastructures, are gaining importance when image processing is feasible. However, the interpretability of machine learning predictions so that doctors can understand them, trust them and gain useful insights for the clinical practice is still rarely considered, which is a factor that needs to be improved to enhance doctors' predictive capacity and achieve individualised therapies in the near future.
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Affiliation(s)
- Antonio Jesús Banegas-Luna
- Structural Bioinformatics and High-Performance Computing Research Group (BIO-HPC), Universidad Católica de Murcia (UCAM), 30107 Murcia, Spain; (J.P.-G.); (A.B.-C.)
| | - Jorge Peña-García
- Structural Bioinformatics and High-Performance Computing Research Group (BIO-HPC), Universidad Católica de Murcia (UCAM), 30107 Murcia, Spain; (J.P.-G.); (A.B.-C.)
| | - Adrian Iftene
- Faculty of Computer Science, Universitatea Alexandru Ioan Cuza (UAIC), 700505 Jashi, Romania;
| | - Fiorella Guadagni
- Interinstitutional Multidisciplinary Biobank (BioBIM), IRCCS San Raffaele Roma, 00166 Rome, Italy; (F.G.); (P.F.)
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, 00166 Rome, Italy;
| | - Patrizia Ferroni
- Interinstitutional Multidisciplinary Biobank (BioBIM), IRCCS San Raffaele Roma, 00166 Rome, Italy; (F.G.); (P.F.)
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, 00166 Rome, Italy;
| | - Noemi Scarpato
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, 00166 Rome, Italy;
| | - Fabio Massimo Zanzotto
- Dipartimento di Ingegneria dell’Impresa “Mario Lucertini”, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Andrés Bueno-Crespo
- Structural Bioinformatics and High-Performance Computing Research Group (BIO-HPC), Universidad Católica de Murcia (UCAM), 30107 Murcia, Spain; (J.P.-G.); (A.B.-C.)
| | - Horacio Pérez-Sánchez
- Structural Bioinformatics and High-Performance Computing Research Group (BIO-HPC), Universidad Católica de Murcia (UCAM), 30107 Murcia, Spain; (J.P.-G.); (A.B.-C.)
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796
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Groot Koerkamp ML, de Hond YJM, Maspero M, Kontaxis C, Mandija S, Vasmel JE, Charaghvandi RK, Philippens MEP, van Asselen B, van den Bongard HJGD, Hackett SS, Houweling AC. Synthetic CT for single-fraction neoadjuvant partial breast irradiation on an MRI-linac. Phys Med Biol 2021; 66. [PMID: 33761491 DOI: 10.1088/1361-6560/abf1ba] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/24/2021] [Indexed: 01/08/2023]
Abstract
A synthetic computed tomography (sCT) is required for daily plan optimization on an MRI-linac. Yet, only limited information is available on the accuracy of dose calculations on sCT for breast radiotherapy. This work aimed to (1) evaluate dosimetric accuracy of treatment plans for single-fraction neoadjuvant partial breast irradiation (PBI) on a 1.5 T MRI-linac calculated on a) bulk-density sCT mimicking the current MRI-linac workflow and b) deep learning-generated sCT, and (2) investigate the number of bulk-density levels required. For ten breast cancer patients we created three bulk-density sCTs of increasing complexity from the planning-CT, using bulk-density for: (1) body, lungs, and GTV (sCTBD1); (2) volumes for sCTBD1plus chest wall and ipsilateral breast (sCTBD2); (3) volumes for sCTBD2plus ribs (sCTBD3); and a deep learning-generated sCT (sCTDL) from a 1.5 T MRI in supine position. Single-fraction neoadjuvant PBI treatment plans for a 1.5 T MRI-linac were optimized on each sCT and recalculated on the planning-CT. Image evaluation was performed by assessing mean absolute error (MAE) and mean error (ME) in Hounsfield Units (HU) between the sCTs and the planning-CT. Dosimetric evaluation was performed by assessing dose differences, gamma pass rates, and dose-volume histogram (DVH) differences. The following results were obtained (median across patients for sCTBD1/sCTBD2/sCTBD3/sCTDLrespectively): MAE inside the body contour was 106/104/104/75 HU and ME was 8/9/6/28 HU, mean dose difference in the PTVGTVwas 0.15/0.00/0.00/-0.07 Gy, median gamma pass rate (2%/2 mm, 10% dose threshold) was 98.9/98.9/98.7/99.4%, and differences in DVH parameters were well below 2% for all structures except for the skin in the sCTDL. Accurate dose calculations for single-fraction neoadjuvant PBI on an MRI-linac could be performed on both bulk-density and deep learning sCT, facilitating further implementation of MRI-guided radiotherapy for breast cancer. Balancing simplicity and accuracy, sCTBD2showed the optimal number of bulk-density levels for a bulk-density approach.
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Affiliation(s)
- M L Groot Koerkamp
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Y J M de Hond
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - M Maspero
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.,Computational Imaging Group for MR diagnostics & therapy, Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C Kontaxis
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Mandija
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.,Computational Imaging Group for MR diagnostics & therapy, Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J E Vasmel
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R K Charaghvandi
- Department of Radiation Oncology, Radboudumc, Nijmegen, The Netherlands
| | - M E P Philippens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B van Asselen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - S S Hackett
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A C Houweling
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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797
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Babar M, Katz A, Ciatto M. Dosimetric and clinical outcomes of SpaceOAR in men undergoing external beam radiation therapy for localized prostate cancer: A systematic review. J Med Imaging Radiat Oncol 2021; 65:384-397. [PMID: 33855816 DOI: 10.1111/1754-9485.13179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 12/30/2022]
Abstract
SpaceOAR, an absorbable polyethylene glycol hydrogel, increases the space between the prostate and rectum to reduce the radiation received by the rectum during prostate cancer radiation therapy. The objective of this systematic review was to evaluate controlled studies on the dosimetric and clinical outcomes of SpaceOAR in men undergoing external beam radiation therapy for localized prostate cancer. Eight studies were included in the review. All of the studies showed SpaceOAR to reduce the radiation dose volume to the rectum over numerous dosimetry levels. Of the four studies that assessed toxicity, one reported SpaceOAR to significantly decrease acute Grade 1 diarrhoea and two reported SpaceOAR to significantly decrease late Grade 1 and Grade ≥2 rectal toxicities. Two studies assessed cumulative incidence of toxicity at 3 years in which one reported SpaceOAR to significantly decrease urinary incontinence and Grade ≥1 and Grade ≥2 rectal toxicities, and the other reported SpaceOAR to significantly decrease Grade 1 diarrhoea and Grade 2 proctitis. Moreover, one study reported that fewer SpaceOAR patients experienced 10-point declines in bowel quality of life at 3 years, but another study reported no significant difference in 10-point declines in bowel quality of life between the SpaceOAR and control groups at 5 years. With the current research available, SpaceOAR may be beneficial to those who did not meet the standard rectal dose-volume criteria, have higher risk factors of developing rectal toxicities post-radiation, or wish to decrease the length and costs of radiotherapy by increasing the dose of radiation per fraction.
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Affiliation(s)
| | - Alan Katz
- St. Francis Hospital, Roslyn, NY, USA
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798
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Bryant CM, Henderson RH, Nichols RC, Mendenhall WM, Hoppe BS, Vargas CE, Daniels TB, Choo CR, Parikh RR, Giap H, Slater JD, Vapiwala N, Barrett W, Nanda A, Mishra MV, Choi S, Liao JJ, Mendenhall NP. Consensus Statement on Proton Therapy for Prostate Cancer. Int J Part Ther 2021; 8:1-16. [PMID: 34722807 PMCID: PMC8489490 DOI: 10.14338/ijpt-20-00031.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 02/02/2021] [Indexed: 11/21/2022] Open
Abstract
Proton therapy is a promising but controversial treatment in the management of prostate cancer. Despite its dosimetric advantages when compared with photon radiation therapy, its increased cost to patients and insurers has raised questions regarding its value. Multiple prospective and retrospective studies have been published documenting the efficacy and safety of proton therapy for patients with localized prostate cancer and for patients requiring adjuvant or salvage pelvic radiation after surgery. The Particle Therapy Co-Operative Group (PTCOG) Genitourinary Subcommittee intends to address current proton therapy indications, advantages, disadvantages, and cost effectiveness. We will also discuss the current landscape of clinical trials. This consensus report can be used to guide clinical practice and research directions.
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Affiliation(s)
- Curtis M. Bryant
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Randal H. Henderson
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - R. Charles Nichols
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - William M. Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Bradford S. Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - C. Richard Choo
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Rahul R. Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Huan Giap
- Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Jerry D. Slater
- Department of Radiation Oncology, Loma Linda University, Loma Linda, CA, USA
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - William Barrett
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, USA
| | - Akash Nanda
- Department of Radiation Oncology, Orlando Health, Orlando, FL, USA
| | - Mark V. Mishra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Seungtaek Choi
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jay J. Liao
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, WA, USA
| | - Nancy P. Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
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799
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Ingrosso G, Saldi S, Marani S, Wong AYW, Bertelli M, Aristei C, Zelante T. Breakdown of Symbiosis in Radiation-Induced Oral Mucositis. J Fungi (Basel) 2021; 7:jof7040290. [PMID: 33921294 PMCID: PMC8068946 DOI: 10.3390/jof7040290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 01/06/2023] Open
Abstract
Oral mucositis is an acute side effect of radiation therapy that is especially common with head and neck cancer treatment. In recent years, several studies have revealed the predisposing factors for mucositis, leading to the pre-treatment of patients to deter the development of opportunistic oral fungal infections. Although many clinical protocols already advise the use of probiotics to counteract inflammation and fungal colonization, preclinical studies are needed to better delineate the mechanisms by which a host may acquire benefits via co-evolution with oral microbiota, probiotics, and fungal commensals, such as Candida albicans, especially during acute inflammation. Here, we review the current understanding of radiation therapy-dependent oral mucositis in terms of pathology, prevention, treatment, and related opportunistic infections, with a final focus on the oral microbiome and how it may be important for future therapy.
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Affiliation(s)
- Gianluca Ingrosso
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy; (G.I.); (S.M.); (C.A.)
- Radiation Oncology Section, Perugia General Hospital, 06129 Perugia, Italy;
| | - Simonetta Saldi
- Radiation Oncology Section, Perugia General Hospital, 06129 Perugia, Italy;
| | - Simona Marani
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy; (G.I.); (S.M.); (C.A.)
- Radiation Oncology Section, Perugia General Hospital, 06129 Perugia, Italy;
| | - Alicia Y. W. Wong
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, 141 86 Stockholm, Sweden;
| | | | - Cynthia Aristei
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy; (G.I.); (S.M.); (C.A.)
- Radiation Oncology Section, Perugia General Hospital, 06129 Perugia, Italy;
| | - Teresa Zelante
- Pathology Section, Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy
- Correspondence: ; Tel.: +39-075-585-8236
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800
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Sakai Y, Tanooka M, Okada W, Sano K, Nakamura K, Shibata M, Ueda Y, Mizuno H, Tanaka M. Characteristics of a bolus created using thermoplastic sheets for postmastectomy radiation therapy. Radiol Phys Technol 2021; 14:179-185. [PMID: 33837911 DOI: 10.1007/s12194-021-00618-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/19/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
This study applied a "shell bolus," an immobilizing thermoplastic shell locally thickened with extra layers over the radiation target, during postmastectomy radiation therapy (PMRT). We performed ion chamber and film measurements for a solid water phantom for thermoplastic sheets and a gel bolus for dosimetric characterization using a 6-MV X-ray flattening-filter-free (FFF) beam. The air gaps between the body surface for the gel and shell bolus were measured using computed tomography (CT) images in patients who underwent PMRT. This included seven and 13 patients treated with the gel and shell boluses, respectively. A comparison of the dose differences between a 10-mm gel bolus and a 9.6-mm-thick thermoplastic sheet at the surface and 5 cm below the surface showed a 4.2% higher surface dose and 0.5% lower dose at 5-cm depth for the thermoplastic sheet compared to those for the gel bolus. The mean (p = 0.029) and maximum (p < 0.001) air gaps of the shell bolus were significantly thinner than those of the gel bolus. Thus, the shell bolus provided a close fit and robust bolus effect. In addition, the shell bolus reduced respiratory motion and eliminated the need for skin marking. Therefore, this system can be effectively used as a bolus for PMRT.
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Affiliation(s)
- Yusuke Sakai
- Radiation Therapy Center, Takarazuka City Hospital, 4-5-1 Kohama, Takarazuka, Hyogo, 665-0827, Japan.
| | - Masao Tanooka
- Radiation Therapy Center, Takarazuka City Hospital, 4-5-1 Kohama, Takarazuka, Hyogo, 665-0827, Japan
| | - Wataru Okada
- Radiation Therapy Center, Takarazuka City Hospital, 4-5-1 Kohama, Takarazuka, Hyogo, 665-0827, Japan
| | - Keisuke Sano
- Radiation Therapy Center, Takarazuka City Hospital, 4-5-1 Kohama, Takarazuka, Hyogo, 665-0827, Japan
| | - Kenji Nakamura
- Radiation Therapy Center, Takarazuka City Hospital, 4-5-1 Kohama, Takarazuka, Hyogo, 665-0827, Japan
| | - Mayuri Shibata
- Radiation Therapy Center, Takarazuka City Hospital, 4-5-1 Kohama, Takarazuka, Hyogo, 665-0827, Japan
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 537-8567, Japan
| | - Hirokazu Mizuno
- Division of Central Radiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Masahiro Tanaka
- Radiation Therapy Center, Takarazuka City Hospital, 4-5-1 Kohama, Takarazuka, Hyogo, 665-0827, Japan
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