101
|
Thureau S, Hapdey S, Vera P. [Role of functional imaging in the definition of target volumes for lung cancer radiotherapy]. Cancer Radiother 2016; 20:699-704. [PMID: 27614514 DOI: 10.1016/j.canrad.2016.08.121] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/01/2016] [Indexed: 12/23/2022]
Abstract
Functional imaging with positron emission tomography (PET) is interesting to optimize lung radiotherapy planning, and probably to deliver a heterogeneous dose or adapt the radiation dose during treatment. Only fluorodeoxyglucose (FDG) PET-computed tomography (CT) is validated for staging lung cancer and planning radiotherapy. The optimal segmentation methods remain to be defined as well as the interest of "dose painting" from pre-treatment PET (metabolism: FDG) or hypoxia (fluoromisonidazole: FMISO) and the interest of replanning based on pertherapeutic PET.
Collapse
Affiliation(s)
- S Thureau
- Département de médecine nucléaire, centre de lutte contre le cancer Henri-Becquerel, rue d'Amiens, 76000 Rouen, France; Département de radiothérapie et de physique médicale, centre de lutte contre le cancer Henri-Becquerel, rue d'Amiens, 76000 Rouen, France; Laboratoire QuantIF, EA4108-Litis, FR CNRS 3638, 1, rue d'Amiens, 76000 Rouen, France.
| | - S Hapdey
- Département de médecine nucléaire, centre de lutte contre le cancer Henri-Becquerel, rue d'Amiens, 76000 Rouen, France; Laboratoire QuantIF, EA4108-Litis, FR CNRS 3638, 1, rue d'Amiens, 76000 Rouen, France
| | - P Vera
- Département de médecine nucléaire, centre de lutte contre le cancer Henri-Becquerel, rue d'Amiens, 76000 Rouen, France; Laboratoire QuantIF, EA4108-Litis, FR CNRS 3638, 1, rue d'Amiens, 76000 Rouen, France
| |
Collapse
|
102
|
Szeto YZ, Witte MG, van Kranen SR, Sonke JJ, Belderbos J, van Herk M. Effects of anatomical changes on pencil beam scanning proton plans in locally advanced NSCLC patients. Radiother Oncol 2016; 120:286-92. [PMID: 27393217 DOI: 10.1016/j.radonc.2016.04.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 04/02/2016] [Accepted: 04/03/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE Daily anatomical variations can cause considerable differences between delivered and planned dose. This study simulates and evaluates these effects in spot-scanning proton therapy for lung cancer patients. MATERIALS AND METHODS Robust intensity modulated treatment plans were designed on the mid-position CT scan for sixteen locally advanced lung cancer patients. To estimate dosimetric uncertainty, deformable registration was performed on their daily CBCTs to generate 4DCT equivalent scans for each fraction and to map recomputed dose to a common frame. RESULTS Without adaptive planning, eight patients had an undercoverage of the targets of more than 2GyE (maximum of 14.1GyE) on the recalculated treatment dose from the daily anatomy variations including respiration. In organs at risk, a maximum increase of 4.7GyE in the D1 was found in the mediastinal structures. The effect of respiratory motion alone is smaller: 1.4GyE undercoverage for targets and less than 1GyE for organs at risk. CONCLUSIONS Daily anatomical variations over the course of treatment can cause considerable dose differences in the robust planned dose distribution. An advanced planning strategy including knowledge of anatomical uncertainties would be recommended to improve plan robustness against interfractional variations. For large anatomical changes, adaptive therapy is mandatory.
Collapse
Affiliation(s)
- Yenny Z Szeto
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marnix G Witte
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Simon R van Kranen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - José Belderbos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marcel van Herk
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| |
Collapse
|
103
|
Cazoulat G, Owen D, Matuszak MM, Balter JM, Brock KK. Biomechanical deformable image registration of longitudinal lung CT images using vessel information. Phys Med Biol 2016; 61:4826-39. [PMID: 27273115 DOI: 10.1088/0031-9155/61/13/4826] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Spatial correlation of lung tissue across longitudinal images, as the patient responds to treatment, is a critical step in adaptive radiotherapy. The goal of this work is to expand a biomechanical model-based deformable registration algorithm (Morfeus) to achieve accurate registration in the presence of significant anatomical changes. Six lung cancer patients previously treated with conventionally fractionated radiotherapy were retrospectively evaluated. Exhale CT scans were obtained at treatment planning and following three weeks of treatment. For each patient, the planning CT was registered to the follow-up CT using Morfeus, a biomechanical model-based deformable registration algorithm. To model the complex response of the lung, an extension to Morfeus has been developed: an initial deformation was estimated with Morfeus consisting of boundary conditions on the chest wall and incorporating a sliding interface with the lungs. It was hypothesized that the addition of boundary conditions based on vessel tree matching would provide a robust reduction of the residual registration error. To achieve this, the vessel trees were segmented on the two images by thresholding a vesselness image based on the Hessian matrix's eigenvalues. For each point on the reference vessel tree centerline, the displacement vector was estimated by applying a variant of the Demons registration algorithm between the planning CT and the deformed follow-up CT. An expert independently identified corresponding landmarks well distributed in the lung to compute target registration errors (TRE). The TRE was: [Formula: see text], [Formula: see text] and [Formula: see text] mm after rigid registration, Morfeus and Morfeus with boundary conditions on the vessel tree, respectively. In conclusion, the addition of boundary conditions on the vessels significantly improved the accuracy in modeling the response of the lung and tumor over the course of radiotherapy. Minimizing and modeling these geometrical uncertainties will enable future plan adaptation strategies.
Collapse
Affiliation(s)
- Guillaume Cazoulat
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, USA
| | | | | | | | | |
Collapse
|
104
|
Veiga C, Janssens G, Teng CL, Baudier T, Hotoiu L, McClelland JR, Royle G, Lin L, Yin L, Metz J, Solberg TD, Tochner Z, Simone CB, McDonough J, Kevin Teo BK. First Clinical Investigation of Cone Beam Computed Tomography and Deformable Registration for Adaptive Proton Therapy for Lung Cancer. Int J Radiat Oncol Biol Phys 2016; 95:549-559. [DOI: 10.1016/j.ijrobp.2016.01.055] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 01/26/2016] [Accepted: 01/28/2016] [Indexed: 12/25/2022]
|
105
|
Tiong A, Lao L, MacKean J, Goonetilleke M, Kron T. Faculty of Radiation Oncology Position Paper on the use of Image-Guided Radiation Therapy. J Med Imaging Radiat Oncol 2016; 60:772-780. [PMID: 27122102 DOI: 10.1111/1754-9485.12463] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/17/2016] [Indexed: 12/26/2022]
Abstract
The development of technology such as intensity-modulated radiotherapy (IMRT), volumetric arc therapy (VMAT) and stereotactic ablative body radiotherapy (SABR) has resulted in highly conformal radiotherapy treatments. While such technology has allowed for improved dose delivery, it has also meant that improved accuracy in the treatment room is required. Image-guided radiotherapy (IGRT), the use of imaging prior to or during treatment delivery, has been shown to improve the accuracy of treatment delivery and in some circumstances, clinical outcomes. Allied with the adoption of highly conformal treatments, there is a need for stringent quality assurance processes in a multidisciplinary environment. In 2015, the Royal Australian and New Zealand College of Radiologist (RANZCR) updated its position paper on IGRT. The draft document was distributed through the membership of the Faculty of Radiation Oncology (FRO) for review and the final version was endorsed by the board of FRO. This article describes issues that radiotherapy departments throughout Australia and New Zealand should consider. It outlines the role of IGRT and reviews current clinical evidence supporting the benefit of IGRT in genitourinary, head and neck, and lung cancers. It also highlights important international publications which provide guidance on implementation and quality assurances for IGRT. A set of key recommendations are provided to guide safe and effective IGRT implementation and practice in the Australian and New Zealander context.
Collapse
Affiliation(s)
- Albert Tiong
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Louis Lao
- Department of Radiation Oncology, Auckland City Hospital, Auckland, New Zealand.,Auckland Radiation Oncology, Auckland, New Zealand.,University of Auckland, Auckland, New Zealand
| | - James MacKean
- Genesis Cancer Care Queensland, Brisbane, Queensland, Australia
| | - Madhavi Goonetilleke
- Department of Radiation Oncology, Townsville Cancer Centre, Townsville, Queensland, Australia
| | - Tomas Kron
- Department of Medical Physics, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| |
Collapse
|
106
|
Duffton A, Harrow S, Lamb C, McJury M. An assessment of cone beam CT in the adaptive radiotherapy planning process for non-small-cell lung cancer patients. Br J Radiol 2016; 89:20150492. [PMID: 27052681 DOI: 10.1259/bjr.20150492] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the potential use of cone beam CT (CBCT) in adaptive radiotherapy (ART) planning process for non-small-cell lung cancer (NSCLC). METHODS 17 retrospective patients with NSCLC Stage T1-T4, who had completed a course of radiotherapy with weekly CBCT imaging were selected for the study. The patients had been delineated and planned for three-dimensional (3D) conformal treatment (prescription: 55 Gy in 20 fractions) based on free-breathing four-dimensional CT data. Of these initial 17 patients, 12 had full quantitative data on gross tumour volume (GTV) position and volume throughout treatment. GTV delineation was carried out on weekly CBCT by a clinical oncologist. For each patient, mean percentage change in GTV and centre of mass (COM) displacement (based on 3D vectors) were calculated throughout treatment. Volume overlap between GTVs was calculated. Correlation of the COM displacement and planning GTV (pGTV) was assessed. A linear mixed model with patients as random effects was fitted to the data to assess potential benefit from using ART for these patients. RESULTS Comparison of CBCT-based GTV acquired prior to Fraction 1 (cbctGTV1) to pGTV showed mean 20 ± 19% volume increase using a related sample Wilcoxon signed rank test p = 0.04. Correlation was identified between volume reductions and dose delivered (beta = -0.003, p < 0.001)-a highly statistically significant association. Compared with cbctGTV1, the mean ratios ± standard deviation were cbctGTV2, 0.93 ± 0.08; cbctGTV3, 0.84 ± 0.12; and cbctGTV4, 0.75 ± 0.14. The dice similarity coefficient was 0.81 ± 0.14, 0.78 ± 0.17, 0.73 ± 0.19, respectively. The COM was consistent throughout treatment (mean 0.35 ± 0.24 cm). A fitted model predicts that a mean change of 30% volume relative to cbctGTV1 occurs at a dose of approximately 50 Gy. CONCLUSION Using a 30% reduction in volume, ART would not be of benefit for all radiotherapy-alone-treated patients with NSCLC assessed in this study. For individual patients and patients with atelectasis, CBCT imaging was able to identify volume change. ADVANCES IN KNOWLEDGE For patients treated with 55 Gy in 20 fractions, target volume changes throughout treatment have been demonstrated using CBCT and can be used to highlight patients who may benefit from ART.
Collapse
Affiliation(s)
- Aileen Duffton
- 1 Department of Radiotherapy, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Stephen Harrow
- 1 Department of Radiotherapy, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Carolynn Lamb
- 1 Department of Radiotherapy, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Mark McJury
- 2 Department of Clinical Physics and Bio-Engineering, Beatson West of Scotland Cancer Centre, Glasgow, UK
| |
Collapse
|
107
|
Baumann M, Krause M, Overgaard J, Debus J, Bentzen SM, Daartz J, Richter C, Zips D, Bortfeld T. Radiation oncology in the era of precision medicine. Nat Rev Cancer 2016; 16:234-49. [PMID: 27009394 DOI: 10.1038/nrc.2016.18] [Citation(s) in RCA: 531] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Technological advances and clinical research over the past few decades have given radiation oncologists the capability to personalize treatments for accurate delivery of radiation dose based on clinical parameters and anatomical information. Eradication of gross and microscopic tumours with preservation of health-related quality of life can be achieved in many patients. Two major strategies, acting synergistically, will enable further widening of the therapeutic window of radiation oncology in the era of precision medicine: technology-driven improvement of treatment conformity, including advanced image guidance and particle therapy, and novel biological concepts for personalized treatment, including biomarker-guided prescription, combined treatment modalities and adaptation of treatment during its course.
Collapse
Affiliation(s)
- Michael Baumann
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden
- OncoRay - National Center for Radiation Research in Oncology (NCRO), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstrasse 74, 01307 Dresden
- National Center for Tumor Diseases (NCT), Fetscherstrasse 74, 01307 Dresden
- German Cancer Consortium (DKTK) Dresden, Germany
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiation Oncology, Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - Mechthild Krause
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden
- OncoRay - National Center for Radiation Research in Oncology (NCRO), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstrasse 74, 01307 Dresden
- National Center for Tumor Diseases (NCT), Fetscherstrasse 74, 01307 Dresden
- German Cancer Consortium (DKTK) Dresden, Germany
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiation Oncology, Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Jürgen Debus
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), University of Heidelberg Medical School and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120 Heidelberg
- Heidelberg Ion Therapy Center (HIT), Department of Radiation Oncology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120 Heidelberg
- German Cancer Consortium (DKTK) Heidelberg, Germany
| | - Søren M Bentzen
- Department of Epidemiology and Public Health and Greenebaum Cancer Center, University of Maryland School of Medicine, 22 S Greene Street S9a03, Baltimore, Maryland 21201, USA
| | - Juliane Daartz
- Department of Radiation Oncology, Physics Division, Massachusetts General Hospital and Harvard Medical School, 1000 Blossom Street Cox 362, Boston, Massachusetts 02114, USA
| | - Christian Richter
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden
- OncoRay - National Center for Radiation Research in Oncology (NCRO), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstrasse 74, 01307 Dresden
- National Center for Tumor Diseases (NCT), Fetscherstrasse 74, 01307 Dresden
- German Cancer Consortium (DKTK) Dresden, Germany
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Daniel Zips
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- German Cancer Consortium Tübingen, Postfach 2669, 72016 Tübingen
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Tübingen, Eberhard Karls Universität Tübingen, Hoppe-Seyler-Strasse 3, 72016 Tübingen, Germany
| | - Thomas Bortfeld
- Department of Radiation Oncology, Physics Division, Massachusetts General Hospital and Harvard Medical School, 1000 Blossom Street Cox 362, Boston, Massachusetts 02114, USA
| |
Collapse
|
108
|
Feng Y, Lawrence J, Cheng K, Montgomery D, Forrest L, Mclaren DB, McLaughlin S, Argyle DJ, Nailon WH. INVITED REVIEW-IMAGE REGISTRATION IN VETERINARY RADIATION ONCOLOGY: INDICATIONS, IMPLICATIONS, AND FUTURE ADVANCES. Vet Radiol Ultrasound 2016; 57:113-23. [DOI: 10.1111/vru.12342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 10/21/2015] [Accepted: 11/06/2015] [Indexed: 11/26/2022] Open
Affiliation(s)
- Yang Feng
- Department of Oncology Physics, Edinburgh Cancer Centre, Western General Hospital; The University of Edinburgh; Edinburgh UK
- Royal (Dick) School of Veterinary Studies and Roslin Institute; The University of Edinburgh; Edinburgh UK
- Healthcare Department; Philips Research China; Shanghai 200233 P.R. China
| | - Jessica Lawrence
- Royal (Dick) School of Veterinary Studies and Roslin Institute; The University of Edinburgh; Edinburgh UK
| | - Kun Cheng
- Department of Oncology Physics, Edinburgh Cancer Centre, Western General Hospital; The University of Edinburgh; Edinburgh UK
| | - Dean Montgomery
- Department of Oncology Physics, Edinburgh Cancer Centre, Western General Hospital; The University of Edinburgh; Edinburgh UK
| | - Lisa Forrest
- Department of Surgical Sciences; The University of Wisconsin-Madison; 2015 Linden Drive Madison WI
| | - Duncan B. Mclaren
- Department of Oncology Physics, Edinburgh Cancer Centre, Western General Hospital; The University of Edinburgh; Edinburgh UK
| | - Stephen McLaughlin
- School of Engineering and Physical Sciences; Heriot-Watt University; Edinburgh EH14 4AS UK
| | - David J. Argyle
- Royal (Dick) School of Veterinary Studies and Roslin Institute; The University of Edinburgh; Edinburgh UK
| | - William H. Nailon
- Department of Oncology Physics, Edinburgh Cancer Centre, Western General Hospital; The University of Edinburgh; Edinburgh UK
| |
Collapse
|
109
|
Cone-beam CT-guided radiotherapy in the management of lung cancer: Diagnostic and therapeutic value. Strahlenther Onkol 2015; 192:83-91. [PMID: 26630946 DOI: 10.1007/s00066-015-0927-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/18/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Recent studies have demonstrated an increase in the necessity of adaptive planning over the course of lung cancer radiation therapy (RT) treatment. In this study, we evaluated intrathoracic changes detected by cone-beam CT (CBCT) in lung cancer patients during RT. METHODS AND MATERIALS A total of 71 lung cancer patients treated with fractionated CBCT-guided RT were evaluated. Intrathoracic changes and plan adaptation priority (AP) scores were compared between small cell lung cancer (SCLC, n = 13) and non-small cell lung cancer (NSCLC, n = 58) patients. RESULTS The median cumulative radiation dose administered was 54 Gy (range 30-72 Gy) and the median fraction dose was 1.8 Gy (range 1.8-3.0 Gy). All patients were subjected to a CBCT scan at least weekly (range 1-5/week). We observed intrathoracic changes in 83 % of the patients over the course of RT [58 % (41/71) regression, 17 % (12/71) progression, 20 % (14/71) atelectasis, 25 % (18/71) pleural effusion, 13 % (9/71) infiltrative changes, and 10 % (7/71) anatomical shift]. Nearly half, 45 % (32/71), of the patients had one intrathoracic soft tissue change, 22.5 % (16/71) had two, and three or more changes were observed in 15.5 % (11/71) of the patients. Plan modifications were performed in 60 % (43/71) of the patients. Visual volume reduction did correlate with the number of CBCT scans acquired (r = 0.313, p = 0.046) and with the timing of chemotherapy administration (r = 0.385, p = 0.013). CONCLUSION Weekly CBCT monitoring provides an adaptation advantage in patients with lung cancer. In this study, the monitoring allowed for plan adaptations due to tumor volume changes and to other anatomical changes.
Collapse
|
110
|
Cobben DCP, de Boer HCJ, Tijssen RH, Rutten EGGM, van Vulpen M, Peerlings J, Troost EGC, Hoffmann AL, van Lier ALHMW. Emerging Role of MRI for Radiation Treatment Planning in Lung Cancer. Technol Cancer Res Treat 2015; 15:NP47-NP60. [PMID: 26589726 DOI: 10.1177/1533034615615249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/01/2015] [Indexed: 12/25/2022] Open
Abstract
Magnetic resonance imaging (MRI) provides excellent soft-tissue contrast and allows for specific scanning sequences to optimize differentiation between various tissue types and properties. Moreover, it offers the potential for real-time motion imaging. This makes magnetic resonance imaging an ideal candidate imaging modality for radiation treatment planning in lung cancer. Although the number of clinical research protocols for the application of magnetic resonance imaging for lung cancer treatment is increasing (www.clinicaltrials.gov) and the magnetic resonance imaging sequences are becoming faster, there are still some technical challenges. This review describes the opportunities and challenges of magnetic resonance imaging for radiation treatment planning in lung cancer.
Collapse
Affiliation(s)
- David C P Cobben
- Department of Radiation Oncology, University Medical Center, Utrecht, the Netherlands
| | - Hans C J de Boer
- Department of Radiation Oncology, University Medical Center, Utrecht, the Netherlands
| | - Rob H Tijssen
- Department of Radiation Oncology, University Medical Center, Utrecht, the Netherlands
| | - Emma G G M Rutten
- Department of Radiation Oncology, University Medical Center, Utrecht, the Netherlands
| | - Marco van Vulpen
- Department of Radiation Oncology, University Medical Center, Utrecht, the Netherlands
| | - Jurgen Peerlings
- Department of Radiation Oncology, MAASTRO Clinic, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Esther G C Troost
- Department of Radiation Oncology, MAASTRO Clinic, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,OncoRay, National Center for Radiation Research in Oncology, Dresden, Germany.,Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Aswin L Hoffmann
- Department of Radiation Oncology, MAASTRO Clinic, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,OncoRay, National Center for Radiation Research in Oncology, Dresden, Germany.,Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | | |
Collapse
|
111
|
Bibault JE, Arsène-Henry A, Durdux C, Mornex F, Hamza S, Trouette R, Thureau S, Faivre JC, Boisselier P, Lerouge D, Paragios N, Giraud P. Radiothérapie adaptative du carcinome bronchique non à petites cellules. Cancer Radiother 2015; 19:458-62. [DOI: 10.1016/j.canrad.2015.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 05/27/2015] [Indexed: 11/26/2022]
|
112
|
Berkovic P, Paelinck L, Lievens Y, Gulyban A, Goddeeris B, Derie C, Surmont V, De Neve W, Vandecasteele K. Adaptive radiotherapy for locally advanced non-small cell lung cancer, can we predict when and for whom? Acta Oncol 2015; 54:1438-44. [PMID: 26405809 DOI: 10.3109/0284186x.2015.1061209] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Adaptive radiotherapy (ART) could be a tool to reduce toxicity and to facilitate dose escalation in stage III NSCLC. Our aim was to identify the most appropriate time and potential benefit of ART. MATERIAL AND METHODS We analyzed volume reduction and dosimetric consequences of 41 patients who were treated with concurrent (cCRT) (n = 21) or sequential (sCRT) chemoradiotherapy to a median dose of 70 Gy, 2 Gy/F. At every treatment fraction a cone-beam CT (CBCT) was performed. The gross tumor volume (GTV-T) was adapted (exclusion of lymph nodes) to create the GTV-T-F1. Every fifth fraction (F5-F30), the GTV-T-F1 was adapted on the CBCT to create a GTV-T-Fx. Dose volume histograms were recalculated for every GTV-T-Fx, enabling to create lookup tables to predict the theoretical dosimetric advantage on common lung dose constraints. RESULTS The average GTV reduction was 42.1% (range 4.0-69.3%); 50.1% and 33.7% for the cCRT and sCRT patients, respectively. A linear relationship between GTV-T-F1 volume and absolute volume decrease was found for both groups. The mean V5, V20, V30 and mean lung dose increased by 0.8, 3.1, 5.2 and 3.4%, respectively. A larger increase (p < 0.05) was observed for peripheral tumors and cCRT. Lookup tables were generated. CONCLUSION ART offers the most beneficial dosimetric effects when performed around fraction 15, especially for patients with a large initial GTV-T treated by cCRT.
Collapse
Affiliation(s)
- Patrick Berkovic
- a Department of Radiation Oncology , Ghent University Hospital , Ghent , Belgium
- b Department of Radiation Oncology , Liège University Hospital , Liège , Belgium
| | - Leen Paelinck
- a Department of Radiation Oncology , Ghent University Hospital , Ghent , Belgium
| | - Yolande Lievens
- a Department of Radiation Oncology , Ghent University Hospital , Ghent , Belgium
| | - Akos Gulyban
- b Department of Radiation Oncology , Liège University Hospital , Liège , Belgium
| | - Bruno Goddeeris
- a Department of Radiation Oncology , Ghent University Hospital , Ghent , Belgium
| | - Cristina Derie
- a Department of Radiation Oncology , Ghent University Hospital , Ghent , Belgium
| | - Veerle Surmont
- a Department of Radiation Oncology , Ghent University Hospital , Ghent , Belgium
| | - Wilfried De Neve
- a Department of Radiation Oncology , Ghent University Hospital , Ghent , Belgium
| | | |
Collapse
|
113
|
Tvilum M, Khalil AA, Møller DS, Hoffmann L, Knap MM. Clinical outcome of image-guided adaptive radiotherapy in the treatment of lung cancer patients. Acta Oncol 2015. [PMID: 26206515 DOI: 10.3109/0284186x.2015.1062544] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Adaptive strategy with daily online tumour match is a treatment option when treating locally advanced lung cancer patients with curative intended radiotherapy (RT). MATERIAL AND METHODS Fifty-two consecutive lung cancer patients treated with soft tissue match, adaptive RT and small planning target volumes (PTV) margins were analysed. A control group of 52 consecutive patients treated with bone match, no adaptive strategy and larger margins was included. Patients were followed with computed tomography (CT) scans every third month. CT-images showing loco-regional recurrences were identified. The recurrence gross tumour volume was delineated and registered with the original radiation treatment plan to identify site of failure. All patients were toxicity-scored using CTCAE 4.03 grading scale. Data were analysed using the Kaplan-Meier analysis. RESULTS The median follow-up time was 16 months (3-35). Within a year, 35% of the patients in the adaptive group (ART-group) and 53% in the control group (No-ART-group) experienced loco-regional failure, showing improved loco-regional control in the ART group (p = 0.05). One patient in the ART-group and four patients in the No-ART-group showed marginal failure. Median overall progression-free survival time for the ART-group was 10 months (95% CI 8-12), and 8 months (95% CI 6-9) for the No-ART-group. Severe pneumonitis (grade 3-5) decreased from 22% in the No-ART-group to 18% in the ART-group (non-significant, p = 0.6). No significant difference in severe dysphagia was found between the two groups. CONCLUSION In the first small cohort of patients investigated, implementation of soft-tissue tumour match and adaptive strategies for locally advanced lung cancer patients increased the loco-regional control rate without increasing treatment-related toxicity.
Collapse
Affiliation(s)
- Marie Tvilum
- a Department of Oncology , Aarhus University Hospital , Aarhus , Denmark
| | - Azza A Khalil
- a Department of Oncology , Aarhus University Hospital , Aarhus , Denmark
| | - Ditte S Møller
- b Department of Medical Physics , Aarhus University Hospital , Aarhus , Denmark
| | - Lone Hoffmann
- b Department of Medical Physics , Aarhus University Hospital , Aarhus , Denmark
| | - Marianne M Knap
- a Department of Oncology , Aarhus University Hospital , Aarhus , Denmark
| |
Collapse
|
114
|
Tumour Movement in Proton Therapy: Solutions and Remaining Questions: A Review. Cancers (Basel) 2015; 7:1143-53. [PMID: 26132317 PMCID: PMC4586762 DOI: 10.3390/cancers7030829] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 06/10/2015] [Accepted: 06/18/2015] [Indexed: 12/25/2022] Open
Abstract
Movement of tumours, mostly by respiration, has been a major problem for treating lung cancer, liver tumours and other locations in the abdomen and thorax. Organ motion is indeed one component of geometrical uncertainties that includes delineation and target definition uncertainties, microscopic disease and setup errors. At present, minimising motion seems to be the easiest to implement in clinical practice. If combined with adaptive approaches to correct for gradual anatomical variations, it may be a practical strategy. Other approaches such as repainting and tracking could increase the accuracy of proton therapy delivery, but advanced 4D solutions are needed. Moreover, there is a need to perform clinical studies to investigate which approach is the best in a given clinical situation. The good news is that existing and emerging technology and treatment planning systems as will without doubt lead in the forthcoming future to practical solutions to tackle intra-fraction motion in proton therapy. These developments may also improve motion management in photon therapy as well.
Collapse
|
115
|
Mehta A, Dobersch S, Romero-Olmedo AJ, Barreto G. Epigenetics in lung cancer diagnosis and therapy. Cancer Metastasis Rev 2015; 34:229-41. [DOI: 10.1007/s10555-015-9563-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
116
|
|
117
|
Kwint M, Conijn S, Schaake E, Knegjens J, Rossi M, Remeijer P, Sonke JJ, Belderbos J. Intra thoracic anatomical changes in lung cancer patients during the course of radiotherapy. Radiother Oncol 2014; 113:392-7. [DOI: 10.1016/j.radonc.2014.10.009] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 10/14/2014] [Accepted: 10/18/2014] [Indexed: 10/24/2022]
|
118
|
Gardner SJ, Studenski MT, Giaddui T, Cui Y, Galvin J, Yu Y, Xiao Y. Investigation into image quality and dose for different patient geometries with multiple cone-beam CT systems. Med Phys 2014; 41:031908. [PMID: 24593726 DOI: 10.1118/1.4865788] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To provide quantitative and qualitative image quality metrics and imaging dose for modern Varian On-board Imager (OBI) (ver. 1.5) and Elekta X-ray Volume Imager (XVI) (ver. 4.5R) cone-beam computed tomography (CBCT) systems in a clinical adaptive radiation therapy environment by accounting for varying patient thickness. METHODS Image quality measurements were acquired with Catphan 504 phantom (nominal diameter and with additional 10 cm thickness) for OBI and XVI systems and compared to planning CT (pCT) (GE LightSpeed). Various clinical protocols were analyzed for the OBI and XVI systems and analyzed using image quality metrics, including spatial resolution, low contrast detectability, uniformity, and HU sensitivity. Imaging dose measurements were acquired in Wellhofer Scanditronix i'mRT phantom at nominal phantom diameter and with additional 4 cm phantom diameter using GafChromic XRQA2 film. Calibration curves were generated using previously published in-air Air Kerma calibration method. RESULTS The OBI system full trajectory scans exhibited very little dependence on phantom thickness for accurate HU calculation, while half-trajectory scans with full-fan filter exhibited dependence of HU calculation on phantom thickness. The contrast-to-noise ratio (CNR) for the OBI scans decreased with additional phantom thickness. The uniformity of Head protocol scan was most significantly affected with additional phantom thickness. The spatial resolution and CNR compared favorably with pCT, while the uniformity of the OBI system was slightly inferior to pCT. The OBI scan protocol dose levels for nominal phantom thickness at the central portion of the phantom were 2.61, 0.72, and 1.88 cGy, and for additional phantom thickness were 1.95, 0.48, and 1.52 cGy, for the Pelvis, Thorax, and Spotlight protocols, respectively. The XVI system scans exhibited dependence on phantom thickness for accurate HU calculation regardless of trajectory. The CNR for the XVI scans decreased with additional phantom thickness. The uniformity of the XVI scans was significantly dependent on the selection of the proper FOV setting for all phantom geometries. The spatial resolution, CNR, and uniformity for XVI were lower than values measured for pCT. The XVI scan protocol dose levels at the central portion of the phantom for nominal phantom thickness were 2.14, 2.15, and 0.33 cGy, and for additional phantom thickness were 1.56, 1.68, and 0.21 cGy, for the Pelvis M20, Chest M20, and Prostate Seed S10 scan protocols, respectively. CONCLUSIONS The OBI system offered comparable spatial resolution and CNR results to the results for pCT. Full trajectory scans with the OBI system need little-to-no correction for HU calculation based on HU stability with changing phantom thickness. The XVI system offered lower spatial resolution and CNR results than pCT. In addition, the HU calculation for all scan protocols was dependent on the phantom thickness. The uniformity for each CBCT system was inferior to that of pCT for each phantom geometry. The dose for each system and scan protocol in the interior of the phantom tended to decrease by approximately 25% with 4 cm additional phantom thickness.
Collapse
Affiliation(s)
- Stephen J Gardner
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan 48202
| | - Matthew T Studenski
- Department of Radiation Oncology, University of Miami - Miller School of Medicine, Miami, Florida 33136
| | - Tawfik Giaddui
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107
| | - Yunfeng Cui
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710
| | - James Galvin
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107
| | - Yan Yu
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107
| | - Ying Xiao
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107
| |
Collapse
|
119
|
Kai Y, Kai N, Fujita Y, Maruyama M, Nakaguchi Y, Kuraoka A, Saito T, Murakami R. [Potential uncertainty about image registration in thoracic image-guided radiotherapy]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2014; 70:1311-1317. [PMID: 25410339 DOI: 10.6009/jjrt.2014_jsrt_70.11.1311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE Although image-guided radiotherapy (IGRT) is widely used to determine and correct daily setup errors, the additional interpretation for image registration would provide another error. We evaluated the uncertainty in image registration in IGRT. METHOD The subjects consisted of 12 consecutive patients treated with IGRT for thoracic esophageal cancer. Two radiation therapists had consensually achieved daily 3D registration between planning computed tomography (CT) and cone beam CT (CBCT). The original data sets of image registration in all fractions except for boost irradiations with a change in the isocenter positions were selected for evaluation. There were 20 to 32 data sets for each patient: a total of 318 data sets. To evaluate daily setup errors, the mean 3D displacement vector was calculated for each patient. To assess the reproducibility of image registration, two other radiation therapists reviewed the data sets and recorded geometric differences as uncertainty in the image registration. RESULTS The mean 3D displacement vector for each patient ranged from 4.9 to 15.5 mm for setup errors and 0.7 to 2.2 mm for uncertainty in image registration. There was a positive correlation between the 3D vectors for setup error and uncertainty in image registration (r = 0.487, p = 0.016). CONCLUSION Although IGRT can correct the setup errors, potential uncertainty exists in image registration. The setup error would disturb the image registration in IGRT.
Collapse
Affiliation(s)
- Yudai Kai
- Department of Radiological Technology, Kumamoto University Hospital
| | | | | | | | | | | | | | | |
Collapse
|
120
|
Separating the dosimetric consequences of changing tumor anatomy from positional uncertainty for conventionally fractionated lung cancer patients. Pract Radiat Oncol 2014; 4:455-65. [DOI: 10.1016/j.prro.2014.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 02/17/2014] [Accepted: 02/18/2014] [Indexed: 11/23/2022]
|
121
|
Pseudo-progression after stereotactic radiotherapy of brain metastases: lesion analysis using MRI cine-loops. J Neurooncol 2014; 119:437-43. [DOI: 10.1007/s11060-014-1519-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 06/22/2014] [Indexed: 01/13/2023]
|
122
|
Brink C, Bernchou U, Bertelsen A, Hansen O, Schytte T, Bentzen SM. Locoregional control of non-small cell lung cancer in relation to automated early assessment of tumor regression on cone beam computed tomography. Int J Radiat Oncol Biol Phys 2014; 89:916-23. [PMID: 24867537 DOI: 10.1016/j.ijrobp.2014.03.038] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/18/2014] [Accepted: 03/21/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE Large interindividual variations in volume regression of non-small cell lung cancer (NSCLC) are observable on standard cone beam computed tomography (CBCT) during fractionated radiation therapy. Here, a method for automated assessment of tumor volume regression is presented and its potential use in response adapted personalized radiation therapy is evaluated empirically. METHODS AND MATERIALS Automated deformable registration with calculation of the Jacobian determinant was applied to serial CBCT scans in a series of 99 patients with NSCLC. Tumor volume at the end of treatment was estimated on the basis of the first one third and two thirds of the scans. The concordance between estimated and actual relative volume at the end of radiation therapy was quantified by Pearson's correlation coefficient. On the basis of the estimated relative volume, the patients were stratified into 2 groups having volume regressions below or above the population median value. Kaplan-Meier plots of locoregional disease-free rate and overall survival in the 2 groups were used to evaluate the predictive value of tumor regression during treatment. Cox proportional hazards model was used to adjust for other clinical characteristics. RESULTS Automatic measurement of the tumor regression from standard CBCT images was feasible. Pearson's correlation coefficient between manual and automatic measurement was 0.86 in a sample of 9 patients. Most patients experienced tumor volume regression, and this could be quantified early into the treatment course. Interestingly, patients with pronounced volume regression had worse locoregional tumor control and overall survival. This was significant on patient with non-adenocarcinoma histology. CONCLUSIONS Evaluation of routinely acquired CBCT images during radiation therapy provides biological information on the specific tumor. This could potentially form the basis for personalized response adaptive therapy.
Collapse
Affiliation(s)
- Carsten Brink
- Institute of Clinical Research, University of Southern Denmark, Denmark; Laboratory of Radiation Physics, Odense University Hospital, Denmark.
| | - Uffe Bernchou
- Institute of Clinical Research, University of Southern Denmark, Denmark; Laboratory of Radiation Physics, Odense University Hospital, Denmark
| | - Anders Bertelsen
- Laboratory of Radiation Physics, Odense University Hospital, Denmark
| | - Olfred Hansen
- Institute of Clinical Research, University of Southern Denmark, Denmark; Department of Oncology, Odense University Hospital, Denmark
| | - Tine Schytte
- Department of Oncology, Odense University Hospital, Denmark
| | - Soren M Bentzen
- Division of Biostatistics and Bioinformatics, University of Maryland Greenebaum Cancer Center, and Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| |
Collapse
|
123
|
Skinner HD, Komaki RU, Chang JY, Cox JD. Individualized Radiotherapy by Dose Escalation and Altered Fractionation in Non-Small Cell Lung Cancer. Lung Cancer 2014. [DOI: 10.1002/9781118468791.ch24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
124
|
Glide-Hurst CK, Chetty IJ. Improving radiotherapy planning, delivery accuracy, and normal tissue sparing using cutting edge technologies. J Thorac Dis 2014; 6:303-18. [PMID: 24688775 PMCID: PMC3968554 DOI: 10.3978/j.issn.2072-1439.2013.11.10] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 11/07/2013] [Indexed: 12/25/2022]
Abstract
In the United States, more than half of all new invasive cancers diagnosed are non-small cell lung cancer, with a significant number of these cases presenting at locally advanced stages, resulting in about one-third of all cancer deaths. While the advent of stereotactic ablative radiation therapy (SABR, also known as stereotactic body radiotherapy, or SBRT) for early-staged patients has improved local tumor control to >90%, survival results for locally advanced stage lung cancer remain grim. Significant challenges exist in lung cancer radiation therapy including tumor motion, accurate dose calculation in low density media, limiting dose to nearby organs at risk, and changing anatomy over the treatment course. However, many recent technological advancements have been introduced that can meet these challenges, including four-dimensional computed tomography (4DCT) and volumetric cone-beam computed tomography (CBCT) to enable more accurate target definition and precise tumor localization during radiation, respectively. In addition, advances in dose calculation algorithms have allowed for more accurate dosimetry in heterogeneous media, and intensity modulated and arc delivery techniques can help spare organs at risk. New delivery approaches, such as tumor tracking and gating, offer additional potential for further reducing target margins. Image-guided adaptive radiation therapy (IGART) introduces the potential for individualized plan adaptation based on imaging feedback, including bulky residual disease, tumor progression, and physiological changes that occur during the treatment course. This review provides an overview of the current state of the art technology for lung cancer volume definition, treatment planning, localization, and treatment plan adaptation.
Collapse
|
125
|
Robertson SP, Weiss E, Hugo GD. A block matching-based registration algorithm for localization of locally advanced lung tumors. Med Phys 2014; 41:041704. [PMID: 24694124 PMCID: PMC3978354 DOI: 10.1118/1.4867860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 02/17/2014] [Accepted: 02/20/2014] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To implement and evaluate a block matching-based registration (BMR) algorithm for locally advanced lung tumor localization during image-guided radiotherapy. METHODS Small (1 cm(3)), nonoverlapping image subvolumes ("blocks") were automatically identified on the planning image to cover the tumor surface using a measure of the local intensity gradient. Blocks were independently and automatically registered to the on-treatment image using a rigid transform. To improve speed and robustness, registrations were performed iteratively from coarse to fine image resolution. At each resolution, all block displacements having a near-maximum similarity score were stored. From this list, a single displacement vector for each block was iteratively selected which maximized the consistency of displacement vectors across immediately neighboring blocks. These selected displacements were regularized using a median filter before proceeding to registrations at finer image resolutions. After evaluating all image resolutions, the global rigid transform of the on-treatment image was computed using a Procrustes analysis, providing the couch shift for patient setup correction. This algorithm was evaluated for 18 locally advanced lung cancer patients, each with 4-7 weekly on-treatment computed tomography scans having physician-delineated gross tumor volumes. Volume overlap (VO) and border displacement errors (BDE) were calculated relative to the nominal physician-identified targets to establish residual error after registration. RESULTS Implementation of multiresolution registration improved block matching accuracy by 39% compared to registration using only the full resolution images. By also considering multiple potential displacements per block, initial errors were reduced by 65%. Using the final implementation of the BMR algorithm, VO was significantly improved from 77% ± 21% (range: 0%-100%) in the initial bony alignment to 91% ± 8% (range: 56%-100%;p < 0.001). Left-right, anterior-posterior, and superior-inferior systematic BDE were 3.2, 2.4, and 4.4 mm, respectively, with random BDE of 2.4, 2.1, and 2.7 mm. Margins required to include both localization and delineation uncertainties ranged from 5.0 to 11.7 mm, an average of 40% less than required for bony alignment. CONCLUSIONS BMR is a promising approach for automatic lung tumor localization. Further evaluation is warranted to assess the accuracy and robustness of BMR against other potential localization strategies.
Collapse
Affiliation(s)
- Scott P Robertson
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia, 23298
| | - Elisabeth Weiss
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia, 23298
| | - Geoffrey D Hugo
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia, 23298
| |
Collapse
|
126
|
Ottosson W, Lykkegaard Andersen JA, Borrisova S, Mellemgaard A, Behrens CF. Deformable image registration for geometrical evaluation of DIBH radiotherapy treatment of lung cancer patients. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/1742-6596/489/1/012077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
127
|
Cole A, Hanna G, Jain S, O'Sullivan J. Motion Management for Radical Radiotherapy in Non-small Cell Lung Cancer. Clin Oncol (R Coll Radiol) 2014; 26:67-80. [DOI: 10.1016/j.clon.2013.11.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 09/23/2013] [Accepted: 09/24/2013] [Indexed: 11/28/2022]
|
128
|
Bostel T, Nicolay NH, Grossmann JG, Mohr A, Delorme S, Echner G, Häring P, Debus J, Sterzing F. MR-guidance--a clinical study to evaluate a shuttle- based MR-linac connection to provide MR-guided radiotherapy. Radiat Oncol 2014; 9:12. [PMID: 24401489 PMCID: PMC3904210 DOI: 10.1186/1748-717x-9-12] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 12/13/2013] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this clinical study is to investigate the clinical feasibility and safety of a shuttle-based MR-linac connection to provide MR-guided radiotherapy. Methods/Design A total of 40 patients with an indication for a neoadjuvant, adjuvant or definitive radiation treatment will be recruited including tumors of the head and neck region, thorax, upper gastrointestinal tract and pelvic region. All study patients will receive standard therapy, i.e. highly conformal radiation techniques like CT-guided intensity-modulated radiotherapy (IMRT) with or without concomitant chemotherapy or other antitumor medication, and additionally daily short MR scans in treatment position with the same immobilisation equipment used for irradiation for position verification and imaging of the anatomical and functional changes during the course of radiotherapy. For daily position control, skin marks and a stereotactic frame will be used for both imaging modalities. Patient transfer between the MR device and the linear accelerator will be performed with a shuttle system which uses an air-bearing patient platform for both procedures. The daily acquired MR and CT data sets will be digitally registrated, correlated with the planning CT and compared with each other regarding translational and rotational errors. Aim of this clinical study is to establish a shuttle-based approach for realising MR-guided radiotherapy for certain clinical situations. Second objectives are to compare MR-guided radiotherapy with the gold standard of CT image guidance for quality assurance of radiotherapy, to establish an appropiate MR protocol therefore, and to assess the possibility of using MR-based image guidance not only for position verification but also for adaptive strategies in radiotherapy. Discussion Compared to CT, MRI might offer the advantage of providing IGRT without delivering an additional radiation dose to the patients and the possibility of optimisation of adaptive therapy strategies due to its superior soft tissue contrast. However, up to now, hybrid MR-linac devices are still under construction and not clinically applicable. For the near future, a shuttle-based approach would be a promising alternative for providing MR-guided radiotherapy, so that the present study was initiated to determine feasibility and safety of such an approach. Besides positioning information, daily MR data under treatment offer the possibility to assess tumor regression and functional parameters, with a potential impact not only on adaptive therapy strategies but also on early assessment of treatment response.
Collapse
Affiliation(s)
- Tilman Bostel
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
129
|
Volumetric CT-based segmentation of NSCLC using 3D-Slicer. Sci Rep 2013; 3:3529. [PMID: 24346241 PMCID: PMC3866632 DOI: 10.1038/srep03529] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 11/25/2013] [Indexed: 01/10/2023] Open
Abstract
Accurate volumetric assessment in non-small cell lung cancer (NSCLC) is critical for adequately informing treatments. In this study we assessed the clinical relevance of a semiautomatic computed tomography (CT)-based segmentation method using the competitive region-growing based algorithm, implemented in the free and public available 3D-Slicer software platform. We compared the 3D-Slicer segmented volumes by three independent observers, who segmented the primary tumour of 20 NSCLC patients twice, to manual slice-by-slice delineations of five physicians. Furthermore, we compared all tumour contours to the macroscopic diameter of the tumour in pathology, considered as the "gold standard". The 3D-Slicer segmented volumes demonstrated high agreement (overlap fractions > 0.90), lower volume variability (p = 0.0003) and smaller uncertainty areas (p = 0.0002), compared to manual slice-by-slice delineations. Furthermore, 3D-Slicer segmentations showed a strong correlation to pathology (r = 0.89, 95%CI, 0.81-0.94). Our results show that semiautomatic 3D-Slicer segmentations can be used for accurate contouring and are more stable than manual delineations. Therefore, 3D-Slicer can be employed as a starting point for treatment decisions or for high-throughput data mining research, such as Radiomics, where manual delineating often represent a time-consuming bottleneck.
Collapse
|
130
|
Zhang P, Yorke E, Hu YC, Mageras G, Rimner A, Deasy JO. Predictive treatment management: incorporating a predictive tumor response model into robust prospective treatment planning for non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2013; 88:446-52. [PMID: 24315562 DOI: 10.1016/j.ijrobp.2013.10.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 10/23/2013] [Accepted: 10/28/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE We hypothesized that a treatment planning technique that incorporates predicted lung tumor regression into optimization, predictive treatment planning (PTP), could allow dose escalation to the residual tumor while maintaining coverage of the initial target without increasing dose to surrounding organs at risk (OARs). METHODS AND MATERIALS We created a model to estimate the geometric presence of residual tumors after radiation therapy using planning computed tomography (CT) and weekly cone beam CT scans of 5 lung cancer patients. For planning purposes, we modeled the dynamic process of tumor shrinkage by morphing the original planning target volume (PTVorig) in 3 equispaced steps to the predicted residue (PTVpred). Patients were treated with a uniform prescription dose to PTVorig. By contrast, PTP optimization started with the same prescription dose to PTVorig but linearly increased the dose at each step, until reaching the highest dose achievable to PTVpred consistent with OAR limits. This method is compared with midcourse adaptive replanning. RESULTS Initial parenchymal gross tumor volume (GTV) ranged from 3.6 to 186.5 cm(3). On average, the primary GTV and PTV decreased by 39% and 27%, respectively, at the end of treatment. The PTP approach gave PTVorig at least the prescription dose, and it increased the mean dose of the true residual tumor by an average of 6.0 Gy above the adaptive approach. CONCLUSIONS PTP, incorporating a tumor regression model from the start, represents a new approach to increase tumor dose without increasing toxicities, and reduce clinical workload compared with the adaptive approach, although model verification using per-patient midcourse imaging would be prudent.
Collapse
Affiliation(s)
- Pengpeng Zhang
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York.
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Yu-Chi Hu
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Gig Mageras
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Joseph O Deasy
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| |
Collapse
|
131
|
Testa M, Verburg JM, Rose M, Min CH, Tang S, Bentefour EH, Paganetti H, Lu HM. Proton radiography and proton computed tomography based on time-resolved dose measurements. Phys Med Biol 2013; 58:8215-33. [DOI: 10.1088/0031-9155/58/22/8215] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
132
|
Reduction in cardiac volume during chemoradiotherapy for patients with esophageal cancer. Radiother Oncol 2013; 109:200-3. [DOI: 10.1016/j.radonc.2013.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 08/29/2013] [Accepted: 09/01/2013] [Indexed: 12/13/2022]
|
133
|
Ellegaard MBB, Knap MM, Hoffmann L. Inter-tester reproducibility of tumour change in small cell lung cancer patients undergoing chemoradiotherapy. Acta Oncol 2013; 52:1520-5. [PMID: 24007392 DOI: 10.3109/0284186x.2013.818250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Tumour volume change during delivery of chemoradiotherapy is observed in small cell lung cancer (SCLC) patients. In this study, we have compared tumour volume and anatomical changes, e.g. atelectasis or pleural effusions determined by three different methods. METHOD A total of 37 SCLC patients undergoing thoracic radiotherapy during 2010-2011 were included. The patients were treated based on a daily three-dimensional (3D) cone beam computed tomography (CBCT) bony anatomy registration. The CBCT scans were retrospectively reviewed visually by a radiation therapist (Visual-RTT) in order to register tumour volume changes. Furthermore, the tumour volume changes were obtained by either deformable image registration (DIR) or delineation by a radiation oncologist (RO). Kappa (κ) statistics and paired t-tests were used for evaluation of the inter-tester agreement. RESULTS The tumour volume change between the Visual-RTT, the DIR and the RO assessments obtained 84-97% agreement (κ = 0.68-0.95). Furthermore, there was no statistically significant difference between the tumour change assessment of the RO (mean 13.6 ml) and the DIR (mean 14.5 ml), p = 0.59. Tumour shrinkage was observed in 15 (41%) patients and anatomical changes in seven (19%) patients. CONCLUSION The inter-tester reproducibility of tumour volume change between the three methods is excellent. Visual-RTT on-line inspection may be used to determine tumour shrinkage and anatomical changes as atelectasis or pleural effusions during the radiotherapy course by use of daily CBCT scans.
Collapse
|
134
|
Schmidt ML, Hoffmann L, Kandi M, Møller DS, Poulsen PR. Dosimetric impact of respiratory motion, interfraction baseline shifts, and anatomical changes in radiotherapy of non-small cell lung cancer. Acta Oncol 2013; 52:1490-6. [PMID: 23905673 DOI: 10.3109/0284186x.2013.815798] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The survival rates for patients with non-small cell lung cancer (NSCLC) may be improved by dose escalation; however, margin reduction may be required in order to keep the toxicity at an acceptable level. In this study we have investigated the dosimetric impact of tumor motion and anatomical changes during intensity-modulated radiotherapy (IMRT) of patients with NSCLC. MATERIAL AND METHODS Sixteen NSCLC patients received IMRT with concomitant chemotherapy. The tumor and lymph node targets were delineated in the mid-ventilation phase of a planning 4DCT scan (CT1). Typically 66 Gy was delivered in 33 fractions using daily CBCT with bony anatomy match for patient setup. The daily baseline shifts of the mean tumor position relative to the spine were extracted from the CBCT scans. A second 4DCT scan (CT2) was acquired halfway through the treatment course and the respiratory tumor motion was extracted. The plan was recalculated on CT2 with and without inclusion of the respiratory tumor motion and baseline shifts in order to investigate the impact of tumor motion and anatomical changes on the tumor dose. RESULTS Respiratory tumor motion was largest in the cranio-caudal (CC) direction (range 0-13.1 mm). Tumor baseline shifts up to 18 mm (CC direction) and 24 mm (left-right and anterior-posterior) were observed. The average absolute difference in CTV mean dose to the primary tumor (CTV-t) between CT1 and CT2 was 1.28% (range 0.1-4.0%) without motion. Respiratory motion and baseline shifts lead to average absolute CTV-t mean dose changes of 0.46% (0-1.9%) and 0.65% (0.0-2.1%), respectively. For most patients, the changes in the CTV-t dose were caused by anatomical changes rather than internal target motion. CONCLUSION Anatomical changes had larger impact on the target dose distribution than internal target motion. Adaptive radiotherapy could be used to achieve better target coverage throughout the treatment course.
Collapse
|
135
|
Microscopic disease extensions as a risk factor for loco-regional recurrence of NSCLC after SBRT. Radiother Oncol 2013; 109:26-31. [DOI: 10.1016/j.radonc.2013.08.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 08/16/2013] [Accepted: 08/17/2013] [Indexed: 12/31/2022]
|
136
|
Adaptive Stereotactic Body Radiation Therapy Planning for Lung Cancer. Int J Radiat Oncol Biol Phys 2013; 87:209-15. [DOI: 10.1016/j.ijrobp.2013.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 04/19/2013] [Accepted: 05/02/2013] [Indexed: 01/12/2023]
|
137
|
Robertson S, Weiss E, Hugo GD. Deformable mesh registration for the validation of automatic target localization algorithms. Med Phys 2013; 40:071721. [PMID: 23822425 DOI: 10.1118/1.4811105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate deformable mesh registration (DMR) as a tool for validating automatic target registration algorithms used during image-guided radiation therapy. METHODS DMR was implemented in a hierarchical model, with rigid, affine, and B-spline transforms optimized in succession to register a pair of surface meshes. The gross tumor volumes (primary tumor and involved lymph nodes) were contoured by a physician on weekly CT scans in a cohort of lung cancer patients and converted to surface meshes. The meshes from weekly CT images were registered to the mesh from the planning CT, and the resulting registered meshes were compared with the delineated surfaces. Known deformations were also applied to the meshes, followed by mesh registration to recover the known deformation. Mesh registration accuracy was assessed at the mesh surface by computing the symmetric surface distance (SSD) between vertices of each registered mesh pair. Mesh registration quality in regions within 5 mm of the mesh surface was evaluated with respect to a high quality deformable image registration. RESULTS For 18 patients presenting with a total of 19 primary lung tumors and 24 lymph node targets, the SSD averaged 1.3 ± 0.5 and 0.8 ± 0.2 mm, respectively. Vertex registration errors (VRE) relative to the applied known deformation were 0.8 ± 0.7 and 0.2 ± 0.3 mm for the primary tumor and lymph nodes, respectively. Inside the mesh surface, corresponding average VRE ranged from 0.6 to 0.9 and 0.2 to 0.9 mm, respectively. Outside the mesh surface, average VRE ranged from 0.7 to 1.8 and 0.2 to 1.4 mm. The magnitude of errors generally increased with increasing distance away from the mesh. CONCLUSIONS Provided that delineated surfaces are available, deformable mesh registration is an accurate and reliable method for obtaining a reference registration to validate automatic target registration algorithms for image-guided radiation therapy, specifically in regions on or near the target surfaces.
Collapse
Affiliation(s)
- Scott Robertson
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia 23298, USA
| | | | | |
Collapse
|
138
|
Weiss E, Fatyga M, Wu Y, Dogan N, Balik S, Sleeman W, Hugo G. Dose escalation for locally advanced lung cancer using adaptive radiation therapy with simultaneous integrated volume-adapted boost. Int J Radiat Oncol Biol Phys 2013; 86:414-9. [PMID: 23523321 PMCID: PMC3665644 DOI: 10.1016/j.ijrobp.2012.12.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 11/21/2012] [Accepted: 12/11/2012] [Indexed: 12/25/2022]
Abstract
PURPOSE To test the feasibility of a planned phase 1 study of image-guided adaptive radiation therapy in locally advanced lung cancer. METHODS AND MATERIALS Weekly 4-dimensional fan beam computed tomographs (4D FBCT) of 10 lung cancer patients undergoing concurrent chemoradiation therapy were used to simulate adaptive radiation therapy: After an initial intensity modulated radiation therapy plan (0-30 Gy/2 Gy), adaptive replanning was performed on week 2 (30-50 Gy/2 Gy) and week 4 scans (50-66 Gy/2 Gy) to adjust for volume and shape changes of primary tumors and lymph nodes. Week 2 and 4 clinical target volumes (CTV) were deformably warped from the initial planning scan to adjust for anatomical changes. On the week 4 scan, a simultaneous integrated volume-adapted boost was created to the shrunken primary tumor with dose increases in 5 0.4-Gy steps from 66 Gy to 82 Gy in 2 scenarios: plan A, lung isotoxicity; plan B, normal tissue tolerance. Cumulative dose was assessed by deformably mapping and accumulating biologically equivalent dose normalized to 2 Gy-fractions (EQD2). RESULTS The 82-Gy level was achieved in 1 in 10 patients in scenario A, resulting in a 13.4-Gy EQD2 increase and a 22.1% increase in tumor control probability (TCP) compared to the 66-Gy plan. In scenario B, 2 patients reached the 82-Gy level with a 13.9 Gy EQD2 and 23.4% TCP increase. CONCLUSIONS The tested image-guided adaptive radiation therapy strategy enabled relevant increases in EQD2 and TCP. Normal tissue was often dose limiting, indicating a need to modify the present study design before clinical implementation.
Collapse
Affiliation(s)
- Elisabeth Weiss
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA 23298, USA.
| | | | | | | | | | | | | |
Collapse
|
139
|
Dowdell S, Grassberger C, Sharp GC, Paganetti H. Interplay effects in proton scanning for lung: a 4D Monte Carlo study assessing the impact of tumor and beam delivery parameters. Phys Med Biol 2013; 58:4137-56. [PMID: 23689035 PMCID: PMC3752993 DOI: 10.1088/0031-9155/58/12/4137] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Relative motion between a tumor and a scanning proton beam results in a degradation of the dose distribution (interplay effect). This study investigates the relationship between beam scanning parameters and the interplay effect, with the goal of finding parameters that minimize interplay. 4D Monte Carlo simulations of pencil beam scanning proton therapy treatments were performed using the 4DCT geometry of five lung cancer patients of varying tumor size (50.4-167.1 cc) and motion amplitude (2.9-30.1 mm). Treatments were planned assuming delivery in 35 × 2.5 Gy(RBE) fractions. The spot size, time to change the beam energy (τes), time required for magnet settling (τss), initial breathing phase, spot spacing, scanning direction, scanning speed, beam current and patient breathing period were varied for each of the five patients. Simulations were performed for a single fraction and an approximation of conventional fractionation. For the patients considered, the interplay effect could not be predicted using the superior-inferior motion amplitude alone. Larger spot sizes (σ ~ 9-16 mm) were less susceptible to interplay, giving an equivalent uniform dose (EUD) of 99.0 ± 4.4% (1 standard deviation) in a single fraction compared to 86.1 ± 13.1% for smaller spots (σ ~ 2-4 mm). The smaller spot sizes gave EUD values as low as 65.3% of the prescription dose in a single fraction. Reducing the spot spacing improved the target dose homogeneity. The initial breathing phase can have a significant effect on the interplay, particularly for shorter delivery times. No clear benefit was evident when scanning either parallel or perpendicular to the predominant axis of motion. Longer breathing periods decreased the EUD. In general, longer delivery times led to lower interplay effects. Conventional fractionation showed significant improvement in terms of interplay, giving a EUD of at least 84.7% and 100.0% of the prescription dose for the small and larger spot sizes respectively. The interplay effect is highly patient specific, depending on the motion amplitude, tumor location and the delivery parameters. Large degradations of the dose distribution in a single fraction were observed, but improved significantly using conventional fractionation.
Collapse
Affiliation(s)
- S Dowdell
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
| | | | | | | |
Collapse
|
140
|
Estimating Internal Respiratory Motion from Respiratory Surrogate Signals Using Correspondence Models. 4D MODELING AND ESTIMATION OF RESPIRATORY MOTION FOR RADIATION THERAPY 2013. [DOI: 10.1007/978-3-642-36441-9_9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
|
141
|
Filippi AR, Mantovani C, Ricardi U. Innovative technologies in thoracic radiation therapy for lung cancer. Transl Lung Cancer Res 2012; 1:263-8. [PMID: 25806191 PMCID: PMC4367545 DOI: 10.3978/j.issn.2218-6751.2012.10.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 10/23/2012] [Indexed: 12/25/2022]
Abstract
Radiation therapy plays a major role in the cure of patients affected with lung cancer, both in early and locally advanced disease. Local control and survival rates are still poor, even with the best combination with chemotherapy and/or targeted agents. The recent technical advances in radiotherapy changed the planning and delivery processes, enabling radiation oncologists to modify treatment schedules towards further dose intensification, while opening a new scenario for future clinical studies. In this paper we briefly review the major technical changes in the field of thoracic radiotherapy for primary lung tumors and their potential in improving clinical outcomes.
Collapse
Affiliation(s)
- Andrea Riccardo Filippi
- Radiation Oncology Unit, Department of Oncology, University of Torino, via Genova 3, 10126 Torino, Italy
| | - Cristina Mantovani
- Radiation Oncology Unit, Department of Oncology, University of Torino, via Genova 3, 10126 Torino, Italy
| | - Umberto Ricardi
- Radiation Oncology Unit, Department of Oncology, University of Torino, via Genova 3, 10126 Torino, Italy
| |
Collapse
|
142
|
Predicting outcomes in radiation oncology--multifactorial decision support systems. Nat Rev Clin Oncol 2012; 10:27-40. [PMID: 23165123 DOI: 10.1038/nrclinonc.2012.196] [Citation(s) in RCA: 276] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
With the emergence of individualized medicine and the increasing amount and complexity of available medical data, a growing need exists for the development of clinical decision-support systems based on prediction models of treatment outcome. In radiation oncology, these models combine both predictive and prognostic data factors from clinical, imaging, molecular and other sources to achieve the highest accuracy to predict tumour response and follow-up event rates. In this Review, we provide an overview of the factors that are correlated with outcome-including survival, recurrence patterns and toxicity-in radiation oncology and discuss the methodology behind the development of prediction models, which is a multistage process. Even after initial development and clinical introduction, a truly useful predictive model will be continuously re-evaluated on different patient datasets from different regions to ensure its population-specific strength. In the future, validated decision-support systems will be fully integrated in the clinic, with data and knowledge being shared in a standardized, instant and global manner.
Collapse
|
143
|
Rios Velazquez E, Aerts HJWL, Gu Y, Goldgof DB, De Ruysscher D, Dekker A, Korn R, Gillies RJ, Lambin P. A semiautomatic CT-based ensemble segmentation of lung tumors: comparison with oncologists' delineations and with the surgical specimen. Radiother Oncol 2012; 105:167-73. [PMID: 23157978 PMCID: PMC3749821 DOI: 10.1016/j.radonc.2012.09.023] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 09/04/2012] [Accepted: 09/12/2012] [Indexed: 12/28/2022]
Abstract
PURPOSE To assess the clinical relevance of a semiautomatic CT-based ensemble segmentation method, by comparing it to pathology and to CT/PET manual delineations by five independent radiation oncologists in non-small cell lung cancer (NSCLC). MATERIALS AND METHODS For 20 NSCLC patients (stages Ib-IIIb) the primary tumor was delineated manually on CT/PET scans by five independent radiation oncologists and segmented using a CT based semi-automatic tool. Tumor volume and overlap fractions between manual and semiautomatic-segmented volumes were compared. All measurements were correlated with the maximal diameter on macroscopic examination of the surgical specimen. Imaging data are available on www.cancerdata.org. RESULTS High overlap fractions were observed between the semi-automatically segmented volumes and the intersection (92.5±9.0, mean±SD) and union (94.2±6.8) of the manual delineations. No statistically significant differences in tumor volume were observed between the semiautomatic segmentation (71.4±83.2 cm(3), mean±SD) and manual delineations (81.9±94.1 cm(3); p=0.57). The maximal tumor diameter of the semiautomatic-segmented tumor correlated strongly with the macroscopic diameter of the primary tumor (r=0.96). CONCLUSIONS Semiautomatic segmentation of the primary tumor on CT demonstrated high agreement with CT/PET manual delineations and strongly correlated with the macroscopic diameter considered as the "gold standard". This method may be used routinely in clinical practice and could be employed as a starting point for treatment planning, target definition in multi-center clinical trials or for high throughput data mining research. This method is particularly suitable for peripherally located tumors.
Collapse
|
144
|
Gauthier JF, Varfalvy N, Tremblay D, Cyr MF, Archambault L. Characterization of lung tumors motion baseline using cone-beam computed tomography. Med Phys 2012; 39:7062-70. [DOI: 10.1118/1.4762563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
145
|
Riboldi M, Orecchia R, Baroni G. Real-time tumour tracking in particle therapy: technological developments and future perspectives. Lancet Oncol 2012; 13:e383-91. [PMID: 22935238 DOI: 10.1016/s1470-2045(12)70243-7] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A key challenge in radiation oncology is accurate delivery of the prescribed dose to tumours that move because of respiration. Tumour tracking involves real-time target localisation and correction of radiation beam geometry to compensate for motion. Uncertainties in tumour localisation are important in particle therapy (proton therapy, carbon-ion therapy) because charged particle beams are highly sensitive to geometrical and associated density and radiological variations in path length, which will affect the treatment plan. Target localisation and motion compensation methods applied in x-ray photon radiotherapy require careful performance assessment for clinical applications in particle therapy. In this Review, we summarise the efforts required for an application of real-time tumour tracking in particle therapy, by comparing and assessing competing strategies for time-resolved target localisation and related clinical outcomes in x-ray radiation oncology.
Collapse
Affiliation(s)
- Marco Riboldi
- Department of Bioengineering, Politecnico di Milano, Milan, Italy.
| | | | | |
Collapse
|
146
|
Persson GF, Nygaard DE, Hollensen C, Munck af Rosenschöld P, Mouritsen LS, Due AK, Berthelsen AK, Nyman J, Markova E, Roed AP, Roed H, Korreman S, Specht L. Interobserver delineation variation in lung tumour stereotactic body radiotherapy. Br J Radiol 2012; 85:e654-60. [PMID: 22919015 PMCID: PMC3487081 DOI: 10.1259/bjr/76424694] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 08/22/2011] [Accepted: 09/12/2011] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES In radiotherapy, delineation uncertainties are important as they contribute to systematic errors and can lead to geographical miss of the target. For margin computation, standard deviations (SDs) of all uncertainties must be included as SDs. The aim of this study was to quantify the interobserver delineation variation for stereotactic body radiotherapy (SBRT) of peripheral lung tumours using a cross-sectional study design. METHODS 22 consecutive patients with 26 tumours were included. Positron emission tomography/CT scans were acquired for planning of SBRT. Three oncologists and three radiologists independently delineated the gross tumour volume. The interobserver variation was calculated as a mean of multiple SDs of distances to a reference contour, and calculated for the transversal plane (SD(trans)) and craniocaudal (CC) direction (SD(cc)) separately. Concordance indexes and volume deviations were also calculated. RESULTS Median tumour volume was 13.0 cm(3), ranging from 0.3 to 60.4 cm(3). The mean SD(trans) was 0.15 cm (SD 0.08 cm) and the overall mean SD(cc) was 0.26 cm (SD 0.15 cm). Tumours with pleural contact had a significantly larger SD(trans) than tumours surrounded by lung tissue. CONCLUSIONS The interobserver delineation variation was very small in this systematic cross-sectional analysis, although significantly larger in the CC direction than in the transversal plane, stressing that anisotropic margins should be applied. This study is the first to make a systematic cross-sectional analysis of delineation variation for peripheral lung tumours referred for SBRT, establishing the evidence that interobserver variation is very small for these tumours.
Collapse
Affiliation(s)
- G F Persson
- Department of Radiation Oncology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
147
|
[Image guidance for the evaluation of setup accuracy]. Cancer Radiother 2012; 16:439-43. [PMID: 22921983 DOI: 10.1016/j.canrad.2012.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Accepted: 06/16/2012] [Indexed: 12/25/2022]
Abstract
Information obtained by different methods of image-guided radiotherapy now allows us to reposition the target volume. This evolution causes a change in practice and positioning control. In order to control positioning errors, a systematic control during the first three to five sessions is required. Random repositioning errors and clinical target volume motions can be mastered only by performing a daily imaging. Finally, image-guided radiotherapy allows assessing anatomical changes occurring during treatment, and opens the field of adaptive radiotherapy.
Collapse
|
148
|
Fiorino C, Rizzo G, Scalco E, Broggi S, Belli ML, Dell'Oca I, Dinapoli N, Ricchetti F, Rodriguez AM, Di Muzio N, Calandrino R, Sanguineti G, Valentini V, Cattaneo GM. Density variation of parotid glands during IMRT for head–neck cancer: Correlation with treatment and anatomical parameters. Radiother Oncol 2012; 104:224-9. [PMID: 22809587 DOI: 10.1016/j.radonc.2012.06.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 05/15/2012] [Accepted: 06/17/2012] [Indexed: 11/17/2022]
|
149
|
Josipovic M, Persson GF, Logadottir A, Smulders B, Westmann G, Bangsgaard JP. Translational and rotational intra- and inter-fractional errors in patient and target position during a short course of frameless stereotactic body radiotherapy. Acta Oncol 2012; 51:610-7. [PMID: 22263924 DOI: 10.3109/0284186x.2011.626448] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Implementation of cone beam computed tomography (CBCT) in frameless stereotactic body radiotherapy (SBRT) of lung tumours enables setup correction based on tumour position. The aim of this study was to compare setup accuracy with daily soft tissue matching to bony anatomy matching and evaluate intra- and inter-fractional translational and rotational errors in patient and target positions. MATERIAL AND METHODS Fifteen consecutive SBRT patients were included in the study. Vacuum cushions were used for immobilisation. SBRT plans were based on midventilation phase of four-dimensional (4D)-CT or three-dimensional (3D)-CT from PET/CT. Margins of 5 mm in the transversal plane and 10 mm in the cranio-caudal (CC) direction were applied. SBRT was delivered in three fractions within a week. At each fraction, CBCT was performed before and after the treatment. Setup accuracy comparison between soft tissue matching and bony anatomy matching was evaluated on pretreatment CBCTs. From differences in pre- and post-treatment CBCTs, we evaluated the extent of translational and rotational intra-fractional changes in patient position, tumour position and tumour baseline shift. All image registration was rigid with six degrees of freedom. RESULTS The median 3D difference between patient position based on bony anatomy matching and soft tissue matching was 3.0 mm (0-8.3 mm). The median 3D intra-fractional change in patient position was 1.4 mm (0-12.2 mm) and 2.2 mm (0-13.2 mm) in tumour position. The median 3D intra-fractional baseline shift was 2.2 mm (0-4.7 mm). With correction of translational errors, the remaining systematic and random errors were approximately 1°. CONCLUSION . Soft tissue tumour matching improved precision of treatment delivery in frameless SBRT of lung tumours compared to image guidance using bone matching. The intra-fractional displacement of the target position was affected by both translational and rotational changes in tumour baseline position relative to the bony anatomy and by changes in patient position.
Collapse
Affiliation(s)
- Mirjana Josipovic
- Department of Radiation Oncology, Rigshospitalet, Copenhagen, Denmark.
| | | | | | | | | | | |
Collapse
|
150
|
Robertson SP, Weiss E, Hugo GD. Localization accuracy from automatic and semi-automatic rigid registration of locally-advanced lung cancer targets during image-guided radiation therapy. Med Phys 2012; 39:330-41. [PMID: 22225303 DOI: 10.1118/1.3671929] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To evaluate localization accuracy resulting from rigid registration of locally-advanced lung cancer targets using fully automatic and semi-automatic protocols for image-guided radiation therapy. METHODS Seventeen lung cancer patients, fourteen also presenting with involved lymph nodes, received computed tomography (CT) scans once per week throughout treatment under active breathing control. A physician contoured both lung and lymph node targets for all weekly scans. Various automatic and semi-automatic rigid registration techniques were then performed for both individual and simultaneous alignments of the primary gross tumor volume (GTV(P)) and involved lymph nodes (GTV(LN)) to simulate the localization process in image-guided radiation therapy. Techniques included "standard" (direct registration of weekly images to a planning CT), "seeded" (manual prealignment of targets to guide standard registration), "transitive-based" (alignment of pretreatment and planning CTs through one or more intermediate images), and "rereferenced" (designation of a new reference image for registration). Localization error (LE) was assessed as the residual centroid and border distances between targets from planning and weekly CTs after registration. RESULTS Initial bony alignment resulted in centroid LE of 7.3 ± 5.4 mm and 5.4 ± 3.4 mm for the GTV(P) and GTV(LN), respectively. Compared to bony alignment, transitive-based and seeded registrations significantly reduced GTV(P) centroid LE to 4.7 ± 3.7 mm (p = 0.011) and 4.3 ± 2.5 mm (p < 1 × 10(-3)), respectively, but the smallest GTV(P) LE of 2.4 ± 2.1 mm was provided by rereferenced registration (p < 1 × 10(-6)). Standard registration significantly reduced GTV(LN) centroid LE to 3.2 ± 2.5 mm (p < 1 × 10(-3)) compared to bony alignment, with little additional gain offered by the other registration techniques. For simultaneous target alignment, centroid LE as low as 3.9 ± 2.7 mm and 3.8 ± 2.3 mm were achieved for the GTV(P) and GTV(LN), respectively, using rereferenced registration. CONCLUSIONS Target shape, volume, and configuration changes during radiation therapy limited the accuracy of standard rigid registration for image-guided localization in locally-advanced lung cancer. Significant error reductions were possible using other rigid registration techniques, with LE approaching the lower limit imposed by interfraction target variability throughout treatment.
Collapse
Affiliation(s)
- Scott P Robertson
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia 23298, USA
| | | | | |
Collapse
|