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Zeng Z, Zhang F, Yan J. Moderated Hypofractionated Online Adaptive Radiotherapy in Locally Advanced Cervical Cancer: A Case Report. Cureus 2024; 16:e66552. [PMID: 39252725 PMCID: PMC11381937 DOI: 10.7759/cureus.66552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2024] [Indexed: 09/11/2024] Open
Abstract
Cervical cancer is one of the most frequent malignant tumors in females. Concurrent chemoradiotherapy is one of the treatment options for cervical cancer. The treatment time of conventional radiotherapy is long. Moderately hypofractionated radiotherapy (MHRT) offers the advantage of shortening the overall treatment duration and enhancing the radiobiological effects on tumors. MHRT shortens the overall treatment duration while enhancing the radiobiological effects on tumors. Previous studies have reported that MHRT of cervical cancer has relatively high toxicity. Daily online adaptive radiation therapy (oART) showed improvements in dosimetry and a decrease in toxicity. To the best of our knowledge, this case was the first reported case of moderated hypofractionated oART used in a cervical cancer patient to date in a prospective clinical trial (NCT05994300). This case serves as a critical reminder that cervical cancer is a potential tumor that may be in MHRT with iterative cone beam computed tomography-guided oART. Further data are needed to confirm the toxicity and efficacy of this technique.
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Affiliation(s)
- Zheng Zeng
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, CHN
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, CHN
| | - Junfang Yan
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, CHN
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Jones S, Thompson K, Porter B, Shepherd M, Sapkaroski D, Grimshaw A, Hargrave C. Automation and artificial intelligence in radiation therapy treatment planning. J Med Radiat Sci 2024; 71:290-298. [PMID: 37794690 PMCID: PMC11177028 DOI: 10.1002/jmrs.729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023] Open
Abstract
Automation and artificial intelligence (AI) is already possible for many radiation therapy planning and treatment processes with the aim of improving workflows and increasing efficiency in radiation oncology departments. Currently, AI technology is advancing at an exponential rate, as are its applications in radiation oncology. This commentary highlights the way AI has begun to impact radiation therapy treatment planning and looks ahead to potential future developments in this space. Historically, radiation therapist's (RT's) role has evolved alongside the adoption of new technology. In Australia, RTs have key clinical roles in both planning and treatment delivery and have been integral in the implementation of automated solutions for both areas. They will need to continue to be informed, to adapt and to transform with AI technologies implemented into clinical practice in radiation oncology departments. RTs will play an important role in how AI-based automation is implemented into practice in Australia, ensuring its application can truly enable personalised and higher-quality treatment for patients. To inform and optimise utilisation of AI, research should not only focus on clinical outcomes but also AI's impact on professional roles, responsibilities and service delivery. Increased efficiencies in the radiation therapy workflow and workforce need to maintain safe improvements in practice and should not come at the cost of creativity, innovation, oversight and safety.
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Affiliation(s)
- Scott Jones
- Radiation Oncology Princess Alexandra Hospital Raymond TerraceBrisbaneQueenslandAustralia
| | - Kenton Thompson
- Department of Radiation Therapy ServicesPeter MacCullum Cancer Care CentreMelbourneVictoriaAustralia
| | - Brian Porter
- Northern Sydney Cancer CentreRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - Meegan Shepherd
- Northern Sydney Cancer CentreRoyal North Shore HospitalSydneyNew South WalesAustralia
- Monash UniversityClaytonVictoriaAustralia
| | - Daniel Sapkaroski
- Department of Radiation Therapy ServicesPeter MacCullum Cancer Care CentreMelbourneVictoriaAustralia
- RMIT UniversityMelbourneVictoriaAustralia
| | | | - Catriona Hargrave
- Radiation Oncology Princess Alexandra Hospital Raymond TerraceBrisbaneQueenslandAustralia
- Queensland University of Technology, Faculty of Health, School of Clinical SciencesBrisbaneQueenslandAustralia
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Weykamp F, Meixner E, Arians N, Hoegen-Saßmannshausen P, Kim JY, Tawk B, Knoll M, Huber P, König L, Sander A, Mokry T, Meinzer C, Schlemmer HP, Jäkel O, Debus J, Hörner-Rieber J. Daily AI-Based Treatment Adaptation under Weekly Offline MR Guidance in Chemoradiotherapy for Cervical Cancer 1: The AIM-C1 Trial. J Clin Med 2024; 13:957. [PMID: 38398270 PMCID: PMC10889253 DOI: 10.3390/jcm13040957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/13/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: External beam radiotherapy (EBRT) and concurrent chemotherapy, followed by brachytherapy (BT), offer a standard of care for patients with locally advanced cervical carcinoma. Conventionally, large safety margins are required to compensate for organ movement, potentially increasing toxicity. Lately, daily high-quality cone beam CT (CBCT)-guided adaptive radiotherapy, aided by artificial intelligence (AI), became clinically available. Thus, online treatment plans can be adapted to the current position of the tumor and the adjacent organs at risk (OAR), while the patient is lying on the treatment couch. We sought to evaluate the potential of this new technology, including a weekly shuttle-based 3T-MRI scan in various treatment positions for tumor evaluation and for decreasing treatment-related side effects. (2) Methods: This is a prospective one-armed phase-II trial consisting of 40 patients with cervical carcinoma (FIGO IB-IIIC1) with an age ≥ 18 years and a Karnofsky performance score ≥ 70%. EBRT (45-50.4 Gy in 25-28 fractions with 55.0-58.8 Gy simultaneous integrated boosts to lymph node metastases) will be accompanied by weekly shuttle-based MRIs. Concurrent platinum-based chemotherapy will be given, followed by 28 Gy of BT (four fractions). The primary endpoint will be the occurrence of overall early bowel and bladder toxicity CTCAE grade 2 or higher (CTCAE v5.0). Secondary outcomes include clinical feasibility, quality of life, and imaging-based response assessment.
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Affiliation(s)
- Fabian Weykamp
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Eva Meixner
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Nathalie Arians
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Philipp Hoegen-Saßmannshausen
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Ji-Young Kim
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Bouchra Tawk
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Maximilian Knoll
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Peter Huber
- Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Anja Sander
- Institute of Medical Biometry, University of Heidelberg, 69120 Heidelberg, Germany
| | - Theresa Mokry
- Department of Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Clara Meinzer
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Department of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Oliver Jäkel
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site, 69120 Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (J.H.-R.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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Kawamura M, Kamomae T, Yanagawa M, Kamagata K, Fujita S, Ueda D, Matsui Y, Fushimi Y, Fujioka T, Nozaki T, Yamada A, Hirata K, Ito R, Fujima N, Tatsugami F, Nakaura T, Tsuboyama T, Naganawa S. Revolutionizing radiation therapy: the role of AI in clinical practice. JOURNAL OF RADIATION RESEARCH 2024; 65:1-9. [PMID: 37996085 PMCID: PMC10803173 DOI: 10.1093/jrr/rrad090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/25/2023] [Accepted: 10/16/2023] [Indexed: 11/25/2023]
Abstract
This review provides an overview of the application of artificial intelligence (AI) in radiation therapy (RT) from a radiation oncologist's perspective. Over the years, advances in diagnostic imaging have significantly improved the efficiency and effectiveness of radiotherapy. The introduction of AI has further optimized the segmentation of tumors and organs at risk, thereby saving considerable time for radiation oncologists. AI has also been utilized in treatment planning and optimization, reducing the planning time from several days to minutes or even seconds. Knowledge-based treatment planning and deep learning techniques have been employed to produce treatment plans comparable to those generated by humans. Additionally, AI has potential applications in quality control and assurance of treatment plans, optimization of image-guided RT and monitoring of mobile tumors during treatment. Prognostic evaluation and prediction using AI have been increasingly explored, with radiomics being a prominent area of research. The future of AI in radiation oncology offers the potential to establish treatment standardization by minimizing inter-observer differences in segmentation and improving dose adequacy evaluation. RT standardization through AI may have global implications, providing world-standard treatment even in resource-limited settings. However, there are challenges in accumulating big data, including patient background information and correlating treatment plans with disease outcomes. Although challenges remain, ongoing research and the integration of AI technology hold promise for further advancements in radiation oncology.
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Affiliation(s)
- Mariko Kawamura
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Takeshi Kamomae
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Masahiro Yanagawa
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Koji Kamagata
- Department of Radiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shohei Fujita
- Department of Radiology, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Daiju Ueda
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yusuke Matsui
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tomoyuki Fujioka
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Taiki Nozaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Akira Yamada
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Kenji Hirata
- Department of Diagnostic Imaging, Faculty of Medicine, Hokkaido University, Kita15, Nishi7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Rintaro Ito
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Noriyuki Fujima
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita15, Nishi7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Fuminari Tatsugami
- Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medicine, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takahiro Tsuboyama
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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Zhang Y, Wang G, Chang Y, Wang Z, Sun X, Sun Y, Zeng Z, Chen Y, Hu K, Qiu J, Yan J, Zhang F. Prospects for daily online adaptive radiotherapy for cervical cancer: Auto-contouring evaluation and dosimetric outcomes. Radiat Oncol 2024; 19:6. [PMID: 38212767 PMCID: PMC10785518 DOI: 10.1186/s13014-024-02398-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Training senior radiation therapists as "adapters" to manage influencers and target editing is critical in daily online adaptive radiotherapy (oART) for cervical cancer. The purpose of this study was to evaluate the accuracy and dosimetric outcomes of automatic contouring and identify the key areas for modification. METHODS A total of 125 oART fractions from five postoperative cervical cancer patients and 140 oART fractions from five uterine cervical cancer patients treated with daily iCBCT-guided oART were enrolled in this prospective study. The same adaptive treatments were replanned using the Ethos automatic contours workflow without manual contouring edits. The clinical target volume (CTV) was subdivided into several separate regions, and the average surface distance dice (ASD), centroid deviation, dice similarity coefficient (DSC), and 95% Hausdorff distance (95% HD) were used to evaluate contouring for the above portions. Dosimetric results from automatic oART plans were compared to supervised oART plans to evaluate target volumes and organs at risk (OARs) dose changes. RESULTS Overall, the paired CTV had high overlap rates, with an average DSC value greater than 0.75. The uterus had the largest consistency differences, with ASD, centroid deviation, and 95% HD being 2.67 ± 1.79 mm, 17.17 ± 12 mm, and 10.45 ± 5.68 mm, respectively. The consistency differences of the lower nodal CTVleft and nodal CTVright were relatively large, with ASD, centroid deviation, and 95% HD being 0.59 ± 0.53 mm, 3.6 ± 2.67 mm, and 5.41 ± 4.08 mm, and 0.59 ± 0.51 mm, 3.6 ± 2.54 mm, and 4.7 ± 1.57 mm, respectively. The automatic online-adapted plan met the clinical requirements of dosimetric coverage for the target volume and improved the OAR dosimetry. CONCLUSIONS The accuracy of automatic contouring from the Ethos adaptive platform is considered clinically acceptable for cervical cancer, and the uterus, upper vaginal cuff, and lower nodal CTV are the areas that need to be focused on in training.
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Affiliation(s)
- Yu Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Guangyu Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Yankui Chang
- School of Nuclear Science and Technology, University of Science and Technology of China, Hefei, China
| | - Zhiqun Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Xiansong Sun
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Yuliang Sun
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Zheng Zeng
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Yining Chen
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Jie Qiu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Junfang Yan
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
- Department of Radiation Oncology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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6
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Guberina M, Guberina N, Hoffmann C, Gogishvili A, Freisleben F, Herz A, Hlouschek J, Gauler T, Lang S, Stähr K, Höing B, Pöttgen C, Indenkämpen F, Santiago A, Khouya A, Mattheis S, Stuschke M. Prospects for online adaptive radiation therapy (ART) for head and neck cancer. Radiat Oncol 2024; 19:4. [PMID: 38191400 PMCID: PMC10775598 DOI: 10.1186/s13014-023-02390-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND The aim of the present study is to examine the impact of kV-CBCT-based online adaptive radiation therapy (ART) on dosimetric parameters in comparison to image-guided-radiotherapy (IGRT) in consecutive patients with tumors in the head and neck region from a prospective registry. METHODS The study comprises all consecutive patients with tumors in the head and neck area who were treated with kV-CBCT-based online ART or IGRT-modus at the linear-accelerator ETHOS™. As a measure of effectiveness, the equivalent-uniform-dose was calculated for the CTV (EUDCTV) and organs-at-risk (EUDOAR) and normalized to the prescribed dose. As an important determinant for the need of ART the interfractional shifts of anatomic landmarks related to the tongue were analyzed and compared to the intrafractional shifts. The latter determine the performance of the adapted dose distribution on the verification CBCT2 postadaptation. RESULTS Altogether 59 consecutive patients with tumors in the head-and-neck-area were treated from 01.12.2021 to 31.01.2023. Ten of all 59 patients (10/59; 16.9%) received at least one phase within a treatment course with ART. Of 46 fractions in the adaptive mode, irradiation was conducted in 65.2% of fractions with the adaptive-plan, the scheduled-plan in the remaining. The dispersion of the distributions of EUDCTV-values from the 46 dose fractions differed significantly between the scheduled and adaptive plans (Ansari-Bradley-Test, p = 0.0158). Thus, the 2.5th percentile of the EUDCTV-values by the adaptive plans amounted 97.1% (95% CI 96.6-99.5%) and by the scheduled plans 78.1% (95% CI 61.8-88.7%). While the EUDCTV for the accumulated dose distributions stayed above 95% at PTV-margins of ≥ 3 mm for all 8 analyzed treatment phases the scheduled plans did for margins ≥ 5 mm. The intrafractional anatomic shifts of all 8 measured anatomic landmarks were smaller than the interfractional with overall median values of 8.5 mm and 5.5 mm (p < 0.0001 for five and p < 0.05 for all parameters, pairwise comparisons, signed-rank-test). The EUDOAR-values for the larynx and the parotid gland were significantly lower for the adaptive compared with the scheduled plans (Wilcoxon-test, p < 0.001). CONCLUSIONS The mobile tongue and tongue base showed considerable interfractional variations. While PTV-margins of 5 mm were sufficient for IGRT, ART showed the potential of decreasing PTV-margins and spare dose to the organs-at-risk.
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Affiliation(s)
- Maja Guberina
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Nika Guberina
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.
| | - C Hoffmann
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - A Gogishvili
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - F Freisleben
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - A Herz
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - J Hlouschek
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - T Gauler
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - S Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - K Stähr
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - B Höing
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - C Pöttgen
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - F Indenkämpen
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - A Santiago
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - A Khouya
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - S Mattheis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - M Stuschke
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
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7
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Hlouschek J, König B, Bos D, Santiago A, Zensen S, Haubold J, Pöttgen C, Herz A, Opitz M, Wetter A, Guberina M, Stuschke M, Zylka W, Kühl H, Guberina N. Experimental Examination of Conventional, Semi-Automatic, and Automatic Volumetry Tools for Segmentation of Pulmonary Nodules in a Phantom Study. Diagnostics (Basel) 2023; 14:28. [PMID: 38201337 PMCID: PMC10804383 DOI: 10.3390/diagnostics14010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/10/2023] [Accepted: 12/17/2023] [Indexed: 01/12/2024] Open
Abstract
The aim of this study is to examine the precision of semi-automatic, conventional and automatic volumetry tools for pulmonary nodules in chest CT with phantom N1 LUNGMAN. The phantom is a life-size anatomical chest model with pulmonary nodules representing solid and subsolid metastases. Gross tumor volumes (GTVis) were contoured using various approaches: manually (0); as a means of semi-automated, conventional contouring with (I) adaptive-brush function; (II) flood-fill function; and (III) image-thresholding function. Furthermore, a deep-learning algorithm for automatic contouring was applied (IV). An intermodality comparison of the above-mentioned strategies for contouring GTVis was performed. For the mean GTVref (standard deviation (SD)), the interquartile range (IQR)) was 0.68 mL (0.33; 0.34-1.1). GTV segmentation was distributed as follows: (I) 0.61 mL (0.27; 0.36-0.92); (II) 0.41 mL (0.28; 0.23-0.63); (III) 0.65 mL (0.35; 0.32-0.90); and (IV) 0.61 mL (0.29; 0.33-0.95). GTVref was found to be significantly correlated with GTVis (I) p < 0.001, r = 0.989 (III) p = 0.001, r = 0.916, and (IV) p < 0.001, r = 0.986, but not with (II) p = 0.091, r = 0.595. The Sørensen-Dice indices for the semi-automatic tools were 0.74 (I), 0.57 (II) and 0.71 (III). For the semi-automatic, conventional segmentation tools evaluated, the adaptive-brush function (I) performed closest to the reference standard (0). The automatic deep learning tool (IV) showed high performance for auto-segmentation and was close to the reference standard. For high precision radiation therapy, visual control, and, where necessary, manual correction, are mandatory for all evaluated tools.
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Affiliation(s)
- Julian Hlouschek
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Britta König
- Department of Radiology, University Hospital Muenster (UKM), Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany
| | - Denise Bos
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Alina Santiago
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Sebastian Zensen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Johannes Haubold
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Christoph Pöttgen
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Andreas Herz
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Marcel Opitz
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Axel Wetter
- Department of Diagnostic and Interventional Radiology, Neuroradiology, Asklepios Klinikum Harburg, Eißendorfer Pferdeweg 52, 21075 Hamburg, Germany
| | - Maja Guberina
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Martin Stuschke
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Waldemar Zylka
- Westphalian University, Campus Gelsenkirchen, Neidenburger Str. 43, 45897 Gelsenkirchen, Germany
| | - Hilmar Kühl
- Department of Radiology, St. Bernhard-Hospital Kamp-Lintfort, Bürgermeister-Schmelzing-Str. 90, 47475 Kamp-Lintfort, Germany
| | - Nika Guberina
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
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Pöttgen C, Hoffmann C, Gauler T, Guberina M, Guberina N, Ringbaek T, Santiago Garcia A, Krafft U, Hadaschik B, Khouya A, Stuschke M. Fractionation versus Adaptation for Compensation of Target Volume Changes during Online Adaptive Radiotherapy for Bladder Cancer: Answers from a Prospective Registry. Cancers (Basel) 2023; 15:4933. [PMID: 37894299 PMCID: PMC10605897 DOI: 10.3390/cancers15204933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
Online adaptive radiotherapy (ART) allows adaptation of the dose distribution to the anatomy captured by with pre-adaptation imaging. ART is time-consuming, and thus intra-fractional deformations can occur. This prospective registry study analyzed the effects of intra-fraction deformations of clinical target volume (CTV) on the equivalent uniform dose (EUDCTV) of focal bladder cancer radiotherapy. Using margins of 5-10 mm around CTV on pre-adaptation imaging, intra-fraction CTV-deformations found in a second imaging study reduced the 10th percentile of EUDCTV values per fraction from 101.1% to 63.2% of the prescribed dose. Dose accumulation across fractions of a series was determined with deformable-image registration and worst-case dose accumulation that maximizes the correlation of cold spots. A strong fractionation effect was demonstrated-the EUDCTV was above 95% and 92.5% as determined by the two abovementioned accumulation methods, respectively, for all series of dose fractions. A comparison of both methods showed that the fractionation effect caused the EUDCTV of a series to be insensitive to EUDCTV-declines per dose fraction, and this could be explained by the small size and spatial variations of cold spots. Therefore, ART for each dose fraction is unnecessary, and selective ART for fractions with large inter-fractional deformations alone is sufficient for maintaining a high EUDCTV for a radiotherapy series.
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Affiliation(s)
- Christoph Pöttgen
- Department of Radiotherapy, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Christian Hoffmann
- Department of Radiotherapy, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Thomas Gauler
- Department of Radiotherapy, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Maja Guberina
- Department of Radiotherapy, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Nika Guberina
- Department of Radiotherapy, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Toke Ringbaek
- Department of Radiotherapy, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Alina Santiago Garcia
- Department of Radiotherapy, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Ulrich Krafft
- Department of Urology, University of Duisburg-Essen, 45147 Essen, Germany (B.H.)
| | - Boris Hadaschik
- Department of Urology, University of Duisburg-Essen, 45147 Essen, Germany (B.H.)
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Aymane Khouya
- Department of Radiotherapy, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Martin Stuschke
- Department of Radiotherapy, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
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