1
|
Ai Y, Zhu X, Zhang Y, Li W, Li H, Zhao Z, Zhang J, Ning B, Li C, Zheng Q, Zhang J, Jin J, Li Y, Xie C, Jin X. MRI radiomics nomogram integrating postoperative adjuvant treatments in recurrence risk prediction for patients with early-stage cervical cancer. Radiother Oncol 2024; 197:110328. [PMID: 38761884 DOI: 10.1016/j.radonc.2024.110328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 05/02/2024] [Accepted: 05/07/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND AND PURPOSE Adjuvant treatments are valuable to decrease the recurrence rate and improve survival for early-stage cervical cancer patients (ESCC), Therefore, recurrence risk evaluation is critical for the choice of postoperative treatment. A magnetic resonance imaging (MRI) based radiomics nomogram integrating postoperative adjuvant treatments was constructed and validated externally to improve the recurrence risk prediction for ESCC. MATERIAL AND METHODS 212 ESCC patients underwent surgery and adjuvant treatments from three centers were enrolled and divided into the training, internal validation, and external validation cohorts. Their clinical data, pretreatment T2-weighted images (T2WI) were retrieved and analyzed. Radiomics models were constructed using machine learning methods with features extracted and screen from sagittal and axial T2WI. A nomogram for recurrence prediction was build and evaluated using multivariable logistic regression analysis integrating radiomic signature and adjuvant treatments. RESULTS A total of 8 radiomic features were screened out of 1020 extracted features. The extreme gradient boosting (XGboost) model based on MRI radiomic features performed best in recurrence prediction with an area under curve (AUC) of 0.833, 0.822 in the internal and external validation cohorts, respectively. The nomogram integrating radiomic signature and clinical factors achieved an AUC of 0.806, 0.718 in the internal and external validation cohorts, respectively, for recurrence risk prediction for ESCC. CONCLUSION In this study, the nomogram integrating T2WI radiomic signature and clinical factors is valuable to predict the recurrence risk, thereby allowing timely planning for effective treatments for ESCC with high risk of recurrence.
Collapse
Affiliation(s)
- Yao Ai
- Radiotherapy Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoyang Zhu
- Department of Radiotherapy, the Second Affiliated Hospital Zhejiang University School of Medicine, Zhejiang, China
| | - Yu Zhang
- Department of Information Division, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenlong Li
- Radiotherapy Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Heng Li
- Radiotherapy Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zeshuo Zhao
- Radiotherapy Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jicheng Zhang
- Radiotherapy Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Boda Ning
- Radiotherapy Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chenyu Li
- Radiotherapy Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiao Zheng
- Radiotherapy Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ji Zhang
- Radiotherapy Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Juebin Jin
- Department of Medical Engineering, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yiran Li
- Radiotherapy Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Congying Xie
- Radiotherapy Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Xiance Jin
- Radiotherapy Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; School of Basic Medical Science, Wenzhou Medical University, Wenzhou, China.
| |
Collapse
|
2
|
Wu Z, Jia X, Lu L, Xu C, Pang Y, Peng S, Liu M, Wu Y. Multi-center Dose Prediction Using Attention-aware Deep learning Algorithm Based on Transformers for Cervical Cancer Radiotherapy. Clin Oncol (R Coll Radiol) 2024; 36:e209-e223. [PMID: 38631974 DOI: 10.1016/j.clon.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/22/2024] [Accepted: 03/21/2024] [Indexed: 04/19/2024]
Abstract
AIMS Accurate dose delivery is crucial for cervical cancer volumetric modulated arc therapy (VMAT). We aimed to develop a robust deep-learning (DL) algorithm for fast and accurate dose prediction of cervical cancer VMAT in multicenter datasets and then explore the feasibility of the DL algorithm to endometrial cancer VMAT with different prescriptions. MATERIALS AND METHODS We proposed the AtTranNet algorithm for three-dimensional dose prediction. A total of 367 cervical patients were enrolled in this study. Three hundred twenty-two cervical patients from 3 centers were randomly divided into 70%, 10%, and 20% as training, validation, and testing sets, respectively. Forty-five cervical patients from another center were selected for external testing. Moreover, 70 patients of endometrial cancer with different prescriptions were further selected to test the model. Prediction precision was evaluated by dosimetric difference, dose map, and dose-volume histogram metrics. RESULTS The prediction results were all clinically acceptable. The mean absolute error within the body in internal testing was 0.66 ± 0.63%. The maximum |δD| for planning target volume was observed in D98, which is 1.24 ± 2.73 Gy. The maximum |δD| for organs at risk was observed in Dmean of bladder, which is 4.79 ± 3.14 Gy. The maximum |δV| were observed in V40 of pelvic bones, which is 4.77 ± 4.48%. CONCLUSION AtTranNet showed the feasibility and reasonable accuracy in the dose prediction for cervical cancer in multiple centers. The model can also be generalized for endometrial cancer with different prescriptions without any transfer learning.
Collapse
Affiliation(s)
- Z Wu
- Department of Digital Medicine, School of Biomedical Engineering and Medical Imaging, Army Medical University, Chongqing, PR China; Department of Radiotherapy, Zigong First People's Hospital, Sichuan, PR China; Yu-Yue Pathology Research Center, Jinfeng Laboratory, Chongqing, PR China
| | - X Jia
- Department of Radiotherapy, The Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - L Lu
- Department of Radiotherapy, Tongling People's Hospital, Anhui, PR China
| | - C Xu
- Department of Radiotherapy, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, PR China
| | - Y Pang
- Department of Radiotherapy, Zigong First People's Hospital, Sichuan, PR China
| | - S Peng
- Department of Radiotherapy, Zigong First People's Hospital, Sichuan, PR China
| | - M Liu
- Department of Digital Medicine, School of Biomedical Engineering and Medical Imaging, Army Medical University, Chongqing, PR China.
| | - Y Wu
- Department of Digital Medicine, School of Biomedical Engineering and Medical Imaging, Army Medical University, Chongqing, PR China; Yu-Yue Pathology Research Center, Jinfeng Laboratory, Chongqing, PR China.
| |
Collapse
|
3
|
Han C, Zhang J, Yu B, Zheng H, Wu Y, Lin Z, Ning B, Yi J, Xie C, Jin X. Integrating plan complexity and dosiomics features with deep learning in patient-specific quality assurance for volumetric modulated arc therapy. Radiat Oncol 2023; 18:116. [PMID: 37434171 DOI: 10.1186/s13014-023-02311-7] [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: 01/26/2023] [Accepted: 06/30/2023] [Indexed: 07/13/2023] Open
Abstract
PURPOSE To investigate the feasibility and performance of deep learning (DL) models combined with plan complexity (PC) and dosiomics features in the patient-specific quality assurance (PSQA) for patients underwent volumetric modulated arc therapy (VMAT). METHODS Total of 201 VMAT plans with measured PSQA results were retrospectively enrolled and divided into training and testing sets randomly at 7:3. PC metrics were calculated using house-built algorithm based on Matlab. Dosiomics features were extracted and selected using Random Forest (RF) from planning target volume (PTV) and overlap regions with 3D dose distributions. The top 50 dosiomics and 5 PC features were selected based on feature importance screening. A DL DenseNet was adapted and trained for the PSQA prediction. RESULTS The measured average gamma passing rate (GPR) of these VMAT plans was 97.94% ± 1.87%, 94.33% ± 3.22%, and 87.27% ± 4.81% at the criteria of 3%/3 mm, 3%/2 mm, and 2%/2 mm, respectively. Models with PC features alone demonstrated the lowest area under curve (AUC). The AUC and sensitivity of PC and dosiomics (D) combined model at 2%/2 mm were 0.915 and 0.833, respectively. The AUCs of DL models were improved from 0.943, 0.849, 0.841 to 0.948, 0.890, 0.942 in the combined models (PC + D + DL) at 3%/3 mm, 3%/2 mm and 2%/2 mm, respectively. A best AUC of 0.942 with a sensitivity, specificity and accuracy of 100%, 81.8%, and 83.6% was achieved with combined model (PC + D + DL) at 2%/2 mm. CONCLUSIONS Integrating DL with dosiomics and PC metrics is promising in the prediction of GPRs in PSQA for patients underwent VMAT.
Collapse
Affiliation(s)
- Ce Han
- Department of Radiotherapy Center, 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ji Zhang
- Department of Radiotherapy Center, 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bing Yu
- Department of Radiotherapy Center, 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haoze Zheng
- Department of Radiotherapy Center, 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yibo Wu
- Department of Radiotherapy Center, 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhixi Lin
- Department of Radiotherapy Center, 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Boda Ning
- Department of Radiotherapy Center, 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jinling Yi
- Department of Radiotherapy Center, 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Congying Xie
- Department of Radiotherapy Center, 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
- Department of Medical and Radiation Oncology, 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Xiance Jin
- Department of Radiotherapy Center, 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
- School of Basic Medical Science, Wenzhou Medical University, Wenzhou, China.
| |
Collapse
|
4
|
Serarslan A, Daştan Y, Aksu T, Yıldız RE, Gürsel B, Meydan D, Okumuş NÖ. Ninety-degree angled collimator: a dosimetric study related to dynamic intensity-modulated radiotherapy in patients with endometrial carcinoma. BMC Cancer 2023; 23:515. [PMID: 37280543 DOI: 10.1186/s12885-023-11033-8] [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: 03/09/2023] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Our purpose was to ensure that the dose constraints of the organs at risk (OARs) were not exceeded while increasing the prescription dose to the planning target volume (PTV) from 45 to 50.4 Gray (Gy) with the dynamic intensity-modulated radiotherapy (IMRT) technique. While trying for this purpose, a new dynamic IMRT technique named 90° angled collimated dynamic IMRT (A-IMRT) planning was developed by us. METHODS This study was based on the computed tomography data sets of 20 patients with postoperatively diagnosed International Federation of Gynecology and Obstetrics stage 2 endometrial carcinoma. For each patient, conventional dynamic IMRT (C-IMRT, collimator angle of 0° at all gantry angles), A-IMRT (collimator angle of 90° at gantry angles of 110°, 180°, 215°, and 285°), and volumetric modulated arc therapy (VMAT) were planned. Planning techniques were compared with parameters used to evaluate PTV and OARs via dose-volume-histogram analysis using the paired two-tailed Wilcoxon's signed-rank test; p < 0.05 was considered indicative of statistical significance. RESULTS All plans achieved adequate dose coverage for PTV. Although the technique with the lowest mean conformality index was A-IMRT (0.76 ± 0.05) compared to both C-IMRT (0.79 ± 0.04, p = 0.000) and VMAT (0.83 ± 0.03, p = 0.000), it protected the OARs especially the bladder (V45 = 32.84 ± 2.03 vs. 44.21 ± 6.67, p = 0.000), rectum (V30 = 56.18 ± 2.05 vs. 73.80 ± 4.75, p = 0.000) and both femoral heads (V30 for right = 12.19 ± 1.34 vs. 21.42 ± 4.03, p = 0.000 and V30 for left = 12.58 ± 1.48 vs. 21.35 ± 4.16, p = 0.000) better than C-IMRT. While the dose constraints of the bladder, rectum and bilateral femoral heads were not exceeded in any patient with A-IMRT or VMAT, they were exceeded in 19 (95%), 20 (100%) and 20 (100%) patients with C-IMRT, respectively. CONCLUSIONS OARs are better protected when external beam radiotherapy is applied to the pelvis at a dose of 50.4 Gy by turning the collimator angle to 90° at some gantry angles with the dynamic IMRT technique in the absence of VMAT.
Collapse
Affiliation(s)
- Alparslan Serarslan
- Department of Radiation Oncology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, 55139, Turkey.
| | - Yalçın Daştan
- Department of Radiation Oncology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, 55139, Turkey
| | - Telat Aksu
- Department of Radiation Oncology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, 55139, Turkey
| | - Rana Elif Yıldız
- Department of Radiation Oncology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, 55139, Turkey
| | - Bilge Gürsel
- Department of Radiation Oncology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, 55139, Turkey
| | - Deniz Meydan
- Department of Radiation Oncology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, 55139, Turkey
| | - Nilgün Özbek Okumuş
- Department of Radiation Oncology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, 55139, Turkey
| |
Collapse
|
5
|
Yang X, Cai M, Li N. Complete Remission of Vulvar Squamous Cell Carcinoma After Volumetric Modulated Arc Therapy in Copper Smelting and Purification Workers: A Case Report. Clin Cosmet Investig Dermatol 2023; 16:185-192. [PMID: 36711071 PMCID: PMC9879774 DOI: 10.2147/ccid.s398275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
Vulvar squamous cell carcinoma (VSCC) is the most frequent vulvar neoplasia, with invasiveness and metastasis. Typically, surgery is the preferred treatment. Radiotherapy is commonly used for unresectable locally advanced tumors and for early-stage patients who are at risk of serious complications from surgery or have a severe concomitant disease that prevents them from undergoing surgery. Compared to external irradiation, three-dimensional conformal radiotherapy (3D-CRT), and intensity-modulated radiotherapy (IMRT), various studies using volumetric modulated arc therapy (VMAT) alone in early-stage VSCC have been reported rarely. In this case, the patient had a large skin lesion and no lymph node metastasis. Surgical excision would seriously affect the urinary function and vulvar shape, so radical radiotherapy was given. To ensure the radiation dose for the radical treatment effect and to avoid high-dose radiation to normal organs, the volumetric intensity-modulated radiotherapy technique was chosen. After treatment, the patient's vulvar appearance returned to normal, and the tumor achieved complete remission without further surgery or chemotherapy, with no local recurrence or associated toxic side effects. This suggests that the efficacy of VMAT alone in early-stage VSCC is accurate and worthy of clinical promotion. The patient had been engaged in copper smelting and purification for many years, and it is unusual for her to have skin lesions with such a large surface area. In conjunction with her previous history of nasal basal cell carcinoma, the mechanism of oxidative stress during metal exposure should be further clinically examined, as it may be crucial in the formation and progression of malignancies.
Collapse
Affiliation(s)
- Xiaoting Yang
- Department of Dermatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Mei Cai
- Department of Dermatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China,Correspondence: Mei Cai, Department of Dermatology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Yunnan-Myanmar Avenue, Kunming, Yunnan, 650101, People’s Republic of China, Tel +86 13888532488, Email
| | - Nan Li
- Department of Oncology, The Second Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| |
Collapse
|
6
|
Palani D, Govindaraj K, Sampathrajan S, Karunagaran L, Ganesh KM. A Dosimetric Analysis of Modified Volumetric Modulated Arc Therapy for Bone Marrow Sparing Radiotherapy in Cervical Cancer-An alternative Approach to Conventional VMAT. Asian Pac J Cancer Prev 2022; 23:4323-4332. [PMID: 36580016 PMCID: PMC9971454 DOI: 10.31557/apjcp.2022.23.12.4323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND External beam radiotherapy remains the primary treatment modality in cervical cancer. Nowadays Intensity Modulated Radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) are increasingly being used to reduce normal tissue toxicity. The drawback of conventional VMAT is that a considerable volume of pelvic bone marrow receives a low dose. AIM We analyzed whether there was a way to reduce the volume of the low dose regions of bone marrow, and assessed the potential benefit of conventional-4Arc (C-4Arc VMAT), and Modified-4Arc (M-4Arc VMAT) over the conventional 2 ARC VMAT. MATERIALS AND METHODS Twelve clinically proven locally advanced cervical cancer patients treated with concurrent chemo-radiotherapy by Conventional VMAT (RapidArc) in dual rotation mode (C-2Arc VMAT) were selected for this study.C-4Arc VMAT and M-4Arc VMAT dose plans were generated for these twelve patients and these three different types of plans were evaluated for the quality and compared dosimetrically. RESULTS M-4Arc VMAT designs exhibited a greater bone marrow sparing when compared with conventional VMATs with respect to volume receiving 5Gy to 35Gy without compromising PTV dose coverage. M-4Arc VMAT plans, the bone marrow volume receiving 30 Gy (V30Gy),40Gy (V40Gy), and mean doses were lower than the C- 4 Arc plan and a similar result was observed for V50(Gy) also when comparing with the standard 2 Arc plan. In modified VMAT plans, the rectum and bladder dose volumes were lower than standard VMAT. Similarly, the bowel bag V35(Gy), V40(Gy), V50(Gy), mean doses. The right and left femoral head doses were reduced significantly when compared to conventional VMAT plans. CONCLUSION The M-4Arc VMAT plans are better than the C-2Arc and C-4Arc VMAT plans for reducing the dose to bone marrow by limiting the MLC field width travel.
Collapse
Affiliation(s)
- Dharmendran Palani
- Research and Development Centre, Bharathiar University, Coimbatore, India. ,For Correspondence:
| | - Kesavan Govindaraj
- Research and Development Centre, Bharathiar University, Coimbatore, India. ,Department of Radiotherapy, Vadamalayan Hospitals Integrated Cancer Centre, Madurai, India.
| | - Sowmiya Sampathrajan
- Department of Radiotherapy, Vadamalayan Hospitals Integrated Cancer Centre, Madurai, India.
| | - Lavanya Karunagaran
- Oral and Maxillofacial Pathology, Department, Asan Memorial Dental College and Hospital, Tamil Nadu, India.
| | - Kadirampatti M. Ganesh
- Department of Radiation Physics, Kidwai Memorial Institute of Oncology, Bengaluru, India.
| |
Collapse
|
7
|
Rhee DJ, Jhingran A, Huang K, Netherton TJ, Fakie N, White I, Sherriff A, Cardenas CE, Zhang L, Prajapati S, Kry SF, Beadle BM, Shaw W, O'Reilly F, Parkes J, Burger H, Trauernicht C, Simonds H, Court LE. Clinical acceptability of fully automated external beam radiotherapy for cervical cancer with three different beam delivery techniques. Med Phys 2022; 49:5742-5751. [PMID: 35866442 PMCID: PMC9474595 DOI: 10.1002/mp.15868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 06/16/2022] [Accepted: 07/12/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To fully automate CT‐based cervical cancer radiotherapy by automating contouring and planning for three different treatment techniques. Methods We automated three different radiotherapy planning techniques for locally advanced cervical cancer: 2D 4‐field‐box (4‐field‐box), 3D conformal radiotherapy (3D‐CRT), and volumetric modulated arc therapy (VMAT). These auto‐planning algorithms were combined with a previously developed auto‐contouring system. To improve the quality of the 4‐field‐box and 3D‐CRT plans, we used an in‐house, field‐in‐field (FIF) automation program. Thirty‐five plans were generated for each technique on CT scans from multiple institutions and evaluated by five experienced radiation oncologists from three different countries. Every plan was reviewed by two of the five radiation oncologists and scored using a 5‐point Likert scale. Results Overall, 87%, 99%, and 94% of the automatically generated plans were found to be clinically acceptable without modification for the 4‐field‐box, 3D‐CRT, and VMAT plans, respectively. Some customizations of the FIF configuration were necessary on the basis of radiation oncologist preference. Additionally, in some cases, it was necessary to renormalize the plan after it was generated to satisfy radiation oncologist preference. Conclusion Approximately, 90% of the automatically generated plans were clinically acceptable for all three planning techniques. This fully automated planning system has been implemented into the radiation planning assistant for further testing in resource‐constrained radiotherapy departments in low‐ and middle‐income countries.
Collapse
Affiliation(s)
- Dong Joo Rhee
- The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas, USA.,Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kai Huang
- The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas, USA.,Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tucker J Netherton
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nazia Fakie
- Division of Radiation Oncology and Medical Physics, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Ingrid White
- Radiotherapy Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Alicia Sherriff
- Department of Oncology, University of the Free State, Bloemfontein, South Africa
| | - Carlos E Cardenas
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lifei Zhang
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Surendra Prajapati
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen F Kry
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - William Shaw
- Department of Medical Physics (G68), University of the Free State, Bloemfontein, South Africa
| | - Frederika O'Reilly
- Department of Medical Physics (G68), University of the Free State, Bloemfontein, South Africa
| | - Jeannette Parkes
- Division of Radiation Oncology and Medical Physics, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Hester Burger
- Division of Radiation Oncology and Medical Physics, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Chris Trauernicht
- Division of Medical Physics, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Hannah Simonds
- Division of Radiation Oncology, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Laurence E Court
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
8
|
Liang J, Yu F, Zhu J, Song T. [Impact of multi-leaf collimator positioning accuracy on quality control of volumetric modulation arc therapy plan for cervical cancer treated with Elekta linear accelerator]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2022; 42:1089-1094. [PMID: 35869775 DOI: 10.12122/j.issn.1673-4254.2022.07.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the influence of positioning accuracy of the multi-leaf collimators (MLC) on the passing rate of the plan dose verification for volumetric modulation arc therapy (VMAT) of cervical cancer using an Elekta linear accelerator. METHODS The dose distributions were measured using Sun Nuclear's Mapcheck and Arccheck semiconductors matrix before and after MLC calibration in30 cervical cancer patients undergoing VMAT. Dosimetric comparisons were performed with 2D and 3D gamma passing rates of 3%, 3 mm and 2%, and 2 mm. The 3D gamma distribution was reconstructed with respect to the patient's anatomy using 3DVH software to evaluate the possible influence of MLC positioning accuracy. RESULTS Before and after MLC calibration, the gamma passing rates of Mapcheck were (88.80±1.81)% and (99.25 ± 0.53)% under 3% and 3 mm standard, respectively, with an average increase of 10.45%. The corresponding gamma passing rates of Arccheck were (87.61±1.98)% and (98.13±0.99)%, respectively, with an average increase of 10.52%. The gamma passing rates of 3DVH were (89.87±2.28)% and (98.3±1.15)%, respectively, with an average increase of 8.43%. CONCLUSION The MLC positioning accuracy is one of the main factors influencing dosimetric accuracy of VMAT for cervical cancer. The application of Autocal software facilitates MLC calibration and improves the accuracy and safety of VMAT delivery for cervical cancer.
Collapse
Affiliation(s)
- J Liang
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China.,State Key Laboratory of Oncology in South China//Department of Radiotherapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - F Yu
- State Key Laboratory of Oncology in South China//Department of Radiotherapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - J Zhu
- State Key Laboratory of Oncology in South China//Department of Radiotherapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - T Song
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| |
Collapse
|
9
|
Xiao C, Jin J, Yi J, Han C, Zhou Y, Ai Y, Xie C, Jin X. RefineNet-based 2D and 3D automatic segmentations for clinical target volume and organs at risks for patients with cervical cancer in postoperative radiotherapy. J Appl Clin Med Phys 2022; 23:e13631. [PMID: 35533205 PMCID: PMC9278674 DOI: 10.1002/acm2.13631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/09/2021] [Accepted: 04/18/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE An accurate and reliable target volume delineation is critical for the safe and successful radiotherapy. The purpose of this study is to develop new 2D and 3D automatic segmentation models based on RefineNet for clinical target volume (CTV) and organs at risk (OARs) for postoperative cervical cancer based on computed tomography (CT) images. METHODS A 2D RefineNet and 3D RefineNetPlus3D were adapted and built to automatically segment CTVs and OARs on a total of 44 222 CT slices of 313 patients with stage I-III cervical cancer. Fully convolutional networks (FCNs), U-Net, context encoder network (CE-Net), UNet3D, and ResUNet3D were also trained and tested with randomly divided training and validation sets, respectively. The performances of these automatic segmentation models were evaluated by Dice similarity coefficient (DSC), Jaccard similarity coefficient, and average symmetric surface distance when comparing them with manual segmentations with the test data. RESULTS The DSC for RefineNet, FCN, U-Net, CE-Net, UNet3D, ResUNet3D, and RefineNet3D were 0.82, 0.80, 0.82, 0.81, 0.80, 0.81, and 0.82 with a mean contouring time of 3.2, 3.4, 8.2, 3.9, 9.8, 11.4, and 6.4 s, respectively. The generated RefineNetPlus3D demonstrated a good performance in the automatic segmentation of bladder, small intestine, rectum, right and left femoral heads with a DSC of 0.97, 0.95, 091, 0.98, and 0.98, respectively, with a mean computation time of 6.6 s. CONCLUSIONS The newly adapted RefineNet and developed RefineNetPlus3D were promising automatic segmentation models with accurate and clinically acceptable CTV and OARs for cervical cancer patients in postoperative radiotherapy.
Collapse
Affiliation(s)
- Chengjian Xiao
- Department of Radiotherapy Center, Wenzhou Medical University First Affiliated Hospital, Wenzhou, People's Republic of China
| | - Juebin Jin
- Department of Medical Engineering, Wenzhou Medical University First Affiliated Hospital, Wenzhou, People's Republic of China
| | - Jinling Yi
- Department of Radiotherapy Center, Wenzhou Medical University First Affiliated Hospital, Wenzhou, People's Republic of China
| | - Ce Han
- Department of Radiotherapy Center, Wenzhou Medical University First Affiliated Hospital, Wenzhou, People's Republic of China
| | - Yongqiang Zhou
- Department of Radiotherapy Center, Wenzhou Medical University First Affiliated Hospital, Wenzhou, People's Republic of China
| | - Yao Ai
- Department of Radiotherapy Center, Wenzhou Medical University First Affiliated Hospital, Wenzhou, People's Republic of China
| | - Congying Xie
- Department of Radiotherapy Center, Wenzhou Medical University First Affiliated Hospital, Wenzhou, People's Republic of China.,Department of Radiation and Medical Oncology, Wenzhou Medical University Second Affiliated Hospital, Wenzhou, People's Republic of China
| | - Xiance Jin
- Department of Radiotherapy Center, Wenzhou Medical University First Affiliated Hospital, Wenzhou, People's Republic of China.,School of Basic Medical Science, Wenzhou Medical University, Wenzhou, People's Republic of China
| |
Collapse
|
10
|
Martín-Tovar EA, Badillo-Alvarado AH, Cocom-Poot LE. Dosimetric study of a hybrid plan technique for external beam radiotherapy in patients with cervical cancer. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2021; 60:653-662. [PMID: 34363120 DOI: 10.1007/s00411-021-00931-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/31/2021] [Indexed: 06/13/2023]
Abstract
The aim of this study was to investigate the effect of a hybrid technique which results from combining intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) for the treatment of cervical cancer patients. Plans made with the hybrid technique and pure IMRT and VMAT were retrospectively compared in 20 patients with cervical cancer at different stages. All plans were made using the same contours based on the original computed tomography (CT) scans. Conformity (CI) and homogeneity (HI) indices of the planning target volumes (PTVs) were calculated for each technique in order to evaluate plan quality. All techniques were compared in terms of dose to organs at risk (OARs), number of monitor units (MUs) and treatment time. It turned out that plans made with the hybrid technique had improved dose conformity and homogeneity compared to plans made only with IMRT and VMAT (p < 0.001). Regarding the OARs, the maximum dose (Dmax) delivered to the bladder, rectum and femoral heads was lower for the hybrid plans compared to the IMRT and VMAT plans (p < 0.001). The volumes irradiated to doses of 50 Gy (V50Gy) for rectum, bladder and bowel were lower for the hybrid plans (p < 0.001, p = 0.002). Furthermore, the treatment time and MU values for the hybrid plans were found to be between of the values for the IMRT and VMAT plans. It is concluded that, as compared to IMRT and VMAT plans, the hybrid plan technique allowed a better conformity and homogeneity for the dose distribution in the PTV and a dose reduction to the OARs.
Collapse
Affiliation(s)
- E A Martín-Tovar
- División de Oncología y Uronefrología, Departamento de Radioterapia, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional "Ignacio García Téllez", Instituto Mexicano del Seguro Social, CP 97150, Mérida, Yucatán, México.
| | - A H Badillo-Alvarado
- División de Oncología y Uronefrología, Departamento de Radioterapia, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional "Ignacio García Téllez", Instituto Mexicano del Seguro Social, CP 97150, Mérida, Yucatán, México
| | - L E Cocom-Poot
- División de Oncología y Uronefrología, Departamento de Radioterapia, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional "Ignacio García Téllez", Instituto Mexicano del Seguro Social, CP 97150, Mérida, Yucatán, México
| |
Collapse
|
11
|
Pisani R, Bezzina P, Couto JG. Effect of patient thickness on acute gastrointestinal toxicities following radiotherapy for prostate cancer. ACTA ACUST UNITED AC 2021; 26:352-359. [PMID: 34277088 PMCID: PMC8281905 DOI: 10.5603/rpor.a2021.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 02/23/2021] [Indexed: 11/25/2022]
Abstract
Background There is conflicting literature regarding the effect of patient size on radiotherapy toxicities. This study aimed to determine whether there is any association between patient thickness and severity and incidence of acute GI toxicities of prostate cancer patients receiving VMAT radiotherapy. The impact of confounding factors was also examined: rectal dose, age and lymph node irradiation. Materials and methods This study used a non-experimental, retrospective, descriptive and cross-sectional design. All patients who complied with the inclusion criteria (n = 96) were included. GI toxicity scores (baseline and last week of radiotherapy), rectal dose, lymph nodes irradiation and patient age at diagnosis were collected from the treatment file. Patient separations were measured from the CT-Simulator images. Statistical tests were performed to analyse the influence of these factors on acute GI toxicities. Results Patient thickness was shown to have no statistically significant effect on the incidence (p = 0.947 for antero-posterior and p = 0.839 for lateral thicknesses), and severity (p = 0.986 and 0.905, respectively) of acute GI toxicities. Severity of GI toxicities increased following radiotherapy: the Expanded Prostate Cancer Index Composite (EPIC) score increased by 2.64 from baseline (p < 0.001). The confounding factors had no statistically significant effect on toxicities (p > 0.05). Conclusion As expected, most patients experienced an increase in GI toxicity following radiotherapy. No relationship was established between patient thickness and the severity or incidence of acute GI toxicities, adding to the existing body of knowledge. Therefore, all patients should receive adequate follow up, irrespective of size. Side-effect recording tools should be implemented systematically for continuous assessment of this relationship.
Collapse
Affiliation(s)
- Robert Pisani
- Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Paul Bezzina
- Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Jose Guilherme Couto
- Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, Malta
| |
Collapse
|
12
|
Han C, Yi J, Zhu K, Zhou Y, Ai Y, Zheng X, Xie C, Jin X. Cross verification of independent dose recalculation, log files based, and phantom measurement-based pretreatment quality assurance for volumetric modulated arc therapy. J Appl Clin Med Phys 2020; 21:98-104. [PMID: 33001540 PMCID: PMC7700942 DOI: 10.1002/acm2.13036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 11/09/2022] Open
Abstract
Independent treatment planning system (TPS) check with Mobius3D software, log files based quality assurance (QA) with MobiusFX, and phantom measurement‐based QA with ArcCHECK were performed and cross verified for head‐and‐neck (17 patients), chest (16 patients), and abdominal (19 patients) cancer patients who underwent volumetric modulated arc therapy (VMAT). Dosimetric differences and percentage gamma passing rates (%GPs) were evaluated and compared for this cross verification. For the dosimetric differences in planning target volume (PTV) coverage, there was no significant difference among TPS vs. Mobius3D, TPS vs. MobiusFX, and TPS vs. ArcCHECK. For the dosimetric differences in organs at risks (OARs), the number of metrics with an average dosimetric differences higher than ±3% for TPS vs Mobius3D, TPS vs MobiusFX, and TPS vs ArcCHECK were 1, 1, 7; 2, 1, 4; 1, 1, 5 for the patients with head‐and‐neck, abdomen, and chest cancer, respectively. The %GPs of global gamma indices for Mobius3D and MobiousFX were above 97%, while it ranged from 92% to 96% for ArcCHECK. The %GPs of individual volume‐based gamma indices were around 98% for Mobius3D and MobiousFX, except for γPTV for chest and abdominal cancer (88.9% to 92%); while it ranged from 86% to 99% for ArcCHECK. In conclusion, some differences in dosimetric metrics and gamma passing rates were observed with ArcCHECK measurement‐based QA in comparison with independent dosecheck and log files based QA. Care must be taken when considering replacing phantom measurement‐based IMRT/VMAT QA.
Collapse
Affiliation(s)
- Ce Han
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jinling Yi
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kecheng Zhu
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yongqiang Zhou
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yao Ai
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaomin Zheng
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Congying Xie
- Department of Radiation and Medical Oncology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiance Jin
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
13
|
Pinzi V, Landoni V, Cattani F, Lazzari R, Jereczek-Fossa BA, Orecchia R. IMRT and brachytherapy comparison in gynaecological cancer treatment: thinking over dosimetry and radiobiology. Ecancermedicalscience 2019; 13:993. [PMID: 32010217 PMCID: PMC6974373 DOI: 10.3332/ecancer.2019.993] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Indexed: 12/29/2022] Open
Abstract
Background The role of radiotherapy and brachytherapy in the management of locally advanced cervical and endometrial cancer is well established. However, in some cases, intracavitary brachytherapy (ICBRT) is not recommended or cannot be carried out. We aimed to investigate whether external-beam irradiation delivered by means of intensity-modulated radiation therapy (IMRT) might replace ICBRT in gynaecological cancer when the standard ICBRT boost delivering cannot be administered for technical or clinical reasons. Materials and methods Fifteen already delivered treatments for gynaecological cancer patients were analysed. The treatments were performed through 3-dimensional conformal radiotherapy (3D-CRT) to the whole-pelvis up to the dose of 45–50.4 Gy followed by a boost dose administered with ICBRT in high-dose-rate or pulsed-dose-rate modality. For each patient, IMRT plans were elaborated to mimic the ICBRT. We analysed the ICBRT boost versus IMRT boost in terms of dosimetric and radiobiological aspects. Results Mean conformity index value calculated on boost volume was 0.73 for ICBRT and 0.97 for IMRT. Mean conformation number was 0.24 for ICBRT boost and 0.78 for IMRT boost. Mean normal tissue complication probability (NTCP) values for 3D-CRT plus ICBRT and for IMRT (pelvis plus boost) were, respectively, 28% and 5% for rectum; 1.5% and 0.1% for urinary bladder and 8.9% and 6.1% for bowel. Conclusions Our findings suggest that IMRT may represent a viable alternative in delivering the boost in patients diagnosed with gynaecological cancer not amenable to ICBRT.
Collapse
Affiliation(s)
- Valentina Pinzi
- Department of Neurosurgery, Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Valeria Landoni
- Laboratory of Medical Physics and Expert System, IRCCS Istituto Nazionale Tumori Regina Elena, 00128 Rome, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology IRCCS (IEO), 20141 Milan, Italy
| | - Roberta Lazzari
- Department of Radiation Oncology of IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiation Oncology of IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy.,Department of Oncology and Hemato-Oncology of University of Milan, 20122 Milan, Italy
| | - Roberto Orecchia
- Scientific Directory of IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| |
Collapse
|
14
|
Goossens ME, Van den Bulcke M, Gevaert T, Meheus L, Verellen D, Cosset JM, Storme G. Is there any benefit to particles over photon radiotherapy? Ecancermedicalscience 2019; 13:982. [PMID: 32010206 PMCID: PMC6974365 DOI: 10.3332/ecancer.2019.982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Indexed: 12/18/2022] Open
Abstract
Particle, essentially, proton radiotherapy (RT) could provide some benefits over photon RT, especially in reducing the side effects of RT. We performed a systematic review to identify the performed randomised clinical trials (RCTs) and ongoing RCTs comparing particle RT with photon therapy. So far, there are no results available from phase 3 RCTs comparing particle RT with photon therapy. Furthermore, the results on side effects comparing proton and carbon ion beam RT with photon RT do vary. The introduction of new techniques in photon RT, such as image-guided RT (IGRT), intensity-modulated RT (IMRT), volumetric arc therapy (VMAT) and stereotactic body RT (SBRT) was already effective in reducing side effects. At present, the lack of evidence limits the indications for proton and carbon ion beam RTs and makes the particle RT still experimental.
Collapse
Affiliation(s)
- Maria E Goossens
- Cancer Centre, Sciensano (Scientific Institute of Public Health), 1050 Brussels, Belgium
| | - Marc Van den Bulcke
- Cancer Centre, Sciensano (Scientific Institute of Public Health), 1050 Brussels, Belgium
| | - Thierry Gevaert
- Department of Radiotherapy, University Hospital Brussels, Vrije Universiteit Brussel, 1050 Brussel, Belgium
| | - Lydie Meheus
- The Anticancer Fund, Reliable Cancer Therapies, Strombeek-Bever, 1853, Belgium
| | - Dirk Verellen
- Department of Radiotherapy, University Hospital Brussels, Vrije Universiteit Brussel, 1050 Brussel, Belgium
- Iridium Kankernetwerk Antwerp, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1050 Brussel, Belgium
| | - Jean-Marc Cosset
- Centre de Radiothérapie Charlebourg, Groupe Amethyst, 65, Avenue Foch, 92250 La Garenne-Colombes, France
| | - Guy Storme
- Department of Radiotherapy, University Hospital Brussels, Vrije Universiteit Brussel, 1050 Brussel, Belgium
| |
Collapse
|
15
|
Knapp P, Eva B, Reseigh G, Gibbs A, Sim L, Daly T, Cox J, Bernard A. The role of volumetric modulated arc therapy (VMAT) in gynaecological radiation therapy: A dosimetric comparison of intensity modulated radiation therapy versus VMAT. J Med Radiat Sci 2019; 66:44-53. [PMID: 30387550 PMCID: PMC6399190 DOI: 10.1002/jmrs.311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION For gynaecological cancers, volumetric modulated arc therapy (VMAT) offers comparable plan quality with shorter treatment delivery times when compared to intensity modulated radiation therapy (IMRT). METHODS The clinical IMRT plans of twenty gynaecological cancer patients were compared with a retrospectively generated VMAT plan. Planning target volume (PTV) metrics compared were D95 > 99%, homogeneity index, and conformity index. Organs at risk (OAR) doses compared were bladder V45 < 35%, bowel V40 < 30%, femoral head and neck (FHN) V30 < 50%, V44 < 35% and V44 < 5%. Plan quality was also assessed by comparing the monitor units (MU), treatment time and the patient-specific quality assurance results. RESULTS VMAT and IMRT resulted in comparable PTV coverage with D95 values of 98.92% ± 0.69% and 98.91% ± 1.43% respectively, and homogeneity index values of 0.08 ± 0.02 (VMAT) and 0.08 ± 0.03 (IMRT). The conformity index for VMAT was 0.93 ± 0.04 and IMRT 0.85 ± 0.06 (P < 0.001). For the bowel tolerance (40 Gy < 30%) VMAT resulted in 22.39% ± 12.5% compared to 28.8% ± 16.78% for IMRT, with bladder and FHN VMAT doses also lower. VMAT MU were 694.35 ± 126.56 compared to 606.8 ± 96.16 for IMRT (P < 0.01). Treatment times of 6.6 ± 0.82 min and 2.47 ± 0.35 min were achieved for IMRT and VMAT respectively. CONCLUSION VMAT showed improvements in sparing OAR compared to IMRT. Target volume coverage with VMAT was equivalent or better than that of IMRT. These results in conjunction with the confirmed shorter treatment delivery time, have led to the development and implementation of a clinical protocol.
Collapse
Affiliation(s)
- Penelope Knapp
- Radiation Oncology PrincessAlexandra Hospital Raymond Terrace, Cancer ServicesMetro South Health Service DistrictSouth BrisbaneQueenslandAustralia
| | - Belinda Eva
- Radiation Oncology PrincessAlexandra Hospital Raymond Terrace, Cancer ServicesMetro South Health Service DistrictSouth BrisbaneQueenslandAustralia
| | - Gemma Reseigh
- Radiation Oncology PrincessAlexandra Hospital Raymond Terrace, Cancer ServicesMetro South Health Service DistrictSouth BrisbaneQueenslandAustralia
| | - Adrian Gibbs
- Radiation Oncology PrincessAlexandra Hospital Raymond Terrace, Cancer ServicesMetro South Health Service DistrictSouth BrisbaneQueenslandAustralia
| | - Lucy Sim
- Radiation Oncology PrincessAlexandra Hospital Raymond Terrace, Cancer ServicesMetro South Health Service DistrictSouth BrisbaneQueenslandAustralia
| | - Tiffany Daly
- Radiation Oncology PrincessAlexandra Hospital Raymond Terrace, Cancer ServicesMetro South Health Service DistrictSouth BrisbaneQueenslandAustralia
| | - Judith Cox
- Radiation Oncology PrincessAlexandra Hospital Raymond Terrace, Cancer ServicesMetro South Health Service DistrictSouth BrisbaneQueenslandAustralia
| | - Anne Bernard
- QFAB BioinformaticsInstitute for Molecular BioscienceThe University of QueenslandBrisbaneQueenslandAustralia
| |
Collapse
|
16
|
Bai W, Kou C, Yu W, Li Y, Hua W, Yu L, Wang J. Dosimetric comparison of volumetric-modulated arc therapy and intensity-modulated radiation therapy in patients with cervical cancer: a meta-analysis. Onco Targets Ther 2018; 11:7179-7186. [PMID: 30425510 PMCID: PMC6203086 DOI: 10.2147/ott.s178336] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) are two of the main treatment techniques for cervical cancer. Whether either technique significantly reduces irradiated volumes of organs at risk (OARs) remains controversial. The aim of this study was to explore which of these treatment paradigms is the superior technique in cervical treatment, taking clinical outcomes and treatment efficiency from published findings into consideration. Materials and methods PubMed, EMBASE, and Cochrane Library databases were utilized. The average percent irradiated volumes of OAR were extracted from all included studies. Dual arc results were extracted due to their superiority to single arc methods in terms of plan quality. Standard mean deviations and 95% CIs were calculated for delivery time, monitor units, and average percent irradiated volumes of OAR. Assessment of publication bias and sensitivity analyses were performed. All statistical analyses were conducted using R 3.5.0 software. Results Eight studies were included in this meta-analysis. For irradiated volumes of OARs, irradiated volume of rectum receiving 40 Gy (rectum V40) was significantly decreased in VMAT compared with IMRT. However, no significant differences were observed between IMRT and VMAT plans in bladder V40 or small bowel V40/V30. In addition, delivery times and monitor units were significantly lower in the VMAT plan than in the IMRT plan. Conclusion Compared with IMRT, VMAT is significantly more protective for the rectum, suggesting that it may be an optional therapy technique for patients with cervical cancer.
Collapse
Affiliation(s)
- Wei Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun 130021, Jilin Province, China
| | - Changgui Kou
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun 130021, Jilin Province, China
| | - Weiying Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun 130021, Jilin Province, China
| | - Yuanyuan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun 130021, Jilin Province, China
| | - Wanqing Hua
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun 130021, Jilin Province, China
| | - Lei Yu
- Department of Radiotherapy, Second Hospital of Jilin University, Changchun 130041, Jilin Province, China,
| | - Jianfeng Wang
- Department of Radiotherapy, China-Japan Union Hospital, Changchun 130033, Jilin Province, China,
| |
Collapse
|
17
|
Han C, Yu W, Zheng X, Zhou Y, Gong C, Xie C, Jin X. Composite QA for intensity-modulated radiation therapy using individual volume-based 3D gamma indices. JOURNAL OF RADIATION RESEARCH 2018; 59:669-676. [PMID: 30085157 PMCID: PMC6151639 DOI: 10.1093/jrr/rry061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/19/2018] [Indexed: 06/08/2023]
Abstract
The aim of this study was to investigate the feasibility and sensitivity of using individual volume-based 3D gamma indices for composite dose-volume histogram (DVH)-based intensity-modulated radiation therapy (IMRT) quality assurance (QA). Composite IMRT QA for 15 cervical cancer patients was performed with ArcCHECK. The percentage dosimetric errors (%DEs) of DVH metrics when comparing treatment planning system and QA-reconstructed dose distribution, percentage gamma passing rates (%GPs) with different criteria for individual volumes and global gamma indices were evaluated, as well as their correlations. Receiver operating characteristic (ROC) curves were applied in order to study the sensitivities of the global and individual volume gamma indices. Most %DEs of the DVH metrics were within 3%. The γPTV and γrectum were <80% at 2%/2 mm; apart from these two individual volume indices, all other individual volume gamma indices and global indices had acceptable %GPs. For the criteria of 2%/2 mm, 3%/3 mm and 4%/4 mm, individual volume-based %GPs and global %GPs were correlated in 11, 1 and 12 out of 24 %DE metrics, and in 5, 4 and 5 out of 24 %DE metrics, respectively. Individual volume-based %GPs had a higher percentage of correlation with DVH metrics (%DEs) compared with global %GPs in composite IMRT QA. The areas under the curve (AUCs) of individual volume %GPs were higher than those of global %GPs. In conclusion, individual volume-based %GPs had a higher correlation with %DEs of metrics and a higher sensitivity presented by ROC analysis compared with global %GPs for composite IMRT QA. Thus, use of individual volume-based 3D gamma indices was found to be feasible and sensitive for composite IMRT QA.
Collapse
Affiliation(s)
- Ce Han
- Department of Radiation and Medical Oncology, the 1st Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, China
| | - Wenliang Yu
- Department of Radiation Oncology, Quzhou People’s Hospital, No.2 Zhongloudi Road, Quzhou, China
| | - Xiaomin Zheng
- Department of Radiation and Medical Oncology, the 1st Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, China
| | - Yongqiang Zhou
- Department of Radiation and Medical Oncology, the 1st Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, China
| | - Changfei Gong
- Department of Radiation and Medical Oncology, the 1st Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, China
| | - Congying Xie
- Department of Radiation and Medical Oncology, the 1st Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, China
| | - Xiance Jin
- Department of Radiation and Medical Oncology, the 1st Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, China
| |
Collapse
|
18
|
Dosimetric Analysis of Unflattened (FFFB) and Flattened (FB) Photon Beam Energy for Gastric Cancers Using IMRT and VMAT-a Comparative Study. J Gastrointest Cancer 2018. [PMID: 29520733 DOI: 10.1007/s12029-018-0080-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the feasibility of flattening filter free beam (FFFB) for the treatment of gastric tumors and to review their benefits over 6MV flatten beam (6MV_FFB). METHODS Fifteen patients with histologically proven gastric carcinoma were selected. CT scans with slice thickness of 0.3 cm were acquired and planning target volume (PTV) and organ at risk (OAR) were delineated. Plans were made retrospectively for each patient for the prescription dose of 45 Gy/25 fractions to the PTV. Four isocentric plans were compared in the present study on Varian TrueBeam linear accelerator (Varian Medical Systems, Palo Alto, CA, USA). RESULTS PTV D98% was 44.41 ± 0.12, 44.38 ± 0.13, 44.59 ± 0.14, and 44.49 ± 0.19 Gy for IMRT 6MV_FFB, IMRT 6MV_FFFB, VMAT 6MV_FFB, and VMAT 6MV_FFFB respectively. 6MV_FFFB beam minimizes the mean heart dose Dmean (P = 0.001). VMAT dominates over IMRT when it came to kidney doses V12Gy (P = 0.02), V23Gy (P = 0.015), V28Gy (P = 0.011), and Dmax (P < 0.01). VMAT has significantly reduced the doses to kidneys. It was analyzed that 6MV_FFFB significantly reduces the dose to normal tissues (P = 0.006 and P = 0.018). VMAT significantly reduces the TMU, which is required to deliver the similar dose by IMRT (P < 0.01). CONCLUSIONS Unflattened beam spares the organs at risk significantly to avoid the chances of secondary malignancies and reduces the intra-fraction motion during treatment due to provision of higher dose rate. Hence, we conclude that 6MV unflattened beam can be used to treat gastric carcinoma.
Collapse
|
19
|
Fu Y, Wang Y, Huang L, Jin Y, Xie C, Jin X. The effect of enforced fixed-field on the delivery accuracy of IMRT in the treatment of cervical cancer patients. Biomed Phys Eng Express 2017. [DOI: 10.1088/2057-1976/aa87b9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|