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Aleman BMP, Ricardi U, van der Maazen RWM, Meijnders P, Beijert M, Boros A, Izar F, Janus CPM, Levis M, Martin V, Specht L, Corning C, Clementel E, Raemaekers JM, André MP, Federico M, Fortpied C, Girinsky T. A Quality Control Study on Involved Node Radiation Therapy in the European Organisation for Research and Treatment of Cancer/Lymphoma Study Association/Fondazione Italiana Linfomi H10 Trial on Stages I and II Hodgkin Lymphoma: Lessons Learned. Int J Radiat Oncol Biol Phys 2023; 117:664-674. [PMID: 37179034 DOI: 10.1016/j.ijrobp.2023.05.011] [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: 01/04/2023] [Revised: 04/29/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE Involved node radiation therapy (INRT) was introduced in the European Organisation for Research and Treatment of Cancer/Lymphoma Study Association/Fondazione Italiana Linfomi H10 trial, a large multicenter trial in early-stage Hodgkin Lymphoma. The present study aimed to evaluate the quality of INRT in this trial. METHODS AND MATERIALS A retrospective, descriptive study was initiated to evaluate INRT in a representative sample encompassing approximately 10% of all irradiated patients in the H10 trial. Sampling was stratified by academic group, year of treatment, size of the treatment center, and treatment arm, and it was done proportional to the size of the strata. The sample was completed for all patients with known recurrences to enable future research on relapse patterns. Radiation therapy principle, target volume delineation and coverage, and applied technique and dose were evaluated using the EORTC Radiation Therapy Quality Assurance platform. Each case was reviewed by 2 reviewers and, in case of disagreement also by an adjudicator for a consensus evaluation. RESULTS Data were retrieved for 66 of 1294 irradiated patients (5.1%). Data collection and analysis were hampered more than anticipated by changes in archiving of diagnostic imaging and treatment planning systems during the running period of the trial. A review could be performed on 61 patients. The INRT principle was applied in 86.6%. Overall, 88.5% of cases were treated according to protocol. Unacceptable variations were predominately due to geographic misses of the target volume delineations. The rate of unacceptable variations decreased during trial recruitment. CONCLUSIONS The principle of INRT was applied in most of the reviewed patients. Almost 90% of the evaluated patients were treated according to the protocol. The present results should, however, be interpreted with caution because the number of patients evaluated was limited. Individual case reviews should be done in a prospective fashion in future trials. Radiation therapy Quality Assurance tailored to the clinical trial objectives is strongly recommended.
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Affiliation(s)
- Berthe M P Aleman
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands.
| | | | | | - Paul Meijnders
- Department of Radiotherapy, Iridium Network, Centre for Oncological Research of the University of Antwerp, Antwerp, Belgium
| | - Max Beijert
- Department of Radiotherapy, University Medical Center Groningen, Groningen, Netherlands
| | - Angela Boros
- Radiation Oncology Department, Center Hospitalier Lyon Sud, Pierre Benite, France
| | - Françoise Izar
- Department of Radiotherapy, Institut universitaire du cancer de Toulouse, Toulouse, France
| | - Cécile P M Janus
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Mario Levis
- Department of Oncology, University of Turin, Turin, Italy
| | - Valentine Martin
- Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France
| | - Lena Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark
| | - Coreen Corning
- The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Enrico Clementel
- The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - John M Raemaekers
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, Netherlands
| | - Marc P André
- Department of Hematology, CHU UCL Namur, Yvoir, Belgium
| | - Massimo Federico
- CHIMOMO Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Catherine Fortpied
- The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Theodore Girinsky
- Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France
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2
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Potiron V, Delpon G, Ollivier L, Vaugier L, Doré M, Guimas V, Rio E, Thillays F, Llagostera C, Moignier A, Josset S, Chiavassa S, Perennec T, Supiot S. [Clinical research in radiation oncology: how to move from the laboratory to the patient?]. Cancer Radiother 2022; 26:808-813. [PMID: 35999162 DOI: 10.1016/j.canrad.2022.07.009] [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: 06/14/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 11/19/2022]
Abstract
Translational research in radiation oncology is undergoing intense development. An increasingly rapid transfer is taking place from the laboratory to the patients, both in the selection of patients who can benefit from radiotherapy and in the development of innovative irradiation strategies or the development of combinations with drugs. Accelerating the passage of discoveries from the laboratory to the clinic represents the ideal of any translational research program but requires taking into account the multiple obstacles that can slow this progress. The ambition of the RadioTransNet network, a project to structure preclinical research in radiation oncology in France, is precisely to promote scientific and clinical interactions at the interface of radiotherapy and radiobiology, in its preclinical positioning, in order to identify priorities for strategic research dedicated to innovation in radiotherapy. The multidisciplinary radiotherapy teams with experts in biology, medicine, medical physics, mathematics and engineering sciences are able to meet these new challenges which will allow these advances to be made available to patients as quickly as possible.
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Affiliation(s)
- V Potiron
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France; Unité en sciences biologiques et biotechnologies, UMR CNRS 6286, 2, rue de la Houssinière, 44322 Nantes, France
| | - G Delpon
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France; IMT Atlantique, UMR CNRS 6457/IN2P3, Subatech, laboratoire de physique subatomique et des technologies associées, Nantes, France
| | - L Ollivier
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - L Vaugier
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - M Doré
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - V Guimas
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - E Rio
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - F Thillays
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - C Llagostera
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - A Moignier
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - S Josset
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - S Chiavassa
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France; IMT Atlantique, UMR CNRS 6457/IN2P3, Subatech, laboratoire de physique subatomique et des technologies associées, Nantes, France
| | - T Perennec
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - S Supiot
- Institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France; Unité en sciences biologiques et biotechnologies, UMR CNRS 6286, 2, rue de la Houssinière, 44322 Nantes, France.
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3
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Nilsson M, Olafsdottir H, Alexandersson von Döbeln G, Villegas F, Gagliardi G, Hellström M, Wang QL, Johansson H, Gebski V, Hedberg J, Klevebro F, Markar S, Smyth E, Lagergren P, Al-Haidari G, Rekstad LC, Aahlin EK, Wallner B, Edholm D, Johansson J, Szabo E, Reynolds JV, Pramesh CS, Mummudi N, Joshi A, Ferri L, Wong RKS, O’Callaghan C, Lukovic J, Chan KKW, Leong T, Barbour A, Smithers M, Li Y, Kang X, Kong FM, Chao YK, Crosby T, Bruns C, van Laarhoven H, van Berge Henegouwen M, van Hillegersberg R, Rosati R, Piessen G, de Manzoni G, Lordick F. Neoadjuvant Chemoradiotherapy and Surgery for Esophageal Squamous Cell Carcinoma Versus Definitive Chemoradiotherapy With Salvage Surgery as Needed: The Study Protocol for the Randomized Controlled NEEDS Trial. Front Oncol 2022; 12:917961. [PMID: 35912196 PMCID: PMC9326032 DOI: 10.3389/fonc.2022.917961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/08/2022] [Indexed: 12/24/2022] Open
Abstract
Background The globally dominant treatment with curative intent for locally advanced esophageal squamous cell carcinoma (ESCC) is neoadjuvant chemoradiotherapy (nCRT) with subsequent esophagectomy. This multimodal treatment leads to around 60% overall 5-year survival, yet with impaired post-surgical quality of life. Observational studies indicate that curatively intended chemoradiotherapy, so-called definitive chemoradiotherapy (dCRT) followed by surveillance of the primary tumor site and regional lymph node stations and surgery only when needed to ensure local tumor control, may lead to similar survival as nCRT with surgery, but with considerably less impairment of quality of life. This trial aims to demonstrate that dCRT, with selectively performed salvage esophagectomy only when needed to achieve locoregional tumor control, is non-inferior regarding overall survival, and superior regarding health-related quality of life (HRQOL), compared to nCRT followed by mandatory surgery, in patients with operable, locally advanced ESCC. Methods This is a pragmatic open-label, randomized controlled phase III, multicenter trial with non-inferiority design with regard to the primary endpoint overall survival and a superiority hypothesis for the experimental intervention dCRT with regard to the main secondary endpoint global HRQOL one year after randomization. The control intervention is nCRT followed by preplanned surgery and the experimental intervention is dCRT followed by surveillance and salvage esophagectomy only when needed to secure local tumor control. A target sample size of 1200 randomized patients is planned in order to reach 462 events (deaths) during follow-up. Clinical Trial Registration www.ClinicalTrials.gov, identifier: NCT04460352.
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Affiliation(s)
- Magnus Nilsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
- *Correspondence: Magnus Nilsson,
| | - Halla Olafsdottir
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Thoracic Oncology Center, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Gabriella Alexandersson von Döbeln
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Thoracic Oncology Center, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Fernanda Villegas
- Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Giovanna Gagliardi
- Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Hellström
- Center for Clinical Cancer Studies, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Qiao-Li Wang
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Hemming Johansson
- Center for Clinical Cancer Studies, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Jakob Hedberg
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Fredrik Klevebro
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Sheraz Markar
- Nuffield Department of Surgery, University of Oxford, Oxford, United Kingdom
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Elizabeth Smyth
- Department of Oncology, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Pernilla Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | - Lars Cato Rekstad
- Department of Gastrointestinal Surgery, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Eirik Kjus Aahlin
- Department of GI and HPB Surgery, University Hospital of Northern Norway, Tromsø, Norway
| | - Bengt Wallner
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - David Edholm
- Department of Surgery, Linköping University Hospital, Linköping, Sweden
| | - Jan Johansson
- Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - Eva Szabo
- Department of Surgery, University Hospital of Örebro, Örebro, Sweden
| | - John V. Reynolds
- Department of Surgery, Trinity St James’s Cancer Institute, Dublin, Ireland
| | - CS Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Naveen Mummudi
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Amit Joshi
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Lorenzo Ferri
- Department of Thoracic Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Rebecca KS Wong
- Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | | | - Jelena Lukovic
- Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Kelvin KW Chan
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Trevor Leong
- Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Andrew Barbour
- Academy of Surgery, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Mark Smithers
- Academy of Surgery, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Yin Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaozheng Kang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng-Ming Kong
- Thoracic Oncology Center, HKU Shenzhen Hospital, Hong Kong University Li Ka Shing Medical School, Shenzhen, China
| | - Yin-Kai Chao
- Department of thoracic surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Tom Crosby
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, United Kingdom
| | - Christiane Bruns
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | - Hanneke van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Mark van Berge Henegouwen
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | | | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Rafaele Hospital, Vita Salute University, Milan, Italy
| | - Guillaume Piessen
- Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER – Cancer Heterogeneity Plasticity and Resistance to Therapies, F-59000 Lille, France
| | | | - Florian Lordick
- University Cancer Center Leipzig, Leipzig University Medical Center, Leipzig, Germany
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4
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Livermore D, Trappenberg T, Syme A. Machine learning for contour classification in TG-263 noncompliant databases. J Appl Clin Med Phys 2022; 23:e13662. [PMID: 35686988 PMCID: PMC9512347 DOI: 10.1002/acm2.13662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 03/16/2022] [Accepted: 04/19/2022] [Indexed: 11/11/2022] Open
Abstract
A large volume of medical data are labeled using nonstandardized nomenclature. Although efforts have been made by the American Association of Physicists in Medicine (AAPM) to standardize nomenclature through Task Group 263 (TG-263), there remain noncompliant databases. This work aims to create an algorithm that can analyze anatomical contours in patients with head and neck cancer and classify them into TG-263 compliant nomenclature. To create an accurate algorithm capable of such classification, a combined approaching using both binary images of individual slices of anatomical contours themselves, as well as center of mass coordinates of the structures are input into a neural network. The center of mass coordinates were scaled using two normalization schemes, a simple linear normalization scheme agnostic of the patient anatomy, and an anatomical normalization scheme dependent on patient anatomy. The results of all of the individual slice classifications are then aggregated into a single classification by means of a voting algorithm. The total classification accuracy of the final algorithms was 97.6% mean accuracy per class for nonanatomically normalization scheme, and 97.9% mean accuracy per class for anatomically normalization scheme. The total accuracy was 99.0% (13 errors in 1302 structures) for the nonanatomically normalization scheme, and 98.3% (22 errors in 1302 structures) for the anatomically normalization scheme.
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Affiliation(s)
- David Livermore
- Department of Physics and Atmospheric Science, Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada
| | - Thomas Trappenberg
- Faculty of Computer Science, Dalhousie University, 6050 University Avenue, Halifax, NS B3H 4R2, Canada
| | - Alasdair Syme
- Department of Physics and Atmospheric Science, Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada.,Department of Radiation Oncology, Dalhousie University, 5820 University Avenue, Halifax, NS B3H 1V7, Canada
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5
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Taylor PA, Moran JM, Jaffray DA, Buchsbaum JC. A roadmap to clinical trials for FLASH. Med Phys 2022; 49:4099-4108. [PMID: 35366339 PMCID: PMC9321729 DOI: 10.1002/mp.15623] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 02/17/2022] [Accepted: 03/17/2022] [Indexed: 11/29/2022] Open
Abstract
While FLASH radiation therapy is inspiring enthusiasm to transform the field, it is neither new nor well understood with respect to the radiobiological mechanisms. As FLASH clinical trials are designed, it will be important to ensure we can deliver dose consistently and safely to every patient. Much like hyperthermia and proton therapy, FLASH is a promising new technology that will be complex to implement in the clinic and similarly will require customized credentialing for multi‐institutional clinical trials. There is no doubt that FLASH seems promising, but many technologies that we take for granted in conventional radiation oncology, such as rigorous dosimetry, 3D treatment planning, volumetric image guidance, or motion management, may play a major role in defining how to use, or whether to use, FLASH radiotherapy. Given the extended time frame for patients to experience late effects, we recommend moving deliberately but cautiously forward toward clinical trials. In this paper, we review the state of quality assurance and safety systems in FLASH, identify critical pre‐clinical data points that need to be defined, and suggest how lessons learned from previous technological advancements will help us close the gaps and build a successful path to evidence‐driven FLASH implementation.
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Affiliation(s)
- Paige A Taylor
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jean M Moran
- Memorial Sloan Kettering Cancer, New York, New York
| | - David A Jaffray
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey C Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Chan GH, Chin LCL, Abdellatif A, Bissonnette JP, Buckley L, Comsa D, Granville D, King J, Rapley PL, Vandermeer A. Survey of patient-specific quality assurance practice for IMRT and VMAT. J Appl Clin Med Phys 2021; 22:155-164. [PMID: 34145732 PMCID: PMC8292698 DOI: 10.1002/acm2.13294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/03/2021] [Accepted: 05/06/2021] [Indexed: 12/03/2022] Open
Abstract
A first‐time survey across 15 cancer centers in Ontario, Canada, on the current practice of patient‐specific quality assurance (PSQA) for intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) delivery was conducted. The objectives were to assess the current state of PSQA practice, identify areas for potential improvement, and facilitate the continued improvement in standardization, consistency, efficacy, and efficiency of PSQA regionally. The survey asked 40 questions related to PSQA practice for IMRT/VMAT delivery. The questions addressed PSQA policy and procedure, delivery log evaluation, instrumentation, measurement setup and methodology, data analysis and interpretation, documentation, process, failure modes, and feedback. The focus of this survey was on PSQA activities related to routine IMRT/VMAT treatments on conventional linacs, including stereotactic body radiation therapy but excluding stereotactic radiosurgery. The participating centers were instructed to submit answers that reflected the collective view or opinion of their department and represented the most typical process practiced. The results of the survey provided a snapshot of the current state of PSQA practice in Ontario and demonstrated considerable variations in the practice. A large majority (80%) of centers performed PSQA measurements on all VMAT plans. Most employed pseudo‐3D array detectors with a true composite (TC) geometry. No standard approach was found for stopping or reducing frequency of measurements. The sole use of delivery log evaluation was not widely implemented, though most centers expressed interest in adopting this technology. All used the Gamma evaluation method for analyzing PSQA measurements; however, no universal approach was reported on how Gamma evaluation and pass determination criteria were determined. All or some PSQA results were reviewed regularly in two‐thirds of the centers. Planning related issues were considered the most frequent source for PSQA failures (40%), whereas the most frequent course of action for a failed PSQA was to review the result and decide whether to proceed to treatment.
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Affiliation(s)
- Gordon H Chan
- Department of Medical Physics, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Lee C L Chin
- Department of Medical Physics, Odette Cancer Centre, Toronto, Ontario, Canada
| | - Ady Abdellatif
- Department of Medical Physics, R.S. McLaughlin Durham Regional Cancer Centre, Oshawa, Ontario, Canada
| | - Jean-Pierre Bissonnette
- Department of Medical Physics, Princess Margaret Cancer Centre-UHN, Toronto, Ontario, Canada
| | - Lesley Buckley
- Department of Medical Physics, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Daria Comsa
- Radiation Physics Department, Southlake Regional Cancer Centre, Newmarket, Ontario, Canada
| | - Dal Granville
- Department of Medical Physics, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jenna King
- Radiation Oncology Physics, Simcoe Muskoka Regional Cancer Centre, Barrie, Ontario, Canada
| | - Patrick L Rapley
- Medical Physics Department, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Aaron Vandermeer
- Department of Medical Physics, R.S. McLaughlin Durham Regional Cancer Centre, Oshawa, Ontario, Canada
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7
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Marcu LG. The Ever-Changing Role of Medical Physicists in the Era of Personalized Medicine. J Med Phys 2021; 45:197-198. [PMID: 33953493 PMCID: PMC8074720 DOI: 10.4103/jmp.jmp_113_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 11/24/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Loredana G Marcu
- Department of Physics, Faculty of Informatics and Science, University of Oradea, Oradea, Romania.,Cancer Research Institute, University of South Australia, Adelaide, SA, Australia
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8
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Lu L, Chen Y, Shen C, Lian J, Das S, Marks L, Lin W, Zhu T. Initial assessment of 3D magnetic resonance fingerprinting (MRF) towards quantitative brain imaging for radiation therapy. Med Phys 2019; 47:1199-1214. [PMID: 31834641 DOI: 10.1002/mp.13967] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/02/2019] [Accepted: 12/06/2019] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Magnetic resonance fingerprinting (MRF) provides quantitative T1/T2 maps, enabling applications in clinical radiotherapy such as large-scale, multi-center clinical trials for longitudinal assessment of therapy response. We evaluated the feasibility of a quantitative three-dimensional-MRF (3D-MRF) towards its radiotherapy applications of primary brain tumors. METHODS A fast whole-brain 3D-MRF sequence initially developed for diagnostic radiology was optimized using flexible body coils, which is the typical MR imaging setup for radiotherapy treatment planning and for MR imaging (MRI)-guided treatment delivery. Optimization criteria included the accuracy and the precision of T1/T2 quantifications of polyvinylpyrrolidone (PVP) solutions, compared to those from the 3D-MRF using a 32-channel head coil. The accuracy of T1/T2 quantifications from the optimized MRF was first examined in healthy volunteers with two different coil setups. The intra- and inter-scanner variations of image intensity from the optimized sequence were quantified by longitudinal scans of the PVP solutions on two 3T scanners. Using a 3D-printed MRI geometry phantom, susceptibility-induced distortion with the optimized 3D-MRF was quantified as the Dice coefficient of phantom contours, compared to those from CT images. By introducing intentional head motion during 10% of the scan, the robustness of the optimized 3D-MRF towards motion was evaluated through visual inspection of motion artifacts and through quantitative analysis of image sharpness in brain MRF maps. RESULTS The optimized sequence acquired whole-brain T1, T2 and proton density maps and with a resolution of 1.2 × 1.2 × 3 mm3 in 10 min, similar to the total acquisition time of 3D T1- and T2-weighted images of the same resolution. In vivo T1 and T2 values of the white and gray matter were consistent with literature. The intra- and inter-scanner variability of the intensity-normalized MRF T1 was 1.0% ± 0.7% and 2.3% ± 1.0% respectively, in contrast to 5.3% ± 3.8% and 3.2% ± 1.6% from the normalized T1-weighted MRI. Repeatability and reproducibility of MRF T1 were independent of intensity normalization. Both phantom and human data demonstrated that the optimized 3D-MRF is more robust to subject motion and artifacts from subject-specific susceptibility difference. Compared to CT contours, the Dice coefficient of phantom contours from 3D-MRF was 0.93, improved from 0.87 from the T1-weighted MRI. CONCLUSION Compared to conventional MRI, the optimized 3D-MRF demonstrated improved repeatability across time points and reproducibility across scanners for better tissue quantification, as well as improved robustness to subject-specific susceptibility and motion artifacts under a typical MR imaging setup for radiotherapy. More importantly, quantitative MRF T1/T2 measurements lead to promising potentials towards longitudinal quantitative assessment of treatment response for better adaptive therapy and for large-scale, multi-center clinical trials.
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Affiliation(s)
- Lan Lu
- Department of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yong Chen
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Biomedical Research Imaging Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Colette Shen
- Department of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jun Lian
- Department of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shiva Das
- Department of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lawrence Marks
- Department of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Weili Lin
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Biomedical Research Imaging Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tong Zhu
- Department of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Taprogge J, Leek F, Flux GD. Physics aspects of setting up a multicenter clinical trial involving internal dosimetry of radioiodine treatment of differentiated thyroid cancer. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2019; 63:271-277. [PMID: 31315346 DOI: 10.23736/s1824-4785.19.03202-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2024]
Abstract
The field of molecular radiotherapy is expanding rapidly, with the advent of many new radiotherapeutics for the treatment of common as well as for rare cancers. Treatment outcome is dependent on the absorbed doses delivered to target volumes and to healthy organs-at-risk, which are shown to vary widely from fixed administrations of activity. There have been significant developments in quantitative imaging and internal dosimetry in recent years, although clinical implementation of these methods has been slow in comparison with external beam radiotherapy, partly due to there being relatively few patients treated at single centers. Multicenter clinical trials are therefore essential to acquire the data required to ensure best practice and to develop the personalized treatment planning that this area is well suited to, due to the unrivalled opportunity to image the therapeutic drug in vivo. Initial preparation for such trials requires a significant effort in terms of resources and trial design. Imaging systems in participating centers must be characterized and set up for quantitative imaging to allow for collation of data. Data transfer for centralized processing is usually necessary but is hindered in some cases by data protection regulations and local logistics. Recent multicenter clinical trials involving radioiodine therapy have begun to establish the procedures necessary for quantitative SPECT imaging in a multicenter setting using standard and anthropomorphic phantoms. The establishment of national and international multicenter imaging and dosimetry networks will provide frameworks to develop and harmonize best practice with existing therapeutic procedures and to ensure rapid and optimized clinical implementation of new radiotherapeutics across all centers of excellence that offer molecular radiotherapy. This will promote networks and collaborations that can provide a sound basis for further developments and will ensure that nuclear medicine maintains a key role in future developments.
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Affiliation(s)
- Jan Taprogge
- Joint Department of Physics, Royal Marsden NHS Foundation Trust, Sutton, UK -
- The Institute of Cancer Research, London, UK -
| | - Francesca Leek
- Joint Department of Physics, Royal Marsden NHS Foundation Trust, Sutton, UK
- The Institute of Cancer Research, London, UK
| | - Glenn D Flux
- Joint Department of Physics, Royal Marsden NHS Foundation Trust, Sutton, UK
- The Institute of Cancer Research, London, UK
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10
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Villaggi E, Hernandez V, Fusella M, Moretti E, Russo S, Vaccara EML, Nardiello B, Esposito M, Saez J, Cilla S, Marino C, Stasi M, Mancosu P. Plan quality improvement by DVH sharing and planner's experience: Results of a SBRT multicentric planning study on prostate. Phys Med 2019; 62:73-82. [PMID: 31153401 DOI: 10.1016/j.ejmp.2019.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/12/2019] [Accepted: 05/02/2019] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To evaluate, in a multi-institutional context, the role of Dose Volume Histogram (DVH) sharing in order to achieve higher plan quality, to harmonize prostate Stereotactic Body Radiation Therapy (SBRT) plans and to assess if the planner's experience in SBRT could lead to lower dose at organs at risk (OARs). METHODS During the first phase five patients enrolled for prostate SBRT were planned by multiple physicists according to common protocol. The prescription dose was 35 Gy in 5 fractions. Dosimetric parameters, modulation index (MIt), plan parameters, and planner experience level (EL) were statistically analyzed. During the second phase median DVHs from all centers were shared and physicists replanned one patient of the five, aiming at inter-planner harmonization and further OARs sparing. Data were summarized by Spearman-correlogram (p < 0.05) and boxplots. The Kruskal-Wallis test was used to compare the re-plans to the original plans. RESULTS Seventy-eight SBRT plans from 13 centers were evaluated. EL correlated with modulation of plan parameters and reduction of OARs doses, such as volume receiving 28 Gy of rectum (rectum-V28Gy), rectum-V32Gy, and bladder-V30Gy. The re-plans showed significant reduced variability in rectum-V28Gy and increased PTV dose homogeneity. No significant difference in plan complexity metrics and plan parameters between plans and re-plans were obtained. CONCLUSIONS Planner's experience in prostate SBRT was correlated with dosimetric parameters. Sharing median DVHs reduced variability among centers whilst keeping the same level of plan complexity. SBRT planning skills can benefit from a replanning phase after sharing DVHs from multiple centers, improving plan quality and concordance among centers.
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Affiliation(s)
- Elena Villaggi
- Medical Physics Unit, Azienda Unità Sanitaria Locale di Piacenza, Italy.
| | - Victor Hernandez
- Hospital Universitari Sant Joan de Reus, Department of Medical Physics, Tarragona, Spain
| | - Marco Fusella
- Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Eugenia Moretti
- Department of Medical Physics, Azienda Sanitaria Universitaria Integrata di Udine, Italy
| | - Serenella Russo
- Medical Physics Unit, Azienda USL Toscana Centro, Firenze I-50012, Italy
| | | | | | - Marco Esposito
- Medical Physics Unit, Azienda USL Toscana Centro, Firenze I-50012, Italy
| | - Jordi Saez
- Hospital Clinic de Barcelona, Department of Radiation Oncology, Barcelona, Spain
| | - Savino Cilla
- Medical Physics Unit, Fondazione di Ricerca e Cura "Giovanni Paolo II", Campobasso, Italy
| | | | - Michele Stasi
- Department of Medical Physics, Azienda Ospedaliera Ordine Mauriziano di Torino, Turin, Italy
| | - Pietro Mancosu
- Medical Physics Unit of Radiation Oncology Dept., Humanitas Research Hospital, Milano, Italy
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Head and Neck Cancer Adaptive Radiation Therapy (ART): Conceptual Considerations for the Informed Clinician. Semin Radiat Oncol 2019; 29:258-273. [PMID: 31027643 DOI: 10.1016/j.semradonc.2019.02.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
For nearly 2 decades, adaptive radiation therapy (ART) has been proposed as a method to account for changes in head and neck tumor and normal tissue to enhance therapeutic ratios. While technical advances in imaging, planning and delivery have allowed greater capacity for ART delivery, and a series of dosimetric explorations have consistently shown capacity for improvement, there remains a paucity of clinical trials demonstrating the utility of ART. Furthermore, while ad hoc implementation of head and neck ART is reported, systematic full-scale head and neck ART remains an as yet unreached reality. To some degree, this lack of scalability may be related to not only the complexity of ART, but also variability in the nomenclature and descriptions of what is encompassed by ART. Consequently, we present an overview of the history, current status, and recommendations for the future of ART, with an eye toward improving the clarity and description of head and neck ART for interested clinicians, noting practical considerations for implementation of an ART program or clinical trial. Process level considerations for ART are noted, reminding the reader that, paraphrasing the writer Elbert Hubbard, "Art is not a thing, it is a way."
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El Naqa I, Irrer J, Ritter TA, DeMarco J, Al‐Hallaq H, Booth J, Kim G, Alkhatib A, Popple R, Perez M, Farrey K, Moran JM. Machine learning for automated quality assurance in radiotherapy: A proof of principle using
EPID
data description. Med Phys 2019; 46:1914-1921. [DOI: 10.1002/mp.13433] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/02/2019] [Accepted: 01/30/2019] [Indexed: 11/07/2022] Open
Affiliation(s)
- Issam El Naqa
- Department of Radiation Oncology University of Michigan Ann Arbor MI 48103 USA
| | - Jim Irrer
- Department of Radiation Oncology University of Michigan Ann Arbor MI 48103 USA
| | - Tim A. Ritter
- Department of Radiation Oncology Virginia Commonwealth University Richmond VA 23298 USA
| | - John DeMarco
- Department of Radiation Oncology Cedars‐Sinai Medical Center Los Angeles California 90048 USA
| | - Hania Al‐Hallaq
- University of Chicago Radiation and Cellular Oncology Chicago IL 60637 USA
| | - Jeremy Booth
- Royal North Shore Hospital St Leonards New South Wales 2065 Australia
| | - Grace Kim
- University of California at San Diego San Diego CA 92093 USA
| | - Ahmad Alkhatib
- Karmanos Cancer Institute McLaren‐Flint Flint MI 48532 USA
| | - Richard Popple
- University of Alabama at Birmingham Birmingham AL 35249 USA
| | - Mario Perez
- Royal North Shore Hospital St Leonards New South Wales 2065 Australia
| | - Karl Farrey
- University of Chicago Radiation and Cellular Oncology Chicago IL 60637 USA
| | - Jean M. Moran
- Department of Radiation Oncology University of Michigan Ann Arbor MI 48103 USA
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Standardizing Normal Tissue Contouring for Radiation Therapy Treatment Planning: An ASTRO Consensus Paper. Pract Radiat Oncol 2018; 9:65-72. [PMID: 30576843 DOI: 10.1016/j.prro.2018.12.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/29/2018] [Accepted: 12/08/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE The comprehensive identification and delineation of organs at risk (OARs) are vital to the quality of radiation therapy treatment planning and the safety of treatment delivery. This guidance aims to improve the consistency of ontouring OARs in external beam radiation therapy treatment planning by providing a single standardized resource for information regarding specific OARs to be contoured for each disease site. The guidance is organized in table format as a quality assurance tool for practices and a training resource for residents and other radiation oncology students (see supplementary materials). METHODS AND MATERIALS The Task Force formulated recommendations based on clinical practice and consensus. The draft manuscript was peer reviewed by 16 reviewers, the American Society for Radiation Oncology (ASTRO) legal counsel, and ASTRO's Multidisciplinary Quality Assurance Subcommittee and revised accordingly. The recommendations were posted on the ASTRO website for public comment in June 2018 for a 6-week period. The final document was approved by the ASTRO Board of Directors in August 2018. RESULTS Standardization improves patient safety, efficiency, and accuracy in radiation oncology treatment. This consensus guidance represents an ASTRO quality initiative to provide recommendations for the standardization of normal tissue contouring that is performed during external beam treatment planning for each anatomic treatment site. Table 1 defines 2 sets of structures for anatomic sites: Those that are recommended in all adult definitive cases and may assist with organ selection for palliative cases, and those that should be considered on a case-by-case basis depending on the specific clinical scenario. Table 2 outlines some of the resources available to define the parameters of general OAR tissue delineation. CONCLUSIONS Using this paper in conjunction with resources that define tissue parameters and published dose constraints will enable practices to develop a consistent approach to normal tissue evaluation and dose documentation.
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