1
|
Ahmed MM, Wu X, Mohiuddin M, Perez NC, Zhang H, Amendola BE, Malachowska B, Mohiuddin M, Guha C. Optimizing GRID and Lattice Spatially Fractionated Radiation Therapy: Innovative Strategies for Radioresistant and Bulky Tumor Management. Semin Radiat Oncol 2024; 34:310-322. [PMID: 38880540 DOI: 10.1016/j.semradonc.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Treating radioresistant and bulky tumors is challenging due to their inherent resistance to standard therapies and their large size. GRID and lattice spatially fractionated radiation therapy (simply referred to GRID RT and LRT) offer promising techniques to tackle these issues. Both approaches deliver radiation in a grid-like or lattice pattern, creating high-dose peaks surrounded by low-dose valleys. This pattern enables the destruction of significant portions of the tumor while sparing healthy tissue. GRID RT uses a 2-dimensional pattern of high-dose peaks (15-20 Gy), while LRT delivers a three-dimensional array of high-dose vertices (10-20 Gy) spaced 2-5 cm apart. These techniques are beneficial for treating a variety of cancers, including soft tissue sarcomas, osteosarcomas, renal cell carcinoma, melanoma, gastrointestinal stromal tumors (GISTs), pancreatic cancer, glioblastoma, and hepatocellular carcinoma. The specific grid and lattice patterns must be carefully tailored for each cancer type to maximize the peak-to-valley dose ratio while protecting critical organs and minimizing collateral damage. For gynecologic cancers, the treatment plan should align with the international consensus guidelines, incorporating concurrent chemotherapy for optimal outcomes. Despite the challenges of precise dosimetry and patient selection, GRID RT and LRT can be cost-effective using existing radiation equipment, including particle therapy systems, to deliver targeted high-dose radiation peaks. This phased approach of partial high-dose induction radiation therapy with standard fractionated radiation therapy maximizes immune modulation and tumor control while reducing toxicity. Comprehensive treatment plans using these advanced techniques offer a valuable framework for radiation oncologists, ensuring safe and effective delivery of therapy for radioresistant and bulky tumors. Further clinical trials data and standardized guidelines will refine these strategies, helping expand access to innovative cancer treatments.
Collapse
Affiliation(s)
- Mansoor M Ahmed
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, NY.
| | - Xiaodong Wu
- Executive Medical Physics Associates, Miami, FL
| | - Majid Mohiuddin
- Radiation Oncology Consultants and Northwestern Proton Center, Warrenville, IL
| | | | - Hualin Zhang
- Department of Radiation Oncology, University of Southern California, Los Angeles, CA
| | | | - Beata Malachowska
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, NY
| | | | - Chandan Guha
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY
| |
Collapse
|
2
|
Li H, Mayr NA, Griffin RJ, Zhang H, Pokhrel D, Grams M, Penagaricano J, Chang S, Spraker MB, Kavanaugh J, Lin L, Sheikh K, Mossahebi S, Simone CB, Roberge D, Snider JW, Sabouri P, Molineu A, Xiao Y, Benedict SH. Overview and Recommendations for Prospective Multi-institutional Spatially Fractionated Radiation Therapy Clinical Trials. Int J Radiat Oncol Biol Phys 2024; 119:737-749. [PMID: 38110104 PMCID: PMC11162930 DOI: 10.1016/j.ijrobp.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/30/2023] [Accepted: 12/09/2023] [Indexed: 12/20/2023]
Abstract
PURPOSE The highly heterogeneous dose delivery of spatially fractionated radiation therapy (SFRT) is a profound departure from standard radiation planning and reporting approaches. Early SFRT studies have shown excellent clinical outcomes. However, prospective multi-institutional clinical trials of SFRT are still lacking. This NRG Oncology/American Association of Physicists in Medicine working group consensus aimed to develop recommendations on dosimetric planning, delivery, and SFRT dose reporting to address this current obstacle toward the design of SFRT clinical trials. METHODS AND MATERIALS Working groups consisting of radiation oncologists, radiobiologists, and medical physicists with expertise in SFRT were formed in NRG Oncology and the American Association of Physicists in Medicine to investigate the needs and barriers in SFRT clinical trials. RESULTS Upon reviewing the SFRT technologies and methods, this group identified challenges in several areas, including the availability of SFRT, the lack of treatment planning system support for SFRT, the lack of guidance in the physics and dosimetry of SFRT, the approximated radiobiological modeling of SFRT, and the prescription and combination of SFRT with conventional radiation therapy. CONCLUSIONS Recognizing these challenges, the group further recommended several areas of improvement for the application of SFRT in cancer treatment, including the creation of clinical practice guidance documents, the improvement of treatment planning system support, the generation of treatment planning and dosimetric index reporting templates, and the development of better radiobiological models through preclinical studies and through conducting multi-institution clinical trials.
Collapse
Affiliation(s)
- Heng Li
- Department of Radiation Oncology, John Hopkins University, Baltimore, Maryland.
| | - Nina A Mayr
- College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Robert J Griffin
- Department of Radiation Oncology, University of Arkansas for Medical Science, Little Rock, Arkansas
| | - Hualin Zhang
- Department of Radiation Oncology, University of Southern California, Los Angeles, California
| | - Damodar Pokhrel
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky
| | - Michael Grams
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Jose Penagaricano
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Sha Chang
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | | | - James Kavanaugh
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Liyong Lin
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Khadija Sheikh
- Department of Radiation Oncology, John Hopkins University, Baltimore, Maryland
| | - Sina Mossahebi
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York
| | - David Roberge
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - James W Snider
- South Florida Proton Therapy Institute, 5280 Linton Blvd, Delray Beach, Florida
| | - Pouya Sabouri
- Department of Radiation Oncology, University of Arkansas for Medical Science, Little Rock, Arkansas
| | - Andrea Molineu
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stanley H Benedict
- Department of Radiation Oncology, University of California, Davis, Sacramento, California
| |
Collapse
|
3
|
Zhang H, Wu X. Which Modality of SFRT Should be Considered First for Bulky Tumor Radiation Therapy, GRID or LATTICE? Semin Radiat Oncol 2024; 34:302-309. [PMID: 38880539 DOI: 10.1016/j.semradonc.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Spatially fractionated radiation therapy (SFRT), also known as the GRID and LATTICE radiotherapy (GRT, LRT), the concept of treating tumors by delivering a spatially modulated dose with highly non-uniform dose distributions, is a treatment modality of growing interest in radiation oncology, physics, and radiation biology. Clinical experience in SFRT has suggested that GRID and LATTICE therapy can achieve a high response and low toxicity in the treatment of refractory and bulky tumors. Limited initially to GRID therapy using block collimators, advanced, and versatile multi-leaf collimators, volumetric modulated arc technologies and particle therapy have since increased the capabilities and individualization of SFRT and expanded the clinical investigation of SFRT to various dosing regimens, multiple malignancies, tumor types and sites. As a 3D modulation approach outgrown from traditional 2D GRID, LATTICE therapy aims to reconfigure the traditional SFRT as spatial modulation of the radiation is confined solely to the tumor volume. The distinctively different beam geometries used in LATTICE therapy have led to appreciable variations in dose-volume distributions, compared to GRID therapy. The clinical relevance of the variations in dose-volume distribution between LATTICE and traditional GRID therapies is a crucial factor in determining their adoption in clinical practice. In this Point-Counterpoint contribution, the authors debate the pros and cons of GRID and LATTICE therapy. Both modalities have been used in clinics and their applicability and optimal use have been discussed in this article.
Collapse
Affiliation(s)
- Hualin Zhang
- Executive Medical Physics Associates, Miami, FL..
| | - Xiaodong Wu
- Department of Radiation Oncology, University of Southern California, Los Angeles, CA
| |
Collapse
|
4
|
Das IJ, Khan AU, Dogan SK, Longo M. Grid/lattice therapy: consideration of small field dosimetry. Br J Radiol 2024; 97:1088-1098. [PMID: 38552328 PMCID: PMC11135801 DOI: 10.1093/bjr/tqae060] [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: 02/14/2024] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 05/31/2024] Open
Abstract
Small-field dosimetry used in special procedures such as gamma knife, Cyberknife, Tomotherapy, IMRT, and VMAT has been in evolution after several radiation incidences with very significant (70%) errors due to poor understanding of the dosimetry. IAEA-TRS-483 and AAPM-TG-155 have provided comprehensive information on small-fields dosimetry in terms of code of practice and relative dosimetry. Data for various detectors and conditions have been elaborated. It turns out that with a suitable detectors dose measurement accuracy can be reasonably (±3%) achieved for 6 MV beams for fields >1×1 cm2. For grid therapy, even though the treatment is performed with small fields created by either customized blocks, multileaf collimator (MLC), or specialized devices, it is multiple small fields that creates combined treatment. Hence understanding the dosimetry in collection of holes of small field is a separate challenge that needs to be addressed. It is more critical to understand the scattering conditions from multiple holes that form the treatment grid fields. Scattering changes the beam energy (softer) and hence dosimetry protocol needs to be properly examined for having suitable dosimetric parameters. In lieu of beam parameter unavailability in physical grid devices, MLC-based forward and inverse planning is an alternative path for bulky tumours. Selection of detectors in small field measurement is critical and it is more critical in mixed beams created by scattering condition. Ramification of small field concept used in grid therapy along with major consideration of scattering condition is explored. Even though this review article is focussed mainly for dosimetry for low-energy megavoltage photon beam (6 MV) but similar procedures could be adopted for high energy beams. To eliminate small field issues, lattice therapy with the help of MLC is a preferrable choice.
Collapse
Affiliation(s)
- Indra J Das
- Department of Radiation Oncology, Northwest Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Ahtesham Ullah Khan
- San Bortolo Hospital, Medical Physics Department, Viale F. Rodolfi 37, 36100 Vicenza, Italy
| | - Serpil K Dogan
- Department of Radiation Oncology, Northwest Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Mariaconcetta Longo
- San Bortolo Hospital, Medical Physics Department, Viale F. Rodolfi 37, 36100 Vicenza, Italy
| |
Collapse
|
5
|
Zhang H, Ma L, Lim A, Ye J, Lukas L, Li H, Mayr NA, Chang EL. Dosimetric Validation for Prospective Clinical Trial of GRID Collimator-Based Spatially Fractionated Radiation Therapy: Dose Metrics Consistency and Heterogeneous Pattern Reproducibility. Int J Radiat Oncol Biol Phys 2024; 118:565-573. [PMID: 37660738 DOI: 10.1016/j.ijrobp.2023.08.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/19/2023] [Accepted: 08/25/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE Dose heterogeneity within a tumor target is likely responsible for the biologic effects and local tumor control from spatially fractionated radiation therapy (SFRT). This study used a commercially available GRID-pattern dose mudulated nonuniform radiation therapy (GRID) collimator to assess the interplan variability of heterogeneity dose metrics in patients with various bulky tumor sizes and depths. METHODS AND MATERIALS The 3-dimensional heterogeneity metrics of 14 bulky tumors, ranging from 155 to 2161 cm3 in volume, 6 to 23 cm in equivalent diameter, and 3 to 13 cm in depth, and treated with GRID collimator-based SFRT were studied. A prescription dose of 15 Gy was given at the tumor center with 6 MV photons. The dose-volume histogram indices, dose heterogeneity parameters, and peak/valley dose ratios were derived; the equivalent uniform doses of cancer cells with various radiosensitivities in each plan were estimated. To account for the spatial fractionation, high dose core number density of the tumor target was defined and calculated. RESULTS Among 14 plans, the dose-volume histogram indices D5, D10, D50, D90, and D95 (doses covering 5%, 10%, 50%, 90%, and 95% of the target volume) were found within 10% variation. The dose ratio of D10/D90 also showed a moderate consistency (range, 3.9-5.0; mean, 4.4). The equivalent uniform doses were consistent, ranging from 4.3 to 5.5 Gy, mean 4.6 Gy, for radiosensitive cancer cells and from 5.8 to 6.9 Gy, mean 6.2 Gy, for radioresistant cancer cells. The high dose core number density was within 20% among all plans. CONCLUSIONS GRID collimator-based SFRT delivers a consistent heterogeneity dose distribution and high dose core density across bulky tumor plans. The interplan reproducibility and simplicity of GRID therapy may be useful for certain clinical indications and interinstitutional clinical trial design, and its heterogeneity metrics may help guide multileaf-collimator-based SFRT planning to achieve similar or further optimized dose distributions.
Collapse
Affiliation(s)
- Hualin Zhang
- Department of Radiation Oncology, University of Southern California, Los Angeles, California.
| | - Lijun Ma
- Department of Radiation Oncology, University of Southern California, Los Angeles, California
| | - Andrew Lim
- Department of Radiation Oncology, University of Southern California, Los Angeles, California
| | - Jason Ye
- Department of Radiation Oncology, University of Southern California, Los Angeles, California
| | - Lauren Lukas
- Department of Radiation Oncology, University of Southern California, Los Angeles, California
| | - Heng Li
- Department of Radiation Oncology and Molecular Radiation Sciences, John Hopkins University, Baltimore, Maryland
| | - Nina A Mayr
- College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Eric Lin Chang
- Department of Radiation Oncology, University of Southern California, Los Angeles, California
| |
Collapse
|
6
|
At B, Velayudham R. Assessing dosimetric advancements in spatially fractionated radiotherapy: From grids to lattices. Med Dosim 2024:S0958-3947(23)00116-4. [PMID: 38290896 DOI: 10.1016/j.meddos.2023.12.003] [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: 08/17/2023] [Revised: 12/05/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
Spatially fractionated radiotherapy (SFRT) techniques have undergone transformative evolution, encompassing physical GRID therapy, MLC-based grids, virtual TOMO GRIDs, and 3-dimensional high-dose lattices. Historical roots trace back to Alban Köhler's pioneering Spatially fractionated grid therapy (SFGRT), utilizing physical grids for dose modulation. Technological innovations introduced multi-leaf collimators (MLCs), enabling adaptable spatial fractionation and a shift to the broader term "SFRT." Physics and dosimetry-based studies have demonstrated the feasibility of computerized treatment planning and identified the potential to minimize the peripheral dose while using such high-dose therapy. Meanwhile, 3-dimensional high-dose lattices showed enhanced precision. The meticulous placement of high-dose volumetric spheres enables a reduction in the volume of high-dose spills. Advancements in 3-dimensional lattices through intensity-modulated radiotherapy and volumetric modulated arc therapy (VMAT) techniques offer enhanced therapeutic options. A database of SFRT studies identified 723 articles. This review shows the trajectory of SFRT from traditional grids to MLC-based approaches, virtual TOMO GRIDs, and innovative 3-dimensional lattices. Technological innovations, dosimetric advancements, and clinical feasibility have underscored the continual progress in refining spatially fractionated radiotherapy. The integration of MLCs and lattice techniques has demonstrated improved therapeutic outcomes, solidifying their relevance in modern radiation therapy protocols. Research has yet to reveal a clear correlation between treatment outcomes and dosimetric parameters. Additional investigations are necessary to assess the impact of various dosimetric parameters, such as EUD, peak-to-valley ratio (PVDR), D5%, D10%, D20%, D90%, etc., on the effectiveness of treatments.
Collapse
Affiliation(s)
- Bhagyalakshmi At
- Vellore Institute of Technology, Vellore Campus, Katpadi, Tamil Nadu 500036, India; American Oncology Institute at Baby Memorial Hospital, Kozhikode, Kerala 673004, India
| | | |
Collapse
|
7
|
Borzov E, Bar-Deroma R, Lutsyk M. Physical aspects of a spatially fractionated radiotherapy technique for large soft tissue sarcomas. Phys Imaging Radiat Oncol 2022; 22:63-66. [PMID: 35572042 PMCID: PMC9092247 DOI: 10.1016/j.phro.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022] Open
Abstract
This work demonstrates the safety and feasibility of Lattice Radiotherapy (LRT) for large soft tissue sarcoma in neoadjuvant radiotherapy. The treatment consisted of two courses: the LRT course with a single fraction of 20 Gy delivered to high dose nuclei (HDN) regions and the conventional course with 25 fractions of 2 Gy delivered to the planning target volume. HDN shaped as cylinders with a 1 cm diameter and 1 cm height were placed within the gross tumour volume. The number of HDNs and their position were determined based on tumor size and proximity to organs at risk. Three patients were irradiated using the LRT technique.
Collapse
Affiliation(s)
- Egor Borzov
- Corresponding author at: HaAliya HaShniya St 8, Haifa 3109601, Israel.
| | | | | |
Collapse
|
8
|
Moghaddasi L, Reid P, Bezak E, Marcu LG. Radiobiological and Treatment-Related Aspects of Spatially Fractionated Radiotherapy. Int J Mol Sci 2022; 23:3366. [PMID: 35328787 PMCID: PMC8954016 DOI: 10.3390/ijms23063366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/13/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022] Open
Abstract
The continuously evolving field of radiotherapy aims to devise and implement techniques that allow for greater tumour control and better sparing of critical organs. Investigations into the complexity of tumour radiobiology confirmed the high heterogeneity of tumours as being responsible for the often poor treatment outcome. Hypoxic subvolumes, a subpopulation of cancer stem cells, as well as the inherent or acquired radioresistance define tumour aggressiveness and metastatic potential, which remain a therapeutic challenge. Non-conventional irradiation techniques, such as spatially fractionated radiotherapy, have been developed to tackle some of these challenges and to offer a high therapeutic index when treating radioresistant tumours. The goal of this article was to highlight the current knowledge on the molecular and radiobiological mechanisms behind spatially fractionated radiotherapy and to present the up-to-date preclinical and clinical evidence towards the therapeutic potential of this technique involving both photon and proton beams.
Collapse
Affiliation(s)
- Leyla Moghaddasi
- Department of Medical Physics, Austin Health, Ballarat, VIC 3350, Australia;
- School of Physical Sciences, University of Adelaide, Adelaide, SA 5001, Australia;
| | - Paul Reid
- Radiation Health, Environment Protection Authority, Adelaide, SA 5000, Australia;
| | - Eva Bezak
- School of Physical Sciences, University of Adelaide, Adelaide, SA 5001, Australia;
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia
| | - Loredana G. Marcu
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia
- Faculty of Informatics and Science, University of Oradea, 1 Universitatii Str., 410087 Oradea, Romania
| |
Collapse
|
9
|
Mayr NA, Snider JW, Regine WF, Mohiuddin M, Hippe DS, Peñagarícano J, Mohiuddin M, Kudrimoti MR, Zhang H, Limoli CL, Le QT, Simone CB. An International Consensus on the Design of Prospective Clinical–Translational Trials in Spatially Fractionated Radiation Therapy. Adv Radiat Oncol 2022; 7:100866. [PMID: 35198833 PMCID: PMC8843999 DOI: 10.1016/j.adro.2021.100866] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/12/2021] [Indexed: 12/17/2022] Open
Abstract
Purpose Spatially fractionated radiation therapy (SFRT), which delivers highly nonuniform dose distributions instead of conventionally practiced homogeneous tumor dose, has shown high rates of clinical response with minimal toxicities in large-volume primary or metastatic malignancies. However, prospective multi-institutional clinical trials in SFRT are lacking, and SFRT techniques and dose parameters remain variable. Agreement on dose prescription, technical administration, and clinical and translational design parameters for SFRT trials is essential to enable broad participation and successful accrual to rigorously test the SFRT approach. We aimed to develop a consensus for the design of multi-institutional clinical trials in SFRT, tailored to specific primary tumor sites, to help facilitate development and enhance the feasibility of such trials. Methods and Materials Primary tumor sites with sufficient pilot experience in SFRT were identified, and fundamental trial design questions were determined. For each tumor site, a comprehensive consensus effort was established through disease-specific expert panels. Clinical trial design criteria included eligibility, SFRT technology and technique, dose and fractionation, target- and normal-tissue dose parameters, systemic therapies, clinical trial endpoints, and translational science considerations. Iterative appropriateness rank voting, expert panel consensus reviews and discussions, and public comment posting were used for consensus development. Results Clinical trial criteria were developed for head and neck cancer and soft-tissue sarcoma. Final consensus among the 22 trial design categories each (a total of 163 criteria) was high to moderate overall. Uniform patient cohorts of advanced bulky disease, standardization of SFRT technologies and dosimetry and physics parameters, and collection of translational correlates were considered essential to trial design. Final guideline recommendations and the degree of agreement are presented and discussed. Conclusions This consensus provides design guidelines for the development of prospective multi-institutional clinical trials testing SFRT in advanced head and neck cancer and soft-tissue sarcoma through in-advance harmonization of the fundamental clinical trial design among SFRT experts, potential investigators, and the SFRT community.
Collapse
Affiliation(s)
- Nina A. Mayr
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
- Tumor Heterogeneity Imaging and Radiomics Laboratory, University of Washington School of Medicine, Seattle, Washington
- Corresponding author: Nina A. Mayr, MD
| | - James W. Snider
- Department of Radiation Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - William F. Regine
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Majid Mohiuddin
- Radiation Oncology Consultants and Northwestern Proton Center, Warrenville, Illinois
| | - Daniel S. Hippe
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | - Mahesh R. Kudrimoti
- Department of Radiation Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Hualin Zhang
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Charles L. Limoli
- Department of Radiation Oncology, University of California School of Medicine, Irvine, Irvine, California
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Charles B. Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York
| |
Collapse
|
10
|
Guerrieri P, Jacob NK, Maxim PG, Sawant A, Van Nest SJ, Mohindra P, Dominello MM, Burmeister JW, Joiner MC. Three discipline collaborative radiation therapy (3DCRT) special debate: FLASH radiotherapy needs ongoing basic and animal research before implementing it to a large clinical scale. J Appl Clin Med Phys 2022; 23:e13547. [PMID: 35104025 PMCID: PMC8992943 DOI: 10.1002/acm2.13547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Patrizia Guerrieri
- Department of Radiation Oncology, Bon Secours Mercy Health, Youngstown, Ohio, USA
| | | | - Peter G Maxim
- Department of Radiation Oncology, University of California, Irvine, California, USA
| | - Amit Sawant
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland, USA.,Maryland Proton Treatment Center, Baltimore, Maryland, USA
| | - Samantha J Van Nest
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland, USA.,Maryland Proton Treatment Center, Baltimore, Maryland, USA
| | | | - Jay W Burmeister
- Department of Oncology, Wayne State University, Detroit, Michigan, USA.,Gershenson Radiation Oncology Center, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Michael C Joiner
- Department of Oncology, Wayne State University, Detroit, Michigan, USA
| |
Collapse
|
11
|
Cozzi L, Beriwal S, Kuusela E, Chopra S, Burger H, Joubert N, Fogliata A, Agarwal JP, Kupelian P. A novel external beam radiotherapy method for cervical cancer patients using virtual straight or bending boost areas; an in-silico feasibility study. Radiat Oncol 2021; 16:110. [PMID: 34127013 PMCID: PMC8201836 DOI: 10.1186/s13014-021-01838-x] [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: 04/09/2021] [Accepted: 06/10/2021] [Indexed: 12/09/2022] Open
Abstract
Aim To investigate the potential role of a novel spatially fractionated radiation therapy (SFRT) method where heterogeneous dose patterns are created in target areas with virtual rods, straight or curving, of variable position, diameter, separation and alignment personalised to a patient’s anatomy. The images chosen for this study were CT scans acquired for the external beam part of radiotherapy. Methods Ten patients with locally advanced cervical cancer were retrospectively investigated with SFRT. The dose prescription was 30 Gy in 5 fractions to 90% target volume coverage. Peak-and-valley (SFRT_1) and peak-only (SFRT_2) strategies were applied to generate the heterogeneous dose distributions. The planning objectives for the target (CTV) were D90% ≥ 30 Gy, V45Gy ≥ 50–55% and V60Gy ≥ 30%. The planning objectives for the organs at risk (OAR) were: D2cm3 ≤ 23.75 Gy, 17.0 Gy, 19.5 Gy, 17.0 Gy for the bladder, rectum, sigmoid and bowel, respectively. The plan comparison was performed employing the quantitative analysis of the dose-volume histograms. Results The D2cm3 was 22.4 ± 2.0 (22.6 ± 2.1) and 13.9 ± 2.9 (13.2 ± 3.0) for the bladder and the rectum for SFRT_1 (SFRT_2). The results for the sigmoid and the bowel were 2.6 ± 3.1 (2.8 ± 3.0) and 9.1 ± 5.9 (9.7 ± 7.3), respectively. The hotspots in the target volume were V45Gy = 43.1 ± 7.5% (56.6 ± 5.6%) and V60Gy = 15.4 ± 5.6% (26.8 ± 6.6%) for SFRT_1 (SFRT_2). To account for potential uncertainties in the positioning, the dose prescription could be escalated to D90% = 33–35 Gy to the CTV without compromising any constraints to the OARs Conclusion In this dosimetric study, the proposed novel planning technique for boosting the cervix uteri was associated with high-quality plans, respecting constraints for the organs at risk and approaching the level of dose heterogeneity achieved with routine brachytherapy. Based on a sample of 10 patients, the results are promising and might lead to a phase I clinical trial. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01838-x.
Collapse
Affiliation(s)
- Luca Cozzi
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital and Cancer Center, Via Manzoni 56, 20089, Milan-Rozzano, Italy. .,Varian Medical Systems, Palo Alto, USA.
| | - Sushil Beriwal
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Esa Kuusela
- Varian Medical Systems Finland, Helsinki, Finland
| | - Supriya Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
| | - Hester Burger
- Division of Medical Physics, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Nanette Joubert
- Division of Medical Physics, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Antonella Fogliata
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital and Cancer Center, Via Manzoni 56, 20089, Milan-Rozzano, Italy
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhaba National Institute, Mumbai, India
| | - Pat Kupelian
- Varian Medical Systems, Palo Alto, USA.,Radiation Oncology Dept, University of California, Los Angeles, USA
| |
Collapse
|