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Marcello M, Denham JW, Kennedy A, Haworth A, Steigler A, Greer PB, Holloway LC, Dowling JA, Jameson MG, Roach D, Joseph DJ, Gulliford SL, Dearnaley DP, Sydes MR, Hall E, Ebert MA. Relationships between rectal and perirectal doses and rectal bleeding or tenesmus in pooled voxel-based analysis of 3 randomised phase III trials. Radiother Oncol 2020; 150:281-292. [PMID: 32745667 DOI: 10.1016/j.radonc.2020.07.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to identify anatomically-localised regions where planned radiotherapy dose is associated with gastrointestinal toxicities in healthy tissues throughout the pelvic anatomy. MATERIALS AND METHODS Planned dose distributions for up to 657 patients of the Trans Tasman Radiation Oncology Group 03.04 RADAR trial were deformably registered onto a single exemplar computed tomography dataset. Voxel-based multiple comparison permutation dose difference testing, Cox regression modelling and LASSO feature selection were used to identify regions where dose-increase was associated with grade ≥2 rectal bleeding (RB) or tenesmus, according to the LENT/SOMA scale. This was externally validated by registering dose distributions from the RT01 (n = 388) and CHHiP (n = 241) trials onto the same exemplar and repeating the tests on each of these data sets, and on all three datasets combined. RESULTS Voxel-based Cox regression and permutation dose difference testing revealed regions where increased dose was correlated with gastrointestinal toxicity. Grade ≥2 RB was associated with posteriorly extended lateral beams that manifested high doses (>55 Gy) in a small rectal volume adjacent to the clinical target volume. A correlation was found between grade ≥2 tenesmus and increased low-intermediate dose (∼25 Gy) at the posterior beam region, including the posterior rectum and perirectal fat space (PRFS). CONCLUSIONS The serial response of the rectum with respect to RB has been demonstrated in patients with posteriorly extended lateral beams. Similarly, the parallel response of the PRFS with respect to tenesmus has been demonstrated in patients treated with the posterior beam.
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Affiliation(s)
- Marco Marcello
- Department of Physics, University of Western Australia, Crawley, Australia; Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia.
| | - James W Denham
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Angel Kennedy
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Annette Haworth
- School of Physics, University of Sydney, Camperdown, Australia
| | - Allison Steigler
- Prostate Cancer Trials Group, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Peter B Greer
- School of Mathematical and Physical Sciences, University of Newcastle, Callaghan, Australia; Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, Australia
| | - Lois C Holloway
- Department of Medical Physics, Liverpool Cancer Centre, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia; Centre for Medical Radiation Physics, University of Wollongong, Australia
| | - Jason A Dowling
- School of Mathematical and Physical Sciences, University of Newcastle, Callaghan, Australia; CSIRO, Herston, Australia
| | - Michael G Jameson
- Department of Medical Physics, Liverpool Cancer Centre, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia; Centre for Medical Radiation Physics, University of Wollongong, Australia; Cancer Research Team, Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Dale Roach
- Department of Medical Physics, Liverpool Cancer Centre, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia; Cancer Research Team, Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - David J Joseph
- School of Surgery, University of Western Australia, Crawley, Australia; 5D Clinics, Claremont, Australia; GenesisCare WA, Wembley, Australia
| | - Sarah L Gulliford
- Radiotherapy Department, University College London Hospitals NHS Foundation Trust, United Kingdom; Department of Medical Physics and Biomedical Engineering, University College London, United Kingdom
| | - David P Dearnaley
- Academic UroOncology Unit, The Institute of Cancer Research and the Royal Marsden NHS Trust, London, Australia
| | - Mathew R Sydes
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College, London, United Kingdom
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, United Kingdom
| | - Martin A Ebert
- Department of Physics, University of Western Australia, Crawley, Australia; Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia; 5D Clinics, Claremont, Australia
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A M, N R, M M, B NM, H OT. Comparison of Radiobiological Models for Radiation Therapy Plans of Prostate Cancer: Three-dimensional Conformal versus Intensity Modulated Radiation Therapy. J Biomed Phys Eng 2019; 9:267-278. [PMID: 31341872 PMCID: PMC6613163 DOI: 10.31661/jbpe.v9i3jun.655] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 12/08/2016] [Indexed: 02/07/2023]
Abstract
Purpose: In the current study, using different radiobiological models, tumor control probability (TCP) and normal tissue complication probability (NTCP) of radiotherapy plans were calculated for three-dimensional conformal radiation therapy (3D-CRT) and intensity modulated radiation therapy (IMRT) of prostate cancer.
Methods and Materials: 10 prostate plans were randomly selected among patients undergoing radiation therapy of prostate cancer. For each patient, 3D-CRT and IMRT plans were designed to deliver, on average 76 Gy and 82 Gy to planning target volume, respectively. Using different radiobiological models including Poisson, equivalent uniform dose (EUD) and Lyman-Kutcher-Burman (LKB), TCP and NTCP were calculated for prostate and critical organs including bladder, rectum and femoral heads.
Results: IMRT plans provided significantly lower NTCP for bladder, rectum and femoral heads using LKB and EUD models (p-value <0.05). The EUD-calculated TCP for prostate cancer revealed no considerable improvement for IMRT plans relative to 3D-CRT plans. However, the TCPs calculated by Poisson model were dependent on α/β, and higher TCP for IMRT relative to 3D-CRT was seen for α/β higher than 5.
Conclusion: It can be concluded that IMRT plans were superior to 3D-CRT plans in terms of estimated NTCP for studied critical organs. On the other hand, different mathematical models provided different quantitative outcome for TCP of prostate cancer plans. More clinical studies are suggested to confirm the accuracy of studied radiobiological models.
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Affiliation(s)
- Mesbahi A
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Medical Physics Department, Medical School, Tabriz University of Medical Sciences, Tabriz, Iran
- Radiation Oncology Department, Imam Hospital, Tabriz, Iran
| | - Rasouli N
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Medical Physics Department, Medical School, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Nasiri Motlagh B
- Radiation Oncology Department, Imam Hospital, Tabriz, Iran
- Radiation Oncology Department, Tabriz International Hospital, Tabriz, Iran
| | - Ozan Tekin H
- Vocational School of Health Services, Üsküdar University, Istanbul, Turkey
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Dréan G, Acosta O, Ospina JD, Fargeas A, Lafond C, Corrégé G, Lagrange JL, Créhange G, Simon A, Haigron P, de Crevoisier R. Identification of a rectal subregion highly predictive of rectal bleeding in prostate cancer IMRT. Radiother Oncol 2016; 119:388-97. [PMID: 27173457 DOI: 10.1016/j.radonc.2016.04.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/14/2016] [Accepted: 04/16/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE To identify rectal subregions at risks (SRR) highly predictive of 3-year rectal bleeding (RB) in prostate cancer IMRT. MATERIALS AND METHODS Overall, 173 prostate cancer patients treated with IMRT/IGRT were prospectively analyzed, divided into "training" (n=118) and "validation" cohorts (n=53). Dose-volume histograms (DVHs) were calculated in three types of rectal subregions: "geometric", intuitively defined (hemi-rectum,…); "personalized", obtained by non-rigid registration followed by voxel-wise statistical analysis (SRRp); "generic", mapped from SRRps, located within 8×8 rectal subsections (SRRg). DVHs from patients with and without RB were compared and used for toxicity prediction. RESULTS Training cohort SRRps were primarily within the inferior anterior hemi-rectum and upper anal canal, with 3.8Gy mean dose increase for Grade⩾1 RB patients. The SRRg, representing 15% of the absolute rectal volume, was located in 10 inferior-anterior rectal subsections. V18-V70 for SRRps and V58-V65 for SRRg were significantly higher for RB patients than non-RB. Maximum areas under the curve (AUCs) for SRRp and SRRg RB prediction were 71% and 64%, respectively. The validation cohort confirmed the predictive value of SRRg for Grade⩾1 RB. The total cohort confirmed the predictive value of SRRg for Grade⩾2 RB. Geometrical subregions were not RB predictors. CONCLUSION The inferior-anterior hemi anorectum was highly predictive of RB.
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Affiliation(s)
- Gaël Dréan
- INSERM 1099, Rennes, France; LTSI, Université de Rennes 1, Rennes, France
| | - Oscar Acosta
- INSERM 1099, Rennes, France; LTSI, Université de Rennes 1, Rennes, France
| | - Juan D Ospina
- INSERM 1099, Rennes, France; LTSI, Université de Rennes 1, Rennes, France
| | - Auréline Fargeas
- INSERM 1099, Rennes, France; LTSI, Université de Rennes 1, Rennes, France
| | - Caroline Lafond
- INSERM 1099, Rennes, France; LTSI, Université de Rennes 1, Rennes, France; Département de radiothérapie, Centre Eugène Marquis, Rennes, France
| | | | - Jean-L Lagrange
- Hôpital Henri Mondor, France; UPEC, Université Paris Est Créteil, France
| | | | - Antoine Simon
- INSERM 1099, Rennes, France; LTSI, Université de Rennes 1, Rennes, France
| | - Pascal Haigron
- INSERM 1099, Rennes, France; LTSI, Université de Rennes 1, Rennes, France
| | - Renaud de Crevoisier
- INSERM 1099, Rennes, France; LTSI, Université de Rennes 1, Rennes, France; Département de radiothérapie, Centre Eugène Marquis, Rennes, France.
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Jereczek-Fossa BA, Ciardo D, Ferrario S, Fossati P, Fanetti G, Zerini D, Zannoni D, Fodor C, Gerardi MA, Surgo A, Muto M, Cambria R, De Cobelli O, Orecchia R. No increase in toxicity of pelvic irradiation when intensity modulation is employed: clinical and dosimetric data of 208 patients treated with post-prostatectomy radiotherapy. Br J Radiol 2016; 89:20150985. [PMID: 27109736 DOI: 10.1259/bjr.20150985] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To compare the toxicity of image-guided intensity-modulated radiotherapy (IG-IMRT) to the pelvis or prostate bed (PB) only. To test the hypothesis that the potentially injurious effect of pelvic irradiation can be counterbalanced by reduced irradiated normal tissue volume using IG-IMRT. METHODS Between February 2010 and February 2012, 208 patients with prostate cancer were treated with adjuvant or salvage IG-IMRT to the PB (102 patients, Group PB) or the pelvis and prostate bed (P) (106 patients, Group P). The Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria were used to evaluate toxicity. RESULTS Median follow-up was 27 months. Toxicity G ≥ 2 in Group PB: in the bowel acute and late toxicities were 11.8% and 10%, respectively; urinary acute and late toxicities were 10.8% and 15%, respectively. Toxicity G ≥ 2 in Group P: in the bowel acute and late toxicities were both 13.2%; urinary acute and late toxicities were 13.2% and 15.1%, respectively. No statistical difference in acute or late toxicity between the groups was found (bowel: p = 0.23 and p = 0.89 for acute and late toxicity, respectively; urinary: p = 0.39 and p = 0.66 for acute and late toxicity, respectively). Of the clinical variables, only previous abdominal surgery was correlated with acute bowel toxicity. Dosimetric parameters that correlated with bowel toxicity were identified. CONCLUSION The toxicity rates were low and similar in both groups, suggesting that IG-IMRT allows for a safe post-operative irradiation of larger volumes. Further investigation is warranted to exclude bias owing to non-randomized character of the study. ADVANCES IN KNOWLEDGE Our report shows that modern radiotherapy technology and careful planning allow maintaining the toxicity of pelvic lymph node treatment at the acceptable level, as it is in the case of PB radiotherapy.
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Affiliation(s)
- Barbara A Jereczek-Fossa
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.,2 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Delia Ciardo
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Silvia Ferrario
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.,2 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Piero Fossati
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.,2 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Giuseppe Fanetti
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.,2 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Dario Zerini
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | | | - Cristiana Fodor
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Marianna A Gerardi
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.,2 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Alessia Surgo
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.,2 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Matteo Muto
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.,2 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Raffaella Cambria
- 4 Division of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Ottavio De Cobelli
- 2 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,5 Division of Urology, European Institute of Oncology, Milan, Italy
| | - Roberto Orecchia
- 1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.,2 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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Prevention and Management of Radiation-induced Late Gastrointestinal Toxicity. Clin Oncol (R Coll Radiol) 2015; 27:656-67. [DOI: 10.1016/j.clon.2015.06.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 05/26/2015] [Accepted: 06/09/2015] [Indexed: 12/18/2022]
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Coloigner J, Fargeas A, Kachenoura A, Wang L, Drean G, Lafond C, Senhadji L, de Crevoisier R, Acosta O, Albera L. A Novel Classification Method for Prediction of Rectal Bleeding in Prostate Cancer Radiotherapy Based on a Semi-Nonnegative ICA of 3D Planned Dose Distributions. IEEE J Biomed Health Inform 2015; 19:1168-77. [DOI: 10.1109/jbhi.2014.2328315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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7
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Cambria R, Cattani F, Jereczek-Fossa BA, Pansini F, Ciardo D, Vigorito S, Russo S, Zerini D, Cozzi L, Orecchia R. Planning study to compare dynamic and rapid arc techniques for postprostatectomy radiotherapy of prostate cancer. Strahlenther Onkol 2014; 190:569-74. [PMID: 24557057 DOI: 10.1007/s00066-014-0601-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 11/18/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare our standard technique for postprostatectomy radiotherapy of prostate cancer, i.e. using two lateral conformal dynamic arcs with volumetric-modulated arc therapy (VMAT) performed with the RapidArc(®) (Varian Medical Systems, Palo Alto, CA, USA). The plans were referred to as DA and RA, respectively. MATERIALS AND METHODS The treatment plans of 44 patients receiving adjuvant/salvage radiotherapy in the first months of 2010 were compared. In all cases, the prescribed total dose was 66-68.2 Gy (2.2 Gy per fraction). Both DA and RA plans were optimized in terms of dose coverage and constraints. RESULTS Small differences between the techniques were observed for planning target volume (PTV) dose distribution, whereas significant differences in sparing of organs at risk (OARs) were recorded (p < 0.0001). The OAR values (median; 95 % confidence interval, CI) were: rectum: D30 % = 60.7 Gy (59.40-62.04 Gy) and 48.2 Gy (46.40-52.72 Gy), D60 % = 34.1 Gy (28.50-38.92 Gy) and 27.7 Gy (21.80-31.51 Gy); bladder: D30 % = 57.3 Gy (45.83-64.53 Gy) and 46.4 Gy (33.23-61.48 Gy), D50 % = 16.4 Gy (11.89-42.38 Gy) and 17.2 Gy (10.97-27.90 Gy), for DA and RA, respectively. Treatment times were very similar, whereas the monitor units (MU) were 550 ± 29 versus 277 ± 3 for RA and DA, respectively. CONCLUSION Dose-volume histograms (DVHs) show improvements in OAR sparing with RA. However, the RA technique is associated with almost double the number of MUs compared to DA. Regarding the PTV, DA is slightly superior in terms of D2 % and dose homogeneity. On the whole, the results suggest that RA be the favorable technique.
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Affiliation(s)
- R Cambria
- Department of Medical Physics, Istituto Europeo di Oncologia, via Ripamonti 435, 20141, Milan, Italy,
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Gez E, Cytron S, Ben Yosef R, London D, Corn BW, Alani S, Scarzello G, Dal Moro F, Sotti G, Zattoni F, Koziol I, Torre T, Bassignani M, Kalnicki S, Ghavamian R, Blakaj D, Anscher M, Sommerauer M, Jocham D, Melchert C, Huttenlocher S, Kovacs G, Garg M. Application of an interstitial and biodegradable balloon system for prostate-rectum separation during prostate cancer radiotherapy: a prospective multi-center study. Radiat Oncol 2013; 8:96. [PMID: 23618548 PMCID: PMC3643836 DOI: 10.1186/1748-717x-8-96] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 03/28/2013] [Indexed: 12/21/2022] Open
Abstract
Background and purpose Rectal toxicity presents a significant limiting factor in prostate radiotherapy regimens. This study evaluated the safety and efficacy of an implantable and biodegradable balloon specifically designed to protect rectal tissue during radiotherapy by increasing the prostate–rectum interspace. Patients and methods Balloons were transperineally implanted, under transrectal ultrasound guidance, into the prostate–rectum interspace in 27 patients with localized prostate cancer scheduled to undergo radiotherapy. Patients underwent two simulations for radiotherapy planning--the first simulation before implant, and the second simulation seven days post implant. The balloon position, the dimensions of the prostate, and the distance between the prostate and rectum were evaluated by CT/US examinations 1 week after the implant, weekly during the radiotherapy period, and at 3 and 6 months post implant. Dose-volume histograms of pre and post implantation were compared. Adverse events were recorded throughout the study period. Results Four of 27 patients were excluded from the evaluation. One was excluded due to a technical failure during implant, and three patients were excluded because the balloon prematurely deflated. The balloon status was evaluated for the duration of the radiotherapy period in 23 patients. With the balloon implant, the distance between the prostate and rectum increased 10-fold, from a mean 0.22 ± 0.2 cm to 2.47 ± 0.47 cm. During the radiotherapy period the balloon length changed from 4.25 ± 0.49 cm to 3.81 ± 0.84 cm and the balloon height from 1.86 ± 0.24 cm to 1.67 ± 0.22 cm. But the prostate-rectum interspace distance remained constant from beginning to end of radiotherapy: 2.47 ± 0.47 cm and 2.41 ± 0.43 cm, respectively. A significant mean reduction in calculated rectal radiation exposure was achieved. The implant procedure was well tolerated. The adverse events included mild pain at the perineal skin and in the anus. Three patients experienced acute urinary retention which resolved in a few hours following conservative treatment. No infections or thromboembolic events occurred during the implant procedure or during the radiotherapy period. Conclusion The transperineal implantation of the biodegradable balloon in patients scheduled to receive radiotherapy was safe and achieved a significant and constant gap between the prostate and rectum. This separation resulted in an important reduction in the rectal radiation dose. A prospective study to evaluate the acute and late rectal toxicity is needed.
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Acosta O, Drean G, Ospina JD, Simon A, Haigron P, Lafond C, de Crevoisier R. Voxel-based population analysis for correlating local dose and rectal toxicity in prostate cancer radiotherapy. Phys Med Biol 2013; 58:2581-95. [PMID: 23528429 DOI: 10.1088/0031-9155/58/8/2581] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The majority of current models utilized for predicting toxicity in prostate cancer radiotherapy are based on dose-volume histograms. One of their main drawbacks is the lack of spatial accuracy, since they consider the organs as a whole volume and thus ignore the heterogeneous intra-organ radio-sensitivity. In this paper, we propose a dose-image-based framework to reveal the relationships between local dose and toxicity. In this approach, the three-dimensional (3D) planned dose distributions across a population are non-rigidly registered into a common coordinate system and compared at a voxel level, therefore enabling the identification of 3D anatomical patterns, which may be responsible for toxicity, at least to some extent. Additionally, different metrics were employed in order to assess the quality of the dose mapping. The value of this approach was demonstrated by prospectively analyzing rectal bleeding (≥Grade 1 at 2 years) according to the CTCAE v3.0 classification in a series of 105 patients receiving 80 Gy to the prostate by intensity modulated radiation therapy (IMRT). Within the patients presenting bleeding, a significant dose excess (6 Gy on average, p < 0.01) was found in a region of the anterior rectal wall. This region, close to the prostate (1 cm), represented less than 10% of the rectum. This promising voxel-wise approach allowed subregions to be defined within the organ that may be involved in toxicity and, as such, must be considered during the inverse IMRT planning step.
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Cambria R, Jereczek-Fossa BA, Zerini D, Cattani F, Serafini F, Luraschi R, Pedroli G, Orecchia R. Physical and clinical implications of radiotherapy treatment of prostate cancer using a full bladder protocol. Strahlenther Onkol 2011; 187:799-805. [PMID: 22127358 DOI: 10.1007/s00066-011-2259-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 06/16/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the dosimetric and clinical implication when applying the full bladder protocol for the treatment of the localized prostate cancer (PCA). PATIENTS AND METHODS A total of 26 consecutive patients were selected for the present study. Patients underwent two series of CT scans: the day of the simulation and after 40 Gy. Each series consisted of two consecutive scans: (1) full bladder (FB) and (2) empty bladder (EB). The contouring of clinical target volumes (CTVs) and organs at risk (OAR) were compared to evaluate organ motion. Treatment plans were compared by dose distribution and dose-volume histograms (DVH). RESULTS CTV shifts were negligible in the laterolateral and superior-inferior directions (the maximum shift was 1.85 mm). Larger shifts were recorded in the anterior-posterior direction (95% CI, 0.83-4.41 mm). From the dosimetric point of view, shifts are negligible: the minimum dose to the CTV was 98.5% (median; 95%CI, 95-99%). The potential advantage for GU toxicity in applying the FB treatment protocol was measured: the ratio between full and empty bladder dose-volume points (selected from our protocol) is below 0.61, excluding the higher dose region where DVHs converge. CONCLUSION Having a FB during radiotherapy does not affect treatment effectiveness, on the contrary it helps achieve a more favorable DVH and lower GU toxicities.
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Affiliation(s)
- Raffaella Cambria
- Department of Medical Physics, Istituto Europeo di Oncologia, Milan, Italy.
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11
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Pella A, Cambria R, Riboldi M, Jereczek-Fossa BA, Fodor C, Zerini D, Torshabi AE, Cattani F, Garibaldi C, Pedroli G, Baroni G, Orecchia R. Use of machine learning methods for prediction of acute toxicity in organs at risk following prostate radiotherapy. Med Phys 2011; 38:2859-67. [PMID: 21815361 DOI: 10.1118/1.3582947] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The goal of this study is to investigate the advantages of large scale optimization methods vs conventional classification techniques in predicting acute toxicity for urinary bladder and rectum due to prostate irradiation. METHODS Clinical and dosimetric data of 321 patients undergoing prostate conformal radiotherapy were recorded. Gastro-intestinal and genito-urinary acute toxicities were scored according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) scale. Patients were classified in two categories to separate mild (Grade < 2) from severe toxicity levels (Grade > 2). Machine learning methods at different complexity were implemented to predict toxicity as a function of multiple variables. The first approach consisted of a large scale optimization method, based on genetic algorithms (GAs) and artificial neural networks (ANN). The second approach was a binary classifier based on support vector machines (SVM). RESULTS The ANN and SVM-based solutions showed comparable prediction accuracy, exhibiting an area under the receiver operating characteristic (ROC) curve of 0.7. Different sensitivity and specificity features were measured for the two approaches. The ANN algorithm showed enhanced sensitivity if combined with appropriate classification criteria. CONCLUSIONS The results demonstrate that high sensitivity in toxicity prediction can be achieved with optimized ANNs, that are put forward to represent a valuable support in medical decisions. Future studies will be focused on enlarging the available patient database to increase the reliability of toxicity prediction algorithms and to define optimal classification criteria.
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Affiliation(s)
- Andrea Pella
- TBMLab, Department of Bioengineering, Politecnico di Milano University, 20133 Milano, Italy.
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Portaluri M, Fucilli FIM, Gianicolo EAL, Tramacere F, Francavilla MC, De Tommaso C, Castagna R, Pili G. Collection and evaluation of incidents in a radiotherapy department : a reactive risk analysis. Strahlenther Onkol 2010; 186:693-9. [PMID: 21140128 DOI: 10.1007/s00066-010-2141-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 06/14/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE to report on the use of an internal system for incident reporting. PATIENTS AND METHODS from October 2001 until June 2009, data on incidents were collected in the radiotherapy department (RT) by means of an incident reporting worksheet. The risk analysis was based on the US Navy method of mishap cause investigation, the Human Factors Analysis and Classification System (HFACS). RESULTS 37 incidents over 5,635 treatments were collected. Of the incidents, 20 involved deviation of the dose to the patient; only 6 showed clinical evidence of overdosage, while 2 of them showed permanent evidence of overdosage. There were 24 incidents that were classified as near misses (NM). Incorrect data input and use of an incorrect treatment field were the most common causes of the registered incidents. Reactive risk analysis showed how skill-based errors were associated with attention failure at the unsafe act level. Dose prescription and dose calculation are the most critical phases of the entire process. Most of the errors were discovered in set-up/treatment and during treatment visit/follow-up phases. The highest number of correction procedures was necessary in the phases of dose prescription and dose calculation. CONCLUSION collecting and analyzing internal incidents improves the operative procedures used in the department.
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Affiliation(s)
- Maurizio Portaluri
- Department of Radiotherapy, "A. Perrino" General Hospital, ASL Brindisi, Italy.
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Acosta O, Dowling J, Cazoulat G, Simon A, Salvado O, de Crevoisier R, Haigron P. Atlas Based Segmentation and Mapping of Organs at Risk from Planning CT for the Development of Voxel-Wise Predictive Models of Toxicity in Prostate Radiotherapy. ACTA ACUST UNITED AC 2010. [DOI: 10.1007/978-3-642-15989-3_6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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