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Remmerts de Vries IF, Verbakel WFAR, Adema M, Slotman BJ, Dahele M. Spine Stereotactic Body Radiation Therapy Without Immobilization: Detailed Analysis of Intrafraction Motion Using High-Frequency kV Imaging During Irradiation. Int J Radiat Oncol Biol Phys 2024; 118:525-532. [PMID: 37652305 DOI: 10.1016/j.ijrobp.2023.08.054] [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: 04/13/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE Spine stereotactic body radiation therapy (SBRT) requires high positioning accuracy and a stable patient to maximize target coverage and reduce excessive irradiation to organs at risk. Positional verification during spine SBRT delivery helps to ensure accurate positioning for all patients. We report our experience with noninvasive 3-dimensional target position monitoring during volumetric modulated arc therapy of spine metastases in nonimmobilized patients positioned using only a thin mattress and simple arm and knee supports. METHODS AND MATERIALS Fluoroscopic planar kV images were acquired at 7 frames/s using the on-board imaging system during volumetric modulated arc therapy spine SBRT. Template matching and triangulation were used to track the target in vertical, longitudinal, and lateral directions. If the tracking trace deviated >1 mm from the planned position in ≥1 direction, treatment was manually interrupted and 6-dimensional cone beam computed tomography (CBCT)-based couch correction was performed. Tracking data were used to retrospectively analyze the target position. Positional data, agreement with CBCT, correlation between position of the couch and direction of any positional correction, and treatment times were analyzed. RESULTS In total, 175 fractions were analyzed. Delivery was interrupted 83 times in 66 fractions for a deviation >1 mm. In 97% of cases the difference between tracking data and subsequent clinical shift performed after the CBCT match was ≤0.5 mm. Lateral/longitudinal shift performed after intervention correlated with the couch roll/pitch at the start of treatment (correlation coefficient, -0.63/0.53). Mean (SD; range) time between start of first imaging and end of the last arc was 15.2 minutes (5.1; 7.6-36.3). CONCLUSIONS Spine tracking during irradiation can be used to prompt an intervention CBCT scan and repositioning so that a spine SBRT target deviates by ≤1 mm from the planned position, even in nonimmobilized patients. kV tracking and CBCT are in good agreement. The data support verification CBCT after all 6 degrees-of-freedom positional corrections in nonimmobilized spine SBRT patients.
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Affiliation(s)
- Isabel F Remmerts de Vries
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - Wilko F A R Verbakel
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Marrit Adema
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Ben J Slotman
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Max Dahele
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
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Ono T, Miyabe Y, Akimoto M, Mukumoto N, Ishihara Y, Nakamura M, Mizowaki T. Development of a portable quality control application using a tablet-type electronic device. Med Phys 2018; 45:1029-1035. [DOI: 10.1002/mp.12786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/28/2017] [Accepted: 01/08/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Tomohiro Ono
- Department of Radiation Oncology and Image-Applied Therapy; Graduate School of Medicine; Kyoto University; Kyoto 606-8507 Japan
| | - Yuki Miyabe
- Department of Radiation Oncology and Image-Applied Therapy; Graduate School of Medicine; Kyoto University; Kyoto 606-8507 Japan
| | - Mami Akimoto
- Department of Radiation Oncology; Kurashiki Central Hospital; Okayama 710-8602 Japan
| | - Nobutaka Mukumoto
- Department of Radiation Oncology and Image-Applied Therapy; Graduate School of Medicine; Kyoto University; Kyoto 606-8507 Japan
| | - Yoshitomo Ishihara
- Division of Radiation Oncology; Wakayama Red Cross Hospital; Wakayama 640-8558 Japan
| | - Mitsuhiro Nakamura
- Department of Radiation Oncology and Image-Applied Therapy; Graduate School of Medicine; Kyoto University; Kyoto 606-8507 Japan
- Division of Medical Physics; Department of Information Technology and Medical Engineering; Human Health Sciences; Graduate School of Medicine; Kyoto University; Kyoto 606-8507 Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy; Graduate School of Medicine; Kyoto University; Kyoto 606-8507 Japan
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Jiang P, Krockenberger K, Vonthein R, Tereszczuk J, Schreiber A, Liebau S, Huttenlocher S, Imhoff D, Balermpas P, Keller C, Dellas K, Baumann R, Rödel C, Hildebrandt G, Jünemann KP, Merseburger AS, Katz A, Ziegler A, Blanck O, Dunst J. Hypo-fractionated SBRT for localized prostate cancer: a German bi-center single treatment group feasibility trial. Radiat Oncol 2017; 12:138. [PMID: 28821268 PMCID: PMC5562995 DOI: 10.1186/s13014-017-0872-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For prostate cancer treatment, treatment options with minimal side effects are desired. External beam radiation therapy (EBRT) is non-invasive, standard of care and delivered in either conventional fractionation over 8 weeks or with moderate hypo-fractionation over about 5 weeks. Recent advances in radiotherapy technology have made extreme hypo-fractionated stereotactic body radiation therapy (SBRT) of prostate cancer feasible, which has not yet been introduced as a standard treatment method in Germany. Initial results from other countries are promising, but long-term results are not yet available. The aim of this study is to investigate feasibility and effectiveness of SBRT for prostate cancer in Germany. METHODS/DESIGN This German bi-center single group trial (HYPOSTAT) is designed to evaluate feasibility and effectiveness, as measured by toxicity and PSA-response, respectively, of an extreme hypo-fractionated SBRT regimen with five fractions of 7 Gy in treatment of localized low and intermediate risk prostate cancer. The target volume includes the prostate with or without the base of seminal vesicles depending on risk stratification and uncertainty margins that are kept at 3-5 mm. SBRT treatment is delivered with the robotic CyberKnife system, which was recently introduced in Germany. Acute and late toxicity after one year will be evaluated according to Common Terminology Criteria for Adverse Events (CTCAE v. 4.0), Radiation Therapy Oncology Group (RTOG) and International Prostate Symptom Score (IPSS) Scores. The quality of life will be assessed before and after treatment with the EORTC QLQ C30 questionnaire. Hypothesizing that the proportion of patients with grade 2 side effects or higher is less or equal than 2.8%, thus markedly lower than the standard EBRT percentage (17.5%), the recruitment target is 85 patients. DISCUSSION The HYPOSTAT trial aims at demonstrating short term feasibility of extreme hypo-fractioned SBRT for the treatment of prostate cancer and might be used as the pilot study for a multi-center multi-platform or for randomized-controlled trials comparing conventional radiotherapy with SBRT for localized prostate cancer in the future. The study concept of patient enrollment, follow up and evaluation by multiple public university clinics and actual patient treatment in dedicated private radiosurgery practices with high-tech radiation equipment is unique for clinical trials. STUDY STATUS The study is ongoing and currently recruiting patients. TRIAL REGISTRATION Registration number: NCT02635256 ( clinicaltrials.gov ). Registered 8 December 2015.
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Affiliation(s)
- Ping Jiang
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,Klinik für Strahlentherapie, Universitätsklinik für Medizinische Strahlenphysik, Pius Hospital, Oldenburg, Germany
| | | | - Reinhard Vonthein
- Universität zu Lübeck, ZKS, Lübeck, Germany.,Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | | | | | | | - Stefan Huttenlocher
- Saphir Radiochirurgie Zentrum Norddeutschland und Frankfurt am Main, Güstrow, Germany
| | - Detlef Imhoff
- Klinik für Strahlentherapie, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Panagiotis Balermpas
- Saphir Radiochirurgie Zentrum Norddeutschland und Frankfurt am Main, Güstrow, Germany.,Klinik für Strahlentherapie, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Christian Keller
- Saphir Radiochirurgie Zentrum Norddeutschland und Frankfurt am Main, Güstrow, Germany.,Klinik für Strahlentherapie, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Kathrin Dellas
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Rene Baumann
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Claus Rödel
- Klinik für Strahlentherapie, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Guido Hildebrandt
- Klinik für Strahlentherapie, Universitätsmedizin Rostock, Rostock, Germany
| | | | - Alex S Merseburger
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Alan Katz
- Flushing Radiation Oncology Services, New York, USA.,Long Island Radiation Therapy, New York, USA
| | - Andreas Ziegler
- Universität zu Lübeck, ZKS, Lübeck, Germany.,Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany.,School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Oliver Blanck
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,Saphir Radiochirurgie Zentrum Norddeutschland und Frankfurt am Main, Güstrow, Germany
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany. .,School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa. .,Department for Radiation Oncology, University Clinic Copenhagen, Copenhagen, Denmark. .,Department of Radiation Oncology, Karl Lennert Cancer Center, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 50, D-24105, Kiel, Germany.
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Wolf F, Gaisberger C, Ziegler I, Krenn E, Scherer P, Hruby S, Schätz T, Forstner R, Holzinger J, Vaszi A, Kametriser G, Steininger P, Deutschmann H, Sedlmayer F. Comparison of two different rectal spacers in prostate cancer external beam radiotherapy in terms of rectal sparing and volume consistency. Radiother Oncol 2015; 116:221-5. [PMID: 26232129 DOI: 10.1016/j.radonc.2015.07.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 07/03/2015] [Accepted: 07/05/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE In external beam radiation (EBRT) of the prostate, the rectum is the dose-limiting organ at risk, and sparing of the anterior rectal wall is a prerequisite for safe delivery of doses beyond 70 Gy. Spatial sparing of the rectum can be achieved by introducing a spacer material into the retroprostatic space, thus separating the anterior rectal wall from the PTV. MATERIALS AND METHODS Two spacer technologies, Spacer OAR, a polyethylene glycol gel and ProSpace, a saline inflated balloon, were compared in terms of spacer volume, stability, and dose reduction to the anterior rectum wall in 78 patients. RESULTS Both spacer systems significantly reduced the rectum surface encompassed by the 95% isodose (gel: -35%, p<0.01; balloon -63.4%, p<0.001) compared to a control group. The balloon spacer was superior in reducing rectum dose (-27.7%, p=0.034), but exhibited an average volume loss of >50% during the full course of treatment of 37-40 fractions, while the volume of gel spacers remained fairly constant. CONCLUSIONS In choosing between the two spacer technologies, the advantageous dose reduction of the balloon needs to be weighed up against the better volume consistency of the gel spacer with respect to the duration of hypofractionated vs normofractionated regimens.
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Affiliation(s)
- Frank Wolf
- Dpt. of Radiation Oncology, St. Johanns-Spital, Paracelsus Medical University of Salzburg, Austria.
| | - Christoph Gaisberger
- Dpt. of Radiation Oncology, St. Johanns-Spital, Paracelsus Medical University of Salzburg, Austria
| | - Ingrid Ziegler
- Dpt. of Radiation Oncology, St. Johanns-Spital, Paracelsus Medical University of Salzburg, Austria
| | - Elisabeth Krenn
- Salzburg University of Applied Sciences, Paracelsus Medical University of Salzburg, Austria
| | - Philipp Scherer
- Dpt. of Radiation Oncology, St. Johanns-Spital, Paracelsus Medical University of Salzburg, Austria
| | - Stephan Hruby
- Dpt. of Urology, St. Johanns-Spital, Paracelsus Medical University of Salzburg, Austria
| | - Tobias Schätz
- Dpt. of Urology, St. Johanns-Spital, Paracelsus Medical University of Salzburg, Austria
| | - Rosemarie Forstner
- Dpt. of Radiology, St. Johanns-Spital, Paracelsus Medical University of Salzburg, Austria
| | - Josef Holzinger
- Dept. of Surgery, St. Johanns-Spital, Paracelsus Medical University of Salzburg, Austria
| | - Andrea Vaszi
- Dpt. of Radiation Oncology, St. Johanns-Spital, Paracelsus Medical University of Salzburg, Austria
| | - Gerhard Kametriser
- Dpt. of Radiation Oncology, St. Johanns-Spital, Paracelsus Medical University of Salzburg, Austria
| | - Philipp Steininger
- Institute for Research and Development on Advanced Radiation Technologies (radART), St. Johanns-Spital, Paracelsus Medical University of Salzburg, Austria
| | - Heinz Deutschmann
- Dpt. of Radiation Oncology, St. Johanns-Spital, Paracelsus Medical University of Salzburg, Austria; Institute for Research and Development on Advanced Radiation Technologies (radART), St. Johanns-Spital, Paracelsus Medical University of Salzburg, Austria
| | - Felix Sedlmayer
- Dpt. of Radiation Oncology, St. Johanns-Spital, Paracelsus Medical University of Salzburg, Austria; Institute for Research and Development on Advanced Radiation Technologies (radART), St. Johanns-Spital, Paracelsus Medical University of Salzburg, Austria
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