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Rohrer Bley C, Meier V, Turek M, Besserer J, Unterhirkhers S. Stereotactic Radiation Therapy Planning, Dose Prescription and Delivery in Veterinary Medicine: A Systematic Review on Completeness of Reporting and Proposed Reporting Items. Vet Comp Oncol 2024. [PMID: 39367729 DOI: 10.1111/vco.13011] [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: 05/08/2024] [Revised: 08/25/2024] [Accepted: 08/26/2024] [Indexed: 10/06/2024]
Abstract
Increasing numbers of dogs and cats with cancer are treated with stereotactic radiosurgery, stereotactic radiation therapy or stereotactic body radiotherapy (SRS, SRT or SBRT). We provide a systematic review of the current data landscape with a focus on technical and dosimetric data of stereotactic radiotherapy in veterinary oncology. Original peer-reviewed articles on dogs and cats with cancer treated with SRT were included. The systematic search included Medline via PubMed and EMBASE. The study was performed according to the Preferred Reporting Items for Systematic Reviews (PRISMA) statement. We assessed the manuscripts regarding outcome reporting, treatment planning, dose prescription, -delivery and -reporting as well as quality assurance. As of February 2024, there are 80 peer-reviewed publications on various disease entities on SRS, SRT and SBRT in veterinary medicine. Overall, we found often insufficient or highly variable technical data, with incomplete information to reproduce these treatments. While in some instances, technical factors may not impact clinical outcome, the variability found in protocols, outcome and toxicity assessments precludes accurate and reliable conclusions for a benefit of stereotactic radiotherapy for many of the treated diseases. In line with the extensive recommendations from human stereotactic radiotherapy practise, we propose a draft of reporting items for future stereotactic radiation treatments in veterinary medicine. SRS, SRT and SBRT have specific clinical and technological requirements that differ from those of standard radiation therapy. Therefore, a deep understanding of the methodologies, as well as the quality and precision of dose delivery, is essential for effective clinical knowledge transfer.
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Affiliation(s)
- Carla Rohrer Bley
- Clinic for Radiation Oncology & Medical Oncology, Small Animal Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Valeria Meier
- Clinic for Radiation Oncology & Medical Oncology, Small Animal Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Michelle Turek
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Juergen Besserer
- Clinic for Radiation Oncology & Medical Oncology, Small Animal Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Radiation Oncology, Hirslanden Clinic, Zurich, Switzerland
| | - Sergejs Unterhirkhers
- Clinic for Radiation Oncology & Medical Oncology, Small Animal Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
- Radiation Oncology, Hirslanden Clinic, Zurich, Switzerland
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2
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Brunner TB, Boda-Heggemann J, Bürgy D, Corradini S, Dieckmann UK, Gawish A, Gerum S, Gkika E, Grohmann M, Hörner-Rieber J, Kirste S, Klement RJ, Moustakis C, Nestle U, Niyazi M, Rühle A, Lang ST, Winkler P, Zurl B, Wittig-Sauerwein A, Blanck O. Dose prescription for stereotactic body radiotherapy: general and organ-specific consensus statement from the DEGRO/DGMP Working Group Stereotactic Radiotherapy and Radiosurgery. Strahlenther Onkol 2024; 200:737-750. [PMID: 38997440 PMCID: PMC11343978 DOI: 10.1007/s00066-024-02254-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 06/02/2024] [Indexed: 07/14/2024]
Abstract
PURPOSE AND OBJECTIVE To develop expert consensus statements on multiparametric dose prescriptions for stereotactic body radiotherapy (SBRT) aligning with ICRU report 91. These statements serve as a foundational step towards harmonizing current SBRT practices and refining dose prescription and documentation requirements for clinical trial designs. MATERIALS AND METHODS Based on the results of a literature review by the working group, a two-tier Delphi consensus process was conducted among 24 physicians and physics experts from three European countries. The degree of consensus was predefined for overarching (OA) and organ-specific (OS) statements (≥ 80%, 60-79%, < 60% for high, intermediate, and poor consensus, respectively). Post-first round statements were refined in a live discussion for the second round of the Delphi process. RESULTS Experts consented on a total of 14 OA and 17 OS statements regarding SBRT of primary and secondary lung, liver, pancreatic, adrenal, and kidney tumors regarding dose prescription, target coverage, and organ at risk dose limitations. Degree of consent was ≥ 80% in 79% and 41% of OA and OS statements, respectively, with higher consensus for lung compared to the upper abdomen. In round 2, the degree of consent was ≥ 80 to 100% for OA and 88% in OS statements. No consensus was reached for dose escalation to liver metastases after chemotherapy (47%) or single-fraction SBRT for kidney primaries (13%). In round 2, no statement had 60-79% consensus. CONCLUSION In 29 of 31 statements a high consensus was achieved after a two-tier Delphi process and one statement (kidney) was clearly refused. The Delphi process was able to achieve a high degree of consensus for SBRT dose prescription. In summary, clear recommendations for both OA and OS could be defined. This contributes significantly to harmonization of SBRT practice and facilitates dose prescription and reporting in clinical trials investigating SBRT.
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Affiliation(s)
- Thomas B Brunner
- Department of Radiation Oncology, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria.
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, 8036, Graz, Austria.
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medicine Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Bürgy
- Department of Radiation Oncology, University Medicine Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Ute Karin Dieckmann
- Department of Radiation Oncology, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria
| | - Ahmed Gawish
- Department of Radiotherapy, University Medical Center Giessen-Marburg, Marburg, Germany
| | - Sabine Gerum
- Department of Radiation Oncology, Paracelsus University Salzburg, Salzburg, Austria
| | - Eleni Gkika
- Department of Radiation Oncology, University Hospital Bonn, 53127, Bonn, Germany
| | - Maximilian Grohmann
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Simon Kirste
- Department of Radiation Oncology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Rainer J Klement
- Department of Radiotherapy and Radiation Oncology, Leopoldina Hospital Schweinfurt, Robert-Koch-Straße 10, 97422, Schweinfurt, Germany
| | - Christos Moustakis
- Department of Radiation Oncology, University Hospital Leipzig, Stephanstraße 9a, 04103, Leipzig, Germany
| | - Ursula Nestle
- Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Alexander Rühle
- Department of Radiation Oncology, University Hospital Leipzig, Stephanstraße 9a, 04103, Leipzig, Germany
| | - Stephanie-Tanadini Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Peter Winkler
- Department of Radiation Oncology, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, 8036, Graz, Austria
| | - Brigitte Zurl
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, 8036, Graz, Austria
| | | | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
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3
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Moustakis C, Blanck O, Grohmann M, Albers D, Bartels D, Bathen B, Borzì GR, Broggi S, Bruschi A, Casale M, Delana A, Doolan P, Ebrahimi Tazehmahalleh F, Fabiani S, Falco MD, Fehr R, Friedlein M, Gutser S, Hamada AM, Hancock T, Köhn J, Kornhuber C, Krieger T, Lambrecht U, Lappi S, Moretti E, Mirus A, Muedder T, Plaude S, Polvika B, Ravaglia V, Righetto R, Rinaldin G, Schachner H, Scaggion A, Schilling P, Szeverinski P, Villaggi E, Walke M, Wilke L, Winkler P, Nicolay NH, Eich HT, Gkika E, Brunner TB, Schmitt D. Planning Benchmark Study for Stereotactic Body Radiation Therapy of Pancreas Carcinomas With Simultaneously Integrated Boost and Protection: Results of the DEGRO/DGMP Working Group on Stereotactic Radiation Therapy and Radiosurgery. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)03315-7. [PMID: 39222825 DOI: 10.1016/j.ijrobp.2024.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 07/14/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE The proximity or overlap of planning target volume (PTV) and organs-at-risk (OARs) poses a major challenge in stereotactic body radiation therapy (SBRT) of pancreatic cancer (PACA). This international treatment planning benchmark study investigates whether simultaneous integrated boost (SIB) and simultaneous integrated protection (SIP) concepts in PACA SBRT can lead to improved and harmonized plan quality. METHODS AND MATERIALS A multiparametric specification of desired target doses (gross target volume [GTV]D50%, GTVD99%, PTVD95%, and PTV0.5cc) with 2 prescription doses of GTVD50% = 5 × 9.2Gy (46 Gy) and GTVD50% = 8 × 8.25 Gy (66 Gy) and OAR limits were distributed with planning computed tomography and contours from 3 PACA patients. In phase 1, plans were ranked using a scoring system for comparison of trade-offs between GTV/PTV and OAR. In phase 2, replanning was performed for the most challenging case and prescription with dedicated SIB and SIP contours provided for optimization after group discussion. RESULTS For all 3 cases and both phases combined, 292 plans were generated from 42 institutions in 5 countries using commonly available treatment planning systems. The GTVD50% prescription was performed by only 76% and 74% of planners within 2% for 5 and 8 fractions, respectively. The GTVD99% goal was mostly reached, while the balance between OAR and target dose showed initial SIB/SIP-like optimization strategies in about 50% of plans. For plan ranking, 149 and 217 score penalties were given for 5 and 8 fractions, pointing to improvement possibilities. For phase 2, the GTVD50% prescription was performed by 95% of planners within 2%, and GTVD99% as well as OAR doses were better harmonized with notable less score penalties. Fourteen of 19 planners improved their plan rank, 9 of them by at least 2 ranks. CONCLUSIONS Dedicated SIB/SIP concepts in combination with multiparametric prescriptions and constraints can lead to overall harmonized and high treatment plan quality for PACA SBRT. Standardized SIB/SIP treatment planning in multicenter clinical trials appears feasible after group consensus and training.
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Affiliation(s)
- Christos Moustakis
- University Hospital Leipzig, Department of Radiation Oncology, Leipzig, Germany; University Hospital Muenster, Department of Radiation Oncology, Muenster, Germany.
| | - Oliver Blanck
- University Medical Center Schleswig Holstein, Kiel, Department of Radiation Oncology, Kiel, Germany; Saphir Radiosurgery Center, Frankfurt and Kiel, Germany
| | - Maximilian Grohmann
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Albers
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dennis Bartels
- Department of Radiation Oncology Harburg, Hamburg, Germany
| | - Bastian Bathen
- Department of Radiation Oncology, University Hospital, Goethe University, Frankfurt, Germany; Saphir Radiosurgery Center, Frankfurt, Germany
| | | | | | | | | | - Anna Delana
- Medical Physics Unit, "S. Chiara" Hospital, Trento, Italy
| | | | - Fatemeh Ebrahimi Tazehmahalleh
- Helios Hospital Schwerin, Department of Radiation Oncology, Schwerin, Germany; University Hospital Cologne, Department of Radiation Oncology, Cologne, Germany
| | | | - Maria Daniela Falco
- Department of Radiation Oncology, "G.D'Annunzio" University, "SS.Annunziata" Hospital, Chieti, Italy
| | - Roman Fehr
- University Medicine Rostock, Department of Radiation Oncology, Rostock, Germany
| | - Melissa Friedlein
- Department of Radiation Oncology, University Hospital Jena, Jena, Germany
| | - Susanne Gutser
- Department of Radiation Oncology, University Hospital Augsburg, Augsburg, Germany
| | - Abdul Malek Hamada
- University Medicine Rostock, Department of Radiation Oncology, Rostock, Germany
| | | | - Janett Köhn
- Department of Radiation Oncology, University Hospital, Goethe University, Frankfurt, Germany; Saphir Radiosurgery Center, Frankfurt, Germany
| | - Christine Kornhuber
- University Hospital Halle, Department of Radiation Oncology, Halle (Saale), Germany
| | - Thomas Krieger
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - Ulrike Lambrecht
- Department of Radiation Oncology, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | | | | | | | - Thomas Muedder
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Sandija Plaude
- West German Proton Therapy Center Essen (WPE), Essen, Germany
| | | | | | - Roberto Righetto
- Proton Therapy Unit, S. Chiara Hospital - Azienda Provinciale per I Servizi Sanitari (APSS), Trento, Italy
| | | | - Henrik Schachner
- Department of Radiation Oncology at Weilheim Hospital, Weilheim, Germany
| | | | - Philipp Schilling
- Municipal Hospital Dresden-Friedrichstadt - MVZ Radiotherapy, Dresden, Germany
| | - Philipp Szeverinski
- Institute of Medical Physics, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | | | - Mathias Walke
- University Hospital Magdeburg, Department of Radiation Oncology, Magdeburg, Germany
| | - Lotte Wilke
- University Hospital Zürich, Department of Radiation Oncology, Zürich, Switzerland
| | - Peter Winkler
- University Medical Center Graz, Department of Radiation Oncology, Graz, Austria
| | - Nils H Nicolay
- University Hospital Leipzig, Department of Radiation Oncology, Leipzig, Germany; University Hospital of Freiburg, Department of Radiation Oncology, Freiburg, Germany
| | - Hans Theodor Eich
- University Hospital Muenster, Department of Radiation Oncology, Muenster, Germany
| | - Eleni Gkika
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany; University Hospital of Freiburg, Department of Radiation Oncology, Freiburg, Germany
| | - Thomas B Brunner
- University Hospital Magdeburg, Department of Radiation Oncology, Magdeburg, Germany; University Medical Center Graz, Department of Radiation Oncology, Graz, Austria
| | - Daniela Schmitt
- University Medical Center Göttingen, Department of Radiation Oncology, Göttingen, Germany
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4
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Trojani V, Grehn M, Botti A, Balgobind B, Savini A, Boda-Heggemann J, Miszczyk M, Elicin O, Krug D, Andratschke N, Schmidhalter D, van Elmpt W, Bogowicz M, de Areba Iglesias J, Dolla L, Ehrbar S, Fernandez-Velilla E, Fleckenstein J, Granero D, Henzen D, Hurkmans C, Kluge A, Knybel L, Loopeker S, Mirandola A, Richetto V, Sicignano G, Vallet V, van Asselen B, Worm E, Pruvot E, Verhoeff J, Fast M, Iori M, Blanck O. Refining Treatment Planning in STereotactic Arrhythmia Radioablation: Benchmark Results and Consensus Statement From the STOPSTORM.eu Consortium. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)03171-7. [PMID: 39122095 DOI: 10.1016/j.ijrobp.2024.07.2331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 07/09/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE STereotactic Arrhythmia Radioablation (STAR) showed promising results in patients with refractory ventricular tachycardia. However, clinical data are scarce and heterogeneous. The STOPSTORM.eu consortium was established to investigate and harmonize STAR in Europe. The primary goal of this benchmark study was to investigate current treatment planning practice within the STOPSTORM project as a baseline for future harmonization. METHODS AND MATERIALS Planning target volumes (PTVs) overlapping extracardiac organs-at-risk and/or cardiac substructures were generated for 3 STAR cases. Participating centers were asked to create single-fraction treatment plans with 25 Gy dose prescriptions based on in-house clinical practice. All treatment plans were reviewed by an expert panel and quantitative crowd knowledge-based analysis was performed with independent software using descriptive statistics for International Commission on Radiation Units and Measurements report 91 relevant parameters and crowd dose-volume histograms. Thereafter, treatment planning consensus statements were established using a dual-stage voting process. RESULTS Twenty centers submitted 67 treatment plans for this study. In most plans (75%) intensity modulated arc therapy with 6 MV flattening filter free beams was used. Dose prescription was mainly based on PTV D95% (49%) or D96%-100% (19%). Many participants preferred to spare close extracardiac organs-at-risk (75%) and cardiac substructures (50%) by PTV coverage reduction. PTV D0.035cm3 ranged from 25.5 to 34.6 Gy, demonstrating a large variety of dose inhomogeneity. Estimated treatment times without motion compensation or setup ranged from 2 to 80 minutes. For the consensus statements, a strong agreement was reached for beam technique planning, dose calculation, prescription methods, and trade-offs between target and extracardiac critical structures. No agreement was reached on cardiac substructure dose limitations and on desired dose inhomogeneity in the target. CONCLUSIONS This STOPSTORM multicenter treatment planning benchmark study not only showed strong agreement on several aspects of STAR treatment planning, but also revealed disagreement on others. To standardize and harmonize STAR in the future, consensus statements were established; however, clinical data are urgently needed for actionable guidelines for treatment planning.
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Affiliation(s)
- Valeria Trojani
- Department of Medical Physics, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Melanie Grehn
- Department of Radiation Oncology, University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - Andrea Botti
- Department of Medical Physics, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Brian Balgobind
- Department of Radiation Oncology, Amsterdam UMC, Radiation Oncology, Amsterdam, The Netherlands
| | | | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marcin Miszczyk
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice, Poland; Collegium Medicum - Faculty of Medicine, WSB University, Dąbrowa Górnicza, Poland
| | - Olgun Elicin
- Department of Radiation Oncology and Division of Medical Radiation Physics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Krug
- Department of Radiation Oncology, University Medical Center of Schleswig-Holstein, Kiel, Germany
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital of Zurich, Zurich, Switzerland
| | - Daniel Schmidhalter
- Department of Radiation Oncology and Division of Medical Radiation Physics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Wouter van Elmpt
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Marta Bogowicz
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
| | | | - Lukasz Dolla
- Radiotherapy Planning Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Stefanie Ehrbar
- Department of Radiation Oncology, University Hospital of Zurich, Zurich, Switzerland
| | | | - Jens Fleckenstein
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Domingo Granero
- Department of Radiation Oncology, Hospital General Valencia, Valencia, Spain
| | - Dominik Henzen
- Department of Radiation Oncology and Division of Medical Radiation Physics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands; Department of Electrical Engineering and Department of Applied Physics, Technical University Eindhoven, The Netherlands
| | - Anne Kluge
- Department for Radiation Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lukas Knybel
- Department of Oncology, University Hospital and Faculty of Medicine, Ostrava, Czech Republic
| | - Sandy Loopeker
- Department of Radiation Oncology, Amsterdam UMC, Radiation Oncology, Amsterdam, The Netherlands
| | - Alfredo Mirandola
- Radiation Oncology Clinical Department, National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Veronica Richetto
- Medical Physics Unit, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Gianluisa Sicignano
- Department of Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Veronique Vallet
- Department of Radiophysics, Lausanne University Hospital, Lausanne, Switzerland
| | - Bram van Asselen
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Esben Worm
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Etienne Pruvot
- Heart and Vessel Department, Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Joost Verhoeff
- Department of Radiation Oncology, Amsterdam UMC, Radiation Oncology, Amsterdam, The Netherlands; Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin Fast
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mauro Iori
- Department of Medical Physics, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center of Schleswig-Holstein, Kiel, Germany.
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Scaggion A, Cavinato S, Dusi F, El Khouzai B, Guida F, Paronetto C, Rossato MA, Sapignoli S, Scott ASA, Sepulcri M, Paiusco M. On the necessity of specialized knowledge-based models for SBRT prostate treatments plans. Phys Med 2024; 121:103364. [PMID: 38701626 DOI: 10.1016/j.ejmp.2024.103364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/21/2024] [Accepted: 04/19/2024] [Indexed: 05/05/2024] Open
Abstract
PURPOSE Test whether a well-grounded KBP model trained on moderately hypo-fractionated prostate treatments can be used to satisfactorily drive the optimization of SBRT prostate treatments. MATERIALS AND METHODS A KBP model (SBRT-model) was developed, trained and validated using the first forty-seven clinically treated VMAT SBRT prostate plans (42.7 Gy/7fx or 36.25 Gy/5fx). The performance and robustness of this model were compared against a high-quality KBP-model (ST-model) that was already clinically adopted for hypo-fractionated (70 Gy/28fx and 60 Gy/20fx) prostate treatments. The two models were compared in terms of their predictions robustness, and the quality of their outcomes were evaluated against a set of reference clinical SBRT plans. Plan quality was assessed using DVH metrics, blinded clinical ranking, and a dedicated Plan Quality Metric algorithm. RESULTS The plan libraries of the two models were found to share a high degree of anatomical similarity. The overall quality (APQM%) of the plans obtained both with the ST- and SBRT-models was compatible with that of the original clinical plans, namely (93.7 ± 4.1)% and (91.6 ± 3.9)% vs (92.8.9 ± 3.6)%. Plans obtained with the ST-model showed significantly higher target coverage (PTV V95%): (97.9 ± 0.8)% vs (97.1 ± 0.9)% (p < 0.05). Conversely, plans optimized following the SBRT-model showed a small but not-clinically relevant increase in OAR sparing. ST-model generally provided more reliable predictions than SBRT-model. Two radiation oncologists judged as equivalent the plans based on the KBP prediction, which was also judged better that reference clinical plans. CONCLUSION A KBP model trained on moderately fractionated prostate treatment plans provided optimal SBRT prostate plans, with similar or larger plan quality than an embryonic SBRT-model based on a limited number of cases.
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Affiliation(s)
- Alessandro Scaggion
- S.C. Fisica Sanitaria, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy.
| | - Samuele Cavinato
- S.C. Fisica Sanitaria, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Francesca Dusi
- S.C. Fisica Sanitaria, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Badr El Khouzai
- S.C. Radioterapia, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Federica Guida
- S.C. Fisica Sanitaria, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Chiara Paronetto
- S.C. Radioterapia, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | | | - Sonia Sapignoli
- S.C. Fisica Sanitaria, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | | | - Matteo Sepulcri
- S.C. Radioterapia, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Marta Paiusco
- S.C. Fisica Sanitaria, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
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Wang CY, Ho LT, Lin LY, Chan HM, Chen HY, Yu TL, Huang YS, Kuo SH, Lee WJ, Chen JLY. Noninvasive cardiac radioablation for ventricular tachycardia: dosimetric comparison between linear accelerator- and robotic CyberKnife-based radiosurgery systems. Radiat Oncol 2023; 18:187. [PMID: 37950307 PMCID: PMC10638803 DOI: 10.1186/s13014-023-02370-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Few dosimetric comparisons have been published between linear accelerator (LA)-based systems and CyberKnife (CK)-based robotic radiosurgery systems for cardiac radio-ablation in ventricular tachycardia. This study aimed to compare the dosimetry of noninvasive cardiac radio-ablation deliverable on LA with that on CK. METHODS Thirteen patients who underwent noninvasive cardiac radio-ablation by LA were included. The prescribed dose was 25 Gy in 1 fraction, and the average planning target volume was 49.8 ± 31.0 cm3 (range, 14.4-93.7 cm3). CK plans were generated for comparison. RESULTS Both the CK and LA plans accomplished appropriate dose coverage and normal tissue sparing. Compared with the LA plans, the CK plans achieved significantly lower gradient indices (3.12 ± 0.71 vs. 3.48 ± 0.55, p = 0.031) and gradient measures (1.00 ± 0.29 cm vs. 1.17 ± 0.29 cm, p < 0.001). They had similar equivalent conformity indices (CK vs. LA: 0.84 ± 0.08 vs. 0.87 ± 0.07, p = 0.093) and maximum doses 2 cm from the planning target volume (PTV) in any direction (CK vs. LA: 50.8 ± 9.9% vs. 53.1 ± 5.3%, p = 0.423). The dosimetric advantages of CK were more prominent in patients with a PTV of ≤ 50 cm3 or a spherical PTV. In patients with a PTV of > 50 cm3 or a non-spherical PTV, the LA and CK plans were similar regarding dosimetric parameters. CK plans involved more beams (232.2 ± 110.8 beams vs. 10.0 ± 1.7 arcs) and longer treatment times (119.2 ± 43.3 min vs. 22.4 ± 1.6 min, p = 0.007). CONCLUSIONS Both CK and LA are ideal modalities for noninvasive cardiac radio-ablation. Upfront treatment should be considered based on clinical intent.
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Affiliation(s)
- Ching-Yu Wang
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Ting Ho
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Hsing-Min Chan
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Yi Chen
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tung-Lin Yu
- Department of Radiation Oncology, Fu-Jen Catholic University Hospital, Taipei, Taiwan
| | - Yu-Sen Huang
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan S. Rd., Taipei, 100, Taiwan
- Department of Radiology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Sung-Hsin Kuo
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Radiation Oncology, National Taiwan University Cancer Center, No. 57, Ln. 155, Sec. 3, Keelung Rd., Taipei, 106, Taiwan
| | - Wen-Jeng Lee
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan S. Rd., Taipei, 100, Taiwan.
- Department of Radiology, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Jenny Ling-Yu Chen
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Radiation Oncology, National Taiwan University Cancer Center, No. 57, Ln. 155, Sec. 3, Keelung Rd., Taipei, 106, Taiwan.
- Department of Radiology, National Taiwan University College of Medicine, Taipei, Taiwan.
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7
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Gkika E, Kostyszyn D, Fechter T, Moustakis C, Ernst F, Boda-Heggemann J, Sarria G, Dieckmann K, Dobiasch S, Duma MN, Eberle F, Kroeger K, Häussler B, Izaguirre V, Jazmati D, Lautenschläger S, Lohaus F, Mantel F, Menzel J, Pachmann S, Pavic M, Radlanski K, Riesterer O, Gerum S, Röder F, Willner J, Barczyk S, Imhoff D, Blanck O, Wittig A, Guckenberger M, Grosu AL, Brunner TB. Interobserver agreement on definition of the target volume in stereotactic radiotherapy for pancreatic adenocarcinoma using different imaging modalities. Strahlenther Onkol 2023; 199:973-981. [PMID: 37268767 PMCID: PMC10598103 DOI: 10.1007/s00066-023-02085-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/11/2023] [Indexed: 06/04/2023]
Abstract
PURPOSE The aim of this study was to evaluate interobserver agreement (IOA) on target volume definition for pancreatic cancer (PACA) within the Radiosurgery and Stereotactic Radiotherapy Working Group of the German Society of Radiation Oncology (DEGRO) and to identify the influence of imaging modalities on the definition of the target volumes. METHODS Two cases of locally advanced PACA and one local recurrence were selected from a large SBRT database. Delineation was based on either a planning 4D CT with or without (w/wo) IV contrast, w/wo PET/CT, and w/wo diagnostic MRI. Novel compared to other studies, a combination of four metrics was used to integrate several aspects of target volume segmentation: the Dice coefficient (DSC), the Hausdorff distance (HD), the probabilistic distance (PBD), and the volumetric similarity (VS). RESULTS For all three GTVs, the median DSC was 0.75 (range 0.17-0.95), the median HD 15 (range 3.22-67.11) mm, the median PBD 0.33 (range 0.06-4.86), and the median VS was 0.88 (range 0.31-1). For ITVs and PTVs the results were similar. When comparing the imaging modalities for delineation, the best agreement for the GTV was achieved using PET/CT, and for the ITV and PTV using 4D PET/CT, in treatment position with abdominal compression. CONCLUSION Overall, there was good GTV agreement (DSC). Combined metrics appeared to allow a more valid detection of interobserver variation. For SBRT, either 4D PET/CT or 3D PET/CT in treatment position with abdominal compression leads to better agreement and should be considered as a very useful imaging modality for the definition of treatment volumes in pancreatic SBRT. Contouring does not appear to be the weakest link in the treatment planning chain of SBRT for PACA.
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Affiliation(s)
- E Gkika
- Department of Radiation Oncology, University Medical Center Freiburg, Robert Koch Str 3, Freiburg, Germany.
| | - D Kostyszyn
- Department of Radiation Oncology, University Medical Center Freiburg, Robert Koch Str 3, Freiburg, Germany
| | - T Fechter
- Department of Radiation Oncology, University Medical Center Freiburg, Robert Koch Str 3, Freiburg, Germany
| | - C Moustakis
- Department of Radiation Oncology, University Medical Center Muenster, Muenster, Germany
| | - F Ernst
- Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck, Germany
| | - J Boda-Heggemann
- Department of Radiation Oncology, Faculty of Medicine Mannheim, Department of Radiation Oncology, University of Heidelberg, Mannheim, Germany
| | - G Sarria
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - K Dieckmann
- Department of Radiation Oncology, University Departments of the MedUni Vienna, Vienna General Hospital, Vienna, Austria
| | - S Dobiasch
- Department of Radiation Oncology, Klinikum Rechts der Isar, TU Munich, Munich, Germany
| | - M N Duma
- Department of Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller University, Jena, Germany
| | - F Eberle
- Department of Radiation Oncology, University Hospital Marburg, Marburg, Germany
| | - K Kroeger
- Department of Radiation Oncology, University Medical Center Muenster, Muenster, Germany
| | - B Häussler
- Radiation Oncology Dr. Häussler/Dr. Schorer, Munich, Germany
| | - V Izaguirre
- Department of Radiation Oncology, University Hospital Halle, Halle, Germany
| | - D Jazmati
- Proton Therapy Centre, University Hospital Essen, Essen, Germany
| | - S Lautenschläger
- Department of Radiation Oncology, University Hospital, Marburg, Germany
| | - F Lohaus
- Department of Radiation Oncology, University Hospital Dresden, Dresden, Germany
| | - F Mantel
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - J Menzel
- Department of Radiation Oncology, University Hospital Hannover, Hannover, Germany
| | - S Pachmann
- Department of Radiation Oncology, Weilheim Clinic, Weilheim, Germany
| | - M Pavic
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - K Radlanski
- Department of Radiation Oncology, Charite, University Hospital Berlin, Berlin, Germany
| | - O Riesterer
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - S Gerum
- Department of Radiation Oncology, University Clinic, Paracelsus Medical University (PMU), Salzburg, Austria
| | - F Röder
- Department of Radiation Oncology, University Clinic, Paracelsus Medical University (PMU), Salzburg, Austria
| | - J Willner
- Department of Radiation Oncology, University Hospital Bayreuth, Bayreuth, Germany
| | - S Barczyk
- Center for Radiation Oncology, Belegklinik am St. Agnes-Hospital, Bocholt, Germany
| | - D Imhoff
- Department of Radiation Oncology, Saphir Radiosurgery, University Hospital Frankfurt, Frankfurt, Germany
| | - O Blanck
- Saphir Radiosurgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A Wittig
- Department of Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller University, Jena, Germany
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anca-L Grosu
- Department of Radiation Oncology, University Medical Center Freiburg, Robert Koch Str 3, Freiburg, Germany
| | - T B Brunner
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, Graz, Austria
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Das IJ, Yadav P, Andersen AD, Chen ZJ, Huang L, Langer MP, Lee C, Li L, Popple RA, Rice RK, Schiff PB, Zhu TC, Abazeed ME. Dose prescription and reporting in stereotactic body radiotherapy: A multi-institutional study. Radiother Oncol 2023; 182:109571. [PMID: 36822361 PMCID: PMC10121952 DOI: 10.1016/j.radonc.2023.109571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/07/2023] [Accepted: 02/12/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND AND PURPOSE Radiation dose prescriptions are foundational for optimizing treatment efficacy and limiting treatment-related toxicity. We sought to assess the lack of standardization of SBRT dose prescriptions across institutions. MATERIALS & METHODS Dosimetric data from 1298 patients from 9 academic institutions treated with IMRT and VMAT were collected. Dose parameters D100, D98, D95, D50, and D2 were used to assess dosimetric variability. RESULTS Disease sites included lung (48.3 %) followed by liver (29.7 %), prostate (7.5 %), spine (6.8 %), brain (4.1 %), and pancreas (2.5 %). The PTV volume in lung varied widely with bimodality into two main groups (22.0-28.7 cm3) and (48.0-67.1 cm3). A hot spot ranging from 120-150 % was noted in nearly half of the patients, with significant variation across institutions. A D50 ≥ 110 % was found in nearly half of the institutions. There was significant dosimetric variation across institutions. CONCLUSIONS The SBRT prescriptions in the literature or in treatment guidelines currently lack nuance and hence there is significant variation in dose prescriptions across academic institutions. These findings add greater importance to the identification of dose parameters associated with improved clinical outcome comparisons as we move towards more hypofractionated treatments. There is a need for standardized reporting to help institutions in adapting treatment protocols based on the outcome of clinical trials. Dosimetric parameters are subsequently needed for uniformity and thereby standardizing planning guidelines to maximize efficacy, mitigate toxicity, and reduce treatment disparities are urgently needed.
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Affiliation(s)
- Indra J Das
- Department of Radiation Oncology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Poonam Yadav
- Department of Radiation Oncology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Aaron D Andersen
- Department of Radiation Oncology, Renown Medical Center, Reno, NV, USA
| | - Zhe Jay Chen
- Department of Therapeutic Radiology, Yale University, New haven, CT, USA
| | - Long Huang
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT, USA
| | - Mark P Langer
- Department of Radiation Oncology, Indiana University Health, Indianapolis, IN, USA
| | - Choonik Lee
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Lin Li
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Richard A Popple
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roger K Rice
- Department of Radiation Medicine and Applied Science, University of California, San Diego, CA, USA
| | - Peter B Schiff
- Department of Radiation Oncology, New York University Grossman School of Medicine, New York, NY, USA
| | - Timothy C Zhu
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Mohamed E Abazeed
- Department of Radiation Oncology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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9
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Kluge A, Ehrbar S, Grehn M, Fleckenstein J, Baus WW, Siebert FA, Schweikard A, Andratschke N, Mayinger MC, Boda-Heggemann J, Buergy D, Celik E, Krug D, Kovacs B, Saguner AM, Rudic B, Bergengruen P, Boldt LH, Stauber A, Zaman A, Bonnemeier H, Dunst J, Budach V, Blanck O, Mehrhof F. Treatment Planning for Cardiac Radioablation: Multicenter Multiplatform Benchmarking for the XXX Trial. Int J Radiat Oncol Biol Phys 2022; 114:360-372. [PMID: 35716847 DOI: 10.1016/j.ijrobp.2022.06.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/15/2022] [Accepted: 06/05/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Cardiac radioablation is a novel treatment option for patients with refractory ventricular tachycardia (VT) unsuitable for catheter ablation. The quality of treatment planning depends on dose specifications, platform capabilities, and experience of the treating staff. To harmonize the treatment planning, benchmarking of this process is necessary for multicenter clinical studies such as the XXX trial. METHODS AND MATERIALS Planning computed tomography data and consensus structures from three patients were sent to five academic centers for independent plan development using a variety of platforms and techniques with the XXX study protocol serving as guideline. Three-dimensional dose distributions and treatment plan details were collected and analyzed. In addition, an objective relative plan quality ranking system for VT treatments was established. RESULTS For each case, three coplanar volumetric modulated arc (VMAT) plans for C-arm linear accelerators (LINAC) and three non-coplanar treatment plans for robotic arm LINAC were generated. All plans were suitable for clinical applications with minor deviations from study guidelines in most centers. Eleven of 18 treatment plans showed maximal one minor deviation each for target and cardiac substructures. However, dose-volume histograms showed substantial differences: in one case, the PTV≥30Gy ranged from 0.0% to 79.9% and the RIVA V14Gy ranged from 4.0% to 45.4%. Overall, the VMAT plans had steeper dose gradients in the high dose region, while the plans for the robotic arm LINAC had smaller low dose regions. Thereby, VMAT plans required only about half as many monitor units, resulting in shorter delivery times, possibly an important factor in treatment outcome. CONCLUSIONS Cardiac radioablation is feasible with robotic arm and C-arm LINAC systems with comparable plan quality. Although cross-center training and best practice guidelines have been provided, further recommendations, especially for cardiac substructures, and ranking of dose guidelines will be helpful to optimize cardiac radioablation outcomes.
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Affiliation(s)
- Anne Kluge
- Klinik für Radioonkologie und Strahlentherapie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stefanie Ehrbar
- Klinik für Radio-Onkologie, UniversitätsSpital Zürich, University of Zurich, Zürich, CH
| | - Melanie Grehn
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Jens Fleckenstein
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Wolfgang W Baus
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Frank-Andre Siebert
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Achim Schweikard
- University of Lübeck, Institute for Robotic and Cognitive Systems, Lübeck, Germany
| | - Nicolaus Andratschke
- Klinik für Radio-Onkologie, UniversitätsSpital Zürich, University of Zurich, Zürich, CH
| | - Michael C Mayinger
- Klinik für Radio-Onkologie, UniversitätsSpital Zürich, University of Zurich, Zürich, CH
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Buergy
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Eren Celik
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - David Krug
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Boldizsar Kovacs
- Universitäres Herzzentrum, Klinik für Kardiologie, UniversitätsSpital Zürich, University of Zurich, Zürich, CH
| | - Ardan M Saguner
- Universitäres Herzzentrum, Klinik für Kardiologie, UniversitätsSpital Zürich, University of Zurich, Zürich, CH
| | - Boris Rudic
- Medizinische Klinik, Universitätsmedizin Mannheim and German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Paula Bergengruen
- Klinik für Radioonkologie und Strahlentherapie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Leif-Hendrik Boldt
- Med. Klinik m.S. Kardiologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Annina Stauber
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Adrian Zaman
- Klinik für Innere Medizin III, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Hendrik Bonnemeier
- Klinik für Innere Medizin III, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Volker Budach
- Klinik für Radioonkologie und Strahlentherapie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Felix Mehrhof
- Klinik für Radioonkologie und Strahlentherapie, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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10
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Chan M, Gevaert T, Kadoya N, Dorr J, Leung R, Alheet S, Toutaoui A, Farias R, Wong M, Skourou C, Valenti M, Farré I, Otero-Martínez C, O'Doherty D, Waldron J, Hanvey S, Grohmann M, Liu H. Multi-center planning study of radiosurgery for intracranial metastases through Automation (MC-PRIMA) by crowdsourcing prior web-based plan challenge study. Phys Med 2022; 95:73-82. [DOI: 10.1016/j.ejmp.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/10/2022] [Accepted: 01/28/2022] [Indexed: 10/19/2022] Open
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11
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Deshpande SR, Grubb WR, Kharouta M, Zhang Y, Zheng Y, Podder TK, Towe C, Young B, Machtay M, Biswas T. A Comparative Study of Patients With Early-Stage Non-Small Cell Lung Cancer Treated With Stereotactic Body Radiation Therapy Using CyberKnife and Linear Accelerator-Based Volumetric Modulated Arc Therapy. Pract Radiat Oncol 2022; 12:200-209. [PMID: 35177369 DOI: 10.1016/j.prro.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/16/2021] [Accepted: 12/26/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) has become the standard of care for medically inoperable early-stage non-small cell lung cancer. We investigated 2 modalities of lung SBRT, CyberKnife (CK) and volumetric modulated arc therapy (VMAT), for differences in dosimetric parameters, tumor control, and clinical outcomes. METHODS AND MATERIALS Patients who underwent SBRT for T1-2N0M0 non-small cell lung cancer from 2012 to 2018 were included. Dosimetric parameters for target volume coverage and organ-at-risk dose distribution were collected. Survival outcomes were evaluated using the Kaplan-Meier method with log-rank test. A multivariate Cox proportional hazards model was analyzed for local, regional, and distant tumor control; overall survival (OS) and progression-free survival; and radiation pneumonitis. RESULTS Two hundred twenty-seven patients (142 CK, 85 VMAT SBRT) met inclusion criteria. Overall, the local, regional, and distant control rates were 89.3%, 86.3%, and 87.4% at 2 years, and the OS was 67.5% and 32.8% at 2 and 5 years, respectively. VMAT delivered higher maximum doses to the gross tumor volume and planning target volume and had a lower lung and heart V5. Although there was no difference in local or distant failure, progression-free survival, or OS, VMAT was associated with superior freedom from regional failure (adjusted hazard ratio, 0.26; P = .045). With no difference between treatment modalities, 11.9% of patients developed grade 1 to 2 radiation pneumonitis. There were no grade 3+ events of radiation pneumonitis. CONCLUSIONS This study revealed that VMAT and CK provided comparable local and distant control and survival outcomes; however, VMAT exhibited better regional control. Further study in this regard is imperative.
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Affiliation(s)
- Saarang R Deshpande
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - William R Grubb
- Department of Radiation Oncology, Augusta University, Augusta, Georgia
| | - Michael Kharouta
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, Ohio
| | - Yuxia Zhang
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, Ohio
| | - Yiran Zheng
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Tarun K Podder
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Christopher Towe
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Benjamin Young
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Mitchell Machtay
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Tithi Biswas
- Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio.
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12
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Planning benchmark study for SBRT of liver metastases: Results of the DEGRO/DGMP working group stereotactic radiotherapy and radiosurgery. Int J Radiat Oncol Biol Phys 2022; 113:214-227. [PMID: 35074434 DOI: 10.1016/j.ijrobp.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 12/19/2021] [Accepted: 01/07/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate, if liver SBRT treatment planning can be harmonized across different treatment planning systems, delivery techniques and institutions by using a specific prescription method and to minimize the knowledge gap concerning inter-system and inter-user differences. To provide best practice guidelines for all used techniques. METHODS A multiparametric specification of target dose (GTVD50%, GTVD0.1cc, GTVV90%, PTVV70%) with a prescription dose of GTVD50% = 3 × 20 Gy and OAR limits were distributed with CTs and structure sets from three liver metastases patients. Thirty-five institutions provided 132 treatment plans using different irradiation techniques. These plans were first analyzed for target and OAR doses. Four different renormalization methods were performed (PTVDmin, PTVD98%, PTVD2%, PTVDmax). The resulting 660 treatments plans were evaluated regarding target doses in order to study the effect of dose renormalization to different prescription methods. A relative scoring system was used for comparisons. RESULTS GTVD50% prescription can be performed in all systems. Treatment plan harmonization was overall successful with standard deviations for Dmax, PTVD98%, GTVD98% and PTVDmean of 1.6 Gy, 3.3 Gy, 1.9 Gy and 1.5 Gy, respectively. Primary analysis showed 55 major deviations from clinical goals in 132 plans, while in only <20% of deviations GTV/PTV dose was traded for meeting OAR limits. GTVD50% prescription produced the smallest deviation from target planning objectives and between techniques, followed by the PTVDmax, PTVD98%, PTVD2% and PTVDmin prescription. Deviations were significant for all combinations but for the PTVDmax prescription compared with GTVD50% and PTVD98%. Based on the various dose prescription methods, all systems significantly differed from each other, while GTVD50% and PTVD98% prescription showed the least differences between the systems. CONCLUSIONS This study showed the feasibility of harmonizing liver SBRT treatment plans across different treatment planning systems and delivery techniques when a sufficient set of clinical goals is given.
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13
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Boda-Heggemann J, Blanck O, Mehrhof F, Ernst F, Buergy D, Fleckenstein J, Tülümen E, Krug D, Siebert FA, Zaman A, Kluge AK, Parwani AS, Andratschke N, Mayinger MC, Ehrbar S, Saguner AM, Celik E, Baus WW, Stauber A, Vogel L, Schweikard A, Budach V, Dunst J, Boldt LH, Bonnemeier H, Rudic B. Interdisciplinary Clinical Target Volume Generation for Cardiac Radioablation: Multicenter Benchmarking for the RAdiosurgery for VENtricular TAchycardia (RAVENTA) Trial. Int J Radiat Oncol Biol Phys 2021; 110:745-756. [PMID: 33508373 DOI: 10.1016/j.ijrobp.2021.01.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Cardiac radioablation is a novel treatment option for therapy-refractory ventricular tachycardia (VT) ineligible for catheter ablation. Three-dimensional clinical target volume (CTV) definition is a key step, and this complex interdisciplinary procedure includes VT-substrate identification based on electroanatomical mapping (EAM) and its transfer to the planning computed tomography (PCT). Benchmarking of this process is necessary for multicenter clinical studies such as the RAVENTA trial. METHODS AND MATERIALS For benchmarking of the RAVENTA trial, patient data (epicrisis, electrocardiogram, high-resolution EAM, contrast-enhanced cardiac computed tomography, PCT) of 3 cases were sent to 5 university centers for independent CTV generation, subsequent structure analysis, and consensus finding. VT substrates were first defined on multiple EAM screenshots/videos and manually transferred to the PCT. The generated structure characteristics were then independently analyzed (volume, localization, surface distance and conformity). After subsequent discussion, consensus structures were defined. RESULTS VT substrate on the EAM showed visible variability in extent and localization for cases 1 and 2 and only minor variability for case 3. CTVs ranged from 6.7 to 22.9 cm3, 5.9 to 79.9 cm3, and 9.4 to 34.3 cm3; surface area varied from 1087 to 3285 mm2, 1077 to 9500 mm2, and 1620 to 4179 mm2, with a Hausdorff-distance of 15.7 to 39.5 mm, 23.1 to 43.5 mm, and 15.9 to 43.9 mm for cases 1 to 3, respectively. The absolute 3-dimensional center-of-mass difference was 5.8 to 28.0 mm, 8.4 to 26 mm, and 3.8 to 35.1 mm for cases 1 to 3, respectively. The entire process resulted in CTV structures with a conformity index of 0.2 to 0.83, 0.02 to 0.85, and 0.02 to 0.88 (ideal 1) with the consensus CTV as reference. CONCLUSIONS Multicenter efficacy endpoint assessment of cardiac radioablation for therapy-refractory VT requires consistent CTV transfer methods from the EAM to the PCT. VT substrate definition and CTVs were comparable with current clinical practice. Remarkable differences regarding the degree of agreement of the CTV definition on the EAM and the PCT were noted, indicating a loss of agreement during the transfer process between EAM and PCT. Cardiac radioablation should be performed under well-defined protocols and in clinical trials with benchmarking and consensus forming.
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Affiliation(s)
- Judit Boda-Heggemann
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Felix Mehrhof
- Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Floris Ernst
- University of Lübeck, Institute for Robotic and Cognitive Systems, Lübeck, Germany
| | - Daniel Buergy
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jens Fleckenstein
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Erol Tülümen
- I. Medizinische Klinik, Universitätsklinikum Mannheim and German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - David Krug
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Frank-Andre Siebert
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Adrian Zaman
- Klinik für Innere Medizin III, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Anne K Kluge
- Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Abdul Shokor Parwani
- Med. Klinik m.S. Kardiologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Stefanie Ehrbar
- Klinik für Radio-Onkologie, UniversitätsSpital Zürich, Zürich, CH
| | - Ardan M Saguner
- Universitäres Herzzentrum, UniversitätsSpital Zürich, Zürich, CH
| | - Eren Celik
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Wolfgang W Baus
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Annina Stauber
- Klinik III für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Universitätsklinikum Köln, Köln, Germany
| | - Lena Vogel
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Achim Schweikard
- University of Lübeck, Institute for Robotic and Cognitive Systems, Lübeck, Germany
| | - Volker Budach
- Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Leif-Hendrik Boldt
- Med. Klinik m.S. Kardiologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Hendrik Bonnemeier
- Klinik für Innere Medizin III, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Boris Rudic
- I. Medizinische Klinik, Universitätsklinikum Mannheim and German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
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Wilke L, Moustakis C, Blanck O, Albers D, Albrecht C, Avcu Y, Boucenna R, Buchauer K, Etzelstorfer T, Henkenberens C, Jeller D, Jurianz K, Kornhuber C, Kretschmer M, Lotze S, Meier K, Pemler P, Riegler A, Röser A, Schmidhalter D, Spruijt KH, Surber G, Vallet V, Wiehle R, Willner J, Winkler P, Wittig A, Guckenberger M, Tanadini-Lang S. Improving interinstitutional and intertechnology consistency of pulmonary SBRT by dose prescription to the mean internal target volume dose. Strahlenther Onkol 2021; 197:836-846. [PMID: 34196725 PMCID: PMC8397670 DOI: 10.1007/s00066-021-01799-w] [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: 05/13/2020] [Accepted: 05/10/2021] [Indexed: 11/16/2022]
Abstract
Purpose Dose, fractionation, normalization and the dose profile inside the target volume vary substantially in pulmonary stereotactic body radiotherapy (SBRT) between different institutions and SBRT technologies. Published planning studies have shown large variations of the mean dose in planning target volume (PTV) and gross tumor volume (GTV) or internal target volume (ITV) when dose prescription is performed to the PTV covering isodose. This planning study investigated whether dose prescription to the mean dose of the ITV improves consistency in pulmonary SBRT dose distributions. Materials and methods This was a multi-institutional planning study by the German Society of Radiation Oncology (DEGRO) working group Radiosurgery and Stereotactic Radiotherapy. CT images and structures of ITV, PTV and all relevant organs at risk (OAR) for two patients with early stage non-small cell lung cancer (NSCLC) were distributed to all participating institutions. Each institute created a treatment plan with the technique commonly used in the institute for lung SBRT. The specified dose fractionation was 3 × 21.5 Gy normalized to the mean ITV dose. Additional dose objectives for target volumes and OAR were provided. Results In all, 52 plans from 25 institutions were included in this analysis: 8 robotic radiosurgery (RRS), 34 intensity-modulated (MOD), and 10 3D-conformal (3D) radiation therapy plans. The distribution of the mean dose in the PTV did not differ significantly between the two patients (median 56.9 Gy vs 56.6 Gy). There was only a small difference between the techniques, with RRS having the lowest mean PTV dose with a median of 55.9 Gy followed by MOD plans with 56.7 Gy and 3D plans with 57.4 Gy having the highest. For the different organs at risk no significant difference between the techniques could be found. Conclusions This planning study pointed out that multiparameter dose prescription including normalization on the mean ITV dose in combination with detailed objectives for the PTV and ITV achieve consistent dose distributions for peripheral lung tumors in combination with an ITV concept between different delivery techniques and across institutions. Supplementary Information The online version of this article (10.1007/s00066-021-01799-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L Wilke
- Klinik für Radio-Onkologie, Universitätsspital Zürich, Zürich, Switzerland.
| | - C Moustakis
- Klinik für Strahlentherapie, Universitätsklinikum Münster, Münster, Germany
| | - O Blanck
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - D Albers
- Klinik für Strahlentherapie und Radioonkologie, Universtitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - C Albrecht
- CyberKnife Centrum Süd, Schwarzwald-Baar Klinikum Villingen-Schwenningen, Villingen-Schwenningen, Germany
| | - Y Avcu
- Klinik für Strahlentherapie und Radioonkologie, Universitätsspital Basel, Basel, Switzerland
| | - R Boucenna
- Institut de radio-oncologie, Hislanden Lausanne, Lausanne, Switzerland
| | - K Buchauer
- Klinik für Radio-Onkologie, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - T Etzelstorfer
- Radio-Onkologie, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
| | - C Henkenberens
- Klinik für Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - D Jeller
- Radio-Onkologie, Kantonsspital Luzern, Luzern, Switzerland
| | - K Jurianz
- MVZ Gamma-Knife Zentrum Krefeld, Krefeld, Germany
| | - C Kornhuber
- Klinik für Strahlentherapie, Universitätsklinikum Halle, Halle, Germany
| | | | - S Lotze
- Klinik für Radioonkologie und Strahlentherapie, Uniklinik RWTH Aachen, Aachen, Germany
| | - K Meier
- Strahlentherapie, Klinikum Wolfsburg, Wolfsburg, Germany
| | - P Pemler
- Klinik für Radioonkologie, Stadtspital Triemli, Zürich, Switzerland
| | - A Riegler
- Institut für Radioonkologie und Strahlentherapie, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - A Röser
- Strahlentherapie und Radio-Onkologie, Helios Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - D Schmidhalter
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern, Switzerland.,University Hospital, and University of Bern, Bern, Switzerland
| | - K H Spruijt
- Institut de radio-oncologie, Clinique des Grangettes, Geneva, Switzerland
| | - G Surber
- Institut für Radiochirurgie und Präzisionsbestrahlung, CyberKnife Centrum Mitteldeutschland, Erfurt, Germany
| | - V Vallet
- Service de radio-oncologie, Centre hospitalier universitaire vaudois, Lausanne, Switzerland
| | - R Wiehle
- Klinik für Strahlenheilkunde, Universitätsklinikum Freiburg, Freiburg, Germany
| | - J Willner
- Klinik für Strahlentherapie, Klinikum Bayreuth, Bayreuth, Germany
| | - P Winkler
- Universitätsklinik für Strahlentherapie-Radioonkologie, LKH-Univ. Klinikum Graz, Graz, Austria
| | - A Wittig
- Departent of Radiotherapy and Radiation Oncology, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - M Guckenberger
- Klinik für Radio-Onkologie, Universitätsspital Zürich, Zürich, Switzerland
| | - S Tanadini-Lang
- Klinik für Radio-Onkologie, Universitätsspital Zürich, Zürich, Switzerland
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Chan MKH, Chiang CL. Revisiting the formalism of equivalent uniform dose based on the linear-quadratic and universal survival curve models in high-dose stereotactic body radiotherapy. Strahlenther Onkol 2021; 197:622-632. [PMID: 33245378 PMCID: PMC8219592 DOI: 10.1007/s00066-020-01713-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/02/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine the equivalent uniform dose (EUD) formalism using the universal survival curve (USC) applicable to high-dose stereotactic body radiotherapy (SBRT). MATERIALS AND METHODS For nine non-small-cell carcinoma cell (NSCLC) lines, the linear-quadratic (LQ) and USC models were used to calculate the EUD of a set of hypothetical two-compartment tumor dose-volume histogram (DVH) models. The dose was varied by ±5%, ±10%, and ±20% about the prescription dose (60 Gy/3 fractions) to the first compartment, with fraction volume varying from 1% and 5% to 30%. Clinical DVHs of 21 SBRT treatments of NSCLC prescribed to the 70-83% isodose lines were also considered. The EUD of non-standard SBRT dose fractionation (EUDSBRT) was further converted to standard fractionation of 2 Gy (EUDCFRT) using the LQ and USC models to facilitate comparisons between different SBRT dose fractionations. Tumor control probability (TCP) was then estimated from the LQ- and USC-EUDCFRT. RESULTS For non-standard SBRT fractionation, the deviation of the USC- from the LQ-EUDSBRT is largely limited to 5% in the presence of dose variation up to ±20% to fractional tumor volume up to 30% in all NSCLC cell lines. Linear regression with zero constant yielded USC-EUDSBRT = 0.96 × LQ-EUDSBRT (r2 = 0.99) for the clinical DVHs. Converting EUDSBRT into standard 2‑Gy fractions by the LQ formalism produced significantly larger EUDCFRT than the USC formalism, particularly for low [Formula: see text] ratios and large fraction dose. Simplified two-compartment DVH models illustrated that both the LQ- and USC-EUDCFRT values were sensitive to cold spot below the prescription dose with little volume dependence. Their deviations were almost constant for up to 30% dose increase above the prescription. Linear regression with zero constant yielded USC-EUDCFRT = 1.56 × LQ-EUDCFRT (r2 = 0.99) for the clinical DVHs. The clinical LQ-EUDCFRT resulted in median TCP of almost 100% vs. 93.8% with USC-EUDCFRT. CONCLUSION A uniform formalism of EUD should be defined among the SBRT community in order to apply it as a single metric for dose reporting and dose-response modeling in high-dose-gradient SBRT because its value depends on the underlying cell survival model and the model parameters. Further investigations of the optimal formalism to derive the EUD through clinical correlations are warranted.
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Affiliation(s)
- Mark Ka Heng Chan
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Essen, Germany.
- Department of Radiation Oncology, Karl-Lennert-Krebscentrum Nord, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 50, 24105, Kiel, Germany.
| | - Chi-Leung Chiang
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, Hong Kong S.A.R., China
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16
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Chamberlain M, Krayenbuehl J, van Timmeren JE, Wilke L, Andratschke N, Garcia Schüler H, Tanadini-Lang S, Guckenberger M, Balermpas P. Head and neck radiotherapy on the MR linac: a multicenter planning challenge amongst MRIdian platform users. Strahlenther Onkol 2021; 197:1093-1103. [PMID: 33891126 PMCID: PMC8604891 DOI: 10.1007/s00066-021-01771-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/22/2021] [Indexed: 11/30/2022]
Abstract
Purpose Purpose of this study is to evaluate plan quality on the MRIdian (Viewray Inc., Oakwood Village, OH, USA) system for head and neck cancer (HNC) through comparison of planning approaches of several centers. Methods A total of 14 planners using the MRIdian planning system participated in this treatment challenge, centrally organized by ViewRay, for one contoured case of oropharyngeal carcinoma with standard constraints for organs at risk (OAR). Homogeneity, conformity, sparing of OARs, and other parameters were evaluated according to The International Commission on Radiation Units and Measurements (ICRU) recommendations anonymously, and then compared between centers. Differences amongst centers were assessed by means of Wilcoxon test. Each plan had to fulfil hard constraints based on dose–volume histogram (DVH) parameters and delivery time. A plan quality metric (PQM) was evaluated. The PQM was defined as the sum of 16 submetrics characterizing different DVH goals. Results For most dose parameters the median score of all centers was higher than the threshold that results in an ideal score. Six participants achieved the maximum number of points for the OAR dose parameters, and none had an unacceptable performance on any of the metrics. Each planner was able to achieve all the requirements except for one which exceeded delivery time. The number of segments correlated to improved PQM and inversely correlated to brainstem D0.1cc and to Planning Target Volume1 (PTV) D0.1cc. Total planning experience inversely correlated to spinal canal dose. Conclusion Magnetic Resonance Image (MRI) linac-based planning for HNC is already feasible with good quality. Generally, an increased number of segments and increasing planning experience are able to provide better results regarding planning quality without significantly prolonging overall treatment time. Supplementary Information The online version of this article (10.1007/s00066-021-01771-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Madalyne Chamberlain
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
| | - Jerome Krayenbuehl
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | | | - Lotte Wilke
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | | | | | | | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
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17
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Perez-Calatayud MJ, Conde-Moreno AJ, Celada-Álvarez FJ, Rubio C, López-Campos F, Navarro-Martin A, Arribas L, Santos M, Lopez-Torrecilla J, Perez-Calatayud J. SEOR SBRT-SG survey on SRS/SBRT dose prescription criteria in Spain. Clin Transl Oncol 2021; 23:1794-1800. [PMID: 33730312 DOI: 10.1007/s12094-021-02583-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/04/2021] [Indexed: 11/25/2022]
Abstract
AIM Stereotactic body radiotherapy (SBRT) and stereotactic radiosurgery (SRS) are essential tools in radiation oncology. In Spain, the use of these techniques continues to grow as older linear accelerators (linacs) are replaced with modern equipment. However, little is known about inter-centre variability in prescription and dose heterogeneity limits. Consequently, the SBRT-Spanish Task Group (SBRT-SG) of the Spanish Society of Radiation Oncology (SEOR) has undertaken an initiative to assess prescription and homogeneity in SRS/SBRT treatment. In the present study, we surveyed radiation oncology (RO) departments to obtain a realistic overview of prescription methods used for SBRT and SRS treatment in Spain. METHODS A brief survey was developed and sent to 34 RO departments in Spain, mostly those who are members of the SEOR SBRT-SG. The survey contained seven questions about the specific prescription mode, dose distribution heterogeneity limits, prescription strategies according to SRS/SBRT type, and the use of IMRT-VMAT (Intensity Modulated Radiation Therapy-Volumetric Modulated Arc Therapy). RESULTS Responses were received from 29 centres. Most centres (59%) used the prescription criteria D95% ≥ 100%. Accepted dose heterogeneity was wide, ranging from 107 to 200%. Most centres used IMRT-VMAT (93%). CONCLUSIONS This survey about SRS/SBRT prescription and dose heterogeneity has evidenced substantial inter-centre variability in prescription criteria, particularly for intended and accepted dose heterogeneity. These differences could potentially influence the mean planning target volume dose and its correlation with treatment outcomes. The findings presented here will be used by the SEOR SBRT-SG to develop recommendations for SRS/SBRT dose prescription and heterogeneity.
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Affiliation(s)
- M J Perez-Calatayud
- Radiation Oncology Department, Fundacion Instituto Valenciano de Oncologia, C/Beltrán Báguena 8, 46009, Valencia, Spain.
| | | | | | - C Rubio
- Radiation Oncology Department, Hospital HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - F López-Campos
- Radiation Oncology Department, Hospital Ramon Y Cajal, Madrid, Spain
| | - A Navarro-Martin
- Radiation Oncology Department, Hospital Duran I Reynals, Instituto Catalan de Oncología, Barcelona, Spain
| | - L Arribas
- Radiation Oncology Department, Fundacion Instituto Valenciano de Oncologia, C/Beltrán Báguena 8, 46009, Valencia, Spain
| | - M Santos
- Radiation Oncology Department, Clinica Benidorm, Alicante, Spain
| | | | - J Perez-Calatayud
- Radiation Oncology Department, Hospital La Fe, Valencia, Spain.,Radiation Oncology Department, Clinica Benidorm, Alicante, Spain
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18
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Stera S, Miebach G, Buergy D, Dreher C, Lohr F, Wurster S, Rödel C, Marcella S, Krug D, Frank A G, Ehmann M, Fleckenstein J, Blanck O, Boda-Heggemann J. Liver SBRT with active motion-compensation results in excellent local control for liver oligometastases: An outcome analysis of a pooled multi-platform patient cohort. Radiother Oncol 2021; 158:230-236. [PMID: 33667585 DOI: 10.1016/j.radonc.2021.02.036] [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: 06/05/2020] [Revised: 02/10/2021] [Accepted: 02/24/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Local treatment of metastases in combination with systemic therapy can prolong survival of oligo-metastasized patients. To fully exploit this potential, safe and effective treatments are needed to ensure long-term metastases control. Stereotactic body radiotherapy (SBRT) is one means, however, for moving liver tumors correct delivery of high doses is challenging. After validating equal in-vivo treatment accuracy, we analyzed a pooled multi-platform liver-SBRT-database for clinical outcome. METHODS Local control (LC), progression-free interval (PFI), overall survival (OS), predictive factors and toxicity was evaluated in 135 patients with 227 metastases treated by gantry-based SBRT (deep-inspiratory breath-hold-gating; n = 71) and robotic-based SBRT (fiducial-tracking, n = 156) with mean gross tumor volume biological effective dose (GTV-BEDα/β=10Gy) of 146.6 Gy10. RESULTS One-, and five-year LC was 90% and 68.7%, respectively. On multivariate analysis, LC was significantly predicted by colorectal histology (p = 0.006). Median OS was 20 months with one- and two-year OS of 67% and 37%. On multivariate analysis, ECOG-status (p = 0.003), simultaneous chemotherapy (p = 0.003), time from metastasis detection to SBRT-treatment (≥2months; p = 0.021) and LC of the treated metastases (≥12 months, p < 0.009) were significant predictors for OS. One- and two-year PFI were 30.5% and 14%. Acute toxicity was mild and rare (14.4% grade I, 2.3% grade II, 0.6% grade III). Chronic °III/IV toxicities occurred in 1.1%. CONCLUSIONS Patient selection, time to treatment and sufficient doses are essential to achieve optimal outcome for SBRT with active motion compensation. Local control appears favorable compared to historical control. Long-term LC of the treated lesions was associated with longer overall survival.
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Affiliation(s)
- Susanne Stera
- University Hospital Frankfurt, Department of Radiation Oncology, Frankfurt am Main, Germany.
| | - Georgia Miebach
- University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Department of Radiation Oncology, Germany
| | - Daniel Buergy
- University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Department of Radiation Oncology, Germany
| | - Constantin Dreher
- University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Department of Radiation Oncology, Germany
| | - Frank Lohr
- UO di Radioterapia, Dipartimento di Oncologia, Azienda Ospedaliero-Universitaria di Modena, Italy
| | - Stefan Wurster
- Saphir Radiosurgery Center, Güstrow, Germany; University Medicine Greifswald, Department of Radiation Oncology, Germany
| | - Claus Rödel
- University Hospital Frankfurt, Department of Radiation Oncology, Frankfurt am Main, Germany
| | - Szücs Marcella
- University Medicine Rostock, Department of Radiation Oncology, Germany
| | - David Krug
- Saphir Radiosurgery Center, Güstrow, Germany; University Medical Center Schleswig-Holstein, Department of Radiation Oncology, Kiel, Germany
| | - Giordano Frank A
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Germany
| | - Michael Ehmann
- University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Department of Radiation Oncology, Germany
| | - Jens Fleckenstein
- University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Department of Radiation Oncology, Germany
| | - Oliver Blanck
- Saphir Radiosurgery Center, Güstrow, Germany; University Medical Center Schleswig-Holstein, Department of Radiation Oncology, Kiel, Germany
| | - Judit Boda-Heggemann
- University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Department of Radiation Oncology, Germany
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Mancosu P, Hernandez V, Esposito M, Moustakis C, Russo S, Blanck O. Application of the RATING score: In regards to Hansen et al. Radiother Oncol 2021; 158:309-310. [PMID: 33493501 DOI: 10.1016/j.radonc.2020.12.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/24/2020] [Accepted: 12/24/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Pietro Mancosu
- Medical Physics Unit of Radiation Oncology Dept., Humanitas Clinical and Research Hospital-IRCCS, Milano, Italy
| | - Victor Hernandez
- Department of Medical Physics, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - Marco Esposito
- Medical Physics Unit, AUSL Toscana Centro, Florence, Italy.
| | - Christos Moustakis
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | | | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
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Shao W, Chen Z, Bai Y, Xu B, Xu L, Zhao Q, Wang Y, Tang X. Stereotactic body radiation therapy for non-small cell lung cancer using the non-coplanar radiation of Cyberknife and Varian linac. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2021; 29:635-643. [PMID: 33935131 DOI: 10.3233/xst-210867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE This study aims to evaluate the planned dose of stereotactic body radiation therapy (SBRT) for treating early peripheral non-small cell lung cancer (NSCLC) using the non-coplanar radiation from Cyberknife and Varian linac. Moreover, this study investigates whether Cyberknife and Varian linac are qualified for non-coplanar radiation SBRT for treating early peripheral NSCLC, and which one is better for protecting organs at risk (OARs). METHODS Retrospective analysis was performed based on the Cyberknife radiation treatment plans (RTPs) and Varian Eclipse RTPs of 10 patients diagnosed with early peripheral NSCLC. The dose distributions in the target and OARs were compared between the RTPs of Cyberknife and Varian Eclipse using Mim medical imaging software. RESULTS For PTV, no significant difference in D98 and D95 between the Cyberknife and Eclipse was observed (t = -0.35, -1.67, P > 0.05). The homogeneity indexes (HIs) of Cyberknife plans are higher (t = 71.86, P < 0.05) than those of Eclipse plans. The V10, V15, V20, V25, V30 and Dmean of the lung with NSCLC and the V20 of the whole lung for Cyberknife were less than those for Eclipse (t = -4.73, -5.62, -7.75, -6.38, -6.89, -3.14, -7.09, respectively, P < 0.05). Cyberknife plans have smaller spinal cord Dmax, trachea Dmax, heart Dmax, chest wall Dmax (t = -2.49, -2.57, -3.71, -3.56, respectively, P < 0.05) and esophagus Dmax (t = -1.95, P > 0.05) than Varian Eclipse plans. CONCLUSION To fulfill SBRT by non-coplanar radiation, Cyberknife is recommended for the institutions equipped with Cyberknife, while Varian linac can be applied for the institutions that have not adopted Cyberknife in clinical radiotherapy yet.
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Affiliation(s)
- Wencheng Shao
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, P. R. China
- Department of Radiation Physics, Harbin Medical University Cancer Hospital, Harbin, P. R. China
| | - Ziyin Chen
- Department of Radiation Therapy, The First Affiliated Hospital of Harbin Medical University, Harbin, P. R. China
| | - Yanchun Bai
- Department of Radiation Therapy, The First Affiliated Hospital of Harbin Medical University, Harbin, P. R. China
| | - Bingchen Xu
- Department of Radiation Therapy, Jilin Central Hospital, Jilin, P. R. China
| | - Lili Xu
- Department of Radiation Therapy, The First Affiliated Hospital of Harbin Medical University, Harbin, P. R. China
| | - Qiushuang Zhao
- Department of Radiation Therapy, The First Affiliated Hospital of Harbin Medical University, Harbin, P. R. China
| | - Yang Wang
- Accelerator Treatment Site, Harbin Chest Hospital, Harbin, P. R. China
| | - Xiaobin Tang
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, P. R. China
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21
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Klement RJ, Sonke JJ, Allgäuer M, Andratschke N, Appold S, Belderbos J, Belka C, Blanck O, Dieckmann K, Eich HT, Mantel F, Eble M, Hope A, Grosu AL, Nevinny-Stickel M, Semrau S, Sweeney RA, Hörner-Rieber J, Werner-Wasik M, Engenhart-Cabillic R, Ye H, Grills I, Guckenberger M. Correlating Dose Variables with Local Tumor Control in Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer: A Modeling Study on 1500 Individual Treatments. Int J Radiat Oncol Biol Phys 2020; 107:579-586. [PMID: 32188579 DOI: 10.1016/j.ijrobp.2020.03.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/04/2020] [Accepted: 03/02/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Large variation regarding prescription and dose inhomogeneity exists in stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer. The aim of this modeling study was to identify which dose metric correlates best with local tumor control probability to make recommendations regarding SBRT prescription. METHODS AND MATERIALS We combined 2 retrospective databases of patients with non-small cell lung cancer, yielding 1500 SBRT treatments for analysis. Three dose parameters were converted to biologically effective doses (BEDs): (1) the (near-minimum) dose prescribed to the planning target volume (PTV) periphery (yielding BEDmin); (2) the (near-maximum) dose absorbed by 1% of the PTV (yielding BEDmax); and (3) the average between near-minimum and near-maximum doses (yielding BEDave). These BED parameters were then correlated to the risk of local recurrence through Cox regression. Furthermore, BED-based prediction of local recurrence was attempted by logistic regression and fast and frugal trees. Models were compared using the Akaike information criterion. RESULTS There were 1500 treatments in 1434 patients; 117 tumors recurred locally. Actuarial local control rates at 12 and 36 months were 96.8% (95% confidence interval, 95.8%-97.8%) and 89.0% (87.0%-91.1%), respectively. In univariable Cox regression, BEDave was the best predictor of risk of local recurrence, and a model based on BEDmin had substantially less evidential support. In univariable logistic regression, the model based on BEDave also performed best. Multivariable classification using fast and frugal trees revealed BEDmax to be the most important predictor, followed by BEDave. CONCLUSIONS BEDave was generally better correlated with tumor control probability than either BEDmax or BEDmin. Because the average between near-minimum and near-maximum doses was highly correlated to the mean gross tumor volume dose, the latter may be used as a prescription target. More emphasis could be placed on achieving sufficiently high mean doses within the gross tumor volume rather than the PTV covering dose, a concept needing further validation.
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Affiliation(s)
- Rainer J Klement
- Department of Radiotherapy and Radiation Oncology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany.
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Michael Allgäuer
- Department of Radiotherapy, Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Steffen Appold
- Department of Radiation Oncology, Technische Universität Dresden, Dresden, Germany
| | - José Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Claus Belka
- Department of Radiation Oncology, University Hospital of Ludwig-Maximilians-University Munich, Munich, Germany
| | - Oliver Blanck
- Department of Radiation Oncology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Karin Dieckmann
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - Hans T Eich
- Department of Radiotherapy, University Hospital Münster, Münster, Germany
| | - Frederick Mantel
- Department of Radiotherapy and Radiation Oncology, University Hospital Wuerzburg, Wuerzberg, Germany
| | - Michael Eble
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany
| | - Andrew Hope
- Department of Radiation Oncology, University of Toronto and Princess Margaret Cancer Center, Toronto, Canada
| | - Anca L Grosu
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany
| | | | - Sabine Semrau
- Department of Radiation Oncology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Reinhart A Sweeney
- Department of Radiotherapy and Radiation Oncology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Rita Engenhart-Cabillic
- Department of Radiotherapy and Radiation Oncology, Phillips-University Marburg, Marburg, Germany
| | - Hong Ye
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
| | - Inga Grills
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
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22
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Merlotti A, Bonomo P, Ragona R, Trovò M, Alongi F, Mazzola R, Vigna Taglianti R, Gianello L, Reali A, Bergesio F, Lucio F, Boriano A, De Maggi A, Russi E. Dose prescription in SBRT for early-stage non-small cell lung cancer: are we all speaking the same language? TUMORI JOURNAL 2020; 107:182-187. [PMID: 32515301 DOI: 10.1177/0300891620929425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Stereotactic body radiation therapy is increasingly used in the treatment of early-stage lung cancers. Guidelines provide indications regarding the constraints to the organs at risk (OARs) and the minimum coverage of the planning target volume but do not suggest optimal dose distribution. Data on dose distribution from the different published series are not comparable due to different prescription modalities and reported dose parameters. METHODS We conducted a review of the published data on dose prescription, focusing on the role of homogeneity on local tumor control, and present suggestions on how to specify and report the prescriptions to permit comparisons between studies or between cases from different centers. CONCLUSIONS To identify the dose-prescription modality that better correlates with oncologic outcomes, future studies should guarantee a close uniformity of dose distribution between cases and complete dose parameters reporting for treatment volumes and OARs.
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Affiliation(s)
- Anna Merlotti
- Radiation Oncology, Santa Croce e Carle Hospital, Cuneo, Italy
| | | | | | - Marco Trovò
- Department of Radiation Oncology, Azienda Sanitaria Universitaria Integrata UD, Udine, Italy
| | - Filippo Alongi
- Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Rosario Mazzola
- Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | | | - Luca Gianello
- Radiation Oncology, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Alessia Reali
- Radiation Oncology, Santa Croce e Carle Hospital, Cuneo, Italy
| | | | | | | | | | - Elvio Russi
- Radiation Oncology, Santa Croce e Carle Hospital, Cuneo, Italy
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23
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Schmitt D, Blanck O, Gauer T, Fix MK, Brunner TB, Fleckenstein J, Loutfi-Krauss B, Manser P, Werner R, Wilhelm ML, Baus WW, Moustakis C. Technological quality requirements for stereotactic radiotherapy : Expert review group consensus from the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. Strahlenther Onkol 2020; 196:421-443. [PMID: 32211939 PMCID: PMC7182540 DOI: 10.1007/s00066-020-01583-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/13/2020] [Indexed: 12/25/2022]
Abstract
This review details and discusses the technological quality requirements to ensure the desired quality for stereotactic radiotherapy using photon external beam radiotherapy as defined by the DEGRO Working Group Radiosurgery and Stereotactic Radiotherapy and the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. The covered aspects of this review are 1) imaging for target volume definition, 2) patient positioning and target volume localization, 3) motion management, 4) collimation of the irradiation and beam directions, 5) dose calculation, 6) treatment unit accuracy, and 7) dedicated quality assurance measures. For each part, an expert review for current state-of-the-art techniques and their particular technological quality requirement to reach the necessary accuracy for stereotactic radiotherapy divided into intracranial stereotactic radiosurgery in one single fraction (SRS), intracranial fractionated stereotactic radiotherapy (FSRT), and extracranial stereotactic body radiotherapy (SBRT) is presented. All recommendations and suggestions for all mentioned aspects of stereotactic radiotherapy are formulated and related uncertainties and potential sources of error discussed. Additionally, further research and development needs in terms of insufficient data and unsolved problems for stereotactic radiotherapy are identified, which will serve as a basis for the future assignments of the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. The review was group peer-reviewed, and consensus was obtained through multiple working group meetings.
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Affiliation(s)
- Daniela Schmitt
- Klinik für Radioonkologie und Strahlentherapie, National Center for Radiation Research in Oncology (NCRO), Heidelberger Institut für Radioonkologie (HIRO), Universitätsklinikum Heidelberg, Heidelberg, Germany.
| | - Oliver Blanck
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Tobias Gauer
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Michael K Fix
- Abteilung für Medizinische Strahlenphysik und Universitätsklinik für Radio-Onkologie, Inselspital-Universitätsspital Bern, Universität Bern, Bern, Switzerland
| | - Thomas B Brunner
- Universitätsklinik für Strahlentherapie, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | - Jens Fleckenstein
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Britta Loutfi-Krauss
- Klinik für Strahlentherapie und Onkologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Peter Manser
- Abteilung für Medizinische Strahlenphysik und Universitätsklinik für Radio-Onkologie, Inselspital-Universitätsspital Bern, Universität Bern, Bern, Switzerland
| | - Rene Werner
- Institut für Computational Neuroscience, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Maria-Lisa Wilhelm
- Klinik für Strahlentherapie, Universitätsmedizin Rostock, Rostock, Germany
| | - Wolfgang W Baus
- Klinik für Radioonkologie, CyberKnife- und Strahlentherapie, Universitätsklinikum Köln, Cologne, Germany
| | - Christos Moustakis
- Klinik für Strahlentherapie-Radioonkologie, Universitätsklinikum Münster, Münster, Germany
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24
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Blanck O, Buergy D, Vens M, Eidinger L, Zaman A, Krug D, Rudic B, Boda-Heggemann J, Giordano FA, Boldt LH, Mehrhof F, Budach V, Schweikard A, Olbrich D, König IR, Siebert FA, Vonthein R, Dunst J, Bonnemeier H. Radiosurgery for ventricular tachycardia: preclinical and clinical evidence and study design for a German multi-center multi-platform feasibility trial (RAVENTA). Clin Res Cardiol 2020; 109:1319-1332. [PMID: 32306083 PMCID: PMC7588361 DOI: 10.1007/s00392-020-01650-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/08/2020] [Indexed: 12/25/2022]
Abstract
Background Single-session high-dose stereotactic radiotherapy (radiosurgery) is a new treatment option for otherwise untreatable patients suffering from refractory ventricular tachycardia (VT). In the initial single-center case studies and feasibility trials, cardiac radiosurgery has led to significant reductions of VT burden with limited toxicities. However, the full safety profile remains largely unknown. Methods/design In this multi-center, multi-platform clinical feasibility trial which we plan is to assess the initial safety profile of radiosurgery for ventricular tachycardia (RAVENTA). High-precision image-guided single-session radiosurgery with 25 Gy will be delivered to the VT substrate determined by high-definition endocardial electrophysiological mapping. The primary endpoint is safety in terms of successful dose delivery without severe treatment-related side effects in the first 30 days after radiosurgery. Secondary endpoints are the assessment of VT burden, reduction of implantable cardioverter defibrillator (ICD) interventions [shock, anti-tachycardia pacing (ATP)], mid-term side effects and quality-of-life (QoL) in the first year after radiosurgery. The planned sample size is 20 patients with the goal of demonstrating safety and feasibility of cardiac radiosurgery in ≥ 70% of the patients. Quality assurance is provided by initial contouring and planning benchmark studies, joint multi-center treatment decisions, sequential patient safety evaluations, interim analyses, independent monitoring, and a dedicated data and safety monitoring board. Discussion RAVENTA will be the first study to provide the initial robust multi-center multi-platform prospective data on the therapeutic value of cardiac radiosurgery for ventricular tachycardia. Trial registration number NCT03867747 (clinicaltrials.gov). Registered March 8, 2019. The study was initiated on November 18th, 2019, and is currently recruiting patients. Graphic abstract ![]()
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Affiliation(s)
- Oliver Blanck
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 50, 24105, Kiel, Germany.
| | - Daniel Buergy
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Medizinische Fakultät Mannheim, Mannheim, Germany
| | - Maren Vens
- Universität zu Lübeck, Zentrum für Klinische Studien, Lübeck, Germany.,Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Lina Eidinger
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 50, 24105, Kiel, Germany.,Klinik für Innere Medizin III, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Adrian Zaman
- Klinik für Innere Medizin III, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 50, 24105, Kiel, Germany
| | - Boris Rudic
- Medizinische Klinik I, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsmedizin Mannheim, Universität Heidelberg, Medizinische Fakultät Mannheim, Mannheim, Germany
| | - Judit Boda-Heggemann
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Medizinische Fakultät Mannheim, Mannheim, Germany
| | - Frank A Giordano
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Medizinische Fakultät Mannheim, Mannheim, Germany
| | - Leif-Hendrik Boldt
- Medizinische Klinik mit Schwerpunkt Kardiologie (CVK), Abteilung für Elektrophysiologie und Rhythmologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Mehrhof
- Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Volker Budach
- Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Achim Schweikard
- Institut für Robotik und Kognitive Systeme, Universität zu Lübeck, Lübeck, Germany
| | - Denise Olbrich
- Universität zu Lübeck, Zentrum für Klinische Studien, Lübeck, Germany
| | - Inke R König
- Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Frank-Andre Siebert
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 50, 24105, Kiel, Germany
| | - Reinhard Vonthein
- Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 50, 24105, Kiel, Germany
| | - Hendrik Bonnemeier
- Klinik für Innere Medizin III, Abteilung für Elektrophysiologie und Rhythmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
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25
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A novel approach to SBRT patient quality assurance using EPID-based real-time transit dosimetry. Strahlenther Onkol 2020; 196:182-192. [DOI: 10.1007/s00066-019-01549-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/26/2019] [Indexed: 12/25/2022]
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26
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Mix M, Tanny S, Nsouli T, Alden R, Chaudhari R, Kincaid R, Rosenbaum PF, Bogart JA, Aridgides P. Outcomes Following Stereotactic Body Radiotherapy with Intensity-Modulated Therapy versus Three-Dimensional Conformal Radiotherapy in Early Stage Non-Small Cell Lung Cancer. LUNG CANCER-TARGETS AND THERAPY 2019; 10:151-159. [PMID: 31908556 PMCID: PMC6929968 DOI: 10.2147/lctt.s235713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 11/29/2019] [Indexed: 11/23/2022]
Abstract
Introduction The treatment techniques used for stereotactic body radiation therapy (SBRT) for early-stage lung cancer continue to evolve. In this study, clinical outcomes following SBRT were evaluated according to the use of either 3D conformal radiotherapy (3DCRT) or intensity-modulated radiation therapy (IMRT). Patients and methods Patients with stage I NSCLC who received SBRT from 2007 to 2015 were retrospectively reviewed. Disease control and survival were assessed using Kaplan-Meier estimates. Dosimetric analyses for target dose heterogeneity and coverage were performed. Results A total of 297 patients with 351 lesions were included. 3DCRT was used in 52% and IMRT in 48%. IMRT was utilized at a higher rate in more recent years. The most common regimens were 48 Gy in 4 fractions and 54-60 Gy in 3 fractions. With a median follow up of 22.7 months, there were 17 local failures for a crude relapse rate of 5.7%. Local failure did not differ in patients treated with 3DCRT and IMRT (4.9% vs 6.5%, p=0.573). Mean dose to gross tumor volume (GTV) as a percent of prescription dose was higher with 3DCRT compared with IMRT (107.7% vs 103.6%, p < 0.0001). Tumor stage, histology, and SBRT regimen did not correlate with local tumor control. Overall survival for the entire population approximated 72% at 2 years. Treatment was well tolerated with 6 documented grade 3+ events. Conclusion In this single-institution cohort of SBRT for early-stage NSCLC, there was no discernible difference in clinical outcomes between those treated with 3DCRT and IMRT.
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Affiliation(s)
- Michael Mix
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Sean Tanny
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Tamara Nsouli
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Ryan Alden
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Rishabh Chaudhari
- Department of Radiation Oncology, University of Cincinnati/University Hospital Barrett Cancer Center, Cincinatti, OH 45267, USA
| | - Russell Kincaid
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Paula F Rosenbaum
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Jeffrey A Bogart
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Paul Aridgides
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
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27
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Stereotactic body radiotherapy in patients with hepatocellular carcinoma in a multimodal treatment setting. Strahlenther Onkol 2019; 196:334-348. [DOI: 10.1007/s00066-019-01540-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/23/2019] [Indexed: 12/24/2022]
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28
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Dosimetric Multicenter Planning Comparison Studies for Stereotactic Body Radiation Therapy: Methodology and Future Perspectives. Int J Radiat Oncol Biol Phys 2019; 106:403-412. [PMID: 31707124 DOI: 10.1016/j.ijrobp.2019.10.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/03/2019] [Accepted: 10/25/2019] [Indexed: 12/22/2022]
Abstract
In this review a summary of the published literature pertaining to the stereotactic body radiation therapy multiplanning comparison, data sharing strategies, and implementation of benchmark planning cases to improve the skills and knowledge of the participating centers was investigated. A total of 30 full-text articles were included. The studies were subdivided in 3 categories: multiplanning studies on dosimetric variability, planning harmonization before clinical trials, and technical and methodologic studies. The methodology used in the studies were critically analyzed to find common and original elements with the pros and cons. Multicenter planning studies have played a key role in improving treatment plan harmonization, treatment plan compliance, and even clinical practices. This review has highlighted that some fundamental steps should be taken to transform a simple treatment planning comparison study into a potential credentialing method for stereotactic body radiation therapy accreditation. In particular, prescription and general requirements should always be well defined; data analysis should be performed with independent dose volume histogram or dose calculations; quality score indices should be constructed; feedback and correction strategies should be provided; and a simple web-based collaboration platform should be used. The results reported clearly showed that a crowd-based replanning approach is a viable method for achieving harmonization and standardization of treatment planning among centers using different technologies.
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29
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Stereotactic body radiotherapy for ventricular tachycardia (cardiac radiosurgery). Strahlenther Onkol 2019; 196:23-30. [DOI: 10.1007/s00066-019-01530-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 10/09/2019] [Indexed: 11/26/2022]
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30
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Frenzel T, Albers D, Grohmann M, Krüll A. Results of a multicenter intensity modulated radiation therapy treatment planning comparison study for a sample prostate cancer case. Strahlenther Onkol 2019; 195:913-922. [PMID: 31342106 DOI: 10.1007/s00066-019-01496-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 07/02/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the influence of different medical physicists, photon energies, treatment planning systems and treatment machines on the resulting external beam radiotherapy dose distribution for a sample prostate cancer case. METHODS A pre-contoured computed tomography (CT) dataset containing planning target volume 1 (PTV1) prostate and seminal vesicles (single dose [SD] 1.8 Gy, total dose [TD] 59.4 Gy), PTV2 prostate (simultaneously integrated boost [SIB], SD 2.0 Gy, TD 66 Gy), PTV3 prostate and seminal vesicles approach (SD 1.8 Gy, TD 73.8 Gy/80.4 Gy SIB) as well as organs at risk (OAR: rectum, bladder, femoral heads, bowel, anus) was offered to the members of the task group IMRT (intensity-modulated radiation therapy) of the German Society for Medical Physics. The purpose was to calculate one combined treatment plan (TP) for PTV1 and PTV2, as well as a separate one for PTV3. Dose volume histograms (DVH), different dose values, conformity index (CI), homogeneity index (HI), gradient index (GI) and a new "better than average score" were used to analyse the dose distributions. RESULTS Altogether 44 institutions took part in this study and submitted acceptable dose distributions for the PTVs. However, there were statistically significant differences, especially for the doses administered to the OAR, such as rectum, bladder and femoral heads. Differences between the treatment plans were not easily detectable by visual inspection of the isodose distribution. Dose maxima may occur outside the PTV. Even though scoring indices are already published, the new "better than average score" was needed to identify a plan that minimises dose to all OAR simultaneously. CONCLUSION Different medical physicists or dosimetrists, photon energies, treatment planning systems, and treatment machines have an impact on the resulting dose distribution. However, the differences only become apparent when comparing DVH, analysing dose values, comparing CI, HI, GI, as well as reviewing the dose distribution in every single plane. A new score was introduced to identify treatment plans that simultaneously deliver a low dose to all OAR. Such inter- and intra-institutional comparison studies are needed to explore different treatment planning strategies; however, there is still no automatic solution for an "optimal" treatment plan.
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Affiliation(s)
- Thorsten Frenzel
- Outpatient Center of the UKE GmbH, Department for Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Dirk Albers
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Grohmann
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Krüll
- Outpatient Center of the UKE GmbH, Department for Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Lee J, Dean C, Patel R, Webster G, Eaton DJ. Multi-center evaluation of dose conformity in stereotactic body radiotherapy. Phys Imaging Radiat Oncol 2019; 11:41-46. [PMID: 33458276 PMCID: PMC7807546 DOI: 10.1016/j.phro.2019.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND PURPOSE Stereotactic body radiotherapy (SBRT) is an emerging technique for treating oligometastases, but limited data is available on what plan quality is achievable for a range of modalities and clinical sites. METHODS SBRT plans for lung, spine, bone, adrenal, liver and node sites from 17 participating centers were reviewed. Centers used various delivery techniques including static and rotational intensity-modulation and multiple non-coplanar beams. Plans were split into lung and other body sites and evaluated with different plan quality metrics, including two which are independent of target coverage; "prescription dose spillage" (PDS) and "modified gradient index" (MGI). These were compared to constraints from the ROSEL and RTOG 0813 clinical trials. RESULTS Planning target volume (PTV) coverage was compromised (PTV V100% < 90%) in 29% of patient plans in order to meet organ-at-risk (OAR) tolerances, supporting the use of plan quality metrics which are independent of target coverage. Both lung (n = 48) and other body (n = 99) site PDS values agreed well with ROSEL constraints on dose spillage, but RTOG 0813 values were too high to detect sub-optimal plans. MGI values for lung plans were mis-matched to both sets of previous constraints, with ROSEL values too high and RTOG 0813 values too low. MGI values were lower for other body plans as expected, though this was only statistically significant for PTV volumes <20 cm3. CONCLUSIONS Updated guidance for lung and other body site SBRT plan quality using the PDS and MGI metrics is presented.
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Affiliation(s)
- Jonny Lee
- National Radiotherapy Trials QA Group, Mount Vernon Hospital, London HA6 2RN, UK
| | | | - Rushil Patel
- National Radiotherapy Trials QA Group, Mount Vernon Hospital, London HA6 2RN, UK
| | | | - David J. Eaton
- National Radiotherapy Trials QA Group, Mount Vernon Hospital, London HA6 2RN, UK
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Both four-dimensional computed tomography and four-dimensional cone beam computed tomography under-predict lung target motion during radiotherapy. Radiother Oncol 2019; 135:65-73. [DOI: 10.1016/j.radonc.2019.02.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/21/2019] [Accepted: 02/24/2019] [Indexed: 12/25/2022]
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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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ICRU report 91 on prescribing, recording, and reporting of stereotactic treatments with small photon beams : Statement from the DEGRO/DGMP working group stereotactic radiotherapy and radiosurgery. Strahlenther Onkol 2019; 195:193-198. [PMID: 30649567 DOI: 10.1007/s00066-018-1416-x] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 12/13/2018] [Indexed: 12/14/2022]
Abstract
The International Commission on Radiation Units and Measurements (ICRU) report 91 with the title "prescribing, recording, and reporting of stereotactic treatments with small photon beams" was published in 2017. This extensive publication covers different relevant aspects of stereotactic radiotherapy such as small field dosimetry, accuracy requirements for volume definition and planning algorithms, and the precise application of treatment by means of image guidance. Finally, recommendations for prescribing, recording and reporting are given.
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Zehentmayr F, Sprenger M, Rettenbacher L, Wass R, Porsch P, Fastner G, Pirich C, Studnicka M, Sedlmayer F. Survival in early lung cancer patients treated with high dose radiotherapy is independent of pathological confirmation. Thorac Cancer 2019; 10:321-329. [PMID: 30618120 PMCID: PMC6360228 DOI: 10.1111/1759-7714.12966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Approximately 15% of lung cancer patients are diagnosed in early stages. Microscopic proof of disease cannot always be obtained because of comorbidity or reluctance to undergo invasive diagnostic procedures. In the current study, survival data of patients with and without pathology are compared. METHODS One hundred and sixty three patients with NSCLC I-IIb (T3 N0) treated between 2002 and 2016 were eligible: 123 (75%) had pathological confirmation of disease, whereas 40 (25%) did not. In accordance with international guidelines, both groups received radiotherapy. Comorbidity was assessed with the Charlson Comorbidity Index (CCI). RESULTS The median follow-up was 28.6 months (range: 0.3-162): 66 (40%) patients are still alive, while 97 (59%) patients died: 48 (29%) cancer-related deaths and 49 (30%) from causes other than cancer. Median overall survival (OS) in patients without pathological confirmation was 58.6 months (range: 0.5-162), which did not differ from those with microscopic proof of disease (39.4 months, range: 0.3-147.5; logrank P = 0.481). Median cancer-specific survival (CSS) also did not differ at 113.4 months (range: 0.5-162) in the non-confirmation group (logrank P = 0.763) versus 51.5 months (range: 3.7-129.5) in patients with pathology. In Cox regression, a CCI of ≥ 3 was associated with poor OS (hazard ratio 2.0; range 1.2-3.4; P = 0.010) and CSS (hazard ratio 2.0; 1.0-4.0; P = 0.043). CONCLUSION OS and CSS in early lung cancer patients depend on comorbidity rather than on pathological confirmation of disease.
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Affiliation(s)
- Franz Zehentmayr
- Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria.,radART, Paracelsus Medical University, Salzburg, Austria
| | - Martin Sprenger
- Postgraduate Public Health Program, Medical University of Graz, Graz, Austria
| | - Lukas Rettenbacher
- Department of Nuclear Medicine, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Romana Wass
- Department of Pneumology, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Peter Porsch
- Department of Pneumology, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Gerd Fastner
- Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Christian Pirich
- Department of Nuclear Medicine, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Michael Studnicka
- Department of Pneumology, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Felix Sedlmayer
- Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria.,radART, Paracelsus Medical University, Salzburg, Austria
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Aridgides P, Nsouli T, Chaudhari R, Kincaid R, Rosenbaum PF, Tanny S, Mix M, Bogart J. Clinical outcomes following advanced respiratory motion management (respiratory gating or dynamic tumor tracking) with stereotactic body radiation therapy for stage I non-small-cell lung cancer. LUNG CANCER-TARGETS AND THERAPY 2018; 9:103-110. [PMID: 30464667 PMCID: PMC6223331 DOI: 10.2147/lctt.s175168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose To report the outcomes of stereotactic body radiation therapy (SBRT) for stage I non-small-cell lung cancer (NSCLC) according to respiratory motion management method. Methods Patients with stage I NSCLC who received SBRT from 2007 to 2015 were reviewed. Computed tomography (CT) simulation with four-dimensional CT was performed for respiratory motion assessment. Tumor motion >1 cm in the craniocaudal direction was selectively treated with advanced respiratory management: either respiratory gating to a pre-specified portion of the respiratory cycle or dynamic tracking of an implanted fiducial marker. Comparisons were made with internal target volume approach, which treated all phases of respiratory motion. Results Of 297 patients treated with SBRT at our institution, 51 underwent advanced respiratory management (48 with respiratory gating and three with tumor tracking) and 246 underwent all-phase treatment. Groups were similarly balanced with regard to mean age (P=0.242), tumor size (P=0.315), and histology (P=0.715). Tumor location in the lower lung lobes, as compared to middle or upper lobes, was more common in those treated with advanced respiratory management (78.4%) compared to all-phase treatment (25.6%, P<.0001). There were 17 local recurrences in the treated lesions. Kaplan-Meier analyses showed that there were no differences with regard to mean time to local failure (91.5 vs 98.8 months, P=0.56), mean time to any failure (73.2 vs 78.7 months, P=0.73), or median overall survival (43.3 vs 45.5 months, P=0.56) between patients who underwent advanced respiratory motion management and all-phase treatment. Conclusion SBRT with advanced respiratory management (the majority with respiratory gating) showed similar efficacy to all-phase treatment approach for stage I NSCLC.
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Affiliation(s)
- Paul Aridgides
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA,
| | - Tamara Nsouli
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA,
| | - Rishabh Chaudhari
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA,
| | - Russell Kincaid
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA,
| | - Paula F Rosenbaum
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Sean Tanny
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA,
| | - Michael Mix
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA,
| | - Jeffrey Bogart
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA,
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Dreyer J, Bremer M, Henkenberens C. Comorbidity indexing for prediction of the clinical outcome after stereotactic body radiation therapy in non-small cell lung cancer. Radiat Oncol 2018; 13:213. [PMID: 30390700 PMCID: PMC6215615 DOI: 10.1186/s13014-018-1156-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 10/17/2018] [Indexed: 12/25/2022] Open
Abstract
Purpose To determine the prognostic impact of comorbidity and age in medically inoperable early-stage non-small cell lung cancer (NSCLC) treated with stereotactic body radiotherapy (SBRT) using the age-adjusted Charlson Comorbidity Index (aCCI). Patients and methods Between November 2008 and January 2015, 196 consecutive patients with medically inoperable NSCLC were treated with SBRT at a single institution. The prescribed isocenter dose was either 60.0 Gray (Gy) in six fractions for central lung cancer or 56.25 Gy in three fractions for peripheral lung cancer. Baseline comorbidities were retrospectively retrieved according to available outclinic medical records as well as the hospital information system. The aCCI was scored for each patient and subjected according to outcome and toxicity as well as all of the single items of the aCCI and other clinical parameters using univariate and multivariate analysis. Results Thirty-one point 6 % (62/196) of patients were deceased, of whom 17.3% (34/196) died due to lung cancer and 14.3% (28/196) due to comorbidities. The median overall survival (OS) was 15.0 months (95% CI [11.9–18.1]), whereas the median cancer-specific survival (CSS) was not reached. An aCCI ≥7 compared with an aCCI ≤6 was significantly associated with an increased risk of death (HR 1.79, 95% CI [1.02–2.80], p = 0.04) and cancer-specific death (HR 9.26, 95% CI [4.83–24.39], p < 0.001), respectively. Neither OS nor CCS were significantly associated with age, sex, side (left vs. right), lobe, localization (central vs. peripheral), packyears, TNM, or any item of the aCCI. Considering the 14.3% (28/196) of deceased patients who died due to comorbidities, aCCI ≥9 was significantly associated with non-cancer-related death (HR 3.12, 95% CI [1.22–8.33], p = 0.02). The observed cumulative rate of radiation pneumonitis (RP) ≥2 was 12.7% (25/196). The aCCI had no statistical association with RP. Conclusion Advanced age and numerous comorbidities characterizing this patient population were successfully assessed using the aCCI in terms of survival. Therefore, we recommend that age and comorbidity be indexed using the aCCI as a simple scoring system for all patients treated with SBRT for lung cancer.
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Affiliation(s)
- Julia Dreyer
- Department of Radiotherapy and Special Oncology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Michael Bremer
- Department of Radiotherapy and Special Oncology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christoph Henkenberens
- Department of Radiotherapy and Special Oncology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Steiner E, Shieh CC, Caillet V, Booth J, Hardcastle N, Briggs A, Jayamanne D, Haddad C, Eade T, Keall P. 4-Dimensional Cone Beam Computed Tomography–Measured Target Motion Underrepresents Actual Motion. Int J Radiat Oncol Biol Phys 2018; 102:932-940. [DOI: 10.1016/j.ijrobp.2018.04.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/02/2018] [Accepted: 04/19/2018] [Indexed: 12/25/2022]
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SBRT planning for spinal metastasis: indications from a large multicentric study. Strahlenther Onkol 2018; 195:226-235. [PMID: 30353349 DOI: 10.1007/s00066-018-1383-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/08/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND The dosimetric variability in spine stereotactic body radiation therapy (SBRT) planning was investigated in a large number of centres to identify crowd knowledge-based solutions. METHODS Two spinal cases were planned by 48 planners (38 centres). The required prescription dose (PD) was 3 × 10 Gy and the planning target volume (PTV) coverage request was: VPD > 90% (minimum request: VPD > 80%). The dose constraints were: planning risk volume (PRV) spinal cord: V18Gy < 0.35 cm3, V21.9 Gy < 0.03 cm3; oesophagus: V17.7 Gy < 5 cm3, V25.2 Gy < 0.03 cm3. Planners who did not fulfil the protocol requirements were asked to re-optimize the plans, using the results of planners with the same technology. Statistical analysis was performed to assess correlations between dosimetric results and planning parameters. A quality index (QI) was defined for scoring plans. RESULTS In all, 12.5% of plans did not meet the protocol requirements. After re-optimization, 98% of plans fulfilled the constraints, showing the positive impact of knowledge sharing. Statistical analysis showed a significant correlation (p < 0.05) between the homogeneity index (HI) and PTV coverage for both cases, while the correlation between HI and spinal cord sparing was significant only for the single dorsal PTV case. Moreover, the multileaf collimator leaf thickness correlated with the spinal cord sparing. Planners using comparable delivery/planning system techniques produced different QI, highlighting the impact of the planner's skills in the optimization process. CONCLUSION Both the technology and the planner's skills are fundamentally important in spine SBRT planning optimization. Knowledge sharing helped to follow the plan objectives.
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Moustakis C, Chan MKH, Kim J, Nilsson J, Bergman A, Bichay TJ, Palazon Cano I, Cilla S, Deodato F, Doro R, Dunst J, Eich HT, Fau P, Fong M, Haverkamp U, Heinze S, Hildebrandt G, Imhoff D, de Klerck E, Köhn J, Lambrecht U, Loutfi-Krauss B, Ebrahimi F, Masi L, Mayville AH, Mestrovic A, Milder M, Morganti AG, Rades D, Ramm U, Rödel C, Siebert FA, den Toom W, Wang L, Wurster S, Schweikard A, Soltys SG, Ryu S, Blanck O. Treatment planning for spinal radiosurgery : A competitive multiplatform benchmark challenge. Strahlenther Onkol 2018; 194:843-854. [PMID: 29802435 DOI: 10.1007/s00066-018-1314-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/08/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE To investigate the quality of treatment plans of spinal radiosurgery derived from different planning and delivery systems. The comparisons include robotic delivery and intensity modulated arc therapy (IMAT) approaches. Multiple centers with equal systems were used to reduce a bias based on individual's planning abilities. The study used a series of three complex spine lesions to maximize the difference in plan quality among the various approaches. METHODS Internationally recognized experts in the field of treatment planning and spinal radiosurgery from 12 centers with various treatment planning systems participated. For a complex spinal lesion, the results were compared against a previously published benchmark plan derived for CyberKnife radiosurgery (CKRS) using circular cones only. For two additional cases, one with multiple small lesions infiltrating three vertebrae and a single vertebra lesion treated with integrated boost, the results were compared against a benchmark plan generated using a best practice guideline for CKRS. All plans were rated based on a previously established ranking system. RESULTS All 12 centers could reach equality (n = 4) or outperform (n = 8) the benchmark plan. For the multiple lesions and the single vertebra lesion plan only 5 and 3 of the 12 centers, respectively, reached equality or outperformed the best practice benchmark plan. However, the absolute differences in target and critical structure dosimetry were small and strongly planner-dependent rather than system-dependent. Overall, gantry-based IMAT with simple planning techniques (two coplanar arcs) produced faster treatments and significantly outperformed static gantry intensity modulated radiation therapy (IMRT) and multileaf collimator (MLC) or non-MLC CKRS treatment plan quality regardless of the system (mean rank out of 4 was 1.2 vs. 3.1, p = 0.002). CONCLUSIONS High plan quality for complex spinal radiosurgery was achieved among all systems and all participating centers in this planning challenge. This study concludes that simple IMAT techniques can generate significantly better plan quality compared to previous established CKRS benchmarks.
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Affiliation(s)
- Christos Moustakis
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
| | - Mark K H Chan
- Department of Radiation Oncology, University Clinic Schleswig-Holstein, Kiel, Germany
| | - Jinkoo Kim
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Joakim Nilsson
- Department of Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Alanah Bergman
- Vancouver Cancer Centre, Department of Medical Physics, BC Cancer Agency, Vancouver, BC, Canada
| | - Tewfik J Bichay
- Lacks Cancer Center, Department of Radiation Oncology, Mercy Health Saint Mary's, Grand Rapids, MI, USA.,Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Savino Cilla
- Fondazione di Ricerca e Cura "Giovanni Paolo II", Medical Physics Unit, Catholic University of Sacred Heart, Campobasso, Italy
| | - Francesco Deodato
- Fondazione di Ricerca e Cura "Giovanni Paolo II", Radiation Oncology Unit, Catholic University of Sacred Heart, Campobasso, Italy
| | - Raffaela Doro
- Department of Medical Physics and Radiation Oncology, IFCA, Firenze, Italy
| | - Jürgen Dunst
- Department of Radiation Oncology, University Clinic Schleswig-Holstein, Kiel, Germany.,Department of Radiation Oncology, University Clinic Copenhagen, Copenhagen, Denmark
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Pierre Fau
- University of Aix Marseille, Marseille, France.,Physics Department, Institut Paoli Calmettes, Marseille, France
| | - Ming Fong
- Vancouver Cancer Centre, Department of Radiation Therapy, BC Cancer Agency, Vancouver, BC, Canada
| | - Uwe Haverkamp
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Simon Heinze
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Guido Hildebrandt
- Department of Radiation Oncology, University Medicine Rostock, Rostock, Germany
| | - Detlef Imhoff
- Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Erik de Klerck
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Janett Köhn
- Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ulrike Lambrecht
- Department of Radiation Oncology, University Clinic Erlangen, Erlangen, Germany
| | - Britta Loutfi-Krauss
- Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Fatemeh Ebrahimi
- Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Laura Masi
- Department of Medical Physics and Radiation Oncology, IFCA, Firenze, Italy
| | - Alan H Mayville
- Lacks Cancer Center, Department of Radiation Oncology, Mercy Health Saint Mary's, Grand Rapids, MI, USA
| | - Ante Mestrovic
- Vancouver Cancer Centre, Department of Medical Physics, BC Cancer Agency, Vancouver, BC, Canada
| | - Maaike Milder
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Alessio G Morganti
- Radiation Oncology Department, DIMES University of Bologna-S. Orsola Malpighi Hospital, Bologna, Italy
| | - Dirk Rades
- Department of Radiation Oncology, University Clinic Schleswig-Holstein, Lübeck, Germany
| | - Ulla Ramm
- Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Claus Rödel
- Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Frank-Andre Siebert
- Department of Radiation Oncology, University Clinic Schleswig-Holstein, Kiel, Germany
| | - Wilhelm den Toom
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Lei Wang
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Stefan Wurster
- Saphir Radiosurgery Center, Northern Germany and Frankfurt, Güstrow, Germany.,Department of Radiation Oncology, University Medicine Greifswald, Greifswald, Germany
| | - Achim Schweikard
- Institute for Robotic and Cognitive Systems, University of Lübeck, Lübeck, Germany
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Samuel Ryu
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Oliver Blanck
- Department of Radiation Oncology, University Clinic Schleswig-Holstein, Kiel, Germany.,Saphir Radiosurgery Center, Northern Germany and Frankfurt, Güstrow, Germany
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Fleckenstein J, Boda-Heggemann J, Siebenlist K, Gudzheva T, Prakofyeva N, Lohr F, Wenz F, Simeonova-Chergou A. Non-coplanar VMAT combined with non-uniform dose prescription markedly reduces lung dose in breath-hold lung SBRT. Strahlenther Onkol 2018; 194:815-823. [PMID: 29802434 DOI: 10.1007/s00066-018-1316-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/08/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE In this retrospective treatment planning study, the effect of a uniform and non-uniform planning target volume (PTV) dose coverage as well as a coplanar and non-coplanar volumetric modulated arc therapy (VMAT) delivery approach for lung stereotactic body radiation therapy (SBRT) in deep inspiration breath-hold (DIBH) were compared. MATERIALS AND METHODS For 46 patients with lesions in the peripheral lungs, three different treatment plans were generated: First, a coplanar 220° VMAT sequence with a uniform PTV dose prescription (UC). Second, a coplanar 220° VMAT treatment plan with a non-uniform dose distribution in the PTV (nUC). Third, a non-coplanar VMAT dose delivery with four couch angles (0°, ±35°, 90°) and a non-uniform prescription (nUnC) was used. All treatment plans were optimized for pareto-optimality with respect to PTV coverage and ipsilateral lung dose. Treatment sequences were delivered on a flattening-filter-free linear accelerator and beam-on times were recorded. Dosimetric comparison between the three techniques was performed. RESULTS For the three scenarios (UC, nUC, nUnC), median gross tumor volume (GTV) doses were 63.4 ± 2.5, 74.4 ± 3.6, and 77.9 ± 3.8 Gy, and ipsilateral V10Gy lung volumes were 15.7 ± 6.1, 13.9 ± 4.7, and 12.0 ± 5.1%, respectively. Normal tissue complication probability of the ipsilateral lung was 3.9, 3.1, and 2.8%, respectively. The number of monitor units were 5141 ± 1174, 4104 ± 786, and 3657 ± 710 MU and the corresponding beam-on times were 177 ± 54, 143 ± 29, and 148 ± 26 s. CONCLUSION For SBRT treatments in DIBH, a non-uniform dose prescription in the PTV, combined with a non-coplanar VMAT arc arrangement, significantly spares the ipsilateral lung while increasing dose to the GTV without major treatment time increase.
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Affiliation(s)
- Jens Fleckenstein
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Kerstin Siebenlist
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Tanya Gudzheva
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Natallia Prakofyeva
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Frank Lohr
- Unita Operativa di Radioterapia, Department of Oncology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Anna Simeonova-Chergou
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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42
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Baumann R, Chan MKH, Pyschny F, Stera S, Malzkuhn B, Wurster S, Huttenlocher S, Szücs M, Imhoff D, Keller C, Balermpas P, Rades D, Rödel C, Dunst J, Hildebrandt G, Blanck O. Clinical Results of Mean GTV Dose Optimized Robotic-Guided Stereotactic Body Radiation Therapy for Lung Tumors. Front Oncol 2018; 8:171. [PMID: 29868486 PMCID: PMC5966546 DOI: 10.3389/fonc.2018.00171] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/01/2018] [Indexed: 12/24/2022] Open
Abstract
Introduction We retrospectively evaluated the efficacy and toxicity of gross tumor volume (GTV) mean dose optimized stereotactic body radiation therapy (SBRT) for primary and secondary lung tumors with and without robotic real-time motion compensation. Materials and methods Between 2011 and 2017, 208 patients were treated with SBRT for 111 primary lung tumors and 163 lung metastases with a median GTV of 8.2 cc (0.3–174.0 cc). Monte Carlo dose optimization was performed prioritizing GTV mean dose at the potential cost of planning target volume (PTV) coverage reduction while adhering to safe normal tissue constraints. The median GTV mean biological effective dose (BED)10 was 162.0 Gy10 (34.2–253.6 Gy10) and the prescribed PTV BED10 ranged 23.6–151.2 Gy10 (median, 100.8 Gy10). Motion compensation was realized through direct tracking (44.9%), fiducial tracking (4.4%), and internal target volume (ITV) concepts with small (≤5 mm, 33.2%) or large (>5 mm, 17.5%) motion. The local control (LC), progression-free survival (PFS), overall survival (OS), and toxicity were analyzed. Results Median follow-up was 14.5 months (1–72 months). The 2-year actuarial LC, PFS, and OS rates were 93.1, 43.2, and 62.4%, and the median PFS and OS were 18.0 and 39.8 months, respectively. In univariate analysis, prior local irradiation (hazard ratio (HR) 0.18, confidence interval (CI) 0.05–0.63, p = 0.01), GTV/PTV (HR 1.01–1.02, CI 1.01–1.04, p < 0.02), and PTV prescription, mean GTV, and maximum plan BED10 (HR 0.97–0.99, CI 0.96–0.99, p < 0.01) were predictive for LC while the tracking method was not (p = 0.97). For PFS and OS, multivariate analysis showed Karnofsky Index (p < 0.01) and tumor stage (p ≤ 0.02) to be significant factors for outcome prediction. Late radiation pneumonitis or chronic rip fractures grade 1–2 were observed in 5.3% of the patients. Grade ≥3 side effects did not occur. Conclusion Robotic SBRT is a safe and effective treatment for lung tumors. Reducing the PTV prescription and keeping high GTV mean doses allowed the reduction of toxicity while maintaining high local tumor control. The use of real-time motion compensation is strongly advised, however, well-performed ITV motion compensation may be used alternatively when direct tracking is not feasible.
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Affiliation(s)
- Rene Baumann
- Department of Radiation Oncology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,Saphir Radiochirurgie Zentrum Frankfurt und Norddeutschland, Güstrow, Germany
| | - Mark K H Chan
- Department of Radiation Oncology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Florian Pyschny
- Department of Radiation Oncology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Susanne Stera
- Department of Radiation Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Bettina Malzkuhn
- Department of Radiation Oncology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Stefan Wurster
- Saphir Radiochirurgie Zentrum Frankfurt und Norddeutschland, Güstrow, Germany.,Department of Radiation Oncology, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Stefan Huttenlocher
- Saphir Radiochirurgie Zentrum Frankfurt und Norddeutschland, Güstrow, Germany
| | - Marcella Szücs
- Department of Radiation Oncology, Universitätsmedizin Rostock, Rostock, Germany
| | - Detlef Imhoff
- Department of Radiation Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Christian Keller
- Saphir Radiochirurgie Zentrum Frankfurt und Norddeutschland, Güstrow, Germany.,Department of Radiation Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Panagiotis Balermpas
- Saphir Radiochirurgie Zentrum Frankfurt und Norddeutschland, Güstrow, Germany.,Department of Radiation Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Dirk Rades
- Department of Radiation Oncology, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Claus Rödel
- Department of Radiation Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,Department of Radiation Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Guido Hildebrandt
- Department of Radiation Oncology, Universitätsmedizin Rostock, Rostock, Germany
| | - Oliver Blanck
- Department of Radiation Oncology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,Saphir Radiochirurgie Zentrum Frankfurt und Norddeutschland, Güstrow, Germany
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43
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Figlia V, Mazzola R, Cuccia F, Alongi F, Mortellaro G, Cespuglio D, Cucchiara T, Iacoviello G, Valenti V, Molino M, Verderame F, Matranga D, Casto AL, Ferrera G. Hypo-fractionated stereotactic radiation therapy for lung malignancies by means of helical tomotherapy: report of feasibility by a single-center experience. Radiol Med 2018; 123:406-414. [PMID: 29455424 DOI: 10.1007/s11547-018-0858-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/18/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Several experiences in the literature report SBRT as an effective treatment option for medically inoperable early stage non-small cell lung cancer (NSCLC) and oligometastatic disease. The optimal fractionation schedules and total dose remain controversial. In this study, we evaluated the safety in terms of toxicity and efficacy of using of 8-10 fractions schedules with Helical Tomotherapy (HT) for primary and metastatic lung lesions. METHODS Between March 2014 and May 2016, a total of 39 patients (median age 72 years, range 26-91) were treated with HT-SBRT for malignant lung lesions: 22 patients with early stage NSCLC, 17 with oligometastases. Patients received 8-10 fractions with lower daily dose for central and ultracentral lesions. Treatment-related toxicity was evaluated using CTCAE v 4.0 scale. Local control (LC), overall survival (OS) and toxicity rates were prospectively collected. RESULTS Median duration of RT was 15 days (range 10-26 days) and no interruption occurred. With a median follow-up of 13 months (range 3-29), we reported one G2 pneumonitis (2.6%) and one G2 chest pain (2.6%); no ≥ G2 esophagitis was registered. Actuarial local control rate was 95.5% both at 12 and 24 months for early stage NSCLC and 92.9% both at 12 and 24 months for metastatic patients. OS rate was 94.4 and 92.3% at 1 year, and 94.4 and 83.9% at 2 years in primary and metastatic group, respectively. CONCLUSIONS The use of 8-10 fractions schedule HT-SBRT for lung malignancies results in high LC and OS rates with minimal toxicities reported.
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Affiliation(s)
- Vanessa Figlia
- Radiation Oncology School, University of Palermo, Palermo, Italy
| | - Rosario Mazzola
- Radiation Oncology, Sacro Cuore Don Calabria Hospital, Verona, Negrar, Italy
| | - Francesco Cuccia
- Radiation Oncology School, University of Palermo, Palermo, Italy.
| | - Filippo Alongi
- Radiation Oncology, Sacro Cuore Don Calabria Hospital, Verona, Negrar, Italy
- University of Brescia, Brescia, Italy
| | | | | | | | | | - Vito Valenti
- Radiation Oncology School, University of Palermo, Palermo, Italy
| | - Massimo Molino
- Radiology Department, ARNAS-Civico Hospital, Palermo, Italy
| | | | | | - Antonio Lo Casto
- Radiation Oncology School, University of Palermo, Palermo, Italy
| | - Giuseppe Ferrera
- Statistic Science Faculty, University of Palermo, Palermo, Italy
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Direct dose correlation of MRI morphologic alterations of healthy liver tissue after robotic liver SBRT. Strahlenther Onkol 2018; 194:414-424. [PMID: 29404626 DOI: 10.1007/s00066-018-1271-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/16/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE For assessing healthy liver reactions after robotic SBRT (stereotactic body radiotherapy), we investigated early morphologic alterations on MRI (magnetic resonance imaging) with respect to patient and treatment plan parameters. PATIENTS AND METHODS MRI data at 6-17 weeks post-treatment from 22 patients with 42 liver metastases were analyzed retrospectively. Median prescription dose was 40 Gy delivered in 3-5 fractions. T2- and T1-weighted MRI were registered to the treatment plan. Absolute doses were converted to EQD2 (Equivalent dose in 2Gy fractions) with α/β-ratios of 2 and 3 Gy for healthy, and 8 Gy for modelling pre-damaged liver tissue. RESULTS Sharply defined, centroid-shaped morphologic alterations were observed outside the high-dose volume surrounding the GTV. On T2-w MRI, hyperintensity at EQD2 isodoses of 113.3 ± 66.1 Gy2, 97.5 ± 54.7 Gy3, and 66.5 ± 32.0 Gy8 significantly depended on PTV dimension (p = 0.02) and healthy liver EQD2 (p = 0.05). On T1-w non-contrast MRI, hypointensity at EQD2 isodoses of 113.3 ± 49.3 Gy2, 97.4 ± 41.0 Gy3, and 65.7 ± 24.2 Gy8 significantly depended on prior chemotherapy (p = 0.01) and total liver volume (p = 0.05). On T1-w gadolinium-contrast delayed MRI, hypointensity at EQD2 isodoses of 90.6 ± 42.5 Gy2, 79.3 ± 35.3 Gy3, and 56.6 ± 20.9 Gy8 significantly depended on total (p = 0.04) and healthy (p = 0.01) liver EQD2. CONCLUSIONS Early post-treatment changes in healthy liver tissue after robotic SBRT could spatially be correlated to respective isodoses. Median nominal doses of 10.1-11.3 Gy per fraction (EQD2 79-97 Gy3) induce characteristic morphologic alterations surrounding the lesions, potentially allowing for dosimetric in-vivo accuracy assessments. Comparison to other techniques and investigations of the short- and long-term clinical impact require further research.
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45
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Güngör G, Demir M, Aydın G, Yapıcı B, Atalar B, Özyar E. Improvement of conformal arc plans by using deformable margin delineation method for stereotactic lung radiotherapy. J Appl Clin Med Phys 2018; 19:184-193. [PMID: 29218841 PMCID: PMC5768002 DOI: 10.1002/acm2.12237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/15/2017] [Accepted: 11/07/2017] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Stereotactic body radiotherapy (SBRT) is an established treatment technique in the management of medically inoperable early stage non-small cell lung cancer (NSCLC). Different techniques such as volumetric modulated arc (VMAT) and three-dimensional conformal arc (DCA) can be used in SBRT. Previously, it has been shown that VMAT is superior to DCA technique in terms of plan evaluation parameters. However, DCA technique has several advantages such as ease of use and considerable shortening of the treatment time. DCA technique usually results in worse conformity which is not possible to ameliorate by inverse optimization. In this study, we aimed to analyze whether a simple method - deformable margin delineation (DMD) - improves the quality of the DCA technique, reaching similar results to VMAT in terms of plan evaluation parameters. METHODS Twenty stage I-II (T1-2, N0, M0) NSCLC patients were included in this retrospective dosimetric study. Noncoplanar VMAT and conventional DCA plans were generated using 6 MV and 10 MV with flattening filter free (FFF) photon energies. The DCA plan with 6FFF was calculated and 95% of the PTV was covered by the prescription isodose line. Hot dose regions (receiving dose over 100% of prescription dose) outside PTV and cold dose regions (receiving dose under 100% of prescription dose) inside PTV were identified. A new PTV (PTV-DMD) was delineated by deforming PTV margin with respect to hot and cold spot regions obtained from conventional DCA plans. Dynamic multileaf collimators (MLC) were set to PTV-DMD beam eye view (BEV) positions and the new DCA plans (DCA-DMD) with 6FFF were generated. Three-dimensional (3D) dose calculations were computed for PTV-DMD volume. However, the prescription isodose was specified and normalized to cover 95% volume of original PTV. Several conformity indices and lung doses were compared for different treatment techniques. RESULTS DCA-DMD method significantly achieved a superior conformity index (CI), conformity number (CIPaddick ), gradient index (R50% ), isodose at 2 cm (D2 cm ) and external index (CΔ) with respect to VMAT and conventional DCA plans (P < 0.05 for all comparisons). CI ranged between 1.00-1.07 (Mean: 1.02); 1.00-1.18 (Mean: 1.06); 1.01-1.23 (Mean 1.08); 1.03-1.29 (Mean: 1.15); 1.04-1.29 (Mean: 1.18) for DCA-DMD-6FFF, VMAT-6FFF, VMAT-10FFF DCA-6FFF and DCA-10FFF respectively. DCA-DMD-6FFF technique resulted significantly better CI compared to others (P = 0.002; < 0.001; < 0.001; < 0.001). R50% ranged between 3.22-4.74 (Mean: 3.99); 3.24-5.92 (Mean: 4.15) for DCA-DMD-6FFF, VMAT-6FFF, respectively. DCA-DMD-6FFF technique resulted lower intermediate dose spillage compared to VMAT-6FFF, though the difference was statistically insignificant (P = 0.32). D2 cm ranged between 35.7% and 67.0% (Mean: 53.2%); 42.1%-79.2% (Mean: 57.8%) for DCA-DMD-6FFF, VMAT-6FFF respectively. DCA-DMD-6FFF have significantly better and sharp falloff gradient 2 cm away from PTV compared to VMAT-6FFF (P = 0.009). CΔ ranged between 0.052 and 0.140 (Mean: 0.085); 0,056-0,311 (Mean: 0.120) for DCA-DMD, VMAT-6FFF, respectively. DCA-DMD-6FFF have significantly improved CΔ (P = 0.002). VMAT- V20 Gy , V2.5 Gy and mean lung dose (MLD) indices are calculated to be 4.03%, 23.83%, 3.42 Gy and 4.19%, 27.88%,3.72 Gy, for DCA-DMD-6FFF and DCA techniques, respectively. DCA-DMD-6FFF achieved superior lung sparing compared to DCA technique. DCA-DMD-6FFF method reduced MUs 44% and 33% with respect to VMAT-6FFF and 10FFF, respectively, without sacrificing dose conformity (P < 0.001; P < 0.001). CONCLUSIONS Our results demonstrated that DCA plan evaluation parameters can be ameliorated by using the DMD method. This new method improves DCA plan quality and reaches similar results with VMAT in terms of dosimetric parameters. We believe that DCA-DMD is a simple and effective technique for SBRT and can be preferred due to shorter treatment and planning time.
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Affiliation(s)
- Görkem Güngör
- Department of Radiation OncologyAcıbadem University School of MedicineIstanbulTurkey
| | - Melek Demir
- Department of Radiation OncologyAcıbadem University School of MedicineIstanbulTurkey
| | - Gökhan Aydın
- Department of Radiation OncologyAcıbadem University School of MedicineIstanbulTurkey
| | - Bülent Yapıcı
- Department of Radiation OncologyAcıbadem University School of MedicineIstanbulTurkey
| | - Banu Atalar
- Department of Radiation OncologyAcıbadem University School of MedicineIstanbulTurkey
| | - Enis Özyar
- Department of Radiation OncologyAcıbadem University School of MedicineIstanbulTurkey
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Time for standardization of SBRT planning through large scale clinical data and guideline-based approaches. Strahlenther Onkol 2017; 193:1068-1069. [DOI: 10.1007/s00066-017-1216-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 08/30/2017] [Indexed: 12/16/2022]
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47
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Mancosu P, Esposito M, Giglioli F, Stasi M. Time for crowd knowledge-based approach in SBRT planning. Strahlenther Onkol 2017; 193:1066-1067. [DOI: 10.1007/s00066-017-1214-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/30/2017] [Indexed: 11/29/2022]
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