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Zhang J, Fang J, Xu Y, Si G. How AI and Robotics Will Advance Interventional Radiology: Narrative Review and Future Perspectives. Diagnostics (Basel) 2024; 14:1393. [PMID: 39001283 PMCID: PMC11241154 DOI: 10.3390/diagnostics14131393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 06/20/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
The rapid advancement of artificial intelligence (AI) and robotics has led to significant progress in various medical fields including interventional radiology (IR). This review focuses on the research progress and applications of AI and robotics in IR, including deep learning (DL), machine learning (ML), and convolutional neural networks (CNNs) across specialties such as oncology, neurology, and cardiology, aiming to explore potential directions in future interventional treatments. To ensure the breadth and depth of this review, we implemented a systematic literature search strategy, selecting research published within the last five years. We conducted searches in databases such as PubMed and Google Scholar to find relevant literature. Special emphasis was placed on selecting large-scale studies to ensure the comprehensiveness and reliability of the results. This review summarizes the latest research directions and developments, ultimately analyzing their corresponding potential and limitations. It furnishes essential information and insights for researchers, clinicians, and policymakers, potentially propelling advancements and innovations within the domains of AI and IR. Finally, our findings indicate that although AI and robotics technologies are not yet widely applied in clinical settings, they are evolving across multiple aspects and are expected to significantly improve the processes and efficacy of interventional treatments.
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Affiliation(s)
- Jiaming Zhang
- Department of Radiology, Clinical Medical College, Southwest Medical University, Luzhou 646699, China; (J.Z.); (J.F.)
| | - Jiayi Fang
- Department of Radiology, Clinical Medical College, Southwest Medical University, Luzhou 646699, China; (J.Z.); (J.F.)
| | - Yanneng Xu
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou 646699, China;
| | - Guangyan Si
- Department of Radiology, Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou 646699, China;
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Kang HJ, Kwak YK, Kim M, Lee SJ. Application of real-time MRI-guided linear accelerator in stereotactic ablative body radiotherapy for non-small cell lung cancer: one step forward to precise targeting. J Cancer Res Clin Oncol 2022; 148:3215-3223. [PMID: 36040666 DOI: 10.1007/s00432-022-04264-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/02/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Tumor motion is a major challenge in stereotactic ablative body radiotherapy (SABR) for non-small cell lung cancer (NSCLC), causing excessive irradiation to compensate for this motion. Real-time tumor tracking with a magnetic resonance imaging-guided linear accelerator (MR-Linac) could address this problem. This study aimed to assess the effects and advantages of MR-Linac in SABR for the treatment of lung tumors. METHODS Overall, 41 patients with NSCLC treated with SABR using MR-Linac between March 2019 and December 2021 were included. For comparison, 40 patients treated with SABR using computed tomography-based modalities were also enrolled. The SABR dose ranged from 48 to 60 Gy in 3-5 fractions. The primary endpoint was a lower radiation volume compared to CT-based SABR. The secondary endpoint was the local control rate of SABR using the MR-Linac. RESULTS The median follow-up time was 19 months (range: 3-105 months). There was no significant difference in the gross tumor volume between the MR and CT groups (7.1 ± 9.3 cm3 vs 8.0 ± 6.8 cm3, p = 0.643), but the planning target volume was significantly smaller in the MR group (20.8 ± 18.8 cm3 vs 34.1 ± 22.9 cm3, p = 0.005). The 1-year local control rates for the MR and CT groups were 92.1 and 75.4%, respectively (p = 0.07), and the 1-year overall survival rates were 87.4 and 87.0%, respectively (p = 0.30). CONCLUSION Lung SABR with MR-Linac can reduce the radiation field without compromising the local control rate. Further follow-up is needed to assess the long-term effects.
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Affiliation(s)
- Hye Jin Kang
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 21431, Republic of Korea
| | - Yoo-Kang Kwak
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 21431, Republic of Korea.
| | - Myungsoo Kim
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 21431, Republic of Korea
| | - So Jung Lee
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 21431, Republic of Korea
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Ryuno Y, Abe T, Iino M, Saito S, Aoshika T, Oota T, Igari M, Hirai R, Kumazaki Y, Kaira K, Kagamu H, Ishida H, Noda SE, Kato S. High-dose stereotactic body radiotherapy using CyberKnife® for stage I peripheral lung cancer: a single-center retrospective study. Radiat Oncol 2022; 17:128. [PMID: 35854333 PMCID: PMC9297648 DOI: 10.1186/s13014-022-02094-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/29/2022] [Indexed: 12/25/2022] Open
Abstract
Background This retrospective study was performed to evaluate the efficacy and toxicity of high-dose stereotactic body radiotherapy (SBRT) using a CyberKnife® for patients with stage I peripheral non-small cell lung cancer (NSCLC). Methods Ninety-six patients with stage I peripheral NSCLC who were treated with SBRT using a CyberKnife® from August 2010 to June 2019 were identified and included in this study. Local control (LC), local progression-free survival (LPFS), progression-free survival (PFS), overall survival (OS), and late toxicity were evaluated. Potential risk factors associated with LC, LPFS, PFS, or OS were investigated by univariate analyses. Results Data of 96 patients were examined. The prescribed dose to the tumor was 54 Gy in 3 fractions in 91 patients and 60 Gy in 3 fractions in 5 patients. The median follow-up duration was 27 months. The 2-year LC, LPFS, PFS, and OS rates were 97%, 88%, 84%, and 90%, respectively. The T factor was significantly correlated with LC, LPFS, and PFS. The 2-year LC rate for patients with T1a/T1b and T1c/T2a disease was 100% and 90%, respectively (p < 0.05), and the 2-year PFS rate for the corresponding patients was 95% and 65%, respectively (p < 0.001). One patient (1%) developed grade 3 radiation pneumonitis. Conclusions High-dose SBRT using a CyberKnife® for stage I peripheral NSCLC produced favorable treatment outcomes with acceptable late toxicity. Further studies are needed to improve the treatment outcomes for patients with T1c/T2a disease.
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Affiliation(s)
- Yasuhiro Ryuno
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Takanori Abe
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Misaki Iino
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Satoshi Saito
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Tomomi Aoshika
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Tomohiro Oota
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Mitsunobu Igari
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Ryuta Hirai
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Yu Kumazaki
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Hironori Ishida
- Department of General Thoracic Surgery, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Shin-Ei Noda
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shingo Kato
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan.
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Verification of an optimizer algorithm by the beam delivery evaluation of intensity-modulated arc therapy plans. Radiol Oncol 2021; 55:508-515. [PMID: 34821138 PMCID: PMC8647790 DOI: 10.2478/raon-2021-0046] [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: 06/25/2021] [Accepted: 08/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background In the case of dynamic radiotherapy plans, the fractionation schemes can have dosimetric effects. Our goal was to define the effect of the fraction dose on the plan quality and the beam delivery. Materials and methods Treatment plans were created for 5 early-stage lung cancer patients with different dose schedules. The planned total dose was 60 Gy, fraction dose was 2 Gy, 3 Gy, 5 Gy, 12 Gy and 20 Gy. Additionally renormalized plans were created by changing the prescribed fraction dose after optimization. The dosimetric parameters and the beam delivery parameters were collected to define the plan quality and the complexity of the treatment plans. The accuracy of dose delivery was verified with dose measurements using electronic portal imaging device (EPID). Results The plan quality was independent from the used fractionation scheme. The fraction dose could be changed safely after the optimization, the delivery accuracy of the treatment plans with changed prescribed dose was not lower. According to EPID based measurements, the high fraction dose and dose rate caused the saturation of the detector, which lowered the gamma passing rate. The aperture complexity score, the gantry speed and the dose rate changes were not predicting factors for the gamma passing rate values. Conclusions The plan quality and the delivery accuracy are independent from the fraction dose, moreover the fraction dose can be changed safely after the dose optimization. The saturation effect of the EPID has to be considered when the action limits of the quality assurance system are defined.
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Abe T, Ryuno Y, Iino M, Saito S, Aoshika T, Ohta T, Igari M, Hirai R, Kumazaki Y, Kaira K, Kagamu H, Ishida H, Noda SE, Kato S. A 54 Gy in three fractions of stereotactic body radiotherapy using CyberKnife for T1b-2aN0M0 pathologically confirmed non-small cell lung cancer. Jpn J Clin Oncol 2021; 51:1723-1728. [PMID: 34580722 DOI: 10.1093/jjco/hyab154] [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: 04/05/2021] [Accepted: 09/14/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Optimal dose-fractionation regimen of stereotactic body radiotherapy for peripheral early-stage non-small cell lung cancer remains unclear. We retrospectively investigated outcomes of stereotactic body radiotherapy using CyberKnife at 54 Gy in three fractions in 26 patients (median age: 76 years) with pathologically confirmed T1b-T2aN0M0 non-small cell lung cancer. METHODS A 54 Gy in three fractions was prescribed to cover the 99% of gross tumor volume. We estimated cumulative local control, progression-free survival and overall survival rates (Kaplan-Meier method), and toxicity (Common Toxicity Criteria for Adverse Events, version 5.0). RESULTS All the tumors were located at peripheral area of lung. Mean distance from chest wall to tumor was 6.5 mm (range: 0-32 mm). The patients' pathological diagnoses were: adenocarcinoma: n = 18, squamous cell carcinoma: n = 7 and non-small cell carcinoma: n = 1. Their stages were T1b: n = 9, T1c: n = 14 and T2a: n = 3. Median follow-up was 24 months (range: 6-54). Cumulative 2-year effect rates were local control: 100%, progression-free survival 70% and overall survival: 92%. Twenty patients developed grade one radiation pneumonitis, but grade 2 or greater radiation pneumonitis was not observed. CONCLUSIONS We found CyberKnife-stereotactic body radiotherapy for pathologically confirmed T1b-T2aN0M0 non-small cell lung cancer to be effective and safe. However, these results should be validated with a larger patient cohort and prospective follow-up monitoring.
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Affiliation(s)
- Takanori Abe
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Yasuhiro Ryuno
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Misaki Iino
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Satoshi Saito
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Tomomi Aoshika
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Tomohiro Ohta
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Mitsunobu Igari
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Ryuta Hirai
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Yu Kumazaki
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Kyoichi Kaira
- Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Hiroshi Kagamu
- Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Hironori Ishida
- General Thoracic Surgery, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Shin-Ei Noda
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Shingo Kato
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
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Avanzo M, Gagliardi V, Stancanello J, Blanck O, Pirrone G, El Naqa I, Revelant A, Sartor G. Combining computed tomography and biologically effective dose in radiomics and deep learning improves prediction of tumor response to robotic lung stereotactic body radiation therapy. Med Phys 2021; 48:6257-6269. [PMID: 34415574 DOI: 10.1002/mp.15178] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 07/20/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The aim of this study is to improve the performance of machine learning (ML) models in predicting response of non-small cell lung cancer (NSCLC) to stereotactic body radiation therapy (SBRT) by integrating image features from pre-treatment computed tomography (CT) with features from the biologically effective dose (BED) distribution. MATERIALS AND METHODS Image features, consisting of crafted radiomic features or machine-learned features extracted using a convolutional neural network, were calculated from pre-treatment CT data and from dose distributions converted into BED for 80 NSCLC lesions over 76 patients treated with robotic guided SBRT. ML models using different combinations of features were trained to predict complete or partial response according to response criteria in solid tumors, including radiomics CT (RadCT ), radiomics CT and BED (RadCT,BED ), deep learning (DL) CT (DLCT ), and DL CT and BED (DLCT,BED ). Training of ML included feature selection by neighborhood component analysis followed by ensemble ML using robust boosting. A model was considered as acceptable when the sum of average sensitivity and specificity on test data in repeated cross validations was at least 1.5. RESULTS Complete or partial response occurred in 58 out of 80 lesions. The best models to predict the tumor response were those using BED variables, achieving significantly better area under curve (AUC) and accuracy than those using only features from CT, including a RadCT,BED model using three radiomic features from BED, which scored an accuracy of 0.799 (95% confidence intervals (0.75-0.85)) and AUC of 0.773 (0.688-0.846), and a DLCT,BED model also using three variables with an accuracy of 0.798 (0.649-0.829) and AUC of 0.812 (0.755-0.867). CONCLUSION According to our results, the inclusion of BED features improves the response prediction of ML models for lung cancer patients undergoing SBRT, regardless of the use of radiomic or DL features.
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Affiliation(s)
- Michele Avanzo
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, PN, Italy
| | - Vito Gagliardi
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, PN, Italy
| | | | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Giovanni Pirrone
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, PN, Italy
| | - Issam El Naqa
- Department of Machine Learning, Moffitt University, Tampa, Florida, USA
| | - Alberto Revelant
- Radiation Oncology Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, PN, Italy
| | - Giovanna Sartor
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, PN, Italy
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Li GQ, Yang J, Wang Y, Qiu M, Ding Z, Zhang S, Yang SL, Peng Z. Using the Diaphragm as a Tracking Surrogate in CyberKnife Synchrony Treatment. Med Sci Monit 2021; 27:e930139. [PMID: 34379616 PMCID: PMC8366302 DOI: 10.12659/msm.930139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In this study, we assessed the usefulness of diaphragm surrogate tracking in the design of a respiratory model for CyberKnife Synchrony treatment of lung tumors. MATERIAL AND METHODS Twenty-four patients with lung cancer who underwent stereotactic body radiotherapy with CyberKnife between April and November 2019 were enrolled. Simulation plans for each patient were designed using Xsight lung tracking (XLT) and diaphragm tracking (DT) methods, and tumor visualization tests were performed. The offset consistency at each respiratory phase was analyzed. The relative distance along the alignment center of the superior-inferior (SI) axis in the 2 projections (dxAB), uncertainty (%), and average standard error (AvgStdErr)/maximum standard error (MAXStdErr) were also analyzed. RESULTS Bland-Altman analyses revealed that the average differences±standard deviation (SD) between XLT and DT tracking methods were 0.4±2.9 mm, 0.3±4.35 mm, and -1.8±6.8 mm for the SI, left-right (LR), and anterior-posterior (AP) directions, respectively. These results indicated high consistency in the SI and LR directions and poor consistency in the AP direction. Uncertainty differed significantly between XLT and DT (22.813±5.721% vs 9.384±3.799%; t=-5.236; P=0.0008), but we found no significant differences in dxAB, AvgStdErr, or MAXStdErr. CONCLUSIONS In the majority of cases, motion tracking by XLT and DT was consistent and synchronized in the SI directions, but not in the LR and AP directions. With a boundary margin of 0.3±4.35 mm and 1.8±6.8 mm for the LR and AP directions, DT may contribute to better implementation of CyberKnife Synchrony treatment in patients with lung tumors near the diaphragm that cannot be seen in tumor visualization tests.
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Affiliation(s)
- Guo-Quan Li
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Jing Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Yan Wang
- Department of Oncology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Mengjun Qiu
- Department of Gastroenterology and Hepatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Zeyu Ding
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Sheng Zhang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Sheng-Li Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Zhenjun Peng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology,, Wuhan, Hubei, China (mainland)
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Cella L, Monti S, Thor M, Rimner A, Deasy JO, Palma G. Radiation-Induced Dyspnea in Lung Cancer Patients Treated with Stereotactic Body Radiation Therapy. Cancers (Basel) 2021; 13:cancers13153734. [PMID: 34359634 PMCID: PMC8345168 DOI: 10.3390/cancers13153734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary Dyspnea is a common symptomatic side-effect of thoracic radiation therapy. The aim of this study is to build a predictive model of any-grade radiation-induced dyspnea within six months after stereotactic body radiation therapy in patients treated for non-small cell lung cancer. The occurrence of pre-treatment chronic obstructive pulmonary disease and higher relative lungs volume receiving more than 15 Gy as well as heart volume were shown to be risk factors for dyspnea. The obtained results encourage further studies on the topic, which could validate the present organ-based findings and explore the voxel-based landscape of radiation dose sensitivity in the development of dyspnea. Abstract In this study, we investigated the prognostic factors for radiation-induced dyspnea after hypo-fractionated radiation therapy (RT) in 106 patients treated with Stereotactic Body RT for Non-Small-Cell Lung Cancer (NSCLC). The median prescription dose was 50 Gy (range: 40–54 Gy), delivered in a median of four fractions (range: 3–12). Dyspnea within six months after SBRT was scored according to CTCAE v.4.0. Biologically Effective Dose (α/β = 3 Gy) volume histograms for lungs and heart were extracted. Dosimetric parameters along with patient-specific and treatment-related factors were analyzed, multivariable logistic regression method with Leave-One-Out (LOO) internal validation applied. Model performance was evaluated by the area under the receiver operating characteristic (ROC) curve (AUC) and calibration plot parameters. Fifty-seven patients (53.8%) out of 106 developed dyspnea of any grade after SBRT (25/57 grade ≥ 2 cases). A three-variable predictive model including patient comorbidity (COPD), heart volume and the relative lungs volume receiving more than 15 Gy was selected. The model displays an encouraging performance given by a training ROC-AUC = 0.71 [95%CI 0.61–0.80] and a LOO-ROC-AUC = 0.64 [95%CI 0.53–0.74]. Further modeling efforts are needed for dyspnea prediction in hypo-fractionated treatments in order to identify patients at high risk for developing lung toxicity more accurately.
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Affiliation(s)
- Laura Cella
- Institute of Biostructures and Bioimaging, National Research Council, 80145 Napoli, Italy;
- Correspondence: (L.C.); (G.P.)
| | - Serena Monti
- Institute of Biostructures and Bioimaging, National Research Council, 80145 Napoli, Italy;
| | - Maria Thor
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (M.T.); (J.O.D.)
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Joseph O. Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (M.T.); (J.O.D.)
| | - Giuseppe Palma
- Institute of Biostructures and Bioimaging, National Research Council, 80145 Napoli, Italy;
- Correspondence: (L.C.); (G.P.)
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Bousabarah K, Blanck O, Temming S, Wilhelm ML, Hoevels M, Baus WW, Ruess D, Visser-Vandewalle V, Ruge MI, Treuer H, Kocher M. Radiomics for prediction of radiation-induced lung injury and oncologic outcome after robotic stereotactic body radiotherapy of lung cancer: results from two independent institutions. Radiat Oncol 2021; 16:74. [PMID: 33863358 PMCID: PMC8052812 DOI: 10.1186/s13014-021-01805-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 04/11/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To generate and validate state-of-the-art radiomics models for prediction of radiation-induced lung injury and oncologic outcome in non-small cell lung cancer (NSCLC) patients treated with robotic stereotactic body radiation therapy (SBRT). METHODS Radiomics models were generated from the planning CT images of 110 patients with primary, inoperable stage I/IIa NSCLC who were treated with robotic SBRT using a risk-adapted fractionation scheme at the University Hospital Cologne (training cohort). In total, 199 uncorrelated radiomic features fulfilling the standards of the Image Biomarker Standardization Initiative (IBSI) were extracted from the outlined gross tumor volume (GTV). Regularized models (Coxnet and Gradient Boost) for the development of local lung fibrosis (LF), local tumor control (LC), disease-free survival (DFS) and overall survival (OS) were built from either clinical/ dosimetric variables, radiomics features or a combination thereof and validated in a comparable cohort of 71 patients treated by robotic SBRT at the Radiosurgery Center in Northern Germany (test cohort). RESULTS Oncologic outcome did not differ significantly between the two cohorts (OS at 36 months 56% vs. 43%, p = 0.065; median DFS 25 months vs. 23 months, p = 0.43; LC at 36 months 90% vs. 93%, p = 0.197). Local lung fibrosis developed in 33% vs. 35% of the patients (p = 0.75), all events were observed within 36 months. In the training cohort, radiomics models were able to predict OS, DFS and LC (concordance index 0.77-0.99, p < 0.005), but failed to generalize to the test cohort. In opposite, models for the development of lung fibrosis could be generated from both clinical/dosimetric factors and radiomic features or combinations thereof, which were both predictive in the training set (concordance index 0.71- 0.79, p < 0.005) and in the test set (concordance index 0.59-0.66, p < 0.05). The best performing model included 4 clinical/dosimetric variables (GTV-Dmean, PTV-D95%, Lung-D1ml, age) and 7 radiomic features (concordance index 0.66, p < 0.03). CONCLUSION Despite the obvious difficulties in generalizing predictive models for oncologic outcome and toxicity, this analysis shows that carefully designed radiomics models for prediction of local lung fibrosis after SBRT of early stage lung cancer perform well across different institutions.
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Affiliation(s)
- Khaled Bousabarah
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany
| | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany.,Saphir Radiosurgery Center Northern Germany, Guestrow, Germany
| | - Susanne Temming
- Department of Radiation Oncology, University Hospital of Cologne, Cologne, Germany
| | - Maria-Lisa Wilhelm
- Saphir Radiosurgery Center Northern Germany, Guestrow, Germany.,Department of Radiation Oncology, University Medicine Rostock, Rostock, Germany
| | - Mauritius Hoevels
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Wolfgang W Baus
- Department of Radiation Oncology, University Hospital of Cologne, Cologne, Germany
| | - Daniel Ruess
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Maximilian I Ruge
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Harald Treuer
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Martin Kocher
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
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Li M, Xu X, Qin Y, Zhang P, Shen C, Xia Q, Fan L. Radiofrequency ablation vs. stereotactic body radiotherapy for stage IA non-small cell lung cancer in nonsurgical patients. J Cancer 2021; 12:3057-3066. [PMID: 33854605 PMCID: PMC8040894 DOI: 10.7150/jca.51413] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 12/27/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Approximately 20% resectable non-small cell lung cancer (NSCLC) patients are treated non-surgically due to various reasons. The aim of the present study was to compare the effectiveness of radiofrequency ablation (RFA) and stereotactic body radiotherapy (SBRT) in patients with stage IA NSCLC who were ineligible for surgery using the surveillance, epidemiology and end-results (SEER) Database. Methods: Using the SEER registry, we identified a total of 6,195 IA NSCLC patients who received SBRT or RFA between 2004 and 2015 because of ineligibility for surgical resection due to various reasons. Complete clinical information was available in all these patients. Overall survival (OS) and cancer-specific survival (CSS) were compared between RFA and SBRT groups by using propensity score matching (PSM), inverse probability of treatment weight (IPTW), and overlap weighting analysis. Additionally, an exploratory analysis was conducted to determine the effectiveness of RFA treatment based on the subsets of clinically relevant patients. Results: Of the 6,195 nonsurgical IA NSCLC patients, 191 patients (3.1%) received RFA and the other 6,004 patients (96.9%) received SBRT. The one-, three- and five-year OS in the unmatched RFA and SBRT groups were 83.3%, 48.5%and 29.1% vs. 83.8%, 48.3% and 27.4%, respectively, there was similar results in the PSM, IPTW, overlap weighing analysis. Nonsurgical IA NSCLC patients receiving RFA seemed to have better five-year survival than those receiving SBRT, though the difference was not statistically significant (OS, HR; 0.986; 95% CI, 0.827-1.175, P=0.8738; CSS, HR; 0.965; 95% CI, 0.765-1.219, P=0.7663). We found that the odds of receiving RFA decreased with larger tumor size (>2, <3 cm, OR; 0.303; 95% CI, 0.191-0.479; >3 cm, OR; 0.153; 95% CI, 0.093-0.251) compared with tumor size <1 cm. In subgroup analysis, patients receiving RFA seemed to have better OS than those receiving SBRT, though the difference was not statistically significant. This specific trend was even more obvious in patients with tumors <1cm in diameter (P=0.1577). Conclusion: In comparison with SBRT, RFA did not seem to adversely affect CSS and OS of IA NSCLC patients who were not suitable for surgical treatment. In addition, RFA seemed to offer better survival to IA NSCLC patients, especially those with tumors <1 cm.
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Affiliation(s)
- Ming Li
- Department of Respiratory Medicine, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Xiao Xu
- Shanghai Clinical College, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Yingyi Qin
- Department of Health Statistics, Second Military Medical University, Shanghai 200433, China
| | - Peng Zhang
- Department of Cardio-Thoracic Surgery, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Changxing Shen
- Department of Respiratory Medicine, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Qing Xia
- Department of Respiratory Medicine, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Lihong Fan
- Department of Respiratory Medicine, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Clinical College, Anhui Medical University, Hefei 230032, Anhui Province, China
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11
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Abe T, Ryuno Y, Saito S, Aoshika T, Igari M, Hirai R, Kumazaki Y, Kaira K, Kagamu H, Ishida H, Noda SE, Kato S. Stereotactic body radiation therapy using CyberKnife for T1N0M0 lung cancer patients with severe pulmonary dysfunction. JOURNAL OF RADIATION RESEARCH 2020; 61:903-907. [PMID: 32880653 PMCID: PMC7674703 DOI: 10.1093/jrr/rraa075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/10/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Abstract
We retrospectively investigated the efficacy and safety of stereotactic body radiotherapy (SBRT) for T1N0M0 lung cancer using CyberKnife (CK) among 13 patients with severe pulmonary dysfunction which was defined as forced expiratory volume in 1 s (FEV1.0) of <1 L. The prescribed dose was 54 Gy in 3 fractions but adjusted for some patients if their tumors were in close proximity to the organs at risk (54 Gy/3 fractions: n = 11; 50 Gy/5 fractions: n = 1; 60 Gy/8 fractions: n = 1). During follow up (median follow-up: 27 months), we evaluated local control, overall survival and toxicity, using diagnostic imaging and laboratory tests. The patients' median FEV1.0 was 0.84 L. Of the 13 patients, 3 were diagnosed as having lung cancer histologically and 10 diagnosed clinically. Their 2-year rates for overall survival and local control were 89 and 100%, respectively. So far, we have seen no adverse effects of grade 2 or higher. We concluded that CK-SBRT is effective and well tolerated for T1N0M0 lung cancer, even in patients with severe pulmonary dysfunction, but should be further evaluated with a larger cohort and longer follow-up periods.
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Affiliation(s)
- Takanori Abe
- Corresponding author: Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan. Tel: +81-429844136; Fax: +81-429844136;
| | - Yasuhiro Ryuno
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Satoshi Saito
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Tomomi Aoshika
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Mitsunobu Igari
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Ryuta Hirai
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Yu Kumazaki
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Kyoichi Kaira
- Departments of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Hiroshi Kagamu
- Departments of Respiratory Medicine, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Hironori Ishida
- Departments of General Thoracic Surgery, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Shin-ei Noda
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Shingo Kato
- Departments of Radiation Oncology, International Medical Center, Saitama Medical University, Hidaka, Japan
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12
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Long term efficacy and toxicity after stereotactic ablative reirradiation in locally relapsed stage III non-small cell lung cancer. BMC Cancer 2019; 19:305. [PMID: 30943943 PMCID: PMC6448259 DOI: 10.1186/s12885-019-5542-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/28/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In stage III non-small cell lung cancer (NSCLC) treated with concomitant chemoradiotherapy, there is a high rate of relapse. Some of these relapses are only local and can be treated by stereotactic ablative radiation therapy (SABR). Previous studies reporting outcome after SABR reirradiation of the thorax consisted of a heterogeneous population of various lung cancer stages or even different types of cancer. The purpose of study is to evaluate toxicity and outcome of this strategy in locally relapsed stage III NSCLC only. METHODS From February 2007 to November 2015, 46 Stage III NSCLC patients treated with SABR, for lung recurrence following conventionally fractionated radiation therapy (CFRT), were retrospectively analyzed. RESULTS Median follow-up was 47.3 months (1-76.9). The 2 and 4-year progression-free survival (PFS), and overall survival (OS) were of 25.5%/8.6 and 48.9%/30.8%, respectively. Highest presenting toxicity in patients (grade 1 through 5) was: 13 (28.3%), 7 (15.2%), 1 (2.2%), 0 and 2 (4.4%), with deaths due to hemoptysis (n = 1) and alveolitis (n = 1). Although the Biological Effective Dose (at Planning Tumor Volume isocenter) was lower for central tumors treated for an in-field relapse (n = 21, 116 Gy versus 168 Gy, p = 0.005), they had no significant difference in OS than the remaining cohort, but with a higher rate of grade 2-5 toxicities (OR = 0.22, [0.06-0.8], p = 0.02). CONCLUSION Reirradiation with SABR for local relapse in patients previously treated for stage III NSCLC, is feasible and associated with good outcome. This is also true for central tumors treated for an in-field relapse, but should be radiated with caution to mitigate toxicity.
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13
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Bousabarah K, Temming S, Hoevels M, Borggrefe J, Baus WW, Ruess D, Visser-Vandewalle V, Ruge M, Kocher M, Treuer H. Radiomic analysis of planning computed tomograms for predicting radiation-induced lung injury and outcome in lung cancer patients treated with robotic stereotactic body radiation therapy. Strahlenther Onkol 2019; 195:830-842. [PMID: 30874846 DOI: 10.1007/s00066-019-01452-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 03/02/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To predict radiation-induced lung injury and outcome in non-small cell lung cancer (NSCLC) patients treated with robotic stereotactic body radiation therapy (SBRT) from radiomic features of the primary tumor. METHODS In all, 110 patients with primary stage I/IIa NSCLC were analyzed for local control (LC), disease-free survival (DFS), overall survival (OS) and development of local lung injury up to fibrosis (LF). First-order (histogram), second-order (GLCM, Gray Level Co-occurrence Matrix) and shape-related radiomic features were determined from the unprocessed or filtered planning CT images of the gross tumor volume (GTV), subjected to LASSO (Least Absolute Shrinkage and Selection Operator) regularization and used to construct continuous and dichotomous risk scores for each endpoint. RESULTS Continuous scores comprising 1-5 histogram or GLCM features had a significant (p = 0.0001-0.032) impact on all endpoints that was preserved in a multifactorial Cox regression analysis comprising additional clinical and dosimetric factors. At 36 months, LC did not differ between the dichotomous risk groups (93% vs. 85%, HR 0.892, 95%CI 0.222-3.590), while DFS (45% vs. 17%, p < 0.05, HR 0.457, 95%CI 0.240-0.868) and OS (80% vs. 37%, p < 0.001, HR 0.190, 95%CI 0.065-0.556) were significantly lower in the high-risk groups. Also, the frequency of LF differed significantly between the two risk groups (63% vs. 20% at 24 months, p < 0.001, HR 0.158, 95%CI 0.054-0.458). CONCLUSION Radiomic analysis of the gross tumor volume may help to predict DFS and OS and the development of local lung fibrosis in early stage NSCLC patients treated with stereotactic radiotherapy.
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Affiliation(s)
- Khaled Bousabarah
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Susanne Temming
- Department of Radiation Oncology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Mauritius Hoevels
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jan Borggrefe
- Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Wolfgang W Baus
- Department of Radiation Oncology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Daniel Ruess
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Maximilian Ruge
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Martin Kocher
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
- Department of Radiation Oncology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Harald Treuer
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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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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15
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Khadige M, Salleron J, Marchesi V, Oldrini G, Peiffert D, Beckendorf V. Cyberknife ® stereotactic radiation therapy for stage I lung cancer and pulmonary metastases: evaluation of local control at 24 months. J Thorac Dis 2018; 10:4976-4984. [PMID: 30233872 DOI: 10.21037/jtd.2018.07.26] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background CyberKnife® stereotactic radiotherapy allows for minimally invasive treatment with satisfactory results in patients with inoperable primary or metastatic lung cancer. The objective of this study was to identify factors influencing the probability of local control. Methods Ninety-five patients (100 lung tumors) treated between January and December 2013 at our department by SBRT (stereotactic body radiation therapy) using CyberKnife® were included in the study. There were 71 stage T1 or T2 primary tumors and 29 secondary tumors. The tracking methods were as follow: fiducial markers with Synchrony® in 50 cases (gold seeds in 35, coils in 15 cases), spine with 4D-CT and Xsight® Spine in 43 cases, and direct viewing by Xsight® Lung in 7 cases. The methods were allocated according to the characteristics of each target. Results With a median follow-up of 24 months, the probability of local control at 24 months was 88%. The probability of local control differed according to the size of the target (92% for tumors ≤35 mm and 54% for tumors >35 mm: P=0.013) and according to the distance of the fiducial markers in relation to the target (95% when <50 mm and 69% when ≥50 mm: P=0.011). Conclusions The best results were obtained with small lesions. With Synchrony®, the distance of the target relative to the fiducial markers should be less than 50 mm. Gold seeds are recommended, although coils may be used instead of gold seeds. The number of fiducial markers did not have a significant impact on the probability of local control. With an appropriate tracking method, stereotactic radiotherapy is an efficient treatment for stage I lung cancer and lung oligometastases.
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Affiliation(s)
- Myriam Khadige
- Department of Radiotherapy, Institut de Cancérologie de Lorraine, Nancy, France
| | - Julia Salleron
- Data Biostatistics Unit, Institut de Cancérologie de Lorraine, Nancy, France
| | - Vincent Marchesi
- Department of Medical physics, Institut de Cancérologie de Lorraine, Nancy, France
| | - Guillaume Oldrini
- Department of Radiology, Institut de Cancérologie de Lorraine, Nancy, France.,CRAN, UMR 7039, Université de Lorraine, CNRS, Vandoeuvre-lès-Nancy, France
| | - Didier Peiffert
- Department of Radiotherapy, Institut de Cancérologie de Lorraine, Nancy, France
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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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17
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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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18
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Seides BJ, Egan JP, French KD, Kovitz KL, Desai NR. Fiducial marker placement for stereotactic body radiation therapy via convex probe endobronchial ultrasound: a case series and review of literature. J Thorac Dis 2018; 10:1972-1983. [PMID: 29707354 DOI: 10.21037/jtd.2018.03.49] [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] [Indexed: 12/25/2022]
Abstract
Convex probe endobronchial ultrasound (CP-EBUS) and stereotactic body radiotherapy (SBRT) are valuable tools in the diagnosis, staging, and treatment of thoracic malignancies. With widespread clinical adoption, novel uses of CP-EBUS beyond mediastinal diagnosis and staging continue to be discovered. SBRT is an attractive treatment strategy in early-stage lung cancer and oligo-metastatic disease of the chest when a surgical approach is either not feasible or desirable. Accurate application of SBRT is aided by the placement of radio-opaque fiducial markers (FM) to compensate for respiratory cycle movements. We describe eight patients with central thoracic lesions, either known or suspected to be malignant, who underwent EBUS bronchoscopy with lesion sampling and successful intralesional placement of modified FM via our technique, review the existing literature on this topic, and discuss the nuances of coding and billing aspects of FM placement.
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Affiliation(s)
- Benjamin J Seides
- Division of Pulmonary, Critical Care, and Allergy, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - John P Egan
- Chicago Chest Center, Chicago, IL, USA.,Suburban Lung Associates, Chicago, IL, USA.,Section of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | - Kim D French
- Chicago Chest Center, Chicago, IL, USA.,Suburban Lung Associates, Chicago, IL, USA
| | - Kevin L Kovitz
- Chicago Chest Center, Chicago, IL, USA.,Suburban Lung Associates, Chicago, IL, USA.,Section of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | - Neeraj R Desai
- Chicago Chest Center, Chicago, IL, USA.,Suburban Lung Associates, Chicago, IL, USA.,Section of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL, USA
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19
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Chen XR, Dong JN, Zhang F, Yao TL. Efficacy and safety of image-guidance radiotherapy by helical tomotherapy in patients with lung cancer. Medicine (Baltimore) 2018; 97:e9243. [PMID: 29505510 PMCID: PMC5943132 DOI: 10.1097/md.0000000000009243] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to explore the efficacy and toxicity of image-guided stereotactic body radiotherapy (IGSBR) by helical tomotherapy in patients with lung cancer among Chinese Han population.A total of 21 patients with stage I lung cancer were included. They received a total of 60 Gy factions IGSBR. The outcomes included complete response (CR), partial response (PR), stable disease (SD), progress disease (PD), overall response rate (ORR), and overall survival (OS). In addition, toxicities were also recorded in this study.Three-year CR, PR, SD, PD, ORR, and OS were 47.6%, 38.1%, 9.5%, 4.8%, 85.7%, and 48.0 months, respectively. Additionally, mild toxicities were found in this study.This study demonstrated that IGSBR is efficacious for patients with stage I lung cancer with mild toxicities among Chinese Han population.
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Affiliation(s)
- Xiang-ru Chen
- Department of Ultrasound, The Second Affiliated Hospital of Mudanjiang Medical University
| | - Jia-nan Dong
- Department of Rehabilitation Comprehensive Laboratory
| | - Fan Zhang
- School of Image, Mudanjiang Medical University
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