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A C Fiagan Y, Bossuyt E, Nevens D, Machiels M, Chiairi I, Joye I, Paul M, Gevaert T, Verellen D. The use of in-vivo dosimetry to identify head and neck cancer patients needing adaptive radiotherapy. Radiother Oncol 2023; 184:109676. [PMID: 37084887 DOI: 10.1016/j.radonc.2023.109676] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND AND PURPOSE Head and neck cancer (HNC) patients experiencing anatomical changes during their radiotherapy (RT) course may benefit from adaptive RT (ART). We investigated the sensitivity of an electronic portal imaging device (EPID)-based in-vivo dosimetry (EIVD) systemto detect patients that require ART and identified its limitations. MATERIALS AND METHODS A retrospective study was conducted for 182 HNC patients: laryngeal cancer without elective lymph nodes (group A), postoperative RT (group B) and primary RT including elective lymph nodes (group C). The effect of anatomical changes on the dose distribution and volumetric changes was quantified. The receiver operating characteristic curve was used to obtain the optimal cut-off value for the gamma passing rate (%GP) with a dose difference of 3% and a distance to agreement of 3mm. RESULTS Fifty HNC patients receiving ART were analyzed: 1 in group A, 10 in group B and 39 in group C. Failed fractions (FFs) occurred in 1/1, 6/10 and 23/39 cases before ART in group A, B and C respectively. In the four cases in group B without FFs, only minor dosimetric changes were observed. One of the cases in group C without FFs had significant dosimetric changes (false negative). Three cases received ART because of clinical reasons that cannot be detected by EIVD. The optimal cut-off value for the %GP was 95%/95.2% for old/new generation machines respectively. CONCLUSION EIVD in combined with 3D imaging techniques can be synergistic in the detection of anatomical changes in HNC patients who benefit from ART.
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Affiliation(s)
- Yawo A C Fiagan
- Iridium Netwerk, Radiation Oncology, Antwerp, Belgium; Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Evy Bossuyt
- Iridium Netwerk, Radiation Oncology, Antwerp, Belgium
| | - Daan Nevens
- Iridium Netwerk, Radiation Oncology, Antwerp, Belgium; Faculty of Medicine and Health Sciences, Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), Universiteit Antwerpen, Antwerp, Belgium
| | - Melanie Machiels
- Iridium Netwerk, Radiation Oncology, Antwerp, Belgium; Faculty of Medicine and Health Sciences, Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), Universiteit Antwerpen, Antwerp, Belgium
| | - Ibrahim Chiairi
- Iridium Netwerk, Radiation Oncology, Antwerp, Belgium; Faculty of Medicine and Health Sciences, Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), Universiteit Antwerpen, Antwerp, Belgium
| | - Ines Joye
- Iridium Netwerk, Radiation Oncology, Antwerp, Belgium; Faculty of Medicine and Health Sciences, Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), Universiteit Antwerpen, Antwerp, Belgium
| | - Meijnders Paul
- Iridium Netwerk, Radiation Oncology, Antwerp, Belgium; Faculty of Medicine and Health Sciences, Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), Universiteit Antwerpen, Antwerp, Belgium
| | - Thierry Gevaert
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Radiation Oncology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Dirk Verellen
- Iridium Netwerk, Radiation Oncology, Antwerp, Belgium; Faculty of Medicine and Health Sciences, Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), Universiteit Antwerpen, Antwerp, Belgium
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Prospective observational study to estimate set-up errors and optimise PTV margins in patients undergoing IMRT for head and neck cancers from a Government cancer centre of Eastern India. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396919000487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AbstractBackground:The head and neck cancers as a whole are the most common cancers among males in India. Technological advancements have led to an improvement in radiation therapy (RT) techniques with subsequent reduction in normal tissue complications. To correct patient set-up errors, an off-line correction method like no action level (NAL) protocol may be used as a preferred protocol particularly for a busy department. The objectives of the study were to measure the translational set-up errors using kV cone-beam computed tomography (CBCT) in patients undergoing intensity modulated radiotherapy (IMRT) in head and neck cancers and also to optimise clinical target volume (CTV) to planning target volume (PTV) margin using NAL protocol.Material and methods:On the first 5 days of RT, patient’s position was verified by kV-CBCT and then weekly during the course of treatment. The comparison between the reference and kV-CBCT images was performed, and the shifts measured and recorded. The mean error from the initial five consecutive fractions was corrected on the sixth daily fraction. Displacements in all the directions were measured. The population systematic and random errors were determined and used to estimate PTV margins according to the van Herk formula.Results:A total of 322 images were analysed. Before correction, 15, 12 and 9% patients had systematic error ≥3 mm on X, Y and Z axes, but after correction this was reduced to 9, 0 and 0%. The total percentage of patients whose set-up margin was ≥5 mm before correction was 5, 6·25, 3·75%, but after correction it reduced to 1·88, 0, and 0·63%. The margins of total population were reduced to 63, 65 and 56% after correction on X, Y and Z axes, respectively.Conclusion:A simple off-line NAL protocol can correct the set-up errors without daily on-line imaging in patients undergoing IMRT and hence acting as a resource sparing alternative. Five millimetre margin to CTVs was adequate and safe to overcome the problem of set-up errors in head and neck IMRT.
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Kim SH, Oh SA, Yea JW, Park JW. Prospective assessment of inter- or intra-fractional variation according to body weight or volume change in patients with head and neck cancer undergoing radiotherapy. PLoS One 2019; 14:e0216655. [PMID: 31095583 PMCID: PMC6522006 DOI: 10.1371/journal.pone.0216655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/25/2019] [Indexed: 12/25/2022] Open
Abstract
This study aimed to prospectively investigate the association between body weight (ΔBW) or body volume variations (ΔBV) and inter- or intra-fractional variations (Δ(inter) or Δ(intra)) in patients with head and neck cancer (HNC) undergoing radiotherapy (RT). This study enrolled patients with HNC from December 2015 to December 2017. All patients underwent curative intensity-modulated RT (IMRT) either as definitive or adjuvant treatment. Six-dimensional inter- and intra-fractional variations (Δ(inter) and Δ(intra)) were obtained with ExacTrac (BrainLAB, Feldkirchen, Germany) system. BV was measured 7.5 cm cranio-caudally from the centre using cone beam computed tomography. The BW, BV, and Δ(inter) were calculated based on the value obtained on the first treatment day after each simulation. Both Δ(inter) and Δ(intra) were considered in calculating the optimal margins for planning target volume (PTV), which was calculated using van Herk’s formula. In total, 678 fractions with 39 simulations in 22 patients were analysed. The average ΔBW and ΔBV was -0.43±1.90 kg (range, -7.3 to 5.0) and -24.34±69.0 cc (range, -247.15 to 214.88), respectively. In correlation analysis, Δ(intra) was more associated with ΔBW or ΔBV than Δ(inter). Receiver operating characteristic analysis showed Δ(intra) could differentiate ΔBW from ΔBV, while Δ(inter) could not. The optimal margins for PTV considering both Δ(inter) and Δ(intra) were 3.70 mm, 4.52 mm, and 5.12 mm for the right-left, superior-inferior, and anterior-posterior directions, respectively. In conclusion, the PTV margin of 6 mm for anterior-posterior direction and 5 mm for the other directions were needed. ΔBW or ΔBV correlated with Δ(intra) rather than Δ(inter). Therefore, ΔBW or ΔBV should be assessed for accurate IMRT in patients with HNC.
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Affiliation(s)
- Seong Hoon Kim
- Department of Radiation Oncology, Yeungnam University College of Medicine, Nam-gu, Daegu, South Korea
- Department of Radiation Oncology, Yeungnam University Medical Center, Nam-gu, Daegu, South Korea
| | - Se An Oh
- Department of Radiation Oncology, Yeungnam University Medical Center, Nam-gu, Daegu, South Korea
| | - Ji Woon Yea
- Department of Radiation Oncology, Yeungnam University College of Medicine, Nam-gu, Daegu, South Korea
- Department of Radiation Oncology, Yeungnam University Medical Center, Nam-gu, Daegu, South Korea
| | - Jae Won Park
- Department of Radiation Oncology, Yeungnam University College of Medicine, Nam-gu, Daegu, South Korea
- Department of Radiation Oncology, Yeungnam University Medical Center, Nam-gu, Daegu, South Korea
- * E-mail:
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Weppler S, Quon H, Banerjee R, Schinkel C, Smith W. Framework for the quantitative assessment of adaptive radiation therapy protocols. J Appl Clin Med Phys 2018; 19:26-34. [PMID: 30160025 PMCID: PMC6236815 DOI: 10.1002/acm2.12437] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/29/2018] [Accepted: 07/03/2018] [Indexed: 11/30/2022] Open
Abstract
Background Adaptive radiation therapy (ART) “flags,” such as change in external body contour or relative weight loss, are widely used to identify which head and neck cancer (HNC) patients may benefit from replanned treatment. Despite the popularity of ART, few published quantitative approaches verify the accuracy of replan candidate identification, especially with regards to the simple flagging approaches that are considered current standard of practice. We propose a quantitative evaluation framework, demonstrated through the assessment of a single institution's clinical ART flag: change in body contour exceeding 1.5 cm. Methods Ground truth replan criteria were established by surveying HNC radiation oncologists. Patient‐specific dose deviations were approximated by using weekly acquired CBCT images to deform copies of the CT simulation, yielding during treatment “synthetic CTs.” The original plan reapplied to the synthetic CTs estimated interfractional dose deposition and truth table analysis compared ground truth flagging with the clinical ART metric. This process was demonstrated by assessing flagged fractions for 15 HNC patients whose body contour changed by >1.5 cm at some point in their treatment. Results Survey results indicated that geometric shifts of high‐dose volumes relative to image‐guided radiation therapy alignment of bony anatomy were of most interest to HNC physicians. This evaluation framework successfully identified a fundamental discrepancy between the “truth” criteria and the body contour flagging protocol selected to identify changes in central axis dose. The body contour flag had poor sensitivity to survey‐derived major violation criteria (0%–28%). The sensitivity of a random sample for comparable violation/flagging frequencies was 27%. Conclusions These results indicate that centers should establish ground truth replan criteria to assess current standard of practice ART protocols. In addition, more effective replan flags may be tested and identified according to the proposed framework. Such improvements in ART flagging may contribute to better clinical resource allocation and patient outcome.
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Affiliation(s)
- Sarah Weppler
- Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada.,Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Harvey Quon
- Department of Radiation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada.,Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Robyn Banerjee
- Department of Radiation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada.,Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Colleen Schinkel
- Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada.,Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada.,Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Wendy Smith
- Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada.,Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada.,Department of Oncology, University of Calgary, Calgary, AB, Canada
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Setup errors in patients with head-neck cancer (HNC), treated using the Intensity Modulated Radiation Therapy (IMRT) technique: how it influences the customised immobilisation systems, patient's pain and anxiety. Radiat Oncol 2017; 12:72. [PMID: 28449698 PMCID: PMC5408424 DOI: 10.1186/s13014-017-0807-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In patients with head-neck cancer treated with IMRT, immobility of the upper part of the body during radiation is maintained by means of customised immobilisation devices. The main purpose of this study was to determine how the procedures for preparation of customised immobilisation systems and the patients characteristics influence the extent of setup errors. METHODS A longitudinal, prospective study involving 29 patients treated with IMRT. Data were collected before CT simulation and during all the treatment sessions (528 setup errors analysed overall); the correlation with possible risk factors for setup errors was explored using a linear mixed model. RESULTS Setup errors were not influenced by the patient's anxiety and pain. Temporary removal of the thermoplastic mask before carrying out the CT simulation shows statistically borderline, clinically relevant, increase of setup errors (+24.7%, 95% CI: -0.5% - 55.8%). Moreover, a unit increase of radiation therapists who model the customised thermoplastic mask is associated to a -18% (-29.2% - -4.9%) reduction of the errors. The setup error is influenced by the patient's physical features; in particular, it increases both in patients in whom the treatment position is obtained with 'Shoulder down' (+27.9%, 2.2% - 59.7%) and in patients with 'Scoliosis/kyphosis' problems (+65.4%, 2.3% - 164.2%). Using a 'Small size standard plus customized neck support device' is associated to a -52.3% (-73.7% - -11.2%) reduction. The increase in number of radiation therapists encountered during the entire treatment cycle does not show associations. Increase in the body mass index is associated with a slight reduction in setup error by (-2.8%, -5% - -0.7%). CONCLUSION The position of the patient obtained by forcing the shoulders downwards, clinically significant scoliosis or kyphosis and the reduction of the number of radiation therapists who model the thermoplastic mask are found to be statistically significant risk factors that can cause an increase in setup errors, while the use of 'Small size' neck support device and patient BMI can diminish them.
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Saha A, Mallick I, Das P, Shrimali R, Achari R, Chatterjee S. Evaluating the Need for Daily Image Guidance in Head and Neck Cancers Treated with Helical Tomotherapy: A Retrospective Analysis of a Large Number of Daily Imaging-based Corrections. Clin Oncol (R Coll Radiol) 2016; 28:178-84. [DOI: 10.1016/j.clon.2015.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/25/2015] [Accepted: 10/26/2015] [Indexed: 10/22/2022]
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Head and neck intensity modulated radiotherapy parotid glands: time of re-planning. Radiol Med 2013; 119:201-7. [PMID: 24337754 DOI: 10.1007/s11547-013-0326-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 09/25/2012] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate the correct time point for re-planning by evaluating dosimetric changes in the parotid glands (PGs) during intensity-modulated radiotherapy (IMRT) in head and neck cancer patients. MATERIALS AND METHODS Patients with head and neck cancer treated with IMRT were enrolled. During treatment all patients underwent cone-beam computed tomography (CBCT) scans to verify the set-up. CBCT scans at treatment days 10, 15, 20 and 25 were used to transfer the original plan (CBCTplan I, II, III, IV, respectively) using rigid registration between the two. The PGs were retrospectively contoured and evaluated with the dose-volume histogram. The mean dose, the dose to 50 % of volume, and the percentage of volume receiving 30 and 50 Gy were evaluated for each PG. The Wilcoxon sign ranked test was used to evaluate the effects of dosimetric variations and values <0.05 were taken to be significant. RESULTS From February to June 2011, ten patients were enrolled and five IMRT plans were evaluated for each patient. All the dosimetric parameters increased throughout the treatment course. However, this increase was statistically significant at treatment days 10 and 15 (CBCTplan I, II; p = 0.02, p = 0.03, respectively). CONCLUSION CBCT is a feasible method to assess the dosimetric changes in the PGs. Our data showed that checking the PG volume and dose could be indicated during the third week of treatment.
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