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Tanaka O, Taniguchi T, Nakaya S, Adachi K, Kiryu T, Makita C, Matsuo M. Stereotactic body radiation therapy to the spine: contouring the cauda equina instead of the spinal cord is more practical as the organ at risk. Rep Pract Oncol Radiother 2023; 28:407-415. [PMID: 37795406 PMCID: PMC10547411 DOI: 10.5603/rpor.a2023.0040] [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: 11/02/2022] [Accepted: 06/05/2023] [Indexed: 10/06/2023] Open
Abstract
Background Stereotactic body radiotherapy (SBRT) is recognized as a curative treatment for oligometastasis. The spinal cord becomes the cauda equina at the lumbar level, and the nerves are located dorsally. Recently, a consensus has been reached that the cauda equina should be contoured as an organ at risk (OAR). Here, we examined the separate contouring benefits for the spinal canal versus the cauda equina only as the OAR. Materials and methods A medical physicist designed a simulation plan for 10 patients with isolated lumbar metastasis. The OAR was set with three contours: the whole spinal canal, cauda equina only, and cauda equina with bilateral nerve roots. The prescribed dose for the planning target volume (PTV) was 30 Gy/3 fx. Results For the constrained QAR doses, D90 and D95 were statistically significant due to the different OAR contouring. The maximum dose (Dmax) was increased to the spinal canal when the cauda equina max was set to ≤ 20 Gy, but dose hotspots were observed in most cases in the medullary area. The Dmax and PTV coverage were negatively correlated for the cauda equina and the spinal canal if Dmax was set to ≤ 20 Gy for both. Conclusions A portion of the spinal fluid is also included when the spinal canal is set as the OAR. Thus, the PTV coverage rate will be poor if the tumor is in contact with the spinal canal. However, the PTV coverage rate increases if only the cauda equina is set as the OAR.
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Affiliation(s)
- Osamu Tanaka
- Department of Radiation Oncology, Asahi University Hospital, Gifu City, Gifu, Japan
| | - Takuya Taniguchi
- Department of Radiation Oncology, Asahi University Hospital, Gifu City, Gifu, Japan
| | - Shuto Nakaya
- Department of Radiation Oncology, Asahi University Hospital, Gifu City, Gifu, Japan
| | - Kousei Adachi
- Department of Radiation Oncology, Asahi University Hospital, Gifu City, Gifu, Japan
| | - Takuji Kiryu
- Department of Radiation Oncology, Asahi University Hospital, Gifu City, Gifu, Japan
| | - Chiyoko Makita
- Department of Radiology, Gifu University Hospital, Gifu City, Gifu, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University Hospital, Gifu City, Gifu, Japan
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Bahouth SM, Yeboa DN, Ghia AJ, Tatsui CE, Alvarez-Breckenridge CA, Beckham TH, Bishop AJ, Li J, McAleer MF, North RY, Rhines LD, Swanson TA, Chenyang W, Amini B. Advances in the management of spinal metastases: what the radiologist needs to know. Br J Radiol 2023; 96:20220267. [PMID: 35946551 PMCID: PMC10997009 DOI: 10.1259/bjr.20220267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/05/2022] Open
Abstract
Spine is the most frequently involved site of osseous metastases. With improved disease-specific survival in patients with Stage IV cancer, durability of local disease control has become an important goal for treatment of spinal metastases. Herein, we review the multidisciplinary management of spine metastases, including conventional external beam radiation therapy, spine stereotactic radiosurgery, and minimally invasive and open surgical treatment options. We also present a simplified framework for management of spinal metastases used at The University of Texas MD Anderson Cancer Center, focusing on the important decision points where the radiologist can contribute.
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Affiliation(s)
- Sarah M Bahouth
- Musculoskeletal Imaging and Intervention Department, Brigham
and Women’s Hospital, Boston, United States
| | - Debra N Yeboa
- Department of Radiation Oncology, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
| | - Amol J Ghia
- Department of Radiation Oncology, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
| | - Claudio E Tatsui
- Department of Neurosurgery, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
| | | | - Thomas H Beckham
- Department of Radiation Oncology, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
| | - Andrew J Bishop
- Department of Radiation Oncology, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
| | - Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
| | - Robert Y North
- Department of Neurosurgery, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
| | - Laurence D Rhines
- Department of Neurosurgery, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
| | - Todd A Swanson
- Department of Radiation Oncology, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
| | - Wang Chenyang
- Department of Radiation Oncology, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
| | - Behrang Amini
- Department of Musculoskeletal Imaging, The University of Texas
MD Anderson Cancer Center, Houston, TX, United
States
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3
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YILMAZ U, YAPRAK G, IŞIK N. Evaluation of treatment results of stereotactic body radiotherapy for spinal metastases: A single center experience. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1134145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: To assess oncological outcomes and adverse events of patients receiving single or multi-fraction stereotactic body radiotherapy (SBRT) for spine metastases.
Material and Method: Patients with any pathologically proven solid tumor histology who had SBRT to the spine for recurrent or metastatic disease between the years 2010 and 2021 at our department were identified from institutional database. Patient, tumor and treatment characteristics, and follow-up medical records were retrospectively reviewed. Local control (LC) and overall survival (OS) rates were calculated, and adverse events were evaluated.
Results: A total of 47 patients were treated to 50 spine metastases. Median age was 53 years for all patients. Histologies included breast cancer (45%), non-small cell lung cancer (NSCLC; 21%), prostate cancer (15%) and other types (19%). Median follow-up was 16 months for all patients. Of 47 patients, six (13%) developed local failure and 15 (32%) died without local failure. One and two-year actuarial LC rates were 90.1% and 83.6%, respectively. One and two-year OS rates were 75.1% and 62.7%, respectively. Twenty-two (47%) patients had pain before SBRT. Fifteen (68%) of them had complete or partial pain response at 3 months after SBRT. Vertebral compression fracture, which was grade 1 in severity according to the Common Terminology Criteria for Adverse Events (CTCAE [v.4.03]), was observed in only one (2%) patient and it occurred 46 months after SBRT. No cases of treatment-related radiation myelopathy or any≥grade 3 RT induced acute or late toxicities occurred.
Conclusion: This study supports that SBRT to the spine results in high LC without any significant toxicity. The results of ongoing phase 3 trials will highlight whether this high LC benefit reflects to survival in oligometastatic disease.
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Affiliation(s)
- Uğur YILMAZ
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL KARTAL DR. LÜTFİ KIRDAR ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, RADYASYON ONKOLOJİSİ ANABİLİM DALI
| | - Gökhan YAPRAK
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL KARTAL DR. LÜTFİ KIRDAR ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, RADYASYON ONKOLOJİSİ ANABİLİM DALI
| | - Naciye IŞIK
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL KARTAL DR. LÜTFİ KIRDAR ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, RADYASYON ONKOLOJİSİ ANABİLİM DALI
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4
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Yoosuf AM, Ahmad MB, AlShehri S, Alhadab A, Alqathami M. Investigation of optimum minimum segment width on VMAT plan quality and deliverability: A comprehensive dosimetric and clinical evaluation using DVH analysis. J Appl Clin Med Phys 2021; 22:29-40. [PMID: 34592787 PMCID: PMC8598144 DOI: 10.1002/acm2.13417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/23/2021] [Accepted: 08/24/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose Minimum segment width (MSW) plays a fundamental role in the shaping of optimized apertures and creation of segments of varying sizes and shapes in complex radiotherapy treatment plans. The purpose of this work was to study the effect of MSW on dose distribution in patients planned with VMAT for various treatment sites using dose volume histogram (DVH) analysis. Materials and methods For the validation of optimum MSW, 125 clinical treatment plans were evaluated. Five groups were identified (brain, head and neck, thorax, pelvis, and extremity), and five cases were chosen from each group. For each case, five plans were created with different MSW (0.5, 0.8, 1.0, 1.25, and 1.5 cm). The quality of treatment plans created using different MSW were compared using dosimetric indicators such as target coverage (D98—dose to 98% of the planning target volume (PTV), maximum dose (D2—maximum dose to 2% of the PTV), monitor units (MU), and DVH parameters related to organs at risk (OAR). The effect of the MSW on delivery accuracy was quantitatively analyzed using the measured fluence utilizing ionization chamber‐based transmission detector and model‐based dose verification system. Traditional global gamma analysis (2%, 2 mm) and dose volume information was gathered for the PTV and organs at risk and compared for different MSWs. Results A total of 125 plans were created and compared across five groups. In terms of treatment plan quality, the plans using MSW of 0.5 cm was found to be superior in all groups. PTV coverage (D98) decreased significantly (p < 0.05) as the MSW increased. Similarly, the maximum dose (D2) was found to be increased significantly (p < 0.05) as the MSW increased from 0.5 cm, with MSW of 1.5 cm being the least in terms of plan quality for both PTVs and OARs. In terms of plan deliverability using DVH analysis, treatment planning system (TPS) compared to measured fluence, VMAT plans produced with MSW of 0.5 cm showed a better dosimetric index and a smaller deviation for both PTVs and OARs. The deliverability of the plans deteriorated as the MSW increased. Conclusion Dose volume histogram (DVH) analysis demonstrated that treatment plans with minimal MSW showed better plan quality and deliverability and provided clinical relevance as compared to gamma index analysis.
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Affiliation(s)
- Ab Mohamed Yoosuf
- Department of Radiation Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Muhammad Bilal Ahmad
- Department of Radiation Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Salem AlShehri
- Department of Radiation Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulrahman Alhadab
- Department of Radiation Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Mamdouh Alqathami
- Department of Radiation Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Goodall SK, Rampant P, Smith W, Waterhouse D, Rowshanfarzad P, Ebert MA. Investigation of the effects of spinal surgical implants on radiotherapy dosimetry: A study of 3D printed phantoms. Med Phys 2021; 48:4586-4597. [PMID: 34214205 DOI: 10.1002/mp.15070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/29/2021] [Accepted: 06/12/2021] [Indexed: 01/22/2023] Open
Abstract
PURPOSE The use of three-dimensional (3D) printing to develop custom phantoms for dosimetric studies in radiotherapy is increasing. The process allows production of phantoms designed to evaluated specific geometries, patients, or patient groups with a defining feature. The ability to print bone-equivalent phantoms has, however, proved challenging. The purpose of this work was to 3D print a series of three similar spine phantoms containing no surgical implants, implants made of titanium, and implants made of carbon fiber, for future dosimetric and imaging studies. Phantoms were evaluated for (a) tissue and bone equivalence, (b) geometric accuracy compared to design, and (c) similarity to one another. METHODS Sample blocks of PLA, HIPS, and StoneFil PLA-concrete with different infill densities were printed to evaluate tissue and bone equivalence. The samples were used to develop CT to physical (PD) and effective relative electron density (REDeff ) conversion curves and define the settings for printing the phantoms. CT scans of the printed phantoms were obtained to assess the geometry and densities achieved. Mean distance to agreement (MDA) and DICE coefficient (DSC) values were calculated between contours defining the different materials, obtained from design and like phantom modules. HU values were used to determine PD and REDeff and subsequently evaluate tissue and bone equivalence. RESULTS Sample objects showed linear relationships between HU and both PD and REDeff for both PLA and StoneFil. The PD and REDeff of the objects calculated using clinical CT conversion curves were not accurate and custom conversion curves were required. PLA printed with 90% infill density was found to have a PD of 1.11 ± 0.03 g.cm-3 and REDeff of 1.04 ± 0.02 and selected for tissue- equivalent phantom elements. StoneFil printed with 100% infill density showed a PD of 1.35 ± 0.03 g.cm-3 and REDeff of 1.24 ± 0.04 and was selected for bone-equivalent elements. Upon evaluation of the final phantoms, the PLA elements displayed PD in the range of 1.10 ± 0.03 g.cm-3 -1.13 ± 0.03 g.cm-3 and REDeff in the range of 1.02 ± 0.03-1.06 ± 0.03. The StoneFil elements showed PD in the range of 1.43 ± 0.04 g.cm-3 -1.46 ± 0.04 g.cm-3 and REDeff in the range of 1.31 ± 0.04-1.33 ± 0.04. The PLA phantom elements were shown to have MDA of ≤1.00 mm and DSC of ≥0.95 compared to design, and ≤0.48 mm and ≥0.91 compared like modules. The StoneFil elements displayed MDA values of ≤0.44 mm and DSC of ≥0.98 compared to design and ≤0.43 mm and ≥0.92 compared like modules. CONCLUSIONS Phantoms which were radiologically equivalent to tissue and bone were produced with a high level of similarity to design and even higher level of similarity of one another. When used in conjunction with the derived CT to PD or REDeff conversion curves they are suitable for evaluating the effects of spinal surgical implants of varying material of construction.
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Affiliation(s)
- Simon K Goodall
- School of Physics, Mathematics, and Computing, Faculty of Engineering and Mathematical Sciences, University of Western Australia, Crawley, WA, Australia.,GenesisCare, Wembley, WA, Australia
| | | | - Warwick Smith
- School of Physics, Mathematics, and Computing, Faculty of Engineering and Mathematical Sciences, University of Western Australia, Crawley, WA, Australia.,GenesisCare, Wembley, WA, Australia
| | | | - Pejman Rowshanfarzad
- School of Physics, Mathematics, and Computing, Faculty of Engineering and Mathematical Sciences, University of Western Australia, Crawley, WA, Australia
| | - Martin A Ebert
- School of Physics, Mathematics, and Computing, Faculty of Engineering and Mathematical Sciences, University of Western Australia, Crawley, WA, Australia.,Department of Radiation Oncology, Sir Charles Gardiner Hospital, Nedlands, WA, Australia.,5D Clinics, Perth, WA, Australia
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Xi D, Jiang W, Shao Y, Song X, Chen Y, Liu M, Gu W, Li Q. Retrospective analysis of the bleeding risk induced by oral antiplatelet drugs during radiotherapy. Medicine (Baltimore) 2021; 100:e24580. [PMID: 33578556 PMCID: PMC7886460 DOI: 10.1097/md.0000000000024580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 01/14/2021] [Indexed: 01/05/2023] Open
Abstract
We conducted this retrospective analysis to assess whether oral antiplatelet drugs (APDs) during radiotherapy increase bleeding risk.Patients who underwent radiotherapy for esophageal cancer (EC) in the Third Affiliated Hospital of Soochow University from January 2015 to December 2019 were screened. After the differences in clinical parameters were eliminated by a propensity-score matched (PSM) analysis at a 1:1 ratio, the thrombocytopenia, consumption of platelet-increasing drugs, suspension of radiotherapy, and bleeding in patients taking APDs were compared with those in the control group.A total of 986 patients were included in the original dataset. Of these, 34 patients took APDs during radiotherapy. After matching, the APD and control groups each retained 31 patients. There was no significant difference in platelet concentrations between the two groups before radiotherapy (P = .524). The lowest platelet concentration during radiotherapy in the APD group was significantly lower (P = .033). The consumption of platelet-increasing drugs in the APD group was higher than that in the control group (P < .05). However, there was no significant difference in the average number of days of radiotherapy suspension because of thrombocytopenia (P = .933) and no significant difference in the incidence of bleeding between the two groups (P = .605).Oral APDs during radiotherapy lead to a further decrease in platelet concentration, but timely and adequate application of platelet-increasing drugs can avoid the increased risk of bleeding and the reduced efficacy of radiotherapy.
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