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Wong YM, Koh CWY, Lew KS, Chua CGA, Yeap PL, Zhang ET, Ong ALK, Tuan JKL, Ng BF, Lew WS, Lee JCL, Tan HQ. Deformable anthropomorphic pelvis phantom for dose accumulation verification. Phys Med Biol 2024; 69:12NT01. [PMID: 38821109 DOI: 10.1088/1361-6560/ad52e4] [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: 02/25/2024] [Accepted: 05/31/2024] [Indexed: 06/02/2024]
Abstract
Objective.The validation of deformable image registration (DIR) for contour propagation is often done using contour-based metrics. Meanwhile, dose accumulation requires evaluation of voxel mapping accuracy, which might not be accurately represented by contour-based metrics. By fabricating a deformable anthropomorphic pelvis phantom, we aim to (1) quantify the voxel mapping accuracy for various deformation scenarios, in high- and low-contrast regions, and (2) identify any correlation between dice similarity coefficient (DSC), a commonly used contour-based metric, and the voxel mapping accuracy for each organ.Approach. Four organs, i.e. pelvic bone, prostate, bladder and rectum (PBR), were 3D printed using PLA and a Polyjet digital material, and assembled. The latter three were implanted with glass bead and CT markers within or on their surfaces. Four deformation scenarios were simulated by varying the bladder and rectum volumes. For each scenario, nine DIRs with different parameters were performed on RayStation v10B. The voxel mapping accuracy was quantified by finding the discrepancy between true and mapped marker positions, termed the target registration error (TRE). Pearson correlation test was done between the DSC and mean TRE for each organ.Main results. For the first time, we fabricated a deformable phantom purely from 3D printing, which successfully reproduced realistic anatomical deformations. Overall, the voxel mapping accuracy dropped with increasing deformation magnitude, but improved when more organs were used to guide the DIR or limit the registration region. DSC was found to be a good indicator of voxel mapping accuracy for prostate and rectum, but a comparatively poorer one for bladder. DSC > 0.85/0.90 was established as the threshold of mean TRE ⩽ 0.3 cm for rectum/prostate. For bladder, extra metrics in addition to DSC should be considered.Significance. This work presented a 3D printed phantom, which enabled quantification of voxel mapping accuracy and evaluation of correlation between DSC and voxel mapping accuracy.
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Affiliation(s)
- Yun Ming Wong
- Division of Physics and Applied Physics, Nanyang Technological University, Singapore, Singapore
| | - Calvin Wei Yang Koh
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Ai3 Lab, National Cancer Centre Singapore, Singapore, Singapore
| | - Kah Seng Lew
- Division of Physics and Applied Physics, Nanyang Technological University, Singapore, Singapore
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Clifford Ghee Ann Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Ai3 Lab, National Cancer Centre Singapore, Singapore, Singapore
| | - Ping Lin Yeap
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Ee Teng Zhang
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
- Singapore Centre for 3D Printing, Nanyang Technological University, Singapore, Singapore
| | - Ashley Li Kuan Ong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Ai3 Lab, National Cancer Centre Singapore, Singapore, Singapore
| | - Jeffrey Kit Loong Tuan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Ai3 Lab, National Cancer Centre Singapore, Singapore, Singapore
| | - Bing Feng Ng
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Wen Siang Lew
- Division of Physics and Applied Physics, Nanyang Technological University, Singapore, Singapore
| | - James Cheow Lei Lee
- Division of Physics and Applied Physics, Nanyang Technological University, Singapore, Singapore
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Hong Qi Tan
- Division of Physics and Applied Physics, Nanyang Technological University, Singapore, Singapore
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
- Ai3 Lab, National Cancer Centre Singapore, Singapore, Singapore
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Nuyts S, Bollen H, Eisbruch A, Strojan P, Mendenhall WM, Ng SP, Ferlito A. Adaptive radiotherapy for head and neck cancer: Pitfalls and possibilities from the radiation oncologist's point of view. Cancer Med 2024; 13:e7192. [PMID: 38650546 PMCID: PMC11036082 DOI: 10.1002/cam4.7192] [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: 01/11/2024] [Revised: 03/19/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Patients with head and neck cancer (HNC) may experience substantial anatomical changes during the course of radiotherapy treatment. The implementation of adaptive radiotherapy (ART) proves effective in managing the consequent impact on the planned dose distribution. METHODS This narrative literature review comprehensively discusses the diverse strategies of ART in HNC and the documented dosimetric and clinical advantages associated with these approaches, while also addressing the current challenges for integration of ART into clinical practice. RESULTS AND CONCLUSION Although based on mainly non-randomized and retrospective trials, there is accumulating evidence that ART has the potential to reduce toxicity and improve quality of life and tumor control in HNC patients treated with RT. However, several questions remain regarding accurate patient selection, the ideal frequency and timing of replanning, and the appropriate way for image registration and dose calculation. Well-designed randomized prospective trials, with a predetermined protocol for both image registration and dose summation, are urgently needed to further investigate the dosimetric and clinical benefits of ART.
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Affiliation(s)
- Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of OncologyKU LeuvenLeuvenBelgium
- Department of Radiation OncologyLeuven Cancer Institute, University Hospitals LeuvenLeuvenBelgium
| | - Heleen Bollen
- Laboratory of Experimental Radiotherapy, Department of OncologyKU LeuvenLeuvenBelgium
- Department of Radiation OncologyLeuven Cancer Institute, University Hospitals LeuvenLeuvenBelgium
| | - Avrahram Eisbruch
- Department of Radiation OncologyUniversity of MichiganAnn ArborMichiganUSA
| | - Primoz Strojan
- Department of Radiation Oncology Institute of OncologyUniversity of LjubljanaLjubljanaSlovenia
| | - William M. Mendenhall
- Department of Radiation OncologyUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Sweet Ping Ng
- Department of Radiation OncologyOlivia Newton‐John Cancer and Wellness Centre, Austin HealthMelbourneAustralia
| | - Alfio Ferlito
- Coordinator International Head and Neck Scientific GroupUdineItaly
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Blumenfeld P, Arbit E, Den R, Salhab A, Falick Michaeli T, Wygoda M, Hillman Y, Pfeffer RM, Fang M, Misrati Y, Weizman N, Feldman J, Popovtzer A. Real world clinical experience using daily intelligence-assisted online adaptive radiotherapy for head and neck cancer. Radiat Oncol 2024; 19:43. [PMID: 38555453 PMCID: PMC10981810 DOI: 10.1186/s13014-024-02436-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/25/2024] [Indexed: 04/02/2024] Open
Affiliation(s)
- Philip Blumenfeld
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel.
| | - Eduard Arbit
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Robert Den
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
- Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Israel
| | - Ayman Salhab
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Tal Falick Michaeli
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Marc Wygoda
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Yair Hillman
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Raphael M Pfeffer
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Marcel Fang
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Yael Misrati
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Noam Weizman
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Jon Feldman
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Aron Popovtzer
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
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Dohopolski M, Visak J, Choi B, Meng B, Parsons D, Zhong X, Inam E, Avkshtol V, Moon D, Sher D, Lin MH. In silico evaluation and feasibility of near margin-less head and neck daily adaptive radiotherapy. Radiother Oncol 2024; 197:110178. [PMID: 38453056 DOI: 10.1016/j.radonc.2024.110178] [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: 07/24/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE We explore the potential dosimetric benefits of reducing treatment volumes through daily adaptive radiation therapy for head and neck cancer (HNC) patients using the Ethos system/Intelligent Optimizer Engine (IOE). We hypothesize reducing treatment volumes afforded by daily adaption will significantly reduce the dose to adjacent organs at risk. We also explore the capability of the Ethos IOE to accommodate this highly conformal approach in HNC radiation therapy. METHODS Ten HNC patients from a phase II trial were chosen, and their cone-beam CT (CBCT) scans were uploaded to the adaptive RT (ART) emulator. A new initial reference plan was generated using both a 1 mm and 5 mm planning target volume (PTV) expansion. Daily adaptive ART plans (1 mm) were simulated from the clinical CBCT taken every fifth fraction. Additionally, using physician-modified ART contours the larger 5 mm plan was recalculated on this recontoured on daily anatomy. Changes in target and OAR contours were measured using Dice coefficients as a surrogate of clinician effort. PTV coverage and organ-at-risk (OAR) doses were statistically compared, and the robustness of each ART plan was evaluated at fractions 5 and 35 to observe if OAR doses were within 3 Gy of pre-plan. RESULTS This study involved six patients with oropharynx and four with larynx cancer, totaling 70 adaptive fractions. The primary and nodal gross tumor volumes (GTV) required the most adjustments, with median Dice scores of 0.88 (range: 0.80-0.93) and 0.83 (range: 0.66-0.91), respectively. For the 5th and 35th fraction plans, 80 % of structures met robustness criteria (quartile 1-3: 67-100 % and 70-90 %). Adaptive planning improved median PTV V100% coverage for doses of 70 Gy (96 % vs. 95.6 %), 66.5 Gy (98.5 % vs. 76.5 %), and 63 Gy (98.9 % vs. 74.9 %) (p < 0.03). Implementing ART with total volume reduction yielded median dose reductions of 7-12 Gy to key organs-at-risk (OARs) like submandibular glands, parotids, oral cavity, and constrictors (p < 0.05). CONCLUSIONS The IOE enables feasible daily ART treatments with reduced margins while enhancing target coverage and reducing OAR doses for HNC patients. A phase II trial recently finished accrual and forthcoming analysis will determine if these dosimetric improvements correlate with improved patient-reported outcomes.
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Affiliation(s)
- Michael Dohopolski
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Justin Visak
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Byongsu Choi
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, USA; Department of Radiation Oncology, Yonsei Cancer Center, Seoul, Republic of Korea; Medical Physics and Biomedical Engineering Lab, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Boyu Meng
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, USA
| | - David Parsons
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Xinran Zhong
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Enobong Inam
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Vladimir Avkshtol
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Dominic Moon
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, USA
| | - David Sher
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, USA.
| | - Mu-Han Lin
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, USA.
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Roers J, Rolf D, Baehr A, Pöttgen C, Stickan-Verfürth M, Siats J, Hering DA, Moustakis C, Grohmann M, Oertel M, Haverkamp U, Stuschke M, Timmermann B, Eich HT, Reinartz G. Impact of Modern Low Dose Involved Site Radiation Therapy on Normal Tissue Toxicity in Cervicothoracic Non-Hodgkin Lymphomas: A Biophysical Study. Cancers (Basel) 2023; 15:5712. [PMID: 38136257 PMCID: PMC10741516 DOI: 10.3390/cancers15245712] [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: 10/23/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
This biophysical study aimed to determine fitting parameters for the Lyman-Kutcher-Burman (LKB) dose-response model for normal tissue complication probability (NTCP) calculations of acute side effects and to investigate the impact of reduced radiation doses on the probability of their occurrence in supradiaphragmatic non-Hodgkin lymphoma (NHL) irradiation. A cohort of 114 patients with NHL in the cervicothoracic region, treated between 2015 and 2021 at the University Hospitals of Münster, Hamburg, and Essen, with involved site radiation therapy (ISRT), were included. Among them, 68 patients with aggressive NHL (a-NHL) received consolidative radiation therapy with 24-54 Gy following (R-)CHOP chemotherapy. Additionally, 46 patients with indolent NHL (i-NHL) underwent radiotherapy with 22.5-45.0 Gy. Two treatment plans were prospectively created for each patient (a-NHL: 30.0/40.0 Gy; i-NHL: 24.0/30.0 Gy). NTCP were then calculated using the optimized LKB model. The adapted dose-response models properly predicted the patient's probability of developing acute side effects when receiving doses ≤ 50 Gy. In addition, it was shown that reduced radiation doses can influence the NTCP of acute side effects depending on the aggressiveness of NHL significantly. This study provided a foundation to prospectively assess the probability of adverse side effects among today's reduced radiation doses in the treatment of NHL.
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Affiliation(s)
- Julian Roers
- Department of Radiation Oncology, University Hospital of Münster, West German Cancer Center (WTZ) Network Partner Site, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Daniel Rolf
- Department of Radiation Oncology, University Hospital of Münster, West German Cancer Center (WTZ) Network Partner Site, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Andrea Baehr
- Department of Radiation Oncology, University Hospital of Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Christoph Pöttgen
- Department of Radiation Oncology, University Hospital of Essen, West German Cancer Center (WTZ), Hufelandstraße 55, 45147 Essen, Germany
| | - Martina Stickan-Verfürth
- Department of Particle Therapy, University Hospital of Essen, West German Proton Therapy Center Essen (WPE), West German Cancer Center (WTZ), Am Mühlenbach 1, 45147 Essen, Germany
| | - Jan Siats
- Department of Radiation Oncology, University Hospital of Münster, West German Cancer Center (WTZ) Network Partner Site, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Dominik A. Hering
- Department of Radiation Oncology, University Hospital of Münster, West German Cancer Center (WTZ) Network Partner Site, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Christos Moustakis
- Department of Radiation Oncology, University Hospital of Münster, West German Cancer Center (WTZ) Network Partner Site, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
- Department of Radiation Oncology, University Hospital of Leipzig, Stephanstraße 9a, 04103 Leipzig, Germany
| | - Maximilian Grohmann
- Department of Radiation Oncology, University Hospital of Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Michael Oertel
- Department of Radiation Oncology, University Hospital of Münster, West German Cancer Center (WTZ) Network Partner Site, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Uwe Haverkamp
- Department of Radiation Oncology, University Hospital of Münster, West German Cancer Center (WTZ) Network Partner Site, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Martin Stuschke
- Department of Radiation Oncology, University Hospital of Essen, West German Cancer Center (WTZ), Hufelandstraße 55, 45147 Essen, Germany
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital of Essen, West German Proton Therapy Center Essen (WPE), West German Cancer Center (WTZ), Am Mühlenbach 1, 45147 Essen, Germany
| | - Hans T. Eich
- Department of Radiation Oncology, University Hospital of Münster, West German Cancer Center (WTZ) Network Partner Site, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Gabriele Reinartz
- Department of Radiation Oncology, University Hospital of Münster, West German Cancer Center (WTZ) Network Partner Site, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
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Lin M, Kavanaugh JA, Kim M, Cardenas CE, Rong Y. Physicists should perform reference planning for CBCT guided online adaptive radiotherapy. J Appl Clin Med Phys 2023; 24:e14163. [PMID: 37776261 PMCID: PMC10562033 DOI: 10.1002/acm2.14163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 10/02/2023] Open
Affiliation(s)
- Mu‐Han Lin
- Radiation OncologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | | | - Minsun Kim
- Radiation OncologyUniversity of WashingtonSeattleWashingtonUSA
| | - Carlos E. Cardenas
- Radiation OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Yi Rong
- RadiationOncologyMayo ClinicPhoenixArizonaUSA
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