1
|
Patrick HM, Kildea J. More than one way to skin a dose volume: the impact of dose-surface map calculation approach on study reproducibility. Phys Med Biol 2024; 69:025025. [PMID: 38168029 DOI: 10.1088/1361-6560/ad19ef] [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: 09/11/2023] [Accepted: 01/02/2024] [Indexed: 01/05/2024]
Abstract
Objective.Dose-surface maps (DSMs) provide spatial representations of the radiation dose to organ surfaces during radiotherapy and are a valuable tool for identifying dose deposition patterns that are predictive of radiation toxicities. Over the years, many different DSM calculation approaches have been introduced and used in dose-outcome studies. However, little consideration has been given to how these calculation approaches may be impacting the reproducibility of studies in the field. Therefore, we conducted an investigation to determine the level of equivalence of DSMs calculated with different approaches and their subsequent impact on study results.Approach.Rectum and bladder DSMs were calculated for 20 prostate radiotherapy patients using combinations of the most common slice orientation and spacing styles in the literature. Equivalence of differently calculated DSMs was evaluated using pixel-wise comparisons and DSM features (rectum only). Finally, mock cohort comparison studies were conducted with DSMs calculated using each approach to determine the level of dosimetric study reproducibility between calculation approaches.Main results.We found that rectum DSMs calculated using the planar and non-coplanar orientation styles were non-equivalent in the posterior rectal region and that equivalence of DSMs calculated with different slice spacing styles was conditional on the choice of inter-slice distance used. DSM features were highly sensitive to choice of slice orientation style and DSM sampling resolution. Finally, while general result trends were consistent between the comparison studies performed using different DSMs, statisitically significant subregions and features could vary greatly in position and magnitude.Significance.We have determined that DSMs calculated with different calculation approaches are frequently non-equivalent and can lead to differing conclusions between studies performed using the same dataset. We recommend that the DSM research community work to establish consensus calculation approaches to ensure reproducibility within the field.
Collapse
Affiliation(s)
- Haley M Patrick
- Medical Physics Unit, McGill University, Montreal, QC, H4A3J1, Canada
| | - John Kildea
- Medical Physics Unit, McGill University, Montreal, QC, H4A3J1, Canada
| |
Collapse
|
2
|
Chin C, Damast S. Brachytherapy impacts on sexual function: An integrative review of the literature focusing on cervical cancer. Brachytherapy 2023; 22:30-46. [PMID: 36567175 DOI: 10.1016/j.brachy.2022.10.012] [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: 08/02/2022] [Revised: 10/17/2022] [Accepted: 10/27/2022] [Indexed: 12/24/2022]
Abstract
There is growing awareness of the importance of sexual health in the quality of life of cancer patients and survivors. Brachytherapy, a vital component for the curative treatment of cervical cancer, leads to both direct and indirect sequelae that result in vaginal and sexual morbidity. The emergence of 3D image-guided adaptive brachytherapy has led to a better understanding of dose-and-effect relationships for critical organs-at-risk and there are new recommendations for vaginal dose reporting in the ongoing EMBRACE II study. An understanding of the vagina as an organ-at-risk and its dose-and-effect relationships can help brachytherapists limit dose to the vagina and improve sexual morbidity. Brachytherapists play a critical role in the primary and secondary prevention of vaginal and sexual sequelae resulting from treatment. Through close surveillance and recognition of common symptoms, brachytherapists can intervene with effective strategies to prevent and treat vaginal and sexual symptoms. This review summarizes the current literature on dosimetric factors that may predict for vaginal morbidity. It will focus on quantitative and qualitative reports of brachytherapy-related vaginal toxicity and sexual dysfunction. Lastly, it will review the available evidence supporting clinical interventions to mitigate the development and progression of vaginal and sexual sequelae to improve functional quality post-treatment.
Collapse
Affiliation(s)
- Christine Chin
- Radiation Oncology, Columbia University Irving Medical Center New York, New York, NY.
| | - Shari Damast
- Therapeutic Radiology, Yale University School of Medicine, New Haven, CT
| |
Collapse
|
3
|
Patrick HM, Kildea J. Technical note: rtdsm-An open-source software for radiotherapy dose-surface map generation and analysis. Med Phys 2022; 49:7327-7335. [PMID: 35912447 DOI: 10.1002/mp.15900] [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: 03/16/2022] [Revised: 06/07/2022] [Accepted: 07/23/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Dose-outcome studies in radiation oncology have historically excluded spatial information due to dose-volume histograms being the most dominant source of dosimetric information. In recent years, dose-surface maps (DSMs) have become increasingly popular for characterization of spatial dose distributions and identification of radiosensitive subregions for hollow organs. However, methodological variations and lack of open-source, publicly offered code-sharing between research groups have limited reproducibility and wider adoption. PURPOSE This paper presents rtdsm, an open-source software for DSM calculation with the intent to improve the reproducibility of and the access to DSM-based research in medical physics and radiation oncology. METHODS A literature review was conducted to identify essential functionalities and prevailing calculation approaches to guide development. The described software has been designed to calculate DSMs from DICOM data with a high degree of user customizability and to facilitate DSM feature analysis. Core functionalities include DSM calculation, equivalent dose conversions, common DSM feature extraction, and simple DSM accumulation. RESULTS A number of use cases were used to qualitatively and quantitatively demonstrate the use and usefulness of rtdsm. Specifically, two DSM slicing methods, planar and noncoplanar, were implemented and tested, and the effects of method choice on output DSMs were demonstrated. An example comparison of DSMs from two different treatments was used to highlight the use cases of various built-in analysis functions for equivalent dose conversion and DSM feature extraction. CONCLUSIONS We developed and implemented rtdsm as a standalone software that provides all essential functionalities required to perform a DSM-based study. It has been made freely accessible under an open-source license on Github to encourage collaboration and community use.
Collapse
Affiliation(s)
- Haley M Patrick
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada.,Cancer Research Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - John Kildea
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada.,Cancer Research Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
4
|
Dankulchai P, Harn-Utairasmee P, Prasartseree T, Nakkasae P, Trikhirhisthit K, Sithiwong W, Thephamongkhol K, Petsuksiri J, Apiwarodom N, Iampongpaiboon P, Chansilpa Y. Vaginal 11-point and volumetric dose related to late vaginal complications in patients with cervical cancer treated with external beam radiotherapy and image-guided adaptive brachytherapy. Radiother Oncol 2022; 174:77-86. [PMID: 35839936 DOI: 10.1016/j.radonc.2022.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To investigate the vaginal 11-point and volumetric dose-toxicity relationships in definitive cervical cancer radiotherapy. METHODS A retrospective cohort study of patients with cervical cancer with a complete response of at least 12 months was performed. Additional per vaginal examinations and patient-scoring questionnaires on the date of patient enrolment were assessed for vaginal strictures. Retrospective dosimetric analysis of vaginal 11-point and volumetric doses was performed with descriptive and probit analyses to investigate dose-toxicity relationships. RESULTS Ninety-seven patients were included in the study, with a 20-month median follow-up. The incidence rate of grade 3 vaginal strictures was 22.7%. A comparison between patients with grade 1-3 vaginal strictures revealed significant differences in age, stage, initial tumour size, and vaginal involvement. PIBS + 2, PIBS, PIBS-2, D + 5, and D2cc were all significantly different among grade 1-3 vaginal strictures and showed significant probit coefficients. The lateral dose points were significantly higher in grade 2 strictures, but negative probit coefficients failed to establish causal inferences. Post-estimation analyses yielded effective doses (ED) for 15% and 20% probability of grade 3 vaginal strictures (ED15 and ED20) for PIBS + 2 at 57.4 and 111 Gy3, respectively. PIBS-2 yielded an ED20 of 7 Gy3. D + 5 yielded positive ED10, ED15, and ED20 values of 52.2, 66.6, and 78 Gy3, respectively. CONCLUSIONS This study showed a significant relationship between age, tumour size, and lower-third vaginal involvement with the incidence of vaginal toxicity. The goal of a cumulative radiotherapy dose of ≤ 55 Gy3 to PIBS + 2, ≤5 Gy3 to PIBS-2, and ≤ 65 Gy3 to D + 5 points may reduce the risk of grade 3 vaginal stenosis to less than 15-20%.
Collapse
Affiliation(s)
- Pittaya Dankulchai
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.
| | | | - Tissana Prasartseree
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
| | - Pitchayut Nakkasae
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
| | - Kyrhatii Trikhirhisthit
- Division of Radiation Oncology, Department of Radiology, Sawanpracharak Hospital, Nakhon Sawan, Thailand
| | - Wiwatchai Sithiwong
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
| | - Kullathorn Thephamongkhol
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
| | - Janjira Petsuksiri
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
| | - Nantakan Apiwarodom
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
| | - Porntip Iampongpaiboon
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
| | - Yaowalak Chansilpa
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
| |
Collapse
|
5
|
Dose-effect relationship between vaginal dose points and vaginal stenosis in cervical cancer: an EMBRACE-I sub-study. Radiother Oncol 2022; 168:8-15. [DOI: 10.1016/j.radonc.2021.12.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/22/2022]
|
6
|
Serban M, Fokdal L, Nielsen SK, Hokland SB, Hansen AT, Spejlborg H, Rylander S, Petric P, Lindegaard JC, Tanderup K. Characterization of combined intracavitary/interstitial brachytherapy including oblique needles in locally advanced cervix cancer. Brachytherapy 2021; 20:796-806. [PMID: 33994344 DOI: 10.1016/j.brachy.2021.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE To characterize and report on dosimetric outcomes of image guided adaptive brachytherapy (IGABT) using intracavitary and interstitial (IC/IS) applicators including oblique needles (O-needles) in locally advanced cervical cancer (LACC). METHODS AND MATERIALS Twenty LACC patients treated with radio-chemotherapy and offered IC/IS-IGABT including O-needles were analyzed. An in-house 3D-printed vaginal template was used to steer the needles parallel and obliquely in relation to the tandem, supplemented with free-hand needles if needed. Implant characteristics and loading patterns were analyzed. Using the equivalent dose in 2Gy-fractions (EQD2) concept, cumulative (EBRT+BT) V85, V75, V60Gy, targets/OARs doses and high dose volumes (150%, 200% and 300% (100% = 85 Gy EQD210)) were evaluated. RESULTS Median(range) tumor width at diagnosis was 5.5(3.6; 7.5)cm; CTVHR volume was 45(23; 136)cm3 with maximum distance from tandem to CTVHR border of 3.4(2.5; 4.8)cm. T-stage distribution was IIB/III/IVA in 6(30%)/9(45%)/5(25%) of patients. At BT, 13(65%) patients had distal parametrial/pelvic wall infiltration. Median(range) number of needles per patient was 11(8-18). Average distribution of intrauterine, vaginal and interstitial dwell times were 31%, 25% and 44%, respectively. Median(range) dwell-time per dwell position was 11(2-127)% of average point-A based standard loading. Median V85Gy/V150%/V200%/V300% were 85(38; 171)/41(21; 93)/22(12; 41)/7(4; 19) cm3; CTVHR D90% was 93(83; 97)Gy EQD210; bladder/rectum/sigmoid/bowel D2cm3 were 78(64; 104)/65(52; 76)/59(53; 69)/61(47; 76)Gy EQD23. CONCLUSIONS The use of O-needles in patients with large and/or unfavorable tumors resulted in excellent target coverage and OARs sparing. Intrauterine and vaginal loadings were reduced compared to standard loading and almost half of the loading was shifted into IS needles. This was achieved with gentle loading in the majority of dwell positions.
Collapse
Affiliation(s)
- Monica Serban
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Medical Physics, McGill University Health Centre, Montreal, Canada.
| | - Lars Fokdal
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Harald Spejlborg
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Susanne Rylander
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Primoz Petric
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Radiation Oncology, University Hospital Zürich, Switzerland
| | | | - Kari Tanderup
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
7
|
Tanderup K, Nesvacil N, Kirchheiner K, Serban M, Spampinato S, Jensen NBK, Schmid M, Smet S, Westerveld H, Ecker S, Mahantshetty U, Swamidas J, Chopra S, Nout R, Tan LT, Fokdal L, Sturdza A, Jürgenliemk-Schulz I, de Leeuw A, Lindegaard JC, Kirisits C, Pötter R. Evidence-Based Dose Planning Aims and Dose Prescription in Image-Guided Brachytherapy Combined With Radiochemotherapy in Locally Advanced Cervical Cancer. Semin Radiat Oncol 2020; 30:311-327. [DOI: 10.1016/j.semradonc.2020.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|