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Chow JCL, Ruda HE. Mechanisms of Action in FLASH Radiotherapy: A Comprehensive Review of Physicochemical and Biological Processes on Cancerous and Normal Cells. Cells 2024; 13:835. [PMID: 38786057 PMCID: PMC11120005 DOI: 10.3390/cells13100835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
The advent of FLASH radiotherapy (FLASH-RT) has brought forth a paradigm shift in cancer treatment, showcasing remarkable normal cell sparing effects with ultra-high dose rates (>40 Gy/s). This review delves into the multifaceted mechanisms underpinning the efficacy of FLASH effect, examining both physicochemical and biological hypotheses in cell biophysics. The physicochemical process encompasses oxygen depletion, reactive oxygen species, and free radical recombination. In parallel, the biological process explores the FLASH effect on the immune system and on blood vessels in treatment sites such as the brain, lung, gastrointestinal tract, skin, and subcutaneous tissue. This review investigated the selective targeting of cancer cells and the modulation of the tumor microenvironment through FLASH-RT. Examining these mechanisms, we explore the implications and challenges of integrating FLASH-RT into cancer treatment. The potential to spare normal cells, boost the immune response, and modify the tumor vasculature offers new therapeutic strategies. Despite progress in understanding FLASH-RT, this review highlights knowledge gaps, emphasizing the need for further research to optimize its clinical applications. The synthesis of physicochemical and biological insights serves as a comprehensive resource for cell biology, molecular biology, and biophysics researchers and clinicians navigating the evolution of FLASH-RT in cancer therapy.
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Affiliation(s)
- James C. L. Chow
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1X6, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Harry E. Ruda
- Centre of Advance Nanotechnology, Faculty of Applied Science and Engineering, University of Toronto, Toronto, ON M5S 3E4, Canada;
- Department of Materials Science and Engineering, University of Toronto, Toronto, ON M5S 3E4, Canada
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Bouassaly J, Karimi N, Kowalski LP, Sultanem K, Alaoui-Jamali M, Mlynarek A, Mascarella M, Hier M, Sadeghi N, da Silva SD. Rethinking treatment paradigms: Neoadjuvant therapy and de-escalation strategies in HPV-positive head and neck cancer. Crit Rev Oncol Hematol 2024; 196:104326. [PMID: 38479584 DOI: 10.1016/j.critrevonc.2024.104326] [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: 10/04/2023] [Revised: 02/27/2024] [Accepted: 03/07/2024] [Indexed: 03/24/2024] Open
Abstract
Head and neck cancer (HNC) is the 6th most common cancer across the world, with a particular increase in HNC associated with human papilloma virus (HPV) among younger populations. Historically, the standard treatment for this disease consisted of combined surgery and radiotherapy or curative platinum-based concurrent chemoradiotherapy, with associated long term and late toxicities. However, HPV-positive HNC is recognized as a unique cancer subtype, typically with improved clinical outcomes. As such, treatment de-escalation strategies have been widely researched to mitigate the adverse effects associated with the current standard of care without compromising efficacy. These strategies include treatment de-escalation, such as novel surgical techniques, alternative radiation technologies, radiation dose and volume reduction, as well as neoadjuvant chemotherapies, immunotherapies, and combined therapies. Although these therapies show great promise, many of them are still under investigation due to hesitation surrounding their widespread implementation. The objective of this review is to summarize the most recent progress in de-escalation strategies and neoadjuvant therapies designed for HPV-positive HNC. While specific treatments may require additional research before being widely adopted, encouraging results from recent studies have highlighted the advantages of neoadjuvant chemotherapy and immunotherapy, as well as radiation and surgical de-escalation approaches in managing HPV-positive HNC.
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Affiliation(s)
- Jenna Bouassaly
- Division of Experimental Medicine, McGill University, Montreal QC H4A 3J1, Canada; Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Montreal QC H3T 1E2, Canada
| | - Naser Karimi
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal QC H3T 1E2, Canada
| | - Luiz Paulo Kowalski
- AC Camargo Cancer Center, Faculty of Medicine - University of Sao Paulo, Sao Paulo, Brazil
| | - Khalil Sultanem
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal QC H3T 1E2, Canada
| | - Moulay Alaoui-Jamali
- Division of Experimental Medicine, McGill University, Montreal QC H4A 3J1, Canada; Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Montreal QC H3T 1E2, Canada
| | - Alex Mlynarek
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal QC H3T 1E2, Canada
| | - Marco Mascarella
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal QC H3T 1E2, Canada
| | - Michael Hier
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal QC H3T 1E2, Canada
| | - Nader Sadeghi
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal QC H3T 1E2, Canada
| | - Sabrina Daniela da Silva
- Division of Experimental Medicine, McGill University, Montreal QC H4A 3J1, Canada; Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal QC H3T 1E2, Canada; Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Montreal QC H3T 1E2, Canada; AC Camargo Cancer Center, Faculty of Medicine - University of Sao Paulo, Sao Paulo, Brazil.
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Hande V, Ranjan N, Chopra S, Sinha S, Mittal P, Gupta A, Maheshwari A, Gupta S. Longitudinal Costs of Image-Guided Intensity-Modulated Radiation Therapy Versus Three-Dimensional Conformal Radiation: Lessons From Phase III PARCER Trial for Shaping Resource-Stratified Guidelines in Low- and Middle-Income Countries. JCO Glob Oncol 2024; 10:e2300478. [PMID: 38484193 PMCID: PMC10954061 DOI: 10.1200/go.23.00478] [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: 12/19/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 03/19/2024] Open
Abstract
PURPOSE The PARCER trial provided level I evidence for image-guided intensity-modulated radiation therapy (IG-IMRT) in patients with cervical cancer. Further information regarding long-term financial impact is imperative for adoption into the National Cancer Grid of India cervical cancer resource-stratified guidelines. METHODS Patient data from the PARCER trial were analyzed to evaluate the cost implications of transitioning to IG-IMRT. Lacking differences in outcomes between the three-dimensional conformal radiation (3D-CRT) and IG-IMRT, differences in treatment costs, adverse event incidence, and toxicity management costs were examined. The overall financial impact was estimated by adding the treatment costs, toxicity management, and wage loss. This was extrapolated nationally to determine if a transition to IG-IMRT would be feasible for the Indian health care system. RESULTS Of the 300 patients in the PARCER trial, 93 faced grades ≥2 adverse events (3D-CRT = 59, IG-IMRT = 34). Patients in the 3D-CRT and IG-IMRT arms spent an average of 2.39 years and 1.96 years in toxicity, respectively. The average toxicity management and the yearly financial impact per patient were, respectively, 1.50 and 1.44 times higher for 3D-CRT patients compared with IG-IMRT patients. Extrapolation to the national level showed that treatment with 3D-CRT led to a 2.88 times higher cost ratio when compared with treatment with IG-IMRT. CONCLUSION Although the initial costs of IG-IMRT are high, on the basis of longitudinal data, it is financially inefficient to treat with 3D-CRT. Resource-stratified guidelines should include longitudinal health intervention costs rather than solely initial costs for policy decisions to implement advanced radiation technology.
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Affiliation(s)
- Varsha Hande
- Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Nilesh Ranjan
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Supriya Chopra
- Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Shwetabh Sinha
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Prachi Mittal
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Ankita Gupta
- Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Amita Maheshwari
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sudeep Gupta
- Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
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Ghafour H, Ali JS, Taher Ali R, Sirelkhatim E. A Comparison of Field-in-Field and Intensity Modulated Radiation Therapy in Delivering Hypofractionated Radiation Therapy for Prostate Cancer. Adv Radiat Oncol 2024; 9:101356. [PMID: 38405309 PMCID: PMC10885577 DOI: 10.1016/j.adro.2023.101356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/07/2023] [Indexed: 02/27/2024] Open
Abstract
Purpose This study compares the dosimetric performance of the field-in-field (FIF) technique with intensity modulated radiation therapy (IMRT) for delivering hypofractionated radiation therapy to prostate patients with cancer. The FIF technique uses 6 beams, whereas IMRT uses 9 beams. Methods and Materials This study was conducted on 15 patients with prostate cancer treated with step-and-shoot IMRT. The prescribed dose was 60 Gy in 20 fractions. The FIF plans contained 6 photon beams, and IMRT plans were designed using a 9-field step-and-shoot technique. Dose-volume histograms and dose distributions were evaluated to compare FIF and IMRT. Results The results of the planning target volume indices analysis showed a significant difference in the maximum dose, dose to 2% of volume, and homogeneity index in favor of FIF and in the mean dose, dose to 98% of volume, and D95 in favor of IMRT. The results of the organs-at-risk analysis showed significant differences in the volume of the rectum and bladder receiving 60 Gy in favor of FIF and the volume of the rectum and femoral heads receiving 30 Gy, as well as the mean dose to the rectum, in favor of IMRT. IMRT had a higher median number of monitor units (MUs) and segments (886 MU, 64 segments) compared to FIF (434 MUs, 6 segments). Conclusions The FIF technique and IMRT had comparable results in delivering hypofractionated radiation therapy for prostate cancer. The findings of this study may aid in decision-making for patients undergoing treatment.
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Mishra A, Pathak R, Mittal KK, Srivastava AK, Dayashankar MS, Mishra SP, Singh SK. Efficacy of the collapsed cone algorithm calculated radiotherapy plans in intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT): A comparative dosimetric study in tumors of thorax. J Cancer Res Ther 2024; 20:383-388. [PMID: 38554350 DOI: 10.4103/jcrt.jcrt_2171_22] [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: 10/17/2022] [Accepted: 12/08/2022] [Indexed: 04/01/2024]
Abstract
AIM In this study, efficacy of collapsed cone algorithm-generated intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) were evaluated for treatment of thoracic esophageal cancer. MATERIALS AND METHODS Ten previously treated patients with VMAT were considered for evaluation. The planning parameters were evaluated in terms of max dose, mean dose, Homogeneity Index, Conformity Index for planning target volume, and organ at risk doses. Total monitor unit, treatment time, and gamma passing index were also reported. RESULTS The target dose coverage of the VMAT and IMRT plans achieved the clinical dosimetric criteria for all ten patients in the evaluation. Under the condition of equivalent target dose distribution, the VMAT plan's Conformity Index, monitor unit, treatment time, and gamma passing index rate were superior than in the IMRT plan, and the result was statistically significant. CONCLUSION Collapsed cone algorithm-based VMAT can have a more effective and better approach for esophageal cancer than IMRT.
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Affiliation(s)
- Atul Mishra
- Department of Physics, Tilak Dhari P. G. College, Jaunpur, Uttar Pradesh, India
- Veer Bahadur Singh Purvanchal University, Jaunpur, Uttar Pradesh, India
- Department of Radiation Oncology, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
| | - Ramji Pathak
- Department of Physics, Tilak Dhari P. G. College, Jaunpur, Uttar Pradesh, India
- Veer Bahadur Singh Purvanchal University, Jaunpur, Uttar Pradesh, India
- Department of Physics, D.A.V. Degree College, Lucknow, Uttar Pradesh, India
| | - Kailash Kumar Mittal
- Department of Radiation Oncology, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
| | - Anoop Kumar Srivastava
- Department of Radiation Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Maurya Surendrakumar Dayashankar
- Department of Applied Physics, Amity University Gwalior, Madhya Pradesh, India
- Department of Radiation Oncology, Shalby Hospitals Indore, Madhya Pradesh, India
| | - Surendra Prasad Mishra
- Department of Radiation Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sudesh Kumar Singh
- Department of Physics, Tilak Dhari P. G. College, Jaunpur, Uttar Pradesh, India
- Veer Bahadur Singh Purvanchal University, Jaunpur, Uttar Pradesh, India
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Zhong J, Kobus M, Maitre P, Datta A, Eccles C, Dubec M, McHugh D, Buckley D, Scarsbrook A, Hoskin P, Henry A, Choudhury A. MRI-guided Pelvic Radiation Therapy: A Primer for Radiologists. Radiographics 2023; 43:e230052. [PMID: 37796729 DOI: 10.1148/rg.230052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Radiation therapy (RT) is a core pillar of oncologic treatment, and half of all patients with cancer receive this therapy as a curative or palliative treatment. The recent integration of MRI into the RT workflow has led to the advent of MRI-guided RT (MRIgRT). Using MRI rather than CT has clear advantages for guiding RT to pelvic tumors, including superior soft-tissue contrast, improved organ motion visualization, and the potential to image tumor phenotypic characteristics to identify the most aggressive or treatment-resistant areas, which can be targeted with a more focal higher radiation dose. Radiologists should be familiar with the potential uses of MRI in planning pelvic RT; the various RT techniques used, such as brachytherapy and external beam RT; and the impact of MRIgRT on treatment paradigms. Current clinical experience with and the evidence base for MRIgRT in the settings of prostate, cervical, and bladder cancer are discussed, and examples of treated cases are illustrated. In addition, the benefits of MRIgRT, such as real-time online adaptation of RT (during treatment) and interfraction and/or intrafraction adaptation to organ motion, as well as how MRIgRT can decrease toxic effects and improve oncologic outcomes, are highlighted. MRIgRT is particularly beneficial for treating mobile pelvic structures, and real-time adaptive RT for tumors can be achieved by using advanced MRI-guided linear accelerator systems to spare organs at risk. Future opportunities for development of biologically driven adapted RT with use of functional MRI sequences and radiogenomic approaches also are outlined. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Jim Zhong
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Marta Kobus
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Priyamvada Maitre
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Anubhav Datta
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Cynthia Eccles
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Michael Dubec
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Damien McHugh
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - David Buckley
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Andrew Scarsbrook
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Peter Hoskin
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Ann Henry
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Ananya Choudhury
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
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Jang WI, Jo S, Moon JE, Bae SH, Park HC. The Current Evidence of Intensity-Modulated Radiotherapy for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:4914. [PMID: 37894281 PMCID: PMC10605127 DOI: 10.3390/cancers15204914] [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: 08/22/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
Intensity-modulated radiotherapy (IMRT), an advanced RT technique, is a considerable treatment option for hepatocellular carcinoma (HCC). However, the distinguishing features of IMRT for HCC have not yet been clearly defined. A systematic review was performed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The PubMed/MedLine, Embase, Cochrane Library, Web of Science, and KoreaMed were used to screen eligible studies focusing on treatment outcomes after IMRT for HCC until 18 April 2023. A total of 1755 HCC patients receiving IMRT among 29 studies from 2009 to 2023 were selected for the meta-analysis. The median proportion of Barcelona Clinic Liver Cancer stage C was 100% (range: 38-100%). Nineteen studies used combined treatment. Pooled rates of response and 1-year local control were 58% (95% confidence interval [CI], 50-65%) and 84% (95% CI, 70-94%), respectively. The median overall survival (OS) was 13 months (range: 5-45 months), and pooled 1- and 3-year OS rates were 59% (95% CI, 52-66%), and 23% (95% CI, 14-33%), respectively. Pooled rates of classic radiation-induced liver disease (RILD), nonclassic RILD, and hepatic toxicity ≥ grade 3 were 2%, 4%, and 4%, respectively. Although most patients had advanced-stage HCC and combined treatment was commonly used, IMRT for HCC showed similar survival to existing RT modalities and relatively low severe toxicity.
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Affiliation(s)
- Won Il Jang
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, 75, Nowon-ro, Nowon-gu, Seoul 01812, Republic of Korea;
| | - Sunmi Jo
- Department of Radiation Oncology, Haeundae Paik Hospital, Inje University School of Medicine, 875, Haeun-daero, Haeundae-gu, Busan 48108, Republic of Korea;
| | - Ji Eun Moon
- Department of Biostatistics, Soonchunhyang University College of Medicine, Bucheon, 170 Jomaru-ro, Wongmi-gu, Bucheon-si 14584, Gyeonggi-do, Republic of Korea;
| | - Sun Hyun Bae
- Department of Radiation Oncology, Soonchunhyang University College of Medicine, Bucheon, 170 Jomaru-ro, Wongmi-gu, Bucheon-si 14584, Gyeonggi-do, Republic of Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
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Murphy DJ, Mayoral M, Larici AR, Ginsberg MS, Cicchetti G, Fintelmann FJ, Marom EM, Truong MT, Gill RR. Imaging Follow-Up of Nonsurgical Therapies for Lung Cancer: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 221:409-424. [PMID: 37095669 PMCID: PMC11037936 DOI: 10.2214/ajr.23.29104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Lung cancer continues to be the most common cause of cancer-related death worldwide. In the past decade, with the implementation of lung cancer screening programs and advances in surgical and nonsurgical therapies, the survival of patients with lung cancer has increased, as has the number of imaging studies that these patients undergo. However, most patients with lung cancer do not undergo surgical re-section, because they have comorbid disease or lung cancer in an advanced stage at diagnosis. Nonsurgical therapies have continued to evolve with a growing range of systemic and targeted therapies, and there has been an associated evolution in the imaging findings encountered at follow-up examinations after such therapies (e.g., with respect to posttreatment changes, treatment complications, and recurrent tumor). This AJR Expert Panel Narrative Review describes the current status of nonsurgical therapies for lung cancer and their expected and unexpected imaging manifestations. The goal is to provide guidance to radiologists regarding imaging assessment after such therapies, focusing mainly on non-small cell lung cancer. Covered therapies include systemic therapy (conventional chemotherapy, targeted therapy, and immunotherapy), radiotherapy, and thermal ablation.
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Affiliation(s)
- David J. Murphy
- Department of Radiology, St Vincent’s University Hospital and University College Dublin, Dublin, Ireland
| | - Maria Mayoral
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
- Medical Imaging Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Anna R. Larici
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Giuseppe Cicchetti
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Florian J. Fintelmann
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Edith M. Marom
- Chaim Sheba Medical Center, Ramat Gan, and Tel Aviv University, Tel Aviv, Israel
| | - Mylene T. Truong
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ritu R. Gill
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02115. Address correspondence to R. R. Gill ()
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Igari M, Abe T, Iino M, Saito S, Aoshika T, Ryuno Y, Ohta T, Hirai R, Kumazaki Y, Noda S, Kato S. Learning curve of lung dose optimization in intensity-modulated radiotherapy for locally advanced non-small cell lung cancer. Thorac Cancer 2023; 14:2642-2647. [PMID: 37466172 PMCID: PMC10493474 DOI: 10.1111/1759-7714.15046] [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: 06/26/2023] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Intensity-modulated radiotherapy (IMRT) has been increasingly used for patients with locally advanced non-small cell lung cancer (LA-NSCLC). However, there are some barriers to implementing IMRT for LA-NSCLC, including the complexity of treatment plan optimization. This study aimed to evaluate the learning curve of lung dose optimization in IMRT for LA-NSCLC and identify the factors that affect the degree of achievement of lung dose optimization. METHODS We retrospectively evaluated 40 consecutive patients with LA-NSCLC who received concurrent chemoradiotherapy at our institution. These 40 patients were divided into two groups: 20 initially treated patients (earlier group) and 20 subsequently treated patients (later group). Patient and tumor characteristics were compared between the two groups. The dose-volume parameter ratio between the actually delivered IMRT plan and the simulated three-dimensional conformal radiotherapy plan was also compared between the two groups to determine the learning curve of lung dose optimization. RESULTS The dose-volume parameter ratio for lung volume to receive more than 5 Gy (lung V5) and mean lung dose (MLD) significantly decreased in later groups. The spread of the beam path and insufficient optimization of dose coverage of planning target volume (PTV) might cause poor control of lung V5, MLD. CONCLUSIONS A learning curve for lung dose optimization was observed with the accumulation of experience. Appropriate techniques, such as restricting the beam path and ensuring dose coverage of PTV during the optimization process, are essential to control lung dose in IMRT for LA-NSCLC.
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Affiliation(s)
- Mitsunobu Igari
- Department of Radiation Oncology, International Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Takanori Abe
- Department of Radiation Oncology, International Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Misaki Iino
- Department of Radiation Oncology, International Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Satoshi Saito
- Department of Radiation Oncology, International Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Tomomi Aoshika
- Department of Radiation Oncology, International Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Yasuhiro Ryuno
- Department of Radiation Oncology, International Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Tomohiro Ohta
- Department of Radiation Oncology, International Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Ryuta Hirai
- Department of Radiation Oncology, International Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Yu Kumazaki
- Department of Radiation Oncology, International Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Shin‐ei Noda
- Department of Radiation Oncology, International Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Shingo Kato
- Department of Radiation Oncology, International Medical CenterSaitama Medical UniversitySaitamaJapan
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10
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Kawahara D, Nagata Y. Biological dosimetric impact of dose-delivery time for hypoxic tumour with modified microdosimetric kinetic model. Rep Pract Oncol Radiother 2023; 28:514-521. [PMID: 37795224 PMCID: PMC10547428 DOI: 10.5603/rpor.a2023.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/03/2023] [Indexed: 10/06/2023] Open
Abstract
Background An improved microdosimetric kinetic model (MKM) can address radiobiological effects with prolonged delivery times. However, these do not consider the effects of oxygen. The current study aimed to evaluate the biological dosimetric effects associated with the dose delivery time in hypoxic tumours with improved MKM for photon radiation therapy. Materials and methods Cell survival was measured under anoxic, hypoxic, and oxic conditions using the Monte Carlo code PHITS. The effect of the dose rate of 0.5-24 Gy/min for the biological dose (Dbio) was estimated using the microdosimetric kinetic model. The dose per fraction and pressure of O2 (pO2) in the tumour varied from 2 to 20 Gy and from 0.01 to 5.0% pO2, respectively. Results The ratio of the Dbio at 1.0-24 Gy/min to that at 0.5 Gy/min (RDR) was higher at higher doses. The maximum RDR was 1.09 at 1.0 Gy/min, 1.12 at 12 Gy/min, and 1.13 at 24 Gy/min. The ratio of the Dbio at 0.01-2.0% of pO2 to that at 5.0% of pO2 (Roxy) was within 0.1 for 2-20 Gy of physical dose. The maximum Roxy was 0.42 at 0.01% pO2, 0.76 at 0.4% pO2, 0.89 at 1% pO2, and 0.96 at 2% pO2. Conclusion Our proposed model can estimate the cell killing and biological dose under hypoxia in a clinical and realistic patient. A shorter dose-delivery time with a higher oxygen distribution increased the radiobiological effect. It was more effective at higher doses per fraction than at lower doses.
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Affiliation(s)
- Daisuke Kawahara
- Department of Radiation Oncology, Institute of Biomedical & Health Science, Hiroshima University, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Institute of Biomedical & Health Science, Hiroshima University, Japan
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11
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Beck L, Ballisat L, Fletcher S, Velthuis J. Suitability of Athena Monolithic Active Pixel Sensor for upstream monitoring of 6 MV, 6 FFF and 10 MV treatments. Appl Radiat Isot 2023; 198:110799. [PMID: 37201362 DOI: 10.1016/j.apradiso.2023.110799] [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: 02/09/2022] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 05/20/2023]
Abstract
We are developing a thin, real-time radiotherapy verification sensor based on the Athena, a large-scale MAPS. The goal in radiotherapy verification is to measure the multileaf collimator positions and beam intensity to ensure the accuracy and safety of treatment delivery. Previously, results on this have been published. In this paper, we present results that clearly demonstrate that the Athena does not saturate, even at the highest beam intensities in a 6 FFF 10 × 10 cm2 field and thus is suitable for clinical deployment.
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Affiliation(s)
- Lana Beck
- University of Bristol, H.H. Wills Physics Laboratory, Tyndall Avenue, BS8 1TL, Bristol, United Kingdom.
| | - Laura Ballisat
- University of Bristol, H.H. Wills Physics Laboratory, Tyndall Avenue, BS8 1TL, Bristol, United Kingdom
| | - Sally Fletcher
- United Hospitals Bristol NHS Foundation Trust (UHB), at the Department of Medical Physics & Bioengineering at Bristol Haematology and Oncology Centre, Horfield Road, Bristol, United Kingdom
| | - Jaap Velthuis
- University of Bristol, H.H. Wills Physics Laboratory, Tyndall Avenue, BS8 1TL, Bristol, United Kingdom; Swansea University Medical School, Singleton Park, Swansea, United Kingdom; University of South China, School of Nuclear Science and Technology, West Changsheng Rd, Hengyang 421001, China
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12
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Velthuis J, Li Y, Pritchard J, De Sio C, Beck L, Hugtenburg R. Performance of a Full-Scale Upstream MAPS-Based Verification Device for Radiotherapy. SENSORS (BASEL, SWITZERLAND) 2023; 23:1799. [PMID: 36850398 PMCID: PMC9960806 DOI: 10.3390/s23041799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 06/18/2023]
Abstract
Intensity-modulated radiotherapy is a widely used technique for accurately targeting cancerous tumours in difficult locations using dynamically shaped beams. This is ideally accompanied by real-time independent verification. Monolithic active pixel sensors are a viable candidate for providing upstream beam monitoring during treatment. We have already demonstrated that a Monolithic Active Pixel Sensor (MAPS)-based system can fulfill all clinical requirements except for the minimum required size. Here, we report the performance of a large-scale demonstrator system consisting of a matrix of 2 × 2 sensors, which is large enough to cover almost all radiotherapy treatment fields when affixed to the shadow tray of the LINAC head. When building a matrix structure, a small dead area is inevitable. Here, we report that with a newly developed position algorithm, leaf positions can be reconstructed over the entire range with a position resolution of below ∼200 μm in the centre of the sensor, which worsens to just below 300 μm in the middle of the gap between two sensors. A leaf position resolution below 300 μm results in a dose error below 2%, which is good enough for clinical deployment.
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Affiliation(s)
- Jaap Velthuis
- School of Physics, University of Bristol, Bristol BS7 1TL, UK
- Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea SA2 8PP, UK
- School of Nuclear Science and Technology, University of South China, Hengyang 421001, China
| | - Yutong Li
- School of Physics, University of Bristol, Bristol BS7 1TL, UK
| | | | - Chiara De Sio
- School of Physics, University of Bristol, Bristol BS7 1TL, UK
| | - Lana Beck
- School of Physics, University of Bristol, Bristol BS7 1TL, UK
| | - Richard Hugtenburg
- School of Physics, University of Bristol, Bristol BS7 1TL, UK
- Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea SA2 8PP, UK
- Department of Medical Physics and Clinical Engineering, Swansea Bay University Health Board, Swansea SA2 4QA, UK
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13
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Guo XQ, Mao RH, Liu B, Ge H. Study on esophageal cancer radiotherapy dosimetry and position verification for volumetric modulated arc therapy. Asian J Surg 2023; 46:120-125. [PMID: 35221195 DOI: 10.1016/j.asjsur.2022.02.001] [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: 07/22/2021] [Revised: 10/07/2021] [Accepted: 02/11/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND This study analyzed the respective advantages and disadvantages by comparing volumetric modulated arc therapy (VMAT) and intensity modulated radiotherapy (IMRT) on the dose distribution and position verification distribution characteristics in esophageal cancer radiotherapy, in order to provide the reference for the clinical radiotherapy technology optimization of esophageal cancer. METHODS A total of 56 cases of patients with esophageal cancer were selected and applied to the Pinnacle three-dimensional radiation treatment planning system (TPS), in order to design a VMAT plan and IMRT plan under the guidance of image-guided radiotherapy (IGRT). The dosimetry and position verification difference were compared between the two groups. RESULTS Revealed that the target dose distribution of the VMAT plan and IMRT plan meets the requirements in clinical dosimetry for all 56 patients in this study. Under the premise of similar target coverage, the conformal index (CI) of the VMAT plan, homogeneity index (HI), target volume, BODY-PTV radiated volume and spinal cord Dmax, bilateral lung V5, V20 and mean lung dose (MLD), monitor unit (MU) and treatment time (TT), as well as position verification and others, were obviously superior to those in the IMRT plan; and the difference was statistically significant. CONCLUSION CBCT guided VMAT is a potential effective treatment for esophageal cancer and may be more effective and safer than IMRT.
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Affiliation(s)
- Xiao-Qi Guo
- Department of Radiotherapy, The Tumor Hospital Affiliated to Zhengzhou University, Zhengzhou, 476000, China
| | - Rong-Hu Mao
- Department of Radiotherapy, The Tumor Hospital Affiliated to Zhengzhou University, Zhengzhou, 476000, China
| | - Bing Liu
- Department of Radiotherapy, The Tumor Hospital Affiliated to Zhengzhou University, Zhengzhou, 476000, China
| | - Hong Ge
- Department of Radiotherapy, The Tumor Hospital Affiliated to Zhengzhou University, Zhengzhou, 476000, China.
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14
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Abe T, Iino M, Saito S, Aoshika T, Ryuno Y, Ohta T, Igari M, Hirai R, Kumazaki Y, Miura Y, Kaira K, Kagamu H, Noda S, Kato S. Simple method for evaluating achievement degree of lung dose optimization in individual patients with locally advanced non-small cell lung cancer treated with intensity modulated radiotherapy. Thorac Cancer 2022; 13:2890-2896. [PMID: 36054298 PMCID: PMC9575059 DOI: 10.1111/1759-7714.14634] [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: 08/04/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022] Open
Abstract
Background In this study, we developed a simple method for evaluating achievement degree of lung dose optimization in individual patients with locally advanced non‐small cell lung cancer (NSCLC) treated with intensity modulated radiotherapy (IMRT). Methods Data of 28 patients with stage IIB to IIIC NSCLC were retrospectively analyzed. All patients were treated with IMRT and a simulated three‐dimensional conformal radiotherapy (3D‐CRT) plan created for them. Dose‐volume parameters of lung were analyzed for their correlation with radiation pneumonitis (RP). Results Over a median follow‐up of 14 months, grade 1 pneumonitis was diagnosed in 14 patients (50%), grade 2 pneumonitis in 11 (39%), and grade 3 pneumonitis in one (4%). Two patients did not develop pneumonitis. None of the patients developed grade 4 or 5 pneumonitis. Regarding dose‐volume parameter ratios between IMRT and simulated 3D‐CRT, receiver operating characteristic analysis showed that mean lung dose (MLD)IMRT/MLD3D‐CRT had the largest area under curve (0.750). Cumulative 6‐month incidences of grade 2 or greater RP were 78.4% versus 19.5% (MLDIMRT/MLD3D‐CRT, ≥1.0 or less); this difference was significant (p < 0.05). Conclusions We found that cutoff values for dose volume parameter ratios significantly predict grade 2 or greater RP. We believe that these parameter ratios could be useful in assisting evaluation of achievement degree of lung dose optimization in IMRT for LA‐NSCLC.
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Affiliation(s)
- Takanori Abe
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Misaki Iino
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Satoshi Saito
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Tomomi Aoshika
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Yasuhiro Ryuno
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Tomohiro Ohta
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Mitsunobu Igari
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Ryuta Hirai
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Yu Kumazaki
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Yu Miura
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Shinei Noda
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Shingo Kato
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
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15
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Artificial Intelligence in Radiotherapy and Patient Care. Artif Intell Med 2022. [DOI: 10.1007/978-3-030-64573-1_143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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16
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Zhao W, Shen L, Islam MT, Qin W, Zhang Z, Liang X, Zhang G, Xu S, Li X. Artificial intelligence in image-guided radiotherapy: a review of treatment target localization. Quant Imaging Med Surg 2021; 11:4881-4894. [PMID: 34888196 PMCID: PMC8611462 DOI: 10.21037/qims-21-199] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 07/05/2021] [Indexed: 01/06/2023]
Abstract
Modern conformal beam delivery techniques require image-guidance to ensure the prescribed dose to be delivered as planned. Recent advances in artificial intelligence (AI) have greatly augmented our ability to accurately localize the treatment target while sparing the normal tissues. In this paper, we review the applications of AI-based algorithms in image-guided radiotherapy (IGRT), and discuss the indications of these applications to the future of clinical practice of radiotherapy. The benefits, limitations and some important trends in research and development of the AI-based IGRT techniques are also discussed. AI-based IGRT techniques have the potential to monitor tumor motion, reduce treatment uncertainty and improve treatment precision. Particularly, these techniques also allow more healthy tissue to be spared while keeping tumor coverage the same or even better.
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Affiliation(s)
- Wei Zhao
- School of Physics, Beihang University, Beijing, China
| | - Liyue Shen
- Department of Radiation Oncology, Stanford University, Stanford, USA
| | - Md Tauhidul Islam
- Department of Radiation Oncology, Stanford University, Stanford, USA
| | - Wenjian Qin
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Zhicheng Zhang
- Department of Radiation Oncology, Stanford University, Stanford, USA
| | - Xiaokun Liang
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Gaolong Zhang
- School of Physics, Beihang University, Beijing, China
| | - Shouping Xu
- Department of Radiation Oncology, PLA General Hospital, Beijing, China
| | - Xiaomeng Li
- Department of Electronic and Computer Engineering, Hong Kong University of Science and Technology, Hong Kong, China
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17
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Inoue E, Okajima K, Doi H, Fukuda K, Oguma Y, Ri A, Nishikawa D, Yane K, Matsuura T, Nishimura Y. Factors predictive of the development of hypothyroidism after intensity-modulated radiation therapy for pharyngeal cancer. Acta Otolaryngol 2021; 141:1022-1026. [PMID: 34738883 DOI: 10.1080/00016489.2021.1998615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Hypothyroidism is a common adverse event after radiotherapy for head and neck tumors and the incidence need to be re-evaluated because of using intensity-modulated radiotherapy (IMRT). AIMS/OBJECTIVES Confirm the dose-volume effect of IMRT for pharyngeal cancer on hypothyroidism. MATERIALS AND METHODS This was a retrospective analysis of patients underwent IMRT for pharyngeal cancer from June 2011 to May 2018. Patients were classified into group A (thyroid stimulating hormone (TSH) <5μU/ml), group B (5< =TSH < 10), and group C (10< =TSH) based on TSH over 36 months post-radiation. Radiation dose, thyroid volume, and the proportion of the thyroid that received X Gy or greater (Vx) were measured. RESULTS Fifty-two patients were included in this work. Hypothyroidism developed in 33/52 (63%) patients, 13 in group B and 20 in group C. The mean radiation dose to the thyroid was 49.4 Gy and the median time until hypothyroidism was 39 months after irradiation. Hypothyroidism was significantly related to neck dissection (ND) and radiation dose to the thyroid. Patients whose thyroid received 45 Gy or more (V45) >67% had a significantly higher incidence of hypothyroidism. CONCLUSIONS AND SIGNIFICANCE Patients with pharyngeal cancer who had ND and V45 to the thyroid >67% are at risk of hypothyroidism.
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Affiliation(s)
- Eri Inoue
- Department of Radiation Oncology, Nara Hospital Kindai University, Ikoma, Nara, Japan
| | - Kaoru Okajima
- Department of Radiation Oncology, Nara Hospital Kindai University, Ikoma, Nara, Japan
| | - Hiroshi Doi
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Kouhei Fukuda
- Department of Radiation Oncology, Nara Hospital Kindai University, Ikoma, Nara, Japan
| | - Yasuo Oguma
- Department of Radiation Oncology, Nara Hospital Kindai University, Ikoma, Nara, Japan
| | - Aritoshi Ri
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Daisuke Nishikawa
- Department of Otolaryngology, Nara Hospital Kindai University, Ikoma, Nara, Japan
| | - Katsunari Yane
- Department of Otolaryngology, Nara Hospital Kindai University, Ikoma, Nara, Japan
| | - Tomohiro Matsuura
- Department of Radiation Oncology, Yamatotakada Municipal Hospital, Yamatotakada, Nara, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
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Cagni E, Botti A, Rossi L, Iotti C, Iori M, Cozzi S, Galaverni M, Rosca A, Sghedoni R, Timon G, Spezi E, Heijmen B. Variations in Head and Neck Treatment Plan Quality Assessment Among Radiation Oncologists and Medical Physicists in a Single Radiotherapy Department. Front Oncol 2021; 11:706034. [PMID: 34712606 PMCID: PMC8545894 DOI: 10.3389/fonc.2021.706034] [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: 05/06/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background Agreement between planners and treating radiation oncologists (ROs) on plan quality criteria is essential for consistent planning. Differences between ROs and planning medical physicists (MPs) in perceived quality of head and neck cancer plans were assessed. Materials and Methods Five ROs and four MPs scored 65 plans for in total 15 patients. For each patient, the clinical (CLIN) plan and two or four alternative plans, generated with automated multi-criteria optimization (MCO), were included. There was always one MCO plan aiming at maximally adhering to clinical plan requirements, while the other MCO plans had a lower aimed quality. Scores were given as follows: 1-7 and 1-2, not acceptable; 3-5, acceptable if further planning would not resolve perceived weaknesses; and 6-7, straightway acceptable. One MP and one RO repeated plan scoring for intra-observer variation assessment. Results For the 36 unique observer pairs, the median percentage of plans for which the two observers agreed on a plan score (100% = 65 plans) was 27.7% [6.2, 40.0]. In the repeat scoring, agreements between first and second scoring were 52.3% and 40.0%, respectively. With a binary division between unacceptable (scores 1 and 2) and acceptable (3-7) plans, the median inter-observer agreement percentage was 78.5% [63.1, 86.2], while intra-observer agreements were 96.9% and 86.2%. There were no differences in observed agreements between RO-RO, MP-MP, and RO-MP pairs. Agreements for the highest-quality, automatically generated MCO plans were higher than for the CLIN plans. Conclusions Inter-observer differences in plan quality scores were substantial and could result in inconsistencies in generated treatment plans. Agreements among ROs were not better than between ROs and MPs, despite large differences in training and clinical role. High-quality automatically generated plans showed the best score agreements.
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Affiliation(s)
- Elisabetta Cagni
- Medical Physics Unit, Azienda Unità Sanitaria Locale Istituto di Ricovero e Cura a Carattere Scientifico (USL-IRCCS) di Reggio Emilia, Reggio Emilia, Italy.,School of Engineering, Cardiff University, Cardiff, United Kingdom
| | - Andrea Botti
- Medical Physics Unit, Azienda Unità Sanitaria Locale Istituto di Ricovero e Cura a Carattere Scientifico (USL-IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Linda Rossi
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Cinzia Iotti
- Radiotherapy Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mauro Iori
- Medical Physics Unit, Azienda Unità Sanitaria Locale Istituto di Ricovero e Cura a Carattere Scientifico (USL-IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Salvatore Cozzi
- Radiotherapy Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Galaverni
- Radiotherapy Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ala Rosca
- Radiotherapy Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Roberto Sghedoni
- Medical Physics Unit, Azienda Unità Sanitaria Locale Istituto di Ricovero e Cura a Carattere Scientifico (USL-IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Giorgia Timon
- Radiotherapy Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Emiliano Spezi
- School of Engineering, Cardiff University, Cardiff, United Kingdom
| | - Ben Heijmen
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
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Abe T, Iino M, Saito S, Aoshika T, Ryuno Y, Ohta T, Igari M, Hirai R, Kumazaki Y, Miura Y, Kaira K, Kagamu H, Noda SE, Kato S. Feasibility of intensity modulated radiotherapy with involved field radiotherapy for Japanese patients with locally advanced non-small cell lung cancer. JOURNAL OF RADIATION RESEARCH 2021; 62:894-900. [PMID: 34260719 PMCID: PMC8438249 DOI: 10.1093/jrr/rrab063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/31/2021] [Indexed: 06/13/2023]
Abstract
The feasibility of intensity modulated radiotherapy (IMRT) with involved field radiotherapy (IFRT) for Japanese patients with locally advanced non-small cell lung cancer (LA-NSCLC) remains unclear. Here we reviewed our initial experience of IMRT with IFRT for Japanese patients with LA-NSCLC to evaluate the feasibility of the treatment. Twenty LA-NSCLC patients who were treated with IMRT with IFRT during November 2019 to October 2020 were retrospectively analyzed. All patients received 60 Gy in 30 fractions of IMRT and were administered concurrent platinum-based chemotherapy. The median patient age was 71 years old and the group included 15 men and 5 women. The patient group included 2 patients with stage IIB, 11 patients with stage IIIA, 5 patients with stage IIIB, and 2 patients with stage IIIC disease. Histological diagnosis was squamous cell carcinoma in 14 patients, adenocarcinoma in 5 patients, and non-small cell lung cancer in 1 patient. The median follow-up period was 8 months. The incidence of grade 3 or greater pneumonitis was 5%, and grade 3 or greater esophagitis was not observed. None of the patients developed regional lymph node, with only recurrence reported so far. These findings indicate that IMRT with IFRT for Japanese patients with LA-NSCLC is feasible in terms of acute toxicity. Further study with a larger number of patients and longer follow-up to clarify the effect of treatment on patient prognosis is required.
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MESH Headings
- Adenocarcinoma/drug therapy
- Adenocarcinoma/radiotherapy
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Non-Small-Cell Lung/diagnostic imaging
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/radiotherapy
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/radiotherapy
- Combined Modality Therapy
- Dose-Response Relationship, Radiation
- Feasibility Studies
- Female
- Humans
- Japan
- Lung Neoplasms/diagnostic imaging
- Lung Neoplasms/drug therapy
- Lung Neoplasms/radiotherapy
- Male
- Middle Aged
- Multimodal Imaging
- Neoplasm Metastasis
- Organoplatinum Compounds/administration & dosage
- Organs at Risk/radiation effects
- Paclitaxel/administration & dosage
- Radiation Pneumonitis/etiology
- Radiotherapy Planning, Computer-Assisted
- Radiotherapy, Conformal
- Radiotherapy, Intensity-Modulated/adverse effects
- Radiotherapy, Intensity-Modulated/methods
- Retrospective Studies
- User-Computer Interface
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Affiliation(s)
- Takanori Abe
- Corresponding author. Takanori Abe, Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan. E-mail: ; Tel: +81429844136, Fax: +81429844136
| | - 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
| | - Yasuhiro Ryuno
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Tomohiro Ohta
- 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
| | - Yu Miura
- Department of Respiratory Medicine, 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, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka, Saitama 350-1298, 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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20
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Batis N, Brooks JM, Payne K, Sharma N, Nankivell P, Mehanna H. Lack of predictive tools for conventional and targeted cancer therapy: Barriers to biomarker development and clinical translation. Adv Drug Deliv Rev 2021; 176:113854. [PMID: 34192550 PMCID: PMC8448142 DOI: 10.1016/j.addr.2021.113854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 12/30/2022]
Abstract
Predictive tools, utilising biomarkers, aim to objectively assessthe potentialresponse toa particular clinical intervention in order to direct treatment.Conventional cancer therapy remains poorly served by predictive biomarkers, despite being the mainstay of treatment for most patients. In contrast, targeted therapy benefits from a clearly defined protein target for potential biomarker assessment. We discuss potential data sources of predictive biomarkers for conventional and targeted therapy, including patient clinical data andmulti-omicbiomarkers (genomic, transcriptomic and protein expression).Key examples, either clinically adopted or demonstrating promise for clinical translation, are highlighted. Following this, we provide an outline of potential barriers to predictive biomarker development; broadly discussing themes of approaches to translational research and study/trial design, and the impact of cellular and molecular tumor heterogeneity. Future avenues of research are also highlighted.
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Affiliation(s)
- Nikolaos Batis
- Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
| | - Jill M Brooks
- Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Karl Payne
- Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Neil Sharma
- Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Head and Neck Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Paul Nankivell
- Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Head and Neck Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Head and Neck Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
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21
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Bai X, Liu Z, Zhang J, Wang S, Hou Q, Shan G, Chen M, Wang B. Comparing of two dimensional and three dimensional fully convolutional networks for radiotherapy dose prediction in left-sided breast cancer. Sci Prog 2021; 104:368504211038162. [PMID: 34519556 PMCID: PMC10466025 DOI: 10.1177/00368504211038162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fully convolutional networks were developed for predicting optimal dose distributions for patients with left-sided breast cancer and compared the prediction accuracy between two-dimensional and three-dimensional networks. Sixty cases treated with volumetric modulated arc radiotherapy were analyzed. Among them, 50 cases were randomly chosen to conform the training set, and the remaining 10 were to construct the test set. Two U-Net fully convolutional networks predicted the dose distributions, with two-dimensional and three-dimensional convolution kernels, respectively. Computed tomography images, delineated regions of interest, or their combination were considered as input data. The accuracy of predicted results was evaluated against the clinical dose. Most types of input data retrieved a similar dose to the ground truth for organs at risk (p > 0.05). Overall, the two-dimensional model had higher performance than the three-dimensional model (p < 0.05). Moreover, the two-dimensional region of interest input provided the best prediction results regarding the planning target volume mean percentage difference (2.40 ± 0.18%), heart mean percentage difference (4.28 ± 2.02%), and the gamma index at 80% of the prescription dose are with tolerances of 3 mm and 3% (0.85 ± 0.03), whereas the two-dimensional combined input provided the best prediction regarding ipsilateral lung mean percentage difference (4.16 ± 1.48%), lung mean percentage difference (2.41 ± 0.95%), spinal cord mean percentage difference (0.67 ± 0.40%), and 80% Dice similarity coefficient (0.94 ± 0.01). Statistically, the two-dimensional combined inputs achieved higher prediction accuracy regarding 80% Dice similarity coefficient than the two-dimensional region of interest input (0.94 ± 0.01 vs 0.92 ± 0.01, p < 0.05). The two-dimensional data model retrieves higher performance than its three-dimensional counterpart for dose prediction, especially when using region of interest and combined inputs.
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Affiliation(s)
- Xue Bai
- Key Lab of Radiation Physics and
Technology, Ministry of Education, Institute of Nuclear Science and Technology, Sichuan University, China
- Department of Radiation Physics, Cancer Hospital of the University of
Chinese Academy of Sciences (Zhejiang Cancer Hospital), China
| | - Ze Liu
- School of Electronic Information and
Electronical Engineering, Chengdu University, China
| | - Jie Zhang
- Department of Radiation Physics, Cancer Hospital of the University of
Chinese Academy of Sciences (Zhejiang Cancer Hospital), China
| | - Shengye Wang
- Department of Radiation Physics, Cancer Hospital of the University of
Chinese Academy of Sciences (Zhejiang Cancer Hospital), China
| | - Qing Hou
- Key Lab of Radiation Physics and
Technology, Ministry of Education, Institute of Nuclear Science and Technology, Sichuan University, China
| | - Guoping Shan
- Department of Radiation Physics, Cancer Hospital of the University of
Chinese Academy of Sciences (Zhejiang Cancer Hospital), China
| | - Ming Chen
- Department of Radiation Physics, Cancer Hospital of the University of
Chinese Academy of Sciences (Zhejiang Cancer Hospital), China
| | - Binbing Wang
- Department of Radiation Physics, Cancer Hospital of the University of
Chinese Academy of Sciences (Zhejiang Cancer Hospital), China
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22
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Strange CD, Shroff GS, Truong MT, Nguyen QN, Vlahos I, Erasmus JJ. Imaging of the post-radiation chest in lung cancer. Clin Radiol 2021; 77:19-30. [PMID: 34090709 DOI: 10.1016/j.crad.2021.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/29/2021] [Indexed: 12/25/2022]
Abstract
Radiation therapy using conventional fractionated external-beam or high-precision dose techniques including three-dimensional conformal radiotherapy, stereotactic body radiation therapy, intensity-modulated radiation therapy, and proton therapy, is a key component in the treatment of patients with lung cancer. Knowledge of the radiation technique used, radiation treatment plan, expected temporal evolution of radiation-induced lung injury and patient-specific parameters, such as previous radiotherapy, concurrent chemoradiotherapy, and/or immunotherapy, is important in imaging interpretation. This review discusses factors that affect the development and severity of radiation-induced lung injury and its radiological manifestations with emphasis on the differences between conventional radiation and high-precision dose radiotherapy techniques.
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Affiliation(s)
- C D Strange
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA
| | - G S Shroff
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA
| | - M T Truong
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA
| | - Q-N Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA
| | - I Vlahos
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA
| | - J J Erasmus
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030-4009, USA.
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23
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Pritchard JL, Velthuis JJ, Beck L, De Sio C, Hugtenburg RP. High-Resolution MLC Leaf Position Measurements With a Large Area MAPS. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2021. [DOI: 10.1109/trpms.2020.3007859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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24
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Bijman R, Sharfo AW, Rossi L, Breedveld S, Heijmen B. Pre-clinical validation of a novel system for fully-automated treatment planning. Radiother Oncol 2021; 158:253-261. [DOI: 10.1016/j.radonc.2021.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 12/17/2022]
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25
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Wall PDH, Fontenot JD. Quality assurance-based optimization (QAO): Towards improving patient-specific quality assurance in volumetric modulated arc therapy plans using machine learning. Phys Med 2021; 87:136-143. [PMID: 33775567 DOI: 10.1016/j.ejmp.2021.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Previous literature has shown general trade-offs between plan complexity and resulting quality assurance (QA) outcomes. However, existing solutions for controlling this trade-off do not guarantee corresponding improvements in deliverability. Therefore, this work explored the feasibility of an optimization framework for directly maximizing predicted QA outcomes of plans without compromising the dosimetric quality of plans designed with an established knowledge-based planning (KBP) technique. MATERIALS AND METHODS A support vector machine (SVM) was developed - using a database of 500 previous VMAT plans - to predict gamma passing rates (GPRs; 3%/3mm percent dose-difference/distance-to-agreement with local normalization) based on selected complexity features. A heuristic, QA-based optimization (QAO) framework was devised by utilizing the SVM model to iteratively modify mechanical treatment features most commonly associated with suboptimal GPRs. Specifically, leaf gaps (LGs) <50 mm were widened by random amounts, which impacts all aperture-based complexity features. 13 prostate KBP-guided VMAT plans were optimized via QAO using user-specified maximum LG displacements before corresponding changes in predicted GPRs and dose were assessed. RESULTS Predicted GPRs increased by an average of 1.14 ± 1.25% (p = 0.006) with QAO using a 3 mm maximum random LG displacement. There were small differences in dose, resulting in similarly small changes in tumor control probability (maximum increase = 0.05%) and normal tissue complication probabilities in the bladder, rectum, and femoral heads (maximum decrease = 0.2% in the rectum). CONCLUSION This study explored the feasibility of QAO and warrants future investigations of further incorporating QA endpoints into plan optimization.
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Affiliation(s)
- Phillip D H Wall
- Department of Physics and Astronomy, Louisiana State University and Agricultural and Mechanical College, 202 Tower Drive, Baton Rouge, LA 70803-4001, USA.
| | - Jonas D Fontenot
- Department of Physics and Astronomy, Louisiana State University and Agricultural and Mechanical College, 202 Tower Drive, Baton Rouge, LA 70803-4001, USA; Department of Physics, Mary Bird Perkins Cancer Center, 4950 Essen Lane, Baton Rouge, LA 70809, USA
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26
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Sahebnasagh A, Saghafi F, Ghasemi A, Akbari J, Alipour A, Habtemariam S, Safdari M, Ghaleno HR, Salehifar E. Aloe vera for Prevention of Acute Radiation Proctitis in Colorectal Cancer a Preliminary Randomized, Placebo-Controlled Clinical Trial. J Gastrointest Cancer 2021; 53:318-325. [PMID: 33616843 DOI: 10.1007/s12029-021-00597-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine the preventive effects of Aloe vera in colorectal cancer patients undergoing radiotherapy. MATERIAL AND METHOD Twenty colorectal cancer patients, who received radiation, were randomized to receive Aloe vera 3% or placebo ointment, 1 g twice daily for 6 weeks. At weekly visits, acute radiation proctitis (ARP) was evaluated by Radiation Therapy Oncology Group and clinical presentation criteria as the primary endpoint. We also evaluated secondary endpoints of quality of life, psychosocial status, by applying Hospital Anxiety-Depression (HAD) Scale and laboratory measures of quantitative measurement of C-reactive protein (CRP) as a marker for systemic inflammation. RESULTS There was a significant improvement in the symptom index (before treatment vs. after treatment with Aloe vera) for diarrhea (p = 0.029, median score: 0.5 vs. 0.001). The overall primary and secondary outcomes favored Aloe group, while the measures of toxicity did not achieve a statistical significant difference. The lifestyle score improved significantly with A. vera (p = 004), and they also had a lower depression score in HAD scale (p = 0.008). Furthermore, quantitative CRP decreased significantly during the course of treatment with Aloe vera. CONCLUSION The use of topical formulation of Aloe vera 3% diminishes the severity of ARP in colorectal cancer patients.
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Affiliation(s)
- Adeleh Sahebnasagh
- Clinical Research Center, Department of Internal Medicine, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Fatemeh Saghafi
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Arash Ghasemi
- Emam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Jafar Akbari
- Pharmaceutical Research Center, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abbas Alipour
- Faculty of Medicine, Community Medicine Department, Mazandaran University of Medical Sciences, Sari, Iran
| | - Solomon Habtemariam
- Pharmacognosy Research Laboratories and Herbal Analysis Services UK, University of Greenwich, Central Avenue, Chatham-Maritime,, ME4 4TB, Kent, UK
| | - Mohammadreza Safdari
- Department of Orthopedic Surgery, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Hassan Rezai Ghaleno
- Department of Surgery, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ebrahim Salehifar
- Pharmaceutical Sciences Research Center, Faculty of Pharmacy, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran.
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Artificial Intelligence in Radiotherapy and Patient Care. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-58080-3_143-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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28
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Sheeraz Z, Chow JC. Evaluation of dose enhancement with gold nanoparticles in kilovoltage radiotherapy using the new EGS geometry library in Monte Carlo simulation. AIMS BIOPHYSICS 2021. [DOI: 10.3934/biophy.2021027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
<abstract><sec>
<title>Purpose</title>
<p>This study compared the dose enhancement predicted in kilovoltage gold nanoparticle-enhanced radiotherapy using the newly developed EGS lattice and the typical gold-water mixture method in Monte Carlo simulation. This new method considered the gold nanoparticle-added volume consisting of solid nanoparticles instead of a gold-water mixture. In addition, this particle method is more realistic in simulation.</p>
</sec><sec>
<title>Methods</title>
<p>A heterogeneous phantom containing bone and water was irradiated by the 105 and 220 kVp x-ray beams. Gold nanoparticles were added to the tumour volume with concentration varying from 3–40 mg/mL in the phantom. The dose enhancement ratio (DER), defined as the ratio of dose at the tumour with and without adding gold nanoparticles, was calculated by the gold-water mixture and particle method using Monte Carlo simulation for comparison.</p>
</sec><sec>
<title>Results</title>
<p>It is found that the DER was 1.44–4.71 (105 kVp) and 1.27–2.43 (220 kVp) for the gold nanoparticle concentration range of 3–40 mg/mL, when they were calculated by the gold-water mixture method. The DER was slightly larger and equal to 1.47–4.84 (105 kVp) and 1.29–2.5 (220 kVp) for the same concentration range, when the particle method was used. Moreover, the DER predicted by both methods increased with an increase of nanoparticle concentration, and a decrease of x-ray beam energy.</p>
</sec><sec>
<title>Conclusion</title>
<p>The deviation of DER determined by the particle and gold-water mixture method was insignificant when considering the uncertainty in the calculation of DER (2%) in the nanoparticle concentration range of 3–40 mg/mL. It is therefore concluded that the gold-water mixture method could predict the dose enhancement as accurate as the newly developed particle method.</p>
</sec></abstract>
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Sahebnasagh A, Ghasemi A, Akbari J, Alipour A, Lashkardoost H, Ala S, Hosseinimehr SJ, Salehifar E. Prevention of acute radiation-induced Proctitis by Aloe vera: a prospective randomized, double-blind, placebo controlled clinical trial in Pelvic Cancer patients. BMC Complement Med Ther 2020; 20:146. [PMID: 32404169 PMCID: PMC7222341 DOI: 10.1186/s12906-020-02935-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 04/22/2020] [Indexed: 01/28/2023] Open
Abstract
Background Acute radiation-induced proctitis (ARP) is the most common side effect following radiotherapy for malignant pelvic disease. This study evaluated the efficacy of Aloe vera ointment in prevention of ARP. Methods Forty-two patients receiving external-beam radiotherapy (RT) for pelvic malignancies were randomized to receive either Aloe vera 3% or placebo topical ointment during radiotherapy for 6 weeks. These patients were evaluated based on the severity (grade 0–4) of the following symptoms weekly: rectal bleeding, abdominal/rectal pain, diarrhea, or fecal urgency. RTOG acute toxicity criteria and psychosocial status of the patients were also recorded weekly. Lifestyle impact of the symptoms, and quantitative measurement of C-reactive protein (CRP), an indicator of systemic inflammation, were also measured. Results The results of present study demonstrated a significant preventive effect for Aloe vera in occurrence of symptom index for diarrhea (p < 0.001), rectal bleeding (p < 0.001), and fecal urgency (p = 0.001). The median lifestyle score improved significantly with Aloe vera during RT (p < 0.001). Intervention patients had a significant lower burden of systemic inflammation as the values for quantitative CRP decreased significantly over 6 weeks of follow-up (p = 0.009). Conclusion This study showed that Aloe vera topical ointment was effective in prevention of symptoms of ARP in patients undergoing RT for pelvic cancers. Trial registration IRCT201606042027N6. Registration date: 2016-09-04.
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Affiliation(s)
- Adeleh Sahebnasagh
- Clinical Research Center, Department of Internal Medicine, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Arash Ghasemi
- Emam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Jafar Akbari
- Pharmaceutical Research Center, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abbas Alipour
- Epidemiology, Faculty of Medicine, Community medicine Department, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hossein Lashkardoost
- School of Public Health, North Khorasan University of Medical Sciences, Bojnurd, I.R, Iran
| | - Shahram Ala
- Pharmaceutical Research Center, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Jalal Hosseinimehr
- Department of Radiopharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ebrahim Salehifar
- Gastrointestinal Cancer Research Center, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran. .,Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, 48471-16548, Km 18 Khazarabad Road, Khazar sq., Sari, Mazandaran Province, Iran.
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30
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He C, Zhang S, Shi L. Three-Dimensionally-Precise Breast Conformal Device for IMRT in Breast Cancer Patients Treated With Breast-Conserving Surgery-A Pilot Randomized Controlled Trial. Technol Cancer Res Treat 2020; 19:1533033820971563. [PMID: 33174525 PMCID: PMC7672753 DOI: 10.1177/1533033820971563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/05/2020] [Accepted: 09/30/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To examine the accuracy and efficiency of breast radiotherapy after breast-conserving surgery of a novel 3-dimensional (3D) printing tissue compensator technology, the 3D-precise breast conformer, compared with a usual compensator and an unstructured compensator. METHODS This novel device is patented in China (patent No.: ZL2015 2 0259472.9). Thirty patients with breast cancer after breast-conserving surgery were randomly divided into 2 control groups (no compensator, NST group, and usual compensator, ST group) and 1 study group (3D-precise breast conformer, 3D-BCT group) (n = 10/group). Before radiotherapy, all patients were scanned in the same CT positioning conditions to prepare the treatment plans. RESULTS The 3D-BCT showed the best homogeneity index (HI) (0.08 ± 0.03) and conformity index (CI) (0.95 ± 0.03), while the NST group showed the worst HI (0.34 ± 0.07) and CI (0.78 ± 0.06), with the ST group between the 2 (HI: 0.15 ± 0.05; CI: 0.87 ± 0.04) (all P < 0.01). The common tissue compensation membrane could lead to 95-100% of the prescription dose covering 85-95% of the target volume, and the uniformity and conformability of the target dose were improved overall compared with the NST group. In the 3D-BCT group, 100% of the prescription dose covered the target volume of 95-100%. CONCLUSION The 3D-precision breast conformal device had the highest individualization, uniformity, and conformity. The V95, V98, CI, and HI of PTV were optimal in the 3D-BCT group, and an ideal isodose curve distribution of the breast and clavicle upper and lower target areas was achieved. This device could improve the surface dose and the efficacy of radiotherapy after breast-conserving surgery.
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Affiliation(s)
- Chunbo He
- Department of Radiation Oncology, The Fourth Hospital, Harbin Medical University, Harbin, China
| | - Shilin Zhang
- Department of Radiation Oncology, The Fourth Hospital, Harbin Medical University, Harbin, China
| | - Lei Shi
- Department of Radiation Oncology, The Fourth Hospital, Harbin Medical University, Harbin, China
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Medical physics aspects of Intensity-Modulated Radiotherapy practice in Malaysia. Phys Med 2019; 67:34-39. [DOI: 10.1016/j.ejmp.2019.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/05/2019] [Accepted: 10/07/2019] [Indexed: 12/25/2022] Open
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Chierchini S, Ingrosso G, Saldi S, Stracci F, Aristei C. Physician And Patient Barriers To Radiotherapy Service Access: Treatment Referral Implications. Cancer Manag Res 2019; 11:8829-8833. [PMID: 31632142 PMCID: PMC6789154 DOI: 10.2147/cmar.s168941] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/14/2019] [Indexed: 12/24/2022] Open
Abstract
Radiotherapy is one of the mainstays of cancer treatment, and about 60% of cancer patients receive this type of treatment during their course of treatment. An evident gap between optimal and actual radiotherapy utilization proportions has recently been reported, which has been ascribed to lack of referral to radiation oncology. There are many factors influencing the radiotherapy referral, including patient anxiety about toxicity, wrong perception of efficacy and side effects by physicians and patients, insufficient knowledge of referral process. These factors, defined as barriers can be categorized in health system barriers, physician and patient barriers. In the present brief narrative review, we discussed barriers to radiotherapy referral focusing on physician and patient barriers.
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Affiliation(s)
- Sara Chierchini
- Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Gianluca Ingrosso
- Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Simonetta Saldi
- Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Fabrizio Stracci
- Department of Experimental Medicine, Section of Public Health, University of Perugia, Perugia, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
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New approaches for effective and safe pelvic radiotherapy in high-risk prostate cancer. Nat Rev Urol 2019; 16:523-538. [DOI: 10.1038/s41585-019-0213-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2019] [Indexed: 02/07/2023]
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Zhao W, Han B, Yang Y, Buyyounouski M, Hancock SL, Bagshaw H, Xing L. Incorporating imaging information from deep neural network layers into image guided radiation therapy (IGRT). Radiother Oncol 2019; 140:167-174. [PMID: 31302347 DOI: 10.1016/j.radonc.2019.06.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/06/2019] [Accepted: 06/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE To investigate a novel markerless prostate localization strategy using a pre-trained deep learning model to interpret routine projection kilovoltage (kV) X-ray images in image-guided radiation therapy (IGRT). MATERIALS AND METHODS We developed a personalized region-based convolutional neural network to localize the prostate treatment target without implanted fiducials. To train the deep neural network (DNN), we used the patient's planning computed tomography (pCT) images with pre-delineated prostate target to generate a large amount of synthetic kV projection X-ray images in the geometry of onboard imager (OBI) system. The DNN model was evaluated by retrospectively studying 10 patients who underwent prostate IGRT. Three out of the ten patients who had implanted fiducials and the fiducials' positions in the OBI images acquired for treatment setup were examined to show the potential of the proposed method for prostate IGRT. Statistical analysis using Lin's concordance correlation coefficient was calculated to assess the results along with the difference between the digitally reconstructed radiographs (DRR) derived and DNN predicted locations of the prostate. RESULTS Differences between the predicted target positions using DNN and their actual positions are (mean ± standard deviation) 1.58 ± 0.43 mm, 1.64 ± 0.43 mm, and 1.67 ± 0.36 mm in anterior-posterior, lateral, and oblique directions, respectively. Prostate position identified on the OBI kV images is also found to be consistent with that derived from the implanted fiducials. CONCLUSIONS Highly accurate, markerless prostate localization based on deep learning is achievable. The proposed method is useful for daily patient positioning and real-time target tracking during prostate radiotherapy.
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Affiliation(s)
- Wei Zhao
- Stanford University, Department of Radiation Oncology, Stanford, USA.
| | - Bin Han
- Stanford University, Department of Radiation Oncology, Stanford, USA.
| | - Yong Yang
- Stanford University, Department of Radiation Oncology, Stanford, USA.
| | - Mark Buyyounouski
- Stanford University, Department of Radiation Oncology, Stanford, USA.
| | - Steven L Hancock
- Stanford University, Department of Radiation Oncology, Stanford, USA.
| | - Hilary Bagshaw
- Stanford University, Department of Radiation Oncology, Stanford, USA.
| | - Lei Xing
- Stanford University, Department of Radiation Oncology, Stanford, USA.
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Zhao W, Shen L, Han B, Yang Y, Cheng K, Toesca DAS, Koong AC, Chang DT, Xing L. Markerless Pancreatic Tumor Target Localization Enabled By Deep Learning. Int J Radiat Oncol Biol Phys 2019; 105:432-439. [PMID: 31201892 DOI: 10.1016/j.ijrobp.2019.05.071] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 05/17/2019] [Accepted: 05/25/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Deep learning is an emerging technique that allows us to capture imaging information beyond the visually recognizable level of a human being. Because of the anatomic characteristics and location, on-board target verification for radiation delivery to pancreatic tumors is a challenging task. Our goal was to use a deep neural network to localize the pancreatic tumor target on kV x-ray images acquired using an on-board imager for image guided radiation therapy. METHODS AND MATERIALS The network is set up in such a way that the input is either a digitally reconstructed radiograph image or a monoscopic x-ray projection image acquired by the on-board imager from a given direction, and the output is the location of the planning target volume in the projection image. To produce a sufficient number of training x-ray images reflecting the vast number of possible clinical scenarios of anatomy distribution, a series of changes were introduced to the planning computed tomography images, including deformation, rotation, and translation, to simulate inter- and intrafractional variations. After model training, the accuracy of the model was evaluated by retrospectively studying patients who underwent pancreatic cancer radiation therapy. Statistical analysis using mean absolute differences (MADs) and Lin's concordance correlation coefficient were used to assess the accuracy of the predicted target positions. RESULTS MADs between the model-predicted and the actual positions were found to be less than 2.60 mm in anteroposterior, lateral, and oblique directions for both axes in the detector plane. For comparison studies with and without fiducials, MADs are less than 2.49 mm. For all cases, Lin's concordance correlation coefficients between the predicted and actual positions were found to be better than 93%, demonstrating the success of the proposed deep learning for image guided radiation therapy. CONCLUSIONS We demonstrated that markerless pancreatic tumor target localization is achievable with high accuracy by using a deep learning technique approach.
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Affiliation(s)
- Wei Zhao
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Liyue Shen
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Bin Han
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Yong Yang
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Kai Cheng
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Diego A S Toesca
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Albert C Koong
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel T Chang
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Lei Xing
- Department of Radiation Oncology, Stanford University, Stanford, California.
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Rehman JU, Zahra, Ahmad N, Khalid M, Noor ul Huda Khan Asghar H, Gilani ZA, Ullah I, Nasar G, Akhtar MM, Usmani MN. Intensity modulated radiation therapy: A review of current practice and future outlooks. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2019. [DOI: 10.1016/j.jrras.2018.07.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Jalil ur Rehman
- Department of Physics, Baluchistan University of Information Technology, Engineering & Management Sciences, Quetta, 87300, Pakistan
| | - Zahra
- Department of Physics, Baluchistan University of Information Technology, Engineering & Management Sciences, Quetta, 87300, Pakistan
| | - Nisar Ahmad
- Department of Physics, Baluchistan University of Information Technology, Engineering & Management Sciences, Quetta, 87300, Pakistan
| | - Muhammad Khalid
- Department of Physics, Baluchistan University of Information Technology, Engineering & Management Sciences, Quetta, 87300, Pakistan
| | - H.M. Noor ul Huda Khan Asghar
- Department of Physics, Baluchistan University of Information Technology, Engineering & Management Sciences, Quetta, 87300, Pakistan
| | - Zaheer Abbas Gilani
- Department of Physics, Baluchistan University of Information Technology, Engineering & Management Sciences, Quetta, 87300, Pakistan
| | - Irfan Ullah
- Centre for Nuclear Medicine and Radiotherapy (CENAR), Quetta, Pakistan
| | - Gulfam Nasar
- Department of Chemistry, Baluchistan University of Information Technology, Engineering & Management Sciences, Quetta, Pakistan
| | - Malik Muhammad Akhtar
- Department of Environmental Science, Baluchistan University of Information Technology, Engineering & Management Sciences, Quetta, Pakistan
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Ahsen OO, Liang K, Lee HC, Wang Z, Fujimoto JG, Mashimo H. Assessment of chronic radiation proctopathy and radiofrequency ablation treatment follow-up with optical coherence tomography angiography: A pilot study. World J Gastroenterol 2019; 25:1997-2009. [PMID: 31086467 PMCID: PMC6487379 DOI: 10.3748/wjg.v25.i16.1997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/12/2019] [Accepted: 02/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic radiation proctopathy (CRP) occurs as a result of pelvic radiation therapy and is associated with formation of abnormal vasculature that may lead to persistent rectal bleeding. While incidence is declining due to refinement of radiation delivery techniques, CRP remains one of the major complications of pelvic radiation therapy and significantly affects patient quality of life. Radiofrequency ablation (RFA) is an emerging treatment modality for eradicating abnormal vasculature associated with CRP. However, questions remain regarding CRP pathophysiology and optimal disease management.
AIM To study feasibility of optical coherence tomography angiography (OCTA) for investigating subsurface vascular alterations in CRP and response to RFA treatment.
METHODS Two patients with normal rectum and 8 patients referred for, or undergoing endoscopic RFA treatment for CRP were imaged with a prototype ultrahigh-speed optical coherence tomography (OCT) system over 15 OCT/colonoscopy visits (2 normal patients, 5 RFA-naïve patients, 8 RFA-follow-up visits). OCT and OCTA was performed by placing the OCT catheter onto the dentate line and rectum without endoscopic guidance. OCTA enabled depth-resolved microvasculature imaging using motion contrast from flowing blood, without requiring injected dyes. OCTA features of normal and abnormal microvasculature were assessed in the mucosa and submucosa. Blinded reading of OCTA images was performed to assess the association of abnormal rectal microvasculature with CRP and RFA treatment, and rectal telangiectasia density endoscopic scoring.
RESULTS OCTA/OCT images are intrinsically co-registered and enabled depth-resolved visualization of microvasculature in the mucosa and submucosa. OCTA visualized normal vascular patterns with regular honeycomb patterns vs abnormal vasculature with distorted honeycomb patterns and ectatic/tortuous microvasculature in the rectal mucosa. Normal arterioles and venules < 200 μm in diameter versus abnormal heterogenous enlarged arterioles and venules > 200 μm in diameter were visualized in the rectal submucosa. Abnormal mucosal vasculature occurred in 0 of 2 normal patients and 3 of 5 RFA-naïve patients, while abnormal submucosal vasculature occurred more often, in 1 of 2 normal patients and 5 of 5 RFA-naïve patients. After RFA treatment, vascular abnormalities decreased, with abnormal mucosal vasculature observed in 0 of 8 RFA-follow-up visits and abnormal submucosal vasculature observed in only and 2 of 8 RFA-follow-up visits.
CONCLUSION OCTA visualizes depth-resolved microvascular abnormalities in CRP, allowing assessment of superficial features which are endoscopically visible as well as deeper vasculature which cannot be seen endoscopically. OCTA/OCT of the rectum can be performed in conjunction with, or independently from endoscopy. Further studies are warranted to investigate if OCTA/OCT can elucidate pathophysiology of CRP or improve management.
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Affiliation(s)
- Osman Oguz Ahsen
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - Kaicheng Liang
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - Hsiang-Chieh Lee
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - Zhao Wang
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - James G Fujimoto
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - Hiroshi Mashimo
- Gastroenterology Section, VA Boston Healthcare System, Harvard School of Medicine, Boston, MA 02130, United States
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Rikitake R, Tsukada Y, Ando M, Yoshida M, Iwamoto M, Yamasoba T, Higashi T. Use of intensity-modulated radiation therapy for nasopharyngeal cancer in Japan: analysis using a national database. Jpn J Clin Oncol 2019; 49:639-645. [DOI: 10.1093/jjco/hyz042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/25/2019] [Accepted: 03/04/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Intensity-modulated radiation therapy (IMRT) yields better outcomes and fewer toxicities for radiation therapy (RT) of head and neck cancers (HNCs), including nasopharyngeal cancer (NPC). IMRT is the standard RT treatment and has been widely adopted in Western countries to treat HNCs. However, its uptake in clinical practice among NPC patients has never been studied.
Methods
We investigated the use of IMRT for NPC using data from a nationwide cancer registry to describe the use of IMRT among NPC patients in Japan. We analyzed the data of patients with HNC, including NPC, who underwent IMRT between 2012 and 2014, as recorded in the hospital-based cancer registries linked with insurance claims. We calculated the proportion of patients with NPC who underwent IMRT at each hospital. To evaluate the use of IMRT for NPC, the IMRT use for NPC was compared with the proportion of patients with prostate cancer who underwent IMRT.
Results
Among 508 patients with NPC who underwent RT at one of 87 hospitals, 348 (69%) underwent IMRT. This proportion gradually increased between 2012 and 2014 (62%, 64% and 77%). Meanwhile, 4790 patients with prostate cancer (90%) underwent IMRT. Although some hospitals where IMRT was performed treated many patients with NPC, the proportion of patients with NPC who were treated with IMRT was low.
Conclusions
IMRT has not been widely adopted in Japan for treating NPC. Barriers for adopting its use should be identified to close the gap between the standard and actual medical practice in Japan.
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Affiliation(s)
- Ryoko Rikitake
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yoichiro Tsukada
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Mizuo Ando
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masafumi Yoshida
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Momoko Iwamoto
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Takahiro Higashi
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
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Tarutani K, Tanooka M, Doi H, Fujiwara M, Miyashita M, Kagawa K, Kamikonya N, Yamakado K. Improved error detection using a divided treatment plan in volume modulated arc therapy. Rep Pract Oncol Radiother 2019; 24:133-141. [PMID: 30723384 DOI: 10.1016/j.rpor.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 10/09/2018] [Accepted: 12/27/2018] [Indexed: 11/18/2022] Open
Abstract
Aim We sought to improve error detection ability during volume modulated arc therapy (VMAT) by dividing and evaluating the treatment plan. Background VMAT involves moving a beam source delivering radiation to tumor tissue through an arc, which significantly decreases treatment time. Treatment planning for VMAT involves many parameters. Quality assurance before treatment is a major focus of research. Materials and methods We used an established VMAT prostate treatment plan and divided it into 12° × 30° sections. In all the sections, only image data that generated errors in one segment and those that were integrally acquired were evaluated by a gamma analysis. This was done with five different patient plans. Results The integrated image data resulting from errors in each section was 100% (tolerance 0.5 mm/0.5%) in the gamma analysis result in all image data. Division of the treatment plans produced a shift in the mean value of each gamma analysis in the cranial, left, and ventral directions of 94.59%, 98.83%, 96.58%, and the discrimination ability improved. Conclusion The error discrimination ability was improved by dividing and verifying the portal imaging.
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Affiliation(s)
- Kazuo Tarutani
- Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
- Japan Organization of Occupational Health and Safety Kansai Rousai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Masao Tanooka
- Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
- Department of Radiotherapy, Takarazuka City Hospital, 4-5-1, Kohama, Takaraduka, Hyogo 665-0827, Japan
| | - Hiroshi Doi
- Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Sayama, Osaka 589-8511, Japan
| | - Masayuki Fujiwara
- Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Masaki Miyashita
- Japan Organization of Occupational Health and Safety Kansai Rousai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Kazufumi Kagawa
- Japan Organization of Occupational Health and Safety Kansai Rousai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Norihiko Kamikonya
- Japan Organization of Occupational Health and Safety Kansai Rousai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Koichiro Yamakado
- Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
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Gwynne S, Higgins E, Poon King A, Radhakrishna G, Wills L, Mukherjee S, Hawkins M, Jones G, Staffurth J, Crosby T. Driving developments in UK oesophageal radiotherapy through the SCOPE trials. Radiat Oncol 2019; 14:26. [PMID: 30717810 PMCID: PMC6360789 DOI: 10.1186/s13014-019-1225-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 01/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The SCOPE trials (SCOPE 1, NeoSCOPE and SCOPE 2) have been the backbone of oesophageal RT trials in the UK. Many changes in oesophageal RT techniques have taken place in this time. The SCOPE trials have, in addition to adopting these new techniques, been influential in aiding centres with their implementation. We discuss the progress made through the SCOPE trials and include details of a questionnaire sent to participating centres. to establish the role that trial participation played in RT changes in their centre. METHODS Questionnaires were sent to 47 centres, 27 were returned. RESULTS 100% of centres stated their departmental protocol for TVD was based on the relevant SCOPE trial protocol. 4DCT use has increased from 42 to 71%. Type B planning algorithms, mandated in the NeoSCOPE trial, were used in 79.9% pre NeoSCOPE and now in 83.3%. 12.5% of centres were using a stomach filling protocol pre NeoSCOPE, now risen to 50%. CBCT was mandated for IGRT in the NeoSCOPE trial. 66.7% used this routinely pre NeoSCOPE/SCOPE 2 which has risen to 87.5% in the survey. CONCLUSION The results of the questionnaires show how participation in national oesophageal RT trials has led to the adoption of newer RT techniques in UK centres, leading to better patient care.
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Affiliation(s)
- S. Gwynne
- South West Wales Cancer Centre, Swansea, UK
- NIHR Cardiff RTTQA Group, Cardiff, UK
| | - E. Higgins
- South West Wales Cancer Centre, Swansea, UK
| | | | | | - L. Wills
- NIHR Cardiff RTTQA Group, Cardiff, UK
| | - S. Mukherjee
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | - Maria Hawkins
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | - G. Jones
- NIHR Cardiff RTTQA Group, Cardiff, UK
| | - J. Staffurth
- NIHR Cardiff RTTQA Group, Cardiff, UK
- Cardiff University, Cardiff, UK
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De Roover R, Crijns W, Poels K, Michiels S, Nulens A, Vanstraelen B, Petillion S, De Brabandere M, Haustermans K, Depuydt T. Validation and IMRT/VMAT delivery quality of a preconfigured fast‐rotating O‐ring linac system. Med Phys 2018; 46:328-339. [DOI: 10.1002/mp.13282] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Robin De Roover
- Department of Oncology Laboratory of Experimental Radiotherapy KU Leuven – University of Leuven Herestraat 49 B‐3000 Leuven Belgium
| | - Wouter Crijns
- Department of Oncology Laboratory of Experimental Radiotherapy KU Leuven – University of Leuven Herestraat 49 B‐3000 Leuven Belgium
- Department of Radiation Oncology University Hospitals Leuven Herestraat 49 B‐3000 Leuven Belgium
| | - Kenneth Poels
- Department of Radiation Oncology University Hospitals Leuven Herestraat 49 B‐3000 Leuven Belgium
| | - Steven Michiels
- Department of Oncology Laboratory of Experimental Radiotherapy KU Leuven – University of Leuven Herestraat 49 B‐3000 Leuven Belgium
| | - An Nulens
- Department of Radiation Oncology University Hospitals Leuven Herestraat 49 B‐3000 Leuven Belgium
| | - Bianca Vanstraelen
- Department of Radiation Oncology University Hospitals Leuven Herestraat 49 B‐3000 Leuven Belgium
| | - Saskia Petillion
- Department of Radiation Oncology University Hospitals Leuven Herestraat 49 B‐3000 Leuven Belgium
| | - Marisol De Brabandere
- Department of Radiation Oncology University Hospitals Leuven Herestraat 49 B‐3000 Leuven Belgium
| | - Karin Haustermans
- Department of Oncology Laboratory of Experimental Radiotherapy KU Leuven – University of Leuven Herestraat 49 B‐3000 Leuven Belgium
- Department of Radiation Oncology University Hospitals Leuven Herestraat 49 B‐3000 Leuven Belgium
| | - Tom Depuydt
- Department of Oncology Laboratory of Experimental Radiotherapy KU Leuven – University of Leuven Herestraat 49 B‐3000 Leuven Belgium
- Department of Radiation Oncology University Hospitals Leuven Herestraat 49 B‐3000 Leuven Belgium
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Rozanec N, Allibhai Z, Bhatti M, Chan E, McIntosh M, Moseley D, Taremi M, Abbas A. Palliation of Vertebral Metastases with Radiotherapy: Exploration of Volumetric-Modulated Arc Therapy From Development to Implementation in Routine Clinical Practice. J Med Imaging Radiat Sci 2018; 50:68-73. [PMID: 30777251 DOI: 10.1016/j.jmir.2018.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 08/20/2018] [Accepted: 09/06/2018] [Indexed: 12/25/2022]
Abstract
The development of volumetric-modulated arc therapy (VMAT) in radiation therapy has allowed for improved dose escalation and a decrease in radiation-induced toxicities for patients. This article will describe a single centre's experience in development and implementation of VMAT for palliation of vertebral metastases. A retrospective planning analysis of 10 cases identified that utilization of VMAT decreases overall planning time with a statistically significant improvement in target coverage when compared with the current conventional technique. PTV Dmax (P = .02), PTV V9519Gy (95%) (P = .01), dose conformation (P = 1.8e-004), and the homogeneity index (P = .019) were all superior for VMAT plans with an average PTV length of 22.46 cm. Another benefit of VMAT utilization is a significant decrease in treatment delivery time, which reduced treatment times from 9.95 minutes to 2.98 minutes. Immobilization was also carefully considered, and rotational errors were measured and fell within institutional tolerances when VMAT was delivered using simple immobilization devices. Clinical implementation of this technique, utilizing a highly conformal target volume to decrease radiation-induced toxicities and minimizing the length of time patients are required to maintain their treatment positions, aims to improve the palliative radiotherapy experience for patients with painful spinal metastases.
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Affiliation(s)
- Natalie Rozanec
- Southlake Regional Health Centre, Newmarket, Ontario, Canada; Sheffield Hallam University, Sheffield, United Kingdom.
| | - Zishan Allibhai
- Southlake Regional Health Centre, Newmarket, Ontario, Canada; The Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Michael Bhatti
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Edwin Chan
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Marlyn McIntosh
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Douglas Moseley
- Southlake Regional Health Centre, Newmarket, Ontario, Canada; The Princess Margaret Cancer Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Mojgan Taremi
- Southlake Regional Health Centre, Newmarket, Ontario, Canada; The Princess Margaret Cancer Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Ahmar Abbas
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
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Lobo N, Kulkarni M, Hughes S, Nair R, Khan MS, Thurairaja R. Urologic Complications Following Pelvic Radiotherapy. Urology 2018; 122:1-9. [DOI: 10.1016/j.urology.2018.07.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 06/17/2018] [Accepted: 07/07/2018] [Indexed: 11/28/2022]
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Modulated radiotherapy for head and neck carcinomas: an outcome study. JOURNAL OF RADIOTHERAPY IN PRACTICE 2018. [DOI: 10.1017/s1460396918000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackgroundTo evaluate the survival outcomes and toxicities experienced by non-metastatic head and neck cancer (HNC) patients receiving modulated radiotherapy (RT).Materials and methodsA total of 608 HNC patients treated consecutively from March 2010 to December 2014 with common subsites (oral cavity, oropharynx, hypopharynx, larynx and nasopharynx) of HNCs formed the study group. Eligible patients included those treated with radical or postoperative RT between March 2010 and December 2014. More than 90% patients received modulated RT [intensity-modulated radiotherapy (IMRT) or volumetric-modulated arc therapy (VMAT)] with concurrent chemotherapy as per stage guidelines. Demographic parameters and disease-related factors were analysed. Disease-free survival (DFS) was calculated from end date of RT till last follow-up or last date of disease control. Overall survival (OS) was calculated from date of registration to last follow-up date if alive. The primary endpoint was survival. The statistical analyses were performed using SPSS version 20.0 and Kaplan–Meier method was used for calculation survival.ResultsAmong the evaluable patients, the median age was 60 years (range: 16–93) with male preponderance (male:female – 513:95). Majority were squamous cell carcinoma 93·4% (568/608). The subsites treated were oral cavity 36·8% (224). oropharynx 26·4% (161), larynx 19·7% (120), hypopharynx 10% (62) and nasopharynx 6·4% (41). RT intent was radical in 63·5% (386) and postoperative in 36·5% (222), with 59·5% (362) receiving concurrent chemotherapy. At last follow-up, 348 (57·2%) patients were alive, 169 (27·7%) patients had succumbed to disease and 120 (24·6%) patients had recurrent disease. Out of 120 recurrent cases loco-regional recurrence, nodal recurrence and distant metastases were seen in 62 (51·7%), 25 (20·8%), 33 (27·5%), respectively. In the entire study cohort at 2 year OS and DFS was 80 and 79% whereas 3 years OS and DFS was 70 and 75%, respectively.ConclusionsIn our study, 2 years and 3 years OS and DFS rates are found comparable to the international data with acceptable toxicity profile with the use of modulated RT. It seems to be possible because of stringent departmental protocols and good medical physics support. Our data re-validates need and benefit of advanced RT techniques like IG-IMRT and VMAT for both postoperative and radical HNC treatment at the cost of minimal long-term side effects. Future stringent follow-up and quality of life issues are being considered in a prospective manner.
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External validation of an NTCP model for acute esophageal toxicity in locally advanced NSCLC patients treated with intensity-modulated (chemo-)radiotherapy. Radiother Oncol 2018; 129:249-256. [DOI: 10.1016/j.radonc.2018.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/23/2018] [Accepted: 07/23/2018] [Indexed: 01/06/2023]
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Quality indicators in radiation oncology: proposal of the Spanish Society of Radiation Oncology (SEOR) for a continuous improvement of the quality of care in oncology. Clin Transl Oncol 2018; 21:519-533. [DOI: 10.1007/s12094-018-1943-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 09/02/2018] [Indexed: 10/28/2022]
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Alsuhaibani A, Elashwah A, Mahmood R, Abduljabbar A, Alhomoud S, Ashari L, Bazarbashi S, Aljubran A, Alzahrani A, Mohiuddin M, Almanea H, Alhussaini H, AlSanea N. Dose Escalation with Simultaneous Integrated Boost (SIB) Using Volumetric Modulated Arc Therapy (VMAT) in Rectal Cancer. J Gastrointest Cancer 2018; 50:10.1007/s12029-018-0133-0. [PMID: 30006679 DOI: 10.1007/s12029-018-0133-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Assess feasibility-rate of PCR, short-term toxicity after neoadjuvant concurrent chemoradiation (NACRT) delivered via simultaneous integrated boost (SIB) using volumetric modulated arc therapy (VMAT) technique for locally advanced rectal cancer. METHODS Retrospective evaluation of patients with locally advanced rectal cancer treated with VMAT-SIB technique preoperatively at an academic tertiary care center in Riyadh, Saudi Arabia between February 2013 and March 2017. RESULTS One hundred patients with depth of invasion staged as T3/T4 or T2 in 93 and seven patients, respectively. Lymph node metastasis was staged as N1/N2 or N0 in 87 and 13 patients, respectively. Circumferential radial margin (CRM) was involved radiologically prior to treatment in 50 patients. A dose of 55 or 50 Gy was given to 71 and 29 patients, respectively. All treatments were completed without interruption. Grade 3/4 toxicity was not observed. Low anterior resection and abdominoperineal resection were performed with negative proximal, distal, and radial margins in 72 and 28 patients, respectively. There were no immediate significant postoperative complications. Histologically, no residual tumor (grade 0) was noted in 20 patients (pCR). Regression grade 1, 2, and 3 were noted in 31, 34, and 15 patients. Average number of lymph nodes retrieved in the surgical specimen was 12 (range 6-22). Lymph nodes were negative for cancer in 80 patients. CONCLUSION Dose escalation with SIB-VMAT as NACRT for rectal cancer is feasible. Moreover, it can increase the rate of pathological complete response with a favorable toxicity profile. Clinical benefit of this approach needs to be validated in a larger cohort of patients with longer follow-up.
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Affiliation(s)
- Abdullah Alsuhaibani
- Oncology Center ,University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Ahmed Elashwah
- Section of Radiation Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
- Kasr Al-Eini Center of Clinical Oncology (NEMROCK), Cairo University, Cairo, Egypt
| | - Rana Mahmood
- Section of Radiation Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Alaa Abduljabbar
- Section of Colon and Rectal Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Samar Alhomoud
- Section of Colon and Rectal Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Luai Ashari
- Section of Colon and Rectal Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Section of Medical Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ali Aljubran
- Section of Medical Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ahmed Alzahrani
- Section of Medical Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Muhamed Mohiuddin
- Section of Radiation Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Hadeel Almanea
- Pathology and Laboratory Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Hussah Alhussaini
- Pathology and Laboratory Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Nasser AlSanea
- Section of Colon and Rectal Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Spirou SV, Basini M, Lascialfari A, Sangregorio C, Innocenti C. Magnetic Hyperthermia and Radiation Therapy: Radiobiological Principles and Current Practice †. NANOMATERIALS 2018; 8:nano8060401. [PMID: 29865277 PMCID: PMC6027353 DOI: 10.3390/nano8060401] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 02/07/2023]
Abstract
Hyperthermia, though by itself generally non-curative for cancer, can significantly increase the efficacy of radiation therapy, as demonstrated by in vitro, in vivo, and clinical results. Its limited use in the clinic is mainly due to various practical implementation difficulties, the most important being how to adequately heat the tumor, especially deep-seated ones. In this work, we first review the effects of hyperthermia on tissue, the limitations of radiation therapy and the radiobiological rationale for combining the two treatment modalities. Subsequently, we review the theory and evidence for magnetic hyperthermia that is based on magnetic nanoparticles, its advantages compared with other methods of hyperthermia, and how it can be used to overcome the problems associated with traditional techniques of hyperthermia.
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Affiliation(s)
- Spiridon V Spirou
- Department of Radiology, Sismanoglio General Hospital of Attica, Sismanogliou 1, Marousi 15126, Greece.
| | - Martina Basini
- Università degli Studi di Milano, Dipartimento di Fisica, Via Celoria 16, 20133 Milano, Italy.
| | - Alessandro Lascialfari
- Università degli Studi di Milano, Dipartimento di Fisica, Via Celoria 16, 20133 Milano, Italy.
| | - Claudio Sangregorio
- ICCOM-CNR via Madonna del Piano 10, 50019 Sesto Fiorentino, Italy.
- INSTM and Dept. Of Chemistry "U. Schiff", University of Florence, via della Lastruccia 3, 50019 Sesto Fiorentino, Italy.
| | - Claudia Innocenti
- ICCOM-CNR via Madonna del Piano 10, 50019 Sesto Fiorentino, Italy.
- INSTM and Dept. Of Chemistry "U. Schiff", University of Florence, via della Lastruccia 3, 50019 Sesto Fiorentino, Italy.
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Abstract
Over the last few decades, advances in radiation therapy technology have markedly improved radiation delivery. Advancements in treatment planning with the development of image-guided radiotherapy and techniques such as proton therapy, allow precise delivery of high doses of radiation conformed to the tumor. These advancements result in improved locoregional control while reducing radiation dose to surrounding normal tissue. The radiologic manifestations of these techniques can differ from radiation induced lung disease seen with traditional radiation therapy. Awareness of these radiologic manifestations and correlation with radiation treatment plans are important to differentiate expected radiation induced lung injury from recurrence, infection and drug toxicity.
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Spirou SV, Costa Lima SA, Bouziotis P, Vranješ-Djurić S, Efthimiadou EΚ, Laurenzana A, Barbosa AI, Garcia-Alonso I, Jones C, Jankovic D, Gobbo OL. Recommendations for In Vitro and In Vivo Testing of Magnetic Nanoparticle Hyperthermia Combined with Radiation Therapy. NANOMATERIALS (BASEL, SWITZERLAND) 2018; 8:E306. [PMID: 29734795 PMCID: PMC5977320 DOI: 10.3390/nano8050306] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/22/2018] [Accepted: 04/29/2018] [Indexed: 12/23/2022]
Abstract
Magnetic nanoparticle (MNP)-mediated hyperthermia (MH) coupled with radiation therapy (RT) is a novel approach that has the potential to overcome various practical difficulties encountered in cancer treatment. In this work, we present recommendations for the in vitro and in vivo testing and application of the two treatment techniques. These recommendations were developed by the members of Working Group 3 of COST Action TD 1402: Multifunctional Nanoparticles for Magnetic Hyperthermia and Indirect Radiation Therapy ("Radiomag"). The purpose of the recommendations is not to provide definitive answers and directions but, rather, to outline those tests and considerations that a researcher must address in order to perform in vitro and in vivo studies. The recommendations are divided into 5 parts: (a) in vitro evaluation of MNPs; (b) in vitro evaluation of MNP-cell interactions; (c) in vivo evaluation of the MNPs; (d) MH combined with RT; and (e) pharmacokinetic studies of MNPs. Synthesis and characterization of the MNPs, as well as RT protocols, are beyond the scope of this work.
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Affiliation(s)
- Spiridon V Spirou
- Department of Radiology, Sismanoglio General Hospital of Attica, Sismanogliou 1, Marousi 15126, Athens, Greece.
| | - Sofia A Costa Lima
- LAQV, REQUIMTE, Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, Porto 4050-313, Portugal.
| | - Penelope Bouziotis
- Institute of Nuclear & Radiological Sciences & Technology, Energy & Safety, National Center for Scientific Research "Demokritos", Aghia Paraskevi, Athens 15310, Greece.
| | - Sanja Vranješ-Djurić
- "Vinča" Institute of Nuclear Sciences, University of Belgrade, Belgrade 11351, Serbia.
| | - Eleni Κ Efthimiadou
- Inorganic Chemistry Laboratory, Chemistry Department, National and Kapodistrian University of Athens, Panepistimiopolis, Zografou 15784, Greece.
- Institute of Nanoscience and Nanotechnology, NCSR Demokritos, Agia Paraskevi Attikis, Athens 15310, Greece.
| | - Anna Laurenzana
- Department of Biomedical and Clinical Science "Mario Serio", University of Florence, 50134 Firenze, Italy.
| | - Ana Isabel Barbosa
- LAQV, REQUIMTE, Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, Porto 4050-313, Portugal.
| | - Ignacio Garcia-Alonso
- Department of Surgery, Radiology & Ph.M. University of the Basque Country, Bilbao E48940, Spain.
| | - Carlton Jones
- NanoTherics Ltd., Studio 3, Unit 3, Silverdale Enterprise Centre Kents Lane, Newcastle under Lyme ST5 6SR, UK.
| | - Drina Jankovic
- "Vinča" Institute of Nuclear Sciences, University of Belgrade, Belgrade 11351, Serbia.
| | - Oliviero L Gobbo
- School of Pharmacy and Pharmaceutical Sciences, Panoz Institute, Trinity College Dublin, D02PN40 Dublin, Ireland.
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