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Cheng SH, Lee SY, Lee HH. Harnessing the Power of Radiotherapy for Lung Cancer: A Narrative Review of the Evolving Role of Magnetic Resonance Imaging Guidance. Cancers (Basel) 2024; 16:2710. [PMID: 39123438 PMCID: PMC11311467 DOI: 10.3390/cancers16152710] [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: 06/27/2024] [Revised: 07/22/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
Compared with computed tomography (CT), magnetic resonance imaging (MRI) traditionally plays a very limited role in lung cancer management, although there is plenty of room for improvement in the current CT-based workflow, for example, in structures such as the brachial plexus and chest wall invasion, which are difficult to visualize with CT alone. Furthermore, in the treatment of high-risk tumors such as ultracentral lung cancer, treatment-associated toxicity currently still outweighs its benefits. The advent of MR-Linac, an MRI-guided radiotherapy (RT) that combines MRI with a linear accelerator, could potentially address these limitations. Compared with CT-based technologies, MR-Linac could offer superior soft tissue visualization, daily adaptive capability, real-time target tracking, and an early assessment of treatment response. Clinically, it could be especially advantageous in the treatment of central/ultracentral lung cancer, early-stage lung cancer, and locally advanced lung cancer. Increasing demands for stereotactic body radiotherapy (SBRT) for lung cancer have led to MR-Linac adoption in some cancer centers. In this review, a broad overview of the latest research on imaging-guided radiotherapy (IGRT) with MR-Linac for lung cancer management is provided, and development pertaining to artificial intelligence is also highlighted. New avenues of research are also discussed.
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Affiliation(s)
- Sarah Hsin Cheng
- Department of Clinical Education and Training, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Shao-Yun Lee
- Department of Medical Education, Taichung Veterans General Hospital, Taichung 407, Taiwan;
| | - Hsin-Hua Lee
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Ph.D. Program in Environmental and Occupational Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung 807, Taiwan
- Department of Radiation Oncology, Faculty of Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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Tengler B, Künzel LA, Hagmüller M, Mönnich D, Boeke S, Wegener D, Gani C, Zips D, Thorwarth D. Full daily re-optimization improves plan quality during online adaptive radiotherapy. Phys Imaging Radiat Oncol 2024; 29:100534. [PMID: 38298884 PMCID: PMC10827578 DOI: 10.1016/j.phro.2024.100534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 01/03/2024] [Accepted: 01/03/2024] [Indexed: 02/02/2024] Open
Abstract
Background and purpose Daily online treatment plan adaptation requires a fast workflow and planning process. Current online planning consists of adaptation of a predefined reference plan, which might be suboptimal in cases of large anatomic changes. The aim of this study was to investigate plan quality differences between the current online re-planning approach and a complete re-optimization. Material and methods Magnetic resonance linear accelerator reference plans for ten prostate cancer patients were automatically generated using particle swarm optimization (PSO). Adapted plans were created for each fraction using (1) the current re-planning approach and (2) full PSO re-optimization and evaluated overall compliance with institutional dose-volume criteria compared to (3) clinically delivered fractions. Relative volume differences between reference and daily anatomy were assessed for planning target volumes (PTV60, PTV57.6), rectum and bladder and correlated with dose-volume results. Results The PSO approach showed significantly higher adherence to dose-volume criteria than the reference approach and clinical fractions (p < 0.001). In 74 % of PSO plans at most one criterion failed compared to 56 % in the reference approach and 41 % in clinical plans. A fair correlation between PTV60 D98% and relative bladder volume change was observed for the reference approach. Bladder volume reductions larger than 50 % compared to the reference plan recurrently decreased PTV60 D98% below 56 Gy. Conclusion Complete re-optimization maintained target coverage and organs at risk sparing even after large anatomic variations. Re-planning based on daily magnetic resonance imaging was sufficient for small variations, while large variations led to decreasing target coverage and organ-at-risk sparing.
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Affiliation(s)
- Benjamin Tengler
- Section for Biomedical Physics. Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - Luise A. Künzel
- National Center for Tumor Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Markus Hagmüller
- Section for Biomedical Physics. Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - David Mönnich
- Section for Biomedical Physics. Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - Simon Boeke
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - Daniel Wegener
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - Cihan Gani
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - Daniela Thorwarth
- Section for Biomedical Physics. Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
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Ureba A, Toma-Dasu I, Lazzeroni M. Biologically guided automated treatment planning and evaluation: potential for treatment adaptation in head and neck cancer. Acta Oncol 2023; 62:1389-1393. [PMID: 37643087 DOI: 10.1080/0284186x.2023.2249221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Ana Ureba
- Department of Physics, Medical Radiation Physics, Stockholms Universitet, Stockholm, Sweden
- Department of Oncology-Pathology, Medical Radiation Physics, Karolinska Institutet, Stockholm, Sweden
| | - Iuliana Toma-Dasu
- Department of Physics, Medical Radiation Physics, Stockholms Universitet, Stockholm, Sweden
- Department of Oncology-Pathology, Medical Radiation Physics, Karolinska Institutet, Stockholm, Sweden
| | - Marta Lazzeroni
- Department of Physics, Medical Radiation Physics, Stockholms Universitet, Stockholm, Sweden
- Department of Oncology-Pathology, Medical Radiation Physics, Karolinska Institutet, Stockholm, Sweden
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Korreman SS, Behrens CP, Hansen VN, Thygesen J, Andersen TL. New technologies from bench to bedside - report from the Nordic association for clinical physics 2023 symposium. Acta Oncol 2023; 62:1157-1160. [PMID: 37916999 DOI: 10.1080/0284186x.2023.2262111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Stine Sofia Korreman
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Claus Preibisch Behrens
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Vibeke Nordmark Hansen
- Department of Oncology, Copenhagen University Hospital, - Rigshospitalet, Copenhagen, Denmark
| | - Jesper Thygesen
- Department of Clinical Engineering and Procurement, Central Denmark Region, Aarhus Denmark
| | - Thomas Lund Andersen
- Department of Clinical Physiology & Nuclear Medicine, Rigshospitalet, Copenhagen, Denmark
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Naser MA, Wahid KA, Ahmed S, Salama V, Dede C, Edwards BW, Lin R, McDonald B, Salzillo TC, He R, Ding Y, Abdelaal MA, Thill D, O'Connell N, Willcut V, Christodouleas JP, Lai SY, Fuller CD, Mohamed ASR. Quality assurance assessment of intra-acquisition diffusion-weighted and T2-weighted magnetic resonance imaging registration and contour propagation for head and neck cancer radiotherapy. Med Phys 2023; 50:2089-2099. [PMID: 36519973 PMCID: PMC10121748 DOI: 10.1002/mp.16128] [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: 12/21/2021] [Revised: 11/10/2022] [Accepted: 11/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND/PURPOSE Adequate image registration of anatomical and functional magnetic resonance imaging (MRI) scans is necessary for MR-guided head and neck cancer (HNC) adaptive radiotherapy planning. Despite the quantitative capabilities of diffusion-weighted imaging (DWI) MRI for treatment plan adaptation, geometric distortion remains a considerable limitation. Therefore, we systematically investigated various deformable image registration (DIR) methods to co-register DWI and T2-weighted (T2W) images. MATERIALS/METHODS We compared three commercial (ADMIRE, Velocity, Raystation) and three open-source (Elastix with default settings [Elastix Default], Elastix with parameter set 23 [Elastix 23], Demons) post-acquisition DIR methods applied to T2W and DWI MRI images acquired during the same imaging session in twenty immobilized HNC patients. In addition, we used the non-registered images (None) as a control comparator. Ground-truth segmentations of radiotherapy structures (tumour and organs at risk) were generated by a physician expert on both image sequences. For each registration approach, structures were propagated from T2W to DWI images. These propagated structures were then compared with ground-truth DWI structures using the Dice similarity coefficient and mean surface distance. RESULTS 19 left submandibular glands, 18 right submandibular glands, 20 left parotid glands, 20 right parotid glands, 20 spinal cords, and 12 tumours were delineated. Most DIR methods took <30 s to execute per case, with the exception of Elastix 23 which took ∼458 s to execute per case. ADMIRE and Elastix 23 demonstrated improved performance over None for all metrics and structures (Bonferroni-corrected p < 0.05), while the other methods did not. Moreover, ADMIRE and Elastix 23 significantly improved performance in individual and pooled analysis compared to all other methods. CONCLUSIONS The ADMIRE DIR method offers improved geometric performance with reasonable execution time so should be favoured for registering T2W and DWI images acquired during the same scan session in HNC patients. These results are important to ensure the appropriate selection of registration strategies for MR-guided radiotherapy.
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Affiliation(s)
- Mohamed A Naser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kareem A Wahid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sara Ahmed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vivian Salama
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cem Dede
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Benjamin W Edwards
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ruitao Lin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brigid McDonald
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Travis C Salzillo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Renjie He
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yao Ding
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Moamen Abobakr Abdelaal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | | | | | | | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Lee D, Alam S, Jiang J, Cervino L, Hu YC, Zhang P. Seq2Morph: A deep learning deformable image registration algorithm for longitudinal imaging studies and adaptive radiotherapy. Med Phys 2023; 50:970-979. [PMID: 36303270 PMCID: PMC10388694 DOI: 10.1002/mp.16026] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/25/2022] [Accepted: 10/02/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To simultaneously register all the longitudinal images acquired in a radiotherapy course for analyzing patients' anatomy changes for adaptive radiotherapy (ART). METHODS To address the unique needs of ART, we designed Seq2Morph, a novel deep learning-based deformable image registration (DIR) network. Seq2Morph was built upon VoxelMorph which is a general-purpose framework for learning-based image registration. The major upgrades are (1) expansion of inputs to all weekly cone-beam computed tomography (CBCTs) acquired for monitoring treatment responses throughout a radiotherapy course, for registration to their planning CT; (2) incorporation of 3D convolutional long short-term memory between the encoder and decoder of VoxelMorph, to parse the temporal patterns of anatomical changes; and (3) addition of bidirectional pathways to calculate and minimize inverse consistency errors (ICEs). Longitudinal image sets from 50 patients, including a planning CT and 6 weekly CBCTs per patient, were utilized for network training and cross-validation. The outputs were deformation vector fields for all the registration pairs. The loss function was composed of a normalized cross-correlation for image intensity similarity, a DICE for contour similarity, an ICE, and a deformation regularization term. For performance evaluation, DICE and Hausdorff distance (HD) for the manual versus predicted contours of tumor and esophagus on weekly basis were quantified and further compared with other state-of-the-art algorithms, including conventional VoxelMorph and large deformation diffeomorphic metric mapping (LDDMM). RESULTS Visualization of the hidden states of Seq2Morph revealed distinct spatiotemporal anatomy change patterns. Quantitatively, Seq2Morph performed similarly to LDDMM, but significantly outperformed VoxelMorph as measured by GTV DICE: (0.799±0.078, 0.798±0.081, and 0.773±0.078), and 50% HD (mm): (0.80±0.57, 0.88±0.66, and 0.95±0.60). The per-patient inference of Seq2Morph took 22 s, much less than LDDMM (∼30 min). CONCLUSIONS Seq2Morph can provide accurate and fast DIR for longitudinal image studies by exploiting spatial-temporal patterns. It closely matches the clinical workflow and has the potential to serve both online and offline ART.
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Affiliation(s)
- Donghoon Lee
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Sadegh Alam
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Jue Jiang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Laura Cervino
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Yu-Chi Hu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Pengpeng Zhang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA
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Gayol A, Malano F, Ribo Montenovo C, Pérez P, Valente M. Dosimetry Effects Due to the Presence of Fe Nanoparticles for Potential Combination of Hyperthermic Cancer Treatment with MRI-Based Image-Guided Radiotherapy. Int J Mol Sci 2022; 24:ijms24010514. [PMID: 36613959 PMCID: PMC9820326 DOI: 10.3390/ijms24010514] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/03/2022] [Accepted: 12/06/2022] [Indexed: 12/29/2022] Open
Abstract
Nanoparticles have proven to be biocompatible and suitable for many biomedical applications. Currently, hyperthermia cancer treatments based on Fe nanoparticle infusion excited by alternating magnetic fields are commonly used. In addition to this, MRI-based image-guided radiotherapy represents, nowadays, one of the most promising accurate radiotherapy modalities. Hence, assessing the feasibility of combining both techniques requires preliminary characterization of the corresponding dosimetry effects. The present work reports on a theoretical and numerical simulation feasibility study aimed at pointing out preliminary dosimetry issues. Spatial dose distributions incorporating magnetic nanoparticles in MRI-based image-guided radiotherapy have been obtained by Monte Carlo simulation approaches accounting for all relevant radiation interaction properties as well as charged particles coupling with strong external magnetic fields, which are representative of typical MRI-LINAC devices. Two main effects have been evidenced: local dose enhancement (up to 60% at local level) within the infused volume, and non-negligible changes in the dose distribution at the interfaces between different tissues, developing to over 70% for low-density anatomical cavities. Moreover, cellular uptakes up to 10% have been modeled by means of considering different Fe nanoparticle concentrations. A theoretical temperature-dependent model for the thermal enhancement ratio (TER) has been used to account for radiosensitization due to hyperthermia. The outcomes demonstrated the reliability of the Monte Carlo approach in accounting for strong magnetic fields and mass distributions from patient-specific anatomy CT scans to assess dose distributions in MRI-based image-guided radiotherapy combined with magnetic nanoparticles, while the hyperthermic radiosensitization provides further and synergic contributions.
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Affiliation(s)
- Amiel Gayol
- Instituto de Física E. Gaviola (IFEG), CONICET & Facultad de Matemática, Astronomía, Física y Computación (FAMAF), Universidad Nacional de Córdoba, Ciudad Universitaria, Córdoba 5000, Argentina
- Laboratorio de Investigación e Instrumentación en Física Aplicada a la Medicina e Imágenes por Rayos X (LIIFAMIRx), Facultad de Matemática, Astronomía, Física y Computación (FAMAF), Universidad Nacional de Córdoba, Ciudad Universitaria, Córdoba 5000, Argentina
| | - Francisco Malano
- Centro de Excelencia de Física e Ingeniería en Salud (CFIS), Departamento de Ciencias Físicas, Universidad de La Frontera, Av. Salazar 01145, Casilla 54D, Temuco 4811230, Chile
- Correspondence: (F.M.); (M.V.)
| | - Clara Ribo Montenovo
- Laboratorio de Investigación e Instrumentación en Física Aplicada a la Medicina e Imágenes por Rayos X (LIIFAMIRx), Facultad de Matemática, Astronomía, Física y Computación (FAMAF), Universidad Nacional de Córdoba, Ciudad Universitaria, Córdoba 5000, Argentina
| | - Pedro Pérez
- Instituto de Física E. Gaviola (IFEG), CONICET & Facultad de Matemática, Astronomía, Física y Computación (FAMAF), Universidad Nacional de Córdoba, Ciudad Universitaria, Córdoba 5000, Argentina
- Laboratorio de Investigación e Instrumentación en Física Aplicada a la Medicina e Imágenes por Rayos X (LIIFAMIRx), Facultad de Matemática, Astronomía, Física y Computación (FAMAF), Universidad Nacional de Córdoba, Ciudad Universitaria, Córdoba 5000, Argentina
| | - Mauro Valente
- Instituto de Física E. Gaviola (IFEG), CONICET & Facultad de Matemática, Astronomía, Física y Computación (FAMAF), Universidad Nacional de Córdoba, Ciudad Universitaria, Córdoba 5000, Argentina
- Laboratorio de Investigación e Instrumentación en Física Aplicada a la Medicina e Imágenes por Rayos X (LIIFAMIRx), Facultad de Matemática, Astronomía, Física y Computación (FAMAF), Universidad Nacional de Córdoba, Ciudad Universitaria, Córdoba 5000, Argentina
- Centro de Excelencia de Física e Ingeniería en Salud (CFIS), Departamento de Ciencias Físicas, Universidad de La Frontera, Av. Salazar 01145, Casilla 54D, Temuco 4811230, Chile
- Correspondence: (F.M.); (M.V.)
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Whiteside L, McDaid L, Hales RB, Rodgers J, Dubec M, Huddart RA, Choudhury A, Eccles CL. To see or not to see: Evaluation of magnetic resonance imaging sequences for use in MR Linac-based radiotherapy treatment. J Med Imaging Radiat Sci 2022; 53:362-373. [PMID: 35850925 DOI: 10.1016/j.jmir.2022.06.005] [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: 09/20/2021] [Revised: 06/01/2022] [Accepted: 06/20/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND/PURPOSE This work evaluated the suitability of MR derived sequences for use in online adaptive RT workflows on a 1.5 Tesla (T) MR-Linear Accelerator (MR Linac). MATERIALS/METHODS Non-patient volunteers were recruited to an ethics approved MR Linac imaging study. Participants attended 1-3 imaging sessions in which a combination of DIXON, 2D and 3D volumetric T1 and T2 weighted images were acquired axially, with volunteers positioned using immobilisation devices typical for radiotherapy to the anatomical region being scanned. Images from each session were appraised by three independent reviewers to determine optimal sequences over six anatomical regions: head and neck, female and male pelvis, thorax (lung), thorax (breast/chest wall) and abdomen. Site specific anatomical structures were graded by the perceived ability to accurately contour a typical organ at risk. Each structure was independently graded on a 4-point Likert scale as 'Very Clear', 'Clear', 'Unclear' or 'Not visible' by observers, consisting of radiographers (therapeutic and diagnostic) and clinicians. RESULTS From July 2019 to September 2019, 18 non-patient volunteers underwent 24 imaging sessions in the following anatomical regions: head and neck (n=3), male pelvis (n=4), female pelvis (n=5), lung/oesophagus (n=5) abdomen (n=4) and chest wall/breast (n=3). T2 sequences were the most preferred for perceived ability to contour anatomy in both male and female pelvis. For all other sites T1 weighted DIXON sequences were most favourable. CONCLUSION This study has determined the preferential sequence selection for organ visualisation, as a pre-requisite to our institution adopting MR-guided radiotherapy for a more diverse range of disease sites.
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Affiliation(s)
- Lee Whiteside
- The Christie NHS Foundation Trust, Department of Radiotherapy, Manchester, United Kingdom.
| | - Lisa McDaid
- The Christie NHS Foundation Trust, Department of Radiotherapy, Manchester, United Kingdom
| | - Rosie B Hales
- The Christie NHS Foundation Trust, Department of Radiotherapy, Manchester, United Kingdom
| | - John Rodgers
- The Christie NHS Foundation Trust, Department of Radiotherapy, Manchester, United Kingdom
| | - Michael Dubec
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, United Kingdom
| | - Robert A Huddart
- The Institute of Cancer Research, London UK; The Royal Marsden, London, United Kingdom
| | - Ananya Choudhury
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Department of Clinical Oncology, The Christie NHS Foundation Trust, United Kingdom
| | - Cynthia L Eccles
- The Christie NHS Foundation Trust, Department of Radiotherapy, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
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9
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Dong F, Weng X, Deng X, Yang Y, Xu B, Li X. Clinical utility of a new immobilization method in image-guided intensity-modulated radiotherapy for breast cancer patients after radical mastectomy. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2022; 30:641-655. [PMID: 35367978 DOI: 10.3233/xst-221127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate clinical utility of a new immobilization method in image-guided intensity-modulated radiotherapy (IMRT) for breast cancer patients after radical mastectomy. MATERIALS AND METHODS Forty patients with breast cancer who underwent radical mastectomy and postoperative IMRT were prospectively enrolled. The patients were randomly and equally divided into two groups using both a carbon-fiber support board and a hollowed-out cervicothoracic thermoplastic mask (Group A) and using only the board (Group B). An iSCOUT image-guided system was used for acquiring and correcting pretreatment setup errors for each treatment fraction. Initial setup errors and residual errors were obtained by aligning iSCOUT images with digitally reconstructed radiograph (DRR) images generated from planning CT. Totally 600 initial and residual errors were compared and analyzed between two groups, and the planning target volume (PTV) margins before and after the image-guided correction were calculated. RESULTS The initial setup errors of Group A and Group B were (3.14±3.07), (2.21±1.92), (2.45±1.92) mm and (3.14±2.97), (2.94±3.35), (2.80±2.47) mm in the left-right (LAT), superior-inferior (LONG), anterior-posterior (VERT) directions, respectively. The initial errors in Group A were smaller than those in Group B in the LONG direction (P < 0.05). No significant difference was found in the distribution of three initial error ranges (≤3 mm, 3-5 mm and > 5 mm) in each of the three translational directions for the two groups (P > 0.05). The residual errors of Group A and Group B were (1.74±1.03), (1.62±0.92), (1.66±0.91) mm and (1.70±0.97), (1.68±1.18), (1.58±0.98) mm in the three translational directions, respectively. No significant difference was found in the residual errors between two groups (P > 0.05). With the image-guided correction, PTV margins were reduced from 8.01, 5.44, 5.45 mm to 3.54, 2.99, 2.89 mm in three translational directions of Group A, respectively, and from 8.14, 10.89, 6.29 mm to 2.67, 3.64, 2.74 mm in those of Group B, respectively. CONCLUSION The use of hollowed-out cervicothoracic thermoplastic masks combined with a carbon-fiber support board showed better inter-fraction immobilization than the single use of the board in reducing longitudinal setup errors for breast cancer patients after radical mastectomy during IMRT treatment course, which has potential to reduce setup errors and improve the pretreatment immobilization accuracy for breast cancer IMRT after radical mastectomy.
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Affiliation(s)
- Fangfen Dong
- College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Fuzhou, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, China
| | - Xing Weng
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Fuzhou, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, China
| | - Xianzhi Deng
- College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
| | - Yong Yang
- College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Fuzhou, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, China
| | - Benhua Xu
- College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Fuzhou, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, China
| | - Xiaobo Li
- College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Fuzhou, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, China
- Department of Engineering Physics, Tsinghua University, Beijing, China
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10
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Kruis MF. Improving radiation physics, tumor visualisation, and treatment quantification in radiotherapy with spectral or dual-energy CT. J Appl Clin Med Phys 2021; 23:e13468. [PMID: 34743405 PMCID: PMC8803285 DOI: 10.1002/acm2.13468] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 12/11/2022] Open
Abstract
Over the past decade, spectral or dual‐energy CT has gained relevancy, especially in oncological radiology. Nonetheless, its use in the radiotherapy (RT) clinic remains limited. This review article aims to give an overview of the current state of spectral CT and to explore opportunities for applications in RT. In this article, three groups of benefits of spectral CT over conventional CT in RT are recognized. Firstly, spectral CT provides more information of physical properties of the body, which can improve dose calculation. Furthermore, it improves the visibility of tumors, for a wide variety of malignancies as well as organs‐at‐risk OARs, which could reduce treatment uncertainty. And finally, spectral CT provides quantitative physiological information, which can be used to personalize and quantify treatment.
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11
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de Leon J, Woods A, Twentyman T, Meade M, Sproule V, Chandran S, Christiansen J, Kennedy N, Marney M, Barooshian K, Plit M, Lynch J, Jagavkar R, Ormandy H, Christodouleas J, Pietzsch F, Chan M, Jameson MG. Analysis of data to Advance Personalised Therapy with MR-Linac (ADAPT-MRL). Clin Transl Radiat Oncol 2021; 31:64-70. [PMID: 34646950 PMCID: PMC8495756 DOI: 10.1016/j.ctro.2021.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 09/08/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Analysis of Data to Advance Personalised Therapy with MR-Linac (ADAPT-MRL) is a multi-site, multinational, observational cohort registry designed to collect data on the use of the magnetic resonance linear accelerator (MR-Linac) for radiation therapy and patient outcomes. The registry will provide a linked repository of technical and clinical data that will form a platform for prospective studies and technology assessment. METHODS Design: This registry aims to include an estimated 10,000 eligible participants across Australia and other countries over a 7- to 10-year period. Participants will undergo treatment and assessments in accordance with standard practice. Toxicity and survival outcomes will be assessed at baseline, during treatment, and with 3 monthly follow-up until 24 months, patient reported outcome measures will also be collected. Participants with a variety of cancers will be included. DISCUSSION Data obtained from the ADAPT-MRL registry is expected to provide evidence on the safety and efficacy of the MR-Linac, a new technical innovation in radiation oncology. We expect this registry will generate data that will be used to optimise treatment techniques, MR-Linac software algorithms, evaluate participants' outcomes and toxicities and to create a repository of adapted plans, anatomical and functional MR sequences linked to participants' outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - John Christodouleas
- Elekta AB, Stockholm, Sweden
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | | | | | - Michael G Jameson
- GenesisCare, Sydney, Australia
- University of New South Wales, Sydney, Australia
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12
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J F, A S, V E, F P, P M, B T, Sw W. New aspects and innovations in the local treatment of renal and urogenital pediatric tumors. Semin Pediatr Surg 2021; 30:151081. [PMID: 34412882 DOI: 10.1016/j.sempedsurg.2021.151081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Local treatment plays a key role for patients' outcome in tumors of the urogenital tract in children. Despite a great variety of different etiologies, the specific localization of pediatric urogenital tumors renders several characteristic demands to the treating personnel. Surgery and radiotherapy are the main elements of local treatment in this group of neoplasms. Numerous new guidelines and innovative technical developments of surgery and radiotherapy have recently been integrated into treatment concepts for pediatric urogenital tumors. Due to the broadness of the field it is not possible to give a full overview over all aspects. Therefore, this article highlights the most important innovations and new guidelines of surgery and radiotherapy of pediatric urogenital tumors.
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Affiliation(s)
- Fuchs J
- Department of Pediatric Surgery and Pediatric Urology, University Children´s Hospital Tuebingen, Tuebingen, Germany.
| | - Schmidt A
- Department of Pediatric Surgery and Pediatric Urology, University Children´s Hospital Tuebingen, Tuebingen, Germany
| | - Ellerkamp V
- Department of Pediatric Surgery and Pediatric Urology, University Children´s Hospital Tuebingen, Tuebingen, Germany
| | - Paulsen F
- Department of Radiation Oncology, University Hospital Tuebingen, Tuebingen, Germany
| | - Melchior P
- Department of Radiotherapy and Radiation Oncology, University Hospital, Homburg, Germany
| | - Timmermann B
- Department of Particle Therapy, West German Proton Therapy Centre, University Hospital Essen, Essen, Germany
| | - Warmann Sw
- Department of Pediatric Surgery and Pediatric Urology, University Children´s Hospital Tuebingen, Tuebingen, Germany
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13
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Local Control: Also a Strength of Radiotherapy Training? Clin Oncol (R Coll Radiol) 2021; 33:676-679. [PMID: 33902957 DOI: 10.1016/j.clon.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/25/2021] [Accepted: 04/08/2021] [Indexed: 12/30/2022]
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14
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Walls G, Cole A, McAleer J, Hanna G. A Qualitative Assessment of Radiotherapy Training at a UK Regional Cancer Centre. Clin Oncol (R Coll Radiol) 2021; 33:261-269. [DOI: 10.1016/j.clon.2020.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/11/2020] [Accepted: 10/29/2020] [Indexed: 12/27/2022]
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15
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Bitterman DS, Cagney DN, Singer LL, Nguyen PL, Catalano PJ, Mak RH. Master Protocol Trial Design for Efficient and Rational Evaluation of Novel Therapeutic Oncology Devices. J Natl Cancer Inst 2020; 112:229-237. [PMID: 31504680 PMCID: PMC7073911 DOI: 10.1093/jnci/djz167] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/26/2019] [Accepted: 08/14/2019] [Indexed: 12/12/2022] Open
Abstract
Historically, the gold standard for evaluation of cancer therapeutics, including medical devices, has been the randomized clinical trial. Although high-quality clinical data are essential for safe and judicious use of therapeutic oncology devices, class II devices require only preclinical data for US Food and Drug Administration approval and are often not rigorously evaluated prior to widespread uptake. Herein, we review master protocol design in medical oncology and its application to therapeutic oncology devices, using examples from radiation oncology. Unique challenges of clinical testing of radiation oncology devices (RODs) include patient and treatment heterogeneity, lack of funding for trials by industry and health-care payers, and operator dependence. To address these challenges, we propose the use of master protocols to optimize regulatory, financial, administrative, quality assurance, and statistical efficiency of trials evaluating RODs. These device-specific master protocols can be extrapolated to other devices and encompass multiple substudies with the same design, statistical considerations, logistics, and infrastructure. As a practical example, we outline our phase I and II master protocol trial of stereotactic magnetic resonance imaging–guided adaptive radiotherapy, which to the best of our knowledge is the first master protocol trial to test a ROD. Development of more efficient clinical trials is needed to promote thorough evaluation of therapeutic oncology devices, including RODs, in a resource-limited environment, allowing more practical and rapid identification of the most valuable advances in our field.
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Affiliation(s)
- Danielle S Bitterman
- Harvard Radiation Oncology Program, Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA.,Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Daniel N Cagney
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Lisa L Singer
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Paul J Catalano
- Department of Biostatistics & Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Raymond H Mak
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Walls G, McAleer JJ, Hanna GG. Perception of modern radiotherapy learning: study protocol for a mixed-methods analysis of trainees and trainers at a UK cancer centre. BMJ Open 2020; 10:e037171. [PMID: 32467255 PMCID: PMC7259837 DOI: 10.1136/bmjopen-2020-037171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Radiotherapy technology and postgraduate medical training have both evolved significantly over the last 20 years. Clinical Oncology is a recognised craft specialty where the apprenticeship model of clinical training is applicable. The challenges of learning radiotherapy in the modern radiotherapy department workplace have not been comprehensively described and no optimal method has been identified. METHODS AND ANALYSIS Five Clinical Oncology trainers and five Clinical Oncology trainees at a regional cancer centre will be invited to undertake a semistructured interview regarding their personal accounts of learning radiotherapy. Both trainees and consultants will be treated as equal co-investors in the process of radiotherapy learning, with the common shared aim of passing radiotherapy skills from trainers to trainees. Interviews will last up to 40 min. After transcription, an interpretative phenomenological analysis will be performed. All trainees and trainers at the same centre (n=34) will then be invited to complete the same purpose-built questionnaire. Four trainers and three trainees have piloted the questionnaire, and input was sought from the national leads of the biennial UK Clinical Oncology training survey. Significance testing will be performed on predefined questions and thematic analysis on white space questions. ETHICS AND DISSEMINATION Medical education research is evolving in Clinical Oncology and Radiation Oncology but there are few studies comprehensively assessing this from the viewpoint of trainees and trainers. Pending the success of the proposed study, the approach detailed represents a novel method that could be used to identify the strengths and weaknesses of radiotherapy training in other centres and settings. Ethical and governance approvals have been granted by the University Research Ethics Committee and the Integrated Research Application System, respectively. This study has been funded by Friends of the Cancer Centre.
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Affiliation(s)
- Gerard Walls
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, N. Ireland
- Cancer Centre, Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, N. Ireland
| | - James J McAleer
- Cancer Centre, Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, N. Ireland
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Gerard G Hanna
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, N. Ireland
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
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17
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Walls GM, Hanna GG, McAleer JJ. Learning radiotherapy: the state of the art. BMC MEDICAL EDUCATION 2020; 20:150. [PMID: 32393250 PMCID: PMC7216702 DOI: 10.1186/s12909-020-02054-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/27/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The last two decades have seen revolutionary developments in both radiotherapy technology and postgraduate medical training. Trainees are expected to attain competencies using a mix of experiential learning, formal postgraduate teaching, self-directed learning and peer education. Radiation (Clinical) Oncology is a recognised 'craft specialty' where the apprenticeship model of training is applicable. This scoping review examines the evidence in relation to how medical trainees learn radiotherapy. METHODS A systematic search of MEDINE and EMBASE was undertaken to identify studies of trainee and/or trainer experience of radiotherapy learning published 1999-2018. Results pertaining to Medical Oncology, workforce trends, undergraduate radiotherapy exposure, academic training, global health, non-medical staff, health service infrastructure and recruitment to training programmes were not included. RESULTS A total of 146 publications were included in the synthesis. Five themes were apparent through careful iterative analysis representing broadly inter-related issues. Most articles studied radiotherapy training from the perspective of the trainee doctor. Most literature reports results of observational, local or national surveys with a tightly defined scope. Considerable variation exists within hospitals, within countries, over time and between different curricular areas. CONCLUSIONS Medical education has not kept pace with changes in the field of radiotherapy and large differences are demonstrated in experience between trainees in different hospitals, countries and training stages. Interpersonal relationships, departmental organisation, and national curricula impact on training quality. Qualitative and quantitative research examining modern radiotherapy learning has been uncommon and uncoordinated, until recently. To date no single study has been designed to comprehensively assess a department's training scheme.
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Affiliation(s)
- Gerard M Walls
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, Northern Ireland.
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland.
| | - Gerard G Hanna
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - James J McAleer
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, Northern Ireland
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland
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18
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Andreozzi JM, Brůža P, Cammin J, Pogue BW, Gladstone DJ, Green O. Optical imaging method to quantify spatial dose variation due to the electron return effect in an MR-linac. Med Phys 2020; 47:1258-1267. [PMID: 31821573 PMCID: PMC7112467 DOI: 10.1002/mp.13954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 11/21/2019] [Accepted: 11/26/2019] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Treatment planning systems (TPSs) for MR-linacs must employ Monte Carlo-based simulations of dose deposition to model the effects of the primary magnetic field on dose. However, the accuracy of these simulations, especially for areas of tissue-air interfaces where the electron return effect (ERE) is expected, is difficult to validate due to physical constraints and magnetic field compatibility of available detectors. This study employs a novel dosimetric method based on remotely captured, real-time optical Cherenkov and scintillation imaging to visualize and quantify the ERE. METHODS An intensified CMOS camera was used to image two phantoms with designed ERE cavities. Phantom A was a 40 cm × 10 cm × 10 cm clear acrylic block drilled with five holes of increasing diameters (0.5, 1, 2, 3, 4 cm). Phantom B was a clear acrylic block (25 cm × 20 cm × 5 cm) with three cavities of increasing diameter (3, 2, 1 cm) split into two halves in the transverse plane to accommodate radiochromic film. Both phantoms were imaged while being irradiated by 6 MV flattening filter free (FFF) beams within a MRIdian Viewray (Viewray, Cleveland, OH) MR-linac (0.34 T primary field). Phantom A was imaged while being irradiated by 6 MV FFF beams on a conventional linac (TrueBeam, Varian Medical Systems, San Jose, CA) to serve as a control. Images were post processed in Matlab (Mathworks Inc., Natick, MA) and compared to TPS dose volumes. RESULTS Control imaging of Phantom A without the presence of a magnetic field supports the validity of the optical image data to a depth of 6 cm. In the presence of the magnetic field, the optical data shows deviations from the commissioned TPS dose in both intensity and localization. The largest air cavity examined (3 cm) indicated the largest dose differences, which were above 20% at some locations. Experiments with Phantom B illustrated similar agreement between optical and film dosimetry comparisons with TPS data in areas not affected by ERE. CONCLUSION There are some appreciable differences in dose intensity and spatial dose distribution observed between the novel experimental data set and the dose models produced by the current clinically implemented MR-IGRT TPS.
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Affiliation(s)
- Jacqueline M. Andreozzi
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755, USA
- Current: Department of Radiation Oncology, University of Florida, Gainesville, Florida 32608
| | - Petr Brůža
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755, USA
| | - Jochen Cammin
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
| | - Brian W. Pogue
- Thayer School of Engineering and Department of Physics and Astronomy, Dartmouth College, Hanover, New Hampshire 03755, USA
| | - David J. Gladstone
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, Geisel School of Medicine and Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755, USA
| | - Olga Green
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Chin S, Eccles CL, McWilliam A, Chuter R, Walker E, Whitehurst P, Berresford J, Van Herk M, Hoskin PJ, Choudhury A. Magnetic resonance-guided radiation therapy: A review. J Med Imaging Radiat Oncol 2020; 64:163-177. [PMID: 31646742 DOI: 10.1111/1754-9485.12968] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/24/2019] [Indexed: 12/11/2022]
Abstract
Magnetic resonance-guided radiation therapy (MRgRT) is a promising approach to improving clinical outcomes for patients treated with radiation therapy. The roles of image guidance, adaptive planning and magnetic resonance imaging in radiation therapy have been increasing over the last two decades. Technical advances have led to the feasible combination of magnetic resonance imaging and radiation therapy technologies, leading to improved soft-tissue visualisation, assessment of inter- and intrafraction motion, motion management, online adaptive radiation therapy and the incorporation of functional information into treatment. MRgRT can potentially transform radiation oncology by improving tumour control and quality of life after radiation therapy and increasing convenience of treatment by shortening treatment courses for patients. Multiple groups have developed clinical implementations of MRgRT predominantly in the abdomen and pelvis, with patients having been treated since 2014. While studies of MRgRT have primarily been dosimetric so far, an increasing number of trials are underway examining the potential clinical benefits of MRgRT, with coordinated efforts to rigorously evaluate the benefits of the promising technology. This review discusses the current implementations, studies, potential benefits and challenges of MRgRT.
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Affiliation(s)
- Stephen Chin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Cynthia L Eccles
- Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Alan McWilliam
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Robert Chuter
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Emma Walker
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Philip Whitehurst
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Joseph Berresford
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Marcel Van Herk
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Peter J Hoskin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Ananya Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
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Brown S, Banfill K, Aznar MC, Whitehurst P, Faivre Finn C. The evolving role of radiotherapy in non-small cell lung cancer. Br J Radiol 2019; 92:20190524. [PMID: 31535580 PMCID: PMC6913359 DOI: 10.1259/bjr.20190524] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/06/2019] [Accepted: 08/30/2019] [Indexed: 12/12/2022] Open
Abstract
Lung cancer is the most commonly diagnosed cancer and biggest cause of cancer mortality worldwide with non-small cell lung cancer (NSCLC) accounting for most cases. Radiotherapy (RT) plays a key role in its management and is used at least once in over half of patients in both curative and palliative treatments. This narrative review will demonstrate how the evolution of RT for NSCLC has been underpinned by improvements in RT technology. These improvements have facilitated geometric individualization, increasingly accurate treatment and now offer the ability to deliver truly individualized RT. In this review, we summarize and discuss recent developments in the field of advanced RT in early stage, locally advanced and metastatic NSCLC. We highlight limitations in current approaches and discuss future potential treatment strategies for patients with NSCLC.
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Affiliation(s)
- Sean Brown
- The Christie NHS Foundation Trust, Manchester, UK, Manchester, UK
| | | | | | - Philip Whitehurst
- Christie Medical Physics and Engineering (CMPE), The Christie NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
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Abstract
CLINICAL ISSUE Successful radiotherapy requires precise localization of the tumor and requires high-quality imaging for developing a treatment plan. STANDARD TREATMENT Irradiation of the tumor region, including a safety margin. TREATMENT INNOVATIONS The target volume consists of the gross tumor volume (GTV) containing visible parts of the tumor, the clinical target volume (CTV) covering the GTV plus invisible tumor extensions, and the planning target volume (PTV) to account for uncertainties. The non-GTV parts of the CTV are based on historical patient data. The PTV margins are based on a calculation of possible uncertainties during planning, setup, or treatment. Normal tissue deserves the identical care in contouring, since its tolerance may limit the tumor dose, taking into account the contours of organs at risk. Serial risk organs benefit from defining a planning organ of risk volume (PRV) to better limit the dose delivered to them. DIAGNOSTIC WORK-UP The better the imaging, the more reliable the definition of the GTV and treatment success will be. Multiple imaging sequences are desirable to support the delineation of the tumor. They may result in different CTVs that, depending on their tumor burden, may require different doses. PERFORMANCE The definition of standardized target volumes according to the ICRU reports 50, 62, and 83 forms the basis for an individualized radiation treatment planning according to unified criteria on a high-quality level. ACHIEVEMENTS Radio-oncology is by nature interdisciplinary, the diagnostic radiologist being an indispensable team partner. A regular dialogue between the disciplines is pivotal for target volume definition and treatment success. PRACTICAL RECOMMENDATIONS Imaging for target volume definition requires highest quality imaging, the use of functional imaging methods and close cooperation with a diagnostic radiologist experienced in this field.
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Wu VWC, Ng APL, Cheung EKW. Intrafractional motion management in external beam radiotherapy. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:1071-1086. [PMID: 31476194 DOI: 10.3233/xst-180472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The recent advancements in radiotherapy technologies have made delivery of the highly conformal dose to the target volume possible. With the increasing popularity of delivering high dose per fraction in modern radiotherapy schemes such as in stereotactic body radiotherapy and stereotactic body ablative therapy, high degree of treatment precision is essential. In order to achieve this, we have to overcome the potential difficulties caused by patient instability due to immobilization problems; patient anxiety and random motion due to prolonged treatment time; tumor deformation and baseline shift during a treatment course. This is even challenging for patients receiving radiotherapy in the chest and abdominal regions because it is affected by the patient's respiration which inevitably leads to tumor motion. Therefore, monitoring of intrafractional motion has become increasingly important in modern radiotherapy. Major intrafractional motion management strategies including integration of respiratory motion in treatment planning; breath-hold technique; forced shallow breathing with abdominal compression; respiratory gating and dynamic real-time tumor tracking have been developed. Successful intrafractional motion management is able to reduce the planning target margin and ensures planned dose delivery to the target and organs at risk. Meanwhile, the emergency of MRI-linear accelerator has facilitated radiation-free real-time monitoring of soft tissue during treatment and could be the future modality in motion management. This review article summarizes the various approaches that deal with intrafractional target, organs or patient motion with discussion of their advantages and limitations. In addition, the potential future advancements including MRI-based tumor tracking are also discussed.
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Affiliation(s)
- Vincent W C Wu
- Department of Health Technology & Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Amanda P L Ng
- Department of Health Technology & Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Emily K W Cheung
- Department of Health Technology & Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Walls GM, Hanna GG, Qi F, Zhao S, Xia J, Ansari MT, Landau D. Predicting Outcomes From Radical Radiotherapy for Non-small Cell Lung Cancer: A Systematic Review of the Existing Literature. Front Oncol 2018; 8:433. [PMID: 30364202 PMCID: PMC6191477 DOI: 10.3389/fonc.2018.00433] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/17/2018] [Indexed: 12/23/2022] Open
Abstract
Radical radiotherapy (RT) is a potentially curative treatment in non-small cell lung cancer (NSCLC) and is delivered in conventional 2-Gy fractions, hypofractionated and ablative stereotactic courses. No reliable, predictive biomarkers for the clinical events of local control, appearance of distant metastases and development of toxicity have been introduced in routine clinical practice. Such a test would enable the Radiotherapist to tailor the clinical management of individual patients, considering their pre-treatment characteristics, in order reduce the risk of recurrence or toxicity e.g., dose modification, accelerated fractionation, hypofractionation, or concurrent systemic therapy. The aim of this review was to map the published literature relating to investigations of the potential predictive value of patient or treatment characteristics in radical RT for NSCLC. These investigations should remain a research focus for disease control given the upward trends in lung cancer incidence, and for the avoidance of toxicity, given the survivorship afforded to the cohort of patients that do well with radical RT, or with the increasing range of systemic agents following metastatic relapse. The conclusion of the presented analysis is that there are no published, effective and validated predictive tools for estimation of risk of local/distant recurrence or toxicity after radical RT for NSCLC. The authors have identified an important space for future research in the field of lung cancer radiotherapy.
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Affiliation(s)
- Gerard M Walls
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, United Kingdom.,Cancer Centre Belfast City Hospital, Belfast, United Kingdom
| | - Gerard G Hanna
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, United Kingdom.,Cancer Centre Belfast City Hospital, Belfast, United Kingdom
| | - Fang Qi
- Systematic Review Solutions Ltd, The Ingenuity Centre, Nottingham, United Kingdom
| | - Sai Zhao
- Systematic Review Solutions Ltd, The Ingenuity Centre, Nottingham, United Kingdom
| | - Jun Xia
- Department of Global Health & Social Medicine, Faculty of Social Science & Public Policy, King's College London, London, United Kingdom
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - David Landau
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,King's College London, Strand, London, United Kingdom
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Apport du guidage par l’image pour le repositionnement au cours de la radiothérapie des tumeurs encéphaliques. Cancer Radiother 2018; 22:593-601. [DOI: 10.1016/j.canrad.2018.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 06/29/2018] [Indexed: 11/20/2022]
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Noble DJ, Burnet NG. The future of image-guided radiotherapy-is image everything? Br J Radiol 2018; 91:20170894. [PMID: 29616822 PMCID: PMC6221761 DOI: 10.1259/bjr.20170894] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/19/2018] [Accepted: 03/28/2018] [Indexed: 12/31/2022] Open
Abstract
MR-based image-guided (IG) radiotherapy via all-in-one MR treatment units (MR-linacs) is one of the hottest topics in contemporary radiotherapy research. From ingenious engineering solutions to complex physical problems, researchers have developed machines with the promise of superior image quality, and all the advantages this may confer. Benefits include better tumour visualisation, online adaptation and the potential for image biomarker-based personalised RT. However, it is important to remember that the technical challenges are real. In many instances, they are skillfully managed rather than abolished, a point illustrated by the wide variety of MR-linac designs. The proposed benefits also deserve careful inspection. Better visibility of the primary tumour on an IG scan cannot be bad, but does not automatically equate to better IG, which often depends on a more generalised match to daily anatomy. MR-linac will undoubtedly be a rich milieu to search for IMBs, but these will need to be carefully validated, and similar work with CT-based biomarkers using existing, cheaper, and more widely available hardware is currently ongoing. Online adaptation is an attractive concept, but practicalities are complex, and more work is required to understand which patients will benefit from plan adaptation, and when. Finally, the issue of cost cannot be overlooked, nor can the research community's responsibilities to global healthcare inequalities. MR-linac is an exciting and ingenious technology, which merits both investment and research. It may not, however, have the future to itself.
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Pathmanathan AU, van As NJ, Kerkmeijer LGW, Christodouleas J, Lawton CAF, Vesprini D, van der Heide UA, Frank SJ, Nill S, Oelfke U, van Herk M, Li XA, Mittauer K, Ritter M, Choudhury A, Tree AC. Magnetic Resonance Imaging-Guided Adaptive Radiation Therapy: A "Game Changer" for Prostate Treatment? Int J Radiat Oncol Biol Phys 2018; 100:361-373. [PMID: 29353654 DOI: 10.1016/j.ijrobp.2017.10.020] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/09/2017] [Accepted: 10/12/2017] [Indexed: 01/25/2023]
Abstract
Radiation therapy to the prostate involves increasingly sophisticated delivery techniques and changing fractionation schedules. With a low estimated α/β ratio, a larger dose per fraction would be beneficial, with moderate fractionation schedules rapidly becoming a standard of care. The integration of a magnetic resonance imaging (MRI) scanner and linear accelerator allows for accurate soft tissue tracking with the capacity to replan for the anatomy of the day. Extreme hypofractionation schedules become a possibility using the potentially automated steps of autosegmentation, MRI-only workflow, and real-time adaptive planning. The present report reviews the steps involved in hypofractionated adaptive MRI-guided prostate radiation therapy and addresses the challenges for implementation.
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Affiliation(s)
- Angela U Pathmanathan
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
| | - Nicholas J van As
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
| | | | | | | | - Danny Vesprini
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Steven J Frank
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Simeon Nill
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
| | - Uwe Oelfke
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
| | - Marcel van Herk
- Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Science Centre, The Christie National Health Service Foundation Trust, Manchester, United Kingdom; National Institute of Health Research, Manchester Biomedical Research Centre, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - X Allen Li
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kathryn Mittauer
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Mark Ritter
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ananya Choudhury
- Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Science Centre, The Christie National Health Service Foundation Trust, Manchester, United Kingdom; National Institute of Health Research, Manchester Biomedical Research Centre, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.
| | - Alison C Tree
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
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Brochu F, Romanchikova M, Thomas SJ, Hoole ACF, Noble DJ, Simmons MPD, Gurnell M, Parker MA, Burnet NG. Reduction in Total Radiation Exposure Using X-ray Image Guidance Illustrated in a Patient Receiving Pituitary Radiotherapy. Clin Oncol (R Coll Radiol) 2017; 30:199-200. [PMID: 29254603 DOI: 10.1016/j.clon.2017.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 12/01/2017] [Indexed: 11/29/2022]
Affiliation(s)
- F Brochu
- University of Cambridge, Department of Physics, Cavendish Laboratory, Cambridge, UK; University of Cambridge, Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - M Romanchikova
- Department of Medical Physics and Clinical Engineering, Addenbrooke's Hospital, Cambridge, UK
| | - S J Thomas
- Department of Medical Physics and Clinical Engineering, Addenbrooke's Hospital, Cambridge, UK
| | - A C F Hoole
- Department of Medical Physics and Clinical Engineering, Addenbrooke's Hospital, Cambridge, UK
| | - D J Noble
- University of Cambridge, Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - M P D Simmons
- University of Cambridge, Department of Physics, Cavendish Laboratory, Cambridge, UK
| | - M Gurnell
- Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research, Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - M A Parker
- University of Cambridge, Department of Physics, Cavendish Laboratory, Cambridge, UK
| | - N G Burnet
- University of Cambridge, Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
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