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Salazar RM, Duryea JD, Leone AO, Nair SS, Mumme RP, De B, Corrigan KL, Rooney MK, Das P, Holliday EB, Court LE, Niedzielski JS. Random Forest Modeling of Acute Toxicity in Anal Cancer: Effects of Peritoneal Cavity Contouring Approaches on Model Performance. Int J Radiat Oncol Biol Phys 2024; 118:554-564. [PMID: 37619789 DOI: 10.1016/j.ijrobp.2023.08.042] [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: 11/28/2022] [Revised: 08/04/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE Our purpose was to analyze the effect on gastrointestinal (GI) toxicity models when their dose-volume metrics predictors are derived from segmentations of the peritoneal cavity after different contouring approaches. METHODS AND MATERIALS A random forest machine learning approach was used to predict acute grade ≥3 GI toxicity from dose-volume metrics and clinicopathologic factors for 246 patients (toxicity incidence = 9.5%) treated with definitive chemoradiation for squamous cell carcinoma of the anus. Three types of random forest models were constructed based on different bowel bag segmentation approaches: (1) physician-delineated after Radiation Therapy Oncology Group (RTOG) guidelines, (2) autosegmented by a deep learning model (nnU-Net) following RTOG guidelines, and (3) autosegmented but spanning the entire bowel space. Each model type was evaluated using repeated cross-validation (100 iterations; 50%/50% training/test split). The performance of the models was assessed using area under the precision-recall curve (AUPRC) and the receiver operating characteristic curve (AUROCC), as well as optimal F1 score. RESULTS When following RTOG guidelines, the models based on the nnU-Net auto segmentations (mean values: AUROCC, 0.71 ± 0.07; AUPRC, 0.42 ± 0.09; F1 score, 0.46 ± 0.08) significantly outperformed (P < .001) those based on the physician-delineated contours (mean values: AUROCC, 0.67 ± 0.07; AUPRC, 0.34 ± 0.08; F1 score, 0.36 ± 0.07). When spanning the entire bowel space, the performance of the autosegmentation models improved considerably (mean values: AUROCC, 0.87 ± 0.05; AUPRC, 0.70 ± 0.09; F1 score, 0.68 ± 0.09). CONCLUSIONS Random forest models were superior at predicting acute grade ≥3 GI toxicity when based on RTOG-defined bowel bag autosegmentations rather than physician-delineated contours. Models based on autosegmentations spanning the entire bowel space show further considerable improvement in model performance. The results of this study should be further validated using an external data set.
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Affiliation(s)
- Ramon M Salazar
- Department of Radiation Physics, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Jack D Duryea
- Department of Radiation Physics, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Alexandra O Leone
- Department of Radiation Physics, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Saurabh S Nair
- Department of Radiation Physics, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Raymond P Mumme
- Department of Radiation Physics, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Brian De
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Kelsey L Corrigan
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Michael K Rooney
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Prajnan Das
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Emma B Holliday
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Laurence E Court
- Department of Radiation Physics, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Joshua S Niedzielski
- Department of Radiation Physics, The University of Texas, MD Anderson Cancer Center, Houston, Texas.
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Patient-reported bowel and urinary function in long-term survivors of squamous cell carcinoma of the anus treated with definitive intensity-modulated radiotherapy and concurrent chemotherapy. Int J Radiat Oncol Biol Phys 2022; 114:78-88. [DOI: 10.1016/j.ijrobp.2022.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/30/2022] [Accepted: 05/07/2022] [Indexed: 11/22/2022]
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Nilsson MP, Gunnlaugsson A, Johnsson A, Scherman J. Dosimetric and Clinical Predictors for Acute and Late Gastrointestinal Toxicity Following Chemoradiotherapy of Locally Advanced Anal Cancer. Clin Oncol (R Coll Radiol) 2021; 34:e35-e44. [PMID: 34598844 DOI: 10.1016/j.clon.2021.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/04/2021] [Accepted: 09/16/2021] [Indexed: 11/03/2022]
Abstract
AIMS To analyse dosimetric and clinical predictors for acute and late gastrointestinal toxicity following chemoradiotherapy of anal cancer. MATERIALS AND METHODS Consecutive patients with locally advanced (T2 ≥4 cm - T4 or N+) anal cancer were selected from an institutional database (n = 114). All received intensity-modulated radiotherapy with concomitant 5-fluorouracil and mitomycin C. Gastrointestinal toxicity was retrospectively graded according to Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 and bowel cavity, small bowel and large bowel were contoured. Dosimetric and clinical variables were tested for associations with acute grade ≥3 gastrointestinal toxicity and late grade ≥2 gastrointestinal toxicity using the Mann-Whitney test, area under receiver operating characteristic curve (AUC) and logistic regression. RESULTS The median follow-up was 40 months. Acute grade ≥3 gastrointestinal toxicity was seen in 51 (44.7%) of the patients; late grade ≥2 gastrointestinal toxicity was seen in 36 of the patients (39.6% of 91 patients with >1 year recurrence-free follow-up). Bowel cavity V30Gy was the best dosimetric predictor for acute gastrointestinal toxicity (AUC 0.633; P = 0.02). Large bowel V20Gy was the best dosimetric predictor for late gastrointestinal toxicity (AUC 0.698; P = 0.001) but showed no association with acute gastrointestinal toxicity. In multivariate logistic regression, increasing age was significantly associated with acute gastrointestinal toxicity; smoking and large bowel V20Gy were significantly associated with late gastrointestinal toxicity. Patients who experienced acute grade ≥3 gastrointestinal toxicity were not at an increased risk of late grade ≥2 gastrointestinal toxicity (odds ratio 1.3; P = 0.55). CONCLUSIONS Factors of importance for acute and late gastrointestinal toxicity were not the same. Bowel cavity V30Gy is a good metric to use for the prediction of acute gastrointestinal toxicity, but the results of our study indicate that individual large and small bowel loops need to be contoured for better prediction of late gastrointestinal toxicity. The role of the large bowel as an important organ at risk for late gastrointestinal toxicity merits further research.
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Affiliation(s)
- M P Nilsson
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.
| | - A Gunnlaugsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - A Johnsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - J Scherman
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
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Kim KS, Cheong KH, Kim K, Koo T, Koh HK, Chang JH, Chang AR, Park HJ. Interobserver variability in clinical target volume delineation in anal squamous cell carcinoma. Sci Rep 2021; 11:2785. [PMID: 33531643 PMCID: PMC7854655 DOI: 10.1038/s41598-021-82541-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 01/20/2021] [Indexed: 12/24/2022] Open
Abstract
We evaluated the inter-physician variability in the target contouring of the radiotherapy for anal squamous cell carcinoma (ASCC). Clinical target volume (CTV) of three patients diagnosed with ASCC was delineated by seven experienced radiation oncologists from multi-institution. These patients were staged as pT1N1a, cT2N0, and cT4N1a, respectively, according to 8th edition of the American Joint Committee on Cancer staging system. Expert agreement was quantified using an expectation maximization algorithm for Simultaneous Truth and Performance Level Estimation (STAPLE). The maximum distance from the boundaries of the STAPLE generated volume with confidence level of 80% to those of the contour of each CTV in 6 directions was compared. CTV of pelvis which includes primary tumor, perirectal tissue and internal/external iliac lymph node (LN) area (CTV-pelvis) and CTV of inguinal area (CTV-inguinal) were obtained from the seven radiation oncologists. One radiation oncologist did not contain inguinal LN area in the treatment target volume of patient 2 (cT2N0 stage). CTV-inguinal displayed moderate agreement for each patient (overall kappa 0.58, 0.54 and 0.6, respectively), whereas CTV-pelvis showed substantial agreement (overall kappa 0.66, 0.68 and 0.64, respectively). Largest variation among each contour was shown in the inferior margin of the CTV-inguinal. For CTV-pelvis, anterior and superior margin showed the biggest variation. Overall, moderate to substantial agreement was shown for CTV delineation. However, large variations in the anterior and cranial boarder of the CTV-pelvis and the caudal margin of the CTV-inguinal suggest that further studies are needed to establish a clearer target volume delineation guideline.
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Affiliation(s)
- Kyung Su Kim
- Department of Radiation Oncology, Dongnam Institute of Radiological and Medical Sciences, Busan, Republic of Korea.,Department of Radiation Oncology, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro Yangcheon-gu, Seoul, 07985, Republic of Korea
| | - Kwang-Ho Cheong
- Department of Radiation Oncology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro Yangcheon-gu, Seoul, 07985, Republic of Korea.
| | - Taeryool Koo
- Department of Radiation Oncology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Hyeon Kang Koh
- Department of Radiation Oncology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Ji Hyun Chang
- Department of Radiation Oncology, Seoul Metropolitan Government, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Ah Ram Chang
- Department of Radiation Oncology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Hae Jin Park
- Department of Radiation Oncology, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
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Bogach J, Fenech D, Chu W, Ashamalla S, Ung Y, Taggar AS, Chan KKW, Earle CC, Wong CS. Salvage surgery for locally recurrent anal cancer after intensity modulated radiation therapy with concurrent chemotherapy. Cancer Treat Res Commun 2020; 26:100287. [PMID: 33360327 DOI: 10.1016/j.ctarc.2020.100287] [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: 09/29/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Chemoradiation (CRT) with intensity modulated radiation treatment (IMRT) has become the standard for anal cancer. In patients who fail this treatment modality, salvage surgery with abdominal perineal resection can result in long term cancer control. We aimed to evaluate a single centre's experience of salvage surgery for local recurrence since the introduction of IMRT. MATERIALS AND METHODS A retrospective chart review was performed of all patients who underwent definitive CRT for anal carcinoma at a single tertiary referral center since IMRT became standard in 2009. Patients with recurrent or persistent disease after treatment who underwent salvage surgery were included. Details of CRT, salvage surgery and surgical complications, patterns of recurrence after surgery, and survival data were collected and described. RESULTS Between 2009-2018, 181 patients underwent definitive treatment using IMRT for anal carcinoma. Of 26 patients who had locoregional recurrent or persistent disease, 14 underwent salvage surgery. Nine had multi-visceral resection and 8 required autologous flap reconstruction. Twelve patients had resections with clear margins and 2 had microscopic positive margins. Twelve patients (86%) experienced post-operative complications, and eight (57%) had perineal wound complications. After salvage, four patients (29%) recurred locally. None of the 8 patients with rpT2 disease recurred. After salvage surgery, 5-year disease free survival was 68.4% and 5-year overall survival was 75%. CONCLUSION Following IMRT based chemoradiation, salvage surgery has high rates of surgical complications; however disease free and overall survival results are excellent particularly for small recurrences.
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Affiliation(s)
- Jessica Bogach
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Darlene Fenech
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - William Chu
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Shady Ashamalla
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Yee Ung
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Amandeep S Taggar
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Kelvin K W Chan
- Division of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Craig C Earle
- Division of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - C Shun Wong
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
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Muirhead R, Bulte D, Cooke R, Chu KY, Durrant L, Goh V, Jacobs C, Ng SM, Strauss VY, Virdee PS, Qi C, Hawkins MA. A Prospective Study of Diffusion-weighted Magnetic Resonance Imaging as an Early Prognostic Biomarker in Chemoradiotherapy in Squamous Cell Carcinomas of the Anus. Clin Oncol (R Coll Radiol) 2020; 32:874-883. [PMID: 33023818 DOI: 10.1016/j.clon.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/15/2020] [Accepted: 09/03/2020] [Indexed: 12/11/2022]
Abstract
AIMS The use of diffusion-weighted magnetic resonance imaging (DW-MRI) as a prognostic marker of treatment response would enable early individualisation of treatment. We aimed to quantify the changes in mean apparent diffusion coefficient (ΔADCmean) between a DW-MRI at diagnosis and on fraction 8-10 of chemoradiotherapy (CRT) as a biomarker for cellularity, and correlate these with anal squamous cell carcinoma recurrence. MATERIALS AND METHODS This prospective study recruited patients with localised anal cancer between October 2014 and November 2017. DW-MRI was carried out at diagnosis and after fraction 8-10 of radical CRT. A region of interest was delineated for all primary tumours and any lymph nodes >2 cm on high-resolution T2-weighted images and propagated to the ADC map. Routine clinical follow-up was collected from Nation Health Service electronic systems. RESULTS Twenty-three of 29 recruited patients underwent paired DW-MRI scans. Twenty-six regions of interest were delineated among the 23 evaluable patients. The median (range) tumour volume was 13.6 cm3 (2.8-84.9 cm3). Ten of 23 patients had lesions with ΔADCmean ≤ 20%. With a median follow-up of 41.2 months, four patients either failed to have a complete response to CRT or subsequently relapsed. Three of four patients with disease relapse had lesions demonstrating ΔADCmean <20%, the other patient with persistent disease had ΔADCmean of 20.3%. CONCLUSIONS We demonstrated a potential correlation between patients with ΔADCmean <20% and disease relapse. Further investigation of the prognostic merit of DW-MRI change is needed in larger, prospective cohorts.
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Affiliation(s)
- R Muirhead
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - D Bulte
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - R Cooke
- Radiotherapy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - K-Y Chu
- Radiotherapy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | - L Durrant
- Radiotherapy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | - V Goh
- Cancer Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - C Jacobs
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S M Ng
- Oncology Clinical Trials Office, Department of Oncology, University of Oxford, Oxford, UK
| | - V Y Strauss
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - P S Virdee
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - C Qi
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - M A Hawkins
- Radiotherapy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Garda AE, Navin PJ, Merrell KW, Martenson JA, Neben Wittich MA, Haddock MG, Sio TT, Rule WG, Ashman JB, Sheedy SP, Hallemeier CL. Patterns of inguinal lymph node metastases in anal canal cancer and recommendations for elective clinical target volume (CTV) delineation. Radiother Oncol 2020; 149:128-133. [DOI: 10.1016/j.radonc.2020.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/02/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
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Rotundo MS, Zampino MG, Ravenda PS, Bagnardi V, Peveri G, Dell'Acqua V, Surgo A, Trovato C, Bottiglieri L, Bertani E, Petz WL, Fumagalli Romario U, Fazio N. Cisplatin plus capecitabine concomitant with intensity-modulated radiation therapy in non-metastatic anal squamous cell carcinoma: the experience of a single research cancer center. Ther Adv Med Oncol 2020; 12:1758835920940945. [PMID: 32728394 PMCID: PMC7364808 DOI: 10.1177/1758835920940945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 06/12/2020] [Indexed: 12/29/2022] Open
Abstract
Background and Aims: The standard treatment of non-metastatic anal squamous cell carcinoma (ASCC) consists of chemotherapy with mitomycin (MMC) plus 5-fluorouracil (5FU) for 1–2 cycles concomitant with pelvic radiotherapy. Subsequent studies introduced cisplatin (CDDP) combined with 5FU, with unclear results. We evaluated the doublet capecitabine (C) and CDDP as a possible alternative to MMC-5FU regimen concomitant with intensity-modulated radiation therapy (IMRT). Patients and Methods: We carried out a retrospective study on 67 patients affected by stage I–III ASCC, treated with CDDP (60–70 mg/m2 every 21 days for two courses) plus C (825 mg/m2 twice daily for 5 days/week) chemotherapy concomitant with IMRT for curative intent. Results: At a median follow up of 41 months, the clinical complete response calculated at the 6-month time-point (6-moCR), the 6-month objective response rate and the 6-month disease control rate were 93%, 94%, and 99%, respectively. Disease-free survival rates at 1, 2, and 3 years were 89%, 87%, and 85%, while the overall survival rates at 1 and 2 years were 100% and 95%. The colostomy-free survival rates were 90% at 1 year and 88% at 2 years. Grade 3–4 acute adverse events were reported in 61% of patients; predominantly skin toxicity (46%) and limited hematological toxicity (12%). Conclusion: In this retrospective study, chemotherapy with C plus CDDP concomitant with IMRT proved safe and effective, and may represent a possible alternative option to standard MMC-containing regimen for curative intent.
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Affiliation(s)
- Maria Saveria Rotundo
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology IRCCS, Milan, Italy
| | - Maria Giulia Zampino
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology IRCCS, Via Ripamonti 435, Milan 20141, Italy
| | - Paola Simona Ravenda
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology IRCCS, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Lombardia, Italy
| | - Giulia Peveri
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Lombardia, Italy
| | - Veronica Dell'Acqua
- Division of Radiotherapy, European Institute of Oncology IRCCS, Milan, Lombardia, Italy
| | - Alessia Surgo
- Division of Radiotherapy, European Institute of Oncology IRCCS, Milan, Lombardia, Italy
| | - Cristina Trovato
- Division of Endoscopy, European Institute of Oncology IRCCS, Milan, Lombardia, Italy
| | - Luca Bottiglieri
- Division of Pathology, European Institute of Oncology IRCCS, Milan, Lombardia, Italy
| | - Emilio Bertani
- Division of Gastrointestinal Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Wanda Luisa Petz
- Division of Gastrointestinal Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology IRCCS, Milan, Italy
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Bluemke E, Bulte D, Bertrand A, George B, Cooke R, Chu KY, Durrant L, Goh V, Jacobs C, Ng SM, Strauss VY, Hawkins MA, Muirhead R. Oxygen-enhanced MRI MOLLI T1 mapping during chemoradiotherapy in anal squamous cell carcinoma. Clin Transl Radiat Oncol 2020; 22:44-49. [PMID: 32211520 PMCID: PMC7082428 DOI: 10.1016/j.ctro.2020.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/01/2020] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND AND PURPOSE Oxygen-enhanced magnetic resonance imaging (MRI) and T1-mapping was used to explore its effectiveness as a prognostic imaging biomarker for chemoradiotherapy outcome in anal squamous cell carcinoma. MATERIALS AND METHODS T2-weighted, T1 mapping, and oxygen-enhanced T1 maps were acquired before and after 8-10 fractions of chemoradiotherapy and examined whether the oxygen-enhanced MRI response relates to clinical outcome. Patient response to treatment was assessed 3 months following completion of chemoradiotherapy. A mean T1 was extracted from manually segmented tumour regions of interest and a paired two-tailed t-test was used to compare changes across the patient population. Regions of subcutaneous fat and muscle tissue were examined as control ROIs. RESULTS There was a significant increase in T1 of the tumour ROIs across patients following the 8-10 fractions of chemoradiotherapy (paired t-test, p < 0.001, n = 7). At baseline, prior to receiving chemoradiotherapy, there were no significant changes in T1 across patients from breathing oxygen (n = 9). In the post-chemoRT scans (8-10 fractions), there was a significant decrease in T1 of the tumour ROIs across patients when breathing 100% oxygen (paired t-test, p < 0.001, n = 8). Out of the 12 patients from which we successfully acquired a visit 1 T1-map, only 1 patient did not respond to treatment, therefore, we cannot correlate these results with clinical outcome. CONCLUSIONS These clinical data demonstrate feasibility and potential for T1-mapping and oxygen enhanced T1-mapping to indicate perfusion or treatment response in tumours of this nature. These data show promise for future work with a larger cohort containing more non-responders, which would allow us to relate these measurements to clinical outcome.
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Affiliation(s)
- Emma Bluemke
- Institute of Biomedical Engineering, University of Oxford, UK
| | - Daniel Bulte
- Institute of Biomedical Engineering, University of Oxford, UK
| | - Ambre Bertrand
- Institute of Biomedical Engineering, University of Oxford, UK
| | - Ben George
- Institute of Biomedical Engineering, University of Oxford, UK
| | - Rosie Cooke
- Radiotherapy Department, Oxford University Hospitals NHS Foundation Trust, UK
- Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, UK
| | - Kwun-Ye Chu
- Radiotherapy Department, Oxford University Hospitals NHS Foundation Trust, UK
- Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, UK
| | - Lisa Durrant
- Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, UK
| | - Vicky Goh
- Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, UK
| | - Clare Jacobs
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, UK
| | - Stasya M. Ng
- Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, UK
| | | | | | - Rebecca Muirhead
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, UK
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Gleeson I, Rose C, Spurrell J. Dosimetric comparison of helical tomotherapy and VMAT for anal cancer: A single institutional experience. Med Dosim 2019; 44:e32-e38. [PMID: 30639142 DOI: 10.1016/j.meddos.2018.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 11/17/2022]
Abstract
To compare the dosimetric results of helical tomotherapy (HT) and volumetric arc therapy (VMAT) in the treatment of anal cancer. Plans were created for 20 (n = 20) patients treated for anal cancer using HT and 2 arc VMAT. Dosimetric comparison was assessed for doses to targets and organs at risk (small bowel, bladder, external genitalia, and femoral heads). Delivery time and dosimetric verification results were also compared. HT showed a higher V95% for both primary and nodal targets (V95% increase by 0.5% to 1.3%; p = ≤0.05). No differences were seen in V105%, V107%, or V110 % between techniques. HT provided better sparing of the small bowel for dose levels V30, V35, and V40 (p = 0.005, 0.001, and 0.030), but was similar at higher doses. Similarly HT provided better bladder dose at V35 only (p = 0.020). Doses to femoral heads and genitalia were similar. Delivery time was higher for the HT plans (4.58 ± 1.1 min) than VMAT (3.13 ± 0.2 minutes) (p = 0.011). Dose verification results were 99.5 ± 0.9% and 100 ± 0% (HT, n = 6) vs 95.0 ± 3.1% and 99.2 ± 0.8% (VMAT, n = 20) for global gamma criteria 3%/3 mm and 4%/4 mm, respectively. Both HT and VMAT produced high quality plans that frequently met most of the dose objectives apart from genitalia V20, V40, bladder V35, and V50. Although absolute dose differences were small, the PTV V95%, small bowel V30, V35, and V40 and bladder V35 were statistically better in the HT plans. VMAT provided a shorter delivery time by 1.45 minutes; however, our HT plans were more likely to pass tighter plan dose verification criteria than VMAT.
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Affiliation(s)
- Ian Gleeson
- Department of Medical Physics, Addenbrooke's Hospital, Cambridge, CB20QQ, UK.
| | - Christopher Rose
- Department of Medical Physics, Addenbrooke's Hospital, Cambridge, CB20QQ, UK.
| | - Joshua Spurrell
- Department of Medical Physics, Addenbrooke's Hospital, Cambridge, CB20QQ, UK.
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