1
|
Kottakunnan JS, Shoraka S, Dodd A, Kilkenny M, Petty S, Osborn K, Webster A. Proton beam therapy image-guided radiotherapy training for RTTs - Experience from a single institution. Tech Innov Patient Support Radiat Oncol 2025; 33:100299. [PMID: 39850231 PMCID: PMC11755385 DOI: 10.1016/j.tipsro.2024.100299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 11/17/2024] [Accepted: 12/15/2024] [Indexed: 01/25/2025] Open
Abstract
This study investigates whether an Image-Guided Radiation Therapy (IGRT) workbook and Cone Beam Computed Tomography (CBCT) case studies enhances Radiation Therapists' (RTTs) confidence analysing Proton Beam Therapy (PBT) CBCTs. An 11-participant questionnaire-based study was conducted to assess pre- and post-training confidence. Prior to training, RTTs exhibited higher confidence in photon CBCT decision-making over proton CBCT, highlighting the need for PBT-specific IGRT training, irrespective of prior photon experience. After completing the PBT IGRT workbook and case studies, RTTs experienced increased confidence in analysing PBT CBCTs. The workbook was particularly beneficial for junior RTTs, while experienced staff desired clearer guidance and real-life scenarios. The results show the IGRT workbook and CBCT case studies enhance RTTs' confidence in PBT CBCT analysis. PBT departments should consider these results for RTT led IGRT. Future work could involve adjusting training to account for participants' prior IGRT experience and conducting larger-scale studies to validate our results.
Collapse
Affiliation(s)
| | - Samaneh Shoraka
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Amy Dodd
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Maria Kilkenny
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sarah Petty
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kathryn Osborn
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Amanda Webster
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| |
Collapse
|
2
|
Sun H, Sun X, Li J, Zhu J, Yang Z, Meng F, Liu Y, Gong J, Wang Z, Yin Y, Ren G, Cai J, Zhao L. Pseudo-CT synthesis in adaptive radiotherapy based on a stacked coarse-to-fine model: Combing diffusion process and spatial-frequency convolutions. Med Phys 2024; 51:8979-8998. [PMID: 39298684 DOI: 10.1002/mp.17402] [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: 05/22/2024] [Revised: 08/08/2024] [Accepted: 08/25/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Cone beam computed tomography (CBCT) provides critical anatomical information for adaptive radiotherapy (ART), especially for tumors in the pelvic region that undergo significant deformation. However, CBCT suffers from inaccurate Hounsfield Unit (HU) values and lower soft tissue contrast. These issues affect the accuracy of pelvic treatment plans and implementation of the treatment, hence requiring correction. PURPOSE A novel stacked coarse-to-fine model combining Denoising Diffusion Probabilistic Model (DDPM) and spatial-frequency domain convolution modules is proposed to enhance the imaging quality of CBCT images. METHODS The enhancement of low-quality CBCT images is divided into two stages. In the coarse stage, the improved DDPM with U-ConvNeXt architecture is used to complete the denoising task of CBCT images. In the fine stage, the deep convolutional network model jointly constructed by fast Fourier and dilated convolution modules is used to further enhance the image quality in local details and global imaging. Finally, the accurate pseudo-CT (pCT) images consistent with the size of the original data are obtained. Two hundred fifty paired CBCT-CT images from cervical and rectal cancer, combined with 200 public dataset cases, were used collectively for training, validation, and testing. RESULTS To evaluate the anatomical consistency between pCT and real CT, we have used the mean(std) of structure similarity index measure (SSIM), peak signal to noise ratio (PSNR), and normalized cross-correlation (NCC). The numerical results for the above three metrics comparing the pCT synthesized by the proposed model against real CT for cervical cancer cases were 87.14% (2.91%), 34.02 dB (1.35 dB), and 88.01% (1.82%), respectively. For rectal cancer cases, the corresponding results were 86.06% (2.70%), 33.50 dB (1.41 dB), and 87.44% (1.95%). The paired t-test analysis between the proposed model and the comparative models (ResUnet, CycleGAN, DDPM, and DDIM) for these metrics revealed statistically significant differences (p < 0.05). The visual results also showed that the anatomical structures between the real CT and the pCT synthesized by the proposed model were closer. For the dosimetric verification, mean absolute error of dosimetry (MAEdoes) values for the maximum dose (Dmax), the minimum dose (Dmin), and the mean dose (Dmean) in the planning target volume (PTV) were analyzed, with results presented as mean (lower quartile, upper quartile). The experimental results show that the values of the above three dosimetry indexes (Dmin, Dmax, and Dmean) for the pCT images synthesized by the proposed model were 0.90% (0.48%, 1.29%), 0.82% (0.47%, 1.17%), and 0.57% (0.44%, 0.67%). Compared with 10 cases of the original CBCT image by Mann-Whitney test (p < 0.05), it also proved that pCT can significantly improve the accuracy of HU values for the dose calculation. CONCLUSION The pCT synthesized by the proposed model outperforms the comparative models in numerical accuracy and visualization, promising for ART of pelvic cancers.
Collapse
Affiliation(s)
- Hongfei Sun
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiaohuan Sun
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jie Li
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jiarui Zhu
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
| | - Zhi Yang
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Fan Meng
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yufen Liu
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jie Gong
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhongfei Wang
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yutian Yin
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ge Ren
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jing Cai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
| | - Lina Zhao
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| |
Collapse
|
3
|
Pierrard J, Heylen S, Vandermeulen A, Van Ooteghem G. Dealing with rectum motion during radiotherapy: How can we anticipate it? Tech Innov Patient Support Radiat Oncol 2024; 32:100277. [PMID: 39391230 PMCID: PMC11465212 DOI: 10.1016/j.tipsro.2024.100277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 09/02/2024] [Accepted: 09/20/2024] [Indexed: 10/12/2024] Open
Abstract
Introduction Intra- and inter-fraction rectum motion is important for pelvic radiotherapy (RT). This study assesses how RT session duration, the presence or the absence of an intra-rectal tumour, and the distance from the anorectal junction (ARJd) impact rectal motion. Materials and methods Analyses used cone-beam computed tomographies (CBCTs) from RT patients treated for rectal and prostate cancer. Three structures were evaluated: (1) the entire rectum in patients without a rectal tumour (RectumProstate); (2) the non-invaded portion (RectumRectum) and (3) the tumour-invaded portion (RectumTumour) in rectal cancer patients.Intrafraction motion was assessed using the Hausdorff distance 95% and the Mean distance-to-agreement between structures delineated on the first CBCT and the 2 subsequent CBCTs within a same RT session. Interfraction motion was quantified by comparing structures delineated on the planning-CT and the first CBCT of each session.Linear mixed model evaluated rectum motion in relation to time, tumour presence, and ARJd, respectively. Results We included 10 patients with and 10 without rectal cancer, collecting 385 CBCTs. A significant correlation (p < 0.05) between rectum motion and RT session duration was found. Intrafraction motion was significantly higher in prostate cancer patients (RectumProstate motion > RectumRectum and RectumTumour, p < 0.01). For interfraction motion, only the mean distance to agreement was significantly higher for RectumProstate (p < 0.05). Motion increased significantly with ARJd for all three structures (p < 0.001). Conclusions Session duration, absence of a tumour, and ARJd are associated with larger intra- and interfraction rectal motion. This highlights the need for tailored RT treatment, including online-adaptive RT, to manage intra- and interfraction variations. Rectal motion should be handled differently for patients with prostate cancer and those with rectal cancer.
Collapse
Affiliation(s)
- Julien Pierrard
- UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium
- Department of Radiation Oncology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Sofie Heylen
- Department of Radiation Oncology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Ad Vandermeulen
- Department of Radiation Oncology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Geneviève Van Ooteghem
- UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium
- Department of Radiation Oncology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| |
Collapse
|
4
|
Yamada T, Kawamura M, Oie Y, Kozai Y, Okumura M, Nagai N, Yanagi Y, Nimura K, Ishihara S, Naganawa S. The current state and future perspectives of radiotherapy for cervical cancer. J Obstet Gynaecol Res 2024; 50 Suppl 1:84-94. [PMID: 38885951 DOI: 10.1111/jog.15998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 05/25/2024] [Indexed: 06/20/2024]
Abstract
Radiotherapy is an effective treatment method for cervical cancer and is typically administered as external beam radiotherapy followed by intracavitary brachytherapy. In Japan, center shielding is used in external beam radiotherapy to shorten treatment time and reduce the doses delivered to the rectum or bladder. However, it has several challenges, such as uncertainties in calculating the cumulative dose. Recently, external beam radiotherapy has been increasingly performed with intensity-modulated radiotherapy, which reduces doses to the rectum or bladder without center shielding. In highly conformal radiotherapy, uncertainties in treatment delivery, such as inter-fractional anatomical structure movements, affect treatment outcomes; therefore, image-guided radiotherapy is essential for appropriate and safe performance. Regarding intracavitary brachytherapy, the use of magnetic resonance imaging-based image-guided adaptive brachytherapy is becoming increasingly widespread because it allows dose escalation to the tumor and accurately evaluates the dose delivered to the surrounding normal organs. According to current evidence, a minimal dose of D90% of the high-risk clinical target volume is significantly relevant to local control. Further improvements in target coverage have been achieved with combined interstitial and intracavity brachytherapy for massive tumors with extensive parametrical involvement. Introducing artificial intelligence will enable faster and more accurate generation of brachytherapy plans. Charged-particle therapies have biological and dosimetric advantages, and current evidence has proven their effectiveness and safety in cervical cancer treatment. Recently, radiotherapy-related technologies have advanced dramatically. This review provides an overview of technological innovations and future perspectives in radiotherapy for cervical cancer.
Collapse
Affiliation(s)
- Takehiro Yamada
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mariko Kawamura
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yumi Oie
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuka Kozai
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masayuki Okumura
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoya Nagai
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Yanagi
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Radiology, Toyota Memorial Hospital, Toyota, Japan
| | - Kenta Nimura
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Radiology, Tosei General Hospital, Seto, Japan
| | - Shunichi Ishihara
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
5
|
Ma C, Zhou J. First Application of Demand-Triggered Online Adaptive Radiotherapy in the Treatment of Cervical Cancer: A Clinical Report. Cureus 2024; 16:e69703. [PMID: 39429366 PMCID: PMC11490271 DOI: 10.7759/cureus.69703] [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] [Accepted: 09/19/2024] [Indexed: 10/22/2024] Open
Abstract
Gynecology cancers can reap significant benefits from adaptive radiation therapy (ART) for four major reasons: organ motion, organ deformation, density change, and cavity filling. There are three recognized types of adaptive radiotherapy: offline, online, and real-time. This balance of improved dosimetry versus clinic resources, as well as the optimal timing for adaptations, is still under investigation. The emergence of on-demand online adaptive radiotherapy (OART) can solve the above problems. In this context, we introduce two patients with cervical cancer who used on-demand OART for the first time. One patient with cervical cancer received radical radiotherapy on the United Imaging uCT-ART platform, and another patient with cervical cancer received postoperative adjuvant radiotherapy. The radiotherapy process used OART, which was triggered by senior radiotherapists, assisted by artificial intelligence, and guided by fan-beam computer tomography. Patient 1, who was 54 years old with cervical squamous cell carcinoma, International Federation of Gynecology and Obstetrics (FIGO) stage ⅢC1, underwent radical concurrent chemoradiotherapy. The target volume was reduced in the late stage of radiotherapy. The target volume coverage of the OART plan was better, and the bladder and rectum doses were lower than those of the image-guided radiotherapy plan. Patient 2, who was 56 years old with cervical adenocarcinoma, FIGO stage ⅡA1, underwent postoperative concurrent chemoradiotherapy. If the fractionated treatment during radiotherapy was carried out according to the original plan, treatment off-target would occur, while the OART plan could ensure target coverage. The acute toxic reactions that occurred in both patients during radiotherapy were patient-reported outcome Common Terminology Criteria for Adverse Events 1-2, and no toxic reactions of grade 3 or above occurred. This is the first description of the successful implementation of the uCT-ART-based OART system in EBRT for cervical cancer.
Collapse
Affiliation(s)
- Chenying Ma
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, CHN
| | - Juying Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, CHN
| |
Collapse
|
6
|
Prakash A, Kumar Upadhyay A, Show S, Mani A. Treating a Refractory Locally Advanced Carcinoma of the Cervix With Cone-Beam Computed Tomography-Based Adaptive External Beam Radiotherapy: A Case Report. Cureus 2024; 16:e70215. [PMID: 39463639 PMCID: PMC11512669 DOI: 10.7759/cureus.70215] [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] [Accepted: 09/25/2024] [Indexed: 10/29/2024] Open
Abstract
Adaptive radiotherapy (ART) refers to methods that allow a radiation therapy plan to be adjusted based on images obtained during the treatment. Using cutting-edge imaging methods such as computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), ART can adjust the treatment plan in response to observed changes in anatomy and even biology while the patient is receiving treatment. The backbone of ART is intensity-modulated RT (IMRT), which permits better sparing of normal critical organs while still delivering a uniform dose to target tumor volume. Volumetric modulated arc therapy (VMAT) is a more rapid form of IMRT with more conformity, which helps in treating patients in a shorter time. Different types of ART include individualized margins using an internal target volume (ITV) and offline and online methods. ITV uses the margin to appropriately cover the clinical target volume (CTV) based on matching CT scans to different extents of the radiological anatomy of the selected area. Offline adaptive strategies include scheduled replanning throughout the external beam radiotherapy (EBRT) course, depending on intra-fraction or inter-fraction changes. The online ART (oART) strategy takes into account changes in tumor volume and the daily anatomical variations of target volumes and organs at risk structures (OARS). As such, PTV margins have the potential to be reduced. Commercially available oART systems are predominantly MRI-guided, but more recent advances have seen the creation of a cone-beam CT (CBCT)-guided oART system. In this case of FIGO (International Federation of Gynaecology and Obstetrics) stage IIB squamous cell carcinoma of the uterine cervix, we used an offline ART approach to complete the initial part of the treatment, which included concurrent chemoradiation therapy with 50 Gy/25 Fr and weekly cisplatin for five weeks. However, in the final fraction of on-couch kilovoltage CBCT (kvCBCT), it appears that the tumor only partially responded, demonstrating its refractory nature to treatment. The patient then underwent a repeat planning contrast-enhanced CT (CECT) scan, which was fused with the initial planning CECT scan. It revealed that the tumor responded poorly, with only a slight decrease in size. With the OARS toxicity limit in mind, the patient was scheduled for an adapted volumetric modulated arc therapy (VMAT) boost of 8 Gy/4 Fr as a second-phase plan for the tumor. Subsequently, the patient was taken up for intra-cavitary brachytherapy (ICBT) after a one-week gap. She received brachytherapy with 9 Gy/session for two sessions as per institutional protocol on a weekly basis. On subsequent follow-up, the patient underwent a complete response clinico-radiologically, even after two years of follow-up. This case report shows the importance of adaptive radiotherapy in treating tumors with a high therapeutic ratio and less toxicity to OARS despite employing the less frequently used EBRT boost along with ICBT brachytherapy.
Collapse
Affiliation(s)
| | | | - Subhankar Show
- Radiation Oncology, Meherbai Tata Memorial Hospital, Jamshedpur, IND
| | - Ajithkumar Mani
- Radiation Oncology, Meherbai Tata Memorial Hospital, Jamshedpur, IND
| |
Collapse
|
7
|
Yang TK, Wang YJ, Li HJ, Yu YF, Huang KW, Cheng JCH. Efficacy and Safety of Hyperbaric Oxygen Therapy for Radiation-Induced Hemorrhagic Cystitis: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:4724. [PMID: 39200867 PMCID: PMC11355076 DOI: 10.3390/jcm13164724] [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: 06/03/2024] [Revised: 07/26/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Radiation-induced hemorrhagic cystitis (RHC) is a chronic inflammatory disease in patients undergoing radiation therapy that causes a cluster of symptoms which may have a latent period of months to years. The current non-invasive treatments include drug treatment and hyperbaric oxygen therapy (HBOT), which has been widely applied for RHC so far but with limited evidence. Thus, we conducted a systematic review and meta-analysis to clarify the effects and safety of HBOT for RHC. Methods: A systematic review and meta-analysis were utilized, searching in the databases of Embase, Pubmed, and Web of Science. The primary endpoint of the present study was complete remission of hematuria. The meta-analysis was conducted using a random effects model, and a pooled odds ratio with 95% CI was calculated. Results: A total of 317 studies were searched and fourteen articles with 556 patients were collected. The results showed that a total of 500 patients (89.9%) had symptom improvement, and the pooled results demonstrated that 55% of patients with HBOT had complete remission of hematuria (95% CI 51-59%). Conclusions: A significant improvement of symptoms when treated with HBOT was shown in this meta-analysis for patients with RHC.
Collapse
Affiliation(s)
- Teng-Kai Yang
- Department of Surgery, Yonghe Cardinal Tien Hospital, New Taipei City 23445, Taiwan;
- School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City 242062, Taiwan;
| | - Yu-Jen Wang
- School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City 242062, Taiwan;
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Hsing-Ju Li
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei 100225, Taiwan; (H.-J.L.); (Y.-F.Y.); (K.-W.H.)
| | - Ya-Fang Yu
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei 100225, Taiwan; (H.-J.L.); (Y.-F.Y.); (K.-W.H.)
| | - Kai-Wen Huang
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei 100225, Taiwan; (H.-J.L.); (Y.-F.Y.); (K.-W.H.)
- Department of Surgery, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Jason Chia-Hsien Cheng
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei 100225, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei 100225, Taiwan; (H.-J.L.); (Y.-F.Y.); (K.-W.H.)
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei 100225, Taiwan
| |
Collapse
|
8
|
Anghel B, Serboiu C, Marinescu A, Taciuc IA, Bobirca F, Stanescu AD. Recent Advances and Adaptive Strategies in Image Guidance for Cervical Cancer Radiotherapy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1735. [PMID: 37893453 PMCID: PMC10608436 DOI: 10.3390/medicina59101735] [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] [Received: 08/23/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023]
Abstract
The standard of care for locally advanced cervical cancer is external beam radiotherapy (EBRT) with simultaneous chemotherapy followed by an internal radiation boost. New imaging methods such as positron-emission tomography and magnetic resonance imaging have been implemented into daily practice for better tumor delineation in radiotherapy planning. The method of delivering radiation has changed with technical advances in qualitative imaging and treatment delivery. Image-guided radiotherapy (IGRT) plays an important role in minimizing treatment toxicity of pelvic radiation and provides a superior conformality for sparing the organs at risk (OARs) such as bone marrow, bowel, rectum, and bladder. Similarly, three-dimensional image-guided adaptive brachytherapy (3D-IGABT) with computed tomography (CT) or magnetic resonance imaging (MRI) has been reported to improve target coverage and reduce the dose to normal tissues. Brachytherapy is a complementary part of radiotherapy treatment for cervical cancer and, over the past 20 years, 3D-image-based brachytherapy has rapidly evolved and established itself as the gold standard. With new techniques and adaptive treatment in cervical cancer, the concept of personalized medicine is introduced with an enhanced comprehension of the therapeutic index not only in terms of volume (three-dimensional) but during treatment too (four-dimensional). Current data show promising results with integrated IGRT and IGABT in clinical practice and, therefore, better local control and overall survival while reducing treatment-related morbidity. This review gives an overview of the substantial impact that occurred in the progress of image-guided adaptive external beam radiotherapy and brachytherapy.
Collapse
Affiliation(s)
- Beatrice Anghel
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.A.); (I.-A.T.); (F.B.); (A.D.S.)
- Department of Radiation Oncology, Sanador Oncology Centre, 010991 Bucharest, Romania
| | - Crenguta Serboiu
- Department of Histology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Andreea Marinescu
- Radiology and Imaging Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Iulian-Alexandru Taciuc
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.A.); (I.-A.T.); (F.B.); (A.D.S.)
- Nuclear Medicine Department, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Florin Bobirca
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.A.); (I.-A.T.); (F.B.); (A.D.S.)
- General Surgery Department, Cantacuzino Clinical Hospital, 73206 Bucharest, Romania
| | - Anca Daniela Stanescu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.A.); (I.-A.T.); (F.B.); (A.D.S.)
- Department of Obstetrics and Gynecology, St. John Emergency Hospital, Bucur Maternity, 040292 Bucharest, Romania
| |
Collapse
|
9
|
Luo D, Wang X, Ramamurthy G, Walker E, Zhang L, Shirke A, Naidu NG, Burda C, Shakya R, Hostnik E, Joseph M, Ponsky L, Ponomarev V, Rosol TJ, Tweedle MF, Basilion JP. Evaluation of a photodynamic therapy agent using a canine prostate cancer model. Prostate 2023; 83:1176-1185. [PMID: 37211857 PMCID: PMC11135201 DOI: 10.1002/pros.24560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/30/2023] [Accepted: 05/04/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Male dogs can develop spontaneous prostate cancer, which is similar physiologically to human disease. Recently, Tweedle and coworkers have developed an orthotopic canine prostate model allowing implanted tumors and therapeutic agents to be tested in a more translational large animal model. We used the canine model to evaluate prostate-specific membrane antigen (PSMA)-targeted gold nanoparticles as a theranostic approach for fluorescence (FL) imaging and photodynamic therapy (PDT) of early stage prostate cancer. METHODS Dogs (four in total) were immunosuppressed with a cyclosporine-based immunosuppressant regimen and their prostate glands were injected with Ace-1-hPSMA cells using transabdominal ultrasound (US) guidance. Intraprostatic tumors grew in 4-5 weeks and were monitored by ultrasound (US). When tumors reached an appropriate size, dogs were injected intravenously (iv) with PSMA-targeted nano agents (AuNPs-Pc158) and underwent surgery 24 h later to expose the prostate tumors for FL imaging and PDT. Ex vivo FL imaging and histopathological studies were performed to confirm PDT efficacy. RESULTS All dogs had tumor growth in the prostate gland as revealed by US. Twenty-four hours after injection of PSMA-targeted nano agents (AuNPs-Pc158), the tumors were imaged using a Curadel FL imaging device. While normal prostate tissue had minimal fluorescent signal, the prostate tumors had significantly increased FL. PDT was activated by irradiating specific fluorescent tumor areas with laser light (672 nm). PDT bleached the FL signal, while fluorescent signals from the other unexposed tumor tissues were unaffected. Histological analysis of tumors and adjacent prostate revealed that PDT damaged the irradiated areas to a depth of 1-2 mms with the presence of necrosis, hemorrhage, secondary inflammation, and occasional focal thrombosis. The nonirradiated areas showed no visible damages by PDT. CONCLUSION We have successfully established a PSMA-expressing canine orthotopic prostate tumor model and used the model to evaluate the PSMA-targeted nano agents (AuNPs-Pc158) in the application of FL imaging and PDT. It was demonstrated that the nano agents allowed visualization of the cancer cells and enabled their destruction when they were irradiated with a specific wavelength of light.
Collapse
Affiliation(s)
- Dong Luo
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
- Department of Biomedical Science and Engineering, South China University of Technology, Guangzhou, China
| | - Xinning Wang
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | | | - Ethan Walker
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Lifang Zhang
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Aditi Shirke
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Naraen G. Naidu
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Clemens Burda
- Department of Chemistry, Case Western Reserve University, Cleveland, OH, USA
| | - Reena Shakya
- Target Validation Shared Resource, James Comprehensive Cancer Center, The Ohio State University, Columbus Ohio, USA
| | - Eric Hostnik
- College of Veterinary Medicine- Veterinary Medical Center, The Ohio State University, Columbus, OH, USA
| | - Mathew Joseph
- Interventional Cardiology Cath Core Lab, Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Lee Ponsky
- Department of Urology, University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | | | - Thomas J. Rosol
- Department of Biomedical Sciences, Ohio University, Athens, OH, USA
| | - Michael F. Tweedle
- Deptartment of Radiology, The Wright Center for Innovation in Biomolecular Imaging, The Ohio State University, Columbus, OH, USA
| | - James P. Basilion
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
10
|
Morel A, Prunaretty J, Trauchessec D, Ailleres N, Fenoglietto P, Azria D. Comprehensive commissioning and quality assurance validation of Ethos™ therapy. Cancer Radiother 2023; 27:355-361. [PMID: 37085341 DOI: 10.1016/j.canrad.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 04/23/2023]
Abstract
PURPOSE Adaptive radiotherapy with the Ethos® therapy Varian system has been recently implemented at the Montpellier Cancer Institute, France. This article details the commissioning performed before the implementation of this new treatment planning system (TPS). MATERIAL AND METHODS To validate the golden beam data of the machine (Halcyon linear accelerator), percentage depth doses (PDD) and profiles were measured for several field sizes and at different depths with a microdiamond chamber. The final doses calculated for different plan types with the Ethos Acuros XB algorithm and the Halcyon Eclipse Analytic Anisotropic Algorithm were compared using the gamma index method. Lastly, for the patient quality assurance (QA) process, the patient treatment plan results obtained with the Mobius3D QA platform (Varian) were compared with the portal dosimetry results obtained with Epiqa (Epidos). RESULTS Minor differences were observed for the PDD and profile curves (mean difference of 0.2% and 2%, respectively). The χ index pass rate was above 98% for all measures using the 1%/1mm and 2%/2mm criteria for PDD and profile evaluations. The Ethos AXB algorithm was validated for every configuration (fixed fields, standard IMRT and VMAT fields, and clinical plans) with 2D/3D gamma index values>99%. Seventy-three 3-arcs-VMAT QA plans and 27 9-fields-IMRT QA plans were evaluated. Both showed excellent agreement with the TPS calculations (mean gamma pass rate higher than 99%). No difference was observed between IMRT and VMAT. CONCLUSION The beam delivery, the Ethos AXB algorithm, and the patient QA were comprehensively validated using independent tools.
Collapse
Affiliation(s)
- A Morel
- Institut du cancer de Montpellier (ICM), Montpellier, France
| | - J Prunaretty
- Institut du cancer de Montpellier (ICM), Montpellier, France.
| | - D Trauchessec
- Institut du cancer de Montpellier (ICM), Montpellier, France
| | - N Ailleres
- Institut du cancer de Montpellier (ICM), Montpellier, France
| | - P Fenoglietto
- Institut du cancer de Montpellier (ICM), Montpellier, France
| | - D Azria
- Institut du cancer de Montpellier (ICM), Montpellier, France
| |
Collapse
|
11
|
Joyce E, Jackson M, Skok J, Rock B, McNair HA. What do we want? Training! When do we want it? Now? A training needs analysis for adaptive radiotherapy for therapeutic radiographers. Radiography (Lond) 2023; 29:818-826. [PMID: 37331130 DOI: 10.1016/j.radi.2023.05.015] [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: 12/06/2022] [Revised: 04/14/2023] [Accepted: 05/24/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Therapeutic radiographers (TRs) have adapted to the changing requirements and demands of the oncology service and in response to advanced techniques such as on-line adaptive MRI-guided radiotherapy (MRIgRT). The skills required for MRIgRT would benefit many TRs not just those involved in this technique. This study presents the results of a training needs analysis (TNA) for the required MRIgRT skills in readiness for training TRs for current and future practice. METHODS A UK-based TNA was used to ask TRs about their knowledge and experience with essential skills required for MRIgRT based on previous investigations into the topic. A five-point Likert scale was used for each of the skills and the difference in values were used to calculate the training need for current and future practice. RESULTS 261 responses were received (n = 261). The skill rated the most important to current practice was CBCT/CT matching and/or fusion. The current highest priority needs were radiotherapy planning and radiotherapy dosimetry. The skill rated the most important to future practice was CBCT/CT matching and/or fusion. The future highest priority needs were MRI acquisition and MRI Contouring. Over 50% of participants wanted training or additional training in all skills. There was an increase in all values for skills investigated from current to future roles. CONCLUSION Although the examined skills were viewed as important to current roles, the future training needs, both overall and high priority, were different compared to current roles. As the 'future' of radiotherapy can arrive rapidly, it is essential that training is delivered appropriately and timely. Before this can occur, there must be investigations into the method and delivery of this training. IMPLICATIONS FOR PRACTICE Role development. Education changes for therapeutic radiographers.
Collapse
Affiliation(s)
- E Joyce
- Royal Marsden NHS Foundation Trust, London, UK.
| | - M Jackson
- St George's University of London, UK
| | - J Skok
- St George's University of London, UK
| | - B Rock
- Royal Marsden NHS Foundation Trust, London, UK
| | - H A McNair
- Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, UK.
| |
Collapse
|
12
|
Bolderston A, Brydon M. Letter in response to Laing et al., "An evaluation of radiation therapy patient body mass index trends and potential impact on departmental resource planning". J Med Radiat Sci 2023. [PMID: 37182908 DOI: 10.1002/jmrs.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/21/2023] [Indexed: 05/16/2023] Open
Abstract
"An evaluation of radiation therapy patient body mass index trends and potential impact on departmental resource planning" by Laing et al. The authors' comment that research into the experiences of larger bodied patients should focus on compassionately improving care for this patient population rather than framing large-bodied patients as a burden or problem, and should include commentary on the effects of weight-bias in the healthcare system.
Collapse
|
13
|
Laing B, Caldwell P, Vincent D, Rattray G. Response to Letter to the Editor: An evaluation of radiation therapy patient body mass index (BMI) trends and potential impact on departmental resource planning. J Med Radiat Sci 2023. [PMID: 37157160 DOI: 10.1002/jmrs.688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023] Open
Affiliation(s)
- Branagh Laing
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Cancer Care Services, Department of Radiation Oncology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | - Peter Caldwell
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Debra Vincent
- Cancer Care Services, Department of Radiation Oncology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | - Gregory Rattray
- Cancer Care Services, Department of Radiation Oncology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| |
Collapse
|
14
|
Shelley CE, Bolt MA, Hollingdale R, Chadwick SJ, Barnard AP, Rashid M, Reinlo SC, Fazel N, Thorpe CR, Stewart AJ, South CP, Adams EJ. Implementing cone-beam computed tomography-guided online adaptive radiotherapy in cervical cancer. Clin Transl Radiat Oncol 2023; 40:100596. [PMID: 36910024 PMCID: PMC9999162 DOI: 10.1016/j.ctro.2023.100596] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023] Open
Abstract
Background and purpose Adaptive radiotherapy (ART) in locally advanced cervical cancer (LACC) has shown promising outcomes. This study investigated the feasibility of cone-beam computed tomography (CBCT)-guided online ART (oART) for the treatment of LACC. Material and methods The quality of the automated radiotherapy treatment plans and artificial intelligence (AI)-driven contour delineation for LACC on a novel CBCT-guided oART system were assessed. Dosimetric analysis of 200 simulated oART sessions were compared with standard treatment. Feasibility of oART was assessed from the delivery of 132 oART fractions for the first five clinical LACC patients. The simulated and live oART sessions compared a fixed planning target volume (PTV) margin of 1.5 cm around the uterus-cervix clinical target volume (CTV) with an internal target volume-based approach. Workflow timing measurements were recorded. Results The automatically-generated 12-field intensity-modulated radiotherapy plans were comparable to manually generated plans. The AI-driven organ-at-risk (OAR) contouring was acceptable requiring, on average, 12.3 min to edit, with the bowel performing least well and rated as unacceptable in 16 % of cases. The treated patients demonstrated a mean PTV D98% (+/-SD) of 96.7 (+/- 0.2)% for the adapted plans and 94.9 (+/- 3.7)% for the non-adapted scheduled plans (p<10-5). The D2cc (+/-SD) for the bowel, bladder and rectum were reduced by 0.07 (+/- 0.03)Gy, 0.04 (+/-0.05)Gy and 0.04 (+/-0.03)Gy per fraction respectively with the adapted plan (p <10-5). In the live.setting, the mean oART session (+/-SD) from CBCT acquisition to beam-on was 29 +/- 5 (range 21-44) minutes. Conclusion CBCT-guided oART was shown to be feasible with dosimetric benefits for patients with LACC. Further work to analyse potential reductions in PTV margins is ongoing.
Collapse
Affiliation(s)
- Charlotte E Shelley
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Matthew A Bolt
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Rachel Hollingdale
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Susan J Chadwick
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Andrew P Barnard
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Miriam Rashid
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Selina C Reinlo
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Nawda Fazel
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Charlotte R Thorpe
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Alexandra J Stewart
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK.,University of Surrey, Guildford GU2 7XX, UK
| | - Chris P South
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Elizabeth J Adams
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| |
Collapse
|
15
|
Cumur C, Fujibuchi T, Arakawa H, Hamada K. Dose estimation for cone-beam computed tomography in image-guided radiation therapy for pelvic cancer using adult mesh-type reference computational phantoms. Radiol Phys Technol 2023; 16:203-211. [PMID: 36877400 DOI: 10.1007/s12194-023-00708-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 03/07/2023]
Abstract
The use of cone-beam computed tomography (CBCT) is expanding owing to its installation in linear accelerators for radiation therapy, and the imaging dose induced by this system has become the center of attention. Here, the dose to patients caused by the CBCT imager was investigated. Organ doses and effective doses for male and female mesh-type reference computational phantoms (MRCPs) and pelvis CBCT mode, routinely used for pelvic irradiation, were estimated using the Particle and Heavy Ion Transport Code System. The simulation results were confirmed based on the point-dose measurements. The estimated organ doses for male MRCPs with/without raised arms and for female MRCPs with/without raised arms were 0.00286-35.6 mGy, 0.00286-35.1 mGy, 0.00933-39.5 mGy, and 0.00931-39.0 mGy, respectively. The anticipated effective doses for male MRCPs with/without raised arms and female MRCPs with/without raised arms irradiated by pelvis CBCT mode were 4.25 mSv, 4.16 mSv, 7.66 mSv, and 7.48 mSv, respectively. The results of this study will be useful for patients who undergo image-guided radiotherapy with CBCT. However, because this study only covered one type of cancer with one type of imager, and image quality was not considered, more studies should be conducted to estimate the radiation dose from imaging devices in radiation therapy.
Collapse
Affiliation(s)
- Ceyda Cumur
- Graduate School of Medical Sciences, Division of Medical Quantum Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
| | - Toshioh Fujibuchi
- Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Hiroyuki Arakawa
- Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Keisuke Hamada
- Department of Radiological Technology, National Hospital Organization Kyushu Cancer Center, 3-1-1, Notame Minami-Ku, Fukuoka, 811-1395, Japan
| |
Collapse
|
16
|
Garrett MD, Li F, Lemus OD, Lavrova E, Savacool M, Price MJ, Kachnic LA, Horowitz DP, Chin C. Impact of Adapted Radiotherapy Schedules on Bowel Sparing in Node-Positive Cervical Cancer. Pract Radiat Oncol 2023; 13:e184-e191. [PMID: 36539155 DOI: 10.1016/j.prro.2022.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Definitive radiation therapy (RT) for locally advanced node-positive cervical cancer confers significant toxicity to pelvic organs including the small bowel. Gross nodal disease exhibits significant shrinkage during RT, and yet conventional RT does not account for this change. We evaluated the reduction in absorbed bowel dose using various adaptive RT schedules. METHODS AND MATERIALS We obtained 130 evaluable scans (computed tomography simulation and 25 cone beam computed tomography scans per patient) of 5 patients who had received definitive external beam RT for lymph node positive cervical cancer daily over 5 weeks. Using a single universal volumetric modulated arc therapy plan with predefined optimization priorities, we created adapted RT plans in 4 schedules: Daily, Weekly, Twice, and NoAdapt (mimicking conventional nonadapted RT). The in silico (computer modeled) patients were treated to 45 Gy to primary cervical disease with a simultaneous integrated boost to 55 Gy to involved lymph nodes. We evaluated dose metrics including D2cc, D15cc, and V45 to determine the impact of adapted RT schedules on bowel sparing. Statistical tests included the Student t test, analysis of variance, and the Spearman rank correlation. RESULTS The quantity of reduced bowel dose was significantly associated with the chosen planning schedule in all evaluated metrics and was proportional to the frequency of adaptive RT with significant moderate-to-strong monotonicity. Both D2cc and D15cc were reduced an average of 2.7 Gy using daily replanning compared with a nonadapted approach. A minimally adapted strategy of only 2 replans also confers a significant dosimetric benefit over a nonadapted approach. Reduced standard deviations of D2cc and V45 bowel doses over the treatment courses were significantly associated with the choice of planning schedule with strong monotonicity. CONCLUSIONS All adaptive RT schedules evaluated confer significant dosimetric advantages in bowel sparing over a conventional nonadapted technique, with greater sparing seen with more frequent replanning schedules. These findings warrant future trials of adaptive RT for pelvic malignancies.
Collapse
Affiliation(s)
- Matthew D Garrett
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Fiona Li
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Olga Dona Lemus
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Elizaveta Lavrova
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Michelle Savacool
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
| | - Michael J Price
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Lisa A Kachnic
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - David P Horowitz
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Christine Chin
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York.
| |
Collapse
|
17
|
Dosimetric impact of rotational set-up errors in high-risk prostate cancer. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2022. [DOI: 10.2478/pjmpe-2022-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Introduction: Cone-beam computed tomography (CBCT) provides an excellent solution to quantitative assessment and correction of patient set-up errors during radiotherapy. However, most linear accelerators are equipped with conventional therapy tables that can be moved in three translational directions and perform only yaw rotation. Uncorrected roll and pitch result in rotational set-up errors, particularly when the distance from the isocenter to the target border is large. The aim of this study was to investigate the impact of rotational errors on the dose delivered to the clinical target volume (CTV), the planning target volume (PTV) and organs at risk (OAR).
Material and methods: 30 patients with prostate cancer treated with VMAT technique had daily CBCT scans (840 CBCTs in total) prior to treatment delivery. The rotational errors remaining after on-line correction were retrospectively analysed. The sum plans simulating the dose distribution during the treatment course were calculated for selected patients with significant rotational errors.
Results: The dose delivered to the prostate bed CTV reported in the sum plan was not lower than in the original plan for all selected patients. For four patients from the selected group, the D98% for prostate bed PTV was less than 95%. The V47.88Gy for pelvic lymph nodes PTV was less than 98% for two of the selected patients.
Conclusions: The analysis of the dosimetric parameters showed that the impact of uncorrected rotations is not clinically significant in terms of the dose delivered to OAR and the dose coverage of CTV. However, the PTV dose coverage is correlated with distance away from the isocenter and is smaller than planned.
Collapse
|
18
|
Zhang Y, Zhou H, Chu K, Wu C, Ge Y, Shan G, Zhou J, Cai J, Jin J, Sun W, Chen Y, Huang X. Setup error assessment based on “Sphere-Mask” Optical Positioning System: Results from a multicenter study. Front Oncol 2022; 12:918296. [PMID: 36267985 PMCID: PMC9577199 DOI: 10.3389/fonc.2022.918296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/15/2022] [Indexed: 11/15/2022] Open
Abstract
Background The setup accuracy plays an extremely important role in the local control of tumors. The purpose of this study is to verify the feasibility of "Sphere-Mask" Optical Positioning System (S-M_OPS) for fast and accurate setup. Methods From 2016 to 2021, we used S-M_OPS to supervise 15441 fractions in 1981patients (with the cancer in intracalvarium, nasopharynx, esophagus, lung, liver, abdomen or cervix) undergoing intensity-modulated radiation therapy (IMRT), and recorded the data such as registration time and mask deformation. Then, we used S-M_OPS, laser line and cone beam computed tomography (CBCT) for co-setup in 277 fractions, and recorded laser line-guided setup errors and S-M_OPS-guided setup errors with CBCT-guided setup result as the standard. Results S-M_OPS supervision results: The average time for laser line-guided setup was 31.75s. 12.8% of the reference points had an average deviation of more than 2 mm and 5.2% of the reference points had an average deviation of more than 3 mm. Co-setup results: The average time for S-M_OPS-guided setup was 7.47s, and average time for CBCT-guided setup was 228.84s (including time for CBCT scan and manual verification). In the LAT (left/right), VRT (superior/inferior) and LNG (anterior/posterior) directions, laser line-guided setup errors (mean±SD) were -0.21±3.13mm, 1.02±2.76mm and 2.22±4.26mm respectively; the 95% confidence intervals (95% CIs) of laser line-guided setup errors were -6.35 to 5.93mm, -4.39 to 6.43mm and -6.14 to 10.58mm respectively; S-M_OPS-guided setup errors were 0.12±1.91mm, 1.02±1.81mm and -0.10±2.25mm respectively; the 95% CIs of S-M_OPS-guided setup errors were -3.86 to 3.62mm, -2.53 to 4.57mm and -4.51 to 4.31mm respectively. Conclusion S-M_OPS can greatly improve setup accuracy and stability compared with laser line-guided setup. Furthermore, S-M_OPS can provide comparable setup accuracy to CBCT in less setup time.
Collapse
Affiliation(s)
- Yan Zhang
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Han Zhou
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Kaiyue Chu
- Department of Radiotherapy, Nantong Tumor Hospital, Nantong, China
| | - Chuanfeng Wu
- Department of Radiotherapy, Suzhou Municipal Hospital, Suzhou, China
| | - Yun Ge
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
- *Correspondence: Yun Ge, ; Guoping Shan,
| | - Guoping Shan
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
- Department of Radiation Physics, Zhejiang Cancer Hospital, Hangzhou, China
- *Correspondence: Yun Ge, ; Guoping Shan,
| | - Jundong Zhou
- Department of Radiotherapy, Suzhou Municipal Hospital, Suzhou, China
| | - Jing Cai
- Department of Radiotherapy, Nantong Tumor Hospital, Nantong, China
| | - Jianhua Jin
- Department of Radiotherapy, Nantong Tumor Hospital, Nantong, China
| | - Weiyu Sun
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Ying Chen
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Xiaolin Huang
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| |
Collapse
|
19
|
Abdel-Aty H, Warren-Oseni K, Bagherzadeh-Akbari S, Hansen VN, Jones K, Harris V, Tan MP, Mcquaid D, McNair HA, Huddart R, Dunlop A, Hafeez S. Mapping Local Failure Following Bladder Radiotherapy According to Dose. Clin Oncol (R Coll Radiol) 2022; 34:e421-e429. [PMID: 35691760 PMCID: PMC9515812 DOI: 10.1016/j.clon.2022.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/06/2022] [Accepted: 05/05/2022] [Indexed: 11/27/2022]
Abstract
AIMS To determine the relationship between local relapse following radical radiotherapy for muscle-invasive bladder cancer (MIBC) and radiation dose. MATERIALS AND METHODS Patients with T2-4N0-3M0 MIBC were recruited to a phase II study assessing the feasibility of intensity-modulated radiotherapy to the bladder and pelvic lymph nodes. Patients were planned to receive 64 Gy/32 fractions to the bladder tumour, 60 Gy/32 fractions to the involved pelvic nodes and 52 Gy/32 fractions to the uninvolved bladder and pelvic nodes. Pre-treatment set-up was informed by cone-beam CT. For patients who experienced local relapse, cystoscopy and imaging (CT/MRI) was used to reconstruct the relapse gross tumour volume (GTVrelapse) on the original planning CT . GTVrelapse D98% and D95% was determined by co-registering the relapse image to the planning CT utilising deformable image registration (DIR) and rigid image registration (RIR). Failure was classified into five types based on spatial and dosimetric criteria as follows: A (central high-dose failure), B (peripheral high-dose failure), C (central elective dose failure), D (peripheral elective dose failure) and E (extraneous dose failure). RESULTS Between June 2009 and November 2012, 38 patients were recruited. Following treatment, 18/38 (47%) patients experienced local relapse within the bladder. The median time to local relapse was 9.0 months (95% confidence interval 6.3-11.7). Seventeen of 18 patients were evaluable based on the availability of cross-sectional relapse imaging. A significant difference between DIR and RIR methods was seen. With the DIR approach, the median GTVrelapse D98% and D95% was 97% and 98% of prescribed dose, respectively. Eleven of 17 (65%) patients experienced type A failure and 6/17 (35%) patients type B failure. No patients had type C, D or E failure. MIBC failure occurred in 10/17 (59%) relapsed patients; of those, 7/11 (64%) had type A failure and 3/6 (50%) had type B failure. Non-MIBC failure occurred in 7/17 (41%) patients; 4/11 (36%) with type A failure and 3/6 (50%) with type B failure. CONCLUSION Relapse following radiotherapy occurred within close proximity to the original bladder tumour volume and within the planned high-dose region, suggesting possible biological causes for failure. We advise caution when considering margin reduction for future reduced high-dose radiation volume or partial bladder radiotherapy protocols.
Collapse
Affiliation(s)
- H Abdel-Aty
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - K Warren-Oseni
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - S Bagherzadeh-Akbari
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - V N Hansen
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark
| | - K Jones
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - V Harris
- Department of Radiotherapy, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - M P Tan
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - D Mcquaid
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - H A McNair
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - R Huddart
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - A Dunlop
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - S Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK.
| |
Collapse
|
20
|
Joyce E, Jackson M, Skok J, Peet B, McNair HA. Images and images: Current roles of therapeutic radiographers. Radiography (Lond) 2022; 28:1093-1100. [PMID: 36054937 DOI: 10.1016/j.radi.2022.07.016] [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: 04/05/2022] [Revised: 07/26/2022] [Accepted: 07/31/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Therapeutic radiography is a small profession and has adapted in response to advanced techniques. An increase in on-line adaptive MRI-guided radiotherapy (MRIgRT) will require role extension for therapeutic radiographers (TRs). This study will investigate the current role description for TRs and the activities they currently undertake with regards to MRIgRT. METHOD A training needs analysis was used to ask TRs about their current roles and responsibilities and essential skills required for MRIgRT. For the purposes of this paper, the authors present the results from the demographics of the individual, their current job title with roles and responsibilities, and experience with decision making and image assessment. Descriptive statistics was used to analyse the data. RESULTS 261 responses were received (n = 261). Only 28% of job titles listed contained the protected title of 'therapeutic radiographer'. Advanced clinical practice roles were expressed by participants indicating that if a service need is presented, emerging roles will be created. Variation existed across the standardised roles of TRs and this discrepancy could present challenges when training for MRIgRT. TRs are pivotal in image verification and recognition on a standard linac, and skills developed there can be transferred to MRIgRT. Decision making is crucial for adaptive techniques and there are many skills within their current scope of practice that are indispensable for the MRIgRT. CONCLUSION It has been demonstrated that TRs have a range of roles that cover vast areas of the oncology pathway and so it is important that TRs are recognised so the pivotal role they play is understood by all. TRs have extensive soft-tissue IGRT knowledge and experience, aiding the evolution of decision-making skills and application of off-protocol judgments, the basis of MRIgRT. IMPLICATIONS FOR PRACTICE Role development and changes in education for therapeutic radiographers.
Collapse
Affiliation(s)
- E Joyce
- Royal Marsden NHS Foundation Trust, UK
| | - M Jackson
- St George's University of London, UK
| | - J Skok
- St George's University of London, UK
| | - B Peet
- Royal Marsden NHS Foundation Trust, UK
| | - H A McNair
- Royal Marsden NHS Foundation Trust, UK; Institute of Cancer Research, UK.
| |
Collapse
|
21
|
Simultaneous Integrated Boost Volumetric Modulated Arc Therapy for Rectal Cancer: Long-Term Results after Protocol-Based Treatment. JOURNAL OF ONCOLOGY 2022; 2022:6986267. [PMID: 35437441 PMCID: PMC9012974 DOI: 10.1155/2022/6986267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/11/2022] [Indexed: 11/25/2022]
Abstract
Background Volumetric modulated arc therapy (VMAT) with simultaneous integrated boost (SIB) is an advanced form of radiotherapy (RT) technology. The purpose of this study was to report long-term treatment outcomes in patients with locally advanced rectal cancer undergoing VMAT-SIB based concurrent chemoradiotherapy (CRT). Methods Between January 2016 and January 2018, a total of 22 patients with operable stage II-III rectal adenocarcinoma were recruited for the pre-designed VMAT-SIB RT protocol. All patients underwent standard diagnostic and staging work-up. The RT target volumes included the following areas: PTV1 = mesorectum that contained gross tumors and enlarged lymph node regions and PTV2 = mesorectum and regional lymphatics from L4-5/S1 to 3-4 cm below the tumor or levator ani muscle, excluding PTV1. The VMAT-SIB dose prescription was as follows: PTV1 = 52.5 Gy/daily 2.1 Gy/25 fractions, PTV2 = 45 Gy/daily 1.8 Gy/25 fractions. Results The mean age of the study population was 64 (range, 18-84) years, and 15 (68.2%) patients were male. Radical operation (total mesorectal excision) was performed by either low anterior resection, ultralow anterior resection, or abdominal perineal resection. All five (22.7%) of the patients with confirmed increasing serum carcinoembryonic antigen (CEA) level at diagnosis showed normalization of serum CEA level after the planned treatment. Among 20 patients who underwent preoperative CRT and surgery, tumor down staging in T- and N-stages was achieved in 10 patients (50%) and 13 patients (65%), respectively, with 20% of ypT0/Tis. With a median follow-up of 54.2 (range, 22.6-61.1) months, the 5-year disease-free survival, overall survival, and local control rates were 64.6%, 81.8%, and 84.4%, respectively. Five patients developed distant metastasis and one developed local recurrence as a first event. Two cases with anastomosis site leakage, three with adhesive ileus, and two with abscess formation were observed during postoperative periods. Conclusions The current VMAT-SIB-based CRT protocol provided acceptable treatment and toxicity outcomes.
Collapse
|
22
|
Luo D, Wang X, Walker E, Springer S, Ramamurthy G, Burda C, Basilion JP. Targeted Chemoradiotherapy of Prostate Cancer Using Gold Nanoclusters with Protease Activatable Monomethyl Auristatin E. ACS APPLIED MATERIALS & INTERFACES 2022; 14:14916-14927. [PMID: 35316026 PMCID: PMC9153066 DOI: 10.1021/acsami.1c23780] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Combined radiotherapy (RT) and chemotherapy are prescribed to patients with advanced prostate cancer (PCa) to increase their survival; however, radiation-related side effects and systematic toxicity caused by chemotherapeutic drugs are unavoidable. To improve the precision and efficacy of concurrent RT and chemotherapy, we have developed a PCa-targeted gold nanocluster radiosensitizer conjugated with a highly potent cytotoxin, monomethyl auristatin E, PSMA-AuNC-MMAE, for RT and chemotherapy of PCa. This approach resulted in enhanced uptake of NCs by PSMA-positive cancer cells, targeted chemotherapy, and increased efficacy of RT both in vitro and in vivo. In addition, the combination of gold and MMAE further increased the efficacy of either of the agents delivered alone or simultaneously but not covalently linked. The PSMA-AuNC-MMAE conjugates improve the specificity and efficacy of radiation and chemotherapy, potentially reducing the toxicity of each therapy and making this an attractive avenue for clinical treatment of advanced PCa.
Collapse
|
23
|
Mesny E, Jacob J, Culot F, Calugaru V, Jenny C, Fonti B, Bourdais R, Courtault-Deslandes F, Boulle G, Meillan N, Simon JM, Maingon P, Feuvret L. Optic nerve motion and gaze direction: Their impact on intraorbital tumor radiotherapy. Cancer Radiother 2022; 26:678-683. [DOI: 10.1016/j.canrad.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
|
24
|
Torshabi A. Investigation the efficacy of fuzzy logic implementation at image-guided radiotherapy. JOURNAL OF MEDICAL SIGNALS & SENSORS 2022; 12:163-170. [PMID: 35755973 PMCID: PMC9215832 DOI: 10.4103/jmss.jmss_76_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/05/2021] [Accepted: 10/24/2021] [Indexed: 11/04/2022]
|
25
|
Slevin F, Aitken K, Alongi F, Arcangeli S, Chadwick E, Chang AR, Cheung P, Crane C, Guckenberger M, Jereczek-Fossa BA, Kamran SC, Kinj R, Loi M, Mahadevan A, Massaccesi M, Mendez LC, Muirhead R, Pasquier D, Pontoriero A, Spratt DE, Tsang YM, Zelefsky MJ, Lilley J, Dickinson P, Hawkins MA, Henry AM, Murray LJ. An international Delphi consensus for pelvic stereotactic ablative radiotherapy re-irradiation. Radiother Oncol 2021; 164:104-114. [PMID: 34560186 DOI: 10.1016/j.radonc.2021.09.010] [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: 06/28/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Stereotactic Ablative Radiotherapy (SABR) is increasingly used to treat metastatic oligorecurrence and locoregional recurrences but limited evidence/guidance exists in the setting of pelvic re-irradiation. An international Delphi study was performed to develop statements to guide practice regarding patient selection, pre-treatment investigations, treatment planning, delivery and cumulative organs at risk (OARs) constraints. MATERIALS AND METHODS Forty-one radiation oncologists were invited to participate in three online surveys. In Round 1, information and opinion was sought regarding participants' practice. Guidance statements were developed using this information and in Round 2 participants were asked to indicate their level of agreement with each statement. Consensus was defined as ≥75% agreement. In Round 3, any statements without consensus were re-presented unmodified, alongside a summary of comments from Round 2. RESULTS Twenty-three radiation oncologists participated in Round 1 and, of these, 21 (91%) and 22 (96%) completed Rounds 2 and 3 respectively. Twenty-nine of 44 statements (66%) achieved consensus in Round 2. The remaining 15 statements (34%) did not achieve further consensus in Round 3. Consensus was achieved for 10 of 17 statements (59%) regarding patient selection/pre-treatment investigations; 12 of 13 statements (92%) concerning treatment planning and delivery; and 7 of 14 statements (50%) relating to OARs. Lack of agreement remained regarding the minimum time interval between irradiation courses, the number/size of pelvic lesions that can be treated and the most appropriate cumulative OAR constraints. CONCLUSIONS This study has established consensus, where possible, in areas of patient selection, pre-treatment investigations, treatment planning and delivery for pelvic SABR re-irradiation for metastatic oligorecurrence and locoregional recurrences. Further research into this technique is required, especially regarding aspects of practice where consensus was not achieved.
Collapse
Affiliation(s)
- Finbar Slevin
- Leeds Teaching Hospitals NHS Trust, UK; University of Leeds, UK.
| | - Katharine Aitken
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
| | - Filippo Alongi
- IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy; University of Brescia, Italy.
| | - Stefano Arcangeli
- School of Medicine and Surgery, University of Milan Bicocca, Monza, Italy.
| | | | - Ah Ram Chang
- Department of Radiation Oncology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
| | | | - Christopher Crane
- Department of Radiation Oncology, Memorial Sloane Kettering Cancer Centre, New York, USA.
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland.
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Italy; Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy.
| | - Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA.
| | - Rémy Kinj
- Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, Switzerland.
| | - Mauro Loi
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
| | - Anand Mahadevan
- Geisinger Medical Center - Radiation Oncology, Danville, USA.
| | - Mariangela Massaccesi
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica e Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, Roma, Italy.
| | - Lucas C Mendez
- Division of Radiation Oncology, London Health Sciences Centre, Canada.
| | | | - David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France; CRIStAL, UMR 9181, Lille University, Lille, France.
| | - Antonio Pontoriero
- Department of BIOMORF, Radiation Oncology Unit, University of Messina, Italy.
| | - Daniel E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Centre, Cleveland, USA.
| | | | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloane Kettering Cancer Centre, New York, USA.
| | | | | | - Maria A Hawkins
- Medical Physics and Biochemical Engineering, University College London, UK.
| | - Ann M Henry
- Leeds Teaching Hospitals NHS Trust, UK; University of Leeds, UK.
| | - Louise J Murray
- Leeds Teaching Hospitals NHS Trust, UK; University of Leeds, UK.
| |
Collapse
|
26
|
Portner R, Bajaj A, Elumalai T, Huddart R, Murthy V, Nightingale H, Patel K, Sargos P, Song Y, Hoskin P, Choudhury A. A practical approach to bladder preservation with hypofractionated radiotherapy for localised muscle-invasive bladder cancer. Clin Transl Radiat Oncol 2021; 31:1-7. [PMID: 34466667 PMCID: PMC8385113 DOI: 10.1016/j.ctro.2021.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 02/06/2023] Open
Abstract
Bladder preservation with trimodality treatment (TMT) is an alternative strategy to radical cystectomy (RC) for the management of localised muscle invasive bladder cancer (MIBC). TMT comprises of transurethral resection of the bladder tumour (TURBT) followed by radiotherapy with concurrent radiosensitisation. TMT studies have shown neo-adjuvant chemotherapy with cisplatin-based regimens is often given to further improve survival outcomes. A hypofractionated radiotherapy regimen is preferable due to its non-inferiority in local control and late toxicities. Radiosensitisation can comprise concurrent chemotherapy (with gemcitabine, cisplatin or combination fluorouracil and mitomycin), CON (carbogen and nicotinomide) or hyperthermic treatment. Radiotherapy techniques are continuously improving and becoming more personalised. As the bladder is a mobile structure subject to volumetric changes from filling, an adaptive approach can optimise bladder coverage and reduce dose to normal tissue. Adaptive radiotherapy (ART) is an evolving field that aims to overcome this. Improved knowledge of tumour biology and advances in imaging techniques aims to further optimise and personalise treatment.
Collapse
Affiliation(s)
- R. Portner
- The Christie NHS Foundation Trust, Manchester, UK
| | - A. Bajaj
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - T. Elumalai
- The Christie NHS Foundation Trust, Manchester, UK
| | - R. Huddart
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, UK
| | - V. Murthy
- Department of Radiation Oncology, ACTREC and Tata Memorial Hospital, Homi Bhabha National University, Mumbai, India
| | | | - K. Patel
- The Christie NHS Foundation Trust, Manchester, UK
| | - P. Sargos
- Department of Radiation Oncology, Institut Bergonié, F-33076 Bordeaux Cedex, France
| | - Y. Song
- The Christie NHS Foundation Trust, Manchester, UK
| | - P. Hoskin
- Mount Vernon Cancer Centre, Northwood, UK
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - A. Choudhury
- The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| |
Collapse
|
27
|
Shelley CE, Barraclough LH, Nelder CL, Otter SJ, Stewart AJ. Adaptive Radiotherapy in the Management of Cervical Cancer: Review of Strategies and Clinical Implementation. Clin Oncol (R Coll Radiol) 2021; 33:579-590. [PMID: 34247890 DOI: 10.1016/j.clon.2021.06.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/19/2021] [Accepted: 06/11/2021] [Indexed: 02/08/2023]
Abstract
The complex and varied motion of the cervix-uterus target during external beam radiotherapy (EBRT) underscores the clinical benefits afforded by adaptive radiotherapy (ART) techniques. These gains have already been realised in the implementation of image-guided adaptive brachytherapy, where adapting to anatomy at each fraction has seen improvements in clinical outcomes and a reduction in treatment toxicity. With regards to EBRT, multiple adaptive strategies have been implemented, including a personalised internal target volume, offline replanning and a plan of the day approach. With technological advances, there is now the ability for real-time online ART using both magnetic resonance imaging and computed tomography-guided imaging. However, multiple challenges remain in the widespread dissemination of ART. This review investigates the ART strategies and their clinical implementation in EBRT delivery for cervical cancer.
Collapse
Affiliation(s)
- C E Shelley
- Department of Clinical Oncology, St. Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK.
| | - L H Barraclough
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - C L Nelder
- Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK
| | - S J Otter
- Department of Clinical Oncology, St. Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK
| | - A J Stewart
- Department of Clinical Oncology, St. Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK; University of Surrey, Guildford, UK
| |
Collapse
|
28
|
Kong V, Hansen VN, Hafeez S. Image-guided Adaptive Radiotherapy for Bladder Cancer. Clin Oncol (R Coll Radiol) 2021; 33:350-368. [PMID: 33972024 DOI: 10.1016/j.clon.2021.03.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022]
Abstract
Technological advancement has facilitated patient-specific radiotherapy in bladder cancer. This has been made possible by developments in image-guided radiotherapy (IGRT). Particularly transformative has been the integration of volumetric imaging into the workflow. The ability to visualise the bladder target using cone beam computed tomography and magnetic resonance imaging initially assisted with determining the magnitude of inter- and intra-fraction target change. It has led to greater confidence in ascertaining true anatomy at each fraction. The increased certainty of dose delivered to the bladder has permitted the safe reduction of planning target volume margins. IGRT has therefore improved target coverage with a reduction in integral dose to the surrounding tissue. Use of IGRT to feed back into plan and dose delivery optimisation according to the anatomy of the day has enabled adaptive radiotherapy bladder solutions. Here we undertake a review of the stepwise developments underpinning IGRT and adaptive radiotherapy strategies for external beam bladder cancer radiotherapy. We present the evidence in accordance with the framework for systematic clinical evaluation of technical innovations in radiation oncology (R-IDEAL).
Collapse
Affiliation(s)
- V Kong
- Radiation Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - V N Hansen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - S Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK.
| |
Collapse
|
29
|
Impact of a fiducial marker based ART strategy on margins in postoperative IMRT of gynecological tumors. Radiother Oncol 2021; 158:1-6. [PMID: 33587973 DOI: 10.1016/j.radonc.2021.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/24/2020] [Accepted: 01/29/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE To investigate the potential of an offline Adaptive Radiotherapy (ART) strategy, based on the interfractional vagina motion (IVM) measured using fiducial markers (FM) during an initial number of fractions, on the CTV to PTV margins in post-operative gynecological patients. MATERIALS AND METHODS In 18 patients, treated post-operatively for gynecological tumors, the systematic residual IVM was quantified after simulating an offline ART procedure, utilizing the average IVM measured with FM for a varying initial numbers of fractions to find the optimal moment to adapt the treatment plan and a threshold for selecting patients for replanning. Clinical margins for a zero, 2 and 5 mm threshold based strategy were calculated to assess the possible margin reduction. RESULTS Applying an ART strategy based on the average IVM of the initial 5 fractions reduces the systematic IVM significantly (P < 0.025), allowing a reduction of the clinical margin of 3 mm (20%) in the CC direction and 2 mm (13%) in the AP direction. A 2 mm threshold for selecting patients for replanning shows no difference in the reduction of the clinical margin, but reduces the workload with 12%. CONCLUSION An ART strategy based on adapting on the average IVM during the initial 5 fractions of treatment provides an opportunity to reduce the CTV to PTV margins in postoperative gynecological tumors. To keep the workload in balance with the best achievable margin reduction, a threshold for selecting patients for plan adaptation is recommended.
Collapse
|
30
|
Muirhead R. Image-Guided Radiotherapy – The Unsung Hero of Radiotherapy Development. Clin Oncol (R Coll Radiol) 2020; 32:789-791. [DOI: 10.1016/j.clon.2020.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/21/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023]
|