1
|
Ghandourh W, Batumalai V, Boxer M, Holloway L. Can reducing planning safety margins broaden the inclusion criteria for lung stereotactic ablative body radiotherapy? J Med Radiat Sci 2021; 68:298-309. [PMID: 33934559 PMCID: PMC8424332 DOI: 10.1002/jmrs.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/31/2021] [Accepted: 03/24/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Stereotactic ablative body radiotherapy (SABR) is currently indicated for inoperable, early-stage non-small cell lung carcinoma (NSCLC). Advancements in image-guidance technology continue to improve treatment precision and enable reductions in planning safety margins. We investigated the dosimetric benefits of margin reduction, its potential to extend SABR to more NSCLC patients and the factors influencing plan acceptability. METHODS This retrospective analysis included 61 patients (stage IA-IIIA) treated with conventional radiotherapy. Patients were ineligible for SABR due to tumour size or proximity to organs at risk (OAR). Using Pinnacle auto-planning, three SABR plans were generated for each patient: a regular planning target volume margin plan, a reduced margin plan (gross tumour volume GTV+3 mm) and a non-margin plan. Targets were planned to 48Gy/4 or 50Gy/5 fractions depending on location. Plans were compared in terms of target coverage, OAR doses and dosimetric acceptability based on local guidelines. Predictors of acceptability were investigated using logistic regression analysis. RESULTS Compared to regular margin plans, both reduced margin and non-margin plans resulted in significant reductions to almost all dose constraints. Dose conformity was significantly worse in non-margin plans (P < 0.05) and strongly correlated with targets' surface area/volume ratio (R2 = 0.9, P < 0.05). 26% of reduced margin plans were acceptable, compared to 54% of non-margin plans. GTV overlap with OARs significantly affected plan acceptability (OR 0.008, 95% CI 0.001-0.073). CONCLUSION Margin reduction significantly reduced OAR doses enabling acceptable plans to be achieved for patients previously excluded from SABR. Indications for lung SABR may broaden as treatment accuracy continues to improve; further work is needed to identify patients most likely to benefit.
Collapse
Affiliation(s)
- Wsam Ghandourh
- South Western Clinical SchoolFaculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
- Liverpool and Macarthur Cancer Therapy CentresSydneyNew South WalesAustralia
- Ingham Institute of Applied Medical ResearchSydneyNew South WalesAustralia
| | - Vikneswary Batumalai
- South Western Clinical SchoolFaculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
- Liverpool and Macarthur Cancer Therapy CentresSydneyNew South WalesAustralia
- Ingham Institute of Applied Medical ResearchSydneyNew South WalesAustralia
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE)SydneyNew South WalesAustralia
| | - Miriam Boxer
- GenesisCare ConcordSydneyNew South WalesAustralia
| | - Lois Holloway
- South Western Clinical SchoolFaculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
- Liverpool and Macarthur Cancer Therapy CentresSydneyNew South WalesAustralia
- Ingham Institute of Applied Medical ResearchSydneyNew South WalesAustralia
- Centre for Medical Radiation PhysicsUniversity of WollongongWollongongNew South WalesAustralia
- Institute of Medical PhysicsSchool of PhysicsUniversity of SydneySydneyNew South WalesAustralia
- Department of Human OncologySchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| |
Collapse
|
2
|
Woodford K, Panettieri V, Ruben JD, Davis S, Sim E, Tran Le T, Senthi S. Contrast enhanced oesophageal avoidance for stereotactic body radiotherapy: Barium vs. Gastrografin. Tech Innov Patient Support Radiat Oncol 2019; 12:16-22. [PMID: 32095550 PMCID: PMC7033756 DOI: 10.1016/j.tipsro.2019.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 10/13/2019] [Accepted: 10/21/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION SABR may facilitate treatment in a greater proportion of locally-advanced NSCLC patients, just as it has for early-stage disease. The oesophagus is one of the key dose-limiting organs and visualization during IGRT would better ensure toxicity is avoided. As the oesophagus is poorly seen on CBCT, we assessed the extent to which this is improved using two oral contrast agents. MATERIALS & METHODS Six patients receiving radiotherapy for Stage I-III NSCLC were assigned to receive 50 mL Gastrografin or 50 mL barium sulphate prior to simulation and pre-treatment CBCTs. Three additional patients who did not receive contrast were included as a control group. Oesophageal visibility was determined by assessing concordance between six experienced observers in contouring the organ. 36 datasets and 216 contours were analysed. A STAPLE contour was created and compared to each individual contour. Descriptive statistics were used and a Kappa statistic, Dice Coefficient and Hausdorff distance were calculated and compared using a t-test. Contrast-induced artefact was assessed by observer scoring. RESULTS Both contrast agents significantly improved the consistency of oesophagus localisation on CBCT across all comparison metrics compared to CBCTs without contrast. Barium performed significantly better than Gastrografin with improved kappa statistics (p = 0.007), dice coefficients (p < 0.001) and Hausdorff distances (p = 0.002), although at a cost of increased image artefact. DISCUSSION Barium produced lower delineation uncertainties but more image artefact, compared to Gastrografin and no contrast. It is feasible to use oral contrast as a tool in IGRT to help guide clinicians and therapists with online matching and monitoring of the oesophageal position.
Collapse
Affiliation(s)
- Katrina Woodford
- Alfred Health Radiation Oncology, The Alfred, Melbourne, Victoria, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Vanessa Panettieri
- Alfred Health Radiation Oncology, The Alfred, Melbourne, Victoria, Australia
- Department of Medical Imaging and Radiation Sciences, School of Biomedical Sciences, Monash University, Clayton, Victoria, Australia
| | - Jeremy D Ruben
- Alfred Health Radiation Oncology, The Alfred, Melbourne, Victoria, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sidney Davis
- Alfred Health Radiation Oncology, The Alfred, Melbourne, Victoria, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Esther Sim
- Alfred Health Radiation Oncology, The Alfred, Melbourne, Victoria, Australia
| | - Trieumy Tran Le
- Alfred Health Radiation Oncology, The Alfred, Melbourne, Victoria, Australia
| | - Sashendra Senthi
- Alfred Health Radiation Oncology, The Alfred, Melbourne, Victoria, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|