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Xu D, Descovich M, Liu H, Sheng K. Robust localization of poorly visible tumor in fiducial free stereotactic body radiation therapy. Radiother Oncol 2024; 200:110514. [PMID: 39214256 DOI: 10.1016/j.radonc.2024.110514] [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: 05/24/2024] [Revised: 07/27/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND PURPOSE Effective respiratory motion management reduces healthy tissue toxicity and ensures sufficient dose delivery to lung cancer cells in pulmonary stereotactic body radiation therapy (SBRT) with high fractional doses. An articulated robotic arm paired with an X-ray imaging system is designed for real-time motion-tracking (RTMT) dose delivery. However, small tumors (<15 mm) or tumors at challenging locations may not be visible in the X-ray images, disqualifying patients with such tumors from RTMT dose delivery unless fiducials are implanted via an invasive procedure. To track these practically invisible lung tumors in SBRT, we hereby develop a deep learning-enabled template-free tracking framework, SAFE Track. METHODS SAFE Track is a fully supervised framework that trains a generalizable prior for template-free target localization. Two sub-stages are incorporated in SAFE Track, including the initial pretraining on two large-scale medical image datasets (DeepLesion and Node21) followed by fine-tuning on our in-house dataset. A two-stage detector, Faster R-CNN, with a backbone of ResNet50, was selected as our detection network. 94 patients (415 fractions; 40,348 total frames) with low tumor visibility who thus had implanted fiducials were included. The cohort is categorized by the longest dimension of the tumor (<10 mm, 10-15 mm and > 15 mm). The patients were split into training (n = 66) and testing (n = 28) sets. We simulated fiducial-free tumors by removing the fiducials from the X-ray images. We classified the patients into two groups - fiducial implanted inside tumors and implanted outside tumors. To ensure the rigor of our experiment design, we only conducted fiducial removal simulation in training patients and utilized patients with fiducial implanted outside of the tumors for testing. Commercial Xsight Lung Tracking (XLT) and a Deep Match were included for comparison. RESULTS SAFE Track achieves promising outcomes to as accurate as 1.23±1.32 mm 3D distance in testing patients with tumor size > 15 mm where Deep Match is at 4.75±1.67 mm and XLT is at 12.23±4.58 mm 3D distance. Even for the most challenging tumor size (<10 mm), SAFE Track maintains its robustness at 1.82 plus or minus 1.67 mm 3D distance, where Deep Match is at 5.32 plus or minus 2.32 mm, and XLT is at 24.83±12.95 mm 3D distance. Moreover, SAFE Track can detect some considerably challenging cases where the tumor is almost invisible or overlapped with dense anatomies. CONCLUSION SAFE Track is a robust, clinically compatible, fiducial-free, and template-free tracking framework that is applicable to patients with small tumors or tumors obscured by overlapped anatomies in SBRT.
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Affiliation(s)
- Di Xu
- Radiation Oncology, University of California, San Francisco, USA
| | | | - Hengjie Liu
- Radiation Oncology, University of California, Los Angeles, USA
| | - Ke Sheng
- Radiation Oncology, University of California, San Francisco, USA.
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Yao K, Wang M, Du Y, Liu J, Wang Q, Wang R, Wu H, Yue H. Efficient EPID-based quality assurance of beam time delay for respiratory-gated radiotherapy with validation on Catalyst™ and AlignRT™ systems. J Appl Clin Med Phys 2024; 25:e14376. [PMID: 38695849 PMCID: PMC11302812 DOI: 10.1002/acm2.14376] [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: 06/29/2023] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 08/09/2024] Open
Abstract
PURPOSE To propose a straightforward and time-efficient quality assurance (QA) approach of beam time delay for respiratory-gated radiotherapy and validate the proposed method on typical respiratory gating systems, Catalyst™ and AlignRT™. METHODS The QA apparatus was composed of a motion platform and a Winston-Lutz cube phantom (WL3) embedded with metal balls. The apparatus was first scanned in CT-Sim and two types of QA plans specific for beam on and beam off time delay, respectively, were designed. Static reference images and motion testing images of the WL3 cube were acquired with EPID. By comparing the position differences of the embedded metal balls in the motion and reference images, beam time delays were determined. The proposed approach was validated on three linacs with either Catalyst™ or AlignRT™ respiratory gating systems. To investigate the impact of energy and dose rate on beam time delay, a range of QA plans with Eclipse (V15.7) were devised with varying energy and dose rates. RESULTS For all energies, the beam on time delays in AlignRT™ V6.3.226, AlignRT™ V7.1.1, and Catalyst™ were 92.13 ± $ \pm $ 5.79 ms, 123.11 ± $ \pm $ 6.44 ms, and 303.44 ± $ \pm $ 4.28 ms, respectively. The beam off time delays in AlignRT™ V6.3.226, AlignRT™ V7.1.1, and Catalyst™ were 121.87 ± $ \pm $ 1.34 ms, 119.33 ± $ \pm $ 0.75 ms, and 97.69 ± $ \pm $ 2.02 ms, respectively. Furthermore, the beam on delays decreased slightly as dose rates increased for all gating systems, whereas the beam off delays remained unaffected. CONCLUSIONS The validation results demonstrate the proposed QA approach of beam time delay for respiratory-gated radiotherapy was both reproducible and time-efficient to practice for institutions to customize accordingly.
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Affiliation(s)
- Kaining Yao
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing)Department of Radiation OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Meijiao Wang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing)Department of Radiation OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Yi Du
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing)Department of Radiation OncologyPeking University Cancer Hospital & InstituteBeijingChina
- Institute of Medical TechnologyPeking University Health Science CenterBeijingChina
| | - Jiacheng Liu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing)Department of Radiation OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Qingying Wang
- Institute of Medical TechnologyPeking University Health Science CenterBeijingChina
| | - Ruoxi Wang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing)Department of Radiation OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Hao Wu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing)Department of Radiation OncologyPeking University Cancer Hospital & InstituteBeijingChina
- Institute of Medical TechnologyPeking University Health Science CenterBeijingChina
| | - Haizhen Yue
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing)Department of Radiation OncologyPeking University Cancer Hospital & InstituteBeijingChina
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Cheng JC, Buduhan G, Venkataraman S, Tan L, Sasaki D, Bashir B, Ahmed N, Kidane B, Sivananthan G, Koul R, Leylek A, Butler J, McCurdy B, Wong R, Kim JO. Endobronchially Implanted Real-Time Electromagnetic Transponder Beacon-Guided, Respiratory-Gated SABR for Moving Lung Tumors: A Prospective Phase 1/2 Cohort Study. Adv Radiat Oncol 2023; 8:101243. [PMID: 37408673 PMCID: PMC10318214 DOI: 10.1016/j.adro.2023.101243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/03/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose Endobronchial electromagnetic transponder beacons (EMT) provide real-time, precise positional data of moving lung tumors. We report results of a phase 1/2, prospective, single-arm cohort study evaluating the treatment planning effects of EMT-guided SABR for moving lung tumors. Methods and Materials Eligible patients were adults, Eastern Cooperative Oncology Group 0 to 2, with T1-T2N0 non-small cell lung cancer or pulmonary metastasis ≤4 cm with motion amplitude ≥5 mm. Three EMTs were endobronchially implanted using navigational bronchoscopy. Four-dimensional free-breathing computed tomography simulation scans were obtained, and end-exhalation phases were used to define the gating window internal target volume. A 3-mm expansion of gating window internal target volume defined the planning target volume (PTV). EMT-guided, respiratory-gated (RG) SABR was delivered (54 Gy/3 fractions or 48 Gy/4 fractions) using volumetric modulated arc therapy. For each RG-SABR plan, a 10-phase image-guided SABR plan was generated for dosimetric comparison. PTV/organ-at-risk (OAR) metrics were tabulated and analyzed using the Wilcoxon signed-rank pair test. Treatment outcomes were evaluated using RECIST (Response Evaluation Criteria in Solid Tumours; version 1.1). Results Of 41 patients screened, 17 were enrolled and 2 withdrew from the study. Median age was 73 years, with 7 women. Sixty percent had T1/T2 non-small cell lung cancer and 40% had M1 disease. Median tumor diameter was 1.9 cm with 73% of targets located peripherally. Mean respiratory tumor motion was 1.25 cm (range, 0.53-4.04 cm). Thirteen tumors were treated with EMT-guided SABR and 47% of patients received 48 Gy in 4 fractions while 53% received 54 Gy in 3 fractions. RG-SABR yielded an average PTV reduction of 46.9% (P < .005). Lung V5, V10, V20, and mean lung dose had mean relative reductions of 11.3%, 20.3%, 31.1%, and 20.3%, respectively (P < .005). Dose to OARs was significantly reduced (P < .05) except for spinal cord. At 6 months, mean radiographic tumor volume reduction was 53.5% (P < .005). Conclusions EMT-guided RG-SABR significantly reduced PTVs of moving lung tumors compared with image-guided SABR. EMT-guided RG-SABR should be considered for tumors with large respiratory motion amplitudes or those located in close proximity to OARs.
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Affiliation(s)
- Jui Chih Cheng
- Radiation Oncology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gordon Buduhan
- Thoracic Surgery, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Lawrence Tan
- Thoracic Surgery, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David Sasaki
- Medical Physics, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Bashir Bashir
- Radiation Oncology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Naseer Ahmed
- Radiation Oncology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Biniam Kidane
- Thoracic Surgery, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gokulan Sivananthan
- Radiation Oncology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rashmi Koul
- Radiation Oncology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ahmet Leylek
- Radiation Oncology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Butler
- Radiation Oncology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Boyd McCurdy
- Medical Physics, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Ralph Wong
- Medical Oncology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julian O. Kim
- Radiation Oncology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- CancerCare Manitoba Research Institute, Winnipeg, Manitoba, Canada
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Chen F, Cheng YK, Chiang CH, Lu TY, Huang CJ. Simultaneous treatment of two lung cancer lesions with stereotactic MR-guided adaptive radiation therapy: A case report. Medicine (Baltimore) 2023; 102:e32626. [PMID: 36637933 PMCID: PMC9839273 DOI: 10.1097/md.0000000000032626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
RATIONALE Lung cancer is 1 of the most prevalent cancers globally. Definitive stereotactic ablative radiotherapy (SABR) is suggested for those who are unfit for or refuse surgical intervention. Here we present a patient with 2 lung cancer lesions who received SABR simultaneously with magnetic resonance Linear accelerator (Linac)-magnetic resonance (MR). PATIENT CONCERNS A 46-years-old man had history of left lower lung cancer post lobectomy in 2018. Two recurrent tumors were found 2 years following, then became enlarged 4 months later. DIAGNOSES The recurrent tumors were found by computed tomography. INTERVENTIONS SABR was indicated due to inoperability and small size. Simulation was done both by computed tomography and MR scan with ViewRay MRIdian Linac, with the prescription dose being 50 gray in 4 fractions performed every other day within 2 weeks. The 2 lesions were irradiated at the same time with a single isocenter with mean treatment time was 78 minutes. OUTCOMES No acute side effect was noted. Follow-up chest computed tomography scan 14 months after SABR showed mild consolidation and pneumonitis over the upper irradiated site favoring radiation-related reasons, while pneumonitis was resolved over the lower irradiated site. Positron emission tomography showed no definite evidence of FDG-avid recurrence. The patient has survived over 18 months following SABR and more than 4 years from the first diagnosis of lung cancer without significant adverse effects. LESSONS Simultaneous SABR for multiple lung lesions is quite challenging because tumor motion by breathing can increase the risk of missing the target. With help by MR-Linac, simultaneous SABR to multiple lung lesions can be performed safely with efficacy.
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Affiliation(s)
- Frank Chen
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuan-Kai Cheng
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chen-Han Chiang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzu-Ying Lu
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Jen Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- * Correspondence: Chih-Jen Huang, Department of Radiation Oncology, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung 807, Taiwan (e-mail: )
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Potential Morbidity Reduction for Lung Stereotactic Body Radiation Therapy Using Respiratory Gating. Cancers (Basel) 2021; 13:cancers13205092. [PMID: 34680240 PMCID: PMC8533802 DOI: 10.3390/cancers13205092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/08/2021] [Accepted: 10/08/2021] [Indexed: 12/25/2022] Open
Abstract
Simple Summary Lung stereotactic body radiotherapy (SBRT) is the standard of care for early-stage lung cancer and oligometastases. For SBRT, motion has to be considered to avoid misdosage. Respiratory phase gating, meaning to irradiate the target volume only in a predefined gating motion phase window, can be applied to mitigate motion-induced effects. The aim of this study was to exploit the clinical benefit of gating for lung SBRT. For the majority of 14 lung tumor patients and various gating windows, we could prove a reduced dose to normal tissue by gating simulation. A normal tissue complication probability (NTCP) model analysis revealed a major reduction of normal tissue toxicity for moderate gating window sizes. The most beneficial effect of gating was found for those patients with the highest prior toxicity risk. The presented results are useful for personalized risk assessment prior to treatment and may help to select patients and optimal gating windows. Abstract We investigated the potential of respiratory gating to mitigate the motion-caused misdosage in lung stereotactic body radiotherapy (SBRT). For fourteen patients with lung tumors, we investigated treatment plans for a gating window (GW) including three breathing phases around the maximum exhalation phase, GW40–60. For a subset of six patients, we also assessed a preceding three-phase GW20–40 and six-phase GW20–70. We analyzed the target volume, lung, esophagus, and heart doses. Using normal tissue complication probability (NTCP) models, we estimated radiation pneumonitis and esophagitis risks. Compared to plans without gating, GW40–60 significantly reduced doses to organs at risk without impairing the tumor doses. On average, the mean lung dose decreased by 0.6 Gy (p < 0.001), treated lung V20Gy by 2.4% (p = 0.003), esophageal dose to 5cc by 2.0 Gy (p = 0.003), and maximum heart dose by 3.2 Gy (p = 0.009). The model-estimated mean risks of 11% for pneumonitis and 12% for esophagitis without gating decreased upon GW40–60 to 7% and 9%, respectively. For the highest-risk patient, gating reduced the pneumonitis risk from 43% to 32%. Gating is most beneficial for patients with high-toxicity risks. Pre-treatment toxicity risk assessment may help optimize patient selection for gating, as well as GW selection for individual patients.
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Taasti VT, Hattu D, Vaassen F, Canters R, Velders M, Mannens J, van Loon J, Rinaldi I, Unipan M, van Elmpt W. Treatment planning and 4D robust evaluation strategy for proton therapy of lung tumors with large motion amplitude. Med Phys 2021; 48:4425-4437. [PMID: 34214201 PMCID: PMC8456954 DOI: 10.1002/mp.15067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/29/2021] [Accepted: 06/21/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose Intensity‐modulated proton therapy (IMPT) for lung tumors with a large tumor movement is challenging due to loss of robustness in the target coverage. Often an upper cut‐off at 5‐mm tumor movement is used for proton patient selection. In this study, we propose (1) a robust and easily implementable treatment planning strategy for lung tumors with a movement larger than 5 mm, and (2) a four‐dimensional computed tomography (4DCT) robust evaluation strategy for evaluating the dose distribution on the breathing phases. Materials and methods We created a treatment planning strategy based on the internal target volume (ITV) concept (aim 1). The ITV was created as a union of the clinical target volumes (CTVs) on the eight 4DCT phases. The ITV expanded by 2 mm was the target during robust optimization on the average CT (avgCT). The clinical plan acceptability was judged based on a robust evaluation, computing the voxel‐wise min and max (VWmin/max) doses over 28 error scenarios (range and setup errors) on the avgCT. The plans were created in RayStation (RaySearch Laboratories, Stockholm, Sweden) using a Monte Carlo dose engine, commissioned for our Mevion S250i Hyperscan system (Mevion Medical Systems, Littleton, MA, USA). We developed a new 4D robust evaluation approach (4DRobAvg; aim 2). The 28 scenario doses were computed on each individual 4DCT phase. For each scenario, the dose distributions on the individual phases were deformed to the reference phase and combined to a weighted sum, resulting in 28 weighted sum scenario dose distributions. From these 28 scenario doses, VWmin/max doses were computed. This new 4D robust evaluation was compared to two simpler 4D evaluation strategies: re‐computing the nominal plan on each individual 4DCT phase (4DNom) and computing the robust VWmin/max doses on each individual phase (4DRobInd). The treatment planning and dose evaluation strategies were evaluated for 16 lung cancer patients with tumor movement of 4–26 mm. Results The ratio of the ITV and CTV volumes increased linearly with the tumor amplitude, with an average ratio of 1.4. Despite large ITV volumes, a clinically acceptable plan fulfilling all target and organ at risk (OAR) constraints was feasible for all patients. The 4DNom and 4DRobInd evaluation strategies were found to under‐ or overestimate the dosimetric effect of the tumor movement, respectively. 4DRobInd showed target underdosage for five patients, not observed in the robust evaluation on the avgCT or in 4DRobAvg. The accuracy of dose deformation used in 4DRobAvg was quantified and found acceptable, with differences for the dose‐volume parameters below 1 Gy in most cases. Conclusion The proposed ITV‐based planning strategy on the avgCT was found to be a clinically feasible approach with adequate tumor coverage and no OAR overdosage even for large tumor movement. The new proposed 4D robust evaluation, 4DRobAvg, was shown to give an easily interpretable understanding of the effect of respiratory motion dose distribution, and to give an accurate estimate of the dose delivered in the different breathing phases.
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Affiliation(s)
- Vicki Trier Taasti
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Djoya Hattu
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Femke Vaassen
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Richard Canters
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Marije Velders
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Jolein Mannens
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Judith van Loon
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Ilaria Rinaldi
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Mirko Unipan
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology, Maastricht University Medical Centre+, Maastricht, Netherlands
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Yamada T, Takao S, Koyano H, Nihongi H, Fujii Y, Hirayama S, Miyamoto N, Matsuura T, Umegaki K, Katoh N, Yokota I, Shirato H, Shimizu S. Validation of dose distribution for liver tumors treated with real-time-image gated spot-scanning proton therapy by log data based dose reconstruction. JOURNAL OF RADIATION RESEARCH 2021; 62:626-633. [PMID: 33948661 PMCID: PMC8273791 DOI: 10.1093/jrr/rrab024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/02/2020] [Indexed: 06/12/2023]
Abstract
In spot scanning proton therapy (SSPT), the spot position relative to the target may fluctuate through tumor motion even when gating the radiation by utilizing a fiducial marker. We have established a procedure that evaluates the delivered dose distribution by utilizing log data on tumor motion and spot information. The purpose of this study is to show the reliability of the dose distributions for liver tumors treated with real-time-image gated SSPT (RGPT). In the evaluation procedure, the delivered spot information and the marker position are synchronized on the basis of log data on the timing of the spot irradiation and fluoroscopic X-ray irradiation. Then a treatment planning system reconstructs the delivered dose distribution. Dose distributions accumulated for all fractions were reconstructed for eight liver cases. The log data were acquired in all 168 fractions for all eight cases. The evaluation was performed for the values of maximum dose, minimum dose, D99, and D5-D95 for the clinical target volumes (CTVs) and mean liver dose (MLD) scaled by the prescribed dose. These dosimetric parameters were statistically compared between the planned dose distribution and the reconstructed dose distribution. The mean difference of the maximum dose was 1.3% (95% confidence interval [CI]: 0.6%-2.1%). Regarding the minimum dose, the mean difference was 0.1% (95% CI: -0.5%-0.7%). The mean differences of D99, D5-D95 and MLD were below 1%. The reliability of dose distributions for liver tumors treated with RGPT-SSPT was shown by the evaluation of the accumulated dose distributions.
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Affiliation(s)
- Takahiro Yamada
- Hitachi Ltd. 1-1 7-chome, Oomika-cho, Hitachi-shi, Ibaraki 319-1292, Japan
- Graduate School of Biomedical Science and Engineering, Hokkaido University, North15 West7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Seishin Takao
- Corresponding author. Seishin Takao, Department of Medical Physics, Hokkaido University Hospital, North14 West5, Kita-ku, Sapporo, Hokkaido 060-8638, Japan, Tel: (+81)11-706-5254, Fax: (+81) 11-706-5255, E-mail address:
| | - Hidenori Koyano
- Department of Medical Physics, Graduate School of Medicine, Hokkaido University, North15 West7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Hideaki Nihongi
- Hitachi Ltd. 1-1 7-chome, Oomika-cho, Hitachi-shi, Ibaraki 319-1292, Japan
| | - Yusuke Fujii
- Hitachi Ltd. 1-1 7-chome, Oomika-cho, Hitachi-shi, Ibaraki 319-1292, Japan
| | - Shusuke Hirayama
- Hitachi Ltd. 1-1 7-chome, Oomika-cho, Hitachi-shi, Ibaraki 319-1292, Japan
- Graduate School of Biomedical Science and Engineering, Hokkaido University, North15 West7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Naoki Miyamoto
- Department of Medical Physics, Hokkaido University Hospital, North14 West5, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
- Division of Quantum Science and Engineering, Faculty of Engineering, Hokkaido University, North13 West8, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
- Global Station of Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, North15 West7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Taeko Matsuura
- Department of Medical Physics, Hokkaido University Hospital, North14 West5, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
- Division of Quantum Science and Engineering, Faculty of Engineering, Hokkaido University, North13 West8, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
- Global Station of Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, North15 West7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Kikuo Umegaki
- Department of Medical Physics, Hokkaido University Hospital, North14 West5, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
- Division of Quantum Science and Engineering, Faculty of Engineering, Hokkaido University, North13 West8, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
- Global Station of Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, North15 West7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Norio Katoh
- Global Station of Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, North15 West7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
- Department of Therapeutic Radiology, Faculty of Medicine, Hokkaido University, North15 West7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, North15 West7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Hiroki Shirato
- Global Station of Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, North15 West7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
- Department of Proton Beam Therapy, Faculty of Medicine, Hokkaido University, North15 West7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Shinichi Shimizu
- Department of Medical Physics, Hokkaido University Hospital, North14 West5, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
- Global Station of Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, North15 West7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, North15 West7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
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Finazzi T, Schneiders FL, Senan S. Developments in radiation techniques for thoracic malignancies. Eur Respir Rev 2021; 30:200224. [PMID: 33952599 PMCID: PMC9488563 DOI: 10.1183/16000617.0224-2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/27/2020] [Indexed: 12/25/2022] Open
Abstract
Radiation therapy is a cornerstone of modern lung cancer treatment alongside surgery, chemotherapy, immunotherapy and targeted therapies. Advances in radiotherapy techniques have enhanced the accuracy of radiation delivery, which has contributed to the evolution of radiation therapy into a guideline-recommended treatment in both early-stage and locally advanced nonsmall cell lung cancer. Furthermore, although radiotherapy has long been used for palliation of disease in advanced lung cancer, it is increasingly having a role as a locally ablative treatment in patients with oligometastatic disease.This review provides an overview of recent developments in radiation techniques, particularly for non-radiation oncologists who are involved in the care of lung cancer patients. Technical advances are discussed, and findings of recent clinical trials are highlighted, all of which have led to a changing perception of the role of radiation therapy in multidisciplinary care.
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Affiliation(s)
- Tobias Finazzi
- Clinic of Radiotherapy and Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - Famke L Schneiders
- Dept of Radiation Oncology, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
| | - Suresh Senan
- Dept of Radiation Oncology, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands
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9
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Chen L, Bai S, Li G, Li Z, Xiao Q, Bai L, Li C, Xian L, Hu Z, Dai G, Wang G. Accuracy of real-time respiratory motion tracking and time delay of gating radiotherapy based on optical surface imaging technique. Radiat Oncol 2020; 15:170. [PMID: 32650819 PMCID: PMC7350729 DOI: 10.1186/s13014-020-01611-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/02/2020] [Indexed: 02/08/2023] Open
Abstract
Background Surface-guided radiation therapy (SGRT) employs a non-invasive real-time optical surface imaging (OSI) technique for patient surface motion monitoring during radiotherapy. The main purpose of this study is to verify the real-time tracking accuracy of SGRT for respiratory motion and provide a fitting method to detect the time delay of gating. Methods A respiratory motion phantom was utilized to simulate respiratory motion using 17 cosine breathing pattern curves with various periods and amplitudes. The motion tracking of the phantom was performed by the Catalyst™ system. The tracking accuracy of the system (with period and amplitude variations) was evaluated by analyzing the adjusted coefficient of determination (A_R2) and root mean square error (RMSE). Furthermore, 13 actual respiratory curves, which were categorized into regular and irregular patterns, were selected and then simulated by the phantom. The Fourier transform was applied to the respiratory curves, and tracking accuracy was compared through the quantitative analyses of curve similarity using the Pearson correlation coefficient (PCC). In addition, the time delay of amplitude-based respiratory-gating radiotherapy based on the OSI system with various beam hold times was tested using film dosimetry for the Elekta Versa-HD and Varian Edge linacs. A dose convolution-fitting method was provided to accurately measure the beam-on and beam-off time delays. Results A_R2 and RMSE for the cosine curves were 0.9990–0.9996 and 0.110–0.241 mm for periods ranging from 1 s to 10 s and 0.9990–0.9994 and 0.059–0.175 mm for amplitudes ranging from 3 mm to 15 mm. The PCC for the actual respiratory curves ranged from 0.9955 to 0.9994, which was not significantly affected by breathing patterns. For gating radiotherapy, the average beam-on and beam-off time delays were 1664 ± 72 and 25 ± 30 ms for Versa-HD and 303 ± 45 and 34 ± 25 ms for Edge, respectively. The time delay was relatively stable as the beam hold time increased. Conclusions The OSI technique provides high accuracy for respiratory motion tracking. The proposed dose convolution-fitting method can accurately measure the time delay of respiratory-gating radiotherapy. When the OSI technique is used for respiratory-gating radiotherapy, the time delay for the beam-on is considerably longer than the beam-off.
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Affiliation(s)
- Li Chen
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.,School of Physics and Technology, Wuhan University, Wuhan, China
| | - Sen Bai
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Guangjun Li
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
| | - Zhibin Li
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Xiao
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Long Bai
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Changhu Li
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Lixun Xian
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenyao Hu
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Guyu Dai
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Guangyu Wang
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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Finazzi T, Palacios MA, Haasbeek CJ, Admiraal MA, Spoelstra FO, Bruynzeel AM, Slotman BJ, Lagerwaard FJ, Senan S. Stereotactic MR-guided adaptive radiation therapy for peripheral lung tumors. Radiother Oncol 2020; 144:46-52. [DOI: 10.1016/j.radonc.2019.10.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/25/2019] [Accepted: 10/18/2019] [Indexed: 12/22/2022]
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11
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Tong Y, Gong G, Su M, Yin Y. Comparison of the dose on specific 3DCT images and the accumulated dose for cardiac structures in esophageal tumors radiotherapy: whether specific 3DCT images can be used for dose assessment? Radiat Oncol 2019; 14:242. [PMID: 31881901 PMCID: PMC6935068 DOI: 10.1186/s13014-019-1450-6] [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: 06/17/2019] [Accepted: 12/19/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Cardiac activity could impact the accuracy of dose assessment for the heart, pericardium and left ventricular myocardium (LVM). The purpose of this study was to explore whether it is possible to perform dose assessment by contouring the cardiac structures on specific three-dimensional computed tomography (3DCT) images to reduce the impact of cardiac activity. METHODS Electrocardiograph-gated 4DCT (ECG-gated 4DCT) images of 22 patients in breath-hold were collected. MIM Maestro 6.8.2 (MIM) was used to reconstruct specific 3DCT images to obtain the Maximal intensity projection (MIP) image, Average intensity projection (AIP) image and Minimum intensity projection (Min-IP) image. The heart, pericardium and LVM were contoured in 20 phases of 4DCT images (0, 5%... 95%) and the MIP, AIP and Min-IP images. Then, a radiotherapy plan was designed at the 0% phase of the 4DCT images, and the dose was transplanted to all phases of 4DCT to acquire the dose on all phases, the accumulated dose of all phases was calculated using MIM. The dose on MIP, AIP and Min-IP images were also obtained by deformable registration of the dose. The mean dose (Dmean), V5, V10, V20, V30 and V40 for the heart, pericardium and LVM in MIP, AIP and Min-IP images were compared with the corresponding parameters after dose accumulation. RESULTS The mean values of the difference between the Dmean in the MIP image and the Dmean after accumulation for the heart, pericardium and LVM were all less than 1.50 Gy, and the dose difference for the pericardium and LVM was not statistically significant (p > 0.05). For dose-volume parameters, there was no statistically significant difference between V5, V10, and V20 of the heart and pericardium in MIP, AIP, and Min-IP images and those after accumulation (p > 0.05). For the LVM, only in the MIP image, the differences of V5, V10, V20, V30 and V40 were not significant compared to those after dose accumulation (p > 0.05). CONCLUSIONS There was a smallest difference for the dosimetry parameters of cardiac structures on MIP image compared to corresponding parameters after dose accumulation. Therefore, it is recommended to use the MIP image for the delineation and dose assessment of cardiac structures in clinical practice.
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Affiliation(s)
- Ying Tong
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Guanzhong Gong
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Ming Su
- School of Nuclear Science and Technology, University of South China, Hengyang, China
| | - Yong Yin
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
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Rouabhi O, Gross B, Bayouth J, Xia J. The Dosimetric and Temporal Effects of Respiratory-Gated, High-Dose-Rate Radiation Therapy in Patients With Lung Cancer. Technol Cancer Res Treat 2019; 18:1533033818816072. [PMID: 30803374 PMCID: PMC6313263 DOI: 10.1177/1533033818816072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose: To evaluate the dosimetric and temporal effects of high-dose-rate respiratory-gated
radiation therapy in patients with lung cancer. Methods: Treatment plans from 5 patients with lung cancer (3 nongated and 2 gated at 80EX-80IN)
were retrospectively evaluated. Prescription dose for these patients varied from 8 to 18
Gy/fraction with 3 to 5 treatment fractions. Using the same treatment planning criteria,
4 new treatment plans, corresponding to 4 gating windows (20EX-20IN, 40EX-40IN,
60EX-60IN, and 80EX-80IN), were generated for each patient. Mean tumor dose, mean lung
dose, and lung V20 were used to assess the dosimetric effects. A MATLAB algorithm was
developed to compute treatment time. Results: Mean lung dose and lung V20 were on average reduced between −16.1% to −6.0% and −20.0%
to −7.2%, respectively, for gated plans when compared to the corresponding nongated
plans, and between −5.8% to −4.2% and −7.0% to −5.4%, respectively, for plans with
smaller gating windows when compared to the corresponding plans gated at 80EX-80IN.
Treatment delivery times of gated plans using high-dose rate were reduced on average
between −19.7% (−0.10 min/100 MU) and −27.2% (−0.13 min/100 MU) for original nongated
plans and −15.6% (−0.15 min/100 MU) and −20.3% (−0.19 min/100 MU) for original
80EX-80IN-gated plans. Conclusion: Respiratory-gated radiation therapy in patients with lung cancer can reduce lung dose
while maintaining tumor dose. Because treatment delivery during gated therapy is
discontinuous, total treatment time may be prolonged. However, this increase in
treatment time can be offset by increasing the dose delivery rate. Estimation of
treatment time may be helpful in selecting patients for respiratory gating and choosing
appropriate gating windows.
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Affiliation(s)
- Ouided Rouabhi
- 1 Department of Radiation Oncology, University of Iowa, Iowa, IA, USA
| | - Brandie Gross
- 1 Department of Radiation Oncology, University of Iowa, Iowa, IA, USA
| | - John Bayouth
- 1 Department of Radiation Oncology, University of Iowa, Iowa, IA, USA.,2 Department of Human Oncology, University of Wisconsin-Madison, Madison, WI, USA
| | - Junyi Xia
- 1 Department of Radiation Oncology, University of Iowa, Iowa, IA, USA
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13
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Tian S, Switchenko JM, Cassidy RJ, Escott CE, Castillo R, Patel PR, Curran WJ, Higgins KA. Predictors of pneumonitis-free survival following lung stereotactic body radiation therapy. Transl Lung Cancer Res 2019; 8:15-23. [PMID: 30788231 DOI: 10.21037/tlcr.2018.10.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Radiation pneumonitis is a common toxicity following lung stereotactic body radiation therapy (SBRT). We explored whether motion management technique, in conjunction with patient and treatment characteristics, is a predictor of radiation pneumonitis-free survival (PNFS). Methods A single institution multi-center lung SBRT database was retrospectively reviewed. PNFS was defined as time to earliest onset of radiation pneumonitis or last clinical follow-up. Patients were simulated using a 4-dimensional approach, and those with 1 cm or greater tumor motion were selected for respiratory-gated treatment. Real-time Position Management and phase-based gating were employed. Univariate and multivariable Cox proportional hazard models were fit for relevant covariates to determine the impact of free-breathing versus respiratory-gated treatment on PNFS. Results The initial treatment courses of 208 patients were included, with a median follow-up length of 23 months. The median age at treatment was 71 years. About 91.8% of patient had early stage (T1-2) non-small cell lung cancer and were treated with common regimens including 10 Gy ×5, 12 Gy ×4 and 18 Gy ×3; 26.4% underwent respiratory-gated SBRT. The overall rate of grade 3 or higher radiation pneumonitis was 10.1%. PNFS was not significantly different between patients treated with respiratory-gated versus free-breathing SBRT (HR =0.88; P=0.707); tumor location and fractionation were predictors of PNFS in the multivariate setting. Conclusions The method of motion management does not appear to impact PNFS when the tolerance for tumor displacement is 1 cm or less for free-breathing treatment planning and delivery. This approach may be appropriate when selecting patients for respiratory gating.
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Affiliation(s)
- Sibo Tian
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - Richard J Cassidy
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - Chase E Escott
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - Richard Castillo
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - Pretesh R Patel
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - Walter J Curran
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - Kristin A Higgins
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
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14
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Prunaretty J, Boisselier P, Aillères N, Riou O, Simeon S, Bedos L, Azria D, Fenoglietto P. Tracking, gating, free-breathing, which technique to use for lung stereotactic treatments? A dosimetric comparison. Rep Pract Oncol Radiother 2019; 24:97-104. [PMID: 30532657 PMCID: PMC6261085 DOI: 10.1016/j.rpor.2018.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 09/04/2018] [Accepted: 11/10/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The management of breath-induced tumor motion is a major challenge for lung stereotactic body radiation therapy (SBRT). Three techniques are currently available for these treatments: tracking (T), gating (G) and free-breathing (FB). AIM To evaluate the dosimetric differences between these three treatment techniques for lung SBRT. MATERIALS AND METHODS Pretreatment 4DCT data were acquired for 10 patients and sorted into 10 phases of a breathing cycle, such as 0% and 50% phases defined respectively as the inhalation and exhalation maximum. GTVph, PTVph (=GTVph + 3 mm) and the ipsilateral lung were contoured on each phase.For the tracking technique, 9 fixed fields were adjusted to each PTVph for the 10 phases. The gating technique was studied with 3 exhalation phases (40%, 50% and 60%). For the free-breathing technique, ITVFB was created from a sum of all GTVph and a 3 mm margin was added to define a PTVFB. Fields were adjusted to PTVFB and dose distributions were calculated on the average intensity projection (AIP) CT. Then, the beam arrangement with the same monitor units was planned on each CT phase.The 3 modalities were evaluated using DVHs of each GTVph, the homogeneity index and the volume of the ipsilateral lung receiving 20 Gy (V 20Gy). RESULTS The FB system improved the target coverage by increasing D mean (75.87(T)-76.08(G)-77.49(FB)Gy). Target coverage was slightly more homogeneous, too (HI: 0.17(T and G)-0.15(FB)). But the lung was better protected with the tracking system (V 20Gy: 3.82(T)-4.96(G)-6.34(FB)%). CONCLUSIONS Every technique provides plans with a good target coverage and lung protection. While irradiation with free-breathing increases doses to GTV, irradiation with the tracking technique spares better the lung but can dramatically increase the treatment complexity.
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15
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Aridgides P, Nsouli T, Chaudhari R, Kincaid R, Rosenbaum PF, Tanny S, Mix M, Bogart J. Clinical outcomes following advanced respiratory motion management (respiratory gating or dynamic tumor tracking) with stereotactic body radiation therapy for stage I non-small-cell lung cancer. LUNG CANCER-TARGETS AND THERAPY 2018; 9:103-110. [PMID: 30464667 PMCID: PMC6223331 DOI: 10.2147/lctt.s175168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose To report the outcomes of stereotactic body radiation therapy (SBRT) for stage I non-small-cell lung cancer (NSCLC) according to respiratory motion management method. Methods Patients with stage I NSCLC who received SBRT from 2007 to 2015 were reviewed. Computed tomography (CT) simulation with four-dimensional CT was performed for respiratory motion assessment. Tumor motion >1 cm in the craniocaudal direction was selectively treated with advanced respiratory management: either respiratory gating to a pre-specified portion of the respiratory cycle or dynamic tracking of an implanted fiducial marker. Comparisons were made with internal target volume approach, which treated all phases of respiratory motion. Results Of 297 patients treated with SBRT at our institution, 51 underwent advanced respiratory management (48 with respiratory gating and three with tumor tracking) and 246 underwent all-phase treatment. Groups were similarly balanced with regard to mean age (P=0.242), tumor size (P=0.315), and histology (P=0.715). Tumor location in the lower lung lobes, as compared to middle or upper lobes, was more common in those treated with advanced respiratory management (78.4%) compared to all-phase treatment (25.6%, P<.0001). There were 17 local recurrences in the treated lesions. Kaplan-Meier analyses showed that there were no differences with regard to mean time to local failure (91.5 vs 98.8 months, P=0.56), mean time to any failure (73.2 vs 78.7 months, P=0.73), or median overall survival (43.3 vs 45.5 months, P=0.56) between patients who underwent advanced respiratory motion management and all-phase treatment. Conclusion SBRT with advanced respiratory management (the majority with respiratory gating) showed similar efficacy to all-phase treatment approach for stage I NSCLC.
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Affiliation(s)
- Paul Aridgides
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA,
| | - Tamara Nsouli
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA,
| | - Rishabh Chaudhari
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA,
| | - Russell Kincaid
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA,
| | - Paula F Rosenbaum
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Sean Tanny
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA,
| | - Michael Mix
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA,
| | - Jeffrey Bogart
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA,
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Mancosu P, Nisbet A, Jornet N. Editorial: The role of medical physics in lung SBRT. Phys Med 2018; 45:205-206. [PMID: 29325801 DOI: 10.1016/j.ejmp.2018.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 12/24/2022] Open
Abstract
Stereotactic body radiation therapy (SBRT) has become a standard treatment for non-operable patients with early stage non-small cell lung cancer (NSCLC). In this context, medical physics community has largely helped in the starting and the growth of this technique. In fact, SBRT requires the convergence of many different features for delivering large doses in few fractions to small moving target in an heterogeneous medium. The special issue of last month, was focused on the different physics challenges in lung SBRT. Eleven reviews were presented, covering: imaging for treatment planning and for treatment assessment; dosimetry and planning optimization; treatment delivery possibilities; image guidance during delivery; radiobiology. The current cutting edge role of medical physics was reported. We aimed to give a complete overview of different aspects of lung SBRT that would be of interest to both physicists implementing this technique in their institutions and more experienced physicists that would be inspired to start research projects in areas that still need further developments. We also feel that the role that medical physicists have played in the development and safe implementation of SBRT, particularly in lung region, can be taken as an excellent example to be translated to other areas, not only in Radiation Oncology but also in other health sectors.
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Affiliation(s)
- Pietro Mancosu
- Medical Physics service, Radiotherapy department, Humanitas Cancer Center, Rozzano-Milan, Italy.
| | - Andrew Nisbet
- Department of Medical Physics, Royal Surrey County Hospital, United Kingdom; Department of Physics, Faculty of Engineering & Physical Sciences, University of Surrey, United Kingdom
| | - Núria Jornet
- Servei de Radiofísica i Radioprotecció, Hospital Sant Pau, Barcelona, Spain
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17
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Dosimetric evaluation near lung and soft tissue interface region during respiratory-gated and non-gated radiotherapy: A moving phantom study. Phys Med 2017; 42:39-46. [DOI: 10.1016/j.ejmp.2017.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/27/2017] [Accepted: 08/23/2017] [Indexed: 12/25/2022] Open
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Kadoya N, Ichiji K, Uchida T, Nakajima Y, Ikeda R, Uozumi Y, Zhang X, Bukovsky I, Yamamoto T, Takeda K, Takai Y, Jingu K, Homma N. Dosimetric evaluation of MLC-based dynamic tumor tracking radiotherapy using digital phantom: Desired setup margin for tracking radiotherapy. Med Dosim 2017; 43:74-81. [PMID: 28958471 DOI: 10.1016/j.meddos.2017.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 07/12/2017] [Accepted: 08/22/2017] [Indexed: 12/24/2022]
Abstract
The purpose of this study is to evaluate the dosimetric impact of the margin on the multileaf collimator-based dynamic tumor tracking plan. Furthermore, an equivalent setup margin (EM) of the tracking plan was determined according to the gated plan. A 4-dimensional extended cardiac-torso was used to create 9 digital phantom datasets of different tumor diameters (TDs) of 1, 3, and 5 cm and motion ranges (MRs) of 1, 2, and 3 cm. For each dataset, respiratory gating (30% to 70% phase) and tumor tracking treatment plans were prepared using 8-field 3-dimensional conformal radiation therapy by 4-dimensional dose calculation. The total lung V20 was calculated to evaluate the dosimetric impact for each case and to estimate the EM with the same impact on lung V20 obtained with the gating plan with a setup margin of 5 mm. The EMs for {TD = 1 cm, MR = 1 cm}, {TD = 1 cm, MR = 2 cm}, and {TD = 1 cm, MR = 3 cm} were estimated as 5.00, 4.16, and 4.24 mm, respectively. The EMs for {TD = 5 cm, MR = 1 cm}, {TD = 5 cm, MR = 2 cm}, and {TD = 5 cm, MR = 3 cm} were estimated as 4.24 mm, 6.35 mm, and 7.49 mm, respectively. This result showed that with a larger MR, the EM was found to be increased. In addition, with a larger TD, the EM became smaller. Our result showing the EMs provided the desired accuracy for multileaf collimator-based dynamic tumor tracking radiotherapy.
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Affiliation(s)
- Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Kei Ichiji
- Department of Therapeutic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomoya Uchida
- Department of Radiological Imaging and Informatics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yujiro Nakajima
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Radiotherapy, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Ryutaro Ikeda
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yosuke Uozumi
- Department of Radiological Imaging and Informatics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Xiaoyong Zhang
- Department of Electrical Engineering, Graduate School of Engineering, Tohoku University, Sendai, Japan
| | - Ivo Bukovsky
- Department of Radiological Imaging and Informatics, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Instrumentation and Control Engineering, Faculty of Mechanical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ken Takeda
- Department of Therapeutic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshihiro Takai
- Department of Radiation Oncology, Southern Tohoku BNCT Research Center, Koriyama, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriyasu Homma
- Department of Radiological Imaging and Informatics, Tohoku University Graduate School of Medicine, Sendai, Japan
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Archibald-Heeren BR, Byrne MV, Hu Y, Cai M, Wang Y. Robust optimization of VMAT for lung cancer: Dosimetric implications of motion compensation techniques. J Appl Clin Med Phys 2017; 18:104-116. [PMID: 28786213 PMCID: PMC5874938 DOI: 10.1002/acm2.12142] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 12/25/2022] Open
Abstract
In inverse planning of lung radiotherapy, techniques are required to ensure dose coverage of target disease in the presence of tumor motion as a result of respiration. A range of published techniques for mitigating motion effects were compared for dose stability across 5 breath cycles of ±2 cm. Techniques included planning target volume (PTV) expansions, internal target volumes with (OITV) and without tissue override (ITV), average dataset scans (ADS), and mini-max robust optimization. Volumetric arc therapy plans were created on a thorax phantom and verified with chamber and film measurements. Dose stability was compared by DVH analysis in calculations across all geometries. The lung override technique resulted in a substantial lack of dose coverage (-10%) to the tumor in the presence of large motion. PTV, ITV and ADS techniques resulted in substantial (up to 25%) maximum dose increases where solid tissue travelled into low density optimized regions. The results highlight the need for care in optimization of highly heterogeneous where density variations may occur with motion. Robust optimization was shown to provide greater stability in both maximum (<3%) and minimum dose variations (<2%) over all other techniques.
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Affiliation(s)
- Ben R Archibald-Heeren
- Radiation Oncology Centre, Sydney Adventist Hospital, Sydney, NSW, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Mikel V Byrne
- Radiation Oncology Centre, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Yunfei Hu
- Radiation Oncology Centre, Sydney Adventist Hospital, Sydney, NSW, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Meng Cai
- Radiation Oncology Centre, Sydney Adventist Hospital, Sydney, NSW, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Yang Wang
- Radiation Oncology Centre, Sydney Adventist Hospital, Sydney, NSW, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
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Liu F, Ng S, Huguet F, Yorke ED, Mageras GS, Goodman KA. Are fiducial markers useful surrogates when using respiratory gating to reduce motion of gastroesophageal junction tumors? Acta Oncol 2016; 55:1040-6. [PMID: 27152887 DOI: 10.3109/0284186x.2016.1167953] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Radiation therapy (RT) is an integral component of the management of gastroesophageal junction (GEJ) tumors. We evaluated the use of implanted radiopaque fiducials as tumor surrogates to allow for more focal delivery of RT to these mobile tumors when using respiratory gating (RG) to reduce motion. MATERIAL AND METHODS We analyzed four-dimensional computed tomography scans of 20 GEJ patients treated with RG and assessed correlation between tumor and implanted fiducial motion over the whole respiratory cycle and within a clinically realistic gate around end-exhalation. We evaluated fiducial motion concordance in 11 patients with multiple fiducials. RESULTS Gating reduced anterior-posterior (AP) and superior-inferior (SI) mean tumor and fiducial motions by over 50%. Fiducials and primary tumor motions were moderately correlated: R(2) for AP and SI linear fits to the entire group were 0.54 and 0.68, respectively, but the correlation had strong inter-patient variation. For all patients with multiple fiducials, relative in-gate displacements were below 3 mm; results were similar for eight of 11 patients over the whole cycle. CONCLUSION Implanted fiducial and gross tumor volume (GTV) motions correlate well but the correlation is patient-specific and may be dependent on the location of the fiducials with respect to the GTV.
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Affiliation(s)
- Fenghong Liu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Shu Ng
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Florence Huguet
- Department of Radiation Oncology, Hôpital Tenon, Paris, France
| | - Ellen D. Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gikas S. Mageras
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Karyn A. Goodman
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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21
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Yamada T, Miyamoto N, Matsuura T, Takao S, Fujii Y, Matsuzaki Y, Koyano H, Umezawa M, Nihongi H, Shimizu S, Shirato H, Umegaki K. Optimization and evaluation of multiple gating beam delivery in a synchrotron-based proton beam scanning system using a real-time imaging technique. Phys Med 2016; 32:932-7. [DOI: 10.1016/j.ejmp.2016.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 04/28/2016] [Accepted: 06/05/2016] [Indexed: 12/13/2022] Open
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22
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Evaluation of the motion of lung tumors during stereotactic body radiation therapy (SBRT) with four-dimensional computed tomography (4DCT) using real-time tumor-tracking radiotherapy system (RTRT). Phys Med 2016; 32:305-11. [DOI: 10.1016/j.ejmp.2015.10.093] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/09/2015] [Accepted: 10/23/2015] [Indexed: 11/30/2022] Open
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23
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Kim J, Lee Y, Shin H, Ji S, Park S, Kim J, Jang H, Kang Y. Development of deformable moving lung phantom to simulate respiratory motion in radiotherapy. Med Dosim 2016; 41:113-7. [DOI: 10.1016/j.meddos.2015.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/01/2015] [Accepted: 10/04/2015] [Indexed: 11/16/2022]
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24
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Plan robustness in field junction region from arcs with different patient orientation in total marrow irradiation with VMAT. Phys Med 2015; 31:677-82. [DOI: 10.1016/j.ejmp.2015.05.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 01/19/2015] [Accepted: 05/18/2015] [Indexed: 11/21/2022] Open
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25
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Tolakanahalli RP, Tewatia DK, Tomé WA. Time series prediction of lung cancer patients' breathing pattern based on nonlinear dynamics. Phys Med 2015; 31:257-65. [PMID: 25726478 DOI: 10.1016/j.ejmp.2015.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 12/30/2014] [Accepted: 01/28/2015] [Indexed: 11/19/2022] Open
Abstract
This study focuses on predicting breathing pattern, which is crucial to deal with system latency in the treatments of moving lung tumors. Predicting respiratory motion in real-time is challenging, due to the inherent chaotic nature of breathing patterns, i.e. sensitive dependence on initial conditions. In this work, nonlinear prediction methods are used to predict the short-term evolution of the respiratory system for 62 patients, whose breathing time series was acquired using respiratory position management (RPM) system. Single step and N-point multi step prediction are performed for sampling rates of 5 Hz and 10 Hz. We compare the employed non-linear prediction methods with respect to prediction accuracy to Adaptive Infinite Impulse Response (IIR) prediction filters. A Local Average Model (LAM) and local linear models (LLMs) combined with a set of linear regularization techniques to solve ill-posed regression problems are implemented. For all sampling frequencies both single step and N-point multi step prediction results obtained using LAM and LLM with regularization methods perform better than IIR prediction filters for the selected sample patients. Moreover, since the simple LAM model performs as well as the more complicated LLM models in our patient sample, its use for non-linear prediction is recommended.
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Affiliation(s)
- R P Tolakanahalli
- Department of Medical Physics, Hamilton Health Sciences, Hamilton, ON L8V5C2, Canada
| | - D K Tewatia
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - W A Tomé
- Montefiore Medical Center and Institute for Onco-Physics, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Department of Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, USA.
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