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Patel KR, van der Heide UA, Kerkmeijer LGW, Schoots IG, Turkbey B, Citrin DE, Hall WA. Target Volume Optimization for Localized Prostate Cancer. Pract Radiat Oncol 2024:S1879-8500(24)00148-6. [PMID: 39019208 DOI: 10.1016/j.prro.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/17/2024] [Accepted: 06/26/2024] [Indexed: 07/19/2024]
Abstract
PURPOSE To provide a comprehensive review of the means by which to optimize target volume definition for the purposes of treatment planning for patients with intact prostate cancer with a specific emphasis on focal boost volume definition. METHODS Here we conduct a narrative review of the available literature summarizing the current state of knowledge on optimizing target volume definition for the treatment of localized prostate cancer. RESULTS Historically, the treatment of prostate cancer included a uniform prescription dose administered to the entire prostate with or without coverage of all or part of the seminal vesicles. The development of prostate magnetic resonance imaging (MRI) and positron emission tomography (PET) using prostate-specific radiotracers has ushered in an era in which radiation oncologists are able to localize and focally dose-escalate high-risk volumes in the prostate gland. Recent phase 3 data has demonstrated that incorporating focal dose escalation to high-risk subvolumes of the prostate improves biochemical control without significantly increasing toxicity. Still, several fundamental questions remain regarding the optimal target volume definition and prescription strategy to implement this technique. Given the remaining uncertainty, a knowledge of the pathological correlates of radiographic findings and the anatomic patterns of tumor spread may help inform clinical judgement for the definition of clinical target volumes. CONCLUSION Advanced imaging has the ability to improve outcomes for patients with prostate cancer in multiple ways, including by enabling focal dose escalation to high-risk subvolumes. However, many questions remain regarding the optimal target volume definition and prescription strategy to implement this practice, and key knowledge gaps remain. A detailed understanding of the pathological correlates of radiographic findings and the patterns of local tumor spread may help inform clinical judgement for target volume definition given the current state of uncertainty.
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Affiliation(s)
- Krishnan R Patel
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - Linda G W Kerkmeijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ivo G Schoots
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - William A Hall
- Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin
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Shinde P, Jadhav A, Shankar V, Dhoble SJ. Evaluation of the dosimetric influence of interfractional 6D setup error in hypofractionated prostate cancer treated with IMRT and VMAT using daily kV-CBCT. J Med Imaging Radiat Sci 2022; 53:693-703. [PMID: 36289030 DOI: 10.1016/j.jmir.2022.09.026] [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: 05/04/2022] [Revised: 09/01/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Prostate cancer is one of the most common malignant tumors in men and is usually treated with advanced intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT). Significant uncorrected interfractional 6-Dimensional setup errors could impact the delivered dose. The aim of this study was to assess the dosimetric impact of 6D interfractional setup errors in hypofractionated prostate cancer using daily kilovoltage cone-beam computed tomography (kV-CBCT). METHODS This retrospective study comprised twenty prostate cancer patients treated with hypofractionated IMRT (8) and VMAT (12) with daily kV-CBCT image guidance. Interfraction 6D setup errors along lateral, longitudinal, vertical, pitch, roll, and yaw axes were evaluated for 400 CBCTs. For targets and organs at risk (OARs), the dosimetric impact of rotational error (RError), translational error (TError), and translational plus rotational error (T+RError) were evaluated on kV-CBCT images. RESULTS The single fraction maximum TError ranged from 12-20 mm, and the RError ranged from 2.80-3.00. The maximum mean absolute dose variation ΔD in D98% (dose to 98% volume) of CTV-55 and PTV-55 was -0.66±0.82 and -5.94±3.8 Gy, respectively, in the T+RError. The maximum ΔD (%) for D98% and D0.035cc in CTV-55 was -4.29% and 2.49%, respectively, while in PTV-55 it was -24.9% and 2.36%. The mean dose reduction for D98% in CTV-55 and D98% and D95% in PTV-55 was statistically significant (p<0.05) for TError and T+RError. The mean dose variation for Dmean and D50% in the rectum was statistically significant (p<0.05) for TError and T+RError. CONCLUSION The uncorrected interfractional 6D setup error results in significant target underdosing and OAR overdosing in prostate cancer. This emphasizes the need to correct interfractional 6D setup errors daily in IMRT and VMAT.
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Affiliation(s)
| | - Anand Jadhav
- Department of Radiation Oncology, Sir H N Reliance Foundation Hospital and Research Centre, Mumbai, 400004, India
| | - V Shankar
- Department of Radiation Oncology, Apollo Cancer Center, Chennai, 600035, India
| | - S J Dhoble
- Department of Physics, R. T. M. Nagpur University, Nagpur, 440033, India
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De Roover R, Crijns W, Poels K, Dewit B, Draulans C, Haustermans K, Depuydt T. Automated treatment planning of prostate stereotactic body radiotherapy with focal boosting on a fast-rotating O-ring linac: Plan quality comparison with C-arm linacs. J Appl Clin Med Phys 2021; 22:59-72. [PMID: 34318996 PMCID: PMC8425873 DOI: 10.1002/acm2.13345] [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: 04/23/2021] [Accepted: 05/26/2021] [Indexed: 11/14/2022] Open
Abstract
PURPOSE The integration of auto-segmentation and automated treatment planning methods on a fast-rotating O-ring linac may improve the time efficiency of online adaptive radiotherapy workflows. This study investigates whether automated treatment planning of prostate SBRT with focal boosting on the O-ring linac could generate plans that are of similar quality as those obtained through manual planning on clinical C-arm linacs. METHODS For 20 men with prostate cancer, reference treatment plans were generated on a TrueBeam STx C-arm linac with HD120 MLC and a TrueBeam C-arm linac with Millennium 120 MLC using 6 MV flattened dual arc VMAT. Manual planning on the Halcyon fast-rotating O-ring linac was performed using 6 MV FFF dual arc VMAT (HA2-DL10) and triple arc VMAT (HA3-DL10) to investigate the performance of the dual-layer MLC system. Automated planning was performed for triple arc VMAT on the Halcyon linac (ET3-DL10) using the automated planning algorithms of Ethos Treatment Planning. The prescribed dose was 35 Gy to the prostate and 30 Gy to the seminal vesicles in five fractions. The iso-toxic focal boost to the intraprostatic tumor nodule(s) was aimed to receive up to 50 Gy. Plan deliverability was verified using portal image dosimetry measurements. RESULTS Compared to the C-arm linacs, ET3-DL10 shows increased seminal vesicles PTV coverage (D99% ) and reduced high-dose spillage to the bladder (V37Gy ) and urethra (D0.035cc ) but this came at the cost of increased high-dose spillage to the rectum (V38Gy ) and a higher intermediate dose spillage (D2cm). No statistically significant differences were found when benchmarking HA2-DL10 and HA3-DL10 with the C-arm linacs. All plans passed the patient-specific QA tolerance limit. CONCLUSIONS Automated planning of prostate SBRT with focal boosting on the fast-rotating O-ring linac is feasible and achieves similar plan quality as those obtained on clinical C-arm linacs using manual planning.
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Affiliation(s)
- Robin De Roover
- Department of Radiation OncologyUniversity Hospitals LeuvenLeuvenBelgium
- Department of OncologyKU LeuvenLeuvenBelgium
| | - Wouter Crijns
- Department of Radiation OncologyUniversity Hospitals LeuvenLeuvenBelgium
- Department of OncologyKU LeuvenLeuvenBelgium
| | - Kenneth Poels
- Department of Radiation OncologyUniversity Hospitals LeuvenLeuvenBelgium
- Department of OncologyKU LeuvenLeuvenBelgium
| | - Bertrand Dewit
- Department of Radiation OncologyUniversity Hospitals LeuvenLeuvenBelgium
- Department of OncologyKU LeuvenLeuvenBelgium
| | - Cédric Draulans
- Department of Radiation OncologyUniversity Hospitals LeuvenLeuvenBelgium
- Department of OncologyKU LeuvenLeuvenBelgium
| | - Karin Haustermans
- Department of Radiation OncologyUniversity Hospitals LeuvenLeuvenBelgium
- Department of OncologyKU LeuvenLeuvenBelgium
| | - Tom Depuydt
- Department of Radiation OncologyUniversity Hospitals LeuvenLeuvenBelgium
- Department of OncologyKU LeuvenLeuvenBelgium
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van Schie MA, Janssen TM, Eekhout D, Walraven I, Pos FJ, de Ruiter P, Kotte ANTJ, Monninkhof EM, Kerkmeijer LGW, Draulans C, de Roover R, Haustermans K, Kunze-Busch M, Smeenk RJ, van der Heide UA. Knowledge-Based Assessment of Focal Dose Escalation Treatment Plans in Prostate Cancer. Int J Radiat Oncol Biol Phys 2020; 108:1055-1062. [PMID: 32629078 DOI: 10.1016/j.ijrobp.2020.06.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 06/03/2020] [Accepted: 06/26/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE In a randomized focal dose escalation radiation therapy trial for prostate cancer (FLAME), up to 95 Gy was prescribed to the tumor in the dose-escalated arm, with 77 Gy to the entire prostate in both arms. As dose constraints to organs at risk had priority over dose escalation and suboptimal planning could occur, we investigated how well the dose to the tumor was boosted. We developed an anatomy-based prediction model to identify plans with suboptimal tumor dose and performed replanning to validate our model. METHODS AND MATERIALS We derived dose-volume parameters from planned dose distributions of 539 FLAME trial patients in 4 institutions and compared them between both arms. In the dose-escalated arm, we determined overlap volume histograms and derived features representing patient anatomy. We predicted tumor D98% with a linear regression on anatomic features and performed replanning on 21 plans. RESULTS In the dose-escalated arm, the median tumor D50% and D98% were 93.0 and 84.7 Gy, and 99% of the tumors had a dose escalation greater than 82.4 Gy (107% of 77 Gy). In both arms organs at risk constraints were met. Five out of 73 anatomic features were found to be predictive for tumor D98%. Median predicted tumor D98% was 4.4 Gy higher than planned D98%. Upon replanning, median tumor D98% increased by 3.0 Gy. A strong correlation between predicted increase in D98% and realized increase upon replanning was found (ρ = 0.86). CONCLUSIONS Focal dose escalation in prostate cancer was feasible with a dose escalation to 99% of the tumors. Replanning resulted in an increased tumor dose that correlated well with the prediction model. The model was able to identify tumors on which a higher boost dose could be planned. The model has potential as a quality assessment tool in focal dose escalated treatment plans.
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Affiliation(s)
- Marcel A van Schie
- Netherlands Cancer Institute, Radiation Oncology, Amsterdam, The Netherlands.
| | - Tomas M Janssen
- Netherlands Cancer Institute, Radiation Oncology, Amsterdam, The Netherlands
| | - Dave Eekhout
- Netherlands Cancer Institute, Radiation Oncology, Amsterdam, The Netherlands
| | - Iris Walraven
- Netherlands Cancer Institute, Radiation Oncology, Amsterdam, The Netherlands
| | - Floris J Pos
- Netherlands Cancer Institute, Radiation Oncology, Amsterdam, The Netherlands
| | - Peter de Ruiter
- Netherlands Cancer Institute, Radiation Oncology, Amsterdam, The Netherlands
| | - Alexis N T J Kotte
- University Medical Center Utrecht, Radiation Oncology, Utrecht, The Netherlands
| | - Evelyn M Monninkhof
- University Medical Center Utrecht, Radiation Oncology, Utrecht, The Netherlands
| | - Linda G W Kerkmeijer
- University Medical Center Utrecht, Radiation Oncology, Utrecht, The Netherlands; Radboud University Medical Center, Radiation Oncology, Nijmegen, The Netherlands
| | - Cédric Draulans
- University Hospitals Leuven, Radiation Oncology, Leuven, Belgium
| | - Robin de Roover
- University Hospitals Leuven, Radiation Oncology, Leuven, Belgium
| | | | - Martina Kunze-Busch
- Radboud University Medical Center, Radiation Oncology, Nijmegen, The Netherlands
| | - Robert Jan Smeenk
- Radboud University Medical Center, Radiation Oncology, Nijmegen, The Netherlands
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Draulans C, De Roover R, van der Heide UA, Haustermans K, Pos F, Smeenk RJ, De Boer H, Depuydt T, Kunze-Busch M, Isebaert S, Kerkmeijer L. Stereotactic body radiation therapy with optional focal lesion ablative microboost in prostate cancer: Topical review and multicenter consensus. Radiother Oncol 2019; 140:131-142. [PMID: 31276989 DOI: 10.1016/j.radonc.2019.06.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 12/25/2022]
Abstract
Stereotactic body radiotherapy (SBRT) for prostate cancer (PCa) is gaining interest by the recent publication of the first phase III trials on prostate SBRT and the promising results of many other phase II trials. Before long term results became available, the major concern for implementing SBRT in PCa in daily clinical practice was the potential risk of late genitourinary (GU) and gastrointestinal (GI) toxicity. A number of recently published trials, including late outcome and toxicity data, contributed to the growing evidence for implementation of SBRT for PCa in daily clinical practice. However, there exists substantial variability in delivering SBRT for PCa. The aim of this topical review is to present a number of prospective trials and retrospective analyses of SBRT in the treatment of PCa. We focus on the treatment strategies and techniques used in these trials. In addition, recent literature on a simultaneous integrated boost to the tumor lesion, which could create an additional value in the SBRT treatment of PCa, was described. Furthermore, we discuss the multicenter consensus of the FLAME consortium on SBRT for PCa with a focal boost to the macroscopic intraprostatic tumor nodule(s).
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Affiliation(s)
- Cédric Draulans
- Department of Radiation Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium.
| | - Robin De Roover
- Department of Radiation Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium.
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium.
| | - Floris Pos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Robert Jan Smeenk
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Hans De Boer
- Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands.
| | - Tom Depuydt
- Department of Radiation Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium.
| | - Martina Kunze-Busch
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Sofie Isebaert
- Department of Radiation Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium.
| | - Linda Kerkmeijer
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands.
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Zamboglou C, Thomann B, Koubar K, Bronsert P, Krauss T, Rischke HC, Sachpazidis I, Drendel V, Salman N, Reichel K, Jilg CA, Werner M, Meyer PT, Bock M, Baltas D, Grosu AL. Focal dose escalation for prostate cancer using 68Ga-HBED-CC PSMA PET/CT and MRI: a planning study based on histology reference. Radiat Oncol 2018; 13:81. [PMID: 29716617 PMCID: PMC5930745 DOI: 10.1186/s13014-018-1036-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/26/2018] [Indexed: 01/20/2023] Open
Abstract
Background Focal radiation therapy has gained of interest in treatment of patients with primary prostate cancer (PCa). The question of how to define the intraprostatic boost volume is still open. Previous studies showed that multiparametric MRI (mpMRI) or PSMA PET alone could be used for boost volume definition. However, other studies proposed that the combined usage of both has the highest sensitivity in detection of intraprostatic lesions. The aim of this study was to demonstrate the feasibility and to evaluate the tumour control probability (TCP) and normal tissue complication probability (NTCP) of radiation therapy dose painting using 68Ga-HBED-CC PSMA PET/CT, mpMRI or the combination of both in primary PCa. Methods Ten patients underwent PSMA PET/CT and mpMRI followed by prostatectomy. Three gross tumour volumes (GTVs) were created based on PET (GTV-PET), mpMRI (GTV-MRI) and the union of both (GTV-union). Two plans were generated for each GTV. Plan95 consisted of whole-prostate IMRT to 77 Gy in 35 fractions and a simultaneous boost to 95 Gy (Plan95PET/Plan95MRI/Plan95union). Plan80 consisted of whole-prostate IMRT to 76 Gy in 38 fractions and a simultaneous boost to 80 Gy (Plan80PET/Plan80MRI/Plan80union). TCPs were calculated for GTV-histo (TCP-histo), which was delineated based on PCa distribution in co-registered histology slices. NTCPs were assessed for bladder and rectum. Results Dose constraints of published protocols were reached in every treatment plan. Mean TCP-histo were 99.7% (range: 97%–100%) and 75.5% (range: 33%–95%) for Plan95union and Plan80union, respectively. Plan95union had significantly higher TCP-histo values than Plan95MRI (p = 0.008) and Plan95PET (p = 0.008). Plan80union had significantly higher TCP-histo values than Plan80MRI (p = 0.012), but not than Plan80PET (p = 0.472). Plan95MRI had significantly lower NTCP-rectum than Plan95union (p = 0.012). No significant differences in NTCP-rectum and NTCP-bladder were observed for all other plans (p > 0.05). Conclusions IMRT dose escalation on GTVs based on mpMRI, PSMA PET/CT and the combination of both was feasible. Boosting GTV-union resulted in significantly higher TCP-histo with no or minimal increase of NTCPs compared to the other plans. Electronic supplementary material The online version of this article (10.1186/s13014-018-1036-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Constantinos Zamboglou
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, Robert-Koch Straße 3, 79106, Freiburg, Germany. .,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany. .,Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Benedikt Thomann
- Division of Medical Physics, Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Khodor Koubar
- Division of Medical Physics, Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Peter Bronsert
- Department of Pathology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Tobias Krauss
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Hans C Rischke
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, Robert-Koch Straße 3, 79106, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Ilias Sachpazidis
- Division of Medical Physics, Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Vanessa Drendel
- Department of Pathology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Nasr Salman
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, Robert-Koch Straße 3, 79106, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Kathrin Reichel
- Department of Urology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Cordula A Jilg
- Department of Urology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Martin Werner
- Department of Pathology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Philipp T Meyer
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Michael Bock
- Division of Medical Physics, Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Dimos Baltas
- Division of Medical Physics, Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Anca L Grosu
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, Robert-Koch Straße 3, 79106, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
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Sarkar B, Ray J, Ganesh T, Manikandan A, Munshi A, Rathinamuthu S, Kaur H, Anbazhagan S, Giri UK, Roy S, Jassal K, Mohanti BK. Methodology to reduce 6D patient positional shifts into a 3D linear shift and its verification in frameless stereotactic radiotherapy. ACTA ACUST UNITED AC 2018; 63:075004. [DOI: 10.1088/1361-6560/aab231] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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8
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Simulating intrafraction prostate motion with a random walk model. Adv Radiat Oncol 2017; 2:429-436. [PMID: 29114612 PMCID: PMC5605287 DOI: 10.1016/j.adro.2017.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 02/17/2017] [Accepted: 03/18/2017] [Indexed: 12/22/2022] Open
Abstract
Purpose Prostate motion during radiation therapy (ie, intrafraction motion) can cause unwanted loss of radiation dose to the prostate and increased dose to the surrounding organs at risk. A compact but general statistical description of this motion could be useful for simulation of radiation therapy delivery or margin calculations. We investigated whether prostate motion could be modeled with a random walk model. Methods and materials Prostate motion recorded during 548 radiation therapy fractions in 17 patients was analyzed and used for input in a random walk prostate motion model. The recorded motion was categorized on the basis of whether any transient excursions (ie, rapid prostate motion in the anterior and superior direction followed by a return) occurred in the trace and transient motion. This was separately modeled as a large step in the anterior/superior direction followed by a returning large step. Random walk simulations were conducted with and without added artificial transient motion using either motion data from all observed traces or only traces without transient excursions as model input, respectively. Results A general estimate of motion was derived with reasonable agreement between simulated and observed traces, especially during the first 5 minutes of the excursion-free simulations. Simulated and observed diffusion coefficients agreed within 0.03, 0.2 and 0.3 mm2/min in the left/right, superior/inferior, and anterior/posterior directions, respectively. A rapid increase in variance at the start of observed traces was difficult to reproduce and seemed to represent the patient's need to adjust before treatment. This could be estimated somewhat using artificial transient motion. Conclusions Random walk modeling is feasible and recreated the characteristics of the observed prostate motion. Introducing artificial transient motion did not improve the overall agreement, although the first 30 seconds of the traces were better reproduced. The model provides a simple estimate of prostate motion during delivery of radiation therapy.
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Abstract
We reviewed the literature on the use of margins in radiotherapy of patients with prostate cancer, focusing on different options for image guidance (IG) and technical issues. The search in PubMed database was limited to include studies that involved external beam radiotherapy of the intact prostate. Post-prostatectomy studies, brachytherapy and particle therapy were excluded. Each article was characterized according to the IG strategy used: positioning on external marks using room lasers, bone anatomy and soft tissue match, usage of fiducial markers, electromagnetic tracking and adapted delivery. A lack of uniformity in margin selection among institutions was evident from the review. In general, introduction of pre- and in-treatment IG was associated with smaller planning target volume (PTV) margins, but there was a lack of definitive experimental/clinical studies providing robust information on selection of exact PTV values. In addition, there is a lack of comparative research regarding the cost-benefit ratio of the different strategies: insertion of fiducial markers or electromagnetic transponders facilitates prostate gland localization but at a price of invasive procedure; frequent pre-treatment imaging increases patient in-room time, dose and labour; online plan adaptation should improve radiation delivery accuracy but requires fast and precise computation. Finally, optimal protocols for quality assurance procedures need to be established.
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Affiliation(s)
- Slav Yartsev
- 1 London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada.,2 Departments of Oncology and Medical Biophysics, Western University, London, ON, Canada
| | - Glenn Bauman
- 1 London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada.,2 Departments of Oncology and Medical Biophysics, Western University, London, ON, Canada
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10
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Histopathology-derived modeling of prostate cancer tumor control probability: Implications for the dose to the tumor and the gland. Radiother Oncol 2016; 119:97-103. [DOI: 10.1016/j.radonc.2016.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 01/27/2016] [Accepted: 02/04/2016] [Indexed: 11/22/2022]
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11
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Zhang X, Shan GP, Liu JP, Wang BB. Margin evaluation of translational and rotational set-up errors in intensity modulated radiotherapy for cervical cancer. SPRINGERPLUS 2016; 5:153. [PMID: 27026850 PMCID: PMC4766143 DOI: 10.1186/s40064-016-1796-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/12/2016] [Indexed: 12/04/2022]
Abstract
A clinical target volume (CTV) to planning target volume (PTV) margin recipes was routinely used to ensure dose was actually delivered to target for all (most) patients. Currently used margin recipes were associated with only translational set-up errors in radiotherapy. However, when set-up errors extended to six-degree (6D) scope (three translational and three rotational set-up errors), margin recipe should be re-evaluated. The purpose of this study was to investigate dosimetric changes of targets (both CTV and PTV) coverage when 6D set-up errors were introduced and testify the practicability of currently used margin recipe in radiotherapy. A total number of 105 cone beam computer tomography scans for ten patients with cervical cancer were derived prior to treatment delivery and 6D set-up errors were acquired with image registration tools. Target coverage was evaluated retrospectively for 6D set-up errors introduced plan with 6 mm CTV to PTV margin. Target coverage of PTV showed significant decreases (3.3 %) in set-up errors introduced plans compared with original plans. But CTV coverage was not susceptible to these set-up errors. A tendency of coverage decrease for PTV along with distance away from treatment was testified, from −0.2 to −6.2 %. However, CTV seems changed less, from −0.2 to −0.8 %. The result indicate that a CTV to PTV margin of 6 mm was sufficient to take into account 6D set-up errors for most patients with cervical cancer. Future research suggests a smaller margin to further improve both tumor coverage and organs at risk sparing.
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Affiliation(s)
- Xiang Zhang
- Department of Gynecologic Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, 310022 China ; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, 310022 China
| | - Guo-Ping Shan
- Department of Radiation Physics, Zhejiang Cancer Hospital, Hangzhou, 310022 China ; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, 310022 China
| | - Ji-Ping Liu
- Department of Radiation Physics, Zhejiang Cancer Hospital, Hangzhou, 310022 China ; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, 310022 China
| | - Bin-Bing Wang
- Department of Radiation Physics, Zhejiang Cancer Hospital, Hangzhou, 310022 China ; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, 310022 China
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Law G, Leung R, Lee F, Luk H, Lee KC, Wong F, Wong M, Cheung S, Lee V, Mui WH, Chan M. Effectiveness of a Patient-Specific Immobilization and Positioning System to Limit Interfractional Translation and Rotation Setup Errors in Radiotherapy of Prostate Cancers. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ijmpcero.2016.53020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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13
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Steenbergen P, Haustermans K, Lerut E, Oyen R, De Wever L, Van den Bergh L, Kerkmeijer LG, Pameijer FA, Veldhuis WB, van der Voort van Zyp JR, Pos FJ, Heijmink SW, Kalisvaart R, Teertstra HJ, Dinh CV, Ghobadi G, van der Heide UA. Prostate tumor delineation using multiparametric magnetic resonance imaging: Inter-observer variability and pathology validation. Radiother Oncol 2015; 115:186-90. [PMID: 25935742 DOI: 10.1016/j.radonc.2015.04.012] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 03/27/2015] [Accepted: 04/19/2015] [Indexed: 12/19/2022]
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14
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Shang Q, Sheplan Olsen LJ, Stephans K, Tendulkar R, Xia P. Prostate rotation detected from implanted markers can affect dose coverage and cannot be simply dismissed. J Appl Clin Med Phys 2013; 14:4262. [PMID: 23652257 PMCID: PMC5714427 DOI: 10.1120/jacmp.v14i3.4262] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 01/29/2013] [Accepted: 01/25/2013] [Indexed: 11/23/2022] Open
Abstract
With implanted markers, daily prostate displacements can be automatically detected with six degrees of freedom. The reported magnitudes of the rotations, however, are often greater than the typical range of a six‐degree treatment couch. The purpose of this study is to quantify geometric and dosimetric effects if the prostate rotations are not corrected (ROT_NC) and if they can be compensated with translational shifts (ROT_C). Forty‐three kilovoltage cone‐beam CTs (KV‐CBCT) with implanted markers from five patients were available for this retrospective study. On each KV‐CBCT, the prostate, bladder, and rectum were manually contoured by a physician. The prostate contours from the planning CT and CBCT were aligned manually to achieve the best overlaps. This contour registration served as the benchmark method for comparison with two marker registration methods: (a) using six degrees of freedom, but rotations were not corrected (ROT_NC); and (b) using three degrees of freedom while compensating rotations into the translational shifts (ROT_C). The center of mass distance (CMD) and overlap index (OI) were used to evaluate these two methods. The dosimetric effects were also analyzed by comparing the dose coverage of the prostate clinical target volume (CTV) in relation to the planning margins. According to our analysis, the detected rotations dominated in the left–right axis with systematic and random components of 4.6° and 4.1°, respectively. When the rotation angles were greater than 10°, the differences in CMD between the two registrations were greater than 5 mm in 85.7% of these fractions; when the rotation angles were greater than 6°, the differences of CMD were greater than 4 mm in 61.1% of these fractions. With 6 mm/4 mm posterior planning margins, the average difference between the dose to 99% (D99) of the prostate in CBCTs and the planning D99 of the prostate was −8.0±12.3% for the ROT_NC registration, and −3.6±9.0% for the ROT_C registration (p=0.01). When the planning margin decreased to 4 mm/2 mm posterior, the average difference in D99 of the prostate was −22.0±16.2% and −15.1±15.2% for the ROT_NC and ROT_C methods, respectively (p<0.05). In conclusion, prostate rotation cannot be simply dismissed, and the impact of the rotational errors depends on the distance between the isocenter and the centroid of implanted markers and the rotation angle. PACS number: 87.55
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Affiliation(s)
- Qingyang Shang
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH 44195, USA
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15
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Bohoslavsky R, Witte MG, Janssen TM, van Herk M. Probabilistic objective functions for margin-less IMRT planning. Phys Med Biol 2013; 58:3563-80. [PMID: 23640114 DOI: 10.1088/0031-9155/58/11/3563] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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16
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Hybrid Registration of Prostate and Seminal Vesicles for Image Guided Radiation Therapy. Int J Radiat Oncol Biol Phys 2013; 86:177-82. [DOI: 10.1016/j.ijrobp.2012.11.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 11/19/2012] [Accepted: 11/26/2012] [Indexed: 11/19/2022]
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17
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Bol GH, Lagendijk JJW, Raaymakers BW. Virtual couch shift (VCS): accounting for patient translation and rotation by online IMRT re-optimization. Phys Med Biol 2013; 58:2989-3000. [DOI: 10.1088/0031-9155/58/9/2989] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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18
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Pommer T, Falk M, Poulsen PR, Keall PJ, O'Brien RT, Petersen PM, Munck af Rosenschöld P. Dosimetric benefit of DMLC tracking for conventional and sub-volume boosted prostate intensity-modulated arc radiotherapy. Phys Med Biol 2013; 58:2349-61. [PMID: 23492899 DOI: 10.1088/0031-9155/58/7/2349] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study investigated the dosimetric impact of uncompensated motion and motion compensation with dynamic multileaf collimator (DMLC) tracking for prostate intensity modulated arc therapy. Two treatment approaches were investigated; a conventional approach with a uniform radiation dose to the target volume and an intraprostatic lesion (IPL) boosted approach with an increased dose to a subvolume of the prostate. The impact on plan quality of optimizations with a leaf position constraint, which limited the distance between neighbouring adjacent MLC leaves, was also investigated. Deliveries were done with and without DMLC tracking on a linear acceleration with a high-resolution MLC. A cylindrical phantom containing two orthogonal diode arrays was used for dosimetry. A motion platform reproduced six patient-derived prostate motion traces, with the average displacement ranging from 1.0 to 8.9 mm during the first 75 s. A research DMLC tracking system was used for real-time motion compensation with optical monitoring for position input. The gamma index was used for evaluation, with measurements with a static phantom or the planned dose as reference, using 2% and 2 mm gamma criteria. The average pass rate with DMLC tracking was 99.9% (range 98.7-100%, measurement as reference), whereas the pass rate for untracked deliveries decreased distinctly as the average displacement increased, with an average pass rate of 61.3% (range 32.7-99.3%). Dose-volume histograms showed that DMLC tracking maintained the planned dose distributions in the presence of motion whereas traces with >3 mm average displacement caused clear plan degradation for untracked deliveries. The dose to the rectum and bladder had an evident dependence on the motion direction and amplitude for untracked deliveries, and the dose to the rectum was slightly increased for IPL boosted plans compared to conventional plans for anterior motion with large amplitude. In conclusion, optimization using a leaf position constraint had minimal dosimetric effect, DMLC tracking improved the target and normal tissue dose distributions compared to no tracking for target motion >3 mm, with the DMLC tracking distributions showing generally good agreement between the planned and delivered doses.
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Affiliation(s)
- Tobias Pommer
- Radiation Medicine Research Center, Department of Radiation Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Lei S, Piel N, Oermann EK, Chen V, Ju AW, Dahal KN, Hanscom HN, Kim JS, Yu X, Zhang G, Collins BT, Jha R, Dritschilo A, Suy S, Collins SP. Six-Dimensional Correction of Intra-Fractional Prostate Motion with CyberKnife Stereotactic Body Radiation Therapy. Front Oncol 2011; 1:48. [PMID: 22655248 PMCID: PMC3356099 DOI: 10.3389/fonc.2011.00048] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 11/14/2011] [Indexed: 11/13/2022] Open
Abstract
Large fraction radiation therapy offers a shorter course of treatment and radiobiological advantages for prostate cancer treatment. The CyberKnife is an attractive technology for delivering large fraction doses based on the ability to deliver highly conformal radiation therapy to moving targets. In addition to intra-fractional translational motion (left-right, superior-inferior, and anterior-posterior), prostate rotation (pitch, roll, and yaw) can increase geographical miss risk. We describe our experience with six-dimensional (6D) intra-fraction prostate motion correction using CyberKnife stereotactic body radiation therapy (SBRT). Eighty-eight patients were treated by SBRT alone or with supplemental external radiation therapy. Trans-perineal placement of four gold fiducials within the prostate accommodated X-ray guided prostate localization and beam adjustment. Fiducial separation and non-overlapping positioning permitted the orthogonal imaging required for 6D tracking. Fiducial placement accuracy was assessed using the CyberKnife fiducial extraction algorithm. Acute toxicities were assessed using Common Toxicity Criteria v3. There were no Grade 3, or higher, complications and acute morbidity was minimal. Ninety-eight percent of patients completed treatment employing 6D prostate motion tracking with intra-fractional beam correction. Suboptimal fiducial placement limited treatment to 3D tracking in two patients. Our experience may guide others in performing 6D correction of prostate motion with CyberKnife SBRT.
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Affiliation(s)
- Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital Washington, DC, USA
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20
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Lips IM, van der Heide UA, Haustermans K, van Lin ENJT, Pos F, Franken SPG, Kotte ANTJ, van Gils CH, van Vulpen M. Single blind randomized phase III trial to investigate the benefit of a focal lesion ablative microboost in prostate cancer (FLAME-trial): study protocol for a randomized controlled trial. Trials 2011; 12:255. [PMID: 22141598 PMCID: PMC3286435 DOI: 10.1186/1745-6215-12-255] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 12/05/2011] [Indexed: 11/12/2022] Open
Abstract
Background The treatment results of external beam radiotherapy for intermediate and high risk prostate cancer patients are insufficient with five-year biochemical relapse rates of approximately 35%. Several randomized trials have shown that dose escalation to the entire prostate improves biochemical disease free survival. However, further dose escalation to the whole gland is limited due to an unacceptable high risk of acute and late toxicity. Moreover, local recurrences often originate at the location of the macroscopic tumor, so boosting the radiation dose at the macroscopic tumor within the prostate might increase local control. A reduction of distant metastases and improved survival can be expected by reducing local failure. The aim of this study is to investigate the benefit of an ablative microboost to the macroscopic tumor within the prostate in patients treated with external beam radiotherapy for prostate cancer. Methods/Design The FLAME-trial (Focal Lesion Ablative Microboost in prostatE cancer) is a single blind randomized controlled phase III trial. We aim to include 566 patients (283 per treatment arm) with intermediate or high risk adenocarcinoma of the prostate who are scheduled for external beam radiotherapy using fiducial markers for position verification. With this number of patients, the expected increase in five-year freedom from biochemical failure rate of 10% can be detected with a power of 80%. Patients allocated to the standard arm receive a dose of 77 Gy in 35 fractions to the entire prostate and patients in the experimental arm receive 77 Gy to the entire prostate and an additional integrated microboost to the macroscopic tumor of 95 Gy in 35 fractions. The secondary outcome measures include treatment-related toxicity, quality of life and disease-specific survival. Furthermore, by localizing the recurrent tumors within the prostate during follow-up and correlating this with the delivered dose, we can obtain accurate dose-effect information for both the macroscopic tumor and subclinical disease in prostate cancer. The rationale, study design and the first 50 patients included are described. Trial registration This study is registered at ClinicalTrials.gov: NCT01168479
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Affiliation(s)
- Irene M Lips
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
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21
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Lips IM, van Gils CH, Kotte ANTJ, van Leerdam ME, Franken SPG, van der Heide UA, van Vulpen M. A double-blind placebo-controlled randomized clinical trial with magnesium oxide to reduce intrafraction prostate motion for prostate cancer radiotherapy. Int J Radiat Oncol Biol Phys 2011; 83:653-60. [PMID: 22099039 DOI: 10.1016/j.ijrobp.2011.07.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 06/23/2011] [Accepted: 07/18/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE To investigate whether magnesium oxide during external-beam radiotherapy for prostate cancer reduces intrafraction prostate motion in a double-blind, placebo-controlled randomized trial. METHODS AND MATERIALS At the Department of Radiotherapy, prostate cancer patients scheduled for intensity-modulated radiotherapy (77 Gy in 35 fractions) using fiducial marker-based position verification were randomly assigned to receive magnesium oxide (500 mg twice a day) or placebo during radiotherapy. The primary outcome was the proportion of patients with clinically relevant intrafraction prostate motion, defined as the proportion of patients who demonstrated in ≥ 50% of the fractions an intrafraction motion outside a range of 2 mm. Secondary outcome measures included quality of life and acute toxicity. RESULTS In total, 46 patients per treatment arm were enrolled. The primary endpoint did not show a statistically significant difference between the treatment arms with a percentage of patients with clinically relevant intrafraction motion of 83% in the magnesium oxide arm as compared with 80% in the placebo arm (p = 1.00). Concerning the secondary endpoints, exploratory analyses demonstrated a trend towards worsened quality of life and slightly more toxicity in the magnesium oxide arm than in the placebo arm; however, these differences were not statistically significant. CONCLUSIONS Magnesium oxide is not effective in reducing the intrafraction prostate motion during external-beam radiotherapy, and therefore there is no indication to use it in clinical practice for this purpose.
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Affiliation(s)
- Irene M Lips
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
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22
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Mutanga TF, de Boer HC, van der Wielen GJ, Hoogeman MS, Incrocci L, Heijmen BJ. Margin Evaluation in the Presence of Deformation, Rotation, and Translation in Prostate and Entire Seminal Vesicle Irradiation With Daily Marker-Based Setup Corrections. Int J Radiat Oncol Biol Phys 2011; 81:1160-7. [DOI: 10.1016/j.ijrobp.2010.09.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 08/23/2010] [Accepted: 09/26/2010] [Indexed: 11/30/2022]
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Beltran C, Pegram A, Merchant TE. Dosimetric consequences of rotational errors in radiation therapy of pediatric brain tumor patients. Radiother Oncol 2011; 102:206-9. [PMID: 21726913 DOI: 10.1016/j.radonc.2011.06.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 06/03/2011] [Accepted: 06/04/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To quantify the rotational offsets and estimate the dose effect of rotation on the target volume and normal tissues in children with brain tumor. METHODS Twenty-one pediatric patients with brain tumors were included in this study. Cone-beam CT was performed before each treatment and at the end of every other treatment. Translational offsets were corrected before the treatment. An offline analysis was performed to quantify rotational errors. The treatment plans were altered and recalculated to simulate a rotation of 2° and 4°, and the dose changes were quantified. RESULTS 1016 CBCT datasets were analyzed for this report. The mean of the rotations were not meaningfully different from zero. 18.1% of the fractions had rotations with a magnitude ≥2°, 5.0% had rotations ≥3° and 0.9% had rotations ≥4°. For the 2° rotational simulation, the gEUD values of the PTV and critical structures changed by less than 2%. For the 4° simulation, parallel type normal structures had minor changes (<2%), but serial type normal structures and the PTV had changes of 10% and 5%, respectively. CONCLUSIONS The majority of rotational errors observed were less than 1°. A rotational error of 2° produced negligible changes in the gEUD to critical structures or target volumes. Rotational errors ≥4° produced undesirable results, therefore, at a minimum, errors >2° should be corrected.
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Affiliation(s)
- Chris Beltran
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN 38120, USA.
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Influence of antiflatulent dietary advice on intrafraction motion for prostate cancer radiotherapy. Int J Radiat Oncol Biol Phys 2011; 81:e401-6. [PMID: 21664067 DOI: 10.1016/j.ijrobp.2011.04.062] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 03/25/2011] [Accepted: 04/21/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the effect of an antiflatulent dietary advice on the intrafraction prostate motion in patients treated with intensity-modulated radiotherapy (IMRT) for prostate cancer. METHODS AND MATERIALS Between February 2002 and December 2009, 977 patients received five-beam IMRT for prostate cancer to a dose of 76 Gy in 35 fractions combined with fiducial markers for position verification. In July 2008, the diet, consisting of dietary guidelines to obtain regular bowel movements and to reduce intestinal gas by avoiding certain foods and air swallowing, was introduced to reduce the prostate motion. The intrafraction prostate movement was determined from the portal images of the first segment of all five beams. Clinically relevant intrafraction motion was defined as ≥50% of the fractions with an intrafraction motion outside a range of 3 mm. RESULTS A total of 739 patients were treated without the diet and 105 patients were treated with radiotherapy after introduction of the diet. The median and interquartile range of the average intrafraction motion per patient was 2.53 mm (interquartile range, 2.2-3.0) without the diet and 3.00 mm (interquartile range, 2.4-3.5) with the diet (p < .0001). The percentage of patients with clinically relevant intrafraction motion increased statistically significant from 19.1% without diet to 42.9% with a diet (odds ratio, 3.18; 95% confidence interval, 2.07-4.88; p < .0001). CONCLUSIONS The results of the present study suggest that antiflatulent dietary advice for patients undergoing IMRT for prostate cancer does not reduce the intrafraction movement of the prostate. Therefore, antiflatulent dietary advice is not recommended in clinical practice for this purpose.
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Yoon M, Cheong M, Kim J, Shin DH, Park SY, Lee SB. Accuracy of an automatic patient-positioning system based on the correlation of two edge images in radiotherapy. J Digit Imaging 2010; 24:322-30. [PMID: 20127267 DOI: 10.1007/s10278-009-9269-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 11/27/2009] [Accepted: 12/13/2009] [Indexed: 11/29/2022] Open
Abstract
We have clinically evaluated the accuracy of an automatic patient-positioning system based on the image correlation of two edge images in radiotherapy. Ninety-six head & neck images from eight patients undergoing proton therapy were compared with a digitally reconstructed radiograph (DRR) of planning CT. Two edge images, a reference image and a test image, were extracted by applying a Canny edge detector algorithm to a DRR and a 2D X-ray image, respectively, of each patient before positioning. In a simulation using a humanoid phantom, performed to verify the effectiveness of the proposed method, no registration errors were observed for given ranges of rotation, pitch, and translation in the x, y, and z directions. For real patients, however, there were discrepancies between the automatic positioning method and manual positioning by physicians or technicians. Using edged head coronal- and sagittal-view images, the average differences in registration between these two methods for the x, y, and z directions were 0.11 cm, 0.09 cm and 0.11 cm, respectively, whereas the maximum discrepancies were 0.34 cm, 0.38 cm, and 0.50 cm, respectively. For rotation and pitch, the average registration errors were 0.95° and 1.00°, respectively, and the maximum errors were 3.6° and 2.3°, respectively. The proposed automatic patient-positioning system based on edge image comparison was relatively accurate for head and neck patients. However, image deformation during treatment may render the automatic method less accurate, since the test image many differ significantly from the reference image.
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Affiliation(s)
- Myonggeun Yoon
- Proton Therapy Center, National Cancer Center, 809 Madu 1-dong, Ilsandong-gu, Goyang, 411-769, Korea.
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