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Jiang D, Jin P, Xu H, Wang D, Xie C, Wang X, Zhou F, Liu H. Online adaptive radiotherapy in stereotactic body radiotherapy for pancreatic cancer patients. Sci Rep 2024; 14:22101. [PMID: 39333319 PMCID: PMC11436912 DOI: 10.1038/s41598-024-72831-z] [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: 03/29/2024] [Accepted: 09/11/2024] [Indexed: 09/29/2024] Open
Abstract
Stereotactic radiation therapy (SBRT) has emerged as a promising treatment modality for locally advanced pancreatic cancer. The aim of this study is to assess the dosimetric efficacy of online adaptive radiotherapy (ART) in comparison to image-guided radiation therapy (IGRT) for pancreatic cancer. We conducted a retrospective analysis involving 8 patients diagnosed with locally advanced pancreatic cancer. The gross tumor volume (GTV) delineates the visible extent of the tumor on imaging, while the planning tumor volume (PTV) was generated by expanding 5 mm from the GTV and ensuring a 3 mm distance from the small intestine, duodenum, and stomach simultaneously. Treatment planning was executed using the United Imaging Healthcare Treatment Planning System workstation. The control group underwent evaluation based on daily validated fan-beam CT (FBCT) scans, assessing both the dose delivered to actual organs at risk (OARs) and the target volume. Radiotherapy plans were developed utilizing simulation CT, and conventional radiotherapy with daily image-guided radiation therapy (IGRT) was administered using FBCT-Linac. Conversely, patients in the study group received daily validated FBCT-guided adaptive radiotherapy plans, with a focus on mean dose assessment of both the target volume and OARs. Subsequently, we compared the average outcomes of each treatment fraction between IGRT and online adaptive radiotherapy (ART). Comparison between ART and IGRT treatment plans revealed significant differences in various dosimetric parameters: For PTV: V98%: ART (96.28%) vs IGRT (89.73%), p = 0.000, V95%: ART (96.28%) vs IGRT (89.73%), p = 0.031, V90%: ART (98.58%) vs IGRT (93.65%), p = 0.000, Dmean: ART (4912.91) vs IGRT (4804.11), p = 0.000. For GTV: V100%: ART (97.96%) vs IGRT (94.85%), p = 0.314, V98%: ART (100.00%) vs IGRT (96.83%), p = 0.000, V90%: ART (100.00%) vs IGRT (97.75%), p = 0.000, Dmean: ART (4972.17) vs IGRT (4907.23), p = 0.000. For the duodenum: D0.5cc: ART (2883.92) vs IGRT (3359.35), p = 0.000, D1cc: ART (2726.32) vs IGRT (3128.66), p = 0.001, D5cc: ART (2051.96) vs IGRT (2273.93), p = 0.015, D10cc: ART (1650.73) vs IGRT (1731.74), p = 0.211. For the small bowel: D0.5cc: ART (3022.3) vs IGRT (3142.64), p = 0.037. D5cc: ART (2151.09) vs IGRT (2389.15), p = 0.043, D10cc: ART (1775.20) vs IGRT (1942.00), p = 0.079. For the stomach: D0.5cc: ART (3353.92) vs IGRT (4117.85), p = 0.000, D5cc: ART (2860.20) vs IGRT (3235.41), p = 0.000, D10cc: ART (2553.72) vs IGRT (2836.73), p = 0.000. For the Dmean of the left kidney and right kidney: Left kidney: ART (248.28) vs IGRT (239.65), p = 0.100. Right kidney: ART (314.55) vs IGRT (307.17), p = 0.345. These results suggest significant improvements in PTV coverage and sparing of OARs with ART compared to IGRT, indicating the potential of ART in optimizing treatment outcomes for pancreatic cancer patients. Compared to conventional IGRT-guided SBRT programs, ART-based SBRT for pancreatic cancer not only enhances the dose distribution to the target volume but also mitigates the radiation exposure to critical organs-at-risk (OARs) such as the duodenum, small intestine, and stomach. This approach may offer a more favorable safety profile while concurrently enhancing treatment efficacy.
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Affiliation(s)
- Dazhen Jiang
- Radiotherapy Center, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Peng Jin
- Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hui Xu
- Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Dajiang Wang
- Radiotherapy Center, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Conghua Xie
- Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Xiaoyong Wang
- Radiotherapy Center, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Fuxiang Zhou
- Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
| | - Hui Liu
- Radiotherapy Center, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
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2
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Han Z, Sudhyadhom A, Hsu SH, Hu YH, Mak RH, Huynh MA, van Dams RR, Tanguturi S, Venkatachalam V, Mancias JD, Mamon HJ, Martin NE, Lam MB, Leeman JE. Comparison of MR-soft tissue based versus biliary stent based alignment for image guidance in pancreatic SBRT. J Appl Clin Med Phys 2023:e13965. [PMID: 36924220 DOI: 10.1002/acm2.13965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/27/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
PURPOSE The role of biliary stents in image-guided localization for pancreatic cancer has been inconclusive. To date, stent accuracy has been largely evaluated against implanted fiducials on cone beam computed tomography. We aim to use magnetic resonance (MR) soft tissue as a direct reference to examine the geometric and dosimetric impacts of stent-based localization on the newly available MR linear accelerator. METHODS Thirty pancreatic cancer patients (132 fractions) treated on our MR linear accelerator were identified to have a biliary stent. In our standard adaptive workflow, patients were set up to the target using soft tissue for image registration and structures were re-contoured on daily MR images. The original plan was then projected on treatment anatomy and dose predicted, followed by plan re-optimization and treatment delivery. These online predicted plans were soft tissue-based and served as reference plans. Retrospective image registration to the stent was performed offline to simulate stent-based localization and the magnitude of shifts was taken as the geometric accuracy of stent localization. New predicted plans were generated based on stent-alignment for dosimetric comparison. RESULTS Shifts were within 3 mm for 90% of the cases (mean = 1.5 mm); however, larger shifts up to 7.2 mm were observed. Average PTV coverage dropped by 1.1% with a maximum drop of 26.8%. The mean increase in V35Gy was 0.15, 0.05, 0.02, and 0.02 cc for duodenum, stomach, small bowel and large bowel, respectively. Stent alignment was significantly worse for all metrics except for small bowel (p = 0.07). CONCLUSIONS Overall discrepancy between stent- and soft tissue-alignment was modest; however, large discrepancies were observed for select cases. While PTV coverage loss may be compensated for by using a larger margin, the increase in dose to gastrointestinal organs at risk may limit the role of biliary stents in image-guided localization.
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Affiliation(s)
- Zhaohui Han
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Atchar Sudhyadhom
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Shu-Hui Hsu
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Yue-Houng Hu
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Raymond H Mak
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Mai Anh Huynh
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Ritchell R van Dams
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Shyam Tanguturi
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Veena Venkatachalam
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph D Mancias
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Harvey J Mamon
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Neil E Martin
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Miranda B Lam
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan E Leeman
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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Ji T, Feng Z, Sun E, Ng SK, Su L, Zhang Y, Han D, Han-Oh S, Iordachita I, Lee J, Kazanzides P, Bell MAL, Wong J, Ding K. A phantom-based analysis for tracking intra-fraction pancreatic tumor motion by ultrasound imaging during radiation therapy. Front Oncol 2022; 12:996537. [PMID: 36237341 PMCID: PMC9552199 DOI: 10.3389/fonc.2022.996537] [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: 07/17/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeIn this study, we aim to further evaluate the accuracy of ultrasound tracking for intra-fraction pancreatic tumor motion during radiotherapy by a phantom-based study.MethodsTwelve patients with pancreatic cancer who were treated with stereotactic body radiation therapy were enrolled in this study. The displacement points of the respiratory cycle were acquired from 4DCT and transferred to a motion platform to mimic realistic breathing movements in our phantom study. An ultrasound abdominal phantom was placed and fixed in the motion platform. The ground truth of phantom movement was recorded by tracking an optical tracker attached to this phantom. One tumor inside the phantom was the tracking target. In the evaluation of the results, the monitoring results from the ultrasound system were compared with the phantom motion results from the infrared camera. Differences between infrared monitoring motion and ultrasound tracking motion were analyzed by calculating the root-mean-square error.ResultsThe 82.2% ultrasound tracking motion was within a 0.5 mm difference value between ultrasound tracking displacement and infrared monitoring motion. 0.7% ultrasound tracking failed to track accurately (a difference value > 2.5 mm). These differences between ultrasound tracking motion and infrared monitored motion do not correlate with respiratory displacements, respiratory velocity, or respiratory acceleration by linear regression analysis.ConclusionsThe highly accurate monitoring results of this phantom study prove that the ultrasound tracking system may be a potential method for real-time monitoring targets, allowing more accurate delivery of radiation doses.
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Affiliation(s)
- Tianlong Ji
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Ziwei Feng
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Edward Sun
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Sook Kien Ng
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Lin Su
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Yin Zhang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Dong Han
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Sarah Han-Oh
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Iulian Iordachita
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Junghoon Lee
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Peter Kazanzides
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, United States
| | - Muyinatu A. Lediju Bell
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - John Wong
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Kai Ding
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
- *Correspondence: Kai Ding,
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Umezawa R, Wakita A, Katsuta Y, Ito Y, Nakamura S, Okamoto H, Kadoya N, Takahashi K, Inaba K, Murakami N, Igaki H, Jingu K, Itami J. A Pilot Study of Synchronization of Respiration-Induced Motions in the Duodenum and Stomach for the Primary Tumor in Radiation Therapy for Pancreatic Cancer Using 4-Dimensional Computed Tomography. Adv Radiat Oncol 2021; 6:100730. [PMID: 34409214 PMCID: PMC8360956 DOI: 10.1016/j.adro.2021.100730] [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: 12/22/2020] [Revised: 04/07/2021] [Accepted: 05/18/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose We investigated the synchronization of respiration-induced motions at the primary tumor and organs at risk at radiation planning for pancreatic cancer. Methods and Materials Four-dimensional computed tomography images were acquired under the condition of shallow free breathing in patients with pancreatic cancer. The gross tumor volume (GTV), duodenum (DU), and stomach (ST) were contoured. The center of mass was computed for each 4-dimensional volume of interest. The respiration dependence of coordinates for the center of each volume of interest was computed relative to its location at the 50% (maximum exhalation) phase. Based on the shift of the GTV, we investigated the synchronization of respiration-induced motions between each contouring target. We examined the differences in the volume averaged dose to the ST and DU in each respiratory phase. Results Nine patients with pancreatic cancer were analyzed in this study. The mean maximum 3-dimensional excursions at the GTV, DU, and ST were 9.6, 9.8, and 11.4 mm, respectively. At phase 0% and 90% (inhale phases), mean distance changes in the positional relationship with the GTV were 0.3 and 0.7 mm respectively for the DU and -2.5 and -2.4 mm respectively for the ST. There was no significant respiration associated change (RAC) between each respiratory phase in the DU (P = .568), and there was a significant RAC in the ST (P < .001). There was a significant RAC of the volume averaged dose to the ST (P = .023). Conclusions Our results indicate that the DU but not the ST might move synchronously with GTV due to respiration.
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Affiliation(s)
- Rei Umezawa
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan.,Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akihisa Wakita
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshiyuki Katsuta
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshinori Ito
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan.,Department of Radiation Oncology, Showa University School of Medicine, Tokyo, Japan
| | - Satoshi Nakamura
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyuki Okamoto
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kana Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Koji Inaba
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
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Figueiredo M, Bouchart C, Moretti L, Mans L, Engelholm JL, Bali MA, Van Laethem JL, Eisendrath P. EUS-guided placement of fiducial markers for stereotactic body radiation therapy in pancreatic cancer: feasibility, security and a new quality score. Endosc Int Open 2021; 9:E253-E257. [PMID: 33553589 PMCID: PMC7857973 DOI: 10.1055/a-1324-2892] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background and study aims In borderline resectable/locally advanced pancreatic ductal adenocarcinoma (PDAC), stereotactic body radiation therapy (SBRT) is an emerging neoadjuvant treatment option. Endoscopic ultrasound (EUS)-guided insertion of fiducial markers being a prerequisite, our aim was to assess its feasibility and safety and also to evaluate its success, from both the endoscopist's and radiotherapist's perspectives. Patients and methods We prospectively collected data concerning PDAC patients submitted to EUS-guided fiducial placement, from February 2018 to November 2019. Technical success was defined as at least one marker presumed inside the tumor. Quality success was assessed at pre-SBRT computed tomography, accordingly to the number of markers inside or < 1 cm from the tumor, number of markers at the tumor extremity, their location in different planes, the distance between them, and their distance from the biliary stent (if present). A new quality score was then proposed and high-quality success defined as at least six of 12 points. Results Thirty-seven patients were enrolled. A total of 97 fiducials were implanted, with a median of three fiducials per patient (0-4). The technical success rate was 92 %, with failure of fiducial placement in three patients. Three patients (8 %) had adverse events (fever, mild acute pancreatitis, and biliary stent migration). At pre-SBRT evaluation, two patients' markers had migrated. The high-quality success rate was 62.5 %. Conclusions Our results contribute to demonstrating the feasibility and safety of EUS-guided fiducial placement for SBRT treatment in PDAC. It is hoped that the newly proposed quality score will pave the way for improving fiducial positioning and SBRT delivery.
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Affiliation(s)
- Mariana Figueiredo
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Belgium
| | - Christelle Bouchart
- Department of Radiation-Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Belgium
| | - Luigi Moretti
- Department of Radiation-Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Belgium
| | - Laura Mans
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Belgium
| | - Jean-Luc Engelholm
- Department of Radiology, Institut Jules Bordet, Université Libre de Bruxelles, Belgium
| | - Maria-Antonietta Bali
- Department of Radiology, Institut Jules Bordet, Université Libre de Bruxelles, Belgium
| | - Jean-Luc Van Laethem
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Belgium
| | - Pierre Eisendrath
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Belgium,Department of Gastroenterology, Saint-Pierre University Hospital, Université Libre de Bruxelles, Belgium
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6
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Mickevicius NJ, Nencka AS, Paulson ES. Generalized simultaneous multi-orientation 2D imaging. Magn Reson Med 2019; 84:847-856. [PMID: 31872496 DOI: 10.1002/mrm.28150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/02/2019] [Accepted: 12/06/2019] [Indexed: 11/09/2022]
Abstract
PURPOSE Flexibility in slice prescription is critical for precise motion monitoring during MR-guided therapies. Adding more slices to improve spatial coverage during rapid 2D cine imaging often hampers temporal resolution. This work describes a framework to simultaneously acquire multiple arbitrarily oriented slices which share a common frequency encoding axis. This framework allows for higher frame rates for a given number of slices compared to conventional interleaved-slice multi-orientation cine imaging. THEORY AND METHODS A framework to calculate zeroth gradient moments to be played out between sequentially excited slices with multiple orientations is described here. Experiments were performed in phantom, and in vivo in the head/neck and abdomen of patients. RESULTS Images arbitrarily rotated relative to one another were successfully obtained in phantom and in vivo. Simultaneous multi-orientation (SMO) images were also acquired with additional in-plane acceleration to demonstrate the capability of this method to rapidly image objects moving with physiological motion. CONCLUSIONS The technical feasibility of the generalized SMO imaging framework was tested in this study. It shows promise for continued development for motion monitoring during MR-guided therapies.
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Affiliation(s)
| | - Andrew S Nencka
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Eric S Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
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Huang P, Su L, Chen S, Cao K, Song Q, Kazanzides P, Iordachita I, Lediju Bell MA, Wong JW, Li D, Ding K. 2D ultrasound imaging based intra-fraction respiratory motion tracking for abdominal radiation therapy using machine learning. Phys Med Biol 2019; 64:185006. [PMID: 31323649 DOI: 10.1088/1361-6560/ab33db] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We have previously developed a robotic ultrasound imaging system for motion monitoring in abdominal radiation therapy. Owing to the slow speed of ultrasound image processing, our previous system could only track abdominal motions under breath-hold. To overcome this limitation, a novel 2D-based image processing method for tracking intra-fraction respiratory motion is proposed. Fifty-seven different anatomical features acquired from 27 sets of 2D ultrasound sequences were used in this study. Three 2D ultrasound sequences were acquired with the robotic ultrasound system from three healthy volunteers. The remaining datasets were provided by the 2015 MICCAI Challenge on Liver Ultrasound Tracking. All datasets were preprocessed to extract the feature point, and a patient-specific motion pattern was extracted by principal component analysis and slow feature analysis (SFA). The tracking finds the most similar frame (or indexed frame) by a k-dimensional-tree-based nearest neighbor search for estimating the tracked object location. A template image was updated dynamically through the indexed frame to perform a fast template matching (TM) within a learned smaller search region on the incoming frame. The mean tracking error between manually annotated landmarks and the location extracted from the indexed training frame is 1.80 ± 1.42 mm. Adding a fast TM procedure within a small search region reduces the mean tracking error to 1.14 ± 1.16 mm. The tracking time per frame is 15 ms, which is well below the frame acquisition time. Furthermore, the anatomical reproducibility was measured by analyzing the location's anatomical landmark relative to the probe; the position-controlled probe has better reproducibility and yields a smaller mean error across all three volunteer cases, compared to the force-controlled probe (2.69 versus 11.20 mm in the superior-inferior direction and 1.19 versus 8.21 mm in the anterior-posterior direction). Our method reduces the processing time for tracking respiratory motion significantly, which can reduce the delivery uncertainty.
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Affiliation(s)
- Pu Huang
- Shandong Key Laboratory of Medical Physics and Image Processing, School of Physics and Electronics, Shandong Normal University, Jinan, Shandong, People's Republic of China. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States of America. Authors contributed equally to this work
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8
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Sarkar V, Lloyd S, Paxton A, Huang L, Su FC, Tao R, Tward J, Zhao H, Salter B. Daily breathing inconsistency in pancreas SBRT: a 4DCT study. J Gastrointest Oncol 2019; 9:989-995. [PMID: 30603117 DOI: 10.21037/jgo.2018.09.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Stereotactic body radiation therapy (SBRT) treatments of pancreatic cancer typically employ relatively small margins. This study characterizes the motion of high visibility structures in close proximity to the pancreas to determine how much the motion envelope of such a structure changes due to respiratory variation between fractions. Methods Fanbeam, four-dimensional computed tomography (4DCT) studies acquired initially for planning and again prior to each treatment for 6 patients were used to fully characterize the change in motion of high-contrast structures in close proximity to the pancreas. Results Three of the six patients investigated had structures that showed a change in motion over the course of treatment that would not have been covered when using the typical 3 mm planning target volume (PTV) margins. For most of these large changes in motion envelope, a 4 mm uniform PTV margin would have allowed for coverage of the tumor. Conclusions Half of the patients showed a change in motion envelope greater than would be covered by the commonly used PTV margins in pancreas SBRT. This shows that the impact of small margins must be very carefully considered during the planning process.
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Affiliation(s)
- Vikren Sarkar
- Department of Radiation Oncology, University of Utah Huntsman Cancer Hospital, Salt Lake City, UT, USA
| | - Shane Lloyd
- Department of Radiation Oncology, University of Utah Huntsman Cancer Hospital, Salt Lake City, UT, USA
| | - Adam Paxton
- Department of Radiation Oncology, University of Utah Huntsman Cancer Hospital, Salt Lake City, UT, USA
| | - Long Huang
- Department of Radiation Oncology, University of Utah Huntsman Cancer Hospital, Salt Lake City, UT, USA
| | - Fan-Chi Su
- Department of Radiation Oncology, University of Utah Huntsman Cancer Hospital, Salt Lake City, UT, USA
| | - Randa Tao
- Department of Radiation Oncology, University of Utah Huntsman Cancer Hospital, Salt Lake City, UT, USA
| | - Jonathan Tward
- Department of Radiation Oncology, University of Utah Huntsman Cancer Hospital, Salt Lake City, UT, USA
| | - Hui Zhao
- Department of Radiation Oncology, University of Utah Huntsman Cancer Hospital, Salt Lake City, UT, USA
| | - Bill Salter
- Department of Radiation Oncology, University of Utah Huntsman Cancer Hospital, Salt Lake City, UT, USA
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9
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Mickevicius NJ, Chen X, Boyd Z, Lee HJ, Ibbott GS, Paulson ES. Simultaneous motion monitoring and truth-in-delivery analysis imaging framework for MR-guided radiotherapy. ACTA ACUST UNITED AC 2018; 63:235014. [DOI: 10.1088/1361-6560/aaec91] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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10
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Mostafaei F, Tai A, Omari E, Song Y, Christian J, Paulson E, Hall W, Erickson B, Li XA. Variations of MRI-assessed peristaltic motions during radiation therapy. PLoS One 2018; 13:e0205917. [PMID: 30359413 PMCID: PMC6201905 DOI: 10.1371/journal.pone.0205917] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/03/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Understanding complex abdominal organ motion is essential for motion management in radiation therapy (RT) of abdominal tumors. This study investigates abdominal motion induced by respiration and peristalsis, during various time durations relevant to RT, using various CT and MRI techniques acquired under free breathing (FB) and breath hold (BH). METHODS A series of CT and MRI images acquired with various techniques under free breathing and/or breath hold from 37 randomly-selected pancreatic or liver cancer patients were analyzed to assess the motion in various time frames. These data include FB 4DCT from 15 patients (for motion in time duration of 5 sec), FB 2D cine-MRI from 4 patients (time duration of 1.7 min, 1 second acquisition time per slice), FB cine-MRI acquired using MR-Linac from 6 patients in various fractions (acquisition time is less than 0.6 seconds per slice), FB 4DMRI from 2 patients (time duration of 2 min), respiration-gated T2 with gating at the end expiration (time duration of 3-5 min), and BH T1 with multiphase dynamic contrast in acquisition times of 17 seconds for each of five phases (pre-contrast, arterial, venous, portal venous and delayed post-contrast) from 10 patients. Motions of various organs including gallbladder (GB) and liver were measured based on these MRI data. The GB motion includes both respiration and peristalsis, while liver motion is primarily respiration. By subtracting liver motion (respiration) from GB motion (respiration and peristalsis), the peristaltic motion, along with small residual motion, was obtained. RESULTS From cine-MRI, the residual motion beyond the respiratory motion was found to be up to 0.6 cm in superior-inferior (SI) and 0.55 cm in anterior-posterior (AP) directions. From 2D cine-MRI acquired by the MR-Linac, different peristaltic motions were found from different fractions for each patient. The peristaltic motion was found to vary between 0.3-1 cm. From BH T1 phase images, the average motions that were primarily due to peristalsis movements were found to be 1.2 cm in SI, 0.7 cm in AP, and 0.9 cm in left-right (LR) directions. The average motions assessed from 4DCT were 1.0 cm in SI and 0.3 cm in AP directions, which were generally smaller than the motions assessed from cine-MRI, i.e., 1.8 cm in SI and 0.6 cm in AP directions, for the same patients. However, average motions from 4DMRI, which are coming from respiratory were measured to be 1.5, 0.5, and 0.4 cm in SI, AP, and LR directions, respectively. CONCLUSION The abdominal motion due to peristalsis can be similar in magnitude to respiratory motion as assessed. These motions can be irregular and persistent throughout the imaging and RT delivery procedures, and should be considered together with respiratory motion during RT for abdominal tumors.
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Affiliation(s)
- Farshad Mostafaei
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - An Tai
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Eenas Omari
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Yingqiu Song
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Union Hospital Cancer Center, Huazhong University of Science and Technology, Wuhan, China
| | - James Christian
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Eric Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - William Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - X. Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- * E-mail:
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Stemkens B, Paulson ES, Tijssen RHN. Nuts and bolts of 4D-MRI for radiotherapy. ACTA ACUST UNITED AC 2018; 63:21TR01. [DOI: 10.1088/1361-6560/aae56d] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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12
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Mostafaei F, Tai A, Gore E, Johnstone C, Haase W, Ehlers C, Cooper DT, Lachaine M, Li XA. Feasibility of real-time lung tumor motion monitoring using intrafractional ultrasound and kV cone beam projection images. Med Phys 2018; 45:4619-4626. [DOI: 10.1002/mp.13104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/13/2018] [Accepted: 07/18/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Farshad Mostafaei
- Department of Radiation Oncology; Medical College of Wisconsin; Milwaukee WI 53226 USA
| | - An Tai
- Department of Radiation Oncology; Medical College of Wisconsin; Milwaukee WI 53226 USA
| | - Elizabeth Gore
- Department of Radiation Oncology; Medical College of Wisconsin; Milwaukee WI 53226 USA
| | - Candice Johnstone
- Department of Radiation Oncology; Medical College of Wisconsin; Milwaukee WI 53226 USA
| | - William Haase
- Department of Radiation Oncology; Medical College of Wisconsin; Milwaukee WI 53226 USA
| | - Christopher Ehlers
- Department of Radiology; Medical College of Wisconsin; Milwaukee WI 53226 USA
| | | | | | - X. Allen Li
- Department of Radiation Oncology; Medical College of Wisconsin; Milwaukee WI 53226 USA
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Takahashi S, Anada M, Kinoshita T, Shibata T. Respiratory motion of lymph node stations in pancreatic cancer: Analyses using contrast-enhanced four-dimensional computed tomography. Radiother Oncol 2018; 128:569-574. [PMID: 29801722 DOI: 10.1016/j.radonc.2018.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 05/03/2018] [Accepted: 05/06/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Data regarding respiratory motion of lymph node (LN) stations in pancreatic cancer is limited. Therefore, we assessed their respiratory motion using contrast-enhanced four-dimensional-computed tomography (CE-4DCT). MATERIAL AND METHODS We evaluated respiratory motion in 18 pancreatic cancer patients. We selected LN stations around major arteries which were visible on CE-4DCT images. This included the common hepatic, celiac, splenic, and superior mesenteric stations. Two radiation oncologists individually delineated the gross tumor volume (GTV) and the LN stations as observers 1 and 2. RESULTS The respiratory motion of the celiac (median, 3.9 mm each for both observers) and superior mesenteric (median, 4.5 and 5.0 mm for observers 1 and 2, respectively) stations in the craniocaudal (CC) directions was significantly smaller than that of the GTV (median, 8.9 and 7.8 mm for observers 1 and 2, respectively). The respiratory motion of the common hepatic station (median, 3.8 and 3.6 mm for observers 1 and 2, respectively) in the anterior-posterior (AP) direction was significantly larger than that of the GTV (median, 2.8 and 2.2 mm for observers 1 and 2, respectively). CONCLUSIONS We observed significant differences in respiratory motion between the GTV and the LN stations in pancreatic cancer.
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Affiliation(s)
- Shigeo Takahashi
- Department of Radiation Oncology, Kagawa University Hospital, Japan.
| | - Masahide Anada
- Department of Radiation Oncology, Kagawa University Hospital, Japan
| | | | - Toru Shibata
- Department of Radiation Oncology, Kagawa University Hospital, Japan
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Tsai YL, Wu CJ, Shaw S, Yu PC, Nien HH, Lui LT. Quantitative analysis of respiration-induced motion of each liver segment with helical computed tomography and 4-dimensional computed tomography. Radiat Oncol 2018; 13:59. [PMID: 29609631 PMCID: PMC5879734 DOI: 10.1186/s13014-018-1007-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/22/2018] [Indexed: 12/16/2022] Open
Abstract
Background To analyze the respiratory-induced motion of each liver segment using helical computed tomography (helical CT) and 4-dimensional computed tomography (4DCT), and to establish the individual segment expansion margin of internal target volume (ITV) to facilitate target delineation of tumors in different liver segments. Methods Twenty patients who received radiotherapy with CT-simulation scanning of the whole liver in both helical CT and 10-phase-gated 4DCT were investigated, including 2 patients with esophagus cancer, 4 with lung cancer, 10 with breast cancer, 2 with liver cancer, 1 with thymoma, and 1 with gastric diffuse large B-cell lymphoma (DLBCL). For each patient, 9 representative points were drawn on the helical CT images of liver segments 1, 2, 3, 4a, 4b, 5, 6, 7, and 8, respectively, and adaptively deformed to 2 phases of the 4DCT images at the end of inspiration (phase 0 CT) and expiration (phase 50 CT) in the treatment planning system. Using the amplitude of each point between phase 0 CT and phase 50 CT, we established quantitative data for the respiration-induced motion of each liver segment in 3-dimensional directions. Moreover, using the amplitude between the original helical CT and both 4DCT images, we rendered the individual segment expansion margin of ITV for hepatic target delineation to cover more than 95% of each tumor. Results The average amplitude (mean ± standard deviation) was 0.6 ± 3.0 mm in the left-right (LR) direction, 2.3 ± 2.4 mm in the anterior-posterior (AP) direction, and 5.7 ± 3.4 mm in the superior-inferior (SI) direction, respectively. All of the segments moved posteriorly and superiorly during expiration. Segment 7 had the largest amplitude in the SI direction, at 8.6 ± 3.4 mm. Otherwise, the segments over the lateral side, including segments 2, 3, 6, and 7, had greater excursion in the SI direction compared to the medial segments. To cover more than 95% of each tumor, the required expansion margin of ITV in the LR, AP, and SI directions were at least 2.5 mm, 2.5 mm, and 5.0 mm on average, respectively, with variations between different segments. Conclusions The greatest excursion occurred in liver segment 7, followed by the segments over the lateral side in the SI direction. The individual segment expansion margin of ITV is required to delineate targets for each segment and direction.
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Affiliation(s)
- Yu-Lun Tsai
- Department of Radiation Oncology, Cathay General Hospital, Taipei, Taiwan
| | - Ching-Jung Wu
- Department of Radiation Oncology, Cathay General Hospital, Taipei, Taiwan.,Department of Radiation Oncology, National Defense Medical Center, Taipei, Taiwan.,Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Suzun Shaw
- Department of Radiation Oncology, Cathay General Hospital, Taipei, Taiwan
| | - Pei-Chieh Yu
- Department of Radiation Oncology, Cathay General Hospital, Taipei, Taiwan
| | - Hsin-Hua Nien
- Department of Radiation Oncology, Cathay General Hospital, Taipei, Taiwan
| | - Louis Tak Lui
- Department of Radiation Oncology, Cathay General Hospital, Taipei, Taiwan.
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Evaluation of Bony Anatomy Versus Endobiliary Stents as Surrogates for Volumetric Image Guidance in Pancreatic Cancer. J Med Imaging Radiat Sci 2017; 48:352-359. [PMID: 31047470 DOI: 10.1016/j.jmir.2017.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/24/2017] [Accepted: 03/27/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE Online treatment setup verification through cone-beam computed tomography (CBCT) in pancreatic cancer patients is limited by low soft tissue contrast. This study aims to quantify the relative positional displacements between bony anatomy and endobiliary stents as surrogates for pancreatic cancers. METHODS Under ethics approval, 258 localization CBCT images from 15 pancreatic patients with endobiliary stents were evaluated. CBCTs were registered through two methods to assess translations and rotations: target adjacent bony anatomy through automatic registration and automatic stent registration through a shaped region of interest. Displacement vector differences between surrogate registrations were calculated and analysed. RESULTS Mean (±standard deviation) translational displacements in the right/left, superior/inferior, anterior/posterior directions were 0.9 ± 3.1 mm, 1.8 ± 4.2 mm, and 0.4 ± 2.5 mm for bone registrations, respectively, and 0.9 ± 5.6 mm, -1.5 ± 5.7 mm, and -0.5 ± 4.3 mm for stent registrations, respectively. Mean (±standard deviation) rotational displacements for pitch, roll, and yaw were 0.16 ± 0.97°, -0.32 ± 0.96°, and -0.77 ± 1.8° for bone registrations, respectively, and -0.94 ± 4.6°, -0.4 ± 7.4°, and -0.13 ± 6.64° for stent registrations, respectively. Mean displacement vector between surrogates was 4 mm, with 43% of fractions measuring displacement vectors >5 mm. A maximum displacement vector of 22.6 mm between surrogates was observed. CONCLUSIONS Varying positional differences were observed between bone and stent registration for pancreas CBCT-image-guided radiation therapy. Setup errors for stent matching were larger than bone registrations. Further research is required to determine if endobiliary stent position is equivalent to the pancreas' location to determine its suitability as a surrogate.
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16
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Karava K, Ehrbar S, Riesterer O, Roesch J, Glatz S, Klöck S, Guckenberger M, Tanadini-Lang S. Potential dosimetric benefits of adaptive tumor tracking over the internal target volume concept for stereotactic body radiation therapy of pancreatic cancer. Radiat Oncol 2017; 12:175. [PMID: 29121945 PMCID: PMC5680781 DOI: 10.1186/s13014-017-0906-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/30/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Radiotherapy for pancreatic cancer has two major challenges: (I) the tumor is adjacent to several critical organs and, (II) the mobility of both, the tumor and its surrounding organs at risk (OARs). A treatment planning study simulating stereotactic body radiation therapy (SBRT) for pancreatic tumors with both the internal target volume (ITV) concept and the tumor tracking approach was performed. The two respiratory motion-management techniques were compared in terms of doses to the target volume and organs at risk. METHODS AND MATERIALS Two volumetric-modulated arc therapy (VMAT) treatment plans (5 × 5 Gy) were created for each of the 12 previously treated pancreatic cancer patients, one using the ITV concept and one the tumor tracking approach. To better evaluate the overall dose delivered to the moving tumor volume, 4D dose calculations were performed on four-dimensional computed tomography (4DCT) scans. The resulting planning target volume (PTV) size for each technique was analyzed. Target and OAR dose parameters were reported and analyzed for both 3D and 4D dose calculation. RESULTS Tumor motion ranged from 1.3 to 11.2 mm. Tracking led to a reduction of PTV size (max. 39.2%) accompanied with significant better tumor coverage (p<0.05, paired Wilcoxon signed rank test) both in 3D and 4D dose calculations and improved organ at risk sparing. Especially for duodenum, stomach and liver, the mean dose was significantly reduced (p<0.05) with tracking for 3D and 4D dose calculations. CONCLUSIONS By using an adaptive tumor tracking approach for respiratory-induced pancreatic motion management, a significant reduction in PTV size can be achieved, which subsequently facilitates treatment planning, and improves organ dose sparing. The dosimetric benefit of tumor tracking is organ and patient-specific.
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Affiliation(s)
- Konstantina Karava
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland. .,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland.
| | - Stefanie Ehrbar
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland.,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland
| | - Oliver Riesterer
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland.,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland
| | - Johannes Roesch
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland.,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland
| | - Stefan Glatz
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland.,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland
| | - Stephan Klöck
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland.,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland.,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland.,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland
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Cheesman AR, DiMaio CJ. Role and technique of endoscopic ultrasound placement of fiducial markers in gastrointestinal malignancies. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2017. [DOI: 10.1016/j.tgie.2017.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Yoganathan SA, Maria Das KJ, Agarwal A, Kumar S. Magnitude, Impact, and Management of Respiration-induced Target Motion in Radiotherapy Treatment: A Comprehensive Review. J Med Phys 2017; 42:101-115. [PMID: 28974854 PMCID: PMC5618455 DOI: 10.4103/jmp.jmp_22_17] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/31/2017] [Accepted: 07/11/2017] [Indexed: 12/11/2022] Open
Abstract
Tumors in thoracic and upper abdomen regions such as lungs, liver, pancreas, esophagus, and breast move due to respiration. Respiration-induced motion introduces uncertainties in radiotherapy treatments of these sites and is regarded as a significant bottleneck in achieving highly conformal dose distributions. Recent developments in radiation therapy have resulted in (i) motion-encompassing, (ii) respiratory gating, and (iii) tracking methods for adapting the radiation beam aperture to account for the respiration-induced target motion. The purpose of this review is to discuss the magnitude, impact, and management of respiration-induced tumor motion.
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Affiliation(s)
- S. A. Yoganathan
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - K. J. Maria Das
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arpita Agarwal
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shaleen Kumar
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Versteijne E, Lens E, van der Horst A, Bel A, Visser J, Punt CJA, Suker M, van Eijck CHJ, van Tienhoven G. Quality assurance of the PREOPANC trial (2012-003181-40) for preoperative radiochemotherapy in pancreatic cancer : The dummy run. Strahlenther Onkol 2017; 193:630-638. [PMID: 28608305 PMCID: PMC5519646 DOI: 10.1007/s00066-017-1153-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 05/11/2017] [Indexed: 01/09/2023]
Abstract
Background The Dutch Pancreatic Cancer Group initiated the national, multicentre, controlled PREOPANC trial, randomising between preoperative radiochemotherapy and direct explorative laparotomy for patients with (borderline) resectable pancreatic cancer. The aim of this dummy run is to evaluate compliance with the radiotherapy protocol of this trial, and the quality of delineation and radiation plans. Methods Eleven radiation oncology departments open for accrual of patients in the PREOPANC trial were provided with all necessary information of a selected ‘dummy’ patient. Each institute was asked to delineate the target volumes, including gross tumour volume, internal gross tumour volume (iGTV), internal clinical target volume, and planning target volume. The institutions were also asked to provide a radiation treatment plan in accordance with the PREOPANC trial protocol. Results The range of the iGTV was 19.3–77.2 cm3 with a mean iGTV of 41.5 cm3 (standard deviation 14.8 cm3). Nine institutions made a treatment plan using an arc technique for treatment delivery, one an intensity modulated technique and one a 3-field conformal technique. All institutions reached the prescribed target coverage, without exceeding the organs at risk constraints. The institution with the 3‑field conformal technique was advised to use a more sophisticated technique (e. g. volumetric modulated arc therapy) to reduce the dose to the spinal cord. Conclusion All institutions showed acceptable deviations from the PREOPANC trial protocol and achieved an acceptable quality of delineation and radiation technique. All institutions were allowed to continue participation in the PREOPANC trial. Electronic supplementary material The online version of this article (doi:10.1007/s00066-017-1153-6) contains supplementary material, which is available to authorized users. Supplementary material: PREOPANC Protocol, version 11, radiotherapy part
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Affiliation(s)
- Eva Versteijne
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Eelco Lens
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Astrid van der Horst
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Arjan Bel
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jorrit Visser
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Cornelis J A Punt
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Mustafa Suker
- Department of Surgery, Erasmus Medical Center, Erasmus University, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Casper H J van Eijck
- Department of Surgery, Erasmus Medical Center, Erasmus University, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Geertjan van Tienhoven
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Akimoto M, Nakamura M, Nakamura A, Mukumoto N, Kishi T, Goto Y, Mizowaki T, Hiraoka M. Inter- and Intrafractional Variation in the 3-Dimensional Positions of Pancreatic Tumors Due to Respiration Under Real-Time Monitoring. Int J Radiat Oncol Biol Phys 2017; 98:1204-1211. [PMID: 28721905 DOI: 10.1016/j.ijrobp.2017.03.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/15/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To quantify the 3-dimensional pancreatic tumor motion during the overall treatment course using real-time orthogonal kilovoltage X-ray imaging. METHODS AND MATERIALS This study included 10 patients with pancreatic cancer who underwent 6-port static intensity modulated radiation therapy with real-time tumor tracking in 15 fractions, except for 1 patient (5 fractions). The tumor and abdominal wall positions were acquired simultaneously during the overall treatment course. Then the tumor motion amplitude and reference positions were determined. RESULTS The mean tumor amplitudes were 4.9, 6.5, and 13.4 mm in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions, respectively. The intrafractional variations of the reference tumor position were up to 5.4, 10.2, and 10.7 mm in the LR, AP, and SI directions, and those of the reference abdominal position were up to 10.5 mm. The reference tumor position drifted significantly in the AP and SI directions after 10 minutes, and that of abdominal wall motion drifted during the first 15 minutes (P<.05). The interfractional variation of the reference tumor position after setup correction, based on bony structures, was up to 8.9, 9.8, and 11.0 mm in the LR, AP, and SI directions, respectively. CONCLUSIONS Appropriate respiratory motion management techniques should be applied for the accurate localization of pancreatic tumors.
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Affiliation(s)
- Mami Akimoto
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mitsuhiro Nakamura
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Akira Nakamura
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nobutaka Mukumoto
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Kishi
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoko Goto
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahiro Hiraoka
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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21
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Versteijne E, Gurney-Champion OJ, van der Horst A, Lens E, Kolff MW, Buijsen J, Ebrahimi G, Neelis KJ, Rasch CRN, Stoker J, van Herk M, Bel A, van Tienhoven G. Considerable interobserver variation in delineation of pancreatic cancer on 3DCT and 4DCT: a multi-institutional study. Radiat Oncol 2017; 12:58. [PMID: 28335780 PMCID: PMC5364627 DOI: 10.1186/s13014-017-0777-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 02/06/2017] [Indexed: 12/13/2022] Open
Abstract
Background The delineation of pancreatic tumors on CT is challenging. In this study, we quantified the interobserver variation for pancreatic tumor delineation on 3DCT as well as on 4DCT. Methods Eight observers (radiation oncologists) from six institutions delineated pancreatic tumors of four patients with (borderline) resectable pancreatic cancer. The study consisted of two stages. In the 3DCT-stage, the gross tumor volume (GTV) was delineated on a contrast-enhanced scan. In the 4DCT-stage, the internal GTV (iGTV) was delineated, accounting for the respiratory motion. We calculated the volumes of the (i)GTV, the overlap of the delineated volumes (expressed as generalized conformity index: CIgen), the local observer variation (local standard deviation: SD) and the overall observer variation (overall SD). We compared these results between GTVs and iGTVs. Additionally, observers were asked to fill out a questionnaire concerning the difficulty of the delineation and their experience in delineating pancreatic tumors. Results The ratios of the largest to the smallest delineated GTV and iGTV within the same patient were 6.8 and 16.5, respectively. As the iGTV incorporates the GTV during all respiratory phases, the mean volumes of the iGTV (40.07 cm3) were larger than those of the GTV (29.91 cm3). For all patients, CIgen was larger for the iGTV than for the GTV. The mean overall observer variation (root-mean-square of all local SDs over four patients) was 0.63 cm and 0.80 cm for GTV and iGTV, respectively. The largest local observer variations were seen close to biliary stents and suspicious pathological enlarged lymph nodes, as some observers included them and some did not. This variation was more pronounced for the iGTV than for the GTV. The observers rated the 3DCT-stage and 4DCT-stage equally difficult and treated on average three to four pancreatic cancer patients per year. Conclusions A considerable interobserver variation in delineation of pancreatic tumors was observed. This variation was larger for 4D than for 3D delineation. The largest local observer variation was found around biliary stents and suspicious pathological enlarged lymph nodes. Electronic supplementary material The online version of this article (doi:10.1186/s13014-017-0777-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eva Versteijne
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Oliver J Gurney-Champion
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Astrid van der Horst
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Eelco Lens
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M Willemijn Kolff
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jeroen Buijsen
- Department of Radiation Oncology, MAASTRO clinic, Doctor Tanslaan 12, 6229 ET, Maastricht, The Netherlands
| | - Gati Ebrahimi
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Karen J Neelis
- Department of Radiation Oncology, Leiden University Medical Center, Leiden University, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Coen R N Rasch
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jaap Stoker
- Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marcel van Herk
- Faculty of Biology, Medicine & Health, Division of Molecular & Clinical Cancer Sciences, University of Manchester and Christie NHS trust, Oxford Road Manchester, M13 9PL, Manchester, United Kingdom
| | - Arjan Bel
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Geertjan van Tienhoven
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Omari EA, Erickson B, Ehlers C, Quiroz F, Noid G, Cooper DT, Lachaine M, Li XA. Preliminary results on the feasibility of using ultrasound to monitor intrafractional motion during radiation therapy for pancreatic cancer. Med Phys 2017; 43:5252. [PMID: 27587056 DOI: 10.1118/1.4960004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Substantial intrafraction organ motion during radiation therapy (RT) for pancreatic cancer is well recognized as a major limiting factor for accurate delivery of RT. The aim of this work is to determine the feasibility of monitoring the intrafractional motion of the pancreas or surrounding structures using ultrasound for RT delivery. METHODS Transabdominal ultrasound (TAUS) and 4DCT data were acquired on ten pancreatic cancer patients during radiation therapy process in a prospective study. In addition, TAUS and MRI were collected for five healthy volunteers. The portal vein (PV) and the head of the pancreas (HP) along with other structures were contoured on these images. Volume changes, distance between the HP and PV, and motion difference between the HP and PV were measured to examine whether PV can be used as a motion surrogate for HP. TAUS images were acquired and processed using a research version of the Clarity autoscan ultrasound system (CAUS). Motion monitoring was performed with the ultrasound probe mounted on an arm fixed to the couch. Video segments of the monitoring sessions were captured. RESULTS On TAUS, PV is better visualized than HP. The measured mean volume deviation for all patients for the HP and PV was 1.4 and 0.6 ml, respectively. The distance between the HP and PV was close to a constant with 0.22 mm mean deviation throughout the ten breathing phases. The mean of the absolute motion difference for all patients was 1.7 ± 0.8 mm in LR, 1.5 ± 0.5 mm in AP, and 2.3 ± 0.7 mm in SI, suggesting that the PV is a good surrogate for HP motion estimation. By using this surrogate, the HP motion tracking using TAUS was demonstrated. CONCLUSIONS Large intrafractional organ motion due to respiratory and/or bowel motion is a limiting factor in administering curative radiation doses to pancreatic tumors. The authors investigate the use of real-time ultrasound to track pancreas motion. Due to the poor visibility of the pancreas head on an ultrasound image, the portal vein is identified as a surrogate. The authors have demonstrated the feasibility of tracking HP motion through the localization of the PV using TAUS. This will potentially allow real-time tracking of intrafractional motion to justify small PTV-margins and to account for unusual motions, thus, improving normal tissue sparing.
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Affiliation(s)
- Eenas A Omari
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | - Christopher Ehlers
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | - Francisco Quiroz
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | - George Noid
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
| | | | | | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226
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Choi W, Xue M, Lane BF, Kang MK, Patel K, Regine WF, Klahr P, Wang J, Chen S, D'Souza W, Lu W. Individually optimized contrast-enhanced 4D-CT for radiotherapy simulation in pancreatic ductal adenocarcinoma. Med Phys 2017; 43:5659. [PMID: 27782710 DOI: 10.1118/1.4963213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To develop an individually optimized contrast-enhanced (CE) 4D-computed tomography (CT) for radiotherapy simulation in pancreatic ductal adenocarcinomas (PDA). METHODS Ten PDA patients were enrolled. Each underwent three CT scans: a 4D-CT immediately following a CE 3D-CT and an individually optimized CE 4D-CT using test injection. Three physicians contoured the tumor and pancreatic tissues. Image quality scores, tumor volume, motion, tumor-to-pancreas contrast, and contrast-to-noise ratio (CNR) were compared in the three CTs. Interobserver variations were also evaluated in contouring the tumor using simultaneous truth and performance level estimation. RESULTS Average image quality scores for CE 3D-CT and CE 4D-CT were comparable (4.0 and 3.8, respectively; P = 0.082), and both were significantly better than that for 4D-CT (2.6, P < 0.001). Tumor-to-pancreas contrast results were comparable in CE 3D-CT and CE 4D-CT (15.5 and 16.7 Hounsfield units (HU), respectively; P = 0.21), and the latter was significantly higher than in 4D-CT (9.2 HU, P = 0.001). Image noise in CE 3D-CT (12.5 HU) was significantly lower than in CE 4D-CT (22.1 HU, P = 0.013) and 4D-CT (19.4 HU, P = 0.009). CNRs were comparable in CE 3D-CT and CE 4D-CT (1.4 and 0.8, respectively; P = 0.42), and both were significantly better in 4D-CT (0.6, P = 0.008 and 0.014). Mean tumor volumes were significantly smaller in CE 3D-CT (29.8 cm3, P = 0.03) and CE 4D-CT (22.8 cm3, P = 0.01) than in 4D-CT (42.0 cm3). Mean tumor motion was comparable in 4D-CT and CE 4D-CT (7.2 and 6.2 mm, P = 0.17). Interobserver variations were comparable in CE 3D-CT and CE 4D-CT (Jaccard index 66.0% and 61.9%, respectively) and were worse for 4D-CT (55.6%) than CE 3D-CT. CONCLUSIONS CE 4D-CT demonstrated characteristics comparable to CE 3D-CT, with high potential for simultaneously delineating the tumor and quantifying tumor motion with a single scan.
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Affiliation(s)
- Wookjin Choi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York 10065 and Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201
| | - Ming Xue
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201
| | - Barton F Lane
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201
| | - Min Kyu Kang
- Department of Radiation Oncology, Kyungpook National University School of Medicine, Daegu 41944, South Korea
| | - Kruti Patel
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201
| | - William F Regine
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201
| | - Paul Klahr
- Philips Healthcare, Highland Heights, Ohio 44143
| | - Jiahui Wang
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201
| | - Shifeng Chen
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201
| | - Warren D'Souza
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201
| | - Wei Lu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York 10065 and Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201
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Mickevicius NJ, Paulson ES. Simultaneous orthogonal plane imaging. Magn Reson Med 2016; 78:1700-1710. [DOI: 10.1002/mrm.26555] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/10/2016] [Accepted: 10/28/2016] [Indexed: 12/25/2022]
Affiliation(s)
| | - Eric S. Paulson
- Department of Biophysics; Medical College of Wisconsin; Milwaukee Wisconsin USA
- Department of Radiation Oncology; Medical College of Wisconsin; Milwaukee Wisconsin USA
- Department of Radiology; Medical College of Wisconsin; Milwaukee Wisconsin USA
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Individually optimized stereotactic radiotherapy for pancreatic head tumors: A planning feasibility study. Rep Pract Oncol Radiother 2016; 21:548-554. [PMID: 27708554 DOI: 10.1016/j.rpor.2016.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/10/2016] [Accepted: 09/01/2016] [Indexed: 12/15/2022] Open
Abstract
AIM Aim of this study was to perform a planning feasibility analysis of a 3-level dose prescription using an IMRT-SIB technique. BACKGROUND Radiation therapy of locally advanced pancreatic cancer should administer a minimum dose to the duodenum and a very high dose to the vascular infiltration areas to improve the possibility of a radical resection. MATERIALS AND METHODS Fifteen patients with pancreatic head adenocarcinoma and vascular involvement were included. The duodenal PTV (PTVd) was defined as the GTV overlapping the duodenal PRV. Vascular CTV (CTVv) was defined as the surface of contact or infiltration between the tumor and vessel plus a 5 mm margin. Vascular PTV (PTVv) was considered as the CTVv plus an anisotropic margin. The tumor PTV (PTVt) was defined as the GTV plus a margin including the PTVv and excluding the PTVd. The following doses were prescribed: 30 Gy (6 Gy/fraction) to PTVd, 37.5 Gy (7.5 Gy/fraction) to PTVt, and 45 Gy (9 Gy/fraction) to PTVv, respectively. Treatment was planned with an IMRT technique. RESULTS The primary end-point (PTVv Dmean > 90%) was achieved in all patients. PTVv D98% > 90% was achieved in 6 patients (40%). OARs constraints were achieved in all patients. CONCLUSIONS Although the PTVv D95% > 95% objective was achieved only in 40% of patients, the study showed that in 100% of patients it was possible to administer a strongly differentiated mean/median dose. Prospective trials based on clinical application of this strategy seem to be justified in selected patients without overlap between PTVd and PTVv.
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Kishi T, Matsuo Y, Nakamura A, Nakamoto Y, Itasaka S, Mizowaki T, Togashi K, Hiraoka M. Comparative evaluation of respiratory-gated and ungated FDG-PET for target volume definition in radiotherapy treatment planning for pancreatic cancer. Radiother Oncol 2016; 120:217-21. [PMID: 27492203 DOI: 10.1016/j.radonc.2016.07.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/15/2016] [Accepted: 07/17/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the usefulness of respiratory-gated positron emission tomography (4D-PET) in pancreatic cancer radiotherapy treatment planning (RTTP). MATERIALS AND METHODS Fourteen patients with 18F-fluorodeoxyglucose (FDG)-avid pancreatic tumours were evaluated between December 2013 and March 2015. Two sets of volumes were contoured for the pancreatic tumour of each patient. The biological target volume in three-dimensional RTTP (BTV3D) was contoured using conventional respiratory un-gated PET. The BTV3D was then expanded using population-based margins to generate a series of internal target volume 3D (ITV3D) values. The ITV 4D (ITV4D) was contoured using 4D-PET. Each of the five phases of 4D-PET was used for 4D contouring, and the ITV4D was constructed by summing the volumes defined on the five individual 4D-PET images. The relative volumes and normalized volumetric overlap were computed between ITV3D and ITV4D. RESULTS On average, the FDG-avid tumour volumes were 1.6 (range: 0.8-2.3) fold greater in the ITV4D than in the BTV3D. On average, the ITV3D values were 2.0 (range: 1.1-3.4) fold larger than the corresponding ITV4D values. CONCLUSION The ITV generated from 4D-PET can be used to improve the accuracy or reduce normal tissue irradiation compared with conventional un-gated PET-based ITV.
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Affiliation(s)
- Takahiro Kishi
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan
| | - Akira Nakamura
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Japan
| | - Satoshi Itasaka
- Department of Radiation Oncology, Kurashiki Central Hospital, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Japan
| | - Masahiro Hiraoka
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan
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Myrehaug S, Sahgal A, Russo SM, Lo SS, Rosati LM, Mayr NA, Lock M, Small W, Dorth JA, Ellis RJ, Teh BS, Herman JM. Stereotactic body radiotherapy for pancreatic cancer: recent progress and future directions. Expert Rev Anticancer Ther 2016; 16:523-30. [PMID: 26999329 DOI: 10.1586/14737140.2016.1168698] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Despite advances in surgical, medical, and radiation therapy for pancreatic cancer, the prognosis remains poor. At this time, the only chance for long-term survival is surgical resection. More challenging is the optimal management of unresectable locally advanced pancreatic cancer, which has historically been treated with concurrent chemoradiation or chemotherapy alone. However, the survival and local control benefit of conventional radiotherapy in addition to chemotherapy was unclear. More recently, stereotactic body radiotherapy (SBRT) is emerging as a viable approach to maximizing local tumor control with a tolerable side effect profile. SBRT achieves sharp dose fall-off facilitating safe delivery of highly focused radiation to the tumor over 1-5 days. Although the optimal regimen of pancreas SBRT has not yet been established, its short treatment course limits the delay of additional. Future directions involve prospective study of pancreas SBRT and exploration of biomarkers and imaging technology in order to adopt a personalized management paradigm.
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Affiliation(s)
- Sten Myrehaug
- a Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre , University of Toronto , Toronto , ON , Canada
| | - Arjun Sahgal
- a Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre , University of Toronto , Toronto , ON , Canada
| | - Suzanne M Russo
- b Department of Radiation Oncology , University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center , Cleveland , OH , USA
| | - Simon S Lo
- b Department of Radiation Oncology , University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center , Cleveland , OH , USA
| | - Lauren M Rosati
- c Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center , Johns Hopkins University , Baltimore , MD , USA
| | - Nina A Mayr
- d Department of Radiation Oncology , University of Washington , Seattle , WA , USA
| | - Michael Lock
- e Department of Radiation Oncology, London Regional Cancer Program , University of Western Ontario , London , ON , Canada
| | - William Small
- f Department of Radiation Oncology , Loyola University Medical Center , Maywood , IL , USA
| | - Jennifer A Dorth
- b Department of Radiation Oncology , University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center , Cleveland , OH , USA
| | - Rodney J Ellis
- b Department of Radiation Oncology , University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center , Cleveland , OH , USA
| | - Bin S Teh
- g Department of Radiation Oncology , Houston Methodist Hospital, Weill Cornell Medical College , Houston , TX , USA
| | - Joseph M Herman
- c Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center , Johns Hopkins University , Baltimore , MD , USA
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Effect of contrast enhancement in delineating GTV and constructing IGTV of thoracic oesophageal cancer based on 4D-CT scans. Radiother Oncol 2016; 119:172-8. [PMID: 26987472 DOI: 10.1016/j.radonc.2016.02.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 01/27/2016] [Accepted: 02/05/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the effect of contrast enhancement on delineating the gross tumour volumes (GTVs) of different respiratory phases and constructing the corresponding internal GTVs (IGTVs) of primary thoracic oesophageal cancer based on four-dimensional computed tomography (4D-CT) scans. METHODS Forty-five patients with upper (14 cases), middle (16 cases), or lower (15 cases) thoracic oesophageal cancer sequentially underwent conventional plain and contrast-enhanced 4D-CT scans during free breathing. First, the GTVs were delineated on plain 4D-CT, and the corresponding IGTVs were constructed by a physician. Then the GTVs were delineated on contrast-enhanced 4D-CT images, and the corresponding IGTVs were constructed by the same physician using the same standards. RESULTS The coefficient of variation for the target volume delineated on contrast-enhanced 4D-CT images was constantly smaller than that for plain 4D-CT images. The length of the GTVs along the z axis, as well as the volumes of the GTVs that were delineated and the IGTVs that were constructed, did not change between contrast-enhanced and plain 4D-CT images in patients with upper or lower thoracic oesophageal cancer (P>0.05), but showed significant differences in patients with middle thoracic oesophageal cancer (P<0.05). CONCLUSIONS Contrast-enhanced 4D-CT scans can reduce the error of target volume delineation and be used to construct a more accurate internal target volume in patients with middle thoracic oesophageal cancer, however, whether GTV delineation or IGTV construction for patients with upper or lower thoracic oesophageal cancer, no significant benefit was found from contrast-enhanced 4D-CT scan.
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Shimizu M, Sato T, Sawa Y, Terashima K, Yanou T, Ida R. [The Usefulness of Using Fiducial Marker in Proton Therapy for Locally Advanced Pancreatic Cancer]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2016; 72:1074-1083. [PMID: 27867166 DOI: 10.6009/jjrt.2016_jsrt_72.11.1074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Though the dosimetric criteria for the gastrointestinal tract were met, late gastrointestinal toxicity was seen in several cases. Therefore, we thought that it was caused by the positional variation of gastrointestine surrounding pancreatic cancer because of peristalsis. METHOD They were confirmed by CT image regularly. And we evaluated that how much the difference of matching methods for correcting the positional variation influenced dose distribution. RESULT The fiducial markers could follow the position of pancreatic cancer and the duodenum. But it could reproduce the dose distribution to pancreatic cancer and the duodenum. DISCUSSION In proton therapy, the reproducible improvement of the duodenum position did not make the dose of the duodenum same as planning dose because the matching of fiducial markers made the positional relations between beam compensator and the duodenum change. CONCLUSION The fiducial markers are useful for correcting the position of pancreatic cancer and the duodenum. But in proton therapy, it could not reproduce the dose distribution to pancreatic cancer and the duodenum.
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Affiliation(s)
- Masakazu Shimizu
- Department of Radiation Technology, Hyogo Ion Beam Medical Center
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Cvek J, Knybel L, Molenda L, Otahal B, Jonszta T, Czerny D, Feltl D. A single reference measurement can predict liver tumor motion during respiration. Rep Pract Oncol Radiother 2015; 21:278-83. [PMID: 27601962 DOI: 10.1016/j.rpor.2015.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/30/2015] [Indexed: 01/13/2023] Open
Abstract
AIM To evaluate liver tumor motion and how well reference measurement predicts motion during treatment. MATERIAL AND METHODS This retrospective study included 20 patients with colorectal cancer that had metastasized to the liver who were treated with stereotactic ablative radiotherapy. An online respiratory tumor tracking system was used. Tumor motion amplitudes in the superior-inferior (SI), latero-lateral (LL), and anterior-posterior (AP) directions were collected to generate patient-specific margins. Reference margins were generated as the mean motion and 95th percentile of motion from measurements recorded for different lengths of time (1, 3, and 5 min). We analyzed the predictability of tumor motion in each axis, based on the reference measurement and intra-/interfraction motions. RESULTS About 96,000 amplitudes were analyzed. The mean tumor motions were 9.9 ± 4.2 mm, 2.6 ± 0.8 mm, and 4.5 ± 1.8 mm in the SI, LL, and AP directions, respectively. The intrafraction variations were 3.5 ± 1.8 mm, 0.63 ± 0.35 mm, and 1.4 ± 0.65 mm for the SI, LL, and AP directions, respectively. The interfraction motion variations were 1.32 ± 0.79 mm, 0.31 ± 0.23 mm, and 0.68 ± 0.62 mm for the SI, LL, and AP directions, respectively. The Pearson's correlation coefficients for margins based on the reference measurement (mean motion or 95th percentile) and margins covering 95% of the motion during the whole treatment were 0.8-0.91, 0.57-0.7, and 0.77-0.82 in the SI, LL, and AP directions, respectively. CONCLUSION Liver tumor motion in the SI direction can be adequately represented by the mean tumor motion amplitude generated from a single 1 min reference measurement. Longer reference measurements did not improve results for patients who were well-educated about the importance of regular breathing. Although the study was based on tumor tracking data, the results are useful for ITV delineation when tumor tracking is not available.
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Affiliation(s)
- Jakub Cvek
- Dept. of Oncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Lukas Knybel
- VŠB-Technical University of Ostrava, Ostrava, Czech Republic
| | - Lukas Molenda
- Dept. of Oncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Bretislav Otahal
- Dept. of Oncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Tomas Jonszta
- Dept. of Radiology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Daniel Czerny
- Dept. of Radiology, University Hospital Ostrava, Ostrava, Czech Republic
| | - David Feltl
- Dept. of Oncology, University Hospital Ostrava, Ostrava, Czech Republic
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Pham D, Kron T, Bressel M, Foroudi F, Hardcastle N, Schneider M, Soteriou S, Innes J, Siva S. Image guidance and stabilization for stereotactic ablative body radiation therapy (SABR) treatment of primary kidney cancer. Pract Radiat Oncol 2015; 5:e597-605. [PMID: 26547828 DOI: 10.1016/j.prro.2015.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/10/2015] [Accepted: 08/14/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Stereotactic ablative body radiation therapy for primary kidney cancer treatment relies on motion management that can quantify both the trajectory of kidney motion and stabilize the patient. A prospective ethics-approved clinical trial of stereotactic treatment to primary kidney targets was conducted at our institution. Our aim was to report on specific kidney tumor motion and the inter- and intrafraction motion as seen on treatment. METHODS AND MATERIALS Patients with tumor size <5 cm received a dose of 26 Gy in 1 fraction and those with tumor size ≥5 cm received 42 Gy in 3 fractions. All patients underwent a 4-dimensional computed tomography planning scan, immobilized in a dual-vacuum system. A conventional linear accelerator cone beam computed tomography scan was used for pre-, mid-, and posttreatment imaging to verify target position. RESULTS Between July 2012 and October 2014, 33 targets from 32 consecutive patients (24 males/8 females) were treated. Seventeen targets were prescribed 26 Gy/1 fraction and the remaining 16 targets received 42 Gy/3 fractions. Kidney motion at each of the poles was not affected by the presence of tumor (P = .875), nor was the motion statistically different from the corresponding contralateral kidney pole (P = .909). The mean 3-dimensional displacement of the target at mid- and posttreatment was 1.3 mm (standard deviation ± 1.6) and 1.0 mm (standard deviation ± 1.3), respectively. The maximum displacement in any direction for 95% of the fractions at mid- and posttreatment was ≤3 mm. CONCLUSION In summary, stereotactic ablative body radiation therapy of primary kidney targets can be accurately delivered on a conventional linear accelerator with protocol that has minimal intrafractional target motion.
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Affiliation(s)
- Daniel Pham
- Department of Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Australia.
| | - Tomas Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Mathias Bressel
- Department of Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Farshad Foroudi
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Olivia Newton-John Cancer Centre/Austin Health, Melbourne, Australia
| | - Nicholas Hardcastle
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Australia
| | - Sally Soteriou
- Department of Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jayson Innes
- Department of Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
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Amoush A, Abdel-Wahab M, Abazeed M, Xia P. Potential systematic uncertainties in IGRT when FBCT reference images are used for pancreatic tumors. J Appl Clin Med Phys 2015; 16:5257. [PMID: 26103487 PMCID: PMC5690118 DOI: 10.1120/jacmp.v16i3.5257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 01/26/2015] [Accepted: 01/05/2015] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to quantify the systematic uncertainties resulting from using free breathing computed tomography (FBCT) as a reference image for image‐guided radiation therapy (IGRT) for patients with pancreatic tumors, and to quantify the associated dosimetric impact that resulted from using FBCT as reference for IGRT. Fifteen patients with implanted fiducial markers were selected for this study. For each patient, a FBCT and an average intensity projection computed tomography (AIP) created from four‐dimensional computed tomography (4D CT) were acquired at the simulation. The treatment plan was created based on the FBCT. Seventy‐five weekly kilovoltage (kV) cone‐beam computed tomography (CBCT) images (five for each patient) were selected for this study. Bony alignment without rotation correction was performed 1) between the FBCT and CBCT, 2) between the AIP and CBCT, and 3) between the AIP and FBCT. The contours of the fiducials from the FBCT and AIP were transferred to the corresponding CBCT and were compared. Among the 75 CBCTs, 20 that had >3 mm differences in centers of mass (COMs) in any directions between the FBCT and AIP were chosen for further dosimetric analysis. These COM discrepancies were converted into isocenter shifts in the corresponding planning FBCT, and dose was recalculated and compared to the initial FBCT plans. For the 75 CBCTs studied, the mean absolute differences in the COMs of the fiducial markers between the FBCT and CBCTs were 3.3 mm±2.5 mm,3.5 mm±2.4 mm, and 5.8 mm±4.4 mm in the right–left (RL), anterior–posterior (AP), and superior–inferior (SI) directions, respectively. Between the AIP and CBCTs, the mean absolute differences were 3.2 mm±2.2 mm,3.3 mm±2.3 mm, and 6.3 mm±5.4 mm. The absolute mean discrepancies in these COMs shifts between FBCT/CBCT and AIP/CBCT were 1.1 mm±0.8 mm,1.3 mm±0.9 mm, and 3.3 mm±2.6 mm in RL, AP, and SI, respectively. This represented a potential systematic error. For the 20 CBCTs that had COM discrepancies >3 mm in any direction, the average reduction in planning target volume (PTV) coverage (PTV volume receiving 100% of prescription dose) was 5.3%±3.1% (range: 0.7%–12.8%). Using FBCT as a reference for IGRT may introduce potential interfractional systematic COM shifts if the FBCT is acquired at a different breathing phase than the average breathing phase. The potential systematic error could be significant in the SI direction and varied among patients for the other directions. AIP is a better choice of reference image set for IGRT in order to correct interfractional variations due to respiratory motion and nonrespiratory organ displacement. PACS numbers: 87.55.D, 87.55.dk, 87.55.km
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Pepin E, Olsen L, Badiyan S, Murad F, Mullady D, Wang-Gillam A, Linehan D, Parikh P, Olsen J. Comparison of implanted fiducial markers and self-expandable metallic stents for pancreatic image guided radiation therapy localization. Pract Radiat Oncol 2015; 5:e193-e199. [DOI: 10.1016/j.prro.2014.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/14/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
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Nakamura M, Akimoto M, Ono T, Nakamura A, Yano S, Nakata M, Itasaka S, Mizowaki T, Shibuya K, Hiraoka M. Interfraction positional variation in pancreatic tumors using daily breath-hold cone-beam computed tomography with visual feedback. J Appl Clin Med Phys 2015; 16:5123. [PMID: 26103180 PMCID: PMC5690071 DOI: 10.1120/jacmp.v16i2.5123] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 12/10/2014] [Accepted: 12/08/2014] [Indexed: 12/11/2022] Open
Abstract
We assessed interfraction positional variation in pancreatic tumors using daily breath‐hold cone‐beam computed tomography at end‐exhalation (EE) with visual feedback (BH‐CBCT). Eleven consecutive patients with pancreatic cancer who underwent BH intensity‐modulated radiation therapy with visual feedback were enrolled. All participating patients stopped oral intake, with the exception of drugs and water, for >3 hr before treatment planning and daily treatment. Each patient was fixed in the supine position on an individualized vacuum pillow. An isotropic margin of 5 mm was added to the clinical target volume to create the planning target volume (PTV). The prescription dose was 42 to 51 Gy in 15 fractions. After correcting initial setup errors based on bony anatomy, the first BH‐CBCT scans were performed before beam delivery in every fraction. BH‐CBCT acquisition was obtained in three or four times breath holds by interrupting the acquisition two or three times, depending on the patient's BH ability. The image acquisition time for a 360° gantry rotation was approximately 90 s, including the interruption time due to BH. The initial setup errors were corrected based on bony structure, and the residual errors in the target position were then recorded. The magnitude of the interruptions variation in target position was assessed for 165 fractions. The systematic and random errors were 1.2 and 1.8 mm, 1.1 and 1.8 mm, and 1.7 and 2.9 mm in the left–right (LR), anterior–posterior (AP), and superior–inferior (SI) directions, respectively. Absolute interfraction variations of >5 mm were observed in 18 fractions (11.0%) from seven patients because of EE‐BH failure. In conclusion, target matching is required to correct interfraction variation even with visual feedback, especially to ensure safe delivery of escalated doses to patients with pancreatic cancer. PACS number: 87.57.Q‐, 87.57.‐s, 87.55.Qr
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Huguet F, Yorke ED, Davidson M, Zhang Z, Jackson A, Mageras GS, Wu AJ, Goodman KA. Modeling Pancreatic Tumor Motion Using 4-Dimensional Computed Tomography and Surrogate Markers. Int J Radiat Oncol Biol Phys 2015; 91:579-87. [DOI: 10.1016/j.ijrobp.2014.10.058] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 10/09/2014] [Accepted: 10/10/2014] [Indexed: 10/24/2022]
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Dosimetric benefit of adaptive re-planning in pancreatic cancer stereotactic body radiotherapy. Med Dosim 2015; 40:318-24. [DOI: 10.1016/j.meddos.2015.04.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/28/2015] [Accepted: 04/07/2015] [Indexed: 02/06/2023]
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Utilization of intensity-modulated radiation therapy and image-guided radiation therapy in pancreatic cancer: is it beneficial? Semin Radiat Oncol 2014; 24:132-9. [PMID: 24635870 DOI: 10.1016/j.semradonc.2013.11.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The recent development of intensity-modulated radiation therapy (IMRT) and improvements in image-guided radiotherapy (IGRT) have provided considerable advances in the utilization of radiation therapy (RT) for the management of pancreatic cancer. IGRT allows for the reduction of treatment volumes, potentially less chance of a marginal miss, and quality assurance of gastrointestinal filling, while IMRT has been shown to reduce both sudden and late side effects compared with 3-dimensional conformal RT. Here, we review published data and provide essential recommendations on the utilization of IMRT and IGRT for the management of patients with pancreatic cancer.
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Lens E, van der Horst A, Kroon PS, van Hooft JE, Dávila Fajardo R, Fockens P, van Tienhoven G, Bel A. Differences in respiratory-induced pancreatic tumor motion between 4D treatment planning CT and daily cone beam CT, measured using intratumoral fiducials. Acta Oncol 2014; 53:1257-64. [PMID: 24758251 DOI: 10.3109/0284186x.2014.905699] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND In radiotherapy, the magnitude of respiratory-induced tumor motion is often measured using a single four-dimensional computed tomography (4DCT). This magnitude is required to determine the internal target volume. The aim of this study was to compare the magnitude of respiratory-induced motion of pancreatic tumors on a single 4DCT with the motion on daily cone beam CT (CBCT) scans during a 3-5-week fractionated radiotherapy scheme. In addition, we investigated changes in the respiratory motion during the treatment course. MATERIAL AND METHODS The mean peak-to-peak motion (i.e. magnitude of motion) of pancreatic tumors was measured for 18 patients using intratumoral gold fiducials visible on CBCT scans made prior to each treatment fraction (10-27 CBCTs per patient; 401 CBCTs in total). For each patient, these magnitudes were compared to the magnitude measured on 4DCT. Possible time trends were investigated by applying linear fits to the tumor motion determined from daily CBCTs as a function of treatment day. RESULTS We found a significant (p ≤ 0.01) difference between motion magnitude on 4DCT and on CBCT in superior-inferior, anterior-posterior and left-right direction, in 13, 9 and 12 of 18 patients, respectively. In the anterior- posterior and left-right direction no fractions had a difference ≥ 5 mm. In the superior-inferior direction the difference was ≥ 5 mm for 17% of the 401 fractions. In this direction, a significant (p ≤ 0.05) time trend in tumor motion was observed in 4 of 18 patients, but all trends were small (- 0.17-0.10 mm/day) and did not explain the large differences in motion magnitude between 4DCT and CBCT. CONCLUSION A single measurement of the respiratory-induced motion magnitude of pancreatic tumors using 4DCT is often not representative for the magnitude during daily treatment over a 3-5-week radiotherapy scheme. For this patient group it may be beneficial to introduce breath-hold to eliminate respiratory-induced tumor motion.
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Affiliation(s)
- Eelco Lens
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
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Fuccio L, Guido A, Larghi A, Antonini F, Lami G, Fabbri C. The role of endoscopic ultrasound in the radiation treatment of pancreatic tumor. Expert Rev Gastroenterol Hepatol 2014; 8:793-802. [PMID: 24766230 DOI: 10.1586/17474124.2014.913479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Radiotherapy is an established treatment modality for patients with pancreatic cancer. Image-guided radiation therapy (IGRT) allows the delivery of high doses to the tumour, while sparing the sensitive tissues around it, thus reducing side effects. However, the need of precisely contouring and identifying the target lesion is mandatory to be able to perform IGRT. Endoscopic ultrasound has been progressively implemented in the field of radiotherapy as a tool for intra-lesional placement of fiducial markers to perform IGRT and for direct placing of sealed radioactive sources in contact with the target lesions. In the current paper we provide an updated review on the role of endoscopic ultrasound in the radiation treatment of pancreatic cancer, highlighting areas of future research.
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Affiliation(s)
- Lorenzo Fuccio
- Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Knybel L, Cvek J, Otahal B, Jonszta T, Molenda L, Czerny D, Skacelikova E, Rybar M, Dvorak P, Feltl D. The analysis of respiration-induced pancreatic tumor motion based on reference measurement. Radiat Oncol 2014; 9:192. [PMID: 25175267 PMCID: PMC4158040 DOI: 10.1186/1748-717x-9-192] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 08/23/2014] [Indexed: 01/17/2023] Open
Abstract
Background To evaluate pancreatic tumor motion and its dynamics during respiration. Methods and materials This retrospective study includes 20 patients with unresectable pancreatic cancer who were treated with stereotactic ablative radiotherapy. An online respiratory tumor tracking system was used. Periodical maximum and minimum tumor positions with respiration in superior-inferior (SI), latero-lateral (LL), and anterior-posterior (AP) directions were collected for tumor motion evaluation. The predictability of tumor motion in each axis, based on reference measurement, was analyzed. Results The use of a 20-mm and 5-mm constant margins for SI and LL/AP directions, avoids target underdosage, without the need for reference measurement. Pearson’s correlation coefficient indicated only a modest correlation between reference and subsequent measurements in the SI direction (r = 0.50) and no correlation in LL (r = 0.17) and AP (r = 0.35) directions. When margins based on the reference measurement of respiratory tumor motion are used, then 30% of patients have a risk zone of underdosage >3 mm (in average). ITV (internal target volume) optimization based on the reference measurement is possible, but allows only modest margin reduction (approximately from 20 mm to 16-17 mm) in SI direction and no reduction in AP and LL directions. Conclusion Our results support the use of 20-mm margin in the SI direction and 5-mm margins in the LL and AP directions to account for respiratory motion without reference measurement. Single measurement of tumor motion allows only modest margin reduction. Further margin reduction is only possible when there is on-line tumor motion control according to internal markers.
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Affiliation(s)
- Lukas Knybel
- Department of Oncology, University Hospital Ostrava, 17, listopadu 1790, 708 52 Ostrava, Czech Republic.
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Pham D, Kron T, Foroudi F, Schneider M, Siva S. A Review of Kidney Motion under Free, Deep and Forced-Shallow Breathing Conditions: Implications for Stereotactic Ablative Body Radiotherapy Treatment. Technol Cancer Res Treat 2014; 13:315-23. [DOI: 10.7785/tcrt.2012.500387] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Motion management strategies are important during stereotactic ablative body radiotherapy for abdominal targets. The kidney is a mobile retroperitoneal organ that moves with respiration. A review of the literature was performed to investigate the reported degree of kidney motion associated with various breathing conditions. A structured search was performed using Medline from January 1970 to May 2013 for all publications describing cranial-caudal kidney motion. Relevance to radiotherapy practice was reviewed based on any breathing instructions and/or immobilization equipment that could affect breathing pattern. Studies were categorized under three types of breathing conditions: Forced-shallow, breath-hold/deep and free. A total of 25 publications were identified describing cranial-caudal kidney motion with a combined total of 415 participants. Three publications described forced-shallow breathing using prone positioning or abdominal compression plates. Prone positioning, compared to supine positioning, did little to minimise kidney motion, however use of compression plates can result in kidney motion of less than 5 mm. Eight publications described deep breathing/breath hold techniques that showed average kidney motion ranging between 10 mm-40 mm. Fifteen publications investigated kidney motion under free breathing with the majority reporting mean motion of less than 10 mm. Kidney movement of up to 8.1 mm in the anterior posterior direction and 6.2 mm laterally were reported with no indications that breathing technique can influence the extent of this motion. In summary, kidney movement is complex and consideration should be made to ensure that motion management strategies provide the desired radiotherapy benefit. There are limited publications on the effectiveness of abdominal compression on reducing kidney motion which warrant further investigation in this area.
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Affiliation(s)
- D. Pham
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, St. Andrews Place East Melbourne, Victoria, AUSTRALIA 3002
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, AUSTRALIA 3800
| | - T. Kron
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, St. Andrews Place East Melbourne, Victoria, AUSTRALIA 3002
| | - F. Foroudi
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, St. Andrews Place East Melbourne, Victoria, AUSTRALIA 3002
| | - M. Schneider
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, AUSTRALIA 3800
| | - S. Siva
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, St. Andrews Place East Melbourne, Victoria, AUSTRALIA 3002
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Lediju Bell MA, Sen HT, Iordachita I, Kazanzides P, Wong J. In vivo reproducibility of robotic probe placement for a novel ultrasound-guided radiation therapy system. J Med Imaging (Bellingham) 2014; 1:025001. [PMID: 26158038 DOI: 10.1117/1.jmi.1.2.025001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 06/08/2014] [Accepted: 06/17/2014] [Indexed: 11/14/2022] Open
Abstract
Ultrasound can provide real-time image guidance of radiation therapy, but the probe-induced tissue deformations cause local deviations from the treatment plan. If placed during treatment planning, the probe causes streak artifacts in required computed tomography (CT) images. To overcome these challenges, we propose robot-assisted placement of an ultrasound probe, followed by replacement with a geometrically identical, CT-compatible model probe. In vivo reproducibility was investigated by implanting a canine prostate, liver, and pancreas with three 2.38-mm spherical markers in each organ. The real probe was placed to visualize the markers and subsequently replaced with the model probe. Each probe was automatically removed and returned to the same position or force. Under position control, the median three-dimensional reproducibility of marker positions was 0.6 to 0.7 mm, 0.3 to 0.6 mm, and 1.1 to 1.6 mm in the prostate, liver, and pancreas, respectively. Reproducibility was worse under force control. Probe substitution errors were smallest for the prostate (0.2 to 0.6 mm) and larger for the liver and pancreas (4.1 to 6.3 mm), where force control generally produced larger errors than position control. Results indicate that position control is better than force control for this application, and the robotic approach has potential, particularly for relatively constrained organs and reproducibility errors that are smaller than established treatment margins.
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Affiliation(s)
- Muyinatu A Lediju Bell
- Johns Hopkins University , Laboratory for Computational Sensing and Robotics, Baltimore, Maryland 21218, United States
| | - H Tutkun Sen
- Johns Hopkins University , Laboratory for Computational Sensing and Robotics, Baltimore, Maryland 21218, United States ; Johns Hopkins University , Department of Computer Science, Baltimore, Maryland 21218, United States
| | - Iulian Iordachita
- Johns Hopkins University , Laboratory for Computational Sensing and Robotics, Baltimore, Maryland 21218, United States ; Johns Hopkins University , Department of Mechanical Engineering, Baltimore, Maryland 21218, United States
| | - Peter Kazanzides
- Johns Hopkins University , Laboratory for Computational Sensing and Robotics, Baltimore, Maryland 21218, United States ; Johns Hopkins University , Department of Computer Science, Baltimore, Maryland 21218, United States
| | - John Wong
- Johns Hopkins University , Department of Radiation Oncology, Baltimore, Maryland 21287, United States
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Depuydt T, Poels K, Verellen D, Engels B, Collen C, Buleteanu M, Van den Begin R, Boussaer M, Duchateau M, Gevaert T, Storme G, De Ridder M. Treating patients with real-time tumor tracking using the Vero gimbaled linac system: implementation and first review. Radiother Oncol 2014; 112:343-51. [PMID: 25049177 DOI: 10.1016/j.radonc.2014.05.017] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 05/14/2014] [Accepted: 05/24/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE To report on the first clinical application of a real-time tumor tracking (RTTT) solution based on the Vero SBRT gimbaled linac system for treatment of moving tumors. METHODS AND MATERIALS A first group of 10 SBRT patients diagnosed with NSCLC or oligometastatic disease in lung or liver was treated with the RTTT technique. The PTV volumes and OAR exposure were benchmarked against the widely used ITV approach. Based on data acquired during execution of RTTT treatments, a first review was performed of the process. RESULTS The 35% PTV volume reduction with RTTT of the studied single lesions SBRT irradiations of small target volumes is expected to result in a small (<1%) reduction of lung or liver NTCP. A GTV-PTV margin of 5.0mm was applied for treatment planning of RTTT. From patient data on residual geometric uncertainties, a CTV-PTV margin of 3.2mm was calculated. Reduction of the GTV-PTV margin below 5.0mm without better understanding of biological definition of tumor boundaries was discouraged. Total treatment times were reduced to 34.4 min on average. CONCLUSION A considerable PTV volume reduction was achieved applying RTTT and time efficiency for respiratory correlated SBRT was reestablished with Vero RTTT.
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Affiliation(s)
- Tom Depuydt
- Radiotherapy Department, UZ Brussel, Vrije Universiteit Brussel, Brussels; Vrije Universiteit Brussel, Medical Imaging and Physical Sciences Group, Faculty of Medicine and Pharmacy; Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium.
| | - Kenneth Poels
- Vrije Universiteit Brussel, Medical Imaging and Physical Sciences Group, Faculty of Medicine and Pharmacy
| | - Dirk Verellen
- Radiotherapy Department, UZ Brussel, Vrije Universiteit Brussel, Brussels; Vrije Universiteit Brussel, Medical Imaging and Physical Sciences Group, Faculty of Medicine and Pharmacy
| | - Benedikt Engels
- Radiotherapy Department, UZ Brussel, Vrije Universiteit Brussel, Brussels
| | - Christine Collen
- Radiotherapy Department, UZ Brussel, Vrije Universiteit Brussel, Brussels
| | - Manuela Buleteanu
- Radiotherapy Department, UZ Brussel, Vrije Universiteit Brussel, Brussels
| | | | - Marlies Boussaer
- Radiotherapy Department, UZ Brussel, Vrije Universiteit Brussel, Brussels
| | - Michael Duchateau
- Radiotherapy Department, UZ Brussel, Vrije Universiteit Brussel, Brussels
| | - Thierry Gevaert
- Radiotherapy Department, UZ Brussel, Vrije Universiteit Brussel, Brussels
| | - Guy Storme
- Radiotherapy Department, UZ Brussel, Vrije Universiteit Brussel, Brussels; Vrije Universiteit Brussel, Medical Imaging and Physical Sciences Group, Faculty of Medicine and Pharmacy
| | - Mark De Ridder
- Radiotherapy Department, UZ Brussel, Vrije Universiteit Brussel, Brussels; Vrije Universiteit Brussel, Medical Imaging and Physical Sciences Group, Faculty of Medicine and Pharmacy
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Abbas H, Chang B, Chen ZJ. Motion management in gastrointestinal cancers. J Gastrointest Oncol 2014; 5:223-35. [PMID: 24982771 DOI: 10.3978/j.issn.2078-6891.2014.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 12/17/2022] Open
Abstract
The presence of tumor and organ motions complicates the planning and delivery of radiotherapy for gastrointestinal cancers. Without proper accounting of the movements, target volume could be under-dosed and the nearby normal critical organs could be over-dosed. This situation is further exacerbated by the close proximity of abdominal tumors to many normal organs at risk (OARs). A number of strategies have been developed to deal with tumor and organ motions in radiotherapy. This article presents a review of the techniques used in the evaluation, quantification, and management of tumor and organ motions for radiotherapy of gastrointestinal cancers.
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Affiliation(s)
- Hassan Abbas
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Bryan Chang
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Zhe Jay Chen
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
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van der Horst A, Lens E, Wognum S, de Jong R, van Hooft JE, van Tienhoven G, Bel A. Limited role for biliary stent as surrogate fiducial marker in pancreatic cancer: stent and intratumoral fiducials compared. Int J Radiat Oncol Biol Phys 2014; 89:641-8. [PMID: 24803041 DOI: 10.1016/j.ijrobp.2014.03.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 02/09/2014] [Accepted: 03/12/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE Because of low soft-tissue contrast of cone beam computed tomography (CBCT), fiducial markers are often used for radiation therapy patient setup verification. For pancreatic cancer patients, biliary stents have been suggested as surrogate fiducials. Using intratumoral fiducials as standard for tumor position, this study aims to quantify the suitability of biliary stents for measuring interfractional and respiratory-induced position variations of pancreatic tumors. METHODS AND MATERIALS Eleven pancreatic cancer patients with intratumoral fiducials and a biliary stent were included in this study. Daily CBCT scans (243 in total) were registered with a reference CT scan, based on bony anatomy, on fiducial markers, and on the biliary stent, respectively. We analyzed the differences in tumor position (ie, markers center-of-mass position) among these 3 registrations. In addition, we measured for 9 patients the magnitude of respiratory-induced motion (MM) of the markers and of the stent on 4-dimensional CT (4DCT) and determined the difference between these 2 magnitudes (ΔMM). RESULTS The stent indicated tumor position better than bony anatomy in 67% of fractions; the absolute difference between the markers and stent registration was >5 mm in 46% of fractions and >10 mm in 20% of fractions. Large PTV margins (superior-inferior direction, >19 mm) would be needed to account for this interfractional position variability. On 4DCT, we found in superior-inferior direction a mean ΔMM of 0.5 mm (range, -2.6 to 4.2 mm). CONCLUSIONS For respiratory-induced motion, the mean ΔMM is small, but for individual patients the absolute difference can be >4 mm. For interfractional position variations, a stent is, on average, a better surrogate fiducial than bony anatomy, but large PTV margins would still be required. Therefore, intratumoral fiducials are recommended for online setup verification for all pancreatic patients scheduled for radiation therapy, including patients with a biliary stent.
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Affiliation(s)
- Astrid van der Horst
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Eelco Lens
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Silvia Wognum
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Rianne de Jong
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Geertjan van Tienhoven
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Arjan Bel
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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EUS-guided fiducial markers placement with a 22-gauge needle for image-guided radiation therapy in pancreatic cancer. Gastrointest Endosc 2014; 79:851-5. [PMID: 24518121 DOI: 10.1016/j.gie.2013.12.027] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 12/21/2013] [Indexed: 02/08/2023]
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Jang JW, Brown JG, Mauch PM, Ng AK. Four-dimensional versus 3-dimensional computed tomographic planning for gastric mucosa associated lymphoid tissue lymphoma. Pract Radiat Oncol 2014; 3:124-9. [PMID: 24674315 DOI: 10.1016/j.prro.2012.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 05/08/2012] [Accepted: 05/10/2012] [Indexed: 12/28/2022]
Abstract
PURPOSE This study compares dosimetric parameters of 4-dimensional (4D) and 3-dimensional (3D) computed tomographic (CT) planning for gastric mucosa-associated lymphoid tissue (MALT) lymphoma in an attempt to identify any potential benefit of 4DCT planning. METHODS AND MATERIALS We identified 18 patients who received definitive 4DCT radiation planning from September 2006 to September 2011 for gastric MALT lymphoma at our institution. In addition to the kidneys and liver, we contoured an internal target volume (ITV) and static clinical target volume (sCTV) for each patient based on the 4D and 3D images, respectively, to develop 3D conformal radiation plans. Using the static and motion plans, we measured the volume of ITV covered by at least 95% of the prescribed dose (V95), the minimum dose received by 95% of the ITV (D95), and the volume of organs receiving at least 20 Gy or 30 Gy (V20 or V30). RESULTS Volumes of the ITV, motion liver, left kidney, and right kidney were significantly larger than their static counterparts. The static plan significantly lowered the ITV V95 and D95 compared with the motion plan. However, this undercoverage was significantly associated with the superior-inferior (SI) respiratory excursions. A V95 of >98% was observed in 92% of patients with SI excursions <15 mm versus 33% of patients with SI excursions >15 mm (P = .02). When compared with the motion plan, the static plan also significantly lowered the liver V30 and left kidney V20. CONCLUSIONS The 3DCT planning can result in undercoverage of the ITV and altered estimation of doses to normal structures. However, in patients with limited respiratory excursions (<15 mm), 4D and 3D images generated similar ITV coverage.
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Affiliation(s)
- Joanne W Jang
- Harvard Radiation Oncology Program, Boston, Massachusetts.
| | - Johann G Brown
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Peter M Mauch
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Andrea K Ng
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
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Shin EJ, Khashab M. The role of endoscopy in the treatment, management, and personalization of pancreatic cancer. Curr Probl Cancer 2013; 37:293-300. [PMID: 24331185 DOI: 10.1016/j.currproblcancer.2013.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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50
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Wolfgang CL, Herman JM, Laheru DA, Klein AP, Erdek MA, Fishman EK, Hruban RH. Recent progress in pancreatic cancer. CA Cancer J Clin 2013; 63:318-48. [PMID: 23856911 PMCID: PMC3769458 DOI: 10.3322/caac.21190] [Citation(s) in RCA: 647] [Impact Index Per Article: 58.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 03/22/2013] [Accepted: 03/22/2013] [Indexed: 02/06/2023] Open
Abstract
Pancreatic cancer is currently one of the deadliest of the solid malignancies. However, surgery to resect neoplasms of the pancreas is safer and less invasive than ever, novel drug combinations have been shown to improve survival, advances in radiation therapy have resulted in less toxicity, and enormous strides have been made in the understanding of the fundamental genetics of pancreatic cancer. These advances provide hope but they also increase the complexity of caring for patients. It is clear that multidisciplinary care that provides comprehensive and coordinated evaluation and treatment is the most effective way to manage patients with pancreatic cancer.
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Affiliation(s)
- Christopher L. Wolfgang
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine
- Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine
| | - Joseph M. Herman
- Department of Radiation Oncology & Molecular Radiation Sciences, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine
| | - Daniel A. Laheru
- Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine
| | - Alison P. Klein
- Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine
- Department of Epidemiology, the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Michael A. Erdek
- Department of Anesthesiology and Critical Care Medicine, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine
| | - Elliot K. Fishman
- Department of Radiology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine
| | - Ralph H. Hruban
- Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine
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