1
|
Faccenda V, Panizza D, Pisoni V, Trivellato S, Daniotti MC, Bianchi SP, De Ponti E, Arcangeli S. Single-Isocenter Linac-Based Radiosurgery for Brain Metastases with Coplanar Arcs: A Dosimetric and Clinical Analysis. Cancers (Basel) 2023; 15:4496. [PMID: 37760466 PMCID: PMC10526167 DOI: 10.3390/cancers15184496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
The efficacy of linac-based SRS/fSRS treatments using the single-isocenter coplanar FFF-VMAT technique for both single and multiple BM was investigated. Seventy patients (129 BM) treated with 15-21 Gy in 1 (n = 59) or 27 Gy in 3 (n = 11) fractions were analyzed. For each fraction, plans involving the intra-fractional errors measured by post-treatment CBCT were recalculated. The relationships of BM size, distance-to-isocenter, and barycenter shift with the difference in target coverage were evaluated. Clinical outcomes were assessed using logistic regression and Kaplan-Meier analysis. The median delivery time was 3.78 min (range, 1.83-9.25). The median post-treatment 3D error was 0.5 mm (range, 0.1-2.7) and the maximum rotational error was 0.3° (range, 0.0-1.3). In single BM patients, the GTV D95% was never reduced by >5%, whereas PTV D95% reductions >1% occurred in only 11 cases (29%). In multiple BM patients, dose deficits >5% and >1% occurred in 2 GTV (2%) and 34 PTV (37%), respectively. The differences in target coverage showed a moderate-to-strong correlation only with barycenter shift. Local failure of at least one treated BM occurred in 13 (21%) patients and the 1-year and 2-year local control rates for all lesions were 94% and 90%, respectively. The implemented workflow ensured that the degradation of target and brain dose metrics in delivered treatments was negligible. Along with encouraging clinical outcomes, these findings warrant a reduction in the PTV margins at our institution.
Collapse
Affiliation(s)
- Valeria Faccenda
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (V.F.); (D.P.); (S.T.); (M.C.D.); (E.D.P.)
| | - Denis Panizza
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (V.F.); (D.P.); (S.T.); (M.C.D.); (E.D.P.)
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy;
| | - Valerio Pisoni
- Radiation Oncology Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy;
| | - Sara Trivellato
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (V.F.); (D.P.); (S.T.); (M.C.D.); (E.D.P.)
| | - Martina Camilla Daniotti
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (V.F.); (D.P.); (S.T.); (M.C.D.); (E.D.P.)
| | - Sofia Paola Bianchi
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy;
| | - Elena De Ponti
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (V.F.); (D.P.); (S.T.); (M.C.D.); (E.D.P.)
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy;
| | - Stefano Arcangeli
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy;
- Radiation Oncology Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy;
| |
Collapse
|
2
|
van Prooijen M, Chau L, Tsui G, Kelly V, Holwell M, Tadic T, Tsang DS, Krema H, Laperriere N. Simple and effective immobilization for radiation treatment of choroidal melanoma. Med Dosim 2023:S0958-3947(23)00023-7. [PMID: 37120386 DOI: 10.1016/j.meddos.2023.03.002] [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: 10/04/2022] [Revised: 03/03/2023] [Accepted: 03/11/2023] [Indexed: 05/01/2023]
Abstract
At our institution, patients diagnosed with choroidal melanoma requiring external beam radiation therapy are treated with two 6 MV volumetric-modulated arcs delivering 50 Gy over 5 daily fractions. The patient is immobilized using an Orfit head and neck mask and is directed to look at a light emitting diode (LED) during CT simulation and treatment to minimize eye movement. Patient positioning is checked with cone beam computed tomography (CBCT) daily. Translational and rotational displacements greater than 1 mm or 1° off the planned isocenter position are corrected using a Hexapod couch. The aim of this study is to verify that the mask system provides adequate immobilization and to verify our 2-mm planning target volume (PTV) margins are sufficient. Residual displacements provided by pretreatment verification and post-treatment CBCT data sets were used to assess the impact of patient mobility during treatment on the reconstructed delivered dose to the target and organs at risk. The PTV margin calculated using van Herk's method1 was used to assess patient motion plus other factors that affect treatment position, such as kV-MV isocenter coincidence. Patient position variations were small and were shown to not cause significant dose variations between the planned and reconstructed dose to the target and organs at risk. The PTV margin analysis showed patient translational motion alone required a PTV margin of 1 mm. Given other factors that affect treatment delivery accuracy, a 2-mm PTV margin was shown to be sufficient for treatment of 95% of our patients with 100% of dose delivered to the GTV. The mask immobilization with LED focus is robust and we showed a 2-mm PTV margin is adequate with this technique.
Collapse
Affiliation(s)
- Monique van Prooijen
- Department of Medical Physics, Princess Margaret Cancer Centre, Toronto, ON, M5G 1Z5, Canada.
| | - Lily Chau
- Department of Radiation Therapy, Princess Margaret Cancer Centre, Toronto, ON, M5G 2M9, Canada
| | - Grace Tsui
- Department of Radiation Therapy, Princess Margaret Cancer Centre, Toronto, ON, M5G 2M9, Canada
| | - Valerie Kelly
- Department of Radiation Therapy, Princess Margaret Cancer Centre, Toronto, ON, M5G 2M9, Canada
| | - Michael Holwell
- Department of Radiation Therapy, Princess Margaret Cancer Centre, Toronto, ON, M5G 2M9, Canada
| | - Tony Tadic
- Department of Medical Physics, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, M5G 1Z5, Canada; Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, M5G 1Z5, Canada
| | - Derek S Tsang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, M5G 1Z5, Canada
| | - Hatem Krema
- Department of Ocular Oncology, Princess Margaret Cancer Centre/ UHN, University of Toronto, Toronto, ON, M5G 2M9, Canada
| | - Normand Laperriere
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, M5G 1Z5, Canada
| |
Collapse
|
3
|
Mamballikalam G, Senthilkumar S, Clinto CO, Ahamed Basith PM, Jaon Bos RC, Thomas T. Time motion study to evaluate the impact of flattening filter free beam on overall treatment time for frameless intracranial radiosurgery using Varian TrueBeam ® linear accelerator. Rep Pract Oncol Radiother 2021; 26:111-118. [PMID: 34046221 DOI: 10.5603/rpor.a2021.0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 12/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background The aim was to study the impact of the flattening filter free (FFF) beam on overall treatment time for frameless intracranial radiosurgery using TrueBeam® LINAC.The development of frameless stereotactic radiosurgery (SRS) is possible due to the incorporation of image guidance in the delivery of treatment. It is important to analyze the cost and benefits of FFF beams for treating SRS by understanding the impact of FFF beams in reducing the treatment time. Materials and methods Dynamic conformal arc (DCA ) and volumetric arc therapy (VMAT) plans were generated using 6 MV with a flattening filter (FF) and FFF beams. Overall treatment time was divided into beam on time (BOT) and beam off time (BFT). Percentage beam on time reduction (PBOTR) and Percentage total time reduction (PTTR) factors were defined for the comparison. Results BOT reduction was observed to be significant for higher dose per fraction but subjected to the treatment technique and modulation differences. PBOTR values are much higher than PTTR values. The 39.9% of PBOTR resulted in only 8% PTTR for DCA and 65.3% resulted in 15.9% PTTR for VMAT. Conclusion Major BFT was utilized for imaging and verification. FFF beam significantly reduced the beam on time and was found to be most effective if the fractional dose was as high as that for SRS. Newly defined PBOTR and PTTR factors are very useful indicators to evaluate the efficacy of FFF beams in terms of time reduction.
Collapse
Affiliation(s)
- Gopinath Mamballikalam
- R&D, Bharathiar University, Coimbatore, Tamilnadu, India.,Department of Radiation Oncology, Aster Medcity, Kochi, Kerala, India
| | - S Senthilkumar
- Department of Radiotherapy, Rajaji Hospital and Madurai Medical College, Madurai, Tamilnadu, India
| | - C O Clinto
- Department of Radiation Oncology, Aster Medcity, Kochi, Kerala, India
| | - P M Ahamed Basith
- Department of Radiation Oncology, Aster Medcity, Kochi, Kerala, India
| | - R C Jaon Bos
- Department of Radiation Oncology, Aster Medcity, Kochi, Kerala, India
| | - Tems Thomas
- Department of Radiation Oncology, Aster Medcity, Kochi, Kerala, India
| |
Collapse
|
4
|
Positioning error analysis of the fraxion localization system in the intracranial stereotactic radiotherapy of tumors. Clin Transl Oncol 2020; 23:43-47. [PMID: 32462396 DOI: 10.1007/s12094-020-02382-y] [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: 03/18/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate positioning error analysis of the Fraxion localization system in the intracranial stereotactic radiotherapy of tumors. METHODS 64 patients were divided into two groups: a control group (36 patients with the standard thermoplastic mask) and a model group (28 patients with the Fraxion localization system). 3D images of the treated position were obtained by cone-beam computed tomography (CBCT). Positioning errors were obtained by, respectively, registering these two sets of CBCT images to planning CT images, using a 6°-freedom robotic patient positioning system (HexaPOD Evo RT System). The changes in positioning errors with the Fraxion localization system and with the standard thermoplastic mask were analyzed. RESULTS CBCT scan results of the model group showed that the mean of linear error of three directions [superior-inferior (SI), lateral (LAT), and anterior-posterior (AP)] was 0.710 ± 0.676 mm, 0.817 ± 0.687 mm, and 0.710 ± 0.685 mm, respectively. The corresponding PTV was 1.23 mm, 1.26 mm, and 1.36 mm. The differences between the 3D images and the planned CT images were significant (p < 0.001). CONCLUSION The Fraxion radiotherapy system can not only improve the positioning accuracy and reduce positioning errors but also narrow the PTV margin and reduce the radiated volume of normal tissue.
Collapse
|
5
|
Estimation of technical treatment accuracy in fractionated stereotactic radiosurgery. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396919000128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractAim:The purpose of this study was to estimate technical treatment accuracy in fractionated stereotactic radiosurgery (fSRS) using the Extend™ system (ES) of Gamma Knife (GK).Methods and materials:The fSRS with GK relies on a re-locatable ES where the reference treatment position is estimated using repositioning check tool (RCT). A patient surveillance unit (PSU) monitors the head and neck movement of the patient during treatment and imaging. The quality assurance test of RCT was performed to evaluate a standard error (SE) associated with a measurement tool called digital probe. A ‘4-mm collimator shot’ dose plan for a head–neck phantom was investigated using EBT3 films. CT and MR distortion measurement studies were combined to evaluate SEimaging. The combined uncertainty from all measurements was evaluated using statistical methods, and the resultant treatment accuracy was investigated for the ES.Results:Four sets of RCT measurements and 20 observations of associated digital probe showed SERCT of ±0·0186 mm and SEdigital probe of ±0·0002 mm. The mean positional shift of 0·2752 mm (σ = 0·0696 mm) was observed for 20 treatment settings of the phantom. The differences between radiological and predefined isocentres were 0·4650 and 0·4270 mm for two independent experiments. SEimaging and SEdiode tool were evaluated as ±0·1055 and ±0·0096 mm, respectively. An expanded uncertainty of ±0·2371 mm (at 95% confidence level) was observed with our system.Conclusions:The combined result of the positional shift and expanded uncertainty showed close agreement with film investigations.
Collapse
|
6
|
Gamma Knife radiosurgery: Scenarios and support for re-irradiation. Phys Med 2019; 68:75-82. [PMID: 31760329 DOI: 10.1016/j.ejmp.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 09/16/2019] [Accepted: 11/01/2019] [Indexed: 12/25/2022] Open
Abstract
Stereotactic radiosurgery (SRS) involves the focal delivery of large, cytotoxic doses of radiation to small targets within the brain, often located in close proximity to radiosensitive normal tissue structures and requiring very low procedural uncertainties to perform safely. Historically, neurosurgeons considered SRS as a one-time, single session procedure. However therapeutic advances and a better understanding of the clinical response to SRS have caused a renewal of interest in a variety of re-irradiation scenarios; including re-irradiation of the same target after prior SRS, SRS treatments after prior broad-field radiation, hypofractionated treatments, and volume-staged treatments. Re-irradiation may in some cases require even greater effort towards minimizing treatment uncertainties as compared to one-time-only treatments. Gamma Knife radiosurgery (GKRS) has evolved over time in ways that directly supports many re-irradiation scenarios while helping to minimize overall procedural uncertainty.
Collapse
|
7
|
Carminucci A, Nie K, Weiner J, Hargreaves E, Danish SF. Assessment of motion error for frame-based and noninvasive mask-based fixation using the Leksell Gamma Knife Icon radiosurgery system. J Neurosurg 2018; 129:133-139. [DOI: 10.3171/2018.7.gks181516] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/24/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe Leksell Gamma Knife Icon (GK Icon) radiosurgery system can utilize cone-beam computed tomography (CBCT) to evaluate motion error. This study compares the accuracy of frame-based and frameless mask-based fixation using the Icon system.METHODSA retrospective cohort study was conducted to evaluate patients who had undergone radiosurgery with the GK Icon system between June and December 2017. Patients were immobilized in either a stereotactic head frame or a noninvasive thermoplastic mask with stereotactic infrared (IR) camera monitoring. Setup error was defined as displacement of the skull in the stereotactic space upon setup as noted on pretreatment CBCT compared to its position in the stereotactic space defined by planning MRI for frame patients and defined as skull displacement on planning CBCT compared to its position on pretreatment CBCT for mask patients. For frame patients, the intrafractionation motion was measured by comparing pretreatment and posttreatment CBCT. For mask patients, the intrafractionation motion was evaluated by comparing pretreatment CBCT and additional CBCT obtained during the treatment. The translational and rotational errors were recorded.RESULTSData were collected from 77 patients undergoing SRS with the GK Icon. Sixty-four patients underwent frame fixation, with pre- and posttreatment CBCT studies obtained. Thirteen patients were treated using mask fixation to deliver a total of 33 treatment fractions. Mean setup and intrafraction translational and rotation errors were small for both fixation systems, within 1 mm and 1° in all axes. Yet mask fixation demonstrated significantly larger intrafraction errors than frame fixation. Also, there was greater variability in both setup and intrafraction errors for mask fixation than for frame fixation in all translational and rotational directions. Whether the GK treatment was for metastasis or nonmetastasis did not influence motion uncertainties between the two fixation types. Additionally, monitoring IR-based intrafraction motion for mask fixation—i.e., the number of treatment stoppages due to reaching the IR displacement threshold—correlated with increasing treatment time.CONCLUSIONSCompared to frame-based fixation, mask-based fixation demonstrated larger motion variations. The variability in motion error associated with mask fixation must be taken into account when planning for small lesions or lesions near critical structures.
Collapse
Affiliation(s)
| | - Ke Nie
- 2Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Joseph Weiner
- 2Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Eric Hargreaves
- 1Department of Neurological Surgery, Rutgers University; and
| | | |
Collapse
|
8
|
Chiu J, Braunstein S, Nakamura J, Theodosopoulos P, Sneed P, McDermott M, Ma L. A robustness check procedure for hypofractionated Gamma Knife radiosurgery. J Neurosurg 2018; 129:140-146. [PMID: 30544295 DOI: 10.3171/2018.7.gks181581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 07/25/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEInterfractional residual patient shifts are often observed during the delivery of hypofractionated brain radiosurgery. In this study, the authors developed a robustness treatment planning check procedure to assess the dosimetric effects of residual target shifts on hypofractionated Gamma Knife radiosurgery (GKRS).METHODSThe residual patient shifts were determined during the simulation process immediately after patient immobilization. To mimic incorporation of residual target shifts during treatment delivery, a quality assurance procedure was developed to sample and shift individual shots according to the residual uncertainties in the prescribed treatment plan. This procedure was tested and demonstrated for 10 hypofractionated GKRS cases.RESULTSThe maximum residual target shifts were less than 1 mm for the studied cases. When incorporating such shifts, the target coverage varied by 1.9% ± 2.2% (range 0.0%-7.1%) and selectivity varied by 3.6% ± 2.5% (range 1.1%-9.3%). Furthermore, when incorporating extra random shifts on the order of 0.5 mm, the target coverage decreased by as much as 7%, and nonisocentric variation in the dose distributions was noted for the studied cases.CONCLUSIONSA pretreatment robustness check procedure was developed and demonstrated for hypofractionated GKRS. Further studies are underway to implement this procedure to assess maximum tolerance levels for individual patient cases.
Collapse
Affiliation(s)
- Joshua Chiu
- 1University of Arizona College of Medicine, Tucson, Arizona; and
| | | | | | | | | | | | - Lijun Ma
- Departments of2Radiation Oncology and
| |
Collapse
|
9
|
Ferrer C, Huertas C, Plaza R, Aza Z, Corredoira E. Dosimetric effects of a repositioning head frame system and treatment planning system dose calculation accuracy. J Appl Clin Med Phys 2018; 19:124-132. [PMID: 30255659 PMCID: PMC6236818 DOI: 10.1002/acm2.12456] [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: 07/02/2018] [Revised: 08/16/2018] [Accepted: 08/26/2018] [Indexed: 11/29/2022] Open
Abstract
This work aims to study the effect on surface dose and dose distribution caused by the Elekta Fraxion cranial immobilization system. The effect of Fraxion inclusion in Elekta Monaco treatment planning system and its calculation accuracy is also checked. To study the dose attenuation, a cylindrical phantom was located over the Elekta Fraxion with an IBA CC13 ionization chamber placed in the central insert at the linac isocenter. Dose measurements at multiple gantry angles were performed for three open fields, 10 × 10 cm, 5 × 5 cm and other smaller 2 × 2 cm. Measured doses were compared with the ones calculated by Monaco. Surface dose and dose distribution in the buildup region were measured placing several Gafchromic Films EBT3 at linac CAX between the slabs of a RW3 phantom located over Fraxion and read using FilmQA Pro software. Measures were performed for two open field sizes and results were compared with Monaco calculations. Measurements show a 1% attenuation for 180° gantry angle but it can be as high as 3.4% (5 × 5 open field) for 150°/210° gantry angle, as with these angles the beam goes through the Fraxion's headrest twice. If Fraxion is not included in the calculation Monaco calculation can result in a 3% difference between measured and calculated doses, while with Fraxion in the calculation, the maximum difference is 0.9%. Fraxion increases 3.7 times the surface dose, which can be calculated by Monaco with a difference lower than 2%. Monaco also calculated correctly the PDD for both open fields (2%) when Fraxion is included in the calculation. This work shows that the attenuation varies with gantry angle. The inclusion of Fraxion in Monaco improves the calculation from 3% difference to 1% in the worst case. Furthermore, the surface dose increment and the dose in the buildup region are correctly calculated.
Collapse
Affiliation(s)
- Carlos Ferrer
- Department of Medical Physics and Radiation Protection; H.U. La Paz; Madrid Spain
| | - Concepción Huertas
- Department of Medical Physics and Radiation Protection; H.U. La Paz; Madrid Spain
| | - Rodrigo Plaza
- Department of Medical Physics and Radiation Protection; H.U. La Paz; Madrid Spain
| | - Zulima Aza
- Department of Medical Physics and Radiation Protection; H.U. La Paz; Madrid Spain
| | - Eva Corredoira
- Department of Medical Physics and Radiation Protection; H.U. La Paz; Madrid Spain
| |
Collapse
|
10
|
Tailored Treatment Options for Patients with Brain Metastases by a Relocatable Frame System with Gamma Knife Radiosurgery. World Neurosurg 2018; 119:e338-e348. [PMID: 30059780 DOI: 10.1016/j.wneu.2018.07.157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/16/2018] [Accepted: 07/18/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To report on our experience with the Elekta Extend system, a relocatable frame system used in patients with brain metastases for single-session, hypofractionated, or staged hypofractionated Gamma Knife radiosurgery (GKRS); and the evaluation of its efficacy. METHODS From March 2014 to September 2016, 856 patients with brain metastases underwent GKRS at our hospital. Of them, 35 patients who were retrospectively investigated, were selected for treatment with GKRS using the relocatable frame system. Individualized treatment strategy was chosen according to prior treatment history, number, size and location of tumor, or tumor harboring gene mutation. RESULTS Thirty-two (91.4%) patients underwent treatment with hypofractionated GKRS or staged hypofractionated GKRS, whereas 3 (8.6%) patients underwent single session GKRS. The mean radial setup difference from the reference measurements was 0.50 ± 0.16 mm. The median follow-up time after GKRS with the Extend system was 12 months (range, 1-45 months). The median overall survival time was 12 months (95% confidence interval 6.43-17.57). On multivariable analysis, performance status and extracranial metastases were independently prognostic factors for overall survival. Radiation necrosis developed in 4 cases (11.4%) during the follow-up period (2 with common terminology criteria for adverse events grade 2 and 2 with its grade 3). CONCLUSIONS The relocatable frame system can maintain submillimetric accuracy and provide tailored treatment option with reasonable tumor control and good survival benefits in selected patients with brain metastases. Especially, hypofractionated GKRS or staged hypofractionated GKRS with noninvasive frame is a safe and effective treatment option for large brain metastases or tumor adjacent to eloquent structures.
Collapse
|
11
|
Wen N, Kim J, Doemer A, Glide-Hurst C, Chetty IJ, Liu C, Laugeman E, Xhaferllari I, Kumarasiri A, Victoria J, Bellon M, Kalkanis S, Siddiqui MS, Movsas B. Evaluation of a magnetic resonance guided linear accelerator for stereotactic radiosurgery treatment. Radiother Oncol 2018; 127:460-466. [PMID: 29807837 DOI: 10.1016/j.radonc.2018.04.034] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 04/30/2018] [Accepted: 04/30/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The purpose of this study was to investigate the systematic localization accuracy, treatment planning capability, and delivery accuracy of an integrated magnetic resonance imaging guided Linear Accelerator (MR-Linac) platform for stereotactic radiosurgery. MATERIALS AND METHODS The phantom for the end-to-end test comprises three different compartments: a rectangular MR/CT target phantom, a Winston-Lutz cube, and a rectangular MR/CT isocenter phantom. Hidden target tests were performed at gantry angles of 0, 90, 180, and 270 degrees to quantify the systematic accuracy. Five patient plans with a total of eleven lesions were used to evaluate the dosimetric accuracy. Single-isocenter IMRT treatment plans using 10-15 coplanar beams were generated to treat the multiple metastases. RESULTS The end-to-end localization accuracy of the system was 1.0 ± 0.1 mm. The conformity index, homogeneity index and gradient index of the plans were 1.26 ± 0.22, 1.22 ± 0.10, and 5.38 ± 1.44, respectively. The average absolute point dose difference between measured and calculated dose was 1.64 ± 1.90%, and the mean percentage of points passing the 3%/1 mm gamma criteria was 96.87%. CONCLUSIONS Our experience demonstrates that excellent plan quality and delivery accuracy was achievable on the MR-Linac for treating multiple brain metastases with a single isocenter.
Collapse
Affiliation(s)
- Ning Wen
- Department of Radiation Oncology, Henry Ford Health System, Detroit, USA.
| | - Joshua Kim
- Department of Radiation Oncology, Henry Ford Health System, Detroit, USA
| | - Anthony Doemer
- Department of Radiation Oncology, Henry Ford Health System, Detroit, USA
| | - Carri Glide-Hurst
- Department of Radiation Oncology, Henry Ford Health System, Detroit, USA
| | - Indrin J Chetty
- Department of Radiation Oncology, Henry Ford Health System, Detroit, USA
| | - Chang Liu
- Department of Radiation Oncology, Henry Ford Health System, Detroit, USA
| | - Eric Laugeman
- Department of Radiation Oncology, Henry Ford Health System, Detroit, USA
| | - Ilma Xhaferllari
- Department of Radiation Oncology, Henry Ford Health System, Detroit, USA
| | - Akila Kumarasiri
- Department of Radiation Oncology, Henry Ford Health System, Detroit, USA
| | | | | | - Steve Kalkanis
- Department of Neurosurgery, Henry Ford Health System, Detroit, USA
| | - M Salim Siddiqui
- Department of Radiation Oncology, Henry Ford Health System, Detroit, USA
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Health System, Detroit, USA
| |
Collapse
|
12
|
Babic S, Lee Y, Ruschin M, Lochray F, Lightstone A, Atenafu E, Phan N, Mainprize T, Tsao M, Soliman H, Sahgal A. To frame or not to frame? Cone-beam CT-based analysis of head immobilization devices specific to linac-based stereotactic radiosurgery and radiotherapy. J Appl Clin Med Phys 2018; 19:111-120. [PMID: 29363282 PMCID: PMC5849846 DOI: 10.1002/acm2.12251] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 11/27/2017] [Accepted: 12/08/2017] [Indexed: 12/02/2022] Open
Abstract
Purpose Noninvasive frameless systems are increasingly being utilized for head immobilization in stereotactic radiosurgery (SRS). Knowing the head positioning reproducibility of frameless systems and their respective ability to limit intrafractional head motion is important in order to safely perform SRS. The purpose of this study was to evaluate and compare the intrafractional head motion of an invasive frame and a series of frameless systems for single fraction SRS and fractionated/hypofractionated stereotactic radiotherapy (FSRT/HF‐SRT). Methods The noninvasive PinPoint system was used on 15 HF‐SRT and 21 SRS patients. Intrafractional motion for these patients was compared to 15 SRS patients immobilized with Cosman‐Roberts‐Wells (CRW) frame, and a FSRT population that respectively included 23, 32, and 15 patients immobilized using Gill‐Thomas‐Cosman (GTC) frame, Uniframe, and Orfit. All HF‐SRT and FSRT patients were treated using intensity‐modulated radiation therapy on a linear accelerator equipped with cone‐beam CT (CBCT) and a robotic couch. SRS patients were treated using gantry‐mounted stereotactic cones. The CBCT image‐guidance protocol included initial setup, pretreatment and post‐treatment verification images. The residual error determined from the post‐treatment CBCT was used as a surrogate for intrafractional head motion during treatment. Results The mean intrafractional motion over all fractions with PinPoint was 0.62 ± 0.33 mm and 0.45 ± 0.33 mm, respectively, for the HF‐SRT and SRS cohort of patients (P‐value = 0.266). For CRW, GTC, Orfit, and Uniframe, the mean intrafractional motions were 0.30 ± 0.21 mm, 0.54 ± 0.76 mm, 0.73 ± 0.49 mm, and 0.76 ± 0.51 mm, respectively. For CRW, PinPoint, GTC, Orfit, and Uniframe, intrafractional motion exceeded 1.5 mm in 0%, 0%, 5%, 6%, and 8% of all fractions treated, respectively. Conclusions The noninvasive PinPoint system and the invasive CRW frame stringently limit cranial intrafractional motion, while the latter provides superior immobilization. Based on the results of this study, our clinical practice for malignant tumors has evolved to apply an invasive CRW frame only for metastases in eloquent locations to minimize normal tissue exposure.
Collapse
Affiliation(s)
- Steven Babic
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Young Lee
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Mark Ruschin
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Fiona Lochray
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Alex Lightstone
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Eshetu Atenafu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Nic Phan
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Todd Mainprize
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - May Tsao
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
13
|
Abstract
PURPOSE OF REVIEW Skull base reirradiation is challenging due to complex anatomy, enrichment of treatment-resistant clonogens, and increased risk of severe treatment complications. Without local therapy, early mortality is certain and tumor progression can result in debilitating symptoms. Modern radiotherapy advancements, such as image-guided radiation therapy (IGRT), intensity-modulated radiation therapy (IMRT), particle therapy, and stereotactic radiation therapy (SRT), are attractive for skull base reirradiation. RECENT FINDINGS Although limited by their retrospective nature and heterogeneous patient populations, several studies have demonstrated that reirradiation with these highly conformal techniques is feasible. Compared to IMRT or particle therapy reirradiation, SRT reirradiation appears promising with lower toxicity and increased convenience. Here, we provide thorough explanations for each technology and summarize the most relevant and recent studies, with particular attention to efficacy and toxicity. Skull base reirradiation using these extremely conformal therapy techniques requires meticulous treatment planning and should be delivered by experienced teams.
Collapse
|
14
|
Bisht RK, Kale SS, Natanasabapathi G, Singh MJ, Agarwal D, Garg A, Rath GK, Julka PK, Kumar P, Thulkar S, Sharma BS. Verification of gamma knife based fractionated radiosurgery with newly developed head-thorax phantom. RADIAT MEAS 2016. [DOI: 10.1016/j.radmeas.2016.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
15
|
Alongi F, Fiorentino A, Mancosu P, Navarria P, Giaj Levra N, Mazzola R, Scorsetti M. Stereotactic radiosurgery for intracranial metastases: linac-based and gamma-dedicated unit approach. Expert Rev Anticancer Ther 2016; 16:731-40. [DOI: 10.1080/14737140.2016.1190648] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Filippo Alongi
- Radiation Oncology Department, Sacro Cuore Hospital, Negrar, Italy
| | - Alba Fiorentino
- Radiation Oncology Department, Sacro Cuore Hospital, Negrar, Italy
| | - Pietro Mancosu
- Radiation Oncology Department, Istituto Clinico Humanitas, Milan, Italy
| | - Pierina Navarria
- Radiation Oncology Department, Istituto Clinico Humanitas, Milan, Italy
| | | | - Rosario Mazzola
- Radiation Oncology Department, Sacro Cuore Hospital, Negrar, Italy
| | - Marta Scorsetti
- Radiation Oncology Department, Istituto Clinico Humanitas, Milan, Italy
| |
Collapse
|
16
|
Wong K, Cheng J, Bowlin K, Olch A. Adaptation of vacuum-assisted mouthpiece head immobilization system for precision infant brain radiation therapy. Pract Radiat Oncol 2016; 6:425-428. [PMID: 27156425 DOI: 10.1016/j.prro.2016.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/22/2016] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Our purpose was to describe an adaptation of a commercially available mouthpiece for vacuum-assisted mouthpiece immobilization for radiation therapy in infants. METHODS AND MATERIALS An infant diagnosed with a brain tumor required radiation therapy. After reviewing dental literature about obturators, we designed a modification for the smallest commercially available mouthpiece tray. RESULTS The patient was simulated with the adapted mouthpiece tray. We achieved excellent immobilization and had small daily image guided treatment position shifts. Our patient tolerated treatment well without injury to oral cavity or mucosa. CONCLUSIONS Head immobilization with a vacuum-assisted modified mouthpiece has not been described in infants. Our modification is a novel and safe and permits effective and accurate immobilization for infants for radiation therapy. New manufacturing technologies may allow creation of individualized mouthpieces.
Collapse
Affiliation(s)
- Kenneth Wong
- Radiation Oncology Program, Division of Hematology Oncology, Children's Hospital Los Angeles, Los Angeles, California; Department of Radiation Oncology, University of Southern California, Los Angeles, California.
| | - Justine Cheng
- Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Kristine Bowlin
- Radiation Oncology Program, Division of Hematology Oncology, Children's Hospital Los Angeles, Los Angeles, California
| | - Arthur Olch
- Radiation Oncology Program, Division of Hematology Oncology, Children's Hospital Los Angeles, Los Angeles, California; Department of Radiation Oncology, University of Southern California, Los Angeles, California
| |
Collapse
|
17
|
Russo M, Owen R, Bernard A, Moutrie V, Foote M. Evaluation of accuracy and reproducibility of a relocatable maxillary fixation system for fractionated intracranial stereotactic radiation therapy. J Med Radiat Sci 2016; 63:41-7. [PMID: 27087974 PMCID: PMC4775825 DOI: 10.1002/jmrs.142] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 06/24/2015] [Accepted: 08/16/2015] [Indexed: 12/17/2022] Open
Abstract
Introduction Accurate localisation is an essential component for the delivery of intracranial stereotactic treatment. For fractionated stereotactic radiotherapy, we compared the daily localisation accuracy of a standard thermoplastic mask with a new maxillary fixation device (MFD). Methods Daily pre‐treatment kV cone‐beam computed tomography (CBCT) scans of 23 patients (12 localised in the MFD and 11 in the mask) with benign skull‐based lesions were reviewed retrospectively. The set up accuracy was measured in 6° of freedom, to ascertain both individual and population random and systematic errors. The appropriate clinical target volume to planning target volume margin was computed from set up error data. Results A total of 682 CBCT scans were evaluated. Systematic (Σ) and random (σ) population errors were Σ = 0.8 mm, 0.2 mm and 0.2 mm and σ = 0.3 mm, 0.3 mm and 0.2 mm, respectively, for the standard mask in the left/right (LR), superior/inferior (SI), and anterior/posterior (AP) translational planes, and Σ = 0.2 mm, 0.1 mm and 0.2 mm and σ = 0.2 mm, 0.3 mm and 0.2 mm, respectively, for the MFD. There was a reduction in rotation errors in the MFD compared to the mask. Margin calculations suggested an isotropic margin could be safely reduced to 2 mm for the MFD. Conclusion The two devices demonstrate similar daily positional accuracy for fractionated stereotactic treatment of intracranial lesions. Combined with daily image guidance and couch correction, either of these devices is a viable frameless option for fractionated stereotactic radiation therapy.
Collapse
Affiliation(s)
- Majella Russo
- Department of Radiation Oncology Princess Alexandra Hospital Brisbane Queensland Australia
| | - Rebecca Owen
- Radiation Oncology Mater Centre Princess Alexandra Hospital South Brisbane Queensland Australia
| | - Anne Bernard
- QFAB Bioinformatics Institute for Molecular Bioscience University of Queensland Brisbane Queensland Australia
| | - Vaughan Moutrie
- Department of Radiation Oncology Princess Alexandra Hospital Brisbane Queensland Australia
| | - Matthew Foote
- Department of Radiation Oncology Princess Alexandra Hospital Brisbane Queensland Australia; School of Medicine University of Queensland Brisbane Queensland Australia
| |
Collapse
|
18
|
Bisht R, Kale S, Nathanasabapathi G. Preliminary experience of fractionated stereotactic radiosurgery with extend system of Gamma Knife. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2016. [DOI: 10.14319/ijcto.41.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
19
|
Li W, Bootsma G, Von Schultz O, Carlsson P, Laperriere N, Millar BA, Jaffray D, Chung C. Preliminary Evaluation of a Novel Thermoplastic Mask System with Intra-fraction Motion Monitoring for Future Use with Image-Guided Gamma Knife. Cureus 2016; 8:e531. [PMID: 27081592 PMCID: PMC4829406 DOI: 10.7759/cureus.531] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objectives A non-invasive immobilization system consisting of a thermoplastic mask with image-guidance using cone-beam CT (CBCT) and infrared (IR) tracking has been developed to ensure minimal inter- and intra-fractional movement during Gamma Knife radiosurgery. Prior to clinical use for patients on a Gamma Knife, this study clinically evaluates the accuracy and stability of this novel immobilization system with image-guidance in patients treated with standard fractionated radiation therapy on a linear accelerator. Materials & methods This prospective cohort study evaluated adult patients planned for fractionated brain radiotherapy. Patients were immobilized with a thermoplastic mask (with the nose cut out) and customized head cushion. A reflective marker was placed on the patient’s nose tip and tracked with a stereoscopic IR camera throughout treatment. For each fraction, a pre-treatment, verification (after any translational correction for inter-fraction set-up variation), and post-treatment CBCT was acquired to evaluate inter- and intra-fraction movement of the target and nose. Intra-fraction motion of the nose tip measured on CBCT and IR tracking were compared. Results Corresponding data from 123 CBCT and IR datasets from six patients are summarized. The mean ± standard deviation (SD) intra-fraction motion of the nose tip was 0.41±0.36 mm based on pre- and post-treatment CBCT data compared with 0.56±0.51 mm using IR tracking. The maximum intra-fraction motion of the nose tip was 1.7 mm using CBCT and 3.2 mm using IR tracking. The mean ± SD intra-fraction motion of the target was 0.34±0.25 mm, and the maximum intra-fraction motion was 1.5 mm. Conclusions: This initial clinical evaluation of the thermoplastic mask immobilization system using both IR tracking and CBCT demonstrate that mean intra-fraction motion of the nose and target is small. The presence of isolated measures of larger intra-fraction motion supports the need for image-guidance and intra-fraction motion management when using this mask-based immobilization system for radiosurgery.
Collapse
Affiliation(s)
- Winnie Li
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - Gregory Bootsma
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON / University Health Network, Toronto, ON
| | - Oscar Von Schultz
- Elekta Research & Development, Elekta Instruments AB, Stockholm, Sweden
| | - Per Carlsson
- Elekta Research & Development, Elekta Instruments AB, Stockholm, Sweden
| | - Normand Laperriere
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - Barbara-Ann Millar
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - David Jaffray
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - Caroline Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON / University Health Network, Toronto, ON
| |
Collapse
|
20
|
Kim T, Sheehan J, Schlesinger D. Inter- and intrafractional dose uncertainty in hypofractionated Gamma Knife radiosurgery. J Appl Clin Med Phys 2016; 17:487-496. [PMID: 27074468 PMCID: PMC5875566 DOI: 10.1120/jacmp.v17i2.5851] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 01/28/2016] [Accepted: 11/23/2015] [Indexed: 12/31/2022] Open
Abstract
The purpose of this study is to evaluate inter‐ and intrafractional dose variations resulting from head position deviations for patients treated with the Extend relocatable frame system utilized in hypofractionated Gamma Knife radiosurgery (GKRS). While previous reports characterized the residual setup and intrafraction uncertainties of the system, the dosimetric consequences have not been investigated. A digital gauge was used to measure the head position of 16 consecutive Extend patients (62 fractions) at the time of simulation, before each fraction, and immediately following each fraction. Vector interfraction (difference between simulation and prefraction positions) and intrafraction (difference between postfraction and prefraction positions) shifts in patient position were calculated. Planned dose distributions were shifted by the offset to determine the time‐of‐treatment dose. Variations in mean and maximum target and organ at risk (OAR) doses as a function of positional shift were evaluated. The mean vector interfraction shift was 0.64 mm (Standard Deviation (SD): 0.25 mm, maximum: 1.17 mm). The mean intrafraction shift was 0.39 mm (SD: 0.25 mm, maximum: 1.44 mm). The mean variation in mean target dose was 0.66% (SD: 1.15%, maximum: 5.77%) for interfraction shifts and 0.26% (SD: 0.34%, maximum: 1.85%) for intrafraction shifts. The mean variation in maximum dose to OARs was 7.15% (SD: 5.73%, maximum: 30.59%) for interfraction shifts and 4.07% (SD: 4.22%, maximum: 17.04%) for intrafraction shifts. Linear fitting of the mean variation in maximum dose to OARs as a function of position yielded dose deviations of 10.58%/mm for interfractional shifts and 7.69%/mm for intrafractional shifts. Positional uncertainties when performing hypofractionated Gamma Knife radiosurgery with the Extend system are small and comparable to frame‐based uncertainties (<1 mm). However, the steep dose gradient characteristics of GKRS mean that the dosimetric consequences of positional uncertainties should be considered as part of treatment planning. These dose uncertainties should be evaluated in the context of tumor response and OAR tolerance for hypofractionated treatment scenarios where any increase in dose may be tempered by the increased protection hypofractionation provides to normal tissue. PACS number(s): 87.52.‐g
Collapse
Affiliation(s)
- Taeho Kim
- University of Virginia Health System; Virginia Commonwealth University.
| | | | | |
Collapse
|
21
|
Sager O, Dincoglan F, Beyzadeoglu M. Stereotactic radiosurgery of glomus jugulare tumors: current concepts, recent advances and future perspectives. CNS Oncol 2015; 4:105-14. [PMID: 25768334 DOI: 10.2217/cns.14.56] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Stereotactic radiosurgery (SRS), a very highly focused form of therapeutic irradiation, has been widely recognized as a viable treatment option in the management of intracranial pathologies including benign tumors, malign tumors, vascular malformations and functional disorders. The applications of SRS are continuously expanding thanks to the ever-increasing advances and corresponding improvements in neuroimaging, radiation treatment techniques, equipment, treatment planning and delivery systems. In the context of glomus jugulare tumors (GJT), SRS is being more increasingly used both as the upfront management modality or as a complementary or salvage treatment option. As its safety and efficacy is being evident with compiling data from studies with longer follow-up durations, SRS appears to take the lead in the management of most patients with GJT. Herein, we address current concepts, recent advances and future perspectives in SRS of GJT in light of the literature.
Collapse
Affiliation(s)
- Omer Sager
- Department of Radiation Oncology, Gulhane Military Medical Academy, Gn. Tevfik Saglam Cad. 06018, Etlik, Kecioren, Ankara, Turkey
| | | | | |
Collapse
|
22
|
Barbés B, Azcona JD, Prieto E, de Foronda JM, García M, Burguete J. Development and clinical evaluation of a simple optical method to detect and measure patient external motion. J Appl Clin Med Phys 2015; 16:306–321. [PMID: 26699313 PMCID: PMC5690156 DOI: 10.1120/jacmp.v16i5.5524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 04/26/2015] [Accepted: 04/22/2015] [Indexed: 12/25/2022] Open
Abstract
A simple and independent system to detect and measure the position of a number of points in space was devised and implemented. Its application aimed to detect patient motion during radiotherapy treatments, alert of out‐of‐tolerances motion, and record the trajectories for subsequent studies. The system obtains the 3D position of points in space, through its projections in 2D images recorded by two cameras. It tracks black dots on a white sticker placed on the surface of the moving object. The system was tested with linear displacements of a phantom, circular trajectories of a rotating disk, oscillations of an in‐house phantom, and oscillations of a 4D phantom. It was also used to track 461 trajectories of points on the surface of patients during their radiotherapy treatments. Trajectories of several points were reproduced with accuracy better than 0.3 mm in the three spatial directions. The system was able to follow periodic motion with amplitudes lower than 0.5 mm, to follow trajectories of rotating points at speeds up to 11.5 cm/s, and to track accurately the motion of a respiratory phantom. The technique has been used to track the motion of patients during radiotherapy and to analyze that motion. The method is flexible. Its installation and calibration are simple and quick. It is easy to use and can be implemented at a very affordable price. Data collection does not involve any discomfort to the patient and does not delay the treatment, so the system can be used routinely in all treatments. It has an accuracy similar to that of other, more sophisticated, commercially available systems. It is suitable to implement a gating system or any other application requiring motion detection, such as 4D CT, MRI or PET. PACS numbers: 87.55.N, 87.56.Da
Collapse
Affiliation(s)
- Benigno Barbés
- Clinica Universidad de Navarra; Recinto de Complejo Hospitalario de Navarra.
| | | | | | | | | | | |
Collapse
|
23
|
Five-fraction Gamma Knife radiosurgery using the Extend relocatable system for benign neoplasms close to optic pathways. Pract Radiat Oncol 2015; 5:e119-e125. [DOI: 10.1016/j.prro.2014.08.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 08/23/2014] [Accepted: 08/26/2014] [Indexed: 11/20/2022]
|
24
|
Torrens M, Chung C, Chung HT, Hanssens P, Jaffray D, Kemeny A, Larson D, Levivier M, Lindquist C, Lippitz B, Novotny J, Paddick I, Prasad D, Yu CP. Standardization of terminology in stereotactic radiosurgery: Report from the Standardization Committee of the International Leksell Gamma Knife Society. J Neurosurg 2014; 121 Suppl:2-15. [DOI: 10.3171/2014.7.gks141199] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ObjectThis report has been prepared to ensure more uniform reporting of Gamma Knife radiosurgery treatment parameters by identifying areas of controversy, confusion, or imprecision in terminology and recommending standards.MethodsSeveral working group discussions supplemented by clarification via email allowed the elaboration of a series of provisional recommendations. These were also discussed in open session at the 16th International Leksell Gamma Knife Society Meeting in Sydney, Australia, in March 2012 and approved subject to certain revisions and the performance of an Internet vote for approval from the whole Society. This ballot was undertaken in September 2012.ResultsThe recommendations in relation to volumes are that Gross Target Volume (GTV) should replace Target Volume (TV); Prescription Isodose Volume (PIV) should generally be used; the term Treated Target Volume (TTV) should replace TVPIV, GTV in PIV, and so forth; and the Volume of Accepted Tolerance Dose (VATD) should be used in place of irradiated volume. For dose prescription and measurement, the prescription dose should be supplemented by the Absorbed Dose, or DV% (for example, D95%), the maximum and minimum dose should be related to a specific tissue volume (for example, D2% or preferably D1 mm3), and the median dose (D50%) should be recorded routinely. The Integral Dose becomes the Total Absorbed Energy (TAE). In the assessment of planning quality, the use of the Target Coverage Ratio (TTV/ GTV), Paddick Conformity Index (PCI = TTV2/[GTV · PIV]), New Conformity Index (NCI = [GTV · PIV]/TTV2), Selectivity Index (TTV/PIV), Homogeneity Index (HI = [D2% –D98%]/D50%), and Gradient Index (GI = PIV0.5/PIV) are reemphasized. In relation to the dose to Organs at Risk (OARs), the emphasis is on dose volume recording of the VATD or the dose/volume limit (for example, V10) in most cases, with the additional use of a Maximum Dose to a small volume (such as 1 mm3) and/or a Point Dose and Mean Point Dose in certain circumstances, particularly when referring to serial organs. The recommendations were accepted by the International Leksell Gamma Knife Society by a vote of 92% to 8%.ConclusionsAn agreed-upon and uniform terminology and subsequent standardization of certain methods and procedures will advance the clinical science of stereotactic radiosurgery.
Collapse
Affiliation(s)
- Michael Torrens
- 1Department of Neurosurgery, Hygeia Hospital, Athens, Greece
| | - Caroline Chung
- 2Department of Radiation Oncology, University of Toronto, Ontario, Canada
| | - Hyun-Tai Chung
- 3Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Patrick Hanssens
- 4Gamma Knife Centre, St. Elizabeth Hospital, Tilburg, The Netherlands
| | - David Jaffray
- 2Department of Radiation Oncology, University of Toronto, Ontario, Canada
| | - Andras Kemeny
- 5National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - David Larson
- 6Department of Radiation Oncology, University of California, San Francisco, California
| | - Marc Levivier
- 7Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Bodo Lippitz
- 8Gamma Knife Department, Cromwell Hospital, London, United Kingdom
| | - Josef Novotny
- 9Department of Medical Physics, Na Homolce Hospital, Prague, Czech Republic
| | - Ian Paddick
- 8Gamma Knife Department, Cromwell Hospital, London, United Kingdom
| | - Dheerendra Prasad
- 10Departments of Radiation Medicine and Neurosurgery, Roswell Park Cancer Institute, Buffalo, New York; and
| | - Chung Ping Yu
- 11Gamma Knife, Canossa Hospital, Hong Kong, People's Republic of China
| |
Collapse
|
25
|
Ma L, Sahgal A, Larson DA, Pinnaduwage D, Fogh S, Barani I, Nakamura J, McDermott M, Sneed P. Impact of millimeter-level margins on peripheral normal brain sparing for gamma knife radiosurgery. Int J Radiat Oncol Biol Phys 2014; 89:206-13. [PMID: 24725703 DOI: 10.1016/j.ijrobp.2014.01.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 01/04/2014] [Accepted: 01/08/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate how millimeter-level margins beyond the gross tumor volume (GTV) impact peripheral normal brain tissue sparing for Gamma Knife radiosurgery. METHODS AND MATERIALS A mathematical formula was derived to predict the peripheral isodose volume, such as the 12-Gy isodose volume, with increasing margins by millimeters. The empirical parameters of the formula were derived from a cohort of brain tumor and surgical tumor resection cavity cases (n=15) treated with the Gamma Knife Perfexion. This was done by first adding margins from 0.5 to 3.0 mm to each individual target and then creating for each expanded target a series of treatment plans of nearly identical quality as the original plan. Finally, the formula was integrated with a published logistic regression model to estimate the treatment-induced complication rate for stereotactic radiosurgery when millimeter-level margins are added. RESULTS Confirmatory correlation between the nominal target radius (ie, RT) and commonly used maximum target size was found for the studied cases, except for a few outliers. The peripheral isodose volume such as the 12-Gy volume was found to increase exponentially with increasing Δ/RT, where Δ is the margin size. Such a curve fitted the data (logarithmic regression, R(2) >0.99), and the 12-Gy isodose volume was shown to increase steeply with a 0.5- to 3.0-mm margin applied to a target. For example, a 2-mm margin on average resulted in an increase of 55% ± 16% in the 12-Gy volume; this corresponded to an increase in the symptomatic necrosis rate of 6% to 25%, depending on the Δ/RT values for the target. CONCLUSIONS Millimeter-level margins beyond the GTV significantly impact peripheral normal brain sparing and should be applied with caution. Our model provides a rapid estimate of such an effect, particularly for large and/or irregularly shaped targets.
Collapse
Affiliation(s)
- Lijun Ma
- Department of Radiation Oncology, University of California, San Francisco, California.
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - David A Larson
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Dilini Pinnaduwage
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Shannon Fogh
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Igor Barani
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Jean Nakamura
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Michael McDermott
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Penny Sneed
- Department of Radiation Oncology, University of California, San Francisco, California
| |
Collapse
|
26
|
Nakazawa H, Mori Y, Komori M, Tsugawa T, Shibamoto Y, Kobayashi T, Hashizume C, Uchiyama Y, Hagiwara M. Simulational study of a dosimetric comparison between a Gamma Knife treatment plan and an intensity-modulated radiotherapy plan for skull base tumors. JOURNAL OF RADIATION RESEARCH 2014; 55:518-526. [PMID: 24351459 PMCID: PMC4014159 DOI: 10.1093/jrr/rrt136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 10/07/2013] [Accepted: 10/24/2013] [Indexed: 06/03/2023]
Abstract
Fractionated stereotactic radiotherapy (SRT) is performed with a linear accelerator-based system such as Novalis. Recently, Gamma Knife Perfexion (PFX) featured the Extend system with relocatable fixation devices available for SRT. In this study, the dosimetric results of these two modalities were compared from the viewpoint of conformity, heterogeneity and gradient in target covering. A total of 14 patients with skull base tumors were treated with Novalis intensity-modulated (IM)-SRT. Treatment was planned on an iPlan workstation. Five- to seven-beam IM-SRT was performed in 14-18 fractions with a fraction dose of 2.5 or 3 Gy. With these patients' data, additional treatment planning was simulated using a GammaPlan workstation for PFX-SRT. Reference CT images with planning structure contour sets on iPlan, including the planning target volume (PTV, 1.1-102.2 ml) and organs at risk, were exported to GammaPlan in DICOM-RT format. Dosimetric results for Novalis IM-SRT and PFX-SRT were evaluated in the same prescription doses. The isocenter number of PFX was between 12 and 50 at the isodose contour of 50-60%. The PTV coverage was 95-99% for Novalis and 94-98% for PFX. The conformity index (CI) was 1.11-1.61 and 1.04-1.15, the homogeneity index (HI) was 1.1-3.62 and 2.3-3.25, and the gradient index (GI) was 3.72-7.97 and 2.54-3.39 for Novalis and PFX, respectively. PTV coverage by Novalis and PFX was almost equivalent. PFX was superior in CI and GI, and Novalis was better in HI. Better conformality would be achieved by PFX, when the homogeneity inside tumors is less important.
Collapse
Affiliation(s)
- Hisato Nakazawa
- Department of Radiological Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Yoshimasa Mori
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Masataka Komori
- Department of Radiological Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takahiko Tsugawa
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Tatsuya Kobayashi
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Chisa Hashizume
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Yukio Uchiyama
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Masahiro Hagiwara
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| |
Collapse
|
27
|
Ma L, Pinnaduwage D, McDermott M, Sneed PK. Whole-procedural radiological accuracy for delivering multi-session gamma knife radiosurgery with a relocatable frame system. Technol Cancer Res Treat 2013; 13:403-8. [PMID: 24000986 PMCID: PMC4527471 DOI: 10.7785/tcrtexpress.2013.600259] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A newly developed Gamma Knife relocatable eXtend frame system has enabled the delivery of multi-session Gamma Knife radiosurgery without the use of skull pin fixation frame system. In this study, we investigate and report for the first time the whole procedural radiological accuracy for administering such treatments. To quantify the radiological alignment, the commonly used Winston-Lutz test was modified and used to determine the device accuracy of the eXtend frame system. Patient setup uncertainties relative to the device were further measured for a series of treatment sessions (n = 58), and then incorporated with the Winston-Lutz test results from individual patient-specific eXtend frame systems. The whole-procedure mean 3D radiological setup uncertainty was determined to be 0.69 ± 0.73 mm (1σ) from all the cases analyzed, and the mean 90% confidence level margins were found to be 0.55, 0.78 and 0.72 mm along the x-, y-, and z-axis, respectively. Our results therefore demonstrated that sub-millimetric radiological accuracy is clinically achievable for multi-session Gamma Knife radiosurgery treatments and a 1 mm margin along the major axes is sufficient for planning multi-session Gamma Knife radiosurgery treatments.
Collapse
Affiliation(s)
- Lijun Ma
- Department of Radiation Oncology, University of California, San Francisco, CA 94143.
| | | | | | | |
Collapse
|
28
|
Ghobadi K, Ghaffari HR, Aleman DM, Jaffray DA, Ruschin M. Automated treatment planning for a dedicated multi-source intra-cranial radiosurgery treatment unit accounting for overlapping structures and dose homogeneity. Med Phys 2013; 40:091715. [DOI: 10.1118/1.4817555] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
29
|
Nguyen T, Hsu W, Lim M, Naff N. Delivery of stereotactic radiosurgery: a cross-platform comparison. Neurol Res 2013; 33:787-91. [DOI: 10.1179/016164111x13123658647409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
30
|
Kawamura M, Maeda Y, Takamatsu S, Tameshige Y, Sasaki M, Asahi S, Shimizu Y, Yamamoto K, Tamamura H, Kondo S. The usefulness of vinyl polysiloxane dental impression material as a proton beam stopper to save normal tissue during irradiation of the oral cavity: Basic and clinical verifications. Med Phys 2013; 40:081707. [DOI: 10.1118/1.4813300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
31
|
Ruschin M, Komljenovic PT, Ansell S, Ménard C, Bootsma G, Cho YB, Chung C, Jaffray D. Cone Beam Computed Tomography Image Guidance System for a Dedicated Intracranial Radiosurgery Treatment Unit. Int J Radiat Oncol Biol Phys 2013; 85:243-50. [DOI: 10.1016/j.ijrobp.2012.03.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 03/12/2012] [Accepted: 03/13/2012] [Indexed: 10/27/2022]
|
32
|
Lesiuk MJ, Spencer DP, Chan AK, Voroney JP, Lau H. Image-Guided Treatment of Fractionated Stereotactic Radiotherapy Patients: A Quantitative Analysis of Pre- and Post-Treatment Orthogonal kV Images of Patients Immobilized with Thermoplastic Masks. J Med Imaging Radiat Sci 2012; 43:239-244. [DOI: 10.1016/j.jmir.2012.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 06/19/2012] [Accepted: 07/04/2012] [Indexed: 10/27/2022]
|
33
|
Sayer FT, Sherman JH, Yen CP, Schlesinger DJ, Kersh R, Sheehan JP. Initial Experience with the eXtend System: A Relocatable Frame System for Multiple-Session Gamma Knife Radiosurgery. World Neurosurg 2011; 75:665-72. [DOI: 10.1016/j.wneu.2010.12.051] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 11/10/2010] [Accepted: 12/17/2010] [Indexed: 11/25/2022]
|