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Katz MS, Mihai A, Milano MT. A Dose of Reality: Embracing the Unseen to Improve Stereotactic Radiotherapy. Clin Oncol (R Coll Radiol) 2022; 34:395-397. [PMID: 35094939 DOI: 10.1016/j.clon.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/30/2021] [Accepted: 01/11/2022] [Indexed: 12/24/2022]
Affiliation(s)
- M S Katz
- Department of Radiation Medicine, Lowell General Hospital, Lowell, MA, USA.
| | - A Mihai
- Department of Radiation Oncology, Beacon Hospital, Sandyford, Dublin, Ireland
| | - M T Milano
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York, USA
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2
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Abstract
We present the update of the recommendations of the French society of oncological radiotherapy on hepatic tumours. Recent technological progress led to develop the concept of focused liver radiation therapy. We must distinguish primary and secondary tumours, as the indications are restricted and must be discussed as an alternative to surgical or medical treatments. The tumour volume, its liver location close to the organs at risk determine the irradiation technique (repositioning method, total dose delivered, dose fractionation regimens). Tumour (and liver) breathing related motions should be taken into account. Strict dosimetric criteria must be observed with particular attention to the dose-volume histograms of non-tumoral liver as well as of the hollow organs, particularly in case of hypofractionated high dose radiotherapy "under stereotaxic conditions". Stereotactic body radiotherapy is being evaluated and is often preferred to radiofrequency for primary or secondary tumours (usually less than 5cm). An adaptation can be proposed, with a conformal fractionated irradiation protocol with or without intensity modulation, for hepatocellular carcinomas larger than 5cm.
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Affiliation(s)
- E Rio
- Service de radiothérapie, institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44805 Saint-Herblain, France.
| | - F Mornex
- Département de radiothérapie-oncologie, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; EMR 3738, université Claude-Bernard Lyon 1, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - P Maingon
- Service d'oncologie radiothérapie, groupe hospitalier La Pitié Salpêtrière, Sorbonne université, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | - D Peiffert
- Service de radiothérapie, institut de cancérologie de Lorraine Alexis-Vautrin, 6, avenue de Bourgogne, 54511 Vandœuvre-lès-Nancy, France
| | - L Parent
- Département d'ingénierie et de physique médicale, institut Claudius-Regaud (ICR), institut universitaire du cancer de Toulouse-Oncopole (IUCT-O), 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
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Schmitt D, Blanck O, Gauer T, Fix MK, Brunner TB, Fleckenstein J, Loutfi-Krauss B, Manser P, Werner R, Wilhelm ML, Baus WW, Moustakis C. Technological quality requirements for stereotactic radiotherapy : Expert review group consensus from the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. Strahlenther Onkol 2020; 196:421-443. [PMID: 32211939 PMCID: PMC7182540 DOI: 10.1007/s00066-020-01583-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/13/2020] [Indexed: 12/25/2022]
Abstract
This review details and discusses the technological quality requirements to ensure the desired quality for stereotactic radiotherapy using photon external beam radiotherapy as defined by the DEGRO Working Group Radiosurgery and Stereotactic Radiotherapy and the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. The covered aspects of this review are 1) imaging for target volume definition, 2) patient positioning and target volume localization, 3) motion management, 4) collimation of the irradiation and beam directions, 5) dose calculation, 6) treatment unit accuracy, and 7) dedicated quality assurance measures. For each part, an expert review for current state-of-the-art techniques and their particular technological quality requirement to reach the necessary accuracy for stereotactic radiotherapy divided into intracranial stereotactic radiosurgery in one single fraction (SRS), intracranial fractionated stereotactic radiotherapy (FSRT), and extracranial stereotactic body radiotherapy (SBRT) is presented. All recommendations and suggestions for all mentioned aspects of stereotactic radiotherapy are formulated and related uncertainties and potential sources of error discussed. Additionally, further research and development needs in terms of insufficient data and unsolved problems for stereotactic radiotherapy are identified, which will serve as a basis for the future assignments of the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. The review was group peer-reviewed, and consensus was obtained through multiple working group meetings.
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Affiliation(s)
- Daniela Schmitt
- Klinik für Radioonkologie und Strahlentherapie, National Center for Radiation Research in Oncology (NCRO), Heidelberger Institut für Radioonkologie (HIRO), Universitätsklinikum Heidelberg, Heidelberg, Germany.
| | - Oliver Blanck
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Tobias Gauer
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Michael K Fix
- Abteilung für Medizinische Strahlenphysik und Universitätsklinik für Radio-Onkologie, Inselspital-Universitätsspital Bern, Universität Bern, Bern, Switzerland
| | - Thomas B Brunner
- Universitätsklinik für Strahlentherapie, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | - Jens Fleckenstein
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Britta Loutfi-Krauss
- Klinik für Strahlentherapie und Onkologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Peter Manser
- Abteilung für Medizinische Strahlenphysik und Universitätsklinik für Radio-Onkologie, Inselspital-Universitätsspital Bern, Universität Bern, Bern, Switzerland
| | - Rene Werner
- Institut für Computational Neuroscience, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Maria-Lisa Wilhelm
- Klinik für Strahlentherapie, Universitätsmedizin Rostock, Rostock, Germany
| | - Wolfgang W Baus
- Klinik für Radioonkologie, CyberKnife- und Strahlentherapie, Universitätsklinikum Köln, Cologne, Germany
| | - Christos Moustakis
- Klinik für Strahlentherapie-Radioonkologie, Universitätsklinikum Münster, Münster, Germany
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In-vivo treatment accuracy analysis of active motion-compensated liver SBRT through registration of plan dose to post-therapeutic MRI-morphologic alterations. Radiother Oncol 2019; 134:158-165. [PMID: 31005210 DOI: 10.1016/j.radonc.2019.01.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/18/2019] [Accepted: 01/19/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND/PURPOSE In-vivo-accuracy analysis (IVA) of dose-delivery with active motion-management (gating/tracking) was performed based on registration of post-radiotherapeutic MRI-morphologic-alterations (MMA) to the corresponding dose-distributions of gantry-based/robotic SBRT-plans. METHODS Forty targets in two patient cohorts were evaluated: (1) gantry-based SBRT (deep-inspiratory breath-hold-gating; GS) and (2) robotic SBRT (online fiducial-tracking; RS). The planning-CT was deformably registered to the first post-treatment contrast-enhanced T1-weighted MRI. An isodose-structure cropped to the liver (ISL) and corresponding to the contoured MMA was created. Structure and statistical analysis regarding volumes, surface-distance, conformity metrics and center-of-mass-differences (CoMD) was performed. RESULTS Liver volume-reduction was -43.1 ± 148.2 cc post-RS and -55.8 ± 174.3 cc post-GS. The mean surface-distance between MMA and ISL was 2.3 ± 0.8 mm (RS) and 2.8 ± 1.1 mm (GS). ISL and MMA volumes diverged by 5.1 ± 23.3 cc (RS) and 16.5 ± 34.1 cc (GS); the median conformity index of both structures was 0.83 (RS) and 0.80 (GS). The average relative directional errors were ≤0.7 mm (RS) and ≤0.3 mm (GS); the median absolute 3D-CoMD was 3.8 mm (RS) and 4.2 mm (GS) without statistically significant differences between the two techniques. Factors influencing the IVA included GTV and PTV (p = 0.041 and p = 0.020). Four local relapses occurred without correlation to IVA. CONCLUSIONS For the first time a method for IVA was presented, which can serve as a benchmarking-tool for other treatment techniques. Both techniques have shown median deviations <5 mm of planned dose and MMA. However, IVA also revealed treatments with errors ≥5 mm, suggesting a necessity for patient-specific safety-margins. Nevertheless, the treatment accuracy of well-performed active motion-compensated liver SBRT seems not to be a driving factor for local treatment failure.
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Direct dose correlation of MRI morphologic alterations of healthy liver tissue after robotic liver SBRT. Strahlenther Onkol 2018; 194:414-424. [PMID: 29404626 DOI: 10.1007/s00066-018-1271-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/16/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE For assessing healthy liver reactions after robotic SBRT (stereotactic body radiotherapy), we investigated early morphologic alterations on MRI (magnetic resonance imaging) with respect to patient and treatment plan parameters. PATIENTS AND METHODS MRI data at 6-17 weeks post-treatment from 22 patients with 42 liver metastases were analyzed retrospectively. Median prescription dose was 40 Gy delivered in 3-5 fractions. T2- and T1-weighted MRI were registered to the treatment plan. Absolute doses were converted to EQD2 (Equivalent dose in 2Gy fractions) with α/β-ratios of 2 and 3 Gy for healthy, and 8 Gy for modelling pre-damaged liver tissue. RESULTS Sharply defined, centroid-shaped morphologic alterations were observed outside the high-dose volume surrounding the GTV. On T2-w MRI, hyperintensity at EQD2 isodoses of 113.3 ± 66.1 Gy2, 97.5 ± 54.7 Gy3, and 66.5 ± 32.0 Gy8 significantly depended on PTV dimension (p = 0.02) and healthy liver EQD2 (p = 0.05). On T1-w non-contrast MRI, hypointensity at EQD2 isodoses of 113.3 ± 49.3 Gy2, 97.4 ± 41.0 Gy3, and 65.7 ± 24.2 Gy8 significantly depended on prior chemotherapy (p = 0.01) and total liver volume (p = 0.05). On T1-w gadolinium-contrast delayed MRI, hypointensity at EQD2 isodoses of 90.6 ± 42.5 Gy2, 79.3 ± 35.3 Gy3, and 56.6 ± 20.9 Gy8 significantly depended on total (p = 0.04) and healthy (p = 0.01) liver EQD2. CONCLUSIONS Early post-treatment changes in healthy liver tissue after robotic SBRT could spatially be correlated to respective isodoses. Median nominal doses of 10.1-11.3 Gy per fraction (EQD2 79-97 Gy3) induce characteristic morphologic alterations surrounding the lesions, potentially allowing for dosimetric in-vivo accuracy assessments. Comparison to other techniques and investigations of the short- and long-term clinical impact require further research.
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He Z, Chen G, Ouyang B, Zhang H, Chen H, Wang Y, Yan S, Pan W. Conformal Radiation Therapy or Stereotactic Body Radiation Therapy: Institutional Experience in the Management of Colorectal Liver Metastases by Radiation Therapy. Technol Cancer Res Treat 2018. [PMCID: PMC6295685 DOI: 10.1177/1533033818816080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aim: Methods: Results: Conclusions:
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Affiliation(s)
- Zemin He
- Department of General Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Gang Chen
- Department of Oncology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Bo Ouyang
- Department of General Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Haoyue Zhang
- Department of General Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hui Chen
- Department of Radiation Oncology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yehuang Wang
- National Chinese Medical Center of Colorectal Diseases, The Third Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Shushan Yan
- Department of Gastrointestinal and Anal Diseases Surgery, The Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Wei Pan
- Department of Radiation Oncology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Yang Q, Qi H, Zhang R, Wan C, Song Z, Zhang L, Fan W. Risk Factors for Local Progression after Percutaneous Radiofrequency Ablation of Lung Tumors: Evaluation Based on a Review of 147 Tumors. J Vasc Interv Radiol 2017; 28:481-489. [DOI: 10.1016/j.jvir.2016.11.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 10/25/2016] [Accepted: 11/21/2016] [Indexed: 02/07/2023] Open
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Institutional experience in the treatment of colorectal liver metastases with stereotactic body radiation therapy. Rep Pract Oncol Radiother 2016; 22:126-131. [PMID: 28490983 DOI: 10.1016/j.rpor.2016.10.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 07/10/2016] [Accepted: 10/11/2016] [Indexed: 12/17/2022] Open
Abstract
AIM To investigate whether the impact of dose escalation in our patient population represented an improvement in local control without increasing treatment related toxicity. MATERIALS AND METHODS A cohort of consecutive patients with colorectal liver metastases treated with stereotactic body radiation therapy (SBRT) between December 2002 and December 2013 were eligible for this study. Inclusion criteria were a Karnofsky performance status ≥80% and, according to the multidisciplinary tumor board, ineligibility for surgery or radiofrequency ablation. Exclusion criteria were a lesion size >6 cm, more than 3 metastases, and treatment delivered with other fractionation scheme than 3 times 12.5 Gy or 16.75 Gy prescribed at the 65-67% isodose. To analyze local control, CT or MRI scans were acquired during follow-up. Toxicity was scored using the Common Toxicity Criteria Adverse Events v4.0. RESULTS A total of 40 patients with 55 colorectal liver metastases were included in this study. We delivered 37.5 Gy to 32 lesions, and 50.25 Gy to 23 lesions. Median follow-up was 26 and 25 months for these two groups. Local control at 2 and 3 years was 74 and 66% in the low dose group while 90 and 81% was reached in the high dose group. No significant difference in local control between the two dose fractionation schemes could be found. Grade 3 toxicity was limited and was not increased in the high dose group. CONCLUSIONS SBRT for colorectal liver metastases offers a high chance of local control at long term. High irradiation doses may contribute to enhance this effect without increasing toxicity.
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Dionisi F, Guarneri A, Dell'Acqua V, Leonardi M, Niespolo R, Macchia G, Comito T, Amichetti M, Franco P, Cilla S, Caravatta L, Alongi F, Mantello G. Radiotherapy in the multidisciplinary treatment of liver cancer: a survey on behalf of the Italian Association of Radiation Oncology. Radiol Med 2016; 121:735-43. [PMID: 27255503 DOI: 10.1007/s11547-016-0650-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/09/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE To report the results of the first Italian survey investigating the role of liver-directed radiotherapy in the multidisciplinary approach of primary and metastatic liver cancer. MATERIALS AND METHODS A 21-item, two-section questionnaire was sent to all Italian radiotherapy centers on June 2014. The two sections aimed at: (1) evaluating the presence of a multidisciplinary liver tumor board and describing the role of radiation oncologists within the latter, (2) analyzing Radiotherapy treatment details and differences between centers. RESULTS A total of 37 centers completed the survey. A multidisciplinary liver tumor board was available in most centers (73 %), with a radiation oncologist routinely attending the latter in the majority of cases (85 %). Most of the respondents considered liver-directed Radiotherapy as the third line choice when other therapies were not indicated or technically suitable. 18 centers reported the use of liver-directed radiotherapy. The majority of centers started liver irradiation after 2010. The most adopted motion management strategy was abdominal compression. The most adopted GTV-CTV expansion was 0 and 5 mm for metastases and hepatocellular carcinoma, respectively. Stereotactic body radiotherapy was the technique of choice; several treatment schedules were registered, being 45 Gy in three fractions the most reported fractionation scheme. Dose was prescribed at the PTV margin in most cases. CONCLUSION Liver-directed radiotherapy represents a new field of interest which is currently adopted by 10 % of all Italian Centers. The technical equipment seems adequate. The variations observed in the treatment regimens reflect the lack of a well-established standard schedule.
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Affiliation(s)
- Francesco Dionisi
- Proton Therapy Unit, Department of Oncology, Azienda Provinciale per i Servizi Sanitari, APSS, Via al desert, 14, 38123, Trento, Italy.
| | - Alessia Guarneri
- Department of Oncology, Radiation Oncology, University of Torino, Turin, Italy
| | - Veronica Dell'Acqua
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | | | - Rita Niespolo
- Department of Radiation Oncology, San Gerardo Hospital-University of Milan-Bicocca, Monza, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Research and Care Foundation 'Giovanni Paolo II', Catholic University of Sacred Heart, Campobasso, Italy
| | - Tiziana Comito
- Radiation Oncology Department, Humanitas Clinical and Research Center, Italy Cancer Center, Rozzano, Milan, Italy
| | - Maurizio Amichetti
- Proton Therapy Unit, Department of Oncology, Azienda Provinciale per i Servizi Sanitari, APSS, Via al desert, 14, 38123, Trento, Italy
| | | | - Savino Cilla
- Medical Physics Unit, Research and Care Foundation 'Giovanni Paolo II', Catholic University of Sacred Heart, Campobasso, Italy
| | - Luciana Caravatta
- Radiation Oncology Department, "San Francesco" Hospital, Nuoro, Italy
| | - Filippo Alongi
- Radiation Oncology, Sacro Cuore-Don Calabria Hospital, Negrar-Verona, Italy
| | - Giovanna Mantello
- Department of Oncology and Radiotherapy, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
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Clinical results of mean GTV dose optimized robotic guided SBRT for liver metastases. Radiat Oncol 2016; 11:74. [PMID: 27236333 PMCID: PMC4884398 DOI: 10.1186/s13014-016-0652-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 05/18/2016] [Indexed: 02/07/2023] Open
Abstract
Background We retrospectively evaluated the efficacy and toxicity of gross tumor volume (GTV) mean-dose-optimized and real-time motion-compensated robotic stereotactic body radiation therapy (SBRT) in the treatment of liver metastases. Methods Between March 2011 and July 2015, 52 patients were treated with SBRT for a total of 91 liver metastases (one to four metastases per patient) with a median GTV volume of 12 cc (min 1 cc, max 372 cc). The optimization of mean GTV dose was prioritized during treatment planning at the potential cost of planning target volume (PTV) coverage reduction while adhering to safe normal tissue constraints. The delivered median GTV biological effective dose (BED10) was 142.1 Gy10 (range, 60.2 Gy10 –165.3 Gy10) and the prescribed PTV BED10 ranged from 40.6 Gy10 to 112.5 Gy10 (median, 86.1 Gy10). We analyzed local control (LC), progression-free interval (PFI), overall survival (OS), and toxicity. Results Median follow-up was 17 months (range, 2–49 months). The 2-year actuarial LC, PFI, and OS rates were 82.1, 17.7, and 45.0 %, and the median PFI and OS were 9 and 23 months, respectively. In univariate analysis histology (p < 0.001), PTV prescription BED10 (HR 0.95, CI 0.91–0.98, p = 0.002) and GTV mean BED10 (HR 0.975, CI 0.954–0.996, p = 0.011) were predictive for LC. Multivariate analysis showed that only extrahepatic disease status at time of treatment was a significant factor (p = 0.033 and p = 0.009, respectively) for PFI and OS. Acute nausea or fatigue grade 1 was observed in 24.1 % of the patients and only 1 patient (1.9 %) had a side effect of grade ≥ 2. Conclusions Robotic real-time motion-compensated SBRT is a safe and effective treatment for one to four liver metastases. Reducing the PTV prescription dose and keeping a high mean GTV dose allowed the reduction of toxicity while maintaining a high local control probability for the treated lesions.
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Liu QY, He CD, Zhou Y, Huang D, Lin H, Wang Z, Wang D, Wang JQ, Liao LP. Application of gemstone spectral imaging for efficacy evaluation in hepatocellular carcinoma after transarterial chemoembolization. World J Gastroenterol 2016; 22:3242-3251. [PMID: 27004002 PMCID: PMC4790000 DOI: 10.3748/wjg.v22.i11.3242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/31/2015] [Accepted: 01/18/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the value of gemstone spectral imaging (GSI) in efficacy evaluation in hepatocellular cancer (HCC) after transcatheter arterial chemoembolization (TACE) treatment.
METHODS: Thirty patients with HCC underwent GSI, including nonenhanced, arterial, portalvenous and delayed phase scans, after TACE treatment. Arterial phase images were acquired with GSI for reconstruction of virtual nonenhanced images and color overlay images. Digital subtraction angiography (DSA) was performed in all these patients. Two blinded and independent readers evaluated the data in two reading sessions; standard nonenhanced, arterial, portalvenous, and delayed phase images were read in session A, and the optimal monochromatic images, iodine/water based images and spectrum features were read in session B. Sensitivity and specificity were calculated with the DSA data as the reference standard. The sensitivity and specificity were compared using the χ2 test.
RESULTS: DSA revealed 154 lesions in 30 patients, and 100 of them had blood supply. Overall sensitivity and specificity were 72% (72/100) and 77.8% (42/54) for session A, and 97% (97/100) and 94.4% (51/54) for session B, respectively. The sensitivity and specificity of the two reading sessions were significantly different (χ2 = 23.04, χ2 = 7.11, P < 0.05).
CONCLUSION: Compared with conventional CT, GSI could significantly improve the detection of small and multiple lesions without increasing the radiation dose. Based on spectrum features, GSI could assess tumor homogeneity and more accurately identify residual tumors and recurrent or metastatic lesions during efficacy evaluation and follow-up in HCC after TACE treatment.
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Tran T, Sundaram CP, Bahler CD, Eble JN, Grignon DJ, Monn MF, Simper NB, Cheng L. Correcting the Shrinkage Effects of Formalin Fixation and Tissue Processing for Renal Tumors: toward Standardization of Pathological Reporting of Tumor Size. J Cancer 2015; 6:759-66. [PMID: 26185538 PMCID: PMC4504112 DOI: 10.7150/jca.12094] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/05/2015] [Indexed: 01/27/2023] Open
Abstract
Given the importance of correctly staging renal cell carcinomas, specific guidelines should be in place for tumor size measurement. While a standard means of renal tumor measurement has not been established, intuitively, tumor size should be based on fresh measurements. We sought to assess the accuracy of postfixation and microscopic measurements of renal tumor size, as compared to fresh measurements and radiographic size. Thirty-four nephrectomy cases performed by a single surgeon were prospectively measured at different time points. The study cases included 23 clear cell renal cell carcinomas, 6 papillary renal cell carcinomas, and 5 other renal tumors. Radiologic tumors were 12.1% larger in diameter than fresh tumors (P<0.01). Furthermore, fresh specimens were 4.6% larger than formalin-fixed specimens (P<0.01), and postfixation measurements were 7.1% greater than microscopic measurements (P<0.01). The overall mean percentage of shrinkage between fresh and histological specimens was 11.4% (P<0.01). Histological processing would cause a tumor stage shift from pT1b to pT1a for two tumors in this study. The shrinkage effects of formalin fixation and histological processing may result in understaging of renal cell carcinomas. The shrinkage factor should be considered when reporting tumor size.
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Affiliation(s)
- Thu Tran
- 1. Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Chandru P Sundaram
- 2. Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Clinton D Bahler
- 2. Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John N Eble
- 1. Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - David J Grignon
- 1. Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - M Francesca Monn
- 2. Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Novae B Simper
- 1. Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Liang Cheng
- 1. Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA ; 2. Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
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Mari L, Acocella F. Vascular anatomy of canine hepatic venous system: a basis for liver surgery. Anat Histol Embryol 2014; 44:212-24. [PMID: 25090952 DOI: 10.1111/ahe.12129] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 06/08/2014] [Indexed: 12/23/2022]
Abstract
Detailed knowledge of the vascular anatomy is important for improving surgical approaches to the liver. Twelve canine livers were skeletonized to describe the anatomy of their portal and hepatic veins in details. Our data suggest that the liver can be divided into two sections, three divisions, seven lobes and two to four sub-lobes. This differs from the classic division into four lobes, four sub-lobes and two processes. The right section was perfused by the right portal branch and drained by independent hepatic veins, while most of the left section, perfused by the left portal branch, was drained by the main hepatic vein deriving from the middle and the left hepatic vein confluence. Part of the right medial lobe, and in some cases the papillary process of the caudate lobe, drained directly into the caudal vena cava. A proper right hepatic vein draining blood from more than one lobe was never observed. Portal connections between the quadrate and the left medial lobe were frequently recorded. Two sub-lobes with different portal blood supply and venous drainage could be identified in the right lateral (33.3% of cases) and the left lateral (100% of cases) lobes. From our results, the classic nomenclature of the liver lobes does not reflect their vascularization. Based on similarities between canine lobes and human segments, a new nomenclature is possible and may be less confounding in surgical settings.
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Affiliation(s)
- L Mari
- Department of Veterinary Sciences for Health, Animal Production and Food Safeness V.E.S.P.A., Faculty of Veterinary Medicine, University of Milan, Milan, Italy
| | - F Acocella
- Department of Veterinary Sciences for Health, Animal Production and Food Safeness V.E.S.P.A., Faculty of Veterinary Medicine, University of Milan, Milan, Italy
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Segmentation precision of abdominal anatomy for MRI-based radiotherapy. Med Dosim 2014; 39:212-7. [PMID: 24726701 DOI: 10.1016/j.meddos.2014.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 12/20/2013] [Accepted: 02/10/2014] [Indexed: 01/24/2023]
Abstract
The limited soft tissue visualization provided by computed tomography, the standard imaging modality for radiotherapy treatment planning and daily localization, has motivated studies on the use of magnetic resonance imaging (MRI) for better characterization of treatment sites, such as the prostate and head and neck. However, no studies have been conducted on MRI-based segmentation for the abdomen, a site that could greatly benefit from enhanced soft tissue targeting. We investigated the interobserver and intraobserver precision in segmentation of abdominal organs on MR images for treatment planning and localization. Manual segmentation of 8 abdominal organs was performed by 3 independent observers on MR images acquired from 14 healthy subjects. Observers repeated segmentation 4 separate times for each image set. Interobserver and intraobserver contouring precision was assessed by computing 3-dimensional overlap (Dice coefficient [DC]) and distance to agreement (Hausdorff distance [HD]) of segmented organs. The mean and standard deviation of intraobserver and interobserver DC and HD values were DC(intraobserver) = 0.89 ± 0.12, HD(intraobserver) = 3.6mm ± 1.5, DC(interobserver) = 0.89 ± 0.15, and HD(interobserver) = 3.2mm ± 1.4. Overall, metrics indicated good interobserver/intraobserver precision (mean DC > 0.7, mean HD < 4mm). Results suggest that MRI offers good segmentation precision for abdominal sites. These findings support the utility of MRI for abdominal planning and localization, as emerging MRI technologies, techniques, and onboard imaging devices are beginning to enable MRI-based radiotherapy.
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Li F, Li J, Xing J, Zhang Y, Fan T, Xu M, Shang D, Liu T, Song J. Analysis of the advantage of individual PTVs defined on axial 3D CT and 4D CT images for liver cancer. J Appl Clin Med Phys 2012; 13:4017. [PMID: 23149795 PMCID: PMC5718544 DOI: 10.1120/jacmp.v13i6.4017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 07/10/2012] [Accepted: 07/17/2012] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to compare positional and volumetric differences of planning target volumes (PTVs) defined on axial three dimensional CT (3D CT) and four dimensional CT (4D CT) for liver cancer. Fourteen patients with liver cancer underwent 3D CT and 4D CT simulation scans during free breathing. The tumor motion was measured by 4D CT. Three internal target volumes (ITVs) were produced based on the clinical target volume from 3DCT (CTV3D): i) A conventional ITV (ITVconv) was produced by adding 10 mm in CC direction and 5 mm in LR and and AP directions to CTV3D; ii) A specific ITV (ITVspec) was created using a specific margin in transaxial direction; iii) ITVvector was produced by adding an isotropic margin derived from the individual tumor motion vector. ITV4D was defined on the fusion of CTVs on all phases of 4D CT. PTVs were generated by adding a 5 mm setup margin to ITVs. The average centroid shifts between PTVs derived from 3DCT and PTV4D in left–right (LR), anterior–posterior (AP), and cranial–caudal (CC) directions were close to zero. Comparing PTV4D to PTVconv, PTVspec, and PTVvector resulted in a decrease in volume size by 33.18% ±12.39%, 24.95% ±13.01%, 48.08% ±15.32%, respectively. The mean degree of inclusions (DI) of PTV4D in PTVconv, and PTV4D in PTVspec, and PTV4D in PTVvector was 0.98, 0.97, and 0.99, which showed no significant correlation to tumor motion vector (r=‐0.470, 0.259, and 0.244; p=0.090, 0.371, and 0.401). The mean DIs of PTVconv in PTV4D, PTVspec in PTV4D, and PTVvector in PTV4D was 0.66, 0.73, and 0.52. The size of individual PTV from 4D CT is significantly less than that of PTVs from 3DCT. The position of targets derived from axial 3DCT images scatters around the center of 4D targets randomly. Compared to conventional PTV, the use of 3D CT‐based PTVs with individual margins cannot significantly reduce normal tissues being unnecessarily irradiated, but may contribute to reducing the risk of missing targets for tumors with large motion. PACS number: 87
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Affiliation(s)
- Fengxiang Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, China
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Vásquez Osorio EM, Hoogeman MS, Méndez Romero A, Wielopolski P, Zolnay A, Heijmen BJM. Accurate CT/MR vessel-guided nonrigid registration of largely deformed livers. Med Phys 2012; 39:2463-77. [DOI: 10.1118/1.3701779] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
Imaging for radiation therapy treatment planning and delivery is a critical component of the radiation planning process for liver cancer. Because of the lack of inherent contrast between liver tumors and the surrounding liver, intravenous contrast is required for accurate target delineation on the planning computed tomography scan. The appropriate phase of contrast is tumor specific, with arterial phase imaging usually used to define hepatocellular carcinoma and venous phase imaging for vascular thrombosis related to hepatocellular carcinoma and most types of liver metastases. Breathing motion and changes in the liver position day to day may be substantial and need to be considered at the time of radiation planning and treatment. Many types of integrated imaging-radiation treatment systems and image-guidance strategies are available to produce volumetric and/or planar imaging at the time of treatment delivery to reduce the negative impact of geometric changes that may occur. Image-guided radiation therapy facilitates reduced PTV margins and dose escalation and improves the precision of radiation therapy, so the prescribed doses are more likely to represent those actually delivered.
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Affiliation(s)
- Kristy K Brock
- Radiation Medicine Program, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
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Høyer M, Thor M, Thörnqvist S, Søndergaard J, Lassen-Ramshad Y, Paul Muren L. Advances in radiotherapy: from 2D to 4D. Cancer Imaging 2011; 11 Spec No A:S147-52. [PMID: 22185864 PMCID: PMC3266568 DOI: 10.1102/1470-7330.2011.9036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Imaging techniques are increasingly integrated into modern radiotherapy (RT). Multimodal imaging is used to define the target for RT planning and imaging technology is also being integrated into linear accelerators, with the purpose to ensure delivery of radiation with high geometric accuracy. The integration of imaging in RT calls for a stronger collaboration between diagnostic radiologists and the professions involved in RT.
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Affiliation(s)
- Morten Høyer
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
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