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Le Bao V, Haworth A, Dowling J, Walker A, Arumugam S, Jameson M, Chlap P, Wiltshire K, Keats S, Cloak K, Sidhom M, Kneebone A, Holloway L. Evaluating the relationship between contouring variability and modelled treatment outcome for prostate bed radiotherapy. Phys Med Biol 2024; 69:085008. [PMID: 38471173 DOI: 10.1088/1361-6560/ad3325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/12/2024] [Indexed: 03/14/2024]
Abstract
Objectives.Contouring similarity metrics are often used in studies of inter-observer variation and automatic segmentation but do not provide an assessment of clinical impact. This study focused on post-prostatectomy radiotherapy and aimed to (1) identify if there is a relationship between variations in commonly used contouring similarity metrics and resulting dosimetry and (2) identify the variation in clinical target volume (CTV) contouring that significantly impacts dosimetry.Approach.The study retrospectively analysed CT scans of 10 patients from the TROG 08.03 RAVES trial. The CTV, rectum, and bladder were contoured independently by three experienced observers. Using these contours reference simultaneous truth and performance level estimation (STAPLE) volumes were established. Additional CTVs were generated using an atlas algorithm based on a single benchmark case with 42 manual contours. Volumetric-modulated arc therapy (VMAT) treatment plans were generated for the observer, atlas, and reference volumes. The dosimetry was evaluated using radiobiological metrics. Correlations between contouring similarity and dosimetry metrics were calculated using Spearman coefficient (Γ). To access impact of variations in planning target volume (PTV) margin, the STAPLE PTV was uniformly contracted and expanded, with plans created for each PTV volume. STAPLE dose-volume histograms (DVHs) were exported for plans generated based on the contracted/expanded volumes, and dose-volume metrics assessed.Mainresults. The study found no strong correlations between the considered similarity metrics and modelled outcomes. Moderate correlations (0.5 <Γ< 0.7) were observed for Dice similarity coefficient, Jaccard, and mean distance to agreement metrics and rectum toxicities. The observations of this study indicate a tendency for variations in CTV contraction/expansion below 5 mm to result in minor dosimetric impacts.Significance. Contouring similarity metrics must be used with caution when interpreting them as indicators of treatment plan variation. For post-prostatectomy VMAT patients, this work showed variations in contours with an expansion/contraction of less than 5 mm did not lead to notable dosimetric differences, this should be explored in a larger dataset to assess generalisability.
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Affiliation(s)
- Viet Le Bao
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Annette Haworth
- Institute of Medical Physics, School of Physics, University of Sydney, Australia
| | - Jason Dowling
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Amy Walker
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Sankar Arumugam
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
| | - Michael Jameson
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia
- GenesisCare, Sydney, NSW, Australia
| | - Phillip Chlap
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
| | - Kirsty Wiltshire
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - Sarah Keats
- Ingham Institute for Applied Medical Research, Sydney, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
| | - Kirrily Cloak
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
| | - Mark Sidhom
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
| | | | - Lois Holloway
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- Institute of Medical Physics, School of Physics, University of Sydney, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
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Staal FH, Siang KNW, Brouwer CL, Janssen J, Budiharto TC, Haverkort DM, Hollmann B, Jacobs I, De Jong MA, van de Sande MA, Vanneste BG, De Jong IJ, Verzijlbergen JF, Langendijk JA, Smeenk RJ, Aluwini S. Pretrial Quality Assurance for Hypofractionated Salvage Radiation Therapy After Prostatectomy in the Multi-Institutional PERYTON-trial. Adv Radiat Oncol 2024; 9:101379. [PMID: 38405312 PMCID: PMC10885595 DOI: 10.1016/j.adro.2023.101379] [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: 04/19/2023] [Accepted: 09/12/2023] [Indexed: 02/27/2024] Open
Abstract
Purpose The PERYTON trial is a multicenter randomized controlled trial that will investigate whether the treatment outcome of salvage external beam radiation therapy (sEBRT) will be improved with hypofractionated radiation therapy. A pretrial quality assurance (QA) program was undertaken to ensure protocol compliance within the PERYTON trial and to assess variation in sEBRT treatment protocols between the participating centers. Methods and Materials Completion of the QA program was mandatory for each participating center (N = 8) to start patient inclusion. The pretrial QA program included (1) a questionnaire on the center-specific sEBRT protocol, (2) a delineation exercise of the clinical target volume (CTV) and organs at risk, and (3) a treatment planning exercise. All contours were analyzed using the pairwise dice similarity coefficient (DSC) and the 50th and 95th percentile Hausdorff distance (HD50 and HD95, respectively). The submitted treatment plans were reviewed for protocol compliance. Results The results of the questionnaire showed that high-quality, state-of-the-art radiation therapy techniques were used in the participating centers and identified variations of the sEBRT protocols used concerning the position verification and preparation techniques. The submitted CTVs showed significant variation, with a range in volume of 29 cm3 to 167 cm3, a mean pairwise DSC of 0.52, and a mean HD50 and HD95 of 2.3 mm and 24.4 mm, respectively. Only in 1 center the treatment plan required adaptation before meeting all constraints of the PERYTON protocol. Conclusions The pretrial QA of the PERYTON trial demonstrated that high-quality, but variable, radiation techniques were used in the 8 participating centers. The treatment planning exercise confirmed that the dose constraints of the PERYTON protocol were feasible for all participating centers. The observed variation in CTV delineation led to agreement on a new (image-based) delineation guideline to be used by all participating centers within the PERYTON trial.
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Affiliation(s)
- Floor H.E. Staal
- Department of Radiation Oncology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Kelvin Ng Wei Siang
- Department of Radiation Oncology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Charlotte L. Brouwer
- Department of Radiation Oncology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jorinde Janssen
- Department of Radiation Oncology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Tom C.G. Budiharto
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Birgit Hollmann
- Department of Radiation Oncology, HAGA Ziekenhuis, Den Haag, The Netherlands
| | - Inge Jacobs
- Zuidwest Radiotherapy Institute Vlissingen/Roosendaal, Vlissingen, The Netherlands
| | | | | | - Ben G.L. Vanneste
- Department of Radiation Oncology, MAASTRO Clinic, GROW—School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Igle Jan De Jong
- Department of Urology, University Medical Centre Groningen, Groningen, The Netherlands
| | - J. Fred Verzijlbergen
- Department of Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Johannes A. Langendijk
- Department of Radiation Oncology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Robert Jan Smeenk
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Shafak Aluwini
- Department of Radiation Oncology, University Medical Centre Groningen, Groningen, The Netherlands
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Dal Pra A, Dirix P, Khoo V, Carrie C, Cozzarini C, Fonteyne V, Ghadjar P, Gomez-Iturriaga A, Panebianco V, Zapatero A, Bossi A, Wiegel T. ESTRO ACROP guideline on prostate bed delineation for postoperative radiotherapy in prostate cancer. Clin Transl Radiat Oncol 2023; 41:100638. [PMID: 37251620 PMCID: PMC10209331 DOI: 10.1016/j.ctro.2023.100638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/06/2023] [Indexed: 05/31/2023] Open
Abstract
Purpose/Objective Radiotherapy to the prostate bed is a potentially curative salvage option after radical prostatectomy. Although prostate bed contouring guidelines are available in the literature, important variabilities exist. The objective of this work is to provide a contemporary consensus guideline for prostate bed delineation for postoperative radiotherapy. Methods An ESTRO-ACROP contouring consensus panel consisting of 11 radiation oncologists and one radiologist, all with known subspecialty expertise in prostate cancer, was established. Participants were asked to delineate the prostate bed clinical target volumes (CTVs) in 3 separate clinically relevant scenarios: adjuvant radiation, salvage radiation with PSA progression, and salvage radiation with persistently elevated PSA. These cases focused on the presence of positive surgical margin, extracapsular extension, and seminal vesicles involvement. None of the cases had radiographic evidence of local recurrence on imaging. A single computed tomography (CT) dataset was shared via FALCON platform and contours were performed using EduCaseTM software. Contours were analyzed qualitatively using heatmaps which provided a visual assessment of controversial regions and quantitatively analyzed using Sorensen-Dice similarity coefficients. Participants also answered case-specific questionnaires addressing detailed recommendations on target delineation. Discussions via electronic mails and videoconferences for final editing and consensus were performed. Results The mean CTV for the adjuvant case was 76 cc (SD = 26.6), salvage radiation with PSA progression was 51.80 cc (SD = 22.7), and salvage radiation with persistently elevated PSA 57.63 cc (SD = 25.2). Compared to the median, the mean Sorensen-Dice similarity coefficient for the adjuvant case was 0.60 (SD 0.10), salvage radiation with PSA progression was 0.58 (SD = 0.12), and salvage radiation with persistently elevated PSA 0.60 (SD = 0.11). A heatmap for each clinical scenario was generated. The group agreed to proceed with a uniform recommendation for all cases, independent of the radiotherapy timing. Several controversial areas of the prostate bed CTV were identified based on both heatmaps and questionnaires. This formed the basis for discussions via videoconferences where the panel achieved consensus on the prostate bed CTV to be used as a novel guideline for postoperative prostate cancer radiotherapy. Conclusion Variability was observed in a group formed by experienced genitourinary radiation oncologists and a radiologist. A single contemporary ESTRO-ACROP consensus guideline was developed to address areas of dissonance and improve consistency in prostate bed delineation, independent of the indication.There is important variability in existing contouring guidelines for postoperative prostate bed (PB) radiotherapy (RT) after radical prostatectomy. This work aimed at providing a contemporary consensus guideline for PB delineation. An ESTRO ACROP consensus panel including radiation oncologists and a radiologist, all with known subspecialty expertise in prostate cancer, delineated the PB CTV in 3 scenarios: adjuvant RT, salvage RT with PSA progression, and salvage RT with persistently elevated PSA. None of the cases had evidence of local recurrence. Contours were analysed qualitatively using heatmaps for visual assessment of controversial regions and quantitatively using Sorensen-Dice coefficient. Case-specific questionnaires were also discussed via e-mails and videoconferences for consensus. Several controversial areas of the PB CTV were identified based on both heatmaps and questionnaires. This formed the basis for discussions via videoconferences. Finally, a contemporary ESTRO-ACROP consensus guideline was developed to address areas of dissonance and improve consistency in PB delineation, independent of the indication.
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Affiliation(s)
- Alan Dal Pra
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, USA
- University of Bern, Bern University Hospital, Bern, Switzerland
| | - Piet Dirix
- Department of Radiation Oncology, Iridium Network, Antwerp, Belgium
| | - Vincent Khoo
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | | | - Cesare Cozzarini
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valérie Fonteyne
- Department of Radiotherapy-Oncology, Ghent University Hospital, Ghent, Belgium
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | - Alfonso Gomez-Iturriaga
- Radiation Oncology, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Almudena Zapatero
- Department of Radiation Oncology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria IP, Madrid, Spain
| | - Alberto Bossi
- Radiation Oncology, Centre Charlebourg, La Garenne Colombe, France
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
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Padayachee J, Chaudhary S, Shim B, So J, Lim R, Raman S. Utilizing clinical, pathological and radiological information to guide postoperative radiotherapy in prostate cancer. Expert Rev Anticancer Ther 2023; 23:293-305. [PMID: 36795862 DOI: 10.1080/14737140.2023.2181795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
INTRODUCTION A detectable and rising PSA following radical prostatectomy is indicative of recurrent prostate cancer. Salvage radiotherapy (SRT) with/without androgen deprivation therapy represents the main treatment option for these patients and has been historically associated with a biochemical control rate of ~70%. To determine the optimal timing, diagnostic workup, radiotherapy dosefractionation, treatment volume, and use of systemic therapy, several informative studies have been conducted in the last decade. AREAS COVERED This review examines the recent evidence to guide radiotherapy decision making in the SRT setting. Key topics include adjuvant vs salvage RT, utilization of molecular imaging and genomic classifiers, length of androgen deprivation therapy, inclusion of elective pelvic volume, and emerging role for hypofractionation. EXPERT OPINION Recently reported trials, conducted in an era prior to the routine use of molecular imaging and genomic classifiers, have been pivotal in establishing the current standard of care for SRT in prostate cancer. However, decisions about radiation treatment and systemic therapy may be tailored based on available prognostic and predictive biomarkers. Data from contemporary clinical trials are awaited to define and establish individualized, biomarker-driven approaches for SRT.
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Affiliation(s)
- Jerusha Padayachee
- Department of Radiation Oncology, Auckland City Hospital, Auckland, New Zealand
| | - Simone Chaudhary
- Princess Margaret Hospital Cancer Centre, Radiation Medicine Program, Toronto, ON, Canada
| | - Brian Shim
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jonathan So
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Remy Lim
- Mercy PET/CT Epsom, Auckland, New Zealand.,Department of Radiology, Auckland City Hospital, Auckland, New Zealand
| | - Srinivas Raman
- Princess Margaret Hospital Cancer Centre, Radiation Medicine Program, Toronto, ON, Canada
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Adherence to contouring and treatment planning requirements within a multicentric trial -results of the quality assurance of the SAKK 09/10 trial. Int J Radiat Oncol Biol Phys 2022; 113:80-91. [PMID: 34990777 DOI: 10.1016/j.ijrobp.2021.12.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the results of the radiation therapy (RT) quality assurance (QA) program of the phase III randomized "XXXX-Anonymized for Review" trial in biochemically recurrent prostate cancer (PC) patients after prostatectomy. METHODS AND MATERIALS Within the "XXXX-Anonymized for Review" trial testing 64Gy versus 70Gy salvage RT, a central collection of treatment plans were performed, which were thoroughly reviewed by a dedicated medical physicist and radiation oncologist. Adherence to the treatment protocol and specifically to the European Organization for the Research and Treatment of Cancer (EORTC) guidelines for target volume definition (classified as deviation observed yes vs. no) and its potential correlation with acute and late toxicity (Common Terminology Criteria for Adverse Events (CTCAE) v4.0) and freedom from biochemical progression (FFBP) were investigated. RESULTS The treatment plans of 344 patients treated between February 2011 and April 2014 depicted important deviations to the EORTC guidelines and to the recommendations per trial protocol. For example, in up to half of the cases, the delineated structures deviated from the protocol (e.g., prostate bed (PB) in 48.8%, rectal wall (RW) in 41%). In addition, variations in clinical (CTV) - and planning target volume (PTV) occurred frequently (e.g., CTV and PTV deviations in up to 42.4% and 25.9%, respectively). The detected deviations showed a significant association with a lower risk of grade ≥ 2 gastrointestinal (GI) acute toxicity when CTV not overlapped RW vs. CTV overlapping RW, (OR 0.43; CI [0.22, 0.85]; p= 0.014), and a higher rate of grade ≥ 2 late genitourinary (GU) toxicity in case of the CTV overlapped with RW, (OR 2.58; CI [1.17, 5.72]; p= 0.019). A marginally significant lower risk of grade ≥ 2 late GU toxicity in patients when PB not overlapping RW versus overlapping RW was observed (OR 0.51; CI [0.25, 1.03]; p= 0.06). In addition, a marginally significant decrease of FFBP in patients with PTV not including surgical clips as potential markers of the limits of the prostate bed, (HR 1.44; CI [0.96, 2.17]; p= 0.07) was observed. CONCLUSIONS Despite a thorough QA program, the central review of a phase-III trial showed limited adherence to treatment protocol recommendations which was associated with a higher risk of toxicity by means of acute or late GI or GU toxicity and showed a trend towards worse FFBP. Data from this QA review may help refine future QA programs and prostate bed delineation guidelines.
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Sadeghi S, Siavashpour Z, Vafaei Sadr A, Farzin M, Sharp R, Gholami S. A rapid review of influential factors and appraised solutions on organ delineation uncertainties reduction in radiotherapy. Biomed Phys Eng Express 2021; 7. [PMID: 34265746 DOI: 10.1088/2057-1976/ac14d0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/15/2021] [Indexed: 11/11/2022]
Abstract
Background and purpose.Accurate volume delineation plays an essential role in radiotherapy. Contouring is a potential source of uncertainties in radiotherapy treatment planning that could affect treatment outcomes. Therefore, reducing the degree of contouring uncertainties is crucial. The role of utilized imaging modality in the organ delineation uncertainties has been investigated. This systematic review explores the influential factors on inter-and intra-observer uncertainties of target volume and organs at risk (OARs) delineation focusing on the used imaging modality for these uncertainties reduction and the reported subsequent histopathology and follow-up assessment.Methods and materials.An inclusive search strategy has been conducted to query the available online databases (Scopus, Google Scholar, PubMed, and Medline). 'Organ at risk', 'target', 'delineation', 'uncertainties', 'radiotherapy' and their relevant terms were utilized using every database searching syntax. Final article extraction was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Included studies were limited to the ones published in English between 1995 and 2020 and that just deal with computed tomography (CT) and magnetic resonance imaging (MRI) modalities.Results.A total of 923 studies were screened and 78 were included of which 31 related to the prostate 20 to the breast, 18 to the head and neck, and 9 to the brain tumor site. 98% of the extracted studies performed volumetric analysis. Only 24% of the publications reported the dose deviations resulted from variation in volume delineation Also, heterogeneity in studied populations and reported geometric and volumetric parameters were identified such that quantitative synthesis was not appropriate.Conclusion.This review highlightes the inter- and intra-observer variations that could lead to contouring uncertainties and impede tumor control in radiotherapy. For improving volume delineation and reducing inter-observer variability, the implementation of well structured training programs, homogeneity in following consensus and guidelines, reliable ground truth selection, and proper imaging modality utilization could be clinically beneficial.
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Affiliation(s)
- Sogand Sadeghi
- Department of Nuclear Physics, Faculty of Sciences, University of Mazandaran, Babolsar, Iran
| | - Zahra Siavashpour
- Department of Radiation Oncology, Shohada-e Tajrish Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Vafaei Sadr
- Département de Physique Théorique and Center for Astroparticle Physics, Université de Genève, Geneva, Switzerland
| | - Mostafa Farzin
- Radiation Oncology Research Center (RORC), Tehran University of Medical Science, Tehran, Iran.,Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ryan Sharp
- Department of Health Physics and Diagnostic Sciences, University of Nevada, Las Vegas, NV, United States of America
| | - Somayeh Gholami
- Radiotherapy Oncology Department, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
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Bernstein D, Taylor A, Nill S, Imseeh G, Kothari G, Llewelyn M, De Paepe KN, Rockall A, Shiarli AM, Oelfke U. An Inter-observer Study to Determine Radiotherapy Planning Target Volumes for Recurrent Gynaecological Cancer Comparing Magnetic Resonance Imaging Only With Computed Tomography-Magnetic Resonance Imaging. Clin Oncol (R Coll Radiol) 2021; 33:307-313. [PMID: 33640196 PMCID: PMC8051139 DOI: 10.1016/j.clon.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/11/2021] [Accepted: 02/05/2021] [Indexed: 11/25/2022]
Abstract
AIMS Target delineation uncertainty is arguably the largest source of geometric uncertainty in radiotherapy. Several factors can affect it, including the imaging modality used for delineation. It is accounted for by applying safety margins to the target to produce a planning target volume (PTV), to which treatments are designed. To determine the margin, the delineation uncertainty is measured as the delineation error, and then a margin recipe used. However, there is no published evidence of such analysis for recurrent gynaecological cancers (RGC). The aims of this study were first to quantify the delineation uncertainty for RGC gross tumour volumes (GTVs) and to calculate the associated PTV margins and then to quantify the difference in GTV, delineation uncertainty and PTV margin, between a computed tomography-magnetic resonance imaging (CT-MRI) and MRI workflow. MATERIALS AND METHODS Seven clinicians delineated the GTV for 20 RGC tumours on co-registered CT and MRI datasets (CT-MRI) and on MRI alone. The delineation error, the standard deviation of distances from each clinician's outline to a reference, was measured and the required PTV margin determined. Differences between using CT-MRI and MRI alone were assessed. RESULTS The overall delineation error and the resulting margin were 3.1 mm and 8.5 mm, respectively, for CT-MRI, reducing to 2.5 mm and 7.1 mm, respectively, for MRI alone. Delineation errors and therefore the theoretical margins, varied widely between patients. MRI tumour volumes were on average 15% smaller than CT-MRI tumour volumes. DISCUSSION This study is the first to quantify delineation error for RGC tumours and to calculate the corresponding PTV margin. The determined margins were larger than those reported in the literature for similar patients, bringing into question both current margins and margin calculation methods. The wide variation in delineation error between these patients suggests that applying a single population-based margin may result in PTVs that are suboptimal for many. Finally, the reduced tumour volumes and safety margins suggest that patients with RGC may benefit from an MRI-only treatment workflow.
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Affiliation(s)
- D Bernstein
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK.
| | - A Taylor
- Gynaecology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - S Nill
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, London, UK
| | - G Imseeh
- Gynaecology Unit, Royal Marsden NHS Foundation Trust, London, UK; Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, London, UK
| | - G Kothari
- Gynaecology Unit, Royal Marsden NHS Foundation Trust, London, UK; Peter MacCallum Cancer Center, Melbourne, Victoria, Australia
| | - M Llewelyn
- Gynaecology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - K N De Paepe
- Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, London, UK; Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Rockall
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, UK; Department of Surgery and Cancer, Imperial College London, London, UK
| | - A-M Shiarli
- Gynaecology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - U Oelfke
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, London, UK
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Robin S, Jolicoeur M, Palumbo S, Zilli T, Crehange G, De Hertogh O, Derashodian T, Sargos P, Salembier C, Supiot S, Udrescu C, Chapet O. Prostate Bed Delineation Guidelines for Postoperative Radiation Therapy: On Behalf Of The Francophone Group of Urological Radiation Therapy. Int J Radiat Oncol Biol Phys 2021; 109:1243-1253. [PMID: 33186618 DOI: 10.1016/j.ijrobp.2020.11.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/14/2020] [Accepted: 11/02/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE Prostate bed (PB) irradiation is considered the standard postoperative treatment after radical prostatectomy (RP) for tumors with high-risk features or persistent prostate-specific antigen, or for salvage treatment in case of biological relapse. Four consensus guidelines have been published to standardize practices and reduce the interobserver variability in PB delineation but with discordant recommendations. To improve the reproducibility in the PB delineation, the Francophone Group of Urological Radiotherapy (Groupe Francophone de Radiothérapie Urologique [GFRU]) worked to propose a new and more reproducible consensus guideline for PB clinical target volume (CTV) definition. METHODS AND MATERIALS A 4-step procedure was used. First, a group of 10 GFRU prostate experts evaluated the 4 existing delineation guidelines for postoperative radiation therapy (European Organization for Research and Treatment of Cancer; the Faculty of Radiation Oncology Genito-Urinary Group; the Radiation Therapy Oncology Group; and the Princess Margaret Hospital) to identify divergent issues. Second, data sets of 50 magnetic resonance imaging studies (25 after RP and 25 with an intact prostate gland) were analyzed to identify the relevant anatomic boundaries of the PB. Third, a literature review of surgical, anatomic, histologic, and imaging data was performed to identify the relevant PB boundaries. Fourth, a final consensus on PB CTV definition was reached among experts. RESULTS Definitive limits of the PB CTV delineation were defined using easily visible landmarks on computed tomography scans (CT). The purpose was to ensure a better reproducibility of PB definition for any radiation oncologist even without experience in postoperative radiation therapy. CONCLUSIONS New recommendations for PB delineation based on simple anatomic boundaries and available as a CT image atlas are proposed by the GFRU. Improvement in uniformity in PB CTV definition and treatment homogeneity in the context of clinical trials are expected.
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Affiliation(s)
- Sophie Robin
- Radiation Oncology Department, Center Hospitalier Lyon Sud, Pierre Benite, France
| | - Marjory Jolicoeur
- Radiation Oncology Department, Charles LeMoyne Hospital, CISSS Montérégie-center, Montréal, Canada
| | - Samuel Palumbo
- Radiation Oncology Department, CHU UCL Namur - Sainte Elisabeth, Namur, Belgium
| | - Thomas Zilli
- Radiation Oncology Department, Geneva University Hospital, Geneva, Switzerland and Faculty of Medicine, Geneva, Switzerland
| | - Gilles Crehange
- Radiation Oncology Department, Institut Curie, Saint-Cloud, France
| | - Olivier De Hertogh
- Radiation Oncology Department, CHR Verviers East Belgium, Verviers, Belgium
| | - Talar Derashodian
- Radiation Oncology Department, Charles LeMoyne Hospital, CISSS Montérégie-center, Montréal, Canada
| | - Paul Sargos
- Radiation Oncology Department, Jewish General Hospital, McGill, Montreal, Canada
| | - Carl Salembier
- Department of Radiotherapy, Europe Hospitals Brussels, Belgium
| | - Stéphane Supiot
- Radiation Oncology Department, Institut de Cancérologie de l'Ouest, Nantes Saint-Herblain, France; CRCINA CNRS Inserm, University of Nantes and Angers, Nantes, France
| | - Corina Udrescu
- Radiation Oncology Department, Center Hospitalier Lyon Sud, Pierre Benite, France
| | - Olivier Chapet
- Radiation Oncology Department, Center Hospitalier Lyon Sud, Pierre Benite, France.
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9
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Patrick HM, Souhami L, Kildea J. Reduction of inter-observer contouring variability in daily clinical practice through a retrospective, evidence-based intervention. Acta Oncol 2021; 60:229-236. [PMID: 32988249 DOI: 10.1080/0284186x.2020.1825801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Inter-observer variations (IOVs) arising during contouring can potentially impact plan quality and patient outcomes. Regular assessment of contouring IOV is not commonly performed in clinical practice due to the large time commitment required of clinicians from conventional methods. This work uses retrospective information from past treatment plans to facilitate a time-efficient, evidence-based intervention to reduce contouring IOV. METHODS The contours of 492 prostate cancer treatment plans created by four radiation oncologists were analyzed in this study. Structure volumes, lengths, and DVHs were extracted from the treatment planning system and stratified based on primary oncologist and inclusion of a pelvic lymph node (PLN) target. Inter-observer variations and their dosimetric consequences were assessed using Student's t-tests. Results of this analysis were presented at an intervention meeting, where new consensus contour definitions were agreed upon. The impact of the intervention was assessed one-year later by repeating the analysis on 152 new plans. RESULTS Significant IOV in prostate and PLN target delineation existed pre-intervention between oncologists, impacting dose to nearby OARs. IOV was also present for rectum and penile-bulb structures. Post-intervention, IOV decreased for all previously discordant structures. Dosimetric variations were also reduced. Although target contouring concordance increased significantly, some variations still persisted for PLN structures, highlighting remaining areas for improvement. CONCLUSION We detected significant contouring IOV in routine practice using easily accessible retrospective data and successfully decreased IOV in our clinic through a reflective intervention. Continued application of this approach may aid improvements in practice standardization and enhance quality of care.
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Affiliation(s)
- H. M. Patrick
- Medical Physics Unit, McGill University, Montreal, Canada
| | - L. Souhami
- Department of Oncology, McGill University Health Centre, Montreal, Canada
| | - J. Kildea
- Medical Physics Unit, McGill University, Montreal, Canada
- Department of Oncology, McGill University Health Centre, Montreal, Canada
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10
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Sabater S, Pastor-Juan MR, Andres I, López-Martinez L, Lopez-Honrubia V, Tercero-Azorin MI, Sevillano M, Lozano-Setien E, Jimenez-Jimenez E, Berenguer R, Rovirosa A, Castro-Larefors S, Magdalena Marti-Laosa M, Roche O, Martinez-Terol F, Arenas M. MRI prostate contouring is not impaired by the use of a radiotherapy image acquisition set-up. An intra- and inter-observer paired comparative analysis with diagnostic set-up images. Cancer Radiother 2021; 25:107-113. [PMID: 33423967 DOI: 10.1016/j.canrad.2020.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/09/2020] [Accepted: 05/14/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The use of MRI for radiotherapy planning purposes is growing but image acquisition using radiotherapy set-ups has impaired image quality. Whether differences in image acquisition set-up could modify organ contouring has not been evaluated. Therefore, we aimed to evaluate differences in contouring between paired of image sets that were acquired in the same scanning session using different parameters. MATERIAL AND METHODS Ten patients underwent RT treatment planning with MRI co-registration. MRI was carried out using two different set-ups during the same session, MRI radiotherapy set-ups and MRI diagnostic set-ups. Prostates and rectums were retrospectively contoured in both image sets by 5 radiation oncologists and 4 radiologists. Intra-observer analysis was carried out comparing organ volumes, the Dice coefficient and hausdorff distance values between two contouring rounds. Inter-observer analysis was carried out by comparing individual contours to a generated STAPLE consensus contour, which is considered the gold standard reference. RESULTS No significant differences were observed between MRI acquisition set-ups. Significant differences were observed for the dice and hausdorff parameters, comparing individual contours to the STAPLE consensus contour, when analysing diagnostic images between rounds, although raw values were similar. CONCLUSION Prostate and rectum contours did not differ significantly when using diagnostic or radiotherapy MRI acquisition set-ups.
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Affiliation(s)
- S Sabater
- Department of radiation oncology, Complejo hospitalario universitario de Albacete (CHUA), C/Hnos Falcó 37, 02006 Albacete, Spain.
| | - M R Pastor-Juan
- Department of radiology, Complejo hospitalario universitario de Albacete (CHUA), Albacete, Spain
| | - I Andres
- Department of radiation oncology, Complejo hospitalario universitario de Albacete (CHUA), C/Hnos Falcó 37, 02006 Albacete, Spain
| | - L López-Martinez
- Department of radiology, Complejo hospitalario universitario de Albacete (CHUA), Albacete, Spain
| | - V Lopez-Honrubia
- Department of radiation oncology, Complejo hospitalario universitario de Albacete (CHUA), C/Hnos Falcó 37, 02006 Albacete, Spain
| | - M I Tercero-Azorin
- Department of radiology, Complejo hospitalario universitario de Albacete (CHUA), Albacete, Spain
| | - M Sevillano
- Department of radiation oncology, Complejo hospitalario universitario de Albacete (CHUA), C/Hnos Falcó 37, 02006 Albacete, Spain
| | - E Lozano-Setien
- Department of radiology, Complejo hospitalario universitario de Albacete (CHUA), Albacete, Spain
| | - E Jimenez-Jimenez
- Department of radiation oncology, hospital universitario Santa Lucia, Cartagena, Spain
| | - R Berenguer
- Department of radiation oncology, Complejo hospitalario universitario de Albacete (CHUA), C/Hnos Falcó 37, 02006 Albacete, Spain
| | - A Rovirosa
- Gynecological cancer unit, radiation oncology department, ICMHO, IDIBAPS, university of Barcelona, hospital clinic, Barcelona, Spain
| | - S Castro-Larefors
- Department of radiation oncology, Complejo hospitalario universitario de Albacete (CHUA), C/Hnos Falcó 37, 02006 Albacete, Spain
| | - M Magdalena Marti-Laosa
- Department of radiation oncology, Complejo hospitalario universitario de Albacete (CHUA), C/Hnos Falcó 37, 02006 Albacete, Spain
| | - O Roche
- Laboratorio de oncología, unidad de medicina molecular, unidad asociada de biomedicina UCLM, unidad asociada al CSIC, centro regional de investigaciones biomédicas, universidad de Castilla-La Mancha, Albacete, Spain; Departamento de ciencias médicas, facultad de medicina de Albacete, universidad de Castilla-La Mancha, Albacete, Spain
| | - F Martinez-Terol
- Complejo hospitalario universitario de Albacete (CHUA), Albacete, Spain
| | - M Arenas
- Department of radiation oncology, hospital universitari Sant Joan, Reus, Spain
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11
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Cloak K, Jameson MG, Paneghel A, Wiltshire K, Kneebone A, Pearse M, Sidhom M, Tang C, Fraser‐Browne C, Holloway LC, Haworth A. Contour variation is a primary source of error when delivering post prostatectomy radiotherapy: Results of the Trans‐Tasman Radiation Oncology Group 08.03 Radiotherapy Adjuvant Versus Early Salvage (RAVES) benchmarking exercise. J Med Imaging Radiat Oncol 2019; 63:390-398. [DOI: 10.1111/1754-9485.12884] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/10/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Kirrily Cloak
- South Western Sydney Clinical School University of NSW Sydney New South Wales Australia
- Cancer Therapy Centre Liverpool Hospital Sydney New South Wales Australia
- Ingham Institute of Applied Medical Research Liverpool Hospital Sydney New South Wales Australia
| | - Michael G Jameson
- South Western Sydney Clinical School University of NSW Sydney New South Wales Australia
- Cancer Therapy Centre Liverpool Hospital Sydney New South Wales Australia
- Ingham Institute of Applied Medical Research Liverpool Hospital Sydney New South Wales Australia
| | | | | | - Andrew Kneebone
- University of Sydney Sydney New South Wales Australia
- Royal North Shore Hospital Sydney New South Wales Australia
| | | | - Mark Sidhom
- South Western Sydney Clinical School University of NSW Sydney New South Wales Australia
- Cancer Therapy Centre Liverpool Hospital Sydney New South Wales Australia
| | - Colin Tang
- Sir Charles Gairdner Hospital Perth Western Australia Australia
| | | | - Lois C Holloway
- South Western Sydney Clinical School University of NSW Sydney New South Wales Australia
- Cancer Therapy Centre Liverpool Hospital Sydney New South Wales Australia
- Ingham Institute of Applied Medical Research Liverpool Hospital Sydney New South Wales Australia
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12
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Draulans C, Joniau S, Fonteyne V, Delrue L, Decaestecker K, Everaerts W, Dirix P, Van den Bergh L, Crijns W, Vandendriessche H, Van Wynsberge L, Ost P, Lumen N, Buelens P, Haustermans K, Berghen C, De Meerleer G. Benefits of Elective Para-Aortic Radiotherapy for pN1 Prostate Cancer Using Arc Therapy (Intensity-Modulated or Volumetric Modulated Arc Therapy): Protocol for a Nonrandomized Phase II Trial. JMIR Res Protoc 2018; 7:e11256. [PMID: 30545809 PMCID: PMC6315267 DOI: 10.2196/11256] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In patients with prostate cancer (PCa) with histopathologically proven pelvic lymph node (LN) metastasis (pN1) after extended pelvic lymph node dissection (ePLND), multimodality treatment consisting of treatment of the primary tumor and whole pelvic radiotherapy (WPRT) combined with androgen deprivation therapy (ADT) offers promising results, leading to better cause-specific survival rates compared with ADT alone. However, in case more than one pelvic LN is invaded by the tumor, approximately 40% of the patients relapse biochemically and clinically. Clinical relapse is present in the para-aortic LNs (M1a disease) in up to 77% of the relapsing cases. OBJECTIVE We hypothesize that, based on the evidence that positive LNs represent the door to hematogenous dissemination, elective para-aortic irradiation will reduce the development of both retroperitoneal nodal (M1a) and distant metastasis (M1b or M1c disease), postpone the need for palliative ADT, and prolong the time to castration-refractory disease. METHODS To test this hypothesis, we will conduct a prospective, nonrandomized phase II trial to study the efficacy of additional elective para-aortic radiotherapy (PART) in pN1 patients compared with those who were historically treated with adjuvant WPRT alone. We aim to include 137 patients with PCa and presence of pN1 disease after ePLND. With this number of patients, an improvement of 15% in the 5-year clinical relapse-free survival can be detected with a power of 80%. RESULTS Recruitment of patients for this trial started in 2017 and will be completed approximately by March 2020. CONCLUSIONS This is the first phase II trial to investigate the benefits of an elective PART in patients with PCa. The results of this trial will potentially serve as a sound base for a later randomized phase III trial. All participants are given a PART information sheet and required to give written informed consent. Results are expected to be published in a peer-reviewed journal. TRIAL REGISTRATION ClinicalTrials.gov NCT03079323; https://clinicaltrials.gov/ct2/show/NCT03079323 (Archived by WebCite at http://www.webcitation.org/73ELimv1d). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/11256.
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Affiliation(s)
- Cédric Draulans
- Department of Radiation Oncology, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Valérie Fonteyne
- Department of Radiation Oncology, Ghent University Hospital, University of Ghent, Ghent, Belgium
| | - Louke Delrue
- Department of Radiology, Ghent University Hospital, University of Ghent, Ghent, Belgium
| | - Karel Decaestecker
- Department of Urology, Ghent University Hospital, University of Ghent, Ghent, Belgium
| | - Wouter Everaerts
- Department of Urology, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Piet Dirix
- Department of Radiation Oncology, Iridium Cancer Network, Wilrijk, Antwerp, Belgium
| | | | - Wouter Crijns
- Department of Radiation Oncology, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | | | | | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital, University of Ghent, Ghent, Belgium
| | - Nicolaas Lumen
- Department of Urology, Ghent University Hospital, University of Ghent, Ghent, Belgium
| | - Pieterjan Buelens
- Department of Radiation Oncology, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Charlien Berghen
- Department of Radiation Oncology, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Gert De Meerleer
- Department of Radiation Oncology, University Hospitals Leuven, University of Leuven, Leuven, Belgium
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13
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Salembier C, Villeirs G, De Bari B, Hoskin P, Pieters BR, Van Vulpen M, Khoo V, Henry A, Bossi A, De Meerleer G, Fonteyne V. ESTRO ACROP consensus guideline on CT- and MRI-based target volume delineation for primary radiation therapy of localized prostate cancer. Radiother Oncol 2018; 127:49-61. [PMID: 29496279 DOI: 10.1016/j.radonc.2018.01.014] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 01/22/2018] [Accepted: 01/22/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Delineation of clinical target volumes (CTVs) remains a weak link in radiation therapy (RT), and large inter-observer variation is seen. Guidelines for target and organs at risk delineation for prostate cancer in the primary setting are scarce. The aim was to develop a delineation guideline obtained by consensus between a broad European group of radiation oncologists. MATERIAL AND METHODS An ESTRO contouring consensus panel consisting of leading radiation oncologists and one radiologist with known subspecialty expertise in prostate cancer was asked to delineate the prostate, seminal vesicles and rectum on co-registered CT and MRI scans. After evaluation of the different contours, literature review and multiple informal discussions by electronic mail a CTV definition was defined and a guide for contouring the CTV of the prostate and the rectum was developed. RESULTS The panel achieved consensus CTV contouring definitions to be used as guideline for primary RT of localized prostate cancer. CONCLUSION The ESTRO consensus on CT/MRI based CTV delineation for primary RT of localized prostate cancer, endorsed by a broad base of the radiation oncology community, is presented to improve consistency and reliability.
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Affiliation(s)
- Carl Salembier
- Department of Radiation Oncology, Europe Hospitals Brussels, Belgium
| | - Geert Villeirs
- Department of Radiology, Ghent University Hospital, Belgium
| | | | - Peter Hoskin
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Bradley R Pieters
- Department of Radiation Oncology, Academic Medical Center/University of Amsterdam, The Netherlands
| | - Marco Van Vulpen
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
| | - Vincent Khoo
- Department of Clinical Oncology, Royal Marsden Hospital, London, United Kingdom
| | - Ann Henry
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, United Kingdom
| | - Alberto Bossi
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Gert De Meerleer
- Department of Radiation Oncology, University Hospital Leuven, Belgium
| | - Valérie Fonteyne
- Department of Radiation Oncology, Ghent University Hospital, Belgium.
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14
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Garibaldi C, Fodor C, Riva G, Rojas DP, Dicuonzo S, Pace E, Fanetti G, De Marco P, Dell'acqua V, Marvaso G, Leonardi MC, Lazzari R, Cattani F, Cremonesi M, Orecchia R, Jereczek-Fossa BA. Cone-beam CT-based inter-fraction localization errors for tumors in the pelvic region. Phys Med 2018. [PMID: 29519410 DOI: 10.1016/j.ejmp.2018.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate inter-fraction tumor localization errors (TE) in the RapidArc® treatment of pelvic cancers based on CBCT. Appropriate CTV-to PTV margins in a non-IGRT scenario have been proposed. METHODS Data of 928 patients with prostate, gynecological, and rectum/anal canal cancers were retrospectively analyzed to determine systematic and random localization errors. Two protocols were used: daily online IGRT (d-IGRT) and weekly IGRT. The latter consisted in acquiring a CBCT for the first 3 fractions and subsequently once a week. TE for patients who underwent d-IGRT protocol were calculated using either all CBCTs or the first 3. RESULTS The systematic (and random) TE in the AP, LL, and SI direction were: for prostate bed 2.7(3.2), 2.3(2.8) and 1.9(2.2) mm; for prostate 4.2(3.1), 2.9(2.8) and 2.3(2.2) mm; for gynecological 3.0(3.6), 2.4(2.7) and 2.3(2.5) mm; for rectum 2.8(2.8), 2.4(2.8) and 2.3(2.5) mm; for anal canal 3.1(3.3), 2.1(2.5) and 2.2(2.7) mm. CTV-to-PTV margins determined from all CBCTs were 14 mm in the AP, 10 mm in the LL and 9-9.5 mm in the SI directions for the prostate and the gynecological groups and 9.5-10.5 mm in AP, 9 mm in LL and 8-10 mm in the SI direction for the prostate bed and the rectum/anal canal groups. If assessed on the basis of the first 3 CBCTs, the calculated CTV-to-PTV margins were slightly larger. CONCLUSIONS without IGRT, large CTV-to-PTV margins up to 15 mm are required to account for inter-fraction tumor localization errors. Daily IGRT should be used for all hypo-fractionated treatments to reduce margins and avoid increased toxicity to critical organs.
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Affiliation(s)
| | - Cristiana Fodor
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Giulia Riva
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | - Damaris Patricia Rojas
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | - Samantha Dicuonzo
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Elisa Pace
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Giuseppe Fanetti
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Paolo De Marco
- Medical Physic Unit, European Institute of Oncology, Milano, Italy
| | - Veronica Dell'acqua
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | | | - Roberta Lazzari
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Federica Cattani
- Medical Physic Unit, European Institute of Oncology, Milano, Italy
| | - Marta Cremonesi
- Radiation Research Unit, European Institute of Oncology, Milano, Italy
| | - Roberto Orecchia
- Scientific Director, European Institute of Oncology, Milano, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
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15
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Roach D, Jameson MG, Dowling JA, Ebert MA, Greer PB, Kennedy AM, Watt S, Holloway LC. Correlations between contouring similarity metrics and simulated treatment outcome for prostate radiotherapy. ACTA ACUST UNITED AC 2018; 63:035001. [DOI: 10.1088/1361-6560/aaa50c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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16
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Kristensen I, Nilsson K, Agrup M, Belfrage K, Embring A, Haugen H, Svärd AM, Knöös T, Nilsson P. A dose based approach for evaluation of inter-observer variations in target delineation. Tech Innov Patient Support Radiat Oncol 2017; 3-4:41-47. [PMID: 32095566 PMCID: PMC7033785 DOI: 10.1016/j.tipsro.2017.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Substantial inter-observer variations in target delineation have been presented previously. Target delineation for paediatric cases is difficult due to the small number of children, the variation in paediatric targets, the number of study protocols, and the individual patient's specific needs and demands. Uncertainties in target delineation might lead to under-dosage or over-dosage. The aim of this work is to apply the concept of a consensus volume and good quality treatment plans to visualise and quantify inter-observer target delineation variations in dosimetric terms in addition to conventional geometrically based volume concordance indices. MATERIAL AND METHODS Two paediatric cases were used to demonstrate the potential of adding dose metrics when evaluating target delineation diversity; Hodgkin's disease (case 1) and rhabdomyosarcoma of the parotid gland (case 2). The variability in target delineation (PTV delineations) between six centres was quantified using the generalised conformity index, CIgen, generated for volume overlap. The STAPLE algorithm, as implemented in CERR, was used for both cases to derive a consensus volumes. STAPLE is a probabilistic estimate of the true volume generated from all observers. Dose distributions created by each centre for the original target volumes were then applied to this consensus volume. RESULTS A considerable variation in target segmentation was seen in both cases. For case 1 the variation was 374-960 cm3 (average 669 cm3) and for case 2; 65-126 cm3 (average 109 cm3). CIgen were 0.53 and 0.70, respectively. The DVHs in absolute volume displayed for the delineated target volume as well as for the consensus volume adds information on both "compliant" target volumes as well as outliers which are hidden with just the use of concordance indices. CONCLUSIONS The DVHs in absolute volume add valuable and easily understood information to various indices for evaluating uniformity in target delineation.
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Affiliation(s)
- Ingrid Kristensen
- Department of Oncology, Clinical Sciences, Lund University, Lund, Sweden
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Kristina Nilsson
- Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology, Clinical Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Måns Agrup
- Department of Oncology, Linköping University Hospital, Linköping, Sweden
| | - Karin Belfrage
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Anna Embring
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Hedda Haugen
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna-Maja Svärd
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Tommy Knöös
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Department of Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden
| | - Per Nilsson
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Department of Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden
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17
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Lipman D, Pieters BR, De Reijke TM. Improving postoperative radiotherapy following radical prostatectomy. Expert Rev Anticancer Ther 2017; 17:925-937. [PMID: 28787182 DOI: 10.1080/14737140.2017.1364994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Prostate cancer has one of the highest incidences in the world, with good curative treatment options like radiotherapy and radical prostatectomy. Unfortunately, about 30% of the patients initially treated with curative intent will develop a recurrence and need adjuvant treatment. Five randomized trials covered the role of postoperative radiotherapy after radical prostatectomy, but there is still a lot of debate about which patients should receive postoperative radiotherapy. Areas covered: This review will give an overview on the available literature concerning post-operative radiotherapy following radical prostatectomy with an emphasis on the five randomized trials. Also, new imaging techniques like prostate-specific membrane antigen positron emission tomography (PSMA-PET) and multiparametric magnetic resonance imaging (mp-MRI) and the development of biomarkers like genomic classifiers will be discussed in the search for an improved selection of patients who will benefit from postoperative radiotherapy following radical prostatectomy. With new treatment techniques like Intensity Modulated Radiotherapy, toxicity profiles will be kept low. Expert commentary: Patients with biochemical recurrence following radical prostatectomy with an early rise in prostate-specific antigen (PSA) will benefit most from postoperative radiotherapy. In this way, patients with only high risk pathological features can avoid unnecessary treatment and toxicity, and early intervention in progressing patients would not compromise the outcome.
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Affiliation(s)
- D Lipman
- a Department of Radiation Oncology , Academic Medical Center/University of Amsterdam , Amsterdam , The Netherlands
| | - B R Pieters
- a Department of Radiation Oncology , Academic Medical Center/University of Amsterdam , Amsterdam , The Netherlands
| | - Theo M De Reijke
- b Department of Urology , Academic Medical Center/University of Amsterdam , Amsterdam , The Netherlands
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18
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Latorzeff I, Sargos P, Loos G, Supiot S, Guerif S, Carrie C. Delineation of the Prostate Bed: The "Invisible Target" Is Still an Issue? Front Oncol 2017; 7:108. [PMID: 28620579 PMCID: PMC5449739 DOI: 10.3389/fonc.2017.00108] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 05/10/2017] [Indexed: 11/13/2022] Open
Abstract
For pathological high-risk prostate cancer, adjuvant irradiation has shown a survival benefit. Phase III studies have highlighted that half men would face biochemical relapse and would be candidate for radiotherapy at adjuvant or salvage times. Despite at least four published international contouring guidelines from different collaborative groups, discrepancies remain for volumes, delineation, and margins to be considered in order to optimize radiotherapy planning. This article from “Groupe d’Etude des Tumeurs UroGénitales (GETUG)” members will focus on controversies to help clinicians to create best volume delineation for adjuvant or salvage post prostatectomy radiotherapy.
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Affiliation(s)
- Igor Latorzeff
- Department of Oncology Radiotherapy, Bât Atrium, Clinique Pasteur, Toulouse, France
| | - Paul Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
| | - Geneviève Loos
- Department of Radiotherapy, Centre Jean-Perrin, Clermont-Ferrand, France
| | - Stéphane Supiot
- Department of Radiotherapy, Institut de Cancérologie de L'Ouest René Gauducheau, Nantes, France
| | - Stéphane Guerif
- Department of Radiotherapy, CHU de Poitiers, Poitiers, France
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19
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Dirix P, van Walle L, Deckers F, Van Mieghem F, Buelens G, Meijnders P, Huget P, Van Laere S. Proposal for magnetic resonance imaging-guided salvage radiotherapy for prostate cancer. Acta Oncol 2017; 56:27-32. [PMID: 27587084 DOI: 10.1080/0284186x.2016.1223342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND A subset of patients experience a biochemical recurrence following radical prostatectomy. Radiotherapy can salvage those patients, provided that all disease is encompassed within the target volume. We hypothesized that this can be achieved more adequately with magnetic resonance imaging (MRI)-guided treatment planning. MATERIAL AND METHODS From January 2009 to April 2014, 183 patients were referred to our department for salvage radiotherapy (SRT). According to protocol, patients received a planning computed tomography (CT) as well as an MRI in treatment position. All MRI scans were retrospectively reviewed by an experienced uro-radiologist. RESULTS Median prostate-specific antigen (PSA) value at time of referral was 0.3 ng/ml (range 0.02-4.7 ng/ml). MRI did not show any suspected macroscopic disease in 137 patients (75%). In 46 (25%) patients, MRI did indicate a pelvic recurrence. The mean PSA level was significantly higher in patients with a suspected recurrence on MRI (0.4 vs. 1.4 ng/ml, p < .001) on a Student's t-test. The mean follow-up was 33 months (range 5-69 months). Biochemical disease-free survival (bDFS) was significantly worse in patients with suspected disease on MRI [hazard ratio (HR) 2.9, p < .0001]. bDFS was significantly worse in the subgroup where the macroscopic recurrences on MRI received a lower radiation dose (HR 3.4, p = .01). CONCLUSION MRI detects loco-regional disease in a substantial subset of patients with a biochemical recurrence after prostatectomy, especially in a PSA above 0.5 μg/l. Lack of MRI-based dose escalation on these macroscopic recurrences could explain some of the biochemical progression observed after SRT.
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Affiliation(s)
- Piet Dirix
- Department of Radiation Oncology, Iridium Cancer Network, Wilrijk, Antwerp, Belgium
- Center for Oncological Research, Molecular Imaging, Pathology, Radiotherapy & Oncology (MIPRO), Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Antwerp, Belgium
| | - Lien van Walle
- Department of Radiation Oncology, Iridium Cancer Network, Wilrijk, Antwerp, Belgium
| | - Filip Deckers
- Department of Radiology, GZA St Augustinus, Wilrijk, Antwerp, Belgium
| | | | - Guido Buelens
- Department of Radiation Oncology, Iridium Cancer Network, Wilrijk, Antwerp, Belgium
| | - Paul Meijnders
- Department of Radiation Oncology, Iridium Cancer Network, Wilrijk, Antwerp, Belgium
- Center for Oncological Research, Molecular Imaging, Pathology, Radiotherapy & Oncology (MIPRO), Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Antwerp, Belgium
| | - Philippe Huget
- Department of Radiation Oncology, Iridium Cancer Network, Wilrijk, Antwerp, Belgium
| | - Steven Van Laere
- Center for Oncological Research, Molecular Imaging, Pathology, Radiotherapy & Oncology (MIPRO), Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Antwerp, Belgium
- Translational Cancer Research Unit (TRCU), Iridium Cancer Network, Wilrijk, Antwerp, Belgium
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Zaorsky NG, Showalter TN, Ezzell GA, Nguyen PL, Assimos DG, D'Amico AV, Gottschalk AR, Gustafson GS, Keole SR, Liauw SL, Lloyd S, McLaughlin PW, Movsas B, Prestidge BR, Taira AV, Vapiwala N, Davis BJ. ACR Appropriateness Criteria ® external beam radiation therapy treatment planning for clinically localized prostate cancer, part I of II. Adv Radiat Oncol 2016; 2:62-84. [PMID: 28740916 PMCID: PMC5514238 DOI: 10.1016/j.adro.2016.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/12/2016] [Indexed: 12/24/2022] Open
Affiliation(s)
| | | | | | - Gary A Ezzell
- Mayo Clinic, Phoenix, Arizona (research author, contributing)
| | - Paul L Nguyen
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts (panel vice-chair)
| | - Dean G Assimos
- University of Alabama School of Medicine, Birmingham, Alabama (American Urological Association)
| | - Anthony V D'Amico
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts (American Society of Clinical Oncology)
| | | | | | | | | | - Shane Lloyd
- Huntsman Cancer Hospital, Salt Lake City, Utah
| | | | | | | | - Al V Taira
- Mills Peninsula Hospital, San Mateo, California
| | - Neha Vapiwala
- University of Pennsylvania, Philadelphia, Pennsylvania
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Vinod SK, Jameson MG, Min M, Holloway LC. Uncertainties in volume delineation in radiation oncology: A systematic review and recommendations for future studies. Radiother Oncol 2016; 121:169-179. [PMID: 27729166 DOI: 10.1016/j.radonc.2016.09.009] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/27/2016] [Accepted: 09/25/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Volume delineation is a well-recognised potential source of error in radiotherapy. Whilst it is important to quantify the degree of interobserver variability (IOV) in volume delineation, the resulting impact on dosimetry and clinical outcomes is a more relevant endpoint. We performed a literature review of studies evaluating IOV in target volume and organ-at-risk (OAR) delineation in order to analyse these with respect to the metrics used, reporting of dosimetric consequences, and use of statistical tests. METHODS AND MATERIALS Medline and Pubmed databases were queried for relevant articles using keywords. We included studies published in English between 2000 and 2014 with more than two observers. RESULTS 119 studies were identified covering all major tumour sites. CTV (n=47) and GTV (n=38) were most commonly contoured. Median number of participants and data sets were 7 (3-50) and 9 (1-132) respectively. There was considerable heterogeneity in the use of metrics and methods of analysis. Statistical analysis of results was reported in 68% (n=81) and dosimetric consequences in 21% (n=25) of studies. CONCLUSION There is a lack of consistency in conducting and reporting analyses from IOV studies. We suggest a framework to use for future studies evaluating IOV.
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Affiliation(s)
- Shalini K Vinod
- Cancer Therapy Centre, Liverpool Hospital, Australia; South Western Sydney Clinical School, University of New South Wales, Australia; Western Sydney University, Australia.
| | - Michael G Jameson
- Cancer Therapy Centre, Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research, Liverpool Hospital, Australia; Centre for Medical Radiation Physics, University of Wollongong, Australia
| | - Myo Min
- Cancer Therapy Centre, Liverpool Hospital, Australia; South Western Sydney Clinical School, University of New South Wales, Australia; Ingham Institute of Applied Medical Research, Liverpool Hospital, Australia
| | - Lois C Holloway
- Cancer Therapy Centre, Liverpool Hospital, Australia; South Western Sydney Clinical School, University of New South Wales, Australia; Ingham Institute of Applied Medical Research, Liverpool Hospital, Australia; Centre for Medical Radiation Physics, University of Wollongong, Australia
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Target volume definition for post prostatectomy radiotherapy: Do the consensus guidelines correctly define the inferior border of the CTV? Rep Pract Oncol Radiother 2016; 21:525-31. [PMID: 27656107 DOI: 10.1016/j.rpor.2016.07.003] [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: 11/19/2015] [Revised: 04/01/2016] [Accepted: 07/03/2016] [Indexed: 11/22/2022] Open
Abstract
AIM We compare urethrogram delineation of the caudal aspect of the anastomosis to the recommended guidelines of post prostatectomy radiotherapy. BACKGROUND Level one evidence has established the indications for, and importance of, adjuvant radiotherapy following radical prostatectomy. Several guidelines have recently addressed delineation of the prostate bed target volume including identification of the vesico-urethral anastomosis, taken as the first CT slice caudal to visible urine in the bladder neck. The inferior border of clinical target volume is then variably defined 5-12 mm below this anastomosis or 15 mm cranial to the penile bulb. METHODS AND MATERIALS Thirty-three patients who received adjuvant radiotherapy following radical prostatectomy were reviewed. All underwent planning CT with urethrogram. The authors (MM, JC) independently identified the CT slice caudal to the last slice showing urine in the bladder neck (called the CT Reference Slice), and measured the distance between this and the tip of the urethrogram cone. Five patients also had a diagnostic MRI at the time of CT planning to better visualize the anatomy. RESULTS Sixty-six readings were obtained. The mean distance between the Bladder CT Reference Slice and the most cranial urethrogram contrast slice was 16.1 mm (MM 16.4 mm, JC 15.8 mm), range: 6.8-34.2 mm. The mean distance between the urethrogram tip and the ischial tuberosities was 19.9 mm (range 12.5-29.8 mm). The mean distance between the CT Reference Slice and the ischial tuberosities was 36.9 mm (range 28.3-52.4 mm). CONCLUSIONS Guidelines for prostate bed radiation post prostatectomy have been developed after publication of the trials proving benefit of such treatment, and are thus untested. The anastomosis is a frequent site of local relapse but is variably defined by the existing guidelines, none of which take into account anatomic patient variation and all of which are at variance with urethrogram data. We recommend the use of planning urethrogram to better delineate the vesico-urethral junction and minimize the potential for geographic misses.
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Delpon G, Escande A, Ruef T, Darréon J, Fontaine J, Noblet C, Supiot S, Lacornerie T, Pasquier D. Comparison of Automated Atlas-Based Segmentation Software for Postoperative Prostate Cancer Radiotherapy. Front Oncol 2016; 6:178. [PMID: 27536556 PMCID: PMC4971890 DOI: 10.3389/fonc.2016.00178] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/19/2016] [Indexed: 11/17/2022] Open
Abstract
Automated atlas-based segmentation (ABS) algorithms present the potential to reduce the variability in volume delineation. Several vendors offer software that are mainly used for cranial, head and neck, and prostate cases. The present study will compare the contours produced by a radiation oncologist to the contours computed by different automated ABS algorithms for prostate bed cases, including femoral heads, bladder, and rectum. Contour comparison was evaluated by different metrics such as volume ratio, Dice coefficient, and Hausdorff distance. Results depended on the volume of interest showed some discrepancies between the different software. Automatic contours could be a good starting point for the delineation of organs since efficient editing tools are provided by different vendors. It should become an important help in the next few years for organ at risk delineation.
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Affiliation(s)
- Grégory Delpon
- Medical Physics Department, Institut de Cancérologie de l'Ouest, Centre René Gauducheau , Saint Herblain , France
| | - Alexandre Escande
- Radiation Oncology Department, Centre Oscar Lambret , Lille , France
| | - Timothée Ruef
- Medical Physics Department, SELARL d'imagerie médicale et de cancérologie du Pont Saint Vaast , Douai , France
| | - Julien Darréon
- Medical Physics Department, Institut Paoli-Calmettes , Marseille , France
| | - Jimmy Fontaine
- Medical Physics Department, Institut de Cancérologie de l'Ouest, Centre René Gauducheau , Saint Herblain , France
| | - Caroline Noblet
- Medical Physics Department, Institut de Cancérologie de l'Ouest, Centre René Gauducheau , Saint Herblain , France
| | - Stéphane Supiot
- Radiotherapy Department, Institut de Cancérologie de l'Ouest, Centre René Gauducheau , Saint Herblain , France
| | | | - David Pasquier
- Radiation Oncology Department, Centre Oscar Lambret, Lille, France; CRISTAL UMR CNRS 9189, Lille University, Lille, France
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Swisher-McClure S, Yin L, Rosen M, Batra S, Berman AT, Both S, Vapiwala N. Prospective MRI-based imaging study to assess feasibility of proton therapy for post-prostatectomy radiation. Acta Oncol 2016; 55:828-33. [PMID: 27145164 DOI: 10.3109/0284186x.2016.1161826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE/OBJECTIVES To optimize delivery of post-prostatectomy radiation (PPRT) with protons by examining dosimetric effects of variations in physician contouring, organ motion, and patient alignment during a course of PPRT. MATERIAL AND METHODS We enrolled 10 patients receiving PPRT in a prospective imaging study. All patients underwent combined computed tomography (CT)/magnetic resonance imaging (MRI) simulation with endorectal balloon (ERB) and received intensity modulated radiation therapy (IMRT) per institutional standards. Study patients underwent weekly MRI verification scans in the treatment position. Three radiation oncologists contoured clinical target volumes (CTV) on initial and verification scans using two consensus guidelines (RTOG and EORTC). We generated IMRT, double scattering (DS), and pencil beam scanning (PBS) proton plans and examined the dosimetric impact of contour variations, inter-fraction motion, and patient alignment techniques. RESULTS Inter-observer variations in contouring reduced median CTV coverage (D100) by 0.9% for IMRT plans, 2.8% for DS proton plans, 3.4-4.9% for PBS Proton Plans. Inter-fraction changes in target volumes due to internal organ motion resulted in a median loss of target dose coverage (D98) of 0% with IMRT, 3.5% with DS, and 8.1-8.3% with PBS. Median bladder V65Gy increased during the treatment course with all techniques (6.0-7.5%). Changes in the median rectal V60Gy remained small regardless of the treatment technique (0.5-3.1% increase). Alignment to the ERB after cranio-caudal bony alignment reduced CTV displacement compared to bony alignment alone, and as a result CTV coverage (D98) changed <2% with IMRT, DS, and PBS. CONCLUSION Proton-based treatments are more sensitive to changes in inter-fraction organ motion during PPRT compared to IMRT, and therefore motion management and patient alignment methods are critical. Patient alignment using bony anatomy as well as the ERB minimizes displacement of the CTV, and reduces variation in target dose coverage particularly for PBS proton therapy.
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Affiliation(s)
- Samuel Swisher-McClure
- Department of Radiation Oncology Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Lingshu Yin
- Department of Radiation Oncology Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Mark Rosen
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Sonny Batra
- Department of Radiation Oncology Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Abigail T. Berman
- Department of Radiation Oncology Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Stefan Both
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Neha Vapiwala
- Department of Radiation Oncology Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
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25
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Vinod SK, Min M, Jameson MG, Holloway LC. A review of interventions to reduce inter-observer variability in volume delineation in radiation oncology. J Med Imaging Radiat Oncol 2016; 60:393-406. [DOI: 10.1111/1754-9485.12462] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/16/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Shalini K Vinod
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- South Western Sydney Clinical School; University of NSW; Sydney New South Wales Australia
- Western Sydney University; Sydney New South Wales Australia
| | - Myo Min
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- South Western Sydney Clinical School; University of NSW; Sydney New South Wales Australia
| | - Michael G Jameson
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- Ingham Institute of Applied Medical Research; Liverpool Hospital; Liverpool New South Wales Australia
- Centre for Medical Radiation Physics; University of Wollongong; Wollongong New South Wales Australia
| | - Lois C Holloway
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- South Western Sydney Clinical School; University of NSW; Sydney New South Wales Australia
- Western Sydney University; Sydney New South Wales Australia
- Ingham Institute of Applied Medical Research; Liverpool Hospital; Liverpool New South Wales Australia
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26
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Barkati M, Simard D, Taussky D, Delouya G. Magnetic resonance imaging for prostate bed radiotherapy planning: An inter- and intra-observer variability study. J Med Imaging Radiat Oncol 2015; 60:255-9. [DOI: 10.1111/1754-9485.12416] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 10/10/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Maroie Barkati
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame; Montreal Québec Canada
| | - Dany Simard
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame; Montreal Québec Canada
| | - Daniel Taussky
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame; Montreal Québec Canada
| | - Guila Delouya
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame; Montreal Québec Canada
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Croke J, Maclean J, Nyiri B, Li Y, Malone K, Avruch L, Kayser C, Malone S. Proposal of a post-prostatectomy clinical target volume based on pre-operative MRI: volumetric and dosimetric comparison to the RTOG guidelines. Radiat Oncol 2014; 9:303. [PMID: 25534278 PMCID: PMC4307684 DOI: 10.1186/s13014-014-0303-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 12/14/2014] [Indexed: 12/15/2022] Open
Abstract
Background Recurrence rates following radiotherapy for prostate cancer in the post-operative adjuvant or salvage setting remain substantial. Previous work from our institution demonstrated that published prostate bed CTV guidelines frequently do not cover the pre-operative MRI defined prostate. Inadequate target delineation may contribute to the high recurrence rates, but increasing target volumes may increase dose to organs at risk. Methods We propose guidelines for delineating post-prostatectomy target volumes based upon an individual’s co-registered pre-operative MRI. MRI-based CTVs and PTVs were compared to those created using the RTOG guidelines in 30 patients. Contours were analysed in terms of absolute volume, intersection volume (Jaccard Index) and the ability to meet the RADICALS and QUANTEC rectal and bladder constraints (tomotherapy IMRT plans with PTV coverage of V98% ≥98%). Results CTV MRI was a mean of 18.6% larger than CTV RTOG: CTV MRI mean 138 cc (range 72.3 - 222.2 cc), CTV RTOG mean 116.3 cc (range 62.1 - 176.6 cc), (p < 0.0001). The difference in mean PTV was only 4.6%: PTV MRI mean 386.9 cc (range 254.4 – 551.2), PTV RTOG mean 370 cc (range 232.3 - 501.6) (p = 0.05). The mean Jaccard Index representing intersection volume between CTVs was 0.72 and 0.84 for PTVs. Both criteria had a similar ability to meet rectal and bladder constraints. Rectal DVH: 77% of CTV RTOG cases passed all RADICALS criteria and 37% all QUANTEC criteria; versus 73% and 40% for CTV MRI (p = 1.0 for both). Bladder DVH; 47% of CTV RTOG cases passed all RADICALS criteria and 67% all QUANTEC criteria, versus 57% and 60% for CTV MRI (p = 0.61for RADICALS, p = 0.79 for QUANTEC). CTV MRI spares more of the lower anterior bladder wall than CTV RTOG but increases coverage of the superior lateral bladder walls. Conclusion CTV contours based upon the patient’s co-registered pre-operative MRI in the post-prostatectomy setting may improve coverage of the individual’s prostate bed without substantially increasing the PTV size or dose to bladder/ rectum compared to RTOG CTV guidelines. Further evaluation of whether the use of pre-operative MRI improves local control rates is warranted.
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Affiliation(s)
- Jennifer Croke
- The Ottawa Hospital Cancer Centre, K1H 8 L6, Ottawa, Ontario, Canada.
| | - Jillian Maclean
- The Ottawa Hospital Cancer Centre, K1H 8 L6, Ottawa, Ontario, Canada.
| | - Balazs Nyiri
- The Ottawa Hospital Cancer Centre, K1H 8 L6, Ottawa, Ontario, Canada.
| | - Yan Li
- The Ottawa Hospital Cancer Centre, K1H 8 L6, Ottawa, Ontario, Canada.
| | - Kyle Malone
- The Ottawa Hospital Cancer Centre, K1H 8 L6, Ottawa, Ontario, Canada.
| | - Leonard Avruch
- The Ottawa Hospital Cancer Centre, K1H 8 L6, Ottawa, Ontario, Canada.
| | - Cathleen Kayser
- The Ottawa Hospital Cancer Centre, K1H 8 L6, Ottawa, Ontario, Canada.
| | - Shawn Malone
- The Ottawa Hospital Cancer Centre, K1H 8 L6, Ottawa, Ontario, Canada.
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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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Van de Velde J, Vercauteren T, De Gersem W, Wouters J, Vandecasteele K, Vuye P, Vanpachtenbeke F, D’Herde K, Kerckaert I, De Neve W, Van Hoof T. Reliability and accuracy assessment of radiation therapy oncology group-endorsed guidelines for brachial plexus contouring. Strahlenther Onkol 2014; 190:628-32, 634-5. [DOI: 10.1007/s00066-014-0657-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 03/11/2014] [Indexed: 12/25/2022]
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Impact of delineation uncertainties on dose to organs at risk in CT-guided intracavitary brachytherapy. Brachytherapy 2014; 13:210-8. [DOI: 10.1016/j.brachy.2013.08.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 07/30/2013] [Accepted: 08/22/2013] [Indexed: 11/23/2022]
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Sassowsky M, Gut P, Hölscher T, Hildebrandt G, Müller AC, Najafi Y, Kohler G, Kranzbühler H, Guckenberger M, Zwahlen DR, Azinwi NC, Plasswilm L, Takacs I, Reuter C, Sumila M, Manser P, Ost P, Böhmer D, Pilop C, Aebersold DM, Ghadjar P. Use of EORTC target definition guidelines for dose-intensified salvage radiation therapy for recurrent prostate cancer: results of the quality assurance program of the randomized trial SAKK 09/10. Int J Radiat Oncol Biol Phys 2013; 87:534-41. [PMID: 23972722 DOI: 10.1016/j.ijrobp.2013.06.2053] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 06/18/2013] [Accepted: 06/22/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE Different international target volume delineation guidelines exist and different treatment techniques are available for salvage radiation therapy (RT) for recurrent prostate cancer, but less is known regarding their respective applicability in clinical practice. METHODS AND MATERIALS A randomized phase III trial testing 64 Gy vs 70 Gy salvage RT was accompanied by an intense quality assurance program including a site-specific and study-specific questionnaire and a dummy run (DR). Target volume delineation was performed according to the European Organisation for the Research and Treatment of Cancer guidelines, and a DR-based treatment plan was established for 70 Gy. Major and minor protocol deviations were noted, interobserver agreement of delineated target contours was assessed, and dose-volume histogram (DVH) parameters of different treatment techniques were compared. RESULTS Thirty European centers participated, 43% of which were using 3-dimensional conformal RT (3D-CRT), with the remaining centers using intensity modulated RT (IMRT) or volumetric modulated arc technique (VMAT). The first submitted version of the DR contained major deviations in 21 of 30 (70%) centers, mostly caused by inappropriately defined or lack of prostate bed (PB). All but 5 centers completed the DR successfully with their second submitted version. The interobserver agreement of the PB was moderate and was improved by the DR review, as indicated by an increased κ value (0.59 vs 0.55), mean sensitivity (0.64 vs 0.58), volume of total agreement (3.9 vs 3.3 cm(3)), and decrease in the union volume (79.3 vs 84.2 cm(3)). Rectal and bladder wall DVH parameters of IMRT and VMAT vs 3D-CRT plans were not significantly different. CONCLUSIONS The interobserver agreement of PB delineation was moderate but was improved by the DR. Major deviations could be identified for the majority of centers. The DR has improved the acquaintance of the participating centers with the trial protocol.
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Affiliation(s)
- Manfred Sassowsky
- Department of Radiation Oncology and Division of Medical Radiation Physics, Bern University Hospital, Switzerland
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Quality assurance of the EORTC 22043-30041 trial in post-operative radiotherapy in prostate cancer: Results of the Dummy Run procedure. Radiother Oncol 2013; 107:346-51. [DOI: 10.1016/j.radonc.2013.04.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 03/20/2013] [Accepted: 04/27/2013] [Indexed: 11/13/2022]
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Hellebust TP, Tanderup K, Lervåg C, Fidarova E, Berger D, Malinen E, Pötter R, Petrič P. Dosimetric impact of interobserver variability in MRI-based delineation for cervical cancer brachytherapy. Radiother Oncol 2013; 107:13-9. [DOI: 10.1016/j.radonc.2012.12.017] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 12/22/2012] [Accepted: 12/29/2012] [Indexed: 10/27/2022]
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Technology assessment of automated atlas based segmentation in prostate bed contouring. Radiat Oncol 2011; 6:110. [PMID: 21906279 PMCID: PMC3180272 DOI: 10.1186/1748-717x-6-110] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 09/09/2011] [Indexed: 11/17/2022] Open
Abstract
Background Prostate bed (PB) contouring is time consuming and associated with inter-observer variability. We evaluated an automated atlas-based segmentation (AABS) engine in its potential to reduce contouring time and inter-observer variability. Methods An atlas builder (AB) manually contoured the prostate bed, rectum, left femoral head (LFH), right femoral head (RFH), bladder, and penile bulb of 75 post-prostatectomy cases to create an atlas according to the recent RTOG guidelines. 5 other Radiation Oncologists (RO) and the AABS contoured 5 new cases. A STAPLE contour for each of the 5 patients was generated. All contours were anonymized and sent back to the 5 RO to be edited as clinically necessary. All contouring times were recorded. The dice similarity coefficient (DSC) was used to evaluate the unedited- and edited- AABS and inter-observer variability among the RO. Descriptive statistics, paired t-tests and a Pearson correlation were performed. ANOVA analysis using logit transformations of DSC values was calculated to assess inter-observer variability. Results The mean time for manual contours and AABS was 17.5- and 14.1 minutes respectively (p = 0.003). The DSC results (mean, SD) for the comparison of the unedited-AABS versus STAPLE contours for the PB (0.48, 0.17), bladder (0.67, 0.19), LFH (0.92, 0.01), RFH (0.92, 0.01), penile bulb (0.33, 0.25) and rectum (0.59, 0.11). The DSC results (mean, SD) for the comparison of the edited-AABS versus STAPLE contours for the PB (0.67, 0.19), bladder (0.88, 0.13), LFH (0.93, 0.01), RFH (0.92, 0.01), penile bulb (0.54, 0.21) and rectum (0.78, 0.12). The DSC results (mean, SD) for the comparison of the edited-AABS versus the expert panel for the PB (0.47, 0.16), bladder (0.67, 0.18), LFH (0.83, 0.18), RFH (0.83, 0.17), penile bulb (0.31, 0.23) and rectum (0.58, 0.09). The DSC results (mean, SD) for the comparison of the STAPLE contours and the 5 RO are PB (0.78, 0.15), bladder (0.96, 0.02), left femoral head (0.87, 0.19), right femoral head (0.87, 0.19), penile bulb (0.70, 0.17) and the rectum (0.89, 0.06). The ANOVA analysis suggests inter-observer variability among at least one of the 5 RO (p value = 0.002). Conclusion The AABS tool results in a time savings, and when used to generate auto-contours for the femoral heads, bladder and rectum had superior to good spatial overlap. However, the generated auto-contours for the prostate bed and penile bulb need improvement.
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