1
|
Eekers DBP, Zegers CML, Ahmed KA, Amelio D, Gupta T, Harrabi SB, Kazda T, Scartoni D, Seidel C, Shih HA, Minniti G. Controversies in neuro-oncology: Focal proton versus photon radiation therapy for adult brain tumors. Neurooncol Pract 2024; 11:369-382. [PMID: 39006517 PMCID: PMC11241386 DOI: 10.1093/nop/npae040] [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: 07/16/2024] Open
Abstract
Radiation therapy (RT) plays a fundamental role in the treatment of malignant and benign brain tumors. Current state-of-the-art photon- and proton-based RT combines more conformal dose distribution of target volumes and accurate dose delivery while limiting the adverse radiation effects. PubMed was systematically searched from from 2000 to October 2023 to identify studies reporting outcomes related to treatment of central nervous system (CNS)/skull base tumors with PT in adults. Several studies have demonstrated that proton therapy (PT) provides a reduced dose to healthy brain parenchyma compared with photon-based (xRT) radiation techniques. However, whether dosimetric advantages translate into superior clinical outcomes for different adult brain tumors remains an open question. This review aims at critically reviewing the recent studies on PT in adult patients with brain tumors, including glioma, meningiomas, and chordomas, to explore its potential benefits compared with xRT.
Collapse
Affiliation(s)
- Danielle B P Eekers
- Department of Radiation Oncology (Maastro), Maastricht University Medical Center, GROW-School for Oncology and Reproduction, Maastricht, The Netherlands
| | - Catharina M L Zegers
- Department of Radiation Oncology (Maastro), Maastricht University Medical Center, GROW-School for Oncology and Reproduction, Maastricht, The Netherlands
| | - Kamran A Ahmed
- Departments of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Dante Amelio
- Trento Proton Therapy Center, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Tejpal Gupta
- Department of Radiation Oncology, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Semi Ben Harrabi
- Department of Radiation Oncology, Heidelberg Ion Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg, Germany
| | - Tomas Kazda
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University and Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Daniele Scartoni
- Trento Proton Therapy Center, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Clemens Seidel
- Comprehensive Cancer Center Central Germany, Leipzig, Germany
- Department of Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany
| | - Helen A Shih
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Giuseppe Minniti
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
- IRCCS Neuromed, Pozzilli IS, Italy
| |
Collapse
|
2
|
Schindhelm R, Razinskas G, Ringholz J, Kraft J, Sauer OA, Wegener S. Evaluation of a head rest prototype for rotational corrections in three degrees of freedom. J Appl Clin Med Phys 2024; 25:e14172. [PMID: 37793069 PMCID: PMC10860431 DOI: 10.1002/acm2.14172] [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: 06/20/2023] [Revised: 08/22/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023] Open
Abstract
Cranial stereotactic irradiations require accurate reproduction of the planning CT patient position at the time of treatment, including removal of rotational offsets. A device prototype was evaluated for potential clinical use to correct rotational positional offsets in image-guided radiotherapy workflow. Analysis was carried out with a prototype device "RPS head" by gKteso GmbH, rotatable up to 4° in three dimensions by hand wheels. A software tool accounts for the nonrectangular rotation axes and also indicates translational motions to be performed with the standard couch to correct the initial offset and translational shifts introduced by the rotational motion. The accuracy of angular corrections and positioning of an Alderson RANDO head phantom using the prototype device was evaluated for nine treatment plans for cranial targets. Corrections were obtained from cone beam computed tomography (CBCT) imaging. The phantom position was adjusted and the final position was then verified by another CBCT. The long-term stability of the prototype device was evaluated. Attenuation by the device along its three main axes was assessed. A planning study was performed to evaluate if regions of high-density material can be avoided during plan generation. The device enabled the accurate correction of rotational offsets in a clinical setup with a mean residual angular difference of (0.0 ± 0.1)° and a maximum deviation of 0.2°. Translational offsets were less than 1 mm. The device was stable over a period of 20 min, not changing the head support plate position by more than (0.7 ± 0.6) mm. The device contains high-density material in the adjustment mechanism and slightly higher density in the support structures. These can be avoided during planning generation maintaining comparable plan quality. The head positioning device can be used to correct rotational offsets in a clinical setting.
Collapse
Affiliation(s)
| | - Gary Razinskas
- Radiation OncologyUniversity Hospital WurzburgWurzburgGermany
| | - Jonas Ringholz
- Radiation OncologyUniversity Hospital WurzburgWurzburgGermany
| | - Johannes Kraft
- Radiation OncologyUniversity Hospital WurzburgWurzburgGermany
| | - Otto A. Sauer
- Radiation OncologyUniversity Hospital WurzburgWurzburgGermany
| | - Sonja Wegener
- Radiation OncologyUniversity Hospital WurzburgWurzburgGermany
| |
Collapse
|
3
|
Bodensohn R, Maier SH, Belka C, Minniti G, Niyazi M. Stereotactic Radiosurgery of Multiple Brain Metastases: A Review of Treatment Techniques. Cancers (Basel) 2023; 15:5404. [PMID: 38001664 PMCID: PMC10670108 DOI: 10.3390/cancers15225404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/22/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023] Open
Abstract
The advancement of systemic targeted treatments has led to improvements in the management of metastatic disease, particularly in terms of survival outcomes. However, brain metastases remain less responsive to systemic therapies, underscoring the significance of local interventions for comprehensive disease control. Over the past years, the threshold for treating brain metastases through stereotactic radiosurgery has risen. Yet, as the number of treated metastases increases, treatment complexity and duration also escalate. This trend has made multi-isocenter radiosurgery treatments, such as those with the Gamma Knife, challenging to plan and lengthy for patients. In contrast, single-isocenter approaches employing linear accelerators offer an efficient and expeditious treatment option. This review delves into the literature, comparing different linear-accelerator-based techniques with each other and in relation to dedicated systems, focusing on dosimetric considerations and feasibility.
Collapse
Affiliation(s)
- Raphael Bodensohn
- Department of Radiation Oncology, University Hospital Tübingen, 72076 Tübingen, Germany;
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Sebastian H. Maier
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, 81377 Munich, Germany; (S.H.M.); (C.B.)
| | - Claus Belka
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, 81377 Munich, Germany; (S.H.M.); (C.B.)
- German Cancer Consortium (DKTK), Partner Site Munich, A Partnership between DKFZ and LMU University Hospital, 81377 Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Giuseppe Minniti
- IRCCS Neuromed, 86077 Pozzilli, Italy;
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital Tübingen, 72076 Tübingen, Germany;
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, 72076 Tübingen, Germany
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, 81377 Munich, Germany; (S.H.M.); (C.B.)
- German Cancer Consortium (DKTK), Partner Site Tübingen, A Partnership between DKFZ and University Hospital, 72076 Tübingen, Germany
| |
Collapse
|
4
|
Tham BZ, Aleman D, Nordström H, Nygren N, Coolens C. Plan Assessment Metrics for Dose Painting in Stereotactic Radiosurgery. Adv Radiat Oncol 2023; 8:101281. [PMID: 37415903 PMCID: PMC10320410 DOI: 10.1016/j.adro.2023.101281] [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: 10/18/2022] [Accepted: 05/23/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose As radiation therapy treatment precision increases with advancements in imaging and radiation delivery, dose painting treatment becomes increasingly feasible, where targets receive a nonuniform radiation dose. The high precision of stereotactic radiosurgery (SRS) makes it a good candidate for dose painting treatments, but no suitable metrics to assess dose painting SRS plans exist. Existing dose painting assessment metrics weigh target overdose and underdose equally but are unsuited for SRS plans, which typically avoid target underdose more. Current SRS metrics also prioritize reducing healthy tissue dose through selectivity and dose fall-off, and these metrics assume single prescriptions. We propose a set of metrics for dose painting SRS that would meet clinical needs and are calculated with nonuniform dose painting prescriptions. Methods and Materials Sample dose painting SRS prescriptions are first created from Gamma Knife SRS cases, apparent diffusion coefficient magnetic resonance images, and various image-to-prescription functions. Treatment plans are found through semi-infinite linear programming optimization and using clinically determined isocenters, then assessed with existing and proposed metrics. Modified versions of SRS metrics are proposed, including coverage, selectivity, conformity, efficiency, and gradient indices. Quality factor, a current dose painting metric, is applied both without changes and with modifications. A new metric, integral dose ratio, is proposed as a measure of target overdose. Results The merits of existing and modified metrics are demonstrated and discussed. A modified conformity index using mean or minimum prescription dose would be suitable for dose painting SRS with integral or maximum boost methods, respectively. Either modified efficiency index is a suitable replacement for the existing gradient index. Conclusions The proposed modified SRS metrics are appropriate measures of plan quality for dose painting SRS plans and have the advantage of giving equal values as the original SRS metrics when applied to single-prescription plans.
Collapse
Affiliation(s)
- Benjamin Z. Tham
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Dionne Aleman
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Catherine Coolens
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Belkacemi Y, Biston MC, Benchekroun N, Benider A, Chargari C, Debbi K, Doré M, El Kacimi H, Flandin I, Lalya I, Samlali H, Sellal N, Supiot S. Limited applicability and implementation of the international oncology treatments guidelines in low- and middle-income countries, an example from the Mediterranean area borders. Cancer Radiother 2023; 27:666-675. [PMID: 37550156 DOI: 10.1016/j.canrad.2023.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 08/09/2023]
Abstract
The quality of cancer care in the modern era is based on a precise diagnosis and personalized therapy according to patients and their disease based on validated guidelines with a high level of evidence. During cancer patients' management, the objective is first to make an accurate diagnosis and then offer the best treatment, validated beforehand in a multidisciplinary board meeting, with the best benefit/risk ratio. In the context of many low- and middle-income countries, the limited available means do not allow an adequate offer, resulting in non-optimal patients' care. In addition, in many low- and middle-income countries, priority can be given to other types of disease than cancer, which may considerably reduce allocation of specific resources to cancer care. Thus, the limited availability of systemic therapy, radiotherapy machines, brachytherapy and technological development may come up against another difficulty, that of geographical distribution of the means in the countries or a lack of expertise due to insufficient training programs. For all these reasons, the implementation of the guidelines established in Western countries could be impossible for many low- and middle-income countries which, moreover, have to face a completely different epidemiology of cancers compared to developed countries. In this work, we will discuss through a few examples of common cancers on both borders of the Mediterranean area, the applicability of the guidelines and the limits of their implementation for optimal cancer care.
Collapse
Affiliation(s)
- Y Belkacemi
- Department of Radiation Oncology and Henri-Mondor Breast Center, centre hospitalier universitaire Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France; Inserm U955, i-Biot Team, IMRB, university of Paris-Est Crétil, Créteil, France.
| | - M-C Biston
- Centre Léon-Bérard and Creatis, CNRS UMR 5225, Inserm U1044, Insa-Lyon, université Lyon 1, Villeurbanne, France
| | - N Benchekroun
- Department of Radiation Oncology, centre Mohamed-VI, université de Casablanca, Casablanca, Morocco
| | - A Benider
- Department of Radiation Oncology, centre Mohamed-VI, université de Casablanca, Casablanca, Morocco
| | - C Chargari
- Department of Radiation Oncology, groupe hospitalier Pitié-Salpêtrière, AP-HP, Sorbonne Université Paris VI, Paris, France
| | - K Debbi
- Department of Radiation Oncology and Henri-Mondor Breast Center, centre hospitalier universitaire Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France; Inserm U955, i-Biot Team, IMRB, university of Paris-Est Crétil, Créteil, France
| | - M Doré
- Department of Radiation Oncology, Institute de cancérologie de l'Ouest (ICO) centre René-Gauducheau, Saint-Herblain, France
| | - H El Kacimi
- Department of Radiation Oncology, Institut d'oncologie de Rabat, Rabat, Morocco
| | - I Flandin
- Department of Radiation Oncology, centre hospitalier universitaire de Grenoble, Grenoble, France
| | - I Lalya
- Department of Radiation Oncology, hôpital militaire Mohamed-V, Rabat, Morocco
| | - H Samlali
- Department of Radiation Oncology, clinique d'oncologie le Littoral, Casablanca, Morocco
| | - N Sellal
- Department of Radiation Oncology, hôpital universitaire Mohmed-VI, université Abdelmalek-Essadi, Tanger, Morocco
| | - S Supiot
- Department of Radiation Oncology, Institute de cancérologie de l'Ouest (ICO) centre René-Gauducheau, Saint-Herblain, France; Université de Nantes, Nantes, France
| |
Collapse
|
6
|
Gutiérrez A, Gevaert T, Boussaer M, Everaert T, Ferro Teixeira C, De Ridder M. Gantry triggered x-ray verification during single-isocenter stereotactic radiosurgery: Increased certainty for a no-margin strategy. Radiother Oncol 2023; 186:109808. [PMID: 37468067 DOI: 10.1016/j.radonc.2023.109808] [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: 10/05/2022] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Single-isocenter linac-based stereotactic radiosurgery (SRS) has emerged as a dedicated treatment option for multiple brain metastases. Consequently, image-guidance for patient positioning and motion management has become very important. The purpose of this study was to analyze intra-fraction errors measured with stereoscopic x-rays and their impact on the dose distribution. MATERIALS AND METHODS Treatments were planned with non- coplanar dynamic conformal arcs for 33 patients corresponding to 127 brain lesions and 356 arcs. Intra-arc positioning errors were measuredusing stereoscopic x-rays (ExacTrac Dynamic, Brainlab), triggered during arc delivery. Couch corrections above 0.7 mm and 0.5° were always applied. Intra-arc positioning data was analyzed. The dose impact was evaluated by applying the measured errors to the dose given in each arc. RESULTS Median residual errors were 0.10 mm, 0.13 mm and 0.08 mm for the lateral, longitudinal and vertical directions and 0.10°, 0.08° and 0.13° for the pitch, roll and yaw angles respectively. 90% of the treatment arcs showed shifts of less than 0.4 mm and 0.4°in all directions. Dosimetric impact of motion showed the largest losses in coverage on small targets. All targets achieved at least 95% of the prescription dose to 95% of their volume, even when planned without margins. CONCLUSIONS Intra-fractional errors measured during beam delivery were found to be notably low with a dose impact that showed acceptable target coverage when applying these intra-arc errors to the dose distributions of the individual treatment arcs. Using an adequate immobilization and intra-fraction imaging prior to and during irradiation, no margins need to be added to compensate for intra-fraction motion.
Collapse
Affiliation(s)
- Adrián Gutiérrez
- Department of Radiotherapy, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Thierry Gevaert
- Department of Radiotherapy, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Marlies Boussaer
- Department of Radiotherapy, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Tim Everaert
- Department of Radiotherapy, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Mark De Ridder
- Department of Radiotherapy, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
7
|
Bolten JH, Dunst J, Siebert FA. Geometric accuracy in patient positioning for stereotactic radiotherapy of intracranial tumors. Phys Imaging Radiat Oncol 2023; 27:100461. [PMID: 37720460 PMCID: PMC10500024 DOI: 10.1016/j.phro.2023.100461] [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: 01/06/2023] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 09/19/2023] Open
Abstract
Background/Purpose This study determines and compares the geometric setup errors between stereoscopic x-ray and kilo-voltage cone beam CT (CBCT) in phantom tests on a linear accelerator (linac) for image-guided (IG) stereotactic radiotherapy of intracranial tumors. Additionally, dose-volume metrics in the target volumes of the setup errors of CBCT were evaluated. Materials/Methods A Winston-Lutz- and an anthropomorphic phantom were used. The mean deviation and root mean square error (RMSE) of CBCT and stereoscopic x-ray were compared. Dose-volume metrics of the planning target volume (PTV) and gross target volume (GTV) for CBCT were calculated. Results The RMSEs in the tests with the Winston-Lutz-Phantom were 0.3 mm, 1.1 mm and 0.3 mm for CBCT and 0.1 mm, 0,1 mm and <0.1 mm for stereoscopic x-ray in the translational dimensions (right-left, anterior-posterior and superior-inferior). The RMSEs in the tests with the anthropomorphic phantom were 0.3 mm, 0.2 mm and 0.1 mm for CBCT and 0.1 mm, 0,1 mm and <0.1 mm for stereoscopic x-ray. The effects on dose-volume metrics of the setup errors of CBCT on the GTV were within 1 % for all considered dose values. The effects on the PTV were within 5 % for all considered dose values. Conclusion Both IG systems provide high accuracy patient positioning within a submillimeter range. The phantom tests exposed a slightly higher accuracy of stereoscopic x-ray than CBCT. The comparison with other studies with a similar purpose emphasizes the importance of individual IG installation quality assurance.
Collapse
Affiliation(s)
- Jan-Hendrik Bolten
- Clinic of Radiotherapy (Radiooncology), University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Dunst
- Clinic of Radiotherapy (Radiooncology), University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Frank-André Siebert
- Clinic of Radiotherapy (Radiooncology), University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| |
Collapse
|
8
|
Petragallo R, Bertram P, Halvorsen P, Iftimia I, Low DA, Morin O, Narayanasamy G, Saenz DL, Sukumar KN, Valdes G, Weinstein L, Wells MC, Ziemer BP, Lamb JM. Development and multi-institutional validation of a convolutional neural network to detect vertebral body mis-alignments in 2D x-ray setup images. Med Phys 2023; 50:2662-2671. [PMID: 36908243 DOI: 10.1002/mp.16359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/11/2023] [Accepted: 02/16/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Misalignment to the incorrect vertebral body remains a rare but serious patient safety risk in image-guided radiotherapy (IGRT). PURPOSE Our group has proposed that an automated image-review algorithm be inserted into the IGRT process as an interlock to detect off-by-one vertebral body errors. This study presents the development and multi-institutional validation of a convolutional neural network (CNN)-based approach for such an algorithm using patient image data from a planar stereoscopic x-ray IGRT system. METHODS X-rays and digitally reconstructed radiographs (DRRs) were collected from 429 spine radiotherapy patients (1592 treatment fractions) treated at six institutions using a stereoscopic x-ray image guidance system. Clinically-applied, physician approved, alignments were used for true-negative, "no-error" cases. "Off-by-one vertebral body" errors were simulated by translating DRRs along the spinal column using a semi-automated method. A leave-one-institution-out approach was used to estimate model accuracy on data from unseen institutions as follows: All of the images from five of the institutions were used to train a CNN model from scratch using a fixed network architecture and hyper-parameters. The size of this training set ranged from 5700 to 9372 images, depending on exactly which five institutions were contributing data. The training set was randomized and split using a 75/25 split into the final training/ validation sets. X-ray/ DRR image pairs and the associated binary labels of "no-error" or "shift" were used as the model input. Model accuracy was evaluated using images from the sixth institution, which were left out of the training phase entirely. This test set ranged from 180 to 3852 images, again depending on which institution had been left out of the training phase. The trained model was used to classify the images from the test set as either "no-error" or "shifted", and the model predictions were compared to the ground truth labels to assess the model accuracy. This process was repeated until each institution's images had been used as the testing dataset. RESULTS When the six models were used to classify unseen image pairs from the institution left out during training, the resulting receiver operating characteristic area under the curve values ranged from 0.976 to 0.998. With the specificity fixed at 99%, the corresponding sensitivities ranged from 61.9% to 99.2% (mean: 77.6%). With the specificity fixed at 95%, sensitivities ranged from 85.5% to 99.8% (mean: 92.9%). CONCLUSION This study demonstrated the CNN-based vertebral body misalignment model is robust when applied to previously unseen test data from an outside institution, indicating that this proposed additional safeguard against misalignment is feasible.
Collapse
Affiliation(s)
- Rachel Petragallo
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California, USA
| | | | - Per Halvorsen
- Department of Radiation Oncology, Beth Israel - Lahey Health, Burlington, Massachusetts, USA
| | - Ileana Iftimia
- Department of Radiation Oncology, Beth Israel - Lahey Health, Burlington, Massachusetts, USA
| | - Daniel A Low
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California, USA
| | - Olivier Morin
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Ganesh Narayanasamy
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Daniel L Saenz
- Department of Radiation Oncology, University of Texas HSC SA, San Antonio, Texas, USA
| | - Kevinraj N Sukumar
- Department of Radiation Oncology, Piedmont Healthcare, Atlanta, Georgia, USA
| | - Gilmer Valdes
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Lauren Weinstein
- Department of Radiation Oncology, Kaiser Permanente, South San Francisco, California, USA
| | - Michelle C Wells
- Department of Radiation Oncology, Piedmont Healthcare, Atlanta, Georgia, USA
| | - Benjamin P Ziemer
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - James M Lamb
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California, USA
| |
Collapse
|
9
|
Hua W, Xu B, Zhang X, Zhang X, Chen T. Setup error and residual error analysis of ExacTrac X-ray image guidance system in stereotactic radiotherapy for brain metastases. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [DOI: 10.1016/j.jrras.2022.100474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
10
|
De La Peña NM, Singh R, Anderson ML, Koester SW, Sio TT, Ashman JB, Vora SA, Patel NP. High-Dose Frameless Stereotactic Radiosurgery for Trigeminal Neuralgia: A Single-Institution Experience and Systematic Review. World Neurosurg 2022; 167:e432-e443. [PMID: 35973520 DOI: 10.1016/j.wneu.2022.08.038] [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: 07/31/2022] [Accepted: 08/08/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Stereotactic radiosurgery is an effective treatment option for trigeminal neuralgia (TN), with frameless stereotactic radiosurgery (fSRS) allowing for a less invasive experience. A single-institutional series and systematic review of the literature were performed for cases of TN treated with fSRS. METHODS Patients at our institution with TN that were treated with fSRS from the years 2012-2021 were included. Similarly, multiple databases were searched for studies regarding TN treated with fSRS where patient-level data was included from 2004-2020. Pain levels, via the Barrow Neurological Institute (BNI) scale, before and after treatment were analyzed. Pooled analysis was performed to compare treatment outcomes between studies using CyberKnife and LINAC modalities. RESULTS Twenty-three patients at our institution were treated with LINAC fSRS (median treatment dose: 85 Gy). Most patients had TN refractory to previous procedural treatments. Eight (35%) patients had an excellent posttreatment response (BNI I-II), while 11 (48%) patients had a good result (BNI IIIa/b). Eight patients had recurrence of pain. A total of 30 articles were included in the systematic review, encompassing 1705 patients. At last follow-up, 63.1% (774/1227) of patients endorsed an excellent response, while 16.1% (197/1227) had a good response, and 22.5% (215/957) of patients had recurrence. Pain response, facial numbness rates, and pain recurrence rates were not significantly different between CyberKnife and LINAC modalities. CONCLUSIONS Frameless SRS for TN appears to be an efficacious noninvasive option for patients with substantial comorbidities, who have failed other treatment methods, although it can be limited by higher recurrence rates.
Collapse
Affiliation(s)
| | - Rohin Singh
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
| | | | - Stefan W Koester
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Jonathan B Ashman
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Sujay A Vora
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Naresh P Patel
- Department of Neurological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
| |
Collapse
|
11
|
Zhang Y, Zhou H, Chu K, Wu C, Ge Y, Shan G, Zhou J, Cai J, Jin J, Sun W, Chen Y, Huang X. Setup error assessment based on “Sphere-Mask” Optical Positioning System: Results from a multicenter study. Front Oncol 2022; 12:918296. [PMID: 36267985 PMCID: PMC9577199 DOI: 10.3389/fonc.2022.918296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/15/2022] [Indexed: 11/15/2022] Open
Abstract
Background The setup accuracy plays an extremely important role in the local control of tumors. The purpose of this study is to verify the feasibility of "Sphere-Mask" Optical Positioning System (S-M_OPS) for fast and accurate setup. Methods From 2016 to 2021, we used S-M_OPS to supervise 15441 fractions in 1981patients (with the cancer in intracalvarium, nasopharynx, esophagus, lung, liver, abdomen or cervix) undergoing intensity-modulated radiation therapy (IMRT), and recorded the data such as registration time and mask deformation. Then, we used S-M_OPS, laser line and cone beam computed tomography (CBCT) for co-setup in 277 fractions, and recorded laser line-guided setup errors and S-M_OPS-guided setup errors with CBCT-guided setup result as the standard. Results S-M_OPS supervision results: The average time for laser line-guided setup was 31.75s. 12.8% of the reference points had an average deviation of more than 2 mm and 5.2% of the reference points had an average deviation of more than 3 mm. Co-setup results: The average time for S-M_OPS-guided setup was 7.47s, and average time for CBCT-guided setup was 228.84s (including time for CBCT scan and manual verification). In the LAT (left/right), VRT (superior/inferior) and LNG (anterior/posterior) directions, laser line-guided setup errors (mean±SD) were -0.21±3.13mm, 1.02±2.76mm and 2.22±4.26mm respectively; the 95% confidence intervals (95% CIs) of laser line-guided setup errors were -6.35 to 5.93mm, -4.39 to 6.43mm and -6.14 to 10.58mm respectively; S-M_OPS-guided setup errors were 0.12±1.91mm, 1.02±1.81mm and -0.10±2.25mm respectively; the 95% CIs of S-M_OPS-guided setup errors were -3.86 to 3.62mm, -2.53 to 4.57mm and -4.51 to 4.31mm respectively. Conclusion S-M_OPS can greatly improve setup accuracy and stability compared with laser line-guided setup. Furthermore, S-M_OPS can provide comparable setup accuracy to CBCT in less setup time.
Collapse
Affiliation(s)
- Yan Zhang
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Han Zhou
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Kaiyue Chu
- Department of Radiotherapy, Nantong Tumor Hospital, Nantong, China
| | - Chuanfeng Wu
- Department of Radiotherapy, Suzhou Municipal Hospital, Suzhou, China
| | - Yun Ge
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
- *Correspondence: Yun Ge, ; Guoping Shan,
| | - Guoping Shan
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
- Department of Radiation Physics, Zhejiang Cancer Hospital, Hangzhou, China
- *Correspondence: Yun Ge, ; Guoping Shan,
| | - Jundong Zhou
- Department of Radiotherapy, Suzhou Municipal Hospital, Suzhou, China
| | - Jing Cai
- Department of Radiotherapy, Nantong Tumor Hospital, Nantong, China
| | - Jianhua Jin
- Department of Radiotherapy, Nantong Tumor Hospital, Nantong, China
| | - Weiyu Sun
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Ying Chen
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Xiaolin Huang
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| |
Collapse
|
12
|
Da Silva Mendes V, Reiner M, Huang L, Reitz D, Straub K, Corradini S, Niyazi M, Belka C, Kurz C, Landry G, Freislederer P. ExacTrac Dynamic workflow evaluation: Combined surface optical/thermal imaging and X-ray positioning. J Appl Clin Med Phys 2022; 23:e13754. [PMID: 36001389 DOI: 10.1002/acm2.13754] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 07/07/2022] [Accepted: 07/19/2022] [Indexed: 11/09/2022] Open
Abstract
In modern radiotherapy (RT), especially for stereotactic radiotherapy or stereotactic radiosurgery treatments, image guidance is essential. Recently, the ExacTrac Dynamic (EXTD) system, a new combined surface-guided RT and image-guided RT (IGRT) system for patient positioning, monitoring, and tumor targeting, was introduced in clinical practice. The purpose of this study was to provide more information about the geometric accuracy of EXTD and its workflow in a clinical environment. The surface optical/thermal- and the stereoscopic X-ray imaging positioning systems of EXTD was evaluated and compared to cone-beam computed tomography (CBCT). Additionally, the congruence with the radiation isocenter was tested. A Winston Lutz test was executed several times over 1 year, and repeated end-to-end positioning tests were performed. The magnitude of the displacements between all systems, CBCT, stereoscopic X-ray, optical-surface imaging, and MV portal imaging was within the submillimeter range, suggesting that the image guidance provided by EXTD is accurate at any couch angle. Additionally, results from the evaluation of 14 patients with intracranial tumors treated with open-face masks are reported, and limited differences with a maximum of 0.02 mm between optical/thermal- and stereoscopic X-ray imaging were found. As the optical/thermal positioning system showed a comparable accuracy to other IGRT systems, and due to its constant monitoring capability, it can be an efficient tool for detecting intra-fractional motion and for real-time tracking of the surface position during RT.
Collapse
Affiliation(s)
| | - Michael Reiner
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Lili Huang
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Reitz
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Katrin Straub
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Christopher Kurz
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Philipp Freislederer
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
13
|
Kienzler JC, Tenn S, Chivukula S, Chu FI, Sparks HD, Agazaryan N, Kim W, Salles AD, Selch M, Gorgulho A, Kaprealian T, Pouratian N. Linear accelerator-based radiosurgery for trigeminal neuralgia: comparative outcomes of frame-based and mask-based techniques. J Neurosurg 2022; 137:217-226. [PMID: 34826815 DOI: 10.3171/2021.8.jns21658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Precise and accurate targeting is critical to optimize outcomes after stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN). The aim of this study was to compare the outcomes after SRS for TN in which two different techniques were used: mask-based 4-mm cone versus frame-based 5-mm cone. METHODS The authors performed a retrospective review of patients who underwent SRS for TN at their institution between 1996 and 2019. The Barrow Neurological Institute (BNI) pain score and facial hypesthesia scale were used to evaluate pain relief and facial numbness. RESULTS A total of 234 patients were included in this study; the mean age was 67 years. In 97 patients (41.5%) radiation was collimated by a mask-based 4-mm cone, whereas a frame-based 5-mm cone was used in the remaining 137 patients (58.5%). The initial adequate pain control rate (BNI I-III) was 93.4% in the frame-based 5-mm group, compared to 87.6% in the mask-based 4-mm group. This difference between groups lasted, with an adequate pain control rate at ≥ 24 months of 89.9% and 77.8%, respectively. Pain relief was significantly different between groups from initial response until the last follow-up (≥ 24 months, p = 0.02). A new, permanent facial hypesthesia occurred in 30.3% of patients (33.6% in the frame-based 5-mm group vs 25.8% in the mask-based 4-mm group). However, no significant association between the BNI facial hypesthesia score and groups was found. Pain recurrence occurred earlier (median time to recurrence 12 months vs 29 months, p = 0.016) and more frequently (38.1% vs 20.4%, p = 0.003) in the mask-based 4-mm than in the frame-based 5-mm group. CONCLUSIONS Frame-based 5-mm collimator SRS for TN resulted in a better long-term pain relief with similar toxicity profiles to that seen with mask-based 4-mm collimator SRS.
Collapse
Affiliation(s)
- Jenny C Kienzler
- 1Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles
| | - Stephen Tenn
- 2Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles
| | - Srinivas Chivukula
- 1Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles
| | - Fang-I Chu
- 2Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles
| | - Hiro D Sparks
- 1Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles
| | - Nzhde Agazaryan
- 2Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles
| | - Won Kim
- 1Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles
| | - Antonio De Salles
- 1Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles
| | - Michael Selch
- 2Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles
| | - Alessandra Gorgulho
- 1Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles
| | - Tania Kaprealian
- 2Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles
| | - Nader Pouratian
- 1Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles
- 2Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles
- 3Department of Bioengineering, UCLA Samueli School of Engineering, University of California, Los Angeles; and
- 4Brain Research Institute, University of California, Los Angeles, California
| |
Collapse
|
14
|
Luo G, Cameron BD, Wang L, Yu H, Neimat JS, Hedera P, Phibbs F, Bradley EB, Cmelak AJ, Kirschner AN. Targeting for stereotactic radiosurgical thalamotomy based on tremor treatment response. J Neurosurg 2022; 136:1387-1394. [PMID: 34715657 DOI: 10.3171/2021.7.jns21160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stereotactic radiosurgery (SRS) treats severe, medically refractory essential tremor and tremor-dominant Parkinson disease. However, the optimal target for SRS treatment within the thalamic ventral intermediate nucleus (VIM) is not clearly defined. This work evaluates the precision of the physician-selected VIM target, and determines the optimal SRS target within the VIM by correlation between early responders and nonresponders. METHODS Early responders and nonresponders were assessed retrospectively by Elements Basal Ganglia Atlas autocontouring of the VIM on the pre-SRS-treatment 1-mm slice thickness T1-weighted MRI and correlating the center of the post-SRS-treatment lesion. Using pre- and posttreatment diffusion tensor imaging, the fiber tracking package in the Elements software generated tremor-related tracts from autosegmented motor cortex, thalamus, red nucleus, and dentate nucleus. Autocontouring of the VIM was successful for all patients. RESULTS Among 23 patients, physician-directed SRS targets had a medial-lateral target range from +2.5 mm to -2.0 mm from the VIM center. Relative to the VIM center, the SRS isocenter target was 0.7-0.9 mm lateral for 6 early responders and 0.9-1.1 mm medial for 4 nonresponders (p = 0.019), and without differences in the other dimensions: 0.2 mm posterior and 0.6 mm superior. Dose-volume histogram analyses for the VIM had no significant differences between responders and nonresponders between 20 Gy and 140 Gy, mean or maximum dose, and dose to small volumes. Tractography data was obtained for 4 patients. CONCLUSIONS For tremor control in early responders, the Elements Basal Ganglia Atlas autocontour for the VIM provides the optimal SRS target location that is 0.7-0.9 mm lateral to the VIM center.
Collapse
Affiliation(s)
| | | | | | - Hong Yu
- 3Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph S Neimat
- 4Department of Neurological Surgery, University of Louisville, Kentucky; and
| | - Peter Hedera
- 5Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Fenna Phibbs
- 5Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elise B Bradley
- 5Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | |
Collapse
|
15
|
Chow VUY, Cheung MLM, Kan MWK, Chan ATC. Shift detection discrepancy between ExacTrac Dynamic system and cone‐beam computed tomography. J Appl Clin Med Phys 2022; 23:e13567. [PMID: 35188333 PMCID: PMC9121052 DOI: 10.1002/acm2.13567] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 01/12/2022] [Accepted: 02/03/2022] [Indexed: 02/01/2023] Open
Abstract
Accurate detection of patient shift is essential during radiation therapy such that optimal dose is delivered to the tumor while minimizing radiation to surrounding normal tissues. The shift detectability of a newly developed optical surface and thermal tracking system, which was known as ExacTrac Dynamic (EXTD), was evaluated by comparing its performance with the image guidance under cone‐beam computed tomography (CBCT). Anthropomorphic cranial and pelvis phantoms with internal bone‐like structures and external heat pad were utilized to study the shift detection discrepancy between EXTD system and CBCT. Random displacements within the range of ± 2 cm for translations and ± 2 degrees for rotations were intentionally applied to the phantom. Positional shifts detected by optical surface and thermal tracking (EXTD_Thml), stereoscopic X‐ray (EXTD_Xray), and CBCT were compared in 6 degrees of freedom. The translational difference between EXTD_Thml and CBCT was 0.57 ± 0.41 mm and 0.66 ± 0.40 mm for cranial and pelvis phantom, respectively, while it was 0.60 ± 0.43 mm and 0.76 ± 0.49 mm between EXTD_Xray and CBCT, respectively. For rotational movement, the difference between EXTD_Thml and CBCT was 0.19 ± 0.16° and 0.19 ± 0.22° for cranial and pelvis phantom, respectively, while it was 0.13 ± 0.18° and 0.65 ± 0.46° between EXTD_Xray and CBCT, respectively. This study demonstrated that the EXTD system with thermal mapping ability could offer comparable accuracy for shift detection with CBCT on both cranial and pelvis phantoms.
Collapse
Affiliation(s)
- Vivian U. Y. Chow
- Department of Clinical Oncology Prince of Wales Hospital Hong Kong SAR China
| | | | - Monica W. K. Kan
- Department of Clinical Oncology Prince of Wales Hospital Hong Kong SAR China
- Department of Clinical Oncology The Chinese University of Hong Kong Hong Kong SAR China
| | - Anthony T. C. Chan
- Department of Clinical Oncology Prince of Wales Hospital Hong Kong SAR China
- Department of Clinical Oncology The Chinese University of Hong Kong Hong Kong SAR China
| |
Collapse
|
16
|
Doudard A, Guérin C, Dufreneix S, Josset S. Design and automation of specific geometric quality controls for cone-radiosurgery treatments. Phys Med 2022; 96:1-8. [PMID: 35189430 DOI: 10.1016/j.ejmp.2022.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/12/2022] [Accepted: 02/12/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The Varian TrueBeam STx linac can be equipped with BrainLAB stereotactic cones and ExacTrac imaging system for SRS treatments. However, these two third-party systems lack integration in a self-performance diagnosis tool dedicated to the SRS platform. The aim of this work was to design and automate essential geometric tests considering the complete set of cones with diameter range from 4 to 15 mm. METHODS EPID-based tests were focused on the cone alignment, the radiation isocentricity and the isocenters congruence. Images acquired with or without the BrainLAB pointer were analysed using the Hough transform and morphological filtering operations, after assessment of the algorithm accuracy using simulated images. The new Machine QA program was experimented over one year. RESULTS A subpixel resolution of 0.02 mm was found for the circular-field center detection algorithm. The tests results did not depend on the pointer location. The maximum deviations reported were in accordance with the AAPM SRS guidelines. The accurate localization of the linac radiation isocenter allowed for guidance of the ExacTrac calibration. A misalignment reaching 0.2 mm was measured for all cones but one, highlighting the benefit of systematizing this control before each patient SRS treatment. CONCLUSION An effective in-house QA program dedicated to SRS cones was developed to supplement the standard machine performance check on our mixed SRS platform. Specific geometric tests even include the smallest 4-mm cone, which could be of great interest for future clinical indications such as the radiosurgery of functional disorders.
Collapse
Affiliation(s)
- A Doudard
- Department of Medical Physics, Institut de Cancérologie de l'Ouest, Saint-Herblain/Angers, France
| | - C Guérin
- Department of Medical Physics, Institut de Cancérologie de l'Ouest, Saint-Herblain/Angers, France
| | - S Dufreneix
- Department of Medical Physics, Institut de Cancérologie de l'Ouest, Saint-Herblain/Angers, France
| | - S Josset
- Department of Medical Physics, Institut de Cancérologie de l'Ouest, Saint-Herblain/Angers, France.
| |
Collapse
|
17
|
Sarkar B, Manikandan A, Munshi A, Krishnankutty S, Ganesh T, Mohanti B, Manikandan S, Anirudh P, Chandrasekharan S. Calculation of set-up margin in frameless stereotactic radiotherapy accounting for translational and rotational patient positing error. J Cancer Res Ther 2022. [DOI: 10.4103/jcrt.jcrt_359_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
18
|
Radiation therapy for atypical and anaplastic meningiomas: an overview of current results and controversial issues. Neurosurg Rev 2022; 45:3019-3033. [PMID: 35665867 PMCID: PMC9492595 DOI: 10.1007/s10143-022-01806-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/11/2022] [Accepted: 05/02/2022] [Indexed: 02/03/2023]
Abstract
Meningiomas are the most common intracranial tumors. Most meningiomas are WHO grade 1 tumors whereas less than one-quarter of all meningiomas are classified as atypical (WHO grade 2) and anaplastic (WHO grade 3) tumors, based on local invasiveness and cellular features of atypia. Surgical resection remains the cornerstone of meningioma therapy and represents the definitive treatment for the majority of patients; however, grade 2 and grade 3 meningiomas display more aggressive behavior and are difficult to treat. Several retrospective series have shown the efficacy and safety of postoperative adjuvant external beam radiation therapy (RT) for patients with atypical and anaplastic meningiomas. More recently, two phase II prospective trials by the Radiation Therapy Oncology Group (RTOG 0539) and the European Organisation for Research and Treatment of Cancer (EORTC 2042) have confirmed the potential benefits of fractionated RT for patients with intermediate and high-risk meningiomas; however, several issues remain a matter of debate. Controversial topics include the timing of radiation treatment in patients with totally resected atypical meningiomas, the optimal radiation technique, dose and fractionation, and treatment planning/target delineation. Ongoing randomized trials are evaluating the efficacy of early adjuvant RT over observation in patients undergoing gross total resection.
Collapse
|
19
|
Régis J, Merly L, Balossier A, Baumstarck K, Hamdi H, Mariani S, Delsanti C, Vincent M, Nigoul JM, Beltaifa Y, Muracciole X. Mask-Based versus Frame-Based Gamma Knife ICON Radiosurgery in Brain Metastases: A Prospective Randomized Trial. Stereotact Funct Neurosurg 2021; 100:86-94. [PMID: 34933308 DOI: 10.1159/000519280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Radiosurgery is performed with a diversity of instruments relying usually either on a stereotactic frame or a mask for patient head fixation. Comfort and safety efficacy of the 2 systems have never been rigorously evaluated and compared. MATERIAL AND METHOD Between February 2016 and January 2017, 58 patients presenting with nonsmall cell lung cancer brain metastases have been treated by Gamma Knife radiosurgery (GKS) with random use of a frame or a mask for fixation were included patients older than 18, with <5 brain metastases (at the exclusion of brainstem and optic pathway's locations) and no earlier history of radiotherapy. The primary outcome measure was the pain scale assessment (PSA) at the beginning of the GKS procedure. RESULTS The PSA at the beginning of the GKS procedure was not different between the 2 groups. The PSA at the day before GKS, before magnetic resonance imaging, just after frame application, and the day after radiosurgery (departure) has shown no difference between the 2 groups. At the end of the radiosurgery itself (just after frame or mask removal) and 1 h after, the mean pain scale was higher in patients treated with the frame (p < 0.05 and p < 0.001, respectively) but 2 patients were not able to tolerate the mask discomfort and had to be treated with frame. Tumor control and morbidity probability were demonstrated to be no difference between the 2 groups in this population of patients with BM not in highly functional area. The median of the extra dose to the body due to the cone-beam computed tomography was 7.5 mGy with a maximum of 35 mGy in patients treated with a mask fixation (null in the others treated with frame). Mask fixation was associated to longer treatment time although the beam on time was not different between the 2 groups. CONCLUSION In selected patients, with brain oligo-metastases out of critical location, single-dose mask-based GKS can be done with a comfort and a safety efficacy comparable to frame-based GKS. There seems to be no clear patient data that confirm the value of the mask system with regards to comfort.
Collapse
Affiliation(s)
- Jean Régis
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Louise Merly
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Anne Balossier
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Karine Baumstarck
- Department of Biostatistic, Aix Marseille University, Marseille, France
| | - Hussein Hamdi
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Sarah Mariani
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Christine Delsanti
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Marion Vincent
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Jean Marc Nigoul
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Yassin Beltaifa
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France.,Department of Functional Neurosurgery, Hôpital d'Adulte de la Timone, Marseille, France
| | - Xavier Muracciole
- Department of Radiotherapy, Aix Marseille University, Marseille, France
| |
Collapse
|
20
|
Tsui SSW, Wu VWC, Cheung JSC. Comparison of dosimetric impact of intra-fractional setup discrepancy between multiple- and single-isocenter approaches in linac-based stereotactic radiotherapy of multiple brain metastases. J Appl Clin Med Phys 2021; 23:e13484. [PMID: 34931447 PMCID: PMC8833285 DOI: 10.1002/acm2.13484] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/23/2021] [Accepted: 11/09/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Treatment of multiple brain metastases by linac‐based stereotactic radiotherapy (SRT) can employ either a multiple‐isocenter (MI) or single‐isocenter (SI) approach. The purposes of this study were to evaluate the dosimetric results of MI and SI approaches and compare the impacts of intra‐fractional setup discrepancies on the robustness of respective approaches using isocenter shifts, whether the same magnitude of translational and rotational effects could lead to a significant difference between the two approaches. Methods Twenty‐two patients with multiple brain metastases treated by linac‐based SRT were recruited. Treatment plans were computed with both the MI and SI approaches. For the MI approach, the isocenter was located at the geometric center of each planning target volumes (PTVs), whereas the isocenter of the SI approach was located midway between the PTV centroids. To simulate the intra‐fractional errors, isocenter displacements including translational and rotational shifts were hypothetically applied. Apart from the dosimetric outcomes of the two approaches, the impact of the isocenter shifts on PTVs and organs at risk (OARs) were recorded in terms of the differences (δ) in dose parameters relative to the reference plan and was then compared between the MI and SI approaches. Results Both MI and SI plans met the plan acceptance criteria. The mean Paddick conformity index (Paddick CI) and Dmax of most OARs between MI and SI plans did not show a significant difference, except that higher doses to the left optic nerve and optic chiasm were found in SI plans (p = 0.03). After the application of the isocenter shifts, δCI increased with an increase in the magnitude of the isocenter shift. When comparing between MI and SI plans, the δCIs were similar (p > 0.05) for all extents of translational shifts, but δCIs were significantly higher in SI plans after application of all rotations particularly ±1.5° and ±2.0° shifts. Despite the result that the majority of δDMax of OARs were higher in the SI plans, only the differences in the left optic nerve and chiasm showed generally consistent significance after both translational ≥±1 mm and rotational shifts of ≥±1∘. Conclusion Both MI and SI approaches could produce clinically acceptable plans. However, isocenter shifts brought dosimetric impacts to both MI and SI approaches and the effects increased with the increase of the shift magnitude. Although similar impacts were shown in plans of both approaches after translational isocenter shift, SI plans were relatively more vulnerable than MI plans to rotational shifts.
Collapse
Affiliation(s)
- Sylvia S W Tsui
- Department of Clinical Oncology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Vincent W C Wu
- Department of Health Technology & Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Jerry S C Cheung
- Department of Clinical Oncology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| |
Collapse
|
21
|
Sakuragawa K, Sasaki M, Kamomae T, Yokoishi M, Kasai R, Kajino A, Ikushima H. Differences in image density adjustment parameters on the image matching accuracy of a floor-mounted kV X-ray image-guided radiation therapy system. J Appl Clin Med Phys 2021; 23:e13505. [PMID: 34931431 PMCID: PMC8833277 DOI: 10.1002/acm2.13505] [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: 08/25/2021] [Revised: 10/22/2021] [Accepted: 12/04/2021] [Indexed: 11/07/2022] Open
Abstract
This study aimed to investigate the effect of two different image density adjustment parameters on the results of image matching at six degrees of freedom using radiographic images generated by the ExacTrac X‐ray system in brain stereotactic radiosurgery (SRS). This study comprised 32 patients who underwent brain SRS at our hospital from January 2020 to December 2020. In this study, (1) the default parameter (an image density parameter between “tissue” and “bone”) was an image density parameter for digitally reconstructed radiograph (DRR) generation used at many facilities, and (2) the bone parameter was the steepest contrast parameter used at our hospital. Of the 32 patients, 24 (75%) had a couch angle of 0.5 mm or more in the translational direction or 0.5° or more in the rotational direction, and 10 (31%) had a couch angle of 1.0 mm or more in the translational direction or 1.0° or more in the rotational direction. Among the 131 cases of all couch angles, 46 (35%) cases had a translational direction of 0.5 mm or more or a rotational direction of 0.5° or more, and 15 (11%) had a translational direction of 1.0 mm or more or a rotational direction of 1.0° or more. The results of this study indicate the usefulness of using appropriate DRR parameters for each case, rather than using the default settings. The use of appropriate DRR parameters can lead to accurate position matching results, leading to fewer image‐guided radiation therapy shots and a lower imaging dose.
Collapse
Affiliation(s)
- Kanako Sakuragawa
- Department of Radiological Technology, Tokushima University Hospital, Tokushima, 770-8503, Japan
| | - Motoharu Sasaki
- Department of Therapeutic Radiology Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, 770-8503, Japan
| | - Takeshi Kamomae
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, 466-8550, Japan
| | - Michihiro Yokoishi
- Department of Radiological Technology, Tokushima University Hospital, Tokushima, 770-8503, Japan
| | - Ryosuke Kasai
- Department of Radiological Technology, Tokushima University Hospital, Tokushima, 770-8503, Japan
| | - Akimi Kajino
- Graduate School of Health Sciences, Tokushima University, Tokushima, 770-8503, Japan
| | - Hitoshi Ikushima
- Department of Therapeutic Radiology Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, 770-8503, Japan
| |
Collapse
|
22
|
Sarkar B, Ganesh T, Munshi A, Manikandan A, Choudhari S, Jassal K, Mohanti BK, Pradhan A. Compatibility assessment of Varian and Elekta robotic couch‐assisted six‐dimensional patient positioning correction systems with external independent imaging modalities. PRECISION RADIATION ONCOLOGY 2021. [DOI: 10.1002/pro6.1136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Biplab Sarkar
- Department of Radiation Oncology, Apollo Multispeciality Hospitals Kolkata West Bengal India
- GLA University Mathura Uttar Pradesh India
| | | | - Anusheel Munshi
- Department of Radiation Oncology, Manipal Hospitals New Delhi India
| | | | | | - Kanan Jassal
- Department of Radiation Oncology, Fortis Memorial Research Institute Gurugram Haryana India
| | | | | |
Collapse
|
23
|
Agazaryan N, Tenn S, Lee C, Steinberg M, Hegde J, Chin R, Pouratian N, Yang I, Kim W, Kaprealian T. Simultaneous radiosurgery for multiple brain metastases: technical overview of the UCLA experience. Radiat Oncol 2021; 16:221. [PMID: 34789300 PMCID: PMC8597274 DOI: 10.1186/s13014-021-01944-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/01/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE/OBJECTIVE(S) To communicate our institutional experience with single isocenter radiosurgery treatments for multiple brain metastases, including challenges with determining planning target volume (PTV) margins and resulting consequences, image-guidance translational and rotational tolerances, intra-fraction patient motion, and prescription considerations with larger PTV margins. MATERIALS/METHODS Eight patient treatments with 51 targets were planned with various margins using Elements Multiple Brain Mets SRS treatment planning software (Brainlab, Munich, Germany). Forty-eight plans with 0 mm, 1 mm and 2 mm margins were created, including plans with variable margins, where targets more than 6 cm away from the isocenter were planned with larger margins. The dosimetric impact of the margins were analyzed with V5Gy, V8Gy, V10Gy, V12Gy values. Additionally, 12 patient motion data were analyzed to determine both the impact of the repositioning threshold and the distributions of the patient translational and rotational movements. RESULTS The V5Gy, V8Gy, V10Gy, V12Gy volumes approximately doubled when margins change from 0 to 1 mm and tripled when change from 0 to 2 mm. With variable margins, the aggregated results are similar to results from plans using the lower of two margins, since only 12.2% of the targets were more than 6 cm away from the isocenter. With 0.5 mm re-positioning threshold, 57.4% of the time the patients are repositioned. Reducing the threshold to 0.25 mm results in 91.7% repositioning rate, due to limitations of the fusion algorithm and actual patient motion. The 90th percentile of translational movements in all directions is 0.7 mm, while the 90th percentile of rotational movements in all directions is 0.6 degrees. Median translations and rotations are 0.2 mm and 0.2 degrees, respectively. CONCLUSIONS Based on the data presented, we have switched our modus operandi from 2 to 1 mm PTV margins, with an eventual goal of using 0.5 and 1.0 mm variable margins when an automated margin assignment method becomes available. The 0.5 mm and 0.5 degrees repositioning thresholds are clinically appropriate with small residual patient movements.
Collapse
Affiliation(s)
- Nzhde Agazaryan
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Steve Tenn
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Chul Lee
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Michael Steinberg
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - John Hegde
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Robert Chin
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Nader Pouratian
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Isaac Yang
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Won Kim
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Tania Kaprealian
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| |
Collapse
|
24
|
Dabus G, Kotecha R, Linfante I, Wieczorek DJ, Gutierrez AN, Candela JG, McDermott MW. Analysis of potential time saving in brain arteriovenous malformation stereotactic radiosurgery planning using a new software platform. Med Dosim 2021; 47:38-42. [PMID: 34481717 DOI: 10.1016/j.meddos.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/31/2021] [Accepted: 07/24/2021] [Indexed: 11/15/2022]
Abstract
To evaluate the utility of integrating a 3D vessel tree co-registration software platform into the stereotactic radiosurgery (SRS) workflow and its time saving for brain arteriovenous malformation (bAVM) treatment in adults compared to the conventional stereotactic head frame workflow. Eight consecutive adult bAVM cases were selected and retrospectively reviewed. Total number of angiograms and SRS procedures were 8. The electronic medical records were analyzed by time stamps to determine the length of time for each component of the set-up, transport, and frame removal. Times were averaged and the start of sedation by anesthesia used as a surrogate for the start of the frame application process. Reductions in workflow times were then modeled assuming cerebral angiography as a separate procedure. There were 8 adult bAVM cases included. Six were female. All patients had a single treatment session. Average age was 51.5 years (Range: 36-71). All patients were treated under monitored anesthesia care. In 6 patients, the AVM was deeply located (basal ganglia, midbrain, brainstem); in 2 cases, the lesion was frontal. Spetzler-Martin grades were 4 (50%) Grade 2 and 4 (50%) Grade 3. The average prescription isodose volume (PIV) and 12 Gy volumes (V12Gy) were 0.85 cc and 1.74 cc, respectively. The mean time from frame application to arrival in the angiography room was 111.5 minutes (range 40 to 171 min; median 107 min; SD 35.3 min); transport from angiography room to SRS was 47.5 minutes (range 15 to 107 min; median 36 min; SD 31.1 min), and frame removal after SRS was 20.5 minutes (range 10 to 47 min; median 16 min; SD 11.6 min). The average total additional time for the entire process of frame application, patient transportation, and frame removal was 132 minutes (range 87 to 181 min; median 127.5 min; SD 28.4 min). Therefore, assuming a non-frame based workflow and with angiography performed ahead of the actual radiosurgical treatment, the total time savings on the day of treatment was estimated at 132 minutes (range 87 to 181 min; median 127.5 min; SD 28.4 min). The ability to perform angiography, image fusion, and treatment planning for the actual day-of-delivery using 3-dimensional vessel tree co-registration could result in significant time savings over traditional workflow practices. Further experience with this system will evaluate its accuracy, reproducibility, and potential broader use in SRS workflow paradigms for the treatment of vascular pathologies. For bAVMs, the benefits of this time savings might allow for streamlined workflows on the day of SRS.
Collapse
Affiliation(s)
- Guilherme Dabus
- Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL; Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL; Herbert Wertheim College of Medicine, Florida International University, Miami, FL.
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL; Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Italo Linfante
- Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL; Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL; Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - D Jay Wieczorek
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL; Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Alonso N Gutierrez
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL; Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - John G Candela
- Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL
| | - Michael W McDermott
- Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL; Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| |
Collapse
|
25
|
Tomihara J, Takatsu J, Sugimoto S, Shikama N, Sasai K. Intrafraction stability using full head mask for brain stereotactic radiotherapy. J Appl Clin Med Phys 2021; 22:360-370. [PMID: 34347933 PMCID: PMC8425876 DOI: 10.1002/acm2.13382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/09/2021] [Accepted: 07/19/2021] [Indexed: 11/11/2022] Open
Abstract
Purpose We investigated the immobilization accuracy of a new type of thermoplastic mask—the Double Shell Positioning System (DSPS)—in terms of geometry and dose delivery. Methods Thirty‐one consecutive patients with 1–5 brain metastases treated with stereotactic radiotherapy (SRT) were selected and divided into two groups. Patients were divided into two groups. One group of patients was immobilized by the DSPS (n = 9). Another group of patients was immobilized by a combination of the DSPS and a mouthpiece (n = 22). Patient repositioning was performed with cone beam computed tomography (CBCT) and six‐degree of freedom couch. Additionally, CBCT images were acquired before and after treatment. Registration errors were analyzed with off‐line review. The inter‐ and intrafractional setup errors, and planning target volume (PTV) margin were also calculated. Delivered doses were calculated by shifting the isocenter according to inter‐ and intrafractional setup errors. Dose differences of GTV D99% were compared between planned and delivered doses against the modified PTV margin of 1 mm. Results Interfractional setup errors associated with the mouthpiece group were significantly smaller than the translation errors in another group (p = 0.03). Intrafractional setup errors for the two groups were almost the same in all directions. PTV margins were 0.89 mm, 0.75 mm, and 0.90 mm for the DSPS combined with the mouthpiece in lateral, vertical, and longitudinal directions, respectively. Similarly, PTV margins were 1.20 mm, 0.72 mm, and 1.37 mm for the DSPS in the lateral, vertical, and longitudinal directions, respectively. Dose differences between planned and delivered doses were small enough to be within 1% for both groups. Conclusions The geometric and dosimetric assessments revealed that the DSPS provides sufficient immobilization accuracy. Higher accuracy can be expected when the immobilization is combined with the use of a mouthpiece.
Collapse
Affiliation(s)
- Jun Tomihara
- Department of Radiation Oncology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology, Juntendo University Hospital, Tokyo, Japan
| | - Jun Takatsu
- Department of Radiation Oncology, Juntendo University, Tokyo, Japan
| | - Satoru Sugimoto
- Department of Radiation Oncology, Juntendo University, Tokyo, Japan
| | - Naoto Shikama
- Department of Radiation Oncology, Juntendo University, Tokyo, Japan
| | - Keisuke Sasai
- Department of Radiation Oncology, Juntendo University, Tokyo, Japan
| |
Collapse
|
26
|
Agazaryan N, Tenn S, Pouratian N, Kaprealian T. Intra-Fraction Motion Management for Radiosurgical Treatments of Trigeminal Neuralgia: Clinical Experience, Imaging Frequency, and Motion Analysis. Cureus 2021; 13:e14616. [PMID: 34040916 PMCID: PMC8139874 DOI: 10.7759/cureus.14616] [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] [Indexed: 11/12/2022] Open
Abstract
Purpose The aim of this study is to evaluate the patient positioning and intra-fraction motion management performance of an image-guidance protocol established for radiosurgical treatments of trigeminal neuralgia patients. Specifically, it also aims to analyze patient motion data for the evaluation of current motion tolerance levels and imaging frequency utilized for repositioning patients. Methods A linear accelerator equipped with ExacTrac is used for patient positioning with stereoscopic imaging and treatments. Treatments are delivered with 4-mm conical collimators using seven equally spaced arcs. Arcs are 20 degrees apart and span 100 arc degrees each. Following initial ExacTrac positioning, cone beam computed tomography (CBCT) is obtained for independent confirmation of patient position. Patients are then stereoscopically imaged prior to the delivery of each arc and repositioned when 0.5-mm translational tolerance in any direction is exceeded. After the patient has been repositioned, verification stereoscopic images are obtained. Data from 48 patients with 607 image pairs were analyzed for this study. Results Over the course of 48 patient treatments, the mean magnitude of mean 3D deviations was 0.64 mm ± 0.12 mm (range: 0.07-2.74 mm). With the current 0.50-mm tolerance level for repositioning, patients exceeded the tolerance 51.4% of the time considering only images following an arc segment. For those instances, patients were repositioned with a mean magnitude of 0.85 mm ± 0.15 mm (1 SD). For a 0.25-mm tolerance level, 86.1% of arc segments would have required repositioning following the delivery of an arc segment, with a mean magnitude of 0.68 mm ± 0.12 mm. Conversely, for 0.75-mm and 1.00-mm tolerance levels, the tolerance would have been exceeded only 21.5% and 6.6% of instances following the delivery of an arc segment, with a mean magnitude of 1.08 mm ± 0.21 mm and 1.34 mm ± 0.24 mm, respectively. Each repositioning adds approximately 2 minutes to treatment time, which accounts for parts of the variability in patient treatment times. Following the initial ExacTrac and CBCT, the mean treatment time from first arc to treatment end was 57 minutes (range: 33-63 minutes). Discussions The current 0.50-mm tolerance level results in a clinically manageable but significant number of patient repositions during trigeminal neuralgia treatments. Frequent patient repositioning can result from actual patient motion convolved with the accuracy and precision limitations of the image analysis. Increasing the repositioning tolerance could more selectively correct for actual patient motion and shorten the treatment time at the expense of more variations in patient position. A more lenient tolerance level of 0.75 mm would decrease the repositioning rate by approximately a factor of 2; however, the permissible magnitude of motion will increase, leading to possible dosimetric consequences. Once treatment begins, there was no trend as to when patients exceeded the tolerance. Conclusions Current imaging protocol for patient positioning and intra-fraction motion management fits the clinical workflow with clinically acceptable residual patient motion. The next important step would be to assess how the number of repositions and magnitude of residual movements affect treatment outcomes.
Collapse
Affiliation(s)
- Nzhde Agazaryan
- Radiation Oncology, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, USA
| | - Stephen Tenn
- Radiation Oncology, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, USA
| | - Nader Pouratian
- Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, USA
| | - Tania Kaprealian
- Radiation Oncology, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, USA
| |
Collapse
|
27
|
Yoon S, Yoon CH, Lee D. Topological recovery for non-rigid 2D/3D registration of coronary artery models. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 200:105922. [PMID: 33440300 DOI: 10.1016/j.cmpb.2020.105922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Intra-operative X-ray angiography, the current standard method for visualizing and diagnosing cardiovascular disease, is limited in its ability to provide essential 3D information. These limitations are disadvantages in treating patients. For example, it is a cause of lowering the success rate of interventional procedures. Here, we propose a novel 2D-3D non-rigid registration method to understand vascular geometry during percutaneous coronary intervention. METHODS The proposed method uses the local bijection pair distance as a cost function to minimize the effect of inconsistencies from center-line extraction. Moreover, novel cage-based 3D deformation and multi-threaded particle swarm optimization are utilized to implement real-time registration. We evaluated the proposed method for 154 examinations from 10 anonymous patients by coverage percentage, comparing the average distance of the 2D extracted center-line with that of the registered 3D center-line. RESULTS The proposed 2D-3D non-rigid registration method achieved an average distance of 1.98 mm with a 0.54 s computation time. Additionally, in aiming to reduce the uncertainty of XA images, we used the proposed method to retrospectively visualize the connections between 2D vascular segments and the distal part of occlusions. CONCLUSIONS Ultimately, the proposed 2D/3D non-rigid registration method can successfully register the 3D center-line of coronary arteries with corresponding 2D XA images, and is computationally sufficient for online usage. Therefore, this method can improve the success rate of such procedures as a percutaneous coronary intervention and provide the information necessary to diagnose cardiovascular diseases better.
Collapse
Affiliation(s)
- Siyeop Yoon
- 5, Hwarang-ro 14-gil, Seongbuk-gu, Seoul,Center for Healthcare Robotics, Korea Institute of Science and Technology, South Korea; 5, Hwarang-ro 14-gil, Seongbuk-gu, Seoul, KIST School, Korea University of Science and Technology, South Korea.
| | - Chang Hwan Yoon
- Gumi-ro, 82-gil 173, Bundang-gu, Seongnam, Seoul national university Bundang Hospital, South Korea.
| | - Deukhee Lee
- 5, Hwarang-ro 14-gil, Seongbuk-gu, Seoul,Center for Healthcare Robotics, Korea Institute of Science and Technology, South Korea; 5, Hwarang-ro 14-gil, Seongbuk-gu, Seoul, KIST School, Korea University of Science and Technology, South Korea.
| |
Collapse
|
28
|
Tsuruta Y, Nakata M, Nakamura M, Uto M, Takehana K, Hirashima H, Fujimoto T, Mizowaki T. Evaluation of intrafractional head motion for intracranial stereotactic radiosurgery with a thermoplastic frameless mask and ceiling-floor-mounted image guidance device. Phys Med 2021; 81:245-252. [PMID: 33485142 DOI: 10.1016/j.ejmp.2020.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/17/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To evaluate intrafractional head motion (IFM) in patients who underwent intracranial stereotactic radiosurgery with the ExacTrac X-ray system (ETX) and a frameless mask. METHODS A total of 143 patients who completed a pre-treatment examination for IFM were eligible for this study. The frameless mask type B R408 (Klarity Medical & Equipment Co., Ltd., Guangzhou, China), which covers the back of the head, and the entire face, was used for patient immobilization. After the initial 6D correction and first X-ray verification (IFM1), X-ray verification was performed every 3 min for a duration of 15 min. The IFMp (2 ≤ p ≤ 6) was calculated as the positional difference from IFM1. In addition, the inter-phase IFM (IP-IFM) and IFMm were calculated. The IP-IFM was defined as |IFMp - IFMp-1|, and IFMm as the difference between the values after all patients were asked to move their heads intentionally with the frameless mask on. RESULTS Both translational IFMp and IP-IFM exceeded 1 mm for a single patient, whereas, for all patients, the translational IFMm values were kept to within 1 mm in all directions. The proportions of the rotational IFMp, IP-IFM, and IFMm values within 0.5° were greater than 94.4%, 98.6%, and 90.2% for all of the rotational axes, respectively. CONCLUSIONS A frameless mask achieved highly accurate patient positioning in combination with ETX and a 6°-of-freedom robotic couch; however, a deviation over 1 mm and 0.5° was observed with low frequency. Therefore, X-ray verification and correction are required during treatment.
Collapse
Affiliation(s)
- Yusuke Tsuruta
- Division of Clinical Radiology Service, Kyoto University Hospital, Kyoto 606-8507, Japan; Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Manabu Nakata
- Division of Clinical Radiology Service, Kyoto University Hospital, Kyoto 606-8507, Japan
| | - Mitsuhiro Nakamura
- Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan; Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan.
| | - Megumi Uto
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Keiichi Takehana
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Hideaki Hirashima
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Takahiro Fujimoto
- Division of Clinical Radiology Service, Kyoto University Hospital, Kyoto 606-8507, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| |
Collapse
|
29
|
Combs SE, Baumert BG, Bendszus M, Bozzao A, Brada M, Fariselli L, Fiorentino A, Ganswindt U, Grosu AL, Lagerwaard FL, Niyazi M, Nyholm T, Paddick I, Weber DC, Belka C, Minniti G. ESTRO ACROP guideline for target volume delineation of skull base tumors. Radiother Oncol 2020; 156:80-94. [PMID: 33309848 DOI: 10.1016/j.radonc.2020.11.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/13/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE For skull base tumors, target definition is the key to safe high-dose treatments because surrounding normal tissues are very sensitive to radiation. In the present work we established a joint ESTRO ACROP guideline for the target volume definition of skull base tumors. MATERIAL AND METHODS A comprehensive literature search was conducted in PubMed using various combinations of the following medical subjects headings (MeSH) and free-text words: "radiation therapy" or "stereotactic radiosurgery" or "proton therapy" or "particle beam therapy" and "skull base neoplasms" "pituitary neoplasms", "meningioma", "craniopharyngioma", "chordoma", "chondrosarcoma", "acoustic neuroma/vestibular schwannoma", "organs at risk", "gross tumor volume", "clinical tumor volume", "planning tumor volume", "target volume", "target delineation", "dose constraints". The ACROP committee identified sixteen European experts in close interaction with the ESTRO clinical committee who analyzed and discussed the body of evidence concerning target delineation. RESULTS All experts agree that magnetic resonance (MR) images with high three-dimensional spatial accuracy and tissue-contrast definition, both T2-weighted and volumetric T1-weighted sequences, are required to improve target delineation. In detail, several key issues were identified and discussed: i) radiation techniques and immobilization, ii) imaging techniques and target delineation, and iii) technical aspects of radiation treatments including planning techniques and dose-fractionation schedules. Specific target delineation issues with regard to different skull base tumors, including pituitary adenomas, meningiomas, craniopharyngiomas, acoustic neuromas, chordomas and chondrosarcomas are presented. CONCLUSIONS This ESTRO ACROP guideline achieved detailed recommendations on target volume definition for skull base tumors, as well as comprehensive advice about imaging modalities and radiation techniques.
Collapse
Affiliation(s)
- Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany; Institute of Radiation Medicine, Department of Radiation Sciences, Helmholtz Zentrum München, Munich, Germany; German Cancer Consortium (DKTK) Partner Site (DKTK), Munich, Germany
| | - Brigitta G Baumert
- Institute of Radiation Oncology, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Germany
| | - Alessandro Bozzao
- Dipartimento NESMOS, Università Sapienza Roma, Azienda Ospedaliera Sant'Andrea, Rome, Italy
| | - Michael Brada
- Department of Radiation Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, United Kingdom
| | - Laura Fariselli
- Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alba Fiorentino
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle fonti, Italy
| | - Ute Ganswindt
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anca L Grosu
- Department of Radiation Oncology, Medical Faculty, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, Germany
| | - Frank L Lagerwaard
- Department of Radiation Oncology, Amsterdam University Medical Centers, Location VUmc, The Netherlands
| | - Maximilian Niyazi
- German Cancer Consortium (DKTK) Partner Site (DKTK), Munich, Germany; Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Tufve Nyholm
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
| | - Ian Paddick
- Queen Square Radiosurgery Centre, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | | | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Giuseppe Minniti
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy; IRCCS Neuromed, Pozzilli, Italy.
| |
Collapse
|
30
|
Clinical outcomes of fractionated stereotactic radiosurgery in treating perioptic meningiomas and schwannomas: A single-institutional experience. J Clin Neurosci 2020; 81:409-415. [PMID: 33222952 DOI: 10.1016/j.jocn.2020.09.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 09/06/2020] [Accepted: 09/28/2020] [Indexed: 11/24/2022]
Abstract
Application of radiosurgery to the newly diagnosed or post-operative residual perioptic lesions has been proved to improve tumor control. However, risk of vision injury induced by radiosurgery may increase substantially if the radiation dose is too high or tumor is close to the optic apparatus. The purpose of this study was to evaluate the safety and the effectiveness of fractionated stereotactic radiosurgery (FSRS) for perioptic tumors. We retrospectively analyzed 60 consecutive patients with 53 meningiomas and 7 schwannomas treated with FSRS between October 2007 and February 2020. We administered a marginal dose of 6-7 Gy (mean 6.8 Gy) per fraction and delivered 3 fractions in 3 consecutive days. The median tumor volume was 6.31 cm3 (range 0.3-58.23 cm3). The mean minimum lesion-optic distance (MLOD) is 0.85 mm (range 0-3 mm). After mean follow-up period of 69.6 months (range 6.82-156.32 months; median 58.9 months), the tumor control rates at 1, 3, 5, 8 and 13 years were 98.3%, 93.4%, 90.60%, 88.4% and 88.4%, respectively. Four out of the 60 tumors (6.7%) experienced a transient volume increase after FSRS. None of the patients developed visual impairment related to radiation induced optic neuropathy (RION) after FSRS. In conclusion, FSRS offers an alternative treatment option in treating perioptic meningiomas and schwannomas with acceptable tumor control rates and good visual preservation in the present study.
Collapse
|
31
|
Initial Experience With Single-Isocenter Radiosurgery to Target Multiple Brain Metastases Using an Automated Treatment Planning Software: Clinical Outcomes and Optimal Target Volume Margins Strategy. Adv Radiat Oncol 2020; 5:856-864. [PMID: 33083647 PMCID: PMC7557192 DOI: 10.1016/j.adro.2020.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/24/2020] [Accepted: 06/16/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose Our purpose was to assess the clinical outcomes and target positioning accuracy of frameless linear accelerator single-isocenter multiple-target (SIMT) dynamic conformal arc (DCA) stereotactic radiosurgery (SRS) for multiple brain metastases (BM). Methods and Materials Between October 2016 and September 2018, 31 consecutive patients ≥18 years old with 204 BM <3 cm in maximum size receiving SIMT DCA SRS were retrospectively evaluated. All plans were created using a dedicated automated treatment planning software (Brainlab, Munich, Germany), and treatments were performed with a Truebeam STx or a Novalis Tx (Brainlab and Varian Medical Systems, CA). The accuracy of setup and interfraction patient repositioning was assessed by Brainlab ExacTrac radiograph 6-dimensional image system and the risk of compromised target dose coverage evaluated. Brain control and overall survival were estimated by Kaplan-Meier method calculated from the time of SRS. Results Fourteen patients were treated for 4 to 6 and 17 patients for 7 to 10 BM. The mean gross tumor volume (GTV) was 0.65 cm3 and the mean planning target volume (PTV) was 0.89 cm3. Mean V95 (the volume of the PTV covered by 95% of the prescription dose) and D95 (the prescription dose covering 95% of the PTV) were 99.5% and 21.1 Gy, respectively. With a median clinical follow-up of 11 months (range, 4-26 months), the 1-year survival was 68% and local control was 89%. As a consequence of plan isocenter residual errors, a loss of target coverage, defined as V95 < 95%, occurred in 28 PTVs (10 patients); using a 1 mm GTV-to-PTV margin, adequate dose coverage was maintained for all lesions. Conclusions SIMT DCA SRS represents a fast and effective approach for patients with up to 10 BM. The dosimetric effects of residual set-up and intrafraction positioning errors are modest, although a GTV-to-PTV margin of 1 mm is recommended.
Collapse
|
32
|
Hamada K, Fujibuchi T, Yoshida N, Ohura H. Examination of a dose evaluation method for floor-mounted kV X-ray image-guided radiation therapy systems. Radiol Phys Technol 2020; 13:288-295. [DOI: 10.1007/s12194-020-00570-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 11/28/2022]
|
33
|
Schmitt D, Blanck O, Gauer T, Fix MK, Brunner TB, Fleckenstein J, Loutfi-Krauss B, Manser P, Werner R, Wilhelm ML, Baus WW, Moustakis C. Technological quality requirements for stereotactic radiotherapy : Expert review group consensus from the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. Strahlenther Onkol 2020; 196:421-443. [PMID: 32211939 PMCID: PMC7182540 DOI: 10.1007/s00066-020-01583-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/13/2020] [Indexed: 12/25/2022]
Abstract
This review details and discusses the technological quality requirements to ensure the desired quality for stereotactic radiotherapy using photon external beam radiotherapy as defined by the DEGRO Working Group Radiosurgery and Stereotactic Radiotherapy and the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. The covered aspects of this review are 1) imaging for target volume definition, 2) patient positioning and target volume localization, 3) motion management, 4) collimation of the irradiation and beam directions, 5) dose calculation, 6) treatment unit accuracy, and 7) dedicated quality assurance measures. For each part, an expert review for current state-of-the-art techniques and their particular technological quality requirement to reach the necessary accuracy for stereotactic radiotherapy divided into intracranial stereotactic radiosurgery in one single fraction (SRS), intracranial fractionated stereotactic radiotherapy (FSRT), and extracranial stereotactic body radiotherapy (SBRT) is presented. All recommendations and suggestions for all mentioned aspects of stereotactic radiotherapy are formulated and related uncertainties and potential sources of error discussed. Additionally, further research and development needs in terms of insufficient data and unsolved problems for stereotactic radiotherapy are identified, which will serve as a basis for the future assignments of the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. The review was group peer-reviewed, and consensus was obtained through multiple working group meetings.
Collapse
Affiliation(s)
- Daniela Schmitt
- Klinik für Radioonkologie und Strahlentherapie, National Center for Radiation Research in Oncology (NCRO), Heidelberger Institut für Radioonkologie (HIRO), Universitätsklinikum Heidelberg, Heidelberg, Germany.
| | - Oliver Blanck
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Tobias Gauer
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Michael K Fix
- Abteilung für Medizinische Strahlenphysik und Universitätsklinik für Radio-Onkologie, Inselspital-Universitätsspital Bern, Universität Bern, Bern, Switzerland
| | - Thomas B Brunner
- Universitätsklinik für Strahlentherapie, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | - Jens Fleckenstein
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Britta Loutfi-Krauss
- Klinik für Strahlentherapie und Onkologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Peter Manser
- Abteilung für Medizinische Strahlenphysik und Universitätsklinik für Radio-Onkologie, Inselspital-Universitätsspital Bern, Universität Bern, Bern, Switzerland
| | - Rene Werner
- Institut für Computational Neuroscience, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Maria-Lisa Wilhelm
- Klinik für Strahlentherapie, Universitätsmedizin Rostock, Rostock, Germany
| | - Wolfgang W Baus
- Klinik für Radioonkologie, CyberKnife- und Strahlentherapie, Universitätsklinikum Köln, Cologne, Germany
| | - Christos Moustakis
- Klinik für Strahlentherapie-Radioonkologie, Universitätsklinikum Münster, Münster, Germany
| |
Collapse
|
34
|
Independent 6D quality assurance of stereotactic radiotherapy repositioning on linacs. Cancer Radiother 2020; 24:199-205. [PMID: 32165115 DOI: 10.1016/j.canrad.2020.01.005] [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: 12/11/2019] [Revised: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE A high level of accuracy while positioning the patient is mandatory for frameless stereotactic radiotherapy (SRT), as large doses in multiple fractions can be delivered near organs at risk. The objective of this study is to propose an end-to-end quality assurance method to verify that submillimetre alignment can be achieved with stereotactic conventional linacs. METHODS We used a TrueBeam® linear accelerator equipped with a 6DOF robotic couch. The "ISO Cube" phantom was used with a homemade stand designed to generate known translational and rotational offsets. A reference CT scan was performed with straight alignment of the phantom. The procedure introduced 1.6° angular offset for the couch pitch and roll, at various gantry angles. The couch base was also moved between 0° and 270°. We compared the results with the daily machine performance check tests (MPC, Varian). RESULTS The mean isocentre size, MV and kV imager offsets were found to agree to within 0.1mm, 0.1mm and 0.3mm respectively, and were in close agreement between the methods. For a total four months data collection period, the mean deviation between requested and measured 6DOF couch shifts was 0.6mm and 0.2°. Errors on field size were smaller than 1mm for 97.7% of the 324 data points. CONCLUSION Results demonstrate that the linac equipped with a 6DOF robotic positioner and CBCT imaging satisfies requirements for SRT. Our methodology, based on a modified Winston-Lutz quality control, allowed us to quantitatively assess end-to-end accuracy of a linac in order to safely deliver SRT.
Collapse
|
35
|
Almeida T, da Silva C, Piedade P, Cordova A, Bezerra C, Soboll D, Denyak V, Schelin H. Positioning deviations in frameless and frame-based intracranial stereotactic radiosurgery. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.108363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
36
|
Tanaka Y, Oita M, Inomata S, Fuse T, Akino Y, Shimomura K. Impact of patient positioning uncertainty in noncoplanar intracranial stereotactic radiotherapy. J Appl Clin Med Phys 2020; 21:89-97. [PMID: 31957975 PMCID: PMC7020988 DOI: 10.1002/acm2.12820] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/04/2019] [Accepted: 12/20/2019] [Indexed: 11/28/2022] Open
Abstract
The aim of this study is to evaluate the patient positioning uncertainty in noncoplanar stereotactic radiosurgery or stereotactic radiotherapy (SRS/SRT) for intracranial lesions with the frameless 6D ExacTrac system. In all, 28 patients treated with SRS/SRT of 70 treatment plans at our institution were evaluated in this study. Two X‐ray images with the frameless 6D ExacTrac system were first acquired to correct (XC) and verify (XV) the patient position at a couch angle of 0º. Subsequently, the XC and XV images were also acquired at each planned couch angle for using noncoplanar beams to detect position errors caused by rotating a couch. The translational XC and XV shift values at each couch angle were calculated for each plan. The percentages of the translational XC shift values within 1.0 mm for each planned couch angle for using noncoplanar beams were 77.86%, 72.26%, and 98.47% for the lateral, longitudinal, and vertical directions, respectively. Those within 2.0 mm were 98.22%, 97.96%, and 99.75% for the lateral, longitudinal, and vertical directions, respectively. The maximum absolute values of the translational XC shifts among all planned couch angles for using noncoplanar beams were 2.69, 2.45, and 2.17 mm for the lateral, longitudinal, and vertical directions, respectively. The overall absolute values of the translational XV shifts were less than 1.0 mm for all directions except for one case in the longitudinal direction. The patient position errors were detected after couch rotation for using noncoplanar beams, and they exceeded a planning target volume (PTV) margin of 1.0–2.0 mm used commonly in SRS/SRT treatment. These errors need to be corrected at each planned couch angle, or the PTV margin should be enlarged.
Collapse
Affiliation(s)
- Yoshihiro Tanaka
- Department of Radiation Therapy, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan
| | - Masataka Oita
- Department of Healthcare Sciences, Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Japan
| | - Shinichiro Inomata
- Department of Radiation Therapy, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan
| | - Toshiaki Fuse
- Department of Radiation Therapy, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan
| | - Yuichi Akino
- Oncology Center, Osaka University Hospital, Osaka, Japan
| | | |
Collapse
|
37
|
Albano L, Losa M, Flickinger J, Mortini P, Minniti G. Radiotherapy of Parasellar Tumours. Neuroendocrinology 2020; 110:848-858. [PMID: 32126559 DOI: 10.1159/000506902] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/02/2020] [Indexed: 11/19/2022]
Abstract
Parasellar tumours represent a wide group of intracranial lesions, both benign and malignant. They may arise from several structures located within the parasellar area or they may infiltrate or metastasize this region. The treatment of the tumours located in these areas is challenging because of their complex anatomical location and their heterogenous histology. It often requires a multimodal approach, including surgery, radiation therapy (RT), and medical therapy. Due to the proximity of critical structures and the risks of side effects related to the procedure, a successful surgical resection is often not achievable. Thus, RT plays a crucial role in the treatment of several parasellar tumours. Conventional fractionated RT and modern radiation techniques, like stereotactic radiosurgery and proton beam RT, have become a standard management option, in particular for cases with residual or recurrent tumours after surgery and for those cases where surgery is contraindicated. This review examines the role of RT in parasellar tumours analysing several techniques, outcomes and side effects.
Collapse
Affiliation(s)
- Luigi Albano
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Marco Losa
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - John Flickinger
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Giuseppe Minniti
- Radiation Oncology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy,
- UPMC Hillman Cancer Center San Pietro Hospital, Rome, Italy,
| |
Collapse
|
38
|
Frameless Image Guidance in Stereotactic Radiosurgery. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
39
|
Semeniuk O, Sadeghi P, Farah JD, Moran K, Robar J. Performance optimization of capacitive motion sensing (CMS) system for intra-fraction motion detection during stereotactic radiosurgery. Biomed Phys Eng Express 2019; 6:015013. [DOI: 10.1088/2057-1976/ab5bff] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
40
|
Mangesius J, Seppi T, Weigel R, Arnold CR, Vasiljevic D, Goebel G, Lukas P, Ganswindt U, Nevinny-Stickel M. Intrafractional 6D head movement increases with time of mask fixation during stereotactic intracranial RT-sessions. Radiat Oncol 2019; 14:231. [PMID: 31852497 PMCID: PMC6921566 DOI: 10.1186/s13014-019-1425-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/22/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The present study investigates the intrafractional accuracy of a frameless thermoplastic mask used for head immobilization during stereotactic radiotherapy. Non-invasive masks cannot completely prohibit head movements. Previous studies attempted to estimate the magnitude of intrafractional inaccuracy by means of pre- and postfractional measurements only. However, this might not be sufficient to accurately map also intrafractional head movements. MATERIALS AND METHODS Intrafractional deviation of mask-fixed head positions was measured in five patients during a total of 94 fractions by means of close-meshed repeated ExacTrac measurements (every 1.4 min) conducted during the entire treatment session. A median of six (range: 4 to 11) measurements were recorded per fraction, delivering a dataset of 453 measurements. RESULTS Random errors (SD) for the x, y and z axes were 0.27 mm, 0.29 mm and 0.29 mm, respectively. Median 3D deviation was 0.29 mm. Of all 3D intrafractional motions, 5.5 and 0.4% exceeded 1 mm and 2 mm, respectively. A moderate correlation between treatment duration and mean 3D displacement was determined (rs = 0.45). Mean 3D deviation increased from 0.21 mm (SD = 0.26 mm) in the first 2 min to a maximum of 0.53 mm (SD = 0.31 mm) after 10 min of treatment time. CONCLUSION Pre- and post-treatment measurement is not sufficient to adequately determine the range of intrafractional head motion. Thermoplastic masks provide both reliable interfractional and intrafractional immobilization for image-guided stereotactic hypofractionated radiotherapy. Greater positioning accuracy may be obtained by reducing treatment duration (< 6 min) and applying intrafractional correction. TRIAL REGISTRATION Clinicaltrials.gov, NCT03896555, Registered 01 April 2019 - retrospectively registered.
Collapse
Affiliation(s)
- Julian Mangesius
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Thomas Seppi
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Rocco Weigel
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Christoph Reinhold Arnold
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Danijela Vasiljevic
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Lukas
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Ute Ganswindt
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Meinhard Nevinny-Stickel
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| |
Collapse
|
41
|
Sarkar B, Munshi A, Ganesh T, Manikandan A, Krishnankutty S, Chitral L, Pradhan A, Kalyan Mohanti B. Technical Note: Rotational positional error corrected intrafraction set-up margins in stereotactic radiotherapy: A spatial assessment for coplanar and noncoplanar geometry. Med Phys 2019; 46:4749-4754. [PMID: 31495931 DOI: 10.1002/mp.13810] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/26/2019] [Accepted: 08/26/2019] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The aim of this study is to calculate setup margin based on six-dimensional (6D) corrected residual positional errors from kV cone beam computed tomography (CBCT) and from intrafraction projection kV imaging in coplanar and in noncoplanar couch positions in stereotactic radiotherapy. METHODS Six dimensional positional corrections were carried out before patient treatments, using a robotic couch and CBCT matching. A CBCT and stereoscopic ExacTrac image were acquired post-table position correction. Further, a series of intrafraction ExacTrac images were obtained for the variable couch position. Translational and rotational errors were identified as lateral (X), longitudinal (Y), vertical (Z); roll (Ɵ°), pitch (Φ°) and yaw (Ψ°). A total of 699 intrafraction image sets (361 coplanar and 338 noncoplanar) for 51 SRS/SRT patients were analysed. Rotational errors were corrected in terms of translational coordinates. Residual set-up margins were calculated from CBCT shifts. ExacTrac shifts give residual + intrafraction setup margins as a function of coplanar and noncoplanar couch positions. RESULTS The average residual positional error obtained from CBCT in X, Y, Z, Ɵ, Φ, Ψ were 0.1 ± 0.4 mm, 0.0 ± 0.6 mm, 0.0 ± 0.5 mm, 0.2 ± 0.8°, 0.1 ± 0.6° and -0.1 ± 0.7° respectively. For ExacTrac, the shits were -0.5 ± 0.9 mm, -0.0 ± 1mm, -0.6 ± 1.0mm, 0.4 ± 0.9°, -0.2 ± 0.6°, and -0.0 ± 0.8°. CBCT calculated linear setup margins in X, Y, Z direction were 0.5, 1.2, and 1 mm respectively. ExacTrac yielded coplanar and noncoplanar linear setup margins were 1.2, 1.3, 1.5, 1.4, 1.5, and 2.1 mm respectively. CONCLUSION CBCT-based gross residual set-up margin is equal to 1 mm. ExacTrac calculated residual plus intrafraction setup margin falls within a 2 mm range; attributed to intrafraction patient movement, table position inaccuracies, and poor image fusion in noncoplanar geometry. There could be variations in the required additional margin between centers and between machines, which require further studies.
Collapse
Affiliation(s)
- Biplab Sarkar
- Department of Radiation Oncology, Manipal Hospitals, Dwarka, New Delhi, 110070, India
| | - Anusheel Munshi
- Department of Radiation Oncology, Manipal Hospitals, Dwarka, New Delhi, 110070, India
| | - Tharmarnadar Ganesh
- Department of Radiation Oncology, Manipal Hospitals, Dwarka, New Delhi, 110070, India
| | - Arjunan Manikandan
- Department of Medical Physics, Apollo Proton Cancer Centre, Chennai, 600096, Tamil Nadu, India
| | - Saneg Krishnankutty
- Department of Radiation Oncology, Fortis Memorial Research Institute, Gurgaon, 122002, Haryana, India
| | - Latika Chitral
- Department of Radiation Oncology, Manipal Hospitals, Dwarka, New Delhi, 110070, India
| | - Anirudh Pradhan
- Department of Mathematics, Institute of Applied Sciences & Humanities, GLA University, Mathura, 281406, Uttar Pradesh, India
| | - Bidhu Kalyan Mohanti
- Department of Radiation Oncology, Manipal Hospitals, Dwarka, New Delhi, 110070, India
| |
Collapse
|
42
|
Tanabe S, Utsunomiya S, Abe E, Sato H, Ohta A, Sakai H, Yamada T, Kaidu M, Aoyama H. The impact of the three degrees-of-freedom fiducial marker-based setup compared to soft tissue-based setup in hypofractionated intensity-modulated radiotherapy for prostate cancer. J Appl Clin Med Phys 2019; 20:53-59. [PMID: 31054217 PMCID: PMC6560240 DOI: 10.1002/acm2.12603] [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: 10/21/2018] [Revised: 03/21/2019] [Accepted: 04/10/2019] [Indexed: 11/09/2022] Open
Abstract
Purpose We evaluated the setup accuracy of a three‐degree‐of‐freedom fiducial marker (3DOF‐FM)‐based setup compared to a soft tissue (ST)‐based setup in hypofractionated intensity‐modulated radiotherapy (IMRT) for prostate cancer. Materials and Methods We analyzed the setup accuracy for 17 consecutive prostate cancer patients with three implanted FMs who underwent hypofractionated IMRT. The 3DOF‐ST‐based setup using cone‐beam computed tomography (CT) was performed after a six DOF‐bony structure (BS)‐based setup using an ExacTrac x‐ray system. The 3DOF‐FM‐based matching using the ExacTrac x‐ray system was done during the BS‐ and ST‐based setups. We determined the mean absolute differences and the correlation between the FM‐ and ST‐based translational shifts relative to the BS‐based setup position. The rotational mean shifts detected by the ExacTrac x‐ray system were also evaluated. Results The mean differences in the anterior‐posterior (AP), superior‐inferior (SI), and left‐right (LR) dimensions were 0.69, 0.0, and 0.30 mm, respectively. The Pearson correlation coefficients for both shifts were 0.92 for AP, 0.91 for SI, and 0.68 for LR. The percentages of shift agreements within 2 mm were 85% for AP, 93% for SI, and 99% for LR. The absolute values of rotational shifts were 0.1° for AP, 0.3°, and 1.2° for LR. Conclusions The setup accuracy of the 3DOF‐FM‐based setup has the potential to be interchangeable with a ST‐based setup. Our data are likely to be useful in clinical practice along with the popularization of the hypofractionated IMRT in prostate cancer.
Collapse
Affiliation(s)
- Satoshi Tanabe
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Satoru Utsunomiya
- Department of Radiological Technology, Niigata University Graduate School of Health Sciences, Niigata, Japan
| | - Eisuke Abe
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiraku Sato
- Department of Radiology, Division of Radiation Oncology, Yamagata University, Faculty of Medicine, Yamagata, Japan
| | - Atsushi Ohta
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hironori Sakai
- Section of Radiology, Department of Clinical Support, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Takumi Yamada
- Section of Radiology, Department of Clinical Support, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Motoki Kaidu
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hidefumi Aoyama
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| |
Collapse
|
43
|
Abstract
Radiation therapy (RT) is an effective treatment for patients with either nonfunctioning or secreting pituitary adenomas unsuccessfully treated by surgery and/or medical therapy, resulting in local control of 90-95% at 5-10 years and variable normalization of hormonal hypersecretion for patients with GH-, ACTH-, and prolactin-secreting adenomas in the range of 40-80% at 5 years; however, its use has been limited because of concerns regarding potential late toxicity of radiation and delayed efficacy in normalization of hormone hypersecretion. In the last decades, there have been advances in all aspects of radiation treatment, including more accurate immobilization, imaging, treatment planning and dose delivery. RT has evolved with the development of highly conformal stereotactic techniques and new planning and dose delivery techniques, including intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT). All these new techniques allow precise and sharply focused radiation delivery reducing the dose to surrounding critical neurovascular and brain structures, and potentially limiting the long-term consequences of radiation treatments. In this review, we present a critical analysis of the more recent available literature on the use of RT in patients with both nonfunctioning and secreting pituitary adenomas, focussing particularly on the risk/benefit ratio of modern radiation techniques.
Collapse
Affiliation(s)
- Giuseppe Minniti
- Radiation Unit, UPMC Hillman Cancer Center, San Pietro Hospital, Rome, Italy.
| | - John Flickinger
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| |
Collapse
|
44
|
Njeh CF, Snyder KC, Cai J. The use of six degrees of freedom couch is only clinically beneficial in stereotactic radio surgery. Med Phys 2019; 46:415-418. [DOI: 10.1002/mp.13380] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/02/2019] [Accepted: 01/05/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Christopher F. Njeh
- Department of Radiation Oncology Franciscan Health Indianapolis & Mooresville Indianapolis IN 46237 USA
| | - Karen C. Snyder
- Department of Radiation Oncology Henry Ford Hospital System Detroit MI 48067 USA
| | | |
Collapse
|
45
|
Carminucci A, Nie K, Weiner J, Hargreaves E, Danish SF. Assessment of motion error for frame-based and noninvasive mask-based fixation using the Leksell Gamma Knife Icon radiosurgery system. J Neurosurg 2018; 129:133-139. [DOI: 10.3171/2018.7.gks181516] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/24/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe Leksell Gamma Knife Icon (GK Icon) radiosurgery system can utilize cone-beam computed tomography (CBCT) to evaluate motion error. This study compares the accuracy of frame-based and frameless mask-based fixation using the Icon system.METHODSA retrospective cohort study was conducted to evaluate patients who had undergone radiosurgery with the GK Icon system between June and December 2017. Patients were immobilized in either a stereotactic head frame or a noninvasive thermoplastic mask with stereotactic infrared (IR) camera monitoring. Setup error was defined as displacement of the skull in the stereotactic space upon setup as noted on pretreatment CBCT compared to its position in the stereotactic space defined by planning MRI for frame patients and defined as skull displacement on planning CBCT compared to its position on pretreatment CBCT for mask patients. For frame patients, the intrafractionation motion was measured by comparing pretreatment and posttreatment CBCT. For mask patients, the intrafractionation motion was evaluated by comparing pretreatment CBCT and additional CBCT obtained during the treatment. The translational and rotational errors were recorded.RESULTSData were collected from 77 patients undergoing SRS with the GK Icon. Sixty-four patients underwent frame fixation, with pre- and posttreatment CBCT studies obtained. Thirteen patients were treated using mask fixation to deliver a total of 33 treatment fractions. Mean setup and intrafraction translational and rotation errors were small for both fixation systems, within 1 mm and 1° in all axes. Yet mask fixation demonstrated significantly larger intrafraction errors than frame fixation. Also, there was greater variability in both setup and intrafraction errors for mask fixation than for frame fixation in all translational and rotational directions. Whether the GK treatment was for metastasis or nonmetastasis did not influence motion uncertainties between the two fixation types. Additionally, monitoring IR-based intrafraction motion for mask fixation—i.e., the number of treatment stoppages due to reaching the IR displacement threshold—correlated with increasing treatment time.CONCLUSIONSCompared to frame-based fixation, mask-based fixation demonstrated larger motion variations. The variability in motion error associated with mask fixation must be taken into account when planning for small lesions or lesions near critical structures.
Collapse
Affiliation(s)
| | - Ke Nie
- 2Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Joseph Weiner
- 2Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Eric Hargreaves
- 1Department of Neurological Surgery, Rutgers University; and
| | | |
Collapse
|
46
|
Apport du guidage par l’image pour le repositionnement au cours de la radiothérapie des tumeurs encéphaliques. Cancer Radiother 2018; 22:593-601. [DOI: 10.1016/j.canrad.2018.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 06/29/2018] [Indexed: 11/20/2022]
|
47
|
Sadeghi P, Lincoln J, Avila Ruiz EA, Robar JL. A novel intra-fraction motion monitoring system for stereotactic radiosurgery: proof of concept. ACTA ACUST UNITED AC 2018; 63:165019. [DOI: 10.1088/1361-6560/aad643] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
48
|
Wösle M, Krause L, Sreenivasa S, Vordermark D, Ciernik IF. Stereotactic radiotherapy for choroidal melanomas by means of HybridArc™ : Physics and technique of linac-based photon beam therapy. Strahlenther Onkol 2018; 194:929-943. [PMID: 30116827 DOI: 10.1007/s00066-018-1349-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 08/02/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Stereotactic radiotherapy (SRT) is suitable to treat ocular tumours. The optimal beam geometry for SRT, however, has not been defined. Here we evaluate a combination technique with dynamic conformal arcs (DCAs) and intensity-modulated static fields (IMRT), known as HybridArc™ (HA). METHODS For the first consecutive 25 cases with choroidal melanomas with volumes of 0.02 to 1.18 cm3 treated with 50 Gy in five fractions, the results with respect to dose conformity, homogeneity, and dose distributions were summarised. To describe the dose distribution at the planning target volume (PTV) boundary, we defined a spatially averaged dose gradient (SADG) and compared it with Paddick's gradient index (GI). We made dosimetric comparisons between HA and other irradiation techniques. RESULTS The PTVs ranged from 0.42 to 3.37 cm3. The conformity index (CI) was 1.25 ± 0.15, and the homogeneity index (HI) 0.08 ± 0.02. The SADG was (-3.5 ± 0.5) Gy/mm or (-7.0 ± 1.0) %/mm between the isodose levels 95 and 20%; local minima reached -11.5 Gy/mm or -22.9%/mm. The coefficient of determination for a nonlinear regression of GI on SADG was 0.072. After a median follow-up time of 19.6 months, local tumour control was 100% without any case of post-therapeutic enucleation. Two patients (8%) developed liver metastases. CONCLUSION SRT of ocular tumours by HA is highly appropriate, and HA is superior to intensity-modulated arc therapy (IMAT) concerning dose reduction in organs at risk (OARs). The novel gradient measure SADG is more informative than Paddick's GI.
Collapse
Affiliation(s)
- Markus Wösle
- Klinik für Strahlentherapie und Radioonkologie, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau-Roßlau, Germany.
| | - Lothar Krause
- Klinik für Augenheilkunde und Zentrum für Refraktive Chirurgie, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau-Roßlau, Germany
| | - Shanthala Sreenivasa
- Klinik für Strahlentherapie und Radioonkologie, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau-Roßlau, Germany.,Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Straße 8, 06108, Halle (Saale), Germany
| | - Dirk Vordermark
- Universitätsklinik und Poliklinik für Strahlentherapie, Universitätsklinikum Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
| | - Ilja F Ciernik
- Klinik für Strahlentherapie und Radioonkologie, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau-Roßlau, Germany
| |
Collapse
|
49
|
Jeon SH, Kim JH. Positional uncertainties of cervical and upper thoracic spine in stereotactic body radiotherapy with thermoplastic mask immobilization. Radiat Oncol J 2018; 36:122-128. [PMID: 29983032 PMCID: PMC6074070 DOI: 10.3857/roj.2017.00591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/07/2018] [Indexed: 01/19/2023] Open
Abstract
Purpose To investigate positional uncertainty and its correlation with clinical parameters in spine stereotactic body radiotherapy (SBRT) using thermoplastic mask (TM) immobilization. Materials and Methods A total of 21 patients who underwent spine SBRT for cervical or upper thoracic spinal lesions were retrospectively analyzed. All patients were treated with image guidance using cone beam computed tomography (CBCT) and 4 degrees-of-freedom (DoF) positional correction. Initial, pre-treatment, and post-treatment CBCTs were analyzed. Setup error (SE), pre-treatment residual error (preRE), post-treatment residual error (postRE), intrafraction motion before treatment (IM1), and intrafraction motion during treatment (IM2) were determined from 6 DoF manual rigid registration. Results The three-dimensional (3D) magnitudes of translational uncertainties (mean ± 2 standard deviation) were 3.7±3.5 mm (SE), 0.9±0.9 mm (preRE), 1.2±1.5 mm (postRE), 1.4±2.4 mm (IM1), and 0.9±1.0 mm (IM2), and average angular differences were 1.1°±1.2° (SE), 0.9°±1.1° (preRE), 0.9°±1.1° (postRE), 0.6°±0.9° (IM1), and 0.5°±0.5° (IM2). The 3D magnitude of SE, preRE, postRE, IM1, and IM2 exceeded 2 mm in 18, 0, 3, 3, and 1 patients, respectively. No association were found between all positional uncertainties and body mass index, pain score, and treatment location (p > 0.05, Mann-Whitney test). There was a tendency of intrafraction motion to increase with overall treatment time; however, the correlation was not statistically significant (p > 0.05, Spearman rank correlation test). Conclusion In spine SBRT using TM immobilization, CBCT and 4 DoF alignment correction, a minimum residual translational uncertainty was 2 mm. Shortening overall treatment time and 6 DoF positional correction may further reduce positional uncertainties.
Collapse
Affiliation(s)
- Seung Hyuck Jeon
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
50
|
Abstract
External beam radiotherapy (RT) is an essential part of the management of intracranial tumors and has been used in treating pituitary adenomas for more than five decades. It has been demonstrated that conventional RT for postoperative residual or progressive nonfunctioning pituitary adenomas (NFAs) present an excellent long-term local tumor control, although its use has been limited because of the potential late toxicity related to radiation treatments. Recent advances in radiation techniques have led to more accurate treatments, rendering obsolete many commonly held views of the "old" radiotherapy. New techniques include intensity modulated radiotherapy, volumetric-modulated arc therapy, and stereotactic techniques, either stereotactic radiosurgery or fractionated stereotactic radiotherapy. New techniques allow the delivering of higher radiation doses to the target with rapid dose fall-off in the surrounding normal tissues, and potentially limiting the long term toxicity of radiation. In this review, we present a critical analysis of the most recent available literature on the use of radiation in patients with NFAs, focusing particularly on the efficacy and safety of radiation stereotactic techniques.
Collapse
Affiliation(s)
- Giuseppe Minniti
- UPMC San Pietro FBF, Rome, Italy.
- IRCCS Neuromed, 86077, Pozzilli, IS, Italy.
| | - John Flickinger
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | |
Collapse
|