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Nikou P, Thompson A, Nisbet A, Gulliford S, McClelland J. Modelling systematic anatomical uncertainties of head and neck cancer patients during fractionated radiotherapy treatment. Phys Med Biol 2024; 69:155017. [PMID: 38981595 DOI: 10.1088/1361-6560/ad611b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 07/09/2024] [Indexed: 07/11/2024]
Abstract
Objective.Head and neck cancer patients experience systematic as well as random day to day anatomical changes during fractionated radiotherapy treatment. Modelling the expected systematic anatomical changes could aid in creating treatment plans which are more robust against such changes.Approach.Inter- patient correspondence aligned all patients to a model space. Intra- patient correspondence between each planning CT scan and on treatment cone beam CT scans was obtained using diffeomorphic deformable image registration. The stationary velocity fields were then used to develop B-Spline based patient specific (SM) and population average (AM) models. The models were evaluated geometrically and dosimetrically. A leave-one-out method was used to compare the training and testing accuracy of the models.Main results.Both SMs and AMs were able to capture systematic changes. The average surface distance between the registration propagated contours and the contours generated by the SM was less than 2 mm, showing that the SM are able to capture the anatomical changes which a patient experiences during the course of radiotherapy. The testing accuracy was lower than the training accuracy of the SM, suggesting that the model overfits to the limited data available and therefore, also captures some of the random day to day changes. For most patients the AMs were a better estimate of the anatomical changes than assuming there were no changes, but the AMs could not capture the variability in the anatomical changes seen in all patients. No difference was seen in the training and testing accuracy of the AMs. These observations were highlighted in both the geometric and dosimetric evaluations and comparisons.Significance.In this work, a SM and AM are presented which are able to capture the systematic anatomical changes of some head and neck cancer patients over the course of radiotherapy treatment. The AM is able to capture the overall trend of the population, but there is large patient variability which highlights the need for more complex, capable population models.
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Affiliation(s)
- Poppy Nikou
- University College London, London, WC1E 6AE, United Kingdom
| | - Anna Thompson
- University College London Hospital, London, NW1 2BU, United Kingdom
| | - Andrew Nisbet
- University College London, London, WC1E 6AE, United Kingdom
| | - Sarah Gulliford
- University College London, London, WC1E 6AE, United Kingdom
- University College London Hospital, London, NW1 2BU, United Kingdom
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Sreejeev AT, Joseph D, Krishnan AS, Pasricha R, Gupta S, Ahuja R, Sharma N, Sikdar D, Raut S, Sasi A, Gupta M. Weekly assessment of volumetric and dosimetric changes during volumetric modulated arc therapy of locally advanced head and neck carcinoma: Implications for adaptive radiation therapy-A prospective study. Head Neck 2024; 46:1547-1556. [PMID: 38436506 DOI: 10.1002/hed.27710] [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: 11/06/2023] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Chemoradiation in head and neck carcinoma (HNC) shows significant anatomical resulting in erroneous dose deposition in the target or the organ at risk (OAR). Adaptive radiotherapy (ART) can overcome this. Timing of significant target and OAR changes with dosimetric impact; thus, most suitable time and frequency of ART is unclear. METHODS This dosimetric study used prospective weekly non-contrast CT scans in 12 HNC patients (78 scans). OARs and TVs were manually contoured after registration with simulation scan. Dose overlay done on each scan without reoptimization. Dosimetric and volumetric variations assessed. RESULTS Commonest site was oropharynx. Gross Tumor Volume (GTV) reduced from 47.5 ± 19.2 to 17.8 ± 10.7 cc. Nodal GTV reduced from 15.7 ± 18.8 to 4.7 ± 7.1 cc. Parotid showed mean volume loss of 35%. T stage moderately correlated with GTV regression. CONCLUSION Maximum GTV changes occurred after 3 weeks. Best time to do single fixed interval ART would be by the end of 3 weeks.
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Affiliation(s)
| | - Deepa Joseph
- Department of Radiation Oncology, AIIMS, Rishikesh, India
| | - Ajay S Krishnan
- Department of Radiation Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre, Varanasi, India
| | | | - Sweety Gupta
- Department of Radiation Oncology, AIIMS, Rishikesh, India
| | - Rachit Ahuja
- Department of Radiation Oncology, Shri Mahant Indiresh Hospital, Dehradun, India
| | - Nidhi Sharma
- Department of Radiation Oncology, AIIMS, Rishikesh, India
| | | | - Sagar Raut
- Department of Radiation Oncology, AIIMS, Rishikesh, India
| | | | - Manoj Gupta
- Department of Radiation Oncology, AIIMS, Rishikesh, India
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Gan Y, Langendijk JA, Oldehinkel E, Lin Z, Both S, Brouwer CL. Optimal timing of re-planning for head and neck adaptive radiotherapy. Radiother Oncol 2024; 194:110145. [PMID: 38341093 DOI: 10.1016/j.radonc.2024.110145] [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: 11/15/2023] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND AND PURPOSE Adaptive radiotherapy (ART) relies on re-planning to correct treatment variations, but the optimal timing of re-planning to account for dose changes in head and neck organs at risk (OARs) is still under investigation. We aimed to find out the optimal timing of re-planning in head and neck ART. MATERIALS AND METHODS A total of 110 head and neck cancer patients were retrospectively enrolled. A semi auto-segmentation method was applied to obtain the weekly mean dose (Dmean) to OARs. The K-nearest-neighbour method was used for missing data imputation of weekly Dmean. A dose deviation map was built using the planning Dmean and weekly Dmean values and then used to simulate different ART scenarios consisting of 1 to 6 re-plannings. The difference between accumulated Dmean and planning Dmean before re-planning (ΔDmean_acc_noART) and after re-planning (ΔDmean_acc_ART) were evaluated and compared. RESULTS Among all the OARs, supraglottic showed the largest ΔDmean_acc_noART (1.23 ± 3.13 Gy) and most cases of ΔDmean_acc_noART > 3 Gy (26 patients). The 3rd week is suggested in the optimal timing of re-planning for 10 OARs. For all the organs except arytenoid, 2 re-plannings were able to guarantee the ΔDmean_acc_ART below 3 Gy while the average |ΔDmean_acc_ART| was below 1 Gy. ART scenarios of 2_4, 3_4, 3_5 (week of re-planning separated with "_") were able to guarantee ΔDmean_acc_ART of 99 % of patients below 3 Gy simultaneously for 19 OARs. CONCLUSIONS The optimal timing of re-planning was suggested for different organs at risk in head and neck adaptive radiotherapy. Generic scenarios of timing and frequency for re-planning can be applied to guarantee the increase of accumulated mean dose within 3 Gy simultaneously for multiple organs.
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Affiliation(s)
- Yong Gan
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands; Shantou University, Cancer Hospital of Shantou University Medical College, Department of Radiotherapy, China.
| | - Johannes A Langendijk
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - Edwin Oldehinkel
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - Zhixiong Lin
- Shantou University, Cancer Hospital of Shantou University Medical College, Department of Radiotherapy, China
| | - Stefan Both
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - Charlotte L Brouwer
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
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Nuyts S, Bollen H, Eisbruch A, Strojan P, Mendenhall WM, Ng SP, Ferlito A. Adaptive radiotherapy for head and neck cancer: Pitfalls and possibilities from the radiation oncologist's point of view. Cancer Med 2024; 13:e7192. [PMID: 38650546 PMCID: PMC11036082 DOI: 10.1002/cam4.7192] [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: 01/11/2024] [Revised: 03/19/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Patients with head and neck cancer (HNC) may experience substantial anatomical changes during the course of radiotherapy treatment. The implementation of adaptive radiotherapy (ART) proves effective in managing the consequent impact on the planned dose distribution. METHODS This narrative literature review comprehensively discusses the diverse strategies of ART in HNC and the documented dosimetric and clinical advantages associated with these approaches, while also addressing the current challenges for integration of ART into clinical practice. RESULTS AND CONCLUSION Although based on mainly non-randomized and retrospective trials, there is accumulating evidence that ART has the potential to reduce toxicity and improve quality of life and tumor control in HNC patients treated with RT. However, several questions remain regarding accurate patient selection, the ideal frequency and timing of replanning, and the appropriate way for image registration and dose calculation. Well-designed randomized prospective trials, with a predetermined protocol for both image registration and dose summation, are urgently needed to further investigate the dosimetric and clinical benefits of ART.
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Affiliation(s)
- Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of OncologyKU LeuvenLeuvenBelgium
- Department of Radiation OncologyLeuven Cancer Institute, University Hospitals LeuvenLeuvenBelgium
| | - Heleen Bollen
- Laboratory of Experimental Radiotherapy, Department of OncologyKU LeuvenLeuvenBelgium
- Department of Radiation OncologyLeuven Cancer Institute, University Hospitals LeuvenLeuvenBelgium
| | - Avrahram Eisbruch
- Department of Radiation OncologyUniversity of MichiganAnn ArborMichiganUSA
| | - Primoz Strojan
- Department of Radiation Oncology Institute of OncologyUniversity of LjubljanaLjubljanaSlovenia
| | - William M. Mendenhall
- Department of Radiation OncologyUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Sweet Ping Ng
- Department of Radiation OncologyOlivia Newton‐John Cancer and Wellness Centre, Austin HealthMelbourneAustralia
| | - Alfio Ferlito
- Coordinator International Head and Neck Scientific GroupUdineItaly
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Chen A, Chen X, Jiang X, Wang Y, Chi F, Xie D, Zhou M. Anatomical changes and dosimetric analysis of the neck region based on FBCT for nasopharyngeal carcinoma patients during radiotherapy. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2024; 32:783-795. [PMID: 38457140 DOI: 10.3233/xst-230280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND The study aimed to investigate anatomical changes in the neck region and evaluate their impact on dose distribution in patients with nasopharyngeal carcinoma (NPC) undergoing intensity modulated radiation therapy (IMRT). Additionally, the study sought to determine the optimal time for replanning during the course of treatment. METHODS Twenty patients diagnosed with NPC underwent IMRT, with weekly pretreatment kV fan beam computed tomography (FBCT) scans in the treatment room. Metastasized lymph nodes in the neck region and organs at risk (OARs) were redelineation using the images from the FBCT scans. Subsequently, the original treatment plan (PLAN0) was replicated to each FBCT scan to generate new plans labeled as PLAN 1-6. The dose-volume histograms (DVH) of the new plans and the original plan were compared. One-way repeated measure ANOVA was utilized to establish threshold(s) at various time points. The presence of such threshold(s) would signify significant change(s), suggesting the need for replanning. RESULTS Progressive volume reductions were observed over time in the neck region, the gross target volume for metastatic lymph nodes (GTVnd), as well as the submandibular glands and parotids. Compared to PLAN0, the mean dose (Dmean) of GTVnd-L significantly increased in PLAN5, while the minimum dose covering 95% of the volume (D95%) of PGTVnd-L showed a significant decrease from PLAN3 to PLAN6. Similarly, the Dmean of GTVnd-R significantly increased from PLAN4 to PLAN6, whereas the D95% of PGTVnd-R exhibited a significant decrease during the same period. Furthermore, the dose of bilateral parotid glands, bilateral submandibular glands, brainstem and spinal cord was gradually increased in the middle and late period of treatment. CONCLUSION Significant anatomical and dosimetric changes were noted in both the target volumes and OARs. Considering the thresholds identified, it is imperative to undertake replanning at approximately 20 fractions. This measure ensures the delivery of adequate doses to target volumes while mitigating the risk of overdosing on OARs.
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Affiliation(s)
- Aoqiang Chen
- Department of Radiation Medicine, Guangdong Provincial Key Laboratory of Tropical Disease Research, NMPA Key Laboratory for Safety Evaluation of Cosmetics, School of Public Health, Southern Medical University, Guangzhou, China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xuemei Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xiaobo Jiang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yajuan Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Feng Chi
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Dehuan Xie
- Department of Radiation Oncology, Guangdong Provincial People's Hospital, Southern Medical University, Guangzhou, China
| | - Meijuan Zhou
- Department of Radiation Medicine, Guangdong Provincial Key Laboratory of Tropical Disease Research, NMPA Key Laboratory for Safety Evaluation of Cosmetics, School of Public Health, Southern Medical University, Guangzhou, China
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Delaby N, Barateau A, Chiavassa S, Biston MC, Chartier P, Graulières E, Guinement L, Huger S, Lacornerie T, Millardet-Martin C, Sottiaux A, Caron J, Gensanne D, Pointreau Y, Coutte A, Biau J, Serre AA, Castelli J, Tomsej M, Garcia R, Khamphan C, Badey A. Practical and technical key challenges in head and neck adaptive radiotherapy: The GORTEC point of view. Phys Med 2023; 109:102568. [PMID: 37015168 DOI: 10.1016/j.ejmp.2023.102568] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 02/15/2023] [Accepted: 03/18/2023] [Indexed: 04/05/2023] Open
Abstract
Anatomical variations occur during head and neck (H&N) radiotherapy (RT) treatment. These variations may result in underdosage to the target volume or overdosage to the organ at risk. Replanning during the treatment course can be triggered to overcome this issue. Due to technological, methodological and clinical evolutions, tools for adaptive RT (ART) are becoming increasingly sophisticated. The aim of this paper is to give an overview of the key steps of an H&N ART workflow and tools from the point of view of a group of French-speaking medical physicists and physicians (from GORTEC). Focuses are made on image registration, segmentation, estimation of the delivered dose of the day, workflow and quality assurance for an implementation of H&N offline and online ART. Practical recommendations are given to assist physicians and medical physicists in a clinical workflow.
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Franzese C, Tomatis S, Bianchi SP, Pelizzoli M, Teriaca MA, Badalamenti M, Comito T, Clerici E, Franceschini D, Navarria P, Di Cristina L, Dei D, Galdieri C, Reggiori G, Mancosu P, Scorsetti M. Adaptive Volumetric-Modulated Arc Radiation Therapy for Head and Neck Cancer: Evaluation of Benefit on Target Coverage and Sparing of Organs at Risk. Curr Oncol 2023; 30:3344-3354. [PMID: 36975467 PMCID: PMC10047863 DOI: 10.3390/curroncol30030254] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
Background: Radiotherapy is essential in the management of head–neck cancer. During the course of radiotherapy, patients may develop significant anatomical changes. Re-planning with adaptive radiotherapy may ensure adequate dose coverage and sparing of organs at risk. We investigated the consequences of adaptive radiotherapy on head–neck cancer patients treated with volumetric-modulated arc radiation therapy compared to simulated non-adaptive plans: Materials and methods: We included in this retrospective dosimetric analysis 56 patients treated with adaptive radiotherapy. The primary aim of the study was to analyze the dosimetric differences with and without an adaptive approach for targets and organs at risk, particularly the spinal cord, parotid glands, oral cavity and larynx. The original plan (OPLAN) was compared to the adaptive plan (APLAN) and to a simulated non-adaptive dosimetric plan (DPLAN). Results: The non-adaptive DPLAN, when compared to OPLAN, showed an increased dose to all organs at risk. Spinal cord D2 increased from 27.91 (21.06–31.76) Gy to 31.39 (27.66–38.79) Gy (p = 0.00). V15, V30 and V45 of the DPLAN vs. the OPLAN increased by 20.6% (p = 0.00), 14.78% (p = 0.00) and 15.55% (p = 0.00) for right parotid; and 16.25% (p = 0.00), 18.7% (p = 0.00) and 20.19% (p = 0.00) for left parotid. A difference of 36.95% was observed in the oral cavity V40 (p = 0.00). Dose coverage was significantly reduced for both CTV (97.90% vs. 99.96%; p = 0.00) and PTV (94.70% vs. 98.72%; p = 0.00). The APLAN compared to the OPLAN had similar values for all organs at risk. Conclusions: The adaptive strategy with re-planning is able to avoid an increase in dose to organs at risk and better target coverage in head–neck cancer patients, with potential benefits in terms of side effects and disease control.
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Affiliation(s)
- Ciro Franzese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Correspondence: ; Tel.: +39-0282247454
| | - Stefano Tomatis
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Sofia Paola Bianchi
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Marco Pelizzoli
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Maria Ausilia Teriaca
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Marco Badalamenti
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Tiziana Comito
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Elena Clerici
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Davide Franceschini
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Pierina Navarria
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Luciana Di Cristina
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Damiano Dei
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Carmela Galdieri
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Giacomo Reggiori
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Pietro Mancosu
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
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Brink A, Stewart K, Hargrave C. Evaluation of dose accumulation methods and workflows utilising cone beam computed tomography images. J Med Radiat Sci 2022; 70 Suppl 2:26-36. [PMID: 36168134 PMCID: PMC10122928 DOI: 10.1002/jmrs.622] [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: 02/09/2022] [Accepted: 09/13/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Various adaptive radiation therapy (ART) methods have emerged, with little consensus amongst the literature as to which is most appropriate. This study aimed to compare dose mapping (DM) versus Monte Carlo recalculation (MCR), using cone beam computed tomography (CBCT) images when utilised in automated ART dose accumulation workflows in the MIM Maestro software package. METHODS The treatment plans for 38 cancer patients (19 prostate and 19 head and neck cases) were used to perform DM or MCR retrospectively upon CBCTs acquired during treatment, which were then deformably registered to the planning CT (DR-pCT) to facilitate dose accumulation. Dose-volume and region-of-interest data were extracted for the planning target volumes and organs at risk. Intraclass correlation (ICC) values and Bland-Altman plots were utilised to compare DM versus MCR doses on the CBCT images as well as CBCT versus DR-pCT doses. RESULTS When comparing DM and MCR on CBCTs, the differences across dose level mean dose differences were mostly within a ±5% level of agreement based on the Bland-Altman plots, with over 67% of ICC values over 0.9 and indicative of good correlation. When these distributions were deformed back to the planning CT, the agreement was reduced considerably, with larger differences (exceeding ±5%) resulting from workflow-related issues. CONCLUSION The results emphasise the need to consider and make adaptations to minimise the effect of workflows on algorithm performance. Manual user intervention, refined departmental protocols and further developments to the MIM Maestro software will enhance the use of this tool.
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Affiliation(s)
- Amelia Brink
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Radiation Oncology, Royal Brisbane and Women's Hospital (RBWH), Metro North Health Service District, Herston, Queensland, Australia
| | - Kate Stewart
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Radiation Oncology, Royal Brisbane and Women's Hospital (RBWH), Metro North Health Service District, Herston, Queensland, Australia
| | - Catriona Hargrave
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Radiation Oncology PAH - Raymond Terrace Campus, Division of Cancer Services, Metro South Health Service District, South Brisbane, Queensland, Australia
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Dolezel M, Slavik M, Blazek T, Kazda T, Koranda P, Veverkova L, Burkon P, Cvek J. FMISO-Based Adaptive Radiotherapy in Head and Neck Cancer. J Pers Med 2022; 12:jpm12081245. [PMID: 36013194 PMCID: PMC9410424 DOI: 10.3390/jpm12081245] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/12/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
Concurrent chemoradiotherapy represents one of the most used strategies in the curative treatment of patients with head and neck (HNC) cancer. Locoregional failure is the predominant recurrence pattern. Tumor hypoxia belongs to the main cause of treatment failure. Positron emission tomography (PET) using hypoxia radiotracers has been studied extensively and has proven its feasibility and reproducibility to detect tumor hypoxia. A number of studies confirmed that the uptake of FMISO in the recurrent region is significantly higher than that in the non-recurrent region. The escalation of dose to hypoxic tumors may improve outcomes. The technical feasibility of optimizing radiotherapeutic plans has been well documented. To define the hypoxic tumour volume, there are two main approaches: dose painting by contour (DPBC) or by number (DPBN) based on PET images. Despite amazing technological advances, precision in target coverage, and surrounding tissue sparring, radiation oncology is still not considered a targeted treatment if the “one dose fits all” approach is used. Using FMISO and other hypoxia tracers may be an important step for individualizing radiation treatment and together with future radiomic principles and a possible genome-based adjusting dose, will move radiation oncology into the precise and personalized era.
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Affiliation(s)
- Martin Dolezel
- Department of Oncology, Palacky University Medical School & Teaching Hospital, 77900 Olomouc, Czech Republic;
| | - Marek Slavik
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, 65652 Brno, Czech Republic; (T.K.); (P.B.)
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
- Correspondence:
| | - Tomas Blazek
- Department of Oncology, Faculty of Medicine, University Hospital Ostrava, 70852 Ostrava, Czech Republic; (T.B.); (J.C.)
| | - Tomas Kazda
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, 65652 Brno, Czech Republic; (T.K.); (P.B.)
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
| | - Pavel Koranda
- Department of Nuclear Medicine, Palacky University Medical School & Teaching Hospital, 77900 Olomouc, Czech Republic;
| | - Lucia Veverkova
- Department of Radiology, Palacky University Medical School & Teaching Hospital, 77900 Olomouc, Czech Republic;
| | - Petr Burkon
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, 65652 Brno, Czech Republic; (T.K.); (P.B.)
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
| | - Jakub Cvek
- Department of Oncology, Faculty of Medicine, University Hospital Ostrava, 70852 Ostrava, Czech Republic; (T.B.); (J.C.)
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Gupta S, Srivastava S, Singh N, Ghosh A. Volumetric and Dosimetric Inconstancy of Parotid Glands and Tumor in Head and Neck Cancer during IMRT. Radiat Oncol 2022. [DOI: 10.5772/intechopen.104745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The treatment of head and neck cancer using external beam radiotherapy is commonly done with three field techniques, which involves bilateral parallel opposed beams and one anterior lower neck field. Conventional treatment is based on 2D fluoroscopic images where there is no facility to shield the organs at risk like parotid. The most common side effect of such conventional radiotherapy treatment is xerostomia. The incidence of radiotherapy-related xerostomia varies depending on the specific radiotherapy technique used and the dose delivered to the parotid glands. Dosimetric variation in the tumor and normal tissue including parotid glands due to volume shrinkage during intensity modulated radiotherapy is the leading challenges in radiotherapy delivery in head and neck malignancy in terms of acute and late radiation related toxicities. Therefore if the planning target volume and normal tissue anatomy are changing with time during intensity modulated radiotherapy, it would be beneficial and acceptable to adapt our treatment delivery to minimize normal tissue toxicities where it really matters.
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Gros SAA, Santhanam AP, Block AM, Emami B, Lee BH, Joyce C. Retrospective Clinical Evaluation of a Decision-Support Software for Adaptive Radiotherapy of Head and Neck Cancer Patients. Front Oncol 2022; 12:777793. [PMID: 35847951 PMCID: PMC9279735 DOI: 10.3389/fonc.2022.777793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 05/16/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose This study aimed to evaluate the clinical need for an automated decision-support software platform for adaptive radiation therapy (ART) of head and neck cancer (HNC) patients. Methods We tested RTapp (SegAna), a new ART software platform for deciding when a treatment replan is needed, to investigate a set of 27 HNC patients’ data retrospectively. For each fraction, the software estimated key components of ART such as daily dose distribution and cumulative doses received by targets and organs at risk (OARs) from daily 3D imaging in real-time. RTapp also included a prediction algorithm that analyzed dosimetric parameter (DP) trends against user-specified thresholds to proactively trigger adaptive re-planning up to four fractions ahead. The DPs evaluated for ART were based on treatment planning dose constraints. Warning (V95<95%) and adaptation (V95<93%) thresholds were set for PTVs, while OAR adaptation dosimetric endpoints of +10% (DE10) were set for all Dmax and Dmean DPs. Any threshold violation at end of treatment (EOT) triggered a review of the DP trends to determine the threshold-crossing fraction Fx when the violations occurred. The prediction model accuracy was determined as the difference between calculated and predicted DP values with 95% confidence intervals (CI95). Results RTapp was able to address the needs of treatment adaptation. Specifically, we identified 18/27 studies (67%) for violating PTV coverage or parotid Dmean at EOT. Twelve PTVs had V95<95% (mean coverage decrease of −6.8 ± 2.9%) including six flagged for adaptation at median Fx= 6 (range, 1–16). Seventeen parotids were flagged for exceeding Dmean dose constraints with a median increase of +2.60 Gy (range, 0.99–6.31 Gy) at EOT, including nine with DP>DE10. The differences between predicted and calculated PTV V95 and parotid Dmean was up to 7.6% (mean ± CI95, −2.7 ± 4.1%) and 5 Gy (mean ± CI95, 0.3 ± 1.6 Gy), respectively. The most accurate predictions were obtained closest to the threshold-crossing fraction. For parotids, the results showed that Fx ranged between fractions 1 and 23, with a lack of specific trend demonstrating that the need for treatment adaptation may be verified for every fraction. Conclusion Integrated in an ART clinical workflow, RTapp aids in predicting whether specific treatment would require adaptation up to four fractions ahead of time.
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Affiliation(s)
- Sebastien A. A. Gros
- Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, IL, United States
- *Correspondence: Sebastien A. A. Gros,
| | - Anand P. Santhanam
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Alec M. Block
- Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, IL, United States
| | - Bahman Emami
- Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, IL, United States
| | - Brian H. Lee
- Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, IL, United States
| | - Cara Joyce
- Department of Public Health, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
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Evaluation and risk factors of volume and dose differences of selected structures in patients with head and neck cancer treated on Helical TomoTherapy by using Deformable Image Registration tool. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2022. [DOI: 10.2478/pjmpe-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract
Introduction: The aim of this study was the evaluation of volume and dose differences in selected structures in patients with head and neck cancer during treatment on Helical TomoTherapy (HT) using a commercially available deformable image registration (DIR) tool. We attempted to identify anatomical and clinical predictive factors for significant volume changes probability.
Material and methods: According to our institutional protocol, we retrospectively evaluated the group of 20 H&N cancer patients treated with HT who received Adaptive Radiotherapy (ART) due to soft tissue alterations spotted on daily MVCT. We compared volumes on initial computed tomography (iCT) and replanning computed tomography (rCT) for clinical target volumes (CTV) – CTV1 (the primary tumor) and CTV2 (metastatic lymph nodes), parotid glands (PG) and body contour (B-body). To estimate the planned and delivered dose discrepancy, the dose from the original plan was registered and deformed to create a simulation of dose distribution on rCT (DIR-rCT).
Results: The decision to replan was made at the 4th week of RT (N = 6; 30%). The average volume reduction in parotid right PG[R] and left PG[L] was 4.37 cc (18.9%) (p < 0.001) and 3.77 cc (16.8%) (p = 0.004), respectively. In N = 13/20 cases, the delivered dose was greater than the planned dose for PG[R] of mean 3 Gy (p < 0.001), and in N = 6/20 patients for PG[L] the mean of 3.6 Gy (p = 0.031). Multivariate regression analysis showed a very strong predictor explaining 88% (R2 = 0.88) and 83% (R2 = 0.83) of the variance based on the mean dose of iPG[R] and iPG[L] (p < 0.001), respectively. No statistically significant correlation between volume changes and risk factors was found.
Conclusions: Dosimetric changes to the target demonstrated the validity of replanning. A DIR tool can be successfully used for dose deformation and ART qualification, significantly reducing the workload of radiotherapy centers. In addition, the mean dose for PG was a significant predictor that may indicate the need for a replan.
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Bak B, Skrobala A, Adamska A, Kazmierska J, Jozefacka N, Piotrowski T, Malicki J. Criteria for Verification and Replanning Based on the Adaptive Radiotherapy Protocol "Best for Adaptive Radiotherapy" in Head and Neck Cancer. Life (Basel) 2022; 12:722. [PMID: 35629389 PMCID: PMC9144703 DOI: 10.3390/life12050722] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
No clear criteria have yet been established to guide decision-making for patient selection and the optimal timing of adaptive radiotherapy (ART) based on image-guided radiotherapy (IGRT). We have developed a novel protocol—the Best for Adaptive Radiotherapy (B-ART) protocol—to guide patient selection for ART. The aim of the present study is to describe this protocol, to evaluate its validity in patients with head and neck (HN) cancer, and to identify the anatomical and clinical predictors of the need for replanning. We retrospectively evaluated 82 patients with HN cancer who underwent helical tomotherapy (HT) and subsequently required replanning due to soft tissue changes upon daily MVCT. Under the proposed criteria, patients with anatomical changes >3 mm on three to four consecutive scans are candidates for ART. We compared the volumes on the initial CT scan (iCT) and the replanning CT (rCT) scan for the clinical target volumes (CTV1, referring to primary tumor or tumor bed and CTV2, metastatic lymph nodes) and for the parotid glands (PG) and body contour (B-body). The patients were stratified by primary tumor localization, clinical stage, and treatment scheme. The main reasons for replanning were: (1) a planning target volume (PTV) outside the body contour (n = 70; 85.4%), (2) PG shrinkage (n = 69; 84.1%), (3) B-body deviations (n = 69; 84.1%), and (4) setup deviations (n = 40; 48.8%). The replanning decision was made, on average, during the fourth week of treatment (n = 47; 57.3%). The mean reductions in the size of the right and left PG volumes were 6.31 cc (20.9%) and 5.98 cc (20.5%), respectively (p < 0.001). The reduction in PG volume was ≥30% in 30 patients (36.6%). The volume reduction in all of the anatomical structures was statistically significant. Four variables—advanced stage disease (T3−T4), chemoradiation, increased weight loss, and oropharyngeal localization—were significantly associated with the need for ART. The B-ART protocol provides clear criteria to eliminate random errors, and to allow for an early response to relevant changes in target volumes.
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Affiliation(s)
- Bartosz Bak
- Department of Electroradiology, Poznan University of Medical Science, 61-866 Poznan, Poland; (A.S.); (J.K.); (T.P.); (J.M.)
- Department of Radiotherapy II, Greater Poland Cancer Centre, 61-866 Poznan, Poland
| | - Agnieszka Skrobala
- Department of Electroradiology, Poznan University of Medical Science, 61-866 Poznan, Poland; (A.S.); (J.K.); (T.P.); (J.M.)
- Department of Medical Physics, Greater Poland Cancer Centre, 61-866 Poznan, Poland
| | - Anna Adamska
- Department and Radiotherapy Ward I, Greater Poland Cancer Centre, 61-866 Poznan, Poland;
| | - Joanna Kazmierska
- Department of Electroradiology, Poznan University of Medical Science, 61-866 Poznan, Poland; (A.S.); (J.K.); (T.P.); (J.M.)
- Department of Radiotherapy II, Greater Poland Cancer Centre, 61-866 Poznan, Poland
| | - Natalia Jozefacka
- Institute of Psychology, Pedagogical University in Krakow, 30-084 Krakow, Poland;
| | - Tomasz Piotrowski
- Department of Electroradiology, Poznan University of Medical Science, 61-866 Poznan, Poland; (A.S.); (J.K.); (T.P.); (J.M.)
- Department of Medical Physics, Greater Poland Cancer Centre, 61-866 Poznan, Poland
| | - Julian Malicki
- Department of Electroradiology, Poznan University of Medical Science, 61-866 Poznan, Poland; (A.S.); (J.K.); (T.P.); (J.M.)
- Department of Medical Physics, Greater Poland Cancer Centre, 61-866 Poznan, Poland
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Ding S, Liu H, Li Y, Wang B, Li R, Huang X. Dosimetric Accuracy of MR-Guided Online Adaptive Planning for Nasopharyngeal Carcinoma Radiotherapy on 1.5 T MR-Linac. Front Oncol 2022; 12:858076. [PMID: 35463359 PMCID: PMC9022004 DOI: 10.3389/fonc.2022.858076] [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: 01/19/2022] [Accepted: 03/11/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose The aim of this study is to evaluate the dose accuracy of bulk relative electron density (rED) approach for application in 1.5 T MR-Linac and assess the reliability of this approach in the case of online adaptive MR-guided radiotherapy for nasopharyngeal carcinoma (NPC) patients. Methods Ten NPC patients formerly treated on conventional linac were included in this study, with their original planning CT and MRI collected. For each patient, structures such as the targets, organs at risk, bone, and air regions were delineated on the original CT in the Monaco system (v5.40.02). To simulate the online adaptive workflow, firstly all contours were transferred to MRI from the original CT using rigid registration in the Monaco system. Based on the structures, three different types of synthetic CT (sCT) were generated from MRI using the bulk rED assignment approach: the sCTICRU uses the rED values recommended by ICRU46, the sCTtailor uses the patient-specific mean rED values, and the sCTHomogeneity uses homogeneous water equivalent values. The same treatment plan was calculated on the three sCTs and the original CT. Dose calculation accuracy was investigated in terms of gamma analysis, point dose comparison, and dose volume histogram (DVH) parameters. Results Good agreement of dose distribution was observed between sCTtailor and the original CT, with a gamma passing rate (3%/3 mm) of 97.81% ± 1.06%, higher than that of sCTICRU (94.27% ± 1.48%, p = 0.005) and sCTHomogeneity (96.50% ± 1.02%, p = 0.005). For stricter criteria 1%/1 mm, gamma passing rates for plans on sCTtailor, sCTICRU, and sCTHomogeneity were 86.79% ± 4.31%, 79.81% ± 3.63%, and 77.56% ± 4.64%, respectively. The mean point dose difference in PTVnx between sCTtailor and planning CT was −0.14% ± 1.44%, much lower than that calculated on sCTICRU (−8.77% ± 2.33%) and sCTHomogeneity (1.65% ± 2.57%), all with p < 0.05. The DVH differences for the plan based on sCTtailor were much smaller than sCTICRU and sCTHomogeneity. Conclusions The bulk rED-assigned sCT by adopting the patient-specific rED values can achieve a clinically acceptable level of dose calculation accuracy in the presence of a 1.5 T magnetic field, making it suitable for online adaptive MR-guided radiotherapy for NPC patients.
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Affiliation(s)
- Shouliang Ding
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hongdong Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yongbao Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Bin Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rui Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaoyan Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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Al-Rawi SAI, Abouelenein H, Khalil MM, Alabdei HH, Sulaiman AA, Al-Nuaimi DS, Nagdy MESEL. Evaluation of conformity and homogeneity indices consistency throughout the course of head and neck cancer treatment with and without using adaptive volumetric modulated arc radiotherapy CI and HI with and without adaptive VMAT in HNC. Adv Radiat Oncol 2022; 7:100905. [PMID: 35465630 PMCID: PMC9026624 DOI: 10.1016/j.adro.2022.100905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 01/14/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose Conformity indices (CI) and homogeneity indices (HI) are important tools for evaluating treatment plan quality. In this study, we evaluate the consistency of these indices with respect to anatomic changes undergone by patients. Methods and Materials Fifty-five patients with advanced head and neck cancer were treated with simultaneous integrated boost volumetric modulated arc therapy. The initial plan (iplan) then was projected on the new computed tomographs (CT) and 2 adaptive plans (Aplans) for each patient were performed on the new CTs. A comparison of CI and HI between the iplan, hybrid plan (Hplan), and Aplan was performed. Results There was a significant weight loss (P < .001) between CT1, CT2, and CT3, where the median weight at CT1 was 75.78 (68.95-83.42) kg, and 74.88 (68.35-82.2) kg at CT2 and 73.1 (67.6-80.7) kg at CT3. Also, gross tumor volume (GTV) showed significant decrease at CT1, CT2, and CT3. The initial GTV was 32.3 (21-58.6) cc and 28.24 (15.85-48.63) cc at CT2 and 25.12 (14.1-42.2) at CT3. In addition, there was a significant decrease in left parotid volume after 10 and 20 fractions; the median left parotid gland volume at CT1 was 31.04 (26.34-36.27) cc, then was 25.84 (19.19-28.59) cc after 10 fractions and 19.5 (13.53-22.25) cc after 20 fractions; the median right parotid volume at CT1 was 29.81 (24.6-38.75) cc and 22.38 (18.19-30.12) cc at CT2, then the volume fell to 17.74 (13.41-22.66) cc at CT3. Also, a significant increase in dose to organs at risk were noticed at Hplans, the median dose for brain stem at iplan was 5156 (4561-5324) cGy then increased to 5321 (4688-5545) cGy at Hplan1 then increased again to reach 5401 (4821-5812) cGy at Hplan2. The CI showed regression at Hplan1 and Hplan2 and then improvement at Aplan1 and Aplan2. The HI also showed regression in its value at the Hplans and then improved at the Aplans. Conclusions Based on the results, we conclude that anatomic changes such as weight loss greatly affect the quality of plan, and with Aplans, we maintained the quality of plan by sustaining the values of CI and HI as in the iplan
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Affiliation(s)
- Salam Abdulrazzaq Ibrahim Al-Rawi
- Department of Radiation Oncology, Baghdad Radiation Oncology and Nuclear Medicine Center, Baghdad Medical City Complex, Ministry of Health/Environment, Baghdad, Iraq
- Department of physics, Faculty of Science, Helwan University, Cairo, Egypt
| | | | - Magdy Mohammed Khalil
- Department of physics, Faculty of Science, Helwan University, Cairo, Egypt
- Department of Biotechnology, School of Biotechnology, Badr University in Cairo (BUC), Cairo, Egypt
| | - Haidar Hamza Alabdei
- Department of Radiation Oncology, Baghdad Radiation Oncology and Nuclear Medicine Center, Baghdad Medical City Complex, Ministry of Health/Environment, Baghdad, Iraq
- Department of Surgery, College of Medicine, Baghdad University, Baghdad, Iraq
| | - Awf Abdulrahman Sulaiman
- Department of Radiation Oncology, Baghdad Radiation Oncology and Nuclear Medicine Center, Baghdad Medical City Complex, Ministry of Health/Environment, Baghdad, Iraq
| | - Dalya Saad Al-Nuaimi
- Department of Radiation Oncology, Baghdad Radiation Oncology and Nuclear Medicine Center, Baghdad Medical City Complex, Ministry of Health/Environment, Baghdad, Iraq
- Corresponding author: Dalya Saad Al-Nuaimi
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Bak B, Skrobala A, Adamska A, Malicki J. What information can we gain from performing adaptive radiotherapy of head and neck cancer patients from the past 10 years? Cancer Radiother 2021; 26:502-516. [PMID: 34772603 DOI: 10.1016/j.canrad.2021.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/06/2021] [Accepted: 08/12/2021] [Indexed: 01/10/2023]
Abstract
The aim of the review was to present the current literature status about replanning regarding anatomical and dosimetric changes in the target and OARs in the head and neck region during radiotherapy, to discuss and to analyze factors influencing the decision for adaptive radiotherapy of head and neck cancer patients. Significant progress has been made in head and neck patients' evaluation and qualification for adapted radiotherapy over the past ten years. Many factors leading to anatomical and dosimetric changes during treatment have been identified. Based on the literature, the most common factors triggering re-plan are weight loss, tumor and nodal changes, and parotid glands shrinkage. The fluctuations in dose distribution in the clinical area are significant predictive factors for patients' quality of life and the possibility of recovery. It has been shown that re-planning influence clinical outcomes: local control, disease free survival and overall survival. Regarding literature studies, it seems that adaptive radiotherapy would be the most beneficial for tumors of immense volume or those in the nearest proximity of the OARs. All researchers agree that the timing of re-planning is a crucial challenge, and there are still no clear consensus guidelines for time or criteria of re-planning. Nowadays, thanks to significant technological progress, the decision is mostly made based on observation and supported with IGRT verification. Although further research is still needed, adaptive strategies are evolving and now became the state of the art of modern radiotherapy.
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Affiliation(s)
- B Bak
- Radiotherapy Department II, Greater Poland Cancer Center, Poznan, Poland; Department of Electroradiology, University of Medical Science, Poznan, Poland.
| | - A Skrobala
- Department of Electroradiology, University of Medical Science, Poznan, Poland; Department of Medical Physics, Greater Poland Cancer Center, Poznan, Poland
| | - A Adamska
- Radiotherapy Ward I and Department I, Greater Poland Cancer Center, Poznan, Poland
| | - J Malicki
- Department of Electroradiology, University of Medical Science, Poznan, Poland
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Adaptive radiation therapy: When, how and what are the benefits that literature provides? Cancer Radiother 2021; 26:622-636. [PMID: 34688548 DOI: 10.1016/j.canrad.2021.08.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE To identify from the current literature when is the right time to replan and to assign thresholds for the optimum process of replanning. Nowadays, adaptive radiotherapy (ART) for head and neck cancer plays an exceptional role consisting of an evaluation procedure of the prominent anatomical and dosimetric variations. By performing complex radiotherapy methods, the credibility of the therapeutic result is crucial. Image guided radiotherapy (IGRT) was developed to ensure locoregional control and thus changes that might occur during radiotherapy be dealt with. MATERIALS AND METHODS An electronic research of articles published in PubMed/MEDLINE and Science Direct databases from January 2004 to October 2020 was performed. Among a total of 127 studies assessed for eligibility, 85 articles were ultimately retained for the review. RESULTS The most noticeable changes have been reported in the middle fraction of the treatment. Therefore, the suggested optimal time to replan is between the third and the fourth week. Anatomical deviations>1cm in the external contour, average weight loss>10%, violation in the dose coverage of the targets>5%, and violation in the dose of the peripherals were some of the thresholds that are currently used, and which lead to replanning. CONCLUSION ART may decrease toxicity and improve local-control. Whether it is beneficial or not, depends ultimately on each patient. However, more investigation of the changes should be performed in future prospective studies to obtain more accurate results.
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Geiger JL, Ismaila N, Beadle B, Caudell JJ, Chau N, Deschler D, Glastonbury C, Kaufman M, Lamarre E, Lau HY, Licitra L, Moore MG, Rodriguez C, Roshal A, Seethala R, Swiecicki P, Ha P. Management of Salivary Gland Malignancy: ASCO Guideline. J Clin Oncol 2021; 39:1909-1941. [PMID: 33900808 DOI: 10.1200/jco.21.00449] [Citation(s) in RCA: 154] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To provide evidence-based recommendations for practicing physicians and other healthcare providers on the management of salivary gland malignancy. METHODS ASCO convened an Expert Panel of medical oncology, surgical oncology, radiation oncology, neuroradiology, pathology, and patient advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2000 through 2020. Outcomes of interest included survival, diagnostic accuracy, disease recurrence, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 293 relevant studies to inform the evidence base for this guideline. Six main clinical questions were addressed, which included subquestions on preoperative evaluations, surgical diagnostic and therapeutic procedures, appropriate radiotherapy techniques, the role of systemic therapy, and follow-up evaluations. RECOMMENDATIONS When possible, evidence-based recommendations were developed to address the diagnosis and appropriate preoperative evaluations for patients with a salivary gland malignancy, therapeutic procedures, and appropriate treatment options in various salivary gland histologies.Additional information is available at www.asco.org/head-neck-cancer-guidelines.
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Affiliation(s)
| | | | | | | | | | | | | | - Marnie Kaufman
- Adenoid Cystic Carcinoma Research Foundation, Needham, MA
| | | | | | - Lisa Licitra
- Istituto Nazionale Tumori, Milan, Italy.,University of Milan, Milan, Italy
| | | | | | | | | | | | - Patrick Ha
- University of California San Francisco, San Francisco, CA
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Lee D, Zhang P, Nadeem S, Alam S, Jiang J, Caringi A, Allgood N, Aristophanous M, Mechalakos J, Hu YC. Predictive dose accumulation for HN adaptive radiotherapy. Phys Med Biol 2020; 65:235011. [PMID: 33007769 DOI: 10.1088/1361-6560/abbdb8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
During radiation therapy (RT) of head and neck (HN) cancer, the shape and volume of the parotid glands (PG) may change significantly, resulting in clinically relevant deviations of delivered dose from the planning dose. Early and accurate longitudinal prediction of PG anatomical changes during the RT can be valuable to inform decisions on plan adaptation. We developed a deep neural network for longitudinal predictions using the displacement fields (DFs) between the planning computed tomography (pCT) and weekly cone beam computed tomography (CBCT). Sixty-three HN patients treated with volumetric modulated arc were retrospectively studied. We calculated DFs between pCT and week 1-3 CBCT by B-spline and Demon deformable image registration (DIR). The resultant DFs were subsequently used as input to our novel network to predict the week 4 to 6 DFs for generating predicted weekly PG contours and weekly dose distributions. For evaluation, we measured dice similarity (DICE), and the uncertainty of accumulated dose. Moreover, we compared the detection accuracies of candidates for adaptive radiotherapy (ART) when the trigger criteria were mean dose difference more than 10%, 7.5%, and 5%, respectively. The DICE of ipsilateral/contralateral PG at week 4 to 6 using the prediction model trained with B-spline were 0.81 [Formula: see text] 0.07/0.81 [Formula: see text] 0.04 (week 4), 0.79 [Formula: see text] 0.06/0.81 [Formula: see text] 0.05 (week 5) and 0.78 [Formula: see text] 0.06/0.82 [Formula: see text] (week 6). The DICE with the Demons model were 0.78 [Formula: see text] 0.08/0.82 [Formula: see text] 0.03 (week 4), 0.77 [Formula: see text] 0.07/0.82 [Formula: see text] 0.04 (week 5) and 0.75 [Formula: see text] 0.07/0.82 [Formula: see text] 0.02 (week 6). The dose volume histogram (DVH) analysis with the predicted accumulated dose showed the feasibility of predicting dose uncertainty due to the PG anatomical changes. The AUC of ART candidate detection with our predictive model was over 0.90. In conclusion, the proposed network was able to predict future anatomical changes and dose uncertainty of PGs with clinically acceptable accuracy, and hence can be readily integrated into the ART workflow.
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Affiliation(s)
- Donghoon Lee
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center New York, NY, United States of America
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McCulloch MM, Cazoulat G, Ford AC, Elgohari B, Bahig H, Kim AD, Elhalawani H, He R, Wang J, Ding Y, Mohamed AS, Polan DF, King JB, Peterson CB, Ohrt AN, Fuller CD, Lai SY, Brock KK. Biomechanical modeling of radiation dose-induced volumetric changes of the parotid glands for deformable image registration. Phys Med Biol 2020; 65:165017. [PMID: 32320955 DOI: 10.1088/1361-6560/ab8bf1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE Early animal studies suggest that parotid gland (PG) toxicity prediction could be improved by an accurate estimation of the radiation dose to sub-regions of the PG. Translation to clinical investigation requires voxel-level dose accumulation in this organ that responds volumetrically throughout treatment. To date, deformable image registration (DIR) has been evaluated for the PG using only surface alignment. We sought to develop and evaluate an advanced DIR technique capable of modeling these complex PG volume changes over the course of radiation therapy. MATERIALS AND METHODS Planning and mid-treatment magnetic resonance images from 19 patients and computed tomography images from nine patients who underwent radiation therapy for head and neck cancer were retrospectively evaluated. A finite element model (FEM)-based DIR algorithm was applied between the corresponding pairs of images, based on boundary conditions on the PG surfaces only (Morfeus-spatial). To investigate an anticipated improvement in accuracy, we added a population model-based thermal expansion coefficient to simulate the dose distribution effect on the volume change inside the glands (Morfeus-spatialDose). The model accuracy was quantified using target registration error for magnetic resonance images, where corresponding anatomical landmarks could be identified. The potential clinical impact was evaluated using differences in mean dose, median dose, D98, and D50 of the PGs. RESULTS In the magnetic resonance images, the mean (±standard deviation) target registration error significantly reduced by 0.25 ± 0.38 mm (p = 0.01) when using Morfeus-spatialDose instead of Morfeus-spatial. In the computed tomography images, differences in the mean dose, median dose, D98, and D50 of the PGs reached 2.9 ± 0.8, 3.8, 4.1, and 3.8 Gy, respectively, between Morfeus-spatial and Morfeus-spatialDose. CONCLUSION Differences between Morfeus-spatial and Morfeus-spatialDose may be impactful when considering high-dose gradients of radiation in the PGs. The proposed DIR model can allow more accurate PG alignment than the standard model and improve dose estimation and toxicity prediction modeling.
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Affiliation(s)
- Molly M McCulloch
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America. Department of Radiation Medicine, School of Medicine, Oregon Health and Science University, Portland, OR 97239, United States of America
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Morgan HE, Sher DJ. Adaptive radiotherapy for head and neck cancer. CANCERS OF THE HEAD & NECK 2020; 5:1. [PMID: 31938572 PMCID: PMC6953291 DOI: 10.1186/s41199-019-0046-z] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/11/2019] [Indexed: 12/14/2022]
Abstract
Background Although there have been dramatic improvements in radiotherapy for head and neck squamous cell carcinoma (HNSCC), including robust intensity modulation and daily image guidance, these advances are not able to account for inherent structural and spatial changes that may occur during treatment. Many sources have reported volume reductions in the primary target, nodal volumes, and parotid glands over treatment, which may result in unintended dosimetric changes affecting the side effect profile and even efficacy of the treatment. Adaptive radiotherapy (ART) is an exciting treatment paradigm that has been developed to directly adjust for these changes. Main body Adaptive radiotherapy may be divided into two categories: anatomy-adapted (A-ART) and response-adapted ART (R-ART). Anatomy-adapted ART is the process of re-planning patients based on structural and spatial changes occurring over treatment, with the intent of reducing overdosage of sensitive structures such as the parotids, improving dose homogeneity, and preserving coverage of the target. In contrast, response-adapted ART is the process of re-planning patients based on response to treatment, such that the target and/or dose changes as a function of interim imaging during treatment, with the intent of dose escalating persistent disease and/or de-escalating surrounding normal tissue. The impact of R-ART on local control and toxicity outcomes is actively being investigated in several currently accruing trials. Conclusions Anatomy-adapted ART is a promising modality to improve rates of xerostomia and coverage in individuals who experience significant volumetric changes during radiation, while R-ART is currently being studied to assess its utility in either dose escalation of radioresistant disease, or de-intensification of surrounding normal tissue following treatment response. In this paper, we will review the existing literature and recent advances regarding A-ART and R-ART.
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Affiliation(s)
- Howard E Morgan
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 2280 Inwood Rd, Dallas, TX 75390 USA
| | - David J Sher
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 2280 Inwood Rd, Dallas, TX 75390 USA
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22
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Grepl J, Sirak I, Vosmik M, Tichy A. The Changes in Pharyngeal Constrictor Muscles Related to Head and Neck Radiotherapy: A Systematic Review. Technol Cancer Res Treat 2020; 19:1533033820945805. [PMID: 32734851 PMCID: PMC7406920 DOI: 10.1177/1533033820945805] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 06/05/2020] [Accepted: 06/26/2020] [Indexed: 11/17/2022] Open
Abstract
It is well known that radiation damage of the pharyngeal constrictor muscles, the glottic larynx, and the supraglottic larynx may lead to dysphagia, an unwanted effect of head and neck radiotherapy. The reduction of radiotherapy-induced dysphagia might be achieved by adaptive radiotherapy. Although the number of studies concerning adaptive radiotherapy of head and neck cancer is continuously increasing, there are only a few studies concerning changes in dysphagia-related structures during radiotherapy.The goal of this review is to summarize the current knowledge about volumetric, dosimetric, and other changes of the pharyngeal constrictor muscles associated with head and neck radiotherapy. A literature search was performed in the MEDLINE database according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The conclusions of 8 studies that passed the criteria indicate a significant increase in the volume and the thickness of the pharyngeal constrictor muscles during radiotherapy. Moreover, the changes in magnetic resonance imaging signal intensity of the pharyngeal constrictor muscles correlate with the absorbed dose (typically higher than 50 Gy) and also with the grade of dysphagia. This systematic review presents 2 variables, which are suitable for estimation of radiotherapy-related pharyngeal constrictor muscles changes-magnetic resonance imaging signal intensity and the thickness. In the case of the thickness, there is no consensus in the level of the measurement-C2 vertebra, C3 vertebra, and the middle of the craniocaudal axis are used. It seems that reference to a position associated with a vertebral body could be more reproducible and beneficial for future research. Although late pharyngeal toxicity remains a challenge in head and neck cancer treatment, better knowledge of radiotherapy-related changes in the pharyngeal constrictor muscles contributes to adaptive radiotherapy development and thus improves the treatment results.
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Affiliation(s)
- Jakub Grepl
- Department of Oncology and Radiotherapy, University Hospital, Hradec Kralove, Czech Republic
- Department of Radiobiology, Faculty of Military Health Sciences, Hradec Kralove, University of Defence, Brno, Czech Republic
| | - Igor Sirak
- Department of Oncology and Radiotherapy, University Hospital, Hradec Kralove, Czech Republic
| | - Milan Vosmik
- Department of Oncology and Radiotherapy, University Hospital, Hradec Kralove, Czech Republic
| | - Ales Tichy
- Department of Radiobiology, Faculty of Military Health Sciences, Hradec Kralove, University of Defence, Brno, Czech Republic
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23
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Dosimetric changes achieved and changes in target and parotid volumes in patients undergoing adaptive planning during chemoradiation therapy with helical delivery of treatment. JOURNAL OF RADIOTHERAPY IN PRACTICE 2019. [DOI: 10.1017/s1460396919000189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractAim:Re-planning mid-treatment, with the adjustment of target volumes, has been performed as part of the normal workflow at our institution. We sought to quantify the benefit of this approach and identify factors to optimise plan adaptive strategies.Materials and methods:Patients with locally advanced oropharyngeal cancer treated to 70 Gy with concurrent chemoradiation (CCRT) on TomoTherapy® who underwent re-planning during the treatment were eligible. Survival and prognostic factors were evaluated with Kaplan–Meier and Cox proportional hazards, two-sidep-value <0·05 significant.Results:Forty-two patients were identified with Stage III (n= 5), IVA (n= 34) and IVB (n= 3) [AJCC 7th] disease. Median re-planning dose was 40 Gy (14–60 Gy). Median change in mean total parotid dose was reduction of 1 Gy (range –7·5 Gy to +13·9 Gy). The volume of PTV70 and PTV60 receiving 99% of the prescribed (V99) dose was increased by 2·2% (–3·3 to +16·6%) and 1·9% (–11·5 to +12·6%) by re-planning. As a continuous variable, increasing per cent nodal regression was associated with the improved disease control in a multivariate model including stage, pack years smoking and human papilloma viral (HPV) status (HR: 0·85, 0·71–0·99,p= 0·05).Findings:Adaptive planning generates a superior plan for the majority of patients, but there is modest overall parotid gland sparing.
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24
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Heukelom J, Kantor ME, Mohamed ASR, Elhalawani H, Kocak-Uzel E, Lin T, Yang J, Aristophanous M, Rasch CR, Fuller CD, Sonke JJ. Differences between planned and delivered dose for head and neck cancer, and their consequences for normal tissue complication probability and treatment adaptation. Radiother Oncol 2019; 142:100-106. [PMID: 31431381 DOI: 10.1016/j.radonc.2019.07.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Anatomical changes induce differences between planned and delivered dose. Adaptive radiotherapy (ART) may reduce these differences but the optimal implementation is insufficiently clear. The aims of this study were to quantify the difference between planned and delivered dose in HNC patients, assess the consequential difference in normal tissue complication probability (ΔNTCP) and to explore the value of ΔNTCP as an objective selection strategy for ART. MATERIALS AND METHODS For 52 patients, daily doses were accumulated to estimate the delivered dose. The difference from planned dose was analyzed for CTVs and 9 organs-at-risk (OAR). ΔNTCP was calculated for xerostomia, dysphagia, parotid gland dysfunction and tube feeding dependency at 6 months. ART was deemed necessary if ΔNTCP was >5%. The positive predicted value (PPV) was calculated for identification of ART-patients by clinical judgement, and ΔNTCP at fraction 10 and 15. RESULTS ΔNTCP >5% was seen five times for dysphagia and twice for the other toxicities. Only 5/9 patients with any ΔNTCP >5% clinically received ART, although ART had been done for 13/52 patients (PPV: 0.38). PPV was 0.86 and 0.75 for accumulated dose at fraction 10 and 15, respectively, using a ΔNTCP cut-off for the allocation of ART of 5%. Using other ΔNTCP cut-offs did not substantially improve PPV. With this cut-off the negative predictive value was 0.93 for ΔNTCP method of fraction 10 and fraction 15, and 0.90 for clinical judgement. CONCLUSION To identify patients accurately for ART, NTCP calculations based on the dose differences between planned and delivered dose at fraction 10 are superior to clinical judgement.
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Affiliation(s)
- Jolien Heukelom
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michael E Kantor
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Abdallah S R Mohamed
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Hesham Elhalawani
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Esengul Kocak-Uzel
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Radiation Oncology, SBU Sisli Etfal Teaching and Research Hospital, İstanbul, Turkey
| | - Timothy Lin
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Michalis Aristophanous
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, USA
| | - Coen R Rasch
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Clifton David Fuller
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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25
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Sun XS, Li XY, Chen QY, Tang LQ, Mai HQ. Future of Radiotherapy in Nasopharyngeal Carcinoma. Br J Radiol 2019; 92:20190209. [PMID: 31265322 DOI: 10.1259/bjr.20190209] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Nasopharyngeal carcinoma (NPC) is a malignancy with unique clinical biological profiles such as associated Epstein-Barr virus infection and high radiosensitivity. Radiotherapy has long been recognized as the mainstay for the treatment of NPC. However, the further efficacy brought by radical radiotherapy has reached the bottleneck in advanced patients, who are prone to develop recurrence and distant metastasis after treatment. The application of photon therapy makes it possible for radiation dose escalation in refractory cases and may provide second chance for recurrent patients with less unrecoverable tissue damage. The concept of adaptive radiotherapy is put forward in consideration of target volume shrinkage during treatment. The replanning procedure offers better protection for the organ at risk. However, the best timing and candidates for adaptive radiotherapy is still under debate. The current tendency of artificial intelligence in NPC mainly focuses on image recognition, auto-segmentation and dose prediction. Although artificial intelligence is still in developmental stage, the future of it is promising.To further improve the efficacy of NPC, multimodality treatment is encouraged. In-depth studies on genetic and epigenetic variations help to explain the great heterogeneity among patients, and could further be applied to precise screening and prediction, personalized radiotherapy and the evolution of targeted drugs. Given the clinical benefit of immunotherapy in other cancers, the application of immunotherapy, especially immune checkpoint inhibitor, in NPC is also of great potential. Results from ongoing clinical trials combining immunotherapy with radiotherapy in NPC are expected.
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Affiliation(s)
- Xue-Song Sun
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, P R China.,Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, P R China
| | - Xiao-Yun Li
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, P R China.,Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, P R China
| | - Qiu-Yan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, P R China.,Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, P R China
| | - Lin-Quan Tang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, P R China.,Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, P R China
| | - Hai-Qiang Mai
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, P R China.,Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, P R China
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26
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Stauch Z, Zoller W, Tedrick K, Walston S, Christ D, Hunzeker A, Lenards N, Culp L, Gamez ME, Blakaj D. An evaluation of adaptive planning by assessing the dosimetric impact of weight loss throughout the course of radiotherapy in bilateral treatment of head and neck cancer patients. Med Dosim 2019; 45:52-59. [PMID: 31221447 DOI: 10.1016/j.meddos.2019.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/16/2019] [Accepted: 05/21/2019] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to investigate the dosimetric impact of weight loss in head and neck (H&N) patients and examine the effectiveness of adaptive planning. Data was collected from 22 H&N cancer patients who experienced weight loss during their course of radiotherapy. The robustness of Intensity Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) treatment plans were compared including the potential need for replanning. The dosimetric impact of weight loss was evaluated by calculating a verification plan for each patient on an assessment CT scan taken during the course of treatment. Using a regression analysis, significance was tested for the dosimetric change in target volumes and 10 specific organs at risk (OAR) using an anatomical separation difference in the H&N at corresponding levels. For both the IMRT and VMAT plans, a significant correlation was found for the dose to 5% of the high risk Planning Target Volume (PTV) (D5), dose to 95% of the intermediate risk PTV and Clinical Target Volume (CTV) (D95), and the percentage of the pharynx receiving 65 Gy. An independent t-test was also performed for each metric in the VMAT and IMRT plans showing the dose to 95% of the intermediate risk PTV as significant. No quantitative method for finding the threshold of anatomical separation difference requiring a replan was established. Based on the increase in dose to organs at risk and increased target coverage due to separation loss, it was concluded that adaptive radiotherapy may not always be necessary when alignment of bony anatomy and remaining soft tissue is within tolerance. Physician judgment and preference is needed in such situations.
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Affiliation(s)
- Zachary Stauch
- Medical Dosimetry Program at the University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
| | - Wesley Zoller
- The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
| | - Kayla Tedrick
- Medical Dosimetry Program at the University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
| | - Steve Walston
- The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Daniel Christ
- The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Ashley Hunzeker
- Medical Dosimetry Program at the University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
| | - Nishele Lenards
- Medical Dosimetry Program at the University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
| | - Lee Culp
- Medical Dosimetry Program at the University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
| | - Mauricio E Gamez
- The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Dukagjin Blakaj
- The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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McCulloch MM, Lee C, Rosen BS, Kamp JD, Lockhart CM, Lee JY, Polan DF, Hawkins PG, Anderson CJR, Heukelom J, Sonke JJ, Fuller CD, Balter JM, Ten Haken RK, Eisbruch A, Brock KK. Predictive Models to Determine Clinically Relevant Deviations in Delivered Dose for Head and Neck Cancer. Pract Radiat Oncol 2019; 9:e422-e431. [PMID: 30836190 DOI: 10.1016/j.prro.2019.02.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 01/23/2019] [Accepted: 02/22/2019] [Indexed: 11/15/2022]
Abstract
PURPOSE This study aimed to improve the understanding of deviations between planned and accumulated doses and to establish metrics to predict clinically significant dosimetric deviations midway through treatment to evaluate the potential need to re-plan during fractionated radiation therapy (RT). METHODS AND MATERIALS A total of 100 patients with head and neck cancer were retrospectively evaluated. Contours were mapped from the planning computed tomography (CT) scan to each fraction cone beam CT via deformable image registration. The dose was calculated on each cone beam CT and evaluated based on the mapped contours. The mean dose at each fraction was averaged to approximate the accumulated dose for structures with mean dose constraints, and the daily maximum dose was summed to approximate the accumulated dose for structures with maximum dose constraints. A threshold deviation value was calculated to predict for patients needing midtreatment re-planning. This predictive model was applied to 52 patients treated at a separate institution. RESULTS Dose was accumulated on 10 organs over 100 patients. To generate a threshold deviation that predicted the need to re-plan with 100% sensitivity, the submandibular glands required re-planning if the delivered dose was at least 3.5 Gy higher than planned by fraction 15. This model predicts the need to re-plan the submandibular glands with 98.7% specificity. In the independent evaluation cohort, this model predicts the need to re-plan the submandibular glands with 100% sensitivity and 98.0% specificity. The oral cavity, intermediate clinical target volume, left parotid, and inferior constrictor patient groups each had 1 patient who exceeded the threshold deviation by the end of RT. By fraction 15 of 30 to 35 total fractions, the left parotid gland, inferior constrictor, and intermediate clinical target volume had a dose deviation of 3.1 Gy, 5.9 Gy, and 4.8 Gy, respectively. When a deformable image registration failure was observed, the dose deviation exceeded the threshold for at least 1 organ, demonstrating that an automated deformable image registration-based dose assessment process could be developed with user evaluation for cases that result in dose deviations. CONCLUSIONS A midtreatment threshold deviation was determined to predict the need to replan for the submandibular glands by fraction 15 of 30 to 35 total fractions of RT.
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Affiliation(s)
- Molly M McCulloch
- Department of Radiation Oncology, The University of Michigan, Ann Arbor, Michigan; Department of Nuclear Engineering and Radiological Sciences, The University of Michigan, Ann Arbor, Michigan; Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Choonik Lee
- Department of Radiation Oncology, The University of Michigan, Ann Arbor, Michigan
| | - Benjamin S Rosen
- Department of Radiation Oncology, The University of Michigan, Ann Arbor, Michigan
| | - Justin D Kamp
- Department of Radiation Oncology, The University of Michigan, Ann Arbor, Michigan
| | - Chrissy M Lockhart
- Department of Radiation Oncology, The University of Michigan, Ann Arbor, Michigan
| | - Jae Y Lee
- Department of Radiation Oncology, The University of Michigan, Ann Arbor, Michigan; Princeton Radiation Oncology, Princeton, New Jersey
| | - Daniel F Polan
- Department of Radiation Oncology, The University of Michigan, Ann Arbor, Michigan; Department of Nuclear Engineering and Radiological Sciences, The University of Michigan, Ann Arbor, Michigan
| | - Peter G Hawkins
- Department of Radiation Oncology, The University of Michigan, Ann Arbor, Michigan
| | - Carlos J R Anderson
- Department of Radiation Oncology, The University of Michigan, Ann Arbor, Michigan
| | - Jolien Heukelom
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - James M Balter
- Department of Radiation Oncology, The University of Michigan, Ann Arbor, Michigan
| | - Randall K Ten Haken
- Department of Radiation Oncology, The University of Michigan, Ann Arbor, Michigan
| | - Avraham Eisbruch
- Department of Radiation Oncology, The University of Michigan, Ann Arbor, Michigan
| | - Kristy K Brock
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Giacometti V, King RB, Agnew CE, Irvine DM, Jain S, Hounsell AR, McGarry CK. An evaluation of techniques for dose calculation on cone beam computed tomography. Br J Radiol 2019; 92:20180383. [PMID: 30433821 DOI: 10.1259/bjr.20180383] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE: To assess the accuracy and efficiency of four different techniques, thus determining the optimum method for recalculating dose on cone beam CT (CBCT) images acquired during radiotherapy treatments. METHODS: Four established techniques were investigated and their accuracy assessed via dose calculations: (1) applying a standard planning CT (pCT) calibration curve, (2) applying a CBCT site-specific calibration curve, (3) performing a density override and (4) using deformable registration. Each technique was applied to 15 patients receiving volumetric modulated arc therapy to one of three treatment sites, head and neck, lung and prostate. Differences between pCT and CBCT recalculations were determined with dose volume histogram metrics and 2.0%/0.1 mm gamma analysis using the pCT dose distribution as a reference. RESULTS: Dose volume histogram analysis indicated that all techniques yielded differences from expected results between 0.0 and 2.3% for both target volumes and organs at risk. With volumetric gamma analysis, the dose recalculation on deformed images yielded the highest pass-rates. The median pass-rate ranges at 50% threshold were 99.6-99.9%, 94.6-96.0%, and 94.8.0-96.0% for prostate, head and neck and lung patients, respectively. CONCLUSION: Deformable registration, HU override and site-specific calibration curves were all identified as dosimetrically accurate and efficient methods for dose calculation on CBCT images. ADVANCES IN KNOWLEDGE: With the increasing adoption of CBCT, this study provides clinical radiotherapy departments with invaluable information regarding the comparison of dose reconstruction methods, enabling a more accurate representation of a patient's treatment. It can also integrate studies in which CBCT is used in image-guided radiation therapy and for adaptive radiotherapy planning processes.
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Affiliation(s)
- Valentina Giacometti
- 1 Centre for Cancer Research and Cell Biology, Queen's University Belfast , Belfast , UK
| | - Raymond B King
- 1 Centre for Cancer Research and Cell Biology, Queen's University Belfast , Belfast , UK.,2 Radiotherapy Physics, Northern Ireland Cancer Centre , Belfast , UK
| | - Christina E Agnew
- 2 Radiotherapy Physics, Northern Ireland Cancer Centre , Belfast , UK
| | - Denise M Irvine
- 2 Radiotherapy Physics, Northern Ireland Cancer Centre , Belfast , UK
| | - Suneil Jain
- 1 Centre for Cancer Research and Cell Biology, Queen's University Belfast , Belfast , UK.,2 Radiotherapy Physics, Northern Ireland Cancer Centre , Belfast , UK
| | - Alan R Hounsell
- 1 Centre for Cancer Research and Cell Biology, Queen's University Belfast , Belfast , UK.,2 Radiotherapy Physics, Northern Ireland Cancer Centre , Belfast , UK
| | - Conor K McGarry
- 1 Centre for Cancer Research and Cell Biology, Queen's University Belfast , Belfast , UK.,2 Radiotherapy Physics, Northern Ireland Cancer Centre , Belfast , UK
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CT-based dose recalculations in head and neck cancer radiotherapy: comparison of daily dose recalculations to less time-consuming approaches. Strahlenther Onkol 2018; 195:475-481. [PMID: 30523417 DOI: 10.1007/s00066-018-1406-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The goal of this study was to investigate if daily dose recalculations are necessary or if less time-consuming approaches can be used to identify dose differences to the planned dose in patients with head and neck cancers (H&N). METHODS For 12 H&N patients treated with helical tomotherapy, daily dose calculations were performed retrospectively. Four different summation doses (SuDo) were calculated: DayDo (daily dose calculation), MVCTx2, MVCTx5, and MVCTx10 (dose calculations every second, fifth, and tenth fraction). Dose recalculations were depicted on the last contoured mega voltage CT (MVCT). The DayDo was compared to the planned dose and to the less time-consuming SuDo scenarios. The doses were assessed for the planning target volume (PTV) and the organs at risk (OARs): mandible (mand), spinal cord (SC), spinal cord +5 mm (SC+5 mm), parotid glands (PG). RESULTS The ipsilateral PG, contralateral PG, and PTV volume decreased by -22.5% (range: -34.8 to 5.2%), -19.5% (-31.5 to 15.8%), and -2.6% (-16.7 to 0.2%), respectively. There was a significant median mean dose (Dmean) dose difference for DayDo compared to the planned dose for PG total of 1.9 Gy (-3.3 to 7.3 Gy). But less time-consuming SuDo compared to DayDo showed statistically significant but not clinically relevant (<2%) dose differences for several organs. Hence the small dose difference to the gold standard (DayDo), we recommend dose recalculations every fifth MVCT in order to identify the occurrence of dose differences compared to the planned dose. CONCLUSION Daily dose calculations are the most precise to assess dose differences between actual and planned dose. Dose recalculations on every fifth MVCT (i. e., weekly control CTs) are an applicable and time-saving way of identifying patients with significant dose differences compared to the planned dose.
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Routine Adaptive Replanning of p16-Positive Stage N2b Oropharyngeal Cancer: Quality Improvement or Waste of Time? Am J Clin Oncol 2018; 41:1211-1215. [PMID: 29727312 DOI: 10.1097/coc.0000000000000453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE/OBJECTIVE(S) To determine if routinely replanning patients treated for oropharyngeal cancer that is p16-positive and clinical neck stage N2b (AJCC 7th edition) is likely to result in dose changes that will improve patient outcomes to a meaningful degree. METHODS In 10 consecutive patients treated with primary radiotherapy (RT) and concurrent weekly chemotherapy for p16-positive N2b oropharyngeal carcinoma, we prospectively evaluated dose changes from replanning for the final 4 or 2 weeks of RT of a 7-week RT program. RESULTS Replanning for the final 4 or 2 weeks improved planning target volume coverage by an average of 4 and 2 percentage points, respectively. For all normal structures, the dose change was small (<1 Gy) with replanning. CONCLUSIONS In patients with p16-positive N2b oropharynx cancer, the value of replanning RT is a small improvement in target coverage with minimal improvement in normal tissue sparing. In response to our study, some of the physicians in our group replan most node-positive oropharyngeal cancer cases while others think routine replanning is not valuable.
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Branchini M, Broggi S, Dell'Oca I, Cattaneo GM, Calandrino R, Di Muzio NG, Fiorino C. Skin dose calculation during radiotherapy of head and neck cancer using deformable image registration of planning and mega-voltage computed tomography scans. Phys Imaging Radiat Oncol 2018; 8:44-50. [PMID: 33458416 PMCID: PMC7807680 DOI: 10.1016/j.phro.2018.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 11/21/2018] [Accepted: 11/22/2018] [Indexed: 11/29/2022] Open
Abstract
Background and Purpose Head-Neck (HN) patients may experience severe acute skin complications that can cause treatment interruption and increase the risk of late fibrosis. This study assessed a method for accurately monitoring skin dose changes during helical tomotherapy for HN cancer based on deformable image registration of planning computed tomography (CT) and mega-voltage CT (MVCT). Materials and Methods Planning CTs of nine patients were deformably registered to mid-treatment MVCT (MV15) images resulting in CTdef images. The original plans were recalculated on both CTdef and mid-treatment kilo-voltage CT (CT15) taken as ground truth. Superficial layers (SL) of the body with thicknesses of 2, 3 and 5 mm (SL2, SL3, SL5) were considered as derma surrogates. SL V95%, V97%, V98%, V100%, V102%, V105% and V107% of the prescribed PTV dose were extracted for CT15/CTdef and compared (considering patients with skin dose > 95%). For comparison, doses were calculated directly on the calibrated MVCT and analyzed in the same way. Results Differences between SL2/SL3/SL5 V95%-V107% in CT15/CTdef were very small: for eight of nine patients the difference between the considered SL2 Vd% computed on CTdef and CT15 was less than 1.4 cm3 for all d%. A larger value was found when using MVCT for skin dose calculation (4.8 cm3 for SL2), although CTdef body contour matched CT15 body with accuracy similar to that of MV15. Conclusions Deforming the planning CT-to-MVCT was shown to be accurate considering external body contours and skin DVHs. The method was able to accurately identify superficial overdosing.
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Affiliation(s)
- Marco Branchini
- Department of Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Sara Broggi
- Department of Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Italo Dell'Oca
- Department of Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | | | - Riccardo Calandrino
- Department of Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | | | - Claudio Fiorino
- Department of Medical Physics, San Raffaele Scientific Institute, Milano, Italy
- Corresponding author at: Medical Physics Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, MI, Italy.
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Castelli J, Simon A, Lafond C, Perichon N, Rigaud B, Chajon E, De Bari B, Ozsahin M, Bourhis J, de Crevoisier R. Adaptive radiotherapy for head and neck cancer. Acta Oncol 2018; 57:1284-1292. [PMID: 30289291 DOI: 10.1080/0284186x.2018.1505053] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Large anatomical variations can be observed during the treatment course intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC), leading to potential dose variations. Adaptive radiotherapy (ART) uses one or several replanning sessions to correct these variations and thus optimize the delivered dose distribution to the daily anatomy of the patient. This review, which is focused on ART in the HNC, aims to identify the various strategies of ART and to estimate the dosimetric and clinical benefits of these strategies. MATERIAL AND METHODS We performed an electronic search of articles published in PubMed/MEDLINE and Science Direct from January 2005 to December 2016. Among a total of 134 articles assessed for eligibility, 29 articles were ultimately retained for the review. Eighteen studies evaluated dosimetric variations without ART, and 11 studies reported the benefits of ART. RESULTS Eight in silico studies tested a number of replanning sessions, ranging from 1 to 6, aiming primarily to reduce the dose to the parotid glands. The optimal timing for replanning appears to be early during the first two weeks of treatment. Compared to standard IMRT, ART decreases the mean dose to the parotid gland from 0.6 to 6 Gy and the maximum dose to the spinal cord from 0.1 to 4 Gy while improving target coverage and homogeneity in most studies. Only five studies reported the clinical results of ART, and three of those studies included a non-randomized comparison with standard IMRT. These studies suggest a benefit of ART in regard to decreasing xerostomia, increasing quality of life, and increasing local control. Patients with the largest early anatomical and dose variations are the best candidates for ART. CONCLUSION ART may decrease toxicity and improve local control for locally advanced HNC. However, randomized trials are necessary to demonstrate the benefit of ART before using the technique in routine practice.
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Affiliation(s)
- J. Castelli
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
- INSERM U1099 LTSI, Rennes, France
- Université de Rennes 1, Rennes, France
| | - A. Simon
- INSERM U1099 LTSI, Rennes, France
- Université de Rennes 1, Rennes, France
| | - C. Lafond
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
- INSERM U1099 LTSI, Rennes, France
- Université de Rennes 1, Rennes, France
| | - N. Perichon
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
| | - B. Rigaud
- INSERM U1099 LTSI, Rennes, France
- Université de Rennes 1, Rennes, France
| | - E. Chajon
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
| | - B. De Bari
- Radiotherapy Department, CHU Jean-Minjoz, Besançon, France
| | - M. Ozsahin
- Radiotherapy Department, Lausanne University Hospital, Lausanne, Switzerland
| | - J. Bourhis
- Radiotherapy Department, Lausanne University Hospital, Lausanne, Switzerland
| | - R. de Crevoisier
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
- INSERM U1099 LTSI, Rennes, France
- Université de Rennes 1, Rennes, France
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Pogson E, Arumugam S, Hansen C, Currie M, Blake S, Roberts N, Carolan M, Vial P, Alharthi T, Holloway L, Thwaites D. Comparison of multi-institutional pre-treatment verification for VMAT of nasopharynx with delivery errors. Phys Med 2018; 53:25-31. [DOI: 10.1016/j.ejmp.2018.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/19/2018] [Accepted: 07/21/2018] [Indexed: 10/28/2022] Open
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Lou J, Huang P, Ma C, Zheng Y, Chen J, Liang Y, Li H, Yin Y, Liu D, Yu G, Li D. Parotid gland radiation dose-xerostomia relationships based on actual delivered dose for nasopharyngeal carcinoma. J Appl Clin Med Phys 2018; 19:251-260. [PMID: 29664218 PMCID: PMC5978560 DOI: 10.1002/acm2.12327] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 02/04/2018] [Accepted: 03/04/2018] [Indexed: 11/30/2022] Open
Abstract
Xerostomia induced by radiotherapy is a common toxicity for head and neck carcinoma patients. In this study, the deformable image registration of planning computed tomography (CT) and weekly cone‐beam CT (CBCT) was used to override the Hounsfield unit value of CBCT, and the modified CBCT was introduced to estimate the radiation dose delivered during the course of treatment. Herein, the beams from each patient's treatment plan were applied to the modified CBCT to construct the weekly delivered dose. Then, weekly doses were summed together to obtain the accumulated dose. A total of 42 parotid glands (PGs) of 21 nasopharyngeal carcinoma patients were analyzed. Doses delivered to the parotid glands significantly increased compared with the planning doses. V20, V30, V40, Dmean, and D50 increased by 11.3%, 28.6%, 44.4%, 9.5%, and 8.4% respectively. Of the 21 patients included in the study, eight developed xerostomia and the remaining 13 did not. Both planning and delivered PG Dmean for all patients exceeded tolerance (26 Gy). Among the 21 patients, the planning dose and delivered dose of Dmean were 30.6 Gy and 33.6 Gy, respectively, for patients with xerostomia, and 26.3 Gy and 28.0 Gy, respectively, for patients without xerostomia. The D50 of the planning and delivered dose for patients was below tolerance (30 Gy). The results demonstrated that the p‐value of V20, V30, D50, and Dmean difference of the delivery dose between patients with xerostomia and patients without xerostomia was less than 0.05. However, for the planning dose, the significant dosimetric difference between the two groups only existed in D50 and Dmean. Xerostomia is closely related to V20, V30, D50, and Dmean.
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Affiliation(s)
- Jingjiao Lou
- Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, Institute of Biomedical Sciences, School of Physics and Electronics, Shandong Normal University, No.88, Wenhua East Road, Jinan, 250014, China
| | - Pu Huang
- Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, Institute of Biomedical Sciences, School of Physics and Electronics, Shandong Normal University, No.88, Wenhua East Road, Jinan, 250014, China
| | - Changsheng Ma
- Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, No.440, Jiyan Road, Jinan, 250117, China
| | - Yue Zheng
- Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, Institute of Biomedical Sciences, School of Physics and Electronics, Shandong Normal University, No.88, Wenhua East Road, Jinan, 250014, China
| | - Jinhu Chen
- Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, No.440, Jiyan Road, Jinan, 250117, China
| | - Yueqiang Liang
- Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, No.440, Jiyan Road, Jinan, 250117, China
| | - Hongsheng Li
- Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, No.440, Jiyan Road, Jinan, 250117, China
| | - Yong Yin
- Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, No.440, Jiyan Road, Jinan, 250117, China
| | - Danhua Liu
- Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, Institute of Biomedical Sciences, School of Physics and Electronics, Shandong Normal University, No.88, Wenhua East Road, Jinan, 250014, China
| | - Gang Yu
- Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, Institute of Biomedical Sciences, School of Physics and Electronics, Shandong Normal University, No.88, Wenhua East Road, Jinan, 250014, China
| | - Dengwang Li
- Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, Institute of Biomedical Sciences, School of Physics and Electronics, Shandong Normal University, No.88, Wenhua East Road, Jinan, 250014, China
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Hawkins PG, Kadam AS, Jackson WC, Eisbruch A. Organ-Sparing in Radiotherapy for Head-and-Neck Cancer: Improving Quality of Life. Semin Radiat Oncol 2018; 28:46-52. [DOI: 10.1016/j.semradonc.2017.08.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Pogson EM, Aruguman S, Hansen CR, Currie M, Oborn BM, Blake SJ, Juresic J, Ochoa C, Yakobi J, Haman A, Trtovac A, Carolan M, Holloway L, Thwaites DI. Multi-institutional comparison of simulated treatment delivery errors in ssIMRT, manually planned VMAT and autoplan-VMAT plans for nasopharyngeal radiotherapy. Phys Med 2017; 42:55-66. [DOI: 10.1016/j.ejmp.2017.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/03/2017] [Accepted: 08/20/2017] [Indexed: 11/25/2022] Open
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Dewan A, Sharma S, Dewan A, Srivastava H, Rawat S, Kakria A, Mishra M, T S, Mehrotra K. Impact of Adaptive Radiotherapy on Locally Advanced Head and Neck Cancer - A Dosimetric and Volumetric Study. Asian Pac J Cancer Prev 2017; 17:985-92. [PMID: 27039824 DOI: 10.7314/apjcp.2016.17.3.985] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED Objective of the study is to evaluate volumetric and dosimetric alterations taking place during radiotherapy for locally advanced head and neck cancer (LAHNC) and to assess benefit of replanning in them. MATERIALS AND METHODS Thirty patients with LAHNC fulfilling the inclusion and exclusion criteria were enrolled in a prospective study. Planning scans were acquired both pre-treatment and after 20 fractions (mid-course) of radiotherapy. Single plan (OPLAN) based on initial CT scan was generated and executed for entire treatment course. Beam configuration of OPLAN was applied to anatomy of interim scan and a hybrid plan (HPLAN30) was generated. Adaptive replanning (RPLAN30) for remaining fractions was done and dose distribution with and without replanning compared for remaining fractions. RESULTS Substantial shrinkage of target volume (TV) and parotids after 4 weeks of radiotherapy was reported (p<0.05). No significant difference between planned and delivered doses was seen for remaining fractions. Hybrid plans showed increase in delivered dose to spinal cord and parotids for remaining fractions. Interim replanning improved homogeneity of treatment plan and significantly reduced doses to cord (Dmax, D2% and D1%) and ipsilateral parotid (D33%, D50% and D66%) (p<0.05). CONCLUSIONS Use of one or two mid-treatment CT scans and replanning provides greater normal tissue sparing alongwith improved TV coverage.
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Affiliation(s)
- Abhinav Dewan
- Department of Radiotherapy, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India E-mail :
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Duffy O, Forde E, Leech M. The dilemma of parotid gland and pharyngeal constrictor muscles preservation—Is daily online image guidance required? A dosimetric analysis. Med Dosim 2017; 42:24-30. [PMID: 28126473 DOI: 10.1016/j.meddos.2016.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 10/19/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
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Deshpande S, Geurts M, Vial P, Metcalfe P, Lee M, Holloway L. Clinical significance of treatment delivery errors for helical TomoTherapy nasopharyngeal plans – A dosimetric simulation study. Phys Med 2017; 33:159-169. [PMID: 28110824 DOI: 10.1016/j.ejmp.2017.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 12/06/2016] [Accepted: 01/07/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Shrikant Deshpande
- Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia.
| | - Mark Geurts
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, USA.
| | - Philip Vial
- Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia; Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia.
| | - Peter Metcalfe
- Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia.
| | - Mark Lee
- Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia.
| | - Lois Holloway
- Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia; Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia; South West Clinical School, University of New South Wales, Sydney, NSW, Australia.
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Veresezan O, Troussier I, Lacout A, Kreps S, Maillard S, Toulemonde A, Marcy PY, Huguet F, Thariat J. Adaptive radiation therapy in head and neck cancer for clinical practice: state of the art and practical challenges. Jpn J Radiol 2016; 35:43-52. [DOI: 10.1007/s11604-016-0604-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
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Hamming-Vrieze O, van Kranen SR, Heemsbergen WD, Lange CAH, van den Brekel MWM, Verheij M, Rasch CRN, Sonke JJ. Analysis of GTV reduction during radiotherapy for oropharyngeal cancer: Implications for adaptive radiotherapy. Radiother Oncol 2016; 122:224-228. [PMID: 27866848 DOI: 10.1016/j.radonc.2016.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 07/15/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE Adaptive field size reduction based on gross tumor volume (GTV) shrinkage imposes risk on coverage. Fiducial markers were used as surrogate for behavior of tissue surrounding the GTV edge to assess this risk by evaluating if GTVs during treatment are dissolving or actually shrinking. MATERIALS AND METHODS Eight patients with oropharyngeal tumors treated with chemo-radiation were included. Before treatment, fiducial markers (0.035×0.2cm2, n=40) were implanted at the edge of the primary tumor. All patients underwent planning-CT, daily cone beam CT (CBCT) and MRIs (pre-treatment, weeks 3 and 6). Marker displacement on CBCT was compared to local GTV surface displacement on MRIs. Additionally, marker displacement relative to the GTV surfaces during treatment was measured. RESULTS GTV surface displacement derived from MRI was larger than derived from fiducial markers (average difference: 0.1cm in week 3). During treatment, the distance between markers and GTV surface on MRI in week 3 increased in 33%>0.3cm and in 10%>0.5cm. The MRI-GTV shrank faster than the surrounding tissue represented by the markers, i.e. adapting to GTV shrinkage may cause under-dosage of microscopic disease. CONCLUSIONS We showed that adapting to primary tumor GTV shrinkage on MRI mid-treatment is potentially not safe since at least part of the GTV is likely to be dissolving. Adjustment to clear anatomical boundaries, however, may be done safely.
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Affiliation(s)
- Olga Hamming-Vrieze
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Simon R van Kranen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wilma D Heemsbergen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Charlotte A H Lange
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Marcel Verheij
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Coen R N Rasch
- Department of Radiotherapy, Academic Medical Centre, Amsterdam, The Netherlands
| | - Jan Jakob Sonke
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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van Kranen S, Hamming-Vrieze O, Wolf A, Damen E, van Herk M, Sonke JJ. Head and Neck Margin Reduction With Adaptive Radiation Therapy: Robustness of Treatment Plans Against Anatomy Changes. Int J Radiat Oncol Biol Phys 2016; 96:653-60. [PMID: 27681762 DOI: 10.1016/j.ijrobp.2016.07.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 07/05/2016] [Accepted: 07/13/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE We set out to investigate loss of target coverage from anatomy changes in head and neck cancer patients as a function of applied safety margins and to verify a cone beam computed tomography (CBCT)-based adaptive strategy with an average patient anatomy to overcome possible target underdosage. METHODS AND MATERIALS For 19 oropharyngeal cancer patients, volumetric modulated arc therapy treatment plans (2 arcs; simultaneous integrated boost, 70 and 54.25 Gy; 35 fractions) were automatically optimized with uniform clinical target volume (CTV)-to-planning target volume margins of 5, 3, and 0 mm. We applied b-spline CBCT-to-computed tomography (CT) deformable registration to allow recalculation of the dose on modified CT scans (planning CT deformed to daily CBCT following online positioning) and dose accumulation in the planning CT scan. Patients with deviations in primary or elective CTV coverage >2 Gy were identified as candidates for adaptive replanning. For these patients, a single adaptive intervention was simulated with an average anatomy from the first 10 fractions. RESULTS Margin reduction from 5 mm to 3 mm to 0 mm generally led to an organ-at-risk (OAR) mean dose (Dmean) sparing of approximately 1 Gy/mm. CTV shrinkage was mainly seen in the elective volumes (up to 10%), likely related to weight loss. Despite online repositioning, substantial systematic errors were present (>3 mm) in lymph node CTV, the parotid glands, and the larynx. Nevertheless, the average increase in OAR dose was small: maximum of 1.2 Gy (parotid glands, Dmean) for all applied margins. Loss of CTV coverage >2 Gy was found in 1, 3, and 7 of 73 CTVs, respectively. Adaptive intervention in 0-mm plans substantially improved coverage: in 5 of 7 CTVs (in 6 patients) to <2 Gy of initially planned. CONCLUSIONS Volumetric modulated arc therapy head and neck cancer treatment plans with 5-mm margins are robust for anatomy changes and show a modest increase in OAR dose. Margin reduction improves OAR sparing with approximately 1 Gy/mm at the expense of target coverage in a subgroup of patients. Patients at risk of CTV underdosage >2 Gy in 0-mm plans may be identified early in treatment using dose accumulation. A single intervention with an average anatomy derived from CBCT effectively mitigates discrepancies.
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Affiliation(s)
- Simon van Kranen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Olga Hamming-Vrieze
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Annelisa Wolf
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Eugène Damen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marcel van Herk
- Christie Hospital and University of Manchester, Manchester, United Kingdom
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Brown E, Owen R, Harden F, Mengersen K, Oestreich K, Houghton W, Poulsen M, Harris S, Lin C, Porceddu S. Head and neck adaptive radiotherapy: Predicting the time to replan. Asia Pac J Clin Oncol 2016; 12:460-467. [PMID: 27435432 DOI: 10.1111/ajco.12516] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/10/2016] [Accepted: 04/11/2016] [Indexed: 11/27/2022]
Abstract
AIM Head and neck (H&N) cancer patients can undergo anatomical change throughout radiotherapy treatment. Adaptive radiotherapy (ART) is effective in addressing the impact of this change on the planned dose distribution. The aim of this study was to identify pretreatment factors that influence the need for and timing of replanning for patients receiving chemoradiotherapy for node-positive nasopharyngeal (NPC) and oropharyngeal carcinoma (OPC). METHODS Of 110 patients enrolled in a prospective H&N ART study, 21 (19%) underwent a second planning scan (re-CT) and were included in this review. Univariate and multivariate analysis was used to compare those patients who were replanned with those that were not. Factors influencing the timing of replanning were assessed including patient and tumor characteristics and structure volume details. RESULTS Of the five replanned patients, three were diagnosed with NPC (P = 0.06) and had significantly larger initial nodal volumes (median volume 140.3 cc vs. 39.1 cc, P = 0.019). Overall the median time of re-CT was significantly different between replanned and non-replanned patients, with replanned patients having an earlier re-CT: median fraction 18 versus fraction 23 (P = 0.01). Specifically, NPC patients who were replanned had a re-CT performed earlier than OPC patients (median fraction 11 vs. 20). CONCLUSION For H&N patients with large nodes receiving definitive chemoradiotherapy, replanning may be considered at the commencement of week 3 for NPC patients and in week 4 of treatment for OPC patients. This information may facilitate a forward planning approach to H&N ART that enables allocation of departmental resources prior to treatment commencement.
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Affiliation(s)
- Elizabeth Brown
- Radiation Oncology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Queensland University of Technology, Brisbane, Queensland, Australia
| | - Rebecca Owen
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Fiona Harden
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Kerrie Mengersen
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Kimberley Oestreich
- Radiation Oncology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Whitney Houghton
- Radiation Oncology Department, Radiation Oncology Mater Centre, Brisbane, Queensland, Australia
| | - Michael Poulsen
- Radiation Oncology Department, Radiation Oncology Mater Centre, Brisbane, Queensland, Australia
| | - Selina Harris
- Radiation Oncology Department, Royal Brisbane and Women's, Brisbane, Queensland, Australia
| | - Charles Lin
- Radiation Oncology Department, Royal Brisbane and Women's, Brisbane, Queensland, Australia
| | - Sandro Porceddu
- Radiation Oncology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Zhang P, Simon A, Rigaud B, Castelli J, Ospina Arango JD, Nassef M, Henry O, Zhu J, Haigron P, Li B, Shu H, De Crevoisier R. Optimal adaptive IMRT strategy to spare the parotid glands in oropharyngeal cancer. Radiother Oncol 2016; 120:41-7. [PMID: 27372223 DOI: 10.1016/j.radonc.2016.05.028] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 05/21/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE In oropharyngeal cancer adaptive radiation therapy (ART), this study aimed to quantify the dosimetric benefit of numerous replanning strategies, defined by various numbers and timings of replannings, with regard to parotid gland (PG) sparing. MATERIAL AND METHODS Thirteen oropharyngeal cancer patients had one planning and then six weekly CT scans during the seven weeks of IMRT. Weekly doses were recalculated without replanning or with replanning to spare the PG. Sixty-three ART scenarios were simulated by considering all the combinations of numbers and timings of replanning. The PG cumulated doses corresponding to "standard" IMRT and ART scenarios were estimated and compared, either by calculating the average of weekly doses or using deformable image registration (DIR). RESULTS Considering average weekly doses, the mean PG overdose using standard IMRT, compared to the planned dose, was 4.1Gy. The mean dosimetric benefit of 6 replannings was 3.3Gy. Replanning at weeks 1, 1-5, 1-2-5, 1-2-4-5 and 1-2-4-5-6 produced the lowest PG mean doses, 94% of the maximum benefit being obtained with 3 replannings. The percentage of patients who had a benefit superior to 5Gy for the contralateral PG was 31% for the three-replannings strategy. The same conclusions were found using DIR. CONCLUSION Early replannings proved the most beneficial for PG sparing, three replannings (weeks 1-2-5), representing an attractive combination for ART in oropharyngeal cancer.
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Affiliation(s)
- Pengcheng Zhang
- National Key Laboratory for Electronic Measurement Technology, North University of China, Taiyuan, People's Republic of China; Université de Rennes 1, LTSI, France; INSERM, U1099, Rennes, France; Centre de Recherche en Information médicale sino-français (CRIBs), Rennes, France
| | - Antoine Simon
- Université de Rennes 1, LTSI, France; INSERM, U1099, Rennes, France; Centre de Recherche en Information médicale sino-français (CRIBs), Rennes, France
| | - Bastien Rigaud
- Université de Rennes 1, LTSI, France; INSERM, U1099, Rennes, France.
| | - Joël Castelli
- Université de Rennes 1, LTSI, France; INSERM, U1099, Rennes, France; Centre Eugene Marquis, Radiotherapy Department, Rennes, France
| | | | - Mohamed Nassef
- Université de Rennes 1, LTSI, France; INSERM, U1099, Rennes, France
| | - Olivier Henry
- Centre Eugene Marquis, Radiotherapy Department, Rennes, France
| | - Jian Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital, Jinan, People's Republic of China; Laboratory of Image Science and Technology, Southeast University, Nanjing, People's Republic of China
| | - Pascal Haigron
- Université de Rennes 1, LTSI, France; INSERM, U1099, Rennes, France; Centre de Recherche en Information médicale sino-français (CRIBs), Rennes, France
| | - Baosheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital, Jinan, People's Republic of China; Laboratory of Image Science and Technology, Southeast University, Nanjing, People's Republic of China
| | - Huazhong Shu
- Centre de Recherche en Information médicale sino-français (CRIBs), Rennes, France; Laboratory of Image Science and Technology, Southeast University, Nanjing, People's Republic of China
| | - Renaud De Crevoisier
- Université de Rennes 1, LTSI, France; INSERM, U1099, Rennes, France; Centre de Recherche en Information médicale sino-français (CRIBs), Rennes, France; Centre Eugene Marquis, Radiotherapy Department, Rennes, France.
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Castelli J, Simon A, Rigaud B, Lafond C, Chajon E, Ospina JD, Haigron P, Laguerre B, Loubière AR, Benezery K, de Crevoisier R. A Nomogram to predict parotid gland overdose in head and neck IMRT. Radiat Oncol 2016; 11:79. [PMID: 27278960 PMCID: PMC4898383 DOI: 10.1186/s13014-016-0650-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/17/2016] [Indexed: 11/25/2022] Open
Abstract
Purposes To generate a nomogram to predict parotid gland (PG) overdose and to quantify the dosimetric benefit of weekly replanning based on its findings, in the context of intensity-modulated radiotherapy (IMRT) for locally-advanced head and neck carcinoma (LAHNC). Material and methods Twenty LAHNC patients treated with radical IMRT underwent weekly computed tomography (CT) scans during IMRT. The cumulated PG dose was estimated by elastic registration. Early predictors of PG overdose (cumulated minus planned doses) were identified, enabling a nomogram to be generated from a linear regression model. Its performance was evaluated using a leave-one-out method. The benefit of weekly replanning was then estimated for the nomogram-identified PG overdose patients. Results Clinical target volume 70 (CTV70) and the mean PG dose calculated from the planning and first weekly CTs were early predictors of PG overdose, enabling a nomogram to be generated. A mean PG overdose of 2.5Gy was calculated for 16 patients, 14 identified by the nomogram. All patients with PG overdoses >1.5Gy were identified. Compared to the cumulated delivered dose, weekly replanning of these 14 targeted patients enabled a 3.3Gy decrease in the mean PG dose. Conclusion Based on the planning and first week CTs, our nomogram allowed the identification of all patients with PG overdoses >2.5Gy to be identified, who then benefitted from a final 4Gy decrease in mean PG overdose by means of weekly replanning.
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Affiliation(s)
- J Castelli
- Centre Eugene Marquis, Radiotherapy, de la Bataille Flandre Dunkerque, F-35000, Rennes, France. .,Rennes University 1, LTSI, Campus de Beaulieu, Rennes, F-35000, France. .,INSERM, U1099, Campus de Beaulieu, Rennes, F-35000, France.
| | - A Simon
- Rennes University 1, LTSI, Campus de Beaulieu, Rennes, F-35000, France.,INSERM, U1099, Campus de Beaulieu, Rennes, F-35000, France
| | - B Rigaud
- Rennes University 1, LTSI, Campus de Beaulieu, Rennes, F-35000, France.,INSERM, U1099, Campus de Beaulieu, Rennes, F-35000, France
| | - C Lafond
- Centre Eugene Marquis, Radiotherapy, de la Bataille Flandre Dunkerque, F-35000, Rennes, France
| | - E Chajon
- Centre Eugene Marquis, Radiotherapy, de la Bataille Flandre Dunkerque, F-35000, Rennes, France
| | - J D Ospina
- Rennes University 1, LTSI, Campus de Beaulieu, Rennes, F-35000, France.,INSERM, U1099, Campus de Beaulieu, Rennes, F-35000, France
| | - P Haigron
- Rennes University 1, LTSI, Campus de Beaulieu, Rennes, F-35000, France.,INSERM, U1099, Campus de Beaulieu, Rennes, F-35000, France
| | - B Laguerre
- Centre Eugene Marquis, Medical oncology, Rennes, F-35000, France
| | | | - K Benezery
- Centre Antoine Lacassagne, Radiotherapy, Nice, F-06100, France
| | - R de Crevoisier
- Centre Eugene Marquis, Radiotherapy, de la Bataille Flandre Dunkerque, F-35000, Rennes, France.,Rennes University 1, LTSI, Campus de Beaulieu, Rennes, F-35000, France.,INSERM, U1099, Campus de Beaulieu, Rennes, F-35000, France
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Samuels SE, Tao Y, Lyden T, Haxer M, Spector M, Malloy KM, Prince ME, Bradford CR, Worden FP, Schipper M, Eisbruch A. Comparisons of dysphagia and quality of life (QOL) in comparable patients with HPV-positive oropharyngeal cancer receiving chemo-irradiation or cetuximab-irradiation. Oral Oncol 2016; 54:68-74. [PMID: 26776757 DOI: 10.1016/j.oraloncology.2015.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/08/2015] [Accepted: 12/15/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE Compare functional outcomes of radiotherapy (RT) concurrent with cetuximab (cet-RT) or with chemotherapy (chemo-RT) for comparable, good prognosis patients with human papillomavirus related (HPV+) oropharyngeal cancer (OPC). METHODS Outcomes of patients with stage III/IV HPV+ OPC patients with minimal smoking history and non-T4/N3/N2C, treated on prospective protocol of RT concurrent with cetuximab (cet-RT), were compared to similar patients on prospective chemo-RT protocols. In both groups, videofluoroscopy (VF), observer rated dysphagia (ORD), and validated QOL questionnaires: xerostomia questionnaire (XQ), head and neck QOL, and University of Washington QOL, were performed periodically and compared to pretreatment. Mixed effects models with adjustment for baseline assessed differences between groups. RESULTS 26 cet-RT patients were compared to 27 chemo-RT patients with similar baseline characteristics. In the chemo-RT group, no recurrences occurred. In the cet-RT group, 1 patient had persistent microscopic disease on salvage neck dissection and 1 distant failure. Both groups had mild VF-based swallowing dysfunction pre-treatment, worsened at 3 months (P<0.02) and persisted at 12 months, not differing between groups (P>0.11). For both groups ORD was very low pretreatment, worsened at 3 months and improved at 12 months, without differences between treatment groups (P=0.26). QOL Summary and domain scores for eating were good pretreatment, worse at 3 mo, and then improved to near baseline at 12 months, without differences between the groups in any QOL domains (P>0.10). CONCLUSION Both groups had excellent clinical outcomes without significant differences in objective or subjective functions. These data question using cetuximab instead of chemotherapy for treatment de-intensification for HPV+ OPC.
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Affiliation(s)
- Stuart E Samuels
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Yebin Tao
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
| | - Teresa Lyden
- Department of Speech Pathology, University of Michigan, Ann Arbor, MI, United States
| | - Marc Haxer
- Department of Speech Pathology, University of Michigan, Ann Arbor, MI, United States
| | - Matthew Spector
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States
| | - Kelly M Malloy
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States
| | - Mark E Prince
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States
| | - Carol R Bradford
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States
| | - Francis P Worden
- Department of Medicine - Medical Oncology Division, University of Michigan, United States
| | - Matthew Schipper
- Department of Radiation Oncology and Biostatistics, University of Michigan, Ann Arbor, MI, United States
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States.
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Replanning Criteria and Timing Definition for Parotid Protection-Based Adaptive Radiation Therapy in Nasopharyngeal Carcinoma. BIOMED RESEARCH INTERNATIONAL 2015; 2015:476383. [PMID: 26793717 PMCID: PMC4697077 DOI: 10.1155/2015/476383] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 11/30/2015] [Indexed: 11/30/2022]
Abstract
The goal of this study was to evaluate real-time volumetric and dosimetric changes of the parotid gland so as to determine replanning criteria and timing for parotid protection-based adaptive radiation therapy in nasopharyngeal carcinoma. Fifty NPC patients were treated with helical tomotherapy; volumetric and dosimetric (Dmean, V1, and D50) changes of the parotid gland at the 1st, 6th, 11th, 16th, 21st, 26th, 31st, and 33rd fractions were evaluated. The clinical parameters affecting these changes were studied by analyses of variance methods for repeated measures. Factors influencing the actual parotid dose were analyzed by a multivariate logistic regression model. The cut-off values predicting parotid overdose were developed from receiver operating characteristic curves and judged by combining them with a diagnostic test consistency check. The median absolute value and percentage of parotid volume reduction were 19.51 cm3 and 35%, respectively. The interweekly parotid volume varied significantly (p < 0.05). The parotid Dmean, V1, and D50 increased by 22.13%, 39.42%, and 48.45%, respectively. The actual parotid dose increased by an average of 11.38% at the end of radiation therapy. Initial parotid volume, initial parotid Dmean, and weight loss rate are valuable indicators for parotid protection-based replanning.
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Mendez LC, Moraes FY, Poon I, Marta GN. The management of head and neck tumors with high technology radiation therapy. Expert Rev Anticancer Ther 2015; 16:99-110. [PMID: 26568146 DOI: 10.1586/14737140.2016.1121111] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Squamous cell carcinoma is responsible for 90% of the head and neck cancers affecting over 600,000 people worldwide. Radiation therapy, surgery and chemotherapy are the most important treatment modalities in head and neck squamous cell carcinoma. The aim of this review is to summarize the recent innovations in head and neck radiation therapy, which intends to appreciate the cutting-edge intensity-modulated radiation therapy strategies to mitigate long-term toxicities and evaluate promising technologies in the field as adaptive treatment, dose painting and proton therapy.
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Affiliation(s)
- Lucas Castro Mendez
- a Service of Radiation Oncology , Hospital Israelita Albert Einstein and Instituto de Radiologia (INRAD) - Faculdade de Medicina da Universidade de São Paulo (FMUSP) , São Paulo , Brazil
| | - Fabio Ynoe Moraes
- b Department of Radiation Oncology , Hospital Sírio-Libanes , São Paulo , Brazil.,c Service of Radiotherapy , Instituto de Radiologia (INRAD) - Faculdade de Medicina da Universidade de São Paulo (University of São Paulo - FMUSP) , São Paulo , Brazil
| | - Ian Poon
- d Department of Radiation Oncology , Sunnybrook Odette Cancer Centre - University of Toronto , Toronto , Canada
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Muren LP, Jornet N, Georg D, Garcia R, Thwaites DI. Improving radiotherapy through medical physics developments. Radiother Oncol 2015; 117:403-6. [DOI: 10.1016/j.radonc.2015.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 11/19/2015] [Indexed: 01/21/2023]
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50
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Vainshtein JM, Samuels S, Tao Y, Lyden T, Haxer M, Spector M, Schipper M, Eisbruch A. Impact of xerostomia on dysphagia after chemotherapy-intensity-modulated radiotherapy for oropharyngeal cancer: Prospective longitudinal study. Head Neck 2015; 38 Suppl 1:E1605-12. [DOI: 10.1002/hed.24286] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - Stuart Samuels
- Department of Radiation Oncology; University of Michigan; Ann Arbor Michigan
| | - Yebin Tao
- Department of Biostatistics; University of Michigan; Ann Arbor Michigan
| | - Teresa Lyden
- Department of Speech Pathology; University of Michigan; Ann Arbor Michigan
| | - Marc Haxer
- Department of Speech Pathology; University of Michigan; Ann Arbor Michigan
| | - Matthew Spector
- Department of Otolaryngology; University of Michigan; Ann Arbor Michigan
| | - Matthew Schipper
- Department of Radiation Oncology; University of Michigan; Ann Arbor Michigan
- Department of Biostatistics; University of Michigan; Ann Arbor Michigan
| | - Avraham Eisbruch
- Department of Radiation Oncology; University of Michigan; Ann Arbor Michigan
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