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Yen A, Zhong X, Lin MH, Nwachukwu C, Albuquerque K, Hrycushko B. Optimizing Online Adaptation Timing in the Treatment of Locally Advanced Cervical Cancer. Pract Radiat Oncol 2024; 14:e159-e164. [PMID: 37923136 DOI: 10.1016/j.prro.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE Online adaptive radiation therapy (ART) has emerged as a new treatment modality for cervical cancer. Daily online adapting improves target coverage and organ-at-risk (OAR) sparing compared with traditional image guided radiation therapy (IGRT); however, the required resources may not be feasible in a busy clinical setting. Less frequent adapting may still benefit cervical cancer patients due to large volume changes of the uterocervix of the treatment course. In this study, the dosimetry from different online adapt-on-demand schedules was compared. MATERIALS AND METHODS A retrospective cohort of 10 patients with cervical cancer treated with 260 fractions of definitive daily online ART was included. Plans with different adaptation schedules were simulated with adaptations weekly, every other week, once during treatment, and no adaptations (IGRT). These plans were applied to the synthetic computed tomography (CT) images and contours generated during the patient's delivered daily adaptive workflow. The dosimetry of the weekly replan, every-other-week replan, once replan, and IGRT plans were compared using a paired t test. RESULTS Compared with traditional IGRT plans, weekly and every-other-week ART plans had similar clinical target volume (CTV) coverage, but statistically significant improved sparing of OARs. Weekly and every-other-week ART had reduced bowel bag V40 by 1.57% and 1.41%, bladder V40 by 3.82% and 1.64%, rectum V40 by 8.49% and 7.50%, and bone marrow Dmean by 0.81% and 0.61%, respectively. Plans with a single adaptation had statistically significantly worse target coverage, and moderate improvements in OAR sparing. Of the 18-dose metrics evaluated, improvements were seen in 15 for weekly ART, 14 for every-other-week ART, and 10 for single ART plans compared with IGRT. When every-other-week ART was compared with weekly ART, both plans had similar CTV coverage and OAR sparing with only small improvements in bone marrow dosimetry with weekly ART. CONCLUSIONS This retrospective work compares different adapt-on-demand treatment schedules using data collected from patients treated with daily online adaptive radiation therapy. Results suggest weekly or every-other-week online ART is beneficial for reduced OAR dose compared with IGRT by exploiting the gradual changes in the uterocervix target volume.
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Affiliation(s)
- Allen Yen
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Xinran Zhong
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mu-Han Lin
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chika Nwachukwu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kevin Albuquerque
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Brian Hrycushko
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Kishigami Y, Nakamura M, Okamoto H, Takahashi A, Iramina H, Sasaki M, Kawata K, Igaki H. Organ-contour-driven auto-matching algorithm in image-guided radiotherapy. J Appl Clin Med Phys 2024; 25:e14220. [PMID: 37994694 PMCID: PMC10795436 DOI: 10.1002/acm2.14220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/02/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023] Open
Abstract
PURPOSE This study aimed to demonstrate the potential clinical applicability of an organ-contour-driven auto-matching algorithm in image-guided radiotherapy. METHODS This study included eleven consecutive patients with cervical cancer who underwent radiotherapy in 23 or 25 fractions. Daily and reference magnetic resonance images were converted into mesh models. A weight-based algorithm was implemented to optimize the distance between the mesh model vertices and surface of the reference model during the positioning process. Within the cost function, weight parameters were employed to prioritize specific organs for positioning. In this study, three scenarios with different weight parameters were prepared. The optimal translation and rotation values for the cervix and uterus were determined based on the calculated translations alone or in combination with rotations, with a rotation limit of ±3°. Subsequently, the coverage probabilities of the following two planning target volumes (PTV), an isotropic 5 mm and anisotropic margins derived from a previous study, were evaluated. RESULTS The percentage of translations exceeding 10 mm varied from 9% to 18% depending on the scenario. For small PTV sizes, more than 80% of all fractions had a coverage of 80% or higher. In contrast, for large PTV sizes, more than 90% of all fractions had a coverage of 95% or higher. The difference between the median coverage with translational positioning alone and that with both translational and rotational positioning was 1% or less. CONCLUSION This algorithm facilitates quantitative positioning by utilizing a cost function that prioritizes organs for positioning. Consequently, consistent displacement values were algorithmically generated. This study also revealed that the impact of rotational corrections, limited to ±3°, on PTV coverage was minimal.
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Affiliation(s)
- Yukako Kishigami
- Department of Advanced Medical PhysicsGraduate School of MedicineKyoto UniversityKyotoJapan
| | - Mitsuhiro Nakamura
- Department of Advanced Medical PhysicsGraduate School of MedicineKyoto UniversityKyotoJapan
| | - Hiroyuki Okamoto
- Radiation Safety and Quality Assurance DivisionNational Cancer Center HospitalTokyoJapan
| | - Ayaka Takahashi
- Department of Radiation OncologyNational Cancer Center HospitalTokyoJapan
| | - Hiraku Iramina
- Department of Radiation Oncology and Image‐Applied TherapyKyoto UniversityKyotoJapan
| | - Makoto Sasaki
- Division of Clinical Radiology ServiceKyoto University HospitalKyotoJapan
| | - Kohei Kawata
- Department of Radiation Oncology and Image‐Applied TherapyKyoto UniversityKyotoJapan
| | - Hiroshi Igaki
- Department of Radiation OncologyNational Cancer Center HospitalTokyoJapan
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Meyers SM, Winter JD, Obeidi Y, Chung P, Menard C, Warde P, Fong H, McPartlin A, Parameswaran S, Berlin A, Bayley A, Catton C, Craig T. A feasibility study of adaptive radiation therapy for postprostatectomy prostate cancer. Med Dosim 2023; 49:150-158. [PMID: 37985297 DOI: 10.1016/j.meddos.2023.10.008] [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: 03/06/2023] [Revised: 10/13/2023] [Accepted: 10/21/2023] [Indexed: 11/22/2023]
Abstract
Postoperative prostate radiotherapy requires large planning target volume (PTV) margins to account for motion and deformation of the prostate bed. Adaptive radiation therapy (ART) can incorporate image-guidance data to personalize PTVs that maintain coverage while reducing toxicity. We present feasibility and dosimetry results of a prospective study of postprostatectomy ART. Twenty-one patients were treated with single-adaptation ART. Conventional treatments were delivered for fractions 1 to 6 and adapted plans for the remaining 27 fractions. Clinical target volumes (CTVs) and small bowel delineated on fraction 1 to 4 CBCT were used to generate adapted PTVs and planning organ-at-risk (OAR) volumes for adapted plans. PTV volume and OAR dose were compared between ART and conventional using Wilcoxon signed-rank tests. Weekly CBCT were used to assess the fraction of CTV covered by PTV, CTV D99, and small bowel D1cc. Clinical metrics were compared using a Student's t-test (p < 0.05 significant). Offline adaptive planning required 1.9 ± 0.4 days (mean ± SD). ART decreased mean adapted PTV volume 61 ± 37 cc and bladder wall D50 compared with conventional treatment (p < 0.01). The CTV was fully covered for 96% (97%) of fractions with ART (conventional). Reconstructing dose on weekly CBCT, a nonsignificant reduction in CTV D99 was observed with ART (94%) compared to conventional (96%). Reduced CTV D99 with ART was significantly correlated with large anterior-posterior rectal diameter on simulation CT. ART reduced the number of fractions exceeding our institution's small bowel D1c limit from 14% to 7%. This study has demonstrated the feasibility of offline ART for post-prostatectomy cancer. ART facilitates PTV volume reduction while maintaining reasonable CTV coverage and can reduce the dose to adjacent normal tissues.
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Affiliation(s)
- Sandra M Meyers
- Department of Radiation Medicine and Applied Sciences, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Jeff D Winter
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | | | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia Menard
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Padraig Warde
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Heng Fong
- The Ministry of Health Malaysia, Daerah Timur Laut, Penang, Malaysia
| | - Andrew McPartlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | | | - Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Bayley
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Charles Catton
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Tim Craig
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
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Kishigami Y, Nakamura M, Nakao M, Okamoto H, Takahashi A, Igaki H. Three-dimensional assessment of interfractional cervical and uterine motions using daily magnetic resonance images to determine margins and timing of replanning. J Appl Clin Med Phys 2023; 24:e14073. [PMID: 37317937 PMCID: PMC10562032 DOI: 10.1002/acm2.14073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/09/2023] [Accepted: 05/31/2023] [Indexed: 06/16/2023] Open
Abstract
PURPOSE This study was conducted to determine the margins and timing of replanning by assessing the daily interfractional cervical and uterine motions using magnetic resonance (MR) images. METHODS Eleven patients with cervical cancer, who underwent intensity-modulated radiotherapy (IMRT) in 23-25 fractions, were considered in this study. The daily and reference MR images were converted into three-dimensional (3D) shape models. Patient-specific anisotropic margins were calculated from the proximal 95% of vertices located outside the surface of the reference model. Population-based margins were defined as the 90th percentile values of the patient-specific margins. The expanded volume of interest (expVOI) for the cervix and uterus was generated by expanding the reference model based on the population-based margin to calculate the coverage for daily deformable mesh models. For comparison, expVOIconv was generated using conventional margins: right (R), left (L), anterior (A), posterior (P), superior (S), and inferior (I) were (5, 5, 15, 15, 10, 10) and (10, 10, 20, 20, 15, 15) mm for the cervix and uterus, respectively. Subsequently, a replanning scenario was developed based on the cervical volume change. ExpVOIini and expVOIreplan were generated before and after replanning, respectively. RESULTS Population-based margins were (R, L, A, P, S, I) of (7, 7, 11, 6, 11, 8) and (14, 13, 27, 19, 15, 21) mm for the cervix and uterus, respectively. The timing of replanning was found to be the 16th fraction, and the volume of expVOIreplan decreased by >30% compared to that of expVOIini . However, margins cannot be reduced to ensure equivalent coverage after replanning. CONCLUSION We determined the margins and timing of replanning through detailed daily analysis. The margins of the cervix were smaller than conventional margins in some directions, while the margins of the uterus were larger in almost all directions. A margin equivalent to that at the initial planning was required for replanning.
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Affiliation(s)
- Yukako Kishigami
- Department, of Advanced Medical Physics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mitsuhiro Nakamura
- Department, of Advanced Medical Physics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Megumi Nakao
- Department of Biomedical Engineering and Intelligence, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Okamoto
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
| | - Ayaka Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
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Lemus OMD, Tanny S, Cummings M, Webster M, Wancura J, Jung H, Zhou Y, Yoon J, Pacella M, Zheng D. Influence of air mapping errors on the dosimetric accuracy of prostate CBCT-guided online adaptive radiation therapy. J Appl Clin Med Phys 2023; 24:e14057. [PMID: 37276082 PMCID: PMC10562036 DOI: 10.1002/acm2.14057] [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: 02/07/2023] [Revised: 04/27/2023] [Accepted: 05/11/2023] [Indexed: 06/07/2023] Open
Abstract
PURPOSE CBCT-guided online adaptive radiotherapy (oART) plans presently utilize daily synthetic CTs (sCT) that are automatically generated using deformable registration algorithms. These algorithms may have poor performance at reproducing variable volumes of gas present during treatment. Therefore, we have analyzed the air mapping error between the daily CBCTs and the corresponding sCT and explored its dosimetric effect on oART plan calculation. METHODS Abdominopelvic air volume was contoured on both the daily CBCT images and the corresponding synthetic images for 207 online adaptive pelvic treatments. Air mapping errors were tracked over all fractions. For two case studies representing worst case scenarios, dosimetric effects of air mapping errors were corrected in the sCT images using the daily CBCT air contours, then recalculating dose. Dose volume histogram statistics and 3D gamma passing rates were used to compare the original and air-corrected sCT-based dose calculations. RESULTS All analyzed patients showed observable air pocket contour differences between the sCT and the CBCT images. The largest air volume difference observed in daily CBCT images for a given patient was 276.3 cc, a difference of more than 386% compared to the sCT. For the two case studies, the largest observed change in DVH metrics was a 2.6% reduction in minimum PTV dose, with all other metrics varying by less than 1.5%. 3D gamma passing rates using 1%/1 mm criteria were above 90% when comparing the uncorrected and corrected dose distributions. CONCLUSION Current CBCT-based oART workflow can lead to inaccuracies in the mapping of abdominopelvic air pockets from daily CBCT to the sCT images used for the optimization and calculation of the adaptive plan. Despite the large observed mapping errors, the dosimetric effects of such differences on the accuracy of the adapted plan dose calculation are unlikely to cause differences greater than 3% for prostate treatments.
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Affiliation(s)
- Olga M. Dona Lemus
- Department of Radiation OncologyUniversity of Rochester Medical CenterNew YorkNew YorkUSA
| | - Sean Tanny
- Department of Radiation OncologyUniversity of Rochester Medical CenterNew YorkNew YorkUSA
| | - Michael Cummings
- Department of Radiation OncologyUniversity of Rochester Medical CenterNew YorkNew YorkUSA
| | - Matthew Webster
- Department of Radiation OncologyUniversity of Rochester Medical CenterNew YorkNew YorkUSA
| | - Joshua Wancura
- Department of Radiation OncologyUniversity of Rochester Medical CenterNew YorkNew YorkUSA
| | - Hyunuk Jung
- Department of Radiation OncologyUniversity of Rochester Medical CenterNew YorkNew YorkUSA
| | - Yuwei Zhou
- Department of Radiation OncologyUniversity of Rochester Medical CenterNew YorkNew YorkUSA
| | - Jihyung Yoon
- Department of Radiation OncologyUniversity of Rochester Medical CenterNew YorkNew YorkUSA
| | - Matthew Pacella
- Department of Radiation OncologyUniversity of Rochester Medical CenterNew YorkNew YorkUSA
| | - Dandan Zheng
- Department of Radiation OncologyUniversity of Rochester Medical CenterNew YorkNew YorkUSA
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Yock AD, Ahmed M, Masick S, Morales‐Paliza M, Kluwe C, Shinde A, Kirschner A, Shinohara E. Triggering daily online adaptive radiotherapy in the pelvis: Dosimetric effects and procedural implications of trigger parameter-value selection. J Appl Clin Med Phys 2023; 24:e14060. [PMID: 37276079 PMCID: PMC10562041 DOI: 10.1002/acm2.14060] [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: 09/06/2022] [Revised: 05/01/2023] [Accepted: 05/19/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Online adaptive radiotherapy (ART) can address dosimetric consequences of variations in anatomy by creating a new plan during treatment. However, ART is time- and labor-intensive and should be implemented in a resource-conscious way. Adaptive triggers composed of parameter-value pairs may direct the judicious use of online ART. PURPOSE This work analyzed our clinical experience using CBCT-based daily online ART to demonstrate how a conceptual framework based on adaptive triggers affects the dosimetric and procedural impact of ART. METHODS Sixteen patients across several pelvic sites were treated with CBCT-based daily online ART. Differences in standardized dose metrics were compared between the original plan, the original plan recalculated on the daily anatomy, and an adaptive plan. For each metric, trigger values were analyzed in terms of the proportion of treatments adapted and the distribution of metric values. RESULTS Target coverage metrics were compromised due to anatomic variation with the average change per treatment ranging from -0.90 to -0.05 Gy, -0.47 to -0.02 Gy, -0.31 to -0.01 Gy, and -12.45% to -2.65% for PTV D99%, PTV D95%, CTV D99%, and CTV V100%, respectively. These were improved using the adaptive plan (-0.03 to 0.01 Gy, -0.02 to 0.00 Gy, -0.03 to 0.00 Gy, and -4.70% to 0.00%, respectively). Increasingly strict triggers resulted in a non-linear increase in the proportion of treatments adapted and improved the distribution of metric values with diminishing returns. Some organ-at-risk (OAR) metrics were compromised by anatomic variation and improved using the adaptive plan, but changes in most OAR metrics were randomly distributed. CONCLUSIONS Daily online ART improved target coverage across multiple pelvic treatment sites and techniques. These effects were larger than those for OAR metrics, suggesting that maintaining target coverage was our primary benefit of CBCT-based daily online ART. Analyses like these can determine online ART triggers from a cost-benefit perspective.
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Affiliation(s)
- Adam D. Yock
- Department of Radiation OncologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Mahmoud Ahmed
- Department of Radiation OncologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Sarah Masick
- Department of Radiation OncologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Manuel Morales‐Paliza
- Department of Radiation OncologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Christien Kluwe
- Department of Radiation OncologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Ashwin Shinde
- Department of Radiation OncologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Austin Kirschner
- Department of Radiation OncologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Eric Shinohara
- Department of Radiation OncologyVanderbilt University Medical CenterNashvilleTennesseeUSA
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Jaffray DA, Knaul F, Baumann M, Gospodarowicz M. Harnessing progress in radiotherapy for global cancer control. NATURE CANCER 2023; 4:1228-1238. [PMID: 37749355 DOI: 10.1038/s43018-023-00619-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/22/2023] [Indexed: 09/27/2023]
Abstract
The pace of technological innovation over the past three decades has transformed the field of radiotherapy into one of the most technologically intense disciplines in medicine. However, the global barriers to access this highly effective treatment are complex and extend beyond technological limitations. Here, we review the technological advancement and current status of radiotherapy and discuss the efforts of the global radiation oncology community to formulate a more integrative 'diagonal approach' in which the agendas of science-driven advances in individual outcomes and the sociotechnological task of global cancer control can be aligned to bring the benefit of this proven therapy to patients with cancer everywhere.
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Affiliation(s)
- David A Jaffray
- Departments of Radiation Physics and Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Felicia Knaul
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Mary Gospodarowicz
- Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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Fischer AM, Hague T, Hoskin PJ. CBCT-based deformable dose accumulation of external beam radiotherapy in cervical cancer. Acta Oncol 2023; 62:923-931. [PMID: 37488951 DOI: 10.1080/0284186x.2023.2238543] [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: 03/24/2023] [Accepted: 06/22/2023] [Indexed: 07/26/2023]
Abstract
Background: Delivered radiotherapy doses do not exactly match those planned for a course of treatment, largely due to inter-fraction changes in anatomy. In this study, accumulated delivered dose was calculated for a sample of cervical cancer patients, by deformably registering daily cone beam computed tomography (CBCT) images to the planning computed tomography (CT) scan. Planned and accumulated doses were compared for the clinical target volume (CTV), bladder, and rectum.Material and Methods: For 10 patients receiving 45 Gy in 25 fractions of external beam radiotherapy, daily dose distributions were calculated on CBCT. These images were deformed onto the planning CT and the dose was accumulated using Velocity 4.1 (Varian Medical Systems, Palo Alto, USA). The quality of deformable image registration was evaluated visually and by calculating Dice similarity coefficients and mean distance to agreement.Results: V95%>99% was achieved for the primary CTV in 9/10 patients for the planned dose distribution and 7/10 patients for the accumulated dose distribution. Primary CTV coverage by 95% of the prescription dose was reduced in one patient, due to an increase in anterior-posterior separation. Comparison of planned and accumulated dose volume histograms (DVHs) for the bladder and rectum found agreement within 5% at low and intermediate doses, but differences exceeded 20% at higher doses. Direct addition of CBCT DVHs was seen to be a poor estimate for the accumulated DVH at higher doses.Conclusion: Computation of delivered radiotherapy dose that accounts for inter-fraction anatomical changes is important for establishing dose-effect relationships. Updating delivered dose distributions after each fraction would support informed clinical decision making on any potential treatment interventions.
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Affiliation(s)
| | | | - Peter J Hoskin
- Mount Vernon Cancer Centre, Northwood, UK
- Division of Cancer Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
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Qiu Z, Olberg S, den Hertog D, Ajdari A, Bortfeld T, Pursley J. Online adaptive planning methods for intensity-modulated radiotherapy. Phys Med Biol 2023; 68:10.1088/1361-6560/accdb2. [PMID: 37068488 PMCID: PMC10637515 DOI: 10.1088/1361-6560/accdb2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/17/2023] [Indexed: 04/19/2023]
Abstract
Online adaptive radiation therapy aims at adapting a patient's treatment plan to their current anatomy to account for inter-fraction variations before daily treatment delivery. As this process needs to be accomplished while the patient is immobilized on the treatment couch, it requires time-efficient adaptive planning methods to generate a quality daily treatment plan rapidly. The conventional planning methods do not meet the time requirement of online adaptive radiation therapy because they often involve excessive human intervention, significantly prolonging the planning phase. This article reviews the planning strategies employed by current commercial online adaptive radiation therapy systems, research on online adaptive planning, and artificial intelligence's potential application to online adaptive planning.
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Affiliation(s)
- Zihang Qiu
- Department of Business Analytics, University of Amsterdam, The Netherlands
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, United States of America
| | - Sven Olberg
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, United States of America
| | - Dick den Hertog
- Department of Business Analytics, University of Amsterdam, The Netherlands
| | - Ali Ajdari
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, United States of America
| | - Thomas Bortfeld
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, United States of America
| | - Jennifer Pursley
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, United States of America
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Shelley CE, Bolt MA, Hollingdale R, Chadwick SJ, Barnard AP, Rashid M, Reinlo SC, Fazel N, Thorpe CR, Stewart AJ, South CP, Adams EJ. Implementing cone-beam computed tomography-guided online adaptive radiotherapy in cervical cancer. Clin Transl Radiat Oncol 2023; 40:100596. [PMID: 36910024 PMCID: PMC9999162 DOI: 10.1016/j.ctro.2023.100596] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023] Open
Abstract
Background and purpose Adaptive radiotherapy (ART) in locally advanced cervical cancer (LACC) has shown promising outcomes. This study investigated the feasibility of cone-beam computed tomography (CBCT)-guided online ART (oART) for the treatment of LACC. Material and methods The quality of the automated radiotherapy treatment plans and artificial intelligence (AI)-driven contour delineation for LACC on a novel CBCT-guided oART system were assessed. Dosimetric analysis of 200 simulated oART sessions were compared with standard treatment. Feasibility of oART was assessed from the delivery of 132 oART fractions for the first five clinical LACC patients. The simulated and live oART sessions compared a fixed planning target volume (PTV) margin of 1.5 cm around the uterus-cervix clinical target volume (CTV) with an internal target volume-based approach. Workflow timing measurements were recorded. Results The automatically-generated 12-field intensity-modulated radiotherapy plans were comparable to manually generated plans. The AI-driven organ-at-risk (OAR) contouring was acceptable requiring, on average, 12.3 min to edit, with the bowel performing least well and rated as unacceptable in 16 % of cases. The treated patients demonstrated a mean PTV D98% (+/-SD) of 96.7 (+/- 0.2)% for the adapted plans and 94.9 (+/- 3.7)% for the non-adapted scheduled plans (p<10-5). The D2cc (+/-SD) for the bowel, bladder and rectum were reduced by 0.07 (+/- 0.03)Gy, 0.04 (+/-0.05)Gy and 0.04 (+/-0.03)Gy per fraction respectively with the adapted plan (p <10-5). In the live.setting, the mean oART session (+/-SD) from CBCT acquisition to beam-on was 29 +/- 5 (range 21-44) minutes. Conclusion CBCT-guided oART was shown to be feasible with dosimetric benefits for patients with LACC. Further work to analyse potential reductions in PTV margins is ongoing.
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Affiliation(s)
- Charlotte E Shelley
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Matthew A Bolt
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Rachel Hollingdale
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Susan J Chadwick
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Andrew P Barnard
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Miriam Rashid
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Selina C Reinlo
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Nawda Fazel
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Charlotte R Thorpe
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Alexandra J Stewart
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK.,University of Surrey, Guildford GU2 7XX, UK
| | - Chris P South
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
| | - Elizabeth J Adams
- Department of Oncology, St. Luke's Cancer Centre, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey GU2 7XX, UK
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Van Asselt N, Randhawa K, Kvasnica K, Ferris W, Christensen N. Evaluation of mega-voltage CT images for completed radiotherapy treatments for dogs and cats reveals uncommon but potentially consequential dose deviation in thoracic and abdominal tumors. Vet Radiol Ultrasound 2023; 64:149-154. [PMID: 36373282 PMCID: PMC10099812 DOI: 10.1111/vru.13176] [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: 01/04/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
As advanced delivery techniques such as intensity-modulated radiation therapy (IMRT) become conventional in veterinary radiotherapy, highly modulated radiation delivery helps to decrease dose to normal tissues. However, IMRT is only effective if patient setup and anatomy are accurately replicated for each treatment. Numerous techniques have been implemented to decrease patient setup error, however tumor shrinkage, variations in the patient's contour and weight loss continue to be hard to control and can result in clinically relevant dose deviation in radiotherapy plans. Adaptive radiotherapy (ART) is often the most effective means to account for gradual changes such as tumor shrinkage and weight loss, however it is often unclear when adaption is necessary. The goal of this retrospective, observational study was to review dose delivery in dogs and cats who received helical radiotherapy at University of Wisconsin, using detector dose data (D2%, D50%, D98%) and daily megavoltage computed tomography (MVCT) images, and to determine whether ART should be considered more frequently than it currently is. A total of 52 treatment plans were evaluated and included cancers of the head and neck, thorax, and abdomen. After evaluation, 6% of the radiotherapy plan delivered had clinically relevant dose deviations in dose delivery. Dose deviations were more common in thoracic and abdominal targets. While adaptation may have been considered in these cases, the decision to adapt can be complex and all factors, such as treatment delay, cost, and imaging modality, must be considered when adaptation is to be pursued.
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Affiliation(s)
- N Van Asselt
- University of Wisconsin - Madison Veterinary Care, Madison, Wisconsin, USA
| | - K Randhawa
- University of Wisconsin - Madison Veterinary Care, Madison, Wisconsin, USA
| | - K Kvasnica
- University of Wisconsin - Madison Veterinary Care, Madison, Wisconsin, USA
| | - W Ferris
- University of Wisconsin - Madison Veterinary Care, Madison, Wisconsin, USA
| | - N Christensen
- University of Wisconsin - Madison Veterinary Care, Madison, Wisconsin, USA
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12
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Liang Y, Feng S, Xie W, Jiang Q, Yang Y, Luo R, Kidd EA, Zhai T, Xie L. Comparison of survival, acute toxicities, and dose-volume parameters between intensity-modulated radiotherapy with or without internal target volume delineation method and three-dimensional conformal radiotherapy in cervical cancer patients: A retrospective and propensity score-matched analysis. Cancer Med 2022; 11:151-165. [PMID: 34821082 PMCID: PMC8704157 DOI: 10.1002/cam4.4439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/25/2021] [Accepted: 10/26/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To evaluate whether the use of the internal target volume (ITV) delineation method improves the performance of intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT) in terms of survival, acute toxicities, and dose-volume parameters. METHODS A total number of 477 cervical cancer patients who received concurrent chemoradiotherapy (CCRT) from January 2012 to December 2016 were retrospectively analyzed. They were divided into four groups: the non-ITV (N-ITV) + IMRT, ITV + IMRT, N-ITV + 3DCRT, and ITV + 3DCRT groups, with 76, 41, 327, and 33 patients, respectively. Survival analysis was performed with the Kaplan-Meier and the log-rank tests, and acute toxicity analysis was performed with the chi-squared test and the binary logistic regression test. Using the propensity score matching (PSM) method, 92 patients were matched among the four groups, and their dose-volume parameters were assessed with the Kruskal-Wallis method. RESULTS The median follow-up time was 49 months (1-119) for overall survival (OS). The 5-year OS rate was 66.4%. The ITV delineation method was an independent prognostic factor for OS (HR [95% CI]: 0.52 [0.27, 0.98], p = 0.044) and progression-free survival (PFS) (HR [95% CI]: 0.59 [0.36, 0.99], p = 0.045). The ITV + IMRT group had the lowest incidence rate (22%) and the N-ITV + IMRT group had the highest incidence rate of grade ≥3 hematological toxicity (HT) (46.1%) among the four groups. The pelvic bone marrow relative V10, V20, and V30 in the N-ITV + IMRT group was higher than those in the ITV + IMRT and N-ITV + 3DCRT groups (p < 0.05). CONCLUSIONS The use of ITV for IMRT treatment planning was associated with improved overall survival and progression-free survival, with lower HT rate.
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Affiliation(s)
- Yu‐Qin Liang
- Department of Radiation Oncology, Xiang’an Hospital of Xiamen University, Xiamen, China
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Sen‐Quan Feng
- Department of Radiation OncologyCancer Hospital of Shantou University Medical CollegeShantouChina
- Department of Radiation OncologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Wen‐Jia Xie
- Department of Radiation OncologyXiang’an Hospital of Xiamen UniversityXiamenChina
- Department of Radiation OncologyCancer Hospital of Shantou University Medical CollegeShantouChina
| | - Qiong‐Zhi Jiang
- Department of Radiation OncologyCancer Hospital of Shantou University Medical CollegeShantouChina
| | - Yan‐Fen Yang
- Department of Science and EducationXiang’an Hospital of Xiamen UniversityXiamenChina
| | - Ren Luo
- Department of Radiation OncologyFaculty of MedicineUniversity of FreiburgFreiburgGermany
- Faculty of BiologyUniversity of FreiburgFreiburgGermany
| | - Elizabeth A. Kidd
- Department of Radiation OncologyStanford UniversityStanfordCaliforniaUSA
| | - Tian‐Tian Zhai
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Liang‐Xi Xie
- Department of Radiation Oncology, Xiang’an Hospital of Xiamen University, Xiamen, China
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
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13
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Paganetti H, Botas P, Sharp GC, Winey B. Adaptive proton therapy. Phys Med Biol 2021; 66:10.1088/1361-6560/ac344f. [PMID: 34710858 PMCID: PMC8628198 DOI: 10.1088/1361-6560/ac344f] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/28/2021] [Indexed: 12/25/2022]
Abstract
Radiation therapy treatments are typically planned based on a single image set, assuming that the patient's anatomy and its position relative to the delivery system remains constant during the course of treatment. Similarly, the prescription dose assumes constant biological dose-response over the treatment course. However, variations can and do occur on multiple time scales. For treatment sites with significant intra-fractional motion, geometric changes happen over seconds or minutes, while biological considerations change over days or weeks. At an intermediate timescale, geometric changes occur between daily treatment fractions. Adaptive radiation therapy is applied to consider changes in patient anatomy during the course of fractionated treatment delivery. While traditionally adaptation has been done off-line with replanning based on new CT images, online treatment adaptation based on on-board imaging has gained momentum in recent years due to advanced imaging techniques combined with treatment delivery systems. Adaptation is particularly important in proton therapy where small changes in patient anatomy can lead to significant dose perturbations due to the dose conformality and finite range of proton beams. This review summarizes the current state-of-the-art of on-line adaptive proton therapy and identifies areas requiring further research.
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Affiliation(s)
- Harald Paganetti
- Department of Radiation Oncology, Physics Division, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Pablo Botas
- Department of Radiation Oncology, Physics Division, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Foundation 29 of February, Pozuelo de Alarcón, Madrid, Spain
| | - Gregory C Sharp
- Department of Radiation Oncology, Physics Division, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Brian Winey
- Department of Radiation Oncology, Physics Division, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
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14
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Lao Y, Cao M, Yang Y, Kishan AU, Yang W, Wang Y, Sheng K. Bladder surface dose modeling in prostate cancer radiotherapy: An analysis of motion-induced variations and the cumulative dose across the treatment. Med Phys 2021; 48:8024-8036. [PMID: 34734414 DOI: 10.1002/mp.15326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/15/2021] [Accepted: 10/21/2021] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To introduce a novel surface-based dose mapping method to improve quantitative bladder dosimetric assessment in prostate cancer (PC) radiotherapy. METHODS Based on the planning and daily pre and postfraction MRIs of 12 PC patients, bladder surface models (SMs) were generated on manually delineated contours and regionally aligned via surface-based registration. Subsequently, bladder surface dose models (SDMs) were created using face-wise dose sampling. To determine the bladder intrafractional and interfractional motion and dose variation, we performed a pose analysis between pre and postfraction bladder SMs, as well as surface mapping for fractional SMs. Discrepancies between the received dose, accumulated from daily SDMs, and the planned dose were then assessed on the corresponding SDMs. Complementary to the surface dose mapping, dose surface histogram (DSH)-based comparisons were also performed. RESULTS The intrafraction pose analysis revealed a significant (p < 0.05) bladder expansion, as well as an anterior/superior drift during the treatment. The intrafraction motion substantially altered dose to mid-bladder body, but not the bladder surface areas distal to or contiguous with the target. A similar pattern of dose variations was also detected by interfraction comparisons. With surface registration to the common SM, the cumulative bladder dose significantly differs from the planned dose. The discrepancy is evident in the mid-posterior range that corresponds to a mid- to high-dose region. The received DSH significantly differs from the planned DSH after permutation correction (p = 0.0122), while the overall surface-based comparison after multiple comparison correction is nonsignificant (p = 0.0800). CONCLUSIONS We developed a novel surface-based intra and interdose mapping framework applied to a unique daily MR dataset for image-guided radiotherapy. The framework identified significant intrafraction bladder positional changes, localized the intra and interfraction variations, and quantified planned versus received dose differences on the bladder surface. The result indicates the importance of adopting the motion-integrated bladder SDM for bladder dose management.
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Affiliation(s)
- Yi Lao
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | - Minsong Cao
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | - Yingli Yang
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | - Wensha Yang
- Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA
| | - Yalin Wang
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, Arizona, USA
| | - Ke Sheng
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
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15
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Shelley CE, Barraclough LH, Nelder CL, Otter SJ, Stewart AJ. Adaptive Radiotherapy in the Management of Cervical Cancer: Review of Strategies and Clinical Implementation. Clin Oncol (R Coll Radiol) 2021; 33:579-590. [PMID: 34247890 DOI: 10.1016/j.clon.2021.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/19/2021] [Accepted: 06/11/2021] [Indexed: 02/08/2023]
Abstract
The complex and varied motion of the cervix-uterus target during external beam radiotherapy (EBRT) underscores the clinical benefits afforded by adaptive radiotherapy (ART) techniques. These gains have already been realised in the implementation of image-guided adaptive brachytherapy, where adapting to anatomy at each fraction has seen improvements in clinical outcomes and a reduction in treatment toxicity. With regards to EBRT, multiple adaptive strategies have been implemented, including a personalised internal target volume, offline replanning and a plan of the day approach. With technological advances, there is now the ability for real-time online ART using both magnetic resonance imaging and computed tomography-guided imaging. However, multiple challenges remain in the widespread dissemination of ART. This review investigates the ART strategies and their clinical implementation in EBRT delivery for cervical cancer.
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Affiliation(s)
- C E Shelley
- Department of Clinical Oncology, St. Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK.
| | - L H Barraclough
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - C L Nelder
- Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK
| | - S J Otter
- Department of Clinical Oncology, St. Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK
| | - A J Stewart
- Department of Clinical Oncology, St. Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK; University of Surrey, Guildford, UK
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16
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Rigaud B, Anderson BM, Yu ZH, Gobeli M, Cazoulat G, Söderberg J, Samuelsson E, Lidberg D, Ward C, Taku N, Cardenas C, Rhee DJ, Venkatesan AM, Peterson CB, Court L, Svensson S, Löfman F, Klopp AH, Brock KK. Automatic Segmentation Using Deep Learning to Enable Online Dose Optimization During Adaptive Radiation Therapy of Cervical Cancer. Int J Radiat Oncol Biol Phys 2021; 109:1096-1110. [DOI: 10.1016/j.ijrobp.2020.10.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/24/2020] [Accepted: 10/29/2020] [Indexed: 02/08/2023]
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Impact of a fiducial marker based ART strategy on margins in postoperative IMRT of gynecological tumors. Radiother Oncol 2021; 158:1-6. [PMID: 33587973 DOI: 10.1016/j.radonc.2021.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/24/2020] [Accepted: 01/29/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE To investigate the potential of an offline Adaptive Radiotherapy (ART) strategy, based on the interfractional vagina motion (IVM) measured using fiducial markers (FM) during an initial number of fractions, on the CTV to PTV margins in post-operative gynecological patients. MATERIALS AND METHODS In 18 patients, treated post-operatively for gynecological tumors, the systematic residual IVM was quantified after simulating an offline ART procedure, utilizing the average IVM measured with FM for a varying initial numbers of fractions to find the optimal moment to adapt the treatment plan and a threshold for selecting patients for replanning. Clinical margins for a zero, 2 and 5 mm threshold based strategy were calculated to assess the possible margin reduction. RESULTS Applying an ART strategy based on the average IVM of the initial 5 fractions reduces the systematic IVM significantly (P < 0.025), allowing a reduction of the clinical margin of 3 mm (20%) in the CC direction and 2 mm (13%) in the AP direction. A 2 mm threshold for selecting patients for replanning shows no difference in the reduction of the clinical margin, but reduces the workload with 12%. CONCLUSION An ART strategy based on adapting on the average IVM during the initial 5 fractions of treatment provides an opportunity to reduce the CTV to PTV margins in postoperative gynecological tumors. To keep the workload in balance with the best achievable margin reduction, a threshold for selecting patients for plan adaptation is recommended.
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18
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Webster A, Appelt A, Eminowicz G. Image-Guided Radiotherapy for Pelvic Cancers: A Review of Current Evidence and Clinical Utilisation. Clin Oncol (R Coll Radiol) 2020; 32:805-816. [DOI: 10.1016/j.clon.2020.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/18/2020] [Accepted: 09/30/2020] [Indexed: 02/07/2023]
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19
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Shang H, Pu Y, Wang W, Dai Z, Jin F. Evaluation of plan quality and robustness of IMPT and helical IMRT for cervical cancer. Radiat Oncol 2020; 15:34. [PMID: 32054496 PMCID: PMC7020599 DOI: 10.1186/s13014-020-1483-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/04/2020] [Indexed: 12/24/2022] Open
Abstract
Background Both plan quality and robustness were investigated through comparing some dosimetric metrics between intensity modulated proton therapy (IMPT) and helical tomotherapy based intensity modulated radiotherapy (IMRT) for cervical cancer. Methods Both a spot-scanning robust (SRO) IMPT plan and a helical tomotherapy robust (TRO) IMRT plan were generated for each of 18 patients. In order to evaluate the quality of nominal plans without dose perturbations, planning scores (PS) on clinical target volume (CTV) and five organs at risk (OARs) based on clinical experience, and normal tissue complication probabilities (NTCP) of rectum and sigmoid were calculated based on Lyman-Kutcher-Burman (LKB) model. Dose volume histogram bands width (DVHBW) were calculated in 28 perturbed scenarios to evaluate plan robustness. Results Compared with TRO, the average scores of SRO nominal plans were higher in target metrics [V46.8Gy, V50Gy, Conformity and Homogeneity](16.5 vs. 15.1), and in OARs metrics (60.9 vs. 53.3), including bladder [V35,V45, Dmean,D2cc], rectum [V40,V45,D2cc,Dmax], bowel [V35,V40,V45, Dmax], sigmoid [V40,Dmax] and femoral heads [V30,Dmax]. Meanwhile, NTCP calculation showed that the toxicities of rectum and sigmoid in SRO were lower than those in TRO (rectum: 2.8% vs. 4.8%, p < 0.05; sigmoid: 5.2% vs. 5.7%, p < 0.05). DVHBW in target coverage for the SRO plan was smaller than that for the TRO plan (0.6% vs. 2.1%), which means that the SRO plan generated a more robust plan in target. Conclusion Better CTV coverage and OAR Sparing were obtained in SRO nominal plan. Based on NTCP calculation, SRO was expected to allow a small reduction in rectal toxicity. Furthermore, SRO generated a more robust plan in CTV target coverage.
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Affiliation(s)
- Haijiao Shang
- Shanghai Institute of Applied Physics, Chinese Academy of Sciences, 201800, Shanghai, People's Republic of China.,University of Chinese Academy of Sciences, 100049, Beijing, People's Republic of China.,RaySearch China, 200120, Shanghai, People's Republic of China
| | - Yuehu Pu
- Shanghai Institute of Applied Physics, Chinese Academy of Sciences, 201800, Shanghai, People's Republic of China.,University of Chinese Academy of Sciences, 100049, Beijing, People's Republic of China
| | - Wei Wang
- Department of Radiation Oncology, Xinhua hospital affiliated to shanghai Jiao tong university school of medicine, Shanghai, People's Republic of China
| | - Zhitao Dai
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, People's Republic of China. .,School of Physics and Technology, Wuhan University, Wuhan, 430072, People's Republic of China.
| | - Fu Jin
- Department of Radiation Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, No. 181 Hanyu Road, Shapingba District, Chongqing, 400030, People's Republic of China.
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20
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Alexander S, Hopkins N, Lalondrelle S, Taylor A, Titmarsh K, McNair H. RTT-led IGRT for cervix cancer; training, implementation and validation. Tech Innov Patient Support Radiat Oncol 2019; 12:41-49. [PMID: 32095554 PMCID: PMC7033802 DOI: 10.1016/j.tipsro.2019.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/18/2019] [Accepted: 10/31/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION IGRT in cervical cancer treatment delivery is complex due to significant target and organs at risk (OAR) motion. Implementing image assessment of soft-tissue target and OAR position to improve accuracy is recommended. We report the development and refinement of a training and competency programme (TCP), leading to on-line Radiation Therapist (RTT) led soft-tissue assessment, evaluated by a prospective audit. METHODS AND MATERIALS The TCP comprised didactic lectures and practical sessions, supported by a comprehensive workbook. The content was decided by a team comprised of Clinical Oncologists, RTTs, and Physicists. On completion of training, RTT soft-tissue review proficiency (after bony anatomy registration) was assessed against a clinician gold-standard from a database of 20 cervical cancer CBCT images. Reviews were graded pass or fail based on PTV coverage assessment and decision taken in concordance with the gold-standard. Parity was set at ≥80% agreement.The initial TCP (stage one) focussed on offline verification and decision making. Sixteen RTTs completed this stage, four achieved ≥80%. This was not sufficient to support clinical implementation.The TCP was redesigned, more stringent review guidelines and greater anatomy teaching was added. TCP stage two focussed on online verification and decision making supported by a decision flowchart. Twenty-one RTTs completed this TCP, all achieved ≥80%. This supported clinical implementation of RTT-led soft-tissue review under prospective audit conditions.The prospective audit was conducted between March 2017 and August 2017. Daily online review was performed by two trained RTTs. Online review and decision making proficiency was evaluated by a clinician. RESULTS Thirteen patients were included in the audit. Daily online RTT-led IGRT was achieved for all 343 fractions. Two-hundred CBCT images were reviewed offline by the clinician; the mean number of reviews per patient was 15. 192/200 (96%) RTT image reviews were in agreement with clinician review, presenting excellent concordance. DISCUSSION AND CONCLUSION Multidisciplinary involvement in training development, redesign of the TCP and inclusion of summative competency assessment were important factors to support RTT skill development. Consequently, RTT-led cervical cancer soft-tissue IGRT was clinically implemented in the hospital.
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Affiliation(s)
| | - N. Hopkins
- The Royal Marsden NHS Foundation Trust, United Kingdom
| | - S. Lalondrelle
- The Royal Marsden NHS Foundation Trust, United Kingdom
- The Institute of Cancer Research, United Kingdom
| | - A. Taylor
- The Royal Marsden NHS Foundation Trust, United Kingdom
- The Institute of Cancer Research, United Kingdom
| | - K. Titmarsh
- Formerly Kingston and St Georges University of London, United Kingdom
| | - H.A. McNair
- The Royal Marsden NHS Foundation Trust, United Kingdom
- The Institute of Cancer Research, United Kingdom
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21
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Briens A, Castelli J, Barateau A, Jaksic N, Gnep K, Simon A, De Crevoisier R. Radiothérapie adaptative : stratégies et bénéfices selon les localisations tumorales. Cancer Radiother 2019; 23:592-608. [DOI: 10.1016/j.canrad.2019.07.135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 07/16/2019] [Indexed: 12/14/2022]
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22
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Jalan M, Olsen KS, Powell SN. Emerging Roles of RAD52 in Genome Maintenance. Cancers (Basel) 2019; 11:E1038. [PMID: 31340507 PMCID: PMC6679097 DOI: 10.3390/cancers11071038] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 12/22/2022] Open
Abstract
The maintenance of genome integrity is critical for cell survival. Homologous recombination (HR) is considered the major error-free repair pathway in combatting endogenously generated double-stranded lesions in DNA. Nevertheless, a number of alternative repair pathways have been described as protectors of genome stability, especially in HR-deficient cells. One of the factors that appears to have a role in many of these pathways is human RAD52, a DNA repair protein that was previously considered to be dispensable due to a lack of an observable phenotype in knock-out mice. In later studies, RAD52 deficiency has been shown to be synthetically lethal with defects in BRCA genes, making RAD52 an attractive therapeutic target, particularly in the context of BRCA-deficient tumors.
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Affiliation(s)
- Manisha Jalan
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Kyrie S Olsen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Simon N Powell
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
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23
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White IM, Scurr E, Wetscherek A, Brown G, Sohaib A, Nill S, Oelfke U, Dearnaley D, Lalondrelle S, Bhide S. Realizing the potential of magnetic resonance image guided radiotherapy in gynaecological and rectal cancer. Br J Radiol 2019; 92:20180670. [PMID: 30933550 PMCID: PMC6592079 DOI: 10.1259/bjr.20180670] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 02/24/2019] [Accepted: 03/21/2019] [Indexed: 12/25/2022] Open
Abstract
CT-based radiotherapy workflow is limited by poor soft tissue definition in the pelvis and reliance on rigid registration methods. Current image-guided radiotherapy and adaptive radiotherapy models therefore have limited ability to improve clinical outcomes. The advent of MRI-guided radiotherapy solutions provides the opportunity to overcome these limitations with the potential to deliver online real-time MRI-based plan adaptation on a daily basis, a true "plan of the day." This review describes the application of MRI guided radiotherapy in two pelvic tumour sites likely to benefit from this approach.
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Affiliation(s)
- Ingrid M White
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Erica Scurr
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Andreas Wetscherek
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Gina Brown
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Aslam Sohaib
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Simeon Nill
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Uwe Oelfke
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - David Dearnaley
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Susan Lalondrelle
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Shreerang Bhide
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
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24
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Rigaud B, Klopp A, Vedam S, Venkatesan A, Taku N, Simon A, Haigron P, de Crevoisier R, Brock KK, Cazoulat G. Deformable image registration for dose mapping between external beam radiotherapy and brachytherapy images of cervical cancer. Phys Med Biol 2019; 64:115023. [PMID: 30913542 DOI: 10.1088/1361-6560/ab1378] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
For locally advanced cervical cancer (LACC), anatomy correspondence with and without BT applicator needs to be quantified to merge the delivered doses of external beam radiation therapy (EBRT) and brachytherapy (BT). This study proposed and evaluated different deformable image registration (DIR) methods for this application. Twenty patients who underwent EBRT and BT for LACC were retrospectively analyzed. Each patient had a pre-BT CT at EBRT boost (without applicator) and a CT and MRI at BT (with applicator). The evaluated DIR methods were the diffeomorphic Demons, commercial intensity and hybrid methods, and three different biomechanical models. The biomechanical models considered different boundary conditions (BCs). The impact of the BT devices insertion on the anatomy was quantified. DIR method performances were quantified using geometric criteria between the original and deformed contours. The BT dose was deformed toward the pre-CT BT by each DIR method. The impact of boundary conditions to drive the biomechanical model was evaluated based on the deformation vector field and dose differences. The GEC-ESTRO guideline dose indices were reported. Large organ displacements, deformations, and volume variations were observed between the pre-BT and BT anatomies. Rigid registration and intensity-based DIR resulted in poor geometric accuracy with mean Dice similarity coefficient (DSC) inferior to 0.57, 0.63, 0.42, 0.32, and 0.43 for the rectum, bladder, vagina, cervix and uterus, respectively. Biomechanical models provided a mean DSC of 0.96 for all the organs. By considering the cervix-uterus as one single structure, biomechanical models provided a mean DSC of 0.88 and 0.94 for the cervix and uterus, respectively. The deformed doses were represented for each DIR method. Caution should be used when performing DIR for this application as standard techniques may have unacceptable results. The biomechanical model with the cervix-uterus as one structure provided the most realistic deformations to propagate the BT dose toward the EBRT boost anatomy.
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Affiliation(s)
- B Rigaud
- Univ Rennes, CLCC Eugène Marquis, Inserm, LTSI-UMR 1099, F-35000 Rennes, France. Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America. Author to whom any correspondence should be addressed
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Affiliation(s)
- Kristy K Brock
- Department of Imaging Physics, Department of Radiation Physics, The University of Texas MD Anderson Cancer Center.
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Green OL, Henke LE, Hugo GD. Practical Clinical Workflows for Online and Offline Adaptive Radiation Therapy. Semin Radiat Oncol 2019; 29:219-227. [PMID: 31027639 DOI: 10.1016/j.semradonc.2019.02.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Adaptive radiotherapy emerged over 20 years ago and is now an established clinical practice in a number of organ sites. No one solution for adaptive therapy exists. Rather, adaptive radiotherapy is a process which combines multiple tools for imaging, assessment of need for adaptation, treatment planning, and quality assurance of this process. Workflow is therefore a critical aspect to ensure safe, effective, and efficient implementation of adaptive radiotherapy. In this work, we discuss the tools for online and offline adaptive radiotherapy and introduce workflow concepts for these types of adaptive radiotherapy. Common themes and differences between the workflows are introduced and controversies and areas of active research are discussed.
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Affiliation(s)
- Olga L Green
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Lauren E Henke
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Geoffrey D Hugo
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO.
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Radiothérapie guidée par l’image des cancers gynécologiques. Cancer Radiother 2018; 22:608-616. [DOI: 10.1016/j.canrad.2018.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/26/2018] [Indexed: 11/24/2022]
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Cree A, Livsey J, Barraclough L, Dubec M, Hambrock T, Van Herk M, Choudhury A, McWilliam A. The Potential Value of MRI in External-Beam Radiotherapy for Cervical Cancer. Clin Oncol (R Coll Radiol) 2018; 30:737-750. [PMID: 30209010 DOI: 10.1016/j.clon.2018.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/02/2018] [Accepted: 08/20/2018] [Indexed: 01/01/2023]
Abstract
The reference standard treatment for cervical cancer is concurrent chemoradiotherapy followed by magnetic resonance imaging (MRI)-guided brachytherapy. Improvements in brachytherapy have increased local control rates, but late toxicity remains high with rates of 11% grade ≥3. The primary clinical target volume (CTV) for external-beam radiotherapy includes the cervix and uterus, which can show significant inter-fraction motion. This means that generous margins are required to cover the primary CTV, increasing the radiation dose to organs at risk and, therefore, toxicity. A number of image-guided radiotherapy techniques (IGRT) have been developed, but motion can be random and difficult to predict prior to treatment. In light of the development of integrated MRI linear accelerators, this review discusses the potential value of MRI in external-beam radiotherapy. Current solutions for managing pelvic organ motion are reviewed, including the potential for online adaptive radiotherapy. The impacts of the use of MRI in tumour delineation and in the delivery of stereotactic ablative body radiotherapy (SABR) are highlighted. The potential role and challenges of using multi parametric MRI to guide radiotherapy are also discussed.
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Affiliation(s)
- A Cree
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust Christie Hospital, Manchester Academic Health Science Centre, Manchester M20 4BX, UK
| | - J Livsey
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK
| | - L Barraclough
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK
| | - M Dubec
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK
| | - T Hambrock
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK
| | - M Van Herk
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust Christie Hospital, Manchester Academic Health Science Centre, Manchester M20 4BX, UK
| | - A Choudhury
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust Christie Hospital, Manchester Academic Health Science Centre, Manchester M20 4BX, UK
| | - A McWilliam
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust Christie Hospital, Manchester Academic Health Science Centre, Manchester M20 4BX, UK.
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Zhang J, Ahunbay E, Li XA. Technical Note: Acceleration of online adaptive replanning with automation and parallel operations. Med Phys 2018; 45:4370-4376. [PMID: 30053325 DOI: 10.1002/mp.13106] [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: 10/23/2017] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Limited by various human interventions and manual operations, the routine practice of online adaptive replanning (OLAR) is time consuming and impractical with the current planning technology. To accelerate OLAR and to minimize human efforts, the methods and software tools are developed to automate OLAR workflow and to use parallel processing during OLAR. METHODS Speedy online adaptive replanning SOLAR, a software tool, was developed to automate the OLAR workflow and to implement parallel operation in plan generation and contour editing. The SOLAR tool is designed to automate and monitor the operation of OLAR on multiple client workstations and to allow parallel manual contour editing and plan generation with multiple workstations. The performance of the SOLAR tool was tested on selected prostate and pancreatic cancer cases. RESULTS The SOLAR system has been tested in the clinical environment. With the automation and parallel operations, the operation time for OLAR can be reduced by 70%, allowing OLAR to be completed within 10 min for the tested prostate cancer cases and within 15 min for the pancreatic cancer cases. The SOLAR system generated superior plans compared to the standard repositioning method. CONCLUSION SOLAR software was developed to accelerate online adaptive replanning workflow with automation and parallel operations. By reducing the time and human intervention, thus, reducing potential human error, the SOLAR solution would improve the practicality of OLAR.
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Affiliation(s)
- Jingqiao Zhang
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Ergun Ahunbay
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
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Rigaud B, Simon A, Gobeli M, Lafond C, Leseur J, Barateau A, Jaksic N, Castelli J, Williaume D, Haigron P, De Crevoisier R. CBCT-guided evolutive library for cervical adaptive IMRT. Med Phys 2018; 45:1379-1390. [DOI: 10.1002/mp.12818] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 12/29/2017] [Accepted: 02/02/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Bastien Rigaud
- LTSI; Université de Rennes 1; Campus de Beaulieu Rennes F-35042 France
- INSERM; U1099, Campus de Beaulieu Rennes F-35042 France
| | - Antoine Simon
- LTSI; Université de Rennes 1; Campus de Beaulieu Rennes F-35042 France
- INSERM; U1099, Campus de Beaulieu Rennes F-35042 France
| | - Maxime Gobeli
- Radiotherapy Department; Centre Eugene Marquis; Rennes F-35000 France
| | - Caroline Lafond
- LTSI; Université de Rennes 1; Campus de Beaulieu Rennes F-35042 France
- Radiotherapy Department; Centre Eugene Marquis; Rennes F-35000 France
| | - Julie Leseur
- Radiotherapy Department; Centre Eugene Marquis; Rennes F-35000 France
| | - Anais Barateau
- LTSI; Université de Rennes 1; Campus de Beaulieu Rennes F-35042 France
- INSERM; U1099, Campus de Beaulieu Rennes F-35042 France
| | - Nicolas Jaksic
- Radiotherapy Department; Centre Eugene Marquis; Rennes F-35000 France
| | - Joël Castelli
- LTSI; Université de Rennes 1; Campus de Beaulieu Rennes F-35042 France
- INSERM; U1099, Campus de Beaulieu Rennes F-35042 France
- Radiotherapy Department; Centre Eugene Marquis; Rennes F-35000 France
| | - Danièle Williaume
- Radiotherapy Department; Centre Eugene Marquis; Rennes F-35000 France
| | - Pascal Haigron
- LTSI; Université de Rennes 1; Campus de Beaulieu Rennes F-35042 France
- INSERM; U1099, Campus de Beaulieu Rennes F-35042 France
| | - Renaud De Crevoisier
- LTSI; Université de Rennes 1; Campus de Beaulieu Rennes F-35042 France
- INSERM; U1099, Campus de Beaulieu Rennes F-35042 France
- Radiotherapy Department; Centre Eugene Marquis; Rennes F-35000 France
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Arnesen MR, Hellebust TP, Malinen E. Impact of dose escalation and adaptive radiotherapy for cervical cancers on tumour shrinkage—a modelling study. Phys Med Biol 2017; 62:N107-N119. [DOI: 10.1088/1361-6560/aa5de2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Maingon P. Argumentaire clinique pour la radiothérapie guidée par imagerie par résonance magnétique. Cancer Radiother 2016; 20:558-63. [DOI: 10.1016/j.canrad.2016.07.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 11/24/2022]
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Sun R, Mazeron R, Chargari C, Barillot I. CTV to PTV in cervical cancer: From static margins to adaptive radiotherapy. Cancer Radiother 2016; 20:622-8. [PMID: 27614513 DOI: 10.1016/j.canrad.2016.07.088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 07/17/2016] [Accepted: 07/19/2016] [Indexed: 01/31/2023]
Abstract
Intensity-modulated radiotherapy (IMRT) is increasingly used in order to minimize the gastrointestinal, genitourinary, and hematological toxicity in cervical and uterine cancers. However, the benefit of this high-precision approach is detracted by the margins applied to the clinical target volume (CTV) to generate the planning tumor volume (PTV), taking into account tumor and surrounding organs movements, deformations, and volume changes. Adequate PTV margins should be large enough to prevent geographical misses, but not excessive, which might end the benefit from IMRT. The objectives of this review were: (a) to present the evidence available for the determination of CTV-PTV margin for uterine cancers; (b) to highlight the impact of these margins in the context of adaptive radiotherapy; and (c) to discuss the role of the PTV concept in intracavitary brachytherapy.
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Affiliation(s)
- R Sun
- Radiation Oncology Department, Gustave-Roussy Cancer Campus, Paris-Sud University, 94805 Villejuif cedex, France.
| | - R Mazeron
- Radiation Oncology Department, Gustave-Roussy Cancer Campus, Paris-Sud University, 94805 Villejuif cedex, France
| | - C Chargari
- Radiation Oncology Department, Gustave-Roussy Cancer Campus, Paris-Sud University, 94805 Villejuif cedex, France
| | - I Barillot
- Radiation Oncology Department, Bretonneau University Hospital, 37000 Tours, France; François-Rabelais University, 37000 Tours, France
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Seppenwoolde Y, Stock M, Buschmann M, Georg D, Bauer-Novotny KY, Pötter R, Georg P. Impact of organ shape variations on margin concepts for cervix cancer ART. Radiother Oncol 2016; 120:526-531. [DOI: 10.1016/j.radonc.2016.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/01/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
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Thörnqvist S, Hysing LB, Tuomikoski L, Vestergaard A, Tanderup K, Muren LP, Heijmen BJM. Adaptive radiotherapy strategies for pelvic tumors - a systematic review of clinical implementations. Acta Oncol 2016; 55:943-58. [PMID: 27055486 DOI: 10.3109/0284186x.2016.1156738] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
UNLABELLED Introdution: Variation in shape, position and treatment response of both tumor and organs at risk are major challenges for accurate dose delivery in radiotherapy. Adaptive radiotherapy (ART) has been proposed to customize the treatment to these motion/response patterns of the individual patients, but increases workload and thereby challenges clinical implementation. This paper reviews strategies and workflows for clinical and in silico implemented ART for prostate, bladder, gynecological (gyne) and ano-rectal cancers. MATERIAL AND METHODS Initial identification of papers was based on searches in PubMed. For each tumor site, the identified papers were screened independently by two researches for selection of studies describing all processes of an ART workflow: treatment monitoring and evaluation, decision and execution of adaptations. Both brachytherapy and external beam studies were eligible for review. RESULTS The review consisted of 43 clinical studies and 51 in silico studies. For prostate, 1219 patients were treated with offline re-planning, mainly to adapt prostate motion relative to bony anatomy. For gyne 1155 patients were treated with online brachytherapy re-planning while 25 ano-rectal cancer patients were treated with offline re-planning, all to account for tumor regression detected by magnetic resonance imaging (MRI)/computed tomography (CT). For bladder and gyne, 161 and 64 patients, respectively, were treated with library-based online plan selection to account for target volume and shape variations. The studies reported sparing of rectum (prostate and bladder cancer), bladder (ano-rectal cancer) and bowel cavity (gyne and bladder cancer) as compared to non-ART. CONCLUSION Implementations of ART were dominated by offline re-planning and online brachytherapy re-planning strategies, although recently online plan selection workflows have increased with the availability of cone-beam CT. Advantageous dosimetric and outcome patterns using ART was documented by the studies of this review. Despite this, clinical implementations were scarce due to challenges in target/organ re-contouring and suboptimal patient selection in the ART workflows.
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Affiliation(s)
- Sara Thörnqvist
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Liv B. Hysing
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Laura Tuomikoski
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | - Anne Vestergaard
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Kari Tanderup
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Ludvig P. Muren
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Ben J. M. Heijmen
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Acharya S, Fischer-Valuck BW, Kashani R, Parikh P, Yang D, Zhao T, Green O, Wooten O, Li HH, Hu Y, Rodriguez V, Olsen L, Robinson C, Michalski J, Mutic S, Olsen J. Online Magnetic Resonance Image Guided Adaptive Radiation Therapy: First Clinical Applications. Int J Radiat Oncol Biol Phys 2016; 94:394-403. [PMID: 26678659 DOI: 10.1016/j.ijrobp.2015.10.015] [Citation(s) in RCA: 213] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/06/2015] [Accepted: 10/06/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Sahaja Acharya
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | | | - Rojano Kashani
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Parag Parikh
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Deshan Yang
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Tianyu Zhao
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Olga Green
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Omar Wooten
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - H Harold Li
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Yanle Hu
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Vivian Rodriguez
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Lindsey Olsen
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Sasa Mutic
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Jeffrey Olsen
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri.
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A review of segmentation and deformable registration methods applied to adaptive cervical cancer radiation therapy treatment planning. Artif Intell Med 2015; 64:75-87. [DOI: 10.1016/j.artmed.2015.04.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 04/16/2015] [Accepted: 04/26/2015] [Indexed: 01/18/2023]
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Jaffray DA, Chung C, Coolens C, Foltz W, Keller H, Menard C, Milosevic M, Publicover J, Yeung I. Quantitative Imaging in Radiation Oncology: An Emerging Science and Clinical Service. Semin Radiat Oncol 2015; 25:292-304. [PMID: 26384277 DOI: 10.1016/j.semradonc.2015.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Radiation oncology has long required quantitative imaging approaches for the safe and effective delivery of radiation therapy. The past 10 years has seen a remarkable expansion in the variety of novel imaging signals and analyses that are starting to contribute to the prescription and design of the radiation treatment plan. These include a rapid increase in the use of magnetic resonance imaging, development of contrast-enhanced imaging techniques, integration of fluorinated deoxyglucose-positron emission tomography, evaluation of hypoxia imaging techniques, and numerous others. These are reviewed with an effort to highlight challenges related to quantification and reproducibility. In addition, several of the emerging applications of these imaging approaches are also highlighted. Finally, the growing community of support for establishing quantitative imaging approaches as we move toward clinical evaluation is summarized and the need for a clinical service in support of the clinical science and delivery of care is proposed.
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Affiliation(s)
- David Anthony Jaffray
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; TECHNA Institute/University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.
| | - Caroline Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Coolens
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; TECHNA Institute/University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Warren Foltz
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; TECHNA Institute/University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Harald Keller
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; TECHNA Institute/University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia Menard
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; TECHNA Institute/University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Michael Milosevic
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Julia Publicover
- TECHNA Institute/University Health Network, Toronto, Ontario, Canada
| | - Ivan Yeung
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; TECHNA Institute/University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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