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Sheng K, Cao M, Godley A, Lin MH, Henze L, Hammond L, Delombaerde L, Hierholz K, Kouptsidis J. Quantification of Dosimetry Improvement With or Without Patient Surface Guidance. Adv Radiat Oncol 2024; 9:101570. [PMID: 39188998 PMCID: PMC11345286 DOI: 10.1016/j.adro.2024.101570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 06/21/2024] [Indexed: 08/28/2024] Open
Abstract
Purpose Noncoplanar beams and arcs are routinely used to improve dosimetry for intracranial cases, but their application for extracranial cases has been hampered by the risk of collision. This has led to conservative beam selection whose impact on plan dosimetry has not been previously studied. Methods and Materials A full-body 3-dimensional patient surface was acquired using optical cameras for a single lung patient at the time of computed tomography simulation. Eight stereotactic body radiation therapy (SBRT) plans were created for the patient, with varying degrees of noncoplanarity and deliverability. The plans included volumetric modulated arc therapy and intensity modulated radiation therapy (IMRT) plans ranging from simple, coplanar arcs to multiple noncoplanar arcs and IMRT beams. A total of 70 fields were created across the 8 plans, of which 21 fields were undeliverable with a 5-cm buffer. Organs-at-risk (OARs) metrics including R50, Dmax 2 cm from the PTV, lung V20, and chest wall V30 were evaluated. Five expert SBRT dosimetrists from 5 institutions evaluated field deliverability, with or without the guidance of the clearance map. Results In the dosimetry evaluation, a clear trend in increasing dosimetric compactness and OAR sparing is observed with increasing plan noncoplanarity. R50, Dmax 2 cm, lung V20, and chest wall V30 decreased 41%, 39%, 43%, and 57%, respectively, from plan 1 (2 coplanar partial arcs) to plan 8 (19 noncoplanar IMRT beams). In the observer tests, the expert dosimetrists' ability to accurately discern beam deliverability because of collision significantly increases with the clearance map. The errors in predicting colliding fields were eliminated using the whole-body surface and clearance map, and the user was able to select fields based on plan quality and patient comfort instead of being overly conservative. Conclusion The study shows that incorporating a personalized, whole-body clearance map in the treatment planning workflow can facilitate the adoption of noncoplanar beams or arcs that benefit the SBRT plan dosimetry.
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Affiliation(s)
- Ke Sheng
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Minsong Cao
- Department of Radiation Oncology, University of California, Los Angeles, California
| | - Andrew Godley
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mu-Han Lin
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lukas Henze
- Cancer Center Berlin-Neukölln, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Laura Hammond
- Radiotherapy Department, Raigmore Hospital, Inverness, United Kingdom
| | | | - Kirsten Hierholz
- Klinikum Darmstadt GmbH, Institut für Radionkologie und Strahlentherapie, Darmstadt, Germany
| | - Jana Kouptsidis
- Klinikum Darmstadt GmbH, Institut für Radionkologie und Strahlentherapie, Darmstadt, Germany
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Schipaanboord BWK, Giżyńska MK, Rossi L, de Vries KC, Heijmen BJM, Breedveld S. Fully automated treatment planning for MLC-based robotic radiotherapy. Med Phys 2021; 48:4139-4147. [PMID: 34037258 PMCID: PMC8457110 DOI: 10.1002/mp.14993] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/06/2021] [Accepted: 05/14/2021] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To propose and validate a fully automated multicriterial treatment planning solution for a CyberKnife® equipped with an InCiseTM 2 multileaf collimator. METHODS The AUTO BAO plans are generated using fully automated prioritized multicriterial optimization (AUTO MCO) of pencil-beam fluence maps with integrated noncoplanar beam angle optimization (BAO), followed by MLC segment generation. Both the AUTO MCO and segmentation algorithms have been developed in-house. AUTO MCO generates for each patient a single, high-quality Pareto-optimal IMRT plan. The segmentation algorithm then accurately mimics the AUTO MCO 3D dose distribution, while considering all candidate beams simultaneously, rather than replicating the fluence maps. Pencil-beams, segment dose depositions, and final dose calculations are performed with a stand-alone version of the clinical dose calculation engine. For validation, AUTO BAO plans were generated for 33 prostate SBRT patients and compared to reference plans (REF) that were manually generated with the commercial treatment planning system (TPS), in absence of time pressure. REF plans were also compared to AUTO RB plans, for which fluence map optimization was performed for the beam angle configuration used in the REF plan, and the segmentation could use all these beams or only a subset, depending on the dosimetry. RESULTS AUTO BAO plans were clinically acceptable and dosimetrically similar to REF plans, but had on average reduced numbers of beams ((beams in AUTO BAO)/(beams in REF) (relative improvement): 24.7/48.3 (-49%)), segments (59.5/98.9 (-40%)), and delivery times (17.1/22.3 min. (-23%)). Dosimetry of AUTO RB and REF were also similar, but AUTO RB used on average fewer beams (38.0/48.3 (-21%)) and had on average shorter delivery times (18.6/22.3 min. (-17%)). Delivered Monitor Units (MU) were similar for all three planning approaches. CONCLUSIONS A new, vendor-independent optimization workflow for fully automated generation of deliverable high-quality CyberKnife® plans was proposed, including BAO. Compared to manual planning with the commercial TPS, fraction delivery times were reduced by 5.3 min. (-23%) due to large reductions in beam and segment numbers.
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Affiliation(s)
- Bastiaan W K Schipaanboord
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Zuid Holland, 3015GD, The Netherlands
| | - Marta K Giżyńska
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Zuid Holland, 3015GD, The Netherlands
| | - Linda Rossi
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Zuid Holland, 3015GD, The Netherlands
| | - Kim C de Vries
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Zuid Holland, 3015GD, The Netherlands
| | - Ben J M Heijmen
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Zuid Holland, 3015GD, The Netherlands
| | - Sebastiaan Breedveld
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Zuid Holland, 3015GD, The Netherlands
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Schipaanboord BWK, Heijmen B, Breedveld S. Accurate 3D-dose-based generation of MLC segments for robotic radiotherapy. ACTA ACUST UNITED AC 2020; 65:175011. [DOI: 10.1088/1361-6560/ab97e7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Haseai S, Arimura H, Asai K, Yoshitake T, Shioyama Y. Similar-cases-based planning approaches with beam angle optimizations using water equivalent path length for lung stereotactic body radiation therapy. Radiol Phys Technol 2020; 13:119-127. [PMID: 32172525 DOI: 10.1007/s12194-020-00558-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/23/2020] [Accepted: 02/24/2020] [Indexed: 12/30/2022]
Abstract
This study aimed to propose automated treatment planning approaches based on similar cases with beam angle optimizations using water equivalent path length (WEPL) to avoid lung and rib doses for lung stereotactic body radiation therapy (SBRT). Similar cases to an objective case were defined as cases, which were close to the objective case with respect to the Euclidean distances based on geometrical features. Initial similar-case-based (ISC) plans were generated by applying lung SBRT plans of similar cases to objective cases. Similar cases were selected using the Euclidean distances based on lung shape and geometrical features from a radiation treatment planning database with 174 cases. Beam angles of the ISC plans were optimized using a greedy algorithm based on a cost function to include absorbed doses in the lung and ribs in the WEPL. The 12 dose evaluation indices for the planning target volume, lung, spinal cord, and ribs were evaluated in the original plans, ISC plans, and optimized similar-case-based (OSC) plans with and without WEPL for 20 test cases to investigate its dosimetric impact. These findings revealed that V10 and the mean dose for the lung and V20, V30, and V40 for the ribs in the OSC plan with WEPL improved more significantly than those in the original and ISC plans. This study indicates a potential of similar cases, whose beam angle configurations were optimized with WEPL to avoid lung and rib doses in lung SBRT plans.
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Affiliation(s)
- Shu Haseai
- SAGA Heavy Ion Medical Accelerator in Tosu, 3049, Harakogamachi, Tosu, 841-0071, Japan
| | - Hidetaka Arimura
- Division of Medical Quantum Science, Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Kaori Asai
- Division of Medical Quantum Science, Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tadamasa Yoshitake
- Division of Medical Quantum Science, Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshiyuki Shioyama
- Division of Medical Quantum Science, Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Scobioala S, Kittel C, Elsayad K, Kroeger K, Oertel M, Samhouri L, Haverkamp U, Eich HT. A treatment planning study comparing IMRT techniques and cyber knife for stereotactic body radiotherapy of low-risk prostate carcinoma. Radiat Oncol 2019; 14:143. [PMID: 31399115 PMCID: PMC6689170 DOI: 10.1186/s13014-019-1353-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/01/2019] [Indexed: 02/14/2023] Open
Abstract
PURPOSE Comparing radiation treatment plans by using the same safety margins and dose objectives for all techniques, to ascertain the optimal radiation technique for the stereotactic body radiotherapy (SBRT) of low-risk prostate cancer. MATERIAL AND METHODS Treatment plans for 27 randomly selected patients were compared using intensity-modulated (IMRT) techniques as Sliding Window (SW), volumetric modulated arc therapy (VMAT), and helical tomotherapy (HT), as well as Cyber Knife (CK) system. The target dose was calculated to 36.25 Gy delivered in five fractions over 1 week. Dosimetric indices for target volume and organs at risk (OAR) as well as normal tissue complication probability (NTCP) of late rectal and urinary bladder toxicities were analyzed. RESULTS The CK provided lower homogeneity in the target volume, but higher values for most of the conformity indices compared to the IMRT approaches. The SW demonstrated superior rectum sparing at medium-to-high dose range (V18 Gy - V32.6 Gy) compared to other techniques (p < 0.05). The whole urinary bladder experienced the best shielding by SW and VMAT at the medium dose (V18 Gy, p < 0.05 versus CK), however we obtained no relevant differences between techniques at the high dose. Generally, the CK demonstrated significantly superior rectum and bladder exposure at V18 Gy as compared to HT, SW, and VMAT. For the rectum, mean NTCP values were significantly superior for HT (NTCP = 2.3%, p < 0.05), and for urinary bladder, the NTCP showed no significant advantages for any technique. CONCLUSION No absolute dosimetric advantage was revealed to choose between CK or IMRT techniques for the SBRT of low-grade prostate cancer. Using the same safety margins and dose objectives, IMRT techniques demonstrated superior sparing of the rectum and bladder at a medium dose compared to CK. Comparing different IMRT approaches SW displayed superior rectum sparing at a medium-to-high dose range, whereas both SW and RA revealed superior bladder sparing compared to HT. HT demonstrated a significantly lower NTCP outcome compared to CK or IMRT techniques regarding the rectum. Radiation plans can be optimized further by an individual modification of dose objectives independent of the treatment plan strategy.
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Affiliation(s)
- Sergiu Scobioala
- Department of Radiation Oncology of the University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude 1, 48149 Muenster, Germany
| | - Christopher Kittel
- Department of Radiation Oncology of the University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude 1, 48149 Muenster, Germany
| | - Khaled Elsayad
- Department of Radiation Oncology of the University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude 1, 48149 Muenster, Germany
| | - Kai Kroeger
- Department of Radiation Oncology of the University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude 1, 48149 Muenster, Germany
| | - Michael Oertel
- Department of Radiation Oncology of the University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude 1, 48149 Muenster, Germany
| | - Laith Samhouri
- Department of Radiation Oncology of the University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude 1, 48149 Muenster, Germany
| | - Uwe Haverkamp
- Department of Radiation Oncology of the University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude 1, 48149 Muenster, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology of the University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude 1, 48149 Muenster, Germany
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Niu C, Li M, Yan H, Guo C, Dai J. Selecting noncoplanar beam directions in a patient coordinate system for radiotherapy planning. Med Dosim 2019; 44:279-283. [DOI: 10.1016/j.meddos.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/27/2018] [Accepted: 10/22/2018] [Indexed: 11/25/2022]
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Stereotactic Body Radiotherapy (SBRT) for liver metastasis - clinical outcomes from the international multi-institutional RSSearch® Patient Registry. Radiat Oncol 2018; 13:26. [PMID: 29439707 PMCID: PMC5811977 DOI: 10.1186/s13014-018-0969-2] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/02/2018] [Indexed: 02/07/2023] Open
Abstract
Background Stereotactic body radiotherapy (SBRT) is an emerging treatment option for liver metastases in patients unsuitable for surgery. We investigated factors associated with clinical outcomes for liver metastases treated with SBRT from a multi-center, international patient registry. Methods Patients with liver metastases treated with SBRT were identified in the RSSearch® Patient Registry. Patient, tumor and treatment characteristics associated with treatment outcomes were assessed. Dose fractionations were normalized to BED10. Overall survival (OS) and local control (LC) were evaluated using Kaplan Meier analysis and log-rank test. Results The study included 427 patients with 568 liver metastases from 25 academic and community-based centers. Median age was 67 years (31–91 years). Colorectal adenocarcinoma (CRC) was the most common primary cancer. 73% of patients received prior chemotherapy. Median tumor volume was 40 cm3 (1.6–877 cm3), median SBRT dose was 45 Gy (12–60 Gy) delivered in a median of 3 fractions [1–5]. At a median follow-up of 14 months (1–91 months) the median overall survival (OS) was 22 months. Median OS was greater for patients with CRC (27 mo), breast (21 mo) and gynecological (25 mo) metastases compared to lung (10 mo), other gastro-intestinal (GI) (18 mo) and pancreatic (6 mo) primaries (p < 0.0001). Smaller tumor volumes (< 40 cm3) correlated with improved OS (25 months vs 15 months p = 0.0014). BED10 ≥ 100 Gy was also associated with improved OS (27 months vs 15 months p < 0.0001). Local control (LC) was evaluable in 430 liver metastases from 324 patients. Two-year LC rates was better for BED10 ≥ 100 Gy (77.2% vs 59.6%) and the median LC was better for tumors < 40 cm3 (52 vs 39 months). There was no difference in LC based on histology of the primary tumor. Conclusions In a large, multi-institutional series of patients with liver metastasis treated with SBRT, reasonable LC and OS was observed. OS and LC depended on dose and tumor volume, while OS varied by primary tumor. Future prospective trials on the role of SBRT for liver metastasis from different primaries in the setting of multidisciplinary management including systemic therapy, is warranted. Trial registration Clinicaltrials.gov: NCT01885299.
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Individualized Selection of Beam Angles and Treatment Isocenter in Tangential Breast Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2017; 98:447-453. [DOI: 10.1016/j.ijrobp.2017.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 01/31/2017] [Accepted: 02/07/2017] [Indexed: 11/22/2022]
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van Haveren R, Ogryczak W, Verduijn GM, Keijzer M, Heijmen BJM, Breedveld S. Fast and fuzzy multi-objective radiotherapy treatment plan generation for head and neck cancer patients with the lexicographic reference point method (LRPM). Phys Med Biol 2017; 62:4318-4332. [PMID: 28475495 DOI: 10.1088/1361-6560/62/11/4318] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Previously, we have proposed Erasmus-iCycle, an algorithm for fully automated IMRT plan generation based on prioritised (lexicographic) multi-objective optimisation with the 2-phase ϵ-constraint (2pϵc) method. For each patient, the output of Erasmus-iCycle is a clinically favourable, Pareto optimal plan. The 2pϵc method uses a list of objective functions that are consecutively optimised, following a strict, user-defined prioritisation. The novel lexicographic reference point method (LRPM) is capable of solving multi-objective problems in a single optimisation, using a fuzzy prioritisation of the objectives. Trade-offs are made globally, aiming for large favourable gains for lower prioritised objectives at the cost of only slight degradations for higher prioritised objectives, or vice versa. In this study, the LRPM is validated for 15 head and neck cancer patients receiving bilateral neck irradiation. The generated plans using the LRPM are compared with the plans resulting from the 2pϵc method. Both methods were capable of automatically generating clinically relevant treatment plans for all patients. For some patients, the LRPM allowed large favourable gains in some treatment plan objectives at the cost of only small degradations for the others. Moreover, because of the applied single optimisation instead of multiple optimisations, the LRPM reduced the average computation time from 209.2 to 9.5 min, a speed-up factor of 22 relative to the 2pϵc method.
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Affiliation(s)
- Rens van Haveren
- Department of Radiation Oncology, Erasmus MC-Cancer Institute, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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Breedveld S, Heijmen B. Data for TROTS - The Radiotherapy Optimisation Test Set. Data Brief 2017; 12:143-149. [PMID: 28417100 PMCID: PMC5387893 DOI: 10.1016/j.dib.2017.03.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/15/2017] [Accepted: 03/28/2017] [Indexed: 11/03/2022] Open
Abstract
The Radiotherapy Optimisation Test Set (TROTS) is an extensive set of problems originating from radiotherapy (radiation therapy) treatment planning. This dataset is created for 2 purposes: (1) to supply a large-scale dense dataset to measure performance and quality of mathematical solvers, and (2) to supply a dataset to investigate the multi-criteria optimisation and decision-making nature of the radiotherapy problem. The dataset contains 120 problems (patients), divided over 6 different treatment protocols/tumour types. Each problem contains numerical data, a configuration for the optimisation problem, and data required to visualise and interpret the results. The data is stored as HDF5 compatible Matlab files, and includes scripts to work with the dataset.
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Affiliation(s)
- Sebastiaan Breedveld
- Erasmus University Medical Center - Cancer Institute, Department of Radiation Oncology, Rotterdam, The Netherlands
| | - Ben Heijmen
- Erasmus University Medical Center - Cancer Institute, Department of Radiation Oncology, Rotterdam, The Netherlands
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Sharfo AWM, Dirkx MLP, Breedveld S, Méndez Romero A, Heijmen BJM. VMAT plus a few computer-optimized non-coplanar IMRT beams (VMAT+) tested for liver SBRT. Radiother Oncol 2017; 123:49-56. [PMID: 28341061 DOI: 10.1016/j.radonc.2017.02.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 02/13/2017] [Accepted: 02/25/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To propose a novel treatment approach, designated VMAT+, involving addition of <5 IMRT beams with computer-optimized non-coplanar orientations to VMAT, and evaluate it for liver Stereotactic Body Radiation Therapy (SBRT). VMAT+ is investigated as an alternative for (1) coplanar VMAT and (2) multi-beam non-coplanar treatment. METHODS/MATERIALS For fifteen patients with liver metastases, VMAT+ plans were compared with (1) dual-arc VMAT and (2) 25-beam, non-coplanar treatment with computer-optimized beam orientations (25-NCP). All plans were generated fully automatically for delivery of the highest feasible tumor Biologically Effective Dose (BED). OAR doses, intermediate-dose-spillage, dose-compactness, and measured delivery times were evaluated. RESULTS With VMAT+ the maximum achievable tumor BED was equal to that of 25-NCP. Conversely, VMAT resulted in a lower tumor BED in 5 patients. Compared to VMAT, VMAT+ yielded significant dose reductions in OARs. Intermediate-dose-spillage and dose-compactness were significantly improved by 9.8% and 17.3% (p≤0.002), respectively. Treatment times with VMAT+ were only enhanced by 4.1min on average, compared to VMAT (8.4min). Improvements in OAR sparing with 25-NCP, compared to VMAT+, were generally modest and/or statistically insignificant, while delivery times were on average 20.5min longer. CONCLUSIONS For liver SBRT, VMAT+ is equivalent to time-consuming treatment with 25 non-coplanar beams in terms of achievable tumor BED. Compared to VMAT, OAR sparing and intermediate-dose-spillage are significantly improved, with minor increase in delivery time.
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Affiliation(s)
- Abdul Wahab M Sharfo
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Maarten L P Dirkx
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Sebastiaan Breedveld
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Ben J M Heijmen
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Rocha H, Dias J, Ventura T, Ferreira B, Lopes MDC. A derivative-free multistart framework for an automated noncoplanar beam angle optimization in IMRT. Med Phys 2016; 43:5514. [DOI: 10.1118/1.4962477] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Mancosu P, Clemente S, Landoni V, Ruggieri R, Alongi F, Scorsetti M, Stasi M. SBRT for prostate cancer: Challenges and features from a physicist prospective. Phys Med 2016; 32:479-84. [PMID: 27061869 DOI: 10.1016/j.ejmp.2016.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/29/2016] [Accepted: 03/12/2016] [Indexed: 01/26/2023] Open
Abstract
Emerging data are showing the safety and the efficacy of Stereotactic Body Radiation Therapy (SBRT) in prostate cancer management. In this context, the medical physicists are regularly involved to review the appropriateness of the adopted technology and to proactively study new solutions. From the physics point of view there are two major challenges in prostate SBRT: (1) mitigation of geometrical uncertainty and (2) generation of highly conformal dose distributions that maximally spare the OARs. Geometrical uncertainties have to be limited as much as possible in order to avoid the use of large PTV margins. Furthermore, advanced planning and delivery techniques are needed to generate maximally conformal dose distributions. In this non-systematic review the technology and the physics aspects of SBRT for prostate cancer were analyzed. In details, the aims were: (i) to describe the rationale of reducing the number of fractions (i.e. increasing the dose per fraction), (ii) to analyze the features to be accounted for performing an extreme hypo-fractionation scheme (>6-7Gy), and (iii) to describe technological solutions for treating in a safe way. The analysis of outcomes, toxicities, and other clinical aspects are not object of the present evaluation.
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Affiliation(s)
- Pietro Mancosu
- Humanitas Clinical and Research Hospital, Rozzano, Milano, Italy.
| | | | | | | | - Filippo Alongi
- Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Marta Scorsetti
- Humanitas Clinical and Research Hospital, Rozzano, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milano, Italy
| | - Michele Stasi
- Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Italy
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