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Hrbacek J, Kacperek A, Beenakker JWM, Mortimer L, Denker A, Mazal A, Shih HA, Dendale R, Slopsema R, Heufelder J, Mishra KK. PTCOG Ocular Statement: Expert Summary of Current Practices and Future Developments in Ocular Proton Therapy. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00748-X. [PMID: 38971383 DOI: 10.1016/j.ijrobp.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 05/08/2024] [Accepted: 06/18/2024] [Indexed: 07/08/2024]
Abstract
Although rare cancers, ocular tumors are a threat to vision, quality of life, and potentially life expectancy of a patient. Ocular proton therapy (OPT) is a powerful tool for successfully treating this disease. The Particle Therapy Co-Operative Ocular Group) formulated an Evidence and Expert-Based Executive Summary of Current Practices and Future Developments in OPT: comparative dosimetric and clinical analysis with the different OPT systems is essential to set up planning guidelines, implement best practices, and establish benchmarks for eye preservation, vision, and quality of life measures. Contemporary prospective trials in select subsets of patients (eg, tumors near the optic disc and/or macula) may allow for dosimetric and clinical analysis between different radiation modalities and beamline systems to evaluate differences in radiation delivery and penumbra, and resultant tumor control, normal tissue complication rates, and overall clinical cost-effectiveness. To date, the combination of multimodal imaging (fundus photography, ultrasound, etc), ophthalmologist assessment, and clip surgery with radiation planning have been keys to successful treatment. Increased use of three-dimensional imaging (computed tomography/magnetic resonance imaging) is anticipated although its spatial resolution might be a limiting factor (eg, detection of flat diffuse tumor parts). Commercially produced ocular treatment-planning systems are under development and their future use is expected to expand across OPT centers. Future continuity of OPT will depend on the following: (1) maintaining and upgrading existing older dedicated low-energy facilities, (2) maintaining shared, degraded beamlines at large proton therapy centers, and (3) developing adapted gantry beams of sufficient quality to maintain the clinical benefits of sharp beam conformity. Option (1) potentially offers the sharpest beams, minimizing impact on healthy tissues, whereas (2) and (3) potentially offer the advantage of substantial long-term technical support and development as well as the introduction of new approaches. Significant patient throughputs and close cooperation between medical physics, ophthalmology, and radiation therapy, underpinned by mutual understanding, is crucial for a successful OPT service.
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Affiliation(s)
- Jan Hrbacek
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland.
| | | | - Jan-Willem M Beenakker
- Department of Ophthalmology, Leiden University Medical Center, Leiden, Netherlands; Department of Radiology, C.J. Gorter MRI Center, Leiden University Medical Center, Leiden, Netherlands; Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands; HollandPTC, Delft, Netherlands
| | - Linda Mortimer
- Medical Physics Department, The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom
| | - Andrea Denker
- Helmholtz-Zentrum Berlin für Materialien und Energie, Proton Therapy (BE-APT), Berlin, Germany
| | - Alejandro Mazal
- Medical Physics Service, Centro de Protonterapia Quironsalud, Madrid, Spain
| | - Helen A Shih
- Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Remi Dendale
- Institut Curie Protontherapy Center, Orsay, France
| | - Roelf Slopsema
- Department of Radiation Oncology, Emory Proton Therapy Center, Atlanta, Georgia
| | - Jens Heufelder
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, BerlinProtonen am HZB, Berlin, Germany
| | - Kavita K Mishra
- Proton Ocular Radiation Therapy Program, Department of Radiation Oncology, Osher Center for Integrative Health, Osher Foundation Endowed Chair in Clinical Programs in Integrative Health, University of California San Francisco, San Francisco, California
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Klaassen L, Haasjes C, Hol M, Cambraia Lopes P, Spruijt K, van de Steeg-Henzen C, Vu K, Bakker P, Rasch C, Verbist B, Beenakker JW. Geometrical accuracy of magnetic resonance imaging for ocular proton therapy planning. Phys Imaging Radiat Oncol 2024; 31:100598. [PMID: 38993288 PMCID: PMC11234150 DOI: 10.1016/j.phro.2024.100598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/31/2024] [Accepted: 06/05/2024] [Indexed: 07/13/2024] Open
Abstract
Background & purpose Magnetic resonance imaging (MRI) is increasingly used in treatment preparation of ocular proton therapy, but its spatial accuracy might be limited by geometric distortions due to susceptibility artefacts. A correct geometry of the MR images is paramount since it defines where the dose will be delivered. In this study, we assessed the geometrical accuracy of ocular MRI. Materials & methods A dedicated ocular 3 T MRI protocol, with localized shimming and increased gradients, was compared to computed tomography (CT) and X-ray images in a phantom and in 15 uveal melanoma patients. The MRI protocol contained three-dimensional T2-weighted and T1-weighted sequences with an isotropic reconstruction resolution of 0.3-0.4 mm. Tantalum clips were identified by three observers and clip-clip distances were compared between T2-weighted and T1-weighted MRI, CT and X-ray images for the phantom and between MRI and X-ray images for the patients. Results Interobserver variability was below 0.35 mm for the phantom and 0.30(T1)/0.61(T2) mm in patients. Mean absolute differences between MRI and reference were below 0.27 ± 0.16 mm and 0.32 ± 0.23 mm for the phantom and in patients, respectively. In patients, clip-clip distances were slightly larger on MRI than on X-ray images (mean difference T1: 0.11 ± 0.38 mm, T2: 0.10 ± 0.44 mm). Differences did not increase at larger distances and did not correlate to interobserver variability. Conclusions A dedicated ocular MRI protocol can produce images of the eye with a geometrical accuracy below half the MRI acquisition voxel (<0.4 mm). Therefore, these images can be used for ocular proton therapy planning, both in the current model-based workflow and in proposed three-dimensional MR-based workflows.
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Affiliation(s)
- Lisa Klaassen
- Leiden University Medical Center, Department of Ophthalmology, Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiology, Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiation Oncology, Leiden, the Netherlands
| | - Corné Haasjes
- Leiden University Medical Center, Department of Ophthalmology, Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiology, Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiation Oncology, Leiden, the Netherlands
| | - Martijn Hol
- Leiden University Medical Center, Department of Radiation Oncology, Leiden, the Netherlands
- HollandPTC, Delft, the Netherlands
| | | | | | - Christal van de Steeg-Henzen
- Leiden University Medical Center, Department of Radiology, Leiden, the Netherlands
- HollandPTC, Delft, the Netherlands
| | - Khanh Vu
- Leiden University Medical Center, Department of Ophthalmology, Leiden, the Netherlands
| | - Pauline Bakker
- Leiden University Medical Center, Department of Radiation Oncology, Leiden, the Netherlands
- HollandPTC, Delft, the Netherlands
| | - Coen Rasch
- Leiden University Medical Center, Department of Radiation Oncology, Leiden, the Netherlands
- HollandPTC, Delft, the Netherlands
| | - Berit Verbist
- Leiden University Medical Center, Department of Radiology, Leiden, the Netherlands
- HollandPTC, Delft, the Netherlands
| | - Jan-Willem Beenakker
- Leiden University Medical Center, Department of Ophthalmology, Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiology, Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiation Oncology, Leiden, the Netherlands
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Manke H, Fluehs D, Stroth M, Bechrakis NE, Foerster AMH, Albrecht J. Measurements regarding a combined therapy concept for ophthalmic tumors consisting of brachytherapy and x-rays. Biomed Phys Eng Express 2024; 10:045056. [PMID: 38588642 DOI: 10.1088/2057-1976/ad3bbb] [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: 09/11/2023] [Accepted: 04/08/2024] [Indexed: 04/10/2024]
Abstract
Objective.We present a novel concept to treat ophthalmic tumors which combines brachytherapy and low-energy x-ray therapy. Brachytherapy with106Ru applicators is inadequate for intraocular tumors with a height of 7 mm or more. This results from a steep dose gradient, and it is unfeasible to deliver the required dose at the tumor apex without exceeding the maximum tolerable sclera dose of usually 1000 Gy to 1500 Gy. Other modalities, such as irradiation with charged particles, may be individually contraindicated. A dose boost at the apex provided by a superficial x-ray therapy unit, performed simultaneously with the brachytherapy, results in a more homogeneous dose profile than brachytherapy alone. This avoids damage to organs at risk. The applicator may also serve as a beam stop for x-rays passing through the target volume, which reduces healthy tissue dosage. This study aims to investigate the suitability of the applicator to serve as a beam stop for the x-rays.Approach.A phantom with three detector types comprising a soft x-ray ionization chamber, radiochromic films, and a self-made scintillation detector was constructed to perform dosimetry. Measurements were performed using a conventional x-ray unit for superficial therapy to investigate the uncertainties of the phantom and the ability of the applicator to absorb x-rays. The manufacturer provided a dummy plaque to obtain x-ray dose profiles without noise from106Ru decays.Results.The phantom is generally feasible to obtain dose profiles with three different detector types. The interaction of x-rays with the silver of the applicator leads to an increased dose rate in front of the applicator. The dose rate of the x-rays is reduced by up to 90% behind a106Ru applicator. Therefore, a106Ru applicator can be used as a beam stop in combined x-ray and brachytherapy treatment.
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Affiliation(s)
- H Manke
- Department of Physics, TU Dortmund University, Otto-Hahn-Str. 4a, 44227 Dortmund, Germany
| | - D Fluehs
- Radiation and Tumor Clinic, Essen University Hospital, Hufelandstr. 55, 45147 Essen, Germany
| | - M Stroth
- Department of Physics, TU Dortmund University, Otto-Hahn-Str. 4a, 44227 Dortmund, Germany
| | - N E Bechrakis
- Radiation and Tumor Clinic, Essen University Hospital, Hufelandstr. 55, 45147 Essen, Germany
| | - A M H Foerster
- Radiation and Tumor Clinic, Essen University Hospital, Hufelandstr. 55, 45147 Essen, Germany
| | - J Albrecht
- Department of Physics, TU Dortmund University, Otto-Hahn-Str. 4a, 44227 Dortmund, Germany
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Wulff J, Koska B, Ahmad Khalil D, Richter R, Maximilian Bäcker C, Bäumer C, Foerster A, Bechrakis NE, Timmermann B. Uncertainties in ocular proton planning and their impact on required margins. Phys Med 2024; 121:103358. [PMID: 38643558 DOI: 10.1016/j.ejmp.2024.103358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 03/11/2024] [Accepted: 04/16/2024] [Indexed: 04/23/2024] Open
Abstract
PURPOSE To review required margins in ocular proton therapy (OPT) based on an uncertainty estimation and to compare them with widely used values. Further, uncertainties when using registered funduscopy images in the 3D model is investigated. METHODS An uncertainty budget in planning and delivery was defined to determine required aperture and range margins. Setup uncertainties were considered for a cohort of treated patients and tested in a worst-case estimation. Other uncertainties were based on a best-guess and knowledge of institutional specifics, e.g. range reproducibility. Margins for funduscopy registration were defined resulting from scaling, rotation and translation of the image. Image formation for a wide-field fundus camera was reviewed and compared to the projection employed in treatment planning systems. RESULTS Values for aperture and range with margins of 2.5 mm as reported in literature could be determined. Aperture margins appear appropriate for setup uncertainties below 0.5 mm, but depend on lateral penumbra. Range margins depend on depth and associated density uncertainty in tissue. Registration of funduscopy images may require margins of >2 mm, increasing towards the equator. Difference in the projection may lead to discrepancies of several mm. CONCLUSIONS The commonly used 2.5 mm aperture margin was validated as an appropriate choice, while range margins could be reduced for lower ranges. Margins may however not include uncertainties in contouring and possible microscopic spread. If a target base is contoured on registered funduscopy images care must be taken as they are subject to larger uncertainties. Multimodal imaging approach in OPT remains advisable.
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Affiliation(s)
- Jörg Wulff
- West German Proton Therapy Centre Essen (WPE), Essen, Germany; University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany.
| | - Benjamin Koska
- West German Proton Therapy Centre Essen (WPE), Essen, Germany; University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany
| | - Dalia Ahmad Khalil
- West German Proton Therapy Centre Essen (WPE), Essen, Germany; University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany; Department of Particle Therapy, Essen, Germany
| | - Ronald Richter
- West German Proton Therapy Centre Essen (WPE), Essen, Germany; University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany; Department of Particle Therapy, Essen, Germany
| | - Claus Maximilian Bäcker
- West German Proton Therapy Centre Essen (WPE), Essen, Germany; University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany
| | - Christian Bäumer
- West German Proton Therapy Centre Essen (WPE), Essen, Germany; University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany; German Cancer Consortium (DKTK), Essen, Germany; Department of Physics, TU Dortmund University, Dortmund, Germany
| | - Andreas Foerster
- University Hospital Essen, Essen, Germany; Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Nikolaos E Bechrakis
- University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany; Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Beate Timmermann
- West German Proton Therapy Centre Essen (WPE), Essen, Germany; University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany; Department of Particle Therapy, Essen, Germany; German Cancer Consortium (DKTK), Essen, Germany
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Chvetsov AV. Equivalent uniform RBE-weighted dose in eye plaque brachytherapy. Med Phys 2024; 51:3093-3100. [PMID: 38353266 DOI: 10.1002/mp.16982] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/22/2023] [Accepted: 01/30/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Brachytherapy for ocular melanoma is based on the application of eye plaques with different spatial dose nonuniformity, time-dependent dose rates and relative biological effectiveness (RBE). PURPOSE We propose a parameter called the equivalent uniform RBE-weighted dose (EUDRBE) that can be used for quantitative characterization of integrated cell survival in radiotherapy modalities with the variable RBE, dose nonuniformity and dose rate. The EUDRBE is applied to brachytherapy with 125I eye plaques designed by the Collaborative Ocular Melanoma Study (COMS). METHODS The EUDRBE is defined as the uniform dose distribution with RBE = 1 that causes equal cell survival for a given nonuniform dose distribution with the variable RBE > 1. The EUDRBE can be used for comparison of cell survival for nonuniform dose distributions with different RBE, because they are compared to the reference dose with RBE = 1. The EUDRBE is applied to brachytherapy with 125I COMS eye plaques that are characterized by a steep dose gradient in tumor base-apex direction, protracted irradiation during time intervals of 3-8 days, and variable dose-rate dependent RBE with a maximum of about 1.4. The simulations are based on dose of 85 Gy prescribed to the farthest intraocular extent of the tumor (tumor apex). To compute the EUDRBE in eye plaque brachytherapy and correct for protracted irradiation, the distributions of physical dose have been converted to non-uniform distributions of biologically effective dose (BED) to include the biological effects of sublethal cellular repair, Our radiobiological analysis considers the combined effects of different time-dependent dose rates, spatial dose non-uniformity, dose fractionation and different RBE and can be used to derive optimized dose regimens brachytherapy. RESULTS Our simulations show that the EUDRBE increases with the prescription depths and the maximum increase may achieve 6% for the tumor height of 12 mm. This effect stems from a steep dose gradient within the tumor that increases with the prescription depth. The simulations also show that the EUDRBE increase may achieve 12% with increasing the dose rate when implant duration decreases. The combined effect of dose nonuniformity and dose rate may change the EUDRBE up to 18% for the same dose prescription of 85 Gy to tumor apex. The absolute dose range of 48-61 Gy (RBE) for the EUDRBE computed using 4 or 5 fractions is comparable to the dose prescriptions used in stereotactic body radiation therapy (SBRT) with megavoltage X-rays (RBE = 1) for different cancers. The tumor control probabilities in SBRT and eye plaque brachytherapy are very similar at the level of 80% or higher that support the hypothesis that the selected approximations for the EUDRBE are valid. CONCLUSIONS The computed range of the EUDRBE in 125I COMS eye plaque brachytherapy suggests that the selected models and hypotheses are acceptable. The EUDRBE can be useful for analysis of treatment outcomes and comparison of different dose regimens in eye plaque brachytherapy.
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Affiliation(s)
- Alexei V Chvetsov
- Department of Radiation Oncology, University of Washington, Seattle, Washington, USA
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Fleury E, Herault J, Spruijt K, Kouwenberg J, Angellier G, Hofverberg P, Horwacik T, Kajdrowicz T, Pignol JP, Hoogeman M, Trnková P. A generalized model for monitor units determination in ocular proton therapy using machine learning: A proof-of-concept study. Phys Med Biol 2024; 69:045023. [PMID: 38211314 DOI: 10.1088/1361-6560/ad1d68] [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: 08/07/2023] [Accepted: 01/11/2024] [Indexed: 01/13/2024]
Abstract
Objective.Determining and verifying the number of monitor units is crucial to achieving the desired dose distribution in radiotherapy and maintaining treatment efficacy. However, current commercial treatment planning system(s) dedicated to ocular passive eyelines in proton therapy do not provide the number of monitor units for patient-specific plan delivery. Performing specific pre-treatment field measurements, which is time and resource consuming, is usually gold-standard practice. This proof-of-concept study reports on the development of a multi-institutional-based generalized model for monitor units determination in proton therapy for eye melanoma treatments.Approach.To cope with the small number of patients being treated in proton centers, three European institutes participated in this study. Measurements data were collected to address output factor differences across the institutes, especially as function of field size, spread-out Bragg peak modulation width, residual range, and air gap. A generic model for monitor units prediction using a large number of 3748 patients and broad diversity in tumor patterns, was evaluated using six popular machine learning algorithms: (i) decision tree; (ii) random forest, (iii) extra trees, (iv) K-nearest neighbors, (v) gradient boosting, and (vi) the support vector regression. Features used as inputs into each machine learning pipeline were: Spread-out Bragg peak width, range, air gap, fraction and calibration doses. Performance measure was scored using the mean absolute error, which was the difference between predicted and real monitor units, as collected from institutional gold-standard methods.Main results.Predictions across algorithms were accurate within 3% uncertainty for up to 85.2% of the plans and within 10% uncertainty for up to 98.6% of the plans with the extra trees algorithm.Significance.A proof-of-concept of using machine learning-based generic monitor units determination in ocular proton therapy has been demonstrated. This could trigger the development of an independent monitor units calculation tool for clinical use.
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Affiliation(s)
- Emmanuelle Fleury
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
- HollandPTC, Delft, The Netherlands
| | | | | | | | | | | | - Tomasz Horwacik
- Institute of Nuclear Physics Polish Academy of Sciences, Kraków, Poland
| | - Tomasz Kajdrowicz
- Institute of Nuclear Physics Polish Academy of Sciences, Kraków, Poland
| | | | - Mischa Hoogeman
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
- HollandPTC, Delft, The Netherlands
| | - Petra Trnková
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
- Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria
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Jee KW, Verburg JM, Ruggieri TA, Bussière M, Trofimov AV. Modernization of safety environment for a dedicated beamline for proton ocular therapy. Med Phys 2023; 50:7093-7103. [PMID: 37782071 DOI: 10.1002/mp.16767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/25/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Proton therapy is an effective treatment for ocular melanoma, and other tumors of the eye. The fixed horizontal beamline dedicated to ocular treatments at Massachusetts General Hospital was originally commissioned in 2002, with much of the equipment, safety features, and practices dating back to an earlier implementation at Harvard Cyclotron in the 1970s. PURPOSE To describe the experience of reevaluation and enhancement of the safety environment for one of the longest continuously operating proton therapy programs. METHODS Several enhancements in quality control had been introduced throughout the years of operation, as described in this manuscript, to better align the practice with the evolving standards of proton therapy and the demands of a modern hospital. We spotlight the design and results of the failure mode and effect analysis (FMEA), and subsequent actions introduced to mitigate the modes associated with elevated risk. The findings of the FMEA informed the specifications for the new software application, which facilitated the improved management of the treatment workflow and the image-guidance aspects of ocular treatments. RESULTS Eleven failure modes identified as having the highest risk are described. Six of these were mitigated with the clinical roll-out of a new application for image-guided radiation therapy (IGRT). Others were addressed through task automation, the broader introduction of checklists, and enhancements in pre-treatment staff-led time-out. CONCLUSIONS Throughout the task of modernizing the safety system of our dedicated ocular beamline, FMEA proved to be an effective instrument in soliciting inputs from the staff about safety and workflow concerns, helping to identify steps associated with elevated failure risks. Risks were reduced with the clinical introduction of a new IGRT application, which integrates quality management tools widely recognized for their role in risk mitigation: automation of the data transfer and workflow steps, and with the introduction of checklists and redundancy cross-checks.
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Affiliation(s)
- Kyung-Wook Jee
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joost M Verburg
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas A Ruggieri
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marc Bussière
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alexei V Trofimov
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Thariat J, Mathis T, Pace-Loscos T, Peyrichon ML, Maschi C, Rosier L, Nguyen M, Bonnin N, Aloi D, Gastaud L, Gaucher D, Caujolle JP, Château Y, Herault J. Single-Masked Randomized Phase 2 Study Assessing 2 Forms of Hypofractionated Proton Therapy in Patients With Large Choroidal Melanomas. Int J Radiat Oncol Biol Phys 2023; 117:357-369. [PMID: 37257661 DOI: 10.1016/j.ijrobp.2023.04.028] [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: 12/11/2022] [Revised: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE Patients with large uveal melanomas are at major risk of liver metastases. Some patients are reluctant to undergo the standard treatment (ie, immediate enucleation). Proton therapy yields 5-year local control rates and eyeball retention of >85% and ≈20% in large uveal melanomas. Patients with T3/T4 uveal melanomas refusing enucleation were randomized between standard 4 to 13 Gy-fraction or moderately hypofractionated 8 to 6.5 Gy-fraction proton therapy. The main endpoint was the 2-year local recurrence-free survival without enucleation. METHODS AND MATERIALS A single-masked 1:2 randomized phase 2 trial was conducted between 2015 and 2017 with planned endoresection and distance to the posterior pole as strata. Local events were defined as local relapse, or enucleation due to complications or relapse. RESULTS The 32 patients, with a mean age of 64 years, had T3/4 (N = 17/15), M1 (N = 2) uveal melanomas, of mean tumor diameter and thickness of 16.5 mm and 9.1 mm, and of posterior location in 56.5%. Median follow-up was 56.7 months. The 2-year local recurrence-free survival rate without enucleation was 79% (95% confidence interval, 65%-96%), similar in both arms. There were 9 enucleations, 3 at relapse and 6 for toxicities. Twelve patients had distant metastases. The 2-year-overall survival was 72% (95% confidence interval, 58%-89%). At baseline, visual acuity by average logarithm value of the minimum angle of resolution was 0.68 and 0.70 in the standard and experimental arms, and at last follow-up 2 and 1.7, with mean differences of 1.44 and 1.01, respectively (P = .39). CONCLUSION An 8-times 6.5 Gy scheme is feasible without deteriorating local control and with similar toxicity rates in patients with large uveal melanomas. Larger studies incorporating adjuvant treatments are warranted.
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Affiliation(s)
- Juliette Thariat
- Department of Radiation Oncology, Centre François Baclesse, Caen, France; Laboratoire de Physique Corpusculaire, Caen, France; Unicaen-Normandie Université, Caen, France.
| | - Thibaud Mathis
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon; Université Claude Bernard Lyon 1, Lyon, France; UMR5510 MATEIS, CNRS, INSA Lyon, Université Lyon 1, Lyon, France
| | - Tanguy Pace-Loscos
- Department of Radiation Oncology, Proton Therapy Center, Centre Antoine Lacassagne, Nice, France
| | - Marie Laure Peyrichon
- Department of Radiation Oncology, Proton Therapy Center, Centre Antoine Lacassagne, Nice, France
| | - Celia Maschi
- Department of Ophthalmology, Pasteur Hospital, Nice Teaching Hospital, Nice, France
| | - Laurence Rosier
- Eye Clinic, Centre d'Exploration et de Traitement de la Retine et de la Macula, Bordeaux, France
| | - Minh Nguyen
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon; Université Claude Bernard Lyon 1, Lyon, France; UMR5510 MATEIS, CNRS, INSA Lyon, Université Lyon 1, Lyon, France
| | - Nicolas Bonnin
- Department of Ophthalmology, Eye University Clinic Gabriel Montpied, Clermont Ferrand, France
| | - Deborah Aloi
- Department of Radiation Oncology, Proton Therapy Center, Centre Antoine Lacassagne, Nice, France
| | - Lauris Gastaud
- Department of Radiation Oncology, Proton Therapy Center, Centre Antoine Lacassagne, Nice, France
| | - David Gaucher
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - Jean-Pierre Caujolle
- Department of Ophthalmology, Pasteur Hospital, Nice Teaching Hospital, Nice, France
| | - Yann Château
- Department of Radiation Oncology, Proton Therapy Center, Centre Antoine Lacassagne, Nice, France
| | - Joel Herault
- Department of Radiation Oncology, Proton Therapy Center, Centre Antoine Lacassagne, Nice, France
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Jaarsma-Coes MG, Klaassen L, Marinkovic M, Luyten GPM, Vu THK, Ferreira TA, Beenakker JWM. Magnetic Resonance Imaging in the Clinical Care for Uveal Melanoma Patients-A Systematic Review from an Ophthalmic Perspective. Cancers (Basel) 2023; 15:cancers15112995. [PMID: 37296958 DOI: 10.3390/cancers15112995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Conversely to most tumour types, magnetic resonance imaging (MRI) was rarely used for eye tumours. As recent technical advances have increased ocular MRI's diagnostic value, various clinical applications have been proposed. This systematic review provides an overview of the current status of MRI in the clinical care of uveal melanoma (UM) patients, the most common eye tumour in adults. In total, 158 articles were included. Two- and three-dimensional anatomical scans and functional scans, which assess the tumour micro-biology, can be obtained in routine clinical setting. The radiological characteristics of the most common intra-ocular masses have been described extensively, enabling MRI to contribute to diagnoses. Additionally, MRI's ability to non-invasively probe the tissue's biological properties enables early detection of therapy response and potentially differentiates between high- and low-risk UM. MRI-based tumour dimensions are generally in agreement with conventional ultrasound (median absolute difference 0.5 mm), but MRI is considered more accurate in a subgroup of anteriorly located tumours. Although multiple studies propose that MRI's 3D tumour visualisation can improve therapy planning, an evaluation of its clinical benefit is lacking. In conclusion, MRI is a complementary imaging modality for UM of which the clinical benefit has been shown by multiple studies.
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Affiliation(s)
- Myriam G Jaarsma-Coes
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Lisa Klaassen
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Marina Marinkovic
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Gregorius P M Luyten
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - T H Khanh Vu
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Teresa A Ferreira
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Jan-Willem M Beenakker
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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10
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Hickling SV, Corner S, Kruse JJ, Deisher AJ. Design and characterization of an aperture system and spot configuration for ocular treatments with a gantry-based spot scanning proton beam. Med Phys 2023. [PMID: 37084072 DOI: 10.1002/mp.16426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 01/11/2023] [Accepted: 03/23/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND AND PURPOSE Proton therapy is a key modality used in the treatment of ocular melanoma. Traditionally ocular sites are treated using a dedicated eyeline with a passively scattered proton beam and a brass aperture. This work aims to design and characterize a beam-collimating aperture to treat ocular targets with a gantry-based spot scanning proton beam. METHODS A plastic aperture system that slides into the gantry nozzle of a spot scanning proton beam was designed and constructed. It consists of an intermediate scraper layer to attenuate stray protons and a 3D-printed patient-specific aperture positioned 5.7 cm from the surface of the eye. The aperture system was modeled in TOPAS and Monte Carlo simulations were validated with film measurements. Two different spot configurations were investigated for treatment planning and characterized based on lateral penumbra, central axis (CAX) dose and relative efficiency. Alignment and leakage were investigated through experimental film measurements. Range was verified using a multi-layer ionization chamber. Reference dose measurements were made with a PinPoint 3D ion chamber. Neutron dose was evaluated through Monte Carlo simulations. RESULTS Aperture alignment with radiation isocenter was determined to be within 0.31 mm at a gantry angle of 0°. A single-spot configuration with a 10 mm diameter aperture yielded film-measured lateral penumbras of 1 mm to 1.25 mm, depending on depth in the spread-out Bragg peak. TOPAS simulations found that a single spot configuration results in a flat dose distribution for a 10 mm diameter aperture and provides a CAX dose of less than 106% for apertures less than 14 mm in diameter. For larger targets, adding four corner spots to fill in the dose distribution is beneficial. Trade-offs between lateral penumbra, CAX dose and relative efficiency were characterized for different spot configurations and can be used for future clinical decision-making. The aperture was experimentally determined to not affect proton beam range, and no concerning leakage radiation or neutron dose was identified. Reference dose measurements with a PinPoint ion chamber were within 2.1% of Monte Carlo calculated doses. CONCLUSION The aperture system developed in this work provides a method of treating ocular sites on a gantry-based spot scanning proton system. Additional work to develop compatible gaze tracking and gating infrastructure is ongoing.
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Affiliation(s)
- Susannah V Hickling
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Medical Physics, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Stephen Corner
- Division of Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Jon J Kruse
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Amanda J Deisher
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
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11
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Hussain RN, Chiu A, Pittam B, Taktak A, Damato BE, Kacperek A, Errington D, Cauchi P, Chadha V, Connolly J, Salvi S, Rundle P, Cohen V, Arora A, Sagoo M, Bekir O, Kopsidas K, Heimann H. Proton beam radiotherapy for choroidal and ciliary body melanoma in the UK-national audit of referral patterns of 1084 cases. Eye (Lond) 2023; 37:1033-1036. [PMID: 35840716 PMCID: PMC10050435 DOI: 10.1038/s41433-022-02178-0] [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: 03/25/2022] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Proton beam therapy has been utilised for the treatment of uveal melanoma in the UK for over 30 years, undertaken under a single centre. In the UK, all ocular tumours are treated at one of four centres. We aimed to understand the variation in referral patterns to the UK proton service, capturing all uveal melanoma patients treated with this modality. METHODS Retrospective analysis of data regarding all patients treated at the Clatterbridge Proton service between January 2004 and December 2014. RESULTS A total of 1084 patients with uveal melanoma were treated. The mean age was 57 years (range 9-90 years), basal diameter of 11.5 mm (range 2.0-23.4 mm) and tumour thickness of 3.9 mm (range 0.1-15.4 mm). The majority were TNM stage I (39%) or II (36%). The distance to the optic nerve varied from 0 to 24.5 mm with 148 (14%) of patients having ciliary body involvement. There were variations in the phenotypic characteristic of the tumours treated with protons from different centres, with London referring predominantly small tumours at the posterior pole, Glasgow referring large tumours often at the ciliary body and Liverpool sending a mix of these groups. DISCUSSION In the UK, common indications for the use of proton treatment in uveal melanoma include small tumours in the posterior pole poorly accessible for plaque treatment (adjacent to the disc), tumours at the posterior pole affecting the fovea and large anterior tumours traditionally too large for brachytherapy. This is the first UK-wide audit enabling the capture of all patients treated at the single proton centre.
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Affiliation(s)
- R N Hussain
- Liverpool Ocular Oncology Centre, Royal Liverpool Hospital, Liverpool, L7 8XP, UK.
| | - A Chiu
- Liverpool Ocular Oncology Centre, Royal Liverpool Hospital, Liverpool, L7 8XP, UK
| | - B Pittam
- Liverpool Ocular Oncology Centre, Royal Liverpool Hospital, Liverpool, L7 8XP, UK
| | - A Taktak
- Department of Eye and Vision Science and Department of Biostatistics, University of Liverpool, Liverpool, L69 3GL, UK
| | - B E Damato
- Ocular Oncology Service, Moorfields Eye Hospital, London, EC1V 2PD, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, EC1V 2PD, UK
| | - A Kacperek
- University College London, London, WC1E 6BT, UK
| | - D Errington
- Clatterbridge Cancer Centre, Clatterbridge Road, Bebington, Wirral, CH63 4JY, UK
| | - P Cauchi
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - V Chadha
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - J Connolly
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - S Salvi
- The National Sheffield Ocular Oncology Service, Royal Hallamshire Hospital, S10 2JF, Sheffield, UK
| | - P Rundle
- The National Sheffield Ocular Oncology Service, Royal Hallamshire Hospital, S10 2JF, Sheffield, UK
| | - V Cohen
- Ocular Oncology Service, Moorfields Eye Hospital, London, EC1V 2PD, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, EC1V 2PD, UK
| | - A Arora
- Ocular Oncology Service, Moorfields Eye Hospital, London, EC1V 2PD, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, EC1V 2PD, UK
| | - M Sagoo
- Ocular Oncology Service, Moorfields Eye Hospital, London, EC1V 2PD, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, EC1V 2PD, UK
| | - O Bekir
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - K Kopsidas
- The National Sheffield Ocular Oncology Service, Royal Hallamshire Hospital, S10 2JF, Sheffield, UK
| | - H Heimann
- Liverpool Ocular Oncology Centre, Royal Liverpool Hospital, Liverpool, L7 8XP, UK
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12
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Trofimov AV, Aronow ME, Gragoudas ES, Keane FK, Kim IK, Shih HA, Bhagwat MS. A Systematic Comparison of Dose Distributions Delivered in 125I Plaque Brachytherapy and Proton Radiation Therapy for Ocular Melanoma. Int J Radiat Oncol Biol Phys 2023; 115:501-510. [PMID: 35878716 DOI: 10.1016/j.ijrobp.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE To characterize dose distributions with 125I plaque brachytherapy compared with proton radiation therapy for ocular melanoma for relevant clinical scenarios, based on tumor base diameter (d), apical height (h), and location. METHODS AND MATERIALS Plaque and proton treatment plans were created for 4 groups of cases: (1) REF: 39 instances of reference midsize circular-base tumor (d = 12 mm, h = 5 mm), in locations varying by retinal clock hours and distance to fovea, optic disc, and corneal limbus; (2) SUP: 25 superiorly located; (3) TEMP: 25 temporal; and (4) NAS: 25 nasally located tumors that were a fixed distance from the fovea but varying in d (6-18 mm) and h (3-11 mm). For both modalities, 111 unique scenarios were characterized in terms of the distance to points of interest, doses delivered to fovea, optic disc, optic nerve at 3 mm posterior to the disc (ON@3mm), lens, and retina. Comparative statistical evaluation was performed with the Mann-Whitney U test. RESULTS Superior dose distributions favored plaque for sparing of (1) fovea in large (d + h ≥ 21 mm) NAS tumors; (2) ON@3mm in REF cases located ≤4 disc diameters from disc, and in NAS overall. Protons achieved superior dose sparing of (1) fovea and optic disc in REF, SUP, and TEMP; (2) ON@3mm in REF >4 disc diameters from disc, and in SUP and TEMP; and (3) the lens center overall and lens periphery in REF ≤6 mm from the corneal limbus, and in TEMP with h = 3 mm. Although protons could completely spare sections of the retina, plaque dose was more target conformal in the high-dose range (50% and 90% of prescription dose). CONCLUSIONS Although comparison between plaque and proton therapy is not straightforward because of the disparity in dose rate, prescriptions, applicators, and delivery techniques, it is possible to identify distinctions between dose distributions, which could help inform decisions by providers and patients.
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Affiliation(s)
- Alexei V Trofimov
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Mary E Aronow
- Ocular Melanoma Center, Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Evangelos S Gragoudas
- Ocular Melanoma Center, Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Florence K Keane
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ivana K Kim
- Ocular Melanoma Center, Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Helen A Shih
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mandar S Bhagwat
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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13
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Jaarsma-Coes MG, Ferreira TA, Marinkovic M, Vu THK, van Vught L, van Haren GR, Rodrigues MF, Klaver YLB, Verbist BM, Luyten GPM, Rasch CRN, Beenakker JWM. Comparison of Magnetic Resonance Imaging-Based and Conventional Measurements for Proton Beam Therapy of Uveal Melanoma. Ophthalmol Retina 2023; 7:178-188. [PMID: 35840053 DOI: 10.1016/j.oret.2022.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Conventionally, ocular proton therapy (PT) is planned using measurements obtained by an ophthalmologist using ultrasound, fundoscopy, biometry, and intraoperative assessments. Owing to the recent advances in magnetic resonance imaging (MRI) of uveal melanoma (UM), it is possible to acquire high-resolution 3-dimensional images of the eye, providing the opportunity to incorporate MRI in ocular PT planning. In this study, we described how these measurements can be obtained using MRI, compared the MRI-based measurements with conventional ophthalmic measurements, and identified potential pitfalls for both modalities. DESIGN Cross-sectional study. SUBJECTS Data from 23 consecutive patients with UM treated with PT were retrospectively evaluated. METHODS Magnetic resonance imaging-based measurements of axial length, tumor height and basal diameter, and marker-tumor distances were compared with the conventional ophthalmic measurements, and discrepancies were evaluated in a multidisciplinary setting. MAIN OUTCOME MEASURES Tumor prominence and basal diameters on MRI and ultrasound, axial length on MRI and biometry, tumor-marker distances on MRI and measured intraoperatively. RESULTS The mean absolute differences of the tumor height and basal diameter measurements between ultrasound and MRI were 0.57 mm and 1.44 mm, respectively. Larger absolute differences in height and basal diameter were observed when the full tumor extent was not visible on ultrasound (0.92 mm and 1.67 mm, respectively) compared with when the full tumor extent was visible (0.44 mm and 1.15 mm, respectively). When the full tumor was not visible on ultrasound, MRI was considered more reliable. Tumor-marker distances measured using MRI and intraoperative techniques differed < 1 mm in 55% of the markers. For anteriorly located and mushroom-shaped tumors (25% of the markers), MRI provided more accurate measurements. In flat UM (15% of the markers), however, it was difficult to delineate the tumor on MRI. The mean absolute difference in axial length between optical biometry and MRI was 0.50 mm. The presence of the tumor was found to influence optical biometry in 15 of 22 patients; the remaining patients showed a better agreement (0.30 mm). Magnetic resonance imaging-based biometry was considered more reliable in patients with UM. CONCLUSIONS Magnetic resonance imaging allowed for the 3-dimensional assessment of the tumor and surrounding tissue. In specific patients, it provided a more reliable measurement of axial length, tumor dimensions, and marker-tumor distances and could contribute to a more accurate treatment planning. Nevertheless, a combined evaluation remains advised, especially for flat UM.
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Affiliation(s)
- Myriam G Jaarsma-Coes
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Teresa A Ferreira
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marina Marinkovic
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - T H Khanh Vu
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Luc van Vught
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Guido R van Haren
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Myra F Rodrigues
- HollandPTC, Delft, The Netherlands; Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvonne L B Klaver
- HollandPTC, Delft, The Netherlands; Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Berit M Verbist
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; HollandPTC, Delft, The Netherlands
| | - Gregorius P M Luyten
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Coen R N Rasch
- HollandPTC, Delft, The Netherlands; Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan-Willem M Beenakker
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
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14
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Wulff J, Koska B, Heufelder J, Janson M, Bäcker CM, Siregar H, Behrends C, Bäumer C, Foerster A, Bechrakis NE, Timmermann B. Commissioning and validation of a novel commercial TPS for ocular proton therapy. Med Phys 2023; 50:365-379. [PMID: 36195575 DOI: 10.1002/mp.16006] [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: 07/05/2022] [Revised: 09/08/2022] [Accepted: 09/21/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Until today, the majority of ocular proton treatments worldwide were planned with the EYEPLAN treatment planning system (TPS). Recently, the commercial, computed tomography (CT)-based TPS for ocular proton therapy RayOcular was released, which follows the general concepts of model-based treatment planning approach in conjunction with a pencil-beam-type dose algorithm (PBA). PURPOSE To validate RayOcular with respect to two main features: accurate geometrical representation of the eye model and accuracy of its dose calculation algorithm in combination with an Ion Beam Applications (IBA) eye treatment delivery system. METHODS Different 3D-printed eye-ball-phantoms were fabricated to test the geometrical representation of the corresponding CT-based model, both in orthogonal 2D images for X-ray image overlay and in fundus view overlaid with a funduscopy. For the latter, the phantom was equipped with a lens matching refraction of the human eye. Funduscopy was acquired in a Zeiss Claus 500 camera. Tantalum clips and fiducials attached to the phantoms were localized in the TPS model, and residual deviations to the actual position in X-ray images for various orientations of the phantom were determined, after the nominal eye orientation was corrected in RayOcular to obtain a best overall fit. In the fundus view, deviations between known and displayed distances were measured. Dose calculation accuracy of the PBA on a 0.2 mm grid was investigated by comparing between measured lateral and depth-dose profiles in water for various combinations of range, modulation, and field-size. Ultimately, the modeling of dose distributions behind wedges was tested. A 1D gamma-test was applied, and the lateral and distal penumbra were further compared. RESULTS Average residuals between model clips and visible clips/fiducials in orthogonal X-ray images were within 0.3 mm, including different orientations of the phantom. The differences between measured distances on the registered funduscopy image in the RayOcular fundus view and the known ground-truth were within 1 mm up to 10.5 mm distance from the posterior pole. No clear benefit projection of either polar mode or camera mode could be identified, the latter mimicking camera properties. Measured dose distributions were reproduced with gamma-test pass-rates of >95% with 2%/0.3 mm for depth and lateral profiles in the middle of spread-out Bragg-peaks. Distal falloff and lateral penumbra were within 0.2 mm for fields without a wedge. For shallow depths, the agreement was worse, reaching pass-rates down to 80% with 5%/0.3 mm when comparing lateral profiles in air. This is caused by low-energy protons from a scatter source in the IBA system not modeled by RayOcular. Dose distributions modified by wedges were reproduced, matching the wedge-induced broadening of the lateral penumbra to within 0.4 mm for the investigated cases and showing the excess dose within the field due to wedge scatter. CONCLUSION RayOcular was validated for its use with an IBA single scattering delivery nozzle. Geometric modeling of the eye and representation of 2D projections fulfill clinical requirements. The PBA dose calculation reproduces measured distributions and allows explicit handling of wedges, overcoming approximations of simpler dose calculation algorithms used in other systems.
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Affiliation(s)
- Jörg Wulff
- West German Proton Therapy Centre (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ), Essen, Germany
| | - Benjamin Koska
- West German Proton Therapy Centre (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ), Essen, Germany
| | - Jens Heufelder
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Charité-Universitätsmedizin Berlin, BerlinProtonen am Helmholtz-Zentrum Berlin für Materialien und Energie, Berlin, Germany
| | | | - Claus Maximilian Bäcker
- West German Proton Therapy Centre (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany
| | - Hilda Siregar
- West German Proton Therapy Centre (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany
| | - Carina Behrends
- West German Proton Therapy Centre (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany.,Department of Physics, TU Dortmund University, Dortmund, Germany
| | - Christian Bäumer
- West German Proton Therapy Centre (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ), Essen, Germany.,Department of Physics, TU Dortmund University, Dortmund, Germany.,German Cancer Consortium (DKTK), Essen, Germany
| | - Andreas Foerster
- University Hospital Essen, Essen, Germany.,Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Nikolaos E Bechrakis
- University Hospital Essen, Essen, Germany.,Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Beate Timmermann
- West German Proton Therapy Centre (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ), Essen, Germany.,German Cancer Consortium (DKTK), Essen, Germany.,Department of Particle Therapy, University Hospital Essen, Essen, Germany
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15
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Jaarsma-Coes MG, Klaassen L, Verbist BM, Vu TK, Klaver YL, Rodrigues MF, Nabarro C, Luyten GP, Rasch CR, van Herk M, Beenakker JWM. Inter-Observer Variability in MR-Based Target Volume Delineation of Uveal Melanoma. Adv Radiat Oncol 2022; 8:101149. [PMID: 36691449 PMCID: PMC9860418 DOI: 10.1016/j.adro.2022.101149] [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: 06/16/2022] [Accepted: 12/14/2022] [Indexed: 12/26/2022] Open
Abstract
Purpose Several efforts are being undertaken toward MRI-based treatment planning for ocular proton therapy for uveal melanoma (UM). The interobserver variability of the gross target volume (GTV) on magnetic resonance imaging (MRI) is one of the important parameters to design safety margins for a reliable treatment. Therefore, this study assessed the interobserver variation in GTV delineation of UM on MRI. Methods and Materials Six observers delineated the GTV in 10 different patients using the Big Brother contouring software. Patients were scanned at 3T MRI with a surface coil, and tumors were delineated separately on contrast enhanced 3DT1 (T1gd) and 3DT2-weighted scans with an isotropic acquisition resolution of 0.8 mm. Volume difference and overall local variation (median standard deviation of the distance between the delineated contours and the median contour) were analyzed for each GTV. Additionally, the local variation was analyzed for 4 interfaces: sclera, vitreous, retinal detachment, and tumor-choroid interface. Results The average GTV was significantly larger on T1gd (0.57cm3) compared with T2 (0.51cm3, P = .01). A not significant higher interobserver variation was found on T1gd (0.41 mm) compared with T2 (0.35 mm). The largest variations were found at the tumor-choroid interface due to peritumoral enhancement (T1gd, 0.62 mm; T2, 0.52 mm). As a result, a larger part of this tumor-choroid interface appeared to be included on T1gd-based GTVs compared with T2, explaining the smaller volumes on T2. Conclusions The interobserver variation of 0.4 mm on MRI are low with respect to the voxel size of 0.8 mm, enabling small treatment margins. We recommend delineation based on the T1gd-weighted scans, as choroidal tumor extensions might be missed.
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Affiliation(s)
- Myriam G. Jaarsma-Coes
- Leiden University Medical Center, Ophthalmology, Leiden, Netherlands,Leiden University Medical Center, Radiology, Leiden, Netherlands
| | - Lisa Klaassen
- Leiden University Medical Center, Ophthalmology, Leiden, Netherlands,Leiden University Medical Center, Radiology, Leiden, Netherlands
| | - Berit M. Verbist
- Leiden University Medical Center, Radiology, Leiden, Netherlands
| | - T.H. Khanh Vu
- Leiden University Medical Center, Ophthalmology, Leiden, Netherlands
| | - Yvonne L.B. Klaver
- HollandPTC, Radiation oncology, Delft, Netherlands,Leiden University Medical Center, Radiation Oncology, Leiden, Netherlands
| | - Myra F. Rodrigues
- HollandPTC, Radiation oncology, Delft, Netherlands,Leiden University Medical Center, Radiation Oncology, Leiden, Netherlands
| | - Claire Nabarro
- Leiden University Medical Center, Radiology, Leiden, Netherlands
| | | | - Coen R.N. Rasch
- HollandPTC, Radiation oncology, Delft, Netherlands,Leiden University Medical Center, Radiation Oncology, Leiden, Netherlands
| | - Marcel van Herk
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Jan-Willem M. Beenakker
- Leiden University Medical Center, Ophthalmology, Leiden, Netherlands,Leiden University Medical Center, Radiology, Leiden, Netherlands,Leiden University Medical Center, Radiation Oncology, Leiden, Netherlands,Corresponding author: Jan-Willem M. Beenakker
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16
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Lane AM, Oxenreiter MM, Hashmi M, Aronow ME, Trofimov AV, Shih HA, Gragoudas ES, Kim IK. A Comparison of Treatment Outcomes after Standard Dose (70 Gy) versus Reduced Dose (50 Gy) Proton Radiation in Patients with Uveal Melanoma. Ophthalmol Retina 2022; 6:1089-1097. [PMID: 35589076 DOI: 10.1016/j.oret.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/07/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To compare outcomes in a large patient cohort with small-medium tumors located within 1 disc diameter (DD) of the optic nerve and/or fovea treated with 50 Gy or 70 Gy proton therapy. DESIGN Retrospective cohort study. SUBJECTS A total of 1120 patients with uveal melanomas ≤ 15 mm in largest basal diameter, ≤ 5 mm in height, located within 1 DD of the optic nerve and/or fovea, who received primary treatment with protons between 1975 and 2016 at Massachusetts Eye and Ear/Massachusetts General Hospital. METHODS The rates of outcomes were estimated using the Kaplan-Meier method. Differences between the radiation dose groups were tested using the log-rank test. MAIN OUTCOME MEASURES Local tumor recurrence, melanoma-related mortality, and visual acuity preservation (≥ 20/200, ≥ 20/40). RESULTS Local tumor recurrence was observed in 1.8% of the 50 Gy group and 1.5% of the 70 Gy group. The median time to recurrence was 30.7 months for patients treated with 50 Gy and 32.0 months for those treated with 70 Gy (P = 0.28). Five-year rates of vision retention (≥20/40, ≥ 20/200) were 19.4% and 49.3% for patients treated with 50 Gy and 16.4% and 40.7% in those treated with 70 Gy. Ten-year rates of melanoma-related mortality were 8.4% in the 50 Gy group and 8.9% in the 70 Gy group (P = 0.47). CONCLUSIONS Comparable rates of local control are achieved treating small-medium tumors near the optic nerve and/or fovea with 50 Gy or 70 Gy proton therapy, supporting the use of the lower dose in patients with these tumor characteristics.
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Affiliation(s)
- Anne Marie Lane
- Ocular Melanoma Center, Retina Service, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Monica M Oxenreiter
- Ocular Melanoma Center, Retina Service, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Mustafa Hashmi
- Ocular Melanoma Center, Retina Service, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Mary E Aronow
- Ocular Melanoma Center, Retina Service, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Alexei V Trofimov
- Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Helen A Shih
- Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Evangelos S Gragoudas
- Ocular Melanoma Center, Retina Service, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Ivana K Kim
- Ocular Melanoma Center, Retina Service, Massachusetts Eye and Ear, Boston, Massachusetts.
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17
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Klaassen L, Jaarsma-Coes MG, Verbist BM, Vu TK, Marinkovic M, Rasch CR, Luyten GP, Beenakker JWM. Automatic Three-Dimensional Magnetic Resonance-based measurements of tumour prominence and basal diameter for treatment planning of uveal melanoma. Phys Imaging Radiat Oncol 2022; 24:102-110. [PMID: 36386446 PMCID: PMC9649381 DOI: 10.1016/j.phro.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/07/2022] Open
Abstract
Background and Purpose Three-dimensional (3D) Magnetic Resonance Imaging (MRI) is increasingly used to complement conventional two-dimensional ultrasound in the assessment of tumour dimension measurement of uveal melanoma. However, the lack of definitions of the 3D measurements of these tumour dimensions hinders further adaptation of MRI in ocular radiotherapy planning. In this study, we composed 3D MR-based definitions of tumour prominence and basal diameter and compared them to conventional ultrasound. Materials and methods Tumours were delineated on 3DT2 and contrast-enhanced 3DT1 (T1gd) MRI for 25 patients. 3D definitions of tumour prominence and diameter were composed and evaluated automatically on the T1gd and T2 contours. Automatic T1gd measurements were compared to manual MRI measurements, to automatic T2 measurements and to manual ultrasound measurements. Results Prominence measurements were similar for all modalities (median absolute difference 0.3 mm). Automatic T1gd diameter measurements were generally larger than manual MRI, automatic T2 and manual ultrasound measurements (median absolute differences of 0.5, 1.6 and 1.1 mm respectively), mainly due to difficulty defining the axis of the largest diameter. Largest differences between ultrasound and MRI for both prominence and diameter were found in anteriorly located tumours (up to 1.6 and 4.5 mm respectively), for which the tumour extent could not entirely be visualized with ultrasound. Conclusions The proposed 3D definitions for tumour prominence and diameter agreed well with ultrasound measurements for tumours for which the extent was visible on ultrasound. 3D MRI measurements generally provided larger diameter measurements than ultrasound. In anteriorly located tumours, the MRI measurements were considered more accurate than conventional ultrasound.
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Affiliation(s)
- Lisa Klaassen
- Leiden University Medical Center, Department of Ophthalmology, PO Box 9600, 2300 RC Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiology, PO Box 9600, 2300 RC Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiation Oncology, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Myriam G. Jaarsma-Coes
- Leiden University Medical Center, Department of Ophthalmology, PO Box 9600, 2300 RC Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiology, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Berit M. Verbist
- Leiden University Medical Center, Department of Radiology, PO Box 9600, 2300 RC Leiden, the Netherlands
- Holland Particle Therapy Center, PO Box 110, 2600 AC Delft, the Netherlands
| | - T.H. Khanh Vu
- Leiden University Medical Center, Department of Ophthalmology, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Marina Marinkovic
- Leiden University Medical Center, Department of Ophthalmology, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Coen R.N. Rasch
- Leiden University Medical Center, Department of Radiation Oncology, PO Box 9600, 2300 RC Leiden, the Netherlands
- Holland Particle Therapy Center, PO Box 110, 2600 AC Delft, the Netherlands
| | - Gregorius P.M. Luyten
- Leiden University Medical Center, Department of Ophthalmology, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Jan-Willem M. Beenakker
- Leiden University Medical Center, Department of Ophthalmology, PO Box 9600, 2300 RC Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiology, PO Box 9600, 2300 RC Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiation Oncology, PO Box 9600, 2300 RC Leiden, the Netherlands
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18
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Via R, Pica A, Antonioli L, Paganelli C, Fattori G, Spaccapaniccia C, Lomax A, Weber DC, Schalenbourg A, Baroni G, Hrbacek J. MRI and FUNDUS image fusion for improved ocular biometry in Ocular Proton Therapy. Radiother Oncol 2022; 174:16-22. [PMID: 35788353 DOI: 10.1016/j.radonc.2022.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/06/2022] [Accepted: 06/24/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Ocular biometry in Ocular Proton Therapy (OPT) currently relies on a generic geometrical eye model built by referencing surgically implanted markers. An alternative approach based on image fusion of volumetric Magnetic Resonance Imaging (MRI) and panoramic fundus photography was investigated. MATERIALS AND METHODS Eighteen non-consecutive uveal melanoma (UM) patients, who consented for an MRI and had their tumour base visible on panoramic fundus photography, were included in this comparative analysis. Through generating digitally-reconstructed projections from MRI images using the Lambert azimuthal equal-area projection, 2D-3D image fusion between fundus photography and an eye model delineated on MRI scans was achieved and allowed for a novel definition of the target base (MRI + FCTV). MRI + FCTV was compared with MRI-only delineation (MRIGTV) and the conventional (EyePlan) target definition (EPCTV). RESULTS The combined use of fundus photography and MRI to define tumour volumes reduced the average discrepancies by almost 65% with respect to the MRI only tumour definitions when comparing with the conventionally planned EPCTV. With the proposed method, shallow sub-retinal tumour infiltration, otherwise invisible on MRI, can be included in the target volume definition. Moreover, a novel definition of the fovea location improves the accuracy and personalisation of the 3D eye model. CONCLUSION MRI and fundus image fusion overcomes some of the limitations of ophthalmological MRI for tumour volume definition in OPT. This novel eye tumour modelling method might improve treatment planning personalisation, allowing to better anticipate which patients could benefit from prophylactic treatment protocols for radiation induced maculopathy.
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Affiliation(s)
- Riccardo Via
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland.
| | - Alessia Pica
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland
| | - Luca Antonioli
- Dipartimento di Elettronica Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy
| | - Chiara Paganelli
- Dipartimento di Elettronica Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy
| | - Giovanni Fattori
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland
| | - Chiara Spaccapaniccia
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland
| | - Antony Lomax
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland
| | - Damien Charles Weber
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland; Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; Department of Radiation Oncology, University Hospital Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Ann Schalenbourg
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, FAA, Lausanne, Switzerland
| | - Guido Baroni
- Department of Radiation Oncology, University Hospital Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Jan Hrbacek
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland
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19
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Volz L, Sheng Y, Durante M, Graeff C. Considerations for Upright Particle Therapy Patient Positioning and Associated Image Guidance. Front Oncol 2022; 12:930850. [PMID: 35965576 PMCID: PMC9372451 DOI: 10.3389/fonc.2022.930850] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022] Open
Abstract
Particle therapy is a rapidly growing field in cancer therapy. Worldwide, over 100 centers are in operation, and more are currently in construction phase. The interest in particle therapy is founded in the superior target dose conformity and healthy tissue sparing achievable through the particles’ inverse depth dose profile. This physical advantage is, however, opposed by increased complexity and cost of particle therapy facilities. Particle therapy, especially with heavier ions, requires large and costly equipment to accelerate the particles to the desired treatment energy and steer the beam to the patient. A significant portion of the cost for a treatment facility is attributed to the gantry, used to enable different beam angles around the patient for optimal healthy tissue sparing. Instead of a gantry, a rotating chair positioning system paired with a fixed horizontal beam line presents a suitable cost-efficient alternative. Chair systems have been used already at the advent of particle therapy, but were soon dismissed due to increased setup uncertainty associated with the upright position stemming from the lack of dedicated image guidance systems. Recently, treatment chairs gained renewed interest due to the improvement in beam delivery, commercial availability of vertical patient CT imaging and improved image guidance systems to mitigate the problem of anatomical motion in seated treatments. In this review, economical and clinical reasons for an upright patient positioning system are discussed. Existing designs targeted for particle therapy are reviewed, and conclusions are drawn on the design and construction of chair systems and associated image guidance. Finally, the different aspects from literature are channeled into recommendations for potential upright treatment layouts, both for retrofitting and new facilities.
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Affiliation(s)
- Lennart Volz
- Biophysics, GSI Helmholtz Center for Heavy Ion Research GmbH, Darmstadt, Germany.,Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Yinxiangzi Sheng
- Biophysics, GSI Helmholtz Center for Heavy Ion Research GmbH, Darmstadt, Germany.,Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Marco Durante
- Biophysics, GSI Helmholtz Center for Heavy Ion Research GmbH, Darmstadt, Germany.,Institute of Condensed Matter Physics, Technical University of Darmstadt, Darmstadt, Germany
| | - Christian Graeff
- Biophysics, GSI Helmholtz Center for Heavy Ion Research GmbH, Darmstadt, Germany.,Institute of Electrical Engineering and Information Technology, Technical University of Darmstadt, Darmstadt, Germany
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20
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Hérault J, Gérard A, Carnicer A, Aloi D, Peyrichon ML, Barnel C, Vidal M, Angellier G, Fayaud D, Grini JC, Giusto A, Armando C, Donadey G, Cabannes M, Dumas S, Payan Y, Di Carlo JF, Salicis C, Bergerot JM, Rolion M, Trimaud R, Hofverberg P, Mandrillon P, Sauerwein W, Thariat J. 30 years of ocular proton therapy, the Nice view. Cancer Radiother 2022; 26:1016-1026. [PMID: 35803860 DOI: 10.1016/j.canrad.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/15/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE Radiotherapy with protons (PT) is a standard treatment of ocular tumors. It achieves excellent tumor control, limited toxicities, and the preservation of important functional outcomes, such as vision. Although PT may appear as one homogenous technique, it can be performed using dedicated ocular passive scattering PT or, increasingly, Pencil Beam Scanning (PBS), both with various degrees of patient-oriented customization. MATERAIAL AND METHODS MEDICYC PT facility of Nice are detailed with respect to their technical, dosimetric, microdosimetric and radiobiological, patient and tumor-customization process of PT planning and delivery that are key. 6684 patients have been treated for ocular tumors (1991-2020). Machine characteristics (accelerator, beam line, beam monitoring) allow efficient proton extraction, high dose rate, sharp lateral and distal penumbrae, and limited stray radiation in comparison to beam energy reduction and subsequent straggling with high-energy PBS PT. Patient preparation before PT includes customized setup and image-guidance, CT-based planning, and ocular PT software modelling of the patient eye with integration of beam modifiers. Clinical reports have shown excellent tumor control rates (∼95%), vision preservation and limited toxicity rates (papillopathy, retinopathy, neovascular glaucoma, dry eye, madarosis, cataract). RESULTS Although demanding, dedicated ocular PT has proven its efficiency in achieving excellent tumor control, OAR sparing and patient radioprotection. It is therefore worth adaptations of the equipments and practice. CONCLUSIONS Some of these adaptations can be transferred to other PT centers and should be acknowledeged when using non-PT options.
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Affiliation(s)
- J Hérault
- Institut Méditerranéen de ProtonThérapie, Centre Antoine Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France.
| | - A Gérard
- Institut Méditerranéen de ProtonThérapie, Centre Antoine Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
| | - A Carnicer
- IDOM Consulting, Engineering, Architecture, Avinguda de la Fama, 11-15, Arboretum Business Park, Arce Building, 08940 Cornellà de Llobregat, Barcelona, Spain
| | - D Aloi
- Institut Méditerranéen de ProtonThérapie, Centre Antoine Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
| | - M-L Peyrichon
- Institut Méditerranéen de ProtonThérapie, Centre Antoine Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
| | - C Barnel
- Institut Méditerranéen de ProtonThérapie, Centre Antoine Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
| | - M Vidal
- Institut Méditerranéen de ProtonThérapie, Centre Antoine Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
| | - G Angellier
- Institut Méditerranéen de ProtonThérapie, Centre Antoine Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
| | - D Fayaud
- Institut Méditerranéen de ProtonThérapie, Centre Antoine Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
| | - J-C Grini
- Institut Méditerranéen de ProtonThérapie, Centre Antoine Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
| | - A Giusto
- Institut Méditerranéen de ProtonThérapie, Centre Antoine Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
| | - C Armando
- Institut Méditerranéen de ProtonThérapie, Centre Antoine Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
| | - G Donadey
- Institut Méditerranéen de ProtonThérapie, Centre Antoine Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
| | - M Cabannes
- Institut Méditerranéen de ProtonThérapie, Centre Antoine Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
| | - S Dumas
- Institut Méditerranéen de ProtonThérapie, Centre Antoine Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
| | - Y Payan
- Institut Méditerranéen de ProtonThérapie, Centre Antoine Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
| | - J-F Di Carlo
- Institut Méditerranéen de ProtonThérapie, Centre Antoine Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
| | - C Salicis
- Institut Méditerranéen de ProtonThérapie, Centre Antoine Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
| | - J-M Bergerot
- Institut Méditerranéen de ProtonThérapie, Centre Antoine Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
| | - M Rolion
- Institut Méditerranéen de ProtonThérapie, Centre Antoine Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
| | - R Trimaud
- Institut Méditerranéen de ProtonThérapie, Centre Antoine Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
| | - P Hofverberg
- Institut Méditerranéen de ProtonThérapie, Centre Antoine Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
| | - P Mandrillon
- AIMA Development, 227, avenue de la Lanterne, 06200 Nice, France
| | - W Sauerwein
- NCTeam, Strahlenklinik, Universitätsklinikum Essen, Hufelandstraße 55, 45122 Essen, Germany
| | - J Thariat
- Department of Radiation Oncology, Centre François Baclesse, 14000 Caen, France; Laboratoire de Physique Corpusculaire IN2P3/ENSICAEN-UMR6534-Unicaen-Normandie Université, 14000 Caen, France
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21
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Gerard A, Peyrichon M, Vidal M, Barnel C, Sauerwein W, Carnicer A, Angellier G, Mathis T, Mishra K, Thariat J, Herault J. Ocular proton therapy, pencil beam scanning high energy proton therapy or stereotactic radiotherapy for uveal melanoma; an in silico study. Cancer Radiother 2022; 26:1027-1033. [PMID: 35803862 DOI: 10.1016/j.canrad.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/23/2022] [Accepted: 03/30/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE In radiotherapy, the dose and volumes of the irradiated normal tissues is correlated to the complication rate. We assessed the performances of low-energy proton therapy (ocular PT) with eye-dedicated equipment, high energy PT with pencil-beam scanning (PBS) or CyberKnifeR -based stereotactic irradiation (SBRT). MATERIAL AND METHODS CT-based comparative dose distribution between external beam radiotherapy techniques was assessed using an anthropomorphic head phantom. The prescribed dose was 60Gy_RBE in 4 fractions to a typical posterior pole uveal melanoma. Clinically relevant structures were delineated, and doses were calculated using radiotherapy treatment planning softwares and measured using Gafchromic dosimetry films inserted at the ocular level. RESULTS Precision was significantly better with ocular PT than both PBS or SBRT in terms of beam penumbra (80%-20%: laterally 1.4 vs. ≥10mm, distally 0.8 vs. ≥2.5mm). Ocular PT duration was shorter, allowing eye gating and lid sparing more easily. Tumor was excellent with all modalities, but ocular PT resulted in more homogenous and conformal dose compared to PBS or SBRT. The maximal dose to ocular/orbital structures at risk was smaller and often null with ocular PT compared to other modalities. Mean dose to ocular/orbital structures was also lower with ocular PT. Structures like the lids and lacrimal punctum could be preserved with ocular PT using gaze orientation and lid retractors, which is easier to implement clinically than with the other modalities. The dose to distant organs was null with ocular PT and PBS, in contrast to SBRT. CONCLUSIONS ocular PT showed significantly improved beam penumbra, shorter treatment delivery time, better dose homogeneity, and reduced maximal/mean doses to critical ocular structures compared with other current external beam radiation modalities. Similar comparisons may be warranted for other tumor presentations.
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22
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Fleury E, Trnková P, van Rij C, Rodrigues M, Klaver Y, Spruijt K, Naus N, Zolnay A, Pignol JP, Kiliç E, Hoogeman MS. Improving Organs-at-Risk Sparing for Choroidal Melanoma Patients: A CT-based Two-Beam Strategy in Ocular Proton Therapy with a Dedicated Eyeline. Radiother Oncol 2022; 171:173-181. [PMID: 35487435 DOI: 10.1016/j.radonc.2022.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE To investigate the potential clinical benefit of a two-beam arrangement technique using three-dimensional (3D) imaging of uveal melanoma (UM) patients treated with proton therapy and a dedicated eyeline. MATERIAL/METHODS Retrospective CT-based treatment plans of 39 UM patients performed using a single beam (SB) were compared to plans with two beams (TB) optimized for better trade-offs in organs-at-risk sparing. The RBE-weighted prescribed dose was 60 Gy (DRBE, GTV = 60 Gy) in four fractions, assuming an RBE of 1.1. Dosimetric findings were analyzed for three patient groups based on tumor-optic nerve distance and UM staging (group GrA: ≤ 3 mm, T1 T2 UM; GrB: ≤ 3 mm, T3 UM; GrC: > 3 mm, T1 T2 T3 UM). Finally, two schedules were compared on biologically effective dose (BED): both beams being delivered either the same day (TB) or on alternate days (TBalter). RESULTS All strategies resulted in dosimetrically acceptable plans. A dose reduction to the anterior structures was achieved in 23/39 cases with the two-beam plans. D25% was significantly lowered compared to SB plans by 12.4 and 15.4 Gy RBE-weighted median dose in GrA and GrB, respectively. D2% was reduced by 18.6 and 6.0 Gy RBE-weighted median dose in GrA and GrB, respectively. A cost to the optic nerve was observed with a median difference up to 3.8 Gy RBE-weighted dose in GrB. BED differences were statistically significant for all considered parameters in favor of two beams delivered the same day. CONCLUSION A two-beam strategy appears beneficial for posterior tumors abutting the optic nerve. This strategy might have a positive impact on the risk of ocular complications.
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Affiliation(s)
- Emmanuelle Fleury
- Erasmus Medical Center, Cancer Institute, Department of Radiotherapy, Rotterdam, The Netherlands; Holland Proton Therapy Center, Delft, The Netherlands.
| | - Petra Trnková
- Erasmus Medical Center, Cancer Institute, Department of Radiotherapy, Rotterdam, The Netherlands; Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria
| | - Caroline van Rij
- Erasmus Medical Center, Cancer Institute, Department of Radiotherapy, Rotterdam, The Netherlands; Erasmus Medical Center, Department of Ophthalmology, Rotterdam, The Netherlands
| | | | - Yvonne Klaver
- Holland Proton Therapy Center, Delft, The Netherlands
| | - Kees Spruijt
- Holland Proton Therapy Center, Delft, The Netherlands
| | - Nicole Naus
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, The Netherlands
| | - Andras Zolnay
- Erasmus Medical Center, Cancer Institute, Department of Radiotherapy, Rotterdam, The Netherlands
| | | | - Emine Kiliç
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, The Netherlands; Erasmus Medical Center, Department of Clinical Genetics, Rotterdam, The Netherlands
| | - Mischa S Hoogeman
- Erasmus Medical Center, Cancer Institute, Department of Radiotherapy, Rotterdam, The Netherlands; Holland Proton Therapy Center, Delft, The Netherlands
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23
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Wulff J, Koska B, Janson M, Bäumer C, Denker A, Geismar D, Gollrad J, Timmermann B, Heufelder J. Technical Note: Impact of Beam Properties for Uveal Melanoma Proton Therapy - An In-Silico Planning Study. Med Phys 2022; 49:3481-3488. [PMID: 35218037 DOI: 10.1002/mp.15573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate the impact of beam quality in terms of distal fall-off (DFO, 90% to 10%) and lateral penumbra (LP, 80% to 20%) of single beam ocular proton treatment (OPT) and to derive resulting ideal requirements for future systems. METHODS Nine different beam models with DFO varying between 1 mm and 4 mm and LP between 1 mm and 4 mm were created. Beam models were incorporated into the RayStation with RayOcular TPS version 10 B (RaySearch Laboratories, Sweden). Each beam model was applied for eight typical clinical cases, covering different sizes and locations of uveal melanoma. Plans with and without an additional wedge were created, resulting in 117 plans with a total prescribed median dose of 60 Gy(RBE) to the CTV. Treatment plans were analyzed in terms of V20-V80 penumbra volume, D1 (dose to 1% of the volume) for optic disc and macula, optic nerve V30 (volume receiving 30 Gy(RBE), i.e. 50% of prescription), as well as average dose to lens and ciliary body. A LP dependent aperture margin was based on estimated uncertainties, ranging from 1.7 mm to 4.0 mm. RESULTS V20-V80 showed a strong influence by LP, while DFO was less relevant. The optic disc D1 reached an extra dose of up to 3000 cGy(RBE), comparing the defined technical limit of DFO = LP = 1 mm with DFO = 3 mm/ LP = 4 mm. The latter may result from a pencil-beam scanning (PBS) system with static apertures. Plans employing a wedge showed an improvement for organs at risk (OAR) sparing. CONCLUSION Plan quality is strongly influenced by initial beam parameters. The impact of LP is more pronounced when compared to DFO. The latter becomes important in the treatment of posterior tumors near the macula, optic disc or optic nerve. The plan quality achieved by dedicated OPT nozzles in single- or double-scattering design might not be achievable with modified PBS systems. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- J Wulff
- West German Proton Therapy Centre Essen (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ), Essen, Germany
| | - B Koska
- West German Proton Therapy Centre Essen (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ), Essen, Germany
| | - M Janson
- RaySearch Laboratories, Stockholm, Sweden
| | - C Bäumer
- West German Proton Therapy Centre Essen (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ), Essen, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,TU Dortmund University, Dortmund, Germany
| | - A Denker
- Helmholtz-Zentrum Berlin für Materialien und Energie, Protonentherapie, Germany.,Beuth-Hochschule für Technik, Berlin, Germany
| | - D Geismar
- West German Proton Therapy Centre Essen (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ), Essen, Germany.,Department of Particle Therapy, Essen, Germany
| | - J Gollrad
- Charité - Universitätsmedizin Berlin, Department of Radiation Oncology and Radiotherapy, Berlin, Germany
| | - B Timmermann
- West German Proton Therapy Centre Essen (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ), Essen, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,Department of Particle Therapy, Essen, Germany
| | - J Heufelder
- Charité - Universitätsmedizin Berlin, Department of Ophthalmology, Berlin, Germany.,Charité - Universitätsmedizin Berlin, BerlinProtonen am Helmholtz-Zentrum für Materialien und Energie, Berlin, Germany
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24
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Gollrad J, Rabsahl C, Riechardt AI, Heufelder J, Stroux A, Goerling U, Joussen A, Budach V, Boehmer D. Quality of life and treatment-related burden during ocular proton therapy: a prospective trial of 131 patients with uveal melanoma. Radiat Oncol 2021; 16:174. [PMID: 34496895 PMCID: PMC8425039 DOI: 10.1186/s13014-021-01902-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/30/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Proton beam therapy is a well-established treatment option for patients with uveal melanoma (UM). The treatment procedure, in general, includes placing radiopaque clips to ensure exact eye-positioning during radiotherapy, followed by the delivery of proton irradiation. The short-term burden associated with proton therapy in patients with UM has rarely been addressed. In this prospective study, we investigated the physiological and psychological aspects of proton therapy that might affect the well-being of patients during the different stages of treatment. METHODS During the treatment procedure, we conducted longitudinal assessments of the Quality of life (QOL), organ-specific symptoms, and psychological aspects in patients with UM with three questionnaires (EORTC QLQ-C30, EORTC QLQ-OPT30, and GAD-7). Patients completed questionnaires before clip surgery (T0), before proton therapy (T1), after completing treatment (T2), and three months after treatment completion (T3). We also collected data on tumor characteristics and socio-demographics to identify potential risk factors associated with high treatment burdens. RESULTS We prospectively included 131 consecutive patients. Questionnaire data showed a significant, temporary decline in global QOL and an increase in eye-related symptoms, as a result of the clip surgery (T0-T1). After treatment completion (T2), global QOL improved gradually, and none of the eye-related symptoms significantly deteriorated over the course of proton therapy. The global QOL returned to baseline levels three months after treatment (T3). We identified baseline anxiety as an independent risk factor for experiencing an acute treatment-related burden. Furthermore, we found interactions between GAD7 and patient sex showing that anxiety had a more pronounced effect on QOL outcome in female patients. CONCLUSION The short-term treatment-related burden of ocular proton therapy appeared to be largely associated with the preceding clip surgery, rather than the irradiation procedure. We found that anxiety was strongly associated with experiencing QOL issues during the treatment procedure. Our findings could contribute to the development of future strategies for improving the treatment process and psycho-oncologic patient care.
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Affiliation(s)
- Johannes Gollrad
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Christopher Rabsahl
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Jens Heufelder
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea Stroux
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ute Goerling
- Department of Psycho-Oncology, CCCC, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Antonia Joussen
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Volker Budach
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dirk Boehmer
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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25
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Fleury E, Trnková P, Spruijt K, Herault J, Lebbink F, Heufelder J, Hrbacek J, Horwacik T, Kajdrowicz T, Denker A, Gerard A, Hofverberg P, Mamalui M, Slopsema R, Pignol J, Hoogeman M. Characterization of the HollandPTC proton therapy beamline dedicated to uveal melanoma treatment and an interinstitutional comparison. Med Phys 2021; 48:4506-4522. [PMID: 34091930 PMCID: PMC8457201 DOI: 10.1002/mp.15024] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/08/2021] [Accepted: 05/25/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Eye-dedicated proton therapy (PT) facilities are used to treat malignant intraocular lesions, especially uveal melanoma (UM). The first commercial ocular PT beamline from Varian was installed in the Netherlands. In this work, the conceptual design of the new eyeline is presented. In addition, a comprehensive comparison against five PT centers with dedicated ocular beamlines is performed, and the clinical impact of the identified differences is analyzed. MATERIAL/METHODS The HollandPTC eyeline was characterized. Four centers in Europe and one in the United States joined the study. All centers use a cyclotron for proton beam generation and an eye-dedicated nozzle. Differences among the chosen ocular beamlines were in the design of the nozzle, nominal energy, and energy spectrum. The following parameters were collected for all centers: technical characteristics and a set of distal, proximal, and lateral region measurements. The measurements were performed with detectors available in-house at each institution. The institutions followed the International Atomic Energy Agency (IAEA) Technical Report Series (TRS)-398 Code of Practice for absolute dose measurement, and the IAEA TRS-398 Code of Practice, its modified version or International Commission on Radiation Units and Measurements Report No. 78 for spread-out Bragg peak normalization. Energy spreads of the pristine Bragg peaks were obtained with Monte Carlo simulations using Geant4. Seven tumor-specific case scenarios were simulated to evaluate the clinical impact among centers: small, medium, and large UM, located either anteriorly, at the equator, or posteriorly within the eye. Differences in the depth dose distributions were calculated. RESULTS A pristine Bragg peak of HollandPTC eyeline corresponded to the constant energy of 75 MeV (maximal range 3.97 g/cm2 in water) with an energy spread of 1.10 MeV. The pristine Bragg peaks for the five participating centers varied from 62.50 to 104.50 MeV with an energy spread variation between 0.10 and 0.70 MeV. Differences in the average distal fall-offs and lateral penumbrae (LPs) (over the complete set of clinically available beam modulations) among all centers were up to 0.25 g/cm2 , and 0.80 mm, respectively. Average distal fall-offs of the HollandPTC eyeline were 0.20 g/cm2 , and LPs were between 1.50 and 2.15 mm from proximal to distal regions, respectively. Treatment time, around 60 s, was comparable among all centers. The virtual source-to-axis distance of 120 cm at HollandPTC was shorter than for the five participating centers (range: 165-350 cm). Simulated depth dose distributions demonstrated the impact of the different beamline characteristics among institutions. The largest difference was observed for a small UM located at the posterior pole, where a proximal dose between two extreme centers was up to 20%. CONCLUSIONS HollandPTC eyeline specifications are in accordance with five other ocular PT beamlines. Similar clinical concepts can be applied to expect the same high local tumor control. Dosimetrical properties among the six institutions induce most likely differences in ocular radiation-related toxicities. This interinstitutional comparison could support further research on ocular post-PT complications. Finally, the findings reported in this study could be used to define dosimetrical guidelines for ocular PT to unify the concepts among institutions.
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Affiliation(s)
- Emmanuelle Fleury
- Department of RadiotherapyErasmus MC Cancer Institute, University Medical Center RotterdamThe Netherlands
- Holland Proton Therapy CenterDelftThe Netherlands
| | - Petra Trnková
- Department of RadiotherapyErasmus MC Cancer Institute, University Medical Center RotterdamThe Netherlands
- Departement of Radiation OncologyMedical University of ViennaViennaAustria
| | - Kees Spruijt
- Holland Proton Therapy CenterDelftThe Netherlands
| | - Joël Herault
- Departement of Radiation OncologyCentre Antoine LacassagneNiceFrance
| | | | - Jens Heufelder
- Helmholtz‐Zentrum Berlin für Materialien und EnergieBerlinGermany
- Department of OphthalmologyCharité ‐ Universitätsmedizin BerlinBerlinGermany
| | - Jan Hrbacek
- Paul Scherrer Institute Center for Proton TherapyVilligenSwitzerland
| | - Tomasz Horwacik
- Institute of Nuclear PhysicsPolish Academy of SciencesKrakówPoland
| | | | - Andrea Denker
- Helmholtz‐Zentrum Berlin für Materialien und EnergieBerlinGermany
| | - Anaïs Gerard
- Departement of Radiation OncologyCentre Antoine LacassagneNiceFrance
| | - Petter Hofverberg
- Departement of Radiation OncologyCentre Antoine LacassagneNiceFrance
| | - Maria Mamalui
- Department of Radiation OncologyUniversity of FloridaGainesvilleFloridaUSA
| | - Roelf Slopsema
- Department of Radiation OncologyEmory Proton Therapy CenterAtlantaGeorgiaUSA
| | | | - Mischa Hoogeman
- Department of RadiotherapyErasmus MC Cancer Institute, University Medical Center RotterdamThe Netherlands
- Holland Proton Therapy CenterDelftThe Netherlands
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26
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Spaccapaniccia C, Via R, Thominet V, Liffey A, Baroni G, Pica A, Weber DC, Lomax AJ, Hrbacek J. Non-invasive recognition of eye torsion through optical imaging of the iris pattern in ocular proton therapy. Phys Med Biol 2021; 66. [PMID: 34126607 DOI: 10.1088/1361-6560/ac0afb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/14/2021] [Indexed: 11/12/2022]
Abstract
The introduction of non-invasive imaging techniques such as MRI imaging for treatment planning and optical eye tracking for in-room eye localization would obviate the requirement of clips implantation for many patients undergoing ocular proton therapy. This study specifically addresses the issue of torsional eye movement detection during patient positioning. Non-invasive detection of eye torsion is performed by measuring the iris pattern rotations using a beams eye view optical camera. When handling images of patients to be treated using proton therapy, a number of additional challenges are encountered, such as changing eye position, pupil dilatation and illumination. A method is proposed to address these extra challenges while also compensating for the effect of cornea distortion in eye torsion computation. The accuracy of the proposed algorithm was evaluated against corresponding measurement of eye torsion using the clips configuration measured on x-ray images. This study involves twenty patients who received ocular proton therapy at Paul Scherrer Institute and it is covered by ethical approval (EKNZ 2019-01987).
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27
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Convolutional Neural Networks Cascade for Automatic Pupil and Iris Detection in Ocular Proton Therapy. SENSORS 2021; 21:s21134400. [PMID: 34199068 PMCID: PMC8271684 DOI: 10.3390/s21134400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/18/2021] [Accepted: 06/24/2021] [Indexed: 01/07/2023]
Abstract
Eye tracking techniques based on deep learning are rapidly spreading in a wide variety of application fields. With this study, we want to exploit the potentiality of eye tracking techniques in ocular proton therapy (OPT) applications. We implemented a fully automatic approach based on two-stage convolutional neural networks (CNNs): the first stage roughly identifies the eye position and the second one performs a fine iris and pupil detection. We selected 707 video frames recorded during clinical operations during OPT treatments performed at our institute. 650 frames were used for training and 57 for a blind test. The estimations of iris and pupil were evaluated against the manual labelled contours delineated by a clinical operator. For iris and pupil predictions, Dice coefficient (median = 0.94 and 0.97), Szymkiewicz–Simpson coefficient (median = 0.97 and 0.98), Intersection over Union coefficient (median = 0.88 and 0.94) and Hausdorff distance (median = 11.6 and 5.0 (pixels)) were quantified. Iris and pupil regions were found to be comparable to the manually labelled ground truths. Our proposed framework could provide an automatic approach to quantitatively evaluating pupil and iris misalignments, and it could be used as an additional support tool for clinical activity, without impacting in any way with the consolidated routine.
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28
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Elisei G, Pella A, Ricotti R, Via R, Fiore MR, Calvi G, Mastella E, Paganelli C, Tagaste B, Bello F, Fontana G, Meschini G, Buizza G, Valvo F, Orlandi E, Ciocca M, Baroni G. Development and validation of a new set-up simulator dedicated to ocular proton therapy at CNAO. Phys Med 2021; 82:228-239. [PMID: 33657472 DOI: 10.1016/j.ejmp.2021.01.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 11/27/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022] Open
Abstract
An Eye Tracking System (ETS) is used at CNAO for providing a stable and reproducible ocular proton therapy (OPT) set-up, featuring a fixation light (FL) and monitoring stereo-cameras embedded in a rigid case. The aim of this work is to propose an ETS set-up simulation algorithm, that automatically provides the FL positioning in space, according to patient-specific gaze direction and avoiding interferences with patient, beam and collimator. Two configurations are provided: one in the CT room for acquiring images required for treatment planning with the patient lying on a couch, and one related to the treatment room with the patient sitting in front of the beam. Algorithm validation was performed reproducing ETS simulation (CT) and treatment (room) set-up for 30 patients previously treated at CNAO. The positioning accuracy of the device was quantified through a set of 14 control points applied to the ETS case and localizable both in the CT volume and in room X-ray images. Differences between the position of ETS reference points estimated by the algorithm and those measured by imaging systems are reported. The corresponding gaze direction deviation is on average 0.2° polar and 0.3° azimuth for positioning in CT room and 0.1° polar and 0.4° azimuth in the treatment room. The simulation algorithm was embedded in a clinically usable software application, which we assessed as capable of ensuring ETS positioning with an average accuracy of 2 mm in CT room and 1.5 mm in treatment room, corresponding to gaze direction deviations consistently lower than 1°.
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Affiliation(s)
- G Elisei
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department-Bioengineering Unit, Pavia, Italy
| | - A Pella
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department-Bioengineering Unit, Pavia, Italy.
| | - R Ricotti
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department-Bioengineering Unit, Pavia, Italy
| | - R Via
- Center of Proton Therapy, Paul Scherrer Institut, 5232 Villigen, PSI, Switzerland
| | - M R Fiore
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department, Pavia, Italy
| | - G Calvi
- Centro Nazionale di Adroterapia Oncologica CNAO, Particle Accelerator Department, Pavia, Italy
| | - E Mastella
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department - Medical Physics Unit, Pavia, Italy
| | - C Paganelli
- Politecnico di Milano, Department of Electronics Information and Bioengineering, Milano, Italy
| | - B Tagaste
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department-Bioengineering Unit, Pavia, Italy
| | - F Bello
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department-Bioengineering Unit, Pavia, Italy
| | - G Fontana
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department-Bioengineering Unit, Pavia, Italy
| | - G Meschini
- Politecnico di Milano, Department of Electronics Information and Bioengineering, Milano, Italy
| | - G Buizza
- Politecnico di Milano, Department of Electronics Information and Bioengineering, Milano, Italy
| | - F Valvo
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department, Pavia, Italy
| | - E Orlandi
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department, Pavia, Italy
| | - M Ciocca
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department - Medical Physics Unit, Pavia, Italy
| | - G Baroni
- Centro Nazionale di Adroterapia Oncologica CNAO, Clinical Department-Bioengineering Unit, Pavia, Italy; Politecnico di Milano, Department of Electronics Information and Bioengineering, Milano, Italy
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29
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Fleury E, Trnková P, Erdal E, Hassan M, Stoel B, Jaarma‐Coes M, Luyten G, Herault J, Webb A, Beenakker J, Pignol J, Hoogeman M. Three-dimensional MRI-based treatment planning approach for non-invasive ocular proton therapy. Med Phys 2021; 48:1315-1326. [PMID: 33336379 PMCID: PMC7986198 DOI: 10.1002/mp.14665] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 10/05/2020] [Accepted: 11/30/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To develop a high-resolution three-dimensional (3D) magnetic resonance imaging (MRI)-based treatment planning approach for uveal melanomas (UM) in proton therapy. MATERIALS/METHODS For eight patients with UM, a segmentation of the gross tumor volume (GTV) and organs-at-risk (OARs) was performed on T1- and T2-weighted 7 Tesla MRI image data to reconstruct the patient MR-eye. An extended contour was defined with a 2.5-mm isotropic margin derived from the GTV. A broad beam algorithm, which we have called πDose, was implemented to calculate relative proton absorbed doses to the ipsilateral OARs. Clinically favorable gazing angles of the treated eye were assessed by calculating a global weighted-sum objective function, which set penalties for OARs and extreme gazing angles. An optimizer, which we have named OPT'im-Eye-Tool, was developed to tune the parameters of the functions for sparing critical-OARs. RESULTS In total, 441 gazing angles were simulated for every patient. Target coverage including margins was achieved in all the cases (V95% > 95%). Over the whole gazing angles solutions space, maximum dose (Dmax ) to the optic nerve and the macula, and mean doses (Dmean ) to the lens, the ciliary body and the sclera were calculated. A forward optimization was applied by OPT'im-Eye-Tool in three different prioritizations: iso-weighted, optic nerve prioritized, and macula prioritized. In each, the function values were depicted in a selection tool to select the optimal gazing angle(s). For example, patient 4 had a T2 equatorial tumor. The optimization applied for the straight gazing angle resulted in objective function values of 0.46 (iso-weighted situation), 0.90 (optic nerve prioritization) and 0.08 (macula prioritization) demonstrating the impact of that angle in different clinical approaches. CONCLUSIONS The feasibility and suitability of a 3D MRI-based treatment planning approach have been successfully tested on a cohort of eight patients diagnosed with UM. Moreover, a gaze-angle trade-off dose optimization with respect to OARs sparing has been developed. Further validation of the whole treatment process is the next step in the goal to achieve both a non-invasive and a personalized proton therapy treatment.
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Affiliation(s)
- E. Fleury
- Department of Radiation OncologyErasmus Medical CenterRotterdamThe Netherlands
- Department of Radiation OncologyHollandPTCDelftThe Netherlands
| | - P. Trnková
- Department of Radiation OncologyErasmus Medical CenterRotterdamThe Netherlands
- Department of Radiation OncologyHollandPTCDelftThe Netherlands
| | - E. Erdal
- Department of Radiation OncologyHollandPTCDelftThe Netherlands
| | - M. Hassan
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - B. Stoel
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - M. Jaarma‐Coes
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - G. Luyten
- Department of OphthalmologyLeiden University Medical CenterLeidenThe Netherlands
| | - J. Herault
- Department of Radiation OncologyCentre Antoine LacassagneNiceFrance
| | - A. Webb
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - J.‐W. Beenakker
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of OphthalmologyLeiden University Medical CenterLeidenThe Netherlands
| | - J.‐P. Pignol
- Department of Radiation OncologyDalhousie UniversityHalifaxCanada
| | - M. Hoogeman
- Department of Radiation OncologyErasmus Medical CenterRotterdamThe Netherlands
- Department of Radiation OncologyHollandPTCDelftThe Netherlands
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30
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Niendorf T, Beenakker JWM, Langner S, Erb-Eigner K, Bach Cuadra M, Beller E, Millward JM, Niendorf TM, Stachs O. Ophthalmic Magnetic Resonance Imaging: Where Are We (Heading To)? Curr Eye Res 2021; 46:1251-1270. [PMID: 33535828 DOI: 10.1080/02713683.2021.1874021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Magnetic resonance imaging of the eye and orbit (MReye) is a cross-domain research field, combining (bio)physics, (bio)engineering, physiology, data sciences and ophthalmology. A growing number of reports document technical innovations of MReye and promote their application in preclinical research and clinical science. Realizing the progress and promises, this review outlines current trends in MReye. Examples of MReye strategies and their clinical relevance are demonstrated. Frontier applications in ocular oncology, refractive surgery, ocular muscle disorders and orbital inflammation are presented and their implications for explorations into ophthalmic diseases are provided. Substantial progress in anatomically detailed, high-spatial resolution MReye of the eye, orbit and optic nerve is demonstrated. Recent developments in MReye of ocular tumors are explored, and its value for personalized eye models derived from machine learning in the treatment planning of uveal melanoma and evaluation of retinoblastoma is highlighted. The potential of MReye for monitoring drug distribution and for improving treatment management and the assessment of individual responses is discussed. To open a window into the eye and into (patho)physiological processes that in the past have been largely inaccessible, advances in MReye at ultrahigh magnetic field strengths are discussed. A concluding section ventures a glance beyond the horizon and explores future directions of MReye across multiple scales, including in vivo electrolyte mapping of sodium and other nuclei. This review underscores the need for the (bio)medical imaging and ophthalmic communities to expand efforts to find solutions to the remaining unsolved problems and technical obstacles of MReye, with the objective to transfer methodological advancements driven by MR physics into genuine clinical value.
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Affiliation(s)
- Thoralf Niendorf
- MRI.TOOLS GmbH, Berlin, Germany.,Berlin Ultrahigh Field Facility, Max Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Jan-Willem M Beenakker
- Department of Ophthalmology and Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sönke Langner
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Katharina Erb-Eigner
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Meritxell Bach Cuadra
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland.,Department of Radiology, Lausanne University and University Hospital, Lausanne, Switzerland
| | - Ebba Beller
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Jason M Millward
- Berlin Ultrahigh Field Facility, Max Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | | | - Oliver Stachs
- Department Life, Light & Matter, University Rostock, Rostock, Germany.,Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
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31
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Via R, Hennings F, Pica A, Fattori G, Beer J, Peroni M, Baroni G, Lomax A, Weber DC, Hrbacek J. Potential and pitfalls of 1.5T MRI imaging for target volume definition in ocular proton therapy. Radiother Oncol 2021; 154:53-59. [DOI: 10.1016/j.radonc.2020.08.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 12/13/2022]
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32
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Jaarsma-Coes MG, Marinkovic M, Astreinidou E, Schuurmans MS, Peters FP, Luyten GP, Rasch CR, Beenakker JWM. Measuring eye deformation between planning and proton beam therapy position using magnetic resonance imaging. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2020; 16:33-36. [PMID: 33458341 PMCID: PMC7807689 DOI: 10.1016/j.phro.2020.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/04/2020] [Accepted: 09/25/2020] [Indexed: 01/22/2023]
Abstract
Eye and tumour deformation due to gravity is less than 0.4 mm. Conformity index between flexed and supine position for eyes is >0.95. Conformity index between flexed and supine position for tumours is >0.85. Supinely acquired MR images can be used for PBT planning.
Proton beam therapy (PBT) for uveal melanoma (UM) is performed in sitting position, while the acquisition of the Magnetic resonance (MR)-images for treatment planning is performed in supine position. We assessed the effect of this difference in position on the eye- and tumour- shape. Seven subjects and six UM-patients were scanned in supine and a seating mimicking position. The distances between the tumour/sclera in both positions were calculated. The median distance between both positions was 0.1 mm. Change in gravity direction produced no substantial changes in sclera and tumour shape, indicating that supinely acquired MR-images can be used to plan ocular-PBT.
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Affiliation(s)
- Myriam G. Jaarsma-Coes
- Ophthalmology, Leiden University Medical Centre, Leiden, Netherlands
- Radiology, C.J. Gorter Centre for High Field MRI, Leiden University Medical Centre, Leiden, Netherlands
- Corresponding author at: Leiden University Medical Center, P.O. 9600, 2300 RC Leiden, The Netherlands.
| | - Marina Marinkovic
- Ophthalmology, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Megan S. Schuurmans
- Radiology, C.J. Gorter Centre for High Field MRI, Leiden University Medical Centre, Leiden, Netherlands
| | - Femke P. Peters
- Radiotherapy, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Coen R.N. Rasch
- Radiotherapy, Leiden University Medical Centre, Leiden, Netherlands
| | - Jan-Willem M. Beenakker
- Ophthalmology, Leiden University Medical Centre, Leiden, Netherlands
- Radiology, C.J. Gorter Centre for High Field MRI, Leiden University Medical Centre, Leiden, Netherlands
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Yap J, Resta-López J, Kacperek A, Schnuerer R, Jolly S, Boogert S, Welsch C. Beam characterisation studies of the 62 MeV proton therapy beamline at the Clatterbridge Cancer Centre. Phys Med 2020; 77:108-120. [DOI: 10.1016/j.ejmp.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/15/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022] Open
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34
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Mishra KK, Afshar A, Thariat J, Shih HA, Scholey JE, Daftari IK, Kacperek A, Pica A, Hrbacek J, Dendale R, Mazal A, Heufelder J, Char DH, Sauerwein WA, Weber DC, Damato BE. Practice Considerations for Proton Beam Radiation Therapy of Uveal Melanoma During the Coronavirus Disease Pandemic: Particle Therapy Co-Operative Group Ocular Experience. Adv Radiat Oncol 2020; 5:682-686. [PMID: 32337386 PMCID: PMC7179507 DOI: 10.1016/j.adro.2020.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 01/08/2023] Open
Abstract
Uveal melanoma (UM) is a rare but life-threatening cancer of the eye. In light of the coronavirus disease (COVID-19) pandemic, hospitals and proton eye therapy facilities must analyze several factors to ensure appropriate treatment protocols for patients and provider teams. Practice considerations to limit COVID-19 transmission in the proton ocular treatment setting for UM are necessary. The Particle Therapy Co-Operative Group is the largest international community of particle/proton therapy providers. Participating experts have current or former affiliation with the member institutions of the Particle Therapy Co-Operative Group Ocular subcommittee with long-standing high-volume proton ocular programs. The practices reviewed in this document must be taken in conjunction with local hospital procedures, multidisciplinary recommendations, and regional/national guidelines, as each community may have its unique needs, supplies, and protocols. Importantly, as the pandemic evolves, so will the strategies and recommendations. Given the unique circumstances for UM patients, along with indications of potential ophthalmologic transmission as a result of health care providers working in close proximity to patients and intrinsic infectious risk from eyelashes, tears, and hair, practice strategies may be adapted to reduce the risk of viral transmission. Certainly, providers and health care systems will continue to examine and provide as safe and effective care as possible for patients in the current environment.
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Affiliation(s)
- Kavita K. Mishra
- Ocular Tumor Proton Therapy Program, Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Armin Afshar
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Juliette Thariat
- Department of Radiation Oncology, Centre François Baclesse, Normandie Universite, Caen, France
| | - Helen A. Shih
- F.H. Burr Proton Therapy Center, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jessica E. Scholey
- Ocular Tumor Proton Therapy Program, Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Inder K. Daftari
- Ocular Tumor Proton Therapy Program, Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Andrzej Kacperek
- National Proton Therapy Centre, Clatterbridge Cancer Centre, Wirral, United Kingdom
| | - Alessia Pica
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Jan Hrbacek
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Remi Dendale
- Institut Curie Proton Therapy Center, Orsay, France
| | | | - Jens Heufelder
- BerlinProtonen am HZB, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Damien C. Weber
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Bertil E. Damato
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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Riechardt AI, Stroux A, Seibel I, Heufelder J, Zeitz O, Böhmer D, Joussen AM, Gollrad J. Side effects of proton beam therapy of choroidal melanoma in dependence of the dose to the optic disc and the irradiated length of the optic nerve. Graefes Arch Clin Exp Ophthalmol 2020; 258:2523-2533. [DOI: 10.1007/s00417-020-04780-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/14/2020] [Accepted: 06/01/2020] [Indexed: 12/12/2022] Open
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Via R, Hennings F, Fattori G, Pica A, Lomax A, Weber DC, Baroni G, Hrbacek J. Technical Note: Benchmarking automated eye tracking and human detection for motion monitoring in ocular proton therapy. Med Phys 2020; 47:2237-2241. [PMID: 32037578 DOI: 10.1002/mp.14087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/17/2020] [Accepted: 02/03/2020] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Ocular proton therapy is an effective therapeutic option for patients affected with uveal melanomas. An optical eye-tracking system (ETS) aiming at noninvasive motion monitoring was developed and tested in a clinical scenario. MATERIALS AND METHODS The ETS estimates eye position and orientation at 25 frames per second using the three-dimensional position of pupil and cornea curvature centers identified, in the treatment room, through stereoscopic optical imaging and infrared eye illumination. Its capabilities for automatic detection of eye motion were retrospectively evaluated on 60 treatment fractions. Then, the ETS performance was benchmarked against the clinical standard based on visual control and manual beam interruption. RESULTS Eye-tracking system detected eye position successfully in 97% of all available frames. Eye-tracking system-based eye monitoring during therapy guarantees quicker response to involuntary eye motions than manual beam interruptions and avoids unnecessary beam interruptions. CONCLUSIONS Eye-tracking system shows promise for on-line monitoring of eye motion. Its introduction in the clinical workflow will guarantee a swifter treatment course for the patient and the clinical personnel.
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Affiliation(s)
- Riccardo Via
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232, Villigen PSI, Switzerland
| | - Fabian Hennings
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232, Villigen PSI, Switzerland
| | - Giovanni Fattori
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232, Villigen PSI, Switzerland
| | - Alessia Pica
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232, Villigen PSI, Switzerland
| | - Antony Lomax
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232, Villigen PSI, Switzerland
| | - Damien Charles Weber
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232, Villigen PSI, Switzerland.,Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.,Department of Radiation Oncology, University Hospital Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Guido Baroni
- Dipartimento di Elettronica Informazione e Bioingegneria, Politecnico di Milano, Milano, 20133, Italy
| | - Jan Hrbacek
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232, Villigen PSI, Switzerland
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Lomax AJ. Myths and realities of range uncertainty. Br J Radiol 2020; 93:20190582. [PMID: 31778317 PMCID: PMC7066970 DOI: 10.1259/bjr.20190582] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/01/2019] [Accepted: 11/24/2019] [Indexed: 12/25/2022] Open
Abstract
Range uncertainty is a much discussed topic in proton therapy. Although a very real aspect of proton therapy, its magnitude and consequences are sometimes misunderstood or overestimated. In this article, the sources and consequences of range uncertainty are reviewed, a number of myths associated with the effect discussed with the aim of putting range uncertainty into clinical context and attempting to de-bunk some of the more exaggerated claims made as to its consequences.
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Affiliation(s)
- Antony John Lomax
- Centre for Proton Therapy, Paul Scherrer Institute, Switzerland and Department of Physics, ETH Zurich, Switzerland
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Oncologic and visual outcomes after postoperative proton therapy of localized conjunctival melanomas. Radiat Oncol 2019; 14:239. [PMID: 31881977 PMCID: PMC6935064 DOI: 10.1186/s13014-019-1426-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/22/2019] [Indexed: 02/03/2023] Open
Abstract
Introduction conjunctival melanomas have high local relapse rates. Oncologic and visual outcomes can be improved with proton therapy and no-touch surgery. Material and methods a monocentric retrospective study of consecutive patients treated with surgery and proton therapy for conjunctival melanoma was conducted. Proton therapy was performed to a total dose of 45 Grays physical dose delivered in eight fractions over two weeks. Results Ninety-two patients were included. The mean age was 63-year-old. 65.2% of patients had primary acquired melanosis. The mean tumor thickness and diameter was 2.5 mm and 7.0 mm respectively. The clinical stage was T1 in 71.6% of cases, with a quadrangular involvement of more than 90° in 69% of cases. Conjunctival melanomas were of epithelioid cell-type in 40% of cases. Mean follow-up was 4.7 years. Five-year local failure rate was 33.2%. Of 25 local recurrences, 14 were marginal/out-of-field, 4 in-field, others were undetermined. First surgery at expert center resulted in 24.3% of local failure at 5 years versus 38.7% if performed elsewhere (p = 0.41). Salvage exenteration was performed in 13 patients. Tumor stage and quadrangular involvement were significant factors for local failure. Five-year progression-free survival and cause-specific death rates were 61.5 and 3.6%. Stage and epithelioid type were associated with poorer progression-free survival. Trophic toxicity occurred in 22.9% of patients and was treated locally, with grafts in 7 patients. Glaucoma and cataract occurred in 13 and 22 patients respectively. Prognostic factors for visual deterioration were age, tumor extent (multifocality, quadrangular involvement > 180°) and cryotherapy. Conclusions 5-year local failure rate after postoperative proton therapy for conjunctival melanoma was of 33.2%. Radiation-induced complications were overall manageable.
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Mohamed Ali A, Mathis T, Bensadoun RJ, Thariat J. Radiation induced optic neuropathy: Does treatment modality influence the risk? Bull Cancer 2019; 106:1160-1176. [PMID: 31757405 DOI: 10.1016/j.bulcan.2019.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 06/29/2019] [Accepted: 09/20/2019] [Indexed: 11/16/2022]
Abstract
Radiation induced optic neuropathy (RION) is a rare but disastrous complication of radiation therapy in treatment of periorbital tumors. The objective of this study is to investigate the incidence of RION in series of patients treated from peri orbital tumors by recent photon and proton irradiation modalities. We searched the Pub Med database for studies in periorbital tumors including base of skull, sinonasal, pituitary, nasopharyngeal tumors and craniopharyngioma treated with Intensity modulated radiotherapy (IMRT) and with proton beam therapy (PBT) between 1992 and 2017 excluding metastatic tumors, lymphomas, pediatric series, those treated mainly with chemotherapy, target therapy and those written in languages other than English and French. The result retrieved 421 articles that were revised by the panel. Fourteen articles with IMRT and 27 with PBT reported usable data for the review from which 31studies that had pointed to the doses to the optic nerve (ON) and/or optic chiasm (OC) and incidence of RION have been analyzed. We have found that the incidence of RION had been reported fairly in both modalities and many other factors related to the patient, tumor, and irradiation process interplay in its development. We have concluded that proper treatment planning, good selection of treatment modality, adherence to dose constraints applied to critical structures all along with regular oncological and ophthalmological follow up, control of co-morbidities and early intervention, could help reducing its magnitude.
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Affiliation(s)
- Ali Mohamed Ali
- Sohag University, Sohag University Hospital, Department of Clinical Oncology, Sohag East, 82524 Sohag, Egypt
| | - Thibaud Mathis
- Croix-Rousse University Hospital, Department of Ophthalmology, 103, grande rue de la Croix-Rousse, Lyon, France; UMR-CNRS 5510, Mateis, Villeurbanne, Lyon, France
| | | | - Juliette Thariat
- Centre François-Baclesse/ARCHADE, Department of Radiation Oncology, 3, avenue General Harris, 14000 Caen, France; Unicaen - Normandie Université, laboratoire de physique corpusculaire IN2P3/ENSICAEN - UMR6534, boulevard du Marechal Juin, 14050 Caen, France
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40
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Novel Gd 3+-doped silica-based optical fiber material for dosimetry in proton therapy. Sci Rep 2019; 9:16376. [PMID: 31704964 PMCID: PMC6841944 DOI: 10.1038/s41598-019-52608-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 10/14/2019] [Indexed: 12/25/2022] Open
Abstract
Optical fibers hold promise for accurate dosimetry in small field proton therapy due to their superior spatial resolution and the lack of significant Cerenkov contamination in proton beams. One known drawback for most scintillation detectors is signal quenching in areas of high linear energy transfer, as is the case in the Bragg peak region of a proton beam. In this study, we investigated the potential of innovative optical fiber bulk materials using the sol-gel technique for dosimetry in proton therapy. This type of glass is made of amorphous silica (SiO\documentclass[12pt]{minimal}
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\begin{document}$${}^{3+}$$\end{document}3+ ions and possesses very interesting light emission properties with a luminescence band around 314 nm when exposed to protons. The fibers were manufactured at the University of Lille and tested at the TRIUMF Proton Therapy facility with 8.2–62.9 MeV protons and 2–6 nA of extracted beam current. Dose-rate dependence and quenching were measured and compared to other silica-based fibers also made by sol-gel techniques and doped with Ce\documentclass[12pt]{minimal}
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\begin{document}$${}^{3+}$$\end{document}3+ and Cu\documentclass[12pt]{minimal}
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\begin{document}$${}^{+}$$\end{document}+. The three fibers present strong luminescence in the UV (Gd) or visible (Cu,Ce) under irradiation, with the emission intensities related directly to the proton flux. In addition, the 0.5 mm diameter Gd\documentclass[12pt]{minimal}
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\begin{document}$${}^{3+}$$\end{document}3+-doped fiber shows superior resolution of the Bragg peak, indicating significantly reduced quenching in comparison to the Ce\documentclass[12pt]{minimal}
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\begin{document}$${}^{+}$$\end{document}+ fibers with a Birks’ constant, k\documentclass[12pt]{minimal}
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\begin{document}$${}_{B}$$\end{document}B, of (0.0162 \documentclass[12pt]{minimal}
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\begin{document}$$\pm $$\end{document}± 0.0003) cm/MeV in comparison to (0.0333 \documentclass[12pt]{minimal}
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\begin{document}$$\pm $$\end{document}± 0.0006) cm/MeV and (0.0352 \documentclass[12pt]{minimal}
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\begin{document}$$\pm $$\end{document}± 0.0003) cm/MeV, respectively. To our knowledge, this is the first report of such an interesting k\documentclass[12pt]{minimal}
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\begin{document}$${}_{B}$$\end{document}B for a silica-based optical fiber material, showing clearly that this fiber presents lower quenching than common plastic scintillators. This result demonstrates the high potential of this inorganic fiber material for proton therapy dosimetry.
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État des lieux de la protonthérapie en France en 2019. Cancer Radiother 2019; 23:617-624. [DOI: 10.1016/j.canrad.2019.07.129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 07/04/2019] [Indexed: 01/03/2023]
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Via R, Pella A, Romanò F, Fassi A, Ricotti R, Tagaste B, Vai A, Mastella E, Rosaria Fiore M, Valvo F, Ciocca M, Baroni G. A platform for patient positioning and motion monitoring in ocular proton therapy with a non-dedicated beamline. Phys Med 2019; 59:55-63. [PMID: 30928066 DOI: 10.1016/j.ejmp.2019.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/25/2019] [Accepted: 02/25/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE At Centro Nazionale di Adroterapia Oncologica (CNAO, Pavia, Italy) ocular proton therapy (OPT) is delivered using a non-dedicated beamline. This paper describes the novel clinical workflow as well as technologies and methods adopted to achieve accurate target positioning and verification during ocular proton therapy at CNAO. METHOD The OPT clinical protocol at CNAO prescribes a treatment simulation and a delivery phase, performed in the CT and treatment rooms, respectively. The patient gaze direction is controlled and monitored during the entire workflow by means of an eye tracking system (ETS) featuring two optical cameras and an embedded fixation diode light. Thus, the accurate alignment of the fixation light provided to the patient to the prescribed gazed direction is required for an effective treatment. As such, a technological platform based on active robotic manipulators and IR optical tracking-based guidance was developed and tested. The effectiveness of patient positioning strategies was evaluated on a clinical dataset comprising twenty patients treated at CNAO. RESULTS According to experimental testing, the developed technologies guarantee uncertainties lower than one degree in gaze direction definition by means of ETS-guided positioning. Patient positioning and monitoring strategies during treatment effectively mitigated set-up uncertainties and exhibited sub-millimetric accuracy in radiopaque markers alignment. CONCLUSION Ocular proton therapy is currently delivered at CNAO with a non-dedicated beamline. The technologies developed for patient positioning and motion monitoring have proven to be compliant with the high geometrical accuracy required for the treatment of intraocular tumors.
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Affiliation(s)
- Riccardo Via
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy.
| | - Andrea Pella
- Centro Nazionale di Adroterapia Oncologica Foundation, Pavia 27100, Italy
| | | | - Aurora Fassi
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy
| | - Rosalinda Ricotti
- Centro Nazionale di Adroterapia Oncologica Foundation, Pavia 27100, Italy
| | - Barbara Tagaste
- Centro Nazionale di Adroterapia Oncologica Foundation, Pavia 27100, Italy
| | - Alessandro Vai
- Centro Nazionale di Adroterapia Oncologica Foundation, Pavia 27100, Italy
| | - Edoardo Mastella
- Centro Nazionale di Adroterapia Oncologica Foundation, Pavia 27100, Italy
| | | | - Francesca Valvo
- Centro Nazionale di Adroterapia Oncologica Foundation, Pavia 27100, Italy
| | - Mario Ciocca
- Centro Nazionale di Adroterapia Oncologica Foundation, Pavia 27100, Italy
| | - Guido Baroni
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy
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Ciocca M, Magro G, Mastella E, Mairani A, Mirandola A, Molinelli S, Russo S, Vai A, Fiore MR, Mosci C, Valvo F, Via R, Baroni G, Orecchia R. Design and commissioning of the non-dedicated scanning proton beamline for ocular treatment at the synchrotron-based CNAO facility. Med Phys 2019; 46:1852-1862. [PMID: 30659616 DOI: 10.1002/mp.13389] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/11/2018] [Accepted: 01/09/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Only few centers worldwide treat intraocular tumors with proton therapy, all of them with a dedicated beamline, except in one case in the USA. The Italian National Center for Oncological Hadrontherapy (CNAO) is a synchrotron-based hadrontherapy facility equipped with fixed beamlines and pencil beam scanning modality. Recently, a general-purpose horizontal proton beamline was adapted to treat also ocular diseases. In this work, the conceptual design and main dosimetric properties of this new proton eyeline are presented. METHODS A 28 mm thick water-equivalent range shifter (RS) was placed along the proton beamline to shift the minimum beam penetration at shallower depths. FLUKA Monte Carlo (MC) simulations were performed to optimize the position of the RS and patient-specific collimator, in order to achieve sharp lateral dose gradients. Lateral dose profiles were then measured with radiochromic EBT3 films to evaluate the dose uniformity and lateral penumbra width at several depths. Different beam scanning patterns were tested. Discrete energy levels with 1 mm water-equivalent step within the whole ocular energy range (62.7-89.8 MeV) were used, while fine adjustment of beam range was achieved using thin polymethylmethacrylate additional sheets. Depth-dose distributions (DDDs) were measured with the Peakfinder system. Monoenergetic beam weights to achieve flat spread-out Bragg Peaks (SOBPs) were numerically determined. Absorbed dose to water under reference conditions was measured with an Advanced Markus chamber, following International Atomic Energy Agency (IAEA) Technical Report Series (TRS)-398 Code of Practice. Neutron dose at the contralateral eye was evaluated with passive bubble dosimeters. RESULTS Monte Carlo simulations and experimental results confirmed that maximizing the air gap between RS and aperture reduces the lateral dose penumbra width of the collimated beam and increases the field transversal dose homogeneity. Therefore, RS and brass collimator were placed at about 98 cm (upstream of the beam monitors) and 7 cm from the isocenter, respectively. The lateral 80%-20% penumbra at middle-SOBP ranged between 1.4 and 1.7 mm depending on field size, while 90%-10% distal fall-off of the DDDs ranged between 1.0 and 1.5 mm, as a function of range. Such values are comparable to those reported for most existing eye-dedicated facilities. Measured SOBP doses were in very good agreement with MC simulations. Mean neutron dose at the contralateral eye was 68 μSv/Gy. Beam delivery time, for 60 Gy relative biological effectiveness (RBE) prescription dose in four fractions, was around 3 min per session. CONCLUSIONS Our adapted scanning proton beamline satisfied the requirements for intraocular tumor treatment. The first ocular treatment was delivered in August 2016 and more than 100 patients successfully completed their treatment in these 2 yr.
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Affiliation(s)
- Mario Ciocca
- Fondazione CNAO, strada Campeggi 53, 27100, Pavia, Italy
| | - Giuseppe Magro
- Fondazione CNAO, strada Campeggi 53, 27100, Pavia, Italy
| | | | - Andrea Mairani
- Fondazione CNAO, strada Campeggi 53, 27100, Pavia, Italy
| | | | | | - Stefania Russo
- Fondazione CNAO, strada Campeggi 53, 27100, Pavia, Italy
| | - Alessandro Vai
- Fondazione CNAO, strada Campeggi 53, 27100, Pavia, Italy
| | | | - Carlo Mosci
- Ente Ospedaliero Ospedali Galliera, via Mura delle Cappuccine 14, 16128, Genova, Italy
| | | | - Riccardo Via
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, piazza Leonardo da Vinci 32, 20133, Milano, Italy
| | - Guido Baroni
- Fondazione CNAO, strada Campeggi 53, 27100, Pavia, Italy.,Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, piazza Leonardo da Vinci 32, 20133, Milano, Italy
| | - Roberto Orecchia
- Fondazione CNAO, strada Campeggi 53, 27100, Pavia, Italy.,Istituto Europeo di Oncologia, via Ripamonti 435, 20100, Milano, Italy
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Wösle M, Krause L, Sreenivasa S, Vordermark D, Ciernik IF. Stereotactic radiotherapy for choroidal melanomas by means of HybridArc™ : Physics and technique of linac-based photon beam therapy. Strahlenther Onkol 2018; 194:929-943. [PMID: 30116827 DOI: 10.1007/s00066-018-1349-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 08/02/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Stereotactic radiotherapy (SRT) is suitable to treat ocular tumours. The optimal beam geometry for SRT, however, has not been defined. Here we evaluate a combination technique with dynamic conformal arcs (DCAs) and intensity-modulated static fields (IMRT), known as HybridArc™ (HA). METHODS For the first consecutive 25 cases with choroidal melanomas with volumes of 0.02 to 1.18 cm3 treated with 50 Gy in five fractions, the results with respect to dose conformity, homogeneity, and dose distributions were summarised. To describe the dose distribution at the planning target volume (PTV) boundary, we defined a spatially averaged dose gradient (SADG) and compared it with Paddick's gradient index (GI). We made dosimetric comparisons between HA and other irradiation techniques. RESULTS The PTVs ranged from 0.42 to 3.37 cm3. The conformity index (CI) was 1.25 ± 0.15, and the homogeneity index (HI) 0.08 ± 0.02. The SADG was (-3.5 ± 0.5) Gy/mm or (-7.0 ± 1.0) %/mm between the isodose levels 95 and 20%; local minima reached -11.5 Gy/mm or -22.9%/mm. The coefficient of determination for a nonlinear regression of GI on SADG was 0.072. After a median follow-up time of 19.6 months, local tumour control was 100% without any case of post-therapeutic enucleation. Two patients (8%) developed liver metastases. CONCLUSION SRT of ocular tumours by HA is highly appropriate, and HA is superior to intensity-modulated arc therapy (IMAT) concerning dose reduction in organs at risk (OARs). The novel gradient measure SADG is more informative than Paddick's GI.
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Affiliation(s)
- Markus Wösle
- Klinik für Strahlentherapie und Radioonkologie, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau-Roßlau, Germany.
| | - Lothar Krause
- Klinik für Augenheilkunde und Zentrum für Refraktive Chirurgie, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau-Roßlau, Germany
| | - Shanthala Sreenivasa
- Klinik für Strahlentherapie und Radioonkologie, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau-Roßlau, Germany.,Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Straße 8, 06108, Halle (Saale), Germany
| | - Dirk Vordermark
- Universitätsklinik und Poliklinik für Strahlentherapie, Universitätsklinikum Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
| | - Ilja F Ciernik
- Klinik für Strahlentherapie und Radioonkologie, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau-Roßlau, Germany
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Mathis T, Hofverberg P, Caujolle JP, Hérault J, Leal C, Maschi C, Delaunay B, Baillif S, Kodjikian L, Thariat J. Occurrence of Phosphenes in Patients Undergoing Proton Beam Therapy for Ocular Tumor. Am J Ophthalmol 2018; 192:31-38. [PMID: 29753854 DOI: 10.1016/j.ajo.2018.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/06/2018] [Accepted: 05/02/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE Phosphenes are frequently reported by patients irradiated in the head and neck area. The aim of the present study was to characterize and investigate potential mechanisms of proton beam therapy (PBT)-induced phosphenes in a large population of patients undergoing PBT for ocular tumors. DESIGN Prospective cohort study. METHODS Consecutive patients who underwent PBT in a single center were included. Immediately after the first session, all patients completed a questionnaire collecting information about the presence of phosphenes as well as their color, shape, and duration. Patient, tumor and treatment characteristics (dose volume histograms) were also collected. RESULTS Among the 474 patients included, 62.8% reported phosphenes during the first session of PBT. Reported colors were mainly blue-violet (70.5%) and white (14.1%). The prevalence of phosphenes was higher in younger patients (P = .003); other patient or ocular characteristics were not associated with the occurrence of phosphenes. Irradiation of the macula (P < .001) and/or optic disc (P < .001) were significantly associated with the presence of phosphenes, whereas blue-violet color was only associated with young age and irradiation of macular area (P = .04). Pupillary constriction was reported for 57.1% of patients with phosphenes vs 18.5% of patients without (P < .001). Blue-violet phosphenes (P < .001) and irradiation of macula (P = .001) were statistically associated with pupillary constriction. CONCLUSIONS The present study reported a high rate of phosphenes in patients irradiated by PBT for ocular tumor. Their blue-violet color and their association with a pupillary constriction probably indicates the stimulation of S-cones and retinal ganglion cells that reflects the activation of the afferent visual pathway.
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Affiliation(s)
- Thibaud Mathis
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France; UMR-CNRS 5510 Matéis, Villeurbane, France.
| | - Petter Hofverberg
- Department of Radiation Therapy, Proton Therapy Center, Centre Antoine Lacassagne, Nice, France
| | | | - Joël Hérault
- Department of Radiation Therapy, Proton Therapy Center, Centre Antoine Lacassagne, Nice, France
| | - Cécilia Leal
- Department of Ophthalmology, Pasteur II Hospital, Nice, France
| | - Celia Maschi
- Department of Ophthalmology, Pasteur II Hospital, Nice, France
| | - Benoit Delaunay
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France; UMR-CNRS 5510 Matéis, Villeurbane, France
| | - Juliette Thariat
- Department of Radiation Therapy, Centre François Baclesse - ARCHADE, Unicaen - Normandie University, Caen, France
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Automated Treatment Planning System for Uveal Melanomas Treated With Proton Therapy: A Proof-of-Concept Analysis. Int J Radiat Oncol Biol Phys 2018; 101:724-731. [DOI: 10.1016/j.ijrobp.2018.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 01/31/2018] [Accepted: 02/05/2018] [Indexed: 11/20/2022]
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De Caluwé A, Termote K, Van Gestel D, Van Limbergen E. Dose-response in choroidal melanoma. Radiother Oncol 2018; 127:374-378. [PMID: 29680322 DOI: 10.1016/j.radonc.2018.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 01/21/2023]
Abstract
PURPOSE In choroidal melanoma the radiation threshold dose for local control remains largely unknown. The present study examined a group of patients that received a wide range of minimum tumor dose in order to investigate a dose-response relationship. A literature review is performed to compare our results with available evidence in brachytherapy and charged particle external beam radiotherapy. MATERIALS AND METHODS A retrospective study was conducted on all choroidal melanomas treated with Strontium-90 (Sr-90) at the University Hospital of Leuven between 1983 and 2012. Local failure was defined as primary endpoint and was estimated according to the competing risk method. RESULTS In 135 patients, the minimum tumor dose (Dmin) ranged from 0 Gy to 287 Gy (median: 27.6 Gy). Multivariable analysis revealed Dmin ≥ 65 Gy (p = 0.04; HR = 0.09) and tumor distant from the optic disc (p < 0.001, HR = 0.09) to be independent variables favoring local control. The scleral dose, the tumor diameter and tumor height did not significantly affect local failure in multivariate analysis. CONCLUSION This is the first study to examine a group of patients treated with a Dmin ranging from 0 Gy to >250 Gy. Treatment with a Dmin of 65 Gy is necessary to achieve durable tumor response. The dose-response data provided by our study could be used for the design of future trials examining the ideal dose for the treatment of choroidal melanoma with brachytherapy or charged particle external beam radiotherapy.
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Affiliation(s)
- Alex De Caluwé
- Department of Radiation Oncology, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Karolien Termote
- Department of Ophthalmology, University Hospital of Brussels (UZ Brussel), Brussels, Belgium
| | - Dirk Van Gestel
- Department of Radiation Oncology, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Erik Van Limbergen
- Department of Radiation Oncology, University Hospital of Leuven (UZ Leuven), Leuven, Belgium
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Hoehr C, Lindsay C, Beaudry J, Penner C, Strgar V, Lee R, Duzenli C. Characterization of the exradin W1 plastic scintillation detector for small field applications in proton therapy. Phys Med Biol 2018; 63:095016. [PMID: 29634488 DOI: 10.1088/1361-6560/aabd2d] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Accurate dosimetry in small field proton therapy is challenging, particularly for applications such as ocular therapy, and suitable detectors for this purpose are sought. The Exradin W1 plastic scintillating fibre detector is known to out-perform most other detectors for determining relative dose factors for small megavoltage photon beams used in radiotherapy but its potential in small proton beams has been relatively unexplored in the literature. The 1 mm diameter cylindrical geometry and near water equivalence of the W1 makes it an attractive alternative to other detectors. This study examines the dosimetric performance of the W1 in a 74 MeV proton therapy beam with particular focus on detector response characteristics relevant to relative dose measurement in small fields suitable for ocular therapy. Quenching of the scintillation signal is characterized and demonstrated not to impede relative dose measurements at a fixed depth. The background cable-only (Čerenkov and radio-fluorescence) signal is 4 orders of magnitude less than the scintillation signal, greatly simplifying relative dose measurements. Comparison with other detectors and Monte Carlo simulations indicate that the W1 is useful for measuring relative dose factors for field sizes down to 5 mm diameter and shallow spread out Bragg peaks down to 6 mm in depth.
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Affiliation(s)
- C Hoehr
- TRIUMF, 4004 Wesbrook Mall, Vancouver, Canada. University of Victoria, Victoria, Canada
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Via R, Hennings F, Fattori G, Fassi A, Pica A, Lomax A, Weber DC, Baroni G, Hrbacek J. Noninvasive eye localization in ocular proton therapy through optical eye tracking: A proof of concept. Med Phys 2018; 45:2186-2194. [DOI: 10.1002/mp.12841] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/16/2018] [Accepted: 02/17/2018] [Indexed: 11/05/2022] Open
Affiliation(s)
- Riccardo Via
- Dipartimento di Elettronica, Informazione e Bioingegneria; Politecnico di Milano; Milano 20133 Italy
| | - Fabian Hennings
- Center for Proton Therapy; Paul Scherrer Institut; Villigen PSI 5232 Switzerland
| | - Giovanni Fattori
- Center for Proton Therapy; Paul Scherrer Institut; Villigen PSI 5232 Switzerland
| | - Aurora Fassi
- Dipartimento di Elettronica, Informazione e Bioingegneria; Politecnico di Milano; Milano 20133 Italy
| | - Alessia Pica
- Center for Proton Therapy; Paul Scherrer Institut; Villigen PSI 5232 Switzerland
| | - Antony Lomax
- Center for Proton Therapy; Paul Scherrer Institut; Villigen PSI 5232 Switzerland
- Department of Physics; ETH-Hönggerberg; Zurich 8093 Switzerland
| | - Damien Charles Weber
- Center for Proton Therapy; Paul Scherrer Institut; Villigen PSI 5232 Switzerland
- Radiation Oncology Department; Inselspital Universitätsspital Bern; Bern 3010 Switzerland
| | - Guido Baroni
- Dipartimento di Elettronica, Informazione e Bioingegneria; Politecnico di Milano; Milano 20133 Italy
- CNAO Centro Nazionale di Adroterapia Oncologica; Pavia 27100 Italy
| | - Jan Hrbacek
- Center for Proton Therapy; Paul Scherrer Institut; Villigen PSI 5232 Switzerland
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50
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Thariat J, Habrand JL, Lesueur P, Chaikh A, Kammerer E, Lecomte D, Batalla A, Balosso J, Tessonnier T. Apports de la protonthérapie à la radiothérapie d’aujourd’hui, pourquoi, comment ? Bull Cancer 2018; 105:315-326. [DOI: 10.1016/j.bulcan.2017.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/07/2017] [Accepted: 12/12/2017] [Indexed: 01/06/2023]
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