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Comparison of whole brain radiation therapy for synchronous brain metastases with irradiation protecting the hippocampus versus whole brain radiotherapy for sequential brain metastases to boost irradiation in the treatment of brain metastases from SCLC: study protocol for a randomized controlled trial. Trials 2022; 23:876. [PMID: 36242060 PMCID: PMC9569116 DOI: 10.1186/s13063-022-06826-4] [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: 12/21/2021] [Accepted: 10/05/2022] [Indexed: 12/04/2022] Open
Abstract
Background This study is in regard to the comparison of whole brain radiation therapy for synchronous brain metastases with irradiation protecting the hippocampus versus whole brain radiotherapy for sequential brain metastases to boost irradiation in the treatment of brain metastases from small cell lung cancer (SCLC). Therapeutically, they have notably varying dose distributions. Based on theoretical and model studies, it has long been speculated that these modes may result in different prognostic outcomes. We aim to assess the efficacy of tomotherapy in the treatment of SCLC brain metastases while protecting the key functional area, the hippocampus, and minimizing any neurocognitive impairments incurred by radiation. Methods This is a randomized, controlled, prospective study including 102 SCLC patients with brain metastases randomized (1:1) to the experimental (whole brain radiation therapy for synchronous brain metastases with irradiation to protect the hippocampus) or control (whole brain radiotherapy for sequential brain metastases to boost irradiation) group. The sample size is calculated through a single-sided test; 102 participants will be required for the main results to have statistical and clinical significance. We aim to provide clinical trial data support for better prognostic treatment options in patients with SCLC and brain metastases. The clinical trial data include both the primary and secondary outcomes; the primary outcome is the intracranial progression-free survival time after the new technology application. The secondary study outcomes include the assessment of neurological function, the quality of life, and the overall survival rate. Follow-up consultations will be conducted every 2 months. After the final patient completes follow-up, the Statistical Product and Service Solutions software will be used for scientific and rigorous data analysis. Version 1.0 of the protocol was implemented on January 1, 2021; the recruitment process for this clinical trial commenced on April 1, 2021, and will end on March 31, 2024. Discussion The study will provide high-quality clinical evidence to support the efficacy and safety of whole brain radiation therapy for synchronous brain metastases with dose irradiation protecting the hippocampus versus whole brain radiotherapy for sequential brain metastases with push volume irradiation for the treatment of patients who have lung cancer as well as brain metastases. This has not been previously reported. Trial registration This trial is registered with the Chinese Clinical Trial Registry (ChiCTR1900027539; November 17, 2019) (URL: https://www.chictr.org.cn/hvshowproject.aspx?id=20515).
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Dosimetric comparison of Synchrony® real-time motion tracking treatment plans between CyberKnife robotic radiosurgery and Radixact system for stereotactic body radiation therapy of lung and prostate cancer. JOURNAL OF RADIOTHERAPY IN PRACTICE 2022. [DOI: 10.1017/s1460396922000061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
The aim of this study was to assess which machine, Radixact or CyberKnife, can deliver better treatment for lung and prostate stereotactic body radiation therapy (SBRT) with the use of Synchrony® real-time motion tracking system. Ten and eight patients treated with lung and prostate SBRT, respectively, using the CyberKnife system were selected for the assessment. For each patient, a retrospective Radixact plan was created and compared with the original CyberKnife plan. There was no statistically significant difference in the new conformity index of the Radixact plans and that of the Cyberknife plans in both lung and prostate SBRT. The average homogeneity index in the Radixact plans was better in both lung and prostate SBRT with statistical significance (p = 0·04 for lung and p = 0·02 for prostate). In lung SBRT, the dose to lungs was lower in Cyberknife plans (p = 0·002). In prostate SBRT, there was no statistically significant difference in organs at risk sparing between Cyberknife plans and Radixact plans. In conclusion, CyberKnife was better in lung SBRT while Radixact was better in prostate SBRT.
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Brown E, Dundas K, Surjan Y, Miller D, Lim K, Boxer M, Ahern V, Papadatos G, Batumalai V, Harvey J, Lee D, Delaney GP, Holloway L. The effect of imaging modality (magnetic resonance imaging vs. computed tomography) and patient position (supine vs. prone) on target and organ at risk doses in partial breast irradiation. J Med Radiat Sci 2021; 68:157-166. [PMID: 33283982 PMCID: PMC8168067 DOI: 10.1002/jmrs.453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 11/12/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Conventionally computed tomography (CT) has been used to delineate target volumes in radiotherapy; however, magnetic resonance imaging (MRI) is being continually integrated into clinical practice; therefore, the investigation into targets derived from MRI is warranted. The purpose of this study was to evaluate the impact of imaging modality (MRI vs. CT) and patient positioning (supine vs. prone) on planning target volumes (PTVs) and organs at risk (OARs) for partial breast irradiation (PBI). METHODS A retrospective data set, of 35 patients, was accessed where each patient had undergone MRI and CT imaging for tangential whole breast radiotherapy in both the supine and prone position. PTVs were defined from seroma cavity (SC) volumes delineated on each respective image, resulting in 4 PTVs per patient. PBI plans were generated with 6MV external beam radiotherapy (EBRT) using the TROG 06.02 protocol guidelines. A prescription of 38.5Gy in 10 fractions was used for all cases. The impact analysis of imaging modality and patient positioning included dose to PTVs, and OARs based on agreed criteria. Statistical analysis was conducted though Mann-Whitey U, Fisher's exact and chi-squared testing (P < 0.005). RESULTS Twenty-four patients were eligible for imaging analysis. However, positioning analysis could only be investigated on 19 of these data sets. No statistically significant difference was found in OAR doses based on imaging modality. Supine patient position resulted in lower contralateral breast dose (0.10Gy ± 0.35 vs. 0.33Gy ± 0.78, p = 0.011). Prone positioning resulted in a lower dose to ipsilateral lung volumes (10.85Gy ± 11.37 vs. 3.41Gy ± 3.93, P = <0.001). CONCLUSIONS PBI plans with PTVs derived from MRI exhibited no clinically significant differences when compared to plans created from CT in relation to plan compliance and OAR dose. Patient position requires careful consideration regardless of imaging modality chosen. Although there was no proven superiority of MRI derived target volumes, it indicates that MRI could be considered for PBI target delineation.
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Affiliation(s)
- Emily Brown
- Medical Radiation Science (MRS)School of Health SciencesThe University of NewcastleCallaghanNSWAustralia
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- Ingham Institute for Applied Medical ResearchLiverpoolNSWAustralia
| | - Kylie Dundas
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- Ingham Institute for Applied Medical ResearchLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - Yolanda Surjan
- Medical Radiation Science (MRS)School of Health SciencesThe University of NewcastleCallaghanNSWAustralia
| | - Daniela Miller
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
| | - Karen Lim
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - Miriam Boxer
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - Verity Ahern
- Crown Princess Mary Cancer CentreWestmead HospitalSydneyNSWAustralia
- Westmead Clinical SchoolUniversity of SydneySydneyNSWAustralia
| | - George Papadatos
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - Vikneswary Batumalai
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- Ingham Institute for Applied Medical ResearchLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - Jennifer Harvey
- School of MedicineUniversity of QueenslandBrisbaneQLDAustralia
- Princess Alexandra HospitalBrisbaneQLDAustralia
| | - Debra Lee
- Medical Radiation Science (MRS)School of Health SciencesThe University of NewcastleCallaghanNSWAustralia
| | - Geoff P. Delaney
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- Ingham Institute for Applied Medical ResearchLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
- School of MedicineUniversity of Western SydneySydneyNSWAustralia
| | - Lois Holloway
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- Ingham Institute for Applied Medical ResearchLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
- Centre for Medical Radiation PhysicsFaculty of Engineering and Information SciencesUniversity of WollongongWollongongNSWAustralia
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Lv R, Yang G, Huang Y, Wang Y. Dosimetric effects of supine immobilization devices on the skin in intensity-modulated radiation therapy for breast cancer: a retrospective study. BMC Cancer 2021; 21:384. [PMID: 33836670 PMCID: PMC8034111 DOI: 10.1186/s12885-021-08119-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background The dose perturbation effect of immobilization devices is often overlooked in intensity-modulated radiation therapy (IMRT) for breast cancer (BC). This retrospective study assessed the dosimetric effects of supine immobilization devices on the skin using a commercial treatment planning system. Methods Forty women with BC were divided into four groups according to the type of primary surgery: groups A and B included patients with left and right BC, respectively, who received 50 Gy radiotherapy in 25 fractions after radical mastectomy, while groups C and D included patients with left and right BC, respectively, who received breast-conservation surgery (BCS) and 40.05 Gy in 15 fractions as well as a tumor bed simultaneous integrated boost to 45 Gy. A 0.2-cm thick skin contour and two sets of body contours were outlined for each patient. Dose calculations were conducted for the two sets of contours using the same plan. The dose differences were assessed by comparing the dose-volume histogram parameter results and by plan subtraction. Results The supine immobilization devices for BC resulted in significantly increased skin doses, which may ultimately lead to skin toxicity. The mean dose increased by approximately 0.5 and 0.45 Gy in groups A and B after radical mastectomy and by 2.7 and 3.25 Gy in groups C and D after BCS; in groups A–D, the percentages of total normal skin volume receiving equal to or greater than 5 Gy (V5) increased by 0.54, 1.15, 2.67, and 1.94%, respectively, while the V10 increased by 1.27, 1.83, 1.36, and 2.88%; the V20 by 0.85, 1.87, 2.76, and 4.86%; the V30 by 1.3, 1.24, 10.58, and 11.91%; and the V40 by 1.29, 0.65, 10, and 10.51%. The dose encompassing the planning target volume and other organs at risk, showed little distinction between IMRT plans without and with consideration of immobilization devices. Conclusions The supine immobilization devices significantly increased the dose to the skin, especially for patients with BCS. Thus, immobilization devices should be included in the external contour to account for dose attenuation and skin dose increment. Trial registration This study does not report on interventions in human health care.
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Affiliation(s)
- Ran Lv
- Second Affiliated Hospital of Fujian Medical University, NO 950, Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Guangyi Yang
- Second Affiliated Hospital of Fujian Medical University, NO 950, Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Yongzhi Huang
- Second Affiliated Hospital of Fujian Medical University, NO 950, Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Yanhong Wang
- Second Affiliated Hospital of Fujian Medical University, NO 950, Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China.
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VMAT treatment plan acceptability and quality assurance study for prostate cancer in radiotherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396919001031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractAim:The aim of this work was to study the acceptability of plans prepared for prostate patients treated by volumetric modulated arc therapy (VMAT) with the vision to evaluate the quality of plans and test pre-treatment quality assurance (QA).Material methods:VMAT plans of 35 patients, planned on the Eclipse Treatment Planning System (Aria 15), were included in the study. Plan acceptability was checked using statistical analysis, which includes homogeneity index, radical and median homogeneity index, coverage and uniformity index. Dose–volume histograms (DVH) of the plans were also studied to check prescribed dose (PD), Dmax, Dmin, D5 and D95. Portal dosimetry was also done by gamma analysis using 3%/3 mm criterion. SD and mean SD error were also calculated and analysed.Results:Statistical analysis showed a mean HI of 1·054, coverage 0·959, UI 1·055, mDHI 0·962 and rDHI 0·866. SD of HI, coverage, UI, mDHI and rDHI was 0·019, 0·019, 0·014, 0·013 and 0·030, respectively. From the DVHs, mean of D5, D95, Dmin and Dmax was calculated at 6,252·9, 5,757·4, 6,413·3 and 5,657·7 cGy, respectively, with a prescribed dose of 6,000 cGy. According to gamma analysis, area gamma < 1 was 99·12% with a tolerance limit of 95%, maximum gamma was 1·466 with a tolerance limit of 3·5, average gamma was 0·388 with a tolerance limit of 0·5, area gamma > 1·2 was 0·242% with a tolerance limit of 0·5%, maximum dose difference was 0·6 with a tolerance limit of 1·0 and average dose difference was 0·029 with a tolerance limit of 0·2.Conclusion:All three computations showed the results to be within acceptable limits. VMAT possesses a unique feature of delivering the whole treatment with only two rotations of the gantry. VMAT has an improved efficiency of delivery for equivalent dosimetric quality.
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Boczkowski A, Kelly P, Meeks SL, Erhart K, Bova FJ, Willoughby TR. Proton vs Hyperarc™ radiosurgery: A planning comparison. J Appl Clin Med Phys 2020; 21:96-108. [PMID: 33151014 PMCID: PMC7769415 DOI: 10.1002/acm2.13075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 11/29/2022] Open
Abstract
For many patients, stereotactic radiosurgery (SRS) offers a minimally invasive, curative option when surgical techniques are not possible. To date, the literature supporting the efficacy and safety of SRS treatment techniques uses photon beams. However, with the number of proton therapy facilities exponentially growing and the favorable physical properties of proton beam radiation therapy, there is an opportunity to develop proton therapy techniques for SRS. The goal of this paper is to determine the ability of clinical proton treatment planning systems to model small field dosimetry accurately and to compare various planning metrics used to evaluate photon SRS to determine the optimum beam configurations and settings for proton SRS (PSRS) treatment plans. Once established, these plan settings were used to perform a planning comparison on a variety of different SRS cases and compare SRS metrics between the PSRS plans and HyperArc™ (VMAT) SRS plans.
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Affiliation(s)
- A. Boczkowski
- Department of NeurosurgeryUniversity of FloridaGainesvilleFLUSA
| | - P. Kelly
- UF Health Cancer Center–Orlando HealthOrlandoFLUSA
| | - S. L. Meeks
- UF Health Cancer Center–Orlando HealthOrlandoFLUSA
| | | | - F. J. Bova
- Department of NeurosurgeryUniversity of FloridaGainesvilleFLUSA
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Hoekstra N, Habraken S, Swaak-Kragten A, Breedveld S, Pignol JP, Hoogeman M. Reducing the Risk of Secondary Lung Cancer in Treatment Planning of Accelerated Partial Breast Irradiation. Front Oncol 2020; 10:1445. [PMID: 33014782 PMCID: PMC7461936 DOI: 10.3389/fonc.2020.01445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/08/2020] [Indexed: 01/01/2023] Open
Abstract
Purpose: Adjuvant accelerated partial breast irradiation (APBI) results in low local recurrence risks. However, the survival benefit of adjuvant radiotherapy APBI for low-risk breast cancer might partially be offset by the risk of radiation-induced lung cancer. Reducing the lung dose mitigates this risk, but this could result in higher doses to the ipsilateral breast. Different external beam APBI techniques are equally conformal and homogenous, but the intermediate to low dose distribution differs. Thus, the risk of toxicity is different. The purpose of this study is to quantify the trade-off between secondary lung cancer risk and breast dose in treatment planning and to compare an optimal coplanar and non-coplanar technique. Methods: A total of 440 APBI treatment plans were generated using automated treatment planning for a coplanar VMAT beam-setup and a non-coplanar robotic stereotactic radiotherapy beam-setup. This enabled an unbiased comparison of two times 11 Pareto-optimal plans for 20 patients, gradually shifting priority from maximum lung sparing to maximum ipsilateral breast sparing. The excess absolute risks of developing lung cancer and breast fibrosis were calculated using the Schneider model for lung cancer and the Avanzo model for breast fibrosis. Results: Prioritizing lung sparing reduced the mean lung dose from 2.2 Gy to as low as 0.3 Gy for the non-coplanar technique and from 1.9 Gy to 0.4 Gy for the coplanar technique, corresponding to a 7- and 4-fold median reduction of secondary lung cancer risk, respectively, compared to prioritizing breast sparing. The increase in breast dose resulted in a negligible 0.4% increase in fibrosis risk. The use of non-coplanar beams resulted in lower secondary cancer and fibrosis risks (p < 0.001). Lung sparing also reduced the mean heart dose for both techniques. Conclusions: The risk of secondary lung cancer of external beam APBI can be dramatically reduced by prioritizing lung sparing during treatment planning. The associated increase in breast dose did not lead to a relevant increase in fibrosis risk. The use of non-coplanar beams systematically resulted in the lowest risks of secondary lung cancer and fibrosis. Prioritizing lung sparing during treatment planning could increase the overall survival of early-stage breast cancer patients by reducing mortality due to secondary lung cancer and cardiovascular toxicity.
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Affiliation(s)
- Nienke Hoekstra
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Steven Habraken
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | - Sebastiaan Breedveld
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | - Mischa Hoogeman
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
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Isobe I, Mori Y, Kaneda N, Hashizume C, Ishiguchi T, Suzuki K. Dosimetric Comparison of Hypofractionated Multi-Beam Intensity-Modulated Radiation Therapy and Volumetric Modulated Arc Therapy With Flattened Beam and Flattening-Filter-Free Beam for Skull Base Meningioma Adjacent to Optic Pathways. Cureus 2020; 12:e8690. [PMID: 32699688 PMCID: PMC7370696 DOI: 10.7759/cureus.8690] [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: 03/09/2020] [Accepted: 06/18/2020] [Indexed: 11/16/2022] Open
Abstract
Background Since the optic pathways are the most vulnerable to radiation, the treatment of skull base tumors involving them is challenging. In this study simulation plans by multi-beam (MB) intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT), both with the flattened beam (FB) and flattening-filter-free beam (FFF), were compared in terms of covering of the target and sparing of the optic pathways. Materials and methods Treatment planning was simulated by MB-IMRT with FB and FFF and by 2-rotational VMAT with FB and FFF in three cases of skull base meningioma [volume of the planned target volume (PTV; PTV margin=2 mm except for overlapping area with optic pathways or brainstem): 8.6 ml, 34.6 ml, and 55.3 ml respectively], which were treated previously by multi-fractionated MB-IMRT [45 Gy/18 fx. (fraction) with 7-, 6-, and 5-beam] using a conventional Novalis (BrainLAB, Tokyo, Japan) planned by iPlan (BrainLAB, Tokyo, Japan). In all three cases, the optic pathways were adjacent to the lesion. The reference CT with contouring data set of target volumes [gross tumor volume (GTV) and PTV] and OARs (organs at risk) was transferred from iPlan to Eclipse (Varian Medical Systems, Tokyo, Japan). In this study, hypofractionated radiation therapy by 30 Gy/5 fx. was designed; 95% dose (28.5 Gy/5 fx.) was prescribed to D95 (dose to 95% volume of PTV). Conformity index (CI), homogeneity index (HI, D5/D95), D[0.1 ml] (dose to 0.1 ml) for optic pathways, and D[1 ml] for brainstem and eyes, and V[20 Gy] (volume delivered with 20 Gy or more/5 fx.) of the whole brain were evaluated. Results The indices did not differ between FB and FFF, in either MB-IMRT or VMAT. Between MB-IMRT and VMAT, the indices were similar. The mean dose of PTV and HI was a little larger with MB-IMRT than with VMAT. D[0.1 ml] of the optic pathways and D[1 ml] of the ipsilateral eye were smaller with VMAT in all three cases. D[1 ml] of the brainstem was smaller with VMAT in two cases, though it was similar in one case. Conclusion Based on our findings, VMAT with FFF might be the optimal method to treat cases of skull base meningioma involving optic pathways. However, further studies involving more cases are required to arrive at a conclusive verdict.
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Affiliation(s)
- Ikue Isobe
- Radiology, Aichi Medical University, Nagakute, JPN
| | - Yoshimasa Mori
- Radiation Oncology and Neurological Surgery, Shin-Yurigaoka General Hospital, Kawasaki, JPN
- Radiology and Radiation Oncology, Aichi Medical University, Nagakute, JPN
- Neurological Surgery, Ookuma Hospital, Nagoya, JPN
- Neurological Surgery, Aoyama General Hospital, Toyokawa, JPN
| | - Naoki Kaneda
- Radiology and Radiation Oncology, Aichi Medical University, Nagakute, JPN
| | | | - Tsuneo Ishiguchi
- Radiology and Radiation Oncology, Aichi Medical University, Nagakute, JPN
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Low-Cost iPhone-Assisted Processing to Obtain Radiotherapy Bolus Using Optical Surface Reconstruction and 3D-Printing. Sci Rep 2020; 10:8016. [PMID: 32415217 PMCID: PMC7228923 DOI: 10.1038/s41598-020-64967-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/27/2020] [Indexed: 11/08/2022] Open
Abstract
Patient specific boluses can increase the skin dose distribution better for treating tumors located just beneath the skin with high-energy radiation than a flat bolus. We introduce a low-cost, 3D-printed, patient-specific bolus made of commonly available materials and easily produced using the "structure from motion" and a simple desktop 3D printing technique. Nine pictures were acquired with an iPhone camera around a head phantom. The 3D surface of the phantom was generated using these pictures and the "structure from motion" algorithm, with a scale factor calculated by a sphere fitting algorithm. A bolus for the requested position and shape based on the above generated surface was 3D-printed using ABS material. Two intensity modulated radiation therapy plans were designed to simulate clinical treatment for a tumor located under the skin surface with a flat bolus and a printed bolus, respectively. The planned parameters of dose volume histogram, conformity index (CI) and homogeneity index (HI) were compared. The printed bolus plan gave a dose coverage to the tumor with a CI of 0.817 compared to the CI of 0.697 for the plan with flat bolus. The HIs of the plan with printed bolus and flat bolus were 0.910 and 0.887, respectively.
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Warrell GR, Colussi VC, Swanson WL, Caimi PF, Mansur DB, de Lima MJG, Pereira GC. Organ sparing of linac-based targeted marrow irradiation over total body irradiation. J Appl Clin Med Phys 2019; 20:69-79. [PMID: 31605462 PMCID: PMC6839384 DOI: 10.1002/acm2.12742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/09/2019] [Accepted: 09/11/2019] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Targeted marrow irradiation (TMI) is an alternative conditioning regimen to total body irradiation (TBI) before bone marrow transplantation in hematologic malignancies. Intensity-modulation methods of external beam radiation therapy are intended to permit significant organ sparing while maintaining adequate target coverage, improving the therapeutic ratio. This study directly compares the dose distributions to targets and organs at risk from TMI and TBI, both modalities conducted by general-use medical linacs at our institution. METHODS TMI treatments were planned for 10 patients using multi-isocentric feathered volumetric arc therapy (VMAT) plans, delivered by 6 MV photon beams of Elekta Synergy linacs. The computed tomography (CT) datasets used to obtain these plans were also used to generate dose distributions of TBI treatments given in the AP/PA extended-field method. We compared dose distributions normalized to the same prescription for both plan types. The generalized equivalent uniform dose (gEUD) of Niemierko for organs and target volumes was used to quantify effective whole structure dose and dose savings. RESULTS For the clinical target volume (CTV), no significant differences were found in mean dose or gEUD, although the radical dose homogeneity index (minimum dose divided by maximum dose) was 31.7% lower (P = 0.002) and the standard deviation of dose was 28.0% greater (P = 0.027) in the TMI plans than in the TBI plans. For the TMI plans, gEUD to the lungs, brain, kidneys, and liver was significantly lower (P < 0.001) by 47.8%, 33.3%, 55.4%, and 51.0%, respectively. CONCLUSION TMI is capable of maintaining CTV coverage as compared to that achieved in TBI, while significantly sparing organs at risk. Improvement on sparing organs at risk permits a higher prescribed dose to the target or the maximum number of times marrow conditioning may be delivered to a patient while maintaining similar typical tissue complication rates.
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Affiliation(s)
| | | | - Wayne L. Swanson
- Department of Radiation OncologyUniversity HospitalsClevelandOHUSA
| | - Paolo F. Caimi
- Department of Medicine–Hematology and OncologyUniversity HospitalsClevelandOHUSA
| | - David B. Mansur
- Department of Radiation OncologyUniversity HospitalsClevelandOHUSA
| | - Marcos J. G. de Lima
- Department of Medicine–Hematology and OncologyUniversity HospitalsClevelandOHUSA
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Grendarova P, Roumeliotis M, Quirk S, Lesiuk M, Craighead P, Liu HW, Pinilla J, Wilson J, Bignell K, Phan T, Olivotto IA. One-Year Cosmesis and Fibrosis From ACCEL: Accelerated Partial Breast Irradiation (APBI) Using 27 Gy in 5 Daily Fractions. Pract Radiat Oncol 2019; 9:e457-e464. [DOI: 10.1016/j.prro.2019.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/28/2019] [Accepted: 04/02/2019] [Indexed: 11/24/2022]
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Stelczer G, Major T, Mészáros N, Polgár C, Pesznyák C. External beam accelerated partial breast irradiation: dosimetric assessment of conformal and three different intensity modulated techniques. Radiol Oncol 2019; 53:123-130. [PMID: 30661060 PMCID: PMC6411019 DOI: 10.2478/raon-2019-0001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 11/29/2018] [Indexed: 01/20/2023] Open
Abstract
Background The aim of the study was to evaluate and compare four different external beam radiotherapy techniques of accelerated partial breast irradiation (APBI) considering target coverage, dose to organs at risk and overall plan quality. The investigated techniques were three dimensional conformal radiotherapy (3D-CRT), "step and shoot" (SS) and "sliding window" (SW) intensity-modulated radiotherapy (IMRT), intensity-modulated arc therapy (RA). Patients and methods CT scans of 40 APBI patients were selected for the study. The planning objectives were set up according to the international recommendations. Homogeneity, conformity and plan quality indices were calculated from volumetric and dosimetric parameters of target volumes and organs at risk. The total monitor units and feasibility were also investigated. Results There were no significant differences in the coverage of the target volume between the techniques. The homogeneity indices of 3D-CRT, SS, SW and RA plans were 0.068, 0.074, 0.058 and 0.081, respectively. The conformation numbers were 0.60, 0.80, 0.82 and 0.89, respectively. The V50% values of the ipsilateral breast for 3D-CRT, SS, SW and RA were 47.5%, 40.2%, 39.9% and 31.6%, respectively. The average V10% and V40% values of ipsilateral lung were 13.1%, 28.1%, 28%, 36% and 2.6%, 1.9%, 1.9%, 3%, respectively. The 3D-CRT technique provided the best heart protection, especially in the low dose region. All contralateral organs received low doses. The SW technique achieved the best plan quality index (PQI). Conclusions Good target volume coverage and tolerable dose to the organs at risk are achievable with all four techniques. Taking into account all aspects, we recommend the SW IMRT technique for APBI.
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Affiliation(s)
- Gábor Stelczer
- Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary
- Institute of Nuclear Techniques, Budapest University of Technology and Economics, BudapestHungary
| | - Tibor Major
- Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Norbert Mészáros
- Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary
- Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Csaba Polgár
- Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary
- Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Csilla Pesznyák
- Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary
- Institute of Nuclear Techniques, Budapest University of Technology and Economics, BudapestHungary
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Chan TY, Tang JI, Tan PW, Roberts N. Dosimetric evaluation and systematic review of radiation therapy techniques for early stage node-negative breast cancer treatment. Cancer Manag Res 2018; 10:4853-4870. [PMID: 30425577 PMCID: PMC6205528 DOI: 10.2147/cmar.s172818] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Radiation therapy (RT) is essential in treating women with early stage breast cancer. Early stage node-negative breast cancer (ESNNBC) offers a good prognosis; hence, late effects of breast RT becomes increasingly important. Recent literature suggests a potential for an increase in cardiac and pulmonary events after RT. However, these studies have not taken into account the impact of newer and current RT techniques that are now available. Hence, this review aimed to evaluate the clinical evidence for each technique and determine the optimal radiation technique for ESNNBC treatment. Currently, six RT techniques are consistently used and studied: 1) prone positioning, 2) proton beam RT, 3) intensity-modulated RT, 4) breath-hold, 5) partial breast irradiation, and 6) intraoperative RT. These techniques show dosimetric promise. However, limited data on late cardiac and pulmonary events exist due to challenges in long-term follow-up. Moving forward, future studies are needed to validate the efficacy and clinical outcomes of these current techniques.
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Affiliation(s)
- Tabitha Y Chan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore,
| | - Johann I Tang
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore,
| | - Poh Wee Tan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore,
| | - Neill Roberts
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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14
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Jurkovic IA, Stathakis S, Li Y, Patel A, Vincent J, Papanikolaou N, Mavroidis P. Use of lung treatment plans to evaluate DIR algorithms. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2018; 41:837-845. [PMID: 30144019 DOI: 10.1007/s13246-018-0677-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 08/19/2018] [Indexed: 10/28/2022]
Abstract
The purpose of the study is to evaluate the accuracy of two deformable image registration algorithms by examining their influence on the dose summation results obtained using 4DCT (four dimensional computed tomography) dose distributions based on '4D' planned and '4D optimal' IMRT (intensity modulated radiation therapy) plans. For ten lung cancer patients, 4D step and shoot IMRT plans were produced. The breathing cycle was divided into ten parts and for each part a set of CT images was acquired. For each patient the treatment plan was copied to the CTs of each phase and subsequently recalculated. Each phase CT was then registered to the average intensity projection (AIP) CT using a deformable image registration (DIR) algorithm and the composite dose distribution was then calculated by summing up the deformed dose distributions from all the phases ('4D' treatment plan). The '4D optimal' treatment plan was created by producing an optimal plan on the CTs of each phase of the respiratory cycle and summing up the deformed dose distributions from all the phases. The results indicate that it is possible to map the dose distributions of different breathing phases in lung using DIR, and that different DIR methods and target characteristics (motion amplitude, size, location) affect the differences between original plan, '4D' and '4D optimal' dose distributions. Although the '4D optimal' plans were designed to achieve 95% target coverage, both of the used DIR methods failed to translate that coverage in some instances. The same variation between these methods was also observed in the '4D' plan comparison. This study shows that it is feasible to perform an acceptably accurate calculation of the composite deformed dose. However, it is important to account for tumor motion and body deformation especially when the tumor volume is small and/or located in the lower lobe of the lung.
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Affiliation(s)
- Ines-Ana Jurkovic
- Department of Radiation Oncology, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA
| | - Sotirios Stathakis
- Department of Radiation Oncology, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA
| | - Ying Li
- Department of Radiation Oncology, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA
| | - Abhilasha Patel
- Department of Radiation Oncology, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA
| | - Jill Vincent
- Department of Radiation Oncology, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA
| | - Nikos Papanikolaou
- Department of Radiation Oncology, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA
| | - Panayiotis Mavroidis
- Department of Radiation Oncology, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA. .,Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA.
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15
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Evaluation of various dose homogeneity indices for treatment of patients with cervix cancer using intensity-modulated radiation therapy technique. JOURNAL OF RADIOTHERAPY IN PRACTICE 2018. [DOI: 10.1017/s1460396918000249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractAimThis study is primarily aimed at the analysis of various dose homogeneity indices (HIs) essential for the evaluation of therapeutic plans by employing intensity-modulated radiation therapy (IMRT) on patients with cervix cancer. Also integral dose (ID) to healthy surrounding organs is computed.Materials and methodsEffectiveness of different HIs (A, B, C, D) was explored for IMRT plans using 15 MV photon beam. In total, 18 patients were selected at random for treatment of cervix cancer, and dose of 5,040 cGy was delivered in 28 equal fractions.ResultsThe study was undertaken to compare four HI formulas and coefficient of determination between each set of HI was known by calculating R2 value. Mean±SD of HI A, HI B, HI C and HI D were 1·12±0·02, 0·13±0·04, 0·10±0·02 and 0·99±0·03, respectively. Mean value of ID for rectum is 3·16 and for bladder is 10·3.FindingsOur data suggested that HI calculated using four formulas provided good plan quality. The results advocate that all the studied HIs can be effectively used for assessment of uniformity inside the target volume. However, values of HI C were closest to ideal value as compared with other three formulas; hence, it is considered a better measure to compute homogeneity of dose within target volume. The ID gives satisfactory results for surrounding normal tissues such as rectum and bladder and significant critical tissue sparing was achieved by using IMRT technique.
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Chen L, Peng YL, Gu SY, Shen H, Zhang DD, Sun WZ, Wu JH, Deng XW. Dosimetric Effects of Head and Neck Immobilization Devices on Multi-field Intensity Modulated Radiation Therapy for Nasopharyngeal Carcinoma. J Cancer 2018; 9:2443-2450. [PMID: 30026841 PMCID: PMC6036882 DOI: 10.7150/jca.24887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/01/2018] [Indexed: 11/11/2022] Open
Abstract
Background: In practice, the dose perturbation effect of head and neck immobilization devices is often overlooked in intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC). Purpose of this study is to verify and analyze the dosimetric effect of head and neck immobilization devices on NPC multi-field IMRT. Methods: Ten patients with nasopharyngeal carcinoma were randomly selected. Two sets of body contours were established for each patient. One set of body contours did not contain the immobilization device, and the other contour set included the immobilization device. For each patient, dose calculations were conducted for the two sets of contours using the same 9-field IMRT plan, which were recorded as Plan- and Plan+. The dose difference caused by the head and neck immobilization devices was assessed by comparing the dose-volume histogram (DVH) parameter results and by plan subtraction. The gafchromic EBT3 film and anthropomorphic phantom were used to verify the calculated doses. Results: The target coverage and average dose of Plan+ were lower than those of Plan- : the prescription dose coverage rates for PTVnx, PTVnd, PTV1 and PTV2 decreased by 2.4%, 9.9%, 1.5%, and 3.6%, respectively, and the mean doses were reduced by 0.9%, 1.9%, 1.1%, and 1.5%, respectively. Doses in the organs at risk showed no significant differences or slight reductions (the maximum reduction in mean dose was 1.7%). From the EBT3 measurements, the skin dose on the posterior neck was increased by approximately 53%. Conclusion: The attenuation and bolus effects of the head and neck immobilization device reduce dose coverage rate and average dose of the planning target volumes in nasopharyngeal carcinoma and lead to an increase in the skin dose. During treatment planning and dose calculation, the immobilization device should be included within body contour to account for the dose attenuation and skin dose increment.
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Affiliation(s)
- Li Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Ying-Lin Peng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Shi-Yong Gu
- Department of Radiation Oncology, Wuhan General Hospital of Guangzhou Military, No. 627, Wuluo Road, Hongshan District, Wuhan 430064, China
| | - Hui Shen
- Department of Radiation Oncology, Yangjiang Hospital, No.42, Dongshan Road, Jiangcheng District, Yangjiang 529599, China
| | - Dan-Dan Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Wen-Zhao Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Jian-Hua Wu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Xiao-Wu Deng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
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A novel voxel based homogeneity index: Rationale and clinical implications for whole-brain radiation therapy. Radiother Oncol 2018; 128:229-235. [PMID: 29699833 DOI: 10.1016/j.radonc.2018.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 03/30/2018] [Accepted: 04/06/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE OR OBJECTIVE A homogeneity index (HI) measures the uniformity of a dose distribution within a given target volume. Traditional HIs only use a limited number of dose-volume histogram data-points for calculation. A voxel-based homogeneity index (VHI) is proposed which utilizes the entire information of the three-dimensional dose distribution. We compared the VHI with existing HIs and analyzed if VHI results were associated with treatment outcomes in patients who underwent therapeutic WBRT. MATERIAL AND METHODS The VHI analyzes deviations from the prescribed dose in each voxel of the target volume. We retrospectively analyzed WBRT treatment plans. Overall survival (OS), CNS progression-free-survival (CNS PFS) and hazard rates were compared for tertile-split levels of the VHI using the Kaplan-Meier methods and multivariable Cox-regression analysis. RESULTS WBRT treatment plans (n = 770) were used for HIs comparison. OS and CNS PFS were assessed for 430 patients. The VHI showed a higher sensitivity for dose inhomogeneities. Lower OS and CNS PFS were observed for higher levels of VHIUnderdosage, particularly in patients with good performance status (KPS >70%) (OS: Log-rank P = .007, HR = 1.37 95%CI [1.09, 1.72]). CONCLUSION Higher sensitivity and feasibility to assess treatment plan quality using the VHI were demonstrated. First clinical implications were found in terms of compromised OS/CNS PFS for WBRT with radiation underdosage.
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18
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Lozza L, Fariselli L, Sandri M, Rampa M, Pinzi V, De Santis MC, Franceschini M, Trecate G, Maugeri I, Fumagalli L, Bonfantini F, Bianchi G, Pignoli E, De Martin E, Agresti R. Partial breast irradiation with CyberKnife after breast conserving surgery: a pilot study in early breast cancer. Radiat Oncol 2018; 13:49. [PMID: 29566762 PMCID: PMC5865347 DOI: 10.1186/s13014-018-0991-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 03/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Local recurrences after breast conserving treatment are mainly close to the original tumor site, and as such shorter fractionation strategies focused on and nearest mammary gland, i.e. accelerated partial breast irradiation (APBI), have been developed. Stereotactic APBI has been attempted, although there is little experience using CyberKnife (CK) for early breast cancer. METHODS This pilot study was designed to assess the feasibility of CK-APBI on 20 evaluable patients of 29 eligible, followed for 2 years. The primary endpoint was acute/sub-acute toxicity; secondary endpoints were late toxicity and the cosmetic result. RESULTS Mean pathological tumor size was 10.5 mm (±4.3, range 3-18), 8 of these patients were classified as LumA-like, 11 as LumB-like, and 1 as LumB-HER2-enriched. Using CK-APBI with Iris, the treatment time was approximately 60 min (range~ 35 to ~ 120). All patients received 30 Gy in five fractions delivered to the PTV. The median number of beams was 180 (IQR 107-213; range:56-325) with a median PTV isodose prescription of 86.0% (IQR 85.0-88.5; range:82-94). The median PTV was 88.1 cm3 (IQR 63.8-108.6; range:32.3-238.8). The median breast V100 and V50 was 0.6 (IQR 0.1-1.5; range:0-13) and 18.6 (IQR 13.1-21.7; range:7.5-37), respectively. The median PTV minimum dose was 26.2 Gy (IQR 24.7-27.6; range 22.3-29.3). Mild side effects were recorded during the period of observation. Cosmetic evaluations were performed by three observers from the start of radiotherapy up to 2 years. Patients' evaluation progressively increase from 60% to 85% of excellent rating; this trend was similar to that of external observer. CONCLUSIONS These preliminary results showed the safe feasibility of CK-APBI in early breast cancer, with mild acute and late toxicity and very good cosmetic results. TRIAL REGISTRATION The present study is registered at Clinicaltrial.gov ( NCT02896322 ). Retrospectively egistered August 4, 2016.
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Affiliation(s)
- Laura Lozza
- Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Fariselli
- Health Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Sandri
- Molecular Targeting Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mario Rampa
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valentina Pinzi
- Health Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Marzia Franceschini
- Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Trecate
- Radiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ilaria Maugeri
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luisa Fumagalli
- Health Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesca Bonfantini
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giulia Bianchi
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Emanuele Pignoli
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena De Martin
- Health Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Roberto Agresti
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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Sayan M, Hard D, Wilson K, Nelson C, Gagne H, Rubin D, Heimann R. Long-term cosmesis following a novel schedule of accelerated partial breast radiation in selected early stage breast cancer: result of a prospective clinical trial. Radiat Oncol J 2017; 35:325-331. [PMID: 29207864 PMCID: PMC5769880 DOI: 10.3857/roj.2017.00171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/06/2017] [Accepted: 07/10/2017] [Indexed: 11/03/2022] Open
Abstract
PURPOSE There is controversy regarding the cosmetic outcome after accelerated partial breast radiation (APBR). We report the cosmetic outcome from a single-arm prospective clinical trial of APBR delivered using intensity-modulated radiation therapy (IMRT) in elderly patients with stage I breast cancer (BC), using a novel fractionation schedule. MATERIALS AND METHODS Forty-two patients aged ≥65, with Stage I BC who underwent breast-conserving surgery were enrolled in a phase I/II study evaluating a 2-week course of APBR. Thirty eligible patients received 40 Gy in 4 Gy daily fractions. Cosmetic outcome was assessed subjectively by physician/patient and objectively by using a computer program (BCCT.core) before APBR, during, and after completion of the treatment. RESULTS The median age was 72 years, the median tumor size was 0.8 cm, and the median follow-up was 50.5 months. The 5-year locoregional control in this cohort was 97% and overall survival 87%. At the last follow-up, patients and physicians rated cosmesis as 'excellent' or 'good' in 100% and 91 %, respectively. The BCCT.core program scored the cosmesis as 'excellent' or 'good' in 87% of the patients at baseline and 81% at the last follow-up. The median V50 (20 Gy) of the whole breast volume (WBV) was 37.2%, with the median WBV V100 (40 Gy) of 10.9%. CONCLUSION An excellent rate of tumor control was observed in this prospective trial. By using multiple assessment techniques, we are showing acceptable cosmesis, supporting the use of IMRT planned APBR with daily schedule in elderly patients with early stage BC.
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Affiliation(s)
- Mutlay Sayan
- Department of Radiation Oncology, University of Vermont Medical Center, Burlington, VT, USA
| | - Daphne Hard
- Department of Radiation Oncology, University of Vermont Medical Center, Burlington, VT, USA
| | - Karen Wilson
- University of Vermont Cancer Center, Burlington, VT, USA
| | - Carl Nelson
- Department of Radiation Oncology, University of Vermont Medical Center, Burlington, VT, USA
| | - Havaleh Gagne
- Department of Radiation Oncology, University of Vermont Medical Center, Burlington, VT, USA
| | - Deborah Rubin
- Department of Radiation Oncology, University of Vermont Medical Center, Burlington, VT, USA
| | - Ruth Heimann
- Department of Radiation Oncology, University of Vermont Medical Center, Burlington, VT, USA
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Park JM, Shin KH, Kim JI, Park SY, Jeon SH, Choi N, Kim JH, Wu HG. Air–electron stream interactions during magnetic resonance IGRT. Strahlenther Onkol 2017; 194:50-59. [DOI: 10.1007/s00066-017-1212-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
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21
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Zeinali-Rafsanjani B, Mosleh-Shirazi MA, Haghighatafshar M, Jalli R, Saeedi-Moghadam M. Assessment of the dose distribution of Minibeam radiotherapy for lung tumors in an anthropomorphic phantom: A feasibility study. Technol Health Care 2017; 25:683-692. [DOI: 10.3233/thc-170818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Banafsheh Zeinali-Rafsanjani
- Nuclear Medicine and Molecular Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Amin Mosleh-Shirazi
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Radiotherapy and Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Haghighatafshar
- Nuclear Medicine and Molecular Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Jalli
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Saeedi-Moghadam
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Sayan M, Wilson K, Nelson C, Gagne H, Rubin D, Heimann R. A novel schedule of accelerated partial breast radiation using intensity-modulated radiation therapy in elderly patients: survival and toxicity analysis of a prospective clinical trial. Radiat Oncol J 2017; 35:32-38. [PMID: 28183159 PMCID: PMC5398344 DOI: 10.3857/roj.2016.01963] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/19/2016] [Accepted: 11/11/2016] [Indexed: 12/30/2022] Open
Abstract
Purpose Several accelerated partial breast radiation (APBR) techniques have been investigated in patients with early-stage breast cancer (BC); however, the optimal treatment delivery techniques remain unclear. We evaluated the feasibility and toxicity of APBR delivered using intensity-modulated radiation therapy (IMRT) in elderly patients with stage I BC, using a novel fractionation schedule. Materials and Methods Forty-two patients aged ≥65 years, with stage I BC who underwent breast conserving surgery were enrolled in a phase I/II study evaluating APBR using IMRT. Forty eligible patients received 40 Gy in 4 Gy daily fractions. Patients were assessed for treatment related toxicities, and cosmesis, before APBR, during, and after completion of the treatment. Results The median age was 73 years, median tumor size 0.8 cm and the median follow-up was 54 months. The 5-year locoregional control was 97.5% and overall survival 90%. Erythema and skin pigmentation was the most common acute adverse event, reported by 27 patients (69%). Twenty-six patients (65%) reported mild pain, rated 1-4/10. This improved at last follow-up to only 2 (15%). Overall the patient and physician reported worst late toxicities were lower than the baseline and at last follow-up, patients and physicians rated cosmesis as excellent/good in 93% and 86 %, respectively. Conclusion In this prospective trial, we observed an excellent rate of tumor control with daily APBR. The acceptable toxicity profile and cosmetic results of this study support the use of IMRT planned APBR with daily schedule in elderly patients with early stage BC.
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Affiliation(s)
- Mutlay Sayan
- Department of Radiation Oncology, University of Vermont Medical Center, Burlington, VT, USA
| | - Karen Wilson
- University of Vermont Cancer Center, Burlington, VT, USA
| | - Carl Nelson
- Department of Radiation Oncology, University of Vermont Medical Center, Burlington, VT, USA
| | - Havaleh Gagne
- Department of Radiation Oncology, University of Vermont Medical Center, Burlington, VT, USA
| | - Deborah Rubin
- Department of Radiation Oncology, University of Vermont Medical Center, Burlington, VT, USA
| | - Ruth Heimann
- Department of Radiation Oncology, University of Vermont Medical Center, Burlington, VT, USA
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Yadav P, Yan Y, Ignatowski T, Olson A. Dosimetric aspects of breast radiotherapy with three-dimensional and intensity-modulated radiotherapy helical tomotherapy planning modules. Med Dosim 2017; 42:42-46. [PMID: 28129971 DOI: 10.1016/j.meddos.2016.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 09/08/2016] [Accepted: 11/15/2016] [Indexed: 11/19/2022]
Abstract
In this work, we investigated the dosimetric differences between the intensity-modulated radiotherapy (IMRT) plans and the three-dimensional (3D) helical plans based on the TomoTherapy system. A total of 15 patients with supine setup were randomly selected from the data base. For patients with lumpectomy planning target volume (PTV), regional lymph nodes were also included as part of the target. For dose sparing, the significant differences between the helical IMRT and helical 3D were only found in the heart and contralateral breast. For the dose to the heart, helical IMRT reduced the maximum point dose by 6.98Gy compared to the helical 3D plan (p = 0.01). For contralateral breast, the helical IMRT plans significantly reduced the maximum point dose by 5.6Gy compared to the helical 3D plan. However, compared to the helical 3D plan, the helical IMRT plan increased the volume for lower dose (13.08% increase in V5Gy, p = 0.01). In general, there are no significant differences in dose sparing between helical IMRT and helical 3D plans.
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Affiliation(s)
- Poonam Yadav
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI; Service of Radiation Therapy, University of Wisconsin Aspirus Cancer Center, Wisconsin Rapids, WI
| | - Yue Yan
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Tasha Ignatowski
- Service of Radiation Therapy, University of Wisconsin Aspirus Cancer Center, Wisconsin Rapids, WI
| | - Anna Olson
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI; Service of Radiation Therapy, University of Wisconsin Aspirus Cancer Center, Wisconsin Rapids, WI
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MacDonald RL, Robar JL, Thomas CG. Overlap-guided fixed-patient support positioning optimization for cranial SRT. Med Phys 2017; 44:17-27. [PMID: 28044324 DOI: 10.1002/mp.12008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 11/09/2016] [Accepted: 11/10/2016] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To investigate potential dosimetric improvements through the optimization of fixed-couch rotational position in cranial cancer stereotactic treatments. METHODS Using previously delivered cranial stereotactic radiotherapy plans treated at the Nova Scotia Health Authority (NSHA), we have redesigned the treatment arrangement to find the optimal couch rotation positions based on the reduction of overlap between organs-at-risk of exposure (OARs) and target volume (PTV). Maintaining the gantry arrangements from the delivered treatment, the couch positions were determined based on a cost function analysis of accumulation of overlap score from an equation developed by Yang et al. and refined by MacDonald et al. The algorithm incorporates factors for radiation dose sensitivities of each OAR, depth of both OARs and target (PTV) volumes, and orthogonality of the 3D vector between OAR and PTV in the case of proximal OAR position. RESULTS The plan evaluation was conducted on 16 acoustic neuroma patients treated with stereotactic radiotherapy plans at the NSHA. Maximum and mean doses to the OARs were reduced by approximately 14.30% ± 2.86% and 19.25% ± 2.10%, respectively, with application of this optimization technique as compared to the delivered treatment plans. In addition, PTV conformity and homogeneity were improved with application of this optimization technique. CONCLUSION This variation of the existing delivery techniques with guidance from a PTV-OAR overlap cost function analysis technique can yield significant dosimetric improvements with no increase to delivery or planning time.
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Affiliation(s)
- R Lee MacDonald
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| | - James L Robar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, B3H 4R2, Canada.,Department of Medical Physics, Nova Scotia Health Authority, Halifax, NS, B3H 1V7, Canada.,Department of Radiation Oncology, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| | - Christopher G Thomas
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, B3H 4R2, Canada.,Department of Medical Physics, Nova Scotia Health Authority, Halifax, NS, B3H 1V7, Canada.,Department of Radiation Oncology, Dalhousie University, Halifax, NS, B3H 4R2, Canada.,Department of Radiology, Dalhousie University, Halifax, NS, B3H 4R2, Canada
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Major T, Stelczer G, Pesznyák C, Mészáros N, Polgár C. Multicatheter interstitial brachytherapy versus intensity modulated external beam therapy for accelerated partial breast irradiation: A comparative treatment planning study with respect to dosimetry of organs at risk. Radiother Oncol 2017; 122:17-23. [DOI: 10.1016/j.radonc.2016.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 08/01/2016] [Accepted: 08/01/2016] [Indexed: 11/16/2022]
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Breast Cancer in Lymphoma Survivors. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Zeinali-Rafsanjani B, Faghihi R, Mosleh-Shirazi MA, Mosalaei A, Hadad K. Revision of orthovoltage chest wall treatment using Monte Carlo simulations. Technol Health Care 2016; 25:413-424. [PMID: 27886021 DOI: 10.3233/thc-161276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Given the high local control rates observed in breast cancer patients undergoing chest wall irradiation by kilovoltage x-rays, we aimed to revisit this treatment modality by accurate calculation of dose distributions using Monte Carlo simulation. METHODS AND MATERIAL The machine components were simulated using the MCNPX code. This model was used to assess the dose distribution of chest wall kilovoltage treatment in different chest wall thicknesses and larger contour or fat patients in standard and mid sternum treatment plans. Assessments were performed at 50 and 100 cm focus surface distance (FSD) and different irradiation angles. In order to evaluate different plans, indices like homogeneity index, conformity index, the average dose of heart, lung, left anterior descending artery (LAD) and percentage target coverage (PTC) were used. Finally, the results were compared with the indices provided by electron therapy which is a more routine treatment of chest wall. RESULT These indices in a medium chest wall thickness in standard treatment plan at 50 cm FSD and 15 degrees tube angle was as follows: homogeneity index 2.57, conformity index 7.31, average target dose 27.43 Gy, average dose of heart, lung and LAD, 1.03, 2.08 and 1.60 Gy respectively and PTC 11.19%. Assessments revealed that dose homogeneity in planning target volume (PTV) and conformity between the high dose region and PTV was poor. To improve the treatment indices, the reference point was transferred from the chest wall skin surface to the center of PTV. The indices changed as follows: conformity index 7.31, average target dose 60.19 Gy, the average dose of heart, lung and LAD, 3.57, 6.38 and 5.05 Gy respectively and PTC 55.24%. Coverage index of electron therapy was 89% while it was 22.74% in the old orthovoltage method and also the average dose of the target was about 50 Gy but in the given method it was almost 30 Gy. CONCLUSION The results of the treatment study show that the optimized standard and mid sternum treatment for different chest wall thicknesses is with 50 cm FSD and zero (vertical) tube angle, while in large contour patients, it is with 100 cm FSD and zero tube angle. Finally, chest wall kilovoltage and electron therapies were compared, which revealed that electron therapy produces a better dose distribution than kilovoltage therapy.
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Affiliation(s)
- B Zeinali-Rafsanjani
- Medical Radiation Department, School of Mechanical Engineering, Shiraz University, Shiraz, Iran.,Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - R Faghihi
- Medical Radiation Department, School of Mechanical Engineering, Shiraz University, Shiraz, Iran.,Radiation Research Center, School of Mechanical Engineering, Shiraz University, Shiraz, Iran
| | - M A Mosleh-Shirazi
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Radiotherapy and Oncology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - A Mosalaei
- Radiotherapy and Oncology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - K Hadad
- Medical Radiation Department, School of Mechanical Engineering, Shiraz University, Shiraz, Iran
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Batumalai V, Holloway L, Walker A, Jameson M, Delaney GP. Assessment of dose variation for accelerated partial-breast irradiation using rigid and deformable image registrations. Pract Radiat Oncol 2016; 7:e9-e17. [PMID: 27552811 DOI: 10.1016/j.prro.2016.06.009] [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: 04/11/2016] [Revised: 06/16/2016] [Accepted: 06/20/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to estimate the delivered dose to the target and organs at risk (OAR) for external beam accelerated partial-breast irradiation (APBI) accounting for day-to-day setup uncertainties, using rigid and deformable image registration. METHODS AND MATERIALS One planning computed tomography (CT) scan and 5 cone beam CT scans for each of 25 patients previously treated with tangential breast radiation therapy were used. All cone beam CT scans were registered to the planning CT scan using 3 techniques: (1) rigid registration based on bony anatomy only, (2) rigid registration based on soft-tissue only, and (3) deformable image registration. For each patient, 4 dose distributions were calculated for APBI. The first dose distribution was the original plan. The other 3 were "dose-of-the-day" for each of the registration approaches. The effects of image registrations on estimating delivered dose to targets and OAR were determined. RESULTS The average reductions in V95 (percentage of the PTV that received 95% of the prescribed dose) were 6%, 7%, and 5% for bone, soft-tissue, and deformable registrations, respectively. The average increase in mean dose to the heart were 9%, 9%, and 18% for bone, soft-tissue, and deformable registrations, respectively, whereas the average increase in maximum dose to the contralateral breast were 19%, 20%, and 28%, respectively. CONCLUSIONS The results of this study have shown that there are differences between the planned and estimated delivered dose for APBI because of day-to-day setup uncertainties that may need to be accounted for. Estimated dosimetric impact of setup variation and breast deformation assessed using deformable registration was greater for OARs and smaller for target volumes compared to rigid registration.
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Affiliation(s)
- Vikneswary Batumalai
- Liverpool and Macarthur Cancer Therapy Centres, New South Wales, Australia; Ingham Institute of Applied Medical Research, New South Wales, Australia; South Western Clinical School, University of New South Wales, New South Wales, Australia.
| | - Lois Holloway
- Liverpool and Macarthur Cancer Therapy Centres, New South Wales, Australia; Ingham Institute of Applied Medical Research, New South Wales, Australia; South Western Clinical School, University of New South Wales, New South Wales, Australia; Centre for Medical Radiation Physics, University of Wollongong, New South Wales, Australia; Institute of Medical Physics, School of Physics, University of Sydney, New South Wales, Australia
| | - Amy Walker
- Liverpool and Macarthur Cancer Therapy Centres, New South Wales, Australia; Ingham Institute of Applied Medical Research, New South Wales, Australia; Centre for Medical Radiation Physics, University of Wollongong, New South Wales, Australia
| | - Michael Jameson
- Liverpool and Macarthur Cancer Therapy Centres, New South Wales, Australia; Ingham Institute of Applied Medical Research, New South Wales, Australia; Centre for Medical Radiation Physics, University of Wollongong, New South Wales, Australia
| | - Geoff P Delaney
- Liverpool and Macarthur Cancer Therapy Centres, New South Wales, Australia; Ingham Institute of Applied Medical Research, New South Wales, Australia; South Western Clinical School, University of New South Wales, New South Wales, Australia
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Jumeau R, Péguret N, Zulliger C, Moeckli R, Bourhis J, Ozsahin EM. Optimization of re-irradiation using deformable registration: a case study. BJR Case Rep 2016; 2:20150412. [PMID: 30363697 PMCID: PMC6180895 DOI: 10.1259/bjrcr.20150412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/16/2015] [Accepted: 12/29/2015] [Indexed: 11/25/2022] Open
Abstract
Re-irradiation is frequently performed in radiotherapy (RT) departments. We present an optimization methodology that takes the previous irradiation into account. A 68-year-old female patient suffering from rectal adenocarcinoma, who had previously undergone RT for metastases to the right iliac bone, presented with a recurrence of metastasis to the L5 and the left sacroiliac joint. Re-irradiation was performed using volumetric modulated arc therapy (VMAT). We proceeded to a registration of the previous RT planning CT and RT doses to the new planning CT. Virtual volumes corresponding to the intersection of the small bowel (SB) and each isodose structure were created. We calculated the maximal dose (Dmax) that each virtual structure could receive and considered them as constraints. We called this technique modified VMAT. We compared this technique with a standard VMAT plan and a three-dimensional RT plan. Using the modified VMAT technique, a total dose of 20 Gy in five fractions of 4 Gy was delivered to the planning target volume without any acute toxicity. A composite dosimetry was realized with each technique to compare the dose given to the already irradiated SB. We calculated the Dmax received by the already irradiated SB in equivalent dose of 2 Gy fractions. The Dmax was 46.8, 60 and 52 Gy for modified VMAT, standard VMAT and three-dimensional RT, respectively. Dose deformation was used to create new constraint structures to optimize the dose delivered to surrounding tissues. This methodology is readily feasible in clinical routine to optimize the re-irradiation process.
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Affiliation(s)
- Raphaël Jumeau
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Nicolas Péguret
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Cédric Zulliger
- Institute of Radiation Physics, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Raphaël Moeckli
- Institute of Radiation Physics, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Jean Bourhis
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Esat-Mahmut Ozsahin
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
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Binny D, Lancaster CM, Harris S, Sylvander SR. Effects of changing modulation and pitch parameters on tomotherapy delivery quality assurance plans. J Appl Clin Med Phys 2015; 16:87–105. [PMID: 26699293 PMCID: PMC5690175 DOI: 10.1120/jacmp.v16i5.5282] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 02/19/2015] [Accepted: 02/19/2015] [Indexed: 12/25/2022] Open
Abstract
This study was aimed at investigating delivery quality assurance (DQA) discrepancies observed for helical tomotherapy plans. A selection of tomotherapy plans that initially failed the DQA process was chosen for this investigation. These plans failed the fluence analysis as assessed using gamma criteria (3%, 3 mm) with radiographic film. Each of these plans was modified (keeping the planning constraints the same), beamlets rebatched and reoptimized. By increasing and decreasing the modulation factor, the fluence in a circumferential plane as measured with a diode array was assessed. A subset of these plans was investigated using varied pitch values. Metrics for each plan that were examined were point doses, fluences, leaf opening times, planned leaf sinograms, and uniformity indices. In order to ensure that the treatment constraints remained the same, the dose-volume histograms (DVHs) of all the modulated plans were compared to the original plan. It was observed that a large increase in the modulation factor did not significantly improve DVH uniformity, but reduced the gamma analysis pass rate. This also increased the treatment delivery time by slowing down the gantry rotation speed which then increases the maximum to mean non-zero leaf open time ratio. Increasing and decreasing the pitch value did not substantially change treatment time, but the delivery accuracy was adversely affected. This may be due to many other factors, such as the complexity of the treatment plan and site. Patient sites included in this study were head and neck, right breast, prostate, abdomen, adrenal, and brain. The impact of leaf timing inaccuracies on plans was greater with higher modulation factors. Point-dose measurements were seen to be less susceptible to changes in pitch and modulation factors. The initial modulation factor used by the optimizer, such that the TPS generated 'actual' modulation factor within the range of 1.4 to 2.5, resulted in an improved deliverable plan.
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31
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Glide-Hurst CK, Shah MM, Price RG, Liu C, Kim J, Mahan M, Fraser C, Chetty IJ, Aref I, Movsas B, Walker EM. Intrafraction Variability and Deformation Quantification in the Breast. Int J Radiat Oncol Biol Phys 2015; 91:604-11. [DOI: 10.1016/j.ijrobp.2014.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/31/2014] [Accepted: 11/04/2014] [Indexed: 12/25/2022]
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He Z, Wu S, Zhou J, Li F, Sun J, Lin Q, Lin H, Guan X. Accelerated partial breast irradiation with intensity-modulated radiotherapy is feasible for chinese breast cancer patients. J Breast Cancer 2014; 17:256-64. [PMID: 25320624 PMCID: PMC4197356 DOI: 10.4048/jbc.2014.17.3.256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 07/26/2014] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Several accelerated partial breast irradiation (APBI) techniques are being investigated in patients with early-stage breast cancer. The present study evaluated the feasibility, early toxicity, initial efficacy, and cosmetic outcomes of accelerated partial breast intensity-modulated radiotherapy (IMRT) for Chinese female patients with early-stage breast cancer after breast-conserving surgery. METHODS A total of 38 patients met the inclusion criteria and an accelerated partial breast intensity-modulated radiotherapy (APBI-IMRT) plan was designed for each patient. The prescription dose was 34 Gy in 10 fractions, 3.4 Gy per fraction, twice a day, in intervals of more than 6 hours. RESULTS Of the 38 patients, six patients did not meet the planning criteria. The remaining 32 patients received APBI-IMRT with a mean target volume conformity index of 0.67 and a dose homogeneity index of 1.06. The median follow-up time was 53 months and no local recurrence or distant metastasis was detected. The most common acute toxicities observed within 3 months after radiotherapy were erythema, breast edema, pigmentation, and pain in the irradiated location, among which 43.8%, 12.5%, 31.3%, and 28.1% were grade 1 toxicities, respectively. The most common late toxicities occurring after 3 months until the end of the follow-up period were breast edema, pigmentation, pain in the irradiated location, and subcutaneous fibrosis, among which 6.2%, 28.1%, 21.9%, and 37.5% were grade 1 toxicities, respectively. Thirty-one patients (96.8%) had fine or excellent cosmetic outcomes, and only one patient had a poor cosmetic outcome. CONCLUSION It is feasible for Chinese females to receive APBI-IMRT after breast conserving surgery. The radiotherapeutic toxicity is acceptable, and both the initial efficacy and cosmetic outcomes are good.
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Affiliation(s)
- Zhenyu He
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Sangang Wu
- Department of Radiation Oncology, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Juan Zhou
- Department of Obstetrics and Gynecology, Xiamen Cancer Center, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Fengyan Li
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Jiayan Sun
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Qin Lin
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Huanxin Lin
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Xunxing Guan
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
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Quirk S, Conroy L, Smith WL. When is respiratory management necessary for partial breast intensity modulated radiotherapy: A respiratory amplitude escalation treatment planning study. Radiother Oncol 2014; 112:402-6. [PMID: 25236712 DOI: 10.1016/j.radonc.2014.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 07/15/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
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Lauche O, Kirova YM. Helical tomotherapy in breast cancer treatment. BREAST CANCER MANAGEMENT 2014. [DOI: 10.2217/bmt.14.34] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Nakazawa H, Komori M, Shibamoto Y, Tsugawa T, Mori Y, Kobayashi T. Dosimetric comparison of absolute and relative dose distributions between tissue maximum ratio and convolution algorithms for acoustic neurinoma plans in Gamma Knife radiosurgery. Acta Neurochir (Wien) 2014; 156:1483-9; discussion 1489. [PMID: 24890937 DOI: 10.1007/s00701-014-2143-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 05/21/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The treatment planning for Gamma Knife (GK) stereotactic radiosurgery (SRS) that performs dose calculations based on tissue maximum ratio (TMR) algorithm has disadvantages in predicting dose in tissue heterogeneity. The latest version of the planning software is equipped with a convolution dose algorithm as an optional extra and the new algorithm is able to compensate for head inhomogeneity. However, the effect of this improved calculation method requires detailed validation in clinical cases. In this study, we compared absolute and relative dose distributions of treatment plans for acoustic neurinoma between TMR and the convolution calculation. METHODS Twenty-nine clinically used plans created by TMR algorithm were recalculated by convolution method. Differences between TMR and convolution were evaluated in terms of absolute dose (beam-on time), dosimetric parameters including target coverage, selectivity, conformity index, gradient index, radical homogeneity index and the dose-volume relationship. RESULTS The discrepancy in estimated absolute dose to the target ranged from 1 to 7 % between TMR and convolution. In addition, dosimetric parameters of the two methods achieved statistical significance. However, it was difficult to see the change of relative dose distribution by visual assessment on a monitor. CONCLUSIONS Convolution, heterogeneity correction calculation, and the algorithm are necessary to reduce the dosimetric uncertainty of each case in GK SRS.
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Affiliation(s)
- Hisato Nakazawa
- Department of Radiological Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daikominami, Higashiku, Nagoya, Aichi, 461-8673, Japan,
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Quirk S, Conroy L, Smith WL. Accounting for respiratory motion in partial breast intensity modulated radiotherapy during treatment planning: a new patient selection metric. Eur J Cancer 2014; 50:1872-9. [PMID: 24835033 DOI: 10.1016/j.ejca.2014.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/28/2014] [Accepted: 04/12/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE External beam partial breast irradiation intensity modulated radiotherapy (PBI IMRT) plans experience degradation in coverage and dose homogeneity when delivered during respiration. We examine which characteristics of the breast and seroma result in unacceptable plan degradation due to respiration. METHODS Thirty-six patient datasets were planned with inverse-optimised PBI IMRT. Population respiratory data were used to create a probability density function. This probability density function (PDF) was convolved with the static plan fluences to calculate the delivered dose with respiration. To quantify the difference between static and respiratory plan quality, we analysed the mean dose shift of the target dose volume histogram (DVH), the dose shift at 95% of the volume and the dose shift at the hotspot to 2 cm(3)of the volume. We explore which patient characteristics indicate a clinically significant degradation in delivered plan quality due to respiration. RESULTS Dose homogeneity constraints, rather than dosimetric coverage, were the limiting factors for all patient plans. We propose the dose evaluation volume-to-planning target volume (DEV-to-PTV) ratio as a delineating metric for identifying patient plans that will be more degraded by respiratory motion. The DEV-to-PTV ratio may be a more robust metric than ipsilateral breast volume because the seroma volume is contoured more consistently between physicians and clinics. CONCLUSIONS For patients with a DEV-to-PTV ratio less than 55% we recommend either not using PBI IMRT or employing motion management. Small DEV-to-PTV ratios occur when the seroma is close to inhomogeneities (i.e. air/lung), which exacerbates the dosimetric effect of respiratory motion. For small breast sizes it is unlikely that the DEV-to-PTV ratio will meet these criteria.
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Affiliation(s)
- Sarah Quirk
- Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada; Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada.
| | - Leigh Conroy
- Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada; Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Wendy L Smith
- Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada; Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada; Department of Oncology, University of Calgary, Calgary, AB, Canada
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Nakazawa H, Mori Y, Komori M, Tsugawa T, Shibamoto Y, Kobayashi T, Hashizume C, Uchiyama Y, Hagiwara M. Simulational study of a dosimetric comparison between a Gamma Knife treatment plan and an intensity-modulated radiotherapy plan for skull base tumors. JOURNAL OF RADIATION RESEARCH 2014; 55:518-526. [PMID: 24351459 PMCID: PMC4014159 DOI: 10.1093/jrr/rrt136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 10/07/2013] [Accepted: 10/24/2013] [Indexed: 06/03/2023]
Abstract
Fractionated stereotactic radiotherapy (SRT) is performed with a linear accelerator-based system such as Novalis. Recently, Gamma Knife Perfexion (PFX) featured the Extend system with relocatable fixation devices available for SRT. In this study, the dosimetric results of these two modalities were compared from the viewpoint of conformity, heterogeneity and gradient in target covering. A total of 14 patients with skull base tumors were treated with Novalis intensity-modulated (IM)-SRT. Treatment was planned on an iPlan workstation. Five- to seven-beam IM-SRT was performed in 14-18 fractions with a fraction dose of 2.5 or 3 Gy. With these patients' data, additional treatment planning was simulated using a GammaPlan workstation for PFX-SRT. Reference CT images with planning structure contour sets on iPlan, including the planning target volume (PTV, 1.1-102.2 ml) and organs at risk, were exported to GammaPlan in DICOM-RT format. Dosimetric results for Novalis IM-SRT and PFX-SRT were evaluated in the same prescription doses. The isocenter number of PFX was between 12 and 50 at the isodose contour of 50-60%. The PTV coverage was 95-99% for Novalis and 94-98% for PFX. The conformity index (CI) was 1.11-1.61 and 1.04-1.15, the homogeneity index (HI) was 1.1-3.62 and 2.3-3.25, and the gradient index (GI) was 3.72-7.97 and 2.54-3.39 for Novalis and PFX, respectively. PTV coverage by Novalis and PFX was almost equivalent. PFX was superior in CI and GI, and Novalis was better in HI. Better conformality would be achieved by PFX, when the homogeneity inside tumors is less important.
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Affiliation(s)
- Hisato Nakazawa
- Department of Radiological Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Yoshimasa Mori
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Masataka Komori
- Department of Radiological Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takahiko Tsugawa
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Tatsuya Kobayashi
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Chisa Hashizume
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Yukio Uchiyama
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Masahiro Hagiwara
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
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Mutaf YD, Zhang J, Yu CX, Yi BY, Prado K, D'Souza WD, Regine WF, Feigenberg SJ. Dosimetric and geometric evaluation of a novel stereotactic radiotherapy device for breast cancer: the GammaPod™. Med Phys 2013; 40:041722. [PMID: 23556892 DOI: 10.1118/1.4794477] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE A dedicated stereotactic gamma irradiation device, the GammaPod™ from Xcision Medical Systems, was developed specifically to treat small breast cancers. This study presents the first evaluation of dosimetric and geometric characteristics from the initial prototype installed at University of Maryland Radiation Oncology Department. METHODS The GammaPod™ stereotactic radiotherapy device is an assembly of a hemi-spherical source carrier containing 36 (60)Co sources, a tungsten collimator, a dynamically controlled patient support table, and the breast immobilization system which also functions as a stereotactic frame. The source carrier contains the sources in six columns spaced longitudinally at 60° intervals and it rotates together with the variable-size collimator to form 36 noncoplanar, concentric arcs focused at the isocenter. The patient support table enables motion in three dimensions to position the patient tumor at the focal point of the irradiation. The table moves continuously in three cardinal dimensions during treatment to provide dynamic shaping of the dose distribution. The breast is immobilized using a breast cup applying a small negative pressure, where the immobilization cup is embedded with fiducials also functioning as the stereotactic frame for the breast. Geometric and dosimetric evaluations of the system as well as a protocol for absorbed dose calibration are provided. Dosimetric verifications of dynamically delivered patient plans are performed for seven patients using radiochromic films in hypothetical preop, postop, and target-in-target treatment scenarios. RESULTS Loaded with 36 (60)Co sources with cumulative activity of 4320 Ci, the prototype GammaPod™ unit delivers 5.31 Gy/min at the isocenter using the largest 2.5 cm diameter collimator. Due to the noncoplanar beam arrangement and dynamic dose shaping features, the GammaPod™ device is found to deliver uniform doses to targets with good conformity. The spatial accuracy of the device to locate the radiation isocenter is determined to be less than 1 mm. Single shot profiles with 2.5 cm collimator are measured with radiochromic film and found to be in good agreement with respect to the Monte Carlo based calculations (congruence of FWHM less than 1 mm). Dosimetric verifications corresponding to all hypothetical treatment plans corresponding to three target scenarios for each of the seven patients demonstrated good agreement with gamma index pass rates of better than 97% (99.0% ± 0.7%). CONCLUSIONS Dosimetric evaluation of the first GammaPod™ stereotactic breast radiotherapy unit was performed and the dosimetric and spatial accuracy of this novel technology is found to be feasible with respect to clinical radiotherapy standards. The observed level of agreement between the treatment planning system calculations and dosimetric measurements has confirmed that the system can deliver highly complex treatment plans with remarkable geometric and dosimetric accuracy.
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Affiliation(s)
- Yildirim D Mutaf
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
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van Heijst TCF, den Hartogh MD, Lagendijk JJW, van den Bongard HJGD, van Asselen B. MR-guided breast radiotherapy: feasibility and magnetic-field impact on skin dose. Phys Med Biol 2013; 58:5917-30. [PMID: 23920343 DOI: 10.1088/0031-9155/58/17/5917] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The UMC Utrecht MRI/linac (MRL) design provides image guidance with high soft-tissue contrast, directly during radiotherapy (RT). Breast cancer patients are a potential group to benefit from better guidance in the MRL. However, due to the electron return effect, the skin dose can be increased in presence of a magnetic field. Since large skin areas are generally involved in breast RT, the purpose of this study is to investigate the effects on the skin dose, for whole-breast irradiation (WBI) and accelerated partial-breast irradiation (APBI). In ten patients with early-stage breast cancer, targets and organs at risk (OARs) were delineated on postoperative CT scans co-registered with MRI. The OARs included the skin, comprising the first 5 mm of ipsilateral-breast tissue, plus extensions. Three intensity-modulated RT techniques were considered (2× WBI, 1× APBI). Individual beam geometries were used for all patients. Specially developed MRL treatment-planning software was used. Acceptable plans were generated for 0 T, 0.35 T and 1.5 T, using a class solution. The skin dose was augmented in WBI in the presence of a magnetic field, which is a potential drawback, whereas in APBI the induced effects were negligible. This opens possibilities for developing MR-guided partial-breast treatments in the MRL.
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Affiliation(s)
- Tristan C F van Heijst
- Department of Radiotherapy, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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Comparison study of the partial-breast irradiation techniques: dosimetric analysis of three-dimensional conformal radiation therapy, electron beam therapy, and helical tomotherapy depending on various tumor locations. Med Dosim 2013; 38:327-31. [PMID: 23648000 DOI: 10.1016/j.meddos.2013.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 01/28/2013] [Accepted: 03/08/2013] [Indexed: 11/21/2022]
Abstract
The partial-breast irradiation (PBI) technique, an alternative to whole-breast irradiation, is a beam delivery method that uses a limited range of treatment volume. The present study was designed to determine the optimal PBI treatment modalities for 8 different tumor locations. Treatment planning was performed on computed tomography (CT) data sets of 6 patients who had received lumpectomy treatments. Tumor locations were classified into 8 subsections according to breast quadrant and depth. Three-dimensional conformal radiation therapy (3D-CRT), electron beam therapy (ET), and helical tomotherapy (H-TOMO) were utilized to evaluate the dosimetric effect for each tumor location. Conformation number (CN), radical dose homogeneity index (rDHI), and dose delivered to healthy tissue were estimated. The Kruskal-Wallis, Mann-Whitney U, and Bonferroni tests were used for statistical analysis. The ET approach showed good sparing effects and acceptable target coverage for the lower inner quadrant-superficial (LIQ-S) and lower inner quadrant-deep (LIQ-D) locations. The H-TOMO method was the least effective technique as no evaluation index achieved superiority for all tumor locations except CN. The ET method is advisable for treating LIQ-S and LIQ-D tumors, as opposed to 3D-CRT or H-TOMO, because of acceptable target coverage and much lower dose applied to surrounding tissue.
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Dosimetric comparison of normal structures associated with accelerated partial breast irradiation and whole breast irradiation delivered by intensity modulated radiotherapy for early breast cancer after breast conserving surgery. Clin Transl Oncol 2013; 16:69-76. [PMID: 23615981 DOI: 10.1007/s12094-013-1044-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 04/07/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To assess the heart and lung dosimetry results associated with accelerated partial breast irradiation intensity-modulated radiotherapy (APBI-IMRT) and whole breast field-in-field intensity-modulated radiotherapy (WBI-FIF-IMRT). METHODS A total of 29 patients with early-stage breast cancer after lumpectomy were included in this study. APBI-IMRT and WBI-FIF-IMRT plans were generated for each patient. The dosimetric parameters of ipsilateral lung and heart in both plans were then compared with and without radiobiological correction. RESULTS With and without radiobiological correction, the volume of ipsilateral lung showed a substantially lower radiation exposure in APBI-IMRT with moderate to high doses (P < 0.05) but non-significant increases in volume of ipsilateral lung in 2.5 Gy than WBI-FIF-IMRT (P > 0.905).There was no significant difference in volume of ipsilateral lung receiving 1, 2.5, and 5 Gy between APBI-IMRT and WBI (P > 0.05) in patients with medial tumor location, although APBI-IMRT exposed more lung to 2.5 and 5 Gy. APBI-IMRT significantly decreases the volume of heart receiving low to high doses in left-sided breast cancer (P < 0.05). CONCLUSION APBI-IMRT can significantly spare the volume of heart and ipsilateral lung receiving moderate and high dose. Non-significant increases in volume of the ipsilateral lung exposed to low doses of radiation were observed for APBI-IMRT in comparison to WBI-FIF-IMRT, particularly in patients with medial tumor location. With the increasing interest in APBI-IMRT, our data may help clinicians individualize patient treatment decisions.
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Oh SA, Kang MK, Kim SK, Yea JW. Comparison of IMRT and VMAT Techniques in Spine Stereotactic Radiosurgery with International Spine Radiosurgery Consortium Consensus Guidelines. PROGRESS IN MEDICAL PHYSICS 2013; 24:145. [DOI: 10.14316/pmp.2013.24.3.145] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Affiliation(s)
- Se An Oh
- Department of Radiation Oncology, Yeungnam University Medical Center, Daegu, Korea
- Department of Physics, Yeungnam University, Gyeongsan, Korea
| | - Min Kyu Kang
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea
| | - Sung Kyu Kim
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea
| | - Ji Woon Yea
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea
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Borca VC, Franco P, Catuzzo P, Migliaccio F, Zenone F, Aimonetto S, Peruzzo A, Pasquino M, Russo G, La Porta MR, Cante D, Sciacero P, Girelli G, Ricardi U, Tofani S. Does TomoDirect 3DCRT represent a suitable option for post-operative whole breast irradiation? A hypothesis-generating pilot study. Radiat Oncol 2012; 7:211. [PMID: 23241224 PMCID: PMC3547690 DOI: 10.1186/1748-717x-7-211] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 12/03/2012] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This study investigates the use of TomoDirect™ 3DCRT for whole breast adjuvant radiotherapy (AWBRT) that represents a very attractive treatment opportunity, mainly for radiotherapy departments without conventional Linacs and only equipped with helical tomotherapy units. METHODS Plans were created for 17 breast cancer patients using TomoDirect in 3DCRT and IMRT modality and field-in-field 3DCRT planning (FIF) and compared in terms of PTV coverage, overdosage, homogeneity, conformality and dose to OARs. The possibility to define patient-class solutions for TD-3DCRT employment was investigated, correlating OARs dose constraints to patient specific anatomic parameters. RESULTS TD-3DCRT showed PTV coverage and homogeneity significantly higher than TD-IMRT and FIF. PTV conformality was significantly better for FIF, while no differences were found between TD-3DCRT and TD-IMRT. TD-3DCRT showed mean values of the OARs dosimetric endpoints significantly higher than TD-IMRT; with respect to FIF, TD-3DCRT showed values significantly higher for lung V(20Gy), mean heart dose and V(25Gy), while contralateral lung maximum dose and contralateral breast mean dose resulted significantly lower. The Central Lung Distance (CLD) and the maximal Heart Distance (HD) resulted as useful clinical tools to predict the opportunity to employ TD-3DCRT: positive correlations were found between CLD and both V(20Gy) and mean lung dose and between HD and both V25Gy and the mean heart dose. TD-3DCRT showed a significantly shorter mean beam-on time than TD-IMRT. CONCLUSIONS The present study showed that TD-3DCRT and TD-IMRT are two feasible and dosimetrically acceptable treatment approach for AWBRT, with an optimal PTV coverage and adequate OARs sparing. Some concerns might be raised in terms of dose to organs at risks if TD-3DCRT is applied to a general population. A correct patients clusterization according to simple quantitative anatomic measures, would help to correctly allocate patients to the appropriate treatment planning strategy in terms of target coverage, but also of normal tissue sparing.
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Affiliation(s)
- Valeria Casanova Borca
- Departments of Medical Physics, Ospedale Regionale ‘U. Parini’, AUSL Valle d’Aosta, Aosta, Italy
- Departments of Medical Physics, Azienda Sanitaria ASL TO 4, Ivrea, Italy
| | - Pierfrancesco Franco
- Department of Radiation Oncology, Ospedale Regionale ‘U. Parini’, AUSL Valle d’Aosta, Aosta, Italy
| | - Paola Catuzzo
- Departments of Medical Physics, Ospedale Regionale ‘U. Parini’, AUSL Valle d’Aosta, Aosta, Italy
| | - Fernanda Migliaccio
- Department of Radiation Oncology, Ospedale Regionale ‘U. Parini’, AUSL Valle d’Aosta, Aosta, Italy
| | - Flora Zenone
- Departments of Medical Physics, Ospedale Regionale ‘U. Parini’, AUSL Valle d’Aosta, Aosta, Italy
| | - Stefania Aimonetto
- Departments of Medical Physics, Ospedale Regionale ‘U. Parini’, AUSL Valle d’Aosta, Aosta, Italy
| | - Andrea Peruzzo
- Departments of Medical Physics, Ospedale Regionale ‘U. Parini’, AUSL Valle d’Aosta, Aosta, Italy
| | - Massimo Pasquino
- Departments of Medical Physics, Azienda Sanitaria ASL TO 4, Ivrea, Italy
| | - Giuliana Russo
- Departments of Medical Physics, Azienda Sanitaria ASL TO 4, Ivrea, Italy
| | - Maria Rosa La Porta
- Department of Radiation Oncology, Ospedale Regionale ‘U. Parini’, AUSL Valle d’Aosta, Aosta, Italy
- Departments of Radiotherapy, Azienda Sanitaria ASL TO 4, Ivrea, Italy
| | - Domenico Cante
- Departments of Radiotherapy, Azienda Sanitaria ASL TO 4, Ivrea, Italy
| | - Piera Sciacero
- Departments of Radiotherapy, Azienda Sanitaria ASL TO 4, Ivrea, Italy
| | - Giuseppe Girelli
- Departments of Radiotherapy, Azienda Sanitaria ASL TO 4, Ivrea, Italy
| | - Umberto Ricardi
- Department of Medical and Surgical Sciences, Radiation Oncology Unit, University of Torino, Ospedale S. Giovanni Battista, Turin, Italy
| | - Santi Tofani
- Departments of Medical Physics, Ospedale Regionale ‘U. Parini’, AUSL Valle d’Aosta, Aosta, Italy
- Departments of Medical Physics, Azienda Sanitaria ASL TO 4, Ivrea, Italy
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Li S, DeWeese T, Movsas B, Liu D, Frassica D, Kim J, Chen Q, Walker E. Initial validation and clinical experience with 3D optical-surface-guided whole breast irradiation of breast cancer. Technol Cancer Res Treat 2012; 11:57-68. [PMID: 22181332 DOI: 10.7785/tcrt.2012.500235] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We had introduced 3D optical surface-guided radiotherapy (SGRT) of the breast cancer (BC). We then initiated the feasibility, accuracy, and precision studies of stereovision in detection of any breast displacement through the course of treatment for total thirty breasts undertaken whole breast irradiation (WBI). In the SGRT, CT-based plan data were parsed into an in-house computer program through which the reference surfaces were generated in 3D video format. When patients were positioned on treatment Tables, real-time stereovisions were rapidly acquired while the live surface tracking shown steady thorax motion. The real-time surface images were automatically aligned with the reference surface and detected shape and location changes of the breast were online corrected through the Table and beam adjustments. Accumulated dose to each patient was computed according to the frequency distribution of the measured breast locations during beam on time. Application of SGRT had diminished large skin-marking errors of > 5-mm and daily breast-setup errors of >10-mm that occurred on half of cases. Accuracy (mean) and precision (two standard deviations) of the breast displacements across the tangential field edges in the (U, V) directions were improved from (-0.5 ± 8.8, 2.2 ± 10.8) mm in conventional setup to (0.4 ± 4.6, 0.7 ± 4.4) mm in the final position while intra-fractional motion contributed only (0.1 ± 2.8, 0.0 ± 2.2) mm in free breathing. Dose uniformity and coverage to targets had both been increased by up to 10% and the lung or heart intersections have been decreased by half of those volumes if they were irradiated at the initial positions. SGRT of BC appears to be feasible regardless of skin tones, as fast as a snapshot for 3D imaging, and very accurate and precise for daily setup of flexible breast targets. Importantly, the technique allows us to verify the breast shape and position during beam-on time.
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Affiliation(s)
- S Li
- Department of Radiation Oncology and Molecular Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Bourgier C, Dumas I, Marsiglia H, Rossier C, Taright N, Biron B, Auzac G. Irradiation partielle accélérée du cancer du sein : aspect théorique. Cancer Radiother 2012; 16:470-2. [DOI: 10.1016/j.canrad.2012.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 05/23/2012] [Indexed: 10/28/2022]
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Riou O, Fenoglietto P, Lemanski C, Azria D. Radiothérapie conformationnelle avec modulation d’intensité dans les cancers du sein : intérêt, limitations, modalités techniques. Cancer Radiother 2012; 16:479-84. [DOI: 10.1016/j.canrad.2012.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 05/20/2012] [Indexed: 12/21/2022]
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Acevedo-Henao CM, Heymann S, Rossier C, Garbay JR, Arnedos M, Balleyguier C, Ferchiou M, Marsiglia H, Bourgier C. [Conformal accelerated partial breast irradiation: state of the art]. Cancer Radiother 2012; 16:641-9. [PMID: 22727723 DOI: 10.1016/j.canrad.2012.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 03/09/2012] [Accepted: 03/27/2012] [Indexed: 11/26/2022]
Abstract
Breast conserving treatment (breast conserving surgery followed by whole breast irradiation) has commonly been used in early breast cancer since many years. New radiation modalities have been recently developed in early breast cancers, particularly accelerated partial breast irradiation. Three-dimensional conformal accelerated partial breast irradiation is the most commonly used modality of radiotherapy. Other techniques are currently being developed, such as intensity-modulated radiotherapy, arctherapy, and tomotherapy. The present article reviews the indications, treatment modalities and side effects of accelerated partial breast irradiation.
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Affiliation(s)
- C-M Acevedo-Henao
- Département de radiothérapie, institut de cancérologie Gustave-Roussy, Villejuif cedex, France
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Rong Y, Yadav P, Welsh JS, Fahner T, Paliwal B. Postmastectomy radiotherapy with integrated scar boost using helical tomotherapy. Med Dosim 2012; 37:233-9. [PMID: 22365416 DOI: 10.1016/j.meddos.2011.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 06/14/2011] [Accepted: 09/06/2011] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to evaluate helical tomotherapy dosimetry in postmastectomy patients undergoing treatment for chest wall and positive nodal regions with simultaneous integrated boost (SIB) in the scar region using strip bolus. Six postmastectomy patients were scanned with a 5-mm-thick strip bolus covering the scar planning target volume (PTV) plus 2-cm margin. For all 6 cases, the chest wall received a total cumulative dose of 49.3-50.4 Gy with daily fraction size of 1.7-2.0 Gy. Total dose to the scar PTV was prescribed to 58.0-60.2 Gy at 2.0-2.5 Gy per fraction. The supraclavicular PTV and mammary nodal PTV received 1.7-1.9 dose per fraction. Two plans (with and without bolus) were generated for all 6 cases. To generate no-bolus plans, strip bolus was contoured and overrode to air density before planning. The setup reproducibility and delivered dose accuracy were evaluated for all 6 cases. Dose-volume histograms were used to evaluate dose-volume coverage of targets and critical structures. We observed reduced air cavities with the strip bolus setup compared with what we normally see with the full bolus. The thermoluminescence dosimeters (TLD) in vivo dosimetry confirmed accurate dose delivery beneath the bolus. The verification plans performed on the first day megavoltage computed tomography (MVCT) image verified that the daily setup and overall dose delivery was within 2% accuracy compared with the planned dose. The hotspot of the scar PTV in no-bolus plans was 111.4% of the prescribed dose averaged over 6 cases compared with 106.6% with strip bolus. With a strip bolus only covering the postmastectomy scar region, we observed increased dose uniformity to the scar PTV, higher setup reproducibility, and accurate dose delivered beneath the bolus. This study demonstrates the feasibility of using a strip bolus over the scar using tomotherapy for SIB dosimetry in postmastectomy treatments.
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Affiliation(s)
- Yi Rong
- Department of Human Oncology, University of Wisconsin, Madison, Madison, WI, USA.
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de Almeida C, Fournier-Bidoz N, Massabeau C, Mazal A, Canary P, Kuroki I, Campana F, Fourquet A, Kirova Y. Potential benefits of using cardiac gated images to reduce the dose to the left anterior descending coronary during radiotherapy of left breast and internal mammary nodes. Cancer Radiother 2012; 16:44-51. [DOI: 10.1016/j.canrad.2011.07.244] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 07/06/2011] [Accepted: 07/15/2011] [Indexed: 12/25/2022]
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Breast cancer and funnel chest. Strahlenther Onkol 2012; 188:127-35. [DOI: 10.1007/s00066-011-0022-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 10/04/2011] [Indexed: 02/02/2023]
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