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Lin YC, Lin G, Pandey S, Yeh CH, Wang JJ, Lin CY, Ho TY, Ko SF, Ng SH. Fully automated segmentation and radiomics feature extraction of hypopharyngeal cancer on MRI using deep learning. Eur Radiol 2023; 33:6548-6556. [PMID: 37338554 PMCID: PMC10415433 DOI: 10.1007/s00330-023-09827-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 03/29/2023] [Accepted: 04/14/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES To use convolutional neural network for fully automated segmentation and radiomics features extraction of hypopharyngeal cancer (HPC) tumor in MRI. METHODS MR images were collected from 222 HPC patients, among them 178 patients were used for training, and another 44 patients were recruited for testing. U-Net and DeepLab V3 + architectures were used for training the models. The model performance was evaluated using the dice similarity coefficient (DSC), Jaccard index, and average surface distance. The reliability of radiomics parameters of the tumor extracted by the models was assessed using intraclass correlation coefficient (ICC). RESULTS The predicted tumor volumes by DeepLab V3 + model and U-Net model were highly correlated with those delineated manually (p < 0.001). The DSC of DeepLab V3 + model was significantly higher than that of U-Net model (0.77 vs 0.75, p < 0.05), particularly in those small tumor volumes of < 10 cm3 (0.74 vs 0.70, p < 0.001). For radiomics extraction of the first-order features, both models exhibited high agreement (ICC: 0.71-0.91) with manual delineation. The radiomics extracted by DeepLab V3 + model had significantly higher ICCs than those extracted by U-Net model for 7 of 19 first-order features and for 8 of 17 shape-based features (p < 0.05). CONCLUSION Both DeepLab V3 + and U-Net models produced reasonable results in automated segmentation and radiomic features extraction of HPC on MR images, whereas DeepLab V3 + had a better performance than U-Net. CLINICAL RELEVANCE STATEMENT The deep learning model, DeepLab V3 + , exhibited promising performance in automated tumor segmentation and radiomics extraction for hypopharyngeal cancer on MRI. This approach holds great potential for enhancing the radiotherapy workflow and facilitating prediction of treatment outcomes. KEY POINTS • DeepLab V3 + and U-Net models produced reasonable results in automated segmentation and radiomic features extraction of HPC on MR images. • DeepLab V3 + model was more accurate than U-Net in automated segmentation, especially on small tumors. • DeepLab V3 + exhibited higher agreement for about half of the first-order and shape-based radiomics features than U-Net.
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Affiliation(s)
- Yu-Chun Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Sumit Pandey
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Chih-Hua Yeh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan
| | - Jiun-Jie Wang
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Ying Ho
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Sheung-Fat Ko
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shu-Hang Ng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, 33382, Taiwan.
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Ghazbani A, Abdolahi M, Mansourzadeh MJ, BasirianJahromi R, Behzadipour S, Mohseni Azad A, Talebzadeh B, Khosravi A, Hamidi A. Knowledge domain and emerging trends in brachytherapy: A scientometric analysis. PRECISION RADIATION ONCOLOGY 2022. [DOI: 10.1002/pro6.1171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Arash Ghazbani
- Student Research Committee Bushehr University of Medical Sciences Bushehr Iran
| | - Mohammad Abdolahi
- Department of Radiology Faculty of Paramedicine Bushehr University of Medical Sciences Bushehr Iran
| | | | - Reza BasirianJahromi
- Department of Medical Library and Information Sciences Faculty of Paramedicine Bushehr University of Medical Sciences Bushehr Iran
| | - Sina Behzadipour
- Student Research Committee Bushehr University of Medical Sciences Bushehr Iran
| | - Anali Mohseni Azad
- Department of Surgery Faculty of Medicine Bushehr University of Medical Sciences Bushehr Iran
| | | | - Abdolrasoul Khosravi
- Department of Medical Library and Information Sciences Faculty of Paramedicine Bushehr University of Medical Sciences Bushehr Iran
| | - Ali Hamidi
- Department of Medical Library and Information Sciences Faculty of Paramedicine Bushehr University of Medical Sciences Bushehr Iran
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Zabihollahy F, Viswanathan AN, Schmidt EJ, Lee J. Fully automated segmentation of clinical target volume in cervical cancer from magnetic resonance imaging with convolutional neural network. J Appl Clin Med Phys 2022; 23:e13725. [PMID: 35894782 PMCID: PMC9512359 DOI: 10.1002/acm2.13725] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/25/2022] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Contouring clinical target volume (CTV) from medical images is an essential step for radiotherapy (RT) planning. Magnetic resonance imaging (MRI) is used as a standard imaging modality for CTV segmentation in cervical cancer due to its superior soft-tissue contrast. However, the delineation of CTV is challenging as CTV contains microscopic extensions that are not clearly visible even in MR images, resulting in significant contour variability among radiation oncologists depending on their knowledge and experience. In this study, we propose a fully automated deep learning-based method to segment CTV from MR images. METHODS Our method begins with the bladder segmentation, from which the CTV position is estimated in the axial view. The superior-inferior CTV span is then detected using an Attention U-Net. A CTV-specific region of interest (ROI) is determined, and three-dimensional (3-D) blocks are extracted from the ROI volume. Finally, a CTV segmentation map is computed using a 3-D U-Net from the extracted 3-D blocks. RESULTS We developed and evaluated our method using 213 MRI scans obtained from 125 patients (183 for training, 30 for test). Our method achieved (mean ± SD) Dice similarity coefficient of 0.85 ± 0.03 and the 95th percentile Hausdorff distance of 3.70 ± 0.35 mm on test cases, outperforming other state-of-the-art methods significantly (p-value < 0.05). Our method also produces an uncertainty map along with the CTV segmentation by employing the Monte Carlo dropout technique to draw physician's attention to the regions with high uncertainty, where careful review and manual correction may be needed. CONCLUSIONS Experimental results show that the developed method is accurate, fast, and reproducible for contouring CTV from MRI, demonstrating its potential to assist radiation oncologists in alleviating the burden of tedious contouring for RT planning in cervical cancer.
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Affiliation(s)
- Fatemeh Zabihollahy
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Akila N. Viswanathan
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Ehud J. Schmidt
- Division of Cardiology, Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Junghoon Lee
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Mbarki I, Randriamarosona N, Agbanglanon P, Touimi SH, Elkacemi H, Kebdani T, Elmajjaoui S, Benjaafar N. Evaluation of tumor response three months after concomitant chemoradiotherapy with high dose rate brachytherapy as a definitive treatment modality for locally advanced cervical cancer. Bull Cancer 2021; 109:280-286. [PMID: 34776119 DOI: 10.1016/j.bulcan.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 08/10/2021] [Accepted: 08/26/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Radiotherapy remains an essential part of the management of locally advanced cervical cancer. Post-treatment surveillance allows for tumor response assessment and early detection of progressive prosecutions or local recurrences that may benefit from salvage treatment. The objective of this work is to assess the effectiveness of this therapeutic modality. MATERIALS METHODS This is a retrospective study of 69 patients treated with concomitant radiation chemotherapy followed by high dose rate intracavitary brachytherapy. The tumor response was assessed by gynecologic physical examination at three months after the end of treatment. RESULTS Median age of patients is 54.9 years (33-78 years). The most common histological type is squamous cell carcinoma (89.9%). The average dose received during external radiotherapy is 52.2Gy (46-60Gy). The average dose received during brachytherapy is 27.5Gy (18-28Gy). Three months after completion of treatment, 95.6% of patients had complete tumor remission, and only 4.4% had a tumor residue of 1cm. CONCLUSION Radiation chemotherapy with brachytherapy allows for improved short-term local control in cervical cancer.
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Affiliation(s)
- Imane Mbarki
- Mohammed V University of Rabat, National Institute of Oncology, Department of Radiation Oncology, Rabat, Morocco.
| | - Norosoa Randriamarosona
- Mohammed V University of Rabat, National Institute of Oncology, Department of Radiation Oncology, Rabat, Morocco
| | - Patricia Agbanglanon
- Mohammed V University of Rabat, National Institute of Oncology, Department of Radiation Oncology, Rabat, Morocco
| | - Samia Hajar Touimi
- Mohammed V University of Rabat, National Institute of Oncology, Department of Radiation Oncology, Rabat, Morocco
| | - Hanan Elkacemi
- Mohammed V University of Rabat, National Institute of Oncology, Department of Radiation Oncology, Rabat, Morocco
| | - Tayeb Kebdani
- Mohammed V University of Rabat, National Institute of Oncology, Department of Radiation Oncology, Rabat, Morocco
| | - Sanaa Elmajjaoui
- Mohammed V University of Rabat, National Institute of Oncology, Department of Radiation Oncology, Rabat, Morocco
| | - Noureddine Benjaafar
- Mohammed V University of Rabat, National Institute of Oncology, Department of Radiation Oncology, Rabat, Morocco
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Rosa C, Pizzi AD, Augurio A, Caravatta L, DI Tommaso M, Mincuzzi E, Cinalli S, Basilico R, Porreca A, DI Nicola M, Genovesi D. Volume Delineation in Cervical Cancer With T2 and Diffusion-weighted MRI: Agreement on Volumes Between Observers. In Vivo 2021; 34:1981-1986. [PMID: 32606170 DOI: 10.21873/invivo.11995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 01/25/2023]
Abstract
AIM To delineate cervical cancer gross tumor volume (GTV) on T2-magnetic resonance imaging (MRI) and apparent diffusion coefficient (ADC) maps, assessing volumes and inter-observer agreement between two observers. PATIENTS AND METHODS A radiologist and a radiation oncologist delineated GTV on T2 (T2GTV) and ADC (ADCGTV) sequences. Dice similarity index (DICE) and Bland-Altman analysis were used to estimated concordance. RESULTS Mean T2GTV and ADCGTV volumes were 43.84±71.47 cc and 37.28±68.92 cc according to the radiologist, and 43.4±70.44 cc and 36.65±69.21 cc according to the radiation oncologist. ADC led to statistically significantly smaller volumes compared to T2. The mean DICE index was 0.86 for T2GTV and 0.84 for ADCGTV The Bland-Altman plots globally showed concordance. CONCLUSION GTV delineation was smaller in the ADC maps compared to T2-MRI, reaching an almost perfect agreement between observers. Thanks to this acceptable variability, adding functional imaging might provide more information for tumor delineation, improving reproducibility for image-guided adaptive radiotherapy.
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Affiliation(s)
- Consuelo Rosa
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy .,Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy
| | - Andrea Delli Pizzi
- Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy.,Department of Radiology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Antonietta Augurio
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Luciana Caravatta
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Monica DI Tommaso
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Erica Mincuzzi
- Department of Radiology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | | | - Raffaella Basilico
- Department of Radiology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | | | - Marta DI Nicola
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti, Italy
| | - Domenico Genovesi
- Department of Radiation Oncology, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy.,Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy
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Tang B, Wu F, Fu Y, Wang X, Wang P, Orlandini LC, Li J, Hou Q. Dosimetric evaluation of synthetic CT image generated using a neural network for MR-only brain radiotherapy. J Appl Clin Med Phys 2021; 22:55-62. [PMID: 33527712 PMCID: PMC7984468 DOI: 10.1002/acm2.13176] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/15/2020] [Accepted: 12/01/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE AND BACKGROUND The magnetic resonance (MR)-only radiotherapy workflow is urged by the increasing use of MR image for the identification and delineation of tumors, while a fast generation of synthetic computer tomography (sCT) image from MR image for dose calculation remains one of the key challenges to the workflow. This study aimed to develop a neural network to generate the sCT in brain site and evaluate the dosimetry accuracy. MATERIALS AND METHODS A generative adversarial network (GAN) was developed to translate T1-weighted MRI to sCT. First, the "U-net" shaped encoder-decoder network with some image translation-specific modifications was trained to generate sCT, then the discriminator network was adversarially trained to distinguish between synthetic and real CT images. We enrolled 37 brain cancer patients acquiring both CT and MRI for treatment position simulation. Twenty-seven pairs of 2D T1-weighted MR images and rigidly registered CT image were used to train the GAN model, and the remaining 10 pairs were used to evaluate the model performance through the metric of mean absolute error. Furthermore, the clinical Volume Modulated Arc Therapy plan was calculated on both sCT and real CT, followed by gamma analysis and comparison of dose-volume histogram. RESULTS On average, only 15 s were needed to generate one sCT from one T1-weighted MRI. The mean absolute error between synthetic and real CT was 60.52 ± 13.32 Housefield Unit over 5-fold cross validation. For dose distribution on sCT and CT, the average pass rates of gamma analysis using the 3%/3 mm and 2%/2 mm criteria were 99.76% and 97.25% over testing patients, respectively. For parameters of dose-volume histogram for both target and organs at risk, no significant differences were found between both plans. CONCLUSION The GAN model can generate synthetic CT from one single MRI sequence within seconds, and a state-of-art accuracy of CT number and dosimetry was achieved.
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Affiliation(s)
- Bin Tang
- Key Laboratory of Radiation Physics and Technology of the Ministry of EducationInstitute of Nuclear Science and TechnologySichuan UniversityChengduSichuanChina
- Department of Radiation OncologyRadiation Oncology Key Laboratory Of Sichuan ProvinceSichuan Cancer Hospital & InstituteChengduSichuanChina
| | - Fan Wu
- Department of Radiation OncologyRadiation Oncology Key Laboratory Of Sichuan ProvinceSichuan Cancer Hospital & InstituteChengduSichuanChina
| | - Yuchuan Fu
- Department of RadiotherapyWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Xianliang Wang
- Department of Radiation OncologyRadiation Oncology Key Laboratory Of Sichuan ProvinceSichuan Cancer Hospital & InstituteChengduSichuanChina
| | - Pei Wang
- Department of Radiation OncologyRadiation Oncology Key Laboratory Of Sichuan ProvinceSichuan Cancer Hospital & InstituteChengduSichuanChina
| | - Lucia Clara Orlandini
- Department of Radiation OncologyRadiation Oncology Key Laboratory Of Sichuan ProvinceSichuan Cancer Hospital & InstituteChengduSichuanChina
| | - Jie Li
- Department of Radiation OncologyRadiation Oncology Key Laboratory Of Sichuan ProvinceSichuan Cancer Hospital & InstituteChengduSichuanChina
| | - Qing Hou
- Key Laboratory of Radiation Physics and Technology of the Ministry of EducationInstitute of Nuclear Science and TechnologySichuan UniversityChengduSichuanChina
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Rigaud B, Anderson BM, Yu ZH, Gobeli M, Cazoulat G, Söderberg J, Samuelsson E, Lidberg D, Ward C, Taku N, Cardenas C, Rhee DJ, Venkatesan AM, Peterson CB, Court L, Svensson S, Löfman F, Klopp AH, Brock KK. Automatic Segmentation Using Deep Learning to Enable Online Dose Optimization During Adaptive Radiation Therapy of Cervical Cancer. Int J Radiat Oncol Biol Phys 2021; 109:1096-1110. [DOI: 10.1016/j.ijrobp.2020.10.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/24/2020] [Accepted: 10/29/2020] [Indexed: 02/08/2023]
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Soror T, Siebert FA, Lancellotta V, Placidi E, Fionda B, Tagliaferri L, Kovács G. Quality Assurance in Modern Gynecological HDR-Brachytherapy (Interventional Radiotherapy): Clinical Considerations and Comments. Cancers (Basel) 2021; 13:cancers13040912. [PMID: 33671552 PMCID: PMC7927078 DOI: 10.3390/cancers13040912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary This is a focused review discussing quality assurance during interventional brachytherapy in gynecological cancers. This topic is very large and is usually addressed from the technical and physical sides, therefore, we decided to select “hot-spots” under this large title and discuss them from the point of view of clinicians. We hope that this concise and focused review will help clinicians in improving their quality assurance protocols and draw attention to the discussed issues. Abstract The use of brachytherapy (interventional radiotherapy) in the treatment of gynecological cancers is a crucial element in both definitive and adjuvant settings. The recent developments in high-dose rate remote afterloaders, modern applicators, treatment-planning software, image guidance, and dose monitoring systems have led to improvement in the local control rates and in some cases improved the survival rates. The development of these highly advanced and complicated treatment modalities has been accompanied by challenges, which have made the existence of quality assurance protocols a must to ensure the integrity of the treatment process. Quality assurance aims at standardizing the technical and clinical procedures involved in the treatment of patients, which could eventually decrease the source of uncertainties whether technical (source/equipment related) or clinical. This commentary review sheds light (from a clinical point of view) on some potential sources of uncertainties associated with the use of modern brachytherapy in the treatment of gynecological cancers.
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Affiliation(s)
- Tamer Soror
- Radiation Oncology Department, University of Lübeck/UKSH-CL, 23538 Lübeck, Germany
- Radiation Oncology Department, National Cancer Institute (NCI), Cairo University, Cairo 11796, Egypt
- Correspondence: ; Tel.: +49-176-2369-5626
| | - Frank-André Siebert
- Clinic of Radiotherapy, University Hospital of Schleswig-Holstein, 24105 Campus Kiel, Germany;
| | - Valentina Lancellotta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (V.L.); (E.P.); (B.F.); (L.T.)
| | - Elisa Placidi
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (V.L.); (E.P.); (B.F.); (L.T.)
| | - Bruno Fionda
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (V.L.); (E.P.); (B.F.); (L.T.)
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy; (V.L.); (E.P.); (B.F.); (L.T.)
| | - György Kovács
- Università Cattolica del Sacro Cuore, Radioterapia Oncologica, Gemelli-INTERACTS, 00168 Roma, Italy;
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Optimal method for metabolic tumour volume assessment of cervical cancers with inter-observer agreement on [18F]-fluoro-deoxy-glucose positron emission tomography with computed tomography. Eur J Nucl Med Mol Imaging 2020; 48:2009-2023. [PMID: 33313962 PMCID: PMC8113292 DOI: 10.1007/s00259-020-05136-8] [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: 07/01/2020] [Accepted: 11/24/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Cervical cancer metabolic tumour volume (MTV) derived from [18F]-FDG PET/CT has a role in prognostication and therapy planning. There is no standard method of outlining MTV on [18F]-FDG PET/CT. The aim of this study was to assess the optimal method to outline primary cervical tumours on [18F]-FDG PET/CT using MRI-derived tumour volumes as the reference standard. METHODS 81 consecutive cervical cancer patients with pre-treatment staging MRI and [18F]-FDG PET/CT imaging were included. MRI volumes were compared with different PET segmentation methods. Method 1 measured MTVs at different SUVmax thresholds ranging from 20 to 60% (MTV20-MTV60) with bladder masking and manual adjustment when required. Method 2 created an isocontour around the tumour prior to different SUVmax thresholds being applied. Method 3 used an automated gradient method. Inter-observer agreement of MTV, following manual adjustment when required, was recorded. RESULTS For method 1, the MTV25 and MTV30 were closest to the MRI volumes for both readers (mean percentage change from MRI volume of 2.9% and 13.4% for MTV25 and - 13.1% and - 2.0% for MTV30 for readers 1 and 2). 70% of lesions required manual adjustment at MTV25 compared with 45% at MTV30. There was excellent inter-observer agreement between MTV30 to MTV60 (ICC ranged from 0.898-0.976 with narrow 95% confidence intervals (CIs)) and moderate agreement at lower thresholds (ICC estimates of 0.534 and 0.617, respectively for the MTV20 and MTV25 with wide 95% CIs). Bladder masking was performed in 86% of cases overall. For method 2, excellent correlation was demonstrated at MTV25 and MTV30 (mean % change from MRI volume of -3.9% and - 8.6% for MTV25 and - 16.9% and 19% for MTV30 for readers 1 and 2, respectively). This method also demonstrated excellent ICC across all thresholds with no manual adjustment. Method 3 demonstrated excellent ICC of 0.96 (95% CI 0.94-0.97) but had a mean percentage difference from the MRI volume of - 19.1 and - 18.2% for readers 1 and 2, respectively. 21% required manual adjustment for both readers. CONCLUSION MTV30 provides the optimal correlation with MRI volume taking into consideration the excellent inter-reader agreement and less requirement for manual adjustment.
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Cannon J, Bownes P, Mason J, Cooper R. UK audit of target volume and organ at risk delineation and dose optimisation for cervix radiotherapy treatments. Br J Radiol 2020; 93:20190897. [PMID: 32142373 PMCID: PMC10989738 DOI: 10.1259/bjr.20190897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/07/2020] [Accepted: 03/03/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Assessment of the extent of variation in delineations and dose optimisation performed at multiple UK centres as a result of interobserver variation and protocol differences. METHODS CT/MR images of 2 cervical cancer patients previously treated with external beam radiotherapy (EBRT) and Brachytherapy were distributed to 11 UK centres. Centres delineated structures and produced treatment plans following their local protocol. Organ at risk delineations were assessed dosimetrically through application of the original treatment plan and target volume delineations were assessed in terms of variation in absolute volume and length, width and height. Treatment plan variation was assessed across all centres and across centres that followed EMBRACE II. Treatment plans were assessed using total EQD2 delivered and were compared to EMBRACE II dose aims. Variation in combined intracavitary/interstitial brachytherapy treatments was also assessed. RESULTS Brachytherapy target volume delineations contained variation due to differences in protocol used, window/level technique and differences in interpretations of grey zones. Planning target volume delineations were varied due to protocol differences and extended parametrial tissue inclusion. All centres met EMBRACE II plan aims for PTV V95 and high-riskclinical target volume D90 EQD2, despite variation in prescription dose, fractionation and treatment technique. CONCLUSION Brachytherapy target volume delineations are varied due to differences in contouring guidelines and protocols used. Planning target volume delineations are varied due to the uncertainties surrounding the extent of parametrial involvement. Dosimetric optimisation is sufficient across all centres to satisfy EMBRACE II planning aims despite significant variation in protocols used. ADVANCES IN KNOWLEDGE Previous multi-institutional audits of cervical cancer radiotherapy practices have been performed in Europe and the USA. This study is the first of its kind to be performed in the UK.
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Affiliation(s)
- Jennifer Cannon
- Department of Medical Physics, James Cook University Hospital,
South Tees NHS Trust,
Middlesbrough, United Kingdom
| | - Peter Bownes
- Leeds Cancer Centre, St. James’s University Hospital,
Leeds Teaching Hospitals NHS Trust,
Leeds, United Kingdom
| | - Joshua Mason
- Department of Medical Physics, Imperial College Healthcare NHS
Trust, London, United
Kingdom
| | - Rachel Cooper
- Leeds Cancer Centre, St. James’s University Hospital,
Leeds Teaching Hospitals NHS Trust,
Leeds, United Kingdom
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11
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Cacicedo J, Navarro-Martin A, Gonzalez-Larragan S, De Bari B, Salem A, Dahele M. Systematic review of educational interventions to improve contouring in radiotherapy. Radiother Oncol 2019; 144:86-92. [PMID: 31786422 DOI: 10.1016/j.radonc.2019.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE Contouring is a critical step in the radiotherapy process, but there is limited research on how to teach it and no consensus about the best method. We summarize the current evidence regarding improvement of contouring skills. METHODS AND MATERIALS Comprehensive literature search of the Pubmed-MEDLINE database, EMBASE database and Cochrane Library to identify relevant studies (independently examined by two investigators) that included baseline contouring followed by a re-contouring assessment after an educational intervention. RESULTS 598 papers were identified. 16 studies met the inclusion criteria representing 370 participants (average number of participants per study of 23; range (4-141). Regarding the teaching methodology, 5/16 used onsite courses, 8/16 online courses, and 2/16 used blended learning. Study quality was heterogenous. There were only 3 randomized studies and only 3 analyzed the dosimetric impact of improving contouring homogeneity. Dice similarity coefficient was the most common evaluation metric (7/16), and in all these studies at least some contours improved significantly post-intervention. The time frame for evaluating the learning effect of the teaching intervention was almost exclusively short-time, with only one study evaluating the long-term utility of the educational program beyond 6 months. CONCLUSION The literature on educational interventions designed to improve contouring performance is limited and heterogenous. Onsite, online and blended learning courses have all been shown to be helpful, however, sample sizes are small and impact assessment is almost exclusively short-term and typically does not take into account the effect on treatment planning. The most effective teaching methodology/format is unknown and impact on daily clinical practice is uncertain.
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Affiliation(s)
- Jon Cacicedo
- Radiation Oncology Department, Cruces University Hospital, Osakidetza/Biocruces Health Research Institute/Department of Surgery, Radiology and Physical Medicine of the University of the Basque Country (UPV/EHU), Barakaldo, Spain.
| | - Arturo Navarro-Martin
- Radiation Oncology Department, Hospital Duran i Reynals (ICO) Avda, Gran VIa de ĹHospitalet, Barcelona, Spain.
| | | | - Berardino De Bari
- Radiation Oncology Department, Centre Hospitalier Régional Universitaire Jean Minjoz, INSERM U1098 EFS/BFC, Besançon, France.
| | - Ahmed Salem
- Division of Cancer Sciences, University of Manchester, United Kingdom; Department of Clinical Oncology, The Christie Hospital NHS Trust, Manchester, United Kingdom.
| | - Max Dahele
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC (VUmc location), the Netherlands.
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12
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Zhang N, Tang Y, Guo X, Mao Z, Yang W, Cheng G. Analysis of dose-effect relationship between DVH parameters and clinical prognosis of definitive radio(chemo)therapy combined with intracavitary/interstitial brachytherapy in patients with locally advanced cervical cancer: A single-center retrospective study. Brachytherapy 2019; 19:194-200. [PMID: 31791712 DOI: 10.1016/j.brachy.2019.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of the study was to explore the dose-effect relationship between dose-volume histogram parameters and clinical prognosis of definitive radio(chemo)therapy followed by intracavitary/interstitial brachytherapy in locally advanced cervical cancer. METHODS AND MATERIALS A retrospective analysis was performed on 110 patients with locally advanced cervical cancer who underwent external beam radiotherapy combined with intracavitary/interstitial brachytherapy with or without chemotherapy from July 2010 to September 2018. We reported D100, D98, and D90 for high-risk clinical target volume (HR-CTV) and intermediate-risk clinical target volume, D2cm³ for organs at risk. Multivariate Cox regression was used to screen independent factors. Dose-volume parameters screened by the Cox regression were incorporated into the probit model for investigating its relationship with survival. RESULTS The median followup time was 72.33 months. Multivariate Cox regression analysis showed that HR-CTV D100, HR-CTV D98, and HR-CTV D90 were independent factors, affecting the 5-year overall survival (OS), cancer-specific survival (CSS), and local control (LC) rates. The probit model showed that HR-CTV D98 had predictive values for the 5-year OS, CSS, and LC, and HR-CTV D100 had predictive values for the 5-year OS, CSS, whereas HR-CTV D90 had a predictive value only for the 5-year OS. The HR-CTV D98 corresponding to OS ED90, CSS ED90, and LC ED90 was 86.8, 85.6, and 78.6 Gy, respectively. CONCLUSIONS A significant dependence of OS, CSS, and LC on D98 for HR-CTV was found. When the long-term OS, CSS, and LC rate of the patient was >90%, HR-CTV D98 > 86.8 Gy EQD2, 85.6 Gy EQD2, and 78.6 Gy EQD2 were required.
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Affiliation(s)
- Ning Zhang
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yuhuan Tang
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xin Guo
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhuang Mao
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Wei Yang
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Guanghui Cheng
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China.
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13
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Deep learning for fully automated tumor segmentation and extraction of magnetic resonance radiomics features in cervical cancer. Eur Radiol 2019; 30:1297-1305. [DOI: 10.1007/s00330-019-06467-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/20/2019] [Accepted: 09/19/2019] [Indexed: 12/13/2022]
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14
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Leung E, D'Souza D, Bachand F, Han K, Alfieri J, Huang F, Vigneault E, Barkati M, Wiebe EM, Foster W, Fortin I, Velker V, Bowes D, Barnes E, Patil N, Banerjee R, Barbera L, Ravi A. MRI-based interstitial brachytherapy for vaginal tumors: A multi-institutional study on practice patterns, contouring, and consensus definitions of target volumes. Brachytherapy 2019; 18:598-605. [PMID: 31230941 DOI: 10.1016/j.brachy.2019.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/10/2019] [Accepted: 05/20/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Interstitial brachytherapy (ISBT) can be effective for vaginal tumors due to its ability to deliver conformal treatment with 3D planning. As there is no consensus for 3D vaginal brachytherapy (BT) contouring, the goals of this study are to evaluate the variability in practices and contouring, and to develop consensus concepts on target definitions. METHODS A survey/contouring study was conducted with 16 radiation oncologists from 10 Canadian academic centers. The study included three vaginal ISBT cases. Participants were provided staging, prebrachytherapy (pre-BT), and BT MRIs. Participants responded to a questionnaire and contoured on the provided images. Agreement between contours was analyzed. A meeting was held to develop consensus definitions of targets. RESULTS Median ISBT experience was 3.5 years. All 16 participants regularly contour with MRI, whereas three also plan on MRI. For the three cases, there was variation into how CTVHR and CTVIR was defined. Kappa statistics showed higher agreement with bulky tumors (mean 0.59) as compared with small residual tumors (mean 0.29). For all cases, kappa was highest in pre-BT GTVres as compared with BT GTVres (mean 0.58, 0.46). Consensus concepts to define targets were developed. CONCLUSIONS Variations exist in how ISBT targets are defined for vaginal tumors. Highest contouring variability was seen with small residual at BT. Contouring is more consistent on pre-BT MRI as compared with BT MRI suggesting a needle distortion effect. Consensus CTVHR and CTVIR definitions have been developed and further work is warranted to establish international standards.
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Affiliation(s)
- Eric Leung
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Ontario, Canada.
| | - David D'Souza
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Francois Bachand
- Department of Radiation Oncology, BC Cancer, Kelowna, British Columbia, Canada
| | - Kathy Han
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Joanne Alfieri
- Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Fleur Huang
- Department of Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Eric Vigneault
- Department of Radiation Oncology, CHU de Québec Université Laval, Québec, Québec, Ontario, Canada
| | - Maroie Barkati
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Ericka M Wiebe
- Department of Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - William Foster
- Department of Radiation Oncology, CHU de Québec Université Laval, Québec, Québec, Ontario, Canada
| | - Israel Fortin
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Vikram Velker
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - David Bowes
- Department of Radiation Oncology, Nova Scotia Cancer Centre, Halifax, Nova Scotia, Canada
| | - Elizabeth Barnes
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Ontario, Canada
| | - Nikhilesh Patil
- Department of Radiation Oncology, Nova Scotia Cancer Centre, Halifax, Nova Scotia, Canada
| | - Robyn Banerjee
- Division of Radiation Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Lisa Barbera
- Division of Radiation Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Ananth Ravi
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Ontario, Canada
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15
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White IM, Scurr E, Wetscherek A, Brown G, Sohaib A, Nill S, Oelfke U, Dearnaley D, Lalondrelle S, Bhide S. Realizing the potential of magnetic resonance image guided radiotherapy in gynaecological and rectal cancer. Br J Radiol 2019; 92:20180670. [PMID: 30933550 PMCID: PMC6592079 DOI: 10.1259/bjr.20180670] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 02/24/2019] [Accepted: 03/21/2019] [Indexed: 12/25/2022] Open
Abstract
CT-based radiotherapy workflow is limited by poor soft tissue definition in the pelvis and reliance on rigid registration methods. Current image-guided radiotherapy and adaptive radiotherapy models therefore have limited ability to improve clinical outcomes. The advent of MRI-guided radiotherapy solutions provides the opportunity to overcome these limitations with the potential to deliver online real-time MRI-based plan adaptation on a daily basis, a true "plan of the day." This review describes the application of MRI guided radiotherapy in two pelvic tumour sites likely to benefit from this approach.
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Affiliation(s)
- Ingrid M White
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Erica Scurr
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Andreas Wetscherek
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Gina Brown
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Aslam Sohaib
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Simeon Nill
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Uwe Oelfke
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - David Dearnaley
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Susan Lalondrelle
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Shreerang Bhide
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
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16
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Wu N, Zhao Z, Han D, Cheng G, Zhao H. Dosimetric research into target regions and organs at risk in three-dimensional intracavitary brachytherapy techniques for Chinese patients with cervical carcinoma. JOURNAL OF RADIATION RESEARCH 2019; 60:124-133. [PMID: 30452658 PMCID: PMC6373665 DOI: 10.1093/jrr/rry088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/20/2018] [Indexed: 06/09/2023]
Abstract
The present study aimed to compare the dosages of target regions and organs at risk (OARs) in 3D intracavitary brachytherapy (ICBT) and conventional 2D ICBT for Chinese patients with cervical carcinoma. ICBT was performed in a total of 66 patients with Stage IB to IVA cervical carcinoma who had not received surgery but who had received whole-pelvic external-beam radiotherapy (EBRT). Plans for the 3D-ICBT and the conventional 2D-ICBT were individually designed for every patient. The dosages differences between the target regions and the OARs in patients with each of the various stages of cervical carcinoma were compared between the two ICBT plans. There was no significant difference in the dose at Point A between the two ICBT plans. However, the CTVhr-D90, CTVhr-D100 and CTVir-D90 in 3D-ICBT were much higher than in 2D-ICBT, especially in Stage IIB (P < 0.05). As compared with conventional 2D-ICBT, the dosages of DICRU and D2.0cm3 in the rectum/bladder, and D2.0cm3 in the sigmoid/small bowel were decreased significantly in 3D-ICBT (P < 0.05). For patients with Stage IIA, IIB and IIIB, the D2.0cm3 in the rectum/bladder was significantly reduced in 3D-ICBT (P < 0.05). It was demonstrated that, in Chinese patients, 3D-ICBT for cervical carcinoma could optimize the target coverage and reduce the dosages to the OARs compared with conventional 2D-ICBT.
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Affiliation(s)
- Ning Wu
- Department of Radiation Oncology, China–Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, China
| | - Zhipeng Zhao
- Department of Radiation Oncology, China–Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, China
| | - Dongmei Han
- Department of Radiation Oncology, China–Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, China
| | - Guanghui Cheng
- Department of Radiation Oncology, China–Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, China
| | - Hongfu Zhao
- Department of Radiation Oncology, China–Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, China
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17
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Elzibak AH, Kager PM, Soliman A, Paudel MR, Safigholi H, Han DY, Karotki A, Ravi A, Song WY. Quantitative CT assessment of a novel direction-modulated brachytherapy tandem applicator. Brachytherapy 2017; 17:465-475. [PMID: 29174936 DOI: 10.1016/j.brachy.2017.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/12/2017] [Accepted: 10/12/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study was to quantitatively assess the CT metal-induced artifacts from a novel direction-modulated brachytherapy (DMBT) tandem applicator prototype, recently designed for cervical cancer treatments. METHODS AND MATERIALS A water-based pelvic phantom was constructed for CT scanning. The DMBT applicator was imaged using our institutional protocol, one with higher kVp and mAs settings, and repetition of these protocols using 3-mm slices. A conventional stainless steel applicator was also scanned. In addition to the standard reconstructed images, applicator images were reconstructed using a commercial metal artifact-reduction (MAR) algorithm and an in-house-developed research algorithm. Subsequently, image quality and artifact severity were evaluated. RESULTS Artifact severity, measured in terms of SDs in CT numbers, decreased asymptotically to background water levels with the distance away from the applicator. Artifact-reduction algorithms lead to significant and visible improvements in image quality, with >50% and >20% decrease in artifact severity achieved at a 10-mm distance for the DMBT and stainless steel applicators, respectively. Differences in artifact severity were minimal between the four imaging protocols. DMBT dimensions were the same on images with and without the commercial MAR algorithm, within <1 mm of the theoretical value. Both the commercial and in-house algorithms restored the CT numbers outside the applicator, albeit a better performance was achieved by the in-house algorithm. CONCLUSIONS The artifacts produced by both applicators were minimized with the use of MAR algorithms. Adoption of the DMBT and stainless steel applicators for CT-guided brachytherapy is anticipated as MAR algorithms are widely available on CT scanners.
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Affiliation(s)
- Alyaa H Elzibak
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
| | - Petronella M Kager
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Abraam Soliman
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Moti R Paudel
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Habib Safigholi
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Electrical Engineering, Shiraz Branch, Islamic Azad University, Shiraz, Iran
| | - Dae Yup Han
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - Aliaksandr Karotki
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ananth Ravi
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - William Y Song
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA
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18
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Torheim T, Malinen E, Hole KH, Lund KV, Indahl UG, Lyng H, Kvaal K, Futsaether CM. Autodelineation of cervical cancers using multiparametric magnetic resonance imaging and machine learning. Acta Oncol 2017; 56:806-812. [PMID: 28464746 DOI: 10.1080/0284186x.2017.1285499] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Tumour delineation is a challenging, time-consuming and complex part of radiotherapy planning. In this study, an automatic method for delineating locally advanced cervical cancers was developed using a machine learning approach. MATERIALS AND METHODS A method for tumour segmentation based on image voxel classification using Fisher?s Linear Discriminant Analysis (LDA) was developed. This was applied to magnetic resonance (MR) images of 78 patients with locally advanced cervical cancer. The segmentation was based on multiparametric MRI consisting of T2- weighted (T2w), T1-weighted (T1w) and dynamic contrast-enhanced (DCE) sequences, and included intensity and spatial information from the images. The model was trained and assessed using delineations made by two radiologists. RESULTS Segmentation based on T2w or T1w images resulted in mean sensitivity and specificity of 94% and 52%, respectively. Including DCE-MR images improved the segmentation model?s performance significantly, giving mean sensitivity and specificity of 85?93%. Comparisons with radiologists? tumour delineations gave Dice similarity coefficients of up to 0.44. CONCLUSION Voxel classification using a machine learning approach is a flexible and fully automatic method for tumour delineation. Combining all relevant MR image series resulted in high sensitivity and specificity. Moreover, the presented method can be extended to include additional imaging modalities.
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Affiliation(s)
- Turid Torheim
- Faculty of Science and Technology, Norwegian University of Life Sciences, Ås, Norway
| | - Eirik Malinen
- Department of Physics, University of Oslo, Oslo, Norway
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - Knut Håkon Hole
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Kjersti Vassmo Lund
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Ulf G. Indahl
- Faculty of Science and Technology, Norwegian University of Life Sciences, Ås, Norway
| | - Heidi Lyng
- Department of Radiation Biology, Oslo University Hospital, Oslo, Norway
| | - Knut Kvaal
- Faculty of Science and Technology, Norwegian University of Life Sciences, Ås, Norway
| | - Cecilia M. Futsaether
- Faculty of Science and Technology, Norwegian University of Life Sciences, Ås, Norway
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19
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Rivin Del Campo E, Rivera S, Martínez-Paredes M, Hupé P, Slocker Escarpa A, Borget I, Mazeron R, Scholl S, Palacios Eito A, Haie-Meder C, Chargari C, Deutsch E. Assessment of the novel online delineation workshop dummy run approach using FALCON within a European multicentre trial in cervical cancer (RAIDs). Radiother Oncol 2017; 124:130-138. [PMID: 28532608 DOI: 10.1016/j.radonc.2017.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 04/10/2017] [Accepted: 05/04/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Online delineation workshops (ODW) permit training of geographically dispersed participants. The purpose is to evaluate the methodology of an ODW using FALCON to harmonize delineation within a European multicentre trial on locally advanced cervical cancer (LACC). MATERIAL AND METHODS Two ODW included 46 clinicians (14 centres). Clinicians completed baseline (C1), guideline (C2) and final contours (C3) for external beam radiotherapy (EBRT) and brachytherapy (BT) for LACC. Interobserver and intraobserver variability was evaluated quantitatively (using the DICE index) and qualitatively compared to expert contours. RESULTS Nine clinicians submitted for EBRT and BT for C1-C3. Thirty-two sent any contour. Interobserver quantitative comparisons for EBRT showed significant improvement for C2 vs. C1 for bowel, CTV node, CTV-p and GTV node with significant detriment for GTV node (C3 vs. C1; C2), CTV-p (C3 vs. C2) and bowel (C3 vs. C2), showing in general an improvement in C2 vs. C1, with a detriment in C3 vs. C2 for two target volumes and an organ at risk. For BT there was significant improvement for C2 vs. C1 for bladder, GTV, HR-CTV and IR-CTV, with significant detriment for bladder (C3 vs. C2), thus overall improvement in C2 vs. C1, with only a detriment in C3 vs. C2 for bladder. Centres using MRI imaging for BT contouring did significantly better in the BT case for HR-CTV than those which used other techniques (C2 vs. C1: p<0.005; C3 vs. C1: p=0.02). Intraobserver quantitative comparisons showed significant improvement contouring a region of interest between C2 vs. C1, C3 vs. C1 and C3 vs. C2 for EBRT and between C2 and C1 for BT. CONCLUSIONS ODW offer training, initial contouring harmonization and allow assessment of centres.
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Affiliation(s)
| | - Sofia Rivera
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - María Martínez-Paredes
- Department of Radiology and Medical Physics, Medical School, University of Cordoba, Spain
| | - Philippe Hupé
- Institut Curie, Paris, France; PSL Research University, Paris, France; Inserm, U900, Paris, France; Mines Paris Tech, Fontainebleau, France; CNRS, UMR144, Paris, France
| | | | - Isabelle Borget
- Service de Biostatistique et d'Epidemiologie, Gustave Roussy, Villejuif, France; INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Renaud Mazeron
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Suzy Scholl
- Department of Medical Oncology, Institut Curie, Paris, France
| | - Amalia Palacios Eito
- Department of Radiation Oncology, Reina Sofia University Hospital, Cordoba, Spain
| | - Christine Haie-Meder
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Eric Deutsch
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
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20
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Ohno T, Wakatsuki M, Toita T, Kaneyasu Y, Yoshida K, Kato S, Ii N, Tokumaru S, Ikushima H, Uno T, Noda SE, Kazumoto T, Harima Y. Recommendations for high-risk clinical target volume definition with computed tomography for three-dimensional image-guided brachytherapy in cervical cancer patients. JOURNAL OF RADIATION RESEARCH 2017; 58:341-350. [PMID: 27837120 PMCID: PMC5440858 DOI: 10.1093/jrr/rrw109] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/14/2016] [Indexed: 05/20/2023]
Abstract
Our purpose was to develop recommendations for contouring the computed tomography (CT)-based high-risk clinical target volume (CTVHR) for 3D image-guided brachytherapy (3D-IGBT) for cervical cancer. A 15-member Japanese Radiation Oncology Study Group (JROSG) committee with expertise in gynecological radiation oncology initiated guideline development for CT-based CTVHR (based on a comprehensive literature review as well as clinical experience) in July 2014. Extensive discussions occurred during four face-to-face meetings and frequent email communication until a consensus was reached. The CT-based CTVHR boundaries were defined by each anatomical plane (cranial-caudal, lateral, or anterior-posterior) with or without tumor progression beyond the uterine cervix at diagnosis. Since the availability of magnetic resonance imaging (MRI) with applicator insertion for 3D planning is currently limited, T2-weighted MRI obtained at diagnosis and just before brachytherapy without applicator insertion was used as a reference for accurately estimating the tumor size and topography. Furthermore, utilizing information from clinical examinations performed both at diagnosis and brachytherapy is strongly recommended. In conclusion, these recommendations will serve as a brachytherapy protocol to be used at institutions with limited availability of MRI for 3D treatment planning.
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Affiliation(s)
- Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan
- Corresponding author. Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan. Tel: +81-27-220-8378; Fax: +81-27-220-8379;
| | - Masaru Wakatsuki
- Department of Radiology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Takafumi Toita
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan
| | - Yuko Kaneyasu
- Department of Radiation Oncology, National Hospital Organization Fukuyama Medical Center, 4-14-17 Okinogami-cho, Fukuyama, Hiroshima 720-8520, Japan
| | - Ken Yoshida
- Department of Radiology, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Shingo Kato
- Department of Radiation Oncology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan
| | - Noriko Ii
- Department of Radiation Oncology, Mie University Hospital, 2-174 Edobashi, Tsu-shi, Mie 514-8507, Japan
| | - Sunao Tokumaru
- Department of Radiology, Saga University, 5-1-1, Nabeshima, Saga, Saga 849-8501, Japan
| | - Hitoshi Ikushima
- Department of Therapeutic Radiology, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima 770-8503, Japan
| | - Takashi Uno
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chiba 260-8677, Japan
| | - Shin-ei Noda
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Tomoko Kazumoto
- Department of Radiation Oncology, Fukaya Red Cross Hospital, 5-8-1 Kamishiba-cho-nishi, Fukaya-shi, Saitama 366-0052, Japan
| | - Yoko Harima
- Department of Radiology, Kansai Medical University Medical Center, 10-15, Fumizono-cho, Moriguchi, Osaka 570-8507, Japan
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21
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Dinapoli N, Tartaglione T, Bussu F, Autorino R, Miccichè F, Sciandra M, Visconti E, Colosimo C, Paludetti G, Valentini V. Modelling tumour volume variations in head and neck cancer: contribution of magnetic resonance imaging for patients undergoing induction chemotherapy. ACTA OTORHINOLARYNGOLOGICA ITALICA 2016; 37:9-16. [PMID: 27897274 PMCID: PMC5384316 DOI: 10.14639/0392-100x-906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/04/2016] [Indexed: 11/23/2022]
Abstract
Primary tumour volume evaluation has predictive value for estimating survival outcomes. Using volumetric data acquired by MRI in patients undergoing induction chemotherapy (IC) these outcomes were estimated before the radiotherapy course in head and neck cancer (HNC) patients. MRI performed before and after IC in 36 locally advanced HNC patients were analysed to measure primary tumour volume. The two volumes were correlated using the linear-log ratio (LLR) between the volume in the first MRI and the volume in the second. Cox's proportional hazards models (CPHM) were defined for loco-regional control (LRC), disease-free survival (DFS) and overall survival (OS). Strict evaluation of the influence of volume delineation uncertainties on prediction of final outcomes has been defined. LLR showed good predictive value for all survival outcomes in CPHM. Predictive models for LRC and DFS at 24 months showed optimal discrimination and prediction capability. Evaluation of primary tumour volume variations in HNC after IC provides an example of modelling that can be easily used even for other adaptive treatment approaches. A complete assessment of uncertainties in covariates required for running models is a prerequisite to create reliable clinically models.
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Affiliation(s)
- N Dinapoli
- Institute of Radiotherapy, Università Cattolica del Sacro Cuore, Rome, Italy
| | - T Tartaglione
- Institute of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Bussu
- Institute of Otolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Autorino
- Institute of Radiotherapy, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Miccichè
- Institute of Radiotherapy, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Sciandra
- Institute of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Visconti
- Institute of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Colosimo
- Institute of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Paludetti
- Institute of Otolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - V Valentini
- Institute of Radiotherapy, Università Cattolica del Sacro Cuore, Rome, Italy
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22
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Kim Y, Kim YJ, Kim JY, Lim YK, Jeong C, Jeong J, Kim M, Lim MC, Seo SS, Park SY. Toxicities and dose-volume histogram parameters of MRI-based brachytherapy for cervical cancer. Brachytherapy 2016; 16:116-125. [PMID: 27876378 DOI: 10.1016/j.brachy.2016.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/11/2016] [Accepted: 10/19/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To analyze the toxicities and dose-volume histogram parameters of external-beam and magnetic resonance imaging-based intracavitary brachytherapy in cervical cancer patients. METHODS AND MATERIALS Acute and late toxicities were assessed in 135 patients divided into four groups: group 1, grade 0; group 2, grades 1-4; group 3, grades 0-1; and group 4, grades 2-4. The doses at the International Commission on Radiation Units and Measurements (DICRU) and minimum doses to the most exposed 0.1, 1, 2, and 5 cc (D0.1cc, D1cc, D2cc, and D5cc) of normal organs were calculated as equivalent doses in 2 Gy (α/β = 3). RESULTS The median follow-up was 35.2 months. For rectum, DICRU, D0.1cc, D1cc, and D2cc were significantly different between groups 1 and 2 and DICRU, D0.1cc, and D1cc between groups 3 and 4. For bladder, D0.1cc, D1cc, and D2cc were significantly different between groups 1 and 2 and DICRU, D1cc, D2cc, and D5cc between groups 3 and 4. Grade 2-4 bladder toxicity occurred in fewer patients with D2cc ≤ 95 Gy than those with D2cc > 95 Gy (7% vs. 22%, p = 0.014). CONCLUSIONS DICRU, D0.1cc, D1cc, and D2cc are relevant for predicting late rectal toxicities. The patients with bladder D2cc > 95 Gy are required to be in close observation for severe late toxicities.
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Affiliation(s)
- Youngkyong Kim
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Yeon-Joo Kim
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea; Center for Uterine Cancer, National Cancer Center, Goyang, Republic of Korea.
| | - Joo-Young Kim
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea; Center for Uterine Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Young Kyung Lim
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Chiyoung Jeong
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Jonghwi Jeong
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Meyoung Kim
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Myong Cheol Lim
- Center for Uterine Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Sang-Soo Seo
- Center for Uterine Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Sang-Yoon Park
- Center for Uterine Cancer, National Cancer Center, Goyang, Republic of Korea
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23
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Petric P, Hudej R, Al-Hammadi N, Segedin B. Virtual modelling of novel applicator prototypes for cervical cancer brachytherapy. Radiol Oncol 2016; 50:433-441. [PMID: 27904452 PMCID: PMC5120583 DOI: 10.1515/raon-2016-0048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/29/2016] [Indexed: 11/22/2022] Open
Abstract
Background Standard applicators for cervical cancer Brachytherapy (BT) do not always achieve acceptable balance between target volume and normal tissue irradiation. We aimed to develop an innovative method of Target-volume Density Mapping (TDM) for modelling of novel applicator prototypes with optimal coverage characteristics. Patients and methods. Development of Contour-Analysis Tool 2 (CAT-2) software for TDM generation was the core priority of our task group. Main requests regarding software functionalities were formulated and guided the coding process. Software validation and accuracy check was performed using phantom objects. Concepts and terms for standardized workflow of TDM post-processing and applicator development were introduced. Results CAT-2 enables applicator-based co-registration of Digital Imaging and Communications in Medicine (DICOM) structures from a sample of cases, generating a TDM with pooled contours in applicator-eye-view. Each TDM voxel is assigned a value, corresponding to the number of target contours encompassing that voxel. Values are converted to grey levels and transformed to DICOM image, which is transported to the treatment planning system. Iso-density contours (IDC) are generated as lines, connecting voxels with same grey levels. Residual Volume at Risk (RVR) is created for each IDC as potential volume that could contain organs at risk. Finally, standard and prototype applicators are applied on the TDM and virtual dose planning is performed. Dose volume histogram (DVH) parameters are recorded for individual IDC and RVR delineations and characteristic curves generated. Optimal applicator configuration is determined in an iterative manner based on comparison of characteristic curves, virtual implant complexities and isodose distributions. Conclusions Using the TDM approach, virtual applicator prototypes capable of conformal coverage of any target volume, can be modelled. Further systematic assessment, including studies on clinical feasibility, safety and effectiveness are needed before routine use of novel prototypes can be considered.
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Affiliation(s)
- Primoz Petric
- National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Robert Hudej
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
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An evaluation of the robustness of organ-at-risk recommendations made by GEC/ESTRO according to interobserver variability: a single-center experience. J Contemp Brachytherapy 2016; 8:349-55. [PMID: 27648090 PMCID: PMC5018524 DOI: 10.5114/jcb.2016.61738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 07/20/2016] [Indexed: 12/25/2022] Open
Abstract
Purpose Groupe Européen de Curiethérapie (GEC) and European Society for Radiotherapy & Oncology (ESTRO) has proposed a rectal dose constraint of the most exposed 2-cc volume (D2cc of ≤ 75 Gy EQD2α/β = 3) during external-beam plus high-dose-rate brachytherapy (HDR-BT) in localized prostate cancer patients. This study aimed to evaluate D2cc for rectal contouring via interobserver variability. Material and methods Four blinded observers contoured rectums of 5 patients. Rectal contouring anatomical limits were determined through previous consensus. Dose-volume histogram (DVH) dosimetric parameters (D0.1cc, D1cc, and D2cc) were analyzed according to GEC/ESTRO recommendations and subjected to intra- and interobserver comparisons. Latter comparisons involved coefficients of variation. For each parameter, the mean, standard deviation (SD), and range were evaluated. The effect of interobserver variation on total dose was analyzed by estimating the biologically equivalent rectal dose (EQD2α/β = 3). Results Interobserver coefficients of variation for D0.1cc, D1cc, and D2cc were 5.7%, 4.5%, and 4%, respectively. The highest interobserver rectal delineation variation yielded a rectal dose difference up to 5.8 Gy EQD2. Estimated intraobserver variation for the reported D2cc was 5.5% in the worst-case scenario (non-significant). Conclusions We observed acceptable interobserver variability in EQD2 for D2cc, with strong impacts on clinical threshold levels (D2cc ≤ 75 Gy EQD2) in some cases. This small, single-center analysis will be extended in a multicenter study.
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25
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Wadi-Ramahi S, Alnajjar W, Mahmood R, Jastaniyah N, Moftah B. Failure modes and effects analysis in image-guided high-dose-rate brachytherapy: Quality control optimization to reduce errors in treatment volume. Brachytherapy 2016; 15:669-78. [DOI: 10.1016/j.brachy.2016.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/06/2016] [Accepted: 06/17/2016] [Indexed: 10/21/2022]
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26
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Eminowicz G, Hall-Craggs M, Diez P, McCormack M. Improving target volume delineation in intact cervical carcinoma: Literature review and step-by-step pictorial atlas to aid contouring. Pract Radiat Oncol 2016; 6:e203-e213. [DOI: 10.1016/j.prro.2016.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 12/21/2015] [Accepted: 01/08/2016] [Indexed: 10/22/2022]
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27
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Vinod SK, Lim K, Bell L, Veera J, Ohanessian L, Juresic E, Borok N, Chan P, Chee R, Do V, Govindarajulu G, Sridharan S, Johnson C, Moses D, Van Dyk S, Holloway L. High-risk CTV delineation for cervix brachytherapy: Application of GEC-ESTRO guidelines in Australia and New Zealand. J Med Imaging Radiat Oncol 2016; 61:133-140. [PMID: 27527506 DOI: 10.1111/1754-9485.12509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/14/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Image-based brachytherapy for cervical cancer using MRI has been implemented in Australia and New Zealand. The aims of this study were to measure variability in High-risk CTV (HR-CTV) delineation and evaluate dosimetric consequences of this. METHODS Nine radiation oncologists, one radiation therapist and two radiologists contoured HR-CTV on 3T MRI datasets from ten consecutive patients undergoing cervical brachytherapy at a single institution. Contour comparisons were performed using the Dice Similarity Coefficient (DSC) and Mean Absolute Surface Distance (MASD). Two reference contours were created for brachytherapy planning: a Simultaneous Truth and Performance Level Estimation (STAPLE) and a consensus contour (CONSENSUS). Optimized plans (8 Gy) for both these contours were applied to individual participant's contours to assess D90 and D100 coverage of HR CTV. To compare variability in dosimetry, relative standard deviation (rSD) was calculated. RESULTS Good concordance (mean DSC≥0.7, MASD≤5 mm) was achieved in 8/10 cases when compared to the STAPLE reference and 6/10 cases when compared to the CONSENSUS reference. Greatest variation was visually seen in the cranio-caudal direction. The average mean rSD across all patients was 27% and 34% for the STAPLE HR-CTV D90 and D100, respectively, and 28% and 35% for the CONSENSUS HR-CTV D90 and D100. Delineation uncertainty resulted in an average dosimetric uncertainty of ±1.5-1.6 Gy per fraction based on an 8 Gy prescribed fraction. CONCLUSIONS Delineation of HR-CTV for cervical cancer brachytherapy was consistent amongst observers, suggesting similar interpretation of GEC-ESTRO guidelines. Despite the good concordance, there was dosimetric variation noted, which could be clinically significant.
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Affiliation(s)
- Shalini K Vinod
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia.,South Western Sydney Clinical School, University of NSW, Sydney, New South Wales, Australia
| | - Karen Lim
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia.,South Western Sydney Clinical School, University of NSW, Sydney, New South Wales, Australia
| | - Lauren Bell
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia.,Ingham Institute of Applied Medical Research, Liverpool Hospital, Liverpool, New South Wales, Australia
| | | | - Lucy Ohanessian
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Ewa Juresic
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Nira Borok
- Department of Radiology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Phillip Chan
- Department of Radiation Oncology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Raphael Chee
- Genesis Cancer Care, Perth, Western Australia, Australia.,School of Surgery, University of Western Australia, Perth, Western Australia, Australia
| | - Viet Do
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia.,Nepean Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Geetha Govindarajulu
- Department of Radiation Oncology, Calvary Mater Hospital, Newcastle, New South Wales, Australia
| | - Swetha Sridharan
- Department of Radiation Oncology, Calvary Mater Hospital, Newcastle, New South Wales, Australia
| | - Carol Johnson
- Wellington Blood & Cancer Centre, Wellington Hospital, Wellington, New Zealand
| | - Daniel Moses
- School of Medicine, University of NSW, Sydney, New South Wales, Australia.,Department of Radiology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Sylvia Van Dyk
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Lois Holloway
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia.,South Western Sydney Clinical School, University of NSW, Sydney, New South Wales, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia.,Ingham Institute of Applied Medical Research, Liverpool Hospital, Liverpool, New South Wales, Australia
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28
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Han K, Croke J, Foltz W, Metser U, Xie J, Shek T, Driscoll B, Ménard C, Vines D, Coolens C, Simeonov A, Beiki-Ardakani A, Leung E, Levin W, Fyles A, Milosevic MF. A prospective study of DWI, DCE-MRI and FDG PET imaging for target delineation in brachytherapy for cervical cancer. Radiother Oncol 2016; 120:519-525. [PMID: 27528120 DOI: 10.1016/j.radonc.2016.08.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE We examined the utility of dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted MRI (DWI), and FDG-PET imaging for brachytherapy target delineation in patients with locally advanced cervical cancer. MATERIALS AND METHODS Twenty-two patients had DWI, DCE-MRI, and FDG-PET/CT scans after brachytherapy applicator insertion, in addition to standard T2-weighted (T2w) 3T MRI. Gross tumor volume (GTVB) and high-risk clinical target volume (HRCTV) were contoured first on T2w images, and then modified if indicated upon review of DWI/DCE-MRI/FDG-PET images by two observers. The primary endpoint was utility, determined by the number of patients whose volumes were modified, and interobserver variability. RESULTS Eleven patients' T2w-GTVB were modified based on DWI/DCE-MRI/FDG-PET by observer 1, due to clearer demarcation (7) and residual disease not well visualized on T2w MRI (4). GTVB was modified in 17 patients by observer 2 (11 and 6, respectively). Incorporation of functional imaging improved the conformity index (CI) for GTVB from 0.54 (T2w alone) to 0.65 (P=0.003). HRCTV was modified in 3 and 8 patients by observers 1 and 2, respectively, with a trend toward higher CI using functional imaging (0.71 to 0.76, P=0.06). CONCLUSIONS DWI/DCE-MRI/FDG-PET imaging as a supplement to T2w MRI decreased interobserver variability in GTVB delineation.
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Affiliation(s)
- Kathy Han
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada.
| | - Jennifer Croke
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Warren Foltz
- Department of Radiation Oncology, University of Toronto, Canada
| | - Ur Metser
- Joint Department of Medical Imaging, University Health Network, Toronto, Canada; Department of Medical Imaging, University of Toronto, Canada
| | - Jason Xie
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Tina Shek
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Brandon Driscoll
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Cynthia Ménard
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
| | - Doug Vines
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Catherine Coolens
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Anna Simeonov
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Akbar Beiki-Ardakani
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Eric Leung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Wilfred Levin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Anthony Fyles
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Michael F Milosevic
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Canada
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29
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Pötter R, Federico M, Sturdza A, Fotina I, Hegazy N, Schmid M, Kirisits C, Nesvacil N. Value of Magnetic Resonance Imaging Without or With Applicator in Place for Target Definition in Cervix Cancer Brachytherapy. Int J Radiat Oncol Biol Phys 2016; 94:588-97. [PMID: 26867887 DOI: 10.1016/j.ijrobp.2015.09.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 09/09/2015] [Accepted: 09/14/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To define, in the setting of cervical cancer, to what extent information from additional pretreatment magnetic resonance imaging (MRI) without the brachytherapy applicator improves conformity of CT-based high-risk clinical target volume (CTVHR) contours, compared with the MRI for various tumor stages (International Federation of Gynecology and Obstetrics [FIGO] stages I-IVA). METHODS AND MATERIALS The CTVHR was contoured in 39 patients with cervical cancer (FIGO stages I-IVA) (1) on CT images based on clinical information (CTVHR-CTClinical) alone; and (2) using an additional MRI before brachytherapy, without the applicator (CTVHR-CTpre-BT MRI). The CT contours were compared with reference contours on MRI with the applicator in place (CTVHR-MRIref). Width, height, thickness, volumes, and topography were analyzed. RESULTS The CT-MRIref differences hardly varied in stage I tumors (n=8). In limited-volume stage IIB and IIIB tumors (n=19), CTVHR-CTpre-BT MRI-MRIref volume differences (2.6 cm(3) [IIB], 7.3 cm(3) [IIIB]) were superior to CTVHR-CTClinical-MRIref (11.8 cm(3) [IIB], 22.9 cm(3) [IIIB]), owing to significant improvement of height and width (P<.05). In advanced disease (n=12), improved agreement with MR volume, width, and height was achieved for CTVHR-CTpre-BT MRI. In 5 of 12 cases, MRIref contours were partly missed on CT. CONCLUSIONS Pre-BT MRI helps to define CTVHR before BT implantation appropriately, if only CT images with the applicator in place are available for BT planning. Significant improvement is achievable in limited-volume stage IIB and IIIB tumors. In more advanced disease (extensive IIB to IVA), improvement of conformity is possible but may be associated with geographic misses. Limited impact on precision of CTVHR-CT is expected in stage IB tumors.
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Affiliation(s)
- Richard Pötter
- Department of Radiotherapy, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Mario Federico
- Department of Radiotherapy, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Radiation Oncology, Gran Canaria University Hospital, Las Palmas de Gran Canaria, Spain
| | - Alina Sturdza
- Department of Radiotherapy, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Irina Fotina
- Department of Radiotherapy, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute of Physics and Technology, Tomsk Polytechnic University, Tomsk Oblast, Russia
| | - Neamat Hegazy
- Department of Radiotherapy, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Clinical Oncology, Medical University of Alexandria, Alexandria, Egypt
| | - Maximilian Schmid
- Department of Radiotherapy, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Christian Kirisits
- Department of Radiotherapy, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Nicole Nesvacil
- Department of Radiotherapy, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria.
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30
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Siavashpour Z, Aghamiri MR, Jaberi R, ZareAkha N, Manshadi HRD, Kirisits C, Sedaghat M. A comparison of organs at risk doses in GYN intracavitary brachytherapy for different tandem lengths and bladder volumes. J Appl Clin Med Phys 2016; 17:5-13. [PMID: 27167253 PMCID: PMC5690927 DOI: 10.1120/jacmp.v17i3.5584] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 12/31/2015] [Accepted: 12/18/2015] [Indexed: 12/04/2022] Open
Abstract
The purpose of this study was to investigate the concurrent effects of tandem length and bladder volume on dose to pelvic organs at risk (OARs) in HDR intracavitary brachytherapy treatment of cervical cancer. Twenty patients with locally advanced cervical cancer were selected for brachytherapy using Rotterdam applicators. The patients were CT scanned twice with empty and full bladder. Two treatment plans were prepared on each of the image sets. Patients were categorized into two groups; those treated with a tandem length of 4 cm or smaller (T≤4 cm) and those with tandem length larger than 4 cm (T>4 cm). Only one tandem tip angle of 30° was studied. Dose‐volume histograms (DVHs) of OARs were calculated and compared. Bladder dose was significantly affected by both bladder volume and tandem physical length for T≤4 cm. This was reflected on the values obtained for D2cm3, D1cm3, and D0.1cm3 for both empty and full bladder cases. When T>4 cm, no correlation could be established between variations in bladder dose and bladder volume. Rectum dose was generally lower when the bladder was empty and T>4 cm. Dose to sigmoid was increased when T>4 cm; this increase was larger when the bladder was full. Our results suggest that, for tandems longer than 4 cm, keeping the bladder empty may reduce the dose to rectum and sigmoid. This is contrary to cases where a shorter than 4 cm tandem is used in which a full bladder (about 50–120 cm3) tends to result in a lower dose to rectum and sigmoid. Attention should be given to doses to sigmoid with long tandem lengths, as a larger tandem generally results in a larger dose to sigmoid. PACS number(s): 87.53.Jw
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31
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Cheng ZJ, Bromley RM, Oborn B, Carolan M, Booth JT. On the accuracy of dose prediction near metal fixation devices for spine SBRT. J Appl Clin Med Phys 2016; 17:475-485. [PMID: 27167252 PMCID: PMC5690901 DOI: 10.1120/jacmp.v17i3.5536] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 12/20/2015] [Accepted: 12/15/2015] [Indexed: 11/23/2022] Open
Abstract
The metallic fixations used in surgical procedures to support the spine mechanically usually consist of high‐density materials. Radiation therapy to palliate spinal cord compression can include prophylactic inclusion of potential tumor around the site of such fixation devices. Determination of the correct density and shape of the spine fixation device has a direct effect on the dose calculation of the radiation field. Even with the application of modern computed tomography (CT), under‐ or overestimation of dose, both immediately next to the device and in the surrounding tissues, can occur due to inaccuracies in the dose prediction algorithm. In this study, two commercially available dose prediction algorithms (Eclipse AAA and ACUROS), EGSnrc Monte Carlo, and GAFchromic film measurements were compared for a clinical spine SBRT case to determine their accuracy. An open six‐field plan and a clinical nine‐field IMRT plan were applied to a phantom containing a metal spine fixation device. Dose difference and gamma analysis were performed in and around the tumor region adjacent to the fixation device. Dose calculation inconsistency was observed in the open field plan. However, in the IMRT plan, the dose perturbation effect was not observed beyond 5 mm. Our results suggest that the dose effect of the metal fixation device to the spinal cord and the tumor volume is not observable, and all dose calculation algorithms evaluated can provide clinically acceptable accuracy in the case of spinal SBRT, with the tolerance of 95% for gamma criteria of 3%/3 mm. PACS number(s): 87.53.bn, 87.53.Ly, 87.55.kd
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Eminowicz G, Rompokos V, Stacey C, McCormack M. The dosimetric impact of target volume delineation variation for cervical cancer radiotherapy. Radiother Oncol 2016; 120:493-499. [PMID: 27162158 DOI: 10.1016/j.radonc.2016.04.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/18/2016] [Accepted: 04/19/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cervical cancer inter-observer delineation variation has been demonstrated. This article addresses its dosimetric impact. METHODS 21 centres outlined two INTERLACE trial quality assurance test cases. A gold standard clinical target volume (GSCTV) was created from a consensus and STAPLE outline. RapidArc plans were created for all centres' planning target volumes (PTVs; PTV1+2). Gold standard PTVs (GSPTVs) were created for each plan by applying each centre's CTV-PTV margins to GSCTV. DVH parameters including D95% and Dmean for each PTV1+2 and GSPTV were compared, representing planned versus GSPTV delivered dose. PTV1+2 and GSPTV V95% was also calculated. RESULTS Reviewing all parameters, no plans achieved acceptable GSPTV coverage. GSPTV V95%⩾95% was not achieved for any plan. GSPTV V95%<90% in 15/21 (case 1) and 14/22 (case 2) and <80% in 2 plans from both cases. GSPTV V95% is on average 10-15% lower than planned and GSPTV D95% is 10-20% lower than planned. Most common GSCTV anatomical areas not receiving 95% dose were vagina, obturator and external iliac nodes and, in case 1, the superior nodal aspect. CONCLUSION Cervical cancer CTV delineation variation leads to significant reductions in dose delivered to GSPTV. This highlights the ongoing importance of standardising delineation in the IMRT era.
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Affiliation(s)
- Gemma Eminowicz
- Radiotherapy Department, University College London Hospital, United Kingdom
| | - Vasilis Rompokos
- Radiotherapy Department, University College London Hospital, United Kingdom
| | - Christopher Stacey
- Radiotherapy Department, University College London Hospital, United Kingdom
| | - Mary McCormack
- Radiotherapy Department, University College London Hospital, United Kingdom
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Arana E, Kovacs FM, Royuela A, Asenjo B, Pérez-Ramírez Ú, Zamora J. Spine Instability Neoplastic Score: agreement across different medical and surgical specialties. Spine J 2016; 16:591-9. [PMID: 26471708 DOI: 10.1016/j.spinee.2015.10.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 08/27/2015] [Accepted: 10/06/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal instability is an acknowledged complication of spinal metastases; in spite of recent suggested criteria, it is not clearly defined in the literature. PURPOSE This study aimed to assess intra and interobserver agreement when using the Spine Instability Neoplastic Score (SINS) by all physicians involved in its management. STUDY DESIGN Independent multicenter reliability study for the recently created SINS, undertaken with a panel of medical oncologists, neurosurgeons, radiologists, orthopedic surgeons, and radiation oncologists, was carried out. PATIENT SAMPLE Ninety patients with biopsy-proven spinal metastases and magnetic resonance imaging, reviewed at the multidisciplinary tumor board of our institution, were included. OUTCOME MEASURES Intraclass correlation coefficient (ICC) was used for SINS score agreement. Fleiss kappa statistic was used to assess agreement on the location of the most affected vertebral level; agreement on the SINS category ("stable," "potentially stable," or "unstable"); and overall agreement with the classification established by tumor board. METHODS Clinical data and imaging were provided to 83 specialists in 44 hospitals across 14 Spanish regions. No assessment criteria were pre-established. Each clinician assessed the SINS score twice, with a minimum 6-week interval. Clinicians were blinded to assessments made by other specialists and to their own previous assessment. Subgroup analyses were performed by clinicians' specialty, experience (≤7, 8-13, ≥14 years), and hospital category (four levels according to size and complexity). This study was supported by Kovacs Foundation. RESULTS Intra and interobserver agreement on the location of the most affected levels was "almost perfect" (κ>0.94). Intra-observer agreement on the SINS score was "excellent" (ICC=0.77), whereas interobserver agreement was "moderate" (ICC=0.55). Intra-observer agreement in SINS category was "substantial" (k=0.61), whereas interobserver agreement was "moderate" (k=0.42). Overall agreement with the tumor board classification was "substantial" (κ=0.61). Results were similar across specialties, years of experience, and hospital category. CONCLUSIONS Agreement on the assessment of metastatic spine instability is moderate. The SINS can help improve communication among clinicians in oncology care.
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Affiliation(s)
- Estanislao Arana
- Department of Radiology, Valencian Oncology Institute Foundation, C/ Beltrán Báguena, 19, 46009 Valencia, Spain; Research Institute in Health Services Foundation, C/ San Vicente,112, 3, 46007 Valencia, Spain; Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain.
| | - Francisco M Kovacs
- Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Scientific Department, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain
| | - Ana Royuela
- Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; CIBER Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain; Clinical Biostatistics Unit, Hospital Ramón y Cajal, IRYCIS. Ctra. Colmenar Km. 9.1, 28034 Madrid, Spain
| | - Beatriz Asenjo
- Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Department of Radiology, Hospital Regional Universitario Carlos Haya, Avda Carlos Haya s/n, 29010 Málaga, Spain
| | - Úrsula Pérez-Ramírez
- Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, CPI Building (8E), F access, 1st floor, Cami de Vera, s/n, 46022 Valencia, Spain
| | - Javier Zamora
- Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; CIBER Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain; Clinical Biostatistics Unit, Hospital Ramón y Cajal, IRYCIS. Ctra. Colmenar Km. 9.1, 28034 Madrid, Spain; Barts and the London School of Medicine & Dentistry, Queen Mary University of London, Mile End Road, London E1 4NS, UK
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Kim Y, Modrick JM, Pennington EC, Kim Y. Commissioning of a 3D image-based treatment planning system for high-dose-rate brachytherapy of cervical cancer. J Appl Clin Med Phys 2016; 17:405-426. [PMID: 27074463 PMCID: PMC5874852 DOI: 10.1120/jacmp.v17i2.5818] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 12/11/2015] [Indexed: 11/23/2022] Open
Abstract
The objective of this work is to present commissioning procedures to clinically implement a three-dimensional (3D), image-based, treatment-planning system (TPS) for high-dose-rate (HDR) brachytherapy (BT) for gynecological (GYN) cancer. The physical dimensions of the GYN applicators and their values in the virtual applicator library were varied by 0.4 mm of their nominal values. Reconstruction uncertainties of the titanium tandem and ovoids (T&O) were less than 0.4 mm on CT phantom studies and on average between 0.8-1.0 mm on MRI when compared with X-rays. In-house software, HDRCalculator, was developed to check HDR plan parameters such as independently verifying active tandem or cylinder probe length and ovoid or cylinder size, source calibration and treatment date, and differences between average Point A dose and prescription dose. Dose-volume histograms were validated using another independent TPS. Comprehensive procedures to commission volume optimization algorithms and process in 3D image-based planning were presented. For the difference between line and volume optimizations, the average absolute differences as a percentage were 1.4% for total reference air KERMA (TRAK) and 1.1% for Point A dose. Volume optimization consistency tests between versions resulted in average absolute differences in 0.2% for TRAK and 0.9 s (0.2%) for total treatment time. The data revealed that the optimizer should run for at least 1 min in order to avoid more than 0.6% dwell time changes. For clinical GYN T&O cases, three different volume optimization techniques (graphical optimization, pure inverse planning, and hybrid inverse optimization) were investigated by comparing them against a conventional Point A technique. End-to-end testing was performed using a T&O phantom to ensure no errors or inconsistencies occurred from imaging through to planning and delivery. The proposed commissioning procedures provide a clinically safe implementation technique for 3D image-based TPS for HDR BT for GYN cancer.
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Eminowicz G, McCormack M. Variability of clinical target volume delineation for definitive radiotherapy in cervix cancer. Radiother Oncol 2015; 117:542-7. [DOI: 10.1016/j.radonc.2015.10.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 10/07/2015] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
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Ngo C, Samuels S, Bagrintseva K, Slocker A, Hupé P, Kenter G, Popovic M, Samet N, Tresca P, von der Leyen H, Deutsch E, Rouzier R, Belin L, Kamal M, Scholl S. From prospective biobanking to precision medicine: BIO-RAIDs - an EU study protocol in cervical cancer. BMC Cancer 2015; 15:842. [PMID: 26531748 PMCID: PMC4632364 DOI: 10.1186/s12885-015-1801-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/16/2015] [Indexed: 11/29/2022] Open
Abstract
Background Cervical cancer (CC) is -second to breast cancer- a dominant cause of gynecological cancer-related deaths worldwide. CC tumor biopsies and blood samples are of easy access and vital for the development of future precision medicine strategies. Design BIO-RAIDs is a prospective multicenter European study, presently recruiting patients in 6 EU countries. Tumor and liquid biopsies from patients with previously non-treated cervical cancer (stages IB2-IV) are collected at defined time points. Patients receive standard primary treatment according to the stage of their disease. 700 patients are planned to be enrolled. The main objectives are the discovery of -dominant molecular alterations, -signalling pathway activation, and -tumor micro-environment patterns that may predict response or resistance to treatment. An exhaustive molecular analysis is performed using 1° Next generation sequencing, 2° Reverse phase protein arrays and 3° Immuno-histochemistry. Discussion The clinical study BIO-RAIDs is activated in all planned countries, 170 patients have been recruited till now. This study will make an important contribution towards precision medicine treatments in cervical cancer. The results will support the development of clinical practice guidelines for cervical cancer patients to improve their prognosis and their quality of life. Trial registration Clinicaltrials.gov: NCT02428842, registered 10 February 2015.
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Affiliation(s)
- Charlotte Ngo
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France.,Present address: Department of gynecological and breast oncological surgery, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Sanne Samuels
- Department of Gynecology, Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AVL), P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - Ksenia Bagrintseva
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France
| | - Andrea Slocker
- Department of Radiation Oncology, Institut Gustave Roussy (IGR), 114 Rue Edouard-Vaillant, 94805, Villejuif Cedex, France
| | - Philippe Hupé
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France.,INSERM U900, Paris, France.,Mines ParisTech, Fontainebleau, France.,CNRS UMR 144, Paris, France
| | - Gemma Kenter
- Department of Gynecology, Netherlands Cancer Institute - Antoni van Leeuwenhoek (NKI-AVL), P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands
| | - Marina Popovic
- Department of Gynecology, Institut of Oncology of Vojvodina (IOV), Put Doktora Goldmana 4, 21204, Sremska Kamenica, Serbia
| | - Nina Samet
- Department of Radiology Gynecology, Institute of Oncology of Republic of Moldova, str. N. Testemiţanu 30, MD-2025, Chişinău, Republica Moldova
| | - Patricia Tresca
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France
| | - Heiko von der Leyen
- Hannover Clinical Trial Center (HCTC) GmbH, Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Eric Deutsch
- Department of Radiation Oncology, Institut Gustave Roussy (IGR), 114 Rue Edouard-Vaillant, 94805, Villejuif Cedex, France
| | - Roman Rouzier
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France
| | - Lisa Belin
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France
| | - Maud Kamal
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France
| | - Suzy Scholl
- Department of Medical Oncology, Institut Curie, 25 Rue d'Ulm, Paris, 75005, France. .,Institut Curie, 26 rue d'Ulm 75248, Paris, Cedex 05, France.
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Minkoff D, Gill BS, Kang J, Beriwal S. Cervical cancer outcome prediction to high-dose rate brachytherapy using quantitative magnetic resonance imaging analysis of tumor response to external beam radiotherapy. Radiother Oncol 2015; 115:78-83. [DOI: 10.1016/j.radonc.2015.03.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/03/2015] [Accepted: 03/09/2015] [Indexed: 11/30/2022]
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van de Schoot AJAJ, de Boer P, Buist MR, Stoker J, Bleeker MCG, Stalpers LJA, Rasch CRN, Bel A. Quantification of delineation errors of the gross tumor volume on magnetic resonance imaging in uterine cervical cancer using pathology data and deformation correction. Acta Oncol 2015; 54:224-31. [PMID: 25437811 DOI: 10.3109/0284186x.2014.983655] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND To safely optimize target volumes using magnetic resonance imaging (MRI) for uterine cervical cancer radiation therapy, MRI findings need to be validated. The aim of this study was to correlate pre-operatively acquired MRI and surgical specimen imaging for uterine cervical cancer patients using deformable image registration and quantify gross tumor volume (GTV) delineation discrepancies. MATERIAL AND METHODS For 16 retrospectively selected early-stage uterine cervical cancer patients, the cervix-uterus structure, uterine cavity and the GTV were delineated on 2D pathology photos after macroscopic intersection and corresponding pre-operatively acquired T2-weighted 2D sagittal MR images. Segmentations of pathology photos and MR images were simultaneously registered using a three-step multi-image registration strategy. The registration outcome was evaluated by the Dice similarity coefficient (DSC) and the surface distance error (SDE). In addition, GTV expansions within the cervix-uterus structure needed to obtain 95% GTV coverage were determined. RESULTS After three-step multi-image registration, the median DSC and median SDE were 0.98 and 0.4 mm (cervix-uterus) and 0.90 and 0.4 mm (uterine cavity), respectively. The average SDE around the GTV was 0.7 mm (range, 0.1 mm - 2.6 mm). An underestimation of MRI-based GTV delineations was found when no margin was applied, indicated by a mean GTV coverage of 61%. To obtain 95% GTV coverage for 90% of the patients, a minimum 12.0 mm margin around MRI-based GTVs was needed. CONCLUSION The presented three-step multi-image registration strategy was suitable and accurate to correlate MRI and pathology data for uterine cervical cancer patients. To cover the pathology-based GTV, a margin of at least 12.0 mm around GTV delineations on T2-weighted MRI is needed.
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Viswanathan AN, Erickson B, Gaffney DK, Beriwal S, Bhatia SK, Lee Burnett O, D'Souza DP, Patil N, Haddock MG, Jhingran A, Jones EL, Kunos CA, Lee LJ, Lin LL, Mayr NA, Petersen I, Petric P, Portelance L, Small W, Strauss JB, Townamchai K, Wolfson AH, Yashar CM, Bosch W. Comparison and consensus guidelines for delineation of clinical target volume for CT- and MR-based brachytherapy in locally advanced cervical cancer. Int J Radiat Oncol Biol Phys 2014; 90:320-8. [PMID: 25304792 DOI: 10.1016/j.ijrobp.2014.06.005] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/28/2014] [Accepted: 06/02/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To create and compare consensus clinical target volume (CTV) contours for computed tomography (CT) and 3-Tesla (3-T) magnetic resonance (MR) image-based cervical-cancer brachytherapy. METHODS AND MATERIALS Twenty-three experts in gynecologic radiation oncology contoured the same 3 cervical cancer brachytherapy cases: 1 stage IIB near-complete response (CR) case with a tandem and ovoid, 1 stage IIB partial response (PR) case with tandem and ovoid with needles, and 1 stage IB2 CR case with a tandem and ring applicator. The CT contours were completed before the MRI contours. These were analyzed for consistency and clarity of target delineation using an expectation maximization algorithm for simultaneous truth and performance level estimation (STAPLE), with κ statistics as a measure of agreement between participants. The conformity index was calculated for each of the 6 data sets. Dice coefficients were generated to compare the CT and MR contours of the same case. RESULTS For all 3 cases, the mean tumor volume was smaller on MR than on CT (P<.001). The κ and conformity index estimates were slightly higher for CT, indicating a higher level of agreement on CT. The Dice coefficients were 89% for the stage IB2 case with a CR, 74% for the stage IIB case with a PR, and 57% for the stage IIB case with a CR. CONCLUSION In a comparison of MR-contoured with CT-contoured CTV volumes, the higher level of agreement on CT may be due to the more distinct contrast medium visible on the images at the time of brachytherapy. MR at the time of brachytherapy may be of greatest benefit in patients with large tumors with parametrial extension that have a partial or complete response to external beam. On the basis of these results, a 95% consensus volume was generated for CT and for MR. Online contouring atlases are available for instruction at http://www.nrgoncology.org/Resources/ContouringAtlases/GYNCervicalBrachytherapy.aspx.
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Affiliation(s)
- Akila N Viswanathan
- Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.
| | | | - David K Gaffney
- University of Utah Huntsman Cancer Hospital, Salt Lake City, Utah
| | - Sushil Beriwal
- University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | | | | | - David P D'Souza
- London Health Sciences Centre and Western University, London, Ontario, Canada
| | - Nikhilesh Patil
- London Health Sciences Centre and Western University, London, Ontario, Canada
| | | | - Anuja Jhingran
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ellen L Jones
- University of North Carolina, Chapel Hill, North Carolina
| | | | - Larissa J Lee
- Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lilie L Lin
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nina A Mayr
- University of Washington, Seattle, Washington
| | | | - Primoz Petric
- Division of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Department of Radiation Oncology, National Center for Cancer Care and Research, Doha, Qatar
| | | | - William Small
- Loyola University Strich School of Medicine, Chicago, Illinois
| | - Jonathan B Strauss
- The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Kanokpis Townamchai
- Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Aaron H Wolfson
- University of Miami Miller School of Medicine, Miami, Florida
| | - Catheryn M Yashar
- University of California, San Diego, California, Washington University, St. Louis, Missouri
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Arnesen MR, Bruheim K, Malinen E, Hellebust TP. Spatial dosimetric sensitivity of contouring uncertainties in gynecological 3D-based brachytherapy. Radiother Oncol 2014; 113:414-9. [DOI: 10.1016/j.radonc.2014.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 11/06/2014] [Accepted: 11/08/2014] [Indexed: 10/24/2022]
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Srivastava A, Datta NR. Brachytherapy in cancer cervix: Time to move ahead from point A? World J Clin Oncol 2014; 5:764-74. [PMID: 25302176 PMCID: PMC4129539 DOI: 10.5306/wjco.v5.i4.764] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 02/28/2014] [Accepted: 04/03/2014] [Indexed: 02/06/2023] Open
Abstract
Brachytherapy forms an integral part of the radiation therapy in cancer cervix. The dose prescription for intracavitary brachytherapy (ICBT) in cancer cervix is based on Tod and Meredith's point A and has been in practice since 1938. This was proposed at a time when accessibility to imaging technology and dose computation facilities was limited. The concept has been in practice worldwide for more than half a century and has been the fulcrum of all ICBT treatments, strategies and outcome measures. The method is simple and can be adapted by all centres practicing ICBT in cancer cervix. However, with the widespread availability of imaging techniques, clinical use of different dose-rates, availability of a host of applicators fabricated with image compatible materials, radiobiological implications of dose equivalence and its impact on tumour and organs at risk; more and more weight is being laid down on individualised image based brachytherapy. Thus, computed tomography, magnetic-resonance imaging and even positron emission computerized tomography along with brachytherapy treatment planning system are being increasingly adopted with promising outcomes. The present article reviews the evolution of dose prescription concepts in ICBT in cancer cervix and brings forward the need for image based brachytherapy to evaluate clinical outcomes. As is evident, a gradual transition from "point" based brachytherapy to "profile" based image guided brachytherapy is gaining widespread acceptance for dose prescription, reporting and outcome evaluation in the clinical practice of ICBT in cancer cervix.
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Cervical gross tumor volume dose predicts local control using magnetic resonance imaging/diffusion-weighted imaging-guided high-dose-rate and positron emission tomography/computed tomography-guided intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys 2014; 90:794-801. [PMID: 25245584 DOI: 10.1016/j.ijrobp.2014.07.039] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 06/05/2014] [Accepted: 07/24/2014] [Indexed: 11/23/2022]
Abstract
PURPOSE Magnetic resonance imaging/diffusion weighted-imaging (MRI/DWI)-guided high-dose-rate (HDR) brachytherapy and (18)F-fluorodeoxyglucose (FDG) - positron emission tomography/computed tomography (PET/CT)-guided intensity modulated radiation therapy (IMRT) for the definitive treatment of cervical cancer is a novel treatment technique. The purpose of this study was to report our analysis of dose-volume parameters predicting gross tumor volume (GTV) control. METHODS AND MATERIALS We analyzed the records of 134 patients with International Federation of Gynecology and Obstetrics stages IB1-IVB cervical cancer treated with combined MRI-guided HDR and IMRT from July 2009 to July 2011. IMRT was targeted to the metabolic tumor volume and lymph nodes by use of FDG-PET/CT simulation. The GTV for each HDR fraction was delineated by use of T2-weighted or apparent diffusion coefficient maps from diffusion-weighted sequences. The D100, D90, and Dmean delivered to the GTV from HDR and IMRT were summed to EQD2. RESULTS One hundred twenty-five patients received all irradiation treatment as planned, and 9 did not complete treatment. All 134 patients are included in this analysis. Treatment failure in the cervix occurred in 24 patients (18.0%). Patients with cervix failures had a lower D100, D90, and Dmean than those who did not experience failure in the cervix. The respective doses to the GTV were 41, 58, and 136 Gy for failures compared with 67, 99, and 236 Gy for those who did not experience failure (P<.001). Probit analysis estimated the minimum D100, D90, and Dmean doses required for ≥90% local control to be 69, 98, and 260 Gy (P<.001). CONCLUSIONS Total dose delivered to the GTV from combined MRI-guided HDR and PET/CT-guided IMRT is highly correlated with local tumor control. The findings can be directly applied in the clinic for dose adaptation to maximize local control.
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Lee CD. Recent developments and best practice in brachytherapy treatment planning. Br J Radiol 2014; 87:20140146. [PMID: 24734939 PMCID: PMC4453147 DOI: 10.1259/bjr.20140146] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/10/2014] [Accepted: 04/14/2014] [Indexed: 12/20/2022] Open
Abstract
Brachytherapy has evolved over many decades, but more recently, there have been significant changes in the way that brachytherapy is used for different treatment sites. This has been due to the development of new, technologically advanced computer planning systems and treatment delivery techniques. Modern, three-dimensional (3D) imaging modalities have been incorporated into treatment planning methods, allowing full 3D dose distributions to be computed. Treatment techniques involving online planning have emerged, allowing dose distributions to be calculated and updated in real time based on the actual clinical situation. In the case of early stage breast cancer treatment, for example, electronic brachytherapy treatment techniques are being used in which the radiation dose is delivered during the same procedure as the surgery. There have also been significant advances in treatment applicator design, which allow the use of modern 3D imaging techniques for planning, and manufacturers have begun to implement new dose calculation algorithms that will correct for applicator shielding and tissue inhomogeneities. This article aims to review the recent developments and best practice in brachytherapy techniques and treatments. It will look at how imaging developments have been incorporated into current brachytherapy treatment and how these developments have played an integral role in the modern brachytherapy era. The planning requirements for different treatments sites are reviewed as well as the future developments of brachytherapy in radiobiology and treatment planning dose calculation.
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Affiliation(s)
- C D Lee
- Physics Department, Clatterbridge Cancer Centre, Bebington, Wirral, UK
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Kim YJ, Kim JY, Kim TH, Lim YK, Yoon MG, Joo JN, Park SY. Dosimetric Evaluation of Magnetic Resonance Imaging-Based Intracavitary Brachytherapy for Cervical Cancer. Technol Cancer Res Treat 2014; 13:243-51. [DOI: 10.7785/tcrt.2012.500372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The purpose of this study was to evaluate the dosimetric benefit of magnetic resonance imaging (MRI)-based dose adaptation in intracavitary brachytherapy (ICR) for cervical cancer. Dose-volume histograms were compared between matched conventional and optimized plans in 22 patients who were treated by MRI-based ICR. Doses to organs-at-risk (OAR) and dose covering 90% of high-risk clinical target volume (HR-CTV) were evaluated to compare OAR sparing and target coverage, respectively. The probability of RTOG rectal toxicity grade of ≥2 in the 22 patients was estimated based on the prediction model generated from previous three-dimensional CT-based ICR data. After optimization, doses to OAR showed a statistically significant decrease. The reduction percentage (reduced dose by optimization × 100/dose in the conventional plan) was higher in patients with HR-CTV >20 cc than in patients with HR-CTV ≤20 cc in the rectum. In patients with HR-CTV ≤20 cc, the mean probability of RTOG rectal toxicity grade ≥2 was 67.6% for the conventional plan and 47.8% for the optimized plan, based on the prediction model. In conclusion, dose adaptation by MRI-based ICR for cervical cancer resulted in significant dose reduction to the rectum, especially in patients with HR-CTV ≤20 cc.
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Affiliation(s)
- Y. J. Kim
- Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - J. Y. Kim
- Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - T. H. Kim
- Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Y. K. Lim
- Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - M. G. Yoon
- Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - J. N. Joo
- Cancer Biostatistics Branch, National Cancer Center, Goyang, Korea
| | - S. Y. Park
- Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Image guided adaptive brachytherapy for cervical cancer: dose contribution to involved pelvic nodes in two cancer centers. J Contemp Brachytherapy 2014; 6:21-7. [PMID: 24790618 PMCID: PMC4003428 DOI: 10.5114/jcb.2014.42021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 02/18/2014] [Accepted: 03/28/2014] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The goal of this study was to determine the dose contributions from image guided adaptive brachytherapy (IGABT) to individual suspicious pelvic lymph nodes (pLNN) in cervical cancer patients. Data were collected in two cancer centers, University of Pittsburgh Cancer Institute (UPCI) and University Medical Center Utrecht (UMCU). MATERIAL AND METHODS 27 and 15 patients with node positive cervical cancer treated with HDR (high dose rate) or PDR (pulsed dose rate)-IGABT were analyzed. HDR-IGABT (UPCI) was delivered with CT/MRI compatible tandem-ring applicators with 5.0-6.0 Gy × five fractions. PDR-IGABT (UMCU) dose was delivered with Utrecht tandem-ovoid applicators with 32 × 0.6 Gy × two fractions. Pelvic lymph nodes with short axis diameter of ≥ 5 mm on pre-treatment MRI or PET-CT were contoured for all BT-plans. Dose contributions to individual pLNN expressed as D90 (dose to 90% of the volume) were calculated from dose-volume histograms as absolute and relative physical dose (% of the reference dose) for each fraction. For each node, the total dose from all fractions was calculated, expressed in EQD2 (equivalent total dose in 2 Gy fractions). RESULTS Fifty-seven (UPCI) and 40 (UMCU) individual pLNN were contoured. The mean D90 pLNN was 10.8% (range 5.7-25.1%) and 20.5% (range 6.8-93.3%), respectively, and therefore different in the two centers. These values translate into 2.7 Gy (1.3-6.6 Gy) EQD2 and 7.1 Gy (2.2-36.7 Gy) EQD2, respectively. Differences are caused by the location of the individual nodes in relation to the spatial dose distribution of IGABT, differences in total dose administered and radiobiology (HDR versus PDR). CONCLUSIONS The IGABT dose contribution to individual pelvic nodes depends on patient and treatment related factors, and varies considerably.
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Optimal single 3T MR imaging sequence for HDR brachytherapy of cervical cancer. J Contemp Brachytherapy 2014; 6:3-9. [PMID: 24790615 PMCID: PMC4003427 DOI: 10.5114/jcb.2014.41528] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/13/2014] [Accepted: 03/28/2014] [Indexed: 12/01/2022] Open
Abstract
Purpose The superior image quality of 3 tesla (3T) magnetic resonance (MR) imaging in cervical cancer offers the potential to use a single image set for brachytherapy. This study aimed to determine a suitable single sequence for contouring tumour and organs at risk, applicator reconstruction, and treatment planning. Material and methods A 3T (Skyra, Siemens Healthcare AG, Germany) MR imaging system with an 18 channel body matrix coil generated HDR cervical cancer brachytherapy planning images on 20 cases using plastic-based treatment applicators. Seven different T2-weighted Turbo Spin Echo (TSE) sequences including both 3D and contiguous 2D scans based on sagittal, axial (transverse), and oblique planes were analysed. Each image set was assessed for total scanning time and usefulness in tumour localization via inter- and intra-observer analysis of high-risk clinical target volume (HR CTV) contouring. Applicator reconstruction in the treatment planning system was also considered. Results The intra-observer difference in HR CTV volumes between 2D and 3D axial-based image sets was low with an average difference of 3.1% for each observer. 2D and 3D sagittal image sets had the highest intra- and inter observer differences (over 15%). A 2D axial ‘double oblique’ sequence was found to produce the best intra- (average difference of 0.6%) and inter-observer (mean SD of 9.2%) consistency and greatest conformity (average 0.80). Conclusions There was little difference between 2D and 3D-based scanning sequences; however the increased scanning time of 3D sequences have potential to introduce greater patient motion artifacts. A contiguous 2D sequence based on an axial T2-weighted turbo-spin-echo (TSE) sequence orientated in all planes of the treatment applicator provided consistent tumour delineation whilst allowing applicator reconstruction and treatment planning.
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Impact of delineation uncertainties on dose to organs at risk in CT-guided intracavitary brachytherapy. Brachytherapy 2014; 13:210-8. [DOI: 10.1016/j.brachy.2013.08.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 07/30/2013] [Accepted: 08/22/2013] [Indexed: 11/23/2022]
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Thompson SR, Delaney GP, Gabriel GS, Barton MB. Patterns of care study of brachytherapy in New South Wales: cervical cancer treatment quality depends on caseload. J Contemp Brachytherapy 2014; 6:28-32. [PMID: 24790619 PMCID: PMC4003429 DOI: 10.5114/jcb.2014.42022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 03/08/2014] [Accepted: 03/28/2014] [Indexed: 11/29/2022] Open
Abstract
PURPOSE We previously conducted modelling and a patterns of care study (POCS) that showed gynaecological brachytherapy (BT) was underutilized in New South Wales (NSW), the USA and Western Europe. The aim of the current study was to assess the quality of cervical BT in NSW, and to determine if caseload affects quality of treatment delivery. MATERIAL AND METHODS All nine NSW radiation oncology departments that treated patients with cervical BT in 2003 were visited. Patient, tumour and treatment related data were collected. Quality of BT was assessed using published quality benchmarks. Higher and lower caseload departments were compared. RESULTS The four higher cervical BT caseload departments treated 11-15 NSW residents in 2003, compared to 1-8 patients for the lower caseload departments. Cervix cancer patients treated at the higher caseload departments were more likely to be treated to a point A dose ≥ 80 Gy (58% vs. 14%, p = 0.001), and to have treatment completed within 8 weeks (66% vs. 35%, p = 0.02). Despite higher point A doses, there was no significant difference in proportions achieving lower than recommended rectal or bladder doses, implying better BT insertions in higher caseload departments. CONCLUSIONS Cervical BT in NSW was dispersed amongst a large number of departments and was frequently of sub-optimal quality. Higher quality BT was achieved in departments treating at least 10 patients per year. It is likely that improved outcomes will be achievable if at least 10 patients are treated per department per year.
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Affiliation(s)
- Stephen R. Thompson
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Liverpool Hospital, Sydney, NSW, Australia
- Department of Radiation Oncology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Geoff P. Delaney
- University of New South Wales, Sydney, NSW, Australia
- University of Western Sydney, Sydney, NSW, Australia
| | - Gabriel S. Gabriel
- University of New South Wales, Sydney, NSW, Australia
- University of Western Sydney, Sydney, NSW, Australia
| | - Michael B. Barton
- University of New South Wales, Sydney, NSW, Australia
- University of Western Sydney, Sydney, NSW, Australia
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Distant metastasis in patients with cervical cancer after primary radiotherapy with or without chemotherapy and image guided adaptive brachytherapy. Gynecol Oncol 2014; 133:256-62. [PMID: 24517875 DOI: 10.1016/j.ygyno.2014.02.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 01/09/2014] [Accepted: 02/04/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study is to investigate patterns of distant relapse after primary radiochemotherapy in cervical cancer patients. METHODS All patients with cervical cancer treated in curative intent with external beam radiotherapy +/- chemotherapy and image-guided adaptive brachytherapy between January 1998 and June 2009 at the Medical University of Vienna were included in this retrospective analysis. Patients with locoregional recurrences were excluded from this study. Presence, site of and time to distant metastases were recorded. For identifying prognostic factors, uni- and multivariate analyses using Cox regression analysis were performed. Based on the result from the multivariate analysis, patients were stratified into a high and a low risk group. The Kaplan-Meier method was used to estimate distant-metastasis-free-survival in the overall cohort, in the risk groups and for analysing the impact of chemotherapy within the risk groups. RESULTS A total number of 189 patients were included in this study. After a median follow-up of 54 months, 49 patients developed distant metastases. Overall, distant-metastasis-free-survival 5 years after treatment was 73%. FIGO stage, lymph node status and the extent of tumour regression during treatment were significant predictors for distant metastasis. Distant-metastasis-free-survival 5 years after treatment was 91% and 60% in the low and high risk groups, respectively. The number of the cycles of chemotherapy had a significant impact on the occurrence of distant metastasis in high risk patients, but not in low risk patients. CONCLUSION Patients with high risk factors have a 40% probability of developing distant metastasis within 5 years. In these patients, decreasing the number of cycles of cisplatin may increase their probability of developing distant metastasis.
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