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Vander Veken L, Dechambre D, Sterpin E, Souris K, Van Ooteghem G, Aldo Lee J, Geets X. Incorporation of tumor motion directionality in margin recipe: The directional MidP strategy. Phys Med 2021; 91:43-53. [PMID: 34710790 DOI: 10.1016/j.ejmp.2021.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/03/2021] [Accepted: 10/09/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Planning target volume (PTV) definition based on Mid-Position (Mid-P) strategy typically integrates breathing motion from tumor positions variances along the conventional axes of the DICOM coordinate system. Tumor motion directionality is thus neglected even though it is one of its stable characteristics in time. We therefore propose the directional MidP approach (MidP dir), which allows motion directionality to be incorporated into PTV margins. A second objective consists in assessing the ability of the proposed method to better take care of respiratory motion uncertainty. METHODS 11 lung tumors from 10 patients with supra-centimetric motion were included. PTV were generated according to the MidP and MidP dir strategies starting from planning 4D CT. RESULTS PTVMidP dir volume didn't differ from the PTVMidP volume: 31351 mm3 IC95% [17242-45459] vs. 31003 mm3 IC95% [ 17347-44659], p = 0.477 respectively. PTVMidP dir morphology was different and appeared more oblong along the main motion axis. The relative difference between 3D and 4D doses was on average 1.09%, p = 0.011 and 0.74%, p = 0.032 improved with directional MidP for D99% and D95%. D2% was not significantly different between both approaches. The improvement in dosimetric coverage fluctuated substantially from one lesion to another and was all the more important as motion showed a large amplitude, some obliquity with respect to conventional axes and small hysteresis. CONCLUSIONS Directional MidP method allows tumor motion to be taken into account more tightly as a geometrical uncertainty without increasing the irradiation volume.
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Affiliation(s)
- Loïc Vander Veken
- UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology(MIRO), 1200 Brussels, Belgium.
| | - David Dechambre
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Edmond Sterpin
- UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology(MIRO), 1200 Brussels, Belgium; KULeuven Department of Oncology, Laboratory of Experimental Radiotherapy, 3000 Leuven, Belgium
| | - Kevin Souris
- UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology(MIRO), 1200 Brussels, Belgium
| | - Geneviève Van Ooteghem
- UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology(MIRO), 1200 Brussels, Belgium; Radiation Oncology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - John Aldo Lee
- UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology(MIRO), 1200 Brussels, Belgium
| | - Xavier Geets
- UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology(MIRO), 1200 Brussels, Belgium; Radiation Oncology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
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2
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Holla R, Khanna D, Narayanan VKS. Dose delivery accuracy on helical tomotherapy for 4-dimensional tumor motion - a phantom study. Rep Pract Oncol Radiother 2021; 26:380-388. [PMID: 34277091 PMCID: PMC8281919 DOI: 10.5603/rpor.a2021.0068] [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: 08/14/2020] [Accepted: 02/25/2021] [Indexed: 11/25/2022] Open
Abstract
Background The advances in image guidance and capability of highly conformal dose deliveries made possible the use of helical tomotherapy (HT) for lung cancer treatment. To determine the effect of respiratory motion on the delivered dose in HT, film dosimetry using a dynamic phantom was performed. This was a phantom study to determine the effect of motion on the delivered dose in HT. Materials and methods 4D computed tomography (4DCT) was acquired for various target motions of CIRS dynamic phantom (CIRS Inc., Norfolk, USA) with 2.5cm diameter spherical target of volume 8.2 cc moving in the COS4 motion pattern. AveIP images and treatment plans were generated in the HT planning system. Target excursions during treatment delivery were changed in the superior-inferior, anteroposterior and lateral directions. The breathing cycle time was varied from 4 to 5 sec. and also the delivery interruptions were introduced. A film was exposed for each delivery and gamma analysis was performed. Results The gamma pass rate (GPR) with 3%, 2 mm criteria for the target motion in the S-I direction showed a significant reduction from 97.5% to 54.4% as the motion increased from 3 mm to 8 mm (p = 0.03). For the target motion in S-I = 8 mm, L-R = A-P = 3 mm, the percentage decrease in the GPR was 74% (p = 0.001) for three interruptions. Conclusion The ITV based approach in HT is ideal for a shallow breathing situation when the tumor excursions were confined to 5 mm in the S-I and 3 mm in L-R and A-P directions.
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Affiliation(s)
| | - David Khanna
- Department of Physics, Karunya Institute of Technology and Sciences, Coimbatore, India
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Huesa-Berral C, Burguete J, Moreno-Jiménez M, Diego Azcona J. A method using 4D dose accumulation to quantify the interplay effect in lung stereotactic body radiation therapy. Phys Med Biol 2021; 66:035025. [PMID: 33264758 DOI: 10.1088/1361-6560/abd00f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The purpose of this study was to devise and evaluate a method to quantify the dosimetric uncertainty produced by the interplay between the movement of multileaf collimator and respiratory motion in lung stereotactic body radiation therapy. The method calculates the dose distribution for all control points from a dynamic treatment in all respiratory phases. The methodology includes some characteristics of a patient's irregular breathing patterns. It selects, for each control point, the phases with maximum and minimum mean dose over the tumor and their corresponding adjacent phases, whenever necessary. According to this selection, the dose matrices from each control point are summed up to obtain two dose distributions in each phase, which are accumulated in the reference phase subsequently by deformable image registration (DIR). D 95 and [Formula: see text] were calculated over those accumulated dose distributions for Gross Tumor Volume (GTV), Planning Target Volume-based on Internal Target Volume approach-and Evaluation Target Volume (ETV), a novel concept that applies to 4D dose accumulation. With the ETV, DIR and interplay uncertainties are separated. The methodology also evaluated how variations in the breathing rate and field size affects the mean dose received by the GTV. The method was applied retrospectively in five patients treated with intensity modulated radiotherapy-minimum area defined by the leaves configuration at any control point was at least 4 cm2. Uncertainties in tumor coverage were small (in most patients, changes on D 95 and [Formula: see text] were below 2% for GTV and ETV) but significant over- and under-dosages near ETV, which can be accentuated by highly irregular breathing. Uncertainties in mean dose for GTV tended to decrease exponentially with increasing field size and were reduced by an increase of breathing rate. The implementation of this method would be helpful to assess treatment quality in patients with irregular breathing. Furthermore, it could be used to study interplay uncertainties when small field sizes are used.
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Affiliation(s)
- Carlos Huesa-Berral
- Department of Physics and Applied Mathematics, School of Sciences, Universidad de Navarra. C/ Irunlarrea, E-31008 Pamplona, Navarra, Spain.,Service of Radiation Physics and Radiation Protection, Clínica Universidad de Navarra, Avda. Pío XII, E-31008 Pamplona, Navarra, Spain
| | - Javier Burguete
- Department of Physics and Applied Mathematics, School of Sciences, Universidad de Navarra. C/ Irunlarrea, E-31008 Pamplona, Navarra, Spain
| | - Marta Moreno-Jiménez
- Service of Radiation Oncology, Clínica Universidad de Navarra, Avda. Pío XII, E-31008 Pamplona, Navarra, Spain
| | - Juan Diego Azcona
- Service of Radiation Physics and Radiation Protection, Clínica Universidad de Navarra, Avda. Pío XII, E-31008 Pamplona, Navarra, Spain
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Adamczyk M, Kruszyna-Mochalska M, Rucińska A, Piotrowski T. Software simulation of tumour motion dose effects during flattened and unflattened ITV-based VMAT lung SBRT. Rep Pract Oncol Radiother 2020; 25:684-691. [PMID: 32581656 DOI: 10.1016/j.rpor.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/04/2020] [Accepted: 06/02/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose Restricted studies comparing different dose rate parameters are available while ITV-based VMAT lung SBRT planning leads to perform the analysis of the most suitable parameters of the external beams used. The special emphasis was placed on the impact of dose rate on dose distribution variations in target volumes due to interplay effects. Methods Four VMAT plans were calculated for 15 lung tumours using 6 MV photon beam quality (flattening filter FF vs. flattening filter free FFF beams) and maximum dose rate of 600 MU/min, 1000 MU/min and 1400 MU/min. Three kinds of motion simulations were performed finally giving 180 plans with perturbed dose distributions. Results 6FFF-1400 MUs/min plans were characterized by the shortest beam on time (1.8 ± 0.2 min). Analysing the performed motion simulation results, the mean dose (Dmean) is not a sensitive parameter to related interplay effects. Looking for local maximum and local minimum doses, some discrepancies were found, but their significance was presented for individual patients, not for the whole cohort. The same was observed for other verified dose metrics. Conclusions Generally, the evaluation of VMAT robustness between FF and FFF concepts against interplay effect showed a negligible effect of simulated motion influence on tumour coverage among different photon beam quality parameters. Due to the lack of FFF beams, smaller radiotherapy centres are able to perform ITV-based VMAT lung SBRT treatment in a safe way. Radiotherapy department having FFF beams could perform safe, fast and efficient ITV-based VMAT lung SBRT without a concern about significance of interplay effects.
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Affiliation(s)
- Marta Adamczyk
- Department of Medical Physics, Greater Poland Cancer Centre, Poznań, Poland
| | - Marta Kruszyna-Mochalska
- Department of Medical Physics, Greater Poland Cancer Centre, Poznań, Poland
- Department of Electroradiology, Poznań University of Medical Sciences, Poznań, Poland
| | - Anna Rucińska
- 1st Radiotherapy Ward, Greater Poland Cancer Centre, Poznań, Poland
| | - Tomasz Piotrowski
- Department of Medical Physics, Greater Poland Cancer Centre, Poznań, Poland
- Department of Electroradiology, Poznań University of Medical Sciences, Poznań, Poland
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Improving the accuracy of converting dose to medium to dose to water algorithms in small megavoltage photon fields in dose to medium based treatment planning systems. Phys Med 2020; 71:62-70. [DOI: 10.1016/j.ejmp.2020.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/17/2020] [Accepted: 01/26/2020] [Indexed: 11/18/2022] Open
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Cuccia F, Mortellaro G, Mazzola R, Donofrio A, Valenti V, Tripoli A, Matranga D, Lo Casto A, Failla G, Di Miceli G, Ferrera G. Prognostic value of two geriatric screening tools in a cohort of older patients with early stage Non-Small Cell Lung Cancer treated with hypofractionated stereotactic radiotherapy. J Geriatr Oncol 2019; 11:475-481. [PMID: 31122872 DOI: 10.1016/j.jgo.2019.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/16/2019] [Accepted: 05/02/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To investigate whether assessment with two geriatric screening tools shows a correlation with clinical outcomes of patients aged 65 years or more, with early-stage Non-Small Cell Lung Cancer (es-NSCLC) treated with hypofractionated stereotactic radiotherapy. METHODS From March 2014 to June 2018 we retrospectively evaluated 42 patients with stage I and II lung tumors. Patients were assessed with Charlson Comorbidity Index (CCI) and G8 screening tool. Median age was 74 years (range, 65-91). Stereotactic radiotherapy was performed with Helical Tomotherapy delivering 50-70 Gray (Gy) in 8-10 fractions. Toxicity was evaluated using Common Terminology Criteria for Adverse Events v4.0 criteria. RESULTS Median CCI and G8 scores were 6 (4-11) and 14 (12-17), respectively. With a median follow-up of 14 months (3-37), we observed: 3 cases of acute Grade 2 (G2) radiation pneumonitis, 1 late G2 non-cardiac chest pain, 1 late G2 dysphagia and 1 case of late G2 radiation pneumonitis. At statistical analysis, G8 scores ≤14 were significantly associated with late toxicity rates (p = .0073). Local failure was predictive of disease free survival and Overall Survival (p < .001 and p = .001). Death occurred in 12 patients, 6 for non-cancer related causes, with 1- and 2-yrs cancer specific survival rates of 94.8% and 90%, 1- and 2-yrs OS rates of 93% and 80%, respectively. CONCLUSIONS Our experience shows a correlation between G8 scores and late toxicity in older patients treated with stereotactic radiotherapy for lung cancer, suggesting the need for prospective studies evaluating its use for the identification of patients at higher risk of adverse events.
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Affiliation(s)
- Francesco Cuccia
- Radiation Oncology School, University of Palermo, Palermo, Italy; Radiation Oncology Unit, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo, Italy
| | - Gianluca Mortellaro
- Radiation Oncology Unit, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo, Italy
| | - Rosario Mazzola
- Department of Radiation Oncology, IRCCS, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Alessandra Donofrio
- Radiation Oncology School, University of Palermo, Palermo, Italy; Radiation Oncology Unit, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo, Italy
| | - Vito Valenti
- Radiation Oncology School, University of Palermo, Palermo, Italy; Radiation Oncology Unit, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo, Italy
| | - Antonella Tripoli
- Radiation Oncology School, University of Palermo, Palermo, Italy; Radiation Oncology Unit, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo, Italy
| | | | - Antonio Lo Casto
- Radiation Oncology School, University of Palermo, Palermo, Italy; Radiology Department, Di.Bi.Med., Radiation Oncology School, University of Palermo, Palermo, Italy
| | - Giuseppe Failla
- Interventional Endoscopic Unit, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo, Italy
| | - Giuseppe Di Miceli
- Chest Surgery Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy
| | - Giuseppe Ferrera
- Radiation Oncology Unit, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo, Italy.
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7
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Figlia V, Mazzola R, Cuccia F, Alongi F, Mortellaro G, Cespuglio D, Cucchiara T, Iacoviello G, Valenti V, Molino M, Verderame F, Matranga D, Casto AL, Ferrera G. Hypo-fractionated stereotactic radiation therapy for lung malignancies by means of helical tomotherapy: report of feasibility by a single-center experience. Radiol Med 2018; 123:406-414. [PMID: 29455424 DOI: 10.1007/s11547-018-0858-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/18/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Several experiences in the literature report SBRT as an effective treatment option for medically inoperable early stage non-small cell lung cancer (NSCLC) and oligometastatic disease. The optimal fractionation schedules and total dose remain controversial. In this study, we evaluated the safety in terms of toxicity and efficacy of using of 8-10 fractions schedules with Helical Tomotherapy (HT) for primary and metastatic lung lesions. METHODS Between March 2014 and May 2016, a total of 39 patients (median age 72 years, range 26-91) were treated with HT-SBRT for malignant lung lesions: 22 patients with early stage NSCLC, 17 with oligometastases. Patients received 8-10 fractions with lower daily dose for central and ultracentral lesions. Treatment-related toxicity was evaluated using CTCAE v 4.0 scale. Local control (LC), overall survival (OS) and toxicity rates were prospectively collected. RESULTS Median duration of RT was 15 days (range 10-26 days) and no interruption occurred. With a median follow-up of 13 months (range 3-29), we reported one G2 pneumonitis (2.6%) and one G2 chest pain (2.6%); no ≥ G2 esophagitis was registered. Actuarial local control rate was 95.5% both at 12 and 24 months for early stage NSCLC and 92.9% both at 12 and 24 months for metastatic patients. OS rate was 94.4 and 92.3% at 1 year, and 94.4 and 83.9% at 2 years in primary and metastatic group, respectively. CONCLUSIONS The use of 8-10 fractions schedule HT-SBRT for lung malignancies results in high LC and OS rates with minimal toxicities reported.
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Affiliation(s)
- Vanessa Figlia
- Radiation Oncology School, University of Palermo, Palermo, Italy
| | - Rosario Mazzola
- Radiation Oncology, Sacro Cuore Don Calabria Hospital, Verona, Negrar, Italy
| | - Francesco Cuccia
- Radiation Oncology School, University of Palermo, Palermo, Italy.
| | - Filippo Alongi
- Radiation Oncology, Sacro Cuore Don Calabria Hospital, Verona, Negrar, Italy
- University of Brescia, Brescia, Italy
| | | | | | | | | | - Vito Valenti
- Radiation Oncology School, University of Palermo, Palermo, Italy
| | - Massimo Molino
- Radiology Department, ARNAS-Civico Hospital, Palermo, Italy
| | | | | | - Antonio Lo Casto
- Radiation Oncology School, University of Palermo, Palermo, Italy
| | - Giuseppe Ferrera
- Statistic Science Faculty, University of Palermo, Palermo, Italy
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Chao EH, Lucas D, Schnarr E. Evaluation of TomoTherapy dose calculations with intrafractional motion and motion compensation. Med Phys 2017; 45:18-28. [PMID: 29106739 DOI: 10.1002/mp.12655] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/06/2017] [Accepted: 10/19/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Anatomical motion, both cyclical and aperiodic, can impact the dose delivered during external beam radiation. In this work, we evaluate the use of a research version of the clinical TomoTherapy® dose calculator to calculate dose with intrafraction rigid motion. We also evaluate the feasibility of a method of motion compensation for helical tomotherapy using the jaws and MLC. METHODS Treatment plans were created using the TomoTherapy treatment planning system. Dose was recalculated for several simple rigid motion traces including a 4 mm step motion applied either longitudinally or transversely, and a sinusoidal motion. The calculated dose volumes were compared to dose measurements that were performed by translating the phantom with the same motion traces used in the calculations. Measurements were made using film and ion chambers. Finally, the delivery plans were modified to compensate for the motion by sweeping the jaws for longitudinal motion and shifting the MLC leaves for transverse motion, and the calculations and measurements were repeated. RESULTS A transverse step motion shifted the dose that was delivered after the step occurred, but otherwise did not impact the dose distribution. Film measurements agreed with dose calculations to within 2%/2 mm for 99% of dose points within the 50% isodose line. A shift in the MLC leaf delivery pattern successfully compensated for the step motion to within the 3 mm accuracy allowed by the finite leaf widths. A longitudinal step motion impacted the dose in the interior of the target volume to a degree that was dependent on the planning field width and step size. Film measurements agreed with dose calculations to within 2%/2 mm for 98% of dose points within the 50% isodose line. Shifts in the jaw position successfully compensated for the longitudinal step motion. Sinusoidal (breathing-like) motion was also studied, with similar results. CONCLUSIONS A research version of the clinical TomoTherapy dose calculator has been shown to accurately calculate the dose from treatment plans delivered in the presence of arbitrary rigid motion. Modifications to the delivery plan using jaw and MLC leaf shifts that follow the motion can successfully compensate for the target motion.
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Affiliation(s)
- Edward H Chao
- Accuray Incorporated, 1240 Deming Way, Madison, WI, 53717, USA
| | - Daniel Lucas
- Accuray Incorporated, 1240 Deming Way, Madison, WI, 53717, USA
| | - Eric Schnarr
- Accuray Incorporated, 1240 Deming Way, Madison, WI, 53717, USA
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An individualized radiation dose escalation trial in non-small cell lung cancer based on FDG-PET imaging. Strahlenther Onkol 2017; 193:812-822. [PMID: 28733723 DOI: 10.1007/s00066-017-1168-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/01/2017] [Indexed: 12/25/2022]
Abstract
AIM The aim of the study was to assess the feasibility of an individualized 18F fluorodeoxyglucose positron emission tomography (FDG-PET)-guided dose escalation boost in non-small cell lung cancer (NSCLC) patients and to assess its impact on local tumor control and toxicity. PATIENTS AND METHODS A total of 13 patients with stage II-III NSCLC were enrolled to receive a dose of 62.5 Gy in 25 fractions to the CT-based planning target volume (PTV; primary turmor and affected lymph nodes). The fraction dose was increased within the individual PET-based PTV (PTVPET) using intensity modulated radiotherapy (IMRT) with a simultaneous integrated boost (SIB) until the predefined organ-at-risk (OAR) threshold was reached. Tumor response was assessed during follow-up by means of repeat FDG-PET/computed tomography. Acute and late toxicity were recorded and classified according to the CTCAE criteria (Version 4.0). Local progression-free survival was determined using the Kaplan-Meier method. RESULTS The average dose to PTVPET reached 89.17 Gy for peripheral and 75 Gy for central tumors. After a median follow-up period of 29 months, seven patients were still alive, while six had died (four due to distant progression, two due to grade 5 toxicity). Local progression was seen in two patients in association with further recurrences. One and 2-year local progression free survival rates were 76.9% and 52.8%, respectively. Three cases of acute grade 3 esophagitis were seen. Two patients with central tumors developed late toxicity and died due to severe hemoptysis. CONCLUSION These results suggest that a non-uniform and individualized dose escalation based on FDG-PET in IMRT delivery is feasible. The doses reached were higher in patients with peripheral compared to central tumors. This strategy enables good local control to be achieved at acceptable toxicity rates. However, dose escalation in centrally located tumors with direct invasion of mediastinal organs must be performed with great caution in order to avoid severe late toxicity.
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Schwarz M, Cattaneo GM, Marrazzo L. Geometrical and dosimetrical uncertainties in hypofractionated radiotherapy of the lung: A review. Phys Med 2017; 36:126-139. [DOI: 10.1016/j.ejmp.2017.02.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/23/2016] [Accepted: 02/14/2017] [Indexed: 12/25/2022] Open
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Lin L, Souris K, Kang M, Glick A, Lin H, Huang S, Stützer K, Janssens G, Sterpin E, Lee JA, Solberg TD, McDonough JE, Simone CB, Ben-Josef E. Evaluation of motion mitigation using abdominal compression in the clinical implementation of pencil beam scanning proton therapy of liver tumors. Med Phys 2017; 44:703-712. [PMID: 28133755 DOI: 10.1002/mp.12040] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/11/2016] [Accepted: 11/25/2016] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To determine whether individual liver tumor patients can be safely treated with pencil beam scanning proton therapy. This study reports a planning preparation workflow that can be used for beam angle selection and the evaluation of the efficacy of abdominal compression (AC) to mitigate motion. METHODS Four-dimensional computed tomography scans (4DCT) with and without AC were available from 10 liver tumor patients with fluoroscopy-proven motion reduction by AC, previously treated using photons. For each scan, the motion amplitudes and the motion-induced variation of water-equivalent thickness (ΔWET) in each voxel of the target volume were evaluated during treatment plan preparation. Optimal proton beam angles were selected after volume analysis of the respective beam-specific planning target volume (BSPTV). M⊥80 and ΔWET80 derived from the 80th percentiles of perpendicular motion amplitude (M⊥ ) and ΔWET were compared with and without AC. Proton plans were created on the average CT to achieve target coverage similar to that of the conventional photon treatments. 4D dynamic dose calculation was performed postplan by synchronizing proton beam delivery timing patterns to the 4DCT phases to assess interplay and fractionation effects, and to determine motion criteria for subsequent patient treatment. RESULTS Selected coplanar beam angles ranged between 180° and 39°, primarily from right lateral (oblique) and posterior (oblique) directions. While AC produced a significant reduction in mean Liver-GTV dose, any reduction in mean heart dose was patient dependent and not significant. Similarly, AC resulted in reductions in M⊥ , ΔWET, and BSPTV volumes and improved dose degradation (ΔD95 and ΔD1 ) within the CTV. For small motion (M⊥80 < 7 mm and ΔWET80 < 5 mm), motion mitigation was not needed. For moderate motion (M⊥80 7-10 mm or ΔWET80 5-7 mm), AC produced a modest improvement. For large motion (M⊥80 > 10 mm or ΔWET80 > 7 mm), AC and/or some other form of mitigation strategies were required. CONCLUSION A workflow for screening patients' motion characteristics and optimizing beam angle selection was established for the pencil beam scanning proton therapy treatment of liver tumors. Abdominal compression was found to be useful at mitigation of moderate and large motion.
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Affiliation(s)
- Liyong Lin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin Souris
- Université catholique de Louvain, MIRO, IREC institute, Louvain-la-Neuve, Belgium.,Université catholique de Louvain, ICTEAM institute, Louvain-la-Neuve, Belgium
| | - Minglei Kang
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Adam Glick
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Haibo Lin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sheng Huang
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristin Stützer
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.,OncoRay - National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | | | - Edmond Sterpin
- Université catholique de Louvain, MIRO, IREC institute, Louvain-la-Neuve, Belgium.,Katholieke Universiteit Leuven, Department of Oncology, Leuven, Belgium
| | - John A Lee
- Université catholique de Louvain, MIRO, IREC institute, Louvain-la-Neuve, Belgium.,Université catholique de Louvain, ICTEAM institute, Louvain-la-Neuve, Belgium
| | - Timothy D Solberg
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - James E McDonough
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Charles B Simone
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Edgar Ben-Josef
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
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12
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Sterpin E, Barragan A, Souris K, Lee JA. [Robust treatment planning in proton therapy]. Cancer Radiother 2016; 20:523-9. [PMID: 27614528 DOI: 10.1016/j.canrad.2016.07.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 07/19/2016] [Indexed: 11/28/2022]
Abstract
The concentration of the dose delivered by protons at the end of their path, the Bragg peak, has the potential to improve external radiotherapy treatments. Unfortunately, the main strength of the protons, their finite range, is also their greatest weakness. Any uncertainty on the range may lead to inadequate target coverage or excessive toxicity. The uncertainties have multiple origins and include, among others, ballistic errors, morphological modifications or inaccurate estimations of the physical quantities necessary to predict the proton range. Uncertainties have been part of daily practice in conventional radiotherapy with X-rays for a long time. However, dose distributions delivered with X-rays are much less sensitive to uncertainties than the ones delivered with protons. This relative insensitivity enabled the management of uncertainties through safety margins using a simple formalism. The conditions of validity of this formalism are much more restrictive for proton therapy, leading to the need of developing new tools and adapted strategies to manage accurately these uncertainties. The objective of this paper is to present a vision for the management of uncertainties in proton therapy in the continuity of formalisms established for X-rays. The latter are first summarized before discussing the necessary developments in order to consistently apply them to protons.
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Affiliation(s)
- E Sterpin
- Katholieke Universiteit Leuven, Department of Oncology, Laboratory of Experimental Radiotherapy, O&N I Herestraat 49, 3000 Leuven, Belgique; Université catholique de Louvain, Center of Molecular Imaging, Radiotherapy and Oncology, institut de recherche expérimentale et clinique, avenue Hippocrate 54, 1200 Brussels, Belgique.
| | - A Barragan
- Université catholique de Louvain, Center of Molecular Imaging, Radiotherapy and Oncology, institut de recherche expérimentale et clinique, avenue Hippocrate 54, 1200 Brussels, Belgique
| | - K Souris
- Université catholique de Louvain, Center of Molecular Imaging, Radiotherapy and Oncology, institut de recherche expérimentale et clinique, avenue Hippocrate 54, 1200 Brussels, Belgique
| | - J A Lee
- Université catholique de Louvain, Center of Molecular Imaging, Radiotherapy and Oncology, institut de recherche expérimentale et clinique, avenue Hippocrate 54, 1200 Brussels, Belgique
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Goossens S, Descampe A, Orban de Xivry J, Lee JA, Delor A, Janssens G, Geets X. Impact of motion induced artifacts on automatic registration of lung tumors in Tomotherapy. Phys Med 2015; 31:963-968. [DOI: 10.1016/j.ejmp.2015.07.140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 06/11/2015] [Accepted: 07/06/2015] [Indexed: 12/25/2022] Open
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Tumour Movement in Proton Therapy: Solutions and Remaining Questions: A Review. Cancers (Basel) 2015; 7:1143-53. [PMID: 26132317 PMCID: PMC4586762 DOI: 10.3390/cancers7030829] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 06/10/2015] [Accepted: 06/18/2015] [Indexed: 12/25/2022] Open
Abstract
Movement of tumours, mostly by respiration, has been a major problem for treating lung cancer, liver tumours and other locations in the abdomen and thorax. Organ motion is indeed one component of geometrical uncertainties that includes delineation and target definition uncertainties, microscopic disease and setup errors. At present, minimising motion seems to be the easiest to implement in clinical practice. If combined with adaptive approaches to correct for gradual anatomical variations, it may be a practical strategy. Other approaches such as repainting and tracking could increase the accuracy of proton therapy delivery, but advanced 4D solutions are needed. Moreover, there is a need to perform clinical studies to investigate which approach is the best in a given clinical situation. The good news is that existing and emerging technology and treatment planning systems as will without doubt lead in the forthcoming future to practical solutions to tackle intra-fraction motion in proton therapy. These developments may also improve motion management in photon therapy as well.
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He J, Huang Y, Shi S, Hu Y, Zeng Z. Comparison of Effects Between Central and Peripheral Stage I Lung Cancer Using Image-Guided Stereotactic Body Radiotherapy via Helical Tomotherapy. Technol Cancer Res Treat 2015; 14:701-7. [PMID: 25911646 DOI: 10.1177/1533034615583206] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 03/29/2015] [Indexed: 01/05/2023] Open
Abstract
Lung cancer is a common malignant tumor with high morbidity and mortality. Here we compared the effects and outcome between central and peripheral stage I lung cancer using image-guided stereotactic body radiotherapy. From June 2011 to July 2013, a total of 33 patients with stage I lung cancer were enrolled. A total of 50 Gy in 10 fractions or 60 Gy in 10 fractions was delivered in the central arm (n = 18), while 50 Gy in 5 fractions in the peripheral arm (n = 15). Statistical analyses were performed using logistic regression analysis and Kaplan-Meier method. The mean follow-up time was 38.1 months. Three-month, 1-, 2-, and 3-year overall response rates were 66.7%, 83.3%, 61.1%, and 72.2% and 66.7%, 80%, 80%, and 80% in the central and peripheral arms, respectively. Three-year local control rates (94.4% vs 93.3%, P = .854), regional control rates (94.4% vs 86.7%, P = .412), and distant control rates (64.2% vs 61.7%, P = .509) had no differences between the central and the peripheral arms. Grade 2 radiation pneumonitis was observed in 6 of 18 patients in the central arm and in 1 of 15 patients in the peripheral arm (P = .92). Grade 2 radiation esophagitis was 5.7% in the central arm, while none occurred in the peripheral arm (P = .008). Five (15.1%) of all patients felt slight fatigue during radiotherapy. Other major complications were not observed. In conclusion, helical image-guided stereotactic body radiotherapy for central stage I lung cancer is safe and effective compared to peripheral stage I lung cancer.
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Affiliation(s)
- Jian He
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yan Huang
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shiming Shi
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong Hu
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhaochong Zeng
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
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Impact of inadequate respiratory motion management in SBRT for oligometastatic colorectal cancer. Radiother Oncol 2014; 113:235-9. [DOI: 10.1016/j.radonc.2014.11.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 11/03/2014] [Accepted: 11/03/2014] [Indexed: 12/22/2022]
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17
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Validation of the mid-position strategy for lung tumors in helical TomoTherapy. Radiother Oncol 2014; 110:529-37. [DOI: 10.1016/j.radonc.2013.10.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 10/18/2013] [Accepted: 10/20/2013] [Indexed: 12/25/2022]
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Van Parijs H, Reynders T, Heuninckx K, Verellen D, Storme G, De Ridder M. Breast conserving treatment for breast cancer: dosimetric comparison of different non-invasive techniques for additional boost delivery. Radiat Oncol 2014; 9:36. [PMID: 24467916 PMCID: PMC3907792 DOI: 10.1186/1748-717x-9-36] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 01/09/2014] [Indexed: 11/29/2022] Open
Abstract
Background Today it is unclear which technique for delivery of an additional boost after whole breast radiotherapy for breast conserved patients should be state of the art. We present a dosimetric comparison of different non-invasive treatment techniques for additional boost delivery. Methods For 10 different tumor bed localizations, 7 different non-invasive treatment plans were made. Dosimetric comparison of PTV-coverage and dose to organs at risk was performed. Results The Vero system achieved an excellent PTV-coverage and at the same time could minimize the dose to the organs at risk with an average near-maximum-dose (D2) to the heart of 0.9 Gy and the average volume of ipsilateral lung receiving 5 Gy (V5) of 1.5%. The TomoTherapy modalities delivered an average D2 to the heart of 0.9 Gy for the rotational and of 2.3 Gy for the static modality and an average V5 to the ipsilateral lung of 7.3% and 2.9% respectively. A rotational technique offers an adequate conformity at the cost of more low dose spread and a larger build-up area. In most cases a 2-field technique showed acceptable PTV-coverage, but a bad conformity. Electrons often delivered a worse PTV-coverage than photons, with the planning requirements achieved only in 2 patients and with an average D2 to the heart of 2.8 Gy and an average V5 to the ipsilateral lung of 5.8%. Conclusions We present advices which can be used as guidelines for the selection of the best individualized treatment.
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Affiliation(s)
- Hilde Van Parijs
- UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
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Dowdell S, Grassberger C, Sharp GC, Paganetti H. Interplay effects in proton scanning for lung: a 4D Monte Carlo study assessing the impact of tumor and beam delivery parameters. Phys Med Biol 2013; 58:4137-56. [PMID: 23689035 PMCID: PMC3752993 DOI: 10.1088/0031-9155/58/12/4137] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Relative motion between a tumor and a scanning proton beam results in a degradation of the dose distribution (interplay effect). This study investigates the relationship between beam scanning parameters and the interplay effect, with the goal of finding parameters that minimize interplay. 4D Monte Carlo simulations of pencil beam scanning proton therapy treatments were performed using the 4DCT geometry of five lung cancer patients of varying tumor size (50.4-167.1 cc) and motion amplitude (2.9-30.1 mm). Treatments were planned assuming delivery in 35 × 2.5 Gy(RBE) fractions. The spot size, time to change the beam energy (τes), time required for magnet settling (τss), initial breathing phase, spot spacing, scanning direction, scanning speed, beam current and patient breathing period were varied for each of the five patients. Simulations were performed for a single fraction and an approximation of conventional fractionation. For the patients considered, the interplay effect could not be predicted using the superior-inferior motion amplitude alone. Larger spot sizes (σ ~ 9-16 mm) were less susceptible to interplay, giving an equivalent uniform dose (EUD) of 99.0 ± 4.4% (1 standard deviation) in a single fraction compared to 86.1 ± 13.1% for smaller spots (σ ~ 2-4 mm). The smaller spot sizes gave EUD values as low as 65.3% of the prescription dose in a single fraction. Reducing the spot spacing improved the target dose homogeneity. The initial breathing phase can have a significant effect on the interplay, particularly for shorter delivery times. No clear benefit was evident when scanning either parallel or perpendicular to the predominant axis of motion. Longer breathing periods decreased the EUD. In general, longer delivery times led to lower interplay effects. Conventional fractionation showed significant improvement in terms of interplay, giving a EUD of at least 84.7% and 100.0% of the prescription dose for the small and larger spot sizes respectively. The interplay effect is highly patient specific, depending on the motion amplitude, tumor location and the delivery parameters. Large degradations of the dose distribution in a single fraction were observed, but improved significantly using conventional fractionation.
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Affiliation(s)
- S Dowdell
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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Sterpin E, Verboomen C, Vynckier S. Impact of the number of discrete angles used during dose computation for TomoTherapy treatments. Med Phys 2012; 39:6947-56. [PMID: 23127088 DOI: 10.1118/1.4762684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To quantify systematically the effect on accuracy of discretizing gantry rotation during the dose calculation process of TomoTherapy treatments. METHODS Up to version 4.0.x included, TomoTherapy treatment planning system (TPS) approximates gantry rotation by computing dose from 51 discrete angles corresponding to the center of the projections used to control the binary multileaf collimator. Potential effects on dose computation accuracy for off-axis targets and low modulation factors have been shown previously for a few treatment configurations. In versions 4.1.x and later, TomoTherapy oversamples the projections to better account for gantry rotation, but only during full scatter optimization and final calculation (i.e., not during optimization in "beamlet" mode). The effect on accuracy of changing the number of angles was quantified with the following framework: (1) predict the impact of the discretization of gantry rotation for various modulation factors, target sizes, and off-axis positions using a simplified analytical algorithm; (2) perform regular quality assurance using measurements with EDR2 radiographic films; (3) isolating the effect of changing the number of discretized angles only (51, 153, and 459) using a previously validated Monte Carlo model (TomoPen). The diameters of the targets were 2, 3, and 5 cm; off-axis central positions of target volumes were 5, 10 and 15, and 17 cm (when accepted by the treatment unit); planned modulation factors were 1.3 and 2.0. RESULTS For extreme configurations (3 cm tumor, 1.3 modulation factor, 15 cm off-axis position), effects on dose distributions were significant with 89.3% and 95.4% of the points passing gamma tests with 2%∕2 mm and 3%∕3 mm criteria, respectively, for TPS software version 4.0.x (51 gantry angles). The passing rate was 100% for both gamma criteria for the 4.1.x version (153 gantry angles). Those differences could be attributed almost completely to gantry motion discretization using TomoPen. Using 51 gantry angles for dose computation, TomoPen reproduced within statistical uncertainties (<1% standard deviation) dose distributions computed with version 4.0.x. Using 153 and 459 gantry angles, TomoPen reproduced within statistical uncertainties measurements and dose distributions computed with version 4.1.x. CONCLUSIONS When low modulation factors and significant off-axis positions are used, accounting for gantry rotation during dose computation using at least 153 gantry angles is required to ensure optimal accuracy.
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Affiliation(s)
- E Sterpin
- Université catholique de Louvain, Brussels, Belgium
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