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Lou Z, Cheng C, Mao R, Li D, Tian L, Li B, Lei H, Ge H. A novel automated planning approach for multi-anatomical sites cancer in Raystation treatment planning system. Phys Med 2023; 109:102586. [PMID: 37062102 DOI: 10.1016/j.ejmp.2023.102586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/18/2023] Open
Abstract
PURPOSE To develop an automated planning approach in Raystation and evaluate its feasibility in multiple clinical application scenarios. METHODS An automated planning approach (Ruiplan) was developed by using the scripting platform of Raystation. Radiotherapy plans were re-generated both automatically by using Ruiplan and manually. 60 patients, including 20 patients with nasopharyngeal carcinoma (NPC), 20 patients with esophageal carcinoma (ESCA), and 20 patients with rectal cancer (RECA) were retrospectively enrolled in this study. Dosimetric and planning efficiency parameters of the automated plans (APs) and manual plans (MPs) were statistically compared. RESULTS For target coverage, APs yielded superior dose homogeneity in NPC and RECA, while maintaining similar dose conformity for all studied anatomical sites. For OARs sparing, APs led to significant improvement in most OARs sparing. The average planning time required for APs was reduced by more than 43% compared with MPs. Despite the increased monitor units (MUs) for NPC and RECA in APs, the beam-on time of APs and MPs had no statistical difference. Both the MUs and beam-on time of APs were significantly lower than that of MPs in ESCA. CONCLUSIONS This study developed a new automated planning approach, Ruiplan, it is feasible for multi-treatment techniques and multi-anatomical sites cancer treatment planning. The dose distributions of targets and OARs in the APs were similar or better than those in the MPs, and the planning time of APs showed a sharp reduction compared with the MPs. Thus, Ruiplan provides a promising approach for realizing automated treatment planning in the future.
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Affiliation(s)
- Zhaoyang Lou
- Department of Radiation Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Chen Cheng
- Department of Radiation Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Ronghu Mao
- Department of Radiation Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Dingjie Li
- Department of Radiation Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Lingling Tian
- Department of Radiation Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Bing Li
- Department of Radiation Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Hongchang Lei
- Department of Radiation Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Hong Ge
- Department of Radiation Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China.
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Yang Y, Shao K, Zhang J, Chen M, Chen Y, Shan G. Automatic Planning for Nasopharyngeal Carcinoma Based on Progressive Optimization in RayStation Treatment Planning System. Technol Cancer Res Treat 2020; 19:1533033820915710. [PMID: 32552600 PMCID: PMC7307279 DOI: 10.1177/1533033820915710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 02/08/2020] [Accepted: 02/26/2020] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To evaluate and quantify the planning performance of automatic planning (AP) with manual planning (MP) for nasopharyngeal carcinoma in the RayStation treatment planning system (TPS). METHODS A progressive and effective design method for AP of nasopharyngeal carcinoma was realized through automated scripts in this study. A total of 30 patients with nasopharyngeal carcinoma with initial treatment was enrolled. The target coverage, conformity index (CI), homogeneity index (HI), organs at risk sparing, and the efficiency of design and execution were compared between automatic and manual volumetric modulated arc therapy (VMAT) plans. RESULTS The results of the 2 design methods met the clinical dose requirement. The differences in D95 between the 2 groups in PTV1 and PTV2 showed statistical significance, and the MPs are higher than APs, but the difference in absolute dose was only 0.21% and 0.16%. The results showed that the conformity index of planning target volumes (PTV1, PTV2, PTVnd and PGTVnx+rpn [PGTVnx and PGTVrpn]), homogeneity index of PGTVnx+rpn, and HI of PTVnd in APs are better than that in MPs. For organs at risk, the APs are lower than the MPs, and the difference was statistically significant (P < .05). The manual operation time in APs was 83.21% less than that in MPs, and the computer processing time was 34.22% more. CONCLUSION IronPython language designed by RayStation TPS has clinical application value in the design of automatic radiotherapy plan for nasopharyngeal carcinoma. The dose distribution of tumor target and organs at risk in the APs was similar or better than those in the MPs. The time of manual operation in the plan design showed a sharp reduction, thus significantly improving the work efficiency in clinical application.
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Affiliation(s)
- Yiwei Yang
- Institute of Cancer and Basic Medical (ICBM), Chinese Academy of
Sciences, Hangzhou, China
- Department of Radiation Physics, Cancer Hospital of University of
Chinese Academy of Sciences, Hangzhou, China
- Department of Radiation Physics, Zhejiang Cancer Hospital, Hangzhou,
China
| | - Kainan Shao
- Institute of Cancer and Basic Medical (ICBM), Chinese Academy of
Sciences, Hangzhou, China
- Department of Radiation Physics, Cancer Hospital of University of
Chinese Academy of Sciences, Hangzhou, China
- Department of Radiation Physics, Zhejiang Cancer Hospital, Hangzhou,
China
| | - Jie Zhang
- Institute of Cancer and Basic Medical (ICBM), Chinese Academy of
Sciences, Hangzhou, China
- Department of Radiation Physics, Cancer Hospital of University of
Chinese Academy of Sciences, Hangzhou, China
- Department of Radiation Physics, Zhejiang Cancer Hospital, Hangzhou,
China
| | - Ming Chen
- Institute of Cancer and Basic Medical (ICBM), Chinese Academy of
Sciences, Hangzhou, China
- Department of Radiation Oncology, Cancer Hospital of University of
Chinese Academy of Sciences, Hangzhou, China
- Department of Radiation Oncology, Zhejiang Cancer Hospital,
Hangzhou, China
| | - Yuanyuan Chen
- Institute of Cancer and Basic Medical (ICBM), Chinese Academy of
Sciences, Hangzhou, China
- Department of Radiation Oncology, Cancer Hospital of University of
Chinese Academy of Sciences, Hangzhou, China
- Department of Radiation Oncology, Zhejiang Cancer Hospital,
Hangzhou, China
| | - Guoping Shan
- Institute of Cancer and Basic Medical (ICBM), Chinese Academy of
Sciences, Hangzhou, China
- Department of Radiation Physics, Cancer Hospital of University of
Chinese Academy of Sciences, Hangzhou, China
- Department of Radiation Physics, Zhejiang Cancer Hospital, Hangzhou,
China
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Hussein M, Heijmen BJM, Verellen D, Nisbet A. Automation in intensity modulated radiotherapy treatment planning-a review of recent innovations. Br J Radiol 2018; 91:20180270. [PMID: 30074813 DOI: 10.1259/bjr.20180270] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Radiotherapy treatment planning of complex radiotherapy techniques, such as intensity modulated radiotherapy and volumetric modulated arc therapy, is a resource-intensive process requiring a high level of treatment planner intervention to ensure high plan quality. This can lead to variability in the quality of treatment plans and the efficiency in which plans are produced, depending on the skills and experience of the operator and available planning time. Within the last few years, there has been significant progress in the research and development of intensity modulated radiotherapy treatment planning approaches with automation support, with most commercial manufacturers now offering some form of solution. There is a rapidly growing number of research articles published in the scientific literature on the topic. This paper critically reviews the body of publications up to April 2018. The review describes the different types of automation algorithms, including the advantages and current limitations. Also included is a discussion on the potential issues with routine clinical implementation of such software, and highlights areas for future research.
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Affiliation(s)
- Mohammad Hussein
- 1 Metrology for Medical Physics Centre, National Physical Laboratory , Teddington , UK
| | - Ben J M Heijmen
- 2 Division of Medical Physics, Erasmus MC Cancer Institute , Rotterdam , The Netherlands
| | - Dirk Verellen
- 3 Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB) , Brussels , Belgium.,4 Radiotherapy Department, Iridium Kankernetwerk , Antwerp , Belgium
| | - Andrew Nisbet
- 5 Department of Medical Physics, Royal Surrey County Hospital NHS Foundation Trust , Guildford , UK.,6 Department of Physics, University of Surrey , Guildford , UK
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Tomotherapy as an adjuvant treatment for gastroesophageal junction and stomach cancer may reduce bowel and bone marrow toxicity compared to intensity-modulated radiotherapy and volumetric-modulated arc therapy. Oncotarget 2018; 8:39727-39735. [PMID: 28061474 PMCID: PMC5503647 DOI: 10.18632/oncotarget.14459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 12/25/2016] [Indexed: 01/15/2023] Open
Abstract
Purpose To compare dosimetric parameters of intensity-modulated radiotherapy (IMRT), volumetric-modulated arc therapy (VMAT) and tomotherapy (TOMO) in the adjuvant treatment of gastroesophageal junction (GEJ)/stomach cancer. The planning goal was to maintain high target coverage while keeping the dose to the bowel and bone marrow (BM) as low as possible. Materials and Methods After curative surgery, 16 patients with GEJ/stomach cancer were re-planned by coplanar IMRT (five fixed beam), VMAT (double-arc), and TOMO. The dose to the planning target volume (PTV) was 45 Gy in 25 fractions. The target parameters, including the homogeneity index (HI) and conformity index (CI), and doses to the organs at risk (OARs) were analyzed. Results Dosimetric parameters for PTV and OARs were comparable among the three techniques. However, TOMO provided improved conformity (CI = 0.92±0.03) and homogeneity (HI = 1.07±0.02) than IMRT (CI = 0.87±0.03; HI = 1.09±0.02; p < 0.05) and VMAT (CI = 0.86±0.03; HI = 1.09±0.02; p < 0.01). TOMO also improved dose sparing of the bowel (percentage of the volume receiving a dose of ≥ 30 Gy [V30] = 23.24±9.85) and BM (V30 = 71.66±6.15) compared with IMRT (bowel V30 = 30.02±11.74; BM V30 = 83.74±8.42; p < 0.01) and VMAT (bowel V30 = 31.88±11.59; BM V30 = 79.51±9.07; p < 0.01). Conclusions TOMO is a good option for adjuvant treatment of GEJ/stomach cancer in patients undergoing radical surgery due to its superior bowel and BM dose sparing, dose conformity and dose homogeneity; however, future studies are required to validate its clinical efficacy.
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Wang J, Chen Z, Li W, Qian W, Wang X, Hu W. A new strategy for volumetric-modulated arc therapy planning using AutoPlanning based multicriteria optimization for nasopharyngeal carcinoma. Radiat Oncol 2018; 13:94. [PMID: 29769101 PMCID: PMC5956620 DOI: 10.1186/s13014-018-1042-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A new strategy for making the appropriate choice of the representative optimization parameters in planning processes and accurate selection criteria during Pareto surface navigation for general multicriteria optimization (MCO) was recommended in the study. The purpose was to combine both benefits of AutoPlanning optimization and MCO (APMCO) for achieving an individual volumetric-modulated arc therapy (VMAT) plan according to the clinically achieved patient-specific tradeoff among conflicting priorities. The preclinical investigation of this optimization approach for nasopharyngeal carcinoma (NPC) radiotherapy was performed and compared to general MCO VMAT. METHODS A total of 60 NPC patients with various stages were enrolled in this study. General MCO and APMCO plans were generated for each patient on the treatment planning system. The differences between two planning schemes were evaluated and compared. RESULTS All plans were capable of achieving the prescription requirement. The planning target volume coverage and conformation number were remarkably similar between general MCO and APMCO plans. There were no significant differences in most of organs at risk (OARs) sparing. However, in APMCO plans, relatively remarkable decreases were observed in the mean dose (Dmean) to the glottic larynx and pharyngeal constrictor muscles. The reductions of average Dmean to the two OARs were 10.5% (p < 0.0001) and 8.4% (p < 0.0001), respectively. APMCO technique was found to increase the planning time for an average of approximately 5 h and did not lead to a significant increase of monitor units compared to general MCO. CONCLUSIONS The potential of the APMCO strategy is best realized with a clinical implementation that exploits individual generation of Pareto surface representations without manual interaction. It also assists physicians to ensure navigation in a more efficient and straightforward manner.
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Affiliation(s)
- Juanqi Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhi Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weiwei Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei Qian
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaosheng Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weigang Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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Xiao J, Li Y, Shi H, Chang T, Luo Y, Wang X, He Y, Chen N. Multi-criteria optimization achieves superior normal tissue sparing in intensity-modulated radiation therapy for oropharyngeal cancer patients. Oral Oncol 2018; 80:74-81. [DOI: 10.1016/j.oraloncology.2018.03.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 10/17/2022]
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Wang J, Hu W, Yang Z, Chen X, Wu Z, Yu X, Guo X, Lu S, Li K, Yu G. Is it possible for knowledge-based planning to improve intensity modulated radiation therapy plan quality for planners with different planning experiences in left-sided breast cancer patients? Radiat Oncol 2017; 12:85. [PMID: 28532508 PMCID: PMC5440994 DOI: 10.1186/s13014-017-0822-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 05/15/2017] [Indexed: 12/25/2022] Open
Abstract
Background Knowledge-based planning (KBP) is a promising technique that can improve plan quality and increase planning efficiency. However, no attempts have been made to extend the domain of KBP for planners with different planning experiences so far. The purpose of this study was to quantify the potential gains for planners with different planning experiences after implementing KBP in intensity modulated radiation therapy (IMRT) plans for left-sided breast cancer patients. Methods The model libraries were populated with 80 expert clinical plans from treated patients who previously received left-sided breast-conserving surgery and IMRT with simultaneously integrated boost. The libraries were created on the RapidPlanTM. 6 planners with different planning experiences (2 beginner planners, 2 junior planners and 2 senior planners) generated manual and KBP optimized plans for additional 10 patients, similar to those included in the model libraries. The plan qualities were compared between manual and KBP plans. Results All plans were capable of achieving the prescription requirement. There were almost no statistically significant differences in terms of the planning target volume (PTV) coverage and dose conformality. It was demonstrated that the doses for most of organs-at-risk (OARs) were on average lower or equal in KBP plans compared to manual plans except for the senior planners, where the very small differences were not statistically significant. KBP data showed a systematic trend to have superior dose sparing at most parameters for the heart and ipsilateral lung. The observed decrease in the doses to these OARs could be achieved, particularly for the beginner and junior planners. Many differences were statistically significant. Conclusions It is feasible to generate acceptable IMRT plans after implementing KBP for left-sided breast cancer. KBP helps to effectively improve the quality of IMRT plans against the benchmark of manual plans for less experienced planners without any manual intervention. KBP showed promise for homogenizing the plan quality by transferring planning expertise from more experienced to less experienced planners.
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Affiliation(s)
- Juanqi Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weigang Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Zhaozhi Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Xiaohui Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhiqiang Wu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaoli Yu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaomao Guo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Saiquan Lu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Kaixuan Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Gongyi Yu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Fogliata A, Nicolini G, Clivio A, Vanetti E, Laksar S, Tozzi A, Scorsetti M, Cozzi L. A broad scope knowledge based model for optimization of VMAT in esophageal cancer: validation and assessment of plan quality among different treatment centers. Radiat Oncol 2015; 10:220. [PMID: 26521015 PMCID: PMC4628288 DOI: 10.1186/s13014-015-0530-5] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 10/26/2015] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND To evaluate the performance of a broad scope model-based optimisation process for volumetric modulated arc therapy applied to esophageal cancer. METHODS AND MATERIALS A set of 70 previously treated patients in two different institutions, were selected to train a model for the prediction of dose-volume constraints. The model was built with a broad-scope purpose, aiming to be effective for different dose prescriptions and tumour localisations. It was validated on three groups of patients from the same institution and from another clinic not providing patients for the training phase. Comparison of the automated plans was done against reference cases given by the clinically accepted plans. RESULTS Quantitative improvements (statistically significant for the majority of the analysed dose-volume parameters) were observed between the benchmark and the test plans. Of 624 dose-volume objectives assessed for plan evaluation, in 21 cases (3.3 %) the reference plans failed to respect the constraints while the model-based plans succeeded. Only in 3 cases (<0.5 %) the reference plans passed the criteria while the model-based failed. In 5.3 % of the cases both groups of plans failed and in the remaining cases both passed the tests. CONCLUSIONS Plans were optimised using a broad scope knowledge-based model to determine the dose-volume constraints. The results showed dosimetric improvements when compared to the benchmark data. Particularly the plans optimised for patients from the third centre, not participating to the training, resulted in superior quality. The data suggests that the new engine is reliable and could encourage its application to clinical practice.
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Affiliation(s)
- Antonella Fogliata
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, Milan-Rozzano, Italy
| | - Giorgia Nicolini
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | | | - Eugenio Vanetti
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Sarbani Laksar
- Radiotherapy Department, Tata Memorial Hospital, Mumbai, India
| | - Angelo Tozzi
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, Milan-Rozzano, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, Milan-Rozzano, Italy
| | - Luca Cozzi
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, Milan-Rozzano, Italy.
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9
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Wang J, Jin X, Zhao K, Peng J, Xie J, Chen J, Zhang Z, Studenski M, Hu W. Patient feature based dosimetric Pareto front prediction in esophageal cancer radiotherapy. Med Phys 2015; 42:1005-11. [PMID: 25652513 DOI: 10.1118/1.4906252] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To investigate the feasibility of the dosimetric Pareto front (PF) prediction based on patient's anatomic and dosimetric parameters for esophageal cancer patients. METHODS Eighty esophagus patients in the authors' institution were enrolled in this study. A total of 2928 intensity-modulated radiotherapy plans were obtained and used to generate PF for each patient. On average, each patient had 36.6 plans. The anatomic and dosimetric features were extracted from these plans. The mean lung dose (MLD), mean heart dose (MHD), spinal cord max dose, and PTV homogeneity index were recorded for each plan. Principal component analysis was used to extract overlap volume histogram (OVH) features between PTV and other organs at risk. The full dataset was separated into two parts; a training dataset and a validation dataset. The prediction outcomes were the MHD and MLD. The spearman's rank correlation coefficient was used to evaluate the correlation between the anatomical features and dosimetric features. The stepwise multiple regression method was used to fit the PF. The cross validation method was used to evaluate the model. RESULTS With 1000 repetitions, the mean prediction error of the MHD was 469 cGy. The most correlated factor was the first principal components of the OVH between heart and PTV and the overlap between heart and PTV in Z-axis. The mean prediction error of the MLD was 284 cGy. The most correlated factors were the first principal components of the OVH between heart and PTV and the overlap between lung and PTV in Z-axis. CONCLUSIONS It is feasible to use patients' anatomic and dosimetric features to generate a predicted Pareto front. Additional samples and further studies are required improve the prediction model.
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Affiliation(s)
- Jiazhou Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xiance Jin
- The 1st Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang 325000, China
| | - Kuaike Zhao
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jiayuan Peng
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jiang Xie
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Junchao Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Matthew Studenski
- Department of Radiation Oncology, University of Miami-Miller School of Medicine, Miami, Florida 33136
| | - Weigang Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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10
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Fan M, Hu W, Zhang Z. Chemoradiation for gastric cancer: controversies, updates and novel techniques. Br J Radiol 2015; 88:20150027. [PMID: 25827208 DOI: 10.1259/bjr.20150027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The INT0116 trial established the role of adjuvant chemoradiation (CRT) in the multidisciplinary approach to the management of locally advanced gastric cancer. However, whether adjuvant CRT is indispensable for patients undergoing D2 dissection remains undefined. The adjuvant chemoradiation therapy in stomach cancer (ARTIST) trial, which was designed to compare adjuvant chemotherapy to CRT, failed to demonstrate differences in disease-free and overall survival in the whole study group; however, subgroup analysis indicated that patients with lymph node metastasis may benefit from additional radiation. A follow-up ARTIST II trial is currently under way. The efficacy of adjuvant CRT remains controversial because of variation among studies in the inclusion criteria and treatment delivery methods; however, the identification of patients who would benefit from CRT is critical. Advanced radiotherapy techniques such as intensity-modulated radiotherapy protect normal tissues via motion management and decreased radiation-induced toxicity and contribute to plan optimization. Further studies integrating clinical and molecular factors as well as neoadjuvant CRT are warranted.
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Affiliation(s)
- M Fan
- 1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - W Hu
- 1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Z Zhang
- 1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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11
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Trip AK, Poppema BJ, van Berge Henegouwen MI, Siemerink E, Beukema JC, Verheij M, Plukker JTM, Richel DJ, Hulshof MCCM, van Sandick JW, Cats A, Jansen EPM, Hospers GAP. Preoperative chemoradiotherapy in locally advanced gastric cancer, a phase I/II feasibility and efficacy study. Radiother Oncol 2014; 112:284-8. [PMID: 24856116 DOI: 10.1016/j.radonc.2014.05.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 04/29/2014] [Accepted: 05/01/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVES This study was initiated to investigate the feasibility and efficacy of preoperative radiotherapy with weekly paclitaxel and carboplatin in locally advanced gastric cancer. METHODS In a prospective study, patients with locally advanced gastric cancer stage IB-IV(M0) were treated with chemoradiotherapy followed by surgery 4-6 weeks after the last irradiation. Chemoradiotherapy consisted of radiation to a total dose of 45 Gy given in 25 fractions of 1.8 Gy, combined with concurrent weekly carboplatin and paclitaxel. RESULTS Between December 2007 and January 2012, 25 patients with cT3 (64%) or cT4 (36%) gastric cancer were included. One patient discontinued concurrent chemotherapy in the 4th week due to toxicity, but completed radiotherapy. Another patient discontinued chemoradiotherapy after the 3rd week due to progressive disease. Grade III adverse events of chemoradiotherapy were: gastrointestinal 12%, haematological 12% and other 8%. All patients, except one who developed progressive disease, were operated. Surgical complications were: general/infectious 48%, anastomotic leakage 12%, and bowel perforation 8%. Postoperative mortality was 4%. Microscopically radical resection rate was 72%. Pathological complete response rate was 16% and near complete response rate 24%. CONCLUSIONS In this study, preoperative chemoradiotherapy for patients with locally advanced gastric cancer was associated with manageable toxicity and encouraging pathological response rates.
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Affiliation(s)
- Anouk K Trip
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Boelo J Poppema
- Department of Medical Oncology, University Medical Centre Groningen, The Netherlands
| | | | - Ester Siemerink
- Department of Internal Medicine, Ziekenhuisgroep Twente, Hengelo, The Netherlands
| | - Jannet C Beukema
- Department of Radiation Oncology, University Medical Centre Groningen, The Netherlands
| | - Marcel Verheij
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - John T M Plukker
- Department of Surgical Oncology, University Medical Centre Groningen, The Netherlands
| | - Dick J Richel
- Department of Medical Oncology, Academic Medical Centre - University of Amsterdam, The Netherlands
| | - Maarten C C M Hulshof
- Department of Radiation Oncology, Academic Medical Centre - University of Amsterdam, The Netherlands
| | - Johanna W van Sandick
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Annemieke Cats
- Department of Gastroenterology and Hepatology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Edwin P M Jansen
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Geke A P Hospers
- Department of Medical Oncology, University Medical Centre Groningen, The Netherlands.
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