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Washington B, Cheek D, Fabian D, Kudrimoti M, Pokhrel D, Wang C, Thayer-Freeman C, Luo W. Effects of Interfraction Dose Variations of Target and Organs at Risk on Clinical Outcomes in High Dose Rate Brachytherapy for Cervical Cancer. Cancers (Basel) 2023; 15:4862. [PMID: 37835556 PMCID: PMC10571581 DOI: 10.3390/cancers15194862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
Meeting dose prescription is critical to control tumors in radiation therapy. Interfraction dose variations (IDVs) from the prescribed dose in high dose rate brachytherapy (HDR) would cause the target dose to deviate from the prescription but their clinical effect has not been widely discussed in the literature. Our previous study found that IDVs followed a left-skewed distribution. The clinical effect of the IDVs in 100 cervical cancer HDR patients will be addressed in this paper. An in-house Monte Carlo (MC) program was used to simulate clinical outcomes by convolving published tumor dose response curves with IDV distributions. The optimal dose and probability of risk-free local control (RFLC) were calculated using the utility model. The IDVs were well-fitted by the left-skewed Beta distribution, which caused a 3.99% decrease in local control probability and a 1.80% increase in treatment failure. Utility with respect to IDV uncertainty increased the RFLC probability by 6.70% and predicted an optimal dose range of 83 Gy-91 Gy EQD2. It was also found that a 10 Gy dose escalation would not affect toxicity. In conclusion, HRCTV IDV uncertainty reduced LC probabilities and increased treatment failure rates. A dose escalation may help mitigate such effects.
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Affiliation(s)
- Brien Washington
- Department of Radiation Medicine, University of Kentucky, 800 Rose Street, Lexington, KY 40536, USA; (B.W.); (D.C.); (D.F.); (M.K.); (D.P.); (C.T.-F.)
| | - Dennis Cheek
- Department of Radiation Medicine, University of Kentucky, 800 Rose Street, Lexington, KY 40536, USA; (B.W.); (D.C.); (D.F.); (M.K.); (D.P.); (C.T.-F.)
| | - Denise Fabian
- Department of Radiation Medicine, University of Kentucky, 800 Rose Street, Lexington, KY 40536, USA; (B.W.); (D.C.); (D.F.); (M.K.); (D.P.); (C.T.-F.)
| | - Mahesh Kudrimoti
- Department of Radiation Medicine, University of Kentucky, 800 Rose Street, Lexington, KY 40536, USA; (B.W.); (D.C.); (D.F.); (M.K.); (D.P.); (C.T.-F.)
| | - Damodar Pokhrel
- Department of Radiation Medicine, University of Kentucky, 800 Rose Street, Lexington, KY 40536, USA; (B.W.); (D.C.); (D.F.); (M.K.); (D.P.); (C.T.-F.)
| | - Chi Wang
- Department of Internal Medicine, University of Kentucky, 800 Rose Street, Lexington, KY 40536, USA;
| | - Cameron Thayer-Freeman
- Department of Radiation Medicine, University of Kentucky, 800 Rose Street, Lexington, KY 40536, USA; (B.W.); (D.C.); (D.F.); (M.K.); (D.P.); (C.T.-F.)
| | - Wei Luo
- Department of Radiation Medicine, University of Kentucky, 800 Rose Street, Lexington, KY 40536, USA; (B.W.); (D.C.); (D.F.); (M.K.); (D.P.); (C.T.-F.)
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Dosimetric Study of Inter-Fraction Variation in Organ at Risk (OAR) in Intracavitary Brachytherapy (ICBT) Using Image Registrations. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-022-00651-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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3
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Washington B, Randall M, Fabian D, Cheek D, Wang C, Luo W. Statistical Analysis of Interfraction Dose Variations of High-Risk Clinical Target Volume and Organs at Risk for Cervical Cancer High-Dose-Rate Brachytherapy. Adv Radiat Oncol 2022; 7:101019. [PMID: 36110265 PMCID: PMC9468354 DOI: 10.1016/j.adro.2022.101019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/29/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose High-dose-rate (HDR) brachytherapy for cervical cancer treatment includes significant uncertainties. The aim of this study was to quantify the interfraction dosimetric variation (IDV) of the high-risk clinical target volume (HRCTV) from the prescribed dose and the corresponding effect on organ-at-risk (OAR) dose based on a comprehensive statistical analysis. Methods and Materials Fifty patients with cervical cancer treated with high-dose-rate intracavity brachytherapy from October 2019 to December 2020 were retrospectively analyzed. The OARs of interest were the rectum, bladder, sigmoid, and bowel. The dosimetric parameters evaluated for all patients was the dose absorbed by 90% of the HRCTV ( D 90 ) and the dose absorbed by 0.1 ( D 0.1 c c ) and 2 cm3 ( D 2 c c ) of each respective OAR. The HRCTV variations were from the prescribed dose and the OAR variations were from the corresponding tolerance dose. Distribution fitting of the HRCTV variations was determined to quantify the IDV. Comparative statistics of the HRCTV variations with the OAR variations were conducted to determine correlations. Results The mean HRCTV variation from the prescribed dose was -2.53% ± 8.74%. The HRCTV variations and OAR variations showed moderate to weak linear correlations despite the variations being relative to each other, with the bladder D 2 c c having the strongest correlation. There was a 30.0% (±2.62%, 95% confidence interval) probability of underdosing the HRCTV (-5% variation from prescription) and a 23.3% (±2.62%, 95% confidence interval) probability of overdosing the HRCTV (+5% variation from prescription). This tendency to underdose the HRCTV was a consequence of HRCTV IDV not being normally distributed. Conclusions HRCTV dosimetric variations and OAR variations were complexly correlated with the bladder D 2 c c having the strongest correlation. HRCTV IDV was best described as a left-skewed distribution that indicates a tendency of underdosing the HRCTV. The clinical significance of such dose variations is expected and will be further investigated.
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Affiliation(s)
- Brien Washington
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky
| | - Marcus Randall
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky
| | - Denise Fabian
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky
| | - Dennis Cheek
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky
| | - Chi Wang
- Department of Internal Medicine, University of Kentucky, Lexington, Kentucky
| | - Wei Luo
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky
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Benson R, Rodgers J, Nelder C, Clough A, Pitt E, Parker J, Whiteside L, Davies L, Bailey R, McMahon J, Kolbe H, Cree A, Dubec M, Van Herk M, Choudhury A, Hoskin P, Eccles C. The impact of an educational tool in cervix image registration across three imaging modalities. Br J Radiol 2022; 95:20211402. [PMID: 35616660 PMCID: PMC10996960 DOI: 10.1259/bjr.20211402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/21/2022] [Accepted: 05/18/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Accurate image registration is vital in cervical cancer where changes in both planning target volume (PTV) and organs at risk (OARs) can make decisions regarding image registration complicated. This work aims to determine the impact of a dedicated educational tool compared with experience gained in MR-guided radiotherapy (MRgRT). METHODS 10 therapeutic radiographers acted as observers and were split into two groups based on previous experience with MRgRT and Monaco treatment planning system. Three CBCT-CT, three MR-CT and two MR-MR registrations were completed per patient by each observer. Observers recorded translations, time to complete image registration and confidence. Data were collected in two phases; prior to and following the introduction of a cervix registration guide. RESULTS No statistically significant differences were noted between imaging modalities. Each group was assessed independently pre- and post-education, no statistically significant differences were noted in either CBCT-CT or MR-CT imaging. Group 1 MR-MR imaging showed a statistically significant reduction in interobserver variability (p=0.04), in Group 2, the result was not statistically significant (p=0.06). Statistically significant increases in confidence were seen in all three modalities (p≤0.05). CONCLUSIONS At The Christie NHS Foundation Trust, radiographers consistently registered images across three different imaging modalities regardless of their previous experience. The implementation of an image registration guide had limited impact on inter- and intraobserver variability. Radiographers' confidence showed statistically significant improvements following the use of the registration manual. ADVANCES IN KNOWLEDGE This work helps evaluate training methods for novel roles that are developing in MRgRT.
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Affiliation(s)
- Rebecca Benson
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
| | - John Rodgers
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
| | - Claire Nelder
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
| | - Abigael Clough
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
| | - Eleanor Pitt
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
| | - Jacqui Parker
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
| | - Lee Whiteside
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
| | - Lucy Davies
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
| | - Rachael Bailey
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
| | - John McMahon
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
| | - Hope Kolbe
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
| | - Anthea Cree
- Department of Clinical Oncology, The Clatterbridge Cancer
Centre, Liverpool,
UK
| | - Michael Dubec
- Department of Medical Physics and Engineering, The Christie NHS
Foundation Trust, Manchester,
UK
| | - Marcel Van Herk
- Department of Clinical Oncology, The Christie NHS Foundation
Trust, Manchester,
UK
- Division of Cancer Sciences, School of Medical Sciences,
Faculty of Biology, Medicine and Health, University of Manchester,
Manchester Academic Health Science Centre,
Manchester, UK
| | - Ananya Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation
Trust, Manchester,
UK
- Division of Cancer Sciences, School of Medical Sciences,
Faculty of Biology, Medicine and Health, University of Manchester,
Manchester Academic Health Science Centre,
Manchester, UK
| | - Peter Hoskin
- Department of Clinical Oncology, The Christie NHS Foundation
Trust, Manchester,
UK
- Division of Cancer Sciences, School of Medical Sciences,
Faculty of Biology, Medicine and Health, University of Manchester,
Manchester Academic Health Science Centre,
Manchester, UK
| | - Cynthia Eccles
- Department of Radiotherapy, The Christie Hospital NHS
Trust, Manchester,
UK
- Division of Cancer Sciences, School of Medical Sciences,
Faculty of Biology, Medicine and Health, University of Manchester,
Manchester Academic Health Science Centre,
Manchester, UK
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Kobayashi K, Hamamoto R. [5. The Potential of Medical Image Analysis Technology in the Field of Cancer Treatment]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2022; 78:101-106. [PMID: 35046214 DOI: 10.6009/jjrt.780110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Kazuma Kobayashi
- Division of Medical AI Research and Development, National Cancer Center Research Institute
- Cancer Translational Research Team, RIKEN Center for Advanced Intelligent Project
| | - Ryuji Hamamoto
- Division of Medical AI Research and Development, National Cancer Center Research Institute
- Cancer Translational Research Team, RIKEN Center for Advanced Intelligent Project
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Wang B, Hu W, Shan G, Xu X. Estimating the accumulative dose uncertainty for intracavitary and interstitial brachytherapy. Biomed Eng Online 2021; 20:106. [PMID: 34663336 PMCID: PMC8524953 DOI: 10.1186/s12938-021-00942-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/03/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Image-guided adaptive brachytherapy shows the ability to deliver high doses to tumors while sparing normal tissues. However, interfraction dose delivery introduces uncertainties to high dose estimation, which relates to normal tissue toxicity. The purpose of this study was to investigate the high-dose regions of two applicator approaches in brachytherapy. METHOD For 32 cervical cancer patients, the CT images from each fraction were wrapped to a reference image, and the displacement vector field (DVF) was calculated with a hybrid intensity-based deformable registration algorithm. The fractional dose was then accumulated to calculate the position and the overlap of high dose (D2cc) during multiple fractions. RESULT The overall Dice similarity coefficient (DSC) of the deformation algorithm for the bladder and the rectum was (0.97 and 0.91). No significant difference was observed between the two applicators. However, the location of the intracavitary brachytherapy (ICBT) high-dose region was relatively concentrated. The overlap volume of bladder and rectum D2cc was 0.42 and 0.71, respectively, which was higher than that of interstitial brachytherapy (ISBT) (0.26 and 0.31). The cumulative dose was overestimated in ISBT cases when using the GEC-recommended method. The ratio of bladder and rectum D2cc to the GEC method was 0.99 and 1, respectively, which was higher than that of the ISBT method (0.96 and 0.94). CONCLUSION High-dose regions for brachytherapy based on different applicator types were different. The 3D-printed ICBT has better high-dose region consistency than freehand ISBT and hence is more predictable.
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Affiliation(s)
- Binbing Wang
- Department of Radiation Physics, Zhejiang Key Laboratory of Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, No. 1. East Banshan Road, Gongshu District, Hangzhou, 310022 Zhejiang China
| | - Weibiao Hu
- Taizhou Hospital of Zhejiang Province, Taizhou, 318000 Zhejiang China
| | - Guoping Shan
- Department of Radiation Physics, Zhejiang Key Laboratory of Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, No. 1. East Banshan Road, Gongshu District, Hangzhou, 310022 Zhejiang China
| | - Xiaoxian Xu
- Department of Radiation Physics, Zhejiang Key Laboratory of Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, No. 1. East Banshan Road, Gongshu District, Hangzhou, 310022 Zhejiang China
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Kobayashi K, Murakami N, Takahashi K, Inaba K, Igaki H, Hamamoto R, Itami J. Tensor Regression-based Model to Investigate Heterogeneous Spatial Radiosensitivity After I-125 Seed Implantation for Prostate Cancer. In Vivo 2021; 35:489-497. [PMID: 33402501 DOI: 10.21873/invivo.12283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM We established a data-driven method for extracting spatial patterns of dose distribution associated with radiation injuries, based on patients with prostate cancer who underwent iodine-125 (I-125) seed implantation. PATIENTS AND METHODS Seventy-five patients underwent I-125 seed implantation for prostate cancer. We modeled the severity of lower urinary tract symptoms (LUTS) to be estimated using a linear model, which is formulated as an inner product between the dose distribution D and voxel-wise radiosensitivity B inside the prostate. For the estimation, tensor regression based on a low-rank decomposition with generalized fused lasso penalty was applied. RESULTS The spatial distribution of B was visually assessed. Positive parameters appeared dominantly in the region close to the urethra and the prostate base. CONCLUSION Our tensor regression-based model can predict intra-organ radiosensitivity in a data-driven manner, providing a compelling parameter distribution associated with the development of LUTS after I-125 seed implantation for prostate cancer.
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Affiliation(s)
- Kazuma Kobayashi
- Division of Molecular Modification and Cancer Biology, National Cancer Center Research Institute, Tokyo, Japan; .,Cancer Translational Research Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan.,Department of NCC Cancer Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kana Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Koji Inaba
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ryuji Hamamoto
- Division of Molecular Modification and Cancer Biology, National Cancer Center Research Institute, Tokyo, Japan.,Cancer Translational Research Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan.,Department of NCC Cancer Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
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Mahantshetty U, Gurram L, Bushra S, Ghadi Y, Aravindakshan D, Paul J, Hande V, Pilar A, Chopra S, Ghosh J, Shylasree TS, Popat P, Sable N, Maheswari A, Gupta S. Single Application Multifractionated Image Guided Adaptive High-Dose-Rate Brachytherapy for Cervical Cancer: Dosimetric and Clinical Outcomes. Int J Radiat Oncol Biol Phys 2021; 111:826-834. [PMID: 34146636 DOI: 10.1016/j.ijrobp.2021.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/29/2021] [Accepted: 06/08/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE A prospective phase 2 study was conducted to evaluate the feasibility and safety of single-application multifractionated (SA-MF), high-dose-rate (HDR), image guided adaptive brachytherapy (IGABT) for cervical cancer. METHODS AND MATERIALS Patients (N = 41) with International Federation of Gynaecology and Obstetrics 2009 stage IIB-IVA disease recruited between 2017 and 2019 underwent SA-MF. After completion of external beam radiation therapy of 50 Gy in 25 fractions, patients received magnetic resonance IGABT. The IGABT protocol consisted of a single brachytherapy (BT) application and treatment with 3 fractions of HDR (9 Gy on day 1; 2 fractions of 7 Gy with a minimum 6-hour gap on day 2) after achieving planning aims of the high-risk clinical target volume (HRCTV) receiving >84 Gy EQD2 and 2 cm3 of the bladder and rectum/sigmoid receiving ≤85 Gy and <71 Gy, respectively. Interfraction variation was addressed by performing computed tomography planning and coregistration using a mutual information-based coordinate system on day 2 before the second fraction. Organ at risk contouring was done on computed tomography, and doses were re-evaluated and reoptimized if required. RESULTS Thirty-eight patients were treated as per the protocol. All patients underwent Intracavitary + Interstitial BT with needles (median, 4; range, 3-11). The mean ± standard deviation HRCTV volume was 41 ± 21 cm3 and HRCTV D90 dose was 87.2 ± 3.6Gy. The 0.1 cm3 and 2 cm3 to bladder, rectum, and sigmoid were -103.2 ± 10.6 Gy and -84.6 ± 6.8 Gy, 82.2 ± 9.5 Gy and -68.3 ± 5.7 Gy, and 83.5 ± 9.8 Gy and -69.5 ± 5.9 Gy, respectively. Six patients required reoptimization before the second fraction to meet planning aims. Mean overall treatment time was 47 ± 6 days. With a median follow up of 22 months (range, 2-37), 2-year local control and disease-free and overall survival were 90.1%, 85%, and 94.5%, respectively. So far 1 patient with grade II and 2 patients with grade III rectal toxicities have been reported. CONCLUSION Magnetic resonance IGABT with SA-MF BT was feasible in 95% of patients. The dosimetric parameters and clinical results achieved so far look promising.
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Affiliation(s)
- Umesh Mahantshetty
- Department of Radiation Oncology & Medical Physics, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India; Department of Radiation Oncology & Medical Physics, Homi Bhabha Cancer Hospital & Research Centre, Visakhapatnam, India.
| | - Lavanya Gurram
- Department of Radiation Oncology & Medical Physics, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | | | - Yogesh Ghadi
- Department of Radiation Oncology & Medical Physics, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Dheera Aravindakshan
- Department of Radiation Oncology & Medical Physics, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - John Paul
- Department of Radiation Oncology & Medical Physics, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vinod Hande
- Department of Radiation Oncology & Medical Physics, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Avinash Pilar
- Department of Radiation Oncology & Medical Physics, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Supriya Chopra
- Department of Radiation Oncology & Medical Physics, ACTREC, Tata Memorial Centre, HBNI, Mumbai, India
| | - Jaya Ghosh
- Department of Medical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - T S Shylasree
- Department of Gynecology Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Palak Popat
- Department of Radiodiagnosis, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Nilesh Sable
- Department of Radiodiagnosis, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Amita Maheswari
- Department of Gynecology Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
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Miyasaka Y, Kadoya N, Umezawa R, Takayama Y, Ito K, Yamamoto T, Tanaka S, Dobashi S, Takeda K, Nemoto K, Iwai T, Jingu K. Comparison of predictive performance for toxicity by accumulative dose of DVH parameter addition and DIR addition for cervical cancer patients. JOURNAL OF RADIATION RESEARCH 2021; 62:155-162. [PMID: 33231258 PMCID: PMC7779363 DOI: 10.1093/jrr/rraa099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/16/2020] [Indexed: 05/11/2023]
Abstract
We compared predictive performance between dose volume histogram (DVH) parameter addition and deformable image registration (DIR) addition for gastrointestinal (GI) toxicity in cervical cancer patients. A total of 59 patients receiving brachytherapy and external beam radiotherapy were analyzed retrospectively. The accumulative dose was calculated by three methods: conventional DVH parameter addition, full DIR addition and partial DIR addition. ${D}_{2{cm}^3}$, ${D}_{1{cm}^3}$ and ${D}_{0.1{cm}^3}$ (minimum doses to the most exposed 2 cm3, 1cm3 and 0.1 cm3 of tissue, respectively) of the rectum and sigmoid were calculated by each method. V50, V60 and V70 Gy (volume irradiated over 50, 60 and 70 Gy, respectively) were calculated in full DIR addition. The DVH parameters were compared between toxicity (≥grade1) and non-toxicity groups. The area under the curve (AUC) of the receiver operating characteristic (ROC) curves were compared to evaluate the predictive performance of each method. The differences between toxicity and non-toxicity groups in ${D}_{2{cm}^3}$ were 0.2, 5.7 and 3.1 Gy for the DVH parameter addition, full DIR addition and partial DIR addition, respectively. The AUCs of ${D}_{2{cm}^3}$ were 0.51, 0.67 and 0.57 for DVH parameter addition, full DIR addition and partial DIR addition, respectively. In full DIR addition, the difference in dose between toxicity and non-toxicity was the largest and AUC was the highest. AUCs of V50, V60 and V70 Gy were 0.51, 0.63 and 0.62, respectively, and V60 and V70 were high values close to the value of ${D}_{2{cm}^3}$ of the full DIR addition. Our results suggested that the full DIR addition may have the potential to predict toxicity more accurately than the conventional DVH parameter addition, and that it could be more effective to accumulate to all pelvic irradiation by DIR.
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Affiliation(s)
- Yuya Miyasaka
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Heavy Particle Medical Science, Yamagata University Graduate School of Medical Science, Yamagata, Japan
| | - Noriyuki Kadoya
- Corresponding author. Department of Radiation Oncology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan. Tel: +81-22-717-7312; Fax: +81-22-717-7316;
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiki Takayama
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Kanagawa Cancer Center, Yokohama, Japan
| | - Kengo Ito
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shohei Tanaka
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Suguru Dobashi
- Course of Radiological Technology, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ken Takeda
- Course of Radiological Technology, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenji Nemoto
- Department of Radiology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Takeo Iwai
- Department of Heavy Particle Medical Science, Yamagata University Graduate School of Medical Science, Yamagata, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
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10
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Predictive value of Excel forms based on an automatic calculation of dose equivalent in 2 Gy per fraction in adaptive brachytherapy for cervical cancer. J Contemp Brachytherapy 2020; 12:454-461. [PMID: 33299434 PMCID: PMC7701924 DOI: 10.5114/jcb.2020.100378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 08/02/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose External beam radiotherapy (EBRT) combined with brachytherapy (BT) is the standard mode of radical radiotherapy for locally advanced cervical cancer. The cumulative equivalent doses in 2 Gy per fraction (EQD2) is an important basis for estimating the probability of local control of tumors and monitoring the occurrence of side effects in normal tissues. The purpose of this study was to explore the predictive value of Excel forms based on an automatic calculation in radical adaptive BT for cervical cancer. Material and methods A retrospective analysis of 119 patients suffering from cervical cancer, treated with radical radiotherapy. All patients were treated with EBRT and adaptive BT. EBRT prescribed dose was 42.0-50.4 Gy in 21-28 fractions. BT nominal prescribed dose was 28 Gy in 4 fractions, separated by one week. Total EQD2 prediction at nth (n = 1-3) BT (TEPBn) or actual cumulative EQD2 (ACEQD2) can be calculated automatically by inputting the physical dose based on an in-house designed application. The relationship between TEPBn and ACEQD2 was evaluated, and the predictive value of Excel forms based on the automatic calculation was analyzed. Results For the volume of high-risk clinical target, there was a significant decrease between BT1 and BT2. Similarly, for the volume of intermediate-risk clinical target, there was a significant decrease between BT2 and BT3. The sensitivity ranges of TEPB1, TEPB2, and TEPB3 prediction were 74.5-91.3%, 83.7-95.7%, and 92.9-99.1%, respectively, and the specificity ranges were 46.7-80.0%, 53.3-90.5%, and 66.7-90.5%, respectively. Conclusions The in-house designed application has the function of quickly reading dose-volume histogram (DVH) parameters from the treatment planning system, which allows for balance between the total dose to target volumes and organs at risk (OARs). Excel forms based on EQD2 automatic calculation presents high predictive accuracy.
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Kobayashi K, Murakami N, Takahashi K, Inaba K, Igaki H, Hamamoto R, Itami J. A Population-based Statistical Model for Investigating Heterogeneous Intraprostatic Sensitivity to Radiation Toxicity After 125I Seed Implantation. In Vivo 2020; 33:2103-2111. [PMID: 31662544 DOI: 10.21873/invivo.11710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 08/28/2019] [Accepted: 09/03/2019] [Indexed: 11/10/2022]
Abstract
AIM To develop a population-based statistical model in order to find a spatial pattern of dose distribution which is related to lower urinary tract symptoms (LUTS) after iodine-125 (125I) seed implantation for prostate cancer. PATIENTS AND METHODS A total of 75 patients underwent 125I seed implantation for prostate cancer. Principal component analysis was applied to the standardized dose array and for each patient dose distribution was uniquely characterized by a combination of weighted eigenvectors. The correlation between eigenvectors and the severity of LUTS was investigated with linear regression analysis. RESULTS Eight eigenvectors were identified as being significantly associated with the severity of LUTS (p<0.05). Multivariate regression model identified that intraprostatic parameters, which were positively associated with the severity of LUTS, were distributed around a portion of the urethral base and a peripheral region of the prostate. CONCLUSION We established a population-based statistical model that may indicate a significant dose pattern associated with the severity of radiation toxicity.
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Affiliation(s)
- Kazuma Kobayashi
- Division of Molecular Modification and Cancer Biology, National Cancer Center Research Institute, Tokyo, Japan .,Cancer Translational Research Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan.,Department of NCC Cancer Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kana Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Koji Inaba
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ryuji Hamamoto
- Division of Molecular Modification and Cancer Biology, National Cancer Center Research Institute, Tokyo, Japan.,Cancer Translational Research Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan.,Department of NCC Cancer Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
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12
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Evaluation of deformable image registration algorithm for determination of accumulated dose for brachytherapy of cervical cancer patients. J Contemp Brachytherapy 2019; 11:469-478. [PMID: 31749857 PMCID: PMC6854864 DOI: 10.5114/jcb.2019.88762] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/17/2019] [Indexed: 12/30/2022] Open
Abstract
Purpose This study was designed to assess the dose accumulation (DA) of bladder and rectum between brachytherapy fractions using hybrid-based deformable image registration (DIR) and compare it with the simple summation (SS) approach of GEC-ESTRO in cervical cancer patients. Material and methods Patients (n = 137) with cervical cancer treated with 3D conformal radiotherapy and three fractions of high-dose-rate brachytherapy were selected. CT images were acquired to delineate organs at risk and targets according to GEC-ESTRO recommendations. In order to determine the DA for the bladder and rectum, hybrid-based DIR was done for three different fractions of brachytherapy and the results were compared with the standard GEC-ESTRO method. Also, we performed a phantom study to calculate the uncertainty of the hybrid-based DIR algorithm for contour matching and dose mapping. Results The mean ± standard deviation (SD) of the Dice similarity coefficient (DICE), Jaccard, Hausdorff distance (HD) and mean distance to agreement (MDA) in the DIR process were 0.94 ±0.02, 0.89 ±0.03, 8.44 ±3.56 and 0.72 ±0.22 for bladder and 0.89 ±0.05, 0.80 ±0.07, 15.46 ±10.14 and 1.19 ±0.59 for rectum, respectively. The median (Q1, Q3; maximum) GyEQD2 differences of total D2cc between DIR-based and SS methods for the bladder and rectum were reduced by –1.53 (–0.86, –2.98; –9.17) and –1.38 (–0.80, –2.14; –7.11), respectively. The mean ± SD of DICE, Jaccard, HD, and MDA for contour matching were 0.98 ±0.008, 0.97 ±0.01, 2.00 ±0.70 and 0.20 ±0.04, respectively for large deformation. Maximum uncertainty of dose mapping was about 3.58%. Conclusions The hybrid-based DIR algorithm demonstrated low registration uncertainty for both contour matching and dose mapping. The DA difference between DIR-based and SS approaches was statistically significant for both bladder and rectum and hybrid-based DIR showed potential to assess DA between brachytherapy fractions.
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Rigaud B, Simon A, Castelli J, Lafond C, Acosta O, Haigron P, Cazoulat G, de Crevoisier R. Deformable image registration for radiation therapy: principle, methods, applications and evaluation. Acta Oncol 2019; 58:1225-1237. [PMID: 31155990 DOI: 10.1080/0284186x.2019.1620331] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Deformable image registration (DIR) is increasingly used in the field of radiation therapy (RT) to account for anatomical deformations. The aims of this paper are to describe the main applications of DIR in RT and discuss current DIR evaluation methods. Methods: Articles on DIR published from January 2000 to October 2018 were extracted from PubMed and Science Direct. Our search was restricted to articles that report data obtained from humans, were written in English, and address DIR methods for RT. A total of 207 articles were selected from among 2506 identified in the search process. Results: At planning, DIR is used for organ delineation using atlas-based segmentation, deformation-based planning target volume definition, functional planning and magnetic resonance imaging-based dose calculation. In image-guided RT, DIR is used for contour propagation and dose calculation on per-treatment imaging. DIR is also used to determine the accumulated dose from fraction to fraction in external beam RT and brachytherapy, both for dose reporting and adaptive RT. In the case of re-irradiation, DIR can be used to estimate the cumulated dose of the two irradiations. Finally, DIR can be used to predict toxicity in voxel-wise population analysis. However, the evaluation of DIR remains an open issue, especially when dealing with complex cases such as the disappearance of matter. To quantify DIR uncertainties, most evaluation methods are limited to geometry-based metrics. Software companies have now integrated DIR tools into treatment planning systems for clinical use, such as contour propagation and fraction dose accumulation. Conclusions: DIR is increasingly important in RT applications, from planning to toxicity prediction. DIR is routinely used to reduce the workload of contour propagation. However, its use for complex dosimetric applications must be carefully evaluated by combining quantitative and qualitative analyses.
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Affiliation(s)
- Bastien Rigaud
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Antoine Simon
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Joël Castelli
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Caroline Lafond
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Oscar Acosta
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Pascal Haigron
- CLCC Eugène Marquis, University of Rennes, Inserm , Rennes , France
| | - Guillaume Cazoulat
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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Rigaud B, Klopp A, Vedam S, Venkatesan A, Taku N, Simon A, Haigron P, de Crevoisier R, Brock KK, Cazoulat G. Deformable image registration for dose mapping between external beam radiotherapy and brachytherapy images of cervical cancer. Phys Med Biol 2019; 64:115023. [PMID: 30913542 DOI: 10.1088/1361-6560/ab1378] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
For locally advanced cervical cancer (LACC), anatomy correspondence with and without BT applicator needs to be quantified to merge the delivered doses of external beam radiation therapy (EBRT) and brachytherapy (BT). This study proposed and evaluated different deformable image registration (DIR) methods for this application. Twenty patients who underwent EBRT and BT for LACC were retrospectively analyzed. Each patient had a pre-BT CT at EBRT boost (without applicator) and a CT and MRI at BT (with applicator). The evaluated DIR methods were the diffeomorphic Demons, commercial intensity and hybrid methods, and three different biomechanical models. The biomechanical models considered different boundary conditions (BCs). The impact of the BT devices insertion on the anatomy was quantified. DIR method performances were quantified using geometric criteria between the original and deformed contours. The BT dose was deformed toward the pre-CT BT by each DIR method. The impact of boundary conditions to drive the biomechanical model was evaluated based on the deformation vector field and dose differences. The GEC-ESTRO guideline dose indices were reported. Large organ displacements, deformations, and volume variations were observed between the pre-BT and BT anatomies. Rigid registration and intensity-based DIR resulted in poor geometric accuracy with mean Dice similarity coefficient (DSC) inferior to 0.57, 0.63, 0.42, 0.32, and 0.43 for the rectum, bladder, vagina, cervix and uterus, respectively. Biomechanical models provided a mean DSC of 0.96 for all the organs. By considering the cervix-uterus as one single structure, biomechanical models provided a mean DSC of 0.88 and 0.94 for the cervix and uterus, respectively. The deformed doses were represented for each DIR method. Caution should be used when performing DIR for this application as standard techniques may have unacceptable results. The biomechanical model with the cervix-uterus as one structure provided the most realistic deformations to propagate the BT dose toward the EBRT boost anatomy.
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Affiliation(s)
- B Rigaud
- Univ Rennes, CLCC Eugène Marquis, Inserm, LTSI-UMR 1099, F-35000 Rennes, France. Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America. Author to whom any correspondence should be addressed
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Choi E, Kim JH, Kim OB, Byun SJ, Kim JH, Oh YK. Dose comparison between prescription methods according to anatomical variations in intracavitary brachytherapy for cervical cancer. Radiat Oncol J 2018; 36:227-234. [PMID: 30309214 PMCID: PMC6226137 DOI: 10.3857/roj.2018.00353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/11/2018] [Indexed: 01/27/2023] Open
Abstract
PURPOSE We compared how doses delivered via two-dimensional (2D) intracavitary brachytherapy (ICBT) and three-dimensional (3D) ICBT varied anatomically. Materials and METHODS A total of 50 patients who received 30 Gy of 3D ICBT after external radiotherapy (RT) were enrolled. We compared the doses of the actual 3D and 2D ICBT plans among patients grouped according to six anatomical variations: differences in a small-bowel V2Gy, small bowel circumference, the direction of bladder distension, bladder volume, sigmoid V3.5Gy, and sigmoid circumference. Seven dose parameters were measured in line with the EMBRACE recommendations. RESULTS In terms of bladder volume, the bladder and small-bowel D2cc values were lower in the 150-250 mL bladder volume subgroup; and the rectum, sigmoid, and bladder D2mL values were all lower in the >250 mL subgroup, for 3D vs. 2D ICBT. In the sigmoid V3.5Gy >2 mL subgroup, the sigmoid and bladder D2mL values were significantly lower for 3D than 2D ICBT. The bladder D2mL value was also significantly lower for 3D ICBT, as reflected by the sigmoid circumference. In patients with a small bowel V2.0Gy >10 mL or small bowel circumference >15%, most dose parameters were significantly lower for 3D than 2D ICBT. The bladder distension direction did not significantly affect the doses. CONCLUSION Compared to 2D ICBT, a greater bladder volume can reduce the internal 3D ICBT organ dose without affecting the target dose.
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Affiliation(s)
- Euncheol Choi
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Jae Ho Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Ok Bae Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Sang Jun Byun
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Young Kee Oh
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Modern Computational Technologies for Establishing Precision Brachytherapy: From Non-rigid Image Registration to Deep Learning. Brachytherapy 2018. [DOI: 10.1007/978-981-13-0490-3_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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17
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Tornero-López AM, Guirado D. Radiobiological considerations in combining doses from external beam radiotherapy and brachytherapy for cervical cancer. Rep Pract Oncol Radiother 2018; 23:562-573. [PMID: 30534020 DOI: 10.1016/j.rpor.2018.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/27/2018] [Accepted: 05/25/2018] [Indexed: 12/11/2022] Open
Abstract
The recommended radio-therapeutic treatment for cervix cancer consists of a first phase of external beam radiotherapy (EBRT) plus a second phase of brachytherapy (BT), the combined treatment being delivered within 8 weeks. In order to assess a comprehensive dosimetry of the whole treatment, it is necessary to take into account that these two phases are characterized by different spatial and temporal dosimetric distributions, which complicates the task of the summation of the two contributions, EBRT and BT. Radiobiology allows to tackle this issue pragmatically by means of the LQ model and, in fact, this is the usual tool currently in use for this matter. In this work, we describe the rationale behind the summation of the dosimetric contributions of the two phases of the treatment, EBRT and BT, for cervix cancer, as carried out with the LQ model. Besides, we address, from a radiobiological point of view, several important considerations regarding the use of the LQ model for this task. One of them is the analysis of the effect of the overall treatment time in the result of the global treatment. Another important question considered is related to the fact that the capacity of LQ to predict the treatment outcomes is deteriorated when the dose per fraction of the radiotherapic scheme exceeds 6-10 Gy, which is a typical brachytherapy fractionation. Finally, we analyze the influence of the uncertainty and the variability of the main parameters utilized in the LQ model formulation in the assessment of the global dosimetry.
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Affiliation(s)
- Ana M Tornero-López
- Servicio de Radiofísica y Protección Radiológica, Hospital Universitario de Gran Canaria Dr. Negrín, E-35010 Las Palmas de Gran Canaria, Spain
| | - Damián Guirado
- Unidad de Radiofísica, Hospital Universitario San Cecilio, E-18016 Granada, Spain
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18
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Moulton CR, House MJ, Lye V, Tang CI, Krawiec M, Joseph DJ, Denham JW, Ebert MA. Accumulation of rectum dose-volume metrics for prostate external beam radiotherapy combined with brachytherapy: Evaluating deformably registered dose distribution addition using parameter-based addition. J Med Imaging Radiat Oncol 2017; 61:534-542. [PMID: 28185419 DOI: 10.1111/1754-9485.12593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 12/29/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To investigate the accuracy of deriving dose-volume histogram (DVH) parameters from deformably registered data by comparing values with the simple addition of DVHs from each phase of a combined external beam radiotherapy (EBRT)/high-dose-rate (HDR-BT) brachytherapy prostate treatment. METHODS Eighty-two patients received EBRT in 23 fractions of 2 Gy and HDR-BT TG43 in three fractions of 6.5 Gy. The HDR-BT CT was deformably registered to the EBRT CT. The rectum D0.1cc , D1cc , D2cc and D10cc were calculated in two ways. (i) Parameter-adding: the EBRT DVH parameters (or the EBRT prescription dose) were added to the unregistered HDR-BT DVH parameters. (ii) Distribution-adding: the parameters were extracted after the EBRT doses were 3D-summed with the registered HDR-BT doses. Resulting differences between the parameters were investigated. RESULTS The D0.1cc , D1cc and D2cc from parameter-adding were 21.3% (P < 0.001), 6.3% (P < 0.001) and 3.5% (P < 0.001) smaller than those from distribution-adding. The D10cc was 2.2% (P = 0.015) larger for distribution-adding. CONCLUSION Distribution-adding was confounded by unsystematic inter/intra-observer rectum-contouring errors and registration accuracy near the anterior rectal wall. Consequently, clinical use of distribution-adding to assess rectal doses requires careful contour and registration evaluation.
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Affiliation(s)
- Calyn R Moulton
- School of Physics, University of Western Australia, Crawley, Western Australia, Australia
| | - Michael J House
- School of Physics, University of Western Australia, Crawley, Western Australia, Australia
| | - Victoria Lye
- Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Colin I Tang
- Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Michele Krawiec
- Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - David J Joseph
- Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,School of Surgery, University of Western Australia, Crawley, Western Australia, Australia
| | - James W Denham
- School of Medicine and Population Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Martin A Ebert
- School of Physics, University of Western Australia, Crawley, Western Australia, Australia.,Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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Meerschaert R, Nalichowski A, Burmeister J, Paul A, Miller S, Hu Z, Zhuang L. A comprehensive evaluation of adaptive daily planning for cervical cancer HDR brachytherapy. J Appl Clin Med Phys 2016; 17:323-333. [PMID: 27929505 PMCID: PMC5690507 DOI: 10.1120/jacmp.v17i6.6408] [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: 04/04/2016] [Revised: 09/06/2016] [Accepted: 08/29/2016] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to evaluate adaptive daily planning for cervical cancer patients who underwent high‐dose‐rate intracavitary brachytherapy (HDR‐BT) using comprehensive interfractional organ motion measurements. This study included 22 cervical cancer patients who underwent 5 fractions of HDR‐BT. Regions of interest (ROIs) including high‐risk clinical tumor volume (HR‐CTV) and organs at risk (OARs) were manually contoured on daily CT images. All patients were clinically treated with adaptive daily plans (ADP), which involved ROI delineation and dose optimization at each treatment fraction. Single treatment plans (SP) were retrospectively generated by applying the first treatment fraction's dwell times adjusted for decay and dwell positions of the applicator to subsequent treatment fractions. Various existing similarity metrics were calculated for the ROIs to quantify interfractional organ variations. A novel similarity (JRARM) score was established, which combined both volumetric overlap metrics (DSC, JSC, and RVD) and distance metrics (ASD, MSD, and RMSD). Linear regression was performed to determine a relationship between interfractional organ variations of various similarity metrics and D2cc variations from both plans. Wilcoxon signed‐rank tests were used to assess ADP and SP by comparing EQD2D2cc(α/β=3) for OARs. For interfractional organ variations, the sigmoid demonstrated the greatest variations based on the JRARM, DSC, and RMSD metrics. Comparisons between paired ROIs showed differences in metrics at each treatment fraction. RVD, MSD, and RMSD were found to be significantly correlated to D2cc variations for bladder and sigmoid. The comparison between plans found ADP provided lower EQD2 D2cc of OARs than SP. Specifically, the sigmoid demonstrated statistically significant dose variations (p=0.015). Substantial interfractional organ motion occurs during HDR‐BT based on comprehensive measurements and may significantly affect D2cc of OARs. Adaptive daily planning provides improved dose sparing for OARs compared to single planning with the extent of sparing being different among OARs. PACS number(s): 87.55.D, 87.55.de, 87.55.kh, 87.57.nj
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Tanderup K, Lindegaard JC, Kirisits C, Haie-Meder C, Kirchheiner K, de Leeuw A, Jürgenliemk-Schulz I, Van Limbergen E, Pötter R. Image Guided Adaptive Brachytherapy in cervix cancer: A new paradigm changing clinical practice and outcome. Radiother Oncol 2016; 120:365-369. [PMID: 27555228 DOI: 10.1016/j.radonc.2016.08.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/03/2016] [Accepted: 08/03/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Kari Tanderup
- Aarhus University Hospital, Department of Oncology, Denmark
| | | | - Christian Kirisits
- Medical University of Vienna, Comprehensive Cancer Center, Department of Radiation Oncology, Austria
| | - Christine Haie-Meder
- Gustave Roussy Cancer Campus Grand Paris, Department of Radiation Oncology, Villejuif, France
| | - Kathrin Kirchheiner
- Medical University of Vienna, Comprehensive Cancer Center, Department of Radiation Oncology, Austria
| | - Astrid de Leeuw
- University Medical Center Utrecht, Department of Radiotherapy, The Netherlands
| | | | - Erik Van Limbergen
- Department of Radiation Oncology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Richard Pötter
- Medical University of Vienna, Comprehensive Cancer Center, Department of Radiation Oncology, Austria.
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In vivo spatial correlation between (18)F-BPA and (18)F-FDG uptakes in head and neck cancer. Appl Radiat Isot 2016; 115:138-146. [PMID: 27372808 DOI: 10.1016/j.apradiso.2016.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 05/24/2016] [Accepted: 05/24/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND PURPOSE Borono-2-(18)F-fluoro-phenylalanine ((18)F-BPA) has been used to estimate the therapeutic effects of boron neutron capture therapy (BNCT), while (18)F-fluorodeoxyglucose ((18)F-FDG) is the most commonly used positron emission tomography (PET) radiopharmaceutical in a routine clinical use. The aim of the present study was to evaluate spatial correlation between (18)F-BPA and (18)F-FDG uptakes using a deformable image registration-based technique. MATERIAL AND METHODS Ten patients with head and neck cancer were recruited from January 2014 to December 2014. All patients underwent whole-body (18)F-BPA PET/computed tomography (CT) and (18)F-FDG PET/CT within a 2-week period. For each patient, (18)F-BPA PET/CT and (18)F-FDG PET/CT images were aligned based on a deformable image registration framework. The voxel-by-voxel spatial correlation of standardized uptake value (SUV) within the tumor was analyzed. RESULTS Our image processing framework achieved accurate and validated registration results for each PET/CT image. In 9/10 patients, the spatial distribution of SUVs between (18)F-BPA and (18)F-FDG showed a significant, positive correlation in the tumor volume. CONCLUSIONS Deformable image registration-based voxel-wise analysis demonstrated a spatial correlation between (18)F-BPA and (18)F-FDG uptakes in the head and neck cancer. A tumor sub-volume with a high (18)F-FDG uptake may predict high accumulation of (18)F-BPA.
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Reniers B, Janssens G, Orban de Xivry J, Landry G, Verhaegen F. Dose distribution for gynecological brachytherapy with dose accumulation between insertions: Feasibility study. Brachytherapy 2016; 15:504-513. [DOI: 10.1016/j.brachy.2016.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/14/2016] [Accepted: 03/14/2016] [Indexed: 10/21/2022]
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Dose reconstruction technique using non-rigid registration to evaluate spatial correspondence between high-dose region and late radiation toxicity: a case of tracheobronchial stenosis after external beam radiotherapy combined with endotracheal brachytherapy for tracheal cancer. J Contemp Brachytherapy 2016; 8:156-63. [PMID: 27257421 PMCID: PMC4873557 DOI: 10.5114/jcb.2016.59688] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/17/2016] [Indexed: 11/20/2022] Open
Abstract
Purpose Small organ subvolume irradiated by a high-dose has been emphasized to be associated with late complication after radiotherapy. Here, we demonstrate a potential use of surface-based, non-rigid registration to investigate how high-dose volume topographically correlates with the location of late radiation morbidity in a case of tracheobronchial radiation stenosis. Material and methods An algorithm of point set registration was implemented to handle non-rigid registration between contour points on the organ surfaces. The framework estimated the global correspondence between the dose distribution and the varying anatomical structure. We applied it to an 80-year-old man who developed tracheobronchial stenosis 2 years after high-dose-rate endobronchial brachytherapy (HDR-EBT) (24 Gy in 6 Gy fractions) and external beam radiotherapy (EBRT) (40 Gy in 2 Gy fractions) for early-stage tracheal cancer. Results and conclusions Based on the transformation function computed by the non-rigid registration, irradiated dose distribution was reconstructed on the surface of post-treatment tracheobronchial stenosis. For expressing the equivalent dose in a fractional dose of 2 Gy in HDR-EBT, α/β of linear quadratic model was assumed as 3 Gy for the tracheal bronchus. The tracheobronchial surface irradiated by more than 100 Gyαβ3 tended to develop severe stenosis, which attributed to a more than 50% decrease in the luminal area. The proposed dose reconstruction technique can be a powerful tool to predict late radiation toxicity with spatial consideration.
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