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Bleeker M, Hulshof MCCM, Bel A, Sonke JJ, van der Horst A. Stomach Motion and Deformation: Implications for Preoperative Gastric Cancer Radiation Therapy. Int J Radiat Oncol Biol Phys 2024; 118:543-553. [PMID: 37633498 DOI: 10.1016/j.ijrobp.2023.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/10/2023] [Accepted: 08/17/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE Selection and development of image guided strategies for preoperative gastric radiation therapy requires quantitative knowledge of the various sources of anatomic changes of the stomach. This study aims to investigate the magnitude of interfractional and intrafractional stomach motion and deformation using fiducial markers and 4-dimensional (4D) imaging. METHODS AND MATERIALS Fourteen patients who underwent preoperative gastric cancer radiation therapy received 2 to 6 fiducial markers distributed throughout the stomach (total of 54 markers) and additional imaging (ie, 1 planning 4D computed tomography [pCT], 20-25 pretreatment 4D cone beam [CB] CTs, 4-5 posttreatment 4D CBCTs). Marker coordinates on all end-exhale (EE) and end-inhale (EI) scans were obtained after a bony anatomy match. Interfractional marker displacements (ie, between EE pCT and all EE CBCTs) were evaluated for 5 anatomic regions (ie, cardia, small curvature, proximal and distal large curvature, and pylorus). Motion was defined as displacement of the center-of-mass of available markers (COMstomach), deformation as the average difference in marker-pair distances. Interfractional (ie, between EE pCT and all EE CBCTs), respiratory (between EE and EI pCT and CBCTs), and pre-post (pre- and posttreatment EE CBCTs) motion and deformation were quantified. RESULTS The interfractional marker displacement varied per anatomic region and direction, with systematic and random errors ranging from 1.6-8.8 mm and 2.2-8.2 mm, respectively. Respiratory motion varied per patient (median, 3-dimensional [3D] amplitude 5.2-20.0 mm) and day (interquartile range, 0.8-4.2 mm). Regarding COMstomach motion, respiratory motion was larger than interfractional motion (median, 10.9 vs 8.9 mm; P < .0001; Wilcoxon rank-sum), which was larger than pre-post motion (3.6 mm; P < .0001). Interfractional deformations (median, 5.8 mm) were significantly larger than pre-post deformations (2.6 mm; P < .0001), which were larger than respiratory deformation (1.8 mm; P < .0001). CONCLUSIONS The demonstrated sizable stomach motions and deformations during radiation therapy stress the need for generous nonuniform planning target volume margins for preoperative gastric cancer radiation therapy. These margins can be decreased by daily image guidance and adaptive radiation therapy.
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Affiliation(s)
- Margot Bleeker
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - Maarten C C M Hulshof
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Arjan Bel
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Astrid van der Horst
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Bleeker M, van der Horst A, Bel A, Sonke JJ, van Hooft JE, Pouw RE, Hulshof MC. Endoscopically placed fiducial markers for image-guided radiotherapy in preoperative gastric cancer: Technical feasibility and potential benefit. Endosc Int Open 2023; 11:E866-E872. [PMID: 37745837 PMCID: PMC10513787 DOI: 10.1055/a-2129-2840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/13/2023] [Indexed: 09/26/2023] Open
Abstract
Background and study aims Fiducial markers have demonstrated clinical value in radiotherapy in several organs, but little is known about markers in the stomach. Here, we assess the technical feasibility of endoscopic placement of markers in gastric cancer patients and their potential benefit for image-guided radiotherapy (IGRT). Patients and methods In this prospective feasibility study, 14 gastric cancer patients underwent endoscopy-guided gold (all patients) and liquid (7 patients) marker placements distributed throughout the stomach. Technical feasibility, procedure duration, and potential complications were evaluated. Assessed benefit for IGRT comprised marker visibility on acquired imaging (3-4 computed tomography [CT] scans and 19-25 cone-beam CTs [CBCTs] per patient) and lack of migration. Marker visibility was compared per marker type and location (gastroesophageal junction (i.e., junction/cardia), corpus (corpus/antrum/fundus), and pylorus). Results Of the 93 marker implantation attempts, 59 were successful, i.e., marker in stomach wall and present during entire 5-week radiotherapy course (2-6 successfully placed markers per patient), with no significant difference (Fisher's exact test; P >0.05) in success rate between gold (39/66=59%) and liquid (20/27=74%). Average procedure duration was 24.4 min (range 16-38). No procedure-related complications were reported. All successfully placed markers were visible on all CTs, with 81% visible on ≥95% of CBCTs. Five markers were poorly visible (on <75% of CBCTs), possibly due to small marker volume and peristaltic motion since all five were liquid markers located in the corpus. No migration was observed. Conclusions Endoscopic placement of fiducial markers in the stomach is technically feasible and safe. Being well visible and positionally stable, markers provide a potential benefit for IGRT.
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Affiliation(s)
- Margot Bleeker
- Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Cancer treatment and quality of life, Imaging and biomarkers, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Astrid van der Horst
- Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Arjan Bel
- Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Cancer treatment and quality of life, Imaging and biomarkers, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Jan-Jakob Sonke
- Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Jeanin E. van Hooft
- Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
- Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - R. E. Pouw
- Cancer treatment and quality of life, Imaging and biomarkers, Cancer Center Amsterdam, Amsterdam, Netherlands
- Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Boekhoff MR, Lagendijk JJ, L.H.M.W. van Lier A, Mook S, Meijer GJ. Intrafraction motion analysis in online adaptive radiotherapy for esophageal cancer. Phys Imaging Radiat Oncol 2023; 26:100432. [PMID: 37020582 PMCID: PMC10068261 DOI: 10.1016/j.phro.2023.100432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 03/22/2023] Open
Abstract
Intrafraction motion during magnetic resonance (MR)-guided dose delivery of esophageal cancer tumors was retrospectively analyzed. Deformable image registration of cine-MR series resulted in gross tumor volume motion profiles in all directions, which were subsequently filtered to isolate respiratory and drift motion. A large variability in intrafraction motion patterns was observed between patients. Median 95% peak-to-peak motion was 7.7 (3.7 - 18.3) mm, 2.1 (0.7 - 5.7) mm and 2.4 (0.5 - 5.6) mm in cranio-caudal, left-right and anterior-posterior directions, relatively. Furthermore, intrafraction drift was generally modest (<5mm). A patient specific approach could lead to very small margins (<3mm) for most patients.
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Opbroek TJ, Willems YC, Verhaegen F, de Ridder R, Hoge C, Melenhorst J, Bakers F, Grabsch HI, Buijsen J, van Limbergen EJ, Canters RA, Berbée M. BioXmark® liquid fiducials to enable radiotherapy tumor boosting in rectal cancer, a feasibility trial. Clin Transl Radiat Oncol 2022; 38:90-95. [PMID: 36407490 PMCID: PMC9668658 DOI: 10.1016/j.ctro.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022] Open
Abstract
BioXmark® is a novel liquid fiducial marker for image-guided radiotherapy. The marker remained stable during chemoradiotherapy in 96% of rectal cancer cases. The fiducial allows for image tracking on CT-based imaging modalities. Marker visibility was good using CT-based imaging without any relevant artifacts. The marker is easy to inject without marker related adverse events.
Background and purpose Dose-escalation in rectal cancer (RCa) may result in an increased complete response rate and thereby enable omission of surgery and organ preservation. In order to implement dose-escalation, it is crucial to develop a technique that allows for accurate image-guided radiotherapy. The aim of the current study was to determine the performance of a novel liquid fiducial marker (BioXmark®) in RCa patients during the radiotherapy course by assessing its positional stability on daily cone-beam CT (CBCT), technical feasibility, visibility on different imaging modalities and safety. Materials and methods Prospective, non-randomized, single-arm feasibility trial with inclusion of twenty patients referred for neoadjuvant chemoradiotherapy for locally advanced RCa. Primary study endpoint was positional stability on CBCT. Furthermore, technical aspects, safety and clinical performance of the marker, such as visibility on different imaging modalities, were evaluated. Results Seventy-four markers from twenty patients were available for analysis. The marker was stable in 96% of the cases. One marker showed clinically relevant migration, one marker was lost before start of treatment and one marker was lost during treatment. Marker visibility was good on computed tomography (CT) and CBCT, and moderate on electronic portal imaging (EPI). Marker visibility on magnetic resonance imaging (MRI) was poor during response evaluation. Conclusion The novel liquid fiducial marker demonstrated positional stability. We provide evidence of the feasibility of the novel fiducial marker for image-guided radiotherapy on daily cone beam CT for RCa patients.
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Shamshad M, Møller DS, Mortensen HR, Ehmsen ML, Jensen MF, Hoffmann L. Bone versus soft-tissue setup in proton therapy for patients with oesophageal cancer. Acta Oncol 2022; 61:994-1003. [PMID: 35775236 DOI: 10.1080/0284186x.2022.2091949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The aim of this study was to investigate the effect of patient positioning based on either bone or soft-tissue matching for PT in oesophageal cancer and its impact on plan adaptation. MATERIALS AND METHODS Two retrospective patient cohorts treated with radiotherapy were included in the study. Cohort A consisted of 26 consecutive patients with a planning 4DCT scan (CT1) and a surveillance 4DCT scan (CT2) at fraction ten. Cohort B consisted of 17 patients selected based on large anatomical changes identified during treatment resulting in a rescan (CT2). Mean dose to the iCTV (sum of the CTVs in all respiratory phases) was 50.4 Gy (RBE) in 28 fractions or 41.4 Gy (RBE) in 23 fractions. A nominal pencil beam scanning plan was created using two posterior beams and robust optimization (5 mm setup, 3.5% range). For each patient, two rigid registrations were made between average (avg) CT1 and CT2: a match on the vertebral column (bone match) and a match on the iCTV (soft-tissue match). Robustness towards setup (5 mm) and range (3.5%) errors was evaluated at CT2. Robustness towards respiration was evaluated by recalculation of the plan on all phases of the CT2 scan. Dose coverage <96% would trigger adaptation. The statistical significance (p-value <0.05) between dose coverage for the two registration methods was assessed using the Wilcoxon signed rank test. RESULTS All plans fulfilled V95%iCTV>99% for the nominal plan and V95%iCTV>97% for all respiratory phases and robustness scenarios at CT1. In two (8%) and three (18%) patients, V95%iCTV<96% on CT2 for Cohort A and B, respectively when bone match was used. For soft-tissue match, V95%iCTV >96% for all patients. V95%iCTV was significantly higher (p-value = 0.0001) for soft-tissue match than bone match. CONCLUSION Anatomical changes during the treatment course led to target dose deterioration and a need for plan adaptation when using a bone match.
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Affiliation(s)
- Muhammad Shamshad
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.,Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Ditte Sloth Møller
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | | | | | | | - Lone Hoffmann
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
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Hoffmann L, Mortensen H, Shamshad M, Berbee M, Bizzocchi N, Bütof R, Canters R, Defraene G, Lykkegaard Ehmsen M, Fiorini F, Haustermans K, Hulley R, Korevaar EW, Clarke M, Makocki S, Muijs CT, Murray L, Nicholas O, Nordsmark M, Radhakrishna G, Thomas M, Troost EGC, Vilches-Freixas G, Visser S, Weber DC, Sloth Møller D. Treatment planning comparison in the PROTECT-trial randomising proton versus photon beam therapy in oesophageal cancer: results from eight european centres. Radiother Oncol 2022; 172:32-41. [PMID: 35513132 DOI: 10.1016/j.radonc.2022.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/06/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare dose distributions and robustness in treatment plans from eight European centres in preparation for the European randomized phase-III PROTECT-trial investigating the effect of proton therapy (PT) versus photon therapy (XT) for oesophageal cancer. MATERIALS AND METHODS All centres optimized one PT and one XT nominal plan using delineated 4DCT scans for four patients receiving 50.4Gy(RBE) in 28 fractions. Target volume receiving 95% of prescribed dose (V95%iCTVtotal) should be >99%. Robustness towards setup, range, and respiration was evaluated. The plans were recalculated on a surveillance 4DCT (sCT) acquired at fraction ten and robustness evaluation was performed to evaluate the effect of respiration and inter-fractional anatomical changes. RESULTS All PT and XT plans complied with V95%iCTVtotal>99% for the nominal plan and V95%iCTVtotal>97% for all respiratory and robustness scenarios. Lung and heart dose varied considerably between centres for both modalities. The difference in mean lung dose and mean heart dose between each pair of XT and PT plans was in median [range] 4.8Gy [1.1;7.6] and 8.4Gy [1.9;24.5], respectively. Patients B and C showed large inter-fractional anatomical changes on sCT. For patient B, the minimum V95%iCTVtotal in the worst-case robustness scenario was 45% and 94% for XT and PT, respectively. For patient C, the minimum V95%iCTVtotal was 57% and 72% for XT and PT, respectively. Patient A and D showed minor inter-fractional changes and the minimum V95%iCTVtotal was >85%. CONCLUSION Large variability in dose to the lungs and heart was observed for both modalities. Inter-fractional anatomical changes led to larger target dose deterioration for XT than PT plans.
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Affiliation(s)
- Lone Hoffmann
- Department of Medical Physics, Aarhus University Hospital, Denmark; Dept. of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark.
| | - Hanna Mortensen
- Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
| | - Muhammad Shamshad
- Department of Medical Physics, Aarhus University Hospital, Denmark; Dept. of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
| | - Maaike Berbee
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, The Netherlands
| | - Nicola Bizzocchi
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland
| | - Rebecca Bütof
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Richard Canters
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, The Netherlands
| | - Gilles Defraene
- KU Leuven - University of Leuven - Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium
| | | | | | - Karin Haustermans
- KU Leuven - University of Leuven - Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium; University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - Ryan Hulley
- South West Wales Cancer Centre, Swansea University Board, UL AND Swansea University Medical School, United Kingdom
| | - Erik W Korevaar
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Matthew Clarke
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Sebastian Makocki
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Christina T Muijs
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Luke Murray
- Rutherford Cancer Centre, Shinfield, Reading, United Kingdom
| | - Owen Nicholas
- South West Wales Cancer Centre, Swansea University Board, UL AND Swansea University Medical School, United Kingdom
| | | | | | - Melissa Thomas
- KU Leuven - University of Leuven - Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium; University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - Esther G C Troost
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany; Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Rossendorf, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Gloria Vilches-Freixas
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, The Netherlands
| | - Sabine Visser
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland; Radiation Oncology Department, University Hospital Zurich, Zurich, Switzerland
| | - Ditte Sloth Møller
- Department of Medical Physics, Aarhus University Hospital, Denmark; Dept. of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
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Measuring distance from the incisors to the esophageal cancer by FDG PET/CT: endoscopy as the reference. BMC Gastroenterol 2022; 22:126. [PMID: 35300618 PMCID: PMC8928607 DOI: 10.1186/s12876-022-02206-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/07/2022] [Indexed: 12/24/2022] Open
Abstract
Background Using endoscopy as the reference, this study evaluated the accuracy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in measuring distance from the incisors to the PET detectable esophageal cancer. If there is high concordance between endoscopic and PET measurements, our results may provide a basis to use FDG PET/CT in cooperation with endoscopic measurement to localize those PET/CT and CT undetectable esophageal tumors for radiotherapy planning. Materials Esophageal cancer patients with pretreatment endoscopy and FDG PET/CT detectable esophageal tumors were recruited retrospectively. The distances from the incisors to the proximal esophageal tumor margins were determined by endoscopy and by the sagittal images of FDG PET/CT. The endoscopic measurement was used as the comparative reference. A nuclear medicine doctor and a radiation oncologist each performed the FDG PET/CT measurement twice for every patient. We analyzed the differences in these measurements, and assessed agreement and reproducibility of the results by the intraclass correlation coefficient (ICC). Results Thirty-four patients, with 35 esophageal tumors, were included. By endoscopy and FDG PET/CT, the mean distances from the incisors to the proximal esophageal tumor margin were 27.3 ± 6.4 cm (range 17.1–40.0 cm) and 26.8 ± 6.3 cm (range 15.7–41.3 cm), respectively. The mean absolute differences between the endoscopic and four FDG PET/CT measurements ranged from 1.129 to 1.289 cm (SD: 0.98–1.19). The measurement agreement between FDG PET/CT and endoscopy by ICC was between 0.962 and 0.971. The intra- and interobserver reproducibilities of the two readers were excellent (intraobserver ICC: 0.985, 0.996; interobserver ICC: 0.976–0.984). Conclusions FDG PET/CT was in high agreement with endoscopy in measuring the distance from the incisors to the proximal esophageal tumor margin. For FDG PET/CT and CT undetectable esophageal cancer, incorporation of the endoscopic measurement with PET/CT might be a way for making radiotherapy plan. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02206-z.
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Shi J, Tang Y, Li N, Song Y, Wang S, Liu Y, Fang H, Lu N, Tang Y, Qi S, Chen B, Li Y, Liu W, Jin J. Assessment and validation of the internal gross tumour volume of gastroesophageal junction cancer during simultaneous integrated boost radiotherapy. Radiat Oncol 2022; 17:22. [PMID: 35115015 PMCID: PMC8811972 DOI: 10.1186/s13014-022-01996-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 01/24/2022] [Indexed: 12/09/2022] Open
Abstract
Background Respiratory motion may introduce errors during radiotherapy. This study aims to assess and validate internal gross tumour volume (IGTV) margins in proximal and distal borders of gastroesophageal junction (GEJ) tumours during simultaneous integrated boost radiotherapy. Methods We enrolled 10 patients in group A and 9 patients in group B. For all patients, two markers were placed at the upper and lower borders of the tumour before treatment. In group A, within the simulation and every 5 fractions of radiotherapy, we used 4-dimensional computed tomography (4DCT) to record the intrafractional displacement of the proximal and distal markers. By fusing the average image of each repeated 4DCT with the simulation image based on the lumbar vertebra, the interfractional displacement could be obtained. We calculated the IGTV margin in the proximal and distal borders of the GEJ tumour. In group B, by referring to the simulation images and cone-beam computed tomography (CBCT) images, the range of tumour displacement in proximal and distal borders of GEJ tumour was estimated. We calculated the proportion of marker displacement range in group B lay within the IGTV margin calculated based on the data obtained in group A to estimate the accuracy of the IGTV margin. Results The intrafractional displacement in the cranial–caudal (CC) direction was significantly larger than that in the anterior–posterior (AP) and left–right (LR) directions for both the proximal and distal markers of the tumour. The interfractional displacement in the AP and LR directions was larger than that in the CC direction (p = 0.001, p = 0.017) based on the distal marker. The IGTV margins in the LR, AP and CC directions were 9 mm, 8.5 mm and 12.1 mm for the proximal marker and 15.8 mm, 12.7 mm and 11.5 mm for the distal marker, respectively. In group B, the proportions of markers that located within the IGTV margin in the LR, AP and CC directions were 96.5%, 91.3% and 96.5% for the proximal marker and 100%, 96.5%, 93.1% for the distal marker, respectively. Conclusions Our study proposed individualized IGTV margins for proximal and distal borders of GEJ tumours during neoadjuvant radiotherapy. The IGTV margin determined in this study was acceptable. This margin could be a reference in clinical practice.
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Affiliation(s)
- Jinming Shi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100021, China
| | - Yuan Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100021, China
| | - Ning Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100021, China
| | - Yongwen Song
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100021, China
| | - Shulian Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100021, China
| | - Yueping Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100021, China
| | - Hui Fang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100021, China
| | - Ningning Lu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100021, China
| | - Yu Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100021, China
| | - Shunan Qi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100021, China
| | - Bo Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100021, China
| | - Yexiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100021, China
| | - Wenyang Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100021, China.
| | - Jing Jin
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100021, China.
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Visser S, den Otter LA, Ribeiro CO, Korevaar EW, Both S, Langendijk JA, Muijs CT, Sijtsema NM, Knopf A. Diaphragm-Based Position Verification to Improve Daily Target Dose Coverage in Proton and Photon Radiation Therapy Treatment of Distal Esophageal Cancer. Int J Radiat Oncol Biol Phys 2021; 112:463-474. [PMID: 34530091 DOI: 10.1016/j.ijrobp.2021.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 08/21/2021] [Accepted: 09/06/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE In modern conformal radiation therapy of distal esophageal cancer, target coverage can be affected by variations in the diaphragm position. We investigated if daily position verification (PV) extended by a diaphragm position correction would optimize target dose coverage for esophageal cancer treatment. METHODS AND MATERIALS For 15 esophageal cancer patients, intensity modulated proton therapy (IMPT) and volumetric modulated arc therapy (VMAT) plans were computed. Displacements of the target volume were correlated with diaphragm displacements using repeated 4-dimensional computed tomography images to determine the correction needed to account for diaphragm variations. Afterwards, target coverage was evaluated for 3 PV approaches based on: (1) bony anatomy (PV_B), (2) bony anatomy corrected for the diaphragm position (PV_BD) and (3) target volume (PV_T). RESULTS The cranial-caudal mean target displacement was congruent with almost half of the diaphragm displacement (y = 0.459x), which was used for the diaphragm correction in PV_BD. Target dose coverage using PV_B was adequate for most patients with diaphragm displacements up till 10 mm (≥94% of the dose in 98% of the volume [D98%]). For larger displacements, the target coverage was better maintained by PV_T and PV_BD. Overall, PV_BD accounted best for target displacements, especially in combination with tissue density variations (D98%: IMPT 94% ± 5%, VMAT 96% ± 5%). Diaphragm displacements of more than 10 mm were observed in 22% of the cases. CONCLUSIONS PV_B was sufficient to achieve adequate target dose coverage in case of small deviations in diaphragm position. However, large deviations of the diaphragm were best mitigated by PV_BD. To detect the cases where target dose coverage could be compromised due to diaphragm position variations, we recommend monitoring of the diaphragm position before treatment through online imaging.
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Affiliation(s)
- Sabine Visser
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Lydia A den Otter
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Cássia O Ribeiro
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erik W Korevaar
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan Both
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Christina T Muijs
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nanna M Sijtsema
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Antje Knopf
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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10
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Boekhoff M, Defize I, Borggreve A, van Hillegersberg R, Kotte A, Lagendijk J, van Lier A, Ruurda J, Takahashi N, Mook S, Meijer G. An in-silico assessment of the dosimetric benefits of MR-guided radiotherapy for esophageal cancer patients. Radiother Oncol 2021; 162:76-84. [PMID: 34237345 DOI: 10.1016/j.radonc.2021.06.038] [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: 03/03/2021] [Revised: 06/17/2021] [Accepted: 06/26/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE To assess the dosimetric benefits of online MR-guided radiotherapy (MRgRT) for esophageal cancer patients and to assess how these benefits could be translated into a local boosting strategy to improve future outcomes. METHODS Twenty-nine patients were in-silico treated with both a MRgRT regimen and a conventional image guided radiotherapy (IGRT) regimen using dose warping techniques. Here, the inter and intrafractional changes that occur over the course of treatment (as derived from 5 MRI scans that were acquired weekly during treatment) were incorporated to assess the total accumulated dose for each regimen. RESULTS A significant reduction in dose to the organs-at-risk (OARs) was observed for all dose-volume-histogram (DVH) parameters for the MRgRT regimen without concessions to target coverage compared to the IGRT regimen. The mean lung dose was reduced by 28%, from 7.9 to 5.7 Gy respectively and V20Gy of the lungs was reduced by 55% (6.3-2.8%). A reduction of 24% was seen in mean heart dose (14.8-11.2 Gy), while the V25Gy of the heart was decreased by 53% (14.3-6.7%) and the V40Gy of the heart was decreased by 69% (3.9-1.2%). In addition, MRgRT dose escalation regimens with a boost up to 66% of the prescription dose to the primary tumor yielded approximately the same dose levels to the OARs as from the conventional IGRT regimen. CONCLUSION This study revealed that MRgRT for esophageal cancer has the potential to significantly reduce the dose to heart and lungs. In addition, online high precision targeting of the primary tumor opens new perspectives for local boosting strategies to improve outcome of the local management of this disease.
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Affiliation(s)
- Mick Boekhoff
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, The Netherlands.
| | - Ingmar Defize
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, The Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Alicia Borggreve
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, The Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht University, The Netherlands
| | | | - Alexis Kotte
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Jan Lagendijk
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Astrid van Lier
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Jelle Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, The Netherlands; Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Stella Mook
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Gert Meijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, The Netherlands.
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11
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Boekhoff MR, Defize IL, Borggreve AS, van Hillegersberg R, Kotte ANTJ, Lagendijk JJW, van Lier ALHMW, Ruurda JP, Takahashi N, Mook S, Meijer GJ. CTV-to-PTV margin assessment for esophageal cancer radiotherapy based on an accumulated dose analysis. Radiother Oncol 2021; 161:16-22. [PMID: 33992628 DOI: 10.1016/j.radonc.2021.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE This study aimed to assess the smallest clinical target volume (CTV) to planned target volume (PTV) margins for esophageal cancer radiotherapy using daily online registration to the bony anatomy that yield full dosimetric coverage over the course of treatment. METHODS 29 esophageal cancer patients underwent six T2-weighted MRI scans at weekly intervals. An online bone-match image-guided radiotherapy treatment of five fractions was simulated for each patient. Multiple conformal treatment plans with increasing margins around the CTV were created for each patient. Then, the dose was warped to obtain an accumulated dose per simulated fraction. Full target coverage by 95% of the prescribed dose was assessed as a function of margin expansion in six directions. If target coverage in a single direction was accomplished, then the respective margin remained fixed for the subsequent dose plans. Margins in uncovered directions were increased in a new dose plan until full target coverage was achieved. RESULTS The smallest set of CTV-to-PTV margins that yielded full dosimetric CTV coverage was 8 mm in posterior and right direction, 9 mm in anterior and cranial direction and 10 mm in left and caudal direction for 27 out of 29 patients. In two patients the curvature of the esophagus considerably changed between fractions, which required a 17 and 23 mm margin in right direction. CONCLUSION Accumulated dose analysis revealed that CTV-to-PTV treatment margins of 8, 9 and 10 mm in posterior & right, anterior & cranial and left & caudal direction, respectively, are sufficient to account for interfraction tumor variations over the course of treatment when applying a daily online bone match. However, two patients with extreme esophageal interfraction motion were insufficiently covered with these margins and were identified as patients requiring replanning to achieve full target coverage.
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Affiliation(s)
- M R Boekhoff
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands.
| | - I L Defize
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - A S Borggreve
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - A N T J Kotte
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - J J W Lagendijk
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - A L H M W van Lier
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - N Takahashi
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands; Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - S Mook
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - G J Meijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands.
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12
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Roos CTG, Faiz Z, Visser S, Dieters M, van der Laan HP, den Otter LA, Plukker JTM, Langendijk JA, Knopf AC, Muijs CT, Sijtsema NM. A comprehensive motion analysis - consequences for high precision image-guided radiotherapy of esophageal cancer patients. Acta Oncol 2021; 60:277-284. [PMID: 33151766 DOI: 10.1080/0284186x.2020.1843707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE When treating patients for esophageal cancer (EC) with photon or proton radiotherapy (RT), breathing motion of the target and neighboring organs may result in deviations from the planned dose distribution. The aim of this study was to evaluate the magnitude and dosimetric impact of breathing motion. Results were based on comparing weekly 4D computed tomography (4D CT) scans with the planning CT, using the diaphragm as an anatomical landmark for EC. MATERIAL AND METHODS A total of 20 EC patients were included in this study. Diaphragm breathing amplitudes and off-sets (changes in position with respect to the planning CT) were determined from delineated left diaphragm structures in weekly 4D CT-scans. The potential dosimetric impact of respiratory motion was shown in several example patients for photon and proton radiotherapy. RESULTS Variation in diaphragm amplitudes were relatively small and ranged from 0 to 0.8 cm. However, the measured off-sets were larger, ranging from -2.1 to 1.9 cm. Of the 70 repeat CT-scans, the off-set exceeded the ITV-PTV margin of 0.8 cm during expiration in 4 CT-scans (5.7%) and during inspiration in 13 CT-scans (18.6%). The dosimetric validation revealed under- and overdosages in the VMAT and IMPT plans. CONCLUSIONS Despite relatively constant breathing amplitudes, the variation in the diaphragm position (off-set), and consequently tumor position, was clinically relevant. These motion effects may result in either treatments that miss the target volume, or dose deviations in the form of highly localized over- or underdosed regions.
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Affiliation(s)
- Catharina T. G. Roos
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Zohra Faiz
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sabine Visser
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Margriet Dieters
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hans Paul van der Laan
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lydia A. den Otter
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - John T. M. Plukker
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes A. Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Antje-Christin Knopf
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Christina T. Muijs
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nanna M. Sijtsema
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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13
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Thomas M, De Roover R, van der Merwe S, Lambrecht M, Defraene G, Haustermans K. The use of tumour markers in oesophageal cancer to quantify setup errors and baseline shifts during treatment. Clin Transl Radiat Oncol 2020; 26:8-14. [PMID: 33251342 PMCID: PMC7677672 DOI: 10.1016/j.ctro.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/01/2020] [Accepted: 11/01/2020] [Indexed: 12/24/2022] Open
Abstract
Implantation of solid gold markers safe. Inter-fractional motion for markers in distal oesophagus largest cranio-caudally. Reduced radiotherapy treatment margins with soft-tissue vs. bony-anatomy matching. Impact of intra-fractional baseline shifts on margin calculation rather small.
Purpose To prospectively evaluate the feasibility of solid gold marker placement in oesophageal cancer patients and to quantify inter-fractional and intra-fractional (baseline shift) marker motion during radiation treatment. Radiotherapy target margins and matching strategies were investigated. Materials/methods Thirty-four markers were implanted by echo-endoscopy in 10 patients. Patients received a planning 4D CT, daily pre-treatment cone-beam CT (CBCT) and a post-treatment CBCT for at least five fractions. For fractions with both pre- and post-treatment CBCT, marker displacement between planning CT and pre-treatment CBCT (inter-fractional) and between pre-treatment and post-treatment CBCT (intra-fractional; only for fractions without rotational treatment couch correction) were calculated in left–right (LR), cranio-caudal (CC) and anterior-posterior (AP) direction after bony-anatomy and soft-tissue matching. Systematic/random setup errors were estimated; treatment margins were calculated. Results No serious adverse events occurred. Twenty-three (67.6%) markers were visible during radiotherapy (n = 3 middle oesophagus, n = 16 distal oesophagus, n = 4 proximal stomach). Margins for inter-fractional displacement after bony-anatomy match depended on the localisation of the primary tumour and were 11.2 mm (LR), 16.4 mm (CC) and 8.2 mm (AP) for distal markers. Soft-tissue matching reduced the CC margin for these markers (16.4 mm to 10.5 mm). The mean intra-fractional shift of 12 distal markers was 0.4 mm (LR), 2.3 mm (CC) and 0.7 mm (AP). Inclusion of this shift resulted in treatment margins for distal markers of 12.8 mm (LR), 17.3 mm (CC) and 10.4 mm (AP) after bony-anatomy matching and 12.4 mm (LR), 11.4 mm (CC) and 9.7 mm (AP) after soft-tissue matching. Conclusion This study demonstrated that the implantation of gold markers was safe, albeit less stable compared to other marker types. Inter-fractional motion was largest cranio-caudally for markers in the distal oesophagus, which was reduced after soft-tissue compared to bony-anatomy matching. The impact of intra-fractional baseline shifts on margin calculation was rather small.
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Key Words
- 2D, two-dimensional
- 3D, three-dimensional
- 4D, four-dimensional
- AP, anterior-posterior
- CBCT, cone-beam computed tomography
- CC, cranio-caudal
- CT, computed tomography
- CTV, clinical target volume
- CTVtotal, total clinical target volume
- DoF, degree-of-freedom
- EUS, endoscopic ultrasound
- Esophageal cancer
- FDG-PET/CT, fluorodeoxyglucose positron emission tomography with integrated computed tomography
- Fiducial gold markers
- GM, grand mean
- GTV, gross tumour volume
- IMRT, intensity modulated radiation therapy
- Inter-fractional motion
- Intra-fractional baseline shifts
- LR, left-right
- MRI, magnetic resonance imaging
- Matching strategies
- OAR, organ at risk
- PTV, planning target volume
- Radiotherapy treatment margins
- iCTV, internal clinical target volume
- kV, kilovoltage
- nCRT, neoadjuvant chemoradiation
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Affiliation(s)
- Melissa Thomas
- KU Leuven - University of Leuven, Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium.,University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - Robin De Roover
- KU Leuven - University of Leuven, Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium.,University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - Schalk van der Merwe
- University Hospitals Leuven, Department of Gastroenterology and Hepatology, Leuven, Belgium
| | - Maarten Lambrecht
- KU Leuven - University of Leuven, Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium.,University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - Gilles Defraene
- KU Leuven - University of Leuven, Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium
| | - Karin Haustermans
- KU Leuven - University of Leuven, Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium.,University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
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14
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Hagens ERC, Künzli HT, van Rijswijk AS, Meijer SL, Mijnals RCD, Weusten BLAM, Geijsen ED, van Laarhoven HWM, van Berge Henegouwen MI, Gisbertz SS. Distribution of lymph node metastases in esophageal adenocarcinoma after neoadjuvant chemoradiation therapy: a prospective study. Surg Endosc 2020; 34:4347-4357. [PMID: 31624944 DOI: 10.1007/s00464-019-07205-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/09/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND The distribution of lymph node metastases in esophageal adenocarcinoma following neoadjuvant chemoradiation (nCRTx) is unclear, but may have consequences for radiotherapy and surgery. The aim of this study was to define the distribution of lymph node metastases and relation to the radiation field in patients following nCRTx and esophagectomy. METHODS Between April 2014 and August 2015 esophageal adenocarcinoma patients undergoing transthoracic esophagectomy with 2-field lymphadenectomy following nCRTx were included in this prospective observational study. Lymph node stations according to AJCC 7 were separately investigated. The location of lymph node metastases in relation to the radiation field was determined. The primary endpoint was the distribution of lymph node metastases and relation to the radiation field, the secondary endpoints were high-risk stations and risk factors for lymph node metastases and relation to survival. RESULTS Fifty consecutive patients were included. Lymph node metastases were found in 60% of patients and most frequently observed in paraesophageal (28%), left gastric artery (24%), and celiac trunk (18%) stations. Fifty-two percent had lymph node metastases within the radiation field. The incidence of lymph node metastases correlated significantly with ypT-stage (p = 0.002), cT-stage (p = 0.005), lymph angioinvasion (p = 0.004), and Mandard (p = 0.002). The number of lymph node metastases was associated with survival in univariable analysis (HR 1.12, 95% CI 1.068-1.173, p < 0.001). CONCLUSIONS Esophageal adenocarcinoma frequently metastasizes to both the mediastinal and abdominal lymph node stations. In this study, more than half of the patients had lymph node metastases within the radiation field. nCRTx is therefore not a reason to minimize lymphadenectomy in patients with esophageal adenocarcinoma.
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Affiliation(s)
- Eliza R C Hagens
- Department of Surgery, Amsterdam UMC (Location AMC), University of Amsterdam, Cancer Center Amsterdam, 1105 AZ, Amsterdam, The Netherlands
| | - Hannah T Künzli
- Department of Gastroenterology and Hepatology, Amsterdam UMC (Location AMC), University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Anne-Sophie van Rijswijk
- Department of Surgery, Amsterdam UMC (Location AMC), University of Amsterdam, Cancer Center Amsterdam, 1105 AZ, Amsterdam, The Netherlands
| | - Sybren L Meijer
- Department of Pathology, Amsterdam UMC (Location AMC), University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - R Clinton D Mijnals
- Department of Pathology, Amsterdam UMC (Location AMC), University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Bas L A M Weusten
- Department of Gastroenterology and Hepatology, Amsterdam UMC (Location AMC), University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - E Debby Geijsen
- Department of Radiotherapy, Amsterdam UMC (Location AMC), University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Amsterdam UMC (Location AMC), University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC (Location AMC), University of Amsterdam, Cancer Center Amsterdam, 1105 AZ, Amsterdam, The Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC (Location AMC), University of Amsterdam, Cancer Center Amsterdam, 1105 AZ, Amsterdam, The Netherlands.
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15
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Boekhoff M, Defize I, Borggreve A, Takahashi N, van Lier A, Ruurda J, van Hillegersberg R, Lagendijk J, Mook S, Meijer G. 3-Dimensional target coverage assessment for MRI guided esophageal cancer radiotherapy. Radiother Oncol 2020; 147:1-7. [DOI: 10.1016/j.radonc.2020.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 01/21/2023]
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16
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Evaluation of a Novel Liquid Fiducial Marker, BioXmark ®, for Small Animal Image-Guided Radiotherapy Applications. Cancers (Basel) 2020; 12:cancers12051276. [PMID: 32443537 PMCID: PMC7280978 DOI: 10.3390/cancers12051276] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/17/2022] Open
Abstract
BioXmark® (Nanovi A/S, Denmark) is a novel fiducial marker based on a liquid, iodine-based and non-metallic formulation. BioXmark® has been clinically validated and reverse translated to preclinical models to improve cone-beam CT (CBCT) target delineation in small animal image-guided radiotherapy (SAIGRT). However, in phantom image analysis and in vivo evaluation of radiobiological response after the injection of BioXmark® are yet to be reported. In phantom measurements were performed to compare CBCT imaging artefacts with solid fiducials and determine optimum imaging parameters for BioXmark®. In vivo stability of BioXmark® was assessed over a 5-month period, and the impact of BioXmark® on in vivo tumour response from single-fraction and fractionated X-ray exposures was investigated in a subcutaneous syngeneic tumour model. BioXmark® was stable, well tolerated and detectable on CBCT at volumes ≤10 µL. Our data showed imaging artefacts reduced by up to 84% and 89% compared to polymer and gold fiducial markers, respectively. BioXmark® was shown to have no significant impact on tumour growth in control animals, but changes were observed in irradiated animals injected with BioXmark® due to alterations in dose calculations induced by the sharp contrast enhancement. BioXmark® is superior to solid fiducials with reduced imaging artefacts on CBCT. With minimal impact on the tumour growth delay, BioXmark® can be implemented in SAIGRT to improve target delineation and reduce set-up errors.
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17
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Sun LC, Su Y, Ding XC, Xu DS, Li CM, Wang L, Li WL, Sun XD, Yu JM, Meng X. In vitro and in vivo evaluation of the safety and efficacy of a novel liquid fiducial marker for image-guided radiotherapy. Oncol Lett 2020; 20:569-580. [PMID: 32565982 PMCID: PMC7286123 DOI: 10.3892/ol.2020.11591] [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: 05/07/2019] [Accepted: 03/26/2020] [Indexed: 12/30/2022] Open
Abstract
The true extent of a tumor is difficult to visualize, during radiotherapy, using current modalities. In the present study, the safety and feasibility of a mixture of N-butyl cyanoacrylate and lipiodol (NBCA/Lip) was evaluated in order to investigate the optimal combination for application as a fiducial marker for radiotherapy. Four combinations of NBCA/Lip injection (1:1–0.1, 1:1–0.15, 1:3–0.1 and 1:3–0.15 ml) were injected into the subcutaneous tissue of BALB/c mice. The changes in gross histopathology, body weight, skin score, marker volume, neutrophil and macrophage counts were observed to analyze the effects of the different mixing ratios and injection volumes, in order to identify the best combination. Evaluation according to the International Organization for Standardization criteria was further conducted in order to test the biocompatibility of the mixture, including an acute systematic assay with mice, cytotoxicity with L929 fibroblasts and delayed-type hypersensitivity tests with guinea pigs and an intradermal test with rabbits. The results revealed that at the seventh week, 42 markers (42/48; 87.5%) were still visible using computed tomography (CT) imaging. No serious adverse effects were observed throughout the study period; however, the combination of 1:1–0.1 ml had the lowest body weight and worst skin score. A review of the histopathological reaction to NBCA/Lip revealed a combination of acute inflammation, chronic inflammation, granulation tissue, foreign-body reaction and fibrous capsule formation. The 1:1 NBCA combination ratio resulted in the most intense tissue repair reaction and a slower degradation rate of markers. In general, the combination of 1:3–0.15 ml had a better fusion with local tissue, maintained a stable imaging nodule on CT images for 7 weeks and the final biocompatibility test demonstrated its safety. Overall, the findings of the present study demonstrated NBCA/Lip as a safe and feasible fiducial marker, when using the 1:3–0.15 ml combination.
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Affiliation(s)
- Liang-Chao Sun
- Department of Radiation Oncology and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, Shandong 300060, P.R. China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Yi Su
- Department of Radiotherapy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University Institution, Yantai, Shandong 264001, P.R. China
| | - Xing-Chen Ding
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Dong-Shui Xu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Cheng-Ming Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Lu Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Wan-Long Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Xin-Dong Sun
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Jin-Ming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Xue Meng
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
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18
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Quantification of Esophageal Tumor Motion and Investigation of Different Image-Guided Correction Strategies. Pract Radiat Oncol 2020; 10:84-92. [DOI: 10.1016/j.prro.2019.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/12/2019] [Accepted: 11/20/2019] [Indexed: 02/07/2023]
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19
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van den Ende RPJ, Kerkhof EM, Rigter LS, van Leerdam ME, Peters FP, van Triest B, Staring M, Marijnen CAM, van der Heide UA. Feasibility of Gold Fiducial Markers as a Surrogate for Gross Tumor Volume Position in Image-Guided Radiation Therapy of Rectal Cancer. Int J Radiat Oncol Biol Phys 2019; 105:1151-1159. [PMID: 31476419 DOI: 10.1016/j.ijrobp.2019.08.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/16/2019] [Accepted: 08/26/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the feasibility of fiducial markers as a surrogate for gross tumor volume (GTV) position in image-guided radiation therapy of rectal cancer. METHODS AND MATERIALS We analyzed 35 fiducials in 19 patients with rectal cancer who received short-course radiation therapy or long-course chemoradiation therapy. Magnetic resonance imaging examinations were performed before and after the first week of radiation therapy, and daily pre- and postirradiation cone beam computed tomography scans were acquired in the first week of radiation therapy. Between the 2 magnetic resonance imaging examinations, the fiducial displacement relative to the center of gravity of the GTV (COGGTV) and the COGGTV displacement relative to bony anatomy were determined. Using the cone beam computed tomography scans, inter- and intrafraction fiducial displacement relative to bony anatomy were determined. RESULTS The systematic error of the fiducial displacement relative to the COGGTV was 2.8, 2.4, and 4.2 mm in the left-right, anterior-posterior (AP), and craniocaudal (CC) directions, respectively. Large interfraction systematic errors of up to 8.0 mm and random errors up to 4.7 mm were found for COGGTV and fiducial displacements relative to bony anatomy, mostly in the AP and CC directions. For tumors located in the mid and upper rectum, these errors were up to 9.4 mm (systematic) and 5.6 mm (random) compared with 4.9 mm and 2.9 mm for tumors in the lower rectum. Systematic and random errors of the intrafraction fiducial displacement relative to bony anatomy were ≤2.1 mm in all directions. CONCLUSIONS Large interfraction errors of the COGGTV and the fiducials relative to bony anatomy were found. Therefore, despite the observed fiducial displacement relative to the COGGTV, the use of fiducials as a surrogate for GTV position reduces the required margins in the AP and CC directions for a GTV boost using image-guided radiation therapy of rectal cancer. This reduction in margin may be larger in patients with tumors located in the mid and upper rectum compared with the lower rectum.
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Affiliation(s)
- Roy P J van den Ende
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands.
| | - Ellen M Kerkhof
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Lisanne S Rigter
- Department of Gastroenterology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Femke P Peters
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Baukelien van Triest
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Marius Staring
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands; Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Corrie A M Marijnen
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Uulke A van der Heide
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands; Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
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20
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Machiels M, Voncken FEM, Jin P, van Dieren JM, Bartels-Rutten A, Alderliesten T, Aleman BMP, van Hooft JE, Hulshof MCCM. A Novel Liquid Fiducial Marker in Esophageal Cancer Image Guided Radiation Therapy: Technical Feasibility and Visibility on Imaging. Pract Radiat Oncol 2019; 9:e506-e515. [PMID: 31279938 DOI: 10.1016/j.prro.2019.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/20/2019] [Accepted: 06/25/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the technical feasibility of injection, visibility on imaging modalities, and positional stability of a novel liquid fiducial marker (ie, BioXmark) for radiation therapy in patients with esophageal cancer. METHODS First, the visibility on imaging of different volumes of the liquid marker was analyzed ex vivo in porcine tissue (ie, on computed tomography [CT], cone beam CT (CBCT), and magnetic resonance imaging [MRI]). Next, for the in vivo part, the liquid fiducial markers were injected under endoscopic (ultrasound) guidance in 10 patients with curable esophageal cancer. The technical feasibility of the injection procedure and the clinical performance (ie, visibility and positional stability on imaging) were evaluated. Planning CT, daily CBCT, and serial MRI images (before, during, and after chemoradiation therapy in a subset of 3 patients) were acquired. RESULTS Ex vivo, the optimal volume for good visibility without artifacts was 0.1 mL per injected marker. In vivo, a total of 28 markers were injected in 10 patients (range, 0.025-0.1 mL). No adverse effects were identified. The first 2 cases (4 markers) were considered as learning cases. A total of 19 of 24 of the liquid markers (79%) were visible on CT, 3 of 4 (75%) on MRI, and 19 of 24 (79%) on the first CBCT. All markers with an injected volume of >0.05 mL were visible on the different imaging modalities. Positional stability analysis on CBCT identified no time trend during the radiation therapy course. No artifacts could be detected for liquid marker volumes of 0.05 and 0.025 mL in CT or CBCT. CONCLUSIONS Injection of a liquid fiducial marker for esophageal cancer radiation therapy is technically feasible with no adverse events identified. Volumes of >0.05 mL have an appropriate visibility on CT, CBCT, and MRI, with an excellent positional stability. Liquid fiducial markers are therefore promising for use in image guided radiation therapy.
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Affiliation(s)
- Mélanie Machiels
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Francine E M Voncken
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Peng Jin
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jolanda M van Dieren
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Tanja Alderliesten
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Berthe M P Aleman
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Maarten C C M Hulshof
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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21
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Setup strategies and uncertainties in esophageal radiotherapy based on detailed intra- and interfractional tumor motion mapping. Radiother Oncol 2019; 136:161-168. [DOI: 10.1016/j.radonc.2019.04.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/05/2019] [Accepted: 04/07/2019] [Indexed: 02/07/2023]
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22
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Machiels M, Jin P, van Hooft JE, Gurney-Champion OJ, Jelvehgaran P, Geijsen ED, Jeene PM, Willemijn Kolff M, Oppedijk V, Rasch CRN, van Herk MB, Alderliesten T, Hulshof MCCM. Reduced inter-observer and intra-observer delineation variation in esophageal cancer radiotherapy by use of fiducial markers. Acta Oncol 2019; 58:943-950. [PMID: 30905243 DOI: 10.1080/0284186x.2019.1588991] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Delineation variation of esophageal tumors remains a large source of geometric uncertainty. In the present study, we investigated the inter- and intra-observer variation in esophageal gross tumor volume (GTV) delineation and the impact of endoscopically implanted fiducial markers on these variations. Material/Methods: Ten esophageal cancer patients with at least two markers endoscopically implanted at the cranial and caudal tumor borders and visible on the planning computed tomography (pCT) were included in this study. Five dedicated gastrointestinal radiation oncologists independently delineated GTVs on the pCT without markers and with markers. The GTV was first delineated on pCTs where markers were digitally removed and next on the original pCT with markers. Both delineation series were executed twice to determine intra-observer variation. For both the inter- and intra-observer analyses, the generalized conformity index (CIgen), and the standard deviation (SD) of the distances between delineated surfaces (i.e., overall, longitudinal, and radial SDs) were calculated. Linear mixed-effect models were used to compare the without and with markers series (α = 0.05). Results: Both the inter- and intra-observer CIgen were significantly larger in the series with markers than in the series without markers (p < .001). For the series without markers vs. with markers, the inter-observer overall SD, longitudinal SD, and radial SD was 0.63 cm vs. 0.22 cm, 1.44 cm vs. 0.42 cm, and 0.26 cm vs. 0.18 cm, respectively (p < .05); moreover, the intra-observer overall SD, longitudinal SD, and radial SD was 0.45 cm vs. 0.26 cm, 1.10 cm vs. 0.41 cm, and 0.22 cm vs. 0.15 cm, respectively (p < .05). Conclusion: The presence of markers at the cranial and caudal tumor borders significantly reduced both inter- and intra-observer GTV delineation variation, especially in the longitudinal direction. Our results endorse the use of markers in GTV delineation for esophageal cancer patients.
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Affiliation(s)
- Mélanie Machiels
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Peng Jin
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Jeanin E. van Hooft
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Oliver J. Gurney-Champion
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Pouya Jelvehgaran
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
- Department of Physics and Astronomy, Institute for Laser Life and Biophotonics Amsterdam, Amsterdam, The Netherlands
| | - Elizabeth D. Geijsen
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Paul M. Jeene
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - M. Willemijn Kolff
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Vera Oppedijk
- Department of Radiation Oncology, Radiotherapy Institute Friesland, Leeuwarden, The Netherlands
| | - Coen. R. N. Rasch
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Marcel B. van Herk
- The Christie NHS Foundation Trust, University of Manchester Institute of Cancer Sciences, Manchester, United Kingdom
| | - Tanja Alderliesten
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Maarten C. C. M. Hulshof
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
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Utility of fiducial markers for target positioning in proton radiotherapy of oesophageal carcinoma. Radiother Oncol 2019; 133:28-34. [DOI: 10.1016/j.radonc.2018.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/11/2018] [Accepted: 12/17/2018] [Indexed: 01/05/2023]
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24
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Jin P, Machiels M, Crama KF, Visser J, van Wieringen N, Bel A, Hulshof MCCM, Alderliesten T. Dosimetric Benefits of Midposition Compared With Internal Target Volume Strategy for Esophageal Cancer Radiation Therapy. Int J Radiat Oncol Biol Phys 2019; 103:491-502. [PMID: 30253234 DOI: 10.1016/j.ijrobp.2018.09.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 09/07/2018] [Accepted: 09/18/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Both midposition (MidP) and internal target volume (ITV) strategies can take the respiration-induced target motion into account. This study aimed to compare these 2 strategies in terms of clinical target volume (CTV) coverage and dose to organs at risk (OARs) for esophageal cancer radiation therapy (RT). METHODS AND MATERIALS Fifteen patients with esophageal cancer were included retrospectively for neoadjuvant RT planning. Per patient, a 10-phase, 4-dimensional (4D) computed tomography (CT) scan (4D-CT) was acquired with CTV and OARs delineated on the 20% phase. The MidP-CT scan was reconstructed based on deformable image registration between the 20% phase and the other 9 phases; thereby, the CTV and OARs delineations were propagated and an ITV was constructed. Both MidP and ITV strategies were used for treatment planning, yielding the planned dose. Next, these plans were applied to the 10-phase 4D-CT to calculate the dose distribution for each phase of the 4D-CT. On the basis of the deformable image registration, these calculated dose distributions were warped and averaged to yield the accumulated 4D dose. Subsequently, we compared, in terms of CTV coverage and dose to OARs, the planned dose with the accumulated 4D dose and the MidP strategy with the ITV strategy. RESULTS The differences between the planned dose and the accumulated 4D dose were limited and clinically irrelevant. In 14 patients, both MidP and ITV strategies showed V95% > 98% for the CTV. Compared with the ITV strategy, the MidP strategy showed a significant reduction of approximately 10% in the dose-volume histogram parameters for the lungs, heart, and liver (P < .001, Wilcoxon signed-rank test). CONCLUSIONS Compared with the ITV strategy, the MidP strategy in treatment planning can lead to a reduction of approximately 10% in the dose to OARs, with an adequate CTV coverage for esophageal cancer RT.
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Affiliation(s)
- Peng Jin
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
| | - Mélanie Machiels
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Koen F Crama
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Jorrit Visser
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Niek van Wieringen
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Arjan Bel
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Maarten C C M Hulshof
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Tanja Alderliesten
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
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van den Ende RPJ, Rigter LS, Kerkhof EM, van Persijn van Meerten EL, Rijkmans EC, Lambregts DMJ, van Triest B, van Leerdam ME, Staring M, Marijnen CAM, van der Heide UA. MRI visibility of gold fiducial markers for image-guided radiotherapy of rectal cancer. Radiother Oncol 2018; 132:93-99. [PMID: 30825976 DOI: 10.1016/j.radonc.2018.11.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/29/2018] [Accepted: 11/25/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND PURPOSE A GTV boost is suggested to result in higher complete response rates in rectal cancer patients, which is attractive for organ preservation. Fiducials may offer GTV position verification on (CB)CT, if the fiducial-GTV spatial relationship can be accurately defined on MRI. The study aim was to evaluate the MRI visibility of fiducials inserted in the rectum. MATERIALS AND METHODS We tested four fiducial types (two Visicoil types, Cook and Gold Anchor), inserted in five patients each. Four observers identified fiducial locations on two MRI exams per patient in two scenarios: without (scenario A) and with (scenario B) (CB)CT available. A fiducial was defined to be consistently identified if 3 out of 4 observers labeled that fiducial at the same position on MRI. Fiducial visibility was scored on an axial and sagittal T2-TSE sequence and a T1 3D GRE sequence. RESULTS Fiducial identification was poor in scenario A for all fiducial types. The Visicoil 0.75 and Gold Anchor were the most consistently identified fiducials in scenario B with 7 out of 9 and 8 out of 11 consistently identified fiducials in the first MRI exam and 2 out of 7 and 5 out of 10 in the second MRI exam, respectively. The consistently identified Visicoil 0.75 and Gold Anchor fiducials were best visible on the T1 3D GRE sequence. CONCLUSION The Visicoil 0.75 and Gold Anchor fiducials were the most visible fiducials on MRI as they were most consistently identified. The use of a registered (CB)CT and a T1 3D GRE MRI sequence is recommended.
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Affiliation(s)
- Roy P J van den Ende
- Department of Radiation Oncology, Leiden University Medical Center, the Netherlands.
| | - Lisanne S Rigter
- Department of Gastroenterology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ellen M Kerkhof
- Department of Radiation Oncology, Leiden University Medical Center, the Netherlands
| | | | - Eva C Rijkmans
- Department of Radiation Oncology, Leiden University Medical Center, the Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Baukelien van Triest
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Marius Staring
- Department of Radiation Oncology, Leiden University Medical Center, the Netherlands; Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Corrie A M Marijnen
- Department of Radiation Oncology, Leiden University Medical Center, the Netherlands
| | - Uulke A van der Heide
- Department of Radiation Oncology, Leiden University Medical Center, the Netherlands; Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
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26
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Jin P, Crama KF, Visser J, van Wieringen N, Bel A, Hulshof MC, Alderliesten T. Density override in treatment planning to mitigate the dosimetric effect induced by gastrointestinal gas in esophageal cancer radiation therapy. Acta Oncol 2018; 57:1646-1654. [PMID: 30289340 DOI: 10.1080/0284186x.2018.1518590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To investigate the dosimetric effect of variable gas volume in esophageal cancer radiation therapy (RT) and whether a density override (DO) in treatment planning can effectively mitigate this dosimetric effect. MATERIAL AND METHODS Nine patients with gastrointestinal gas pockets in the planning computed tomography (pCT) were retrospectively included. Per patient, the intensity-modulated RT (IMRT) and volumetric-modulated arc therapy (VMAT) plans associated with no DO, DO = 0.5, and DO = 1 in the gas pockets were made. Initial and follow-up gas volumes were assessed from the pCTs and cone-beam CTs (CBCTs), respectively. Fractional CTs were created based on the pCT and CBCTs to calculate the fractional doses using all six plans. We then investigated for all six plans the correlation between the gas volume difference (relative to initial gas volume) and the dose difference (relative to planned dose). We also calculated and compared the accumulated dose by summing the fractional doses using two strategies: single-plan strategy (i.e. using each of the six plans separately) and plan-selection strategy (i.e. selecting one of the three plans depending on the fractional gas volume for IMRT and VMAT planning separately). RESULTS The dose difference was approximately linearly correlated to the gas volume difference. Underdoses of >3.5% and overdoses of >7% were found for gas volume decreases >160 mL/330 mL and increases >260 mL/370 mL for IMRT/VMAT planning, respectively. Moreover, for most patients, the single-plan strategy with the use of DO = 0.5 resulted in neither undesired underdose nor much overdose. The plan-selection strategy, however, can always ensure sufficient target coverage and minimize high dose regions to the most extent. CONCLUSIONS The variation in gas volume during the treatment course can result in clinically undesired underdose or overdose. The DO-based plan-selection strategy can effectively mitigate the gas-induced underdose and minimize the overdose for esophageal cancer RT.
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Affiliation(s)
- Peng Jin
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Koen F. Crama
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jorrit Visser
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Niek van Wieringen
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Arjan Bel
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Maarten C.C.M. Hulshof
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Tanja Alderliesten
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
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27
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de Blanck SR, Scherman-Rydhög J, Siemsen M, Christensen M, Baeksgaard L, Irming Jølck R, Specht L, Andresen TL, Persson GF. Feasibility of a novel liquid fiducial marker for use in image guided radiotherapy of oesophageal cancer. Br J Radiol 2018; 91:20180236. [PMID: 29975152 DOI: 10.1259/bjr.20180236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE: To evaluate the feasibility of a new liquid fiducial marker for use in image-guided radiotherapy for oesophageal cancer. METHODS: Liquid fiducial markers were implanted in patients with metastatic or inoperable locally advanced oesophageal or gastro-oesophageal junction cancer receiving radiotherapy. Markers were implanted using a conventional gastroscope equipped with a 22 G Wang needle. Marker visibility was evaluated on fluoroscopy, CT, MRI and cone beam CT scans. RESULTS: Liquid markers (n = 16) were injected in four patients. No Grade 2 or worse adverse events were observed in relation to the implantation procedure, during treatment or in the follow-up period. 12/16 (75%) markers were available at the planning CT-scan and throughout the treatment- and follow-up period. The implanted markers were adequately visible in CT and cone beam CT but were difficult to distinguish in fluoroscopy and MRI without information from the corresponding CT image. CONCLUSION: Liquid fiducial marker placement in the oesophagus proved safe and clinically feasible. ADVANCES IN KNOWLEDGE: This paper presents the first clinical use of a new liquid fiducial marker in patients with oesophageal cancer and demonstrates that marker implantation using standard gastroscopic equipment and subsequent use in three-dimensional image-guided radiation therapy is safe and clinically feasible.
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Affiliation(s)
- Steen Riisgaard de Blanck
- 1Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Jonas Scherman-Rydhög
- 2Department of Physics, Niels Bohr Institute, University of Copenhagen , Copenhagen , Denmark.,3 Department of Radiation Physics, Skane University Hospital , Lund , Sweden
| | - Mette Siemsen
- 4 Department of Thoracic Surgery, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Merete Christensen
- 4 Department of Thoracic Surgery, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Lene Baeksgaard
- 1Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Rasmus Irming Jølck
- 5 DTU Nanotech, Department of Micro-and Nanotechnology, Center for Nanomedicine and Theranostics, Technical University of Denmark , Kongens Lyngby , Denmark.,6 Nanovi A/S, DTU Scion , Kongens Lyngby , Denmark
| | - Lena Specht
- 1Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Thomas Lars Andresen
- 5 DTU Nanotech, Department of Micro-and Nanotechnology, Center for Nanomedicine and Theranostics, Technical University of Denmark , Kongens Lyngby , Denmark
| | - Gitte Fredberg Persson
- 1Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
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Quantifying esophageal motion during free-breathing and breath-hold using fiducial markers in patients with early-stage esophageal cancer. PLoS One 2018; 13:e0198844. [PMID: 29889910 PMCID: PMC5995399 DOI: 10.1371/journal.pone.0198844] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 05/25/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction Cardiac toxicity after definitive chemoradiotherapy for esophageal cancer is a critical issue. To reduce irradiation doses to organs at risk, individual internal margins need to be identified and minimized. The purpose of this study was to quantify esophageal motion using fiducial makers based on four-dimensional computed tomography, and to evaluate the inter-CBCT session marker displacement using breath-hold. Materials and methods Sixteen patients with early stage esophageal cancer, who received endoscopy-guided metallic marker placement for treatment planning, were included; there were 35 markers in total, with 9, 15, and 11 markers in the upper thoracic, middle thoracic, and lower thoracic/esophagogastric junction regions, respectively. We defined fiducial marker motion as motion of the centroidal point of the markers. Respiratory esophageal motion during free-breathing was defined as the amplitude of individual marker motion between the consecutive breathing and end-expiration phases, derived from four-dimensional computed tomography. The inter-CBCT session marker displacement using breath-hold was defined as the amplitudes of marker motion between the first and each cone beam computed tomography image. Marker motion was analyzed in the three regions (upper thoracic, middle thoracic, and lower thoracic/esophagogastric junction) and in three orthogonal directions (right-left; anterior-posterior; and superior-inferior). Results Respiratory esophageal motion during free-breathing resulted in median absolute maximum amplitudes (interquartile range), in right-left, anterior-posterior, and superior-inferior directions, of 1.7 (1.4) mm, 2.0 (1.5) mm, and 3.6 (4.1) mm, respectively, in the upper thoracic region, 0.8 (1.1) mm, 1.4 (1.2) mm, and 4.8 (3.6) mm, respectively, in the middle thoracic region, and 1.8 (0.8) mm, 1.9 (2.0) mm, and 8.0 (4.5) mm, respectively, in the lower thoracic/esophagogastric region. The inter-CBCT session marker displacement using breath-hold resulted in median absolute maximum amplitudes (interquartile range), in right-left, anterior–posterior, and superior-inferior directions, of 1.3 (1.0) mm, 1.1 (0.7) mm, and 3.3 (1.8) mm, respectively, in the upper thoracic region, 0.7 (0.7) mm, 1.1 (0.4) mm, and 3.4 (1.4) mm, respectively, in the middle thoracic region, and 2.0 (0.8) mm, 2.6 (2.2) mm, and 3.5 (1.8) mm, respectively, in the lower thoracic/esophagogastric region. Conclusions During free-breathing, esophageal motion in the superior-inferior direction in all sites was large, compared to the other directions, and amplitudes showed substantial inter-individual variability. The breath-hold technique is feasible for minimizing esophageal displacement during radiotherapy in patients with esophageal cancer.
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Machiels M, Jin P, van Gurp CH, van Hooft JE, Alderliesten T, Hulshof MCCM. Comparison of carina-based versus bony anatomy-based registration for setup verification in esophageal cancer radiotherapy. Radiat Oncol 2018; 13:48. [PMID: 29562919 PMCID: PMC5861603 DOI: 10.1186/s13014-018-0986-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 02/27/2018] [Indexed: 11/11/2022] Open
Abstract
Background To investigate the feasibility and geometric accuracy of carina-based registration for CBCT-guided setup verification in esophageal cancer IGRT, compared with current practice bony anatomy-based registration. Methods Included were 24 esophageal cancer patients with 65 implanted fiducial markers, visible on planning CTs and follow-up CBCTs. All available CBCT scans (n = 236) were rigidly registered to the planning CT with respect to the bony anatomy and the carina. Target coverage was visually inspected and marker position variation was quantified relative to both registration approaches; the variation of systematic (Σ) and random errors (σ) was estimated. Results Automatic carina-based registration was feasible in 94.9% of the CBCT scans, with an adequate target coverage in 91.1% compared to 100% after bony anatomy-based registration. Overall, Σ (σ) in the LR/CC/AP direction was 2.9(2.4)/4.1(2.4)/2.2(1.8) mm using the bony anatomy registration compared to 3.3(3.0)/3.6(2.6)/3.9(3.1) mm for the carina. Mid-thoracic placed markers showed a non-significant but smaller Σ in CC and AP direction when using the carina-based registration. Conclusions Compared with a bony anatomy-based registration, carina-based registration for esophageal cancer IGRT results in inadequate target coverage in 8.9% of cases. Furthermore, large Σ and σ, requiring larger anisotropic margins, were seen after carina-based registration. Only for tumors entirely confined to the mid-thoracic region the carina-based registration might be slightly favorable. Electronic supplementary material The online version of this article (10.1186/s13014-018-0986-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mélanie Machiels
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Peng Jin
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Christianne H van Gurp
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Tanja Alderliesten
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Maarten C C M Hulshof
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
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Jelvehgaran P, Alderliesten T, Weda JJA, de Bruin M, Faber DJ, Hulshof MCCM, van Leeuwen TG, van Herk M, de Boer JF. Visibility of fiducial markers used for image-guided radiation therapy on optical coherence tomography for registration with CT: An esophageal phantom study. Med Phys 2017; 44:6570-6582. [DOI: 10.1002/mp.12624] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 09/14/2017] [Accepted: 10/03/2017] [Indexed: 12/13/2022] Open
Affiliation(s)
- Pouya Jelvehgaran
- Department of Biomedical Engineering and Physics; Academic Medical Center; University of Amsterdam; Amsterdam AZ 1105 The Netherlands
- Department of Radiation Oncology; Academic Medical Center; University of Amsterdam; Amsterdam AZ 1105 The Netherlands
- Institute for Laser Life and Biophotonics Amsterdam; Physics and Astronomy; VU University Amsterdam; Amsterdam HV 1081 The Netherlands
| | - Tanja Alderliesten
- Department of Radiation Oncology; Academic Medical Center; University of Amsterdam; Amsterdam AZ 1105 The Netherlands
| | - Jelmer J. A. Weda
- Institute for Laser Life and Biophotonics Amsterdam; Physics and Astronomy; VU University Amsterdam; Amsterdam HV 1081 The Netherlands
| | - Martijn de Bruin
- Department of Biomedical Engineering and Physics; Academic Medical Center; University of Amsterdam; Amsterdam AZ 1105 The Netherlands
- Department of Urology; Academic Medical Center; University of Amsterdam; Amsterdam AZ 1105 The Netherlands
| | - Dirk J. Faber
- Department of Biomedical Engineering and Physics; Academic Medical Center; University of Amsterdam; Amsterdam AZ 1105 The Netherlands
| | - Maarten C. C. M. Hulshof
- Department of Radiation Oncology; Academic Medical Center; University of Amsterdam; Amsterdam AZ 1105 The Netherlands
| | - Ton G. van Leeuwen
- Department of Biomedical Engineering and Physics; Academic Medical Center; University of Amsterdam; Amsterdam AZ 1105 The Netherlands
| | - Marcel van Herk
- Department of Biomedical Engineering and Physics; Academic Medical Center; University of Amsterdam; Amsterdam AZ 1105 The Netherlands
- Institute of Cancer Sciences; University of Manchester; Manchester UK
| | - Johannes F. de Boer
- Institute for Laser Life and Biophotonics Amsterdam; Physics and Astronomy; VU University Amsterdam; Amsterdam HV 1081 The Netherlands
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van Nunen A, van der Sangen MJC, van Boxtel M, van Haaren PMA. Cone-Beam CT-based position verification for oesophageal cancer: Evaluation of registration methods and anatomical changes during radiotherapy. Tech Innov Patient Support Radiat Oncol 2017; 3-4:30-36. [PMID: 32095564 PMCID: PMC7033772 DOI: 10.1016/j.tipsro.2017.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/21/2017] [Accepted: 07/28/2017] [Indexed: 12/25/2022] Open
Abstract
Purpose To evaluate different registration methods, setup margins and number of corrections for CBCT-based position verification for oesophageal cancer and to evaluate anatomical changes during the course of radiotherapy treatment. Methods From 50 patients, 440 CBCT-scans were registered automatically using a soft tissue or bone registration algorithm and compared to the clinical match. Moreover, relevant anatomical changes were monitored. A sub-analysis was performed to evaluate if tumour location influenced setup variations. Margin calculation was performed and the number of setup corrections was estimated. Results were compared to a patient group previously treated with MV-EPID based position verification. Results CBCT-based setup variations were smaller than EPID-based setup variations, resulting in smaller setup margins of 5.9 mm (RL), 7.5 mm (CC) and 4.7 mm (AP) versus 6.0 mm, 7.8 mm and 5.5 mm, respectively. A reduction in average number of setup corrections per patient was found from 0.75 to 0.36. From all automatically registered CBCT-scans, a clipbox around PTV and vertebras combined with soft tissue registration resulted in the smallest setup margins of 5.9 mm (RL), 7.7 mm (CC), 4.8 mm (AP) and smallest average number of corrections of 0.38. For distally located tumours, a setup margin of 7.7 mm (CC) was required compared to 5.6 mm for proximal tumours. Reduction of GTV volume, heart volume and change in diaphragm position were observed in 16, 10 and 15 patients, respectively. Conclusions CBCT-based set-up variations are smaller than EPID-based variations and vary according to tumour location. When using kV-CBCT a large variety of anatomical changes is revealed, which cannot be observed with MV-EPID.
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Key Words
- AC, Adenocarcinoma
- Anatomical changes
- CBCT, Cone Beam Computed Tomography
- CTV, Clinical Target Volume
- Cone-Beam CT
- EPID, Electronic Portal Imaging Device
- EUS, Endoscopic UltraSound
- GTV, Gross Tumor Volume
- IGRT, Image Guided RadioTherapy
- IMRT, Intensity Modulated Radiotherapy
- OAR, Organs at Risk
- Oesophageal cancer
- PET/CT, Positron Emission Tomography/Computed Tomography
- PTV, Planning Target Volume
- SAL, Shrinking Action Level
- SCC, Squamous Cell Carcinoma
- Setup margins
- Setup variations
- TPS, Treatment Planning System
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Affiliation(s)
- A van Nunen
- Department of Radiotherapy, Catharina Hospital, Eindhoven, The Netherlands
| | | | - M van Boxtel
- Department of Radiotherapy, Catharina Hospital, Eindhoven, The Netherlands
| | - P M A van Haaren
- Department of Radiotherapy, Catharina Hospital, Eindhoven, The Netherlands
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van Dijk IWEM, Huijskens SC, de Jong R, Visser J, Fajardo RD, Rasch CRN, Alderliesten T, Bel A. Interfractional renal and diaphragmatic position variation during radiotherapy in children and adults: is there a difference? Acta Oncol 2017; 56:1065-1071. [PMID: 28281356 DOI: 10.1080/0284186x.2017.1299936] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pediatric safety margins are generally based on data from adult studies; however, adult-based margins might be too large for children. The aim of this study was to quantify and compare interfractional organ position variation in children and adults. MATERIAL AND METHODS For 35 children and 35 adults treated with thoracic/abdominal irradiation, 850 (range 5-30 per patient) retrospectively collected cone beam CT images were registered to the reference CT that was used for radiation treatment planning purposes. Renal position variation was assessed in three orthogonal directions and summarized as 3D vector lengths. Diaphragmatic position variation was assessed in the cranio-caudal (CC) direction only. We calculated means and SDs to estimate group systematic (Σ) and random errors (σ) of organ position variation. Finally, we investigated possible correlations between organ position variation and patients' height. RESULTS Interfractional organ position variation was different in children and adults. Median 3D right and left kidney vector lengths were significantly smaller in children than in adults (2.8, 2.9 mm vs. 5.6, 5.2 mm, respectively; p < .05). Generally, the pediatric Σ and σ were significantly smaller than in adults (p < .007). Overall and within both subgroups, organ position variation and patients' height were only negligibly correlated. CONCLUSIONS Interfractional renal and diaphragmatic position variation in children is smaller than in adults indicating that pediatric margins should be defined differently from adult margins. Underlying mechanisms and other components of geometrical uncertainties need further investigation to explain differences and to appropriately define pediatric safety margins.
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Affiliation(s)
- Irma W. E. M. van Dijk
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sophie C. Huijskens
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Rianne de Jong
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jorrit Visser
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Raquel Dávila Fajardo
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Coen R. N. Rasch
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Tanja Alderliesten
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Arjan Bel
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Jin P, Hulshof MC, van Wieringen N, Bel A, Alderliesten T. Interfractional variability of respiration-induced esophageal tumor motion quantified using fiducial markers and four-dimensional cone-beam computed tomography. Radiother Oncol 2017; 124:147-154. [DOI: 10.1016/j.radonc.2017.05.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 05/18/2017] [Accepted: 05/21/2017] [Indexed: 01/25/2023]
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Jin P, Hulshof MC, de Jong R, van Hooft JE, Bel A, Alderliesten T. Quantification of respiration-induced esophageal tumor motion using fiducial markers and four-dimensional computed tomography. Radiother Oncol 2016; 118:492-7. [DOI: 10.1016/j.radonc.2016.01.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 11/18/2015] [Accepted: 01/07/2016] [Indexed: 12/13/2022]
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