1
|
Castriconi R, Tudda A, Placidi L, Benecchi G, Cagni E, Dusi F, Ianiro A, Landoni V, Malatesta T, Mazzilli A, Meffe G, Oliviero C, Rambaldi Guidasci G, Scaggion A, Trojani V, Del Vecchio A, Fiorino C. Inter-institutional variability of knowledge-based plan prediction of left whole breast irradiation. Phys Med 2024; 120:103331. [PMID: 38484461 DOI: 10.1016/j.ejmp.2024.103331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 02/05/2024] [Accepted: 03/08/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE Within a multi-institutional project, we aimed to assess the transferability of knowledge-based (KB) plan prediction models in the case of whole breast irradiation (WBI) for left-side breast irradiation with tangential fields (TF). METHODS Eight institutions set KB models, following previously shared common criteria. Plan prediction performance was tested on 16 new patients (2 pts per centre) extracting dose-volume-histogram (DVH) prediction bands of heart, ipsilateral lung, contralateral lung and breast. The inter-institutional variability was quantified by the standard deviations (SDint) of predicted DVHs and mean-dose (Dmean). The transferability of models, for the heart and the ipsilateral lung, was evaluated by the range of geometric Principal Component (PC1) applicability of a model to test patients of the other 7 institutions. RESULTS SDint of the DVH was 1.8 % and 1.6 % for the ipsilateral lung and the heart, respectively (20 %-80 % dose range); concerning Dmean, SDint was 0.9 Gy and 0.6 Gy for the ipsilateral lung and the heart, respectively (<0.2 Gy for contralateral organs). Mean predicted doses ranged between 4.3 and 5.9 Gy for the ipsilateral lung and 1.1-2.3 Gy for the heart. PC1 analysis suggested no relevant differences among models, except for one centre showing a systematic larger sparing of the heart, concomitant to a worse PTV coverage, due to high priority in sparing the left anterior descending coronary artery. CONCLUSIONS Results showed high transferability among models and low inter-institutional variability of 2% for plan prediction. These findings encourage the building of benchmark models in the case of TF-WBI.
Collapse
Affiliation(s)
- Roberta Castriconi
- Medical Physics Dept, IRCCS San Raffaele Scientific Institute, Milano, Italy.
| | - Alessia Tudda
- Medical Physics Dept, IRCCS San Raffaele Scientific Institute, Milano, Italy; Università Statale di Milano, Milano, Italy
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanna Benecchi
- Medical Physics Dept, University Hospital of Parma AOUP, Parma, Italy
| | - Elisabetta Cagni
- Medical Physics Unit, Department of Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Dusi
- Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Anna Ianiro
- IRCCS Istituto Nazionale dei Tumori Regina Elena, Rome, Italy
| | - Valeria Landoni
- IRCCS Istituto Nazionale dei Tumori Regina Elena, Rome, Italy
| | - Tiziana Malatesta
- UOC di Radioterapia Oncologica, Fatebenefratelli Isola Tiberina - Gemelli Isola, Roma, Italy
| | - Aldo Mazzilli
- Medical Physics Dept, University Hospital of Parma AOUP, Parma, Italy
| | - Guenda Meffe
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Alessandro Scaggion
- Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Valeria Trojani
- Medical Physics Unit, Department of Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Claudio Fiorino
- Medical Physics Dept, IRCCS San Raffaele Scientific Institute, Milano, Italy
| |
Collapse
|
2
|
Chan MKH. A sub-analysis of multi-center planning radiosurgery for intracranial metastases through automation (MC-PRIMA) comparing UK and international centers. Med Eng Phys 2023; 117:103996. [PMID: 37331750 DOI: 10.1016/j.medengphy.2023.103996] [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: 01/06/2023] [Revised: 04/23/2023] [Accepted: 05/17/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES A sub-analysis of the MC-PRIMA study was performed to compare the plan quality of stereotactic radiosurgery (SRS) to multiple brain metastases (MBM) between UK and other international centres. METHODS AND MATERIALS Six centres from the UK and nineteen from other international centres autoplanned using Multiple Brain Mets™ (AutoMBM; Brainlab, Munich, Germany) software for a five MBM study case from a prior planning competition that was originally organized by the Trans-Tasmania Radiation Oncology Group (TROG). Twenty-three dosimetric metrics and the resulting composite plan score per the TROG planning competition were compared between the UK and other international centres. Planning experience and planning time from each planner were recorded and statistically compared. RESULTS Planning experiences between two groups are equal. Except for mean dose to the hippocampus, all other 22 dosimetric metrics were comparable between two groups. The inter-planner variations in these 23 dosimetric metrics and the composite plan score were also statistically equivalent. Planning time is slightly longer in the UK group (mean = 86.8 min) with a mean difference of 50.3 min. CONCLUSIONS AutoMBM effectively achieves standardization of the plan quality of SRS to MBM within UK and further against the other international centres. Significant planning efficiency gain by AutoMBM both among the UK and other international centres may help to increase the capacity of SRS service by alleviating the clinical and technical loadings.
Collapse
Affiliation(s)
- Mark K H Chan
- University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
| |
Collapse
|
3
|
Paronetto C, den Toom W, Milder MTW, van Norden Y, Baak R, Heijmen BJM, Méndez Romero A. Inter- and intrafraction dose variations in robotic stereotactic body radiation therapy (SBRT) for perihilar cholangiocarcinoma in the prospective phase I STRONG trial. Front Oncol 2023; 13:1114737. [PMID: 36969072 PMCID: PMC10032458 DOI: 10.3389/fonc.2023.1114737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
Using fiducial-marker-based robotic respiratory tumor tracking, we treated perihilar cholangiocarcinoma patients in the STRONG trial with 15 daily fractions of 4 Gy. For each of the included patients, in-room diagnostic-quality repeat CTs (rCT) were acquired pre- and post-dose delivery in 6 treatment fractions to analyze inter- and intrafraction dose variations. Planning CTs (pCTs) and rCTs were acquired in expiration breath-hold. Analogous to treatment, spine and fiducials were used to register rCTs with pCTs. In each rCT, all OARs were contoured, and the target was rigidly copied from the pCT based on grey values. The rCTs acquired were used to calculate the doses to be delivered through the treatment-unit settings. On average, target doses in rCTs and pCTs were similar. However, due to target displacements relative to the fiducials in rCTs, 10% of the rCTs showed PTV coverage losses of >10%. Although target coverages had been planned below desired values in order to protect OARs, many pre-rCTs contained OAR constraint violations: 44.4% for the 6 major constraints. Most OAR dose differences between pre- and post-rCTs were not statistically significant. The dose deviations observed in repeat CTs represent opportunities for more advanced adaptive approaches to enhancing SBRT treatment quality.
Collapse
Affiliation(s)
- Chiara Paronetto
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Radiotherapy, Istituto Oncologico Veneto (IOV), Padova, Italy
- *Correspondence: Chiara Paronetto, ,
| | - Wilhelm den Toom
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Maaike T. W. Milder
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Yvette van Norden
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Rogier Baak
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Ben J. M. Heijmen
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Alejandra Méndez Romero
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| |
Collapse
|
4
|
Tudda A, Castriconi R, Benecchi G, Cagni E, Cicchetti A, Dusi F, Esposito PG, Guernieri M, Ianiro A, Landoni V, Mazzilli A, Moretti E, Oliviero C, Placidi L, Rambaldi Guidasci G, Rancati T, Scaggion A, Trojani V, Fiorino C. Knowledge-based multi-institution plan prediction of whole breast irradiation with tangential fields. Radiother Oncol 2022; 175:10-16. [PMID: 35868603 DOI: 10.1016/j.radonc.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To quantify inter-institute variability of Knowledge-Based (KB) models for right breast cancer patients treated with tangential fields whole breast irradiation (WBI). MATERIALS AND METHODS Ten institutions set KB models by using RapidPlan (Varian Inc.), following previously shared methodologies. Models were tested on 20 new patients from the same institutes, exporting DVH predictions of heart, ipsilateral lung, contralateral lung, and contralateral breast. Inter-institute variability was quantified by the inter-institute SDint of predicted DVHs/Dmean. Association between lung sparing vs PTV coverage strategy was also investigated. The transferability of models was evaluated by the overlap of each model's geometric Principal Component (PC1) when applied to the test patients of the other 9 institutes. RESULTS The overall inter-institute variability of DVH/Dmean ipsilateral lung dose prediction, was less than 2% (20%-80% dose range) and 0.55 Gy respectively (1SD) for a 40 Gy in 15 fraction schedule; it was < 0.2 Gy for other OARs. Institute 6 showed the lowest mean dose prediction value and no overlap between PTV and ipsilateral lung. Once excluded, the predicted ipsilateral lung Dmean was correlated with median PTV D99% (R2 = 0.78). PC1 values were always within the range of applicability (90th percentile) for 7 models: for 2 models they were outside in 1/18 cases. For the model of institute 6, it failed in 7/18 cases. The impact of inter-institute variability of dose calculation was tested and found to be almost negligible. CONCLUSIONS Results show limited inter-institute variability of plan prediction models translating in high inter-institute interchangeability, except for one of ten institutes. These results encourage future investigations in generating benchmarks for plan prediction incorporating inter-institute variability.
Collapse
Affiliation(s)
- Alessia Tudda
- Medical Physics Dept, San Raffaele Scientific Institute, Milano, Italy; Università Statale di Milano, Milano, Italy
| | | | | | - Elisabetta Cagni
- Medical Physics Unit, Department of Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Francesca Dusi
- Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Marika Guernieri
- Department of Medical Physics, University Hospital, Udine, Italy
| | - Anna Ianiro
- Istituto Nazionale dei Tumori Regina Elena, Rome, Italy
| | | | - Aldo Mazzilli
- Medical Physics Dept, University Hospital of Parma AOUP, Italy
| | - Eugenia Moretti
- Department of Medical Physics, University Hospital, Udine, Italy
| | | | - Lorenzo Placidi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giulia Rambaldi Guidasci
- Amethyst Radioterapia Italia, Medical Physics Department, San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - Tiziana Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Scaggion
- Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Valeria Trojani
- Medical Physics Unit, Department of Advanced Technology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Claudio Fiorino
- Medical Physics Dept, San Raffaele Scientific Institute, Milano, Italy
| |
Collapse
|
5
|
Variability of Target Volumes and Organs at Risk Delineation in Breast Cancer Radiation Therapy: Quality Assurance Results of the Pretrial Benchmark Case for the POTENTIAL Trial. Pract Radiat Oncol 2022; 12:397-408. [DOI: 10.1016/j.prro.2021.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 11/17/2022]
|
6
|
Petragallo R, Bardach N, Ramirez E, Lamb JM. Barriers and facilitators to clinical implementation of radiotherapy treatment planning automation: A survey study of medical dosimetrists. J Appl Clin Med Phys 2022; 23:e13568. [PMID: 35239234 PMCID: PMC9121037 DOI: 10.1002/acm2.13568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/22/2021] [Accepted: 02/03/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Little is known about the scale of clinical implementation of automated treatment planning techniques in the United States. In this work, we examine the barriers and facilitators to adoption of commercially available automated planning tools into the clinical workflow using a survey of medical dosimetrists. METHODS/MATERIALS Survey questions were developed based on a literature review of automation research and cognitive interviews of medical dosimetrists at our institution. Treatment planning automation was defined to include auto-contouring and automated treatment planning. Survey questions probed frequency of use, positive and negative perceptions, potential implementation changes, and demographic and institutional descriptive statistics. The survey sample was identified using both a LinkedIn search and referral requests sent to physics directors and senior physicists at 34 radiotherapy clinics in our state. The survey was active from August 2020 to April 2021. RESULTS Thirty-four responses were collected out of 59 surveys sent. Three categories of barriers to use of automation were identified. The first related to perceptions of limited accuracy and usability of the algorithms. Eighty-eight percent of respondents reported that auto-contouring inaccuracy limited its use, and 62% thought it was difficult to modify an automated plan, thus limiting its usefulness. The second barrier relates to the perception that automation increases the probability of an error reaching the patient. Third, respondents were concerned that automation will make their jobs less satisfying and less secure. Large majorities reported that they enjoyed plan optimization, would not want to lose that part of their job, and expressed explicit job security fears. CONCLUSION To our knowledge this is the first systematic investigation into the views of automation by medical dosimetrists. Potential barriers and facilitators to use were explicitly identified. This investigation highlights several concrete approaches that could potentially increase the translation of automation into the clinic, along with areas of needed research.
Collapse
Affiliation(s)
- Rachel Petragallo
- Department of Radiation OncologyUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Naomi Bardach
- Department of PediatricsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Ezequiel Ramirez
- Department of Radiation OncologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - James M. Lamb
- Department of Radiation OncologyUniversity of CaliforniaLos AngelesCaliforniaUSA
| |
Collapse
|
7
|
Duan J, Qiu Q, Zhu J, Shang D, Dou X, Sun T, Yin Y, Meng X. Reproducibility for Hepatocellular Carcinoma CT Radiomic Features: Influence of Delineation Variability Based on 3D-CT, 4D-CT and Multiple-Parameter MR Images. Front Oncol 2022; 12:881931. [PMID: 35494061 PMCID: PMC9047864 DOI: 10.3389/fonc.2022.881931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/21/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Accurate lesion segmentation is a prerequisite for radiomic feature extraction. It helps to reduce the features variability so as to improve the reporting quality of radiomics study. In this research, we aimed to conduct a radiomic feature reproducibility test of inter-/intra-observer delineation variability in hepatocellular carcinoma using 3D-CT images, 4D-CT images and multiple-parameter MR images. Materials and Methods For this retrospective study, 19 HCC patients undergoing 3D-CT, 4D-CT and multiple-parameter MR scans were included in this study. The gross tumor volume (GTV) was independently delineated twice by two observers based on contrast-enhanced computed tomography (CECT), maximum intensity projection (MIP), LAVA-Flex, T2W FRFSE and DWI-EPI images. We also delineated the peritumoral region, which was defined as 0 to 5 mm radius surrounding the GTV. 107 radiomic features were automatically extracted from CECT images using 3D-Slicer software. Quartile coefficient of dispersion (QCD) and intraclass correlation coefficient (ICC) were applied to assess the variability of each radiomic feature. QCD<10% and ICC≥0.75 were considered small variations and excellent reliability. Finally, the principal component analysis (PCA) was used to test the feasibility of dimensionality reduction. Results For tumor tissues, the numbers of radiomic features with QCD<10% indicated no obvious inter-/intra-observer differences or discrepancies in 3D-CT, 4D-CT and multiple-parameter MR delineation. However, the number of radiomic features (mean 89) with ICC≥0.75 was the highest in the multiple-parameter MR group, followed by the 3DCT group (mean 77) and the MIP group (mean 73). The peritumor tissues also showed similar results. A total of 15 and 7 radiomic features presented excellent reproducibility and small variation in tumor and peritumoral tissues, respectively. Two robust features showed excellent reproducibility and small variation in tumor and peritumoral tissues. In addition, the values of the two features both represented statistically significant differences among tumor and peritumoral tissues (P<0.05). The PCA results indicated that the first seven principal components could preserve at least 90% of the variance of the original set of features. Conclusion Delineation on multiple-parameter MR images could help to improve the reproducibility of the HCC CT radiomic features and weaken the inter-/intra-observer influence.
Collapse
Affiliation(s)
- Jinghao Duan
- School of Precision Instrument and Opto-electronics Engineering, Tianjin University, Tianjin, China
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Qingtao Qiu
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jian Zhu
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Dongping Shang
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xue Dou
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Tao Sun
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yong Yin
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xiangjuan Meng
- Department of Clinical Laboratory, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, Jinan, China
- *Correspondence: Xiangjuan Meng,
| |
Collapse
|
8
|
Fu Y, Zhang H, Morris ED, Glide-Hurst CK, Pai S, Traverso A, Wee L, Hadzic I, Lønne PI, Shen C, Liu T, Yang X. Artificial Intelligence in Radiation Therapy. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2022; 6:158-181. [PMID: 35992632 PMCID: PMC9385128 DOI: 10.1109/trpms.2021.3107454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Artificial intelligence (AI) has great potential to transform the clinical workflow of radiotherapy. Since the introduction of deep neural networks, many AI-based methods have been proposed to address challenges in different aspects of radiotherapy. Commercial vendors have started to release AI-based tools that can be readily integrated to the established clinical workflow. To show the recent progress in AI-aided radiotherapy, we have reviewed AI-based studies in five major aspects of radiotherapy including image reconstruction, image registration, image segmentation, image synthesis, and automatic treatment planning. In each section, we summarized and categorized the recently published methods, followed by a discussion of the challenges, concerns, and future development. Given the rapid development of AI-aided radiotherapy, the efficiency and effectiveness of radiotherapy in the future could be substantially improved through intelligent automation of various aspects of radiotherapy.
Collapse
Affiliation(s)
- Yabo Fu
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Hao Zhang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Eric D. Morris
- Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, CA 90095, USA
| | - Carri K. Glide-Hurst
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Suraj Pai
- Maastricht University Medical Centre, Netherlands
| | | | - Leonard Wee
- Maastricht University Medical Centre, Netherlands
| | | | - Per-Ivar Lønne
- Department of Medical Physics, Oslo University Hospital, PO Box 4953 Nydalen, 0424 Oslo, Norway
| | - Chenyang Shen
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75002, USA
| | - Tian Liu
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| |
Collapse
|
9
|
Planning benchmark study for SBRT of liver metastases: Results of the DEGRO/DGMP working group stereotactic radiotherapy and radiosurgery. Int J Radiat Oncol Biol Phys 2022; 113:214-227. [PMID: 35074434 DOI: 10.1016/j.ijrobp.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 12/19/2021] [Accepted: 01/07/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate, if liver SBRT treatment planning can be harmonized across different treatment planning systems, delivery techniques and institutions by using a specific prescription method and to minimize the knowledge gap concerning inter-system and inter-user differences. To provide best practice guidelines for all used techniques. METHODS A multiparametric specification of target dose (GTVD50%, GTVD0.1cc, GTVV90%, PTVV70%) with a prescription dose of GTVD50% = 3 × 20 Gy and OAR limits were distributed with CTs and structure sets from three liver metastases patients. Thirty-five institutions provided 132 treatment plans using different irradiation techniques. These plans were first analyzed for target and OAR doses. Four different renormalization methods were performed (PTVDmin, PTVD98%, PTVD2%, PTVDmax). The resulting 660 treatments plans were evaluated regarding target doses in order to study the effect of dose renormalization to different prescription methods. A relative scoring system was used for comparisons. RESULTS GTVD50% prescription can be performed in all systems. Treatment plan harmonization was overall successful with standard deviations for Dmax, PTVD98%, GTVD98% and PTVDmean of 1.6 Gy, 3.3 Gy, 1.9 Gy and 1.5 Gy, respectively. Primary analysis showed 55 major deviations from clinical goals in 132 plans, while in only <20% of deviations GTV/PTV dose was traded for meeting OAR limits. GTVD50% prescription produced the smallest deviation from target planning objectives and between techniques, followed by the PTVDmax, PTVD98%, PTVD2% and PTVDmin prescription. Deviations were significant for all combinations but for the PTVDmax prescription compared with GTVD50% and PTVD98%. Based on the various dose prescription methods, all systems significantly differed from each other, while GTVD50% and PTVD98% prescription showed the least differences between the systems. CONCLUSIONS This study showed the feasibility of harmonizing liver SBRT treatment plans across different treatment planning systems and delivery techniques when a sufficient set of clinical goals is given.
Collapse
|
10
|
Tyler J, Bernstein D, Seithel M, Rooney K, Petkar I, Miles E, Clark CH, Hall E, Nutting C. Quality assurance of dysphagia-optimised intensity modulated radiotherapy treatment planning for head and neck cancer. Phys Imaging Radiat Oncol 2021; 20:46-50. [PMID: 34754954 PMCID: PMC8560997 DOI: 10.1016/j.phro.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/06/2021] [Accepted: 10/10/2021] [Indexed: 12/04/2022] Open
Abstract
This study aimed to assess the impact of the margin applied to the clinical target volume, to create the planning target volume, on plan quality of a novel dysphagia-optimised intensity modulated radiotherapy technique developed within a head and neck cancer multicentre randomised controlled trial. Protocol compliant plans were used for a single benchmark planning case. Larger margins were associated with higher doses to adjacent organs at risk, particularly the inferior pharyngeal constrictor muscle, but coincided with some improved low dose target coverage. A 3 mm margin is recommended for this technique if local practices allow.
Collapse
Key Words
- CERR, Computational Environment for Radiotherapy Research
- DARS, dysphagia/aspiration related structures
- DICOM, Digital Imaging and Communications in Medicine
- DO-IMRT, dysphagia optimised intensity modulated radiotherapy
- Dysphagia
- Head and neck cancer
- ICR-CTSU, Clinical Trials and Statistics Unit and the Institute of Cancer Research
- IPCM, inferior pharyngeal constrictor muscle
- Intensity modulated radiotherapy (IMRT)
- NIHR, National Institute for Health Research
- PAF, plan assessment form
- Quality assurance
- RTQA, radiotherapy quality assurance
- RTTQA, UK’s National Radiotherapy Trials Quality Assurance Group
- Randomised controlled trial
- S-IMRT, standard intensity modulated radiotherapy
- SMPCM, superior and middle pharyngeal constrictor muscles
- TMG, Trial Management Group
- Volumetric arc therapy (VMAT)
Collapse
Affiliation(s)
- Justine Tyler
- National Radiotherapy Trials Quality Assurance Group, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - David Bernstein
- National Radiotherapy Trials Quality Assurance Group, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
| | - Matthew Seithel
- National Radiotherapy Trials Quality Assurance Group, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Keith Rooney
- Radiotherapy Department, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Imran Petkar
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
- Radiotherapy Department, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Elizabeth Miles
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, Northwood, Middlesex HA6 2RN, UK
| | - Catharine H Clark
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, Northwood, Middlesex HA6 2RN, UK
- Radiotherapy Physics, University College London Hospital NHS Foundation Trust, 5th Floor West, 250 Euston Road, NW1 2PG, UK
- Department of Medical Physics and Biomedical Engineering, University College London, WC1E 6BT, UK
- Metrology for Medical Physics, National Physical Laboratory, Hampton Rd, Teddington, TW11 0PX, UK
| | - Emma Hall
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
| | - Chris Nutting
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
- Radiotherapy Department, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| |
Collapse
|
11
|
Comparison of volumetric modulated arc therapy and intensity-modulated radiotherapy for left-sided whole-breast irradiation using automated planning. Strahlenther Onkol 2021; 198:236-246. [PMID: 34351452 PMCID: PMC8863712 DOI: 10.1007/s00066-021-01817-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 07/01/2021] [Indexed: 11/23/2022]
Abstract
Background Published treatment technique comparisons for postoperative left-sided whole breast irradiation (WBI) with deep-inspiration breath-hold (DIBH) are scarce, small, and inconclusive. In this study, fully automated multi-criterial plan optimization, generating a single high-quality, Pareto-optimal plan per patient and treatment technique, was used to compare for a large patient cohort 1) intensity modulated radiotherapy (IMRT) with two tangential fields and 2) volumetric modulated arc therapy (VMAT) with two small tangential subarcs. Materials and methods Forty-eight randomly selected patients recently treated with DIBH and 16 × 2.66 Gy were included. The optimizer was configured for the clinical planning protocol. Comparisons between IMRT and VMAT included dosimetric plan parameters, estimated excess relative risks (ERR) for toxicities, delivery times, MUs, and deliverability accuracy at a linac. Results The automatically generated IMRT and VMAT plans applied in this study were similar or higher in quality than the manually generated clinical plans. For equal PTVin V95% (98.4 ± 0.9%), VMAT had significant advantages compared to IMRT regarding breast dose homogeneity and doses in heart and ipsilateral lung, at the cost of some minor deteriorations for contralateral breast (few cases with larger deteriorations) and lung. Conformality improved from 1.38 to 1.18 (p < 0.001). With VMAT, ERR for major coronary events and ipsilateral lung tumors were reduced by 3% (range: −1–12%) and 16% (range: −3–38%), respectively. MUs and delivery times were higher for VMAT. There were no statistical differences in γ passing rates. Conclusion For WBI in conservative therapy of left-sided breast patients treated with DIBH, VMAT with two tangential subarcs was generally dosimetrically superior to IMRT with two tangential static fields. Results need confirmation by robustness analyses.
Collapse
|
12
|
van den Ende RPJ, Peters FP, Harderwijk E, Rütten H, Bouwmans L, Berbee M, Canters RAM, Stoian G, Compagner K, Rozema T, de Smet M, Intven MPW, Tijssen RHN, Theuws J, van Haaren P, van Triest B, Eekhout D, Marijnen CAM, van der Heide UA, Kerkhof EM. Radiotherapy quality assurance for mesorectum treatment planning within the multi-center phase II STAR-TReC trial: Dutch results. Radiat Oncol 2020; 15:41. [PMID: 32070386 PMCID: PMC7027245 DOI: 10.1186/s13014-020-01487-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/10/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The STAR-TReC trial is an international multi-center, randomized, phase II study assessing the feasibility of short-course radiotherapy or long-course chemoradiotherapy as an alternative to total mesorectal excision surgery. A new target volume is used for both (chemo)radiotherapy arms which includes only the mesorectum. The treatment planning QA revealed substantial variation in dose to organs at risk (OAR) between centers. Therefore, the aim of this study was to determine the treatment plan variability in terms of dose to OAR and assess the effect of a national study group meeting on the quality and variability of treatment plans for mesorectum-only planning for rectal cancer. METHODS Eight centers produced 25 × 2 Gy treatment plans for five cases. The OAR were the bowel cavity, bladder and femoral heads. A study group meeting for the participating centers was organized to discuss the planning results. At the meeting, the values of the treatment plan DVH parameters were distributed among centers so that results could be compared. Subsequently, the centers were invited to perform replanning if they considered this to be necessary. RESULTS All treatment plans, both initial planning and replanning, fulfilled the target constraints. Dose to OAR varied considerably for the initial planning, especially for dose levels below 20 Gy, indicating that there was room for trade-offs between the defined OAR. Five centers performed replanning for all cases. One center did not perform replanning at all and two centers performed replanning on two and three cases, respectively. On average, replanning reduced the bowel cavity V20Gy by 12.6%, bowel cavity V10Gy by 22.0%, bladder V35Gy by 14.7% and bladder V10Gy by 10.8%. In 26/30 replanned cases the V10Gy of both the bowel cavity and bladder was lower, indicating an overall lower dose to these OAR instead of a different trade-off. In addition, the bowel cavity V10Gy and V20Gy showed more similarity between centers. CONCLUSIONS Dose to OAR varied considerably between centers, especially for dose levels below 20 Gy. The study group meeting and the distribution of the initial planning results among centers resulted in lower dose to the defined OAR and reduced variability between centers after replanning. TRIAL REGISTRATION The STAR-TReC trial, ClinicalTrials.gov Identifier: NCT02945566. Registered 26 October 2016, https://clinicaltrials.gov/ct2/show/NCT02945566).
Collapse
Affiliation(s)
- Roy P. J. van den Ende
- Department of Radiation Oncology, Leiden University Medical Center, P.O. Box 9600 2300, RC, Leiden, the Netherlands
| | - Femke P. Peters
- Department of Radiation Oncology, Leiden University Medical Center, P.O. Box 9600 2300, RC, Leiden, the Netherlands
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ernst Harderwijk
- Department of Radiation Oncology, Leiden University Medical Center, P.O. Box 9600 2300, RC, Leiden, the Netherlands
| | - Heidi Rütten
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Liza Bouwmans
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Maaike Berbee
- Department of Radiation Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Richard A. M. Canters
- Department of Radiation Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Georgiana Stoian
- Department of Radiation Oncology, Isala Clinics, Zwolle, the Netherlands
| | - Kim Compagner
- Department of Radiation Oncology, Isala Clinics, Zwolle, the Netherlands
| | - Tom Rozema
- Department of Radiation Oncology, Verbeeten Institute, Tilburg, the Netherlands
| | - Mariska de Smet
- Department of Radiation Oncology, Verbeeten Institute, Tilburg, the Netherlands
| | - Martijn P. W. Intven
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rob H. N. Tijssen
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jacqueline Theuws
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Paul van Haaren
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Baukelien van Triest
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Dave Eekhout
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Corrie A. M. Marijnen
- Department of Radiation Oncology, Leiden University Medical Center, P.O. Box 9600 2300, RC, Leiden, the Netherlands
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Uulke A. van der Heide
- Department of Radiation Oncology, Leiden University Medical Center, P.O. Box 9600 2300, RC, Leiden, the Netherlands
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ellen M. Kerkhof
- Department of Radiation Oncology, Leiden University Medical Center, P.O. Box 9600 2300, RC, Leiden, the Netherlands
| |
Collapse
|
13
|
Jang WI, Bae SH, Kim MS, Han CJ, Park SC, Kim SB, Cho EH, Choi CW, Kim KS, Hwang S, Kim JH, Chang AR, Park Y, Kim ES, Kim WC, Jo S, Park HJ. A phase 2 multicenter study of stereotactic body radiotherapy for hepatocellular carcinoma: Safety and efficacy. Cancer 2019; 126:363-372. [PMID: 31747476 DOI: 10.1002/cncr.32502] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/10/2019] [Accepted: 07/13/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Although several prospective studies have reported the efficacy of stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC), treatment-related toxicity varies and has not been determined. Therefore, the authors evaluated the safety and efficacy of SBRT for patients with HCC in a hepatitis B virus-endemic area. METHODS This multicenter phase 2 trial enrolled patients with unresectable HCC. Patients received SBRT with 45 to 60 Gy in 3 fractions. To evaluate gastroduodenal toxicity, esophagogastroduodenoscopy (EGD) was performed before and 2 months after SBRT. The primary endpoint was treatment-related severe toxicity at 1 year after SBRT. The secondary endpoints were the 2-year local control, progression-free survival, and overall survival rates. RESULTS In total, 74 patients were enrolled between January 2012 and April 2015, and 65 eligible patients were analyzed. One patient experienced radiation-induced liver disease with acute grade ≥3 toxicity 1 month after SBRT. In addition, 1 patient had a grade 3 esophageal ulcer with stenosis 5 months after SBRT. The actuarial rate of treatment-related severe toxicity at 1 year was 3%. The pre-SBRT and post-SBRT EGD findings were not significantly different among the 57 evaluable patients who underwent EGD. The 2-year and 3-year local control rates were 97% and 95%, respectively. The progression-free and overall survival rates were 48% and 84% at 2 years, respectively, and 36% and 76% at 3 years, respectively. CONCLUSIONS With a median follow-up of 41 months, this prospective multicenter study demonstrated that SBRT for patients with HCC is well tolerated and is an effective treatment modality.
Collapse
Affiliation(s)
- Won Il Jang
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Sun Hyun Bae
- Department of Radiation Oncology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Mi-Sook Kim
- Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Chul Ju Han
- Department of Internal Medicine, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Su Cheol Park
- Department of Internal Medicine, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Sang Bum Kim
- Department of General Surgery, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Eung-Ho Cho
- Department of General Surgery, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Chul Won Choi
- Department of Radiation Oncology, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea
| | - Kyung Su Kim
- Department of Radiation Oncology, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea
| | - Sangyoun Hwang
- Department of Internal Medicine, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - A Ram Chang
- Department of Radiation Oncology, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Younghee Park
- Department of Radiation Oncology, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Eun Seog Kim
- Department of Radiation Oncology, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Woo Chul Kim
- Department of Radiation Oncology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Sunmi Jo
- Department of Radiation Oncology, Haeundae Paik Hospital, Inje University School of Medicine, Busan, Korea
| | - Hae Jin Park
- Department of Radiation Oncology, Hanyang University Hospital, Seoul, Korea
| |
Collapse
|
14
|
Dosimetric Multicenter Planning Comparison Studies for Stereotactic Body Radiation Therapy: Methodology and Future Perspectives. Int J Radiat Oncol Biol Phys 2019; 106:403-412. [PMID: 31707124 DOI: 10.1016/j.ijrobp.2019.10.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/03/2019] [Accepted: 10/25/2019] [Indexed: 12/22/2022]
Abstract
In this review a summary of the published literature pertaining to the stereotactic body radiation therapy multiplanning comparison, data sharing strategies, and implementation of benchmark planning cases to improve the skills and knowledge of the participating centers was investigated. A total of 30 full-text articles were included. The studies were subdivided in 3 categories: multiplanning studies on dosimetric variability, planning harmonization before clinical trials, and technical and methodologic studies. The methodology used in the studies were critically analyzed to find common and original elements with the pros and cons. Multicenter planning studies have played a key role in improving treatment plan harmonization, treatment plan compliance, and even clinical practices. This review has highlighted that some fundamental steps should be taken to transform a simple treatment planning comparison study into a potential credentialing method for stereotactic body radiation therapy accreditation. In particular, prescription and general requirements should always be well defined; data analysis should be performed with independent dose volume histogram or dose calculations; quality score indices should be constructed; feedback and correction strategies should be provided; and a simple web-based collaboration platform should be used. The results reported clearly showed that a crowd-based replanning approach is a viable method for achieving harmonization and standardization of treatment planning among centers using different technologies.
Collapse
|
15
|
Bashier A, Bin Hussain A, Abdelgadir E, Alawadi F, Sabbour H, Chilton R. Consensus recommendations for management of patients with type 2 diabetes mellitus and cardiovascular diseases. Diabetol Metab Syndr 2019; 11:80. [PMID: 31572499 PMCID: PMC6761728 DOI: 10.1186/s13098-019-0476-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/19/2019] [Indexed: 02/12/2023] Open
Abstract
The recent American Diabetes Association and the European Association for the Study of Diabetes guideline mentioned glycaemia management in type 2 diabetes mellitus (T2DM) patients with cardiovascular diseases (CVDs); however, it did not cover the treatment approaches for patients with T2DM having a high risk of CVD, and treatment and screening approaches for CVDs in patients with concomitant T2DM. This consensus guideline undertakes the data obtained from all the cardiovascular outcome trials (CVOTs) to propose approaches for the T2DM management in presence of CV comorbidities. For patients at high risk of CVD, metformin is the drug of choice to manage the T2DM to achieve a patient specific HbA1c target. In case of established CVD, a combination of glucagon-like peptide-1 receptor agonist with proven CV benefits is recommended along with metformin, while for chronic kidney disease or heart failure, a sodium-glucose transporter proteins-2 inhibitor with proven benefit is advised. This document also summarises various screening and investigational approaches for the major CV events with their accuracy and specificity along with the treatment guidance to assist the healthcare professionals in selecting the best management strategies for every individual. Since lifestyle modification and management plays an important role in maintaining the effectiveness of the pharmacological therapies, authors of this consensus recommendation have also briefed on the patient-centric non-pharmacological management of T2DM and CVD.
Collapse
Affiliation(s)
- Alaaeldin Bashier
- Department of Endocrinology, Dubai Health Authority, Dubai Hospital, P.O. Box 94132, Dubai, UAE
| | - Azza Bin Hussain
- Department of Endocrinology, Dubai Health Authority, Dubai Hospital, P.O. Box 94132, Dubai, UAE
| | - Elamin Abdelgadir
- Department of Endocrinology, Dubai Health Authority, Dubai Hospital, P.O. Box 94132, Dubai, UAE
| | - Fatheya Alawadi
- Department of Endocrinology, Dubai Health Authority, Dubai Hospital, P.O. Box 94132, Dubai, UAE
| | - Hani Sabbour
- Cleveland Clinic Abu Dhabi, Heart and Vascular Institute, Al Maryah Island, Abu Dhabi, UAE
| | - Robert Chilton
- Division of Cardiology, University of Texas Health Science Center, Audie L Murphy VA Hospital, San Antonio, TX USA
| |
Collapse
|
16
|
Soni PD, Palta M. Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma: Current State and Future Opportunities. Dig Dis Sci 2019; 64:1008-1015. [PMID: 30868409 DOI: 10.1007/s10620-019-05539-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Hepatocellular carcinoma is a rising cause of morbidity and mortality in the USA and around the world. Surgical resection and liver transplantation are the preferred management strategies; however, less than 30% of patients are eligible for surgery. Stereotactic body radiation therapy is a promising local treatment option for non-surgical candidates. Local control rates between 95 and 100% have been reported at 1-2 years post-treatment, and classical radiation-induced liver disease described with conventional radiation is an unlikely complication from stereotactic radiotherapy. Enrollment in randomized trials will be essential in establishing the role of stereotactic radiation in treatment paradigms for hepatocellular carcinoma.
Collapse
Affiliation(s)
- Payal D Soni
- Radiation Oncology Service, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Blvd, Richmond, VA, 23249, USA.
| | - Manisha Palta
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
17
|
Hussein M, Heijmen BJM, Verellen D, Nisbet A. Automation in intensity modulated radiotherapy treatment planning-a review of recent innovations. Br J Radiol 2018; 91:20180270. [PMID: 30074813 DOI: 10.1259/bjr.20180270] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Radiotherapy treatment planning of complex radiotherapy techniques, such as intensity modulated radiotherapy and volumetric modulated arc therapy, is a resource-intensive process requiring a high level of treatment planner intervention to ensure high plan quality. This can lead to variability in the quality of treatment plans and the efficiency in which plans are produced, depending on the skills and experience of the operator and available planning time. Within the last few years, there has been significant progress in the research and development of intensity modulated radiotherapy treatment planning approaches with automation support, with most commercial manufacturers now offering some form of solution. There is a rapidly growing number of research articles published in the scientific literature on the topic. This paper critically reviews the body of publications up to April 2018. The review describes the different types of automation algorithms, including the advantages and current limitations. Also included is a discussion on the potential issues with routine clinical implementation of such software, and highlights areas for future research.
Collapse
Affiliation(s)
- Mohammad Hussein
- 1 Metrology for Medical Physics Centre, National Physical Laboratory , Teddington , UK
| | - Ben J M Heijmen
- 2 Division of Medical Physics, Erasmus MC Cancer Institute , Rotterdam , The Netherlands
| | - Dirk Verellen
- 3 Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB) , Brussels , Belgium.,4 Radiotherapy Department, Iridium Kankernetwerk , Antwerp , Belgium
| | - Andrew Nisbet
- 5 Department of Medical Physics, Royal Surrey County Hospital NHS Foundation Trust , Guildford , UK.,6 Department of Physics, University of Surrey , Guildford , UK
| |
Collapse
|
18
|
Sharfo AWM, Stieler F, Kupfer O, Heijmen BJM, Dirkx MLP, Breedveld S, Wenz F, Lohr F, Boda-Heggemann J, Buergy D. Automated VMAT planning for postoperative adjuvant treatment of advanced gastric cancer. Radiat Oncol 2018; 13:74. [PMID: 29685166 PMCID: PMC5913894 DOI: 10.1186/s13014-018-1032-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/16/2018] [Indexed: 12/13/2022] Open
Abstract
Background Postoperative/adjuvant radiotherapy of advanced gastric cancer involves a large planning target volume (PTV) with multi-concave shapes which presents a challenge for volumetric modulated arc therapy (VMAT) planning. This study investigates the advantages of automated VMAT planning for this site compared to manual VMAT planning by expert planners. Methods For 20 gastric cancer patients in the postoperative/adjuvant setting, dual-arc VMAT plans were generated using fully automated multi-criterial treatment planning (autoVMAT), and compared to manually generated VMAT plans (manVMAT). Both automated and manual plans were created to deliver a median dose of 45 Gy to the PTV using identical planning and segmentation parameters. Plans were evaluated by two expert radiation oncologists for clinical acceptability. AutoVMAT and manVMAT plans were also compared based on dose-volume histogram (DVH) and predicted normal tissue complication probability (NTCP) analysis. Results Both manVMAT and autoVMAT plans were considered clinically acceptable. Target coverage was similar (manVMAT: 96.6 ± 1.6%, autoVMAT: 97.4 ± 1.0%, p = 0.085). With autoVMAT, median kidney dose was reduced on average by > 25%; (for left kidney from 11.3 ± 2.1 Gy to 8.9 ± 3.5 Gy (p = 0.002); for right kidney from 9.2 ± 2.2 Gy to 6.1 ± 1.3 Gy (p < 0.001)). Median dose to the liver was lower as well (18.8 ± 2.3 Gy vs. 17.1 ± 3.6 Gy, p = 0.048). In addition, Dmax of the spinal cord was significantly reduced (38.3 ± 3.7 Gy vs. 31.6 ± 2.6 Gy, p < 0.001). Substantial improvements in dose conformity and integral dose were achieved with autoVMAT plans (4.2% and 9.1%, respectively; p < 0.001). Due to the better OAR sparing in the autoVMAT plans compared to manVMAT plans, the predicted NTCPs for the left and right kidney and the liver-PTV were significantly reduced by 11.3%, 12.8%, 7%, respectively (p ≤ 0.001). Delivery time and total number of monitor units were increased in autoVMAT plans (from 168 ± 19 s to 207 ± 26 s, p = 0.006) and (from 781 ± 168 MU to 1001 ± 134 MU, p = 0.003), respectively. Conclusions For postoperative/adjuvant radiotherapy of advanced gastric cancer, involving a complex target shape, automated VMAT planning is feasible and can substantially reduce the dose to the kidneys and the liver, without compromising the target dose delivery. Electronic supplementary material The online version of this article (10.1186/s13014-018-1032-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Abdul Wahab M Sharfo
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075, EA, Rotterdam, The Netherlands.
| | - Florian Stieler
- Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Oskar Kupfer
- Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ben J M Heijmen
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075, EA, Rotterdam, The Netherlands
| | - Maarten L P Dirkx
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075, EA, Rotterdam, The Netherlands
| | - Sebastiaan Breedveld
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075, EA, Rotterdam, The Netherlands
| | - Frederik Wenz
- Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frank Lohr
- Unita Operativa di Radioterapia, Dipartimento di Oncologia, Az. Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Judit Boda-Heggemann
- Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Buergy
- Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| |
Collapse
|
19
|
Medical physics in radiation Oncology: New challenges, needs and roles. Radiother Oncol 2017; 125:375-378. [PMID: 29150160 DOI: 10.1016/j.radonc.2017.10.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 12/21/2022]
|