1
|
Maier SH, Schönecker S, Anagnostatou V, Garny S, Nitschmann A, Fleischmann DF, Büttner M, Kaul D, Imhoff D, Fokas E, Seidel C, Hau P, Kölbl O, Popp I, Grosu AL, Haussmann J, Budach W, Celik E, Kahl KH, Hoffmann E, Tabatabai G, Paulsen F, Holzgreve A, Albert NL, Mansmann U, Corradini S, Belka C, Niyazi M, Bodensohn R. Dummy run for planning of isotoxic dose-escalated radiation therapy for glioblastoma used in the PRIDE trial (NOA-28; ARO-2024-01; AG-NRO-06). Clin Transl Radiat Oncol 2024; 47:100790. [PMID: 38765202 PMCID: PMC11101689 DOI: 10.1016/j.ctro.2024.100790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/02/2024] [Accepted: 05/02/2024] [Indexed: 05/21/2024] Open
Abstract
Background The PRIDE trial (NOA-28; ARO-2024-01; AG-NRO-06; NCT05871021) is designed to determine whether a dose escalation with 75.0 Gy in 30 fractions can enhance the median overall survival (OS) in patients with methylguanine methyltransferase (MGMT) promotor unmethylated glioblastoma compared to historical median OS rates, while being isotoxic to historical cohorts through the addition of concurrent bevacizumab (BEV). To ensure protocol-compliant irradiation planning with all study centers, a dummy run was planned and the plan quality was evaluated. Methods A suitable patient case was selected and the computed tomography (CT), magnetic resonance imaging (MRI) and O-(2-[18F]fluoroethyl)-L-tyrosine (FET) positron emission tomography (PET) contours were made available. Participants at the various intended study sites performed radiation planning according to the PRIDE clinical trial protocol. The treatment plans and dose grids were uploaded as Digital Imaging and Communications in Medicine (DICOM) files to a cloud-based platform. Plan quality and protocol adherence were analyzed using a standardized checklist, scorecards and indices such as Dice Score (DSC) and Hausdorff Distance (HD). Results Median DSC was 0.89, 0.90, 0.88 for PTV60, PTV60ex (planning target volume receiving 60.0 Gy for the standard and the experimental plan, respectively) and PTV75 (PTV receiving 75.0 Gy in the experimental plan), respectively. Median HD values were 17.0 mm, 13.9 mm and 12.1 mm, respectively. These differences were also evident in the volumes: The PTV60 had a volume range of 219.1-391.3 cc (median: 261.9 cc) for the standard plans, while the PTV75 volumes for the experimental plans ranged from 71.5-142.7 cc (median: 92.3 cc). The structures with the largest deviations in Dice score were the pituitary gland (median 0.37, range 0.00-0.69) and the right lacrimal gland (median 0.59, range 0.42-0.78). Conclusions The deviations revealed the necessity of systematic trainings with appropriate feedback before the start of clinical trials in radiation oncology and the constant monitoring of protocol compliance throw-out the study. Trial registration NCT05871021.
Collapse
Affiliation(s)
- Sebastian H. Maier
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Stephan Schönecker
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Vasiliki Anagnostatou
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Sylvia Garny
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Alexander Nitschmann
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Daniel F. Fleischmann
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, a partnership between DKFZ and LMU University Hospital, Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marcel Büttner
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - David Kaul
- Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Detlef Imhoff
- Department of Radiotherapy of Oncology, University of Frankfurt, Frankfurt, Germany
| | - Emmanouil Fokas
- Department of Radiotherapy of Oncology, University of Frankfurt, Frankfurt, Germany
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Clemens Seidel
- Department of Radiation Oncology, University Hospital Leipzig, University of Leipzig, Leipzig, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Oliver Kölbl
- Department of Radiotherapy, University Medical Center Regensburg, Regensburg, Germany
| | - Ilinca Popp
- Department of Radiation Oncology, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Jan Haussmann
- Department of Radiation Oncology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Wilfried Budach
- Department of Radiation Oncology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Eren Celik
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- Dept. of Radiation Oncology, Faculty of Medicine and University Hospital Ruhr-University Bochum, Marien Hospital Herne, Herne, Germany
| | - Klaus-Henning Kahl
- Department of Radiooncology, University Hospital Augsburg, Augsburg, Germany
| | - Elgin Hoffmann
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
| | - Ghazaleh Tabatabai
- Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
| | - Adrien Holzgreve
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
- Ahmanson Translational Theranostics Division, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, USA
| | - Nathalie L. Albert
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), partner site Tübingen, a partnership between DKFZ and University Hospital Tübingen, Tübingen, Germany
| | - Raphael Bodensohn
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
| |
Collapse
|
2
|
Wang Y, Deng Y, Zhou XH. Causal inference for time-to-event data with a cured subpopulation. Biometrics 2024; 80:ujae028. [PMID: 38708764 DOI: 10.1093/biomtc/ujae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 12/21/2023] [Accepted: 04/05/2024] [Indexed: 05/07/2024]
Abstract
When studying the treatment effect on time-to-event outcomes, it is common that some individuals never experience failure events, which suggests that they have been cured. However, the cure status may not be observed due to censoring which makes it challenging to define treatment effects. Current methods mainly focus on estimating model parameters in various cure models, ultimately leading to a lack of causal interpretations. To address this issue, we propose 2 causal estimands, the timewise risk difference and mean survival time difference, in the always-uncured based on principal stratification as a complement to the treatment effect on cure rates. These estimands allow us to study the treatment effects on failure times in the always-uncured subpopulation. We show the identifiability using a substitutional variable for the potential cure status under ignorable treatment assignment mechanism, these 2 estimands are identifiable. We also provide estimation methods using mixture cure models. We applied our approach to an observational study that compared the leukemia-free survival rates of different transplantation types to cure acute lymphoblastic leukemia. Our proposed approach yielded insightful results that can be used to inform future treatment decisions.
Collapse
Affiliation(s)
- Yi Wang
- The School of Statistics and Information, Shanghai University of International Business and Economics, Shanghai 201620, China
- Beijing International Center for Mathematical Research, Peking University, Beijing 100871, China
| | - Yuhao Deng
- Beijing International Center for Mathematical Research, Peking University, Beijing 100871, China
| | - Xiao-Hua Zhou
- Beijing International Center for Mathematical Research, Peking University, Beijing 100871, China
- Department of Biostatistics, School of Public Health, Peking University, Beijing 100871, China
- Peking University Chongqing Big Data Research Institute, Chongqing 401333, China
- Pazhou Lab, Guangzhou 510335, China
| |
Collapse
|
3
|
Bodensohn R, Fleischmann DF, Maier SH, Anagnostatou V, Garny S, Nitschmann A, Büttner M, Mücke J, Schönecker S, Unger K, Hoffmann E, Paulsen F, Thorwarth D, Holzgreve A, Albert NL, Corradini S, Tabatabai G, Belka C, Niyazi M. Dosimetric feasibility analysis and presentation of an isotoxic dose-escalated radiation therapy concept for glioblastoma used in the PRIDE trial (NOA-28; ARO-2022-12). Clin Transl Radiat Oncol 2024; 45:100706. [PMID: 38116137 PMCID: PMC10726217 DOI: 10.1016/j.ctro.2023.100706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023] Open
Abstract
Background and purpose The PRIDE trial (NOA-28; ARO-2022-12; NCT05871021) is scheduled to start recruitment in October 2023. Its primary objective is to enhance median overall survival (OS), compared to historical median OS rates, in patients with methylguanine methlyltransferase (MGMT) promotor unmethylated glioblastoma by incorporating isotoxic dose escalation to 75 Gy in 30 fractions. To achieve isotoxicity and counteract the elevated risk of radiation necrosis (RN) associated with dose-escalated regimens, the addition of protective concurrent bevacizumab (BEV) serves as an innovative approach. The current study aims to assess the dosimetric feasibility of the proposed concept. Materials and methods A total of ten patients diagnosed with glioblastoma were included in this dosimetric analysis. Delineation of target volumes for the reference plans adhered to the ESTRO-EANO 2023 guideline. The experimental plans included an additional volume for the integrated boost. Additionally, the 60 Gy-volume was reduced by using a margin of 1.0 cm instead of 1.5 cm. To assess the risk of symptomatic RN, the Normal Tissue Complication Probability (NTCP) was calculated and compared between the reference and experimental plans. Results Median NTCP of the reference plan (NTCPref) and of the experimental plan (NTCPex) were 0.24 (range 0.11-0.29) and 0.42 (range 0.18-0.54), respectively. NTCPex was a median of 1.77 (range 1.60-1.99) times as high as the NTXPref. In a logarithmic comparison, the risk of RN is enhanced by a factor of median 2.00 (range 1.66-2.35). The defined constraints for the organs at risk were feasible. Conclusion When considering the potential protective effect of BEV, which we hypothesized might reduce the risk of RN by approximately two-fold, achieving isotoxicity with the proposed dose-escalated experimental plan for the PRIDE trial seems feasible.
Collapse
Affiliation(s)
- Raphael Bodensohn
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Daniel F. Fleischmann
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, a partnership between DKFZ and LMU University Hospital, Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian H. Maier
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Vasiliki Anagnostatou
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Sylvia Garny
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Alexander Nitschmann
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Marcel Büttner
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Johannes Mücke
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Stephan Schönecker
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Kristian Unger
- Helmholtz Zentrum Munich, Neuherberg, Germany
- Faculty of Medicine, LMU Munich, Munich Germany
| | - Elgin Hoffmann
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
| | - Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Germany
- German Cancer Consortium (DKTK), partner site Tübingen, a partnership between DKFZ and University Hospital, Tübingen, Germany
| | - Adrien Holzgreve
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Nathalie L. Albert
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Ghazaleh Tabatabai
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
- Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Tübingen, Germany
- German Cancer Consortium (DKTK), partner site Tübingen, a partnership between DKFZ and University Hospital, Tübingen, Germany
| | - Claus Belka
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), partner site Tübingen, a partnership between DKFZ and University Hospital, Tübingen, Germany
| |
Collapse
|
4
|
Bodensohn R, Maier SH, Belka C, Minniti G, Niyazi M. Stereotactic Radiosurgery of Multiple Brain Metastases: A Review of Treatment Techniques. Cancers (Basel) 2023; 15:5404. [PMID: 38001664 PMCID: PMC10670108 DOI: 10.3390/cancers15225404] [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: 08/31/2023] [Revised: 10/22/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023] Open
Abstract
The advancement of systemic targeted treatments has led to improvements in the management of metastatic disease, particularly in terms of survival outcomes. However, brain metastases remain less responsive to systemic therapies, underscoring the significance of local interventions for comprehensive disease control. Over the past years, the threshold for treating brain metastases through stereotactic radiosurgery has risen. Yet, as the number of treated metastases increases, treatment complexity and duration also escalate. This trend has made multi-isocenter radiosurgery treatments, such as those with the Gamma Knife, challenging to plan and lengthy for patients. In contrast, single-isocenter approaches employing linear accelerators offer an efficient and expeditious treatment option. This review delves into the literature, comparing different linear-accelerator-based techniques with each other and in relation to dedicated systems, focusing on dosimetric considerations and feasibility.
Collapse
Affiliation(s)
- Raphael Bodensohn
- Department of Radiation Oncology, University Hospital Tübingen, 72076 Tübingen, Germany;
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Sebastian H. Maier
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, 81377 Munich, Germany; (S.H.M.); (C.B.)
| | - Claus Belka
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, 81377 Munich, Germany; (S.H.M.); (C.B.)
- German Cancer Consortium (DKTK), Partner Site Munich, A Partnership between DKFZ and LMU University Hospital, 81377 Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Giuseppe Minniti
- IRCCS Neuromed, 86077 Pozzilli, Italy;
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital Tübingen, 72076 Tübingen, Germany;
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, 72076 Tübingen, Germany
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, 81377 Munich, Germany; (S.H.M.); (C.B.)
- German Cancer Consortium (DKTK), Partner Site Tübingen, A Partnership between DKFZ and University Hospital, 72076 Tübingen, Germany
| |
Collapse
|
5
|
Alirezaei Z, Amouheidari A, Iraji S, Hassanpour M, Hejazi SH, Davanian F, Nami MT, Rastaghi S, Shokrani P, Tsien CI, Nazem-Zadeh MR. Prediction of Normal Tissue Complication Probability (NTCP) After Radiation Therapy Using Imaging and Molecular Biomarkers and Multivariate Modelling. J Mol Neurosci 2023; 73:587-597. [PMID: 37462853 DOI: 10.1007/s12031-023-02136-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/12/2023] [Indexed: 09/24/2023]
Abstract
The aim of this study was to design a predictive radiobiological model of normal brain tissue in low-grade glioma following radiotherapy based on imaging and molecular biomarkers. Fifteen patients with primary brain tumors prospectively participated in this study and underwent radiation therapy. Magnetic resonance imaging (MRI) was obtained from the patients, including T1- and T2-weighted imaging and diffusion tensor imaging (DTI), and a generalized equivalent dose (gEUD) was calculated. The radiobiological model of the normal tissue complication probability (NTCP) was performed using the variables gEUD; axial diffusivity (AD) and radial diffusivity (RD) of the corpus callosum; and serum protein S100B by univariate and multivariate logistic regression XLIIIrd Sir Peter Freyer Memorial Lecture and Surgical Symposium (2018). Changes in AD, RD, and S100B from baseline up to the 6 months after treatment had an increasing trend and were significant in some time points (P-value < 0.05). The model resulting from RD changes in the 6 months after treatment was significantly more predictable of necrosis than other univariate models. The bivariate model combining RD changes in Gy40 dose-volume and gEUD, as well as the trivariate model obtained using gEUD, RD, and S100B, had a higher predictive value among multivariate models at the sixth month of the treatment. Changes in RD diffusion indices and in serum protein S100B value were used in the early-delayed stage as reliable biomarkers for predicting late-delayed damage (necrosis) caused by radiation in the corpus callosum. Current findings could pave the way for intervention therapies to delay the severity of damage to white matter structures, minimize cognitive impairment, and improve the quality of life of patients with low-grade glioma.
Collapse
Affiliation(s)
- Zahra Alirezaei
- Medical Physics Department, Isfahan University of Medical Science, Isfahan, Iran
| | - Alireza Amouheidari
- Research & Education, Department of Radiation Oncology, Isfahan Milad Hospital, Isfahan, Iran
| | - Sajjad Iraji
- Medical Physics and Biomedical Engineering Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Hassanpour
- Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Hosein Hejazi
- Skin Diseases and Leishmaniosis Research Center, Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Fariba Davanian
- Radiology Department, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | | | - Sedighe Rastaghi
- Biostatistics Department, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Parvaneh Shokrani
- Medical Physics Department, Isfahan University of Medical Science, Isfahan, Iran
| | - Christina I Tsien
- Radiation Oncology Department, Washington University, St. Louis, MO, USA
| | - Mohammad-Reza Nazem-Zadeh
- Medical Physics and Biomedical Engineering Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
6
|
Jaspers JPM, Taal W, van Norden Y, Zindler JD, Swaak AT, Habraken SJM, Hoogeman MH, Nout R, van den Bent M, Méndèz Romero A. Early and late contrast enhancing lesions after photon radiotherapy for IDH mutated grade 2 diffuse glioma. Radiother Oncol 2023; 184:109674. [PMID: 37084885 DOI: 10.1016/j.radonc.2023.109674] [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: 11/25/2022] [Revised: 03/13/2023] [Accepted: 04/10/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE The interpretation of new enhancing lesions after radiotherapy for diffuse glioma remains a clinical challenge. We sought to characterize and classify new contrast enhancing lesions in a historical multicenter cohort of patients with IDH mutated grade 2 diffuse glioma treated with photon therapy. METHODS We reviewed all follow-up MRI's of all patients treated with radiotherapy for histologically confirmed, IDH mutated diffuse grade 2 glioma between 1-1-2007 and 31-12-2018 in two tertiary referral centers. Disease progression (PD) was defined in accordance with the RANO criteria for progressive disease in low grade glioma. Pseudoprogression (psPD) was defined as any transient contrast-enhancing lesion between the end of radiotherapy and PD, or any new contrast-enhancing lesion that remained stable over a period of 12 months in patients who did not exhibit PD. RESULTS A total of 860 MRI's of 106 patients were reviewed. psPD was identified in 24 patients (23%) on 76 MRI's. The cumulative incidence of psPD was 13% at 1 year, 22% at 5 years, and 28% at 10 years. The mean of the observed maximal volume of psPD was 2.4cc. The median Dmin in psPD lesions was 50.1 Gy. The presence of an 1p/19q codeletion was associated with an increased risk of psPD (subhazard ratio 2.34, p=0.048). psPD was asymptomatic in 83% of patients. CONCLUSION The cumulative incidence of psPD in grade 2 diffuse glioma increases over time. Consensus regarding event definition and statistical analysis is needed for comparisons between series investigating psPD.
Collapse
Affiliation(s)
- J P M Jaspers
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - W Taal
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Y van Norden
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J D Zindler
- Department of Radiotherapy, Haaglanden Medisch Centrum, Leidschendam, The Netherlands; Holland Proton Therapy Center, Delft, The Netherlands
| | - A T Swaak
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - S J M Habraken
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Holland Proton Therapy Center, Delft, The Netherlands
| | - M H Hoogeman
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - R Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Holland Proton Therapy Center, Delft, The Netherlands
| | - M van den Bent
- Neurology Department, Brain Tumor Center, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - A Méndèz Romero
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Holland Proton Therapy Center, Delft, The Netherlands
| |
Collapse
|
7
|
Niyazi M, Andratschke N, Bendszus M, Chalmers AJ, Erridge SC, Galldiks N, Lagerwaard FJ, Navarria P, Munck Af Rosenschöld P, Ricardi U, van den Bent MJ, Weller M, Belka C, Minniti G. ESTRO-EANO guideline on target delineation and radiotherapy details for glioblastoma. Radiother Oncol 2023; 184:109663. [PMID: 37059335 DOI: 10.1016/j.radonc.2023.109663] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND AND PURPOSE Target delineation in glioblastoma is still a matter of extensive research and debate. This guideline aims to update the existing joint European consensus on delineation of the clinical target volume (CTV) in adult glioblastoma patients. MATERIAL AND METHODS The ESTRO Guidelines Committee identified 14 European experts in close interaction with the ESTRO clinical committee and EANO who discussed and analysed the body of evidence concerning contemporary glioblastoma target delineation, then took part in a two-step modified Delphi process to address open questions. RESULTS Several key issues were identified and are discussed including i) pre-treatment steps and immobilisation, ii) target delineation and the use of standard and novel imaging techniques, and iii) technical aspects of treatment including planning techniques and fractionation. Based on the EORTC recommendation focusing on the resection cavity and residual enhancing regions on T1-sequences with the addition of a reduced 15 mm margin, special situations are presented with corresponding potential adaptations depending on the specific clinical situation. CONCLUSIONS The EORTC consensus recommends a single clinical target volume definition based on postoperative contrast-enhanced T1 abnormalities, using isotropic margins without the need to cone down. A PTV margin based on the individual mask system and IGRT procedures available is advised; this should usually be no greater than 3 mm when using IGRT.
Collapse
Affiliation(s)
- Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Munich, Germany.
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Sara C Erridge
- Edinburgh Centre for Neuro-Oncology, University of Edinburgh, Western General Hospital, Edinburgh, EH4 1EU, UK
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany; Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany; Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
| | - Frank J Lagerwaard
- Department of Radiation Oncology, Amsterdam UMC location Vrije Universiteit Amsterdam, The Netherlands
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Department, IRCCS, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Per Munck Af Rosenschöld
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, and Lund University, Lund, Sweden
| | | | | | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Giuseppe Minniti
- Dept. of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy; IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| |
Collapse
|
8
|
Eulitz J, G C Troost E, Klünder L, Raschke F, Hahn C, Schulz E, Seidlitz A, Thiem J, Karpowitz C, Hahlbohm P, Grey A, Engellandt K, Löck S, Krause M, Lühr A. Increased relative biological effectiveness and periventricular radiosensitivity in proton therapy of glioma patients. Radiother Oncol 2023; 178:109422. [PMID: 36435337 DOI: 10.1016/j.radonc.2022.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/25/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Currently, there is an intense debate on variations in intra-cerebral radiosensitivity and relative biological effectiveness (RBE) in proton therapy of primary brain tumours. Here, both effects were retrospectively investigated using late radiation-induced brain injuries (RIBI) observed in follow-up after proton therapy of patients with diagnosed glioma. METHODS In total, 42 WHO grade 2-3 glioma patients out of a consecutive patient cohort having received (adjuvant) proton radio(chemo)therapy between 2014 and 2017 were eligible for analysis. RIBI lesions (symptomatic or clinically asymptomatic) were diagnosed and delineated on contrast-enhanced T1-weighted magnetic resonance imaging scans obtained in the first two years of follow-up. Correlation of RIBI location and occurrence with dose (D), proton dose-averaged linear energy transfer (LET) and variable RBE dose parameters were tested in voxel- and in patient-wise logistic regression analyses. Additionally, anatomical and clinical parameters were considered. Model performance was estimated through cross-validated area-under-the-curve (AUC) values. RESULTS In total, 64 RIBI lesions were diagnosed in 21 patients. The median time between start of proton radio(chemo)therapy and RIBI appearance was 10.2 months. Median distances of the RIBI volume centres to the cerebral ventricles and to the clinical target volume border were 2.1 mm and 1.3 mm, respectively. In voxel-wise regression, the multivariable model with D, D × LET and periventricular region (PVR) revealed the highest AUC of 0.90 (95 % confidence interval: 0.89-0.91) while the corresponding model without D × LET revealed a value of 0.84 (0.83-0.86). In patient-level analysis, the equivalent uniform dose (EUD11, a = 11) in the PVR using a variable RBE was the most prominent predictor for RIBI with an AUC of 0.63 (0.32-0.90). CONCLUSIONS In this glioma cohort, an increased radiosensitivity within the PVR was observed as well as a spatial correlation of RIBI with an increased RBE. Both need to be considered when delivering radio(chemo)therapy using proton beams.
Collapse
Affiliation(s)
- Jan Eulitz
- 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; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany
| | - Esther G C Troost
- 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; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; National Center for Tumour 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, and; Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lauritz Klünder
- Department of Physics, TU Dortmund University, Dortmund, Germany
| | - Felix Raschke
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany
| | - Christian Hahn
- 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; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Department of Physics, TU Dortmund University, Dortmund, Germany
| | - Erik Schulz
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Annekatrin Seidlitz
- 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; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; National Center for Tumour 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, and; Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Justus Thiem
- 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; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; National Center for Tumour 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, and; Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Caroline Karpowitz
- 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; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; National Center for Tumour 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, and; Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Patricia Hahlbohm
- 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 and Polyclinic for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Arne Grey
- National Center for Tumour 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, and; Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany; Institute and Polyclinic for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kay Engellandt
- National Center for Tumour 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, and; Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany; Institute and Polyclinic for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Steffen Löck
- 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; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; National Center for Tumour 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, and; Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mechthild Krause
- 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; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; National Center for Tumour 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, and; Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Armin Lühr
- 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; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; Department of Physics, TU Dortmund University, Dortmund, Germany.
| |
Collapse
|
9
|
Peters S, Frisch S, Stock A, Merta J, Bäumer C, Blase C, Schuermann E, Tippelt S, Bison B, Frühwald M, Rutkowski S, Fleischhack G, Timmermann B. Proton Beam Therapy for Pediatric Tumors of the Central Nervous System-Experiences of Clinical Outcome and Feasibility from the KiProReg Study. Cancers (Basel) 2022; 14:cancers14235863. [PMID: 36497345 PMCID: PMC9737072 DOI: 10.3390/cancers14235863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
As radiotherapy is an important part of the treatment in a variety of pediatric tumors of the central nervous system (CNS), proton beam therapy (PBT) plays an evolving role due to its potential benefits attributable to the unique dose distribution, with the possibility to deliver high doses to the target volume while sparing surrounding tissue. Children receiving PBT for an intracranial tumor between August 2013 and October 2017 were enrolled in the prospective registry study KiProReg. Patient's clinical data including treatment, outcome, and follow-up were analyzed using descriptive statistics, Kaplan-Meier, and Cox regression analysis. Adverse events were scored according to the Common Terminology Criteria for Adverse Events (CTCAE) 4.0 before, during, and after PBT. Written reports of follow-up imaging were screened for newly emerged evidence of imaging changes, according to a list of predefined keywords for the first 14 months after PBT. Two hundred and ninety-four patients were enrolled in this study. The 3-year overall survival of the whole cohort was 82.7%, 3-year progression-free survival was 67.3%, and 3-year local control was 79.5%. Seventeen patients developed grade 3 adverse events of the CNS during long-term follow-up (new adverse event n = 7; deterioration n = 10). Two patients developed vision loss (CTCAE 4°). This analysis demonstrates good general outcomes after PBT.
Collapse
Affiliation(s)
- Sarah Peters
- West German Proton Therapy Center Essen (WPE), University Hospital Essen, 45147 Essen, Germany
- Clinic for Particle Therapy, University Hospital Essen, 45147 Essen, Germany
- Correspondence: ; Tel.: +49-201-723-8943
| | - Sabine Frisch
- West German Proton Therapy Center Essen (WPE), University Hospital Essen, 45147 Essen, Germany
| | - Annika Stock
- Department of Neuroradiology, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Julien Merta
- West German Proton Therapy Center Essen (WPE), University Hospital Essen, 45147 Essen, Germany
| | - Christian Bäumer
- West German Proton Therapy Center Essen (WPE), University Hospital Essen, 45147 Essen, Germany
| | - Christoph Blase
- AnästhesieNetz Rhein-Ruhr, Westenfelder Str. 62/64, 44867 Bochum, Germany
| | - Eicke Schuermann
- Department of Pediatric Hematology and Oncology, Pediatrics III, University Hospital Essen, 45147 Essen, Germany
| | - Stephan Tippelt
- Department of Pediatric Hematology and Oncology, Pediatrics III, University Hospital Essen, 45147 Essen, Germany
| | - Brigitte Bison
- Diagnostic and Interventional Neuroradiology, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
- Neuroradiological Reference Center for the Pediatric Brain Tumor (HIT) Studies of the German Society of Pediatric Oncology and Hematology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Michael Frühwald
- Pediatric and Adolescent Medicine, Swabian Childrens Cancer Center, University Medical Center Augsburg, 86156 Augsburg, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Gudrun Fleischhack
- Department of Pediatric Hematology and Oncology, Pediatrics III, University Hospital Essen, 45147 Essen, Germany
| | - Beate Timmermann
- West German Proton Therapy Center Essen (WPE), University Hospital Essen, 45147 Essen, Germany
- Clinic for Particle Therapy, University Hospital Essen, 45147 Essen, Germany
- West German Cancer Center (WTZ), 45147 Essen, Germany
- German Cancer Consortium (DKTK), 45147 Essen, Germany
| |
Collapse
|
10
|
Lin X, Li Z, Chen S, Yang Y, He H, Lv X, Qiu Y. Divergent white matter changes in patients with nasopharyngeal carcinoma post-radiotherapy with different outcomes: a potential biomarker for prediction of radiation necrosis. Eur Radiol 2022; 32:7036-7047. [PMID: 35687134 DOI: 10.1007/s00330-022-08907-z] [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: 12/29/2021] [Revised: 05/17/2022] [Accepted: 05/23/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the effects of standard radiotherapy on temporal white matter (WM) and its relationship with radiation necrosis (RN) in patients with nasopharyngeal carcinoma (NPC), and to determine the predictive value of WM volume alterations at the early stage for RN occurrence at the late-delay stage. METHODS Seventy-four treatment-naive NPC patients treated with standard radiotherapy were longitudinally followed up for 36 months. Structural MRIs were collected at multiple time points during the first year post-radiotherapy. Longitudinal structural images were processed using FreeSurfer. Linear mixed models were used to delineate divergent trajectories of temporal WM changes between patients who developed RN and who did not. Four machine learning methods were used to construct predictive models for RN with temporal WM volume alterations at early-stage. RESULTS The superior temporal gyrus (STG) had divergent atrophy trajectories in NPC patients with different outcomes (RN vs. NRN) post-radiotherapy. Patients with RN showed more rapid atrophy than those with NRN. A predictive model constructed with temporal WM volume alterations at early-stage post-radiotherapy had good performance for RN; the areas under the curve (AUC) were 0.879 and 0.806 at 1-3 months and 6 months post-radiotherapy, respectively. Moreover, the predictive model constructed with absolute temporal volume at 1-3 months post-radiotherapy also presented good performance; the AUC was 0.842, which was verified by another independent dataset (AUC = 0.773). CONCLUSIONS NPC patients with RN had more sharp atrophy in the STG than those with NRN. Temporal WM volume at early-stage post-radiotherapy may serve as an in vivo biomarker to identify and predict RN occurrence. KEY POINTS • The STG had divergent atrophy trajectories in NPC patients with different outcomes (RN vs. NRN) post-radiotherapy. • Although both groups exhibited time-dependent atrophy in the STG, the patients with RN showed a more rapid volume decrease than those with NRN. • Temporal WM volume alteration (or absolute volume) at the early stage could predict RN occurrence at the late-delay stage after radiotherapy.
Collapse
Affiliation(s)
- Xiaoshan Lin
- Department of Radiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518052, China
| | - Zhipeng Li
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, China
| | - Shengli Chen
- Department of Radiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518052, China
| | - Yadi Yang
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, China
| | - Haoqiang He
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, China
| | - Xiaofei Lv
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, China.
| | - Yingwei Qiu
- Department of Radiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518052, China.
| |
Collapse
|
11
|
Mirandola A, Russo S, Bonora M, Vischioni B, Camarda AM, Ingargiola R, Molinelli S, Ronchi S, Rossi E, Vai A, Iacovelli NA, Thariat J, Ciocca M, Orlandi E. A Patient Selection Approach Based on NTCP Models and DVH Parameters for Definitive Proton Therapy in Locally Advanced Sinonasal Cancer Patients. Cancers (Basel) 2022; 14:cancers14112678. [PMID: 35681661 PMCID: PMC9179408 DOI: 10.3390/cancers14112678] [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: 04/28/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 12/01/2022] Open
Abstract
(1) Background: In this work, we aim to provide selection criteria based on normal tissue complication probability (NTCP) models and additional explanatory dose-volume histogram parameters suitable for identifying locally advanced sinonasal cancer patients with orbital invasion benefitting from proton therapy. (2) Methods: Twenty-two patients were enrolled, and two advanced radiation techniques were compared: intensity modulated proton therapy (IMPT) and photon volumetric modulated arc therapy (VMAT). Plans were optimized with a simultaneous integrated boost modality: 70 and 56 Gy(RBE) in 35 fractions were prescribed to the high risk/low risk CTV. Several endpoints were investigated, classified for their severity and used as discriminating paradigms. In particular, when NTCP models were already available, a first selection criterion based on the delta-NTCP was adopted. Additionally, an overall analysis in terms of DVH parameters was performed. Furthermore, a second selection criterion based on a weighted sum of the ΔNTCP and ΔDVH was adopted. (3) Results: Four patients out of 22 (18.2%) were suitable for IMPT due to ΔNTCP > 3% for at least one severe toxicity, 4 (18.2%) due to ΔNTCP > 20% for at least three concurrent intermediate toxicities and 16 (72.7%) due to the mixed sum of ΔNTCP and ΔDVH criterion. Since, for some cases, both criteria were contemporary fulfilled, globally 17/22 patients (77.3%) would benefit from IMPT. (4) Conclusions: For this rare clinical scenario, the use of a strategy including DVH parameters and NTCPs when comparing VMAT and IMPT is feasible. We showed that patients affected by sinonasal cancer could profit from IMPT compared to VMAT in terms of optical and central nervous system organs at risk sparing.
Collapse
Affiliation(s)
- Alfredo Mirandola
- Medical Physics Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (S.R.); (S.M.); (E.R.); (A.V.); (M.C.)
- Correspondence: ; Tel.: +39-0382-078-514
| | - Stefania Russo
- Medical Physics Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (S.R.); (S.M.); (E.R.); (A.V.); (M.C.)
| | - Maria Bonora
- Radiotherapy Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (M.B.); (B.V.); (A.M.C.); (R.I.); (S.R.); (E.O.)
| | - Barbara Vischioni
- Radiotherapy Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (M.B.); (B.V.); (A.M.C.); (R.I.); (S.R.); (E.O.)
| | - Anna Maria Camarda
- Radiotherapy Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (M.B.); (B.V.); (A.M.C.); (R.I.); (S.R.); (E.O.)
| | - Rossana Ingargiola
- Radiotherapy Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (M.B.); (B.V.); (A.M.C.); (R.I.); (S.R.); (E.O.)
| | - Silvia Molinelli
- Medical Physics Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (S.R.); (S.M.); (E.R.); (A.V.); (M.C.)
| | - Sara Ronchi
- Radiotherapy Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (M.B.); (B.V.); (A.M.C.); (R.I.); (S.R.); (E.O.)
| | - Eleonora Rossi
- Medical Physics Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (S.R.); (S.M.); (E.R.); (A.V.); (M.C.)
| | - Alessandro Vai
- Medical Physics Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (S.R.); (S.M.); (E.R.); (A.V.); (M.C.)
| | | | - Juliette Thariat
- Department of Radiation Oncology, Françoise Baclesse Center ARCHADE, Normandy University, 14000 Caen, France;
| | - Mario Ciocca
- Medical Physics Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (S.R.); (S.M.); (E.R.); (A.V.); (M.C.)
| | - Ester Orlandi
- Radiotherapy Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; (M.B.); (B.V.); (A.M.C.); (R.I.); (S.R.); (E.O.)
| |
Collapse
|
12
|
Chen M, Wang L, Gong G, Yin Y, Wang P. Quantitative study of the changes in brain white matter before and after radiotherapy by applying multi-sequence MR radiomics. BMC Med Imaging 2022; 22:86. [PMID: 35562722 PMCID: PMC9101859 DOI: 10.1186/s12880-022-00816-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To analyse the changes in brain white matter before and after radiotherapy (RT) by applying multisequence MR radiomics features and to establish a relationship between the changes in radiomics features and radiation dose. Methods Eighty-eight patients with brain tumours who had undergone RT were selected in this study, and MR images (T1, T1+C, T2FLAIR, T2, DWI, and ASL) before and after RT were obtained. The brain white matter was delineated as an ROI under dose gradients of 0–5 Gy, 5–10 Gy, 10–15 Gy, 15–20 Gy, 20–30 Gy, 30–40 Gy, and 40–50 Gy. The radiomics features of each ROI were extracted, and the changes in radiomics features before and after RT for different sequences under different dose gradients were compared. Results At each dose gradient, statistically significant features of different MR sequences were mainly concentrated in three dose gradients, 5–10 Gy, 20–30 Gy, and 30–40 Gy. The T1+C sequence held the most features (66) under the 20–30 Gy dose gradient. There were 20 general features at dose gradients of 20–30 Gy, 30–40 Gy, and 40–50 Gy, and the changes in features first decreased and then increased following dose escalation. With dose gradients of 5–10 Gy and 10–15 Gy, only T1 and T2FLAIR had general features, and the rates of change were − 24.57% and − 29.32% for T1 and − 3.08% and − 10.87% for T2FLAIR, respectively. The changes showed an upward trend with increasing doses. For different MR sequences that were analysed under the same dose gradient, all sequences with 5–10 Gy, 20–30 Gy and 30–40 Gy had general features, except the T2FLAIR sequence, which was concentrated in the FirstOrder category feature, and the changes in features of T1 and T1+C were more significant than those of the other sequences. Conclusions MR radiomics features revealed microscopic changes in brain white matter before and after RT, although there was no constant dose-effect relationship for each feature. The changes in radiomics features in different sequences could reveal the radiation response of brain white matter to different doses.
Collapse
Affiliation(s)
- Mingming Chen
- College of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, 250117, Jinan, China
| | - Lizhen Wang
- Department of Radiation Physics, Shandong First Medical University Affiliated Cancer Hospital, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), 250117, Jinan, China
| | - Guanzhong Gong
- Department of Radiation Physics, Shandong First Medical University Affiliated Cancer Hospital, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), 250117, Jinan, China
| | - Yong Yin
- Department of Radiation Physics, Shandong First Medical University Affiliated Cancer Hospital, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), 250117, Jinan, China.
| | - Pengcheng Wang
- College of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, 250117, Jinan, China.
| |
Collapse
|
13
|
Musta E, van Geloven N, Anninga J, Gelderblom H, Fiocco M. Short-term and long-term prognostic value of histological response and intensified chemotherapy in osteosarcoma: a retrospective reanalysis of the BO06 trial. BMJ Open 2022; 12:e052941. [PMID: 35537786 PMCID: PMC9092180 DOI: 10.1136/bmjopen-2021-052941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Cure rate models accounting for cured and uncured patients, provide additional insights into long and short-term survival. We aim to evaluate the prognostic value of histological response and chemotherapy intensification on the cure fraction and progression-free survival (PFS) for the uncured patients. DESIGN Retrospective analysis of a randomised controlled trial, MRC BO06 (EORTC 80931). SETTING Population-based study but proposed methodology can be applied to other trial designs. PARTICIPANTS A total of 497 patients with resectable highgrade osteosarcoma, of which 118 were excluded because chemotherapy was not started, histological response was not reported, abnormal dose was reported or had disease progression during treatment. INTERVENTIONS Two regimens with the same anticipated cumulative dose (doxorubicin 6×75 mg/m2/week; cisplatin 6×100 mg/m2/week) over different time schedules: every 3 weeks in regimen-C and every 2 weeks in regimen-DI. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome is PFS computed from end of treatment because cure, if it occurs, may happen at any time during treatment. A mixture cure model is used to study the effect of histological response and intensified chemotherapy on the cure status and PFS for the uncured patients. RESULTS Histological response is a strong prognostic factor for the cure status (OR 3.00, 95% CI 1.75 to 5.17), but it has no clear effect on PFS for the uncured patients (HR 0.78, -95% CI 0.53 to 1.16). The cure fractions are 55% (46%-63%) and 29% (22%-35%), respectively, among patients with good and poor histological response (GR, PR). The intensified regimen was associated with a higher cure fraction among PR (OR 1.90, 95% CI 0.93 to 3.89), with no evidence of effect for GR (OR 0.78, 95% CI 0.38 to 1.59). CONCLUSIONS Accounting for cured patients is valuable in distinguishing the covariate effects on cure and PFS. Estimating cure chances based on these prognostic factors is relevant for counselling patients and can have an impact on treatment decisions. TRIAL REGISTRATION NUMBER ISRCTN86294690.
Collapse
Affiliation(s)
- Eni Musta
- Korteweg-de Vries Institute for Mathematics, University of Amsterdam, Amsterdam, The Netherlands
| | - Nan van Geloven
- Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands
| | - Jakob Anninga
- Department of Solid Tumours, Princess Máxima Centre, Utrecht, The Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marta Fiocco
- Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands
- Department of Solid Tumours, Princess Máxima Centre, Utrecht, The Netherlands
- Mathematical Institute, Leiden University, Leiden, The Netherlands
| |
Collapse
|
14
|
Vai A, Molinelli S, Rossi E, Iacovelli NA, Magro G, Cavallo A, Pignoli E, Rancati T, Mirandola A, Russo S, Ingargiola R, Vischioni B, Bonora M, Ronchi S, Ciocca M, Orlandi E. Proton Radiation Therapy for Nasopharyngeal Cancer Patients: Dosimetric and NTCP Evaluation Supporting Clinical Decision. Cancers (Basel) 2022; 14:cancers14051109. [PMID: 35267415 PMCID: PMC8909055 DOI: 10.3390/cancers14051109] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/09/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: we proposed an integrated strategy to support clinical allocation of nasopharyngeal patients between proton and photon radiotherapy. (2) Methods: intensity-modulated proton therapy (IMPT) plans were optimized for 50 consecutive nasopharyngeal carcinoma (NPC) patients treated with volumetric modulated arc therapy (VMAT), and differences in dose and normal tissue complication probability (ΔNTCPx-p) for 16 models were calculated. Patient eligibility for IMPT was assessed using a model-based selection (MBS) strategy following the results for 7/16 models describing the most clinically relevant endpoints, applying a model-specific ΔNTCPx-p threshold (15% to 5% depending on the severity of the complication) and a composite threshold (35%). In addition, a comprehensive toxicity score (CTS) was defined as the weighted sum of all 16 ΔNTCPx-p, where weights follow a clinical rationale. (3) Results: Dose deviations were in favor of IMPT (ΔDmean ≥ 14% for cord, esophagus, brainstem, and glottic larynx). The risk of toxicity significantly decreased for xerostomia (-12.5%), brain necrosis (-2.3%), mucositis (-3.2%), tinnitus (-8.6%), hypothyroidism (-9.3%), and trismus (-5.4%). There were 40% of the patients that resulted as eligible for IMPT, with a greater advantage for T3-T4 staging. Significantly different CTS were observed in patients qualifying for IMPT. (4) Conclusions: The MBS strategy successfully drives the clinical identification of NPC patients, who are most likely to benefit from IMPT. CTS summarizes well the expected global gain.
Collapse
Affiliation(s)
- Alessandro Vai
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (S.M.); (E.R.); (G.M.); (S.R.); (R.I.); (B.V.); (M.B.); (S.R.); (M.C.); (E.O.)
- Correspondence: (A.V.); (N.A.I.); Tel.: +39-0382-078-505 (A.V.)
| | - Silvia Molinelli
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (S.M.); (E.R.); (G.M.); (S.R.); (R.I.); (B.V.); (M.B.); (S.R.); (M.C.); (E.O.)
| | - Eleonora Rossi
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (S.M.); (E.R.); (G.M.); (S.R.); (R.I.); (B.V.); (M.B.); (S.R.); (M.C.); (E.O.)
| | - Nicola Alessandro Iacovelli
- Radiotherapy Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano (INT), 20133 Milan, Italy; (A.C.); (E.P.); (T.R.); (A.M.)
- Correspondence: (A.V.); (N.A.I.); Tel.: +39-0382-078-505 (A.V.)
| | - Giuseppe Magro
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (S.M.); (E.R.); (G.M.); (S.R.); (R.I.); (B.V.); (M.B.); (S.R.); (M.C.); (E.O.)
| | - Anna Cavallo
- Radiotherapy Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano (INT), 20133 Milan, Italy; (A.C.); (E.P.); (T.R.); (A.M.)
| | - Emanuele Pignoli
- Radiotherapy Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano (INT), 20133 Milan, Italy; (A.C.); (E.P.); (T.R.); (A.M.)
| | - Tiziana Rancati
- Radiotherapy Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano (INT), 20133 Milan, Italy; (A.C.); (E.P.); (T.R.); (A.M.)
| | - Alfredo Mirandola
- Radiotherapy Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano (INT), 20133 Milan, Italy; (A.C.); (E.P.); (T.R.); (A.M.)
| | - Stefania Russo
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (S.M.); (E.R.); (G.M.); (S.R.); (R.I.); (B.V.); (M.B.); (S.R.); (M.C.); (E.O.)
| | - Rossana Ingargiola
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (S.M.); (E.R.); (G.M.); (S.R.); (R.I.); (B.V.); (M.B.); (S.R.); (M.C.); (E.O.)
| | - Barbara Vischioni
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (S.M.); (E.R.); (G.M.); (S.R.); (R.I.); (B.V.); (M.B.); (S.R.); (M.C.); (E.O.)
| | - Maria Bonora
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (S.M.); (E.R.); (G.M.); (S.R.); (R.I.); (B.V.); (M.B.); (S.R.); (M.C.); (E.O.)
| | - Sara Ronchi
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (S.M.); (E.R.); (G.M.); (S.R.); (R.I.); (B.V.); (M.B.); (S.R.); (M.C.); (E.O.)
| | - Mario Ciocca
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (S.M.); (E.R.); (G.M.); (S.R.); (R.I.); (B.V.); (M.B.); (S.R.); (M.C.); (E.O.)
| | - Ester Orlandi
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (S.M.); (E.R.); (G.M.); (S.R.); (R.I.); (B.V.); (M.B.); (S.R.); (M.C.); (E.O.)
| |
Collapse
|
15
|
Engeseth GM, Hysing LB, Yepes P, Pettersen HES, Mohan R, Fuller CD, Stokkevåg CH, Wu R, Zhang X, Frank SJ, Gunn GB. Impact of RBE variations on risk estimates of temporal lobe necrosis in patients treated with intensity-modulated proton therapy for head and neck cancer. Acta Oncol 2022; 61:215-222. [PMID: 34534047 PMCID: PMC9969227 DOI: 10.1080/0284186x.2021.1979248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Temporal lobe necrosis (TLN) is a potential late effect after radiotherapy for skull base head and neck cancer (HNC). Several photon-derived dose constraints and normal tissue complication probability (NTCP) models have been proposed, however variation in relative biological effectiveness (RBE) may challenge the applicability of these dose constraints and models in proton therapy. The purpose of this study was therefore to investigate the influence of RBE variations on risk estimates of TLN after Intensity-Modulated Proton Therapy for HNC. MATERIAL AND METHODS Seventy-five temporal lobes from 45 previously treated patients were included in the analysis. Sixteen temporal lobes had radiation associated Magnetic Resonance image changes (TLIC) suspected to be early signs of TLN. Fixed (RWDFix) and variable RBE-weighed doses (RWDVar) were calculated using RBE = 1.1 and two RBE models, respectively. RWDFix and RWDVar for temporal lobes were compared using Friedman's test. Based on RWDFix, six NTCP models were fitted and internally validated through bootstrapping. Estimated probabilities from RWDFix and RWDVar were compared using paired Wilcoxon test. Seven dose constraints were evaluated separately for RWDFix and RWDVar by calculating the observed proportion of TLIC in temporal lobes meeting the specific dose constraints. RESULTS RWDVar were significantly higher than RWDFix (p < 0.01). NTCP model performance was good (AUC:0.79-0.84). The median difference in estimated probability between RWDFix and RWDVar ranged between 5.3% and 20.0% points (p < 0.01), with V60GyRBE and DMax at the smallest and largest differences, respectively. The proportion of TLIC was higher for RWDFix (4.0%-13.1%) versus RWDVar (1.3%-5.3%). For V65GyRBE ≤ 0.03 cc the proportion of TLIC was less than 5% for both RWDFix and RWDVar. CONCLUSION NTCP estimates were significantly influenced by RBE variations. Dmax as model predictor resulted in the largest deviations in risk estimates between RWDFix and RWDVar. V65GyRBE ≤ 0.03 cc was the most consistent dose constraint for RWDFix and RWDVar.
Collapse
Affiliation(s)
- Grete May Engeseth
- University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, USA,Haukeland University Hospital, Department of Oncology and Medical Physics, Bergen, Norway,University of Bergen, Department of Clinical Science, Bergen, Norway,Corresponding author: Grete May Engeseth, , Haukeland University Hospital, Department of Oncology and Medical Physics, Postboks 1400, 5021 Bergen
| | - Liv Bolstad Hysing
- Haukeland University Hospital, Department of Oncology and Medical Physics, Bergen, Norway,University of Bergen, Department of Physics and Technology, Bergen, Norway
| | - Pablo Yepes
- Rice University, Physics and Astronomy Department, Houston, USA
| | | | - Rahde Mohan
- University of Texas MD Anderson Cancer Center, Department of Radiation Physics, Houston, USA
| | - Clifton Dave Fuller
- University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, USA
| | - Camilla Hanquist Stokkevåg
- Haukeland University Hospital, Department of Oncology and Medical Physics, Bergen, Norway,University of Bergen, Department of Physics and Technology, Bergen, Norway
| | - Richard Wu
- University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, USA
| | - Xiaodong Zhang
- University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, USA
| | - Steven Jay Frank
- University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, USA
| | - Gary Brandon Gunn
- University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, USA
| |
Collapse
|
16
|
Du QH, Li J, Gan YX, Zhu HJ, Yue HY, Li XD, Ou X, Zhong QL, Luo DJ, Xie YT, Liang QF, Wang RS, Liu WQ. Potential Defects and Improvements of Equivalent Uniform Dose Prediction Model Based on the Analysis of Radiation-Induced Brain Injury. Front Oncol 2022; 11:743941. [PMID: 35087743 PMCID: PMC8786722 DOI: 10.3389/fonc.2021.743941] [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: 07/20/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To study the impact of dose distribution on volume-effect parameter and predictive ability of equivalent uniform dose (EUD) model, and to explore the improvements. METHODS AND MATERIALS The brains of 103 nasopharyngeal carcinoma patients treated with IMRT were segmented according to dose distribution (brain and left/right half-brain for similar distributions but different sizes; V D with different D for different distributions). Predictive ability of EUDV D (EUD of V D ) for radiation-induced brain injury was assessed by receiver operating characteristics curve (ROC) and area under the curve (AUC). The optimal volume-effect parameter a of EUD was selected when AUC was maximal (mAUC). Correlations between mAUC, a and D were analyzed by Pearson correlation analysis. Both mAUC and a in brain and half-brain were compared by using paired samples t-tests. The optimal D V and V D points were selected for a simple comparison. RESULTS The mAUC of brain/half-brain EUD was 0.819/0.821 and the optimal a value was 21.5/22. When D increased, mAUC of EUDV D increased, while a decreased. The mAUC reached the maximum value when D was 50-55 Gy, and a was always 1 when D ≥55 Gy. The difference of mAUC/a between brain and half-brain was not significant. If a was in range of 1 to 22, AUC of brain/half-brain EUDV55 Gy (0.857-0.830/0.845-0.830) was always larger than that of brain/half-brain EUD (0.681-0.819/0.691-0.821). The AUCs of optimal dose/volume points were 0.801 (brain D2.5 cc), 0.823 (brain V70 Gy), 0.818 (half-brain D1 cc), and 0.827 (half-brain V69 Gy), respectively. Mean dose (equal to EUDV D with a = 1) of high-dose volume (V50 Gy-V60 Gy) was superior to traditional EUD and dose/volume points. CONCLUSION Volume-effect parameter of EUD is variable and related to dose distribution. EUD with large low-dose volume may not be better than simple dose/volume points. Critical-dose-volume EUD could improve the predictive ability and has an invariant volume-effect parameter. Mean dose may be the case in which critical-dose-volume EUD has the best predictive ability.
Collapse
Affiliation(s)
- Qing-Hua Du
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jian Li
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yi-Xiu Gan
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hui-Jun Zhu
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hai-Ying Yue
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiang-De Li
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xue Ou
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qiu-Lu Zhong
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Dan-Jing Luo
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yi-Ting Xie
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qian-Fu Liang
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ren-Sheng Wang
- Department of Radiation Oncology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Wen-Qi Liu
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| |
Collapse
|
17
|
Normal Tissue Complication Probability Modelling for Toxicity Prediction and Patient Selection in Proton Beam Therapy to the Central Nervous System: A Literature Review. Clin Oncol (R Coll Radiol) 2022; 34:e225-e237. [DOI: 10.1016/j.clon.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/22/2021] [Accepted: 12/21/2021] [Indexed: 11/22/2022]
|
18
|
Paganetti H. Mechanisms and Review of Clinical Evidence of Variations in Relative Biological Effectiveness in Proton Therapy. Int J Radiat Oncol Biol Phys 2022; 112:222-236. [PMID: 34407443 PMCID: PMC8688199 DOI: 10.1016/j.ijrobp.2021.08.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/14/2021] [Accepted: 08/10/2021] [Indexed: 01/03/2023]
Abstract
Proton therapy is increasingly being used as a radiation therapy modality. There is uncertainty about the biological effectiveness of protons relative to photon therapies as it depends on several physical and biological parameters. Radiation oncology currently applies a constant and generic value for the relative biological effectiveness (RBE) of 1.1, which was chosen conservatively to ensure tumor coverage. The use of a constant value has been challenged particularly when considering normal tissue constraints. Potential variations in RBE have been assessed in several published reviews but have mostly focused on data from clonogenic cell survival experiments with unclear relevance for clinical proton therapy. The goal of this review is to put in vitro findings in relation to clinical observations. Relevant in vivo pathways determining RBE for tumors and normal tissues are outlined, including not only damage to tumor cells and parenchyma but also vascular damage and immune response. Furthermore, the current clinical evidence of varying RBE is reviewed. The assessment can serve as guidance for treatment planning, personalized dose prescriptions, and outcome analysis.
Collapse
Affiliation(s)
- Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
| |
Collapse
|
19
|
Park S, Demizu Y, Suga M, Taniguchi S, Tanaka S, Maehata I, Takeda M, Takahashi D, Matsuo Y, Sulaiman NS, Terashima K, Tokumaru S, Furukawa K, Okimoto T. Predicted probabilities of brain injury after carbon ion radiotherapy for head and neck and skull base tumors in long-term survivors. Radiother Oncol 2021; 165:152-158. [PMID: 34718054 DOI: 10.1016/j.radonc.2021.10.017] [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: 11/11/2020] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to determine the risk factors for radiation-induced brain injury (RIBI1) after carbon ion radiotherapy (CIRT) to predict their probabilities in long-term survivors. MATERIALS AND METHODS We evaluated 104 patients with head, neck, and skull base tumors who underwent CIRT in a regimen of 32 fractions and were followed up for at least 24 months. RIBI was assessed using the Common Terminology Criteria for Adverse Events. RESULTS The median follow-up period was 45.5 months; 19 (18.3 %) patients developed grade ≥2 RIBI. The maximal absolute dose covering 5 mL of the brain (D5ml) was the only significant risk factor for grade ≥2 RIBI in the multivariate logistic regression analysis (p = 0.001). The tolerance doses of D5ml for the 5% and 50% probabilities of developing grade ≥2 RIBI were estimated to be 55.4 Gy (relative biological effectiveness [RBE]) and 68.4 Gy (RBE) by a logistic model, respectively. CONCLUSION D5ml was most significantly associated with grade ≥2 RIBI and may enable the prediction of its probability.
Collapse
Affiliation(s)
- SungChul Park
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan.
| | - Yusuke Demizu
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan; Department of Radiation Oncology, Hyogo Ion Beam Medical Center Kobe Proton Center, Japan
| | - Masaki Suga
- Department of Radiation Physics, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | - Shingo Taniguchi
- Department of Radiation Technology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | - Shinichi Tanaka
- Department of Radiation Technology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | - Itsumi Maehata
- Department of Radiation Technology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | - Mikuni Takeda
- Department of Radiation Technology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | - Daiki Takahashi
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | - Yoshiro Matsuo
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | | | - Kazuki Terashima
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | - Sunao Tokumaru
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| | - Kyoji Furukawa
- Biostatistics Center, Kurume University Graduate School of Medicine, Fukuoka, Japan
| | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
| |
Collapse
|
20
|
Garbacz M, Cordoni FG, Durante M, Gajewski J, Kisielewicz K, Krah N, Kopeć R, Olko P, Patera V, Rinaldi I, Rydygier M, Schiavi A, Scifoni E, Skóra T, Tommasino F, Rucinski A. Study of relationship between dose, LET and the risk of brain necrosis after proton therapy for skull base tumors. Radiother Oncol 2021; 163:143-149. [PMID: 34461183 DOI: 10.1016/j.radonc.2021.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 07/27/2021] [Accepted: 08/21/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE We investigated the relationship between RBE-weighted dose (DRBE) calculated with constant (cRBE) and variable RBE (vRBE), dose-averaged linear energy transfer (LETd) and the risk of radiographic changes in skull base patients treated with protons. METHODS Clinical treatment plans of 45 patients were recalculated with Monte Carlo tool FRED. Radiographic changes (i.e. edema and/or necrosis) were identified by MRI. Dosimetric parameters for cRBE and vRBE were computed. Biological margin extension and voxel-based analysis were employed looking for association of DRBE(vRBE) and LETd with brain edema and/or necrosis. RESULTS When using vRBE, Dmax in the brain was above the highest dose limits for 38% of patients, while such limit was never exceeded assuming cRBE. Similar values of Dmax were observed in necrotic regions, brain and temporal lobes. Most of the brain necrosis was in proximity to the PTV. The voxel-based analysis did not show evidence of an association with high LETd values. CONCLUSIONS When looking at standard dosimetric parameters, the higher dose associated with vRBE seems to be responsible for an enhanced risk of radiographic changes. However, as revealed by a voxel-based analysis, the large inter-patient variability hinders the identification of a clear effect for high LETd.
Collapse
Affiliation(s)
- Magdalena Garbacz
- Institute of Nuclear Physics Polish Academy of Sciences, 31342 Krakow, Poland.
| | - Francesco Giuseppe Cordoni
- University of Verona, Department of Computer Science, Verona, Italy; Trento Institute for Fundamental Physics and Applications, TIFPA-INFN, Trento, Italy
| | - Marco Durante
- GSI Helmholtzzentrum fur Schwerionenforschung, Darmstadt, Germany; The Technical University of Darmstadt, Germany
| | - Jan Gajewski
- Institute of Nuclear Physics Polish Academy of Sciences, 31342 Krakow, Poland
| | - Kamil Kisielewicz
- National Oncology Institute, National Research Institute, Krakow Branch, Krakow, Poland
| | - Nils Krah
- University of Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Lyon 1, Centre Léon Bérard, France; University of Lyon, Université Claude Bernard Lyon 1, CNRS/IN2P3, IP2I Lyon, UMR 5822, Villeurbanne, France
| | - Renata Kopeć
- Institute of Nuclear Physics Polish Academy of Sciences, 31342 Krakow, Poland
| | - Paweł Olko
- Institute of Nuclear Physics Polish Academy of Sciences, 31342 Krakow, Poland
| | - Vincenzo Patera
- INFN - Section of Rome, Italy; Department of Basic and Applied Sciences for Engineering, Sapienza University of Rome, Italy
| | - Ilaria Rinaldi
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marzena Rydygier
- Institute of Nuclear Physics Polish Academy of Sciences, 31342 Krakow, Poland
| | - Angelo Schiavi
- Department of Basic and Applied Sciences for Engineering, Sapienza University of Rome, Italy
| | - Emanuele Scifoni
- Trento Institute for Fundamental Physics and Applications, TIFPA-INFN, Trento, Italy
| | - Tomasz Skóra
- National Oncology Institute, National Research Institute, Krakow Branch, Krakow, Poland
| | - Francesco Tommasino
- Trento Institute for Fundamental Physics and Applications, TIFPA-INFN, Trento, Italy; Department of Physics, University of Trento, Trento, Italy
| | - Antoni Rucinski
- Institute of Nuclear Physics Polish Academy of Sciences, 31342 Krakow, Poland
| |
Collapse
|
21
|
Stieb S, Lee A, van Dijk LV, Frank S, Fuller CD, Blanchard P. NTCP Modeling of Late Effects for Head and Neck Cancer: A Systematic Review. Int J Part Ther 2021; 8:95-107. [PMID: 34285939 PMCID: PMC8270107 DOI: 10.14338/20-00092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/08/2021] [Indexed: 12/23/2022] Open
Affiliation(s)
- Sonja Stieb
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Center for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Anna Lee
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lisanne V. van Dijk
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Radiation Oncology, University Medical Center–Groningen, Groningen, the Netherlands
| | - Steven Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clifton David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pierre Blanchard
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Radiotherapy, Gustave Roussy Cancer Campus, Universite Paris-Saclay, Villejuif, France
| |
Collapse
|
22
|
Radiation-induced brain injury in patients with meningioma treated with proton or photon therapy. J Neurooncol 2021; 153:169-180. [PMID: 33886111 DOI: 10.1007/s11060-021-03758-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Radiation therapy is often used to treat meningioma with adverse features or when unresectable. Proton therapy has advantages over photon therapy in reducing integral dose to the brain. This study compared the incidence of radiological and clinical adverse events after photon versus proton therapy in the treatment of meningioma. METHODS A retrospective review was conducted on patients with meningioma treated with proton or photon therapy at two high-volume tertiary cancer centers. Patients with a history of prior radiation therapy (RT) or less than 3 months of follow-up were excluded. Post-RT imaging changes were categorized into abnormal T2 signal intensities (T2 changes) or abnormal T1 post-contrast and T2 signal intensities (T1c+T2 changes) on magnetic resonance imaging (MRI). Clinical outcomes of adverse events and survival were compared between the proton and photon therapies. RESULTS Among the total of 77 patients, 38 patients received proton therapy and 39 patients received photon therapy. The median age at diagnosis was 55 years and median follow-up was 2.2 years. No significant differences in symptomatic adverse events were observed between the two groups: grade ≥ 2 adverse events were seen in 4 (10.5%) patients in the proton group and 3 (7.7%) patients in the photon group (p = 0.67). The 2-year cumulative incidences of T2 changes were 38.3% after proton therapy and 47.7% after photon therapy (p = 0.53) and the 2-year cumulative incidences of T1c+T2 changes were 26.8% after proton therapy and 5.3% after photon therapy (p = 0.02). One patient experienced grade ≥ 4 adverse event in each group (p = 0.99). Estimated 2-year progression-free survival was 79.5% (proton therapy 76.0% vs. photon therapy 81.3%, p = 0.66) and 2-year overall survival was 89.7% (proton therapy 86.6% vs. photon therapy 89.3%, p = 0.65). CONCLUSIONS Following RT, high rates of T2 changes were seen in meningioma patients regardless of treatment modality. Proton therapy was associated with significantly higher rates of T1c+T2 changes compared with photon therapy, but severe adverse events were uncommon in both groups and survival outcomes were comparable between the two groups. Future studies will aim at correlating the MRI changes with models that can be incorporated into RT planning to avoid toxicity.
Collapse
|
23
|
Dutz A, Lühr A, Troost EGC, Agolli L, Bütof R, Valentini C, Baumann M, Vermeren X, Geismar D, Timmermann B, Krause M, Löck S. Identification of patient benefit from proton beam therapy in brain tumour patients based on dosimetric and NTCP analyses. Radiother Oncol 2021; 160:69-77. [PMID: 33872640 DOI: 10.1016/j.radonc.2021.04.008] [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] [Received: 08/18/2020] [Revised: 03/17/2021] [Accepted: 04/08/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The limited availability of proton beam therapy (PBT) requires individual treatment selection strategies, such as the model-based approach. In this study, we assessed the dosimetric benefit of PBT compared to photon therapy (XRT), analysed the corresponding changes in normal tissue complication probability (NTCP) on a variety of available models, and illustrated model-based patient selection in an in-silico study for patients with brain tumours. METHODS For 92 patients treated at two PBT centres, volumetric modulated arc therapy treatment plans were retrospectively created for comparison with the clinically applied PBT plans. Several dosimetric parameters for the brain excluding tumour and margins, cerebellum, brain stem, frontal and temporal lobes, hippocampi, cochleae, chiasm, optic nerves, lacrimal glands, lenses, pituitary gland, and skin were compared between both modalities using Wilcoxon signed-rank tests. NTCP differences (ΔNTCP) were calculated for 11 models predicting brain necrosis, delayed recall, temporal lobe injury, hearing loss, tinnitus, blindness, ocular toxicity, cataract, endocrine dysfunction, alopecia, and erythema. A patient was assumed to be selected for PBT if ΔNTCP exceeded a threshold of 10 percentage points for at least one of the side-effects. RESULTS PBT substantially reduced the dose in almost all investigated OARs, especially in the low and intermediate dose ranges and for contralateral organs. In general, NTCP predictions were significantly lower for PBT compared to XRT, in particular in ipsilateral organs. Considering ΔNTCP of all models, 80 patients (87.0%) would have been selected for PBT in this in-silico study, mainly due to predictions of a model on delayed recall (51 patients). CONCLUSION In this study, substantial dose reductions for PBT were observed, mainly in contralateral organs. However, due to the sigmoidal dose response, NTCP was particularly reduced in ipsilateral organs. This underlines that physical dose-volume parameters alone may not be sufficient to describe the clinical relevance between different treatment techniques and highlights potential benefits of NTCP models. Further NTCP models for different modern treatment techniques are mandatory and existing models have to be externally validated in order to implement the model-based approach in clinical practice for cranial radiotherapy.
Collapse
Affiliation(s)
- Almut Dutz
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany
| | - Armin Lühr
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany; Medical Physics and Radiotherapy, Faculty of Physics, TU Dortmund University, Germany
| | - Esther G C Troost
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, 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, and; Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Linda Agolli
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Rebecca Bütof
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, 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, and; Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Chiara Valentini
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Michael Baumann
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, 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, and; Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany; Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - Xavier Vermeren
- West German Proton Therapy Center Essen (WPE), University Hospital Essen, Germany
| | - Dirk Geismar
- West German Proton Therapy Center Essen (WPE), University Hospital Essen, Germany; Department of Particle Therapy, University Hospital Essen, Germany; West German Cancer Center (WTZ), University Hospital Essen, Germany
| | - Beate Timmermann
- West German Proton Therapy Center Essen (WPE), University Hospital Essen, Germany; Department of Particle Therapy, University Hospital Essen, Germany; West German Cancer Center (WTZ), University Hospital Essen, Germany; German Cancer Consortium (DKTK), partner site Essen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mechthild Krause
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, 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, and; Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Steffen Löck
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| |
Collapse
|
24
|
Du QH, Gan YX, Wang RS, Liu WQ, Li J, Liang FF, Li XD, Zhu HJ, Ou X, Zhong QL, Luo DJ, Zhu ZP, Zhu SY. Half-Brain Delineation for Prediction of Radiation-Induced Temporal Lobe Injury in Nasopharyngeal Carcinoma Receiving Intensity-Modulated Radiotherapy. Front Oncol 2021; 11:599942. [PMID: 33868994 PMCID: PMC8047307 DOI: 10.3389/fonc.2021.599942] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/15/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose To investigate the role of half-brain delineation in the prediction of radiation-induced temporal lobe injury (TLI) in nasopharyngeal carcinoma (NPC) receiving intensity-modulated radiotherapy (IMRT). Methods and Materials A total of 220 NPC cases treated with IMRT and concurrent platinum-based chemotherapy were retrospectively analyzed. Dosimetric parameters of temporal lobes, half-brains, and brains included maximum dose (Dmax), doses covering certain volume (DV) from 0.03 to 20 cc and absolute volumes receiving specific dose (VD) from 40 to 80 Gy. Inter-structure variability was assessed by coefficients of variation (CV) and paired samples t-tests. Receiver operating characteristic curve (ROC) and Youden index were used for screening dosimetric parameters to predict TLI. Dose/volume response curve was calculated using the logistic dose/volume response model. Results CVs of brains, left/right half-brains, and left/right temporal lobes were 9.72%, 9.96%, 9.77%, 27.85%, and 28.34%, respectively. Each DV in temporal lobe was significantly smaller than that in half-brain (P < 0.001), and the reduction ranged from 3.10% to 45.98%. The area under the curve (AUC) of DV and VD showed an "increase-maximum-decline" behavior with a peak as the volume or dose increased. The maximal AUCs of DVs in brain, half-brain and temporal lobe were 0.808 (D2cc), 0.828 (D1.2cc) and 0.806 (D0.6cc), respectively, and the maximal AUCs of VDs were 0.818 (D75Gy), 0.834 (V72Gy) and 0.814 (V70Gy), respectively. The cutoffs of V70Gy (0.86 cc), V71Gy (0.72 cc), V72Gy (0.60 cc), and V73Gy (0.45 cc) in half-brain had better Youden index. TD5/5 and TD50/5 of D1.2cc were 58.7 and 80.0 Gy, respectively. The probability of TLI was higher than >13% when V72Gy>0 cc, and equal to 50% when V72Gy = 7.66 cc. Conclusion Half-brain delineation is a convenient and stable method which could reduce contouring variation and could be used in NPC patients. D1.2cc and V72Gy of half-brain are feasible for TLI prediction model. The dose below 70 Gy may be relatively safe for half-brain. The cutoff points of V70-73Gy could be considered when the high dose is inevitable.
Collapse
Affiliation(s)
- Qing-Hua Du
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yi-Xiu Gan
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ren-Sheng Wang
- Department of Radiation Oncology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Wen-Qi Liu
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jian Li
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Fei-Fei Liang
- Department of Radiation Oncology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiang-De Li
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hui-Jun Zhu
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xue Ou
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qiu-Lu Zhong
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Dan-Jing Luo
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhi-Peng Zhu
- Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shang-Yong Zhu
- Department of Medical Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| |
Collapse
|
25
|
Niemierko A, Schuemann J, Niyazi M, Giantsoudi D, Maquilan G, Shih HA, Paganetti H. Brain Necrosis in Adult Patients After Proton Therapy: Is There Evidence for Dependency on Linear Energy Transfer? Int J Radiat Oncol Biol Phys 2021; 109:109-119. [PMID: 32911019 PMCID: PMC7736370 DOI: 10.1016/j.ijrobp.2020.08.058] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To investigate if radiographic imaging changes defined as necrosis correlate with regions in the brain with elevated linear energy transfer (LET) for proton radiation therapy treatments with partial brain involvement in central nervous system and patients with head and neck cancer. METHODS AND MATERIALS Fifty patients with head and neck, skull base, or intracranial tumors who underwent proton therapy between 2004 to 2016 with a minimum prescription dose of 59.4 Gy (relative biological effectiveness) and with magnetic resonance imaging changes indicative of brain necrosis after radiation therapy were retrospectively reviewed. Each treatment plan was recalculated using Monte Carlo simulations to provide accurate dose distributions as well as 3-dimensional distributions of LET. To assess the effect of LET on radiographic imaging changes several voxel-based analyses were performed. RESULTS In this patient cohort, LET adjusted for dose was not found to be associated with risk of brain necrosis. CONCLUSIONS A voxel-based analysis of brain necrosis as an endpoint is difficult owing to uncertainties in the origin of necrosis, timing of imaging, variability in patient specific radiosensitivity, and the simultaneous effect of dose and LET. Even though it is expected that the LET and thus relative biological effectiveness increases at the end of range, effects in patients might be small compared with interpatient variability of radiosensitivity and might be obscured by other confounding factors.
Collapse
Affiliation(s)
- Andrzej Niemierko
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Jan Schuemann
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Maximilian Niyazi
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium, partner site Munich, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - Drosoula Giantsoudi
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Genevieve Maquilan
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Helen A Shih
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
26
|
Ten Eikelder SCM, Ferjančič P, Ajdari A, Bortfeld T, den Hertog D, Jeraj R. Optimal treatment plan adaptation using mid-treatment imaging biomarkers. Phys Med Biol 2020; 65:245011. [PMID: 33053518 DOI: 10.1088/1361-6560/abc130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Previous studies on personalized radiotherapy (RT) have mostly focused on baseline patient stratification, adapting the treatment plan according to mid-treatment anatomical changes, or dose boosting to selected tumor subregions using mid-treatment radiological findings. However, the question of how to find the optimal adapted plan has not been properly tackled. Moreover, the effect of information uncertainty on the resulting adaptation has not been explored. In this paper, we present a framework to optimally adapt radiation therapy treatments to early radiation treatment response estimates derived from pre- and mid-treatment imaging data while considering the information uncertainty. The framework is based on the optimal stopping in radiation therapy (OSRT) framework. Biological response is quantified using tumor control probability (TCP) and normal tissue complication probability (NTCP) models, and these are directly optimized for in the adaptation step. Two adaptation strategies are discussed: (1) uniform dose adaptation and (2) continuous dose adaptation. In the first strategy, the original fluence-map is simply scaled upwards or downwards, depending on whether dose escalation or de-escalation is deemed appropriate based on the mid-treatment response observed from the radiological images. In the second strategy, a full NTCP-TCP-based fluence map re-optimization is performed to achieve the optimal adapted plans. We retrospectively tested the performance of these strategies on 14 canine head and neck cases treated with tomotherapy, using as response biomarker the change in the 3'-deoxy-3'[(18)F]-fluorothymidine (FLT)-PET signals between the pre- and mid-treatment images, and accounting for information uncertainty. Using a 10% uncertainty level, the two adaptation strategies both yield a noteworthy average improvement in guaranteed (worst-case) TCP.
Collapse
Affiliation(s)
- S C M Ten Eikelder
- Department of Econometrics and Operations Research, Tilburg University, Tilburg, The Netherlands
| | | | | | | | | | | |
Collapse
|
27
|
Combs SE, Baumert BG, Bendszus M, Bozzao A, Brada M, Fariselli L, Fiorentino A, Ganswindt U, Grosu AL, Lagerwaard FL, Niyazi M, Nyholm T, Paddick I, Weber DC, Belka C, Minniti G. ESTRO ACROP guideline for target volume delineation of skull base tumors. Radiother Oncol 2020; 156:80-94. [PMID: 33309848 DOI: 10.1016/j.radonc.2020.11.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/13/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE For skull base tumors, target definition is the key to safe high-dose treatments because surrounding normal tissues are very sensitive to radiation. In the present work we established a joint ESTRO ACROP guideline for the target volume definition of skull base tumors. MATERIAL AND METHODS A comprehensive literature search was conducted in PubMed using various combinations of the following medical subjects headings (MeSH) and free-text words: "radiation therapy" or "stereotactic radiosurgery" or "proton therapy" or "particle beam therapy" and "skull base neoplasms" "pituitary neoplasms", "meningioma", "craniopharyngioma", "chordoma", "chondrosarcoma", "acoustic neuroma/vestibular schwannoma", "organs at risk", "gross tumor volume", "clinical tumor volume", "planning tumor volume", "target volume", "target delineation", "dose constraints". The ACROP committee identified sixteen European experts in close interaction with the ESTRO clinical committee who analyzed and discussed the body of evidence concerning target delineation. RESULTS All experts agree that magnetic resonance (MR) images with high three-dimensional spatial accuracy and tissue-contrast definition, both T2-weighted and volumetric T1-weighted sequences, are required to improve target delineation. In detail, several key issues were identified and discussed: i) radiation techniques and immobilization, ii) imaging techniques and target delineation, and iii) technical aspects of radiation treatments including planning techniques and dose-fractionation schedules. Specific target delineation issues with regard to different skull base tumors, including pituitary adenomas, meningiomas, craniopharyngiomas, acoustic neuromas, chordomas and chondrosarcomas are presented. CONCLUSIONS This ESTRO ACROP guideline achieved detailed recommendations on target volume definition for skull base tumors, as well as comprehensive advice about imaging modalities and radiation techniques.
Collapse
Affiliation(s)
- Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany; Institute of Radiation Medicine, Department of Radiation Sciences, Helmholtz Zentrum München, Munich, Germany; German Cancer Consortium (DKTK) Partner Site (DKTK), Munich, Germany
| | - Brigitta G Baumert
- Institute of Radiation Oncology, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Germany
| | - Alessandro Bozzao
- Dipartimento NESMOS, Università Sapienza Roma, Azienda Ospedaliera Sant'Andrea, Rome, Italy
| | - Michael Brada
- Department of Radiation Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, United Kingdom
| | - Laura Fariselli
- Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alba Fiorentino
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle fonti, Italy
| | - Ute Ganswindt
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anca L Grosu
- Department of Radiation Oncology, Medical Faculty, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, Germany
| | - Frank L Lagerwaard
- Department of Radiation Oncology, Amsterdam University Medical Centers, Location VUmc, The Netherlands
| | - Maximilian Niyazi
- German Cancer Consortium (DKTK) Partner Site (DKTK), Munich, Germany; Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Tufve Nyholm
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
| | - Ian Paddick
- Queen Square Radiosurgery Centre, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | | | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Giuseppe Minniti
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy; IRCCS Neuromed, Pozzilli, Italy.
| |
Collapse
|
28
|
Outcomes and patterns of radiation associated brain image changes after proton therapy for head and neck skull base cancers. Radiother Oncol 2020; 151:119-125. [PMID: 32679304 DOI: 10.1016/j.radonc.2020.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE To characterize patterns and outcomes of brain MR image changes after proton therapy (PT) for skull base head and neck cancer (HNC). MATERIAL AND METHODS Post-treatment MRIs ≥6 months were reviewed for radiation-associated image changes (RAIC) in 127 patients. All patients had received at least a point dose of 40 Gy(RBE) to the brain. The MRIs were rigidly registered to planning CTs and RAIC lesions were contoured both on T1 weighted (post-contrast) and T2 weighted sequences, and dose-volume parameters extracted. Probability of RAIC was calculated using multistate survival analysis. Univariate/multivariate analyses were performed using Cox Regression. Recursive partitioning analysis was used to investigate dose-volume correlates of RAIC development. RESULTS 17.3% developed RAIC. All RAIC events were asymptomatic and occurred in the temporal lobe (14), frontal lobe (6) and cerebellum (2). The median volume of the contrast enhanced RAIC lesion was 0.5 cc at their maximum size. The RAIC resolved or improved in 45.5% of the patients and were stable or progressed in 36.4%. The 3-year actuarial rate of developing RAIC was 14.3%. RAIC was observed in 63% of patients when V67 Gy(RBE) of the brain ≥0.17 cc. CONCLUSION Small RAIC lesions after PT occurred in 17.3% of the patients; the majority in nasopharyngeal or sinonasal cancer. The estimated dose-volume correlations confirm the importance of minimizing focal high doses to brain when achievable.
Collapse
|
29
|
Siddique S, Chow JC. Artificial intelligence in radiotherapy. Rep Pract Oncol Radiother 2020; 25:656-666. [PMID: 32617080 PMCID: PMC7321818 DOI: 10.1016/j.rpor.2020.03.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/06/2020] [Accepted: 03/27/2020] [Indexed: 02/06/2023] Open
Abstract
Artificial intelligence (AI) has already been implemented widely in the medical field in the recent years. This paper first reviews the background of AI and radiotherapy. Then it explores the basic concepts of different AI algorithms and machine learning methods, such as neural networks, that are available to us today and how they are being implemented in radiotherapy and diagnostic processes, such as medical imaging, treatment planning, patient simulation, quality assurance and radiation dose delivery. It also explores the ongoing research on AI methods that are to be implemented in radiotherapy in the future. The review shows very promising progress and future for AI to be widely used in various areas of radiotherapy. However, basing on various concerns such as availability and security of using big data, and further work on polishing and testing AI algorithms, it is found that we may not ready to use AI primarily in radiotherapy at the moment.
Collapse
Affiliation(s)
- Sarkar Siddique
- Department of Physics, Ryerson University, Toronto, ON M5B 2K3, Canada
| | - James C.L. Chow
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1X6, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| |
Collapse
|