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Villegas F, Dal Bello R, Alvarez-Andres E, Dhont J, Janssen T, Milan L, Robert C, Salagean GAM, Tejedor N, Trnková P, Fusella M, Placidi L, Cusumano D. Challenges and opportunities in the development and clinical implementation of artificial intelligence based synthetic computed tomography for magnetic resonance only radiotherapy. Radiother Oncol 2024; 198:110387. [PMID: 38885905 DOI: 10.1016/j.radonc.2024.110387] [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: 10/29/2023] [Revised: 06/13/2024] [Accepted: 06/13/2024] [Indexed: 06/20/2024]
Abstract
Synthetic computed tomography (sCT) generated from magnetic resonance imaging (MRI) can serve as a substitute for planning CT in radiation therapy (RT), thereby removing registration uncertainties associated with multi-modality imaging pairing, reducing costs and patient radiation exposure. CE/FDA-approved sCT solutions are nowadays available for pelvis, brain, and head and neck, while more complex deep learning (DL) algorithms are under investigation for other anatomic sites. The main challenge in achieving a widespread clinical implementation of sCT lies in the absence of consensus on sCT commissioning and quality assurance (QA), resulting in variation of sCT approaches across different hospitals. To address this issue, a group of experts gathered at the ESTRO Physics Workshop 2022 to discuss the integration of sCT solutions into clinics and report the process and its outcomes. This position paper focuses on aspects of sCT development and commissioning, outlining key elements crucial for the safe implementation of an MRI-only RT workflow.
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Affiliation(s)
- Fernanda Villegas
- Department of Oncology-Pathology, Karolinska Institute, Solna, Sweden; Radiotherapy Physics and Engineering, Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Solna, Sweden
| | - Riccardo Dal Bello
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Emilie Alvarez-Andres
- OncoRay - National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany; Faculty of Medicine Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
| | - Jennifer Dhont
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Department of Medical Physics, Brussels, Belgium; Université Libre De Bruxelles (ULB), Radiophysics and MRI Physics Laboratory, Brussels, Belgium
| | - Tomas Janssen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lisa Milan
- Medical Physics Unit, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Charlotte Robert
- UMR 1030 Molecular Radiotherapy and Therapeutic Innovations, ImmunoRadAI, Paris-Saclay University, Institut Gustave Roussy, Inserm, Villejuif, France; Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Ghizela-Ana-Maria Salagean
- Faculty of Physics, Babes-Bolyai University, Cluj-Napoca, Romania; Department of Radiation Oncology, TopMed Medical Centre, Targu Mures, Romania
| | - Natalia Tejedor
- Department of Medical Physics and Radiation Protection, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Petra Trnková
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Marco Fusella
- Department of Radiation Oncology, Abano Terme Hospital, Italy
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Rome, Italy.
| | - Davide Cusumano
- Mater Olbia Hospital, Strada Statale Orientale Sarda 125, Olbia, Sassari, Italy
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2
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El-Habashy DM, Wahid KA, He R, McDonald B, Mulder SJ, Ding Y, Salzillo T, Lai SY, Christodouleas J, Dresner A, Wang J, Naser MA, Fuller CD, Mohamed ASR. Dataset of weekly intra-treatment diffusion weighted imaging in head and neck cancer patients treated with MR-Linac. Sci Data 2024; 11:487. [PMID: 38734679 PMCID: PMC11088675 DOI: 10.1038/s41597-024-03217-z] [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: 09/12/2023] [Accepted: 04/03/2024] [Indexed: 05/13/2024] Open
Abstract
Radiation therapy (RT) is a crucial treatment for head and neck squamous cell carcinoma (HNSCC); however, it can have adverse effects on patients' long-term function and quality of life. Biomarkers that can predict tumor response to RT are being explored to personalize treatment and improve outcomes. While tissue and blood biomarkers have limitations, imaging biomarkers derived from magnetic resonance imaging (MRI) offer detailed information. The integration of MRI and a linear accelerator in the MR-Linac system allows for MR-guided radiation therapy (MRgRT), offering precise visualization and treatment delivery. This data descriptor offers a valuable repository for weekly intra-treatment diffusion-weighted imaging (DWI) data obtained from head and neck cancer patients. By analyzing the sequential DWI changes and their correlation with treatment response, as well as oncological and survival outcomes, the study provides valuable insights into the clinical implications of DWI in HNSCC.
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Affiliation(s)
- Dina M El-Habashy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Clinical Oncology and Nuclear Medicine, Menoufia University, Shebin Elkom, Egypt.
| | - Kareem A Wahid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Renjie He
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brigid McDonald
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Samuel J Mulder
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yao Ding
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Travis Salzillo
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen Y Lai
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Molecular and Cellular Oncology, Division of Basic Science Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Alex Dresner
- Philips Healthcare MR Oncology, Cleveland, Ohio, USA
| | - Jihong Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mohamed A Naser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Abdallah Sherif Radwan Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, USA.
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3
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Chiloiro G, Panza G, Boldrini L, Romano A, Placidi L, Nardini M, Galetto M, Votta C, Campitelli M, Cellini F, Massaccesi M, Gambacorta MA. REPeated mAgnetic resonance Image-guided stereotactic body Radiotherapy (MRIg-reSBRT) for oligometastatic patients: REPAIR, a mono-institutional retrospective study. Radiat Oncol 2024; 19:52. [PMID: 38671526 PMCID: PMC11055272 DOI: 10.1186/s13014-024-02445-2] [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: 02/20/2024] [Accepted: 04/22/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Oligo-progression or further recurrence is an open issue in the multi-integrated management of oligometastatic disease (OMD). Re-irradiation with stereotactic body radiotherapy (re-SBRT) technique could represent a valuable treatment option to improve OMD clinical outcomes. MRI-guided allows real-time visualization of the target volumes and online adaptive radiotherapy (oART). The aim of this retrospective study is to evaluate the efficacy and toxicity profile of MRI-guided repeated SBRT (MRIg-reSBRT) in the OMD setting and propose a re-SBRT classification. METHODS We retrospectively analyzed patients (pts) with recurrent liver metastases or abdominal metastatic lesions between 1 and 5 centimeters from liver candidate to MRIg-reSBRT showing geometric overlap between the different SBRT courses and assessing whether they were in field (type 1) or not (type 2). RESULTS Eighteen pts completed MRIg-reSBRT course for 25 metastatic hepatic/perihepatic lesions from July 2019 to January 2020. A total of 20 SBRT courses: 15 Type 1 re-SBRT (75%) and 5 Type 2 re-SBRT (25%) was delivered. Mean interval between the first SBRT and MRIg-reSBRT was 8,6 months. Mean prescribed dose for the first treatment was 43 Gy (range 24-50 Gy, mean BEDα/β10=93), while 41 Gy (range 16-50 Gy, mean BEDα/β10=92) for MRIg-reSBRT. Average liver dose was 3,9 Gy (range 1-10 Gy) and 3,7 Gy (range 1,6-8 Gy) for the first SBRT and MRIg-reSBRT, respectively. No acute or late toxicities were reported at a median follow-up of 10,7 months. The 1-year OS and PFS was 73,08% and 50%, respectively. Overall Clinical Benefit was 54%. CONCLUSIONS MRIg-reSBRT could be considered an effective and safe option in the multi-integrated treatment of OMD.
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Affiliation(s)
- Giuditta Chiloiro
- Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
| | - Giulia Panza
- Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy.
| | - Luca Boldrini
- Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
| | - Angela Romano
- Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
| | - Matteo Nardini
- Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
| | - Matteo Galetto
- Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
| | - Claudio Votta
- Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
| | - Maura Campitelli
- Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
| | - Francesco Cellini
- Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
| | | | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Rabe M, Dietrich O, Forbrig R, Niyazi M, Belka C, Corradini S, Landry G, Kurz C. Repeatability quantification of brain diffusion-weighted imaging for future clinical implementation at a low-field MR-linac. Radiat Oncol 2024; 19:31. [PMID: 38448888 PMCID: PMC10916154 DOI: 10.1186/s13014-024-02424-7] [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: 01/31/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Longitudinal assessments of apparent diffusion coefficients (ADCs) derived from diffusion-weighted imaging (DWI) during intracranial radiotherapy at magnetic resonance imaging-guided linear accelerators (MR-linacs) could enable early response assessment by tracking tumor diffusivity changes. However, DWI pulse sequences are currently unavailable in clinical practice at low-field MR-linacs. Quantifying the in vivo repeatability of ADC measurements is a crucial step towards clinical implementation of DWI sequences but has not yet been reported on for low-field MR-linacs. This study assessed ADC measurement repeatability in a phantom and in vivo at a 0.35 T MR-linac. METHODS Eleven volunteers and a diffusion phantom were imaged on a 0.35 T MR-linac. Two echo-planar imaging DWI sequence variants, emphasizing high spatial resolution ("highRes") and signal-to-noise ratio ("highSNR"), were investigated. A test-retest study with an intermediate outside-scanner-break was performed to assess repeatability in the phantom and volunteers' brains. Mean ADCs within phantom vials, cerebrospinal fluid (CSF), and four brain tissue regions were compared to literature values. Absolute relative differences of mean ADCs in pre- and post-break scans were calculated for the diffusion phantom, and repeatability coefficients (RC) and relative RC (relRC) with 95% confidence intervals were determined for each region-of-interest (ROI) in volunteers. RESULTS Both DWI sequence variants demonstrated high repeatability, with absolute relative deviations below 1% for water, dimethyl sulfoxide, and polyethylene glycol in the diffusion phantom. RelRCs were 7% [5%, 12%] (CSF; highRes), 12% [9%, 22%] (CSF; highSNR), 9% [8%, 12%] (brain tissue ROIs; highRes), and 6% [5%, 7%] (brain tissue ROIs; highSNR), respectively. ADCs measured with the highSNR variant were consistent with literature values for volunteers, while smaller mean values were measured for the diffusion phantom. Conversely, the highRes variant underestimated ADCs compared to literature values, indicating systematic deviations. CONCLUSIONS High repeatability of ADC measurements in a diffusion phantom and volunteers' brains were measured at a low-field MR-linac. The highSNR variant outperformed the highRes variant in accuracy and repeatability, at the expense of an approximately doubled voxel volume. The observed high in vivo repeatability confirms the potential utility of DWI at low-field MR-linacs for early treatment response assessment.
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Affiliation(s)
- Moritz Rabe
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany.
| | - Olaf Dietrich
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Robert Forbrig
- Institute of Neuroradiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- 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, Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
- Department of Radiation Oncology, University of Tübingen, Tübingen, Germany
| | - Claus Belka
- 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, Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christopher Kurz
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
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5
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Hering S, Nieto A, Marschner S, Hofmaier J, Schmidt-Hegemann NS, da Silva Mendes V, Landry G, Niyazi M, Manapov F, Belka C, Corradini S, Eze C. The role of online MR-guided multi-fraction stereotactic ablative radiotherapy in lung tumours. Clin Transl Radiat Oncol 2024; 45:100736. [PMID: 38433949 PMCID: PMC10909605 DOI: 10.1016/j.ctro.2024.100736] [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: 09/01/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 03/05/2024] Open
Abstract
Background The aim of this prospective observational study was to evaluate the dosimetry benefits, changes in pulmonary function, and clinical outcome of online adaptive MR-guided SBRT. Methods From 11/2020-07/2022, 45 consecutive patients with 59 lesions underwent multi-fraction SBRT (3-8 fractions) at our institution. Patients were eligible if they had biopsy-proven NSCLC or lung cancer/metastases diagnosed via clinical imaging. Endpoints were local control (LC) and overall survival (OS). We evaluated PTV/GTV dose coverage, organs at risk exposure, and changes in pulmonary function (PF). Acute toxicity was classified per the National Cancer Institute-Common Terminology Criteria for Adverse Events version 5.0. Results The median PTV was 14.4 cm3 (range: 3.4 - 96.5 cm3). In total 195/215 (91%) plans were reoptimised. In the reoptimised vs. predicted plans, PTV coverage by the prescribed dose increased in 94.6% of all fractions with a median increase in PTV VPD of 5.6% (range: -1.8 - 44.6%, p < 0.001), increasing the number of fractions with PTV VPD ≥ 95% from 33% to 98%. The PTV D95% and D98% (BED10) increased in 93% and 95% of all fractions with a median increase of 7.7% (p < 0.001) and 10.6% (p < 0.001). The PTV D95% (BED10) increased by a mean of 9.6 Gy (SD: 10.3 Gy, p < 0.001). At a median follow-up of 21.4 months (95% CI: 12.3-27.0 months), 1- and 2-year LC rates were 94.8% (95% CI: 87.6 - 100.0%) and 91.1% (95% CI: 81.3 - 100%); 1- and 2-year OS rates were 85.6% (95% CI: 75.0 - 96.3%) and 67.1 % (95% CI: 50.3 - 83.8%). One grade ≥ 3 toxicity and no significant reduction in short-term PF parameters were recorded. Conclusions Online adaptive MR-guided SBRT is an effective, safe and generally well tolerated treatment option for lung tumours achieving encouraging local control rates with significantly improved target volume coverage.
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Affiliation(s)
- Svenja Hering
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Alexander Nieto
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Marschner
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Jan Hofmaier
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | | | | | - Guillaume Landry
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Radiation Oncology, University of Tübingen, Tübingen, Germany
| | - Farkhad Manapov
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich; and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Chukwuka Eze
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
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6
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Ocanto A, Torres L, Montijano M, Rincón D, Fernández C, Sevilla B, Gonsalves D, Teja M, Guijarro M, Glaría L, Hernánz R, Zafra-Martin J, Sanmamed N, Kishan A, Alongi F, Moghanaki D, Nagar H, Couñago F. MR-LINAC, a New Partner in Radiation Oncology: Current Landscape. Cancers (Basel) 2024; 16:270. [PMID: 38254760 PMCID: PMC10813892 DOI: 10.3390/cancers16020270] [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: 12/17/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Technological advances in radiation oncology are oriented towards improving treatment precision and tumor control. Among these advances, magnetic-resonance-image-guided radiation therapy (MRgRT) stands out, with technological advances to deliver targeted treatments adapted to a tumor's anatomy on the day while minimizing incidental exposure to organs at risk, offering an unprecedented therapeutic advantage compared to X-ray-based IGRT delivery systems. This new technology changes the traditional workflow in radiation oncology and requires an evolution in team coordination to administer more precise treatments. Once implemented, it paves the way for newer indication for radiation therapy to safely deliver higher doses than ever before, with better preservation of healthy tissues to optimize patient outcomes. In this narrative review, we assess the technical aspects of the novel linear accelerators that can deliver MRgRT and summarize the available published experience to date, focusing on oncological results and future challenges.
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Affiliation(s)
- Abrahams Ocanto
- Department of Radiation Oncology, Hospital Universitario San Francisco de Asís, GenesisCare, 28002 Madrid, Spain; (L.T.); (M.M.); (D.R.); (C.F.); (B.S.); (D.G.); (M.T.); (M.G.); (L.G.); (R.H.); (F.C.)
- Department of Radiation Oncology, Hospital Universitario Vithas La Milagrosa, GenesisCare, 28010 Madrid, Spain
| | - Lisselott Torres
- Department of Radiation Oncology, Hospital Universitario San Francisco de Asís, GenesisCare, 28002 Madrid, Spain; (L.T.); (M.M.); (D.R.); (C.F.); (B.S.); (D.G.); (M.T.); (M.G.); (L.G.); (R.H.); (F.C.)
- Department of Radiation Oncology, Hospital Universitario Vithas La Milagrosa, GenesisCare, 28010 Madrid, Spain
| | - Miguel Montijano
- Department of Radiation Oncology, Hospital Universitario San Francisco de Asís, GenesisCare, 28002 Madrid, Spain; (L.T.); (M.M.); (D.R.); (C.F.); (B.S.); (D.G.); (M.T.); (M.G.); (L.G.); (R.H.); (F.C.)
- Department of Radiation Oncology, Hospital Universitario Vithas La Milagrosa, GenesisCare, 28010 Madrid, Spain
| | - Diego Rincón
- Department of Radiation Oncology, Hospital Universitario San Francisco de Asís, GenesisCare, 28002 Madrid, Spain; (L.T.); (M.M.); (D.R.); (C.F.); (B.S.); (D.G.); (M.T.); (M.G.); (L.G.); (R.H.); (F.C.)
- Department of Radiation Oncology, Hospital Universitario Vithas La Milagrosa, GenesisCare, 28010 Madrid, Spain
| | - Castalia Fernández
- Department of Radiation Oncology, Hospital Universitario San Francisco de Asís, GenesisCare, 28002 Madrid, Spain; (L.T.); (M.M.); (D.R.); (C.F.); (B.S.); (D.G.); (M.T.); (M.G.); (L.G.); (R.H.); (F.C.)
- Department of Radiation Oncology, Hospital Universitario Vithas La Milagrosa, GenesisCare, 28010 Madrid, Spain
| | - Beatriz Sevilla
- Department of Radiation Oncology, Hospital Universitario San Francisco de Asís, GenesisCare, 28002 Madrid, Spain; (L.T.); (M.M.); (D.R.); (C.F.); (B.S.); (D.G.); (M.T.); (M.G.); (L.G.); (R.H.); (F.C.)
- Department of Radiation Oncology, Hospital Universitario Vithas La Milagrosa, GenesisCare, 28010 Madrid, Spain
| | - Daniela Gonsalves
- Department of Radiation Oncology, Hospital Universitario San Francisco de Asís, GenesisCare, 28002 Madrid, Spain; (L.T.); (M.M.); (D.R.); (C.F.); (B.S.); (D.G.); (M.T.); (M.G.); (L.G.); (R.H.); (F.C.)
- Department of Radiation Oncology, Hospital Universitario Vithas La Milagrosa, GenesisCare, 28010 Madrid, Spain
| | - Macarena Teja
- Department of Radiation Oncology, Hospital Universitario San Francisco de Asís, GenesisCare, 28002 Madrid, Spain; (L.T.); (M.M.); (D.R.); (C.F.); (B.S.); (D.G.); (M.T.); (M.G.); (L.G.); (R.H.); (F.C.)
- Department of Radiation Oncology, Hospital Universitario Vithas La Milagrosa, GenesisCare, 28010 Madrid, Spain
| | - Marcos Guijarro
- Department of Radiation Oncology, Hospital Universitario San Francisco de Asís, GenesisCare, 28002 Madrid, Spain; (L.T.); (M.M.); (D.R.); (C.F.); (B.S.); (D.G.); (M.T.); (M.G.); (L.G.); (R.H.); (F.C.)
- Department of Radiation Oncology, Hospital Universitario Vithas La Milagrosa, GenesisCare, 28010 Madrid, Spain
| | - Luis Glaría
- Department of Radiation Oncology, Hospital Universitario San Francisco de Asís, GenesisCare, 28002 Madrid, Spain; (L.T.); (M.M.); (D.R.); (C.F.); (B.S.); (D.G.); (M.T.); (M.G.); (L.G.); (R.H.); (F.C.)
| | - Raúl Hernánz
- Department of Radiation Oncology, Hospital Universitario San Francisco de Asís, GenesisCare, 28002 Madrid, Spain; (L.T.); (M.M.); (D.R.); (C.F.); (B.S.); (D.G.); (M.T.); (M.G.); (L.G.); (R.H.); (F.C.)
| | - Juan Zafra-Martin
- Group of Translational Research in Cancer Immunotherapy, Centro de Investigaciones Médico-Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), 29010 Málaga, Spain;
- Department of Radiation Oncology, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | - Noelia Sanmamed
- Department of Radiation Oncology, Hospital Universitario Clínico San Carlos, 28040 Madrid, Spain;
| | - Amar Kishan
- Department of Radiation Oncology, University of California, Los Angeles, CA 90095, USA;
| | - Filippo Alongi
- Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Italy;
- University of Brescia, 25121 Brescia, Italy
| | - Drew Moghanaki
- UCLA Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA 90095, USA;
| | - Himanshu Nagar
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY 10065, USA;
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario San Francisco de Asís, GenesisCare, 28002 Madrid, Spain; (L.T.); (M.M.); (D.R.); (C.F.); (B.S.); (D.G.); (M.T.); (M.G.); (L.G.); (R.H.); (F.C.)
- Department of Radiation Oncology, Hospital Universitario Vithas La Milagrosa, GenesisCare, 28010 Madrid, Spain
- GenesisCare, 28043 Madrid, Spain
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7
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Chiloiro G, Gani C, Boldrini L. Rectal Cancer MRI Guided Radiotherapy: A Practical Review for the Physician. Semin Radiat Oncol 2024; 34:64-68. [PMID: 38105095 DOI: 10.1016/j.semradonc.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
MR-guided radiotherapy is a treatment approach that combines the advantages of magnetic resonance imaging (MRI) with the precision of radiation therapy. This practical review provides an overview of the current state-of-the-art of MR-guided radiotherapy for rectal cancer, including its technical aspects, clinical outcomes, and existing limitations. Even though some studies have demonstrated the feasibility and safety of this treatment modality, challenges remain in terms of patient selection, treatment planning optimization, and long-term follow-up. Despite these issues, MR-guided radiotherapy shows promise as a potentially valuable rectal cancer treatment approach.
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Affiliation(s)
- Giuditta Chiloiro
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Cihan Gani
- Department of Radiation Oncology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
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8
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Tengler B, Künzel LA, Hagmüller M, Mönnich D, Boeke S, Wegener D, Gani C, Zips D, Thorwarth D. Full daily re-optimization improves plan quality during online adaptive radiotherapy. Phys Imaging Radiat Oncol 2024; 29:100534. [PMID: 38298884 PMCID: PMC10827578 DOI: 10.1016/j.phro.2024.100534] [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: 05/30/2023] [Revised: 01/03/2024] [Accepted: 01/03/2024] [Indexed: 02/02/2024] Open
Abstract
Background and purpose Daily online treatment plan adaptation requires a fast workflow and planning process. Current online planning consists of adaptation of a predefined reference plan, which might be suboptimal in cases of large anatomic changes. The aim of this study was to investigate plan quality differences between the current online re-planning approach and a complete re-optimization. Material and methods Magnetic resonance linear accelerator reference plans for ten prostate cancer patients were automatically generated using particle swarm optimization (PSO). Adapted plans were created for each fraction using (1) the current re-planning approach and (2) full PSO re-optimization and evaluated overall compliance with institutional dose-volume criteria compared to (3) clinically delivered fractions. Relative volume differences between reference and daily anatomy were assessed for planning target volumes (PTV60, PTV57.6), rectum and bladder and correlated with dose-volume results. Results The PSO approach showed significantly higher adherence to dose-volume criteria than the reference approach and clinical fractions (p < 0.001). In 74 % of PSO plans at most one criterion failed compared to 56 % in the reference approach and 41 % in clinical plans. A fair correlation between PTV60 D98% and relative bladder volume change was observed for the reference approach. Bladder volume reductions larger than 50 % compared to the reference plan recurrently decreased PTV60 D98% below 56 Gy. Conclusion Complete re-optimization maintained target coverage and organs at risk sparing even after large anatomic variations. Re-planning based on daily magnetic resonance imaging was sufficient for small variations, while large variations led to decreasing target coverage and organ-at-risk sparing.
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Affiliation(s)
- Benjamin Tengler
- Section for Biomedical Physics. Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - Luise A. Künzel
- National Center for Tumor Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Markus Hagmüller
- Section for Biomedical Physics. Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - David Mönnich
- Section for Biomedical Physics. Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - Simon Boeke
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - Daniel Wegener
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - Cihan Gani
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - Daniela Thorwarth
- Section for Biomedical Physics. Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
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9
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de Leon J, Twentyman T, Carr M, Jameson M, Batumalai V. Optimising the MR-Linac as a standard treatment modality. J Med Radiat Sci 2023; 70:491-497. [PMID: 37540059 PMCID: PMC10715353 DOI: 10.1002/jmrs.712] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023] Open
Abstract
The magnetic resonance linear accelerator (MR-Linac) offers a new treatment paradigm, providing improved visualisation of targets and organs at risk while allowing for daily adaptation of treatment plans in real time. Online MR-guided adaptive treatment has reduced treatment uncertainties; however, the additional treatment time and resource requirements may be a concern. We present our experience of integrating an MR-Linac into a busy department and provide recommendations for improved clinical and resource efficiency. Furthermore, we discuss potential future technological innovations that can further optimise clinical productivity in a busy department.
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Affiliation(s)
| | | | - Madeline Carr
- GenesisCareAlexandriaNew South WalesAustralia
- Centre for Medical Radiation PhysicsUniversity of WollongongWollongongNew South WalesAustralia
| | - Michael Jameson
- GenesisCareAlexandriaNew South WalesAustralia
- Centre for Medical Radiation PhysicsUniversity of WollongongWollongongNew South WalesAustralia
- School of Clinical Medicine, Faculty of Medicine and HealthUNSW SydneySydneyNew South WalesAustralia
| | - Vikneswary Batumalai
- GenesisCareAlexandriaNew South WalesAustralia
- School of Clinical Medicine, Faculty of Medicine and HealthUNSW SydneySydneyNew South WalesAustralia
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10
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Uno T, Tsuneda M, Abe K, Fujita Y, Harada R, Saito M, Kanazawa A, Kodate A, Abe Y, Ikeda Y, Nemoto MW, Yokota H. A new workflow of the on-line 1.5-T MR-guided adaptive radiation therapy. Jpn J Radiol 2023; 41:1316-1322. [PMID: 37354344 PMCID: PMC10613593 DOI: 10.1007/s11604-023-01457-4] [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: 03/28/2023] [Accepted: 06/04/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The aim of this study was to develop a new workflow for 1.5-T magnetic resonance (MR)-guided on-line adaptive radiation therapy (MRgART) and assess its feasibility in achieving dose constraints. MATERIALS AND METHODS We retrospectively evaluated the clinical data of patients who underwent on-line adaptive radiation therapy using a 1.5-T MR linear accelerator (MR-Linac). The workflow in MRgART was established by reviewing the disease site, number of fractions, and re-planning procedures. Five cases of prostate cancer were selected to evaluate the feasibility of the new workflow with respect to achieving dose constraints. RESULTS Between December 2021 and September 2022, 50 consecutive patients underwent MRgART using a 1.5-T MR-Linac. Of these, 20 had prostate cancer, 10 had hepatocellular carcinoma, 6 had pancreatic cancer, 5 had lymph node oligo-metastasis, 3 had renal cancer, 3 had bone metastasis, 2 had liver metastasis from colon cancer, and 1 had a mediastinal tumor. Among a total of 247 fractions, 235 (95%) were adapt-to-shape (ATS)-based re-planning. The median ATS re-planning time in all 50 cases was 17 min. In the feasibility study, all dose constraint sets were met in all 5 patients by ATS re-planning. Conversely, a total of 14 dose constraints in 5 patients could not be achieved by virtual plan without using adaptive re-planning. These dose constraints included the minimum dose received by the highest irradiated volume of 1 cc in the planning target volume and the maximum dose of the rectal/bladder wall. CONCLUSION A new workflow of 1.5-T MRgART was established and found to be feasible. Our evaluation of the dose constraint achievement demonstrated the effectiveness of the workflow.
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Affiliation(s)
- Takashi Uno
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan.
| | - Masato Tsuneda
- Department of Radiation Oncology, MR Linac ART Division, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Kota Abe
- Department of Radiation Oncology, MR Linac ART Division, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Yukio Fujita
- Department of Radiation Oncology, MR Linac ART Division, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Rintaro Harada
- Department of Radiology, Chiba University Hospital, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Makoto Saito
- Department of Radiology, Chiba University Hospital, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Aki Kanazawa
- Department of Radiology, Chiba University Hospital, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Asuka Kodate
- Department of Radiology, Chiba University Hospital, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Yukinao Abe
- Department of Radiology, Chiba University Hospital, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Yohei Ikeda
- Department of Radiology, Chiba University Hospital, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Miho Watanabe Nemoto
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
| | - Hajime Yokota
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba City, Chiba, 260-8670, Japan
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11
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Lo Greco MC, Marletta G, Marano G, Fazio A, Buffettino E, Iudica A, Liardo RLE, Milazzotto R, Foti PV, Palmucci S, Basile A, Marletta F, Cuccia F, Ferrera G, Parisi S, Pontoriero A, Pergolizzi S, Spatola C. Hypofractionated Radiotherapy in Localized, Low-Intermediate-Risk Prostate Cancer: Current and Future Prospectives. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1144. [PMID: 37374348 DOI: 10.3390/medicina59061144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023]
Abstract
At the time of diagnosis, the vast majority of prostate carcinoma patients have a clinically localized form of the disease, with most of them presenting with low- or intermediate-risk prostate cancer. In this setting, various curative-intent alternatives are available, including surgery, external beam radiotherapy and brachytherapy. Randomized clinical trials have demonstrated that moderate hypofractionated radiotherapy can be considered as a valid alternative strategy for localized prostate cancer. High-dose-rate brachytherapy can be administered according to different schedules. Proton beam radiotherapy represents a promising strategy, but further studies are needed to make it more affordable and accessible. At the moment, new technologies such as MRI-guided radiotherapy remain in early stages, but their potential abilities are very promising.
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Affiliation(s)
- Maria Chiara Lo Greco
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Giulia Marletta
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Giorgia Marano
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Alessandro Fazio
- Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Emanuele Buffettino
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Arianna Iudica
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Rocco Luca Emanuele Liardo
- Radiation Oncology Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Roberto Milazzotto
- Radiation Oncology Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Pietro Valerio Foti
- Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Stefano Palmucci
- Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Antonio Basile
- Radiology I Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | | | | | | | - Silvana Parisi
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Antonio Pontoriero
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Stefano Pergolizzi
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Corrado Spatola
- Radiation Oncology Unit, Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
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12
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McDonald F, Belka C, Hurkmans C, Alicja Jereczek-Fossa B, Poortmans P, van de Kamer JB, Azizaj E, Franco P. Introducing the ESTRO Guidelines Committee, driving force for the new generation of ESTRO guidelines. Radiother Oncol 2023:109724. [PMID: 37244357 DOI: 10.1016/j.radonc.2023.109724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 05/29/2023]
Affiliation(s)
- Fiona McDonald
- Lung Unit, Royal Marsden Hospital, London, United Kingdom; Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich; German Cancer Consortium (DKTK), partner site Munich; Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Jeroen B van de Kamer
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Eralda Azizaj
- European Society for Radiotherapy and Oncology, Brussels, Belgium
| | - Pierfrancesco Franco
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, Novara, Italy; Department of Radiation Oncology, 'Maggiore della Carità' University Hospital, Novara, Italy.
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13
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Boldrini L, Romano A, Chiloiro G, Corradini S, De Luca V, Verusio V, D'Aviero A, Castelluccia A, Alitto AR, Catucci F, Grimaldi G, Trapp C, Hörner-Rieber J, Marchesano D, Frascino V, Mattiucci GC, Valentini V, Gentile P, Gambacorta MA. Magnetic resonance guided SBRT reirradiation in locally recurrent prostate cancer: a multicentric retrospective analysis. Radiat Oncol 2023; 18:84. [PMID: 37218005 DOI: 10.1186/s13014-023-02271-y] [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: 10/26/2022] [Accepted: 04/26/2023] [Indexed: 05/24/2023] Open
Abstract
AIMS Reirradiation of prostate cancer (PC) local recurrences represents an emerging challenge for current radiotherapy. In this context, stereotactic body radiation therapy (SBRT) allows the delivery of high doses, with curative intent. Magnetic Resonance guided Radiation Therapy (MRgRT) has shown promising results in terms of safety, feasibility and efficacy of delivering SBRT thanks to the enhanced soft tissue contrast and the online adaptive workflow. This multicentric retrospective analysis evaluates the feasibility and efficacy of PC reirradiation, using a 0.35 T hybrid MR delivery unit. METHODS Patients affected by local recurrences of PC and treated in five institutions between 2019 and 2022 were retrospectively collected. All patients had undergone previous Radiation Therapy (RT) in definitive or adjuvant setting. Re-treatment MRgSBRT was delivered with a total dose ranging from 25 to 40 Gy in 5 fractions. Toxicity according to CTCAE v 5.0 and treatment response were assessed at the end of the treatment and at follow-up. RESULTS Eighteen patients were included in this analysis. All patients had previously undergone external beam radiation therapy (EBRT) up to a total dose of 59.36 to 80 Gy. Median cumulative biologically effective dose (BED) of SBRT re-treatment was 213,3 Gy (103,1-560), considering an α/β of 1.5. Complete response was achieved in 4 patients (22.2%). No grade ≥ 2 acute genitourinary (GU) toxicity events were recorded, while gastrointestinal (GI) acute toxicity events occurred in 4 patients (22.2%). CONCLUSION The low rates of acute toxicity of this experience encourages considering MRgSBRT a feasibile therapeutic approach for the treatment of clinically relapsed PC. Accurate gating of target volumes, the online adaptive planning workflow and the high definition of MRI treatment images allow delivering high doses to the PTV while efficiently sparing organs at risk (OARs).
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Affiliation(s)
- Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angela Romano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giuditta Chiloiro
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Viola De Luca
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Valeria Verusio
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Andrea D'Aviero
- Radiation Oncology, Mater Olbia Hospital, Olbia, Sassari, Italy
| | - Alessandra Castelluccia
- Radiation Oncology, Ospedale San Pietro Fatebenefratelli di Roma, Rome, Italy
- Radiation Oncology, Department of Radiotherapy, Hospital "A. Perrino", ASL Brindisi, Brindisi, Italy
| | - Anna Rita Alitto
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Gianmarco Grimaldi
- Radiation Oncology, Ospedale San Pietro Fatebenefratelli di Roma, Rome, Italy
| | - Christian Trapp
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Juliane Hörner-Rieber
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Domenico Marchesano
- Radiation Oncology, Ospedale San Pietro Fatebenefratelli di Roma, Rome, Italy
| | - Vincenzo Frascino
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gian Carlo Mattiucci
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
- Radiation Oncology, Mater Olbia Hospital, Olbia, Sassari, Italy
| | - Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Piercarlo Gentile
- Radiation Oncology, Ospedale San Pietro Fatebenefratelli di Roma, Rome, Italy
| | - Maria Antonietta Gambacorta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
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14
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Adair Smith G, Dunlop A, Alexander SE, Barnes H, Casey F, Chick J, Gunapala R, Herbert T, Lawes R, Mason SA, Mitchell A, Mohajer J, Murray J, Nill S, Patel P, Pathmanathan A, Sritharan K, Sundahl N, Tree AC, Westley R, Williams B, McNair HA. Evaluation of therapeutic radiographer contouring for magnetic resonance image guided online adaptive prostate radiotherapy. Radiother Oncol 2023; 180:109457. [PMID: 36608770 PMCID: PMC10074473 DOI: 10.1016/j.radonc.2022.109457] [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: 08/24/2022] [Revised: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE The implementation of MRI-guided online adaptive radiotherapy has facilitated the extension of therapeutic radiographers' roles to include contouring, thus releasing the clinician from attending daily treatment. Following undergoing a specifically designed training programme, an online interobserver variability study was performed. MATERIALS AND METHODS 117 images from six patients treated on a MR Linac were contoured online by either radiographer or clinician and the same images contoured offline by the alternate profession. Dice similarity coefficient (DSC), mean distance to agreement (MDA), Hausdorff distance (HD) and volume metrics were used to analyse contours. Additionally, the online radiographer contours and optimised plans (n = 59) were analysed using the offline clinician defined contours. After clinical implementation of radiographer contouring, target volume comparison and dose analysis was performed on 20 contours from five patients. RESULTS Comparison of the radiographers' and clinicians' contours resulted in a median (range) DSC of 0.92 (0.86 - 0.99), median (range) MDA of 0.98 mm (0.2-1.7) and median (range) HD of 6.3 mm (2.5-11.5) for all 117 fractions. There was no significant difference in volume size between the two groups. Of the 59 plans created with radiographer online contours and overlaid with clinicians' offline contours, 39 met mandatory dose constraints and 12 were acceptable because 95 % of the high dose PTV was covered by 95 % dose, or the high dose PTV was within 3 % of online plan. A clinician blindly reviewed the eight remaining fractions and, using trial quality assurance metrics, deemed all to be acceptable. Following clinical implementation of radiographer contouring, the median (range) DSC of CTV was 0.93 (0.88-1.0), median (range) MDA was 0.8 mm (0.04-1.18) and HD was 5.15 mm (2.09-8.54) respectively. Of the 20 plans created using radiographer online contours overlaid with clinicians' offline contours, 18 met the dosimetric success criteria, the remaining 2 were deemed acceptable by a clinician. CONCLUSION Radiographer and clinician prostate and seminal vesicle contours on MRI for an online adaptive workflow are comparable and produce clinically acceptable plans. Radiographer contouring for prostate treatment on a MR-linac can be effectively introduced with appropriate training and evaluation. A DSC threshold for target structures could be implemented to streamline future training.
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Affiliation(s)
| | - Alex Dunlop
- Joint Department of Physics at the Royal Marsden and The Institute of Cancer Research, United Kingdom
| | - Sophie E Alexander
- The Institute of Cancer Research/The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Helen Barnes
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Francis Casey
- Joint Department of Physics at the Royal Marsden and The Institute of Cancer Research, United Kingdom
| | - Joan Chick
- Joint Department of Physics at the Royal Marsden and The Institute of Cancer Research, United Kingdom
| | - Ranga Gunapala
- Clinical Trials and Statistic Unit, The Institute for Cancer Research, London, United Kingdom
| | - Trina Herbert
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Rebekah Lawes
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Sarah A Mason
- Joint Department of Physics at the Royal Marsden and The Institute of Cancer Research, United Kingdom
| | - Adam Mitchell
- Joint Department of Physics at the Royal Marsden and The Institute of Cancer Research, United Kingdom
| | - Jonathan Mohajer
- Joint Department of Physics at the Royal Marsden and The Institute of Cancer Research, United Kingdom
| | - Julia Murray
- The Institute of Cancer Research/The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Simeon Nill
- Joint Department of Physics at the Royal Marsden and The Institute of Cancer Research, United Kingdom
| | - Priyanka Patel
- The Institute of Cancer Research/The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Angela Pathmanathan
- The Institute of Cancer Research/The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Kobika Sritharan
- The Institute of Cancer Research/The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Nora Sundahl
- The Institute of Cancer Research/The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alison C Tree
- The Institute of Cancer Research/The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Rosalyne Westley
- The Institute of Cancer Research/The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Helen A McNair
- The Institute of Cancer Research/The Royal Marsden NHS Foundation Trust, London, United Kingdom
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15
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Cook N, Shelton N, Gibson S, Barnes P, Alinaghi-Zadeh R, Jameson MG. ACPSEM position paper: the safety of magnetic resonance imaging linear accelerators. Phys Eng Sci Med 2023; 46:19-43. [PMID: 36847966 PMCID: PMC10030425 DOI: 10.1007/s13246-023-01224-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 03/01/2023]
Abstract
Magnetic Resonance Imaging linear-accelerator (MRI-linac) equipment has recently been introduced to multiple centres in Australia and New Zealand. MRI equipment creates hazards for staff, patients and others in the MR environment; these hazards must be well understood, and risks managed by a system of environmental controls, written procedures and a trained workforce. While MRI-linac hazards are similar to the diagnostic paradigm, the equipment, workforce and environment are sufficiently different that additional safety guidance is warranted. In 2019 the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) formed the Magnetic Resonance Imaging Linear-Accelerator Working Group (MRILWG) to support the safe clinical introduction and optimal use of MR-guided radiation therapy treatment units. This Position Paper is intended to provide safety guidance and education for Medical Physicists and others planning for and working with MRI-linac technology. This document summarises MRI-linac hazards and describes particular effects which arise from the combination of strong magnetic fields with an external radiation treatment beam. This document also provides guidance on safety governance and training, and recommends a system of hazard management tailored to the MRI-linac environment, ancillary equipment, and workforce.
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Affiliation(s)
- Nick Cook
- Christchurch Hospital, Christchurch, New Zealand
| | - Nikki Shelton
- Olivia Newton-John Cancer Wellness and Research Centre, Heidelberg, VIC, Australia
| | | | | | - Reza Alinaghi-Zadeh
- Olivia Newton-John Cancer Wellness and Research Centre, Heidelberg, VIC, Australia
| | - Michael G Jameson
- GenesisCare, Sydney, NSW, Australia.
- University of New South Wales, Sydney, Australia.
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Guberina M, Santiago Garcia A, Khouya A, Pöttgen C, Holubyev K, Ringbaek TP, Lachmuth M, Alberti Y, Hoffmann C, Hlouschek J, Gauler T, Lübcke W, Indenkämpen F, Stuschke M, Guberina N. Comparison of Online-Onboard Adaptive Intensity-Modulated Radiation Therapy or Volumetric-Modulated Arc Radiotherapy With Image-Guided Radiotherapy for Patients With Gynecologic Tumors in Dependence on Fractionation and the Planning Target Volume Margin. JAMA Netw Open 2023; 6:e234066. [PMID: 36947038 PMCID: PMC10034575 DOI: 10.1001/jamanetworkopen.2023.4066] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Importance Patients with newly diagnosed locally advanced cervical carcinomas or recurrences after surgery undergoing radiochemotherapy whose tumor is unsuited for a brachytherapy boost need high-dose percutaneous radiotherapy with small margins to compensate for clinical target volume deformations and set-up errors. Cone-beam computed tomography-based online adaptive radiotherapy (ART) has the potential to reduce planning target volume (PTV) margins below 5 mm for these tumors. Objective To compare online ART technologies with image-guided radiotherapy (IGRT) for gynecologic tumors. Design, Setting, and Participants This comparative effectiveness study comprised all 7 consecutive patients with gynecologic tumors who were treated with ART with artificial intelligence segmentation from January to May 2022 at the West German Cancer Center. All adapted treatment plans were reviewed for the new scenario of organs at risk and target volume. Dose distributions of adapted and scheduled plans optimized on the initial planning computed tomography scan were compared. Exposure Online ART for gynecologic tumors. Main Outcomes and Measures Target dose coverage with ART compared with IGRT for PTV margins of 5 mm or less in terms of the generalized equivalent uniform dose (gEUD) without increasing the gEUD for the organs at risk (bladder and rectum). Results The first 10 treatment series among 7 patients (mean [SD] age, 65.7 [16.5] years) with gynecologic tumors from a prospective observational trial performed with ART were compared with IGRT. For a clinical PTV margin of 5 mm, IGRT was associated with a median gEUD decrease in the interfractional clinical target volume of -1.5% (90% CI, -31.8% to 2.9%) for all fractions in comparison with the planned dose distribution. Online ART was associated with a decrease of -0.02% (90% CI, -3.2% to 1.5%), which was less than the decrease with IGRT (P < .001). This was not associated with an increase in the gEUD for the bladder or rectum. For a PTV margin of 0 mm, the median gEUD deviation with IGRT was -13.1% (90% CI, -47.9% to 1.6%) compared with 0.1% (90% CI, -2.3% to 6.6%) with ART (P < .001). The benefit associated with ART was larger for a PTV margin of 0 mm than of 5 mm (P = .004) due to spreading of the cold spot at the clinical target volume margin from fraction to fraction with a median SD of 2.4 cm (90% CI, 1.9-3.4 cm) for all patients. Conclusions and Relevance This study suggests that ART is associated with an improvement in the percentage deviation of gEUD for the interfractional clinical target volume compared with IGRT. As the gain of ART depends on fractionation and PTV margin, a strategy is proposed here to switch from IGRT to ART, if the delivered gEUD distribution becomes unfavorable in comparison with the expected distribution during the course of treatment.
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Affiliation(s)
- Maja Guberina
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Alina Santiago Garcia
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Aymane Khouya
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Christoph Pöttgen
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Kostyantyn Holubyev
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Toke Printz Ringbaek
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Manfred Lachmuth
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Yasemin Alberti
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Christian Hoffmann
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Julian Hlouschek
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Thomas Gauler
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Wolfgang Lübcke
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Frank Indenkämpen
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Martin Stuschke
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
| | - Nika Guberina
- Department of Radiotherapy, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
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Boldrini L, Alongi F, Romano A, Charles Davies D, Bassetti M, Chiloiro G, Corradini S, Gambacorta MA, Placidi L, Tree AC, Westley R, Nicosia L. Current practices and perspectives on the integration of contrast agents in MRI-guided radiation therapy clinical practice: a worldwide survey. Clin Transl Radiat Oncol 2023; 40:100615. [PMID: 36968577 PMCID: PMC10034422 DOI: 10.1016/j.ctro.2023.100615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 03/12/2023] Open
Abstract
Aims The introduction of on-line magnetic resonance image-guided radiotherapy (MRIgRT) has led to an improvement in the therapeutic workflow of radiotherapy treatments thanks to the better visualization of therapy volumes assured by the higher soft tissue contrast. Magnetic Resonance contrast agents (MRCA) could improve the target delineation in on-line MRIgRT planning as well as reduce inter-observer variability and enable innovative treatment optimization protocols. The aim of this survey is to investigate the utilization of MRCA among centres that clinically implemented on-line MRIgRT technology. Methods In September 2021, we conducted an online survey consisting of a sixteen-question questionnaire that was distributed to the all the hospitals around the world equipped with MR Linacs. The questionnaire was developed by two Italian 0.35 T and 1.5 T MR-Linac centres and was validated by four other collaborating centres, using a Delphi consensus methodology. Results The survey was distributed to 52 centres and 43 centres completed it (82.7%). Among these centres, 23 institutions (53.5%) used the 0.35T MR-Linac system, while the remaining 20 (46.5%) used the 1.5T MR-Linac system.According to results obtained, 25 (58%) of the centres implemented the use of MRCA for on-line MRIgRT. Gadoxetate (Eovist®; Primovist®) was reported to be the most used MRCA (80%) and liver the most common site of application (58%). Over 70% of responders agreed/strongly agreed to the need for international guidelines. Conclusions The use of MRCA in clinical practice presents several pitfalls and future research will be necessary to understand the actual advantage derived from the use of MRCA in clinical practice, their toxicity profiles and better define the need of formulating guidelines for standardising the use of MRCA in MRIgRT workflow.
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Affiliation(s)
- Luca Boldrini
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
- University of Brescia, Brescia, Italy
| | - Angela Romano
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
- Corresponding author.
| | - Diepriye Charles Davies
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Michael Bassetti
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI, USA
| | - Giuditta Chiloiro
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Maria Antonietta Gambacorta
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Lorenzo Placidi
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Alison C. Tree
- The Royal Marsden NHS Foundation Trust, Sutton, UK
- The Institute of Cancer Research, London, UK
| | - Rosalyne Westley
- The Royal Marsden NHS Foundation Trust, Sutton, UK
- The Institute of Cancer Research, London, UK
| | - Luca Nicosia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
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18
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Offersen BV, Aznar MC, Bacchus C, Coppes RP, Deutsch E, Georg D, Haustermans K, Hoskin P, Krause M, Lartigau EF, Lee AWM, Löck S, Thwaites DI, van der Kogel AJ, van der Heide U, Valentini V, Overgaard J, Baumann M. The role of ESTRO guidelines in achieving consistency and quality in clinical radiation oncology practice. Radiother Oncol 2023; 179:109446. [PMID: 36566990 DOI: 10.1016/j.radonc.2022.109446] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Birgitte Vrou Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark; Department of Oncology, Aarhus University Hospital, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Denmark.
| | - Marianne C Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, United Kingdom
| | - Carol Bacchus
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rob P Coppes
- Department of Biomedical Sciences of Cells & Systems, Section Molecular Cell Biology, Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Eric Deutsch
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, France
| | - Dieter Georg
- Division Medical Radiation Physics, Department of Radiation Oncology, Medical University of Vienna, Austria
| | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, Belgium
| | - Peter Hoskin
- Mount Vernon Cancer Centre and University of Manchester, United Kingdom
| | - Mechthild Krause
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany
| | - Eric F Lartigau
- Academic Department of Radiotherapy, Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - Anne W M Lee
- Department of Clinical Oncology, Shenzhen Key Laboratory for Cancer Metastasis and Personalized Therapy, University of Hong Kong - Shenzhen Hospital, China
| | - 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
| | - David I Thwaites
- Institute of Medical Physics, School of Physics, University of Sydney, Australia; Radiotherapy Research Group, St James's Hospital and University of Leeds, United Kingdom
| | - Albert J van der Kogel
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Uulke van der Heide
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
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19
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Leong KX, Sharma D, Czarnota GJ. Focused Ultrasound and Ultrasound Stimulated Microbubbles in Radiotherapy Enhancement for Cancer Treatment. Technol Cancer Res Treat 2023; 22:15330338231176376. [PMID: 37192751 DOI: 10.1177/15330338231176376] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
Radiation therapy (RT) has been the standard of care for treating a multitude of cancer types. However, ionizing radiation has adverse short and long-term side effects which have resulted in treatment complications for decades. Thus, advances in enhancing the effects of RT have been the primary focus of research in radiation oncology. To avoid the usage of high radiation doses, treatment modalities such as high-intensity focused ultrasound can be implemented to reduce the radiation doses required to destroy cancer cells. In the past few years, the use of focused ultrasound (FUS) has demonstrated immense success in a number of applications as it capitalizes on spatial specificity. It allows ultrasound energy to be delivered to a targeted focal area without harming the surrounding tissue. FUS combined with RT has specifically demonstrated experimental evidence in its application resulting in enhanced cell death and tumor cure. Ultrasound-stimulated microbubbles have recently proved to be a novel way of enhancing RT as a radioenhancing agent on its own, or as a delivery vector for radiosensitizing agents such as oxygen. In this mini-review article, we discuss the bio-effects of FUS and RT in various preclinical models and highlight the applicability of this combined therapy in clinical settings.
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Affiliation(s)
- Kai Xuan Leong
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Deepa Sharma
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Gregory J Czarnota
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
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20
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Poon DMC, Yang B, Geng H, Wong OL, Chiu ST, Cheung KY, Yu SK, Chiu G, Yuan J. Analysis of online plan adaptation for 1.5T magnetic resonance-guided stereotactic body radiotherapy (MRgSBRT) of prostate cancer. J Cancer Res Clin Oncol 2023; 149:841-850. [PMID: 35199189 PMCID: PMC8866042 DOI: 10.1007/s00432-022-03950-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/06/2022] [Indexed: 12/11/2022]
Abstract
PURPOSE To analyze and characterize the online plan adaptation of 1.5T magnetic resonance-guided stereotactic body radiotherapy (MRgSBRT) of prostate cancer (PC). METHODS PC patients (n = 107) who received adaptive 1.5 Tesla MRgSBRT were included. Online plan adaptation was implemented by either the adapt-to-position (ATP) or adapt-to-shape (ATS) methods. Patients were assigned to the ATS group if they underwent ≥ 1 ATS fraction (n = 51); the remainder were assigned to the ATP group (n = 56). The online plan adaptation records of 535 (107 × 5) fractions were retrospectively reviewed. Rationales for ATS decision-making were determined and analyzed using predefined criteria. Statistics of ATS fractions were summarized. Associations of patient characteristics and clinical factors with ATS utilization were investigated. RESULTS There were 87 (16.3%) ATS fractions and 448 ATP fractions (83.7%). The numbers of ATS adoptions in fractions 1-5 were 29 (29/107, 27.1%), 18 (16.8%), 15 (14.0%), 16 (15.0%), and 9 (8.4%), respectively, with significant differences in adoption frequency between fractions (p = 0.007). Other baseline patient characteristics and clinical factors were not significantly associated with ATS classification (all p > 0.05). Underlying criteria for the determination of ATS implementation comprised anatomical changes (77 fractions in 50 patients) and discrete multiple targets (15 fractions in 3 patients). No ATS utilization was determined using dosimetric or online quality assurance criteria. CONCLUSIONS This study contributes to facilitating the establishment of a standardized protocol for online MR-guided adaptive radiotherapy in PC.
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Affiliation(s)
- Darren M. C. Poon
- grid.414329.90000 0004 1764 7097Comprehensive Oncology Centre, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, Hong Kong SAR China
| | - Bin Yang
- grid.414329.90000 0004 1764 7097Medical Physics Department, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, Hong Kong SAR China
| | - Hui Geng
- grid.414329.90000 0004 1764 7097Medical Physics Department, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, Hong Kong SAR China
| | - Oi Lei Wong
- grid.414329.90000 0004 1764 7097Research Department, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, Hong Kong SAR China
| | - Sin Ting Chiu
- grid.414329.90000 0004 1764 7097Department of Radiotherapy, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, Hong Kong SAR China
| | - Kin Yin Cheung
- grid.414329.90000 0004 1764 7097Medical Physics Department, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, Hong Kong SAR China
| | - Siu Ki Yu
- grid.414329.90000 0004 1764 7097Medical Physics Department, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, Hong Kong SAR China
| | - George Chiu
- grid.414329.90000 0004 1764 7097Department of Radiotherapy, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, Hong Kong SAR China
| | - Jing Yuan
- grid.414329.90000 0004 1764 7097Research Department, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, Hong Kong SAR China
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21
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1.5T MR-Guided Daily-Adaptive SBRT for Prostate Cancer: Preliminary Report of Toxicity and Quality of Life of the First 100 Patients. J Pers Med 2022; 12:jpm12121982. [PMID: 36556203 PMCID: PMC9785799 DOI: 10.3390/jpm12121982] [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: 11/07/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose: The present study reports the preliminary outcomes in terms of adverse events and quality of life in the first 100 patients treated with 1.5T MR-guided daily-adaptive stereotactic body radiotherapy for prostate cancer. Methods: From October 2019 to December 2020, 100 patients, enrolled in a prospective study, received MR-guided SBRT for prostate cancer. Rectal spacer insertion was optional and administered in 37 patients. In total, 32 patients received androgen deprivation therapy in accordance with international guidelines. A prospective collection of data regarding toxicity and quality of life was performed. Results: The median age was 71 years (range, 52-84). The median total dose delivered was 35 Gy (35-36.25 Gy) in five sessions, either on alternate days (n = 25) or consecutive days (n = 75). For acute toxicity, we recorded: seven cases of acute G2 urinary pain and four cases of G2 gastrointestinal events. The median follow-up was 12 months (3-20), recording three late G2 urinary events and one G3 case, consisting of a patient who required a TURP 8 months after the treatment. For gastrointestinal toxicity, we observed 3 G ≥ 2 GI events, including one patient who received argon laser therapy for radiation-induced proctitis. Up to the last follow-up, all patients are alive and with no evidence of biochemical relapse, except for an M1 low-volume patient in distant progression two months after radiotherapy. QoL evaluation reported a substantial resolution of any discomfort within the second follow-up after radiotherapy, with the only exception being sexual items. Notably, after one year, global health items were improved compared to the baseline assessment. Conclusions: This study reports very promising outcomes in terms of adverse events and QoL, supporting the role of 1.5T MR-guided SBRT for prostate cancer. To date, this series is one of the first and largest available in the literature. Long-term results are warranted.
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22
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van der Heide U, Thwaites DI. Integrated MRI-linac systems: The new paradigm for precision adaptive radiotherapy and biological image-guidance? Radiother Oncol 2022; 176:249-250. [PMID: 36446519 DOI: 10.1016/j.radonc.2022.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/14/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Uulke van der Heide
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - David I Thwaites
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia; Radiotherapy Research Group, Leeds Institute of Medical Research, St James's Hospital and University of Leeds, Leeds, UK.
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23
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Online adaptive MR-guided radiotherapy: Conformity of contour adaptation for prostate cancer, rectal cancer and lymph node oligometastases among radiation therapists and radiation oncologists. Tech Innov Patient Support Radiat Oncol 2022; 23:33-40. [PMID: 36090011 PMCID: PMC9460551 DOI: 10.1016/j.tipsro.2022.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/09/2022] [Accepted: 08/18/2022] [Indexed: 11/23/2022] Open
Abstract
Contour adaptation conformity analyzed for LN-metastases, rectal- + prostate cancer. Contour adaptation conformity among RTTs and radiation oncologists is comparable. Role expansion of RTTs with daily contour adaptation impacts workflow efficiency.
Background and purpose Online adaptive MR-guided treatment planning workflows facilitate daily contour adaptation to the actual anatomy. Allocating contour adaptation to radiation therapists (RTTs) instead of radiation oncologists (ROs) might allow for increasing workflow efficiency. This study investigates conformity of adapted target contours provided by dedicated RTTs and ROs. Materials and methods In a simulated online procedure, 6 RTTs and 6 ROs recontoured targets and organs at risk (OAR) in prostate cancer (n = 2), rectal cancer (n = 2) and lymph node-oligometastases (n = 2) cases. RTTs gained contouring competence beforehand by following a specific in-house training program. For all target contours and the reference delineations volumetric differences were determined and Dice similarity coefficient (DSC), conformity index (CI) and generalized CI were calculated. Delineation time and –confidence were registered for targets and OAR. Impact of contour adaptation on treatment plan quality was investigated. Results Delineation conformity was generally high with DSC, CI and generalized CI values in the range of 0.81–0.94, 0.87–0.95 and 0.63–0.85 for prostate cancer, rectal cancer and LN-oligometastasis, respectively. Target volumes were comparable for both, RTTs and ROs. Time needed and confidence in contour adaptation was comparable as well. Treatment plans derived with adapted contours did not violate dose volume constrains as used in clinical routine. Conclusion After tumor site specific training, daily contour adaptations as needed in adaptive online radiotherapy workflows can be accurately performed by RTTs. Conformity of the derived contours is high and comparable to contours as provided by ROs.
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Keall PJ, Brighi C, Glide-Hurst C, Liney G, Liu PZY, Lydiard S, Paganelli C, Pham T, Shan S, Tree AC, van der Heide UA, Waddington DEJ, Whelan B. Integrated MRI-guided radiotherapy - opportunities and challenges. Nat Rev Clin Oncol 2022; 19:458-470. [PMID: 35440773 DOI: 10.1038/s41571-022-00631-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2022] [Indexed: 12/25/2022]
Abstract
MRI can help to categorize tissues as malignant or non-malignant both anatomically and functionally, with a high level of spatial and temporal resolution. This non-invasive imaging modality has been integrated with radiotherapy in devices that can differentially target the most aggressive and resistant regions of tumours. The past decade has seen the clinical deployment of treatment devices that combine imaging with targeted irradiation, making the aspiration of integrated MRI-guided radiotherapy (MRIgRT) a reality. The two main clinical drivers for the adoption of MRIgRT are the ability to image anatomical changes that occur before and during treatment in order to adapt the treatment approach, and to image and target the biological features of each tumour. Using motion management and biological targeting, the radiation dose delivered to the tumour can be adjusted during treatment to improve the probability of tumour control, while simultaneously reducing the radiation delivered to non-malignant tissues, thereby reducing the risk of treatment-related toxicities. The benefits of this approach are expected to increase survival and quality of life. In this Review, we describe the current state of MRIgRT, and the opportunities and challenges of this new radiotherapy approach.
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Affiliation(s)
- Paul J Keall
- ACRF Image X Institute, The University of Sydney, Sydney, New South Wales, Australia.
| | - Caterina Brighi
- ACRF Image X Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Carri Glide-Hurst
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA
| | - Gary Liney
- Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Paul Z Y Liu
- ACRF Image X Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Suzanne Lydiard
- ACRF Image X Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Chiara Paganelli
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Trang Pham
- Faculty of Medicine and Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Shanshan Shan
- ACRF Image X Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Alison C Tree
- The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, UK
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - David E J Waddington
- ACRF Image X Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Brendan Whelan
- ACRF Image X Institute, The University of Sydney, Sydney, New South Wales, Australia
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25
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Mitchell A, Ingle M, Smith G, Chick J, Diamantopoulos S, Goodwin E, Herbert T, Huddart R, McNair H, Oelfke U, Nill S, Dunlop A, Hafeez S. Feasibility of tumour-focused adaptive radiotherapy for bladder cancer on the MR-linac. Clin Transl Radiat Oncol 2022; 35:27-32. [PMID: 35571274 PMCID: PMC9092067 DOI: 10.1016/j.ctro.2022.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 11/23/2022] Open
Abstract
Bladder tumour-focused magnetic resonance image-guided adaptive radiotherapy using a 1.5 Tesla MR-linac is feasible. A full online workflow adapting to anatomy at each fraction is achievable in approximately 30 min. Intra-fraction bladder filling did not compromise target coverage with the class solution employed.
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Affiliation(s)
- A. Mitchell
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - M. Ingle
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - G. Smith
- The Royal Marsden NHS Foundation Trust, London, UK
| | - J. Chick
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - S. Diamantopoulos
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - E. Goodwin
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - T. Herbert
- The Royal Marsden NHS Foundation Trust, London, UK
| | - R. Huddart
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - H. McNair
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - U. Oelfke
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - S. Nill
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - A. Dunlop
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - S. Hafeez
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
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26
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Nusrat BRM, Sarfehnia A, Renaud J. Monte Carlo optimization and experimental validation of a prototype ionization chamber for accurate magnetic resonance image guided radiation therapy (MRgRT) daily output constancy measurements in solid phantoms. Med Phys 2022; 49:5483-5490. [PMID: 35536047 DOI: 10.1002/mp.15695] [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: 10/08/2021] [Revised: 03/21/2022] [Accepted: 04/25/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To optimize the design, develop and test a prototype ionization chamber for accurate daily output constancy measurements in solid phantoms in clinical MRgRT radiotherapy beams. Up to 4 % variations in response using commercial ionization chambers have been previously reported; the prototype ionization chamber developed here aims to minimize these variations. METHODS Monte Carlo simulations with the EGSnrc code system are used to optimize an ionization chamber design by increasing the thickness of a brass (high-density, non-ferromagnetic, easy-to-machine) wall until results consistent with no air gap are produced for simulations with a 1.5 T and 0.35 T magnetic field, with a 0.2 mm air gap and varying the placement of the chamber model within the air gap. Based on the results of these simulations, prototype ionization chambers are manufactured and tested in conventional linac beams and in a 7 MV Elekta Unity MR-linac. The chambers are rotated about their axes, both parallel and perpendicular to the 1.5 T magnetic field, through 360 degrees in a plastic phantom with measurements made at each cardinal angle. This reveals any variation in chamber response by varying the thickness of the air gap between the chamber and the phantom. RESULTS Monte Carlo simulations demonstrate that the optimal thickness of the chamber wall to mitigate the effect of an asymmetric air gap between the chamber and the plastic phantom is 1.1 mm of brass. With this thickness, the differences between simulations with and without an air gap and with asymmetric placement of the chamber within the air gap are less than 0.2 %. A prototype chamber constructed with a 1.1 mm brass wall thickness exhibits less than 0.3 % variation in response when rotated about its axis in the plastic phantom in a beam from an MR-linac, independent of whether its axis is parallel or perpendicular to the magnetic field. CONCLUSION The optimized ionization chamber design and validated prototype for accurate MR-linac daily output constancy measurements allows utilization of conventional phantoms and procedures in MRgRT systems. This can minimize disruption to clinical workflow for MR-linac QA measurements. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Arman Sarfehnia
- Department of Radiation Oncology, University of Toronto, Toronto, ON, M4N 3M5, Canada
| | - James Renaud
- NRC Metrology Research Centre, National Research Council of Canada, Ottawa, ON, K1A 0R6, Canada
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27
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Kawahara D, Tsuneda M, Ozawa S, Okamoto H, Nakamura M, Nishio T, Nagata Y. Deep learning-based auto segmentation using generative adversarial network on magnetic resonance images obtained for head and neck cancer patients. J Appl Clin Med Phys 2022; 23:e13579. [PMID: 35263027 PMCID: PMC9121028 DOI: 10.1002/acm2.13579] [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: 11/03/2021] [Revised: 01/27/2022] [Accepted: 02/17/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose Adaptive radiotherapy requires auto‐segmentation in patients with head and neck (HN) cancer. In the current study, we propose an auto‐segmentation model using a generative adversarial network (GAN) on magnetic resonance (MR) images of HN cancer for MR‐guided radiotherapy (MRgRT). Material and methods In the current study, we used a dataset from the American Association of Physicists in Medicine MRI Auto‐Contouring (RT‐MAC) Grand Challenge 2019. Specifically, eight structures in the MR images of HN region, namely submandibular glands, lymph node level II and level III, and parotid glands, were segmented with the deep learning models using a GAN and a fully convolutional network with a U‐net. These images were compared with the clinically used atlas‐based segmentation. Results The mean Dice similarity coefficient (DSC) of the U‐net and GAN models was significantly higher than that of the atlas‐based method for all the structures (p < 0.05). Specifically, the maximum Hausdorff distance (HD) was significantly lower than that in the atlas method (p < 0.05). Comparing the 2.5D and 3D U‐nets, the 3D U‐net was superior in segmenting the organs at risk (OAR) for HN patients. The DSC was highest for 0.75–0.85, and the HD was lowest within 5.4 mm of the 2.5D GAN model in all the OARs. Conclusions In the current study, we investigated the auto‐segmentation of the OAR for HN patients using U‐net and GAN models on MR images. Our proposed model is potentially valuable for improving the efficiency of HN RT treatment planning.
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Affiliation(s)
- Daisuke Kawahara
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masato Tsuneda
- Department of Radiation Oncology, MR Linac ART Division, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shuichi Ozawa
- Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan
| | - Hiroyuki Okamoto
- Department of Medical Physics, National Cancer Center Hospital, Tokyo, Japan
| | - Mitsuhiro Nakamura
- Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Teiji Nishio
- Medical Physics Laboratory, Division of Health Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan.,Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan
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28
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Kong VC, Dang J, Li W, Navarro I, Padayachee J, Malkov V, Winter J, Raman S, Berlin A, Catton C, Warde P, Chung P. Dosimetric comparison of MR-guided adaptive IMRT versus 3DOF-VMAT for prostate stereotactic radiotherapy. Tech Innov Patient Support Radiat Oncol 2022; 21:64-70. [PMID: 35252598 PMCID: PMC8892164 DOI: 10.1016/j.tipsro.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/13/2022] [Accepted: 02/09/2022] [Indexed: 11/15/2022] Open
Abstract
Prostate SBRT are treated using MR-guided adaptive IMRT (A-IMRT) and VMAT based on translation correction (3DOF-VMAT) at our institution. Comparison of reference and delivered dose between adaptive-IMRT and 3DOF-VMAT to assess the effect of interfractional motion. Despite large interfractional changes, prostate received clinically acceptable dose with a margin of 5 mm through either A-IMRT or 3DOF-VMAT. A-IMRT was more superior than 3DOF-VMAT in sparing the rectum in the high dose region; no difference between the two systems was observed for bladder.
Introduction Methods & Materials Results Conclusions
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Affiliation(s)
- Vickie C. Kong
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Corresponding author at: Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
| | - Jennifer Dang
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Winnie Li
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Inmaculada Navarro
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Jerusha Padayachee
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Victor Malkov
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Jeff Winter
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Srinivas Raman
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Charles Catton
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Padraig Warde
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
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29
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Eze C, Lombardo E, Nierer L, Xiong Y, Niyazi M, Belka C, Manapov F, Corradini S. MR-guided radiotherapy in node-positive non-small cell lung cancer and severely limited pulmonary reserve: a report proposing a new clinical pathway for the management of high-risk patients. Radiat Oncol 2022; 17:43. [PMID: 35209922 PMCID: PMC8876180 DOI: 10.1186/s13014-022-02011-8] [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: 11/17/2021] [Accepted: 02/12/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Online MR-guided radiotherapy (MRgRT) is a relatively novel advancement in the field of radiation oncology, ensuring superior soft-tissue visualisation, allowing for online plan adaptation to anatomical and functional interfractional changes and improved motion management. Platinum-based chemoradiation followed by durvalumab is the recommended treatment for stage IIB(N1)/III NSCLC. However, this is only the case for patients with favourable risk factors and sufficient pulmonary function and reserve. METHODS Herein, we present a technical report on tumour motion and breathing curve analyses of the first patient with node-positive stage IIB NSCLC and severely compromised pulmonary function and reserve [total lung capacity (TLC) 8.78L/132% predicted, residual volume (RV) 6.35L/271% predicted, vital capacity (VC) max 2.43L/58% predicted, FEV1 1.19L/38% predicted, DLCO-SB corrected for hemoglobin 2.76 mmol/min/kPa/30% predicted] treated in a prospective observational study with moderately hypofractionated MRgRT to a total dose of 48.0 Gy/16 daily fractions on the MRIdian system (Viewray Inc, Oakwood, USA). RESULTS Radiotherapy was well tolerated with no relevant toxicity. First follow-up imaging at 3 months post-radiotherapy showed a partial remission. The distinctive features of this case are the patient's severely compromised pulmonary function and the first online MR-guided accelerated hypofractionated radiotherapy treatment for primary node-positive NSCLC. CONCLUSIONS This technical report describes the first patient treated in a prospective observational study evaluating the feasibility of this relatively novel technology in stage IIB(N1)/III disease, proposing a clinical pathway for the management of high-risk patients.
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Affiliation(s)
- Chukwuka Eze
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Elia Lombardo
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Lukas Nierer
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Yuqing Xiong
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany
| | - Farkhad Manapov
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
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de Leon J, Crawford D, Moutrie Z, Alvares S, Hogan L, Pagulayan C, Jelen U, Loo C, Aylward JD, Condon K, Dunkerley N, Heinke MY, Sampaio S, Simon K, Twentyman T, Jameson MG. Early experience with MR-guided adaptive radiotherapy using a 1.5 T MR-Linac: First 6 months of operation using adapt to shape workflow. J Med Imaging Radiat Oncol 2021; 66:138-145. [PMID: 34643065 DOI: 10.1111/1754-9485.13336] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/17/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The magnetic resonance linear accelerator (MRL) offers improved soft tissue visualization to guide daily adaptive radiotherapy treatment. This manuscript aims to report initial experience using a 1.5 T MRL in the first 6 months of operation, including training, workflows, timings and dosimetric accuracy. METHODS All staff received training in MRI safety and MRL workflows. Initial sites chosen for treatment were stereotactic and hypofractionated prostate, thoraco-abdomino-pelvic metastasis, prostate bed and bladder. The Adapt To Shape (ATS) workflow was chosen to be the focus of treatment as it is the most robust solution for daily adaptive radiotherapy. A workflow was created addressing patient suitability, simulation, planning, treatment and peer review. Treatment times were recorded breaking down into the various stages of treatment. RESULTS A total of 37 patients were treated and 317 fractions delivered (of which 313 were delivered using an ATS workflow) in our initial 6 months. Average treatment times over the entire period were 50 and 38 min for stereotactic and non-stereotactic treatments respectively. Average treatment times reduced each month. The average difference between reference planned and ionization chamber measured dose was 0.0 ± 1.4%. CONCLUSION The MRL was successfully established in an Australian setting. A focus on training and creating a detailed workflow from patient selection, review and treatment are paramount to establishing new treatment programmes.
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Affiliation(s)
| | | | - Zoë Moutrie
- GenesisCare, Sydney, New South Wales, Australia
| | | | | | | | | | - Conrad Loo
- GenesisCare, Sydney, New South Wales, Australia
| | - Jack D Aylward
- GenesisCare, Sydney, New South Wales, Australia.,Division of Cancer Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK.,Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, The University of Manchester, Manchester, UK
| | | | | | | | | | - Kathy Simon
- GenesisCare, Sydney, New South Wales, Australia
| | | | - Michael G Jameson
- GenesisCare, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Kerkmeijer LGW, Valentini V, Fuller CDD, Slotman BJ. Editorial: Online Adaptive MR-Guided Radiotherapy. Front Oncol 2021; 11:748685. [PMID: 34527596 PMCID: PMC8435672 DOI: 10.3389/fonc.2021.748685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/11/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Vincenzo Valentini
- Department of Radiation Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Clifton D Dave Fuller
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, United States
| | - Ben J Slotman
- Department of Radiation Oncology, Amsterdam UMC, Amsterdam, Netherlands
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32
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MR-Guided Hypofractionated Radiotherapy: Current Emerging Data and Promising Perspectives for Localized Prostate Cancer. Cancers (Basel) 2021; 13:cancers13081791. [PMID: 33918650 PMCID: PMC8070332 DOI: 10.3390/cancers13081791] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary The biological features of prostate cancer as a tumor with a low alpha beta ratio have led clinicians to consider the use of higher doses per fraction, thus gaining an advantage both in terms of clinical outcomes and of logistic opportunities. To date, moderate hypofractionated schedules are supported by several international clinical guidelines. The subsequent step was represented by the adoption of extreme hypofractionated schedules, for which recent literature data report non-inferiority results for the five-fractions regimens. In this scenario, the recent introduction of MR-guided daily adaptive radiotherapy is a potential paradigm shift, given the ability to increase the resolution of the pelvis anatomy and to take into account of the daily variations in shape and size of the nearby healthy structures. Abstract In this review we summarize the currently available evidence about the role of hybrid machines for MR-guided radiotherapy for prostate stereotactic body radiotherapy. Given the novelty of this technology, to date few data are accessible, but they all report very promising results in terms of tolerability and preliminary clinical outcomes. Most of the studies highlight the favorable impact of on-board magnetic resonance imaging as a means to improve target and organs at risk identification with a consequent advantage in terms of dosimetric results, which is expected to relate to a more favorable toxicity pattern. Still, the longer treatment time per session may potentially affect the patient’s compliance to the treatment, although first quality of life assessment studies have reported substantial tolerability and no major impact on quality of life. Finally, in this review we hypothesize some future scenarios of further investigation, based on the possibility to explore the superior anatomy visualization and the role of daily adapted treatments provided by hybrid MR-Linacs.
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