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Herrick M, Penfold S, Santos A, Hickson K. A systematic review of volumetric image guidance in proton therapy. Phys Eng Sci Med 2023; 46:963-975. [PMID: 37382744 PMCID: PMC10480289 DOI: 10.1007/s13246-023-01294-9] [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: 04/30/2023] [Accepted: 06/19/2023] [Indexed: 06/30/2023]
Abstract
In recent years, proton therapy centres have begun to shift from conventional 2D-kV imaging to volumetric imaging systems for image guided proton therapy (IGPT). This is likely due to the increased commercial interest and availability of volumetric imaging systems, as well as the shift from passively scattered proton therapy to intensity modulated proton therapy. Currently, there is no standard modality for volumetric IGPT, leading to variation between different proton therapy centres. This article reviews the reported clinical use of volumetric IGPT, as available in published literature, and summarises their utilisation and workflow where possible. In addition, novel volumetric imaging systems are also briefly summarised highlighting their potential benefits for IGPT and the challenges that need to be overcome before they can be used clinically.
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Affiliation(s)
- Mitchell Herrick
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia.
- Department of Physics, University of Adelaide, Adelaide, Australia.
| | - Scott Penfold
- Department of Physics, University of Adelaide, Adelaide, Australia
- Australian Bragg Centre for Proton Therapy and Research, Adelaide, Australia
| | - Alexandre Santos
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
- Department of Physics, University of Adelaide, Adelaide, Australia
- Australian Bragg Centre for Proton Therapy and Research, Adelaide, Australia
| | - Kevin Hickson
- SA Medical Imaging, Adelaide, Australia
- University of South Australia, Allied Health & Human Performance, Adelaide, Australia
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2
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Zhang G, Zhou L, Han Z, Zhao W, Peng H. SWFT-Net: a deep learning framework for efficient fine-tuning spot weights towards adaptive proton therapy. Phys Med Biol 2022; 67. [PMID: 36541496 DOI: 10.1088/1361-6560/aca517] [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: 07/03/2022] [Accepted: 11/22/2022] [Indexed: 11/23/2022]
Abstract
Objective. One critical task for adaptive proton therapy is how to perform spot weight re-tuning and reoptimize plan, both of which are time-consuming and labor intensive. We proposed a deep learning framework (SWFT-Net) to speed up such a task, a starting point for us to move towards online adaptive proton therapy.Approach. For a H&N patient case, a reference intensity modulated proton therapy plan was generated. For data augmentation, spot weights were modified to generate three datasets (DS10, DS30, DS50), corresponding to different levels of weight adjustment. For each dataset, the samples were split into the training and testing groups at a ratio of 8:2 (6400 for training, 1706 for testing). To ease the difficulty of machine learning, the residuals of dose maps and spot weights (i.e. difference relative to a reference) were used as inputs and outputs, respectively. Quantitative analyses were performed in terms of normalized root mean square error (NRMSE) of spot weights, Gamma passing rate and dose difference within the PTV.Main results. The SWFT-Net is able to generate an adapted plan in less than a second with a NVIDIA GeForce RTX 3090 GPU. For the 1706 samples in the testing dataset, the NRMSE is 0.41% (DS10), 1.05% (DS30) and 2.04% (DS50), respectively. Cold/hot spots in the dose maps after adaptation are observed. The mean relative dose difference is 0.64% (DS10), 0.92% (DS30) and 0.88% (DS50), respectively. For all three datasets, the mean Gamma passing rate is consistently over 95% for both 1 mm/1% and 3 mm/3% settings.Significance. The proposed SWFT-Net is a promising tool to help realize adaptive proton therapy. It can be used as an alternative tool to other spot fine-tuning optimization algorithms, likely demonstrating superior performance in terms of speed, accuracy, robustness and minimum human interaction. This study lays down a foundation for us to move further incorporating other factors such as daily anatomical changes and propagated PTVs, and develop a truly online adaptive workflow in proton therapy.
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Affiliation(s)
- Guoliang Zhang
- Department of Medical Physics, School of Physics and Technology, Wuhan University, 430072, People's Republic of China
| | - Long Zhou
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310020, People's Republic of China
| | - Zeng Han
- Department of Medical Physics, School of Physics and Technology, Wuhan University, 430072, People's Republic of China
| | - Wei Zhao
- School of Physics, Beihang University, Beijing, 100191, People's Republic of China
| | - Hao Peng
- Department of Medical Physics, School of Physics and Technology, Wuhan University, 430072, People's Republic of China.,Medical Artificial Intelligence and Automation (MAIA) Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States of America
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3
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Real-time dose-guidance in radiotherapy: Proof of principle. Radiother Oncol 2021; 164:175-182. [PMID: 34597738 DOI: 10.1016/j.radonc.2021.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/03/2021] [Accepted: 09/20/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE The outcome of radiotherapy is a direct consequence of the dose delivered to the patient. Yet image-guidance and motion management to date focus on geometrical considerations as a practical surrogate for dose. Here, we propose real-time dose-guidance realized through continuous motion-including dose reconstructions and demonstrate this new concept in simulated liver stereotactic body radiotherapy (SBRT) delivery. MATERIALS AND METHODS During simulated liver SBRT delivery, in-house developed software performed real-time motion-including reconstruction of the tumor dose delivered so far and continuously predicted the remaining fraction tumor dose. The total fraction dose was estimated as the sum of the delivered and predicted doses, both with and without the emulated couch correction that maximized the predicted final CTV D95% (minimum dose to 95% of the clinical target volume). Dose-guided treatments were simulated for 15 liver SBRT patients previously treated with tumor motion monitoring, using both sinusoidal tumor motion and the actual patient-measured motion. A dose-guided couch correction was triggered if it improved the predicted final CTV D95% with 3, 4 or 5 %-points. The final CTV D95% of the dose-guidance strategy was compared with simulated treatments using geometry guided couch corrections (Wilcoxon signed-rank test). RESULTS Compared to geometry guidance, dose-guided couch corrections improved the median CTV D95% with 0.5-1.5 %-points (p < 0.01) for sinusoidal motions and with 0.9 %-points (p < 0.01, 3 %-points trigger threshold), 0.5 %-points (p = 0.03, 4 %-points threshold) and 1.2 %-points (p = 0.09, 5 %-points threshold) for patient-measured tumor motion. CONCLUSION Real-time dose-guidance was proposed and demonstrated to be superior to geometrical adaptation in liver SBRT simulations.
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Busch K, Dahl B, Petersen SE, Rønde HS, Bentzen L, Pilskog S, Muren LP. Anatomically robust proton therapy using multiple planning computed tomography scans for locally advanced prostate cancer. Acta Oncol 2021; 60:598-604. [PMID: 33646069 DOI: 10.1080/0284186x.2021.1892181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Proton therapy (PT) is sensitive towards anatomical changes that may occur during a treatment course. The aim of this study was to investigate if anatomically robust PT (ARPT) plans incorporating patient-specific target motion improved target coverage while still sparing normal tissues, when applied on locally advanced prostate cancer patients where pelvic irradiation is indicated. MATERIAL AND METHODS A planning computed tomography (CT) scan used for dose calculation and two additional CTs (acquired on different days) were used to make patient-specific targets for the ARPT plans on the eight included patients. The plans were compared to a conventional robust PT plan and a volumetric modulated arc therapy (VMAT) photon plan, which were derived from the planning CT (pCT). Worst-case robust optimisation was used for all proton plans with a setup uncertainty of 5 mm and a range uncertainty of 3.5%. Target coverage (V95% and D95%) and normal tissue doses (V5-75 Gy) were evaluated on 6-8 rCTs per patient. RESULTS The ARPT plans improved the prostate target coverage for the most challenging patient compared to conventional robust PT plans (20% point increase for V95% and 31 Gy increase for D95%). Across the whole cohort the estimated mean value for V95% was 97% for the ARPT plans and 95% for the conventional robust PT plans. The ARPT plans had a slight, statistically insignificant increase in normal tissue doses compared to the conventional robust proton plans. Compared to VMAT, the ARPT plans significantly reduced the normal tissue doses in the low-to-intermediate dose range. CONCLUSIONS While both proton plans reduced the low-to-intermediate normal tissue doses compared to VMAT, ARPT plans improved the target coverage for the most challenging patient without significantly increasing the normal tissue doses compared to conventional robust PT plans.
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Affiliation(s)
- Kia Busch
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Benjamin Dahl
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Stine E. Petersen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Heidi S. Rønde
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Lise Bentzen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Sara Pilskog
- Department of Physics and Technology, University of Bergen, Bergen, Norway
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Ludvig P. Muren
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Czerska K, Emert F, Kopec R, Langen K, McClelland JR, Meijers A, Miyamoto N, Riboldi M, Shimizu S, Terunuma T, Zou W, Knopf A, Rucinski A. Clinical practice vs. state-of-the-art research and future visions: Report on the 4D treatment planning workshop for particle therapy - Edition 2018 and 2019. Phys Med 2021; 82:54-63. [PMID: 33588228 DOI: 10.1016/j.ejmp.2020.12.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022] Open
Abstract
The 4D Treatment Planning Workshop for Particle Therapy, a workshop dedicated to the treatment of moving targets with scanned particle beams, started in 2009 and since then has been organized annually. The mission of the workshop is to create an informal ground for clinical medical physicists, medical physics researchers and medical doctors interested in the development of the 4D technology, protocols and their translation into clinical practice. The 10th and 11th editions of the workshop took place in Sapporo, Japan in 2018 and Krakow, Poland in 2019, respectively. This review report from the Sapporo and Krakow workshops is structured in two parts, according to the workshop programs. The first part comprises clinicians and physicists review of the status of 4D clinical implementations. Corresponding talks were given by speakers from five centers around the world: Maastro Clinic (The Netherlands), University Medical Center Groningen (The Netherlands), MD Anderson Cancer Center (United States), University of Pennsylvania (United States) and The Proton Beam Therapy Center of Hokkaido University Hospital (Japan). The second part is dedicated to novelties in 4D research, i.e. motion modelling, artificial intelligence and new technologies which are currently being investigated in the radiotherapy field.
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Affiliation(s)
- Katarzyna Czerska
- Institute of Nuclear Physics Polish Academy of Sciences, PL-31342 Krakow, Poland.
| | - Frank Emert
- Center for Proton Therapy, Paul Scherrer Institute, Switzerland
| | - Renata Kopec
- Institute of Nuclear Physics Polish Academy of Sciences, PL-31342 Krakow, Poland
| | - Katja Langen
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jamie R McClelland
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Arturs Meijers
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Naoki Miyamoto
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan; Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Marco Riboldi
- Department of Medical Physics, Ludwig-Maximilians-Universität München, Germany
| | - Shinichi Shimizu
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan; Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Toshiyuki Terunuma
- Faculty of Medicine, University of Tsukuba, Japan; Proton Medical Research Center, University of Tsukuba Hospital, Japan
| | - Wei Zou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Antje Knopf
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Antoni Rucinski
- Institute of Nuclear Physics Polish Academy of Sciences, PL-31342 Krakow, Poland
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Splinter M, Sachpazidis I, Bostel T, Fechter T, Zamboglou C, Thieke C, Jäkel O, Huber PE, Debus J, Baltas D, Nicolay NH. Dosimetric Impact of the Positional Imaging Frequency for Hypofractionated Prostate Radiotherapy - A Voxel-by-Voxel Analysis. Front Oncol 2020; 10:564068. [PMID: 33134166 PMCID: PMC7550661 DOI: 10.3389/fonc.2020.564068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/02/2020] [Indexed: 12/25/2022] Open
Abstract
Background To investigate deviations between planned and applied treatment doses for hypofractionated prostate radiotherapy and to quantify dosimetric accuracy in dependence of the image guidance frequency. Methods Daily diagnostic in-room CTs were carried out in 10 patients in treatment position as image guidance for hypofractionated prostate radiotherapy. Fraction doses were mapped to the planning CTs and recalculated, and applied doses were accumulated voxel-wise using deformable registration. Non-daily imaging schedules were simulated by deriving position correction vectors from individual scans and used to rigidly register the following scans until the next repositioning before dose recalculation and accumulation. Planned and applied doses were compared regarding dose-volume indices and TCP and NTCP values in dependence of the imaging and repositioning frequency. Results Daily image-guided repositioning was associated with only negligible deviations of analyzed dose-volume parameters and conformity/homogeneity indices for the prostate, bladder and rectum. Average CTV T did not significantly deviate from the plan values, and rectum NTCPs were highly comparable, while bladder NTCPs were reduced. For non-daily image-guided repositioning, there were significant deviations in the high-dose range from the planned values. Similarly, CTV dose conformity and homogeneity were reduced. While TCPs and rectal NTCPs did not significantly deteriorate for non-daily repositioning, bladder NTCPs appeared falsely diminished in dependence of the imaging frequency. Conclusion Using voxel-by-voxel dose accumulation, we showed for the first time that daily image-guided repositioning resulted in only negligible dosimetric deviations for hypofractionated prostate radiotherapy. Regarding dosimetric aberrations for non-daily imaging, daily imaging is required to adequately deliver treatment.
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Affiliation(s)
- Mona Splinter
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,Medical Physics in Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Ilias Sachpazidis
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg im Breisgau, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
| | - Tilman Bostel
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.,Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany
| | - Tobias Fechter
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg im Breisgau, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
| | - Constantinos Zamboglou
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg im Breisgau, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
| | - Christian Thieke
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Oliver Jäkel
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,Medical Physics in Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Peter E Huber
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Debus
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Dimos Baltas
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg im Breisgau, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
| | - Nils H Nicolay
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.,Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg im Breisgau, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
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7
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Albertini F, Matter M, Nenoff L, Zhang Y, Lomax A. Online daily adaptive proton therapy. Br J Radiol 2020; 93:20190594. [PMID: 31647313 PMCID: PMC7066958 DOI: 10.1259/bjr.20190594] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/15/2019] [Accepted: 10/22/2019] [Indexed: 12/11/2022] Open
Abstract
It is recognized that the use of a single plan calculated on an image acquired some time before the treatment is generally insufficient to accurately represent the daily dose to the target and to the organs at risk. This is particularly true for protons, due to the physical finite range. Although this characteristic enables the generation of steep dose gradients, which is essential for highly conformal radiotherapy, it also tightens the dependency of the delivered dose to the range accuracy. In particular, the use of an outdated patient anatomy is one of the most significant sources of range inaccuracy, thus affecting the quality of the planned dose distribution. A plan should be ideally adapted as soon as anatomical variations occur, ideally online. In this review, we describe in detail the different steps of the adaptive workflow and discuss the challenges and corresponding state-of-the art developments in particular for an online adaptive strategy.
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Affiliation(s)
| | | | | | - Ye Zhang
- Paul Scherrer Institute, Center for Proton Therapy, Switzerland
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8
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Scholz M. State-of-the-Art and Future Prospects of Ion Beam Therapy: Physical and Radiobiological Aspects. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2020. [DOI: 10.1109/trpms.2019.2935240] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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9
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Splinter M, Bostel T, Sachpazidis I, Fechter T, Zamboglou C, Jäkel O, Huber PE, Debus J, Baltas D, Nicolay NH. Dosimetric Impact of Interfractional Variations for Post-prostatectomy Radiotherapy to the Prostatic Fossa-Relevance for the Frequency of Position Verification Imaging and Treatment Adaptation. Front Oncol 2019; 9:1191. [PMID: 31788450 PMCID: PMC6856079 DOI: 10.3389/fonc.2019.01191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/21/2019] [Indexed: 12/15/2022] Open
Abstract
Background and purpose: To analyze divergences between the planned and applied treatment doses for post-prostatectomy radiotherapy to the prostatic fossa on a voxel-by-voxel basis based on interfractional anatomic variations and imaging frequency. Materials and methods: For 10 patients receiving intensity-modulated postoperative radiotherapy to the prostatic fossa, position verification was carried out by daily in-room CT imaging in treatment position (340 fraction CTs). Applied fraction doses were recalculated on daily CT scans, and treatment doses were accumulated on a voxel-by-voxel basis after deformable image registration. To simulate weekly imaging, derived weekly position correction vectors were used to rigidly register all daily scans of the respective treatment week onto the planning CT before dose accumulation. Detailed dose statistics of the prescribed and applied treatment doses were compared in relation to the frequency of position verification imaging. Derived NTCP and Pinjury values were calculated for the rectum and bladder. Results: Despite a large variability in the pelvic anatomy, daily CT-based patient repositioning resulted in largely negligible deviations of the analyzed dose-volume, conformity, and uniformity parameters from the planned doses for post-prostatectomy radiotherapy, and only the bladder exhibited significant increases in the accumulated mean and median doses. Derived NTCP for the applied doses to the rectum and bladder and Pinjury values did not significantly deviate from the treatment plan. In contrast, weekly CT-based repositioning resulted in significant decreases of the PTV coverage and dose conformity as well as large deviations of the applied doses to the rectum and bladder from the planned doses. Consecutively, NTCP for the rectum and Pinjury were found falsely reduced for weekly patient repositioning. Conclusions: Our data indicate for the first time in a voxel-by-voxel analysis that daily imaging is required for reliable adaptive delivery of intensity-modulated radiotherapy to the prostatic fossa. This work will help guiding adaptive treatment strategies for post-prostatectomy radiotherapy.
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Affiliation(s)
- Mona Splinter
- Medical Physics in Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.,Clinical Cooperation Unit "Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Tilman Bostel
- Clinical Cooperation Unit "Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany
| | - Ilias Sachpazidis
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
| | - Tobias Fechter
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
| | - Constantinos Zamboglou
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
| | - Oliver Jäkel
- Medical Physics in Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Peter E Huber
- Clinical Cooperation Unit "Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Debus
- Clinical Cooperation Unit "Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Dimos Baltas
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
| | - Nils H Nicolay
- Clinical Cooperation Unit "Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
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10
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Nenoff L, Matter M, Hedlund Lindmar J, Weber DC, Lomax AJ, Albertini F. Daily adaptive proton therapy - the key to innovative planning approaches for paranasal cancer treatments. Acta Oncol 2019; 58:1423-1428. [PMID: 31364904 DOI: 10.1080/0284186x.2019.1641217] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: For proton therapy of paranasal tumors, field directions avoiding volumes that might change during therapy are typically used. If the plan is optimized on the daily anatomy using daily adapted proton therapy (DAPT) however, field directions crossing the nasal cavities might be feasible. In this study, we investigated the effectiveness of DAPT for enabling narrow-field treatment approaches. Material and methods: For five paranasal tumor patients, representing a wide patient spectrum, anatomically robust 4-field-star and narrow-field plans were calculated and their robustness to anatomical and setup uncertainties was compared with and without DAPT. Based on the nominal planning CTs, per patient up to 125 simulated CTs (simCTs) with different nasal cavity fillings were created and random translations and rotations due to patient setup uncertainties were further simulated. Plans were recalculated or re-optimized on all error scenarios, representing non-adapted and DAPT fractions, respectively. From these, 100 possible treatments (60 GyRBE, 30 fx) were simulated and changes in integral dose, target and organs at risk (OARs) doses evaluated. Results: In comparison to the 4-field-star approach, the use of narrow-fields reduced integral dose between 29% and 56%. If OARs did not overlap with the target, OAR doses were also reduced. Finally, the significantly reduced target coverage in non-adapted treatments (mean V95 reductions of up to 34%) could be almost fully restored with DAPT in all cases (differences <1%). Conclusions: DAPT was found to be not only an effective way to increase plan robustness to anatomical and positional uncertainties, but also opened the possibility to use improved and more conformal field arrangements.
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Affiliation(s)
- Lena Nenoff
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
- Department of Physics, ETH Zurich, Zurich, Switzerland
| | - Michael Matter
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
- Department of Physics, ETH Zurich, Zurich, Switzerland
| | - Johanna Hedlund Lindmar
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
- Department of Physics, ETH Zurich, Zurich, Switzerland
| | - Damien Charles Weber
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
- Department of Radiation Oncology, University Hospital Bern, Bern, Switzerland
| | - Antony John Lomax
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
- Department of Physics, ETH Zurich, Zurich, Switzerland
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11
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Bostel T, Sachpazidis I, Splinter M, Bougatf N, Fechter T, Zamboglou C, Jäkel O, Huber PE, Baltas D, Debus J, Nicolay NH. Dosimetric Impact of Interfractional Variations in Prostate Cancer Radiotherapy-Implications for Imaging Frequency and Treatment Adaptation. Front Oncol 2019; 9:940. [PMID: 31612106 PMCID: PMC6776888 DOI: 10.3389/fonc.2019.00940] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/06/2019] [Indexed: 02/06/2023] Open
Abstract
Background and purpose: To analyze deviations of the applied from the planned doses on a voxel-by-voxel basis for definitive prostate cancer radiotherapy depending on anatomic variations and imaging frequency. Materials and methods: Daily in-room CT imaging was performed in treatment position for 10 patients with prostate cancer undergoing intensity-modulated radiotherapy (340 fraction CTs). Applied fraction doses were recalculated on daily images, and voxel-wise dose accumulation was performed using a deformable registration algorithm. For weekly imaging, weekly position correction vectors were derived and used to rigidly register daily scans of that week to the planning CT scan prior to dose accumulation. Applied and prescribed doses were compared in dependence of the imaging frequency, and derived TCP and NTCP values were calculated. Results: Daily CT-based repositioning resulted in non-significant deviations of all analyzed dose-volume, conformity and uniformity parameters to the CTV, bladder and rectum irrespective of anatomic changes. Derived average TCP values were comparable, and NTCP values for the applied doses to the bladder and rectum did not significantly deviate from the planned values. For weekly imaging, the applied D2 to the CTV, rectum and bladder significantly varied from the planned doses, and the CTV conformity index and D98 decreased. While TCP values were comparable, the NTCP for the bladder erroneously appeared reduced for weekly repositioning. Conclusions: Based on daily diagnostic quality CT imaging and voxel-wise dose accumulation, we demonstrated for the first time that daily, but not weekly imaging resulted in only negligible deviations of the applied from the planned doses for prostate intensity-modulated radiotherapy. Therefore, weekly imaging may not be adequately reliable for adaptive treatment delivery techniques for prostate. This work will contribute to devising adaptive re-planning strategies for prostate radiotherapy.
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Affiliation(s)
- Tilman Bostel
- Clinical Cooperation Unit "Radiation Oncology", German Cancer Research Center, Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany
| | - Ilias Sachpazidis
- Department of Radiation Oncology, University of Freiburg Medical Center, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
| | - Mona Splinter
- Heidelberg Institute of Radiation Oncology, National Center for Radiation Research in Oncology, Heidelberg, Germany.,Medical Physics in Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Nina Bougatf
- Clinical Cooperation Unit "Radiation Oncology", German Cancer Research Center, Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology, National Center for Radiation Research in Oncology, Heidelberg, Germany
| | - Tobias Fechter
- Department of Radiation Oncology, University of Freiburg Medical Center, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
| | - Constantinos Zamboglou
- Department of Radiation Oncology, University of Freiburg Medical Center, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
| | - Oliver Jäkel
- Heidelberg Institute of Radiation Oncology, National Center for Radiation Research in Oncology, Heidelberg, Germany.,Medical Physics in Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Peter E Huber
- Clinical Cooperation Unit "Radiation Oncology", German Cancer Research Center, Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology, National Center for Radiation Research in Oncology, Heidelberg, Germany
| | - Dimos Baltas
- Department of Radiation Oncology, University of Freiburg Medical Center, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
| | - Jürgen Debus
- Clinical Cooperation Unit "Radiation Oncology", German Cancer Research Center, Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology, National Center for Radiation Research in Oncology, Heidelberg, Germany
| | - Nils H Nicolay
- Clinical Cooperation Unit "Radiation Oncology", German Cancer Research Center, Heidelberg, Germany.,Department of Radiation Oncology, University of Freiburg Medical Center, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
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