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Saika T, Matsumoto K. [Comparison of Bladder Volume Measurement Accuracy between Portable Ultrasound Diagnostic Equipment and CBCT for Pelvic Prostate Radiotherapy]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2024; 80:760-765. [PMID: 38925920 DOI: 10.6009/jjrt.2024-1461] [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] [Indexed: 06/28/2024]
Abstract
PURPOSE We evaluated the measurement accuracy of the CubeScan BioCon-900 (here after BioCon-900), a portable ultrasound imaging diagnostic device capable of measuring bladder volume, to determine if it can accurately assess bladder volume before intensity-modulated radiation therapy (IMRT) for prostate cancer. METHODS Bladder volume was measured from kV-Cone Beam computed tomography (CBCT) images obtained immediately before the administration of IMRT for prostate cancer using Halcyon. The bladder volume measured from kV-CBCT images (23 patients, total number of scans: 139) immediately before the IMRT procedure was used as the reference value. The difference between the bladder volume measured by the BioCon-900 was then calculated. RESULTS The bladder volume measured from kV-CBCT images was 117.5±49.4 cc. In contrast, the bladder volume obtained with BioCon-900 was 104.1±48.6 ml, resulting in an absolute mean difference of 18.4% and a correlation coefficient of 0.881. The measurements by BioCon-900 tended to be, on average, 11% smaller than the bladder volume measured by kV-CBCT imaging. CONCLUSION kV-CBCT images demonstrated a strong positive correlation between bladder volume and bladder urine output obtained with BioCon-900. BioCon-900 can be used before kV-CBCT imaging to accurately and conveniently assess bladder volume.
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Costa P, Vale J, Fonseca G, Costa A, Kos M. Use of rectal balloon spacer in patients with localized prostate cancer receiving external beam radiotherapy. Tech Innov Patient Support Radiat Oncol 2024; 29:100237. [PMID: 38322778 PMCID: PMC10846399 DOI: 10.1016/j.tipsro.2024.100237] [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: 09/27/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 02/08/2024] Open
Abstract
Objective To evaluate the efficacy of the balloon spacer when used to reduce the radiation dose delivered to the rectum in prostate cancer patients undergoing external beam radiotherapy. Method A single center retrospective analysis including 75 PC patients with localized T1-T3a disease who received balloon spacer followed by EBRT. Pre- and post-implantation computed tomography (CT) scans were utilized for treatment planning for standard EBRT (78-81 Gy in 1.8-2 Gy fractions). Rectal dosimetry was assessed using DVHs, and toxicities were graded with CTCAE v.4. Results A median (IQR) prostate-rectum separation resulted in 1.6 cm (1.4-2.0) post balloon spacer implantation. Overall, 90.6 % (68/75) of patients had a clinically significant 25 % relative reduction in the rectal with a median relative reduction of 91.8 % (71.2-98.6 %) at rV70. Three (4.0 %) patients reported mild procedural adverse events, anal discomfort and dysuria. Within 90 days post-implantation, five patients (6.67 %) and 1 patient (1.33 %) reported grade 1 and grade 2 rectal toxicities (anal pain, constipation, diarrhea and hemorrhoids). Genitourinary (GU) grade 1 toxicity was reported in 37 patients (49.33 %), with only one patient (1.33 %) experiencing grade 2 GU toxicity. No grade ≥ 3 toxicity was reported. Conclusion Balloon spacer implantation effectively increased prostate-rectum separation and associated with dosimetric gains EBRT for PC stage T1-T3a. Further controlled studies are required to ascertain whether this spacer allows for radiotherapy dose escalation and minimizes gastrointestinal (GI) toxicity.
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Affiliation(s)
- Paulo Costa
- CUF Porto Instituto, Rua Fonte das Sete Bicas, 170 - Piso -1 – 4460-188 SENHORA DA HORA, Porto Portugal
| | - Joana Vale
- CUF Porto Instituto, Rua Fonte das Sete Bicas, 170 - Piso -1 – 4460-188 SENHORA DA HORA, Porto Portugal
| | - Graça Fonseca
- CUF Porto Instituto, Rua Fonte das Sete Bicas, 170 - Piso -1 – 4460-188 SENHORA DA HORA, Porto Portugal
| | - Adelina Costa
- CUF Porto Instituto, Rua Fonte das Sete Bicas, 170 - Piso -1 – 4460-188 SENHORA DA HORA, Porto Portugal
| | - Michael Kos
- Brachytherapy Radiation Specialists Summit Cancer, 6506 Regal Ct., Reno, NV 99223, USA
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Campbell LE, Laub SJ, Smith JA, Hartsell WF. Evaluation of the utility of rescans in the treatment of prostate and pelvic nodes with pencil beam scanning protons. Med Dosim 2023; 49:50-55. [PMID: 38103956 DOI: 10.1016/j.meddos.2023.10.012] [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: 09/07/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 12/19/2023]
Abstract
To determine the necessity of the first week CT simulation rescan of pencil beam scanning (PBS) prostate patients requiring treatment to the pelvic lymph nodes. Patients were treated on a prospective registry trial sponsored by the Proton Collaborative Group (PCG-NCT01255748). A total of 42 patients with high-risk prostate cancer requiring treatment to the pelvic lymph nodes were evaluated in a single calendar year. The cohort consisted of a mix of intact prostate and postprostatectomy patients. Most of the patients were treated with a simultaneous integrated boost (SIB) approach for the majority of the plan. The radiation prescriptions varied depending on whether the patient had an intact prostate or prostate bed. The plan geometry consisted of two lateral beams and a single field optimization (SFO) dosimetric matching technique using pencil beam scanning proton therapy. An in-house protocol was established wherein all high-risk prostate patients had at least 1 rescan evaluation performed during the first 5 ± 2 fractions, which was used to determine whether the nominal approved plan was robust to daily setup uncertainties and anatomical variations. If the evaluation failed clinical analysis, an adaptive replan was created. If 5% or more of the evaluated rescans resulted in a qualified adaptive plan, the planning technique would be considered insufficient. Of the 42 patients investigated, five (11.9%) required an adaptive plan. As it turned out, all five of these patients would have been rescanned within the first 5 fractions of treatment, independent of the established rescan protocol, due to a physician, dosimetrist, or therapist requesting a rescan to investigate specific areas of concern regarding setup or anatomic changes. Of the 5 adaptive plans, only one (2.4%) meets the criteria of a qualified adaptive plan. Our findings substantiated that this policy of a planned rescan with the 5th fraction was no longer necessary, the dosimetric technique had proven to be robust, and moving forward we will only perform these rescans if there is a significant issue with daily setups or observed changes in anatomy.
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Affiliation(s)
| | - Steven J Laub
- Northwestern Medicine Proton Center, Warrenville, IL 60555, USA.
| | | | - William F Hartsell
- Northwestern Medicine Proton Center, Warrenville, IL 60555, USA; Radiation Oncology Consultants, Oak Brook, IL 60523, USA
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Bugeja JM, Mehawed G, Roberts MJ, Rukin N, Dowling J, Murray R. Prostate volume analysis in image registration for prostate cancer care: a verification study. Phys Eng Sci Med 2023; 46:1791-1802. [PMID: 37819450 DOI: 10.1007/s13246-023-01342-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
Combined magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) may enhance diagnosis, aid surgical planning and intra-operative orientation for prostate biopsy and radical prostatectomy. Although PET-MRI may provide these benefits, PET-MRI machines are not widely available. Image fusion of Prostate specific membrane antigen PET/CT and MRI acquired separately may be a suitable clinical alternative. This study compares CT-MR registration algorithms for urological prostate cancer care. Paired whole-pelvis MR and CT scan data were used (n = 20). A manual prostate CTV contour was performed independently on each patients MR and CT image. A semi-automated rigid-, automated rigid- and automated non-rigid registration technique was applied to align the MR and CT data. Dice Similarity Index (DSI), 95% Hausdorff distance (95%HD) and average surface distance (ASD) measures were used to assess the closeness of the manual and registered contours. The automated non-rigid approach had a significantly improved performance compared to the automated rigid- and semi-automated rigid-registration, having better average scores and decreased spread for the DSI, 95%HD and ASD (all p < 0.001). Additionally, the automated rigid approach had similar significantly improved performance compared to the semi-automated rigid registration across all accuracy metrics observed (all p < 0.001). Overall, all registration techniques studied here demonstrated sufficient accuracy for exploring their clinical use. While the fully automated non-rigid registration algorithm in the present study provided the most accurate registration, the semi-automated rigid registration is a quick, feasible, and accessible method to perform image registration for prostate cancer care by urologists and radiation oncologists now.
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Affiliation(s)
- Jessica M Bugeja
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Health and Biosecurity, Herston, Australia.
| | - Georges Mehawed
- Herston Biofabrication Institute, Urology Program, Herston, Australia
- Urology Department, Redcliffe Hospital, Redcliffe, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
- Australian Institute of Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Australia
| | - Matthew J Roberts
- Herston Biofabrication Institute, Urology Program, Herston, Australia
- Urology Department, Redcliffe Hospital, Redcliffe, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
- Urology Department, Royal Brisbane and Women's Hospital, Herston, Australia
- University of Queensland, University of Queensland Centre for Clinical Research, Herston, Australia
| | - Nicholas Rukin
- Herston Biofabrication Institute, Urology Program, Herston, Australia
- Urology Department, Redcliffe Hospital, Redcliffe, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Jason Dowling
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Health and Biosecurity, Herston, Australia
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Rebecca Murray
- Herston Biofabrication Institute, Urology Program, Herston, Australia
- Urology Department, Redcliffe Hospital, Redcliffe, Australia
- Australian Institute of Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Australia
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Sakurai T, Takamatsu S, Shibata S, Minamikawa R, Yamazaki M, Kojima H, Noto K, Makino T, Kawaguchi S, Nohara T, Mizokami A, Gabata T. Factors Affecting Prostate Displacement During Volumetric Modulated Arc Therapy in Prone Position After High-Dose-Rate Brachytherapy for Prostate Cancer. Adv Radiat Oncol 2023; 8:101277. [PMID: 38047223 PMCID: PMC10692303 DOI: 10.1016/j.adro.2023.101277] [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: 01/10/2023] [Accepted: 05/17/2023] [Indexed: 12/05/2023] Open
Abstract
Purpose In irradiating the prostate and pelvic lymph node regions, registration based on bony structures matches the pelvic lymph node regions but not necessarily the prostate position, and it is important to identify factors that influence prostate displacement. Therefore, we investigated factors influencing prostate displacement during volumetric modulated arc therapy after single-fraction high-dose-rate brachytherapy (HDR-BT) for prostate cancer and the trends in displacement for each fraction. Methods and Materials Seventy patients who underwent pelvic volumetric modulated arc therapy of 46 Gy in the prone position 15 days after 13 Gy HDR-BT were included. Prostate displacement relative to bony structures was calculated using cone beam computed tomography. Systematic error (SE) and random error (RE) were evaluated in the right-left (RL), craniocaudal (CC), and anteroposterior (AP) directions. The association with clinical and anatomic factors on the planning computed tomography or magnetic resonance imaging was analyzed. Prostate volume change (PVC) was defined as the volume change at 2 days after HDR-BT. Displacement trends were individually examined from the first to 23rd fractions. Results The mean SE in the RL, CC, and AP directions was -0.01 mm, -2.34 mm, and -0.47 mm, respectively. The root mean square of the RE in the RL, CC, and AP directions was 0.44 mm, 1.14 mm, and 1.10 mm, respectively. SE in the CC direction was independently associated with bladder volume (P = .021, t statistic = 2.352) and PVC (P < .001, t statistic = -8.526). SE in the AP direction was independently associated with bladder volume (P = .013, t statistic = -2.553), PVC (P < .001, t statistic = 5.477), and rectal mean area (P = .008, t statistic = 2.743). RE in the CC direction was independently associated with smoking (P = .035). RE in the AP direction was associated with PVC (P = .043). Gradual displacement caudally and posteriorly occurred during the irradiation period. Conclusions Anatomic characteristics of the bladder, rectum, and prostate predict SE. Smoking and PVC predict RE. In particular, whether PVC is ≥140% affects setting internal margins.
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Affiliation(s)
- Takayuki Sakurai
- Department of Radiology, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Shigeyuki Takamatsu
- Department of Radiology, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Satoshi Shibata
- Department of Radiology, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Risako Minamikawa
- Department of Radiology, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Masahiro Yamazaki
- Department of Radiology, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hironori Kojima
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Kimiya Noto
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Tomoyuki Makino
- Department of Integrative Cancer Therapy and Urology, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Shohei Kawaguchi
- Department of Integrative Cancer Therapy and Urology, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Takahiro Nohara
- Department of Integrative Cancer Therapy and Urology, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Toshifumi Gabata
- Department of Radiology, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
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Umbarkar P, Kannan V, Anand VJ, Deshpande S, Hinduja R, Babu V, Naidu S, Jadhav O, Jejurkar A. A comparative study of rectal volume variation in patients with prostate cancer: A tertiary care center study. Radiography (Lond) 2023; 29:845-850. [PMID: 37399732 DOI: 10.1016/j.radi.2023.06.006] [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: 01/28/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Every day variations in rectal filling in prostate cancer radiotherapy can significantly alter the delivered dose distribution from what was intended. The goal of this study was to see if the time of treatment delivery affected the rectal filling. METHODS This is a retrospective study which included 50 patients with localized prostate cancer treated with volumetric modulated arc therapy (VMAT) to the primary and regional lymph nodes. Cone Beam Computed Tomography (CBCT) image-sets were done for all patient's daily setup verification. The radiation therapist contoured the rectum on all CBCT image sets. The rectal volumes delineated on CBCT and the planning CT image sets were compared. The change in rectal volumes between morning and afternoon treatments were calculated and compared. RESULTS A total of 1000 CBCT image sets were obtained on 50 patients in the morning and afternoon. The percentage variation of the CBCT rectal volumes over the planning CT scan was 16.57% in the AM group and 24.35% in the PM group. CONCLUSION The percentage change in rectal volume was significantly lesser in AM group compared to PM group and therefore morning treatments may result in dose distribution that is close to the intended dose distribution. IMPLICATIONS FOR PRACTICE In prostate cancer radiotherapy our study suggests that a simple technique of changing the time of treatment from afternoon to morning can help to reduce the rectal volume.
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Affiliation(s)
- P Umbarkar
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - V Kannan
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - V J Anand
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - S Deshpande
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - R Hinduja
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - V Babu
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - S Naidu
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - O Jadhav
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - A Jejurkar
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
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Shibata M, Okada W, Sano K, Nakamura K, Sakai Y, Ueda Y, Uemoto K, Takei Y, Tanooka M. [Usefulness of an Ultrasound System with Automatic Bladder Urine Volume Measurement Using Artificial Intelligence Technology in Radiotherapy]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2022; 78:1406-1414. [PMID: 36198613 DOI: 10.6009/jjrt.2022-1316] [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] [Indexed: 06/16/2023]
Abstract
PURPOSE We aimed to investigate the usefulness of iViz air ver.4 Convex (FUJIFILM, Tokyo) as a tool to determine the bladder capacity before prostate radiotherapy by comparing it with the existing BladderScan BVI 6100 (Verathon Inc., Bothell, Washington). METHODS We investigated the usefulness of iViz air as a tool to determine the bladder capacity before prostate radiotherapy by comparing it with the current BladderScan. RESULTS The absolute value of each error rate was approximately 30.9%±27.2% and 26.4%±18.9% for the BladderScan and iViz air, respectively, with no significant differences between the instruments (p=0.16). Evaluated by urine volume, the mean error rates for bladder volumes >50 ml were 26.9%±19.0% and 26.1%±18.5% for the Bladder Scan and iViz air, respectively, with no significant differences (p=0.56). However, the BladderScan and iViz air had significantly higher error rates of 89.5%±52.5% and 31.5%±25.1%, respectively, if the bladder volume was <50 ml (p=0.005). CONCLUSION The iViz air has limited measurement error to confirm images, especially in limited volumes, suggesting that it is a useful bladder capacity measurement device in performing prostate radiotherapy.
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Affiliation(s)
- Mayuri Shibata
- Division of Radiotherapy, Department of Medical Technology, Takarazuka City Hospital
| | - Wataru Okada
- Division of Radiotherapy, Department of Medical Technology, Takarazuka City Hospital
| | - Keisuke Sano
- Division of Radiotherapy, Department of Medical Technology, Takarazuka City Hospital
| | - Kenji Nakamura
- Division of Radiotherapy, Department of Medical Technology, Takarazuka City Hospital
| | - Yusuke Sakai
- Division of Radiotherapy, Department of Medical Technology, Takarazuka City Hospital
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute
| | | | - Yoshiki Takei
- Department of Radiology, Kindai University Nara Hospital
| | - Masao Tanooka
- Division of Radiotherapy, Department of Medical Technology, Takarazuka City Hospital
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Zwart LG, Ong F, ten Asbroek LA, van Dieren EB, Koch SA, Bhawanie A, de Wit E, Dasselaar JJ. Cone-beam computed tomography-guided online adaptive radiotherapy is feasible for prostate cancer patients. Phys Imaging Radiat Oncol 2022; 22:98-103. [PMID: 35602545 PMCID: PMC9115122 DOI: 10.1016/j.phro.2022.04.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 12/25/2022] Open
Abstract
Online adaptive radiotherapy (oART) is achievable within twenty minutes. Cone-beam computed tomography-guided oART is feasible in daily clinical practice. The adapted plan was always preferred over the scheduled plan.
Background and purpose Studies have shown the potential of cone-beam computed tomography (CBCT)-guided online adaptive radiotherapy (oART) for prostate cancer patients in a simulation environment. The aim of this study was to evaluate the feasibility of the clinical implementation of CBCT-guided oART for prostate cancer patients. Materials and methods Between February and July 2020, eleven prostate cancer patients were treated with CBCT-guided oART using a fractionation scheme of 20 × 3 Gy to the prostate and 20 × 2.7/3.0 Gy to the seminal vesicles for more advanced stages. The on-couch adaptive workflow consisted of influencer (prostate, seminal vesicles, rectum, bladder) review, target review, scheduled (re-calculated) and adapted (re-optimized) plan generation, an independent QA procedure and treatment delivery. Treatment time, proportion of adapted fractions and reasons for plan adaptation were evaluated. Results Mean total treatment time (±SD) from CBCT acquisition to end of treatment delivery was 17.5 ± 3.2 min (range: 10.8–28.8 min). In all 220 fractions, the PTV coverage was increased for the adapted plan compared to the scheduled plan. The V60Gy of bladder and rectum were below the constraints (<5% and <3%) for both scheduled and adapted plans in 171 out of 220 fractions and for the adapted plan only in 30 out of 220 fractions. In 19 out of 220 fractions, the V60Gy of the bladder and/or rectum was above the constraint for the adapted plan. Conclusions The clinical implementation of CBCT-guided oART is feasible for prostate cancer patients. The adaptive workflow is possible within twenty minutes on average with a dedicated team.
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Calvo-Ortega JF, Moragues-Femenía S, Laosa-Bello C, Torices-Caballero J, Hermida-López M, Casals-Farran J. Clinical Experience in Prostate Ultrahypofractionated Radiation Therapy With an Online Adaptive Method. Pract Radiat Oncol 2021; 12:e144-e152. [PMID: 34670139 DOI: 10.1016/j.prro.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/04/2021] [Accepted: 10/08/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to describe the feasibility of the online adaptive radiation therapy (oART) method developed at the Hospital Quirónsalud Barcelona for prostate cancer, using a standard C-arm linear accelerator (linac) and without the support of artificial intelligence. METHODS AND MATERIALS The first 18 patients treated at the Hospital Quirónsalud Barcelona with the developed oART method were included. An ultrahypofractionated radiation therapy scheme consisting of 7 × 6.1 Gy was used. Patients were treated on 2 conventional Varian C-arm linacs. For each patient, a reference plan based on a planning computed tomography (pCT) scan was generated using the Eclipse system. On each treatment session, the pCT scan was rigidly registered with the daily cone beam computed tomography (CT) scan. The pCT-based target (prostate) and organs at risk were mapped onto the cone beam CT images and manually adapted to take into account the anatomy of the day. The reference plan was then copied to the cone beam CT scan, and a full reoptimization was done for the current anatomy (adapted plan). For each treatment session, the unaltered reference plan was recomputed on the daily cone beam CT scan by mimicking the soft-tissue alignment performed per our standard procedure (nonadapted plan). Over the 126 adapted sessions from the 18 patients, a dosimetric comparison of adapted against nonadapted plans was done. RESULTS A significant difference in the target coverage was found between the adapted and nonadapted plans (97.1 vs 90.4; P < .001) in favor of adapting. Without online adaptation, the optimal coverage of the prostate was not attained in 35% of fractions. Adapting allows for the improvement of the target coverage with compliance of all organ-at-risk dose constraints in all treatment fractions. CONCLUSIONS The oART technique described in this study is technically feasible with a C-arm linac. To our knowledge, this is the first clinical experience with oART for prostate cancer including full replanning and delivered with a C-arm linac without artificial intelligence capability.
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Affiliation(s)
| | | | - Coral Laosa-Bello
- Servicio de Oncología Radioterápica, Hospital Quirónsalud, Barcelona, Spain
| | | | - Marcelino Hermida-López
- Servei de Física i Protecció Radiològica, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Joan Casals-Farran
- Servicio de Oncología Radioterápica, Hospital Quirónsalud, Barcelona, Spain
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Oshikane T, Kaidu M, Abe E, Ohta A, Saito H, Nakano T, Honda M, Tanabe S, Utsunomiya S, Sasamoto R, Ishizaki F, Kasahara T, Nishiyama T, Tomita Y, Aoyama H, Ishikawa H. A comparative study of high-dose-rate brachytherapy boost combined with external beam radiation therapy versus external beam radiation therapy alone for high-risk prostate cancer. JOURNAL OF RADIATION RESEARCH 2021; 62:525-532. [PMID: 33823010 PMCID: PMC8127662 DOI: 10.1093/jrr/rrab006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 07/01/2021] [Accepted: 01/15/2020] [Indexed: 06/12/2023]
Abstract
We aimed to compare the outcomes of high-dose-rate brachytherapy (HDR-BT) boost and external beam radiation therapy (EBRT) alone for high-risk prostate cancer. This was a single-center, retrospective and observational study. Consecutive patients who underwent initial radical treatment by HDR-BT boost or EBRT alone from June 2009 to May 2016 at the Niigata University Medical and Dental Hospital, Japan were included. A total of 96 patients underwent HDR-BT boost, and 61 underwent EBRT alone. The prescription dose of HDR-BT boost was set to 18 Gy twice a day with EBRT 39 Gy/13 fractions. The dose for EBRT alone was mostly 70 Gy/28 fractions. The high-risk group received >6 months of prior androgen deprivation therapy. Overall survival, biochemical-free survival, local control and distant metastasis-free survival rates at 5 years were analyzed. The incidence of urological and gastrointestinal late adverse events of Grade 2 and above was also summarized. In the National Comprehensive Cancer Network (NCCN) high-risk calssification, HDR-BT boost had a significantly higher biochemical-free survival rate at 5 years (98.9% versus 90.7%, P = 0.04). Urethral strictures were more common in the HDR-BT boost group. We will continuously observe the progress of the study patients and determine the longer term results.
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Affiliation(s)
- Tomoya Oshikane
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Motoki Kaidu
- Corresponding author. Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan. Tel: +81-25-227-2315; Fax: +81-25-227-0788;
| | - Eisuke Abe
- Division of Radiation Oncology, Nagaoka Chuo General Hospital, 2041 Kawasaki-cho, Nagaoka 940-8653, Japan
| | - Atsushi Ohta
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Hirotake Saito
- Division of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Toshimichi Nakano
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Moe Honda
- Division of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Satoshi Tanabe
- Division of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Satoru Utsunomiya
- Department of Radiological Technology, Niigata University Graduate School of Health Sciences, 2-746 Asahimachi-dori, Chuo-ku, Niigata 951-8518, Japan
| | - Ryuta Sasamoto
- Department of Radiological Technology, Niigata University Graduate School of Health Sciences, 2-746 Asahimachi-dori, Chuo-ku, Niigata 951-8518, Japan
| | - Fumio Ishizaki
- Department of Urology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Takashi Kasahara
- Department of Urology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Tsutomu Nishiyama
- Division of Urology, Uonuma Kikan Hospital, 4132 Urasa, Minami-Uonuma, Niigata 949-7302, Japan
| | - Yoshihiko Tomita
- Department of Urology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Hidefumi Aoyama
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, Japan
| | - Hiroyuki Ishikawa
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
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11
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Sato H, Kato T, Motoyanagi T, Takemasa K, Narita Y, Kato M, Matsumoto T, Oyama S, Yamaguchi H, Wada H, Murakami M. Preliminary analysis of prostate positional displacement using hydrogel spacer during the course of proton therapy for prostate cancer. JOURNAL OF RADIATION RESEARCH 2021; 62:294-299. [PMID: 33341901 PMCID: PMC7948841 DOI: 10.1093/jrr/rraa115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/29/2020] [Indexed: 06/12/2023]
Abstract
In recent years, a novel technique has been employed to maintain a distance between the prostate and the rectum by transperineally injecting a hydrogel spacer (HS). However, the effect of HS on the prostate positional displacement is poorly understood, despite its stability with HS in place. In this study, we investigated the effect of HS insertion on the interfraction prostate motion during the course of proton therapy (PT) for Japanese prostate cancer patients. The study population consisted of 22 cases of intermediate-risk prostate cancer with 11 cases with HS insertion and 11 cases without HS insertion. The irradiation position and preparation were similar for both groups. To test for reproducibility, regular confirmation computed tomography (RCCT) was done four times during the treatment period, and five times overall [including treatment planning CT (TPCT)] in each patient. Considering the prostate position of the TPCT as the reference, the change in the center of gravity of the prostate relative to the bony anatomy in the RCCTs of each patient was determined in the left-right (LR), superior-inferior (SI) and anterior-posterior (AP) directions. As a result, no significant difference was observed across the groups in the LR and SI directions. Conversely, a significant difference was observed in the AP direction (P < 0.05). The proportion of the 3D vector length ≤5 mm was 95% in the inserted group, but 55% in the non-inserted group. Therefore, HS is not only effective in reducing rectal dose, but may also contribute to the positional reproducibility of the prostate.
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Affiliation(s)
- Hiroki Sato
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Takahiro Kato
- Corresponding author. Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, 172 Yatsuyamada 7 Chome, Koriyama City, Fukushima, 963-8563, Japan. Tel: +81-24-934-3888; Fax: +81-24-934-5393;
| | - Tomoaki Motoyanagi
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Kimihiro Takemasa
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Yuki Narita
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Masato Kato
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Takuya Matsumoto
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Sho Oyama
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Hisashi Yamaguchi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Hitoshi Wada
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Masao Murakami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
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12
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Marnouche EA, Hadadi K, Abdelhak M, Benlemlih M, Hommadi M, Zaghba N, Andaloussi Saghir K, Elmarjany M, Sifat H, Mansouri H. Evaluation of margins in pelvic lymph nodes and prostate radiotherapy and the impact of bladder and rectum on prostate position. Cancer Radiother 2021; 25:161-168. [PMID: 33454191 DOI: 10.1016/j.canrad.2020.06.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aims of this study were: determination of the CTV to PTV margins for prostate and pelvic lymph nodes. Investigation of the impact of registration modality (pelvic bones or prostate) on the CTV to PTV margins of pelvic lymph nodes. Investigation of the variations of bladder and rectum over the treatment course. Investigation of the impact of bladder and rectum variations on prostate position. PATIENTS AND METHODS This study included 15 patients treated for prostate adenocarcinoma. Daily kilo voltage images and weekly CBCT scans were performed to assess prostate displacements and common and external iliac vessels motion. These data was used to calculate the CTV to PTV margins using Van Herk equation in the setting of a daily bone registration. We also compared the CTV to PTV margins of pelvic lymph nodes according to registration method; based on pelvic bone or prostate. We delineated bladder and rectum on all CBCT scans to assess their variations over treatment course at 4 anatomic levels [1.5cm above pubic bone (PB), superior edge, mid- and inferior edge of PB]. RESULTS Using Van Herk equation, the prostate CTV to PTV margins (bone registration) were 8.03mm, 5.42mm and 8.73mm in AP, ML and SI direction with more than 97% of prostate displacements were less than 5mm. The CTV to PTV margins ranged from 3.12mm to 3.25mm for external iliac vessels and from 3.12mm to 4.18mm for common iliac vessels. Compared to registration based on prostate alignment, bone registration resulted in an important reduction of the CTV to PTV margins up to 54.3% for external iliac vessels and up to 39.6% for common iliac vessels. There was no significant variation of the mean bladder volume over the treatment course. There was a significant variation of the mean rectal volume before and after the third week of treatment. After the third week, the mean rectal volume seemed to be stable. The uni- and multivariate analysis identified the anterior wall of rectum as independent factor acting on prostate motion in AP direction at 2 levels (superior edge of, mid PB). The right rectal wall influenced the prostate motion in ML direction at inferior edge of PB. The bladder volume tends toward significance as factor acting on prostate motion in AP direction. CONCLUSIONS We recommend CTV to PTV margins of 8mm, 6mm and 9mm in AP, ML and SI directions for prostate. And, we suggest 4mm and 5mm for external and common iliac vessels respectively. We also prefer registration based on bony landmarks to minimize bowel irradiation. More CBCT scans should be performed during the first 3weeks and especially the first week to check rectum volume.
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Affiliation(s)
- E A Marnouche
- Department of Radiotherapy, Mohamed V Military Hospital, Rabat, Morocco.
| | - K Hadadi
- Department of Radiotherapy, Mohamed V Military Hospital, Rabat, Morocco.
| | - M Abdelhak
- Department of Radiotherapy, Mohamed V Military Hospital, Rabat, Morocco.
| | - M Benlemlih
- Department of Radiotherapy, Mohamed V Military Hospital, Rabat, Morocco.
| | - M Hommadi
- Department of Radiotherapy, Mohamed V Military Hospital, Rabat, Morocco.
| | - N Zaghba
- Department of Radiotherapy, Mohamed V Military Hospital, Rabat, Morocco.
| | | | - M Elmarjany
- Department of Radiotherapy, Mohamed V Military Hospital, Rabat, Morocco.
| | - H Sifat
- Department of Radiotherapy, Mohamed V Military Hospital, Rabat, Morocco.
| | - H Mansouri
- Department of Radiotherapy, Mohamed V Military Hospital, Rabat, Morocco.
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Byun DJ, Gorovets DJ, Jacobs LM, Happersett L, Zhang P, Pei X, Burleson S, Zhang Z, Hunt M, McBride S, Kollmeier MA, Zelefsky MJ. Strict bladder filling and rectal emptying during prostate SBRT: Does it make a dosimetric or clinical difference? Radiat Oncol 2020; 15:239. [PMID: 33066781 PMCID: PMC7565753 DOI: 10.1186/s13014-020-01681-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 10/06/2020] [Indexed: 01/01/2023] Open
Abstract
Background To evaluate inter-fractional variations in bladder and rectum during prostate stereotactic body radiation therapy (SBRT) and determine dosimetric and clinical consequences. Methods Eighty-five patients with 510 computed tomography (CT) images were analyzed. Median prescription dose was 40 Gy in 5 fractions. Patients were instructed to maintain a full bladder and empty rectum prior to simulation and each treatment. A single reviewer delineated organs at risk (OARs) on the simulation (Sim-CT) and Cone Beam CTs (CBCT) for analyses. Results Bladder and rectum volume reductions were observed throughout the course of SBRT, with largest mean reductions of 86.9 mL (19.0%) for bladder and 6.4 mL (8.7%) for rectum noted at fraction #5 compared to Sim-CT (P < 0.01). Higher initial Sim-CT bladder volumes were predictive for greater reduction in absolute bladder volume during treatment (ρ = − 0.69; P < 0.01). Over the course of SBRT, there was a small but significant increase in bladder mean dose (+ 4.5 ± 12.8%; P < 0.01) but no significant change in the D2cc (+ 0.8 ± 4.0%; P = 0.28). The mean bladder trigone displacement was in the anterior direction (+ 4.02 ± 6.59 mm) with a corresponding decrease in mean trigone dose (− 3.6 ± 9.6%; P < 0.01) and D2cc (− 6.2 ± 15.6%; P < 0.01). There was a small but significant increase in mean rectal dose (+ 7.0 ± 12.9%, P < 0.01) but a decrease in rectal D2cc (− 2.2 ± 10.1%; P = 0.04). No significant correlations were found between relative bladder volume changes, bladder trigone displacements, or rectum volume changes with rates of genitourinary or rectal toxicities. Conclusions Despite smaller than expected bladder and rectal volumes at the time of treatment compared to the planning scans, dosimetric impact was minimal and not predictive of detrimental clinical outcomes. These results cast doubt on the need for excessively strict bladder filling and rectal emptying protocols in the context of image guided prostate SBRT and prospective studies are needed to determine its necessity.
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Affiliation(s)
- David J Byun
- Department of Radiation Oncology, NYU Langone Health, 160 East 34th St, New York, NY, USA
| | - Daniel J Gorovets
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Lauren M Jacobs
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Laura Happersett
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Pengpeng Zhang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Xin Pei
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Sarah Burleson
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Zhigang Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Margie Hunt
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA
| | - Sean McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Marisa A Kollmeier
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
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14
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Liang X, Zhao W, Hristov DH, Buyyounouski MK, Hancock SL, Bagshaw H, Zhang Q, Xie Y, Xing L. A deep learning framework for prostate localization in cone beam CT-guided radiotherapy. Med Phys 2020; 47:4233-4240. [PMID: 32583418 PMCID: PMC10823910 DOI: 10.1002/mp.14355] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 01/31/2024] Open
Abstract
PURPOSE To develop a deep learning-based model for prostate planning target volume (PTV) localization on cone beam computed tomography (CBCT) to improve the workflow of CBCT-guided patient setup. METHODS A two-step task-based residual network (T2 RN) is proposed to automatically identify inherent landmarks in prostate PTV. The input to the T2 RN is the pretreatment CBCT images of the patient, and the output is the deep learning-identified landmarks in the PTV. To ensure robust PTV localization, the T2 RN model is trained by using over thousand sets of CT images with labeled landmarks, each of the CTs corresponds to a different scenario of patient position and/or anatomy distribution generated by synthetically changing the planning CT (pCT) image. The changes, including translation, rotation, and deformation, represent vast possible clinical situations of anatomy variations during a course of radiation therapy (RT). The trained patient-specific T2 RN model is tested by using 240 CBCTs from six patients. The testing CBCTs consists of 120 original CBCTs and 120 synthetic CBCTs. The synthetic CBCTs are generated by applying rotation/translation transformations to each of the original CBCT. RESULTS The systematic/random setup errors between the model prediction and the reference are found to be <0.25/2.46 mm and 0.14/1.41° in translation and rotation dimensions, respectively. Pearson's correlation coefficient between model prediction and the reference is higher than 0.94 in translation and rotation dimensions. The Bland-Altman plots show good agreement between the two techniques. CONCLUSIONS A novel T2 RN deep learning technique is established to localize the prostate PTV for RT patient setup. Our results show that highly accurate marker-less prostate setup is achievable by leveraging the state-of-the-art deep learning strategy.
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Affiliation(s)
- Xiaokun Liang
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305 USA
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055 China
| | - Wei Zhao
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305 USA
| | - Dimitre H. Hristov
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305 USA
| | | | - Steven L. Hancock
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305 USA
| | - Hilary Bagshaw
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305 USA
| | - Qin Zhang
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305 USA
| | - Yaoqin Xie
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055 China
| | - Lei Xing
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305 USA
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15
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Noël G, Thariat J, Antoni D. [Uncertainties in the current concept of radiotherapy planning target volume]. Cancer Radiother 2020; 24:667-675. [PMID: 32828670 DOI: 10.1016/j.canrad.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/01/2020] [Accepted: 06/07/2020] [Indexed: 12/12/2022]
Abstract
The planning target volume is an essential notion in radiotherapy, that requires a new conceptualization. Indeed, the variability and diversity of the uncertainties involved or improved with the development of the new modern technologies and devices in radiotherapy suggest that random and systematic errors cannot be currently generalized. This article attempts to discuss these various uncertainties and tries to demonstrate that a redefinition of the concept of planning target volume toward its personalization for each patient and the robustness notion are likely an improvement basis to take into account the radiotherapy uncertainties.
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Affiliation(s)
- G Noël
- Service d'oncologie radiothérapie, Institut de cancérologie Strasbourg Europe (Icans), 17, rue Albert-Calmette, 67033 Strasbourg, France.
| | - J Thariat
- Département de radiothérapie, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France; Association Advance Resource Centre for Hadrontherapy in Europe (Archade), 3, avenue General-Harris, 14000 Caen, France; Laboratoire de physique corpusculaire, Institut national de physique nucléaire et de physique des particules (IN2P3), 6, boulevard Maréchal-Juin, 14000 Caen, France; École nationale supérieure d'ingénieurs de Caen (ENSICaen), 6, boulevard Maréchal-Juin, CS 45053 14050 Caen cedex 4, France; Centre national de la recherche scientifique (CNRS), UMR 6534, 6, boulevard Maréchal-Juin, 14000 Caen, France; Université de Caen Normandie (Unicaen), esplanade de la Paix, CS 14032, 14032 Caen, France
| | - D Antoni
- Service d'oncologie radiothérapie, Institut de cancérologie Strasbourg Europe (Icans), 17, rue Albert-Calmette, 67033 Strasbourg, France
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16
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Patnaikuni SK, Saini SM, Chandola RM, Chandrakar P, Chaudhary V. Study of Asymmetric Margins in Prostate Cancer Radiation Therapy Using Fuzzy Logic. J Med Phys 2020; 45:88-97. [PMID: 32831491 PMCID: PMC7416865 DOI: 10.4103/jmp.jmp_110_19] [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: 12/17/2019] [Revised: 04/18/2020] [Accepted: 04/23/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The purpose of present study is to estimate asymmetric margins of prostate target volume based on biological limitations with help of knowledge based fuzzy logic considering the effect of organ motion and setup errors. MATERIALS AND METHODS A novel application of fuzzy logic modelling technique considering radiotherapy uncertainties including setup, delineation and organ motion was used in this study to derive margins. The new margin was applied in prostate cancer treatment planning and the results compared very well to current techniques Here volumetric modulated arc therapy treatment plans using stepped increments of asymmetric margins of planning target volume (PTV) were performed to calculate the changes in prostate radiobiological indices and results were used to formulate the rule based and membership function for Mamdani-type fuzzy inference system. The optimum fuzzy rules derived from input data, the clinical goals and knowledge-based conditions imposed on the margin limits. The PTV margin obtained using the fuzzy model was compared to the commonly used margin recipe. RESULTS For total displacement standard errors ranging from 0 to 5 mm the fuzzy PTV margin was found to be up to 0.5 mm bigger than the vanHerk derived margin, however taking the modelling uncertainty into account results in a good match between the PTV margin calculated using our model and the one based on van Herk et al. formulation for equivalent errors of up to 5 mm standard deviation (s. d.) at this range. When the total displacement standard errors exceed 5 mm s. d., the fuzzy margin remained smaller than the van Herk margin. CONCLUSION The advantage of using knowledge based fuzzy logic is that a practical limitation on the margin size is included in the model for limiting the dose received by the critical organs. It uses both physical and radiobiological data to optimize the required margin as per clinical requirement in real time or adaptive planning, which is an improvement on most margin models which mainly rely on physical data only.
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Affiliation(s)
- Santosh Kumar Patnaikuni
- Department of Physics, National Institute of Technology, Raipur, Chhattisgarh, India
- Department of Radiotherapy, Pt. JNM Medical College, Raipur, Chhattisgarh, India
| | - Sapan Mohan Saini
- Department of Physics, National Institute of Technology, Raipur, Chhattisgarh, India
| | | | - Pradeep Chandrakar
- Department of Radiotherapy, Pt. JNM Medical College, Raipur, Chhattisgarh, India
| | - Vivek Chaudhary
- Department of Radiotherapy, Pt. JNM Medical College, Raipur, Chhattisgarh, India
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17
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Kai Y, Arimura H, Ninomiya K, Saito T, Shimohigashi Y, Kuraoka A, Maruyama M, Toya R, Oya N. Semi-automated prediction approach of target shifts using machine learning with anatomical features between planning and pretreatment CT images in prostate radiotherapy. JOURNAL OF RADIATION RESEARCH 2020; 61:285-297. [PMID: 31994702 PMCID: PMC7246080 DOI: 10.1093/jrr/rrz105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/26/2019] [Accepted: 01/10/2020] [Indexed: 06/10/2023]
Abstract
The goal of this study was to develop a semi-automated prediction approach of target shifts using machine learning architecture (MLA) with anatomical features for prostate radiotherapy. Our hypothesis was that anatomical features between planning computed tomography (pCT) and pretreatment cone-beam computed tomography (CBCT) images could be used to predict the target, i.e. clinical target volume (CTV) shifts, with small errors. The pCT and daily CBCT images of 20 patients with prostate cancer were selected. The first 10 patients were employed for the development, and the second 10 patients for a validation test. The CTV position errors between the pCT and CBCT images were determined as reference CTV shifts (teacher data) after an automated bone-based registration. The anatomical features associated with rectum, bladder and prostate were calculated from the pCT and CBCT images. The features were fed as the input with the teacher data into five MLAs, i.e. three types of artificial neural networks, support vector regression (SVR) and random forests. Since the CTV shifts along the left-right direction were negligible, the MLAs were developed along the superior-inferior and anterior-posterior directions. The proposed framework was evaluated from the residual errors between the reference and predicted CTV shifts. In the validation test, the mean residual error with its standard deviation was 1.01 ± 1.09 mm in SVR using only one feature (one click), which was associated with positional difference of the upper rectal wall. The results suggested that MLAs with anatomical features could be useful in prediction of CTV shifts for prostate radiotherapy.
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Affiliation(s)
- Yudai Kai
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku Fukuoka 812-8582, Japan
- Department of Radiological Technology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hidetaka Arimura
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku Fukuoka 812-8582, Japan
| | - Kenta Ninomiya
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku Fukuoka 812-8582, Japan
| | - Tetsuo Saito
- Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yoshinobu Shimohigashi
- Department of Radiological Technology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Akiko Kuraoka
- Department of Radiological Technology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masato Maruyama
- Department of Radiological Technology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Ryo Toya
- Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Natsuo Oya
- Department of Radiation Oncology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
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18
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Schaefer C, Zamboglou C, Volegova-Neher N, Martini C, Nicolay NH, Schmidt-Hegemann NS, Rogowski P, Li M, Belka C, Müller AC, Grosu AL, Brunner T. Impact of a low FODMAP diet on the amount of rectal gas and rectal volume during radiotherapy in patients with prostate cancer - a prospective pilot study. Radiat Oncol 2020; 15:27. [PMID: 32000818 PMCID: PMC6993432 DOI: 10.1186/s13014-020-1474-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 01/19/2020] [Indexed: 12/16/2022] Open
Abstract
Background Small inter- and intrafractional prostate motion was shown to be a prerequisite for precise radiotherapy (RT) of prostate cancer (PCa) to achieve good local control and low rectal toxicity. As rectal gas and rectal volume are known to have a relevant effect on prostate motion, this study aims to reduce these parameters by using a Low FODMAP Diet (LFD) and to show feasibility of this intervention. Methods We compared a prospective intervention group (IG, n = 25) which underwent RT for PCa and whose patients were asked to follow a LFD during RT with a retrospective control group (CG, n = 25) which did not get any dietary advice. In the planning CT scan and all available cone beam CT scans rectal gas was classified based on a semiquantitative score (scale from 1 to 5) and rectal volume was measured. Furthermore, patients’ compliance was evaluated by a self-assessment questionnaire. Results Clinical and treatment characteristics were well balanced between both groups. A total of 266 (CG, 10.6 per patient) and 280 CT scans (IG, 11.2 per patient), respectively, were analysed. The frequency distribution of gas scores differed significantly from each other (p < .001) with the IG having lower scores. Rectal volume was smaller in the IG (64.28 cm3, 95% CI 60.92–67.65 cm3, SD 28.64 cm3) than in the CG (71.40 cm3, 95% CI 66.47–76.32 cm3, SD 40.80 cm3) (p = .02). Mean intrapatient standard deviation as a measure for the variability of rectal volume was 22 cm3 in the IG and 23 cm3 in the CG (p = .81). Patients’ compliance and contentment were satisfying. Conclusions The use of a LFD significantly decreased rectal gas and rectal volume. LFD was feasible with an excellent patients’ compliance. However, prospective trials with a larger number of patients and a standardized evaluation of gastrointestinal toxicity and quality of life are reasonable. Trial registration German Clinical Trials Register, DRKS00012955. Registered 29 August 2017 - Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012955
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Affiliation(s)
- Christian Schaefer
- Department of Radiation Oncology, University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany.
| | - Constantinos Zamboglou
- Department of Radiation Oncology, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Natalja Volegova-Neher
- Department of Radiation Oncology, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Carmen Martini
- Department of Radiation Oncology, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Nils Henrik Nicolay
- Department of Radiation Oncology, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | | | - Paul Rogowski
- Department of Radiation Oncology, University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - Minglun Li
- Department of Radiation Oncology, University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Arndt-Christian Müller
- University Clinic for Radiation Oncology, University Hospital Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK), Partner Site Tübingen, Tübingen, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Thomas Brunner
- University Clinic for Radiation Therapy, University Hospital Magdeburg, Magdeburg, Germany
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Snoj Z, Gill AB, Rundo L, Sushentsev N, Barrett T. Three-dimensional MRI evaluation of the effect of bladder volume on prostate translocation and distortion. Radiol Oncol 2020; 54:48-56. [PMID: 31940289 PMCID: PMC7087418 DOI: 10.2478/raon-2020-0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/19/2019] [Indexed: 11/20/2022] Open
Abstract
Background The accuracy of any radiation therapy delivery is limited by target organ translocation and distortion. Bladder filling is one of the recognised factors affecting prostate translocation and distortion. The purpose of our study was to evaluate the effect of bladder volume on prostate translocation and distortion by using detailed three-dimensional prostate delineation on MRI. Patients and methods Fifteen healthy male volunteers were recruited in this prospective, institutional review board-approved study. Each volunteer underwent 4 different drinking preparations prior to imaging, with MR images acquired pre- and post-void. MR images were co-registered by using bony landmarks and three-dimensional contouring was performed in order to assess the degree of prostate translocation and distortion. According to changes in bladder or rectum distention, subdivisions were made into bladder and rectal groups. Studies with concomitant change in both bladder and rectal volume were excluded. Results Forty studies were included in the bladder volume study group and 8 in the rectal volume study group. The differences in rectal volumes yielded higher levels of translocation (p < 0.01) and distortion (p = 0.02) than differences in bladder volume. Moderate correlation of prostate translocation with bladder filling was shown (r = 0.64, p < 0.01). There was no important prostate translocation when bladder volume change was < 2-fold (p < 0.01). Moderate correlation of prostate distortion with bladder filling was shown (r = 0.61, p < 0.01). Conclusions Bladder volume has a minimal effect on prostate translocation and effect on prostate distortion is negligible. Prostate translocation may be minimalised if there is < 2-fold increase in the bladder volume.
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Affiliation(s)
- Ziga Snoj
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK
- Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Andrew B. Gill
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK
- Department of Medical Physics, Cambridge University Hospitals, Cambridge, UK
| | - Leonardo Rundo
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Centre, Cambridge, UK
| | - Nikita Sushentsev
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK
- CamPARI Clinic, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK
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Ghadjar P, Fiorino C, Munck Af Rosenschöld P, Pinkawa M, Zilli T, van der Heide UA. ESTRO ACROP consensus guideline on the use of image guided radiation therapy for localized prostate cancer. Radiother Oncol 2019; 141:5-13. [PMID: 31668515 DOI: 10.1016/j.radonc.2019.08.027] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/29/2019] [Indexed: 12/18/2022]
Abstract
Use of image-guided radiation therapy (IGRT) helps to account for daily prostate position changes during radiation therapy for prostate cancer. However, guidelines for the use of IGRT are scarce. An ESTRO panel consisting of leading radiation oncologists and medical physicists was assembled to review the literature and formulate a consensus guideline of methods and procedure for IGRT in prostate cases. Advanced methods and procedures are also described which the committee judged relevant to further improve clinical practice. Moreover, ranges for margins for the three most popular IGRT scenarios have been suggested as examples.
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Affiliation(s)
- Pirus Ghadjar
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Germany
| | - Claudio Fiorino
- Department of Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Per Munck Af Rosenschöld
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Michael Pinkawa
- Department of Radiation Oncology, MediClin Robert Janker Klinik, Bonn, Germany
| | - Thomas Zilli
- Department of Radiation Oncology, Geneva University Hospital, Switzerland
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiation Oncology, Leiden University Medical Center, The Netherlands.
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21
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Evaluation of seminal vesicle volume variability in patients receiving radiotherapy to the prostate. JOURNAL OF RADIOTHERAPY IN PRACTICE 2019. [DOI: 10.1017/s1460396919000384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AbstractIntroduction:Prostate positional variability has been widely explored with seminal vesicle (SV) variability, coming into the forefront only in recent years. While planning target volume (PTV) margins and preparation protocols ameliorate the effects of bladder and rectum volume changes on prostate, studies on SV variation have looked at only position, not volume variability.Aim:The aim of this study was to investigate whether the inter-fraction volume variability of the VSs can exist in patients receiving radiotherapy to the prostate.Method:SV variability was investigated by comparing four on-treatment cone beam computer tomography scans to a planning computer tomography (CT) image for two patients receiving prostate radiotherapy. For each case, variation in volumes (cm3) was compared with intra-observer variation.Results:SV volume variability was seen in both patients, with the largest change in volume being 78·38%. This variance was considerably (between 2 and 10 times) larger than the measured intra-observer variance.Conclusion:This study identified the potential for daily SV volume variability in patients receiving prostate radiotherapy. Future large-scale studies are warranted to identify the extent of this motion and potential clinical impact. Evidence-informed PTV margins and possible SV volume control protocols may need to be adopted.
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Observed high incidence of prostatic calculi with the potential to act as natural fiducials for prostate image guided radiotherapy. Tech Innov Patient Support Radiat Oncol 2019; 9:35-40. [PMID: 32095594 PMCID: PMC7033768 DOI: 10.1016/j.tipsro.2019.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 01/17/2019] [Accepted: 01/22/2019] [Indexed: 11/23/2022] Open
Abstract
Prostatic calculi are a frequent radiological finding and may aid prostate IGRT. Incidence of prostatic calculi in a population of radiotherapy patients is reported. Significant proportion of patients have calculi detectable on radiotherapy images. Prostatic calculi may reduce the need for surgically implanted markers.
Purpose This study aims to quantify the incidence and distribution of prostatic calculi in a population of prostate radiotherapy patients and assess their potential role in prostate image guided radiotherapy (IGRT). Methods & materials A retrospective analysis of trans-rectal ultrasound (TRUS), computed tomography (CT) planning and treatment verification cone beam CT (CBCT) scans from radical prostate radiotherapy patients (external beam and brachytherapy) between 2012 and 2014 was undertaken by a single experienced observer. An internationally validated schema from the Prostate Imaging Reporting and Data system (PIRADS) was used to map the location of calculi. The association of calculi with patient and disease characteristics was explored. Data was analysed using SPSS (IBM version 22.0) using descriptive statistical methods and logistic binary regression analysis. Results 389 scan sets from 254 patients were included in the analysis. The overall incidence of calculi was 85% (n = 218) of which 79% (n = 201) were intra-prostatic calculi. The mean number of intra-prostatic calculi was 2 (range 1–10) and the mean size of calculi was 3.7 mm (range 0.5–15 mm). Calculi were most frequently observed in the posterior of the mid-gland (PI-RADs 3p, 9p) and posterior of the apex (PI-RADs 5p, 11p). 99% (n = 135) of CT planning scans with a corresponding CBCT had calculi in the same PIRADs location and all calculi were visible at the last fraction. There was no statistically significant association of calculi and N stage, M stage or Gleason score. Conclusions A significant proportion of prostate radiotherapy patients have prostatic calculi detectable on pre radiotherapy imaging. Calculi observed on CT were also detectable on CBCT in 99% of cases and remain visible at the end of treatment. These findings add to the growing evidence base supporting the potential of calculi as an alternative to fiducial markers to aid prostate IGRT.
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Genitourinary System Cancers. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-97145-2_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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24
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Grün A, Kawgan-Kagan M, Kaul D, Badakhshi H, Stromberger C, Budach V, Böhmer D. Impact of bladder volume on acute genitourinary toxicity in intensity modulated radiotherapy for localized and locally advanced prostate cancer. Strahlenther Onkol 2018; 195:517-525. [PMID: 30443682 DOI: 10.1007/s00066-018-1398-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 10/31/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the effect of changes in bladder volume during high-dose intensity-modulated-radiotherapy (IMRT) of prostate cancer on acute genitourinary (GU) toxicity and prospectively evaluate a simple biofeedback technique for reproducible bladder filling with the aim of reducing acute GU toxicity. METHODS One hundred ninety-three patients were trained via a biofeedback mechanism to maintain a partially filled bladder with a reproducible volume of 200-300 cc at planning CT and subsequently at each fraction of radiotherapy. We prospectively analyzed whether and to what extent the patients' ability to maintain a certain bladder filling influenced the degree of acute GU toxicity and whether cut-off values could be differentiated. RESULTS We demonstrated that the ability to reach a reproducible bladder volume above a threshold volume of 180 cc and maintain that volume via biofeedback throughout treatment predicts for a decrease in acute GU toxicity during curative high-dose IMRT of the prostate. Patients who were not able to reach a partial bladder filling to that cut-off value and were not able to maintain a partially filled bladder throughout treatment had a significantly higher risk of developing ≥grade 2 GU acute toxicity. CONCLUSION Our results support the hypothesis that a biofeedback training for the patient is an easy-to-apply, useful, and cost-effective tool for reducing acute GU toxicity in high-dose IMRT of the prostate. Patients who are not able to reach and maintain a certain bladder volume during planning and treatment-two independent risk factors-might need special consideration.
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Affiliation(s)
- Arne Grün
- Department for Radiation Oncology, Charité-University Medicine Berlin, Campus Virchow-Clinic, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Michael Kawgan-Kagan
- Department for Radiation Oncology, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - David Kaul
- Department for Radiation Oncology, Charité-University Medicine Berlin, Campus Virchow-Clinic, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Harun Badakhshi
- Department for Radiation Oncology, Ernst-von-Bergmann Klinikum, Charlottenstraße 72, 14467, Potsdam, Germany
| | - Carmen Stromberger
- Department for Radiation Oncology, Charité-University Medicine Berlin, Campus Virchow-Clinic, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Volker Budach
- Department for Radiation Oncology, Charité-University Medicine Berlin, Campus Virchow-Clinic, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Dirk Böhmer
- Department for Radiation Oncology, Charité-University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
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Feasibility of anatomical feature points for the estimation of prostate locations in the Bayesian delineation frameworks for prostate cancer radiotherapy. Radiol Phys Technol 2018; 11:434-444. [PMID: 30267211 DOI: 10.1007/s12194-018-0481-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
This study aimed to investigate the feasibility of anatomical feature points for the estimation of prostate locations in the Bayesian delineation frameworks for prostate cancer radiotherapy. The relationships between the reference centroids of prostate regions (CPRs) (prostate locations) and anatomical feature points were explored, and the most feasible anatomical feature points were selected based on the smallest location estimation errors of CPRs and the largest Dice's similarity coefficient (DSC) between the reference and extracted prostates. The reference CPRs were calculated according to reference prostate contours determined by radiation oncologists. Five anatomical feature points were manually determined on a prostate, bladder, and rectum in a sagittal plane of a planning computed tomography image for each case. The CPRs were estimated using three machine learning architectures [artificial neural network, random forest, and support vector machine (SVM)], which learned the relationships between the reference CPRs and anatomical feature points. The CPRs were applied for placing a prostate probabilistic atlas at the coordinates and extracting prostate regions using a Bayesian delineation framework. The average estimation errors without and with SVM using three feature points, which indicated the best performance, were 5.6 ± 3.7 mm and 1.8 ± 1.0 mm, respectively (the smallest error) (p < 0.001). The average DSCs without and with SVM using the three feature points were 0.69 ± 0.13 and 0.82 ± 0.055, respectively (the highest DSC) (p < 0.001). The anatomical feature points may be feasible for the estimation of prostate locations, which can be applied to the general Bayesian delineation frameworks for prostate cancer radiotherapy.
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Maeda Y, Sato Y, Shibata S, Bou S, Yamamoto K, Tamamura H, Fuwa N, Takamatsu S, Sasaki M, Tameshige Y, Kume K, Minami H, Saga Y, Saito M. Effects of organ motion on proton prostate treatments, as determined from analysis of daily
CT
imaging for patient positioning. Med Phys 2018; 45:1844-1856. [DOI: 10.1002/mp.12869] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 03/06/2018] [Accepted: 03/06/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yoshikazu Maeda
- Proton Therapy Center Fukui Prefectural Hospital Fukui 9108526 Japan
| | - Yoshitaka Sato
- Proton Therapy Center Fukui Prefectural Hospital Fukui 9108526 Japan
| | - Satoshi Shibata
- Proton Therapy Center Fukui Prefectural Hospital Fukui 9108526 Japan
| | - Sayuri Bou
- Proton Therapy Center Fukui Prefectural Hospital Fukui 9108526 Japan
| | - Kazutaka Yamamoto
- Proton Therapy Center Fukui Prefectural Hospital Fukui 9108526 Japan
| | - Hiroyasu Tamamura
- Proton Therapy Center Fukui Prefectural Hospital Fukui 9108526 Japan
| | - Nobukazu Fuwa
- Department of Radiotherapy Ise Red Cross Hospital Mie 5168521 Japan
| | - Shigeyuki Takamatsu
- Department of Radiotherapy Kanazawa University Hospital Ishikawa 9208641 Japan
| | - Makoto Sasaki
- Proton Therapy Center Fukui Prefectural Hospital Fukui 9108526 Japan
| | - Yuji Tameshige
- Proton Therapy Center Fukui Prefectural Hospital Fukui 9108526 Japan
| | - Kyo Kume
- Research & Development Department The Wakasa Wan Energy Research Center Fukui 9140192 Japan
| | - Hiroki Minami
- Proton Therapy Center Fukui Prefectural Hospital Fukui 9108526 Japan
| | - Yusuke Saga
- Proton Therapy Center Fukui Prefectural Hospital Fukui 9108526 Japan
| | - Makoto Saito
- Proton Therapy Center Fukui Prefectural Hospital Fukui 9108526 Japan
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Maeda Y, Sato Y, Minami H, Yasukawa Y, Yamamoto K, Tamamura H, Shibata S, Bou S, Sasaki M, Tameshige Y, Kume K, Ooto H, Kasahara S, Shimizu Y, Saga Y, Omoya A, Saitou M. Positioning accuracy and daily dose assessment for prostate cancer treatment using in-room CT image guidance at a proton therapy facility. Med Phys 2018. [PMID: 29532489 DOI: 10.1002/mp.12858] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate the effectiveness of CT image-guided proton radiotherapy for prostate cancer by analyzing the positioning uncertainty and assessing daily dose change due to anatomical variations. MATERIALS AND METHODS Patients with prostate cancer were treated by opposed lateral proton beams based on a passive scattering method using an in-room CT image-guided system. The system employs a single couch for both CT scanning and beam delivery. The patient was positioned by matching the boundary between the prostate and the rectum's anterior region identified in the CT images to the corresponding boundary in the simulator images after bone matching. We acquired orthogonal kV x-ray images after couch movement and confirmed the body position by referring to the bony structure prior to treatment. In offline analyses, we contoured the targeted anatomical structures on 375 sets of daily in-room CT images for 10 patients. The uncertainty of the image-matching procedure was evaluated using the prostate contours and actual couch corrections. We also performed dose calculations using the same set of CT images, and evaluated daily change of dose-volume histograms (DVHs) to compare the effectiveness of the treatment using prostate matching to the bone-matching procedure. RESULTS The isocenter shifts by prostate matching after bone matching were 0.5 ± 1.8 and -0.8 ± 2.6 mm along the superior-inferior (SI) and anterior-posterior (AP) directions, respectively. The body movement errors (σ) after couch movement were 0.7, 0.5, and 0.3 mm along the lateral, SI and AP direction, respectively, for 30 patients. The estimated errors (σ) in the prostate matching were 1.0 and 1.3 mm, and, in conjunction with the movement errors, the total positioning uncertainty was estimated to be 1.0 and 1.4 mm along the SI and AP directions, respectively. Daily DVH analyses showed that in the prostate matching, 98.7% and 86.1% of the total 375 irradiations maintained a dose condition of V95% > 95% for the prostate and a dose constraint of V77% < 18% for the rectum, whereas 90.4% and 66.1% of the total irradiations did so when bone matching was used. The dose constraint of the rectum and dose coverage of the prostate were better maintained by prostate matching than bone matching (P < 0.001). The daily variation in the dose to the seminal vesicles (SVs) was large, and only 40% of the total irradiations maintained the initial planned values of V95% for high-risk treatment. Nevertheless, the deviations from the original value were -4 ± 7% and -5 ± 11% in the prostate and bone matching, respectively, and a better dose coverage of the SV was achieved by the prostate matching. CONCLUSION The correction of repositioning along the AP and SI direction from conventional bone matching in CT image-guided proton therapy was found to be effective to maintain the dose constraint of the rectum and the dose coverage of the prostate. This work indicated that prostate cancer treatment by prostate matching using CT image guidance may be effective to reduce the rectal complications and achieve better tumor control of the prostate. However, an adaptive approach is desirable to maintain better dose coverage of the SVs.
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Affiliation(s)
- Yoshikazu Maeda
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui, 9108526, Japan
| | - Yoshitaka Sato
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui, 9108526, Japan
| | - Hiroki Minami
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui, 9108526, Japan
| | - Yutaka Yasukawa
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui, 9108526, Japan
| | - Kazutaka Yamamoto
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui, 9108526, Japan
| | - Hiroyasu Tamamura
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui, 9108526, Japan
| | - Satoshi Shibata
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui, 9108526, Japan
| | - Sayuri Bou
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui, 9108526, Japan
| | - Makoto Sasaki
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui, 9108526, Japan
| | - Yuji Tameshige
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui, 9108526, Japan
| | - Kyo Kume
- Research & Development Department, The Wakasa Wan Energy Research Center, Fukui, 9140192, Japan
| | - Hiroshi Ooto
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui, 9108526, Japan
| | - Shigeru Kasahara
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui, 9108526, Japan
| | - Yasuhiro Shimizu
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui, 9108526, Japan
| | - Yusuke Saga
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui, 9108526, Japan
| | - Akira Omoya
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui, 9108526, Japan
| | - Makoto Saitou
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui, 9108526, Japan
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A feasibility study for the introduction of micro-enema to improve organ consistency in patients receiving radiotherapy for urinary bladder cancer. JOURNAL OF RADIOTHERAPY IN PRACTICE 2018. [DOI: 10.1017/s1460396917000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractAimsThe aim of the study was to assess the effect on rectal consistency, of introducing a micro-enema in the preparation of patients receiving radiotherapy treatment of urinary bladder cancer.Materials and methodsThe treatment cone beam computed tomography (CBCT) images from patients receiving radiotherapy for bladder cancer were retrospectively assessed. CBCT datasets from nine patients treated without rectal preparation (97 CBCT), and 13 patients (134 CBCT) treated following micro-enema use before planning and treatment were evaluated. CBCT were compared with the planning computed tomography for rectal status, rectal diameter and presence of gas.ResultsReproducibility of an empty rectum was achieved in 70% of treatment fractions delivered using an enema protocol compared with 33% of fractions delivered without preparation. In total, 10% of fractions were delivered with the presence of faeces or faeces and gas, compared with 46% of fractions for the non-intervention group. Enemas did not affect the proportion of fractions delivered with gas, however, where gas was present, 65% of CBCT fractions had <5% gas for patients using enemas compared with 32% without.FindingsThe use of a micro-enema before planning scan and each fraction was well tolerated and proved effective in managing and reducing inter-fraction variations in rectal volume and contents.
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Haekal M, Arimura H, Hirose TA, Shibayama Y, Ohga S, Fukunaga J, Umezu Y, Honda H, Sasaki T. Computational analysis of interfractional anisotropic shape variations of the rectum in prostate cancer radiation therapy. Phys Med 2018. [PMID: 29519405 DOI: 10.1016/j.ejmp.2017.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To analyze the uncertainties of the rectum due to anisotropic shape variations by using a statistical point distribution model (PDM). MATERIALS AND METHODS The PDM was applied to the rectum contours that were delineated on planning computed tomography (CT) and cone-beam CT (CBCT) at 80 fractions of 11 patients. The standard deviations (SDs) of systematic and random errors of the shape variations of the whole rectum and the region in which the rectum overlapped with the PTV (ROP regions) were derived from the PDMs at all fractions of each patient. The systematic error was derived by using the PDMs of planning and average rectum surface determined from rectum surfaces at all fractions, while the random error was derived by using a PDM-based covariance matrix at all fractions of each patient. RESULTS Regarding whole rectum, the population SDs were larger than 1.0 mm along all directions for random error, and along the anterior, superior, and inferior directions for systematic error. The deviation is largest along the superior and inferior directions for systematic and random errors, respectively. For ROP regions, the population SDs of systematic error were larger than 1.0 mm along the superior and inferior directions. The population SDs of random error for the ROP regions were larger than 1.0 mm except along the right and posterior directions. CONCLUSIONS The anisotropic shape variations of the rectum, especially in the ROP regions, should be considered when determining a planning risk volume (PRV) margins for the rectum associated with the acute toxicities.
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Affiliation(s)
- Mohammad Haekal
- Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hidetaka Arimura
- Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Taka-Aki Hirose
- Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yusuke Shibayama
- Department of Medical Technology, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Saiji Ohga
- Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Junichi Fukunaga
- Department of Medical Technology, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yoshiyuki Umezu
- Department of Medical Technology, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hiroshi Honda
- Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Tomonari Sasaki
- Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Tsang YM, Hoskin P. The impact of bladder preparation protocols on post treatment toxicity in radiotherapy for localised prostate cancer patients. Tech Innov Patient Support Radiat Oncol 2017; 3-4:37-40. [PMID: 32095565 PMCID: PMC7033795 DOI: 10.1016/j.tipsro.2017.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/03/2017] [Accepted: 10/02/2017] [Indexed: 11/25/2022] Open
Abstract
Our study suggests that excellent outcome in terms of post radiotherapy toxicity. The empty bladder preparation protocol has non-inferior post radiotherapy toxicity. This empty bladder approach can provide better patient comfort and reproducibility.
Objective This study compares the post radiotherapy related toxicity between the use of an empty and a full bladder preparation protocol in patients receiving radical radiotherapy for localised prostate cancer. Methods and materials A retrospective review of patient treatment records in which they were treated with a standard radiotherapy schedule (60Gy/20 fractions) to prostates and base of seminal vesicles only and followed two different bladder preparation (empty and full) protocols was carried out. This included each patient's daily image guided radiotherapy (IGRT) setup, treatment time, bladder size on planning computed tomography, organs at risk dose volume histograms (OAR DVHs) and 12 months post treatment gastrointestinal (GI) and genitourinary (GU) toxicity data. Results 20 patients were included. There were significant differences in IGRT setup between the two groups. Although treatment times of the two groups were not significantly different, 5/200 (2.5%) sessions were longer than 20 min in the full bladder group while this was not found in the other group. Associations between bladder preparation protocols and GI (p = 1.0) and GU (p = 0.6) toxicities were not statistically significant. The bladder size on planning CT was not significantly correlated to the GI (R = 0.06, p = 0.8) or GU (R = 0.27, p = 0.3) toxicity scores. No significant differences were found in OAR DVHs between patients with and without GI and GU toxicities. No grade 3/4 toxicities were reported. Conclusion The empty bladder preparation approach has non-inferior acute and intermediate post RT GI and GU toxicities in patients treated for localised prostate cancer with advanced radiotherapy techniques compared to the full bladder preparation.
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Affiliation(s)
- Yat Man Tsang
- Mount Vernon Cancer Centre, Northwood, HA6 2RN, United Kingdom
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Northwood, HA6 2RN, United Kingdom
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Maggio A, Gabriele D, Garibaldi E, Bresciani S, Delmastro E, Di Dia A, Miranti A, Poli M, Varetto T, Stasi M, Gabriele P. Impact of a rectal and bladder preparation protocol on prostate cancer outcome in patients treated with external beam radiotherapy. Strahlenther Onkol 2017. [PMID: 28620751 DOI: 10.1007/s00066-017-1163-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE AND OBJECTIVE To test the hypothesis that a rectal and bladder preparation protocol is associated with an increase in prostate cancer specific survival (PCSS), clinical disease free survival (CDFS) and biochemical disease free survival (BDFS). PATIENTS AND METHODS From 1999 to 2012, 1080 prostate cancer (PCa) patients were treated with three-dimensional conformal radiotherapy (3DCRT). Of these patients, 761 were treated with an empty rectum and comfortably full bladder (RBP) preparation protocol, while for 319 patients no rectal/bladder preparation (NRBP) protocol was adopted. RESULTS Compared with NRBP patients, patients with RBP had significantly higher BDFS (64% vs 48% at 10 years, respectively), CDFS (81% vs 70.5% at 10 years, respectively) and PCSS (95% vs 88% at 10 years, respectively) (log-rank test p < 0.001). Multivariate analysis (MVA) indicated for all treated patients and intermediate high-risk patients that the Gleason score (GS) and the rectal and bladder preparation were the most important prognostic factors for PCSS, CDFS and BDFS. With regard to high- and very high-risk patients, GS, RBP, prostate cancer staging and RT dose were predictors of PCSS, CDFS and BDFS in univariate analysis (UVA). CONCLUSION We found strong evidence that rectal and bladder preparation significantly decreases biochemical and clinical failures and the probability of death from PCa in patients treated without daily image-guided prostate localization, presumably since patients with RBP are able to maintain a reproducibly empty rectum and comfortably full bladder across the whole treatment compared with NRPB patients.
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Affiliation(s)
- A Maggio
- Medical Physic Department, Candiolo Cancer Institute - FPO,IRCCS, Candiolo (To), Italy.
| | - D Gabriele
- Radiotherapy Department, Candiolo Cancer Institute - FPO,IRCCS, Candiolo (To), Italy.,Division of Radiation Oncology, University of Sassari, Sassari, Italy
| | - E Garibaldi
- Radiotherapy Department, Candiolo Cancer Institute - FPO,IRCCS, Candiolo (To), Italy
| | - S Bresciani
- Medical Physic Department, Candiolo Cancer Institute - FPO,IRCCS, Candiolo (To), Italy
| | - E Delmastro
- Radiotherapy Department, Candiolo Cancer Institute - FPO,IRCCS, Candiolo (To), Italy
| | - A Di Dia
- Medical Physic Department, Candiolo Cancer Institute - FPO,IRCCS, Candiolo (To), Italy
| | - A Miranti
- Medical Physic Department, Candiolo Cancer Institute - FPO,IRCCS, Candiolo (To), Italy
| | - M Poli
- Medical Physic Department, Candiolo Cancer Institute - FPO,IRCCS, Candiolo (To), Italy
| | - T Varetto
- Nuclear Medicine Department, Candiolo Cancer Institute - FPO,IRCCS, Candiolo (To), Italy
| | - M Stasi
- Medical Physic Department, Candiolo Cancer Institute - FPO,IRCCS, Candiolo (To), Italy
| | - P Gabriele
- Radiotherapy Department, Candiolo Cancer Institute - FPO,IRCCS, Candiolo (To), Italy
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Saleh ZH, Jeong J, Quinn B, Mechalakos J, St Germain J, Dauer LT. Results of a 10-year survey of workload for 10 treatment vaults at a high-throughput comprehensive cancer center. J Appl Clin Med Phys 2017; 18:207-214. [PMID: 28422421 PMCID: PMC5689849 DOI: 10.1002/acm2.12076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/18/2016] [Accepted: 02/15/2017] [Indexed: 12/02/2022] Open
Abstract
The workload for shielding purposes of modern linear accelerators (linacs) consists of primary and scatter radiation which depends on the dose delivered to isocenter (cGy) and leakage radiation which depends on the monitor units (MUs). In this study, we report on the workload for 10 treatment vaults in terms of dose to isocenter (cGy), monitor units delivered (MUs), number of treatment sessions (Txs), as well as, use factors (U) and modulation factors (CI) for different treatment techniques. The survey was performed for the years between 2006 and 2015 and included 16 treatment machines which represent different generations of Varian linear accelerators (6EX, 600C, 2100C, 2100EX, and TrueBeam) operating at different electron and x‐ray energies (6, 9, 12, 16 and 20 MeV electrons and, 6 and 15 MV x‐rays). An institutional review board (IRB) approval was acquired to perform this study. Data regarding patient workload, dose to isocenter, number of monitor units delivered, beam energies, gantry angles, and treatment techniques were exported from an ARIA treatment management system (Varian Medical Systems, Palo Alto, Ca.) into Excel spreadsheets and data analysis was performed in Matlab. The average (± std‐dev) number of treatment sessions, dose to isocenter, and number of monitor units delivered per week per machine in 2006 was 119 ± 39 Txs, (300 ± 116) × 102cGys, and (78 ± 28) × 103MUs respectively. In contrast, the workload in 2015 was 112 ± 40 Txs, (337 ± 124) × 102cGys, and (111 ± 46) × 103MUs. 60% of the workload (cGy) was delivered using 6 MV and 30% using 15 MV while the remaining 10% was delivered using electron beams. The modulation factors (MU/cGy) for IMRT and VMAT were 5.0 (± 3.4) and 4.6 (± 1.6) respectively. Use factors using 90° gantry angle intervals were equally distributed (~0.25) but varied considerably among different treatment techniques. The workload, in terms of dose to isocenter (cGy) and subsequently monitor units (MUs), has been steadily increasing over the past decade. This increase can be attributed to increased use of high dose hypo‐fractionated regimens (SBRT, SRS) and the increase in use of IMRT and VMAT, which require higher MUs per cGy as compared to more conventional treatment (3DCRT). Meanwhile, the patient workload in terms of treatment sessions per week remained relatively constant. The findings of this report show that variables used for shielding purposes still fall within the recommendation of NCRP Report 151.
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Affiliation(s)
- Ziad H Saleh
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, York Ave, NY, USA
| | - Jeho Jeong
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, York Ave, NY, USA
| | - Brian Quinn
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, York Ave, NY, USA
| | - James Mechalakos
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, York Ave, NY, USA
| | - Jean St Germain
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, York Ave, NY, USA
| | - Lawrence T Dauer
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, York Ave, NY, USA.,Department of Radiology, Memorial Sloan Kettering Cancer Center, York Ave, NY, USA
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Hosni A, Rosewall T, Craig T, Kong V, Bayley A, Berlin A, Bristow R, Catton C, Warde P, Chung P. The effect of bowel preparation regime on interfraction rectal filling variation during image guided radiotherapy for prostate cancer. Radiat Oncol 2017; 12:50. [PMID: 28279179 PMCID: PMC5345218 DOI: 10.1186/s13014-017-0787-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 02/22/2017] [Indexed: 01/26/2023] Open
Abstract
Background This study aimed to investigate the tolerability and impact of milk of magnesia (MoM) on interfraction rectal filling during prostate cancer radiotherapy. Methods Two groups were retrospectively identified, each consisting of 40 patients with prostate cancer treated with radiotherapy to prostate+/-seminal vesicles, with daily image-guidance in 78Gy/39fractions/8 weeks. The first-group followed anti-flatulence diet with MoM started 3-days prior to planning-CT and continued during radiotherapy, while the second-group followed the same anti-flatulence diet only. The rectum between upper and lower limit of the clinical target volume (CTV) was delineated on planning-CT and on weekly cone-beam-CT (CBCT). Rectal filling was assessed by measurement of anterio-posterior diameter of the rectum at the superior and mid levels of CTV, rectal volume (RV), and average cross-sectional rectal area (CSA; RV/length). Results Overall 720 images (80 planning-CT and 640 CBCT images) from 80 patients were analyzed. Using linear mixed models, and after adjusting for baseline values at the time of planning-CT to test the differences in rectal dimensions between both groups over the 8-week treatment period, there were no significant differences in RV (p = 0.4), CSA (p = 0.5), anterio-posterior diameter of rectum at superior (p = 0.4) or mid level of CTV (p = 0.4). In the non-MoM group; 22.5% of patients had diarrhea compared to 60% in the MoM group, while 40% discontinued use of MoM by end of radiotherapy. Conclusion The addition of MoM to antiflatulence diet did not reduce the interfraction variation in rectal filling but caused diarrhea in a substantial proportion of patients who then discontinued its use.
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Affiliation(s)
- Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Tara Rosewall
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Timothy Craig
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Vickie Kong
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Andrew Bayley
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Robert Bristow
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Charles Catton
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - Peter Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada.
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Ramiandrisoa F, Duvergé L, Castelli J, Nguyen TD, Servagi-Vernat S, de Crevoisier R. [Clinical to planning target volume margins in prostate cancer radiotherapy]. Cancer Radiother 2016; 20:629-39. [PMID: 27614515 DOI: 10.1016/j.canrad.2016.07.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 07/22/2016] [Accepted: 07/27/2016] [Indexed: 02/03/2023]
Abstract
The knowledge of inter- and intrafraction motion and deformations of the intrapelvic target volumes (prostate, seminal vesicles, prostatectomy bed and lymph nodes) as well as the main organs at risk (bladder and rectum) allow to define rational clinical to planning target volume margins, depending on the different radiotherapy techniques and their uncertainties. In case of image-guided radiotherapy, prostate margins and seminal vesicles margins can be between 5 and 10mm. The margins around the prostatectomy bed vary from 10 to 15mm and those around the lymph node clinical target volume between 7 and 10mm. Stereotactic body radiotherapy allows lower margins, which are 3 to 5mm around the prostate. Image-guided and stereotactic body radiotherapy with adequate margins allow finally moderate or extreme hypofractionation.
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Affiliation(s)
- F Ramiandrisoa
- Département de radiothérapie, institut Jean-Godinot, 1, rue du Général-Kœnig, 51100 Reims, France.
| | - L Duvergé
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - J Castelli
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France; LTSI, campus de Beaulieu, université de Rennes 1, 35000 Rennes, France; Inserm U1099, campus de Beaulieu, 35000 Rennes, France
| | - T D Nguyen
- Département de radiothérapie, institut Jean-Godinot, 1, rue du Général-Kœnig, 51100 Reims, France
| | - S Servagi-Vernat
- Département de radiothérapie, institut Jean-Godinot, 1, rue du Général-Kœnig, 51100 Reims, France
| | - R de Crevoisier
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France; LTSI, campus de Beaulieu, université de Rennes 1, 35000 Rennes, France; Inserm U1099, campus de Beaulieu, 35000 Rennes, France
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35
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Lv W, Yu D, He H, Liu Q. Monte Carlo Simulations for Dosimetry in Prostate Radiotherapy with Different Intravesical Volumes and Planning Target Volume Margins. PLoS One 2016; 11:e0159497. [PMID: 27441944 PMCID: PMC4956298 DOI: 10.1371/journal.pone.0159497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 06/14/2016] [Indexed: 11/19/2022] Open
Abstract
In prostate radiotherapy, the influence of bladder volume variation on the dose absorbed by the target volume and organs at risk is significant and difficult to predict. In addition, the resolution of a typical medical image is insufficient for visualizing the bladder wall, which makes it more difficult to precisely evaluate the dose to the bladder wall. This simulation study aimed to quantitatively investigate the relationship between the dose received by organs at risk and the intravesical volume in prostate radiotherapy. The high-resolution Visible Chinese Human phantom and the finite element method were used to construct 10 pelvic models with specific intravesical volumes ranging from 100 ml to 700 ml to represent bladders of patients with different bladder filling capacities during radiotherapy. This series of models was utilized in six-field coplanar 3D conformal radiotherapy simulations with different planning target volume (PTV) margins. Each organ's absorbed dose was calculated using the Monte Carlo method. The obtained bladder wall displacements during bladder filling were consistent with reported clinical measurements. The radiotherapy simulation revealed a linear relationship between the dose to non-targeted organs and the intravesical volume and indicated that a 10-mm PTV margin for a large bladder and a 5-mm PTV margin for a small bladder reduce the effective dose to the bladder wall to similar degrees. However, larger bladders were associated with evident protection of the intestines. Detailed dosimetry results can be used by radiation oncologists to create more accurate, individual water preload protocols according to the patient's anatomy and bladder capacity.
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Affiliation(s)
- Wei Lv
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
- MoE Key Laboratory for Biomedical Photonics, Department of Biomedical Engineering, Huazhong University of Science and Technology, Wuhan, China
| | - Dong Yu
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
- MoE Key Laboratory for Biomedical Photonics, Department of Biomedical Engineering, Huazhong University of Science and Technology, Wuhan, China
| | - Hengda He
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
- MoE Key Laboratory for Biomedical Photonics, Department of Biomedical Engineering, Huazhong University of Science and Technology, Wuhan, China
| | - Qian Liu
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
- MoE Key Laboratory for Biomedical Photonics, Department of Biomedical Engineering, Huazhong University of Science and Technology, Wuhan, China
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36
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Abstract
We reviewed the literature on the use of margins in radiotherapy of patients with prostate cancer, focusing on different options for image guidance (IG) and technical issues. The search in PubMed database was limited to include studies that involved external beam radiotherapy of the intact prostate. Post-prostatectomy studies, brachytherapy and particle therapy were excluded. Each article was characterized according to the IG strategy used: positioning on external marks using room lasers, bone anatomy and soft tissue match, usage of fiducial markers, electromagnetic tracking and adapted delivery. A lack of uniformity in margin selection among institutions was evident from the review. In general, introduction of pre- and in-treatment IG was associated with smaller planning target volume (PTV) margins, but there was a lack of definitive experimental/clinical studies providing robust information on selection of exact PTV values. In addition, there is a lack of comparative research regarding the cost-benefit ratio of the different strategies: insertion of fiducial markers or electromagnetic transponders facilitates prostate gland localization but at a price of invasive procedure; frequent pre-treatment imaging increases patient in-room time, dose and labour; online plan adaptation should improve radiation delivery accuracy but requires fast and precise computation. Finally, optimal protocols for quality assurance procedures need to be established.
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Affiliation(s)
- Slav Yartsev
- 1 London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada.,2 Departments of Oncology and Medical Biophysics, Western University, London, ON, Canada
| | - Glenn Bauman
- 1 London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada.,2 Departments of Oncology and Medical Biophysics, Western University, London, ON, Canada
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Huang Y, Gardner SJ, Wen N, Zhao B, Gordon J, Brown S, Chetty IJ. Radiobiologically optimized couch shift: A new localization paradigm using cone-beam CT for prostate radiotherapy. Med Phys 2016; 42:6028-32. [PMID: 26429278 DOI: 10.1118/1.4931450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To present a novel positioning strategy which optimizes radiation delivery by utilizing radiobiological response knowledge and evaluate its use during prostate external beam radiotherapy. METHODS Five patients with low or intermediate risk prostate cancer were evaluated retrospectively in this IRB-approved study. For each patient, a VMAT plan with one 358° arc was generated on the planning CT (PCT) to deliver 78 Gy in 39 fractions. Five representative pretreatment cone beam CTs (CBCT) were selected for each patient. The CBCT images were registered to PCT by a human observer, which consisted of an initial automated registration with three degrees-of-freedom, followed by manual adjustment for agreement at the prostate/rectal wall interface. To determine the optimal treatment position for each CBCT, a search was performed centering on the observer-matched position (OM-position) utilizing a score function based on radiobiological and dosimetric indices (EUDprostate, D99prostate, NTCPrectum, and NTCPbladder) for the prostate, rectum, and bladder. We termed the optimal treatment position the radiobiologically optimized couch shift position (ROCS-position). RESULTS The dosimetric indices, averaged over the five patients' treatment plans, were (mean ± SD) 79.5 ± 0.3 Gy (EUDprostate), 78.2 ± 0.4 Gy (D99prostate), 11.1% ± 2.7% (NTCPrectum), and 46.9% ± 7.6% (NTCPbladder). The corresponding values from CBCT at the OM-positions were 79.5 ± 0.6 Gy (EUDprostate), 77.8 ± 0.7 Gy (D99prostate), 12.1% ± 5.6% (NTCPrectum), and 51.6% ± 15.2% (NTCPbladder), respectively. In comparison, from CBCT at the ROCS-positions, the dosimetric indices were 79.5 ± 0.6 Gy (EUDprostate), 77.3 ± 0.6 Gy (D99prostate), 8.0% ± 3.3% (NTCPrectum), and 46.9% ± 15.7% (NTCPbladder). Excessive NTCPrectum was observed on Patient 5 (19.5% ± 6.6%) corresponding to localization at OM-position, compared to the planned value of 11.7%. This was mitigated with radiobiologically optimized localization, resulting in a reduced NTCPrectum value of 11.3% ± 3.5%. Overall, the treatment position optimization resulted in similar target dose coverage with reduced risk to rectum. CONCLUSIONS These encouraging results illustrate the potential advantage of applying radiobiologically optimized correction for online image-guided radiotherapy of prostate patients.
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Affiliation(s)
- Yimei Huang
- Department of Radiation Oncology, Henry Ford Health System, 2799 W Grand Boulevard, Detroit, Michigan 48202
| | - Stephen J Gardner
- Department of Radiation Oncology, Henry Ford Health System, 2799 W Grand Boulevard, Detroit, Michigan 48202
| | - Ning Wen
- Department of Radiation Oncology, Henry Ford Health System, 2799 W Grand Boulevard, Detroit, Michigan 48202
| | - Bo Zhao
- Department of Radiation Oncology, Henry Ford Health System, 2799 W Grand Boulevard, Detroit, Michigan 48202
| | - James Gordon
- Department of Radiation Oncology, Henry Ford Health System, 2799 W Grand Boulevard, Detroit, Michigan 48202
| | - Stephen Brown
- Department of Radiation Oncology, Henry Ford Health System, 2799 W Grand Boulevard, Detroit, Michigan 48202
| | - Indrin J Chetty
- Department of Radiation Oncology, Henry Ford Health System, 2799 W Grand Boulevard, Detroit, Michigan 48202
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Fujioka C, Ishii K, Yamanaga T, Ogino R, Kishimoto S, Kawamorita R, Tada T, Nakajima T. Optimal bladder volume at treatment planning for prostate cancer patients receiving volumetric modulated arc therapy. Pract Radiat Oncol 2016; 6:395-401. [PMID: 27374192 DOI: 10.1016/j.prro.2016.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/11/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate optimal bladder volumes at treatment planning (TP) in prostate cancer patients who undergo volumetric modulated arc therapy (VMAT). METHODS AND MATERIALS To determine the minimum value, 122 patients were classified into 6 groups according to the bladder volume at TP: <100 mL (group 1), 100-149 mL (group 2), 150-199 mL (group 3), 200-249 mL (group 4), 250-299 mL (group 5), and ≥300 mL (group 6). Bladder volumes receiving more than 70 Gy (V70Gy) and V50Gy were calculated in each subgroup and compared with the bladder dose-volume constraints specified in our institution. To determine the maximum value, 64 patients who underwent uniform nursing interventions were classified into the same 6 groups. Bladder volumes on cone beam computed tomography (CBCT) images were measured once weekly during treatment, for a total of 8 measurements. Relative bladder volumes (bladder volume on CBCT image [mL]/bladder volume at TP [mL] × 100%) were evaluated in each of the 6 subgroups. RESULTS The upper bounds of the 95% confidence intervals of the mean V70Gy and V50Gy values in group 1 exceeded the dose constraints at our institution. The mean relative bladder volumes were 104%, 91%, 77%, 81%, 63%, and 59% in groups 1, 2, 3, 4, 5, and 6, respectively. The institutional criterion of 70% for the mean relative bladder volume was achieved in groups 1-4, but it could not be achieved in groups 5-6. Therefore, the patients in groups 2-4 met both institutional dose constraints for the bladder at TP and the institutional criterion for the mean relative bladder volume during treatment. CONCLUSIONS The optimal bladder volumes at TP were between 100 and 250 mL in this setting. Nursing intervention needs to be implemented before treatment planning to ensure that patients achieve the optimal bladder volume range.
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Affiliation(s)
- Chiaki Fujioka
- Department of Radiation Oncology, Tane General Hospital, Osaka, Japan.
| | - Kentaro Ishii
- Department of Radiation Oncology, Tane General Hospital, Osaka, Japan
| | - Toshiko Yamanaga
- Department of Radiation Oncology, Tane General Hospital, Osaka, Japan
| | - Ryo Ogino
- Department of Radiation Oncology, Tane General Hospital, Osaka, Japan
| | - Shun Kishimoto
- Department of Radiation Oncology, Tane General Hospital, Osaka, Japan
| | - Ryu Kawamorita
- Department of Radiation Oncology, Tane General Hospital, Osaka, Japan
| | - Takuhito Tada
- Department of Radiology, Izumi Municipal Hospital, Osaka, Japan
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McPartlin AJ, Li XA, Kershaw LE, Heide U, Kerkmeijer L, Lawton C, Mahmood U, Pos F, van As N, van Herk M, Vesprini D, van der Voort van Zyp J, Tree A, Choudhury A. MRI-guided prostate adaptive radiotherapy - A systematic review. Radiother Oncol 2016; 119:371-80. [PMID: 27162159 DOI: 10.1016/j.radonc.2016.04.014] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/08/2016] [Accepted: 04/09/2016] [Indexed: 11/29/2022]
Abstract
Dose escalated radiotherapy improves outcomes for men with prostate cancer. A plateau for benefit from dose escalation using EBRT may not have been reached for some patients with higher risk disease. The use of increasingly conformal techniques, such as step and shoot IMRT or more recently VMAT, has allowed treatment intensification to be achieved whilst minimising associated increases in toxicity to surrounding normal structures. To support further safe dose escalation, the uncertainties in the treatment target position will need be minimised using optimal planning and image-guided radiotherapy (IGRT). In particular the increasing usage of profoundly hypo-fractionated stereotactic therapy is predicated on the ability to confidently direct treatment precisely to the intended target for the duration of each treatment. This article reviews published studies on the influences of varies types of motion on daily prostate position and how these may be mitigated to improve IGRT in future. In particular the role that MRI has played in the generation of data is discussed and the potential role of the MR-Linac in next-generation IGRT is discussed.
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Affiliation(s)
- A J McPartlin
- The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, UK
| | - X A Li
- Medical College of Wisconsin, USA
| | - L E Kershaw
- The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, UK
| | - U Heide
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, The Netherlands
| | - L Kerkmeijer
- University Medical Center Utrecht, The Netherlands
| | - C Lawton
- Medical College of Wisconsin, USA
| | - U Mahmood
- MD Anderson Cancer Center, Houston, USA
| | - F Pos
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, The Netherlands
| | - N van As
- Royal Marsden Hospital, UK; Institute of Cancer Research, UK
| | - M van Herk
- The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, UK
| | - D Vesprini
- Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | | | - A Tree
- Royal Marsden Hospital, UK
| | - A Choudhury
- The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, UK.
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40
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Gurjar OP, Mutneja A, Bagdare P. Cone beam computed tomography: An accurate imaging technique in comparison with orthogonal portal imaging in intensity-modulated radiotherapy for prostate cancer. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2016. [DOI: 10.14319/ijcto.41.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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41
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Poli APDF, Dias RS, Giordani AJ, Segreto HRC, Segreto RA. Strategies to evaluate the impact of rectal volume on prostate motion during three-dimensional conformal radiotherapy for prostate cancer. Radiol Bras 2016; 49:17-20. [PMID: 26929456 PMCID: PMC4770392 DOI: 10.1590/0100-3984.2015.0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the rectal volume influence on prostate motion during
three-dimensional conformal radiotherapy (3D-CRT) for prostate cancer. Materials and Methods Fifty-one patients with prostate cancer underwent a series of three computed
tomography scans including an initial planning scan and two subsequent scans
during 3D-CRT. The organs of interest were outlined. The prostate contour
was compared with the initial CT images considering the anterior, posterior,
superior, inferior and lateral edges of the organ. Variations in the
anterior limits and volume of the rectum were assessed and correlated with
prostate motion in the anteroposterior direction. Results The maximum range of prostate motion was observed in the superoinferior
direction, followed by the anteroposterior direction. A significant
correlation was observed between prostate motion and rectal volume variation
(p = 0.037). A baseline rectal volume superior to 70
cm3 had a significant influence on the prostate motion in the
anteroposterior direction (p = 0.045). Conclusion The present study showed a significant interfraction motion of the prostate
during 3D-CRT with greatest variations in the superoinferior and
anteroposterior directions, and that a large rectal volume influences the
prostate motion with a cutoff value of 70 cm3. Therefore, the
treatment of patients with a rectal volume > 70 cm3 should be
re-planned with appropriate rectal preparation.
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Affiliation(s)
- Ana Paula Diniz Fortuna Poli
- PhD, Physician Assistant, Unit of Radiotherapy, Centro de Atenção Integrada à Saúde da Mulher - Universidade Estadual de Campinas (CAISM-Unicamp), Campinas, SP, Brazil
| | - Rodrigo Souza Dias
- PhD, Physician responsible, Unit of Radiotherapy, Department of Clinical and Experimental Oncology, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Adelmo José Giordani
- PhD, Physicist responsible, Unit of Radiotherapy, Department of Clinical and Experimental Oncology, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Helena Regina Comodo Segreto
- Post-doc Fellow, Associate Professor, Unit of Radiotherapy, Department of Clinical and Experimental Oncology, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Roberto Araujo Segreto
- Private Docent, Associate Professor, Unit of Radiotherapy, Department of Clinical and Experimental Oncology, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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Fredriksson A, Bokrantz R. The scenario-based generalization of radiation therapy margins. Phys Med Biol 2016; 61:2067-82. [DOI: 10.1088/0031-9155/61/5/2067] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Dose impact of rectal gas on prostatic IMRT and VMAT. Jpn J Radiol 2015; 33:723-33. [DOI: 10.1007/s11604-015-0481-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 09/17/2015] [Indexed: 10/22/2022]
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Korhonen J, Kapanen M, Sonke JJ, Wee L, Salli E, Keyriläinen J, Seppälä T, Tenhunen M. Feasibility of MRI-based reference images for image-guided radiotherapy of the pelvis with either cone-beam computed tomography or planar localization images. Acta Oncol 2015; 54:889-95. [PMID: 25233439 DOI: 10.3109/0284186x.2014.958197] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This study introduces methods to conduct image-guided radiotherapy (IGRT) of the pelvis with either cone-beam computed tomography (CBCT) or planar localization images by relying solely on magnetic resonance imaging (MRI)-based reference images. MATERIAL AND METHODS Feasibility of MRI-based reference images for IGRT was evaluated against kV CBCT (50 scans, 5 prostate cancer patients) and kV & MV planar (5 & 5 image pairs and patients) localization images by comparing the achieved patient position corrections to those obtained by standard CT-based reference images. T1/T2*-weighted in-phase MRI, Hounsfield unit conversion-based heterogeneous pseudo-CT, and bulk pseudo-CT images were applied for reference against localization CBCTs, and patient position corrections were obtained by automatic image registration. IGRT with planar localization images was performed manually by 10 observers using reference digitally reconstructed radiographs (DRRs) reconstructed from the pseudo-CTs and standard CTs. Quality of pseudo-DRRs against CT-DRRs was evaluated with image similarity metrics. RESULTS The SDs of differences between CBCT-to-MRI and CBCT-to-CT automatic gray-value registrations were ≤1.0 mm & ≤0.8° and ≤2.5 mm & ≤3.6° with 10 cm diameter cubic VOI and prostate-shaped VOI, respectively. The corresponding values for reference heterogeneous pseudo-CT were ≤1.0 mm & ≤0.7° and ≤2.2 mm & ≤3.3°, respectively. Heterogeneous pseudo-CT was the only type of MRI-based reference image working reliably with automatic bone registration (SDs were ≤0.9 mm & ≤0.7°). The differences include possible residual errors from planning CT to MRI registration. The image similarity metrics were significantly (p≤0.01) better in agreement between heterogeneous pseudo-DRRs and CT-DRRs than between bulk pseudo-DRRs and CT-DRRs. The SDs of differences in manual registrations (3D) with planar kV and MV localization images were ≤1.0 mm and ≤1.7 mm, respectively, between heterogeneous pseudo-DRRs and CT-DRRs, and ≤1.4 mm and ≤2.1 mm between bulk pseudo-DRRs and CT-DRRs. CONCLUSION This study demonstrated that it is feasible to conduct IGRT of the pelvis with MRI-based reference images.
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Affiliation(s)
- Juha Korhonen
- Clinical Research Institute Helsinki University Central Hospital Ltd , Helsinki , Finland
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Boubaker MB, Haboussi M, Ganghoffer JF, Aletti P. Predictive model of the prostate motion in the context of radiotherapy: A biomechanical approach relying on urodynamic data and mechanical testing. J Mech Behav Biomed Mater 2015; 49:30-42. [PMID: 25974099 DOI: 10.1016/j.jmbbm.2015.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 04/13/2015] [Accepted: 04/16/2015] [Indexed: 11/16/2022]
Abstract
In this paper, a biomechanical approach relying on urodynamic data and mechanical tests is proposed for an accurate prediction of the motion of the pelvic organs in the context of the prostate radiotherapy. As a first step, an experimental protocol is elaborated to characterize the mechanical properties of the bladder and rectum wall tissues; uniaxial tensile tests are performed on porcine substrates. In a second step, the parameters of Ogden-type hyperelastic constitutive models are identified; their relevance in the context of the implementation of a human biomechanical model is verified by means of preliminary Finite Elements (FE) simulations against human urodynamic data. In a third step, the identified constitutive equations are employed for the simulations of the motion and interactions of the pelvic organs due to concomitant changes of the distension volumes of the urinary bladder and rectum. The effectiveness of the developed biomechanical model is demonstrated in investigating the motion of the bladder, rectum and prostate organs; the results in terms of displacements are shown to be in good agreement with measurements inherent to a deceased person, with a relative error close to 6%.
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Affiliation(s)
| | - Mohamed Haboussi
- L.S.P.M., U.P.R., C.N.R.S. 3407 Université Paris 13, 99, av. J-B. Clément, 93430 Villetaneuse, France
| | - Jean-François Ganghoffer
- L.E.M.T.A., Université de Lorraine, C.N.R.S., 2 avenue de la forêt de Haye, TSA 60604, 54518 Vandoeuvre CEDEX, France.
| | - Pierre Aletti
- Centre Alexis Vautrin, C.R.A.N., I.N.P.L., C.N.R.S. 54500 Vandoeuvre Cedex, France
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Mazaheri Y, Afaq AA, Jung SI, Goldman DA, Wang L, Aslan H, Zelefsky MJ, Akin O, Hricak H. Volume and landmark analysis: comparison of MRI measurements obtained with an endorectal coil and with a phased-array coil. Clin Radiol 2014; 70:379-86. [PMID: 25554540 DOI: 10.1016/j.crad.2014.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 11/26/2014] [Accepted: 12/03/2014] [Indexed: 11/27/2022]
Abstract
AIM To compare prostate volumes and distances between anatomical landmarks on MRI images obtained with a phased-array coil (PAC) only and with a PAC and an endorectal coil (ERC). MATERIALS AND METHODS Informed consent was waived for this Health Insurance Portability and Accountability Act-compliant study. Fifty-nine men underwent PAC-MRI and ERC-MRI at 1.5 (n = 3) or 3 T (n = 56). On MRI images, two radiologists independently measured prostate volume and distances between the anterior rectal wall (ARW) and symphysis pubis at the level of the verumontanum; ARW and symphysis pubis at the level of the mid-symphysis pubis; and bladder neck and mid-symphysis pubis. Differences between measurements from PAC-MRI and ERC-MRI were assessed with the Wilcoxon RANK SUM test. Inter-reader agreement was assessed using the concordance correlation coefficient (CCC). RESULTS Differences in prostate volume between PAC-MRI and ERC-MRI [median: -0.75 mm(3) (p = 0.10) and median: -0.84 mm(3) (p = 0.06) for readers 1 and 2, respectively] were not significant. For readers 1 and 2, median differences between distances were as follows: -10.20 and -12.75 mm, respectively, ARW to symphysis pubis at the level of the verumontanum; -6.60 and -6.08 mm, respectively, ARW to symphysis pubis at the level of the mid-symphysis pubis; -3 and -3 mm respectively, bladder neck to mid-symphysis pubis. All differences in distance were significant for both readers (p ≤ 0.0005). Distances were larger on PAC-MRI (p ≤ 0.0005). Inter-reader agreement regarding prostate volume was almost perfect on PAC-MRI (CCC: 0.99; 95% CI: 0.98-1.00) and ERC-MRI (CCC: 0.99; 95% CI: 0.99-1.00); inter-reader agreement for distance measurements varied (CCCs: 0.54-0.86). CONCLUSION Measurements of distances between anatomical landmarks differed significantly between ERC-MRI and PAC-MRI, although prostate volume measurements did not.
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Affiliation(s)
- Y Mazaheri
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
| | - A A Afaq
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - S I Jung
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - D A Goldman
- Department of Epidemiology & Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - L Wang
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - H Aslan
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - M J Zelefsky
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - O Akin
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - H Hricak
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Scaife J, Harrison K, Romanchikova M, Parker A, Sutcliffe M, Bond S, Thomas S, Freeman S, Jena R, Bates A, Burnet N. Random variation in rectal position during radiotherapy for prostate cancer is two to three times greater than that predicted from prostate motion. Br J Radiol 2014; 87:20140343. [PMID: 25138155 PMCID: PMC4170867 DOI: 10.1259/bjr.20140343] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: Radiotherapy for prostate cancer does not explicitly take into account daily variation in the position of the rectum. It is important to accurately assess accumulated dose (DA) to the rectum in order to understand the relationship between dose and toxicity. The primary objective of this work was to quantify systematic (Σ) and random (σ) variation in the position of the rectum during a course of prostate radiotherapy. Methods: The rectum was manually outlined on the kilo-voltage planning scan and 37 daily mega-voltage image guidance scans for 10 participants recruited to the VoxTox study. The femoral heads were used to produce a fixed point to which all rectal contours were referenced. Results: Σ [standard deviation (SD) of means] between planning and treatment was 4.2 mm in the anteroposterior (AP) direction and 1.3 mm left–right (LR). σ (root mean square of SDs) was 5.2 mm AP and 2.7 mm LR. Superior–inferior variation was less than one slice above and below the planning position. Conclusion: Our results for Σ are in line with published data for prostate motion. σ, however, was approximately twice as great as that seen for prostate motion. This suggests that DA may differ from planned dose in some patients treated with radiotherapy for prostate cancer. Advances in knowledge: This work is the first to use daily imaging to quantify Σ and σ of the rectum in prostate cancer. σ was found to be greater than published data, providing strong rationale for further investigation of individual DA.
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Affiliation(s)
- J Scaife
- 1 Department of Oncology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
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Holden L, Stanford J, D'Alimonte L, Kiss A, Loblaw A. Timing Variability of Bladder Volumes in Men Receiving Radiotherapy to the Prostate. J Med Imaging Radiat Sci 2014; 45:24-30. [PMID: 31051992 DOI: 10.1016/j.jmir.2013.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 02/06/2013] [Accepted: 02/12/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Dose-escalated external-beam radiotherapy improves outcomes for localized prostate cancer but risks increasing the toxicity. One strategy to decrease this toxicity may be larger and more consistent bladder volumes. The primary objective of this study was to determine the time required for 95% of patients on a dose-escalated external-beam radiotherapy protocol to comfortably achieve a 180-cc bladder volume. In addition, measurement of patients' subjective assessment of urgency related to bladder filling was obtained to determine the feasibility of bladder-filling instructions. METHODOLOGY Thirty consenting patients with localized prostate cancer treated with external-beam radiotherapy were assigned 1:1 to 250-cc vs. 500-cc water preload. After voiding, patients drank the specified fluid preload and had their bladder volume and urinary urgency assessed at regular intervals over 2 hours, repeated at weeks 1, 4, and 7. RESULTS The time required for 95% of patients to achieve a bladder volume of 180 cc was 75 and 57 minutes for groups 1 and 2, respectively (P = .03). Serum creatinine and use of bladder medications did not influence time to optimal bladder filling. Participants in group 2 reported moderate to severe urinary severity more frequently than participants in group 1. CONCLUSIONS Time to optimal bladder volume was highly varied and was faster with a 500-cc fluid preload. Customizing the wait times based on calculated ultrasound-based filling rates appears feasible in a busy radiotherapy department.
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Affiliation(s)
- Lori Holden
- Radiation Therapy, Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Julie Stanford
- Radiation Therapy, Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Laura D'Alimonte
- Radiation Therapy, Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Alex Kiss
- Department of Biostatistics, Institute of Clinically Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Loblaw
- Department of Health Policy, Measurement and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Munck af Rosenschöld P, Desai NB, Oh JH, Apte A, Hunt M, Kalikstein A, Mechalakos J, Happersett L, Deasy JO, Zelefsky MJ. Modeling positioning uncertainties of prostate cancer external beam radiation therapy using pre-treatment data. Radiother Oncol 2014; 110:251-5. [PMID: 24560753 DOI: 10.1016/j.radonc.2013.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 10/14/2013] [Accepted: 12/16/2013] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the influence of treatment plan data and image guidance (IG) on positioning uncertainty during prostate cancer (PCa) radiotherapy (RT). METHODS Body mass index (BMI), planning target volume (PTV), bladder volume (BV), and rectal cross section area (RCS) were collected for 267 consecutive PCa patients undergoing daily IGRT. Radiographic isocenter corrections to intra-prostatic fiducials for 12,490 treatment fractions were used to derive random (RE) and systematic (SE) inter-fraction uncertainties for the cardinal axes. These data were used to simulate RE and SE for weekly IG and Action Level (AL)-IG treatment protocols. RESULTS SE and RE were 2-5 and 3-4mm in the cardinal axes, respectively, during simulation of no IG. Without IG, positive correlations (p<0.01) were noted for (1) anterior-posterior RE vs. RCS and BV and (2) cranio-caudal RE vs. RCS, BV and BMI. The RE increase was 3mm for the highest quartile of RCS, BV and BMI. Daily IGRT eliminated this relationship. 3D IG corrections of 1cm or more occured in 27% of treatment fractions and in 97% of patients. CONCLUSION PCa patients with elevated pre-treatment BV, RCS and BMI have increased inter-fractionation positioning uncertainty and appear the primary candidates for daily IGRT.
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Affiliation(s)
- Per Munck af Rosenschöld
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, USA; Department of Radiation Oncology, Radiation Medicine Research Center, Copenhagen, Denmark; Niels Bohr Institute, University of Copenhagen, Denmark
| | - Neil B Desai
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, USA
| | - Jung Hun Oh
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, USA
| | - Aditya Apte
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, USA
| | - Margie Hunt
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, USA
| | - Abraham Kalikstein
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, USA
| | - James Mechalakos
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, USA
| | - Laura Happersett
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, USA
| | - Joseph O Deasy
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, USA
| | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, USA.
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Seo YE, Kim TH, Lee KS, Cho WY, Lee HS, Hur WJ, Choi Y. Interfraction prostate movement in bone alignment after rectal enema for radiotherapy. Korean J Urol 2014; 55:23-8. [PMID: 24466393 PMCID: PMC3897626 DOI: 10.4111/kju.2014.55.1.23] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 08/28/2013] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To assess the effect of a rectal enema on interfraction prostate movement in bone alignment (BA) for prostate radiotherapy (RT), we analyzed the spatial difference in prostates in a bone-matched setup. MATERIALS AND METHODS We performed BA retrospectively with data from prostate cancer patients who underwent image-guided RT (IGRT). The prostate was identified with implanted fiducial markers. The setup for the IGRT was conducted with the matching of three fiducial markers on RT planning computed tomography images and those on two oblique kV x-ray images. Offline BA was performed at the same position. The coordinates of a virtual prostate in BA and a real prostate were obtained by use of the ExaxTrac/NovalisBody system, and the distance between them was calculated as the spatial difference. Interfraction prostate displacement was drawn from the comparison of the spatial differences. RESULTS A total of 15 patients with localized prostate cancer treated with curative hypofractionated IGRT were enrolled. A total of 420 fractions were analyzed. The mean of the interfraction prostate displacements after BA was 3.12±2.00 mm (range, 0.20-10.53 mm). The directional difference was profound in the anterior-posterior and supero-inferior directions (2.14±1.73 mm and 1.97±1.44 mm, respectively) compared with the right-left direction (0.26±0.22 mm, p<0.05). The required margin around the clinical target volume was 4.97 mm with the formula of van Herk et al. CONCLUSIONS The interfraction prostate displacement was less frequent when a rectal enema was performed before the procedure. A rectal enema can be used to reduce interfraction prostate displacement and resulting clinical target volume-to-planning target volume margin.
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Affiliation(s)
- Young Eun Seo
- Department of Urology, Dong-A University College of Medicine, Busan, Korea
| | - Tae Hyo Kim
- Department of Urology, Dong-A University College of Medicine, Busan, Korea
| | - Ki Soo Lee
- Department of Urology, Dong-A University College of Medicine, Busan, Korea
| | - Won Yeol Cho
- Department of Urology, Dong-A University College of Medicine, Busan, Korea
| | - Hyung-Sik Lee
- Department of Radiation Oncology, Dong-A University College of Medicine, Busan, Korea
| | - Won-Joo Hur
- Department of Radiation Oncology, Dong-A University College of Medicine, Busan, Korea
| | - Youngmin Choi
- Department of Radiation Oncology, Dong-A University College of Medicine, Busan, Korea
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