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Merten R, Fischer M, Christiansen H, Hellms S, von Klot CAJ, Thomas NH, Knöchelmann AC. Using a Further Planning MRI after Neoadjuvant Androgen Deprivation Therapy Significantly Reduces the Radiation Exposure of Organs at Risk in External Beam Radiotherapy of Prostate Cancer. J Clin Med 2023; 12:jcm12020574. [PMID: 36675503 PMCID: PMC9860985 DOI: 10.3390/jcm12020574] [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: 12/13/2022] [Revised: 01/01/2023] [Accepted: 01/07/2023] [Indexed: 01/13/2023] Open
Abstract
Radiotherapy for prostate cancer is often preceded by neoadjuvant androgen deprivation therapy (ADT), which leads to a reduction in the size of the prostate. This study examines whether it is relevant for treatment planning to acquire a second planning magnetic resonance imaging (MRI) after ADT (=MRI 2) or whether it can be planned without disadvantage based on an MRI acquired before starting ADT (=MRI 1). The imaging data for the radiotherapy treatment planning of 17 patients with prostate cancer who received two planning MRIs (before and after neoadjuvant ADT) were analyzed as follows: detailed comparable radiation plans were created separately, each based on the planning CT scan and either MRI 1 or MRI 2. After ADT for an average of 17.2 weeks, the prostate was reduced in size by an average of 24%. By using MRI 2 for treatment planning, the V60Gy of the rectum could be significantly relieved by an average of 15% with the same coverage of the target volume, and the V70Gy by as much as 33% (compared to using MRI 1 alone). Using a second MRI for treatment planning after neoadjuvant ADT in prostate cancer leads to a significant relief for the organs at risk, especially in the high dose range, with the same irradiation of the target volume, and should therefore be carried out regularly. Waiting for the prostate to shrink after a few months of ADT contributes to relief for the organs at risk and to lowering the toxicity. However, the use of reduced target volumes requires an image-guided application, and the oncological outcome needs to be verified in further studies.
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Affiliation(s)
- Roland Merten
- Clinic for Radiotherapy, Hannover Medical School, 30625 Hannover, Germany
- Correspondence: ; Tel.: +49-511-532-2574
| | - Mirko Fischer
- Clinic for Radiotherapy, Hannover Medical School, 30625 Hannover, Germany
| | - Hans Christiansen
- Clinic for Radiotherapy, Hannover Medical School, 30625 Hannover, Germany
| | - Susanne Hellms
- Institute for Radiology, Hannover Medical School, 30625 Hannover, Germany
| | | | - Nele Henrike Thomas
- Institute for Biostatistics, Hannover Medical School, 30625 Hannover, Germany
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Keall PJ, Brighi C, Glide-Hurst C, Liney G, Liu PZY, Lydiard S, Paganelli C, Pham T, Shan S, Tree AC, van der Heide UA, Waddington DEJ, Whelan B. Integrated MRI-guided radiotherapy - opportunities and challenges. Nat Rev Clin Oncol 2022; 19:458-470. [PMID: 35440773 DOI: 10.1038/s41571-022-00631-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2022] [Indexed: 12/25/2022]
Abstract
MRI can help to categorize tissues as malignant or non-malignant both anatomically and functionally, with a high level of spatial and temporal resolution. This non-invasive imaging modality has been integrated with radiotherapy in devices that can differentially target the most aggressive and resistant regions of tumours. The past decade has seen the clinical deployment of treatment devices that combine imaging with targeted irradiation, making the aspiration of integrated MRI-guided radiotherapy (MRIgRT) a reality. The two main clinical drivers for the adoption of MRIgRT are the ability to image anatomical changes that occur before and during treatment in order to adapt the treatment approach, and to image and target the biological features of each tumour. Using motion management and biological targeting, the radiation dose delivered to the tumour can be adjusted during treatment to improve the probability of tumour control, while simultaneously reducing the radiation delivered to non-malignant tissues, thereby reducing the risk of treatment-related toxicities. The benefits of this approach are expected to increase survival and quality of life. In this Review, we describe the current state of MRIgRT, and the opportunities and challenges of this new radiotherapy approach.
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Affiliation(s)
- Paul J Keall
- ACRF Image X Institute, The University of Sydney, Sydney, New South Wales, Australia.
| | - Caterina Brighi
- ACRF Image X Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Carri Glide-Hurst
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA
| | - Gary Liney
- Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Paul Z Y Liu
- ACRF Image X Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Suzanne Lydiard
- ACRF Image X Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Chiara Paganelli
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Trang Pham
- Faculty of Medicine and Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Shanshan Shan
- ACRF Image X Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Alison C Tree
- The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, UK
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - David E J Waddington
- ACRF Image X Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Brendan Whelan
- ACRF Image X Institute, The University of Sydney, Sydney, New South Wales, Australia
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Safety of gadolinium based contrast agents in magnetic resonance imaging-guided radiotherapy – An investigation of chelate stability using relaxometry. Phys Imaging Radiat Oncol 2022; 21:96-100. [PMID: 35243039 PMCID: PMC8885577 DOI: 10.1016/j.phro.2022.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 11/21/2022] Open
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Law MWL, Yuan J, Wong OL, Ying AD, Zhou Y, Cheung KY, Yu SK. Phantom assessment of three-dimensional geometric distortion of a dedicated wide-bore MR-simulator for radiotherapy. Biomed Phys Eng Express 2021; 8. [PMID: 34874313 DOI: 10.1088/2057-1976/ac3f4f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/02/2021] [Indexed: 11/11/2022]
Abstract
This study evaluated the machine-dependent three-dimensional geometric distortion images acquired from a 1.5T 700mm-wide bore MR-simulator based on a large geometric accuracy phantom. With the consideration of radiation therapy (RT) application requirements, every sequence was examined in various combinations of acquisition-orientations and receiver-bandwidths with console-integrated distortion correction enabled. Distortion was repeatedly measured over a six-month period. The distortion measured from the images acquired at the beginning of this period was employed to retrospectively correct the distortion in the subsequent acquisitions. Geometric distortion was analyzed within the largest field-of-view allowed. Six sequences were examined for comprehensive distortion analysis - VIBE, SPACE, TSE, FLASH, BLADE and PETRA. Based on optimal acquisition parameters, their diameter-sphere-volumes (DSVs) of CT-comparable geometric fidelity (where 1mm distortion was allowed) were 333.6mm, 315.1mm, 316.0mm, 318.9mm, 306.2mm and 314.5mm respectively. This was a significant increase from 254.0mm, 245.5mm, 228.9mm, 256.6mm, 230.8mm and 254.2mm DSVs respectively, when images were acquired using un-optimized parameters. The longitudinal stability of geometric distortion and the efficacy of retrospective correction of console-corrected images, based on prior distortion measurements, were inspected using VIBE and SPACE. The retrospectively corrected images achieved over 500mm DSVs with 1mm distortion allowed. The median distortion was below 1mm after retrospective correction, proving that obtaining prior distortion map for subsequent retrospective distortion correction is beneficial. The systematic evaluation of distortion using various combinations of sequence-type, acquisition-orientation and receiver-bandwidth in a six-month time span would be a valuable guideline for optimizing sequence for various RT applications.
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Affiliation(s)
- Max W L Law
- Medical Physics Department, Hong Kong Sanatorium and Hospital, 2nd Village Road, Happy Valley, Hong Kong Island, Hong Kong, 000, HONG KONG
| | - Jing Yuan
- Research Department, Hong Kong Sanatorium and Hospital, 2nd Village Road, Happy Valley, Hong Kong Island, Hong Kong, 000, HONG KONG
| | - Oi Lei Wong
- Research Department, Hong Kong Sanatorium and Hospital, 2nd Village Road, Happy Valley, Hong Kong Island, Hong Kong, NA, 000, HONG KONG
| | - Abby D Ying
- Medical Physics Department, Hong Kong Sanatorium and Hospital, Hong Kong Sanatorium and Hospital, Hong Kong, HONG KONG
| | - Yihang Zhou
- Research Department, Hong Kong Sanatorium and Hospital, 2nd Village Road, Happy Valley, Hong Kong Island, Hong Kong, 000, HONG KONG
| | - Kin Yin Cheung
- Medical Physics Department, Hong Kong Sanatorium and Hospital, 2nd Village Road, Happy Valley, Hong Kong Island, Hong Kong, 000, HONG KONG
| | - Siu Ki Yu
- Medical Physics Department, Hong Kong Sanatorium and Hospital, 2nd Village Road, Happy Valley, Hong Kong Island, Hong Kong, 000, HONG KONG
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Shirley B, Baines J. Considerations when introducing MRI into a radiation therapy environment. J Med Radiat Sci 2021; 68:217-219. [PMID: 34432375 PMCID: PMC8424306 DOI: 10.1002/jmrs.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 11/30/2022] Open
Abstract
This issue of Journal of Medical Radiation Sciences includes two papers presenting different uses of magnetic resonance (MR) in radiation therapy (RT). With the advancement of MR-simulators and Magnetic resonance linear accelerators (MRL), in addition to the use of diagnostic MR becoming more common place in the radiotherapy setting, there are a number of challenges to be considered. In this article, we present the perspectives of radiation therapists and medical physicists involved in the commissioning of an MRL in our centre. Image shows in-house 3D printed supports mounted on the vendor-supplied QA platform. The supports locate an array so that it is centred in the radiation field.
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Affiliation(s)
- Bronwyn Shirley
- Radiation TherapyTownsville Cancer CentreTownsville Hospital and Health ServiceTownsvilleQueenslandAustralia
| | - John Baines
- Radiation TherapyTownsville Cancer CentreTownsville Hospital and Health ServiceTownsvilleQueenslandAustralia
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McGee KP, Tyagi N, Bayouth JE, Cao M, Fallone BG, Glide‐Hurst CK, Goerner FL, Green OL, Kim T, Paulson ES, Yanasak NE, Jackson EF, Goodwin JH, Dieterich S, Jordan DW, Hugo GD, Bernstein MA, Balter JM, Kanal KM, Hazle JD, Pelc NJ. Findings of the AAPM Ad Hoc committee on magnetic resonance imaging in radiation therapy: Unmet needs, opportunities, and recommendations. Med Phys 2021; 48:4523-4531. [PMID: 34231224 PMCID: PMC8457147 DOI: 10.1002/mp.14996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 02/03/2023] Open
Abstract
The past decade has seen the increasing integration of magnetic resonance (MR) imaging into radiation therapy (RT). This growth can be contributed to multiple factors, including hardware and software advances that have allowed the acquisition of high-resolution volumetric data of RT patients in their treatment position (also known as MR simulation) and the development of methods to image and quantify tissue function and response to therapy. More recently, the advent of MR-guided radiation therapy (MRgRT) - achieved through the integration of MR imaging systems and linear accelerators - has further accelerated this trend. As MR imaging in RT techniques and technologies, such as MRgRT, gain regulatory approval worldwide, these systems will begin to propagate beyond tertiary care academic medical centers and into more community-based health systems and hospitals, creating new opportunities to provide advanced treatment options to a broader patient population. Accompanying these opportunities are unique challenges related to their adaptation, adoption, and use including modification of hardware and software to meet the unique and distinct demands of MR imaging in RT, the need for standardization of imaging techniques and protocols, education of the broader RT community (particularly in regards to MR safety) as well as the need to continue and support research, and development in this space. In response to this, an ad hoc committee of the American Association of Physicists in Medicine (AAPM) was formed to identify the unmet needs, roadblocks, and opportunities within this space. The purpose of this document is to report on the major findings and recommendations identified. Importantly, the provided recommendations represent the consensus opinions of the committee's membership, which were submitted in the committee's report to the AAPM Board of Directors. In addition, AAPM ad hoc committee reports differ from AAPM task group reports in that ad hoc committee reports are neither reviewed nor ultimately approved by the committee's parent groups, including at the council and executive committee level. Thus, the recommendations given in this summary should not be construed as being endorsed by or official recommendations from the AAPM.
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Affiliation(s)
- Kiaran P. McGee
- Department of RadiologyMayo ClinicRochesterMinnesota55905USA
| | - Neelam Tyagi
- Department of Medical PhysicsMemorial Sloan‐Kettering Cancer CenterNew YorkNew York10065USA
| | - John E. Bayouth
- Department of Radiation OncologyUniversity of WisconsinMadisonWisconsin53792‐0600USA
| | - Minsong Cao
- Department of Radiation OncologyUniversity of California, Los AngelesLos AngelesCalifornia90095‐6951USA
| | - B. Gino Fallone
- Department of Medical PhysicsCross Cancer InstituteEdmontonAlbertaAB T6G 1Z2Canada
| | | | - Frank L. Goerner
- Department of Radiology/Radiological SciencesQueen's Medical CenterHonoluluHI96813USA
| | - Olga L. Green
- Department of Radiation OncologyWashington University School of MedicineSt. LouisMO63110USA
| | - Taeho Kim
- Department of Radiation OncologyVirginia Commonwealth UniversityGlen AllenVA23059USA
| | - Eric S. Paulson
- Department of Radiation OncologyMedical College of WisconsinMilwaukeeWisconsin53226USA
| | | | - Edward F. Jackson
- Department of Imaging PhysicsUniversity of WisconsinMadisonWI53705USA
| | - James H. Goodwin
- Department of Medical PhysicsUniversity of Vermont Medical CenterBurlingtonVT05401USA
| | - Sonja Dieterich
- Department of Radiation OncologyUC Davis Medical CenterSacramentoCalifornia95817USA
| | - David W. Jordan
- Department of RadiologyUniversity Hospitals Cleveland Medical CenterClevelandOhio44106USA
| | - Geoffrey D. Hugo
- Department of Radiation OncologyWashington University St LouisRichmondVA23298‐0058USA
| | | | - James M. Balter
- Department of Radiation OncologyUniversity of MichiganAnn ArborMI48109USA
| | - Kalpana M. Kanal
- Department of RadiologyUniversity of WashingtonSeattleWA98195‐7987USA
| | - John D. Hazle
- Department of Imaging PhysicsUT MD Anderson Cancer CenterHoustonTX77030‐4095USA
| | - Norbert J. Pelc
- Department of Radiology/Radiological SciencesStanford UniversityStanfordCA94305‐4245USA
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