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Lu L, Ouyang Z, Lin S, Mastroianni A, Stephans KL, Xia P. Dosimetric assessment of patient-specific breath-hold reproducibility on liver motion for SBRT planning. J Appl Clin Med Phys 2020; 21:77-83. [PMID: 32337841 PMCID: PMC7386188 DOI: 10.1002/acm2.12887] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/02/2020] [Accepted: 03/25/2020] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To investigate the impact of breath-hold reproducibility on liver motion using a respiratory motion management device. METHODS Forty-four patients with hepatic tumors, treated with SBRT with breath-hold, were randomly selected for this study. All patients underwent three consecutive computed tomography (CT) scans using active breath-hold coordinator (ABC) with three repeated single breath-hold during simulation. The three CT scans were labeled as ABC1-CT, ABC2-CT, and ABC3-CT. Displacements of centroids of the entire livers among the three ABC-CTs were measured as a surrogate for intrafractional motion. For each patient, two different treatment plans were prepared: (a) a clinical plan using a 5-mm expansion of an ITV that encompassed all three GTVs from each of the three ABC-CTs, and (b) a research plan using a 5-mm expansion of the GTV from only ABC1-CT to create PTV. The clinical plan acceptance criteria were that 95% of the PTV and 99% of the GTV received 100% of the prescription dose. Dosimetric endpoints were analyzed and compared for the two plans. RESULTS All shifts in the medial-lateral direction (range: -3.9 to 2.0 mm) were within 5 mm while 7% of shifts in the anterior-posterior direction (range: -10.5 to 16.7 mm) and 11% of shifts in the superior-inferior direction (range: -17.0 to 8.7 mm) exceeded 5 mm. Six patients (14%) had an intrafraction motion greater than 5 mm in any direction. For these six patients, if a plan was created based on a PTV from a single CT (ex. ABC1-CT), 5 of 12 GTVs captured from other ABC-CTs would fail to meet the clinical acceptance criteria due to poor breath-hold reproducibility. CONCLUSIONS Non-negligible intrafractional motion occurs in patients with poor breath-hold reproducibility. To identify this subgroup of patients, acquiring three CTs with active breath-hold during simulation is a feasible practical method.
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Affiliation(s)
- Lan Lu
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Zi Ouyang
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Sara Lin
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Anthony Mastroianni
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Kevin L Stephans
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Ping Xia
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
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Cozzi L, Dinapoli N, Fogliata A, Hsu WC, Reggiori G, Lobefalo F, Kirienko M, Sollini M, Franceschini D, Comito T, Franzese C, Scorsetti M, Wang PM. Radiomics based analysis to predict local control and survival in hepatocellular carcinoma patients treated with volumetric modulated arc therapy. BMC Cancer 2017; 17:829. [PMID: 29207975 PMCID: PMC5718116 DOI: 10.1186/s12885-017-3847-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/27/2017] [Indexed: 12/23/2022] Open
Abstract
Background To appraise the ability of a radiomics based analysis to predict local response and overall survival for patients with hepatocellular carcinoma. Methods A set of 138 consecutive patients (112 males and 26 females, median age 66 years) presented with Barcelona Clinic Liver Cancer (BCLC) stage A to C were retrospectively studied. For a subset of these patients (106) complete information about treatment outcome, namely local control, was available. Radiomic features were computed for the clinical target volume. A total of 35 features were extracted and analyzed. Univariate analysis was used to identify clinical and radiomics significant features. Multivariate models by Cox-regression hazards model were built for local control and survival outcome. Models were evaluated by area under the curve (AUC) of receiver operating characteristic (ROC) curve. For the LC analysis, two models selecting two groups of uncorrelated features were analyzes while one single model was built for the OS analysis. Results The univariate analysis lead to the identification of 15 significant radiomics features but the analysis of cross correlation showed several cross related covariates. The un-correlated variables were used to build two separate models; both resulted into a single significant radiomic covariate: model-1: energy p < 0.05, AUC of ROC 0.6659, C.I.: 0.5585–0.7732; model-2: GLNUp < 0.05, AUC 0.6396, C.I.:0.5266–0.7526. The univariate analysis for covariates significant with respect to local control resulted in 9 clinical and 13 radiomics features with multiple and complex cross-correlations. After elastic net regularization, the most significant covariates were compacity and BCLC stage, with only compacity significant to Cox model fitting (Cox model likelihood ratio test p < 0.0001, compacity p < 0.00001; AUC of the model is 0.8014 (C.I. = 0.7232–0.8797)). Conclusion A robust radiomic signature, made by one single feature was finally identified. A validation phases, based on independent set of patients is scheduled to be performed to confirm the results.
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Affiliation(s)
- Luca Cozzi
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital, Rozzano, Italy. .,Department of Biomedical Sciences Humanitas University, Rozzano, Italy. .,Humanitas Cancer Center and Research Hospital, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
| | - Nicola Dinapoli
- Polo Scienze Oncologiche ed Ematologiche, Fondazione Policlinico, Universitario Agostino Gemelli, Rome, Italy
| | - Antonella Fogliata
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Wei-Chung Hsu
- Department of Radiation Oncology, Cheng-Ching General Hospital, Taichung, Taiwan
| | - Giacomo Reggiori
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Francesca Lobefalo
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Margarita Kirienko
- Nuclear Medicine Department, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Martina Sollini
- Nuclear Medicine Department, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Davide Franceschini
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Tiziana Comito
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Ciro Franzese
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital, Rozzano, Italy.,Department of Biomedical Sciences Humanitas University, Rozzano, Italy
| | - Po-Ming Wang
- Department of Radiation Oncology, Cheng-Ching General Hospital, Taichung, Taiwan
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Huang B, Fang Z, Huang Y, Lin P, Chen Z. A dosimetric analysis of volumetric-modulated arc radiotherapy with jaw width restriction vs 7 field intensity-modulated radiotherapy for definitive treatment of cervical cancer. Br J Radiol 2014; 87:20140183. [PMID: 24834477 PMCID: PMC4075592 DOI: 10.1259/bjr.20140183] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/03/2014] [Accepted: 05/14/2014] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Radiation therapy treatment planning was performed to compare the dosimetric difference between volumetric-modulated arc radiotherapy (RapidArc™ v. 10; Varian® Medical Systems, Palo Alto, CA) and 7-field intensity-modulated radiotherapy (7f-IMRT) in the definitive treatment of cervical cancer. METHODS 13 patients with cervical cancer were enrolled in this study. Planning target volume (PTV) 50 and PTV60 were prescribed at a dose of 50 and 60 Gy in 28 fractions, respectively. The dose to the PTV60 was delivered as a simultaneous integrated boost to the pelvic lymph nodes. Owing to the mechanical limitation of the multileaf collimator in which the maximum displacement was limited to 15 cm, two types of RapidArc with different jaw width restrictions (15 and 20-23 cm) were investigated to evaluate their dosimetric differences. The RapidArc plan type with dosimetric superiority was then compared against the 7f-IMRT on the target coverage, sparing of the organs at risk (OARs), monitor units, treatment time and delivery accuracy to determine whether RapidArc is beneficial for the treatment of cervical cancer. RESULTS The 15-cm jaw width restriction had better performance compared with the restrictions that were longer than 15 cm in the sparing of the OARs. The 15-cm RapidArc spared the OARs, that is, the bladder, rectum, small intestine, femoral heads and bones, and improved treatment efficiency compared with 7f-IMRT. Both techniques delivered a high quality-assurance passing rate (>90%) according to the Γ3mm,3% criterion. CONCLUSION RapidArc with a 15-cm jaw width restriction spares the OARs and improves treatment efficiency in cervical cancer compared with 7f-IMRT. ADVANCES IN KNOWLEDGE This study describes the dosimetric superiority of RapidArc with a 15-cm jaw width restriction and explores the feasibility of using RapidArc for the definitive treatment of cervical cancer.
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Affiliation(s)
- B Huang
- 1 Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
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