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OHIRA SHINGO, INUI SHOKI, KANAYAMA NAOYUKI, UEDA YOSHIHIRO, MIYAZAKI MASAYOSHI, KOIZUMI MASAHIKO, KONISHI KOJI. Automated Non-coplanar Volumetric Modulated Arc Therapy Planning for Maxillary Sinus Carcinoma. In Vivo 2023; 37:417-423. [PMID: 36593035 PMCID: PMC9843778 DOI: 10.21873/invivo.13094] [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: 09/28/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND/AIM Dosimetric parameters in volumetric modulated arc therapy (VMAT), non-coplanar VMAT (NC-VMAT), and automated NC-VMAT (HyperArc, HA) were compared for patients with maxillary sinus carcinoma (MSC). PATIENTS AND METHODS Twenty HA plans were generated to deliver 70.4, 64, and 46 Gy for planning target volumes with high (PTV1), intermediate (PTV2), and low risk (PTV3), respectively. The VMAT and NC-VMAT plans were retrospectively generated using the same optimized parameters as those used in the HA plans. RESULTS For PTV1, the three treatment plans provided comparable target coverages. For PTV2, the D95%, D99%, and Dmin in the HA plans (64.7±1.2, 62.7±2.1 and 54.6±6.2 Gy, respectively) were significantly higher (p<0.05) than those in the VMAT plans (64.3±1.7, 61.9±2.4 and 52.9±6.4 Gy, respectively). The NC-VMAT and HA plans provided significantly higher (p<0.05) dosimetric parameters for PTV3 than those in the VMAT plans, and D99% in the HA was significantly higher than that in the NC-VMAT plans (52.5±3.0 vs. 51.8±2.7 Gy, p<0.05). The doses to the brain and brainstem were lowest in the HA plans (p<0.05). Moreover, dosimetric parameters of the contralateral organs (lens, optic nerve, retina, and parotid) were lower in the HA plans than in the VMAT and NC-VMAT plans. CONCLUSION The HA plans provided the best target coverage and OAR sparing compared with VMAT and NC-VMAT plans for patients with MSC.
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Affiliation(s)
- SHINGO OHIRA
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan,Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - SHOKI INUI
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - NAOYUKI KANAYAMA
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - YOSHIHIRO UEDA
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - MASAYOSHI MIYAZAKI
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - MASAHIKO KOIZUMI
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - KOJI KONISHI
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
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Hsieh CH, Shueng PW, Wang LY, Liao LJ, Lo WC, Yeh HP, Chou HL, Wu LJ. Single-Institute Clinical Experiences Using Whole-Field Simultaneous Integrated Boost (SIB) Intensity-Modulated Radiotherapy (IMRT) and Sequential IMRT in Postoperative Patients With Oral Cavity Cancer (OCC). Cancer Control 2021; 27:1073274820904702. [PMID: 33047615 PMCID: PMC7791442 DOI: 10.1177/1073274820904702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This study aimed to review clinical experiences using whole-field simultaneous
integrated boost (SIB) intensity-modulated radiotherapy (IMRT) and sequential
IMRT in postoperative patients with oral cavity cancer (OCC). From November 2006
to December 2014, a total of 182 postoperative patients with OCC who underwent
either SIB-IMRT (n = 63) or sequential IMRT (n = 119) were enrolled
retrospectively and matched randomly according to multiple risk factors by a
computer. The differences were well balanced after patient matching
(P = .38). The median follow-up time was 65 months. For
patients treated with the SIB technique and the sequential technique, the
respective mortality rates were 36.8% and 20.0% (P = .04). The
primary recurrence rates were 26.3% and 10.0% (P = .02),
respectively. The respective marginal failure rates were 26.7% and 16.7%. A
multivariate logistic regression analysis showed that patients who received the
SIB technique had a 2.74 times higher risk of death than those who received the
sequential technique (95% confidence interval = 1.10-6.79, P =
.03). Sequential IMRT provided a significantly lower dose to the esophagus (5.2
Gy, P = .02) and trachea (4.6 Gy, P = .03)
than SIB-IMRT. For patients with locally advanced OCC, postoperative sequential
IMRT may overcome an unpredictable geographic miss, potentially with a lower
marginal failure rate in the primary area. Patients treated by sequential IMRT
show equal overall survival benefits to those treated by SIB-IMRT and a lower
mortality rate than those treated by SIB-IMRT. Additionally, a reduced dose to
the esophagus and trachea compared to sequential IMRT was noted.
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Affiliation(s)
- Chen-Hsi Hsieh
- Division of Radiation Oncology, Department of Radiology, 46608Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C. (Republic of China).,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C. (Republic of China).,Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C. (Republic of China)
| | - Pei-Wei Shueng
- Division of Radiation Oncology, Department of Radiology, 46608Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C. (Republic of China).,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C. (Republic of China)
| | - Li-Ying Wang
- Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan, R.O.C. (Republic of China).,School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, R.O.C. (Republic of China)
| | - Li-Jen Liao
- Department of Otolaryngology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C. (Republic of China).,Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan, R.O.C. (Republic of China)
| | - Wu-Chia Lo
- Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan, R.O.C. (Republic of China)
| | - Hsin-Pei Yeh
- Division of Radiation Oncology, Department of Radiology, 46608Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C. (Republic of China)
| | - Hsiu-Ling Chou
- Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C. (Republic of China).,School of Nursing, National Yang-Ming University, Taipei, Taiwan, R.O.C. (Republic of China).,Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan, R.O.C. (Republic of China)
| | - Le-Jung Wu
- Division of Radiation Oncology, Department of Radiology, 46608Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C. (Republic of China)
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Dual-energy computed tomography image-based volumetric-modulated arc therapy planning for reducing the effect of contrast-enhanced agent on dose distributions. Med Dosim 2021; 46:328-334. [PMID: 33931321 DOI: 10.1016/j.meddos.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/01/2021] [Accepted: 03/19/2021] [Indexed: 11/20/2022]
Abstract
To compare the effect of a contrast-enhanced (CE) agent on volumetric-modulated arc therapy plans based on four types of images-virtual monochromatic images (VMIs) captured at 70 and 140 keV (namely VMI70 and VMI140, respectively), water density image (WDI), and virtual non-contrast image (VNC) generated using a dual-energy computed tomography (DECT) system. A tissue characterization phantom and a multi-energy phantom were scanned, and VMI70, VMI140, WDI, and VNC were retrospectively reconstructed. For each image, a lookup table (LUT) was created. For 13 patients with nasopharyngeal cancer, non-CE and CE scans were performed, and volumetric-modulated arc therapy plans were generated on the basis of non-CE VMI70. Subsequently, the doses were re-calculated using the four types of DECT images and their corresponding LUTs. The maximum differences in the physical density estimation were 21.3, 5.2, -3.9, and 0.5% for VMI70, VMI140, WDI, and VNC, respectively. Compared with VMI70, the WDI approach significantly reduced (p < 0.05) the dosimetric difference due to the CE agent for the planning target volume (PTV) (D50%), whereas the difference was significantly increased for D1%. Except for PTV (D1%), the differences were significantly lower (p < 0.05) in the treatment plans based on VMI140 and VNC than that based on VMI70. For the VNC, the mean difference was less than 0.2% for all dosimetric parameters for the PTV. For patients with NPC, treatment plans based on the VNC derived from CE scan showed the best agreement with those based on the non-CE VMI70. Ideally, the effect of CE agent on dose distribution does not appear in treatment planning procedures.
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Mandal A, Choudhary S, Mani N, Aggarwal SK. A radiobiological and dosimetrical comparison between simultaneous integrated and sequential boost intensity-modulated arc treatment of locally advanced head-and-neck cancer. J Cancer Res Ther 2020; 16:508-512. [PMID: 32719258 DOI: 10.4103/jcrt.jcrt_211_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Purpose The study aimed to compare the radiobiological and dosimetric parameters between sequential boost (SEQB) and simultaneous integrated boost (SIB) treatment regimen using intensity-modulated arc therapy technique in locally advanced head-and-neck cancer (LAHNC) patients. Materials and Methods A total of 24 previously untreated LAHNC patients were randomized into SIB (n= 11) and SEQB (n = 13) arms. The planning computed tomography data set was transferred to the treatment planning system. All the target volumes and organ at risk volumes were delineated. Single plan for SIB group and three plans (three phases) were generated for SEQB group of patients. Radiobiological and dosimetric parameters were compared. Results The BED10(planned) value for high-risk (HR) planning target volume (PTV) was same in both groups, whereas for intermediate-risk (IR) PTV and low-risk (LR) PTV, the values were higher in SEQB arm than SIB arm. The V95 values were 100% for all the target volumes in both arms of patients. The average D100 value for gross target volume, HR PTV, and IR PTV was higher in SEQB arm than that in the SIB arm. The average D100 value for LR PTV was higher in the SIB arm compared to that of the SEQB arm. The BED10(achieved) was calculated using D100 values of target volumes. The difference of BED10(achieved) values between SEQB arm and SIB arm further increased than the BED10(planned) values for all target volumes. The maximum doses for spinal cord, spinal cord planning risk volume, and brain stem were within the tolerance dose in both groups of patients. The left and right parotid glands sparing was comparable in both groups of patients. Average integral dose was higher in the SIB group than SEQB group. The average total monitor unit per fraction was higher in the SEQB arm than that in the SIB arm. Conclusion SIB regimen may be considered as more logical and efficient over SEQB regimen in the treatment of LAHNC with comparable radiobiological and dosimetric parameters.
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Affiliation(s)
- Abhijit Mandal
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Sunil Choudhary
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Nilesh Mani
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Sushil Kumar Aggarwal
- Department of Otorhinolaryngology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Kuo YH, Liang JA, Wang TC, Juan CJ, Li CC, Chien CR. Comparative effectiveness of simultaneous integrated boost vs sequential intensity-modulated radiotherapy for oropharyngeal or hypopharyngeal cancer patients: A population-based propensity score-matched analysis. Medicine (Baltimore) 2019; 98:e18474. [PMID: 31861029 PMCID: PMC6940180 DOI: 10.1097/md.0000000000018474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
There were 2 common radiotherapy dose fractionation strategies in head-and-neck cancer patients (such as oropharyngeal cancer [OPC] or hypopharyngeal cancer [HPC]) treated with radiotherapy: intensity-modulated radiotherapy using simultaneous integrated boost (IMRT-SIB) and sequential IMRT (IMRT-SEQ). There is a lack of high-level clinical evidence to compare IMRT-SIB vs IMRT-SEQ specifically for OPC or HPC patients. The present study investigated the survival outcomes of OPC or HPC patients receiving definite concurrent chemoradiotherapy (CCRT) with either IMRT-SIB or IMRT-SEQ via a population-based propensity score (PS)-based analysis.The localized stage OPC or HPC patients diagnosed between 2011 and 2015 were identified based on the Health and Welfare Data Science Center database in Taiwan. These patients received definitive CCRT with either IMRT-SIB or IMRT-SEQ. We constructed a PS-matched cohort (1:1 for IMRT-SIB vs IMRT-SEQ) to balance observable potential confounders. We compared the hazard ratio (HR) of death between IMRT-SIB and IMRT-SEQ during the entire follow-up period. We also evaluated other disease outcome or subgroups.Our study population constituted 200 patients with well balance in observed covariables. The HR of death when IMRT-SIB was compared to IMRT-SEQ was 1.23 (95% confidence interval 0.84-1.80, P = .29). The results were similar for other disease outcome or subgroups.We found the survival outcome might be comparable for those treated with IMRT-SIB vs those treated with IMRT-SEQ.
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Affiliation(s)
- Yao-Hung Kuo
- Department of Radiation Oncology, E-Da Hospital
- College of Medicine, I-Shou University, Kaohsiung
| | - Ji-An Liang
- Department of Radiation Oncology, China Medical University Hospital, Taichung
- School of Medicine, College of Medicine, China Medical University
| | | | - Chun-Jung Juan
- Department of Medical Imaging, China Medical University Hsinchu Hospital, Hsinchu
- Department of Radiology, School of Medicine, College of Medicine, China Medical University, Taichung
| | - Chia-Chin Li
- Department of Radiation Oncology, China Medical University Hospital, Taichung
| | - Chun-Ru Chien
- Department of Radiation Oncology, China Medical University Hospital, Taichung
- School of Medicine, College of Medicine, China Medical University
- Department of Radiation Oncology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
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Jiang L, Zhang Y, Yang Z, Liang F, Wu J, Wang R. A comparison of clinical outcomes between simultaneous integrated boost (SIB) versus sequential boost (SEQ) intensity modulated radiation therapy (IMRT) for head and neck cancer: A meta-analysis. Medicine (Baltimore) 2019; 98:e16942. [PMID: 31441887 PMCID: PMC6716705 DOI: 10.1097/md.0000000000016942] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The optimal intensity modulated radiation therapy (IMRT) technique for head and neck cancer (HNC) has not been determined yet. The present study aimed to compare the clinical outcomes of the simultaneous integrated boost (SIB)-IMRT versus the sequential boost (SEQ)-IMRT in HNC. METHODS A meta-analysis of 7 studies involving a total of 1049 patients was carried out to compare the treatment outcomes together with severe acute adverse effects of the SIB-IMRT versus the SEQ-IMRT in HNC patients. RESULTS Comparison of the SIB-IMRT and SEQ-IMRT showed no significant difference in the measurement of overall survival (OS) (hazard ratio [HR] 0.94; 95% confidence inerval [CI], 0.70-1.27; P = .71), progression free survival (PFS) (HR 1.03; 95% CI, 0.82-1.30; P = .79), locoregional recurrence free survival (LRFS) (HR 0.98; 95% CI, 0.65-1.47; P = .91), and distance metastasis free survival (DMFS) (HR 0.87; 95% CI, 0.50-1.53; P = .63). Moreover, there were no significant differences in adverse effect occurrence between the SIB-IMRT and SEQ-IMRT groups. CONCLUSION SIB-IMRT and SEQ-IMRT can provide comparable outcomes in the treatment of patients afflicted by HNC. Both IMRT techniques were found to carry a similar risk of severe acute adverse effect. SIB-IMRT may have advantages due to its convenience and short-course of treatment; however, the optimum fractionation and prescribed dose remained unclear. Furthermore, both IMRT techniques can be advocated as the technique of choice for HNC. Treatment plan should be individualized for patients.
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Multi-institutional evaluation of knowledge-based planning performance of volumetric modulated arc therapy (VMAT) for head and neck cancer. Phys Med 2019; 64:174-181. [PMID: 31515017 DOI: 10.1016/j.ejmp.2019.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/28/2019] [Accepted: 07/09/2019] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The aim of this study was to investigate whether additional manual objectives are necessary for the RapidPlan (RP) with a single optimization. We conducted multi-institutional comparisons of plan quality for head and neck cancer (HNC) using the models created at each institute. METHODS The ability of RP to produce acceptable plans for dose requirements was evaluated in two types of oropharynx cancers at five institutes in Japan. Volumetric modulated arc therapy plans created without (RP plan) and with additional manual objectives (M-RP plan) were compared in terms of planning target volume (PTV), brainstem, spinal cord and parotid glands in dosimetric parameters. RESULTS There were no major dosimetric PTV differences between RP and M-RP plans. For the brainstem and spinal cord in the RP plans, only 40% and 30% of the plans achieved the dose requirements, while the M-RP plans with upper objective added to volume 0% at all institutes achieved them for 90% of the plans. For the L-parotid gland, there was no difference in the RP and M-RP plans (both were 40%) in achieving the acceptable criteria. For the R-parotid gland, 60% and 80% of the RP and M-RP plans achieved the constraint criteria, and in terms of the achievement rate, the RP plans were relatively high. CONCLUSIONS M-RP plans did not require reoptimization; only an upper objective was needed for the brainstem and spinal cord, while the parotid gland dose was reduced in both RP plans with the auto generated line objectives alone.
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Dobler B, Obermeier T, Hautmann MG, Khemissi A, Koelbl O. Simultaneous integrated boost therapy of carcinoma of the hypopharynx/larynx with and without flattening filter - a treatment planning and dosimetry study. Radiat Oncol 2017; 12:114. [PMID: 28679448 PMCID: PMC5499025 DOI: 10.1186/s13014-017-0850-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 06/28/2017] [Indexed: 01/26/2023] Open
Abstract
Background The aim of this study was to investigate if the flattening filter free (FFF) irradiation mode of a linear accelerator (linac) is advantageous as compared to the flat beam (FF) irradiation mode in intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) for carcinoma of the hypopharynx / larynx. Methods Four treatment plans were created for each of 10 patients for an Elekta Synergy linac with Agility collimating device, a dual arc VMAT and a nine field step and shoot IMRT each with and without flattening filter. Plan quality was compared considering target coverage and dose to the organs at risk. All plans were verified by a 2D–ionization-chamber-array and delivery times were compared. Peripheral point doses were determined as a measure of second cancer risk. The Wilcoxon test was used for statistical analysis with a significance level of 0.05. Results Plan quality was similar for all four treatment plans without statistically significant differences of clinical relevance. The clinical goals were met in all plans for the PTV-SIB (V95% > 95%), the spinal cord (D1ccm < 45 Gy) and the brain stem (D1ccm < 48 Gy). For the parotids, the goal of D50% < 30 Gy was met in 70% and 60% of the plans for the left and right parotid respectively, and the V95% of the SIB reached an average of 94%. Delivery times were similar for FF and FFF and significantly decreased by around 70% for VMAT as compared to IMRT. Peripheral doses were significantly reduced by 18% in FFF mode as compared to FF and by 26% for VMAT as compared to IMRT. Lowest peripheral doses were found for VMAT FFF, followed by VMAT FF. Conclusions The FFF mode of a linear accelerator is advantageous for the treatment of hypopharynx/larynx carcinoma only with respect to reduction of second cancer induction in peripheral organs for the combination of Elekta Synergy linacs and Oncentra® External Beam v4.5 treatment planning system. This might be of interest in a therapy with curative intent.
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Affiliation(s)
- Barbara Dobler
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany.
| | - Tina Obermeier
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany
| | - Matthias G Hautmann
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany
| | - Amine Khemissi
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany
| | - Oliver Koelbl
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany
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