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Chen J, Christodoulou AG, Han P, Xiao J, Han F, Hu Z, Wang N, Han H, Ling DC, Chang EL, Feng M, Scholey JE, Cui S, Li D, Yang W, Fan Z. Abdominal MR Multitasking for radiotherapy treatment planning: A motion-resolved and multicontrast 3D imaging approach. Magn Reson Med 2024. [PMID: 39171431 DOI: 10.1002/mrm.30256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/30/2024] [Accepted: 07/30/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE Radiotherapy treatment planning (RTP) using MR has been used increasingly for the abdominal site. Multiple contrast weightings and motion-resolved imaging are desired for accurate delineation of the target and various organs-at-risk and patient-tailored planning. Current MR protocols achieve these through multiple scans with distinct contrast and variable respiratory motion management strategies and acquisition parameters, leading to a complex and inaccurate planning process. This study presents a standalone MR Multitasking (MT)-based technique to produce volumetric, motion-resolved, multicontrast images for abdominal radiotherapy treatment planning. METHODS The MT technique resolves motion and provides a wide range of contrast weightings by repeating a magnetization-prepared (saturation recovery and T2 preparations) spoiled gradient-echo readout series and adopting the MT image reconstruction framework. The performance of the technique was assessed through digital phantom simulations and in vivo studies of both healthy volunteers and patients with liver tumors. RESULTS In the digital phantom study, the MT technique presented structural details and motion in excellent agreement with the digital ground truth. The in vivo studies showed that the motion range was highly correlated (R2 = 0.82) between MT and 2D cine imaging. MT allowed for a flexible contrast-weighting selection for better visualization. Initial clinical testing with interobserver analysis demonstrated acceptable target delineation quality (Dice coefficient = 0.85 ± 0.05, Hausdorff distance = 3.3 ± 0.72 mm). CONCLUSION The developed MT-based, abdomen-dedicated technique is capable of providing motion-resolved, multicontrast volumetric images in a single scan, which may facilitate abdominal radiotherapy treatment planning.
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Affiliation(s)
- Junzhou Chen
- Department of Radiology, University of Southern California, Los Angeles, California, USA
- Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA
- Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Anthony G Christodoulou
- Department of Bioengineering, University of California, Los Angeles, California, USA
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Pei Han
- Department of Bioengineering, University of California, Los Angeles, California, USA
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Jiayu Xiao
- Department of Radiology, University of Southern California, Los Angeles, California, USA
| | - Fei Han
- Siemens Medical Solutions USA, Inc., Malvern, Pennsylvania, USA
| | - Zhehao Hu
- Department of Radiology, University of Southern California, Los Angeles, California, USA
- Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA
- Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Nan Wang
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Hui Han
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Diane C Ling
- Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA
| | - Eric L Chang
- Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA
| | - Mary Feng
- Department of Radiation Oncology, University of California, San Francisco, California, USA
| | - Jessica E Scholey
- Department of Radiation Oncology, University of California, San Francisco, California, USA
| | - Sophia Cui
- Siemens Medical Solutions USA, Inc., Malvern, Pennsylvania, USA
| | - Debiao Li
- Department of Bioengineering, University of California, Los Angeles, California, USA
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Wensha Yang
- Department of Radiation Oncology, University of California, San Francisco, California, USA
| | - Zhaoyang Fan
- Department of Radiology, University of Southern California, Los Angeles, California, USA
- Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, USA
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Pucci G, Minafra L, Bravatà V, Calvaruso M, Turturici G, Cammarata FP, Savoca G, Abbate B, Russo G, Cavalieri V, Forte GI. Glut-3 Gene Knockdown as a Potential Strategy to Overcome Glioblastoma Radioresistance. Int J Mol Sci 2024; 25:2079. [PMID: 38396757 PMCID: PMC10889562 DOI: 10.3390/ijms25042079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
The hypoxic pattern of glioblastoma (GBM) is known to be a primary cause of radioresistance. Our study explored the possibility of using gene knockdown of key factors involved in the molecular response to hypoxia, to overcome GBM radioresistance. We used the U87 cell line subjected to chemical hypoxia generated by CoCl2 and exposed to 2 Gy of X-rays, as single or combined treatments, and evaluated gene expression changes of biomarkers involved in the Warburg effect, cell cycle control, and survival to identify the best molecular targets to be knocked-down, among those directly activated by the HIF-1α transcription factor. By this approach, glut-3 and pdk-1 genes were chosen, and the effects of their morpholino-induced gene silencing were evaluated by exploring the proliferative rates and the molecular modifications of the above-mentioned biomarkers. We found that, after combined treatments, glut-3 gene knockdown induced a greater decrease in cell proliferation, compared to pdk-1 gene knockdown and strong upregulation of glut-1 and ldha, as a sign of cell response to restore the anaerobic glycolysis pathway. Overall, glut-3 gene knockdown offered a better chance of controlling the anaerobic use of pyruvate and a better proliferation rate reduction, suggesting it is a suitable silencing target to overcome radioresistance.
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Affiliation(s)
- Gaia Pucci
- Institute of Molecular Bioimaging and Physiology (IBFM)-National Research Council (CNR), Cefalù Secondary Site, C/da Pietrapollastra-Pisciotto, 90015 Cefalù, Italy; (G.P.); (V.B.); (M.C.); (F.P.C.); (G.R.); (G.I.F.)
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STeBiCeF), University of Palermo, Viale delle Scienze Bld.17, 90128 Palermo, Italy;
| | - Luigi Minafra
- Institute of Molecular Bioimaging and Physiology (IBFM)-National Research Council (CNR), Cefalù Secondary Site, C/da Pietrapollastra-Pisciotto, 90015 Cefalù, Italy; (G.P.); (V.B.); (M.C.); (F.P.C.); (G.R.); (G.I.F.)
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STeBiCeF), University of Palermo, Viale delle Scienze Bld.17, 90128 Palermo, Italy;
| | - Valentina Bravatà
- Institute of Molecular Bioimaging and Physiology (IBFM)-National Research Council (CNR), Cefalù Secondary Site, C/da Pietrapollastra-Pisciotto, 90015 Cefalù, Italy; (G.P.); (V.B.); (M.C.); (F.P.C.); (G.R.); (G.I.F.)
| | - Marco Calvaruso
- Institute of Molecular Bioimaging and Physiology (IBFM)-National Research Council (CNR), Cefalù Secondary Site, C/da Pietrapollastra-Pisciotto, 90015 Cefalù, Italy; (G.P.); (V.B.); (M.C.); (F.P.C.); (G.R.); (G.I.F.)
| | - Giuseppina Turturici
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STeBiCeF), University of Palermo, Viale delle Scienze Bld.17, 90128 Palermo, Italy;
| | - Francesco P. Cammarata
- Institute of Molecular Bioimaging and Physiology (IBFM)-National Research Council (CNR), Cefalù Secondary Site, C/da Pietrapollastra-Pisciotto, 90015 Cefalù, Italy; (G.P.); (V.B.); (M.C.); (F.P.C.); (G.R.); (G.I.F.)
| | - Gaetano Savoca
- Radiation Oncology, ARNAS-Civico Hospital, 90100 Palermo, Italy; (G.S.); (B.A.)
| | - Boris Abbate
- Radiation Oncology, ARNAS-Civico Hospital, 90100 Palermo, Italy; (G.S.); (B.A.)
| | - Giorgio Russo
- Institute of Molecular Bioimaging and Physiology (IBFM)-National Research Council (CNR), Cefalù Secondary Site, C/da Pietrapollastra-Pisciotto, 90015 Cefalù, Italy; (G.P.); (V.B.); (M.C.); (F.P.C.); (G.R.); (G.I.F.)
| | - Vincenzo Cavalieri
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STeBiCeF), University of Palermo, Viale delle Scienze Bld.17, 90128 Palermo, Italy;
| | - Giusi I. Forte
- Institute of Molecular Bioimaging and Physiology (IBFM)-National Research Council (CNR), Cefalù Secondary Site, C/da Pietrapollastra-Pisciotto, 90015 Cefalù, Italy; (G.P.); (V.B.); (M.C.); (F.P.C.); (G.R.); (G.I.F.)
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STeBiCeF), University of Palermo, Viale delle Scienze Bld.17, 90128 Palermo, Italy;
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Mittauer KE, Tolakanahalli R, Kotecha R, Chuong MD, Mehta MP, Gutierrez AN, Bassiri N. Commissioning Intracranial Stereotactic Radiosurgery for a Magnetic Resonance-Guided Radiation Therapy (MRgRT) System: MR-RT Localization and Dosimetric End-to-End Validation. Int J Radiat Oncol Biol Phys 2024; 118:512-524. [PMID: 37793574 DOI: 10.1016/j.ijrobp.2023.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 08/04/2023] [Accepted: 08/13/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE This is the first reporting of the MRIdian A3iTM intracranial package (BrainTxTM) and benchmarks the end-to-end localization and dosimetric accuracy for commissioning an magnetic resonace (MR)-guided stereotactic radiosurgery program. We characterized the localization accuracy between MR and radiation (RT) isocenter through an end-to-end hidden target test, relative dose profile intercomparison, and absolute dose validation. METHODS AND MATERIALS BrainTx consists of a dedicated head coil, integrated mask immobilization system, and high-resolution MR sequences. Coil and baseplate attenuation was quantified. An in-house phantom (Cranial phantOm foR magNetic rEsonance Localization of a stereotactIc radiosUrgery doSimeter, CORNELIUS) was developed from a mannequin head filled with silicone gel, film, and MR BB with pinprick. A hidden target test evaluated MR-RT localization of the 1×1×1 mm3 TrueFISP MR and relative dose accuracy in film for a 1 cm diameter (International Electrotechnical Commission (IEC)-X/IEC-Y) and 1.5 cm diameter (IEC-Y/IEC-Z) spherical target. Two clinical cases (irregular-shaped target and target abutting brainstem) were mapped to the CORNELIUS phantom for feasibility assessment. A 2-dimensional (2D)-gamma compared calculated and measured dose for spherical and clinical targets with 1 mm/1% and 2 mm/2% criteria, respectively. A small-field chamber (A26MR) measured end-to-end absolute dose for a 1 cm diameter target. RESULTS Coil and baseplate attenuation were 0.7% and 2.7%, respectively. The displacement of MR to RT localization as defined through the pinprick was 0.49 mm (IEC-X), 0.27 mm (IEC-Y), and 0.51 mm (IEC-Z) (root mean square 0.76 mm). The reproducibility across IEC-Y demonstrated high fidelity (<0.02 mm). Gamma pass rates were 97.1% and 95.4% for 1 cm and 1.5 cm targets, respectively. Dose profiles for an irregular-shaped target and abutting organ-at-risk-target demonstrated pass rates of 99.0% and 92.9%, respectively. The absolute end-to-end dose difference was <1%. CONCLUSIONS All localization and dosimetric evaluation demonstrated submillimeter accuracy, per the TG-142, TG-101, MPPG 9.a. criteria for SRS/SRT systems, indicating acceptable delivery capabilities with a 1 mm setup margin.
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Affiliation(s)
- Kathryn E Mittauer
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.
| | - Ranjini Tolakanahalli
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Michael D Chuong
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Alonso N Gutierrez
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Nema Bassiri
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
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Moats E, Siddiqui MS, Parikh P, Snyder KC. Dosimetric comparison of glioblastoma radiotherapy treatment plans on a low-field MRI-guided linear accelerator compared to conventional C-arm linear accelerator. Med Dosim 2024; 49:215-221. [PMID: 38233319 DOI: 10.1016/j.meddos.2023.12.004] [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: 11/17/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Magnetic resonance imaging (MRI)-guided radiation therapy has proven to provide many benefits such as real-time tracking, dose escalation, and the ability to perform online adaptive therapy. The objective of this study is to compare curative treatment plans for glioblastoma tumors on a low-field MR-guided linac vs a C-arm linac and evaluate if they are comparable in terms of coverage, organ at risk sparing, delivery time, and deliverability. METHODS This is a retrospective study that consisted of 15 previously treated patients who received radiation therapy for glioblastoma on a C-arm linac. The CT simulation data used for the original clinical plans was imported into the MR-linac treatment planning system (TPS) and utilized for MR-linac plan generation. The plans were evaluated utilizing the dose volumetric histogram (DVH) and isodose lines, then compared in terms of plan quality consisting of PTV coverage, dose distributions, and OAR constraints. Statistical analysis was performed to compare differences between the two planning techniques. QA was performed on a subset of the plans to verify deliverability. RESULTS Plans generated on the MR-linac were more heterogenous compared to C-arm linac plans. A statistically significant difference was found in the homogeneity index (HI) and the PTV V105% volume (cc) values. The volume of the normal brain receiving 30 Gy also showed a statistically significant (p = 0.0479) difference, where on average an additional 41.5 cc's of the normal brain tissue received 30 Gy in the MR-linac plans. The maximum dose to the normal brain structure also increased in the MR-linac plans on average by 2.6 Gy (p = 0.0002). Similarly, the average maximum dose to the scalp 4 mm structure was 6.5 Gy higher in the MR-linac plans compared to C-arm linac plans (p = 0.0103). The total MU's were higher in the MR-linac plans compared to the C-arm linac plans (p = 0.0015). CONCLUSIONS Both MR-linac and C-arm linac plans met constraints for PTV coverage and OAR sparing, were deliverable, and resulted to be clinically acceptable. However, our study showed that MR-linac plans were not as conformal or as homogenous as C-arm linac plans utilizing noncoplanar beams.
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Li Y, Zhang H, Yue L, Fu C, Grimm R, Li W, Guo W, Tong T. Whole tumor based texture analysis of magnetic resonance diffusion imaging for colorectal liver metastases: A prospective study for diffusion model comparison and early response biomarker. Eur J Radiol 2024; 170:111203. [PMID: 38007855 DOI: 10.1016/j.ejrad.2023.111203] [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: 08/27/2023] [Revised: 10/16/2023] [Accepted: 11/14/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE To evaluate and compare the diagnostic value of diffusion-related texture analysis parameters obtained from various magnetic resonance diffusion models as early predictors of the clinical response to chemotherapy in patients with colorectal liver metastases (CRLM). METHODS Patients (n = 145) with CRLM were prospectively and consecutively enrolled and scanned using diffusion-weighted imaging (DWI)-magnetic resonance imaging (MRI)/intravoxel incoherent motion (IVIM)/diffusion kurtosis imaging (DKI) before (baseline) and two-three weeks after (follow-up) commencing chemotherapy. Therapy response was evaluated based on the Response Evaluation Criteria in Solid Tumors (RECIST, version 1.1). The histogram and texture parameters of each diffusion-related parametric map were analysed between the responding and non-responding groups, screened using LASSO, and fitted with binary logistic regression models. The diagnostic efficacy of each model in the early prediction of CRLM was analysed, and the corresponding receiver operating characteristic (ROC) curve was drawn. The area under the curve (AUC) and 95% confidence intervals (CI) were calculated. RESULTS Of the 145 analysed patients, 69 were in the responding group and 76 were in the non-responding group. Among all models, the difference value based on the histogram and texture features of the DKI-derived parameters performed best for the early prediction of CRLM treatment efficacy. The AUC of the DKI model in the validation set reached 0.795 (95% CI 0.652-0.938). Among the IVIM-derived parameters, the difference model based on D and D* performed best, and the AUC in the validation set reached 0.737 (95% CI 0.586-0.889). Finally, in the DWI sequence, the model comprising baseline features performed the best, with an AUC of 0.699 (95% CI 0.537-0.86) in the validation set. CONCLUSIONS Baseline DWI parameters and follow-up changes in IVIM and DKI parameters predicted the chemotherapeutic response in patients with CRLM. In addition, as very early predictors, DKI-derived parameters were more effective than DWI- and IVIM-related parameters, in which changes in D-parameters performed best.
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Affiliation(s)
- Yue Li
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Huan Zhang
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lei Yue
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Caixia Fu
- MR Collaboration, Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Robert Grimm
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Wenhua Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Weijian Guo
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Tong Tong
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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Sohn JJ, Lim S, Das IJ, Yadav P. An integrated and fast imaging quality assurance phantom for a 0.35 T magnetic resonance imaging linear accelerator. Phys Imaging Radiat Oncol 2023; 27:100462. [PMID: 37449023 PMCID: PMC10338140 DOI: 10.1016/j.phro.2023.100462] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose Periodic imaging quality assurance (QA) of magnetic resonance imaging linear accelerator (MRL) is critical. The feasibility of a new MRL imaging phantom used for QA in the low field was evaluated with automated image analysis of various parameters for accuracy and reproducibility. Methods and materials The new MRL imaging phantom was scanned across every 30 degrees of the gantry, having the on/off state of the linac in a low-field MRL system using three magnetic resonance imaging sequences: true fast imaging with steady-state precession (TrueFISP), T1 weighted (T1W), and T2 weighted (T2W). The DICOM files were used to calculate the imaging parameters: geometric distortion, uniformity, resolution, signal-to-noise ratio (SNR), and laser alignment. The point spread function (PSF) and edge spread function (ESF) were also calculated for resolution analysis. Results The phantom data showed a small standard deviation - and high consistency for each imaging parameter. The highest variability in data was observed with the true fast imaging sequence at the calibration angle, which was expected because of low resolution and short scan time (25 sec). The mean magnitude of the largest distortion measured within 200 mm diameter with TrueFISP was 0.31 ± 0.05 mm. The PSF, ESF, signal uniformity, and SNR measurements remained consistent. Laser alignment traditional offsets and angular deviation remained consistent. Conclusions The new MRL imaging phantom is reliable, reproducible, time effective, and easy to use for a 0.35 T MRL system. The results promise a more streamlined, time-saving, and error-free QA process for low-field MRL adapted in our clinical setting.
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Affiliation(s)
| | | | | | - Poonam Yadav
- Corresponding author at: Department of Radiation Oncology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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La Rosa A, Mittauer KE, Rzepczynski AE, Chuong MD, Kutuk T, Bassiri N, McAllister NC, Hall MD, McCulloch J, Alvarez D, Herrera R, Gutierrez AN, Tolakanahalli R, Odia Y, Ahluwalia MS, Mehta MP, Kotecha R. Treatment of glioblastoma using MRIdian® A3i BrainTx™: Imaging and treatment workflow demonstration. Med Dosim 2023:S0958-3947(23)00019-5. [PMID: 36966049 DOI: 10.1016/j.meddos.2023.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 03/27/2023]
Abstract
For patients with newly diagnosed glioblastoma, the current standard-of-care includes maximal safe resection, followed by concurrent chemoradiotherapy and adjuvant temozolomide, with tumor treating fields. Traditionally, diagnostic imaging is performed pre- and post-resection, without additional dedicated longitudinal imaging to evaluate tumor volumes or other treatment-related changes. However, the recent introduction of MR-guided radiotherapy using the ViewRay MRIdian A3i system includes a dedicated BrainTx package to facilitate the treatment of intracranial tumors and provides daily MR images. We present the first reported case of a glioblastoma imaged and treated using this workflow. In this case, a 67-year-old woman underwent adjuvant chemoradiotherapy after gross total resection of a left frontal glioblastoma. The radiotherapy treatment plan consisted of a traditional two-phase design (46 Gy followed by a sequential boost to a total dose of 60 Gy at 2 Gy/fraction). The treatment planning process, institutional workflow, treatment imaging, treatment timelines, and target volume changes visualized during treatment are presented. This case example using our institutional A3i system workflow successfully allows for imaging and treatment of primary brain tumors and has the potential for margin reduction, detection of early disease progression, or to detect the need for dose adaptation due to interfraction tumor volume changes.
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Affiliation(s)
- Alonso La Rosa
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Kathryn E Mittauer
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA; Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Amy E Rzepczynski
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Michael D Chuong
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA; Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Tugce Kutuk
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Nema Bassiri
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Nicole C McAllister
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Matthew D Hall
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA; Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - James McCulloch
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA; Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Diane Alvarez
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA; Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Roberto Herrera
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Alonso N Gutierrez
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA; Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Ranjini Tolakanahalli
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA; Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Yazmin Odia
- Department of Neuro-Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Manmeet S Ahluwalia
- Department of Medical Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA; Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA; Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
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Snyder KC, Mao W, Kim JP, Cunningham J, Chetty IJ, Siddiqui SM, Parikh P, Dolan J. Commissioning, clinical implementation, and initial experience with a new brain tumor treatment package on a low‐field MR‐linac. J Appl Clin Med Phys 2023. [DOI: 10.1002/acm2.13919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Affiliation(s)
- Karen Chin Snyder
- Department of Radiation Oncology Henry Ford Health Detroit Michigan USA
| | - Weihua Mao
- Department of Radiation Oncology Henry Ford Health Detroit Michigan USA
| | - Joshua P. Kim
- Department of Radiation Oncology Henry Ford Health Detroit Michigan USA
| | | | - Indrin J. Chetty
- Department of Radiation Oncology Henry Ford Health Detroit Michigan USA
| | - Salim M. Siddiqui
- Department of Radiation Oncology Henry Ford Health Detroit Michigan USA
| | - Parag Parikh
- Department of Radiation Oncology Henry Ford Health Detroit Michigan USA
| | - Jennifer Dolan
- Department of Radiation Oncology Henry Ford Health Detroit Michigan USA
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9
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Seravalli E, Sierts M, Brand E, Maspero M, David S, Philippens MEP, Voormolen EHJ, Verhoeff JJC. Dosimetric feasibility of direct post-operative MR-Linac-based stereotactic radiosurgery for resection cavities of brain metastases. Radiother Oncol 2023; 179:109456. [PMID: 36592740 DOI: 10.1016/j.radonc.2022.109456] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Post-operative radiosurgery (SRS) of brain metastases patients is typically planned on a post-recovery MRI, 2-4 weeks after resection. However, the intracranial metastasis may (re-)grow in this period. Planning SRS directly on the post-operative MRI enables shortening this time interval, anticipating the start of adjuvant systemic therapy, and so decreasing the chance of extracranial progression. The MRI-Linac (MRL) allows the simultaneous execution of the post-operative MRI and SRS treatment. The aim of this work was investigating the dosimetric feasibility of MRL-based post-operative SRS. METHODS MRL treatments based on the direct post-operative MRI were simulated, including thirteen patients with resectable single brain metastases. The gross tumor volume (GTV) was contoured on the direct post-operative scans and compared to the post-recovery MRI GTV. Three plans for each patient were created: a non-coplanar VMAT CT-Linac plan (ncVMAT) and a coplanar IMRT MRL plan (cIMRT) on the direct post-operative MRI, and a ncVMAT plan on the post-recovery MRI as the current clinical standard. RESULTS Between the direct post-operative and post-recovery MRI, 15.5 % of the cavities shrunk by > 2 cc, and 46 % expanded by ≥ 2 cc. Although the direct post-operative cIMRT plans had a higher median gradient index (3.6 vs 2.7) and median V3Gy of the skin (18.4 vs 1.1 cc) compared to ncVMAT plans, they were clinically acceptable. CONCLUSION Direct post-operative MRL-based SRS for resection cavities of brain metastases is dosimetrically acceptable, with the advantages of increased patient comfort and logistics. Clinical benefit of this workflow should be investigated given the dosimetric plausibility.
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Affiliation(s)
- Enrica Seravalli
- Department of Radiation Oncology, University Medical Centre Utrecht, the Netherlands.
| | - Michelle Sierts
- Department of Radiation Oncology, University Medical Centre Utrecht, the Netherlands
| | - Eric Brand
- Department of Radiation Oncology, University Medical Centre Utrecht, the Netherlands
| | - Matteo Maspero
- Department of Radiation Oncology, University Medical Centre Utrecht, the Netherlands
| | - Szabolcs David
- Department of Radiation Oncology, University Medical Centre Utrecht, the Netherlands
| | | | | | - Joost J C Verhoeff
- Department of Radiation Oncology, University Medical Centre Utrecht, the Netherlands
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10
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Stewart J, Sahgal A, Zadeh MM, Moazen B, Jabehdar Maralani P, Breen S, Lau A, Binda S, Keller B, Husain Z, Myrehaug S, Detsky J, Soliman H, Tseng CL, Ruschin M. Empirical planning target volume modeling for high precision MRI guided intracranial radiotherapy. Clin Transl Radiat Oncol 2023; 39:100582. [PMID: 36699195 PMCID: PMC9869418 DOI: 10.1016/j.ctro.2023.100582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Purpose Magnetic resonance image-guided radiotherapy for intracranial indications is a promising advance; however, uncertainties remain for both target localization after translation-only MR setup and intrafraction motion. This investigation quantified these uncertainties and developed a population-based planning target volume (PTV) model to explore target and organ-at-risk (OAR) volumetric coverage tradeoffs. Methods Sixty-six patients, 49 with a primary brain tumor and 17 with a post-surgical resection cavity, treated on a 1.5T-based MR-linac across 1329 fractions were included. At each fraction, patients were setup by translation-only fusion of the online T1 MRI to the planning image. Each fusion was independently repeated offline accounting for rotations. The six degree-of-freedom difference between fusions was applied to transform the planning CTV at each fraction (CTVfx). A PTV model parameterized by volumetric CTVfx coverage, proportion of fractions, and proportion of patients was developed. Intrafraction motion was quantified in a 412 fraction subset as the fusion difference between post- and pre-irradiation T1 MRIs. Results For the left-right/anterior-posterior/superior-inferior axes, mean ± SD of the rotational fusion differences were 0.1 ± 0.8/0.1 ± 0.8/-0.2 ± 0.9°. Covering 98 % of the CTVfx in 95 % of fractions in 95 % of patients required a 3 mm PTV margin. Margin reduction decreased PTV-OAR overlap; for example, the proportion of optic chiasm overlapped by the PTV was reduced up to 23.5 % by margin reduction from 4 mm to 3 mm. Conclusions An evidence-based PTV model was developed for brain cancer patients treated on the MR-linac. Informed by this model, we have clinically adopted a 3 mm PTV margin for conventionally fractionated intracranial patients.
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Affiliation(s)
- James Stewart
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Mahtab M. Zadeh
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Bahareh Moazen
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Pejman Jabehdar Maralani
- Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Stephen Breen
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Canada
| | - Angus Lau
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Shawn Binda
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada
| | - Brian Keller
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Canada
| | - Zain Husain
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Mark Ruschin
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Canada
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Corresponding author at: Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
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11
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Guerini AE, Nici S, Magrini SM, Riga S, Toraci C, Pegurri L, Facheris G, Cozzaglio C, Farina D, Liserre R, Gasparotti R, Ravanelli M, Rondi P, Spiazzi L, Buglione M. Adoption of Hybrid MRI-Linac Systems for the Treatment of Brain Tumors: A Systematic Review of the Current Literature Regarding Clinical and Technical Features. Technol Cancer Res Treat 2023; 22:15330338231199286. [PMID: 37774771 PMCID: PMC10542234 DOI: 10.1177/15330338231199286] [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: 04/28/2023] [Revised: 07/24/2023] [Accepted: 08/08/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Possible advantages of magnetic resonance (MR)-guided radiation therapy (MRgRT) for the treatment of brain tumors include improved definition of treatment volumes and organs at risk (OARs) that could allow margin reductions, resulting in limited dose to the OARs and/or dose escalation to target volumes. Recently, hybrid systems integrating a linear accelerator and an magnetic resonance imaging (MRI) scan (MRI-linacs, MRL) have been introduced, that could potentially lead to a fully MRI-based treatment workflow. METHODS We performed a systematic review of the published literature regarding the adoption of MRL for the treatment of primary or secondary brain tumors (last update November 3, 2022), retrieving a total of 2487 records; after a selection based on title and abstracts, the full text of 74 articles was analyzed, finally resulting in the 52 papers included in this review. RESULTS AND DISCUSSION Several solutions have been implemented to achieve a paradigm shift from CT-based radiotherapy to MRgRT, such as the management of geometric integrity and the definition of synthetic CT models that estimate electron density. Multiple sequences have been optimized to acquire images with adequate quality with on-board MR scanner in limited times. Various sophisticated algorithms have been developed to compensate the impact of magnetic field on dose distribution and calculate daily adaptive plans in a few minutes with satisfactory dosimetric parameters for the treatment of primary brain tumors and cerebral metastases. Dosimetric studies and preliminary clinical experiences demonstrated the feasibility of treating brain lesions with MRL. CONCLUSIONS The adoption of an MRI-only workflow is feasible and could offer several advantages for the treatment of brain tumors, including superior image quality for lesions and OARs and the possibility to adapt the treatment plan on the basis of daily MRI. The growing body of clinical data will clarify the potential benefit in terms of toxicity and response to treatment.
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Affiliation(s)
- Andrea Emanuele Guerini
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
- Co-first authors
| | - Stefania Nici
- Medical Physics Department, ASST Spedali Civili Hospital, Brescia, Italy
- Co-first authors
| | - Stefano Maria Magrini
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Stefano Riga
- Medical Physics Department, ASST Spedali Civili Hospital, Brescia, Italy
| | - Cristian Toraci
- Medical Physics Department, ASST Spedali Civili Hospital, Brescia, Italy
| | - Ludovica Pegurri
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Giorgio Facheris
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Claudia Cozzaglio
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
- Medical Physics Department, ASST Spedali Civili Hospital, Brescia, Italy
| | - Davide Farina
- Radiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Roberto Liserre
- Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy
| | - Roberto Gasparotti
- Neuroradiology Unit, Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Ravanelli
- Radiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Paolo Rondi
- Radiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Luigi Spiazzi
- Medical Physics Department, ASST Spedali Civili Hospital, Brescia, Italy
- Co-last author
| | - Michela Buglione
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
- Co-last author
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12
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MRI-guided Radiotherapy (MRgRT) for treatment of Oligometastases: Review of clinical applications and challenges. Int J Radiat Oncol Biol Phys 2022; 114:950-967. [PMID: 35901978 DOI: 10.1016/j.ijrobp.2022.07.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE Early clinical results on the application of magnetic resonance imaging (MRI) coupled with a linear accelerator to deliver MR-guided radiation therapy (MRgRT) have demonstrated feasibility for safe delivery of stereotactic body radiotherapy (SBRT) in treatment of oligometastatic disease. Here we set out to review the clinical evidence and challenges associated with MRgRT in this setting. METHODS AND MATERIALS We performed a systematic review of the literature pertaining to clinical experiences and trials on the use of MRgRT primarily for the treatment of oligometastatic cancers. We reviewed the opportunities and challenges associated with the use of MRgRT. RESULTS Benefits of MRgRT pertaining to superior soft-tissue contrast, real-time imaging and gating, and online adaptive radiotherapy facilitate safe and effective dose escalation to oligometastatic tumors while simultaneously sparing surrounding healthy tissues. Challenges concerning further need for clinical evidence and technical considerations related to planning, delivery, quality assurance (QA) of hypofractionated doses, and safety in the MRI environment must be considered. CONCLUSIONS The promising early indications of safety and effectiveness of MRgRT for SBRT-based treatment of oligometastatic disease in multiple treatment locations should lead to further clinical evidence to demonstrate the benefit of this technology.
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13
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Pang Y, Wang H, Li H. Medical Imaging Biomarker Discovery and Integration Towards AI-Based Personalized Radiotherapy. Front Oncol 2022; 11:764665. [PMID: 35111666 PMCID: PMC8801459 DOI: 10.3389/fonc.2021.764665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/29/2021] [Indexed: 12/22/2022] Open
Abstract
Intensity-modulated radiation therapy (IMRT) has been used for high-accurate physical dose distribution sculpture and employed to modulate different dose levels into Gross Tumor Volume (GTV), Clinical Target Volume (CTV) and Planning Target Volume (PTV). GTV, CTV and PTV can be prescribed at different dose levels, however, there is an emphasis that their dose distributions need to be uniform, despite the fact that most types of tumour are heterogeneous. With traditional radiomics and artificial intelligence (AI) techniques, we can identify biological target volume from functional images against conventional GTV derived from anatomical imaging. Functional imaging, such as multi parameter MRI and PET can be used to implement dose painting, which allows us to achieve dose escalation by increasing doses in certain areas that are therapy-resistant in the GTV and reducing doses in less aggressive areas. In this review, we firstly discuss several quantitative functional imaging techniques including PET-CT and multi-parameter MRI. Furthermore, theoretical and experimental comparisons for dose painting by contours (DPBC) and dose painting by numbers (DPBN), along with outcome analysis after dose painting are provided. The state-of-the-art AI-based biomarker diagnosis techniques is reviewed. Finally, we conclude major challenges and future directions in AI-based biomarkers to improve cancer diagnosis and radiotherapy treatment.
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Affiliation(s)
- Yaru Pang
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Hui Wang
- Department of Chemical Engineering, University College London, London, United Kingdom
| | - He Li
- Department of Engineering, University of Cambridge, Cambridge, United Kingdom
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14
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Han EY, Wang H, Briere TM, Yeboa DN, Boursianis T, Kalaitzakis G, Pappas E, Castillo P, Yang J. Brain stereotactic radiosurgery using MR-guided online adaptive planning for daily setup variation: An end-to-end test. J Appl Clin Med Phys 2022; 23:e13518. [PMID: 34994101 PMCID: PMC8906207 DOI: 10.1002/acm2.13518] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/02/2021] [Accepted: 12/09/2021] [Indexed: 11/21/2022] Open
Abstract
Online magnetic resonance (MR)‐guided radiotherapy is expected to benefit brain stereotactic radiosurgery (SRS) due to superior soft tissue contrast and capability of daily adaptive planning. The purpose of this study was to investigate daily adaptive plan quality with setup variations and to perform an end‐to‐end test for brain SRS with multiple metastases treated with a 1.5‐Tesla MR‐Linac (MRL). The RTsafe PseudoPatient Prime brain phantom was used with a delineation insert that includes two predefined structures mimicking gadolinium contrast‐enhanced brain lesions. Daily adaptive plans were generated using six preset and six random setup variations. Two adaptive plans per daily MR image were generated using the adapt‐to‐position (ATP) and adapt‐to‐shape (ATS) workflows. An adaptive patient plan was generated on a diagnostic MR image with simulated translational and rotational daily setup variation and was compared with the reference plan. All adaptive plans were compared with the reference plan using the target coverage, Paddick conformity index, gradient index (GI), Brain V12 or V20, optimization time and total monitor units. Target doses were measured as an end‐to‐end test with two ionization chambers inserted into the phantom. With preset translational variations, V12 from the ATS plan was 17% lower than that of the ATP plan. With a larger daily setup variation, GI and V12 of the ATS plan were 10% and 16% lower than those of the ATP plan, respectively. Compared to the ATP plans, the plan quality index of the ATS plans was more consistent with the reference plan, and within 5% in both phantom and patient plans. The differences between the measured and planned target doses were within 1% for both treatment workflows. Treating brain SRS using an MRL is feasible and could achieve satisfactory dosimetric goals. Setup uncertainties could be accounted for using online plan adaptation. The ATS workflow achieved better dosimetric results than the ATP workflow at the cost of longer optimization time.
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Affiliation(s)
- Eun Young Han
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - He Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tina Marie Briere
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Debra Nana Yeboa
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | | | - Evangelos Pappas
- Department of Biomedical Sciences, Radiology and Radiotherapy Sector, University of West Attica, Athens, Greece
| | - Pamela Castillo
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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15
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Tan H, Stewart J, Ruschin M, Wang MH, Myrehaug S, Tseng CL, Detsky J, Husain Z, Chen H, Sahgal A, Soliman H. Inter-fraction dynamics during post-operative 5 fraction cavity hypofractionated stereotactic radiotherapy with a MR LINAC: a prospective serial imaging study. J Neurooncol 2022; 156:569-577. [PMID: 34981300 DOI: 10.1007/s11060-021-03938-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE/OBJECTIVE(S) This study examined changes in the clinical target volume (CTV) and associated clinical implications on a magnetic resonance imaging linear accelerator (MR LINAC) during hypofractionated stereotactic radiotherapy (HSRT) to resected brain metastases. In addition, the suitability of using T2/FLAIR (T2f) sequence to define CTV was explored by assessing contouring variability between gadolinium-enhanced T1 (T1c) and T2f sequences. MATERIALS/METHODS Fifteen patients treated to either 27.5 or 30 Gy with five fraction HSRT were imaged with T1c and T2f sequences during treatment; T1c was acquired at planning (FxSim), and fraction 3 (Fx3), and T2f was acquired at FxSim and all five fractions. The CTV were contoured on all acquired images. Inter-fraction cavity dynamics and CTV contouring variability were quantified using absolute volume, Dice similarity coefficient (DSC), and Hausdorff distance (HD) metrics. RESULTS The median CTV on T1c and T2f sequences at FxSim were 12.0cm3 (range, 1.2-30.1) and 10.2cm3 (range, 2.9-27.9), respectively. At Fx3, the median CTV decreased in both sequences to 9.3cm3 (range, 3.7-25.9) and 8.6cm3 (range, 3.3-22.5), translating to a median % relative reduction of - 11.4% on T1c (p = 0.009) and - 8.4% on T2f (p = 0.032). We observed a median % relative reduction in CTV between T1c and T2f at FxSim of - 6.0% (p = 0.040). The mean DSC was 0.85 ± 0.10, and the mean HD was 5.3 ± 2.7 mm when comparing CTV on T1c and T2f at FxSim. CONCLUSION Statistically significant reductions in cavity CTV was observed during HSRT, supporting the use of MR image guided radiation therapy and treatment adaptation to mitigate toxicity. Significant CTV contouring variability was seen between T1c and T2f sequences. Trial registration NCT04075305 - August 30, 2019.
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Affiliation(s)
- Hendrick Tan
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
- GenesisCare, Perth, WA, Australia
| | - James Stewart
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Mark Ruschin
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Department of Medical Physics, Sunnybrook Odette Cancer Centre, Toronto, Canada
| | - Michael H Wang
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Zain Husain
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Hanbo Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
- Department of Radiation Oncology, University of Toronto, Toronto, Canada.
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Kozak MM, Crompton D, Gross BA, Harshman L, Dickens D, Snyder J, Shepard A, St-Aubin J, Dunkerley D, Hyer D, Buatti JM. Initial clinical applications treating pediatric and adolescent patients using MR-guided radiotherapy. Front Oncol 2022; 12:962926. [PMID: 36419881 PMCID: PMC9676495 DOI: 10.3389/fonc.2022.962926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/21/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose To demonstrate the clinical applications and feasibility of online adaptive magnetic resonance image guided radiotherapy (MRgRT) in the pediatric, adolescent and young adult (AYA) population. Methods This is a retrospective case series of patients enrolled onto a prospective study. All pediatric (age < 18) and AYA patients (age< 30), treated on the Elekta Unity MR linear accelerator (MRL) from 2019 to 2021 were enrolled onto a prospective registry. Rationale for MRgRT included improved visualization of and alignment to the primary tumor, re-irradiation in a critical area, ability to use smaller margins, and need for daily adaptive replanning to minimize dose to adjacent critical structures. Step-and-shoot intensity-modulated radiation treatment (IMRT) plans were generated for all Unity patients with a dose grid of 3 mm and a statistical uncertainty of < 1% per plan. Results A total of 15 pediatric and AYA patients have been treated with median age of 13 years (range: 6 mos - 27 yrs). Seven patients were <10 yo. The clinical applications of MRgRT included Wilms tumor with unresectable IVC thrombus (n=1), Ewing sarcoma (primary and metastatic, n=3), recurrent diffuse intrinsic pontine glioma (DIPG, n=2), nasopharyngeal carcinoma (n=1), clival chordoma (n=1), primitive neuroectodermal tumor of the pancreas (n=1), recurrent gluteo-sacral germ cell tumor (n=1), C-spine ependymoma (n=1), and posterior fossa ependymoma (n=1). Two children required general anesthesia. One AYA patient could not complete the MRgRT course due to tumor-related pain exacerbated by longer treatment times. Two AYA patients experienced anxiety related to treatment on the MRL, one of which required daily Ativan. No patient experienced treatment interruptions or unexpected toxicity. Conclusion MRgRT was well-tolerated by pediatric and AYA patients. There was no increased use of anesthesia outside of our usual practice. Dosimetric advantages were seen for patients with tumors in critical locations such as adjacent to or involving optic structures, stomach, kidney, bowel, and heart.
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Affiliation(s)
- Margaret M Kozak
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa, IA, United States
| | - David Crompton
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa, IA, United States
| | - Brandie A Gross
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa, IA, United States
| | - Lyndsay Harshman
- Department of Pediatrics, the University of Iowa Hospitals and Clinics, Iowa, IA, United States
| | - David Dickens
- Department of Hematology/Oncology, University of Iowa Hospitals and Clinics, Iowa, IA, United States
| | - Jeffrey Snyder
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa, IA, United States
| | - Andrew Shepard
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa, IA, United States
| | - Joël St-Aubin
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa, IA, United States
| | - David Dunkerley
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa, IA, United States
| | - Daniel Hyer
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa, IA, United States
| | - John M Buatti
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa, IA, United States
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17
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Xu K, Jiang X, Ariston Gabriel AN, Li X, Wang Y, Xu S. Evolving Landscape of Long Non-coding RNAs in Cerebrospinal Fluid: A Key Role From Diagnosis to Therapy in Brain Tumors. Front Cell Dev Biol 2021; 9:737670. [PMID: 34692695 PMCID: PMC8529119 DOI: 10.3389/fcell.2021.737670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022] Open
Abstract
Long non-coding RNAs (lncRNAs) are a type of non-coding RNAs that act as molecular fingerprints and modulators of many pathophysiological processes, particularly in cancer. Specifically, lncRNAs can be involved in the pathogenesis and progression of brain tumors, affecting stemness/differentiation, replication, invasion, survival, DNA damage response, and chromatin dynamics. Furthermore, the aberrations in the expressions of these transcripts can promote treatment resistance, leading to tumor recurrence. The development of next-generation sequencing technologies and the creation of lncRNA-specific microarrays have boosted the study of lncRNA etiology. Cerebrospinal fluid (CSF) directly mirrors the biological fluid of biochemical processes in the brain. It can be enriched for small molecules, peptides, or proteins released by the neurons of the central nervous system (CNS) or immune cells. Therefore, strategies that identify and target CSF lncRNAs may be attractive as early diagnostic and therapeutic options. In this review, we have reviewed the studies on CSF lncRNAs in the context of brain tumor pathogenesis and progression and discuss their potential as biomarkers and therapeutic targets.
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Affiliation(s)
- Kanghong Xu
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Xinquan Jiang
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | | | - Xiaomeng Li
- Department of Hematology, Jining First People's Hospital, Jining, China
| | - Yunshan Wang
- Department of Clinical Laboratory, The Second Hospital of Shandong University, Jinan, China
| | - Shuo Xu
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China.,Key Laboratory of Brain Function Remodeling, Qilu Hospital of Shandong University, Jinan, China
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Olson JJ. Congress of Neurological Surgeons systematic review and evidence-based guidelines for the treatment of adults with progressive glioblastoma update: introduction and methods. J Neurooncol 2021; 158:133-137. [PMID: 34694566 DOI: 10.1007/s11060-021-03850-3] [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: 08/21/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The management of glioblastoma at the time of progression is an important facet of all physicians involved in neuro-oncology. This is an update of the evidence-based guidelines for management of progressive glioblastoma published by the Congress of Neurological Surgeons and American Association of Neurological Surgeons in 2014. METHODS The medical literature from July 1, 2012 through March 31, 2019 was searched in MEDLINE® and Embase® and the Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Registry, and Cochrane Database of Abstracts of Reviews of Effects to determine if information was available to update, modify or create new recommendations related to imaging, cytoreductive surgery, neuropathology, radiotherapy, cytotoxic chemotherapy, targeted therapy, and immunotherapy. RESULTS The writing group utilized the information from the updated literature search to formulate recommendations that were exclusively evidence based and not founded on potentially biased consensus or expert opinion. CONCLUSION The series of guideline documents provides an update of the information and recommendations that could be derived in the 2014 version. It sets a benchmark as to what we really know about the management of this difficult disease. It also provides clues to key investigations that are necessary to move us toward truly effective disease control.
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Affiliation(s)
- Jeffrey J Olson
- Department of Neurosurgery, School of Medicine, Emory University, 1365 Clifton Road Northeast, Bldg. B, Fl 2, Ste 2200, Atlanta, GA, 30322, USA.
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19
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Lawrence LSP, Chan RW, Chen H, Keller B, Stewart J, Ruschin M, Chugh B, Campbell M, Theriault A, Stanisz GJ, MacKenzie S, Myrehaug S, Detsky J, Maralani PJ, Tseng CL, Czarnota GJ, Sahgal A, Lau AZ. Accuracy and precision of apparent diffusion coefficient measurements on a 1.5 T MR-Linac in central nervous system tumour patients. Radiother Oncol 2021; 164:155-162. [PMID: 34592363 DOI: 10.1016/j.radonc.2021.09.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE MRI linear accelerators (MR-Linacs) may allow treatment adaptation to be guided by quantitative MRI including diffusion-weighted imaging (DWI). The aim of this study was to evaluate the accuracy and precision of apparent diffusion coefficient (ADC) measurements from DWI on a 1.5 T MR-Linac in patients with central nervous system (CNS) tumours through comparison with a diagnostic scanner. MATERIALS AND METHODS CNS patients were treated using a 1.5 T Elekta Unity MR-Linac. DWI was acquired during MR-Linac treatment and on a Philips Ingenia 1.5 T. The agreement between the two scanners on median ADC over the gross tumour/clinical target volumes (GTV/CTV) and in brain regions (white/grey matter, cerebrospinal fluid (CSF)) was computed. Repeated scans were used to estimate ADC repeatability. Daily changes in ADC over the GTV of high-grade gliomas were characterized from MR-Linac scans. RESULTS DWI from 59 patients was analyzed. MR-Linac ADC measurements showed a small bias relative to Ingenia measurements in white matter, grey matter, GTV, and CTV (bias: -0.05 ± 0.03, -0.08 ± 0.05, -0.1 ± 0.1, -0.08 ± 0.07 μm2/ms). ADC differed substantially in CSF (bias: -0.5 ± 0.3 μm2/ms). The repeatability of MR-Linac ADC over white/grey matter was similar to previous reports (coefficients of variation for median ADC: 1.4%/1.8%). MR-Linac ADC changes in the GTV were detectable. CONCLUSIONS It is possible to obtain ADC measurements in the brain on a 1.5 T MR-Linac that are comparable to those of diagnostic-quality scanners. This technical validation study adds to the foundation for future studies that will correlate brain tumour ADC with clinical outcomes.
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Affiliation(s)
- Liam S P Lawrence
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Rachel W Chan
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
| | - Hanbo Chen
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Brian Keller
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - James Stewart
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Mark Ruschin
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Brige Chugh
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Department of Physics, Ryerson University, Toronto, Canada
| | - Mikki Campbell
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Aimee Theriault
- Department of Medical Biophysics, University of Toronto, Toronto, Canada; Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada; Department of Neurosurgery and Paediatric Neurosurgery, Medical University, Lublin, Poland
| | - Greg J Stanisz
- Department of Medical Biophysics, University of Toronto, Toronto, Canada; Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada; Department of Neurosurgery and Paediatric Neurosurgery, Medical University, Lublin, Poland
| | - Scott MacKenzie
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Pejman J Maralani
- Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Greg J Czarnota
- Department of Medical Biophysics, University of Toronto, Toronto, Canada; Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada; Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Angus Z Lau
- Department of Medical Biophysics, University of Toronto, Toronto, Canada; Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada.
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20
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Cuccia F, Alongi F, Belka C, Boldrini L, Hörner-Rieber J, McNair H, Rigo M, Schoenmakers M, Niyazi M, Slagter J, Votta C, Corradini S. Patient positioning and immobilization procedures for hybrid MR-Linac systems. Radiat Oncol 2021; 16:183. [PMID: 34544481 PMCID: PMC8454038 DOI: 10.1186/s13014-021-01910-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/09/2021] [Indexed: 02/08/2023] Open
Abstract
Hybrid magnetic resonance (MR)-guided linear accelerators represent a new horizon in the field of radiation oncology. By harnessing the favorable combination of on-board MR-imaging with the possibility to daily recalculate the treatment plan based on real-time anatomy, the accuracy in target and organs-at-risk identification is expected to be improved, with the aim to provide the best tailored treatment. To date, two main MR-linac hybrid machines are available, Elekta Unity and Viewray MRIdian. Of note, compared to conventional linacs, these devices raise practical issues due to the positioning phase for the need to include the coil in the immobilization procedure and in order to perform the best reproducible positioning, also in light of the potentially longer treatment time. Given the relative novelty of this technology, there are few literature data regarding the procedures and the workflows for patient positioning and immobilization for MR-guided daily adaptive radiotherapy. In the present narrative review, we resume the currently available literature and provide an overview of the positioning and setup procedures for all the anatomical districts for hybrid MR-linac systems.
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Affiliation(s)
- Francesco Cuccia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, VR, Italy.
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, VR, Italy
- University of Brescia, Brescia, Italy
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Luca Boldrini
- Radiology, Radiation Oncology and Hematology Department, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Roma, Italy
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, University Hospital of Heidelberg, National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Helen McNair
- The Royal Marsden NHS Foundation Trust, and Institute of Cancer Research Sutton, Surrey, UK
| | - Michele Rigo
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, VR, Italy
| | - Maartje Schoenmakers
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Judith Slagter
- Department of Radiation Oncology - Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Claudio Votta
- Radiology, Radiation Oncology and Hematology Department, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Roma, Italy
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
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21
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Chun J, Lewis B, Ji Z, Shin JI, Park JC, Kim JS, Kim T. Evaluation of super-resolution on 50 pancreatic cancer patients with real-time cine MRI from 0.35T MRgRT. Biomed Phys Eng Express 2021; 7:055020. [PMID: 34375963 DOI: 10.1088/2057-1976/ac1c51] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/10/2021] [Indexed: 12/25/2022]
Abstract
MR-guided radiotherapy (MRgRT) systems provide excellent soft tissue imaging immediately prior to and in real time during radiation delivery for cancer treatment. However, 2D cine MRI often has limited spatial resolution due to high temporal resolution. This work applies a super resolution machine learning framework to 3.5 mm pixel edge length, low resolution (LR), sagittal 2D cine MRI images acquired on a MRgRT system to generate 0.9 mm pixel edge length, super resolution (SR), images originally acquired at 4 frames per second (FPS). LR images were collected from 50 pancreatic cancer patients treated on a ViewRay MR-LINAC. SR images were evaluated using three methods. 1) The first method utilized intrinsic image quality metrics for evaluation. 2) The second used relative metrics including edge detection and structural similarity index (SSIM). 3) Finally, automatically generated tumor contours were created on both low resolution and super resolution images to evaluate target delineation and compared with DICE and SSIM. Intrinsic image quality metrics all had statistically significant improvements for SR images versus LR images, with mean (±1 SD) BRISQUE scores of 29.65 ± 2.98 and 42.48 ± 0.98 for SR and LR, respectively. SR images showed good agreement with LR images in SSIM evaluation, indicating there was not significant distortion of the images. Comparison of LR and SR images with paired high resolution (HR) 3D images showed that SR images had a mean (±1 SD) SSIM value of 0.633 ± 0.063 and LR a value of 0.587 ± 0.067 (p ≪ 0.05). Contours generated on SR images were also more robust to noise addition than those generated on LR images. This study shows that super resolution with a machine learning framework can generate high spatial resolution images from 4fps low spatial resolution cine MRI acquired on the ViewRay MR-LINAC while maintaining tumor contour quality and without significant acquisition or post processing delay.
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Affiliation(s)
- Jaehee Chun
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Benjamin Lewis
- Department of Radiation Oncology, Washington University in St. Louis, St Louis, MO 63110, United States of America
| | - Zhen Ji
- Department of Radiation Oncology, Washington University in St. Louis, St Louis, MO 63110, United States of America
| | - Jae-Ik Shin
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Justin C Park
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX 75390, United States of America
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Taeho Kim
- Department of Radiation Oncology, Washington University in St. Louis, St Louis, MO 63110, United States of America
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22
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Chan RW, Lawrence LSP, Oglesby RT, Chen H, Stewart J, Theriault A, Campbell M, Ruschin M, Myrehaug S, Atenafu EG, Keller B, Chugh B, MacKenzie S, Tseng CL, Detsky J, Maralani PJ, Czarnota GJ, Stanisz GJ, Sahgal A, Lau AZ. Chemical exchange saturation transfer MRI in central nervous system tumours on a 1.5 T MR-Linac. Radiother Oncol 2021; 162:140-149. [PMID: 34280403 DOI: 10.1016/j.radonc.2021.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe the implementation and initial results of using Chemical Exchange Saturation Transfer (CEST) for monitoring patients with central nervous system (CNS) tumours treated using a 1.5 tesla MR-guided radiotherapy system. METHODS CNS patients were treated with up to 30 fractions (total dose up to 60 Gy) using a 1.5 T Elekta Unity MR-Linac. CEST scans were obtained in 54 subjects at one or more time points during treatment. CEST metrics, including the amide magnetization transfer ratio (MTRAmide), nuclear Overhauser effect (NOE) MTR (MTRNOE) and asymmetry, were quantified in phantoms and CNS patients. The signal was investigated between tumour and white matter, across time, and across disease categories including high- and low-grade tumours. RESULTS The gross tumour volume (GTV) exhibited lower MTRAmide and MTRNOE and higher asymmetry compared to contralateral normal appearing white matter. Signal changes in the GTV during fractionated radiotherapy were observed. There were differences between high- and low-grade tumours, with higher CEST asymmetry associated with higher grade disease. CONCLUSION CEST MRI using a 1.5 T MR-Linac was demonstrated to be feasible for in vivo imaging of CNS tumours. CEST images showed tumour/white-matter contrast, temporal CEST signal changes, and associations with tumour grade. These results show promise for the eventual goal of using metabolic imaging to inform the design of adaptive radiotherapy protocols.
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Affiliation(s)
- Rachel W Chan
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada.
| | - Liam S P Lawrence
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Ryan T Oglesby
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Hanbo Chen
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - James Stewart
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Aimee Theriault
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Mikki Campbell
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Mark Ruschin
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, Canada
| | - Brian Keller
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, Canada
| | - Brige Chugh
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Department of Physics, Ryerson University, Toronto, Canada
| | - Scott MacKenzie
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Pejman J Maralani
- Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Greg J Czarnota
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada; Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Greg J Stanisz
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada; Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Lublin, Poland
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Angus Z Lau
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada
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23
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Kim MM, Sun Y, Aryal MP, Parmar HA, Piert M, Rosen B, Mayo CS, Balter JM, Schipper M, Gabel N, Briceño EM, You D, Heth J, Al-Holou W, Umemura Y, Leung D, Junck L, Wahl DR, Lawrence TS, Cao Y. A Phase 2 Study of Dose-intensified Chemoradiation Using Biologically Based Target Volume Definition in Patients With Newly Diagnosed Glioblastoma. Int J Radiat Oncol Biol Phys 2021; 110:792-803. [PMID: 33524546 PMCID: PMC8920120 DOI: 10.1016/j.ijrobp.2021.01.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/14/2021] [Accepted: 01/21/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE We hypothesized that dose-intensified chemoradiation therapy targeting adversely prognostic hypercellular (TVHCV) and hyperperfused (TVCBV) tumor volumes would improve outcomes in patients with glioblastoma. METHODS AND MATERIALS This single-arm, phase 2 trial enrolled adult patients with newly diagnosed glioblastoma. Patients with a TVHCV/TVCBV >1 cm3, identified using high b-value diffusion-weighted magnetic resonance imaging (MRI) and dynamic contrast-enhanced perfusion MRI, were treated over 30 fractions to 75 Gy to the TVHCV/TVCBV with temozolomide. The primary objective was to estimate improvement in 12-month overall survival (OS) versus historical control. Secondary objectives included evaluating the effect of 3-month TVHCV/TVCBV reduction on OS using Cox proportional-hazard regression and characterizing coverage (95% isodose line) of metabolic tumor volumes identified using correlative 11C-methionine positron emission tomography. Clinically meaningful change was assessed for quality of life by the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire C30, for symptom burden by the MD Anderson Symptom Inventory for brain tumor, and for neurocognitive function (NCF) by the Controlled Oral Word Association Test, the Trail Making Test, parts A and B, and the Hopkins Verbal Learning Test-Revised. RESULTS Between 2016 and 2018, 26 patients were enrolled. Initial patients were boosted to TVHCV alone, and 13 patients were boosted to both TVHCV/TVCBV. Gross or subtotal resection was performed in 87% of patients; 22% were O6-methylguanine-DNA methyltransferase (MGMT) methylated. With 26-month follow-up (95% CI, 19-not reached), the 12-month OS rate among patients boosted to the combined TVHCV/TVCBV was 92% (95% CI, 78%-100%; P = .03) and the median OS was 20 months (95% CI, 18-not reached); the median OS for the whole study cohort was 20 months (95% CI, 14-29 months). Patients whose 3-month TVHCV/TVCBV decreased to less than the median volume (3 cm3) had superior OS (29 vs 12 months; P = .02). Only 5 patients had central or in-field failures, and 93% (interquartile range, 59%-100%) of the 11C-methionine metabolic tumor volumes received high-dose coverage. Late grade 3 neurologic toxicity occurred in 2 patients. Among non-progressing patients, 1-month and 7-month deterioration in quality of life, symptoms, and NCF were similar in incidence to standard therapy. CONCLUSIONS Dose intensification against hypercellular/hyperperfused tumor regions in glioblastoma yields promising OS with favorable outcomes for NCF, symptom burden, and quality of life, particularly among patients with greater tumor reduction 3 months after radiation therapy.
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Affiliation(s)
- Michelle M Kim
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
| | - Yilun Sun
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Madhava P Aryal
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Hemant A Parmar
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Morand Piert
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Benjamin Rosen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Charles S Mayo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - James M Balter
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Matthew Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Nicolette Gabel
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Emily M Briceño
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Daekeun You
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Jason Heth
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Wajd Al-Holou
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Yoshie Umemura
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Denise Leung
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Larry Junck
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Daniel R Wahl
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Theodore S Lawrence
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Yue Cao
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Radiology, University of Michigan, Ann Arbor, Michigan; Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
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24
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Seravalli E, Kroon PS, Buatti JM, Hall MD, Mandeville HC, Marcus KJ, Onal C, Ozyar E, Paulino AC, Paulsen F, Saunders D, Tsang DS, Wolden SL, Janssens GO. The potential role of MR-guided adaptive radiotherapy in pediatric oncology: Results from a SIOPE-COG survey. Clin Transl Radiat Oncol 2021; 29:71-78. [PMID: 34159265 PMCID: PMC8202186 DOI: 10.1016/j.ctro.2021.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Magnetic resonance guided radiotherapy (MRgRT) has been successfully implemented for several routine clinical applications in adult patients. The purpose of this study is to map the potential benefit of MRgRT on toxicity reduction and outcome in pediatric patients treated with curative intent for primary and metastatic sites. MATERIALS AND METHODS Between May and August 2020, a survey was distributed among SIOPE- and COG-affiliated radiotherapy departments, treating at least 25 pediatrics patients annually and being (candidate) users of a MRgRT system. The survey consisted of a table with 45 rows (clinical scenarios for primary (n = 28) and metastatic (n = 17) tumors) and 7 columns (toxicity reduction, outcome improvement, PTV margin reduction, target volume daily adaptation, online re-planning, intrafraction motion compensation and on-board functional imaging) and the option to answer by 'yes/no' . Afterwards, the Dutch national radiotherapy cohort was used to estimate the percentage of pediatric treatments that may benefit from MRgRT. RESULTS The survey was completed by 12/17 (71% response rate) institutions meeting the survey inclusion criteria. Responders indicated an 'expected benefit' from MRgRT for toxicity/outcome in 7% (for thoracic lymphomas and abdominal rhabdomyosarcomas)/0% and 18% (for mediastinal lymph nodes, lymph nodes located in the liver/splenic hilum, and liver metastases)/0% of the considered scenarios for the primary and metastatic tumor sites, respectively, and a 'possible benefit' was estimated in 64%/46% and 47%/59% of the scenarios. When translating the survey outcome into a clinical perspective a toxicity/outcome benefit, either expected or possible, was anticipated for 55%/24% of primary sites and 62%/38% of the metastatic sites. CONCLUSION Although the benefit of MRgRT in pediatric radiation oncology is estimated to be modest, the potential role for reducing toxicity and improving clinical outcomes warrants further investigation. This fits best within the context of prospective studies or registration trials.
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Affiliation(s)
- Enrica Seravalli
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra S. Kroon
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - John M. Buatti
- Departments of Radiation Oncology, University of Iowa, Iowa City, USA
| | - Matthew D. Hall
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL, USA
| | - Henry C. Mandeville
- Department of Radiotherapy, The Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
| | - Karen J. Marcus
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA, USA
| | - Cem Onal
- Department of Radiation Oncology, Baskent University, Ankara, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Arnold C. Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital Tuebingen, Tuebingen, Germany
| | | | - Derek S. Tsang
- Radiation Medicine Program, University Health Network – Princess Margaret Cancer Centre, Toronto, Canada
| | - Suzanne L. Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Geert O. Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Lee SL, Hall WA, Morris ZS, Christensen L, Bassetti M. MRI-Guided Radiation Therapy. ADVANCES IN ONCOLOGY 2021; 1:29-39. [PMID: 37064601 PMCID: PMC10104451 DOI: 10.1016/j.yao.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Affiliation(s)
- Sangjune Laurence Lee
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI, USA
- Department of Oncology, Division of Radiation Oncology, University of Calgary, Calgary, AB, Canada
| | - William A. Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Zachary S. Morris
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Leslie Christensen
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Michael Bassetti
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI, USA
- Corresponding author. Department of Human Oncology, University of Wisconsin, University Hospital L7/B36, 600 Highland Avenue, Madison, WI 53792.
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许 文, 王 长, 马 一, 方 春, 巩 汉, 张 高, 曲 宝, 徐 寿. [Advances in magnetic resonance imaging guided radiation therapy]. SHENG WU YI XUE GONG CHENG XUE ZA ZHI = JOURNAL OF BIOMEDICAL ENGINEERING = SHENGWU YIXUE GONGCHENGXUE ZAZHI 2021; 38:161-168. [PMID: 33899441 PMCID: PMC10307565 DOI: 10.7507/1001-5515.202002029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 10/16/2020] [Indexed: 11/03/2022]
Abstract
Image-guided radiation therapy using magnetic resonance imaging (MRI) is a new technology that has been widely studied and developed in recent years. The technology combines the advantages of MRI imaging, and can offer online real-time tracking of tumor and adjacent organs at risk, as well as real-time optimization of radiotherapy plan. In order to provide a comprehensive understanding of this technology, and to grasp the international development and trends in this field, this paper reviews and summarizes related researches, so as to make the researchers and clinical personnel in this field to understand recent status of this technology, and carry out corresponding researches. This paper summarizes the advantages of MRI and the research progress of MRI linear accelerator (MR-Linac), online guidance, adaptive optimization, and dosimetry-related research. Possible development direction of these technologies in the future is also discussed. It is expected that this review can provide a certain reference value for clinician and related researchers to understand the research progress in the field.
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Affiliation(s)
- 文哲 许
- 北京航空航天大学 物理学院(北京 100191)School of Physics, Beihang University, Beijing 100191, P. R.China
- 一洲肿瘤医院 放疗科(河北涿州 072750)Department of Radiotherapy, Yizhou Tumor Hospital, Zhuozhou, Hebei 072750, P. R. China
| | - 长建 王
- 北京航空航天大学 物理学院(北京 100191)School of Physics, Beihang University, Beijing 100191, P. R.China
- 一洲肿瘤医院 放疗科(河北涿州 072750)Department of Radiotherapy, Yizhou Tumor Hospital, Zhuozhou, Hebei 072750, P. R. China
| | - 一鸣 马
- 北京航空航天大学 物理学院(北京 100191)School of Physics, Beihang University, Beijing 100191, P. R.China
- 一洲肿瘤医院 放疗科(河北涿州 072750)Department of Radiotherapy, Yizhou Tumor Hospital, Zhuozhou, Hebei 072750, P. R. China
| | - 春锋 方
- 北京航空航天大学 物理学院(北京 100191)School of Physics, Beihang University, Beijing 100191, P. R.China
| | - 汉顺 巩
- 北京航空航天大学 物理学院(北京 100191)School of Physics, Beihang University, Beijing 100191, P. R.China
| | - 高龙 张
- 北京航空航天大学 物理学院(北京 100191)School of Physics, Beihang University, Beijing 100191, P. R.China
- 一洲肿瘤医院 放疗科(河北涿州 072750)Department of Radiotherapy, Yizhou Tumor Hospital, Zhuozhou, Hebei 072750, P. R. China
| | - 宝林 曲
- 北京航空航天大学 物理学院(北京 100191)School of Physics, Beihang University, Beijing 100191, P. R.China
- 一洲肿瘤医院 放疗科(河北涿州 072750)Department of Radiotherapy, Yizhou Tumor Hospital, Zhuozhou, Hebei 072750, P. R. China
| | - 寿平 徐
- 北京航空航天大学 物理学院(北京 100191)School of Physics, Beihang University, Beijing 100191, P. R.China
- 一洲肿瘤医院 放疗科(河北涿州 072750)Department of Radiotherapy, Yizhou Tumor Hospital, Zhuozhou, Hebei 072750, P. R. China
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27
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Hoegen P, Spindeldreier CK, Buchele C, Rippke C, Regnery S, Weykamp F, Klüter S, Debus J, Hörner-Rieber J. [Magnetic-resonance-guided radiotherapy : The beginning of a new era in radiation oncology?]. Radiologe 2021; 61:13-20. [PMID: 33052442 DOI: 10.1007/s00117-020-00761-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CLINICAL ISSUE Image-guided radiotherapy (IGRT) using X‑rays and cone-beam computed tomography (CT) has fostered precision radiotherapy. However, inter- and intrafractional variations of target volume position and organs at risk still limit target volume dose and sparing of radiosensitive organs at risk. METHODOLOGICAL INNOVATIONS Hybrid machines directly combining linear accelerators and magnetic resonance (MR) imaging allow for live imaging during radiotherapy. PERFORMANCE Besides highly improved soft tissue contrast, MR-linacs enable online, on-table adaptive radiotherapy. Thus, adaptation of the treatment plan to the anatomy of the day, dose escalation and superior sparing of organs at risk become possible. ACHIEVEMENTS This article summarizes the underlying intention for the development of MR-guided radiotherapy, technical innovations and challenges as well as the current state-of-the-art. Potential clinical benefits and future developments are discussed. PRACTICAL RECOMMENDATIONS Increasing availability of MR imaging at linear accelerators calls for the ability to review and interpret MR images. Therefore, close collaborations of diagnostic radiologists and radiation oncologists are mandatory to foster this fascinating technique.
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Affiliation(s)
- P Hoegen
- Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.,Heidelberger Institut für Radiooncology (HIRO), Heidelberg, Deutschland.,Nationales Centrum für Tumorerkrankungen (NCT), Heidelberg, Deutschland.,Clinical Cooperation Unit Radiation Oncology, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - C K Spindeldreier
- Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.,Heidelberger Institut für Radiooncology (HIRO), Heidelberg, Deutschland
| | - C Buchele
- Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.,Heidelberger Institut für Radiooncology (HIRO), Heidelberg, Deutschland
| | - C Rippke
- Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.,Heidelberger Institut für Radiooncology (HIRO), Heidelberg, Deutschland
| | - S Regnery
- Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.,Heidelberger Institut für Radiooncology (HIRO), Heidelberg, Deutschland.,Nationales Centrum für Tumorerkrankungen (NCT), Heidelberg, Deutschland
| | - F Weykamp
- Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.,Heidelberger Institut für Radiooncology (HIRO), Heidelberg, Deutschland.,Nationales Centrum für Tumorerkrankungen (NCT), Heidelberg, Deutschland
| | - S Klüter
- Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.,Heidelberger Institut für Radiooncology (HIRO), Heidelberg, Deutschland
| | - J Debus
- Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.,Heidelberger Institut für Radiooncology (HIRO), Heidelberg, Deutschland.,Nationales Centrum für Tumorerkrankungen (NCT), Heidelberg, Deutschland.,Clinical Cooperation Unit Radiation Oncology, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland.,Heidelberger Ionenstrahl-Therapiezentrum (HIT), Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.,Standort Heidelberg, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Heidelberg, Deutschland
| | - J Hörner-Rieber
- Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland. .,Heidelberger Institut für Radiooncology (HIRO), Heidelberg, Deutschland. .,Nationales Centrum für Tumorerkrankungen (NCT), Heidelberg, Deutschland. .,Clinical Cooperation Unit Radiation Oncology, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland.
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28
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Chan RW, Chen H, Myrehaug S, Atenafu EG, Stanisz GJ, Stewart J, Maralani PJ, Chan AKM, Daghighi S, Ruschin M, Das S, Perry J, Czarnota GJ, Sahgal A, Lau AZ. Quantitative CEST and MT at 1.5T for monitoring treatment response in glioblastoma: early and late tumor progression during chemoradiation. J Neurooncol 2020; 151:267-278. [PMID: 33196965 DOI: 10.1007/s11060-020-03661-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/07/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Quantitative MRI (qMRI) was performed using a 1.5T protocol that includes a novel chemical exchange saturation transfer/magnetization transfer (CEST/MT) approach. The purpose of this prospective study was to determine if qMRI metrics at baseline, at the 10th and 20th fraction during a 30 fraction/6 week standard chemoradiation (CRT) schedule, and at 1 month following treatment could be an early indicator of response for glioblastoma (GBM). METHODS The study included 51 newly diagnosed GBM patients. Four regions-of-interest (ROI) were analyzed: (i) the radiation defined clinical target volume (CTV), (ii) radiation defined gross tumor volume (GTV), (iii) enhancing-tumor regions, and (iv) FLAIR-hyperintense regions. Quantitative CEST, MT, T1 and T2 parameters were compared between those patients progressing within 6.9 months (early), and those progressing after CRT (late), using mixed modelling. Exploratory predictive modelling was performed to identify significant predictors of early progression using a multivariable LASSO model. RESULTS Results were dependent on the specific tumor ROI analyzed and the imaging time point. The baseline CEST asymmetry within the CTV was significantly higher in the early progression cohort. Other significant predictors included the T2 of the MT pools (for semi-solid at fraction 20 and water at 1 month after CRT), the exchange rate (at fraction 20) and the MGMT methylation status. CONCLUSIONS We observe the potential for multiparametric qMRI, including a novel pulsed CEST/MT approach, to show potential in distinguishing early from late progression GBM cohorts. Ultimately, the goal is to personalize therapeutic decisions and treatment adaptation based on non-invasive imaging-based biomarkers.
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Affiliation(s)
- Rachel W Chan
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada.
| | - Hanbo Chen
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Greg J Stanisz
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University, Lublin, Poland
| | - James Stewart
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | - Aimee K M Chan
- Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Shadi Daghighi
- Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Mark Ruschin
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Sunit Das
- Division of Neurosurgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - James Perry
- Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Gregory J Czarnota
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Arjun Sahgal
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Angus Z Lau
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Medical Biophysics, University of Toronto, Toronto, ON, Canada
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29
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Ali MY, Oliva CR, Noman ASM, Allen BG, Goswami PC, Zakharia Y, Monga V, Spitz DR, Buatti JM, Griguer CE. Radioresistance in Glioblastoma and the Development of Radiosensitizers. Cancers (Basel) 2020; 12:E2511. [PMID: 32899427 PMCID: PMC7564557 DOI: 10.3390/cancers12092511] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/24/2020] [Accepted: 08/28/2020] [Indexed: 02/07/2023] Open
Abstract
Ionizing radiation is a common and effective therapeutic option for the treatment of glioblastoma (GBM). Unfortunately, some GBMs are relatively radioresistant and patients have worse outcomes after radiation treatment. The mechanisms underlying intrinsic radioresistance in GBM has been rigorously investigated over the past several years, but the complex interaction of the cellular molecules and signaling pathways involved in radioresistance remains incompletely defined. A clinically effective radiosensitizer that overcomes radioresistance has yet to be identified. In this review, we discuss the current status of radiation treatment in GBM, including advances in imaging techniques that have facilitated more accurate diagnosis, and the identified mechanisms of GBM radioresistance. In addition, we provide a summary of the candidate GBM radiosensitizers being investigated, including an update of subjects enrolled in clinical trials. Overall, this review highlights the importance of understanding the mechanisms of GBM radioresistance to facilitate the development of effective radiosensitizers.
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Affiliation(s)
- Md Yousuf Ali
- Interdisciplinary Graduate Program in Human Toxicology, University of Iowa, Iowa City, IA 52242, USA;
- Free Radical & Radiation Biology Program, Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA; (C.R.O.); (B.G.A.); (P.C.G.); (D.R.S.)
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA;
| | - Claudia R. Oliva
- Free Radical & Radiation Biology Program, Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA; (C.R.O.); (B.G.A.); (P.C.G.); (D.R.S.)
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA;
| | - Abu Shadat M. Noman
- Department of Biochemistry and Molecular Biology, The University of Chittagong, Chittagong 4331, Bangladesh;
- Department of Pathology, McGill University, Montreal, QC H3A 2B4, Canada
| | - Bryan G. Allen
- Free Radical & Radiation Biology Program, Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA; (C.R.O.); (B.G.A.); (P.C.G.); (D.R.S.)
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA;
| | - Prabhat C. Goswami
- Free Radical & Radiation Biology Program, Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA; (C.R.O.); (B.G.A.); (P.C.G.); (D.R.S.)
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA;
| | - Yousef Zakharia
- Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA; (Y.Z.); (V.M.)
| | - Varun Monga
- Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA; (Y.Z.); (V.M.)
| | - Douglas R. Spitz
- Free Radical & Radiation Biology Program, Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA; (C.R.O.); (B.G.A.); (P.C.G.); (D.R.S.)
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA;
| | - John M. Buatti
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA;
| | - Corinne E. Griguer
- Free Radical & Radiation Biology Program, Department of Radiation Oncology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA; (C.R.O.); (B.G.A.); (P.C.G.); (D.R.S.)
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA;
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30
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Sim AJ, Kaza E, Singer L, Rosenberg SA. A review of the role of MRI in diagnosis and treatment of early stage lung cancer. Clin Transl Radiat Oncol 2020; 24:16-22. [PMID: 32596518 PMCID: PMC7306507 DOI: 10.1016/j.ctro.2020.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/25/2020] [Accepted: 06/01/2020] [Indexed: 12/14/2022] Open
Abstract
Despite magnetic resonance imaging (MRI) being a mainstay in the oncologic care for many disease sites, it has not routinely been used in early lung cancer diagnosis, staging, and treatment. While MRI provides improved soft tissue contrast compared to computed tomography (CT), an advantage in multiple organs, the physical properties of the lungs and mediastinum create unique challenges for lung MRI. Although multi-detector CT remains the gold standard for lung imaging, advances in MRI technology have led to its increased clinical relevance in evaluating early stage lung cancer. Even though positron emission tomography is used more frequently in this context, functional MR imaging, including diffusion-weighted MRI and dynamic contrast-enhanced MRI, are emerging as useful modalities for both diagnosis and evaluation of treatment response for lung cancer. In parallel with these advances, the development of combined MRI and linear accelerator devices (MR-linacs), has spurred the integration of MRI into radiation treatment delivery in the form of MR-guided radiotherapy (MRgRT). Despite challenges for MRgRT in early stage lung cancer radiotherapy, early data utilizing MR-linacs shows potential for the treatment of early lung cancer. In both diagnosis and treatment, MRI is a promising modality for imaging early lung cancer.
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Affiliation(s)
- Austin J. Sim
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr., Tampa, FL, USA
| | - Evangelia Kaza
- Department of Radiation Oncology, Dana Farber Cancer Institute, Brigham & Women’s Hospital & Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - Lisa Singer
- Department of Radiation Oncology, Dana Farber Cancer Institute, Brigham & Women’s Hospital & Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - Stephen A. Rosenberg
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr., Tampa, FL, USA
- University of South Florida Morsani College of Medicine, 12901 Bruce B. Downs Blvd., Tampa, FL, USA
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31
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Glioma consensus contouring recommendations from a MR-Linac International Consortium Research Group and evaluation of a CT-MRI and MRI-only workflow. J Neurooncol 2020; 149:305-314. [PMID: 32860571 PMCID: PMC7541359 DOI: 10.1007/s11060-020-03605-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/23/2020] [Indexed: 02/07/2023]
Abstract
Introduction This study proposes contouring recommendations for radiation treatment planning target volumes and organs-at-risk (OARs) for both low grade and high grade gliomas. Methods Ten cases consisting of 5 glioblastomas and 5 grade II or III gliomas, including their respective gross tumor volume (GTV), clinical target volume (CTV), and OARs were each contoured by 6 experienced neuro-radiation oncologists from 5 international institutions. Each case was first contoured using only MRI sequences (MRI-only), and then re-contoured with the addition of a fused planning CT (CT-MRI). The level of agreement among all contours was assessed using simultaneous truth and performance level estimation (STAPLE) with the kappa statistic and Dice similarity coefficient. Results A high level of agreement was observed between the GTV and CTV contours in the MRI-only workflow with a mean kappa of 0.88 and 0.89, respectively, with no statistically significant differences compared to the CT-MRI workflow (p = 0.88 and p = 0.82 for GTV and CTV, respectively). Agreement in cochlea contours improved from a mean kappa of 0.39 to 0.41, to 0.69 to 0.71 with the addition of CT information (p < 0.0001 for both cochleae). Substantial to near perfect level of agreement was observed in all other contoured OARs with a mean kappa range of 0.60 to 0.90 in both MRI-only and CT-MRI workflows. Conclusions Consensus contouring recommendations for low grade and high grade gliomas were established using the results from the consensus STAPLE contours, which will serve as a basis for further study and clinical trials by the MR-Linac Consortium. Electronic supplementary material The online version of this article (10.1007/s11060-020-03605-6) contains supplementary material, which is available to authorized users.
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32
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Kim MM, Parmar HA, Aryal MP, Mayo CS, Balter JM, Lawrence TS, Cao Y. Developing a Pipeline for Multiparametric MRI-Guided Radiation Therapy: Initial Results from a Phase II Clinical Trial in Newly Diagnosed Glioblastoma. ACTA ACUST UNITED AC 2020; 5:118-126. [PMID: 30854449 PMCID: PMC6403045 DOI: 10.18383/j.tom.2018.00035] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Quantitative mapping of hyperperfused and hypercellular regions of glioblastoma has been proposed to improve definition of tumor regions at risk for local recurrence following conventional radiation therapy. As the processing of the multiparametric dynamic contrast-enhanced (DCE-) and diffusion-weighted (DW-) magnetic resonance imaging (MRI) data for delineation of these subvolumes requires additional steps that go beyond the standard practices of target definition, we sought to devise a workflow to support the timely planning and treatment of patients. A phase II study implementing a multiparametric imaging biomarker for tumor hyperperfusion and hypercellularity consisting of DCE-MRI and high b-value DW-MRI to guide intensified (75 Gy/30 fractions) radiation therapy (RT) in patients with newly diagnosed glioblastoma was launched. In this report, the workflow and the initial imaging outcomes of the first 12 patients are described. Among all the first 12 patients, treatment was initiated within 6 weeks of surgery and within 2 weeks of simulation. On average, the combined hypercellular volume and high cerebral blood volume/tumor perfusion volume were 1.8 times smaller than the T1 gadolinium abnormality and 10 times smaller than the FLAIR abnormality. Hypercellular volume and high cerebral blood volume/tumor perfusion volume each identified largely distinct regions and showed 57% overlap with the enhancing abnormality, and minimal-to-no extension outside of the FLAIR. These results show the feasibility of implementing a workflow for multiparametric magnetic resonance-guided radiation therapy into clinical trials with a coordinated multidisciplinary team, and the unique and complementary tumor subregions identified by the combination of high b-value DW-MRI and DCE-MRI.
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Affiliation(s)
| | | | | | | | | | | | - Yue Cao
- Departments of Radiation Oncology and
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33
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Chin S, Eccles CL, McWilliam A, Chuter R, Walker E, Whitehurst P, Berresford J, Van Herk M, Hoskin PJ, Choudhury A. Magnetic resonance-guided radiation therapy: A review. J Med Imaging Radiat Oncol 2020; 64:163-177. [PMID: 31646742 DOI: 10.1111/1754-9485.12968] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/24/2019] [Indexed: 12/11/2022]
Abstract
Magnetic resonance-guided radiation therapy (MRgRT) is a promising approach to improving clinical outcomes for patients treated with radiation therapy. The roles of image guidance, adaptive planning and magnetic resonance imaging in radiation therapy have been increasing over the last two decades. Technical advances have led to the feasible combination of magnetic resonance imaging and radiation therapy technologies, leading to improved soft-tissue visualisation, assessment of inter- and intrafraction motion, motion management, online adaptive radiation therapy and the incorporation of functional information into treatment. MRgRT can potentially transform radiation oncology by improving tumour control and quality of life after radiation therapy and increasing convenience of treatment by shortening treatment courses for patients. Multiple groups have developed clinical implementations of MRgRT predominantly in the abdomen and pelvis, with patients having been treated since 2014. While studies of MRgRT have primarily been dosimetric so far, an increasing number of trials are underway examining the potential clinical benefits of MRgRT, with coordinated efforts to rigorously evaluate the benefits of the promising technology. This review discusses the current implementations, studies, potential benefits and challenges of MRgRT.
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Affiliation(s)
- Stephen Chin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Cynthia L Eccles
- Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Alan McWilliam
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Robert Chuter
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Emma Walker
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Philip Whitehurst
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Joseph Berresford
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Marcel Van Herk
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Peter J Hoskin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Ananya Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
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Lee S, Stewart J, Lee Y, Myrehaug S, Sahgal A, Ruschin M, Tseng CL. Improved dosimetric accuracy with semi-automatic contour propagation of organs-at-risk in glioblastoma patients undergoing chemoradiation. J Appl Clin Med Phys 2019; 20:45-53. [PMID: 31670900 PMCID: PMC6909175 DOI: 10.1002/acm2.12758] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 09/06/2019] [Accepted: 10/03/2019] [Indexed: 11/22/2022] Open
Abstract
Background We study the changes in organs‐at‐risk (OARs) morphology as contoured on serial MRIs during chemoradiation therapy (CRT) of glioblastoma (GBM). The dosimetric implication of assuming non‐deformable OAR changes and the accuracy and feasibility of semi‐automatic OAR contour propagation are investigated. Methods Fourteen GBM patients who were treated with adjuvant CRT for GBM prospectively underwent MRIs on fractions 0 (i.e., planning), 10, 20, and 1 month post last fraction of CRT. Three sets of OAR contours — (a) manual, (b) rigidly registered (static), and (c) semi‐automatically propagated — were compared using Dice similarity coefficient (DSC) and Hausdorff distance (HD). Dosimetric impact was determined by comparing the minimum dose to the 0.03 cc receiving the highest dose (D0.03 cc) on a clinically approved reference, non‐adapted radiation therapy plan. Results The DSC between the manual contours and the static contours decreased significantly over time (fraction 10: [mean ± 1 SD] 0.78 ± 0.17, post 1 month: 0.76 ± 0.17, P = 0.02) while the HD (P = 0.74) and the difference in D0.03cc did not change significantly (P = 0.51). Using the manual contours as reference, compared to static contours, propagated contours have a significantly higher DSC (propagated: [mean ± 1 SD] 0.81 ± 0.15, static: 0.77 ± 0.17, P < 0.001), lower HD (propagated: 3.77 ± 1.8 mm, static: 3.96 ± 1.6 mm, P = 0.002), and a significantly lower absolute difference in D0.03cc (propagated: 101 ± 159 cGy, static: 136 ± 243 cGy, P = 0.019). Conclusions Nonrigid changes in OARs over time lead to different maximum doses than planned. By using semi‐automatic OAR contour propagation, OARs are more accurately delineated on subsequent fractions, with corresponding improved accuracy of the reported dose to the OARs.
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Affiliation(s)
- Sangjune Lee
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - James Stewart
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Young Lee
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Mark Ruschin
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
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Knowles BR, Friedrich F, Fischer C, Paech D, Ladd ME. Beyond T2 and 3T: New MRI techniques for clinicians. Clin Transl Radiat Oncol 2019; 18:87-97. [PMID: 31341982 PMCID: PMC6630188 DOI: 10.1016/j.ctro.2019.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/11/2019] [Accepted: 04/11/2019] [Indexed: 12/12/2022] Open
Abstract
Technological advances in Magnetic Resonance Imaging (MRI) in terms of field strength and hybrid MR systems have led to improvements in tumor imaging in terms of anatomy and functionality. This review paper discusses the applications of such advances in the field of radiation oncology with regards to treatment planning, therapy guidance and monitoring tumor response and predicting outcome.
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Affiliation(s)
- Benjamin R. Knowles
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Florian Friedrich
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Carola Fischer
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Daniel Paech
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mark E. Ladd
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
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Chun J, Zhang H, Gach HM, Olberg S, Mazur T, Green O, Kim T, Kim H, Kim JS, Mutic S, Park JC. MRI super‐resolution reconstruction for MRI‐guided adaptive radiotherapy using cascaded deep learning: In the presence of limited training data and unknown translation model. Med Phys 2019; 46:4148-4164. [DOI: 10.1002/mp.13717] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/14/2019] [Accepted: 07/07/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jaehee Chun
- Department of Radiation Oncology Washington University in St. Louis St Louis MO 63110 USA
- Department of Radiation Oncology, Yonsei Cancer Center Yonsei University College of Medicine Seoul South Korea
| | - Hao Zhang
- Department of Radiation Oncology Washington University in St. Louis St Louis MO 63110 USA
| | - H. Michael Gach
- Department of Radiation Oncology Washington University in St. Louis St Louis MO 63110 USA
- Departments of Radiology and Biomedical Engineering Washington University in St. Louis St Louis MO 63110 USA
| | - Sven Olberg
- Department of Radiation Oncology Washington University in St. Louis St Louis MO 63110 USA
- Department of Biomedical Engineering Washington University in St. Louis St Louis MO 63110 USA
| | - Thomas Mazur
- Department of Radiation Oncology Washington University in St. Louis St Louis MO 63110 USA
| | - Olga Green
- Department of Radiation Oncology Washington University in St. Louis St Louis MO 63110 USA
| | - Taeho Kim
- Department of Radiation Oncology Washington University in St. Louis St Louis MO 63110 USA
| | - Hyun Kim
- Department of Radiation Oncology Washington University in St. Louis St Louis MO 63110 USA
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei Cancer Center Yonsei University College of Medicine Seoul South Korea
| | - Sasa Mutic
- Department of Radiation Oncology Washington University in St. Louis St Louis MO 63110 USA
| | - Justin C. Park
- Department of Radiation Oncology Washington University in St. Louis St Louis MO 63110 USA
- Department of Biomedical Engineering Washington University in St. Louis St Louis MO 63110 USA
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Zhou Y, Wong OL, Cheung KY, Yu SK, Yuan J. A pilot study of highly accelerated 3D MRI in the head and neck position verification for MR-guided radiotherapy. Quant Imaging Med Surg 2019; 9:1255-1269. [PMID: 31448211 DOI: 10.21037/qims.2019.06.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background To evaluate the performance of a highly accelerated 3D MRI on inter-fractional positional measurement for MR-guided radiotherapy (MRgRT) in the head and neck (HN). Methods Fourteen healthy volunteers received 159 scans on a 1.5 T MR-sim to simulate MRgRT fractions. MRI acquisition included a high-resolution (HQI-MRI, voxel-size =1.05×1.05×1.05 mm3, duration =5 min) and a highly-accelerated low-resolution (true-LQI-MRI, acceleration-factor =9, voxel-size =1.4×1.4×1.4 mm3, duration =86 s) T1w spin-echo sequence (TR/TE =420/7.2 ms). The first session HQI-MRI was used as the reference to mimic planning MRI. Other HQI-MRI was also retrospectively down-sampled in K-space and GRAPPA reconstructed to generate pseudo-LQI-MRI. Inter-sessional positional shift calculated from HQI-MRI, true-LQI-MRI and pseudo-LQI-MRI rigidly registering to the reference were analyzed and compared in the overall HN and the sub-regions of brain, nasopharynx, oropharynx and hypopharynx. Results The calculated SD of systematic errors (Σ) from HQI-MRI/pseudo-LQI-MRI/true-LQI-MRI images for overall HN were 1.11/1.14/1.08, 0.28/0.26/0.29, 0.43/0.44/0.60, and 0.77/0.79/0.74 mm for translation in LR, AP, SI and 3D, respectively; The corresponding RMS of random errors (σ) were 0.97/0.98/0.96, 0.28/0.27/0.26, 0.77/0.77/0.72, and 0.85/0.87/0.85 mm. For all sub-regions, brain showed the smallest Σ and σ in 3D. Other sub-regions showed direction-dependent error patterns, but the positioning results were consistent, independent of the datasets used for registration. Conclusions A highly-accelerated 3D-MRI could be used for MR-guided HN radiotherapy without compromising position verification accuracy.
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Affiliation(s)
- Yihang Zhou
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Oi Lei Wong
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Kin Yin Cheung
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Siu Ki Yu
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Jing Yuan
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
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Danieli L, Riccitelli GC, Distefano D, Prodi E, Ventura E, Cianfoni A, Kaelin-Lang A, Reinert M, Pravatà E. Brain Tumor-Enhancement Visualization and Morphometric Assessment: A Comparison of MPRAGE, SPACE, and VIBE MRI Techniques. AJNR Am J Neuroradiol 2019; 40:1140-1148. [PMID: 31221635 DOI: 10.3174/ajnr.a6096] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/08/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE Postgadolinium MR imaging is crucial for brain tumor diagnosis and morphometric assessment. We compared brain tumor enhancement visualization and the "target" object morphometry obtained with the most commonly used 3D MR imaging technique, MPRAGE, with 2 other routinely available techniques: sampling perfection with application-optimized contrasts by using different flip angle evolutions (SPACE) and volumetric interpolated brain examination (VIBE). MATERIALS AND METHODS Fifty-four contrast-enhancing tumors (38 gliomas and 16 metastases) were assessed using MPRAGE, VIBE, and SPACE techniques randomly acquired after gadolinium-based contrast agent administration on a 3T scanner. Enhancement conspicuity was assessed quantitatively by calculating the contrast rate and contrast-to-noise ratio, and qualitatively, by consensus visual comparative ratings. The total enhancing tumor volume and between-sequence discrepancy in the margin delineation were assessed on the corresponding 3D target objects contoured with a computer-assisted software for neuronavigation. The Wilcoxon signed rank and Pearson χ2 nonparametric tests were used to investigate between-sequence discrepancies in the contrast rate, contrast-to-noise ratio, visual conspicuity ratings, tumor volume, and margin delineation estimates. Differences were also tested for 1D (Response Evaluation Criteria in Solid Tumors) and 2D (Response Assessment in Neuro-Oncology) measurements. RESULTS Compared with MPRAGE, both SPACE and VIBE obtained higher contrast rate, contrast-to-noise ratio, and visual conspicuity ratings in both gliomas and metastases (P range, <.001-.001). The between-sequence 3D target object margin discrepancy ranged between 3% and 19.9% of lesion tumor volume. Larger tumor volumes, 1D and 2D measurements were obtained with SPACE (P range, <.01-.007). CONCLUSIONS Superior conspicuity for brain tumor enhancement can be achieved using SPACE and VIBE techniques, compared with MPRAGE. Discrepancies were also detected when assessing target object size and morphology, with SPACE providing more accurate estimates.
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Affiliation(s)
- L Danieli
- From the Departments of Neuroradiology (L.D., D.D., E.P., E.V., A.C., E.P.)
| | - G C Riccitelli
- Neurology (G.C.R., A.K.-L.).,Neuroimaging Research Unit (G.C.R.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - D Distefano
- From the Departments of Neuroradiology (L.D., D.D., E.P., E.V., A.C., E.P.)
| | - E Prodi
- From the Departments of Neuroradiology (L.D., D.D., E.P., E.V., A.C., E.P.)
| | - E Ventura
- From the Departments of Neuroradiology (L.D., D.D., E.P., E.V., A.C., E.P.)
| | - A Cianfoni
- From the Departments of Neuroradiology (L.D., D.D., E.P., E.V., A.C., E.P.).,Departments of Neuroradiology (A.C.)
| | - A Kaelin-Lang
- Neurology (G.C.R., A.K.-L.).,Neurology (A.K.-L.), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Faculty of Biomedical Sciences (A.K.-L., M.R.), Università della Svizzera Italiana, Lugano, Switzerland
| | - M Reinert
- Neurosurgery (M.R.), Neurocenter of Southern Switzerland, Lugano, Switzerland.,Faculty of Biomedical Sciences (A.K.-L., M.R.), Università della Svizzera Italiana, Lugano, Switzerland
| | - E Pravatà
- From the Departments of Neuroradiology (L.D., D.D., E.P., E.V., A.C., E.P.)
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Corradini S, Alongi F, Andratschke N, Belka C, Boldrini L, Cellini F, Debus J, Guckenberger M, Hörner-Rieber J, Lagerwaard FJ, Mazzola R, Palacios MA, Philippens MEP, Raaijmakers CPJ, Terhaard CHJ, Valentini V, Niyazi M. MR-guidance in clinical reality: current treatment challenges and future perspectives. Radiat Oncol 2019; 14:92. [PMID: 31167658 PMCID: PMC6551911 DOI: 10.1186/s13014-019-1308-y] [Citation(s) in RCA: 243] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/24/2019] [Indexed: 11/23/2022] Open
Abstract
Magnetic Resonance-guided radiotherapy (MRgRT) marks the beginning of a new era. MR is a versatile and suitable imaging modality for radiotherapy, as it enables direct visualization of the tumor and the surrounding organs at risk. Moreover, MRgRT provides real-time imaging to characterize and eventually track anatomical motion. Nevertheless, the successful translation of new technologies into clinical practice remains challenging. To date, the initial availability of next-generation hybrid MR-linac (MRL) systems is still limited and therefore, the focus of the present preview was on the initial applicability in current clinical practice and on future perspectives of this new technology for different treatment sites.MRgRT can be considered a groundbreaking new technology that is capable of creating new perspectives towards an individualized, patient-oriented planning and treatment approach, especially due to the ability to use daily online adaptation strategies. Furthermore, MRL systems overcome the limitations of conventional image-guided radiotherapy, especially in soft tissue, where target and organs at risk need accurate definition. Nevertheless, some concerns remain regarding the additional time needed to re-optimize dose distributions online, the reliability of the gating and tracking procedures and the interpretation of functional MR imaging markers and their potential changes during the course of treatment. Due to its continuous technological improvement and rapid clinical large-scale application in several anatomical settings, further studies may confirm the potential disruptive role of MRgRT in the evolving oncological environment.
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Affiliation(s)
- S. Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - F. Alongi
- Department of Radiation Oncology, IRCSS Sacro Cuore don Calabria Hospital, Negrar-Verona, Italy
- University of Brescia, Brescia, Italy
| | - N. Andratschke
- Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Zürich, Switzerland
| | - C. Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - L. Boldrini
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - F. Cellini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - J. Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M. Guckenberger
- Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Zürich, Switzerland
| | - J. Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - F. J. Lagerwaard
- Department of Radiation Oncology, VU medical center, Amsterdam, The Netherlands
| | - R. Mazzola
- Department of Radiation Oncology, IRCSS Sacro Cuore don Calabria Hospital, Negrar-Verona, Italy
- University of Brescia, Brescia, Italy
| | - M. A. Palacios
- Department of Radiation Oncology, VU medical center, Amsterdam, The Netherlands
| | - M. E. P. Philippens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C. P. J. Raaijmakers
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C. H. J. Terhaard
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - V. Valentini
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Rome, Italy
| | - M. Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
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Chaddad A, Kucharczyk MJ, Daniel P, Sabri S, Jean-Claude BJ, Niazi T, Abdulkarim B. Radiomics in Glioblastoma: Current Status and Challenges Facing Clinical Implementation. Front Oncol 2019; 9:374. [PMID: 31165039 PMCID: PMC6536622 DOI: 10.3389/fonc.2019.00374] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/23/2019] [Indexed: 12/12/2022] Open
Abstract
Radiomics analysis has had remarkable progress along with advances in medical imaging, most notability in central nervous system malignancies. Radiomics refers to the extraction of a large number of quantitative features that describe the intensity, texture and geometrical characteristics attributed to the tumor radiographic data. These features have been used to build predictive models for diagnosis, prognosis, and therapeutic response. Such models are being combined with clinical, biological, genetics and proteomic features to enhance reproducibility. Broadly, the four steps necessary for radiomic analysis are: (1) image acquisition, (2) segmentation or labeling, (3) feature extraction, and (4) statistical analysis. Major methodological challenges remain prior to clinical implementation. Essential steps include: adoption of an optimized standard imaging process, establishing a common criterion for performing segmentation, fully automated extraction of radiomic features without redundancy, and robust statistical modeling validated in the prospective setting. This review walks through these steps in detail, as it pertains to high grade gliomas. The impact on precision medicine will be discussed, as well as the challenges facing clinical implementation of radiomic in the current management of glioblastoma.
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Affiliation(s)
- Ahmad Chaddad
- Division of Radiation Oncology, Department of Oncology, McGill University, Montreal, QC, Canada
| | | | - Paul Daniel
- Division of Radiation Oncology, Department of Oncology, McGill University, Montreal, QC, Canada
| | - Siham Sabri
- Department of Pathology, McGill University, Montreal, QC, Canada.,Research Institute of the McGill University Health Centre, Glen Site, Montreal, QC, Canada
| | - Bertrand J Jean-Claude
- Research Institute of the McGill University Health Centre, Glen Site, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada
| | - Tamim Niazi
- Division of Radiation Oncology, Department of Oncology, McGill University, Montreal, QC, Canada
| | - Bassam Abdulkarim
- Division of Radiation Oncology, Department of Oncology, McGill University, Montreal, QC, Canada.,Research Institute of the McGill University Health Centre, Glen Site, Montreal, QC, Canada
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High-resolution FLAIR MRI at 7 Tesla for treatment planning in glioblastoma patients. Radiother Oncol 2018; 130:180-184. [PMID: 30177373 DOI: 10.1016/j.radonc.2018.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/10/2018] [Accepted: 08/17/2018] [Indexed: 11/24/2022]
Abstract
Ultra-high field MRI is an emerging technique promising high-resolution images for radiotherapy planning. We compared a 7 Tesla FLAIR sequence with clinical FLAIR imaging at 3 Tesla in glioblastoma patients before radiotherapy. High-resolution 7 Tesla FLAIR imaging may enhance the depiction of organs at risk and possibly modify target volumes.
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Ajithkumar T, Horan G, Padovani L, Thorp N, Timmermann B, Alapetite C, Gandola L, Ramos M, Van Beek K, Christiaens M, Lassen-Ramshad Y, Magelssen H, Nilsson K, Saran F, Rombi B, Kortmann R, Janssens GO. SIOPE - Brain tumor group consensus guideline on craniospinal target volume delineation for high-precision radiotherapy. Radiother Oncol 2018; 128:192-197. [PMID: 29729847 DOI: 10.1016/j.radonc.2018.04.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 04/14/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To develop a consensus guideline for craniospinal target volume (TV) delineation in children and young adults participating in SIOPE studies in the era of high-precision radiotherapy. METHODS AND MATERIALS During four consensus meetings (Cambridge, Essen, Liverpool, and Marseille), conventional field-based TV has been translated into image-guided high-precision craniospinal TV by a group of expert paediatric radiation oncologists and enhanced by MRI images of liquor distribution. RESULTS The CTVcranial should include the whole brain, cribriform plate, most inferior part of the temporal lobes, and the pituitary fossa. If the full length of both optic nerves is not included, the dose received by different volumes of optic nerve should be recorded to correlate with future patterns of relapse (no consensus). The CTVcranial should be modified to include the dural cuffs of cranial nerves as they pass through the skull base foramina. Attempts to spare the cochlea by excluding CSF within the internal auditory canal should be avoided. The CTVspinal should include the entire subarachnoid space, including nerve roots laterally. The lower limit of the spinal CTV is at the lower limit of the thecal sac, best visible on MRI scan. There is no need to include sacral root canals in the spinal CTV. CONCLUSION This consensus guideline has the potential to improve consistency of craniospinal TV delineation in an era of high-precision radiotherapy. This proposal will be incorporated in the RTQA guidelines of future SIOPE-BTG trials using CSI.
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Affiliation(s)
| | - Gail Horan
- Department of Oncology, Cambridge University Hospitals, United Kingdom
| | - Laetitia Padovani
- Department of Radiation Oncology, Assistance Publique Hôpitaux de Marseille, France
| | - Nicky Thorp
- Department of Oncology, Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | | | - Claire Alapetite
- Radiation Oncology department and Proton Centre, Institute Curie, Paris and Orsay, France
| | - Lorenza Gandola
- Department of Radiation Oncology, Fondazione IRCCS-Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Ramos
- Hospital Universitari de la Vall d'Hebron, Barcelona, Spain
| | | | | | | | - Henriette Magelssen
- Department of Oncology, Oslo University Hospital (The Norwegian Radium Hospital), Norway
| | - Kristina Nilsson
- Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology, Clinical Oncology, Uppsala University Hospital, Sweden
| | - Frank Saran
- Department of Oncology, Royal Marsden Hospital, Sutton, United Kingdom
| | - Barbara Rombi
- Proton Therapy Center, Santa Chiara Hospital, Trento, Italy
| | - Rolf Kortmann
- Department of Radiation Oncology, University of Leipzig, Germany
| | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, and Princess Maxima Center for Pediatric Oncology, The Netherlands
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Mehrabian H, Myrehaug S, Soliman H, Sahgal A, Stanisz GJ. Evaluation of Glioblastoma Response to Therapy With Chemical Exchange Saturation Transfer. Int J Radiat Oncol Biol Phys 2018; 101:713-723. [PMID: 29893279 DOI: 10.1016/j.ijrobp.2018.03.057] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/02/2018] [Accepted: 03/27/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To monitor cellular and metabolic characteristics of glioblastoma (GBM) over the course of standard 6-week chemoradiation treatment with chemical exchange saturation transfer (CEST)-MRI; and to identify the earliest time point CEST could determine subsequent therapeutic response. METHODS AND MATERIALS Nineteen patients with newly diagnosed GBM were recruited, and CEST-MRI was acquired immediately before (Day0), 2 weeks (Day14) and 4 weeks (Day28) into treatment, and 1 month after the end of treatment (Day70). Several CEST metrics, including magnetization transfer ratio and area under the curve of CEST peaks corresponding to nuclear Overhauser effect (NOE) and amide protons (MTRNOE, MTRAmide, CESTNOE, and CESTAmide respectively), magnetization transfer (MT), and direct water effect were investigated. Lack of early progression was determined as no increase in tumor size or worsening of clinical symptoms according to routine post-chemoradiation serial structural MRI. RESULTS Changes in MTRNOE (nonprogressors = 1.35 ± 0.18, progressors = 0.97 ± 0.22, P = .006) and MTRAmide (nonprogressors = 1.25 ± 0.17, progressors = 0.99 ± 0.10, P = .017) between baseline (Day0) and Day14 resulted in the best separation of nonprogressors from progressors. Moreover, the baseline (Day0) MTRNOE (nonprogressors = 6.5% ± 1.6%, progressors = 9.1% ± 2.1%, P = .015), MTRAmide (nonprogressors = 6.7% ± 1.7%, progressors = 8.9% ± 1.9%, P = .028), MT (nonprogressors = 3.8% ± 0.9%, progressors = 5.4% ± 1.4%, P = .019), and CESTNOE (nonprogressors = 4.1%ċHz ± 1.7%ċHz, progressors = 6.1%ċHz ± 1.9%ċHz, P = .044) were able to identify progressors even before the start of the treatment. CONCLUSIONS Chemical exchange saturation transfer (CEST) provides imaging-based biomarkers of GBM response as early as 2 weeks into the treatment. Certain CEST metrics can characterize tumor aggressiveness and identify early progressors even before beginning the treatment. Such an early biomarker of response may allow for adjusting the GBM treatment plan for adaptive radiation therapy in early progressors and more confidently continuing standard adjuvant treatment for nonprogressors.
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Affiliation(s)
- Hatef Mehrabian
- Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.
| | - Sten Myrehaug
- Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Hany Soliman
- Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada; Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Greg J Stanisz
- Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Neurosurgery and Pediatric Neurosurgery, Medical University, Lublin, Poland
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Mehta S, Gajjar SR, Padgett KR, Asher D, Stoyanova R, Ford JC, Mellon EA. Daily Tracking of Glioblastoma Resection Cavity, Cerebral Edema, and Tumor Volume with MRI-Guided Radiation Therapy. Cureus 2018; 10:e2346. [PMID: 29796358 PMCID: PMC5959724 DOI: 10.7759/cureus.2346] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Radiation therapy (RT) plays a critical role in the treatment of glioblastoma. Studies of brain imaging during RT for glioblastoma have demonstrated changes in the brain during RT. However, frequent or daily utilization of standalone magnetic resonance imaging (MRI) scans during RT have limited feasibility. The recent release of the tri-cobalt-60 MRI-guided RT (MR-IGRT) device (ViewRay MRIdian, Cleveland, OH) allows for daily brain MRI for the RT setup. Daily MRI of three postoperative patients undergoing RT and temozolomide for glioblastoma over a six-week course allowed for the identification of changes to the cavity, edema, and visible tumor on a daily basis. The volumes and dimensions of the resection cavities, edema, and T2-hyperintense tumor were measured. A general trend of daily decreases in cavity measurements was observed in all patients. For the one patient with edema, a trend of daily increases followed by a trend of daily decreases were observed. These results suggest that daily MRI could be used for onboard resimulation and adaptive RT for future fluctuations in the sizes of brain tumors, cavities, or cystic components. This could improve tumor targeting and reduce RT of healthy brain tissue.
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Affiliation(s)
- Shahil Mehta
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami
| | - Shefali R Gajjar
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami
| | - Kyle R Padgett
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami
| | - David Asher
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami
| | - Radka Stoyanova
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami
| | - John C Ford
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami
| | - Eric A Mellon
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami
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Erler D, D'Alimonte L, Campbell M. Opportunity Is Knocking: The Need to Responsively and Responsibly Integrate Therapeutic MRI into Radiation Therapy. J Med Imaging Radiat Sci 2018; 49:16-17. [DOI: 10.1016/j.jmir.2017.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mehrabian H, Myrehaug S, Soliman H, Sahgal A, Stanisz GJ. Quantitative Magnetization Transfer in Monitoring Glioblastoma (GBM) Response to Therapy. Sci Rep 2018; 8:2475. [PMID: 29410469 PMCID: PMC5802834 DOI: 10.1038/s41598-018-20624-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/22/2018] [Indexed: 11/09/2022] Open
Abstract
Quantitative magnetization transfer (qMT) was used as a biomarker to monitor glioblastoma (GBM) response to chemo-radiation and identify the earliest time-point qMT could differentiate progressors from non-progressors. Nineteen GBM patients were recruited and MRI-scanned before (Day0), two weeks (Day14), and four weeks (Day28) into the treatment, and one month after the end of the treatment (Day70). Comprehensive qMT data was acquired, and a two-pool MT model was fit to the data. Response was determined at 3-8 months following the end of chemo-radiation. The amount of magnetization transfer ([Formula: see text]) was significantly lower in GBM compared to normal appearing white matter (p < 0.001). Statistically significant difference was observed in [Formula: see text] at Day0 between non-progressors (1.06 ± 0.24) and progressors (1.64 ± 0.48), with p = 0.006. Changes in several qMT parameters between Day14 and Day0 were able to differentiate the two cohorts with [Formula: see text] providing the best separation (relative [Formula: see text] = 1.34 ± 0.21, relative [Formula: see text] = 1.07 ± 0.08, p = 0.031). Thus, qMT characteristics of GBM are more sensitive to treatment effects compared to clinically used metrics. qMT could assess tumor aggressiveness and identify early progressors even before the treatment. Changes in qMT parameters within the first 14 days of the treatment were capable of separating early progressors from non-progressors, making qMT a promising biomarker to guide adaptive radiotherapy for GBM.
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Affiliation(s)
- Hatef Mehrabian
- Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.
| | - Sten Myrehaug
- Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Hany Soliman
- Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Greg J Stanisz
- Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University, Lublin, Poland
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Thibouw D, Truc G, Bertaut A, Chevalier C, Aubignac L, Mirjolet C. Clinical and dosimetric study of radiotherapy for glioblastoma: three-dimensional conformal radiotherapy versus intensity-modulated radiotherapy. J Neurooncol 2018; 137:429-438. [PMID: 29374810 DOI: 10.1007/s11060-017-2735-y] [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: 08/01/2017] [Accepted: 12/24/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to compare three-dimensional conformal radiotherapy (3D-CRT) with intensity-modulated radiotherapy (IMRT) for the treatment of glioblastoma. MATERIALS AND METHODS Retrospective study of 220 patients with glioblastoma, treated with 3D-CRT or IMRT, with or without surgery. Dosimetric parameters as well as clinical and survival data for the two techniques were analyzed and compared. RESULTS The median conformity index was 1.53 (range 0-2.69) for 3D-CRT and 1.25 (range 0.97-2.01) for IMRT, p < 10-4. The median homogeneity index was 0.10 (range 0.03-0.32) for 3D-CRT and 0.07 (range 0.03-0.18) for IMRT, p < 10-4. There were significantly fewer acute grade 1 and 2 neurological toxicities in the IMRT group especially for edema (1.3 versus 12.4%, p = 0.017), concentration disorders (6.6 versus 19.9%, p = 0.003) and consciousness disorders (2.6 versus 13.2%, p = 0.002) although IMRT patients had a significantly worse pre-treatment neurological status than 3D-CRT patients. Median survival was 16.0 months (range 11.9-17.8) for IMRT and 13.4 months (range 11.7-15.7) for 3D-CRT patients (p = 0.542). CONCLUSION IMRT improved target conformity and reduced neurological toxicities for patients with glioblastomas.
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Affiliation(s)
- David Thibouw
- Department of Radiation Oncology, Georges François Leclerc Cancer Center, Dijon, France
| | - Gilles Truc
- Department of Radiation Oncology, Georges François Leclerc Cancer Center, Dijon, France.
| | - Aurélie Bertaut
- Department of Statistics, Georges François Leclerc Cancer Center, Dijon, France
| | - Cédric Chevalier
- Department of Radiation Oncology, Georges François Leclerc Cancer Center, Dijon, France
| | - Léone Aubignac
- Department of Medical Physics, Georges François Leclerc Cancer Center, Dijon, France
| | - Céline Mirjolet
- Department of Radiation Oncology, Georges François Leclerc Cancer Center, Dijon, France
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