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Sun H, Wang N, Wang X, Huang G, Chang Y, Liu Y. A study of different minimum segment area parameters on automatic IMRT plans for cervical cancer using Pinnacle3 9.10 TPS. Medicine (Baltimore) 2022; 101:e29290. [PMID: 36086767 PMCID: PMC10980374 DOI: 10.1097/md.0000000000029290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/24/2022] [Indexed: 11/25/2022] Open
Abstract
Based on Pinnacle39.10 treatment planning system (TPS) automatic planning module, we investigated the effect of minimum segmentation area (MSA) parameters on Auto-Plan Intensity Modulated Radiotherapy (AP-IMRT) without affecting the dose distribution of the target and the Organ at Risk (OAR). The results provided the basis for the ideal MSA parameters in the design of AP-IMRT plan. Ten patients with cervical cancer in our hospital were selected randomly for AP-IMRT design. Each patient was devised with 10 AP-IMRT plans. The prescription dose of PTV was 50 Gy/25 fractions. The radiotherapy plans of all patients were adopted with 7 field-averaged fixed fields. The MSA was set to 4 cm2, 9 cm2, 14 cm2, 20 cm2, 25 cm2, 40 cm2, 50 cm2, 60 cm2, 80 cm2, and 100 cm2. Plan quality and delivery efficiency were evaluated based on dose-volume histograms (DVHs), control points, monitor units (MUs), dosimetric measurement verification results, and plan delivery time. Except for the small difference in monitor units, the number of segmentations and target dose coverage, there were no statistically significant differences between the other dosimetric parameters in the planning target volumes. With the increase of MSA, the total number of MUs in AP-IMRT decreased from (649 ± 32) MUs to (312 ± 26) MUs, and the total number of segmentations decreased from (69 ± 1) to (28 ± 3). There was no statistical significance in the dose distribution of AP-IMRT target area with the MSA of 4-50 cm2 (P > .05). There was no significant difference in OAR dose between AP-IMRT plans with different MSA (P > .05). The calculated gamma indices using the 3% /3 mm and 2%/2 mm criteria. Both of the gamma pass rate and DTA pass rate all ≥95% under the condition of MSA are greater than 4 cm2, and the difference was no statistically significant (P > .05). The plan delivery times decreased with increasing MSA (P < .05). When using Pinnacle3 9.10 TPS to design AP-IMRT plan for cervical cancer, the parameter of MSA can be increased appropriately. Increasing the MSA allows for improved plan delivery accuracy and efficiency without significantly affecting the AP-IMRT plan quality. The MSA in the range of 14 to 50 cm2 can obtain a more reasonable dose distribution in the target area while the dose of target area and OAR had no significant changes. It is important to improve the plan quality, delivery accuracy, and efficiency for cervical AP-IMRT radiation therapy.
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Affiliation(s)
- Haitao Sun
- Zhongshan Hospital of Traditional Chinese Medicine, Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong Province, People’s Republic of China
| | - Ning Wang
- Zhongshan Hospital of Traditional Chinese Medicine, Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong Province, People’s Republic of China
| | - Xuetao Wang
- Zhongshan Hospital of Traditional Chinese Medicine, Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong Province, People’s Republic of China
| | - Guosen Huang
- Zhongshan Hospital of Traditional Chinese Medicine, Affiliated to Guangzhou University of Chinese Medicine, Zhongshan, Guangdong Province, People’s Republic of China
| | - Yaohua Chang
- School of Control Science and Engineering, Shandong University, Jinan, Shandong Province, People’s Republic of China
| | - Ying Liu
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China
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Fluence map optimisation for prostate cancer intensity modulated radiotherapy planning using iterative solution method. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2020. [DOI: 10.2478/pjmpe-2020-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Here we projected a model-based IMRT treatment plan to produce the optimal radiation dosage by considering that the maximum amount of prescribed dose should be delivered to the target without affecting the surrounding healthy tissues especially the OARs. Fluence mapping is used for inverse planning. This suggested method can generate global minima for IMRT plans with reliable plan quality among diverse treatment planners and to provide better safety for significant parallel OARs in an effective way. The whole methodology is having the capability to handles various objectives and to generate effective treatment procedures as validated with illustrations on the CORT dataset. For the validation of our methodology, we have compared our result with the two other approaches for calculating the objectives based on dose-volume bounds and found that in our methodology dose across the prostate and lymph nodes is maximum and the time required for the convergence is minimum.
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Alongi F, Di Muzio N. Radiobiology and Molecular Oncology: How are they Changing Radiotherapy in Clinical Practice? TUMORI JOURNAL 2018; 96:175-7. [DOI: 10.1177/030089161009600131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Filippo Alongi
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Italy
- Radiotherapy, Scientific institute San Raffaele, Milan, Italy
- Intraoperative Radiotherapy, Breast Unit, San Raffaele-G. Giglio Foundation, Cefalù, Italy
| | - Nadia Di Muzio
- Radiotherapy, Scientific institute San Raffaele, Milan, Italy
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Deshpande S, Geurts M, Vial P, Metcalfe P, Lee M, Holloway L. Clinical significance of treatment delivery errors for helical TomoTherapy nasopharyngeal plans – A dosimetric simulation study. Phys Med 2017; 33:159-169. [PMID: 28110824 DOI: 10.1016/j.ejmp.2017.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 12/06/2016] [Accepted: 01/07/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Shrikant Deshpande
- Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia.
| | - Mark Geurts
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, USA.
| | - Philip Vial
- Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia; Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia.
| | - Peter Metcalfe
- Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia.
| | - Mark Lee
- Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia.
| | - Lois Holloway
- Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia; Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia; South West Clinical School, University of New South Wales, Sydney, NSW, Australia.
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Paganetti H, Yu CX, Orton CG. Photon radiotherapy has reached its limit in terms of catching up dosimetrically with proton therapy. Med Phys 2016; 43:4470. [DOI: 10.1118/1.4954790] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Moon DH, Efstathiou JA, Chen RC. What is the best way to radiate the prostate in 2016? Urol Oncol 2016; 35:59-68. [PMID: 27395453 DOI: 10.1016/j.urolonc.2016.06.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/20/2016] [Accepted: 06/04/2016] [Indexed: 12/25/2022]
Abstract
Prostate cancer treatment with definitive radiation therapy (RT) has evolved dramatically in the past 2 decades. From the initial 2-dimensional planning using X-rays, advances in technology led to 3-dimensional conformal RT, which used computerized tomography-based planning. This has allowed delivery of higher doses of radiation to the prostate while reducing dose to the surrounding organs, resulting in improved cancer control. Today, intensity-modulated RT (IMRT) is considered standard, where radiation beams of different shapes and intensities can be delivered from a wide range of angles, thus further decreasing doses to normal organs and likely reducing treatment-related toxicity. In addition, image guidance ascertains the location of the prostate before daily treatment delivery. Brachytherapy is the placement of radioactive seeds directly in the prostate, and has a long track record as a monotherapy for low-risk prostate cancer patients with excellent long-term cancer control and quality of life outcomes. Recent studies including several randomized trials support the use of brachytherapy in combination with external beam RT for higher-risk patients. RT for prostate cancer continues to evolve. Proton therapy has a theoretical advantage over photons as it deposits most of the dose at a prescribed depth with a rapid dose fall-off thereafter; therefore it reduces some doses delivered to the bladder and rectum. Prospective studies have shown the safety and efficacy of proton therapy for prostate cancer, but whether it leads to improved patient outcomes compared to IMRT is unknown. Hypofractionated RT delivers a larger dose of daily radiation compared to conventional IMRT, and thus reduces the overall treatment time and possibly cost. An extreme form of hypofractionation is stereotactic body radiation therapy where highly precise radiation is used and treatment is completed in a total of 4 to 5 sessions. These techniques take advantage of the biological characteristic of prostate cancer, which is more sensitive to larger radiation doses per fraction, and therefore could be more effective than conventional IMRT. Multiple randomized trials have demonstrated noninferiority of moderately hypofractionated RT compared to conventional fractionation. There is also a growing body of data demonstrating the safety and efficacy of stereotactic body radiation therapy for low- and intermediate-risk prostate cancer.
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Affiliation(s)
- Dominic H Moon
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ronald C Chen
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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Li J, Tang XB, Wang BH, Chen XM, Chen D, Chai L. Comparison between Dual Arc VMAT and 7F-IMRT in the protection of hippocampus for patients during whole brain radiotherapy. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2016; 24:457-466. [PMID: 27257881 DOI: 10.3233/xst-160561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE The purpose of this study was to compare the dosimetric characteristics for protection of the hippocampus between dual arc VMAT (volumetric modulated arc therapy) and 7 fields intensity-modulated radiation therapy (7F-IMRT) for patients with brain metastases from lung cancer under the whole brain radiotherapy. METHODS Based on ten cases with brain metastases from lung cancer, two types of radiotherapy plans were designed, namely, dual arc VMAT and 7F-IMRT. Provided that the clinical requirements were satisfied, the comparisons of target dose distribution, conformity index (CI), homogeneity index (HI), dose of organs at risk (OARs), monitor units (MU) and treatment time between dual arc VMAT and 7F-IMRT were investigated for their dosimetric difference. RESULTS Both treatment plans met the requirements of clinical treatments. However, the PTV-HA conformity and homogeneity of dual arc VMAT were superior to those of 7F-IMRT (P < 0.05). As to OARs, the mean maximum doses (Dmax) of hippocampus, eyes and optic nerves in the dual arc VMAT plan were all lower than those in 7F-IMRT plan (P < 0.05), but the result had no statistical significance (P < 0.05) for the maximum dose of lens. Compared with 7F-IMRT, dual arc VMAT reduced the average number of MU by 67% and the average treatment time by 74%. Therefore, treatment time was shortened by dual arc VMAT. CONCLUSION With regards to the patients with brain metastases from lung cancer under the whole brain radiotherapy, the PTV-HA conformity and homogeneity of dual arc VMAT were superior to those of 7F-IMRT under the precise of meeting the clinical requirements. In addition, dual arc VMAT remarkably reduced the irradiation dose to OARs (hippocampus, eyes and optic nerves), MU and treatment time, as well, guaranteed patients with better protection.
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Affiliation(s)
- Jun Li
- Department of Nuclear Science & Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing City, Jiangsu Province, China
- Radiotherapy Department of Subei People's Hospital, Yangzhou City, Jiangsu Province, China
- Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, China
| | - Xiao-Bin Tang
- Department of Nuclear Science & Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing City, Jiangsu Province, China
- Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, China
| | - Bu-Hai Wang
- Radiotherapy Department of Subei People's Hospital, Yangzhou City, Jiangsu Province, China
- Cancer Institute of Northern Jiangsu People's Hospital, Yangzhou City, Jiangsu Province, China
| | - Xue-Mei Chen
- Radiotherapy Department of Subei People's Hospital, Yangzhou City, Jiangsu Province, China
| | - Da Chen
- Department of Nuclear Science & Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing City, Jiangsu Province, China
- Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, China
| | - Lei Chai
- Department of Nuclear Science & Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing City, Jiangsu Province, China
- Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, China
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Njeh CF, Suh TS, Orton CG. Point/Counterpoint. Radiotherapy using hard wedges is no longer appropriate and should be discontinued. Med Phys 2016; 43:1031-4. [PMID: 26936690 DOI: 10.1118/1.4939262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Christopher F Njeh
- Franciscan St. Francis Health, Indianapolis, Indiana 46237 (Tel: 903-422-0449; E-mail: )
| | - Tae Suk Suh
- Biomedical Engineering, Catholic University Medical College, Seoul 137-701, Republic of Korea (Tel: 822-2258-7234; E-mail: )
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Zhang RH, Fan XM, Bai WW, Cao YK. Implementation of Constant Dose Rate and Constant Angular Spacing Intensity-modulated Arc Therapy for Cervical Cancer by Using a Conventional Linear Accelerator. Chin Med J (Engl) 2016; 129:284-8. [PMID: 26831229 PMCID: PMC4799571 DOI: 10.4103/0366-6999.174500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Volumetric-modulated arc therapy (VMAT) can only be implemented on the new generation linacs such as the Varian Trilogy® and Elekta Synergy®. This prevents most existing linacs from delivering VMAT. The purpose of this study was to investigate the feasibility of using a conventional linear accelerator delivering constant dose rate and constant angular spacing intensity-modulated arc therapy (CDR-CAS-IMAT) for treating cervical cancer. METHODS Twenty patients with cervical cancer previously treated with intensity-modulated radiation therapy (IMRT) using Varian Clinical 23EX were retreated using CDR-CAS-IMAT. The planning target volume (PTV) was set as 50.4 Gy in 28 fractions. Plans were evaluated based on the ability to meet the dose volume histogram. The homogeneity index (HI), target volume conformity index (CI), the dose to organs at risk, radiation delivery time, and monitor units (MUs) were also compared. The paired t-test was used to analyze the two data sets. All statistical analyses were performed using SPSS 19.0 software. RESULTS Compared to the IMRT group, the CDR-CAS-IMAT group showed better PTV CI (0.85 ± 0.03 vs. 0.81 ± 0.03, P = 0.001), clinical target volume CI (0.46 ± 0.05 vs. 0.43 ± 0.05, P = 0.001), HI (0.09 ± 0.02 vs. 0.11 ± 0.02, P = 0.005) and D95 (5196.33 ± 28.24 cGy vs. 5162.63 ± 31.12 cGy, P = 0.000), and cord D2 (3743.8 ± 118.7 cGy vs. 3806.2 ± 98.7 cGy, P = 0.017) and rectum V40 (41.9 ± 6.1% vs. 44.2 ± 4.8%, P = 0.026). Treatment time (422.7 ± 46.7 s vs. 84.6 ± 7.8 s, P = 0.000) and the total plan Mus (927.4 ± 79.1 vs. 787.5 ± 78.5, P = 0.000) decreased by a factor of 0.8 and 0.15, respectively. The IMRT group plans were superior to the CDR-CAS-IMAT group plans considering decreasing bladder V50 (17.4 ± 4.5% vs. 16.6 ± 4.2%, P = 0.049), bowel V30 (39.6 ± 6.5% vs. 36.6 ± 7.5%, P = 0.008), and low-dose irradiation volume; there were no significant differences in other statistical indexes. CONCLUSIONS Patients with cervical cancer treated with CDR-CAS-IMAT using Varian Clinical 23EX can get equivalent or superior dose distribution compared to those treated with IMRT. CDR-CAS-IMAT has a less treatment time and MU, which can reduce the uncertainty factor and patient discomfort in treatment.
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Affiliation(s)
- Ruo-Hui Zhang
- Department of Radiotherapy, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, China
| | - Xiao-Mei Fan
- Department of Radiotherapy, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, China
| | - Wen-Wen Bai
- Department of Radiotherapy, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, China
| | - Yan-Kun Cao
- Department of Radiotherapy, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, China
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Zohrabian VM, Husain ZA, Laurans MS, Chiang VL, Mahajan A, Johnson MH. Practice Building: Achieving Growth Through Computed Tomographic Myelography-Based Stereotactic Body Radiation Therapy for Spinal Metastases. Curr Probl Diagn Radiol 2016; 45:324-9. [PMID: 26920633 DOI: 10.1067/j.cpradiol.2016.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 01/26/2016] [Indexed: 11/22/2022]
Abstract
Stereotactic body radiation therapy (SBRT) is as an effective method to treat spinal metastases. Imaging is a critical component in the workup of patients who undergo stereotactic radiation treatment. Computed tomographic myelography may be more accurate than magnetic resonance imaging in the delineation of neural elements during SBRT. The task we faced was to offer a standardized method to rapidly and safely obtain high-quality computed tomographic myelography as part of a robust spine SBRT program. In detailing our experience, we support the greater, active participation of radiologists in the multidisciplinary care of patients with spinal metastases, while encouraging other radiologists to foster similar collaborations at their own institutions.
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Affiliation(s)
- Vahe M Zohrabian
- Department of Diagnostic Radiology, Yale School of Medicine, New Haven, CT.
| | - Zain A Husain
- Department of Therapeutic Radiology/Radiation Oncology, Yale School of Medicine, New Haven, CT
| | | | - Veronica L Chiang
- Department of Therapeutic Radiology/Radiation Oncology, Yale School of Medicine, New Haven, CT; Department of Neurosurgery, Yale School of Medicine, New Haven, CT
| | - Amit Mahajan
- Department of Diagnostic Radiology, Yale School of Medicine, New Haven, CT
| | - Michele H Johnson
- Department of Diagnostic Radiology, Yale School of Medicine, New Haven, CT; Department of Neurosurgery, Yale School of Medicine, New Haven, CT
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Dosimetric impact of different multileaf collimators on prostate intensity modulated treatment planning. Rep Pract Oncol Radiother 2015; 20:358-64. [PMID: 26549993 DOI: 10.1016/j.rpor.2015.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 04/05/2015] [Accepted: 06/20/2015] [Indexed: 11/22/2022] Open
Abstract
AIM The main purpose of this study is to perform a dosimetric comparison on target volumes and organs at risks (OARs) between prostate intensity modulated treatment plans (IMRT) optimized with different multileaf collimators (MLCs). BACKGROUND The use of MLCs with a small leaf width in the IMRT optimization may improve conformity around the tumor target whilst reducing the dose to normal tissues. MATERIALS AND METHODS Two linacs mounting MLCs with 5 and 10 mm leaf-width, respectively, implemented in Pinnacle(3) treatment planning system were used for this work. Nineteen patients with prostate carcinoma undergoing a radiotherapy treatment were enrolled. Treatment planning with different setup arrangements (7 and 5 beams) were performed for each patient and each machine. Dose volume histograms (DVHs) cut-off points were used in the treatment planning comparison. RESULTS Comparable planning target volume (PTV) coverage was obtained with 7- and 5-beam configuration (both with 5 and 10 mm MLC leaf-width). The comparison of bladder and rectum DVH cut-off points for the 5-beam arrangement shows that 52.6% of the plans optimized with a larger leaf-width did not satisfy at least one of the OARs' constraints. This percentage is reduced to 10.5% for the smaller leaf-width. If a 7-beam arrangement is used the value of 52.6% decreases to 21.1% while the value of 10.5% remains unchanged. CONCLUSION MLCs collimators with different widths and number of leaves lead to a comparable prostate treatment planning if a proper adjustment is made of the number of gantry angles.
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Sulé-Suso J, Finney S, Bisson J, Hammersley S, Jassel S, Knight R, Hicks C, Sargeant S, Lam KP, Belcher J, Collins D, Bhana R, Adab F, O'Donovan C, Moloney A. Pilot study on virtual imaging for patient information on radiotherapy planning and delivery. Radiography (Lond) 2015. [DOI: 10.1016/j.radi.2015.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gurjar OP, Prasad Mishra S. A comparative study on patient specific absolute dosimetry using slab phantom, acrylic body phantom and goat head phantom. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2015. [DOI: 10.14319/ijcto.32.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
Stereotactic body radiotherapy (SBRT) and stereotactic radiosurgery (SRS) for spinal metastases are emerging treatment paradigms in the multidisciplinary management of metastases located within or adjacent (paraspinal) to the vertebral bodies/spinal cord. In this review, we provide a brief overview of spine SBRT/SRS indications, technology, planning, and treatment delivery; review the current state of the literature; and discuss the radiobiology, toxicity, and limitations of SBRT/SRS for metastatic disease of the spine.
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Lan Y, Ren H, Li C, Min Z, Wan J, Ma J, Hung CC. Inverse planning optimization method for intensity modulated radiation therapy. Technol Cancer Res Treat 2013; 12:391-401. [PMID: 23617286 DOI: 10.7785/tcrt.2012.500339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
In order to facilitate the leaf sequencing process in intensity modulated radiation therapy (IMRT), and design of a practical leaf sequencing algorithm, it is an important issue to smooth the planned fluence maps. The objective is to achieve both high-efficiency and high-precision dose delivering by considering characteristics of leaf sequencing process. The key factor which affects total number of monitor units for the leaf sequencing optimization process is the max flow value of the digraph which formulated from the fluence maps. Therefore, we believe that one strategy for compromising dose conformity and total number of monitor units in dose delivery is to balance the dose distribution function and the max flow value mentioned above. However, there are too many paths in the digraph, and we don't know the flow value of which path is the maximum. The maximum flow value among the horizontal paths was selected and used in the objective function of the fluence map optimization to formulate the model. The model is a traditional linear constrained quadratic optimization model which can be solved by interior point method easily. We believe that the smoothed maps from this model are more suitable for leaf sequencing optimization process than other smoothing models. A clinical head-neck case and a prostate case were tested and compared using our proposed model and the smoothing model which is based on the minimization of total variance. The optimization results with the same level of total number of monitor units (TNMU) show that the fluence maps obtained from our model have much better dose performance for the target/non-target region than the maps from total variance based on the smoothing model. This indicates that our model achieves better dose distribution when the algorithm suppresses the TNMU at the same level. Although we have just used the max flow value of the horizontal paths in the diagraph in the objective function, a good balance has been achieved between the dose conformity and the total number of monitor units. This idea can be extended to other fluence map optimization model, and we believe it can also achieve good performance.
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Affiliation(s)
- Yihua Lan
- School of Computer and Information Technology, Nanyang Normal University, Nanyang, Henan 473061, P.R.China.
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Rangaraj D, Zhu M, Yang D, Palaniswaamy G, Yaddanapudi S, Wooten OH, Brame S, Mutic S. Catching errors with patient-specific pretreatment machine log file analysis. Pract Radiat Oncol 2013; 3:80-90. [DOI: 10.1016/j.prro.2012.05.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 05/02/2012] [Accepted: 05/05/2012] [Indexed: 11/28/2022]
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Kim J. Radiotherapy of NPC: Current Strategies and Perspectives. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013. [DOI: 10.1007/978-1-4614-5947-7_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lan Y, Li C, Ren H, Zhang Y, Min Z. Fluence map optimization (FMO) with dose-volume constraints in IMRT using the geometric distance sorting method. Phys Med Biol 2012; 57:6407-28. [PMID: 22996086 DOI: 10.1088/0031-9155/57/20/6407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A new heuristic algorithm based on the so-called geometric distance sorting technique is proposed for solving the fluence map optimization with dose-volume constraints which is one of the most essential tasks for inverse planning in IMRT. The framework of the proposed method is basically an iterative process which begins with a simple linear constrained quadratic optimization model without considering any dose-volume constraints, and then the dose constraints for the voxels violating the dose-volume constraints are gradually added into the quadratic optimization model step by step until all the dose-volume constraints are satisfied. In each iteration step, an interior point method is adopted to solve each new linear constrained quadratic programming. For choosing the proper candidate voxels for the current dose constraint adding, a so-called geometric distance defined in the transformed standard quadratic form of the fluence map optimization model was used to guide the selection of the voxels. The new geometric distance sorting technique can mostly reduce the unexpected increase of the objective function value caused inevitably by the constraint adding. It can be regarded as an upgrading to the traditional dose sorting technique. The geometry explanation for the proposed method is also given and a proposition is proved to support our heuristic idea. In addition, a smart constraint adding/deleting strategy is designed to ensure a stable iteration convergence. The new algorithm is tested on four cases including head-neck, a prostate, a lung and an oropharyngeal, and compared with the algorithm based on the traditional dose sorting technique. Experimental results showed that the proposed method is more suitable for guiding the selection of new constraints than the traditional dose sorting method, especially for the cases whose target regions are in non-convex shapes. It is a more efficient optimization technique to some extent for choosing constraints than the dose sorting method. By integrating a smart constraint adding/deleting scheme within the iteration framework, the new technique builds up an improved algorithm for solving the fluence map optimization with dose-volume constraints.
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Affiliation(s)
- Yihua Lan
- School of Computer Engineering, Huaihai Institute of Technology, Lianyungang, Jiangsu 222005, People's Republic of China.
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Niu Y, Zhang G, Berman BL, Parke WC, Yi B, Yu CX. Improving IMRT-plan quality with MLC leaf position refinement post plan optimization. Med Phys 2012; 39:5118-26. [PMID: 22894437 DOI: 10.1118/1.4737518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE In intensity-modulated radiation therapy (IMRT) planning, reducing the pencil-beam size may lead to a significant improvement in dose conformity, but also increase the time needed for the dose calculation and plan optimization. The authors develop and evaluate a postoptimization refinement (POpR) method, which makes fine adjustments to the multileaf collimator (MLC) leaf positions after plan optimization, enhancing the spatial precision and improving the plan quality without a significant impact on the computational burden. METHODS The authors' POpR method is implemented using a commercial treatment planning system based on direct aperture optimization. After an IMRT plan is optimized using pencil beams with regular pencil-beam step size, a greedy search is conducted by looping through all of the involved MLC leaves to see if moving the MLC leaf in or out by half of a pencil-beam step size will improve the objective function value. The half-sized pencil beams, which are used for updating dose distribution in the greedy search, are derived from the existing full-sized pencil beams without need for further pencil-beam dose calculations. A benchmark phantom case and a head-and-neck (HN) case are studied for testing the authors' POpR method. RESULTS Using a benchmark phantom and a HN case, the authors have verified that their POpR method can be an efficient technique in the IMRT planning process. Effectiveness of POpR is confirmed by noting significant improvements in objective function values. Dosimetric benefits of POpR are comparable to those of using a finer pencil-beam size from the optimization start, but with far less computation and time. CONCLUSIONS The POpR is a feasible and practical method to significantly improve IMRT-plan quality without compromising the planning efficiency.
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Affiliation(s)
- Ying Niu
- Department of Physics, The George Washington University, Washington, DC 20052 , USA
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20
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Kumar SAS, Holla R, Sukumar P, Padmanaban S, Vivekanandan N. Treatment planning and dosimetric comparison study on two different volumetric modulated arc therapy delivery techniques. Rep Pract Oncol Radiother 2012; 18:87-94. [PMID: 24416535 DOI: 10.1016/j.rpor.2012.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 06/10/2012] [Accepted: 07/13/2012] [Indexed: 10/28/2022] Open
Abstract
AIM To compare and evaluate the performance of two different volumetric modulated arc therapy delivery techniques. BACKGROUND Volumetric modulated arc therapy is a novel technique that has recently been made available for clinical use. Planning and dosimetric comparison study was done for Elekta VMAT and Varian RapidArc for different treatment sites. MATERIALS AND METHODS Ten patients were selected for the planning comparison study. This includes 2 head and neck, 2 oesophagus, 1 bladder, 3 cervix and 2 rectum cases. Total dose of 50 Gy was given for all the plans. All plans were done for RapidArc using Eclipse and for Elekta VMAT with Monaco treatment planning system. All plans were generated with 6 MV X-rays for both RapidArc and Elekta VMAT. Plans were evaluated based on the ability to meet the dose volume histogram, dose homogeneity index, radiation conformity index, estimated radiation delivery time, integral dose and monitor units needed to deliver the prescribed dose. RESULTS RapidArc plans achieved the best conformity (CI95% = 1.08 ± 0.07) while Elekta VMAT plans were slightly inferior (CI95% = 1.10 ± 0.05). The in-homogeneity in the PTV was highest with Elekta VMAT with HI equal to 0.12 ± 0.02 Gy when compared to RapidArc with 0.08 ± 0.03. Significant changes were observed between the RapidArc and Elekta VMAT plans in terms of the healthy tissue mean dose and integral dose. Elekta VMAT plans show a reduction in the healthy tissue mean dose (6.92 ± 2.90) Gy when compared to RapidArc (7.83 ± 3.31) Gy. The integral dose is found to be inferior with Elekta VMAT (11.50 ± 6.49) × 10(4) Gy cm(3) when compared to RapidArc (13.11 ± 7.52) × 10(4) Gy cm(3). Both Varian RapidArc and Elekta VMAT respected the planning objective for all organs at risk. Gamma analysis result for the pre-treatment quality assurance shows good agreement between the planned and delivered fluence for 3 mm DTA, 3% DD for all the evaluated points inside the PTV, for both VMAT and RapidArc techniques. CONCLUSION The study concludes that a variable gantry speed with variable dose rate is important for efficient arc therapy delivery. RapidArc presents a slight improvement in the OAR sparing with better target coverage when compared to Elekta VMAT. Trivial differences were noted in all the plans for organ at risk but the two techniques provided satisfactory conformal avoidance and conformation.
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Affiliation(s)
- S A Syam Kumar
- Department of Medical Physics, Cancer Institute (WIA), Chennai, TamilNadu, India
| | - Raghavendra Holla
- Department of Medical Physics, Amrita Institute of Medical Sciences and Research Centre (AIMS), Cochin, Kerala, India
| | - Prabakar Sukumar
- Department of Medical Physics, Cancer Institute (WIA), Chennai, TamilNadu, India
| | - Sriram Padmanaban
- Department of Medical Physics, Cancer Institute (WIA), Chennai, TamilNadu, India
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21
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Fontanarosa D, van der Meer S, Bloemen-van Gurp E, Stroian G, Verhaegen F. Magnitude of speed of sound aberration corrections for ultrasound image guided radiotherapy for prostate and other anatomical sites. Med Phys 2012; 39:5286-92. [DOI: 10.1118/1.4737571] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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22
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Johnston M, Yu E, Kim J. Perineural invasion and spread in head and neck cancer. Expert Rev Anticancer Ther 2012; 12:359-71. [PMID: 22369327 DOI: 10.1586/era.12.9] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Perineural involvement is a well-recognized clinicopathologic entity found in head and neck (H&N) cancers, including mucosal epithelial carcinomas and salivary gland malignancies. Perineural disease remains a diagnostic, prognostic and therapeutic challenge for the multidisciplinary H&N oncology team. Nerves are important routes of tumor spread in H&N malignancies, yet the biology and prognostic implications of perineural tumor growth are not fully understood. On balance, the available evidence suggests that it is associated with an increased risk of locoregional recurrence but the impact on survival remains uncertain. Perineural involvement has implications for locoregional disease diagnosis and management. MRI is the best imaging modality to detect tumor extent. Advanced radiotherapy technologies such as intensity-modulated radiation therapy and image-guided radiation therapy have the potential for more accurate targeting and treatment of anatomically complex patterns of disease spread. This review is limited to nondermatologic H&N cancers.
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Affiliation(s)
- Meredith Johnston
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
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23
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Alongi F, Arcangeli S, Filippi AR, Ricardi U, Scorsetti M. Review and uses of stereotactic body radiation therapy for oligometastases. Oncologist 2012; 17:1100-7. [PMID: 22723509 PMCID: PMC3425528 DOI: 10.1634/theoncologist.2012-0092] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 05/30/2012] [Indexed: 12/12/2022] Open
Abstract
In patients with proven distant metastases from solid tumors, it has been a notion that the condition is incurable, warranting palliative care only. The term "oligometastases" was coined to refer to isolated sites of metastasis, whereby the entire burden of disease can be recognized as a finite number of discrete lesions that can be potentially cured with local therapies. Stereotactic body radiation therapy (SBRT) is a novel treatment modality in radiation oncology that delivers a very high dose of radiation to the tumor target with high precision using single or a small number of fractions. SBRT is the result of technological advances in patient and tumor immobilization, image guidance, and treatment planning and delivery. A number of studies, both retrospective and prospective, showed promising results in terms of local tumor control and, in a limited subset of patients, of survival. This article reviews the radiobiologic, technical, and clinical aspects of SBRT for various anatomical sites.
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Affiliation(s)
- Filippo Alongi
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Stefano Arcangeli
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Andrea Riccardo Filippi
- Department of Medical and Surgical Sciences, Radiation Oncology Unit, University of Turin, Turin, Italy
| | - Umberto Ricardi
- Department of Medical and Surgical Sciences, Radiation Oncology Unit, University of Turin, Turin, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
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Riou O, Fenoglietto P, Laliberté B, Menkarios C, Llacer Moscardo C, Hay MH, Ailleres N, Dubois JB, Rebillard X, Azria D. Three Years of Salvage IMRT for Prostate Cancer: Results of the Montpellier Cancer Center. ISRN UROLOGY 2012; 2012:391705. [PMID: 22567417 PMCID: PMC3329735 DOI: 10.5402/2012/391705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 01/03/2012] [Indexed: 11/23/2022]
Abstract
Background. To assess the feasibility of salvage intensity-modulated radiation Therapy (IMRT) and to examine clinical outcome. Patients and Methods. 57 patients were treated with salvage IMRT to the prostate bed in our center from January, 2007, to February, 2010. The mean prescription dose was 68 Gy in 34 fractions. Forty-four patients received concomitant androgen deprivation. Results. Doses to organs at risk were low without altering target volume coverage. Salvage IMRT was feasible without any grade 3 or 4 acute gastrointestinal or urinary toxicity. With a median follow-up of 21 months, one grade 2 urinary and 1 grade ≥2 rectal late toxicities were reported. Biological relapse-free survival was 96.5% (2.3% (1/44) relapsed with androgen suppression and 7.7% (1/13) without). Conclusion. Salvage IMRT is feasible and results in low acute and chronic side-effects. Longer follow-up is warranted to draw conclusions in terms of oncologic control.
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Affiliation(s)
- Olivier Riou
- Département d'Oncologie Radiothérapie, CRLC Val d'Aurelle-Paul Lamarque, Montpellier 34298, France
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Eldesoky I, Attalla EM, Elshemey WM, Zaghloul MS. A comparison of three commercial IMRT treatment planning systems for selected paediatric cases. J Appl Clin Med Phys 2012; 13:3742. [PMID: 22402392 PMCID: PMC5716417 DOI: 10.1120/jacmp.v13i2.3742] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 11/02/2011] [Accepted: 11/14/2011] [Indexed: 12/25/2022] Open
Abstract
This work aimed at evaluating the performance of three different intensity‐modulated radiotherapy (IMRT) treatment planning systems (TPSs) — KonRad, XiO and Prowess — for selected pediatric cases. For this study, 11 pediatric patients with different types of brain, orbit, head and neck cancer were selected. Clinical step‐and‐shoot IMRT treatment plans were designed for delivery on a Siemens ONCOR accelerator with 82‐leaf multileaf collimators (MLCs). Plans were optimized to achieve the same clinical objectives by applying the same beam energy and the same number and direction of beams. The analysis of performance was based on isodose distributions, dose‐volume histograms (DVHs) for planning target volume (PTV), the relevant organs at risk (OARs), as well as mean dose (Dmean), maximum dose (Dmax), 95% dose (D95), volume of patient receiving 2 and 5 Gy, total number of segments, monitor units per segment (MU/Segment), and the number of MU/cGy. Treatment delivery time and conformation number were two other evaluation parameters that were considered in this study. Collectively, the Prowess and KonRad plans showed a significant reduction in the number of MUs that varied between 1.8% and 61.5% (p−value=0.001) for the different cases, compared to XiO. This was reflected in shorter treatment delivery times. The percentage volumes of each patient receiving 2 Gy and 5 Gy were compared for the three TPSs. The general trend was that KonRad had the highest percentage volume, Prowess showed the lowest (p−value=0.0001). The KonRad achieved better conformality than both of XiO and Prowess. Based on the present results, the three treatment planning systems were efficient in IMRT, yet XiO showed the lowest performance. The three TPSs achieved the treatment goals according to the internationally approved standards.
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Paulson ES, Bradley JA, Wang D, Ahunbay EE, Schultz C, Li XA. Internal margin assessment using cine MRI analysis of deglutition in head and neck cancer radiotherapy. Med Phys 2011; 38:1740-7. [DOI: 10.1118/1.3560418] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Shuryak I, Sachs RK, Brenner DJ. A new view of radiation-induced cancer. RADIATION PROTECTION DOSIMETRY 2011; 143:358-364. [PMID: 21113062 PMCID: PMC3108273 DOI: 10.1093/rpd/ncq389] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Biologically motivated mathematical models are important for understanding the mechanisms of radiation-induced carcinogenesis. Existing models fall into two categories: (1) short-term formalisms, which focus on the processes taking place during and shortly after irradiation (effects of dose, radiation quality, dose rate and fractionation), and (2) long-term formalisms, which track background cancer risks throughout the entire lifetime (effects of age at exposure and time since exposure) but make relatively simplistic assumptions about radiation effects. Grafting long-term mechanisms on to short-term models is badly needed for modelling radiogenic cancer. A combined formalism was developed and applied to cancer risk data in atomic bomb survivors and radiotherapy patients and to background cancer incidence. The data for nine cancer types were described adequately with a set of biologically meaningful parameters for each cancer. These results suggest that the combined short-long-term approach is a potentially promising method for predicting radiogenic cancer risks and interpreting the underlying biological mechanisms.
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Affiliation(s)
- I. Shuryak
- Center for Radiological Research, Columbia University, New York, NY 10032, USA
| | - R. K. Sachs
- Department of Mathematics, University of California, Berkeley, CA 94720, USA
- Department of Physics, University of California, Berkeley, CA 94720, USA
| | - D. J. Brenner
- Center for Radiological Research, Columbia University, New York, NY 10032, USA
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28
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Clinical significance of multi-leaf collimator positional errors for volumetric modulated arc therapy. Radiother Oncol 2010; 97:554-60. [DOI: 10.1016/j.radonc.2010.06.013] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 06/01/2010] [Accepted: 06/04/2010] [Indexed: 11/19/2022]
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29
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Zhuang T, Wu Q. Generating arbitrary one-dimensional dose profiles using rotational therapy. Phys Med Biol 2010; 55:6263-77. [PMID: 20924133 DOI: 10.1088/0031-9155/55/20/014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Conformal radiation therapy can be delivered using several methods: intensity-modulated radiotherapy (IMRT) at fixed gantry angles, through the continuous gantry rotation of linac (rotational arc therapy), or by a dedicated treatment unit such as tomotherapy. The recently developed volumetric modulated arc therapy (VMAT), a form of rotational arc therapy, has attracted lots of attention from investigators to explore its capability of generating highly conformal dose to the target. The main advanced features of VMAT are the variable dose rate and gantry rotation speed. In this paper, we present a theoretical framework of generating arbitrary one-dimensional dose profiles using rotational arc therapy to further explore the new degree of freedom of the VMAT technique. This framework was applied to design a novel technique for total body irradiation (TBI) treatment, where the desired dose distribution can be simplified by a one-dimensional profile. The technique was validated using simulations and experimental measurements. The preliminary results demonstrated that the new TBI technique using either dynamic MLC only, variable dose rate only, or a combination of dynamic MLC and variable dose rate can achieve arbitrary dose distribution in one dimension, such as uniform dose to target and lower dose to critical organ. This technique does not require the use of customized compensators, nor large treatment rooms as in the conventional extended SSD technique.
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Affiliation(s)
- Tingliang Zhuang
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA
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30
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Harel R, Angelov L. Spine metastases: current treatments and future directions. Eur J Cancer 2010; 46:2696-707. [PMID: 20627705 DOI: 10.1016/j.ejca.2010.04.025] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 04/08/2010] [Accepted: 04/28/2010] [Indexed: 11/17/2022]
Abstract
Spinal metastases are the most frequently encountered spinal tumour and can affect up to 50% of cancer patients. Both the incidence and prevalence of metastases are thought to be rising due to better detection and treatment options of the systemic malignancy resulting in increased patient survival. Further, the development and access to newer imaging modalities have resulted in easier screening and diagnosis of spine metastases. Current evidence suggests that pain, neurological symptoms and quality of life are all improved if patients with spine metastases are treated early and aggressively. However, selection of the appropriate therapy depends on several factors including primary histology, extent of the systemic disease, existing co-morbidities, prior treatment modalities, patient age and performance status, predicted life expectancy and available resources. This article reviews the currently available therapeutic options for spinal metastases including conventional external beam radiation therapy, open surgical decompression and stabilisation, vertebral augmentation and other minimally invasive surgery (MIS) options, stereotactic spine radiosurgery, bisphosphonates, systemic radioisotopes and chemotherapy. An algorithm for the management of spine metastases is also proposed. It outlines a multidisciplinary and integrated approach to these patients and it is hoped that this along with future advances and research will result in improved patient care and outcomes.
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Affiliation(s)
- Ran Harel
- Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, S-80, Cleveland, OH 44195, USA
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31
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Yongjie Li, Jie Lei. A Feasible Solution to the Beam-Angle-Optimization Problem in Radiotherapy Planning With a DNA-Based Genetic Algorithm. IEEE Trans Biomed Eng 2010; 57:499-508. [DOI: 10.1109/tbme.2009.2033263] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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32
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Jin R, Min Z, Song E, Liu H, Ye Y. A novel fluence map optimization model incorporating leaf sequencing constraints. Phys Med Biol 2010; 55:1243-64. [DOI: 10.1088/0031-9155/55/4/023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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33
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Stancanello J, Yin FF, Orton CG. The traditional L-shaped gantry for radiotherapy linear accelerators will soon become obsolete. Med Phys 2010; 37:409-11. [DOI: 10.1118/1.3276730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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34
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Oliver M, Ansbacher W, Beckham WA. Comparing planning time, delivery time and plan quality for IMRT, RapidArc and Tomotherapy. J Appl Clin Med Phys 2009; 10:117-131. [PMID: 19918236 PMCID: PMC5720582 DOI: 10.1120/jacmp.v10i4.3068] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 07/14/2009] [Accepted: 07/17/2009] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study is to examine plan quality, treatment planning time, and estimated treatment delivery time for 5- and 9-field sliding window IMRT, single and dual arc RapidArc, and tomotherapy. For four phantoms, 5- and 9-field IMRT, single and dual arc RapidArc and tomotherapy plans were created. Plans were evaluated based on the ability to meet dose-volume constraints, dose homogeneity index, radiation conformity index, planning time, estimated delivery time, integral dose, and volume receiving more than 2 and 5 Gy. For all of the phantoms, tomotherapy was able to meet the most optimization criteria during planning (50% for P1, 67% for P2, 0% for P3, and 50% for P4). RapidArc met less of the optimization criteria (25% for P1, 17% for P2, 0% for P3, and 0% for P4), while IMRT was never able to meet any of the constraints. In addition, tomotherapy plans were able to produce the most homogeneous dose. Tomotherapy plans had longer planning time, longer estimated treatment times, lower conformity index, and higher integral dose. Tomotherapy plans can produce plans of higher quality and have the capability to conform dose distributions better than IMRT or RapidArc in the axial plane, but exhibit increased dose superior and inferior to the target volume. RapidArc, however, is capable of producing better plans than IMRT for the test cases examined in this study.
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Affiliation(s)
- Mike Oliver
- Department of Medical Physics, British Columbia Cancer Agency, Victoria, British Columbia, Canada
| | - Will Ansbacher
- Department of Medical Physics, British Columbia Cancer Agency, Victoria, British Columbia, Canada
| | - Wayne A Beckham
- Department of Medical Physics, British Columbia Cancer Agency, Victoria, British Columbia, Canada
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35
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Should we affraid of induced cancer in group of patients after radical radiotherapy of prostate cancer? Rep Pract Oncol Radiother 2009. [DOI: 10.1016/s1507-1367(10)60034-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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