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Arumugam S, Sidhom M. Robust Optimization for Prostate Radiation Therapy: Assessment of Delivered Dose by Incorporating Intrafraction Prostate Position Deviations. Adv Radiat Oncol 2024; 9:101455. [PMID: 38596454 PMCID: PMC11002539 DOI: 10.1016/j.adro.2024.101455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/18/2024] [Indexed: 04/11/2024] Open
Abstract
Purpose To assess the robustness of the dose delivered to the clinical target volume (CTV) between planning target volume (PTV)-based and robust optimization planning approaches in localized prostate cancer radiation therapy. Methods and Materials Retrospective data of 20 patients with prostate cancer, including radiation therapy and real-time prostate position, were analyzed. Two sets of volumetric modulated arc therapy plans were generated per patient: PTV-based and robust optimization. PTV-based planning used a 7-mm CTV-PTV margin, whereas robust planning considered same-magnitude position deviations. Differences in CTV dose delivered to 99% volume (D99), PTV dose delivered to 95% volume (D95), and bladder and rectum V40 (volume receiving 40 Gy) and V60 (volume receiving 60 Gy) values were evaluated. The target position, determined by in-house position monitoring system, was incorporated for dose assessment with and without position deviation correction. Results In the robust optimization approach, compared with PTV-based planning, the mean (standard deviation) V40 and V60 values of the bladder were reduced by 5.2% (4.1%) and 5.1% (1.9%), respectively. Similarly, for the rectum, the reductions were 0.8% (0.5%) and 0.6% (0.6%). In corrected treatment scenarios, both planning approaches resulted in a mean (standard deviation) CTV D99 difference of 0.1 Gy (0.1 Gy). In the not corrected scenario, PTV-based planning reduced CTV D99 by 0.1 Gy (0.5 Gy), whereas robust planning reduced it by 0.2 Gy (0.6 Gy). There was no statistically significant difference observed in the planned and delivered rectum and bladder dose for both corrected and not corrected scenarios. Conclusions Robust optimization resulted in lower V40 and V60 values for the bladder compared with PTV-based planning. However, no difference in CTV dose accuracy was found between the 2 approaches.
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Affiliation(s)
- Sankar Arumugam
- Department of Medical Physics, Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, New South Wales, Australia
- South Western Sydney, Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Sidhom
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, New South Wales, Australia
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Cai W, Ding S, Li H, Zhou X, Dou W, Zhou L, Song T, Li Y. Automatic IMRT treatment planning through fluence prediction and plan fine-tuning for nasopharyngeal carcinoma. Radiat Oncol 2024; 19:39. [PMID: 38509540 PMCID: PMC10956235 DOI: 10.1186/s13014-024-02401-0] [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: 08/14/2023] [Accepted: 01/09/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND At present, the implementation of intensity-modulated radiation therapy (IMRT) treatment planning for geometrically complex nasopharyngeal carcinoma (NPC) through manual trial-and-error fashion presents challenges to the improvement of planning efficiency and the obtaining of high-consistency plan quality. This paper aims to propose an automatic IMRT plan generation method through fluence prediction and further plan fine-tuning for patients with NPC and evaluates the planning efficiency and plan quality. METHODS A total of 38 patients with NPC treated with nine-beam IMRT were enrolled in this study and automatically re-planned with the proposed method. A trained deep learning model was employed to generate static field fluence maps for each patient with 3D computed tomography images and structure contours as input. Automatic IMRT treatment planning was achieved by using its generated dose with slight tightening for further plan fine-tuning. Lastly, the plan quality was compared between automatic plans and clinical plans. RESULTS The average time for automatic plan generation was less than 4 min, including fluence maps prediction with a python script and automated plan tuning with a C# script. Compared with clinical plans, automatic plans showed better conformity and homogeneity for planning target volumes (PTVs) except for the conformity of PTV-1. Meanwhile, the dosimetric metrics for most organs at risk (OARs) were ameliorated in the automatic plan, especially Dmax of the brainstem and spinal cord, and Dmean of the left and right parotid glands significantly decreased (P < 0.05). CONCLUSION We have successfully implemented an automatic IMRT plan generation method for patients with NPC. This method shows high planning efficiency and comparable or superior plan quality than clinical plans. The qualitative results before and after the plan fine-tuning indicates that further optimization using dose objectives generated by predicted fluence maps is crucial to obtain high-quality automatic plans.
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Affiliation(s)
- Wenwen Cai
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China
| | - Shouliang Ding
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, China
| | - Huali Li
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China
| | - Xuanru Zhou
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China
| | - Wen Dou
- Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Linghong Zhou
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China
| | - Ting Song
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China.
| | - Yongbao Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, China.
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Maragno D, Buti G, Birbil Şİ, Liao Z, Bortfeld T, den Hertog D, Ajdari A. Embedding machine learning based toxicity models within radiotherapy treatment plan optimization. Phys Med Biol 2024; 69:075003. [PMID: 38412530 DOI: 10.1088/1361-6560/ad2d7e] [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: 10/16/2023] [Accepted: 02/27/2024] [Indexed: 02/29/2024]
Abstract
Objective.This study addresses radiation-induced toxicity (RIT) challenges in radiotherapy (RT) by developing a personalized treatment planning framework. It leverages patient-specific data and dosimetric information to create an optimization model that limits adverse side effects using constraints learned from historical data.Approach.The study uses the optimization with constraint learning (OCL) framework, incorporating patient-specific factors into the optimization process. It consists of three steps: optimizing the baseline treatment plan using population-wide dosimetric constraints; training a machine learning (ML) model to estimate the patient's RIT for the baseline plan; and adapting the treatment plan to minimize RIT using ML-learned patient-specific constraints. Various predictive models, including classification trees, ensembles of trees, and neural networks, are applied to predict the probability of grade 2+ radiation pneumonitis (RP2+) for non-small cell lung (NSCLC) cancer patients three months post-RT. The methodology is assessed with four high RP2+ risk NSCLC patients, with the goal of optimizing the dose distribution to constrain the RP2+ outcome below a pre-specified threshold. Conventional and OCL-enhanced plans are compared based on dosimetric parameters and predicted RP2+ risk. Sensitivity analysis on risk thresholds and data uncertainty is performed using a toy NSCLC case.Main results.Experiments show the methodology's capacity to directly incorporate all predictive models into RT treatment planning. In the four patients studied, mean lung dose and V20 were reduced by an average of 1.78 Gy and 3.66%, resulting in an average RP2+ risk reduction from 95% to 42%. Notably, this reduction maintains tumor coverage, although in two cases, sparing the lung slightly increased spinal cord max-dose (0.23 and 0.79 Gy).Significance.By integrating patient-specific information into learned constraints, the study significantly reduces adverse side effects like RP2+ without compromising target coverage. This unified framework bridges the gap between predicting toxicities and optimizing treatment plans in personalized RT decision-making.
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Affiliation(s)
- Donato Maragno
- Amsterdam Business School, University of Amsterdam, Amsterdam, The Netherlands
| | - Gregory Buti
- Massachusetts General Hospital and Harvard Medical School, Department of Radiation Oncology, Division of Radiation BioPhysics, Boston, MA, United States of America
| | - Ş İlker Birbil
- Amsterdam Business School, University of Amsterdam, Amsterdam, The Netherlands
| | - Zhongxing Liao
- University of Texas' MD Anderson Cancer Center, Department of Radiation Oncology, Division of Radiation Oncology, Houston, TX, United States of America
| | - Thomas Bortfeld
- Massachusetts General Hospital and Harvard Medical School, Department of Radiation Oncology, Division of Radiation BioPhysics, Boston, MA, United States of America
| | - Dick den Hertog
- Amsterdam Business School, University of Amsterdam, Amsterdam, The Netherlands
| | - Ali Ajdari
- Massachusetts General Hospital and Harvard Medical School, Department of Radiation Oncology, Division of Radiation BioPhysics, Boston, MA, United States of America
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Nachankar A, Schafasand M, Carlino A, Hug E, Stock M, Góra J, Fossati P. Planning Strategy to Optimize the Dose-Averaged LET Distribution in Large Pelvic Sarcomas/Chordomas Treated with Carbon-Ion Radiotherapy. Cancers (Basel) 2023; 15:4903. [PMID: 37835598 PMCID: PMC10571585 DOI: 10.3390/cancers15194903] [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: 08/30/2023] [Revised: 09/29/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023] Open
Abstract
To improve outcomes in large sarcomas/chordomas treated with CIRT, there has been recent interest in LET optimization. We evaluated 22 pelvic sarcoma/chordoma patients treated with CIRT [large: HD-CTV ≥ 250 cm3 (n = 9), small: HD-CTV < 250 cm3 (n = 13)], DRBE|LEM-I = 73.6 (70.4-73.6) Gy (RBE)/16 fractions, using the local effect model-I (LEM-I) optimization and modified-microdosimetric kinetic model (mMKM) recomputation. We observed that to improve high-LETd distribution in large tumors, at least 27 cm3 (low-LETd region) of HD-CTV should receive LETd of ≥33 keV/µm (p < 0.05). Hence, LETd optimization using 'distal patching' was explored in a treatment planning setting (not implemented clinically yet). Distal-patching structures were created to stop beams 1-2 cm beyond the HD-PTV-midplane. These plans were reoptimized and DRBE|LEM-I, DRBE|mMKM, and LETd were recomputed. Distal patching increased (a) LETd50% in HD-CTV (from 38 ± 3.4 keV/µm to 47 ± 8.1 keV/µm), (b) LETdmin in low-LETd regions of the HD-CTV (from 32 ± 2.3 keV/µm to 36.2 ± 3.6 keV/µm), (c) the GTV fraction receiving LETd of ≥50 keV/µm, (from <10% to >50%) and (d) the high-LETd component in the central region of the GTV, without significant compromise in DRBE distribution. However, distal patching is sensitive to setup/range uncertainties, and efforts to ascertain robustness are underway, before routine clinical implementation.
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Affiliation(s)
- Ankita Nachankar
- MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria; (M.S.); (A.C.); (E.H.); (M.S.); (J.G.); (P.F.)
- ACMIT Gmbh, 2700 Wiener Neustadt, Austria
| | - Mansure Schafasand
- MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria; (M.S.); (A.C.); (E.H.); (M.S.); (J.G.); (P.F.)
- Department of Radiation Oncology, Medical University of Vienna, 1090 Wien, Austria
- Division Medical Physics, Karl Landsteiner University of Health Sciences, 3500 Krems an der Donau, Austria
| | - Antonio Carlino
- MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria; (M.S.); (A.C.); (E.H.); (M.S.); (J.G.); (P.F.)
| | - Eugen Hug
- MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria; (M.S.); (A.C.); (E.H.); (M.S.); (J.G.); (P.F.)
| | - Markus Stock
- MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria; (M.S.); (A.C.); (E.H.); (M.S.); (J.G.); (P.F.)
- Division Medical Physics, Karl Landsteiner University of Health Sciences, 3500 Krems an der Donau, Austria
| | - Joanna Góra
- MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria; (M.S.); (A.C.); (E.H.); (M.S.); (J.G.); (P.F.)
| | - Piero Fossati
- MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria; (M.S.); (A.C.); (E.H.); (M.S.); (J.G.); (P.F.)
- Division Radiation Oncology, Karl Landsteiner University of Health Sciences, 3500 Krems an der Donau, Austria
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Liu X, Yin P, Li T, Yin Y, Li Z. Influence and optimization strategy of the magnetic field in 1.5 T MR-linac liver stereotactic radiotherapy. Radiat Oncol 2023; 18:162. [PMID: 37794505 PMCID: PMC10548616 DOI: 10.1186/s13014-023-02356-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE To compare intensity reduction plans for liver cancer with or without a magnetic field and optimize field and subfield numbers in the intensity-modulated radiotherapy (IMRT) plans designed for liver masses in different regions. METHODS This retrospective study included 62 patients who received radiotherapy for liver cancer at Shandong Cancer Hospital. Based on each patient's original individualized intensity-modulated plan (plan1.5 T), a magnetic field-free plan (plan0 T) and static intensity-modulated plan with four different optimization schemes were redesigned for each patient. The differences in dosimetric parameters among plans were compared. RESULTS In the absence of a magnetic field in the first quadrant, PTV Dmin increased (97.75 ± 17.55 vs. 100.96 ± 22.78)%, Dmax decreased (121.48 ± 29.68 vs. 119.06 ± 28.52)%, D98 increased (101.35 ± 7.42 vs. 109.35 ± 26.52)% and HI decreased (1.14 ± 0.14 vs. 1.05 ± 0.01). In the absence of a magnetic field in the second quadrant, PTV Dmin increased (84.33 ± 19.74 vs. 89.96 ± 21.23)%, Dmax decreased (105 ± 25.08 vs. 104.05 ± 24.86)%, and HI decreased (1.04 ± 0.25 vs. 0.99 ± 0.24). In the absence of a magnetic field in the third quadrant, PTV Dmax decreased (110.21 ± 2.22 vs. 102.31 ± 26)%, L-P V30 decreased (10.66 ± 9.19 vs. 5.81 ± 3.22)%, HI decreased (1.09 ± 0.02 vs. 0.98 ± 0.25), and PTV Dmin decreased (92.12 ± 4.92 vs. 89.1 ± 22.35)%. In the absence of a magnetic field in the fourth quadrant, PTV Dmin increased (89.78 ± 6.72 vs. 93.04 ± 4.86)%, HI decreased (1.09 ± 0.01 vs. 1.05 ± 0.01) and D98 increased (99.82 ± 0.82 vs. 100.54 ± 0.84)%. These were all significant differences. In designing plans for tumors in each liver region, a total number of subfields in the first area of 60, total subfields in the second zone of 80, and total subfields in the third and fourth zones of 60 or 80 can achieve the dose effect without a magnetic field. CONCLUSION In patients with liver cancer, the effect of a magnetic field on the target dose is more significant than that on doses to organs at risk. By controlling the max total number of subfields in different quadrants, the effect of the magnetic field can be greatly reduced or even eliminated.
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Affiliation(s)
- Xin Liu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
- Department of Radiation Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Peijun Yin
- Department of Radiation Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Tengxiang Li
- School of Nuclear Science and Technology, University of South China, Hengyang, 421001, China
| | - Yong Yin
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China.
- Department of Radiation Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China.
| | - Zhenjiang Li
- Department of Radiation Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China.
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Jaafar AM, Arif RK, Ahmed S, Alabedi HH, Khalil MM, Yaseen MN, Ammar H. Comparing biological and physical cost functions in VMAT planning for pediatric nasopharyngeal cancer. J Med Imaging Radiat Sci 2023; 54:473-480. [PMID: 37481373 DOI: 10.1016/j.jmir.2023.07.002] [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: 12/26/2022] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Volumetric Modulated Arc Therapy (VMAT) is an option for the delivery of Radiotherapy treatment technique for pediatric nasopharyngeal cancer, VMAT is the most common treatment technique for pediatric nasopharyngeal cancer. The use of a combination of both biological and physical parameters in VMAT planning optimization may produce better target coverage and sparing of critical organs. This work was to compare Biological Cost Functions (BCFs) and Physical Cost Functions (PCFs) in the VMAT of pediatric nasopharyngeal cancer patients. METHOD VMAT plans for 20 nasopharyngeal pediatric cancer patients were created using Monaco 5.11® treatment planning system (TPS). Three VMAT plans were retrospectively generated for each patient using BCFs, PCFs and mixed plan with a total dose of 61.2 Gy in 34 fractions to planning target volume (PTV). All plans were adjusted to deliver 95% of the prescribed dose to 95% of the PTV. The calculated plans were qualitatively and quantitatively evaluated using the dose-volume histogram (DVH). RESULTS The coverage of the target and the maximum dose for the three plans were nearly the same, and better sparing was achieved in the serial organs (spinal cord and brain stem) with PCFs. On the contrary, more dose spring was observed using the BCFs in the organs at risk (OARs) that were not involved in the dose optimization, such as the optic nerve maximum dose, with a significant p-value (0.035 and 0.0001) respectively. Using the PCFs, both parotids received a lower mean dose, but not for the oral cavity, which had a lower mean dose using BCFs (p=<0.0001). The same values of tumor control probability (TCP) were found for both cost functions in PTVs and normal tissue complications probability (NTCP) (99%). The values reported were as follows: spinal cord = 0.5%, brain stem = 19.1%, and brain = 90.7% for BCFs, compared to spinal cord = 0.3%, brain stem = 14.9%, and brain = 90.7% for PCFs. The delivery time was found to be less in BCFs (p=0.005). CONCLUSION The BCFs are superior to the PCFs in conformity index and time of radiation delivery. However, PCFs were better at dose sparing for the serial organs and achieving a sharper falloff dose around the involved volumes. A patient-specific clinical compromise is recommended to gain the best plan that meets the clinical goals.
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Affiliation(s)
- Ahmed Mousa Jaafar
- Department of Physics, Faculty of Science, Helwan University, Egypt; Baghdad Center for Radiotherapy and Nuclear Medicine, Medical City, Iraq.
| | - Ruba K Arif
- Department of Physics, Faculty of Science, Helwan University, Egypt; Baghdad Center for Radiotherapy and Nuclear Medicine, Medical City, Iraq.
| | - Soha Ahmed
- Clinical oncology, Faculty of Medicine, Suze University, Egypt.
| | | | - Magdy M Khalil
- Department of Physics, Faculty of Science, Helwan University, Egypt; School of Biotechnology, Badr University in Cairo (BUC), Egypt.
| | | | - Hany Ammar
- Radiation Oncology Department, Children's Cancer Hospital, 57357, Egypt; Clinical Oncology Department, Faculty of Medicine, Aswan University, Egypt.
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Li Y, Cai W, Xiao F, Zhou X, Cai J, Zhou L, Dou W, Song T. Simultaneous dose distribution and fluence prediction for nasopharyngeal carcinoma IMRT. Radiat Oncol 2023; 18:110. [PMID: 37403141 DOI: 10.1186/s13014-023-02287-4] [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: 01/17/2023] [Accepted: 05/24/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Current intensity-modulated radiation therapy (IMRT) treatment planning is still a manual and time/resource consuming task, knowledge-based planning methods with appropriate predictions have been shown to enhance the plan quality consistency and improve planning efficiency. This study aims to develop a novel prediction framework to simultaneously predict dose distribution and fluence for nasopharyngeal carcinoma treated with IMRT, the predicted dose information and fluence can be used as the dose objectives and initial solution for an automatic IMRT plan optimization scheme, respectively. METHODS We proposed a shared encoder network to simultaneously generate dose distribution and fluence maps. The same inputs (three-dimensional contours and CT images) were used for both dose distribution and fluence prediction. The model was trained with datasets of 340 nasopharyngeal carcinoma patients (260 cases for training, 40 cases for validation, 40 cases for testing) treated with nine-beam IMRT. The predicted fluence was then imported back to treatment planning system to generate the final deliverable plan. Predicted fluence accuracy was quantitatively evaluated within projected planning target volumes in beams-eye-view with 5 mm margin. The comparison between predicted doses, predicted fluence generated doses and ground truth doses were also conducted inside patient body. RESULTS The proposed network successfully predicted similar dose distribution and fluence maps compared with ground truth. The quantitative evaluation showed that the pixel-based mean absolute error between predicted fluence and ground truth fluence was 0.53% ± 0.13%. The structural similarity index also showed high fluence similarity with values of 0.96 ± 0.02. Meanwhile, the difference in the clinical dose indices for most structures between predicted dose, predicted fluence generated dose and ground truth dose were less than 1 Gy. As a comparison, the predicted dose achieved better target dose coverage and dose hot spot than predicted fluence generated dose compared with ground truth dose. CONCLUSION We proposed an approach to predict 3D dose distribution and fluence maps simultaneously for nasopharyngeal carcinoma patients. Hence, the proposed method can be potentially integrated in a fast automatic plan generation scheme by using predicted dose as dose objectives and predicted fluence as a warm start.
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Affiliation(s)
- Yongbao Li
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Wenwen Cai
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China
| | - Fan Xiao
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China
| | - Xuanru Zhou
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China
| | - Jiajun Cai
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China
| | - Linghong Zhou
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China
| | - Wen Dou
- Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
| | - Ting Song
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China.
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Huang C, Nomura Y, Yang Y, Xing L. Fully automated segmentally boosted VMAT. Med Phys 2023; 50:3842-3851. [PMID: 36779662 PMCID: PMC10272012 DOI: 10.1002/mp.16295] [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: 02/08/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/14/2023] Open
Abstract
PURPOSE Treatment planning for volumetric modulated arc therapy (VMAT) typically involves the use of multiple arcs to achieve sufficient intensity modulation. Alternatively, we can perform segment boosting to achieve similar intensity modulation while also reducing the number of control points used. Here, we propose the MetaPlanner Boosted VMAT (MPBV) approach, which generates boosted VMAT plans through a fully automated framework. METHODS The proposed MPBV approach is an open-source framework that consists of three main stages: meta-optimization of treatment plan hyperparameters, fast beam angle optimization on a coarse dose grid to select desirable segments for boosting, and final plan generation (i.e., constructing the boosted VMAT arc and performing optimization). RESULTS Performance for the MPBV approach is evaluated on 21 prostate cases and 6 head and neck cases using clinically relevant plan quality metrics (i.e., target coverage, dose conformity, dose homogeneity, and OAR sparing). As compared to two baseline methods with multiple arcs, MPBV maintains or improves dosimetric performance for the evaluated metrics while substantially reducing average estimated delivery times (from 2.6 to 2.1 min). CONCLUSION Our proposed MPBV approach provides an automated framework for producing high-quality VMAT plans that uses fewer control points and reduces delivery time as compared to traditional approaches with multiple arcs. MPBV applies automated treatment planning to segmentally boosted VMAT to address the beam utilization inefficiencies of traditional VMAT approaches that use multiple full arcs.
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Affiliation(s)
- Charles Huang
- Department of Bioengineering, Stanford University, Stanford, USA
| | - Yusuke Nomura
- Department of Radiation Oncology, Stanford University, Stanford, USA
| | - Yong Yang
- Department of Radiation Oncology, Stanford University, Stanford, USA
| | - Lei Xing
- Department of Radiation Oncology, Stanford University, Stanford, USA
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Qiu Z, Olberg S, den Hertog D, Ajdari A, Bortfeld T, Pursley J. Online adaptive planning methods for intensity-modulated radiotherapy. Phys Med Biol 2023; 68:10.1088/1361-6560/accdb2. [PMID: 37068488 PMCID: PMC10637515 DOI: 10.1088/1361-6560/accdb2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/17/2023] [Indexed: 04/19/2023]
Abstract
Online adaptive radiation therapy aims at adapting a patient's treatment plan to their current anatomy to account for inter-fraction variations before daily treatment delivery. As this process needs to be accomplished while the patient is immobilized on the treatment couch, it requires time-efficient adaptive planning methods to generate a quality daily treatment plan rapidly. The conventional planning methods do not meet the time requirement of online adaptive radiation therapy because they often involve excessive human intervention, significantly prolonging the planning phase. This article reviews the planning strategies employed by current commercial online adaptive radiation therapy systems, research on online adaptive planning, and artificial intelligence's potential application to online adaptive planning.
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Affiliation(s)
- Zihang Qiu
- Department of Business Analytics, University of Amsterdam, The Netherlands
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, United States of America
| | - Sven Olberg
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, United States of America
| | - Dick den Hertog
- Department of Business Analytics, University of Amsterdam, The Netherlands
| | - Ali Ajdari
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, United States of America
| | - Thomas Bortfeld
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, United States of America
| | - Jennifer Pursley
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, United States of America
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Barna S, Meouchi C, Resch AF, Magrin G, Georg D, Palmans H. 3D printed 2D range modulators preserve radiation quality on a microdosimetric scale in proton and carbon ion beams. Radiother Oncol 2023; 182:109525. [PMID: 36774996 DOI: 10.1016/j.radonc.2023.109525] [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: 11/27/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/12/2023]
Abstract
INTRODUCTION Particle therapy using pencil beam scanning (PBS) faces large uncertain- ties related to ranges and target motion. One possibility to improve existing mitigation strategies is a 2D range modulator (2DRM). A 2DRM offers faster irradiation times by reducing the number of layers and spots needed to create a spread-out Bragg peak. We have investigated the impact of 2DRM on microdosimetric spectra measured in proton and carbon ion beams. MATERIALS AND METHODS Two 2DRMs were designed and 3D printed, one for. 124.7 MeV protons and one for 238.6 MeV/u carbon ions. Their dosimetric validation was performed using Roos and PinPoint ionization chamber and EBT3 films. Monte Carlo simulations were done using GATE. A silicon-based solid-state microdosimeter was used to collect pulse-height spectra along three depths for two irradiation modalities, PBS and a single central beam. RESULTS For both particle types, the original pin design had to be optimized via GATE simulations. The difference between the R80 of the simulated and measured depth dose curve was 0.1 mm. The microdosimetric spectra collected with the two irradiation modalities overlap well. Their mean lineal energy values differ over all positions by 5.2 % for the proton 2DRM and 2.1 % for the carbon ion 2DRM. CONCLUSION Radiation quality in terms of lineal energy was independent of the irradiation method. This supports the current approach in reference dosimetry, where the residual range is chosen as a beam quality index to select stopping power ratios.
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Affiliation(s)
- Sandra Barna
- Department of Radiation Oncology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria.
| | - Cynthia Meouchi
- Atominstitut, Technical University of Vienna, Stadionallee 2, Vienna, Austria
| | - Andreas Franz Resch
- Department of Radiation Oncology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Giulio Magrin
- MedAustron Ion Therapy Center, Marie-Curie-Straße 5, Wiener Neustadt, Austria
| | - Dietmar Georg
- Department of Radiation Oncology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria; MedAustron Ion Therapy Center, Marie-Curie-Straße 5, Wiener Neustadt, Austria
| | - Hugo Palmans
- MedAustron Ion Therapy Center, Marie-Curie-Straße 5, Wiener Neustadt, Austria; National Physical Laboratory, Hampton Road, Teddington, United Kingdom
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Xie K, Gao L, Zhang H, Zhang S, Xi Q, Zhang F, Sun J, Lin T, Sui J, Ni X. Inpainting truncated areas of CT images based on generative adversarial networks with gated convolution for radiotherapy. Med Biol Eng Comput 2023:10.1007/s11517-023-02809-y. [PMID: 36897469 DOI: 10.1007/s11517-023-02809-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
Abstract
This study aimed to inpaint the truncated areas of CT images by using generative adversarial networks with gated convolution (GatedConv) and apply these images to dose calculations in radiotherapy. CT images were collected from 100 patients with esophageal cancer under thermoplastic membrane placement, and 85 cases were used for training based on randomly generated circle masks. In the prediction stage, 15 cases of data were used to evaluate the accuracy of the inpainted CT in anatomy and dosimetry based on the mask with a truncated volume covering 40% of the arm volume, and they were compared with the inpainted CT synthesized by U-Net, pix2pix, and PConv with partial convolution. The results showed that GatedConv could directly and effectively inpaint incomplete CT images in the image domain. For the results of U-Net, pix2pix, PConv, and GatedConv, the mean absolute errors for the truncated tissue were 195.54, 196.20, 190.40, and 158.45 HU, respectively. The mean dose of the planning target volume, heart, and lung in the truncated CT was statistically different (p < 0.05) from those of the ground truth CT ([Formula: see text]). The differences in dose distribution between the inpainted CT obtained by the four models and [Formula: see text] were minimal. The inpainting effect of clinical truncated CT images based on GatedConv showed better stability compared with the other models. GatedConv can effectively inpaint the truncated areas with high image quality, and it is closer to [Formula: see text] in terms of image visualization and dosimetry than other inpainting models.
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Affiliation(s)
- Kai Xie
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213000, China
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou, 213000, China
| | - Liugang Gao
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213000, China
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou, 213000, China
| | - Heng Zhang
- Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, China
- Key Laboratory of Medical Physics, Changzhou, 213000, China
| | - Sai Zhang
- Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, China
- Key Laboratory of Medical Physics, Changzhou, 213000, China
| | - Qianyi Xi
- Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, China
- Key Laboratory of Medical Physics, Changzhou, 213000, China
| | - Fan Zhang
- Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, China
- Key Laboratory of Medical Physics, Changzhou, 213000, China
| | - Jiawei Sun
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213000, China
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou, 213000, China
| | - Tao Lin
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213000, China
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou, 213000, China
| | - Jianfeng Sui
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213000, China
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou, 213000, China
| | - Xinye Ni
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213000, China.
- Jiangsu Province Engineering Research Center of Medical Physics, Changzhou, 213000, China.
- Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, China.
- Key Laboratory of Medical Physics, Changzhou, 213000, China.
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Assessment of dose gradient index variation during simultaneously integrated boost intensity‐modulated radiation therapy for head and neck cancer patients. PRECISION RADIATION ONCOLOGY 2022. [DOI: 10.1002/pro6.1166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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13
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Snyder JE, St-Aubin J, Yaddanapudi S, Marshall S, Strand S, Kruger S, Flynn R, Hyer DE. Reducing MRI-guided radiotherapy planning and delivery times via efficient leaf sequencing and segment shape optimization algorithms. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac5299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/07/2022] [Indexed: 11/12/2022]
Abstract
Abstract
Objective. Extended treatment session times are an operational limitation in magnetic resonance imaging guided adaptive radiotherapy (MRIgRT). In this study a novel leaf sequencing algorithm called optimal fluence levels (OFL) and an optimization algorithm called pseudo gradient descent (PGD) are evaluated with respect to plan quality, beam complexity, and the ability to reduce treatment session times on the Elekta Unity MRIgRT system. Approach. Ten total patients were evaluated on this Institutional Review Board approved study: three with prostate cancer, three with oligometastases, two with pancreatic cancer, and two with liver cancer. Plans were generated using the clinical Monaco Hyperion optimizer and leaf sequencer and then re-optimized using OFL and PGD (OFL + PGD) while holding all IMRT constraints and planning parameters constant. All plans were normalized to ensure 95% of the PTV received the prescription dose. A paired t-test was used to evaluate statistical significance. Main Results. Plan quality in terms of dosimetric OAR sparing was found to be equivalent between the OFL + PGD and conventional Monaco Hyperion optimizer plans. The OFL + PGD plans had a reduction in optimization time of 51.4% ± 5.0% (p = 0.002) and reduction in treatment delivery time of 10.6% ± 7.5% (p = 0.005). OFL + PGD generated plans had on average 13.2% ± 12.6% fewer multi-leaf collimator (MLC) segments (p = 0.009) and 0.1 ± 0.1 lower plan averaged beam modulation (PM) (p = 0.004) relative to the Monaco Hyperion plans. Significance. The OFL + PGD algorithms more quickly generate Unity treatment plans that are faster to deliver than with the conventional approach and without compromising dosimetric plan quality. This is likely due to a delivery complexity reduction enabled by OFL + PGD relative to the Monaco Hyperion plans.
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Huang C, Nomura Y, Yang Y, Xing L. Meta-optimization for fully automated radiation therapy treatment planning. Phys Med Biol 2022; 67. [PMID: 35176734 DOI: 10.1088/1361-6560/ac5672] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/17/2022] [Indexed: 11/11/2022]
Abstract
Objective. Radiation therapy treatment planning is a time-consuming process involving iterative adjustments of hyperparameters. To automate the treatment planning process, we propose a meta-optimization framework, called MetaPlanner (MP).Approach. Our MP algorithm automates planning by performing meta-optimization of treatment planning hyperparameters. The algorithm uses a derivative-free method (i.e. parallel Nelder-Mead simplex search) to search for weight configurations that minimize a meta-scoring function. Meta-scoring is performed by constructing a tier list of the relevant considerations (e.g. dose homogeneity, conformity, spillage, and OAR sparing) to mimic the clinical decision-making process. Additionally, we have made our source code publicly available via github.Main results. The proposed MP method is evaluated on two datasets (21 prostate cases and 6 head and neck cases) collected as part of clinical workflow. MP is applied to both IMRT and VMAT planning and compared to a baseline of manual VMAT plans. MP in both IMRT and VMAT scenarios has comparable or better performance than manual VMAT planning for all evaluated metrics.Significance. Our proposed MP provides a general framework for fully automated treatment planning that produces high quality treatment plans. Our MP method promises to substantially reduce the workload of treatment planners while maintaining or improving plan quality.
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Affiliation(s)
- Charles Huang
- Department of Bioengineering, Stanford University, Stanford, United States of America
| | - Yusuke Nomura
- Department of Radiation Oncology, Stanford University, Stanford, United States of America
| | - Yong Yang
- Department of Radiation Oncology, Stanford University, Stanford, United States of America
| | - Lei Xing
- Department of Radiation Oncology, Stanford University, Stanford, United States of America
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Can S, Ozer EE, Karaçetin D. Various cost functions evaluation of commercial biologically based treatment planning system for nasopharyngeal cancer. Med Dosim 2022; 47:184-190. [DOI: 10.1016/j.meddos.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/21/2021] [Accepted: 02/04/2022] [Indexed: 11/27/2022]
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Al-Rawi SAI, Abouelenein H, Khalil MM, Alabdei HH, Sulaiman AA, Al-Nuaimi DS, Nagdy MESEL. Evaluation of conformity and homogeneity indices consistency throughout the course of head and neck cancer treatment with and without using adaptive volumetric modulated arc radiotherapy CI and HI with and without adaptive VMAT in HNC. Adv Radiat Oncol 2022; 7:100905. [PMID: 35465630 PMCID: PMC9026624 DOI: 10.1016/j.adro.2022.100905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 01/14/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose Conformity indices (CI) and homogeneity indices (HI) are important tools for evaluating treatment plan quality. In this study, we evaluate the consistency of these indices with respect to anatomic changes undergone by patients. Methods and Materials Fifty-five patients with advanced head and neck cancer were treated with simultaneous integrated boost volumetric modulated arc therapy. The initial plan (iplan) then was projected on the new computed tomographs (CT) and 2 adaptive plans (Aplans) for each patient were performed on the new CTs. A comparison of CI and HI between the iplan, hybrid plan (Hplan), and Aplan was performed. Results There was a significant weight loss (P < .001) between CT1, CT2, and CT3, where the median weight at CT1 was 75.78 (68.95-83.42) kg, and 74.88 (68.35-82.2) kg at CT2 and 73.1 (67.6-80.7) kg at CT3. Also, gross tumor volume (GTV) showed significant decrease at CT1, CT2, and CT3. The initial GTV was 32.3 (21-58.6) cc and 28.24 (15.85-48.63) cc at CT2 and 25.12 (14.1-42.2) at CT3. In addition, there was a significant decrease in left parotid volume after 10 and 20 fractions; the median left parotid gland volume at CT1 was 31.04 (26.34-36.27) cc, then was 25.84 (19.19-28.59) cc after 10 fractions and 19.5 (13.53-22.25) cc after 20 fractions; the median right parotid volume at CT1 was 29.81 (24.6-38.75) cc and 22.38 (18.19-30.12) cc at CT2, then the volume fell to 17.74 (13.41-22.66) cc at CT3. Also, a significant increase in dose to organs at risk were noticed at Hplans, the median dose for brain stem at iplan was 5156 (4561-5324) cGy then increased to 5321 (4688-5545) cGy at Hplan1 then increased again to reach 5401 (4821-5812) cGy at Hplan2. The CI showed regression at Hplan1 and Hplan2 and then improvement at Aplan1 and Aplan2. The HI also showed regression in its value at the Hplans and then improved at the Aplans. Conclusions Based on the results, we conclude that anatomic changes such as weight loss greatly affect the quality of plan, and with Aplans, we maintained the quality of plan by sustaining the values of CI and HI as in the iplan
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Affiliation(s)
- Salam Abdulrazzaq Ibrahim Al-Rawi
- Department of Radiation Oncology, Baghdad Radiation Oncology and Nuclear Medicine Center, Baghdad Medical City Complex, Ministry of Health/Environment, Baghdad, Iraq
- Department of physics, Faculty of Science, Helwan University, Cairo, Egypt
| | | | - Magdy Mohammed Khalil
- Department of physics, Faculty of Science, Helwan University, Cairo, Egypt
- Department of Biotechnology, School of Biotechnology, Badr University in Cairo (BUC), Cairo, Egypt
| | - Haidar Hamza Alabdei
- Department of Radiation Oncology, Baghdad Radiation Oncology and Nuclear Medicine Center, Baghdad Medical City Complex, Ministry of Health/Environment, Baghdad, Iraq
- Department of Surgery, College of Medicine, Baghdad University, Baghdad, Iraq
| | - Awf Abdulrahman Sulaiman
- Department of Radiation Oncology, Baghdad Radiation Oncology and Nuclear Medicine Center, Baghdad Medical City Complex, Ministry of Health/Environment, Baghdad, Iraq
| | - Dalya Saad Al-Nuaimi
- Department of Radiation Oncology, Baghdad Radiation Oncology and Nuclear Medicine Center, Baghdad Medical City Complex, Ministry of Health/Environment, Baghdad, Iraq
- Corresponding author: Dalya Saad Al-Nuaimi
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Hong J, Han JH, Luo HL, Song YQ. Optimization of Minimum Segment Width Parameter in the Intensity-Modulated Radiotherapy Plan for Esophageal Cancer. Int J Gen Med 2021; 14:9913-9921. [PMID: 34938110 PMCID: PMC8687524 DOI: 10.2147/ijgm.s336269] [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: 08/27/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose This study was designed to explore the optimal minimum segment width (MSW) in the intensity-modulated radiotherapy (IMRT) plan for esophageal cancer. Patients and Methods The imaging data of 20 esophageal cancer patients were selected for this study. Four IMRT plans were designed for each patient with MSWs of 0.5, 1.0, 1.5, and 2.0 cm. The conformity index (CI) and homogeneity index (HI) of the planning target volumes (PTV), organs at risk (OARs), control points (CP), monitor units (MU), plan delivery time (DT), and gamma passing rates (GPR) were collected and compared to appraise the treatment plan quality and delivery efficiency. Results Lower-MSW plans had larger CI and smaller HI values, and lower dose parameters of OARs and PTVs. The HI, CI, and dose parameter of OARs in the 0.5 and 1.0 cm MSW groups were similar and much better than those of the 1.5 and 2.0 cm MSW groups. Meanwhile, the plan in the 0.5 cm MSW group had significantly higher MUs, CPs, and DTs, and a significantly lower relative dose of GPR with a 3% dose difference and 3 mm distance to agreement criteria than the other three groups. Conclusion The 0.5 and 1 cm MSW groups had better dosimetric parameters and IMRT plan quality than the other groups. However, plans with 0.5 cm MSW had worse delivery accuracy and efficiency than the other three groups. Thus, MSW of 1.0 cm was the optimal choice to ensure good quality, delivery accuracy, and treatment efficiency in IMRT plans for esophageal cancer.
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Affiliation(s)
- Jun Hong
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Jiangsu, Huai'an, 223300, People's Republic of China
| | - Ji-Hua Han
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Jiangsu, Huai'an, 223300, People's Republic of China
| | - Hong-Lei Luo
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Jiangsu, Huai'an, 223300, People's Republic of China
| | - Ya-Qi Song
- Department of Radiation Oncology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Jiangsu, Huai'an, 223300, People's Republic of China
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Liu P, Gao XS, Wang Z, Li X, Xi C, Jia C, Xie M, Lyu F, Ding X. Investigate the Dosimetric and Potential Clinical Benefits Utilizing Stereotactic Body Radiation Therapy With Simultaneous Integrated Boost Technique for Locally Advanced Pancreatic Cancer: A Comparison Between Photon and Proton Beam Therapy. Front Oncol 2021; 11:747532. [PMID: 34631584 PMCID: PMC8493097 DOI: 10.3389/fonc.2021.747532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/30/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose To investigate the potential clinical benefits of using stereotactic body radiation therapy (SBRT) with simultaneous integrated boost (SIB) technique for locally advanced pancreatic cancer (LAPC) among different treatment modalities and planning strategies, including photon and proton. Method A total of 19 patients were retrospectively selected in this study: 13 cases with the tumor located in the head of the pancreas and 6 cases with the tumor in the body of the pancreas. SBRT-SIB plans were generated using volumetric modulated arc therapy (VMAT), two-field Intensity Modulated Proton Therapy (IMPT), and three-field IMPT. The IMPT used the robust optimization parameters of ± 3.5% range and 5-mm setup uncertainties. Root-mean-square deviation dose (RMSD) volume histograms were used to evaluate the target coverage robustness quantitatively. Dosimetric metrics based on the dose-volume histogram (DVH), homogeneity index (HI), and normal tissue complication probability (NTCP) were analyzed to evaluate the potential clinical benefits among different planning groups. Results With a similar CTV and SIB coverage, two-field IMPT provided a lower maximum dose for the stomach (median: 18.6GyE, p<0.05) and duodenum (median: 32.62GyE, p<0.05) when the target was located in the head of the pancreas compared to VMAT and three-field IMPT. The risks of gastric bleed (3.42%) and grade ≥ 3 GI toxicity (4.55%) were also decreased. However, for the target in the body of the pancreas, VMAT showed a lower maximum dose for the stomach (median 30.93GyE, p<0.05) and toxicity of gastric bleed (median: 8.67%, p<0.05) compared to two-field IMPT and three-field IMPT, while other maximum doses and NTCPs were similar. The RMSD volume histogram (RVH) analysis shows that three-field IMPT provided better robustness for targets but not for OARs. Instead, three-field IMPT increased the Dmean of organs such as the stomach, duodenum, and intestine. Conclusion The results indicated that the tumor locations could play a critical role in determining clinical benefits among different treatment modalities. Two-field IMPT could be a better option for LAPC patients whose tumors are located in the head of the pancreas. It provides lower severe toxicity for the stomach and duodenum. Nevertheless, VMAT is preferred for the body with better protection for the possibility of gastric bleed.
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Affiliation(s)
- Peilin Liu
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China
| | - Xian-Shu Gao
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China
| | - Zishen Wang
- Department of Radiation Oncology, Hebei Yizhou Tumor Hospital, Zhuozhou, China
| | - Xiaomei Li
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China
| | - Cao Xi
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China
| | - Chenghao Jia
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China
| | - Mu Xie
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China
| | - Feng Lyu
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China
| | - Xuanfeng Ding
- Department of Radiation Oncology, Beaumont Health, Proton Beam Therapy Center, Royal Oak, MI, United States
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Huang C, Yang Y, Panjwani N, Boyd S, Xing L. Pareto Optimal Projection Search (POPS): Automated Radiation Therapy Treatment Planning by Direct Search of the Pareto Surface. IEEE Trans Biomed Eng 2021; 68:2907-2917. [PMID: 33523802 PMCID: PMC8526351 DOI: 10.1109/tbme.2021.3055822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Radiation therapy treatment planning is a time-consuming, iterative process with potentially high inter-planner variability. Fully automated treatment planning processes could reduce a planner's active treatment planning time and remove inter-planner variability, with the potential to tremendously improve patient turnover and quality of care. In developing fully automated algorithms for treatment planning, we have two main objectives: to produce plans that are 1) Pareto optimal and 2) clinically acceptable. Here, we propose the Pareto optimal projection search (POPS) algorithm, which provides a general framework for directly searching the Pareto front. METHODS Our POPS algorithm is a novel automated planning method that combines two main search processes: 1) gradient-free search in the decision variable space and 2) projection of decision variables to the Pareto front using the bisection method. We demonstrate the performance of POPS by comparing with clinical treatment plans. As one possible quantitative measure of treatment plan quality, we construct a clinical acceptability scoring function (SF) modified from the previously developed general evaluation metric (GEM). RESULTS On a dataset of 21 prostate cases collected as part of clinical workflow, our proposed POPS algorithm produces Pareto optimal plans that are clinically acceptable in regards to dose conformity, dose homogeneity, and sparing of organs-at-risk. CONCLUSION Our proposed POPS algorithm provides a general framework for fully automated treatment planning that achieves clinically acceptable dosimetric quality without requiring active planning from human planners. SIGNIFICANCE Our fully automated POPS algorithm addresses many key limitations of other automated planning approaches, and we anticipate that it will substantially improve treatment planning workflow.
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Huang C, Yang Y, Xing L. Fully automated noncoplanar radiation therapy treatment planning. Med Phys 2021; 48:7439-7449. [PMID: 34519064 DOI: 10.1002/mp.15223] [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: 05/26/2021] [Revised: 08/23/2021] [Accepted: 08/30/2021] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To perform fully automated noncoplanar (NC) treatment planning, we propose a method called NC-POPS to produce NC plans using the Pareto optimal projection search (POPS) algorithm. METHODS NC radiation therapy treatment planning has the potential to improve dosimetric quality as compared to traditional coplanar techniques. Likewise, automated treatment planning algorithms can reduce a planner's active treatment planning time and remove inter-planner variability. Our NC-POPS algorithm extends the original POPS algorithm to the NC setting with potential applications to both intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT). The proposed algorithm consists of two main parts: (1) NC beam angle optimization (BAO) and (2) fully automated inverse planning using the POPS algorithm. RESULTS We evaluate the performance of NC-POPS by comparing between various NC and coplanar configurations. To evaluate plan quality, we compute the homogeneity index (HI), conformity index (CI), and dose-volume histogram statistics for various organs-at-risk (OARs). As compared to the evaluated coplanar baseline methods, the proposed NC-POPS method achieves significantly better OAR sparing, comparable or better dose conformity, and similar dose homogeneity. CONCLUSIONS Our proposed NC-POPS algorithm provides a modular approach for fully automated treatment planning of NC IMRT cases with the potential to substantially improve treatment planning workflow and plan quality.
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Affiliation(s)
- Charles Huang
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Yong Yang
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Lei Xing
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
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Cao Y, Tang D, Xiang Y, Men L, Liu C, Zhou Q, Wu J, Huo L, Song T, Wang Y, Li Z, Wei R, Shen L, Yang Z, Hong J. Study on the Appropriate Timing of Postoperative Adaptive Radiotherapy for High-Grade Glioma. Cancer Manag Res 2021; 13:3561-3572. [PMID: 33953610 PMCID: PMC8089024 DOI: 10.2147/cmar.s300094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/02/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To investigate the appropriate timing of adaptive radiotherapy (ART) for high-grade glioma. Methods Ten patients with high-grade gliomas were selected and underwent CT/MRI (CT1/MRI1, CT2/MRI2, CT3/MRI3, and CT4/MRI4) scans before RT and during 10-, 20- and 30-fraction RT, and the corresponding RT plans (plan1, plan2, plan3 and plan4) were made. The dose of the initial plan (plan1) was projected to CT2 and CT3 using the image registration technique to obtain the projection plans (plan1–2 and plan1–3) and by superimposing the doses to obtain the ART plans (plan10+20 and plan20+10), respectively. The dosimetric differences in the target volume and organs at risk (OARs) were compared between the projection and adaptive plans. The tumor control probability (TCP) for the planning target volume (PTV) and normal tissue complication probability (NTCP) for the OARs were compared between the two adaptive plans. Results Compared with the projection plan, the D2 to the PTV of ART decreased, the conformity index (CI) to the PTV increased, and the D2/Dmean to the brainstem, optic chiasm and pituitary, as well as the V20, V30, V40 and V50 to the normal brain decreased. The D2 to the pituitary and optic chiasm as well as the V20, V30, V40 and V50 to the normal brain in plan10+20 were lower than those in plan20+10, while the CI to the PTV was higher than that in plan20+10. The TCP of the PTV in plan10+20 was higher than that in plan20+10. Conclusion ART can improve the precision of target volume irradiation and reduce the irradiation dose to the OARs in high-grade glioma. The time point after 10 fractions of RT is appropriate for ART.
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Affiliation(s)
- Ying Cao
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Du Tang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Yining Xiang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Li Men
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Chao Liu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Qin Zhou
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Jun Wu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Lei Huo
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Tao Song
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Ying Wang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Zhanzhan Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Rui Wei
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Liangfang Shen
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Zhen Yang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Jidong Hong
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
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22
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Evaluation of dosimetric implications of Pareto and constrained mode of optimization for Monaco TPS generated VMAT plans in post operated carcinoma of the left breast. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2021. [DOI: 10.2478/pjmpe-2021-0002] [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
Intensity-modulated radiotherapy (IMRT) is being practiced for the last several years with a special approach for radiation therapy in post-mastectomy breast cancer patients. Meeting the cardiac dose constraints has always been a challenge during radiotherapy planning by both IMRT and VMAT (volumetric modulated arc therapy) of post-mastectomy left breast patients. With the advancement in IMRT planning techniques, it has been modified to VMAT with more degrees of freedom for modulation and is being utilised more frequently. This helps in obtaining a suitable plan for achieving both the dose homogeneity in target volume and dose constraints to Organ at Risk (OAR). 10 Patients with carcinoma of the left breast (post-mastectomy) were selected for this study. VMAT treatment plans for these patients were generated for 6 MV photons on the Monaco treatment planning system (TPS) using two types of optimization modes i.e. Pareto and Constrained mode available in Monaco TPS. For comparative dosimetric evaluation of the efficacy of these two types of optimization modes similar calculation algorithms, calculation grids, arcs, and beam sequencing parameters were used for generating treatment plans. The dosimetric quantities such as volume receiving more than 95% of the prescribed dose (V95), volume receiving more than 107% of the prescribed dose (V107) and Maximum dose (Dmax) for target volume, mean dose (Dmean) for heart, volume receiving more than 30 Gy (V30) volume receiving more than 20 Gy (V20) volume receiving more than 5 Gy (V5) for ipsilateral lung and total monitor units delivered were analysed for both optimization modes. A judicious mix of multiple planning parameters and variables using these two modes of optimization was applied and recorded. Both optimization modes yielded similar outcomes. However, Pareto mode has shown better coverage for planning target volume (PTV) with comparable doses to OARs.
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Lee DS, Lee YK, Kang YN, Won YG, Park SH, Kim YS, Kim JS, Won HS. Assessment of planning reproducibility in three-dimensional field-in-field radiotherapy technique for breast cancer: impact of surgery-simulation interval. Sci Rep 2021; 11:1556. [PMID: 33452292 PMCID: PMC7810888 DOI: 10.1038/s41598-020-78666-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 10/21/2020] [Indexed: 11/16/2022] Open
Abstract
The three-dimensional field-in-field (3-D FIF) technique for radiotherapy is an advanced, state-of-the-art method that uses multileaf collimators to generate a homogeneous and conformal dose distribution via segmental subfields. The purpose of this study is to evaluate the dosimetric reproducibility of 3-D FIF plans using the original simulation computed tomography (iCT) scans and re-simulation CT (rCT) scans for whole breast irradiation (WBI) schedule. This study enrolled a total of 34 patients. The study population underwent iCT scans for standard WBI and took rCT scans after 45 Gy of WBI for cone down boost plans. The dosimetric parameters (V105%, V103%, V100%, V98%, V95%, V90%, V50%), plan quality indices (conformity index, homogeneity index) and clinical parameters (isocenter-breast axis, isocenter-lung axis, soft tissue volumes within radiation field, lung volumes within radiation field) were assessed. The median time interval from surgery to iCT was 33 days and from iCT to rCT was 35 days. All dosimetric parameters exhibited statistically significant differences between iCT and rCT among cohorts with a surgery-iCT interval of < 60 days. Homogeneity index showed a statistically significant increase from iCT to rCT among all cohorts. Soft tissue volumes (p = 0.001) and isocenter-breast axis (p = 0.032) exhibited statistically significant differences among cohorts with surgery-iCT interval < 60 days. Regarding the reproducibility of the 3-D FIF WBI plans, significant changes were observed in dosimetric and clinical factors, particularly in study cohorts with a surgery-simulation interval < 60 days. The main contributing factor of these transitions seemed to be the changes in volume of the soft tissue within the WBI field. Further confirmative studies are necessary to determine the most suitable timing and technique for WBI.
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Affiliation(s)
- Dong Soo Lee
- Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Young Kyu Lee
- Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Young Nam Kang
- Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong Gyun Won
- Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,AbbVie Biopharmaceutical Company, Seoul, Republic of Korea
| | - Seung Hwan Park
- Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong Seok Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong Soo Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hye Sung Won
- Division of Medical Oncology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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24
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Bhushan M, Tripathi D, Yadav G, Kumar L, Chowdhary RL, Pahuja AK, Suresh T, Shukla SK, Mitra S. Feasibility of Monte-Carlo algorithm in comparison with collapse-cone dose calculation algorithm of a commercial treatment planning system in the presence of high-density metallic implant: a dosimetric study. J Egypt Natl Canc Inst 2021; 33:2. [PMID: 33415487 DOI: 10.1186/s43046-020-00057-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of people with implanted hip prosthesis has grown worldwide. For radiotherapy planning of patients with hip implants, few main challenges are encountered. The aim of the present study was to evaluate the feasibility of different planning algorithms in the presence of high-density metallic implant in the treatment of patients with carcinoma cervix. RESULTS It was found that D98% were 44.49 ± 0.11, 44.51 ± 0.13, 44.39 ± 0.22, and 44.45 ± 0.16 Gy for 4FMC6MV (4-field technique calculated with Monte-Carlo algorithm and 6 MV photon energy), 4FMC6MV_WP (4-field technique calculated with Monte-Carlo algorithm and 6 MV photon energy without prosthesis), 4FCC6MV (4-field technique calculated with collapse-cone-convolution algorithm and 6 MV photon energy), and 4FCC6MV_WP (4-field technique calculated with collapse-cone-convolution algorithm and 6 MV photon energy without prosthesis) respectively. Similarly, D2% were 49.40 ± 0.84, 49.05 ± 0.76, 48.97 ± 0.91, and 48.57 ± 0.85 Gray (Gy) for 4FMC6MV, 4FMC6MV_WP, 4FCC6MV, and 4FCC6MV_WP respectively. The present study has not suggested any major difference between the Monte-Carlo (MC) and collapse-cone-convolution (CCC) calculation algorithm in the presence of high-Z metallic implants. Volume of bowel receiving 15 Gy dose has shown a significant difference with prosthesis cases. This study investigates that hip prosthesis creates considerable changes in the treatment planning of cervical malignancies. CONCLUSION CCC algorithm is in good agreement with MC calculation algorithm in the presence of high-density metallic implants in terms of target coverage and avoidance organ sparing except few parameters.
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Affiliation(s)
- Manindra Bhushan
- Division of Medical Physics & Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi, 110085, India. .,Amity School of Applied Sciences, Amity University (AUUP), Noida, India.
| | - Deepak Tripathi
- Amity School of Applied Sciences, Amity University (AUUP), Noida, India
| | - Girigesh Yadav
- Division of Medical Physics & Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi, 110085, India
| | - Lalit Kumar
- Division of Medical Physics & Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi, 110085, India.,Dr. APJ Abdul Kalam Technical University, Lucknow, UP, India
| | - Rahul Lal Chowdhary
- Division of Medical Physics & Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi, 110085, India
| | - Anjali K Pahuja
- Division of Medical Physics & Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi, 110085, India
| | - Tamilarasu Suresh
- Division of Medical Physics & Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi, 110085, India
| | - Sushil Kumar Shukla
- Division of Medical Physics & Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi, 110085, India
| | - Swarupa Mitra
- Division of Medical Physics & Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi, 110085, India
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25
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Cao T, Dai Z, Ding Z, Li W, Quan H. Analysis of different evaluation indexes for prostate stereotactic body radiation therapy plans: conformity index, homogeneity index and gradient index. PRECISION RADIATION ONCOLOGY 2019. [DOI: 10.1002/pro6.1072] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Tingting Cao
- School of Physics and TechnologyWuhan University Wuhan China
- Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and Technology Wuhan China
| | - Zhitao Dai
- School of Physics and TechnologyWuhan University Wuhan China
- Cancer Hospital Chinese Academy of Medical SciencesShenzhen Center Shenzhen China
| | - Zhen Ding
- Cancer Hospital Chinese Academy of Medical SciencesShenzhen Center Shenzhen China
| | - Wuzhou Li
- School of Physics and TechnologyWuhan University Wuhan China
| | - Hong Quan
- School of Physics and TechnologyWuhan University Wuhan China
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26
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Xie K, Sun H, Gao L, Lin T, Sui J, Ni X. A comparative study of identical VMAT about two adjacent targets with and without fixed-jaw technique. Radiat Oncol 2019; 14:75. [PMID: 31068187 PMCID: PMC6505249 DOI: 10.1186/s13014-019-1284-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The radiation transmission through the multileaf collimators is undesired in modern techniques such as volumetric modulated arc therapy (VMAT). According to identical plans, in this study, we aim to investigate the dosimetric impact of jaw tracking on the VMAT plans on two adjacent targets. METHODS Two treatment plans were designed for eight pelvic (cervical) patients with two targets using the same optimization parameters. The original plan (O-plan) used automatically selected jaw positions. In the new plan (F-plan), the jaws were fixed to block two targets in two beams. The dosimetric parameters of the two plans were compared to evaluate the improvement of dose sparing for the body volume between two targets (named interOAR) in F-VMAT. RESULTS The mean dose of interOAR reduced significantly from 654.96 ± 113.38 cGy for O-VMAT, to 490.84 ± 80.26 cGy for F-VMAT (p = 0.018). The monitor units (MUs) in the F-plans were 1.49-fold higher than that in the O-plan. The F and O-plan performed similarly in target dose homogeneity. The differences in Dmax of spinal cord, Dmax of spinal cord planning organ at risk volume, and V20, V30, and V40 of the intestine were insignificant. CONCLUSIONS VMAT plans with the fixed-jaw method can reduce the volume between two targets effectively. However, despite the plan quality, the method can only be used when the regular methods cannot reach the clinical requirements for critical organs because of additional MUs.
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Affiliation(s)
- Kai Xie
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213003, People's Republic of China.,Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, People's Republic of China
| | - Hongfei Sun
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213003, People's Republic of China.,Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, People's Republic of China
| | - Liugang Gao
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213003, People's Republic of China.,Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, People's Republic of China
| | - Tao Lin
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213003, People's Republic of China.,Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, People's Republic of China
| | - Jianfeng Sui
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213003, People's Republic of China.,Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, People's Republic of China
| | - Xinye Ni
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213003, People's Republic of China. .,Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, People's Republic of China.
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27
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Ding X, Zhou J, Li X, Blas K, Liu G, Wang Y, Qin A, Chinnaiyan P, Yan D, Stevens C, Grills I, Kabolizadeh P. Improving dosimetric outcome for hippocampus and cochlea sparing whole brain radiotherapy using spot-scanning proton arc therapy. Acta Oncol 2019; 58:483-490. [PMID: 30632851 DOI: 10.1080/0284186x.2018.1555374] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This feasibility study shows that Spot-scanning Proton Arc therapy (SPArc) is able to significantly reduce the dose to the hippocampus and cochlea compared to both Volumetric Modulated Arc Photon Therapy (VMAT) and the robust optimized Intensity Modulated Proton Therapy (ro-IMPT) plans in whole brain radiotherapy. Furthermore, SPArc not only improves plan robustness but could potentially deliver a treatment as efficient as ro-IMPT when proton system's energy layer switch time is less than 1 s.
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Affiliation(s)
- Xuanfeng Ding
- Department of Radiation Oncology, Beaumont Health, Proton Beam Therapy Center, Royal Oak, MI, USA
| | - Jun Zhou
- Department of Radiation Oncology, Beaumont Health, Proton Beam Therapy Center, Royal Oak, MI, USA
| | - Xiaoqiang Li
- Department of Radiation Oncology, Beaumont Health, Proton Beam Therapy Center, Royal Oak, MI, USA
| | - Kevin Blas
- Department of Radiation Oncology, Beaumont Health, Proton Beam Therapy Center, Royal Oak, MI, USA
| | - Gang Liu
- Department of Radiation Oncology, Beaumont Health, Proton Beam Therapy Center, Royal Oak, MI, USA
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Artificial Micro- and Nano-Structures of the Ministry of Education and Center for Electronic Microscopy and Department of Physics, Wuhan University, Wuhan, China
| | - Yinan Wang
- Department of Radiation Oncology, Beaumont Health, Proton Beam Therapy Center, Royal Oak, MI, USA
| | - An Qin
- Department of Radiation Oncology, Beaumont Health, Proton Beam Therapy Center, Royal Oak, MI, USA
| | - Prakash Chinnaiyan
- Department of Radiation Oncology, Beaumont Health, Proton Beam Therapy Center, Royal Oak, MI, USA
| | - Di Yan
- Department of Radiation Oncology, Beaumont Health, Proton Beam Therapy Center, Royal Oak, MI, USA
| | - Craig Stevens
- Department of Radiation Oncology, Beaumont Health, Proton Beam Therapy Center, Royal Oak, MI, USA
| | - Inga Grills
- Department of Radiation Oncology, Beaumont Health, Proton Beam Therapy Center, Royal Oak, MI, USA
| | - Peyman Kabolizadeh
- Department of Radiation Oncology, Beaumont Health, Proton Beam Therapy Center, Royal Oak, MI, USA
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28
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Chuter R, van Herk M, Akhiat H, Voet P, MacKay R, Choudhury A, McWilliam A. Comparison of intensity modulated radiotherapy plan optimisation methods for a 1.5 T MR-Linac. J Appl Clin Med Phys 2019; 20:43-49. [PMID: 30371972 PMCID: PMC6333134 DOI: 10.1002/acm2.12475] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/25/2018] [Accepted: 09/09/2018] [Indexed: 11/10/2022] Open
Abstract
PURPOSE For the 1.5 T Elekta MR-Linac it is essential that the optimisation of a treatment plan accounts for the electron return effect on the planned dose distribution. The ability of two algorithms for the first stage fluence optimisation, pencil beam (PB) and Monte Carlo (MC), to produce acceptable plan quality was investigated. Optimisation time for each algorithm was also compared. METHODS Ten head and neck patients, ten lung patients and five prostate patients were selected from the clinical archive. These were retrospectively planned using a research version of Monaco with both the PB and MC algorithms for the fluence optimisation stage. After full optimisation DVH parameters, optimisation time and the number of Monitor Units (MU) as a measure of plan complexity were extracted. RESULTS There were no clinically significant differences between any of the DVH parameters studied or the total number of MUs between using PB or MC for stage 1 optimisation across the three patient groups. However, planning time increased by a factor of ten using MC algorithms for stage 1. CONCLUSION The use of MC calculations compared to PB, for stage 1 fluence optimisation, results in increased planning time without clinical improvement in plan quality or reduction in complexity and is therefore not necessary.
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Affiliation(s)
- Robert Chuter
- Christie Medical Physics and Engineering (CMPE)The Christie NHS Foundation TrustManchesterUK
- Division of Cancer SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Marcel van Herk
- Division of Cancer SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- NIHR Manchester Biomedical Research CentreCentral Manchester University Hospitals NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
| | | | | | - Ranald MacKay
- Christie Medical Physics and Engineering (CMPE)The Christie NHS Foundation TrustManchesterUK
| | - Ananya Choudhury
- Division of Cancer SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Clinical OncologyThe Christie NHS Foundation TrustManchesterUK
| | - Alan McWilliam
- Christie Medical Physics and Engineering (CMPE)The Christie NHS Foundation TrustManchesterUK
- Division of Cancer SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
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29
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Dosimetric evaluation of right coronary artery in radiotherapy for breast cancer. Med Dosim 2018; 44:205-209. [PMID: 30170990 DOI: 10.1016/j.meddos.2018.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 06/09/2018] [Accepted: 06/22/2018] [Indexed: 01/15/2023]
Abstract
Comparison with control groups of untreated patients suggests that right-breast-cancer patients who receive radiotherapy have a higher rate of heart disease. Dose constraint for heart has been established to minimize radiotherapy-induced cardiotoxicity during left breast cancer treatment. Additionally, it is suggested to minimize the dosage on left anterior descending (LAD) artery. Right coronary artery (RCA), is the second largest artery, after left main coronary artery, supplying the heart. A dose evaluation study is not present for RCA; the proximal part of which is included in the irradiation field during breast cancer treatment of right breast. To investigate the presence of a correlation, doses resulting from right and left breast radiotherapy on proximal RCA (pRCA), LAD, and heart are evaluated in this study. Forty breast cancer patients who went under breast-conserving surgery are the subject of this study. Four groups were established; right breast, right breast and internal mammary (IM), left breast and left breast, and IM. pRCA, LAD, and heart volumes were contoured for each group on the planning tomographies. Resultant doses of tangential fields planning on these volumes were compared using dose-volume histograms. Mean and maximum doses of pRCA were statistically compared between groups. The highest mean and maximum point doses (192 to 284 cGy) were found in the right breast + IM group (p < 0.05). The mean and maximum doses only in the right breast and left breast + IM group did not differ statistically. However, the mean and maximum pRCA doses in these 2 groups were higher than only the left breast group (p < 0.05). pRCA receives high doses during radiotherapy of right and left breast especially if IM is included. This may predispose to coronary artery disease.
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30
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Nalbant B, Sert F, Tavlayan E, Olacak N, Özsaran Z. Lokal ileri evre serviks kanserlerinde yoğunluk ayarlı radyoterapi ve volumetrik ayarlı ark tedavinin dozimetrik karşılaştırılması. EGE TIP DERGISI 2018. [DOI: 10.19161/etd.414954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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31
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Pang H, Sun X, Yang B, Wu J. A quality control method for intensity-modulated radiation therapy planning based on generalized equivalent uniform dose. J Appl Clin Med Phys 2018; 19:276-282. [PMID: 29696777 PMCID: PMC5978717 DOI: 10.1002/acm2.12331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 01/22/2018] [Accepted: 03/18/2018] [Indexed: 12/25/2022] Open
Abstract
To ensure good quality intensity-modulated radiation therapy (IMRT) planning, we proposed the use of a quality control method based on generalized equivalent uniform dose (gEUD) that predicts absorbed radiation doses in organs at risk (OAR). We conducted a retrospective analysis of patients who underwent IMRT for the treatment of cervical carcinoma, nasopharyngeal carcinoma (NPC), or non-small cell lung cancer (NSCLC). IMRT plans were randomly divided into data acquisition and data verification groups. OAR in the data acquisition group for cervical carcinoma and NPC were further classified as sub-organs at risk (sOAR). The normalized volume of sOAR and normalized gEUD (a = 1) were analyzed using multiple linear regression to establish a fitting formula. For NSCLC, the normalized intersection volume of the planning target volume (PTV) and lung, the maximum diameter of the PTV (left-right, anterior-posterior, and superior-inferior), and the normalized gEUD (a = 1) were analyzed using multiple linear regression to establish a fitting formula for the lung gEUD (a = 1). The r-squared and P values indicated that the fitting formula was a good fit. In the data verification group, IMRT plans verified the accuracy of the fitting formula, and compared the gEUD (a = 1) for each OAR between the subjective method and the gEUD-based method. In conclusion, the gEUD-based method can be used effectively for quality control and can reduce the influence of subjective factors on IMRT planning optimization.
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Affiliation(s)
- Haowen Pang
- Department of OncologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Xiaoyang Sun
- Department of OncologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Bo Yang
- Department of OncologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Jingbo Wu
- Department of OncologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
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32
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A novel voxel based homogeneity index: Rationale and clinical implications for whole-brain radiation therapy. Radiother Oncol 2018; 128:229-235. [PMID: 29699833 DOI: 10.1016/j.radonc.2018.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 03/30/2018] [Accepted: 04/06/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE OR OBJECTIVE A homogeneity index (HI) measures the uniformity of a dose distribution within a given target volume. Traditional HIs only use a limited number of dose-volume histogram data-points for calculation. A voxel-based homogeneity index (VHI) is proposed which utilizes the entire information of the three-dimensional dose distribution. We compared the VHI with existing HIs and analyzed if VHI results were associated with treatment outcomes in patients who underwent therapeutic WBRT. MATERIAL AND METHODS The VHI analyzes deviations from the prescribed dose in each voxel of the target volume. We retrospectively analyzed WBRT treatment plans. Overall survival (OS), CNS progression-free-survival (CNS PFS) and hazard rates were compared for tertile-split levels of the VHI using the Kaplan-Meier methods and multivariable Cox-regression analysis. RESULTS WBRT treatment plans (n = 770) were used for HIs comparison. OS and CNS PFS were assessed for 430 patients. The VHI showed a higher sensitivity for dose inhomogeneities. Lower OS and CNS PFS were observed for higher levels of VHIUnderdosage, particularly in patients with good performance status (KPS >70%) (OS: Log-rank P = .007, HR = 1.37 95%CI [1.09, 1.72]). CONCLUSION Higher sensitivity and feasibility to assess treatment plan quality using the VHI were demonstrated. First clinical implications were found in terms of compromised OS/CNS PFS for WBRT with radiation underdosage.
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33
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D'Andrea M, Strolin S, Ungania S, Cacciatore A, Bruzzaniti V, Marconi R, Benassi M, Strigari L. Radiobiological Optimization in Lung Stereotactic Body Radiation Therapy: Are We Ready to Apply Radiobiological Models? Front Oncol 2018; 7:321. [PMID: 29359121 PMCID: PMC5766682 DOI: 10.3389/fonc.2017.00321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 12/11/2017] [Indexed: 12/25/2022] Open
Abstract
Lung tumors are often associated with a poor prognosis although different schedules and treatment modalities have been extensively tested in the clinical practice. The complexity of this disease and the use of combined therapeutic approaches have been investigated and the use of high dose-rates is emerging as effective strategy. Technological improvements of clinical linear accelerators allow combining high dose-rate and a more conformal dose delivery with accurate imaging modalities pre- and during therapy. This paper aims at reporting the state of the art and future direction in the use of radiobiological models and radiobiological-based optimizations in the clinical practice for the treatment of lung cancer. To address this issue, a search was carried out on PubMed database to identify potential papers reporting tumor control probability and normal tissue complication probability for lung tumors. Full articles were retrieved when the abstract was considered relevant, and only papers published in English language were considered. The bibliographies of retrieved papers were also searched and relevant articles included. At the state of the art, dose–response relationships have been reported in literature for local tumor control and survival in stage III non-small cell lung cancer. Due to the lack of published radiobiological models for SBRT, several authors used dose constraints and models derived for conventional fractionation schemes. Recently, several radiobiological models and parameters for SBRT have been published and could be used in prospective trials although external validations are recommended to improve the robustness of model predictive capability. Moreover, radiobiological-based functions have been used within treatment planning systems for plan optimization but the advantages of using this strategy in the clinical practice are still under discussion. Future research should be directed toward combined regimens, in order to potentially improve both local tumor control and survival. Indeed, accurate knowledge of the relevant parameters describing tumor biology and normal tissue response is mandatory to correctly address this issue. In this context, the role of medical physicists and the AAPM in the development of radiobiological models is crucial for the progress of developing specific tool for radiobiological-based optimization treatment planning.
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Affiliation(s)
- Marco D'Andrea
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy
| | - Silvia Strolin
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy
| | - Sara Ungania
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy
| | - Alessandra Cacciatore
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy
| | - Vicente Bruzzaniti
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy
| | - Raffaella Marconi
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy
| | - Marcello Benassi
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy
| | - Lidia Strigari
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy
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Giglioli FR, Clemente S, Esposito M, Fiandra C, Marino C, Russo S, Strigari L, Villaggi E, Stasi M, Mancosu P. Frontiers in planning optimization for lung SBRT. Phys Med 2017; 44:163-170. [PMID: 28566240 DOI: 10.1016/j.ejmp.2017.05.064] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 12/25/2022] Open
Abstract
Emerging data are showing the safety and the efficacy of Stereotactic Body Radiation therapy (SBRT) in lung cancer management. In this context, the very high doses delivered to the Planning Target Volume, make the planning phase essential for achieving high dose levels conformed to the shape of the target in order to have a good prognosis for tumor control and to avoid an overdose in relevant healthy adjacent tissue. In this non-systematic review we analyzed the technological and the physics aspects of SBRT planning for lung cancer. In particular, the aims of the study were: (i) to evaluate prescription strategies (homogeneous or inhomogeneous), (ii) to outline possible geometrical solutions by comparing the dosimetric results (iii) to describe the technological possibilities for a safe and effective treatment, (iv) to present the issues concerning radiobiological planning and the automation of the planning process.
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Affiliation(s)
| | | | | | - Christian Fiandra
- Dep. of Oncology Radiation Oncology Unit, University of Torino, Italy
| | | | | | - Lidia Strigari
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer, Institute IFO, Rome, Italy
| | | | - Michele Stasi
- Medical Physics Dept., Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Italy
| | - Pietro Mancosu
- Medical Physics Unit of Radiotherapy Dept., Humanitas Clinical and Research Hospital, Rozzano (MI), Italy
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Lee JC, Chuang KS, Chen YW, Hsu FY, Chou FI, Yen SH, Wu YH. Preliminary dosimetric study on feasibility of multi-beam boron neutron capture therapy in patients with diffuse intrinsic pontine glioma without craniotomy. PLoS One 2017; 12:e0180461. [PMID: 28662135 PMCID: PMC5491244 DOI: 10.1371/journal.pone.0180461] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 06/15/2017] [Indexed: 12/31/2022] Open
Abstract
Diffuse intrinsic pontine glioma is a very frustrating disease. Since the tumor infiltrates the brain stem, surgical removal is often impossible. For conventional radiotherapy, the dose constraint of the brain stem impedes attempts at further dose escalation. Boron neutron capture therapy (BNCT), a targeted radiotherapy, carries the potential to selectively irradiate tumors with an adequate dose while sparing adjacent normal tissue. In this study, 12 consecutive patients treated with conventional radiotherapy in our institute were reviewed to evaluate the feasibility of BNCT. NCTPlan Ver. 1.1.44 was used for dose calculations. Compared with two and three fields, the average maximal dose to the normal brain may be lowered to 7.35 ± 0.72 Gy-Eq by four-field irradiation. The mean ratio of minimal dose to clinical target volume and maximal dose to normal tissue was 2.41 ± 0.26 by four-field irradiation. A therapeutic benefit may be expected with multi-field boron neutron capture therapy to treat diffuse intrinsic pontine glioma without craniotomy, while the maximal dose to the normal brain would be minimized by using the four-field setting.
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Affiliation(s)
- Jia-Cheng Lee
- Department Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Keh-Shih Chuang
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Yi-Wei Chen
- Department Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Fang-Yuh Hsu
- Nuclear Science and Technology Development Center, National Tsing Hua University, Hsinchu, Taiwan
| | - Fong-In Chou
- Nuclear Science and Technology Development Center, National Tsing Hua University, Hsinchu, Taiwan
| | - Sang-Hue Yen
- Department Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuan-Hung Wu
- Department Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Institue of Public Health, National Yang-Ming University, Taipei, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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Radhakrishnan S, Chandrasekaran A, Sarma Y, Balakrishnan S, Nandigam J. Dosimetric Comparison between Single and Dual Arc-Volumetric Modulated Arc Radiotherapy and Intensity Modulated Radiotherapy for Nasopharyngeal Carcinoma Using a Simultaneous Integrated Boost Technique. Asian Pac J Cancer Prev 2017; 18:1395-1402. [PMID: 28612593 PMCID: PMC5555553 DOI: 10.22034/apjcp.2017.18.5.1395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Backround: Plan quality and performance of dual arc (DA) volumetric modulated arc therapy (VMAT), single arc (SA) VMAT and nine field (9F) intensity modulated radiotherapy were compared using a simultaneous integrated boost (SIB) technique. Methods: Twelve patients treated in Elekta Synergy Platform (mlci2) by 9F-IMRT were replanned with SA/DA-VMAT using a CMS Monaco Treatment Planning System (TPS) with Monte Carlo simulation. Target delineation was conducted as per Radiation Therapy Oncology Protocols (RTOG0225 and 0615). A 70Gy dose prescribed to PTV70 and 61Gy to PTV61 in 33 fractions was applied for the SIB technique. The conformity index (CI) and homogeneity index (HI) for targets and the mean dose and maximum dose for OAR’s, treatment delivery time (min), monitor units (MUs) per fraction, normal tissue integral dose and patient specific quality assurance were analysed. Results: Acceptable target coverage was achieved for PTV70 and PTV61 with all the planning techniques. No significant differences were observed except for D98 (PTV61), CI(PTV70) and HI(PTV61). Maximum dose (Dmax) to the spinal cord was lower in DA-VMAT than 9F-IMRT (p=0.002) and SA-VMAT (p=0.001). D50 (%) of parotid glands was better controlled by 9F-IMRT (p=0.001) and DA-VMAT (p=0.001) than SA-VMAT. A lower mean dose to the larynx was achieved with 9F-IMRT (P=0.001) and DA-VMAT (p=0.001) than with SA-VMAT. DA-VMAT achieved higher CI of PTV70 (P= 0.005) than SA-VMAT. For PTV61, DA-VMAT (P=0.001) and 9F-IMRT (P=0.001) achieved better HI than SA-VMAT. The average treatment delivery times were 7.67mins, 3.35 mins, 4.65 mins for 9F-IMRT, SA-VMAT and DA-VMAT, respectively. No significant difference were observed in MU/fr (p=0.9) and NTID (P=0.90) and the patient quality assurance pass rates were >95% (gamma analysis I3mm, 3%). Conclusion: DA-VMAT showed better conformity over target dose and spared the OARs better or equal to IMRT. SA-VMAT could not spare the OARs well. DA-VMAT offered shorter delivery time than IMRT without compromising the plan quality.
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Affiliation(s)
- Sivakumar Radhakrishnan
- Department Of Physics, VIT University, Vellore, India.,Department Of Radiotherapy, Omega Hospitals, Hyderabad, India.
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Feng Z, Tao C, Zhu J, Chen J, Yu G, Qin S, Yin Y, Li D. An integrated strategy of biological and physical constraints in biological optimization for cervical carcinoma. Radiat Oncol 2017; 12:64. [PMID: 28376900 PMCID: PMC5379684 DOI: 10.1186/s13014-017-0784-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 02/22/2017] [Indexed: 01/19/2023] Open
Abstract
Background For cervical carcinoma cases, this study aimed to evaluate the quality of intensity-modulated radiation therapy (IMRT) plans optimized by biological constraints. Furthermore, a new integrated strategy in biological planning module was proposed and verified. Methods Twenty patients of advanced stage cervical carcinoma were enrolled in this study. For each patient, dose volume optimization (DVO), biological model optimization (BMO) and integrated strategy optimization (ISO) plans were created using same treatment parameters. Different biological models were also used for organ at risk (OAR) in BMO plans, which include the LKB and Poisson models. Next, BMO plans were compared with their corresponding DVO plans, in order to evaluate BMO plan quality. ISO plans were also compared with DVO and BMO plans, in order to verify the performance of the integrated strategy. Results BMO plans produced slightly inhomogeneity and less coverage of planning target volume (PTV) (V95=96.79, HI = 0.10: p < 0.01). However, the tumor control probability (TCP) value, both from DVO and BMO plans, were comparable. For the OARs, BMO plans produced lower normal tissue complication probability (NTCP) of rectum (NTCP = 0.11) and bladder (NTCP = 0.14) than in the corresponding DVO plans (NTCP = 0.19 and 0.18 for rectum and bladder; p < 0.01 for rectum and p = 0.03 for bladder). V95, D98, CI and HI values that were produced by ISO plans (V95 = 98.31, D98 = 54.18Gy, CI = 0.76, HI = 0.09) were greatly better than BMO plans (V95 = 96.79, D98 = 53.42Gy, CI = 0.71, HI = 0.10) with significant differences. Furthermore, ISO plans produced lower NTCP values of rectum (NTCP = 0.14) and bladder (NTCP = 0.16) than DVO plans (NTCP = 0.19 and 0.18 for rectum and bladder, respectively) with significant differences. Conclusions BMO plans produced lower NTCP values of OARs compared to DVO plans for cervical carcinoma cases, and resulted in slightly less target coverage and homogeneity. The integrated strategy, proposed in this study, could improve the coverage, conformity and homogeneity of PTV greater than the BMO plans, as well as reduce the NTCP values of OARs greater than the DVO plans.
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Affiliation(s)
- Ziwei Feng
- Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, Institute of Biomedical Sciences, School of Physics and Electronics, Shandong Normal University, No.88, Wenhua East Road, Lixia District, Jinan, 250014, China
| | - Cheng Tao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, No.440, Jiyan Road, Jinan, 250117, China
| | - Jian Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, No.440, Jiyan Road, Jinan, 250117, China
| | - Jinhu Chen
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, No.440, Jiyan Road, Jinan, 250117, China
| | - Gang Yu
- Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, Institute of Biomedical Sciences, School of Physics and Electronics, Shandong Normal University, No.88, Wenhua East Road, Lixia District, Jinan, 250014, China
| | - Shaohua Qin
- Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, Institute of Biomedical Sciences, School of Physics and Electronics, Shandong Normal University, No.88, Wenhua East Road, Lixia District, Jinan, 250014, China
| | - Yong Yin
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, No.440, Jiyan Road, Jinan, 250117, China
| | - Dengwang Li
- Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, Institute of Biomedical Sciences, School of Physics and Electronics, Shandong Normal University, No.88, Wenhua East Road, Lixia District, Jinan, 250014, China.
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Kierkels RGJ, Wopken K, Visser R, Korevaar EW, van der Schaaf A, Bijl HP, Langendijk JA. Multivariable normal tissue complication probability model-based treatment plan optimization for grade 2-4 dysphagia and tube feeding dependence in head and neck radiotherapy. Radiother Oncol 2016; 121:374-380. [PMID: 27614681 DOI: 10.1016/j.radonc.2016.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 08/15/2016] [Accepted: 08/19/2016] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND PURPOSE Radiotherapy of the head and neck is challenged by the relatively large number of organs-at-risk close to the tumor. Biologically-oriented objective functions (OF) could optimally distribute the dose among the organs-at-risk. We aimed to explore OFs based on multivariable normal tissue complication probability (NTCP) models for grade 2-4 dysphagia (DYS) and tube feeding dependence (TFD). MATERIALS AND METHODS One hundred head and neck cancer patients were studied. Additional to the clinical plan, two more plans (an OFDYS and OFTFD-plan) were optimized per patient. The NTCP models included up to four dose-volume parameters and other non-dosimetric factors. A fully automatic plan optimization framework was used to optimize the OFNTCP-based plans. RESULTS All OFNTCP-based plans were reviewed and classified as clinically acceptable. On average, the Δdose and ΔNTCP were small comparing the OFDYS-plan, OFTFD-plan, and clinical plan. For 5% of patients NTCPTFD reduced >5% using OFTFD-based planning compared to the OFDYS-plans. CONCLUSIONS Plan optimization using NTCPDYS- and NTCPTFD-based objective functions resulted in clinically acceptable plans. For patients with considerable risk factors of TFD, the OFTFD steered the optimizer to dose distributions which directly led to slightly lower predicted NTCPTFD values as compared to the other studied plans.
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Affiliation(s)
- Roel G J Kierkels
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands.
| | - Kim Wopken
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands
| | - Ruurd Visser
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands; Department of Medical Imaging and Radiation Therapy, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Erik W Korevaar
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands
| | - Arjen van der Schaaf
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands
| | - Hendrik P Bijl
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands
| | - Johannes A Langendijk
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands
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Senthilkumar K, Maria Das KJ, Balasubramanian K, Deka AC, Patil BR. Estimation of the effects of normal tissue sparing using equivalent uniform dose-based optimization. J Med Phys 2016; 41:123-8. [PMID: 27217624 PMCID: PMC4871001 DOI: 10.4103/0971-6203.181631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
In this study, we intend to estimate the effects of normal tissue sparing between intensity modulated radiotherapy (IMRT) treatment plans generated with and without a dose volume (DV)-based physical cost function using equivalent uniform dose (EUD). Twenty prostate cancer patients were retrospectively selected for this study. For each patient, two IMRT plans were generated (i) EUD-based optimization with a DV-based physical cost function to control inhomogeneity (EUDWith DV) and (ii) EUD-based optimization without a DV-based physical cost function to allow inhomogeneity (EUDWithout DV). The generated plans were prescribed a dose of 72 Gy in 36 fractions to planning target volume (PTV). Mean dose, D30%, and D5% were evaluated for all organ at risk (OAR). Normal tissue complication probability was also calculated for all OARs using BioSuite software. The average volume of PTV for all patients was 103.02 ± 27 cm3. The PTV mean dose for EUDWith DV plans was 73.67 ± 1.7 Gy, whereas for EUDWithout DV plans was 80.42 ± 2.7 Gy. It was found that PTV volume receiving dose more than 115% of prescription dose was negligible in EUDWith DV plans, whereas it was 28% in EUDWithout DV plans. In almost all dosimetric parameters evaluated, dose to OARs in EUDWith DV plans was higher than in EUDWithout DV plans. Allowing inhomogeneous dose (EUDWithout DV) inside the target would achieve better normal tissue sparing compared to homogenous dose distribution (EUDWith DV). Hence, this inhomogeneous dose could be intentionally dumped on the high-risk volume to achieve high local control. Therefore, it was concluded that EUD optimized plans offer added advantage of less OAR dose as well as selectively boosting dose to gross tumor volume.
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Affiliation(s)
- K Senthilkumar
- Department of Medical Physics, Karnataka Cancer Therapy and Research Institute, Hubli, Karnataka, India; Research and Development Centre, Bharathiar University, Coimbatore, Tamil Nadu, India
| | - K J Maria Das
- Department of Radiotherapy, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - K Balasubramanian
- Department of Medical Physics, Karnataka Cancer Therapy and Research Institute, Hubli, Karnataka, India
| | - A C Deka
- Department of Medical Physics, Karnataka Cancer Therapy and Research Institute, Hubli, Karnataka, India
| | - B R Patil
- Department of Medical Physics, Karnataka Cancer Therapy and Research Institute, Hubli, Karnataka, India
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Chuter RW, Rixham PA, Weston SJ, Cosgrove VP. Feasibility of portal dosimetry for flattening filter-free radiotherapy. J Appl Clin Med Phys 2016; 17:112-120. [PMID: 26894337 PMCID: PMC5690198 DOI: 10.1120/jacmp.v17i1.5686] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 09/21/2015] [Accepted: 09/16/2015] [Indexed: 11/23/2022] Open
Abstract
The feasibility of using portal dosimetry (PD) to verify 6 MV flattening filter‐free (FFF) IMRT treatments was investigated. An Elekta Synergy linear accelerator with an Agility collimator capable of delivering FFF beams and a standard iViewGT amorphous silicon (aSi) EPID panel (RID 1640 AL5P) at a fixed SSD of 160 cm were used. Dose rates for FFF beams are up to four times higher than for conventional flattened beams, meaning images taken at maximum FFF dose rate can saturate the EPID. A dose rate of 800 MU/min was found not to saturate the EPID for open fields. This dose rate was subsequently used to characterize the EPID for FFF portal dosimetry. A range of open and phantom fields were measured with both an ion chamber and the EPID, to allow comparison between the two. The measured data were then used to create a model within The Nederlands Kanker Instituut's (NKI's) portal dosimetry software. The model was verified using simple square fields with a range of field sizes and phantom thicknesses. These were compared to calculations performed with the Monaco treatment planning system (TPS) and isocentric ion chamber measurements. It was found that the results for the FFF verification were similar to those for flattened beams with testing on square fields, indicating a difference in dose between the TPS and portal dosimetry of approximately 1%. Two FFF IMRT plans (prostate and lung SABR) were delivered to a homogeneous phantom and showed an overall dose difference at isocenter of ∼0.5% and good agreement between the TPS and PD dose distributions. The feasibility of using the NKI software without any modifications for high‐dose‐rate FFF beams and using a standard EPID detector has been investigated and some initial limitations highlighted. PACS number: 87.55.Qr
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Rechner LA, Eley JG, Howell RM, Zhang R, Mirkovic D, Newhauser WD. Risk-optimized proton therapy to minimize radiogenic second cancers. Phys Med Biol 2015; 60:3999-4013. [PMID: 25919133 PMCID: PMC4443860 DOI: 10.1088/0031-9155/60/10/3999] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Proton therapy confers substantially lower predicted risk of second cancer compared with photon therapy. However, no previous studies have used an algorithmic approach to optimize beam angle or fluence-modulation for proton therapy to minimize those risks. The objectives of this study were to demonstrate the feasibility of risk-optimized proton therapy and to determine the combination of beam angles and fluence weights that minimizes the risk of second cancer in the bladder and rectum for a prostate cancer patient. We used 6 risk models to predict excess relative risk of second cancer. Treatment planning utilized a combination of a commercial treatment planning system and an in-house risk-optimization algorithm. When normal-tissue dose constraints were incorporated in treatment planning, the risk model that incorporated the effects of fractionation, initiation, inactivation, repopulation and promotion selected a combination of anterior and lateral beams, which lowered the relative risk by 21% for the bladder and 30% for the rectum compared to the lateral-opposed beam arrangement. Other results were found for other risk models.
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Affiliation(s)
- Laura A. Rechner
- The University of Texas Health Science Center Houston, Graduate School of Biomedical Sciences, Houston, TX 77030, USA
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
- Present Address: Department of Radiation Oncology, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark
| | - John G. Eley
- The University of Texas Health Science Center Houston, Graduate School of Biomedical Sciences, Houston, TX 77030, USA
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Rebecca M. Howell
- The University of Texas Health Science Center Houston, Graduate School of Biomedical Sciences, Houston, TX 77030, USA
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Rui Zhang
- The University of Texas Health Science Center Houston, Graduate School of Biomedical Sciences, Houston, TX 77030, USA
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, LA 70803, USA
| | - Dragan Mirkovic
- The University of Texas Health Science Center Houston, Graduate School of Biomedical Sciences, Houston, TX 77030, USA
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Wayne D. Newhauser
- The University of Texas Health Science Center Houston, Graduate School of Biomedical Sciences, Houston, TX 77030, USA
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
- Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, LA 70803, USA
- Department of Medical Physics, Mary Bird Perkins Cancer Center, 4950 Essen Lane, Baton Rouge, LA 70809, USA
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McDonald MW, Walter AS, Hoene TA. Technique for comprehensive head and neck irradiation using 3-dimensional conformal proton therapy. Med Dosim 2015; 40:333-9. [PMID: 26002120 DOI: 10.1016/j.meddos.2015.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/18/2015] [Accepted: 04/12/2015] [Indexed: 10/23/2022]
Abstract
Owing to the technical and logistical complexities of matching photon and proton treatment modalities, we developed and implemented a technique of comprehensive head and neck radiation using 3-dimensional (3D) conformal proton therapy. A monoisocentric technique was used with a 30-cm snout. Cervical lymphatics were treated with 3 fields: a posterior-anterior field with a midline block and a right and a left posterior oblique field. The matchline of the 3 cervical nodal fields with the primary tumor site fields was staggered by 0.5cm. Comparative intensity-modulated photon plans were later developed for 12 previously treated patients to provide equivalent target coverage, while matching or improving on the proton plans׳ sparing of organs at risk (OARs). Dosimetry to OARs was evaluated and compared by treatment modality. Comprehensive head and neck irradiation using proton therapy yielded treatment plans with significant dose avoidance of the oral cavity and midline neck structures. When compared with the generated intensity-modulated radiation therapy (IMRT) plans, the proton treatment plans yielded statistically significant reductions in the mean and integral radiation dose to the oral cavity, larynx, esophagus, and the maximally spared parotid gland. There was no significant difference in mean dose to the lesser-spared parotid gland by treatment modality or in mean or integral dose to the spared submandibular glands. A technique for cervical nodal irradiation using 3D conformal proton therapy with uniform scanning was developed and clinically implemented. Use of proton therapy for cervical nodal irradiation resulted in large volume of dose avoidance to the oral cavity and low dose exposure to midline structures of the larynx and the esophagus, with lower mean and integral dose to assessed OARs when compared with competing IMRT plans.
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Affiliation(s)
- Mark W McDonald
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN; Indiana University Health Proton Therapy Center, Bloomington, IN.
| | - Alexander S Walter
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN
| | - Ted A Hoene
- Indiana University Health Proton Therapy Center, Bloomington, IN
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Li H, Zhang X, Park P, Liu W, Chang J, Liao Z, Frank S, Li Y, Poenisch F, Mohan R, Gillin M, Zhu R. Robust optimization in intensity-modulated proton therapy to account for anatomy changes in lung cancer patients. Radiother Oncol 2015; 114:367-72. [PMID: 25708992 DOI: 10.1016/j.radonc.2015.01.017] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 12/26/2014] [Accepted: 01/06/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Robust optimization for IMPT takes setup and range uncertainties into account during plan optimization. However, anatomical changes were not prospectively included. The purpose of this study was to examine robustness and dose variation due to setup uncertainty and anatomical change in IMPT of lung cancer. MATERIAL AND METHODS Plans were generated with multi-field optimization based on planning target volume (MFO-PTV) and worst-case robust optimization (MFO-RO) on simulation computed tomography scans (CT0) for nine patients. Robustness was evaluated on the CT0 by computing the standard deviation of DVH (SD-DVH). Dose variations calculated on weekly CTs were compared with SD-DVH. Equivalent uniform dose (EUD) change from the original plan on weekly dose was also calculated for both plans. RESULTS SD-DVH and dose variation on weekly CTs were both significantly lower in the MFO-RO plans than in the MFO-PTV plans for targets, lungs, and the esophagus (p<0.05). When comparing EUD for ITV between weekly and planned dose distributions, three patients and 28% of repeated CTs for MFO-RO plans, and six patients and 44% of repeated CTs for MFO-PTV plans, respectively, showed an EUD change of >5%. CONCLUSIONS RO in IMPT reduces the dose variation due to setup uncertainty and anatomy changes during treatment compared with PTV-based planning. However, dose variation could still be substantial; repeated imaging and adaptive planning as needed are highly recommended for IMPT of lung tumors.
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Affiliation(s)
- Heng Li
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Xiaodong Zhang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Park
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei Liu
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - Joe Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steve Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yupeng Li
- Applied Research, Varian Medical Systems, Palo Alto, CA, USA
| | - Falk Poenisch
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Radhe Mohan
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Gillin
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ronald Zhu
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Multimodality functional imaging in radiation therapy planning: relationships between dynamic contrast-enhanced MRI, diffusion-weighted MRI, and 18F-FDG PET. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2015; 2015:103843. [PMID: 25788972 PMCID: PMC4350945 DOI: 10.1155/2015/103843] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 09/15/2014] [Accepted: 10/10/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Biologically guided radiotherapy needs an understanding of how different functional imaging techniques interact and link together. We analyse three functional imaging techniques that can be useful tools for achieving this objective. MATERIALS AND METHODS The three different imaging modalities from one selected patient are ADC maps, DCE-MRI, and 18F-FDG PET/CT, because they are widely used and give a great amount of complementary information. We show the relationship between these three datasets and evaluate them as markers for tumour response or hypoxia marker. Thus, vascularization measured using DCE-MRI parameters can determine tumour hypoxia, and ADC maps can be used for evaluating tumour response. RESULTS ADC and DCE-MRI include information from 18F-FDG, as glucose metabolism is associated with hypoxia and tumour cell density, although 18F-FDG includes more information about the malignancy of the tumour. The main disadvantage of ADC maps is the distortion, and we used only low distorted regions, and extracellular volume calculated from DCE-MRI can be considered equivalent to ADC in well-vascularized areas. CONCLUSION A dataset for achieving the biologically guided radiotherapy must include a tumour density study and a hypoxia marker. This information can be achieved using only MRI data or only PET/CT studies or mixing both datasets.
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The use of biologically related model (Eclipse) for the intensity-modulated radiation therapy planning of nasopharyngeal carcinomas. PLoS One 2014; 9:e112229. [PMID: 25372041 PMCID: PMC4221619 DOI: 10.1371/journal.pone.0112229] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 10/06/2014] [Indexed: 01/22/2023] Open
Abstract
Purpose Intensity-modulated radiation therapy (IMRT) is the most common treatment technique for nasopharyngeal carcinoma (NPC). Physical quantities such as dose/dose-volume parameters are used conventionally for IMRT optimization. The use of biological related models has been proposed and can be a new trend. This work was to assess the performance of the biologically based IMRT optimization model installed in a popular commercial treatment planning system (Eclipse) as compared to its dose/dose volume optimization model when employed in the clinical environment for NPC cases. Methods Ten patients of early stage NPC and ten of advanced stage NPC were selected for this study. IMRT plans optimized using biological related approach (BBTP) were compared to their corresponding plans optimized using the dose/dose volume based approach (DVTP). Plan evaluation was performed using both biological indices and physical dose indices such as tumor control probability (TCP), normal tissue complication probability (NTCP), target coverage, conformity, dose homogeneity and doses to organs at risk. The comparison results of the more complex advanced stage cases were reported separately from those of the simpler early stage cases. Results The target coverage and conformity were comparable between the two approaches, with BBTP plans producing more hot spots. For the primary targets, BBTP plans produced comparable TCP for the early stage cases and higher TCP for the advanced stage cases. BBTP plans reduced the volume of parotid glands receiving doses of above 40 Gy compared to DVTP plans. The NTCP of parotid glands produced by BBTP were 8.0±5.8 and 7.9±8.7 for early and advanced stage cases, respectively, while those of DVTP were 21.3±8.3 and 24.4±12.8, respectively. There were no significant differences in the NTCP values between the two approaches for the serial organs. Conclusions Our results showed that the BBTP approach could be a potential alternative approach to the DVTP approach for NPC.
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Kierkels RGJ, Korevaar EW, Steenbakkers RJHM, Janssen T, van't Veld AA, Langendijk JA, Schilstra C, van der Schaaf A. Direct use of multivariable normal tissue complication probability models in treatment plan optimisation for individualised head and neck cancer radiotherapy produces clinically acceptable treatment plans. Radiother Oncol 2014; 112:430-6. [PMID: 25220369 DOI: 10.1016/j.radonc.2014.08.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 08/11/2014] [Accepted: 08/13/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE Recently, clinically validated multivariable normal tissue complication probability models (NTCP) for head and neck cancer (HNC) patients have become available. We test the feasibility of using multivariable NTCP-models directly in the optimiser for inverse treatment planning of radiotherapy to improve the dose distributions and corresponding NTCP-estimates in HNC patients. MATERIAL AND METHODS For 10 HNC cases, intensity-modulated radiotherapy plans were optimised either using objective functions based on the 'generalised equivalent uniform dose' (OFgEUD) or based on multivariable NTCP-models (OFNTCP). NTCP-models for patient-rated xerostomia, physician-rated RTOG grade II-IV dysphagia, and various patient-rated aspects of swallowing dysfunction were incorporated. The NTCP-models included dose-volume parameters as well as clinical factors contributing to a personalised optimisation process. Both optimisation techniques were compared by means of 'pseudo Pareto fronts' (target dose conformity vs. the sum of the NTCPs). RESULTS Both optimisation techniques resulted in clinically realistic treatment plans with only small differences. For nine patients the sum-NTCP was lower for the OFNTCP optimised plans (on average 5.7% (95%CI 1.7-9.9%, p<0.006)). Furthermore, the OFNTCP provided the advantages of fewer unknown optimisation parameters and an intrinsic mechanism of individualisation. CONCLUSIONS Treatment plan optimisation using multivariable NTCP-models directly in the OF is feasible as has been demonstrated for HNC radiotherapy.
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Affiliation(s)
- Roel G J Kierkels
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands.
| | - Erik W Korevaar
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands
| | - Roel J H M Steenbakkers
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands
| | - Tomas Janssen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Aart A van't Veld
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands
| | - Johannes A Langendijk
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands
| | - Cornelis Schilstra
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands; Radiotherapeutic Institute Friesland, Leeuwarden, The Netherlands
| | - Arjen van der Schaaf
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands
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Mock U, Georg D, Sölkner L, Suppan C, Vatnitsky SM, Flechl B, Mayer R, Dieckmann K, Knäusl B. Assessment of improved organ at risk sparing for meningioma: light ion beam therapy as boost versus sole treatment option. Radiother Oncol 2014; 111:451-6. [PMID: 25012644 DOI: 10.1016/j.radonc.2014.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 05/14/2014] [Accepted: 05/31/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare photons, protons and carbon ions and their combinations for treatment of atypical and anaplastical skull base meningioma. MATERIAL AND METHODS Two planning target volumes (PTVinitial/PTVboost) were delineated for 10 patients (prescribed doses 50 Gy(RBE) and 10 Gy(RBE)). Plans for intensity modulated photon (IMXT), proton (IMPT) and carbon ion therapy ((12)C) were generated assuming a non-gantry scenario for particles. The following combinations were compared: IMXT+IMXT/IMPT/(12)C; IMPT+IMPT/(12)C; and (12)C+(12)C. Plan quality was evaluated by target conformity and homogeneity (CI, HI), V95%, D2% and D50% and dose-volume-histogram (DVH) parameters for organs-at-risk (OAR). If dose escalation was possible, it was performed until OAR tolerance levels were reached. RESULTS CI was worst for IMXT. HI<0.05±0.01 for (12)C was significantly better than for IMXT. For all treatment options dose escalation above 60 Gy(RBE) was possible for four patients, but impossible for six patients. Compared to IMXT+IMXT, ion beam therapy showed an improved sparing for most OARs, e.g. using protons and carbon ions D50% was reduced by more than 50% for the ipsilateral eye and the brainstem. CONCLUSION Highly conformal IMPT and (12)C plans could be generated with a non-gantry scenario. Improved OAR sparing favors both sole (12)C and/or IMPT plans.
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Affiliation(s)
- Ulrike Mock
- EBG MedAustron GmbH, Wiener Neustadt, Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria
| | - Dietmar Georg
- Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria; Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/AKH Wien, Austria.
| | - Lukas Sölkner
- Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria; Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/AKH Wien, Austria
| | - Christian Suppan
- EBG MedAustron GmbH, Wiener Neustadt, Austria; Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/AKH Wien, Austria
| | - Stanislav M Vatnitsky
- EBG MedAustron GmbH, Wiener Neustadt, Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria
| | | | - Ramona Mayer
- EBG MedAustron GmbH, Wiener Neustadt, Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria
| | - Karin Dieckmann
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/AKH Wien, Austria
| | - Barbara Knäusl
- Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria; Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/AKH Wien, Austria
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Pyshniak V, Fotina I, Zverava A, Siamkouski S, Zayats E, Kopanitsa G, Okuntsau D. Efficiency of biological versus physical optimization for single-arc VMAT for prostate and head and neck cases. J Appl Clin Med Phys 2014; 15:4514. [PMID: 25207394 PMCID: PMC5875496 DOI: 10.1120/jacmp.v15i4.4514] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 02/12/2014] [Accepted: 02/11/2014] [Indexed: 12/02/2022] Open
Abstract
The aim of this work was to compare different approaches to VMAT optimization (biological vs. physical DVH-based) in two commercial treatment planning systems (TPS) for head and neck and prostate cases, using Pareto fronts. VMAT vs. IMRT Pareto front comparison was additionally performed in order to benchmark the optimizer efficiency and VMAT plan quality for each TPS. Three prostate and three head and neck cancer patients were selected for nine-beam IMRT and single-arc VMAT planning in Monaco 3.00 and Oncentra MasterPlan (OMP) 3.3 planning systems. Pareto fronts for prostate cases were constructed based on PTV coverage by 95% isodose and volume of rectum receiving 60 Gy or more. For head and neck cases, PTV coverage by the same isodose and mean dose to parotid gland were used for the construction of Pareto fronts. DVH analysis was performed together with evaluation of planning and delivery efficiency for all the plans. In the intersystem comparison for prostate plans, Monaco generated very similar IMRT and VMAT solutions. Quality of Monaco VMAT plans was superior compared to Oncentra in terms of conformity, homogeneity, and lower median dose to bladder due to biological formalism of optimization cost functions. For the head and neck cases, IMRT and VMAT plans were similar in both systems, except the case where a very strong modulation was required. In this situation single-arc VMAT plan generated with OMP was inferior compared to IMRT. VMAT OMP solutions were similar to Monaco or slightly better for two less-modulated head and neck cases. However, this advantage was achieved on the cost of lower conformity and homogeneity of the Oncentra VMAT plans. IMRT and VMAT solutions generated by Monaco were very similar for both prostate and head and neck cases. Oncentra system shows a bigger difference, and use of the dual-arc VMAT would be recommended to achieve the same plan quality as nine-field IMRT. Biological optimization seems beneficial in terms of plan conformity and homogeneity and allowed achieving lower OAR doses for prostate cases. In complex anatomical situations represented by head and neck cases, sequencing algorithm in Monaco imposed limitations on VMAT plan quality in the intersystem comparison.
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Andreou M, Karaiskos P, Kordolaimi S, Koutsouveli E, Sandilos P, Dimitriou P, Dardoufas C, Georgiou E. Anatomy- vs. fluence-based planning for prostate cancer treatments using VMAT. Phys Med 2014; 30:202-8. [DOI: 10.1016/j.ejmp.2013.05.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 05/09/2013] [Accepted: 05/22/2013] [Indexed: 12/12/2022] Open
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Giantsoudi D, Baltas D, Karabis A, Mavroidis P, Zamboglou N, Tselis N, Shi C, Papanikolaou N. A gEUD-based inverse planning technique for HDR prostate brachytherapy: feasibility study. Med Phys 2013; 40:041704. [PMID: 23556874 DOI: 10.1118/1.4793766] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The purpose of this work was to study the feasibility of a new inverse planning technique based on the generalized equivalent uniform dose for image-guided high dose rate (HDR) prostate cancer brachytherapy in comparison to conventional dose-volume based optimization. METHODS The quality of 12 clinical HDR brachytherapy implants for prostate utilizing HIPO (Hybrid Inverse Planning Optimization) is compared with alternative plans, which were produced through inverse planning using the generalized equivalent uniform dose (gEUD). All the common dose-volume indices for the prostate and the organs at risk were considered together with radiobiological measures. The clinical effectiveness of the different dose distributions was investigated by comparing dose volume histogram and gEUD evaluators. RESULTS Our results demonstrate the feasibility of gEUD-based inverse planning in HDR brachytherapy implants for prostate. A statistically significant decrease in D10 or/and final gEUD values for the organs at risk (urethra, bladder, and rectum) was found while improving dose homogeneity or dose conformity of the target volume. CONCLUSIONS Following the promising results of gEUD-based optimization in intensity modulated radiation therapy treatment optimization, as reported in the literature, the implementation of a similar model in HDR brachytherapy treatment plan optimization is suggested by this study. The potential of improved sparing of organs at risk was shown for various gEUD-based optimization parameter protocols, which indicates the ability of this method to adapt to the user's preferences.
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Affiliation(s)
- D Giantsoudi
- Department of Radiological Sciences, University of Texas Health Sciences Center, San Antonio, Texas 78229, USA.
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