1
|
Hrbacek J, Kacperek A, Beenakker JWM, Mortimer L, Denker A, Mazal A, Shih HA, Dendale R, Slopsema R, Heufelder J, Mishra KK. PTCOG Ocular Statement: Expert Summary of Current Practices and Future Developments in Ocular Proton Therapy. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00748-X. [PMID: 38971383 DOI: 10.1016/j.ijrobp.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 05/08/2024] [Accepted: 06/18/2024] [Indexed: 07/08/2024]
Abstract
Although rare cancers, ocular tumors are a threat to vision, quality of life, and potentially life expectancy of a patient. Ocular proton therapy (OPT) is a powerful tool for successfully treating this disease. The Particle Therapy Co-Operative Ocular Group) formulated an Evidence and Expert-Based Executive Summary of Current Practices and Future Developments in OPT: comparative dosimetric and clinical analysis with the different OPT systems is essential to set up planning guidelines, implement best practices, and establish benchmarks for eye preservation, vision, and quality of life measures. Contemporary prospective trials in select subsets of patients (eg, tumors near the optic disc and/or macula) may allow for dosimetric and clinical analysis between different radiation modalities and beamline systems to evaluate differences in radiation delivery and penumbra, and resultant tumor control, normal tissue complication rates, and overall clinical cost-effectiveness. To date, the combination of multimodal imaging (fundus photography, ultrasound, etc), ophthalmologist assessment, and clip surgery with radiation planning have been keys to successful treatment. Increased use of three-dimensional imaging (computed tomography/magnetic resonance imaging) is anticipated although its spatial resolution might be a limiting factor (eg, detection of flat diffuse tumor parts). Commercially produced ocular treatment-planning systems are under development and their future use is expected to expand across OPT centers. Future continuity of OPT will depend on the following: (1) maintaining and upgrading existing older dedicated low-energy facilities, (2) maintaining shared, degraded beamlines at large proton therapy centers, and (3) developing adapted gantry beams of sufficient quality to maintain the clinical benefits of sharp beam conformity. Option (1) potentially offers the sharpest beams, minimizing impact on healthy tissues, whereas (2) and (3) potentially offer the advantage of substantial long-term technical support and development as well as the introduction of new approaches. Significant patient throughputs and close cooperation between medical physics, ophthalmology, and radiation therapy, underpinned by mutual understanding, is crucial for a successful OPT service.
Collapse
Affiliation(s)
- Jan Hrbacek
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland.
| | | | - Jan-Willem M Beenakker
- Department of Ophthalmology, Leiden University Medical Center, Leiden, Netherlands; Department of Radiology, C.J. Gorter MRI Center, Leiden University Medical Center, Leiden, Netherlands; Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands; HollandPTC, Delft, Netherlands
| | - Linda Mortimer
- Medical Physics Department, The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom
| | - Andrea Denker
- Helmholtz-Zentrum Berlin für Materialien und Energie, Proton Therapy (BE-APT), Berlin, Germany
| | - Alejandro Mazal
- Medical Physics Service, Centro de Protonterapia Quironsalud, Madrid, Spain
| | - Helen A Shih
- Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Remi Dendale
- Institut Curie Protontherapy Center, Orsay, France
| | - Roelf Slopsema
- Department of Radiation Oncology, Emory Proton Therapy Center, Atlanta, Georgia
| | - Jens Heufelder
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, BerlinProtonen am HZB, Berlin, Germany
| | - Kavita K Mishra
- Proton Ocular Radiation Therapy Program, Department of Radiation Oncology, Osher Center for Integrative Health, Osher Foundation Endowed Chair in Clinical Programs in Integrative Health, University of California San Francisco, San Francisco, California
| |
Collapse
|
2
|
Fleury E, Pignol JP, Kiliç E, Milder M, van Rij C, Naus N, Yavuzyigitoglu S, den Toom W, Zolnay A, Spruijt K, van Vulpen M, Trnková P, Hoogeman M. Comparison of stereotactic radiotherapy and protons for uveal melanoma patients. Phys Imaging Radiat Oncol 2024; 31:100605. [PMID: 39050744 PMCID: PMC11268348 DOI: 10.1016/j.phro.2024.100605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Background and purpose Uveal melanoma (UM) is the most common primary ocular malignancy. We compared fractionated stereotactic radiotherapy (SRT) with proton therapy, including toxicity risks for UM patients. Materials and methods For a total of 66 UM patients from a single center, SRT dose distributions were compared to protons using the same planning CT. Fourteen dose-volume parameters were compared in 2-Gy equivalent dose per fraction (EQD2). Four toxicity profiles were evaluated: maculopathy, optic-neuropathy, visual acuity impairment (Profile I); neovascular glaucoma (Profile II); radiation-induced retinopathy (Profile III); and dry-eye syndrome (Profile IV). For Profile III, retina Mercator maps were generated to visualize the geographical location of dose differences. Results In 9/66 cases, (14 %) proton plans were superior for all dose-volume parameters. Higher T stages benefited more from protons in Profile I, especially tumors located within 3 mm or less from the optic nerve. In Profile II, only 9/66 cases resulted in a better proton plan. In Profile III, better retina volume sparing was always achievable with protons, with a larger gain for T3 tumors. In Profile IV, protons always reduced the risk of toxicity with a median RBE-weighted EQD2 reduction of 15.3 Gy. Conclusions This study reports the first side-by-side imaging-based planning comparison between protons and SRT for UM patients. Globally, while protons appear almost always better regarding the risk of optic-neuropathy, retinopathy and dry-eye syndrome, for other toxicity like neovascular glaucoma, a plan comparison is warranted. Choice would depend on the prioritization of risks.
Collapse
Affiliation(s)
- Emmanuelle Fleury
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
- HollandPTC, Delft, The Netherlands
| | | | - Emine Kiliç
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, The Netherlands
- Erasmus Medical Center, Department of Clinical Genetics, Rotterdam, The Netherlands
| | - Maaike Milder
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
| | - Caroline van Rij
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
| | - Nicole Naus
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, The Netherlands
| | | | - Wilhelm den Toom
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
| | - Andras Zolnay
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
| | | | | | - Petra Trnková
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
- Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria
| | - Mischa Hoogeman
- Erasmus Medical Center Cancer Institute, University Medical Center, Department of Radiotherapy, Rotterdam, The Netherlands
- HollandPTC, Delft, The Netherlands
| |
Collapse
|
3
|
Tseng YH, Hsu CA, Chou YB. Comparing efficacy of charged-particle therapy with brachytherapy in treatment of uveal melanoma. Eye (Lond) 2024; 38:1882-1890. [PMID: 38565600 PMCID: PMC11226678 DOI: 10.1038/s41433-024-03035-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 02/08/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Uveal melanoma (UM) is the most common primary ocular tumour in adults. The most used eye-preserving treatments are charged-particle therapy (CPT) and brachytherapy. We performed a systematic review and meta-analysis to compare efficacies and complications of these two radiotherapies. METHODS We searched EMBASE, PubMed, MEDLINE, and the Cochrane Library from January 2012 to December 2022. Two independent reviewers identified controlled studies comparing outcomes of CPT versus brachytherapy. Case series that utilize either treatment modality were also reviewed. RESULTS One hundred fifty studies met the eligibility criteria, including 2 randomized control trials, 5 controlled cohort studies, and 143 case series studies. We found significant reduction in local recurrence rate among patients treated with CPT compared to brachytherapy (Odds ratio[OR] 0.38, 95% Confidence interval [CI] 0.24-0.60, p < 0.01). Analysis also showed a trend of increased risks of secondary glaucoma after CPT. No statistically significant differences were found in analyzing risks of mortality, enucleation, and cataract. CONCLUSIONS Our study suggested no difference in mortality, enucleation rate and cataract formation rate comparing the two treatments. Lower local recurrence rate and possibly higher secondary glaucoma incidence was noted among patients treated with CPT. Nevertheless, the overall level of evidence is limited, and further high-quality studies are necessary to provide a more definitive conclusion.
Collapse
Affiliation(s)
- Yu-Hsuan Tseng
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, 11217, Taiwan
| | - Chia-An Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, 11217, Taiwan
| | - Yu-Bai Chou
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, 11217, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| |
Collapse
|
4
|
Wulff J, Koska B, Ahmad Khalil D, Richter R, Maximilian Bäcker C, Bäumer C, Foerster A, Bechrakis NE, Timmermann B. Uncertainties in ocular proton planning and their impact on required margins. Phys Med 2024; 121:103358. [PMID: 38643558 DOI: 10.1016/j.ejmp.2024.103358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 03/11/2024] [Accepted: 04/16/2024] [Indexed: 04/23/2024] Open
Abstract
PURPOSE To review required margins in ocular proton therapy (OPT) based on an uncertainty estimation and to compare them with widely used values. Further, uncertainties when using registered funduscopy images in the 3D model is investigated. METHODS An uncertainty budget in planning and delivery was defined to determine required aperture and range margins. Setup uncertainties were considered for a cohort of treated patients and tested in a worst-case estimation. Other uncertainties were based on a best-guess and knowledge of institutional specifics, e.g. range reproducibility. Margins for funduscopy registration were defined resulting from scaling, rotation and translation of the image. Image formation for a wide-field fundus camera was reviewed and compared to the projection employed in treatment planning systems. RESULTS Values for aperture and range with margins of 2.5 mm as reported in literature could be determined. Aperture margins appear appropriate for setup uncertainties below 0.5 mm, but depend on lateral penumbra. Range margins depend on depth and associated density uncertainty in tissue. Registration of funduscopy images may require margins of >2 mm, increasing towards the equator. Difference in the projection may lead to discrepancies of several mm. CONCLUSIONS The commonly used 2.5 mm aperture margin was validated as an appropriate choice, while range margins could be reduced for lower ranges. Margins may however not include uncertainties in contouring and possible microscopic spread. If a target base is contoured on registered funduscopy images care must be taken as they are subject to larger uncertainties. Multimodal imaging approach in OPT remains advisable.
Collapse
Affiliation(s)
- Jörg Wulff
- West German Proton Therapy Centre Essen (WPE), Essen, Germany; University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany.
| | - Benjamin Koska
- West German Proton Therapy Centre Essen (WPE), Essen, Germany; University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany
| | - Dalia Ahmad Khalil
- West German Proton Therapy Centre Essen (WPE), Essen, Germany; University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany; Department of Particle Therapy, Essen, Germany
| | - Ronald Richter
- West German Proton Therapy Centre Essen (WPE), Essen, Germany; University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany; Department of Particle Therapy, Essen, Germany
| | - Claus Maximilian Bäcker
- West German Proton Therapy Centre Essen (WPE), Essen, Germany; University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany
| | - Christian Bäumer
- West German Proton Therapy Centre Essen (WPE), Essen, Germany; University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany; German Cancer Consortium (DKTK), Essen, Germany; Department of Physics, TU Dortmund University, Dortmund, Germany
| | - Andreas Foerster
- University Hospital Essen, Essen, Germany; Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Nikolaos E Bechrakis
- University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany; Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Beate Timmermann
- West German Proton Therapy Centre Essen (WPE), Essen, Germany; University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany; Department of Particle Therapy, Essen, Germany; German Cancer Consortium (DKTK), Essen, Germany
| |
Collapse
|
5
|
Wulff J, Koska B, Heufelder J, Janson M, Bäcker CM, Siregar H, Behrends C, Bäumer C, Foerster A, Bechrakis NE, Timmermann B. Commissioning and validation of a novel commercial TPS for ocular proton therapy. Med Phys 2023; 50:365-379. [PMID: 36195575 DOI: 10.1002/mp.16006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/08/2022] [Accepted: 09/21/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Until today, the majority of ocular proton treatments worldwide were planned with the EYEPLAN treatment planning system (TPS). Recently, the commercial, computed tomography (CT)-based TPS for ocular proton therapy RayOcular was released, which follows the general concepts of model-based treatment planning approach in conjunction with a pencil-beam-type dose algorithm (PBA). PURPOSE To validate RayOcular with respect to two main features: accurate geometrical representation of the eye model and accuracy of its dose calculation algorithm in combination with an Ion Beam Applications (IBA) eye treatment delivery system. METHODS Different 3D-printed eye-ball-phantoms were fabricated to test the geometrical representation of the corresponding CT-based model, both in orthogonal 2D images for X-ray image overlay and in fundus view overlaid with a funduscopy. For the latter, the phantom was equipped with a lens matching refraction of the human eye. Funduscopy was acquired in a Zeiss Claus 500 camera. Tantalum clips and fiducials attached to the phantoms were localized in the TPS model, and residual deviations to the actual position in X-ray images for various orientations of the phantom were determined, after the nominal eye orientation was corrected in RayOcular to obtain a best overall fit. In the fundus view, deviations between known and displayed distances were measured. Dose calculation accuracy of the PBA on a 0.2 mm grid was investigated by comparing between measured lateral and depth-dose profiles in water for various combinations of range, modulation, and field-size. Ultimately, the modeling of dose distributions behind wedges was tested. A 1D gamma-test was applied, and the lateral and distal penumbra were further compared. RESULTS Average residuals between model clips and visible clips/fiducials in orthogonal X-ray images were within 0.3 mm, including different orientations of the phantom. The differences between measured distances on the registered funduscopy image in the RayOcular fundus view and the known ground-truth were within 1 mm up to 10.5 mm distance from the posterior pole. No clear benefit projection of either polar mode or camera mode could be identified, the latter mimicking camera properties. Measured dose distributions were reproduced with gamma-test pass-rates of >95% with 2%/0.3 mm for depth and lateral profiles in the middle of spread-out Bragg-peaks. Distal falloff and lateral penumbra were within 0.2 mm for fields without a wedge. For shallow depths, the agreement was worse, reaching pass-rates down to 80% with 5%/0.3 mm when comparing lateral profiles in air. This is caused by low-energy protons from a scatter source in the IBA system not modeled by RayOcular. Dose distributions modified by wedges were reproduced, matching the wedge-induced broadening of the lateral penumbra to within 0.4 mm for the investigated cases and showing the excess dose within the field due to wedge scatter. CONCLUSION RayOcular was validated for its use with an IBA single scattering delivery nozzle. Geometric modeling of the eye and representation of 2D projections fulfill clinical requirements. The PBA dose calculation reproduces measured distributions and allows explicit handling of wedges, overcoming approximations of simpler dose calculation algorithms used in other systems.
Collapse
Affiliation(s)
- Jörg Wulff
- West German Proton Therapy Centre (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ), Essen, Germany
| | - Benjamin Koska
- West German Proton Therapy Centre (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ), Essen, Germany
| | - Jens Heufelder
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Charité-Universitätsmedizin Berlin, BerlinProtonen am Helmholtz-Zentrum Berlin für Materialien und Energie, Berlin, Germany
| | | | - Claus Maximilian Bäcker
- West German Proton Therapy Centre (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany
| | - Hilda Siregar
- West German Proton Therapy Centre (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany
| | - Carina Behrends
- West German Proton Therapy Centre (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany.,Department of Physics, TU Dortmund University, Dortmund, Germany
| | - Christian Bäumer
- West German Proton Therapy Centre (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ), Essen, Germany.,Department of Physics, TU Dortmund University, Dortmund, Germany.,German Cancer Consortium (DKTK), Essen, Germany
| | - Andreas Foerster
- University Hospital Essen, Essen, Germany.,Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Nikolaos E Bechrakis
- University Hospital Essen, Essen, Germany.,Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Beate Timmermann
- West German Proton Therapy Centre (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ), Essen, Germany.,German Cancer Consortium (DKTK), Essen, Germany.,Department of Particle Therapy, University Hospital Essen, Essen, Germany
| |
Collapse
|
6
|
Via R, Pica A, Antonioli L, Paganelli C, Fattori G, Spaccapaniccia C, Lomax A, Weber DC, Schalenbourg A, Baroni G, Hrbacek J. MRI and FUNDUS image fusion for improved ocular biometry in Ocular Proton Therapy. Radiother Oncol 2022; 174:16-22. [PMID: 35788353 DOI: 10.1016/j.radonc.2022.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/06/2022] [Accepted: 06/24/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Ocular biometry in Ocular Proton Therapy (OPT) currently relies on a generic geometrical eye model built by referencing surgically implanted markers. An alternative approach based on image fusion of volumetric Magnetic Resonance Imaging (MRI) and panoramic fundus photography was investigated. MATERIALS AND METHODS Eighteen non-consecutive uveal melanoma (UM) patients, who consented for an MRI and had their tumour base visible on panoramic fundus photography, were included in this comparative analysis. Through generating digitally-reconstructed projections from MRI images using the Lambert azimuthal equal-area projection, 2D-3D image fusion between fundus photography and an eye model delineated on MRI scans was achieved and allowed for a novel definition of the target base (MRI + FCTV). MRI + FCTV was compared with MRI-only delineation (MRIGTV) and the conventional (EyePlan) target definition (EPCTV). RESULTS The combined use of fundus photography and MRI to define tumour volumes reduced the average discrepancies by almost 65% with respect to the MRI only tumour definitions when comparing with the conventionally planned EPCTV. With the proposed method, shallow sub-retinal tumour infiltration, otherwise invisible on MRI, can be included in the target volume definition. Moreover, a novel definition of the fovea location improves the accuracy and personalisation of the 3D eye model. CONCLUSION MRI and fundus image fusion overcomes some of the limitations of ophthalmological MRI for tumour volume definition in OPT. This novel eye tumour modelling method might improve treatment planning personalisation, allowing to better anticipate which patients could benefit from prophylactic treatment protocols for radiation induced maculopathy.
Collapse
Affiliation(s)
- Riccardo Via
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland.
| | - Alessia Pica
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland
| | - Luca Antonioli
- Dipartimento di Elettronica Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy
| | - Chiara Paganelli
- Dipartimento di Elettronica Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy
| | - Giovanni Fattori
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland
| | - Chiara Spaccapaniccia
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland
| | - Antony Lomax
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland
| | - Damien Charles Weber
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland; Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; Department of Radiation Oncology, University Hospital Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Ann Schalenbourg
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, FAA, Lausanne, Switzerland
| | - Guido Baroni
- Department of Radiation Oncology, University Hospital Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Jan Hrbacek
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland
| |
Collapse
|
7
|
Valmaggia P, Friedli P, Hörmann B, Kaiser P, Scholl HPN, Cattin PC, Sandkühler R, Maloca PM. Feasibility of Automated Segmentation of Pigmented Choroidal Lesions in OCT Data With Deep Learning. Transl Vis Sci Technol 2022; 11:25. [PMID: 36156729 PMCID: PMC9526362 DOI: 10.1167/tvst.11.9.25] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the feasibility of automated segmentation of pigmented choroidal lesions (PCLs) in optical coherence tomography (OCT) data and compare the performance of different deep neural networks. Methods Swept-source OCT image volumes were annotated pixel-wise for PCLs and background. Three deep neural network architectures were applied to the data: the multi-dimensional gated recurrent units (MD-GRU), the V-Net, and the nnU-Net. The nnU-Net was used to compare the performance of two-dimensional (2D) versus three-dimensional (3D) predictions. Results A total of 121 OCT volumes were analyzed (100 normal and 21 PCLs). Automated PCL segmentations were successful with all neural networks. The 3D nnU-Net predictions showed the highest recall with a mean of 0.77 ± 0.22 (MD-GRU, 0.60 ± 0.31; V-Net, 0.61 ± 0.25). The 3D nnU-Net predicted PCLs with a Dice coefficient of 0.78 ± 0.13, outperforming MD-GRU (0.62 ± 0.23) and V-Net (0.59 ± 0.24). The smallest distance to the manual annotation was found using 3D nnU-Net with a mean maximum Hausdorff distance of 315 ± 172 µm (MD-GRU, 1542 ± 1169 µm; V-Net, 2408 ± 1060 µm). The 3D nnU-Net showed a superior performance compared with stacked 2D predictions. Conclusions The feasibility of automated deep learning segmentation of PCLs was demonstrated in OCT data. The neural network architecture had a relevant impact on PCL predictions. Translational Relevance This work serves as proof of concept for segmentations of choroidal pathologies in volumetric OCT data; improvements are conceivable to meet clinical demands for the diagnosis, monitoring, and treatment evaluation of PCLs.
Collapse
Affiliation(s)
- Philippe Valmaggia
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland.,Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland.,Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | | | | | | | - Hendrik P N Scholl
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland.,Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Philippe C Cattin
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Robin Sandkühler
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Peter M Maloca
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland.,Department of Ophthalmology, University Hospital Basel, Basel, Switzerland.,Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK
| |
Collapse
|
8
|
Fleury E, Trnková P, van Rij C, Rodrigues M, Klaver Y, Spruijt K, Naus N, Zolnay A, Pignol JP, Kiliç E, Hoogeman MS. Improving Organs-at-Risk Sparing for Choroidal Melanoma Patients: A CT-based Two-Beam Strategy in Ocular Proton Therapy with a Dedicated Eyeline. Radiother Oncol 2022; 171:173-181. [PMID: 35487435 DOI: 10.1016/j.radonc.2022.04.021] [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: 01/19/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE To investigate the potential clinical benefit of a two-beam arrangement technique using three-dimensional (3D) imaging of uveal melanoma (UM) patients treated with proton therapy and a dedicated eyeline. MATERIAL/METHODS Retrospective CT-based treatment plans of 39 UM patients performed using a single beam (SB) were compared to plans with two beams (TB) optimized for better trade-offs in organs-at-risk sparing. The RBE-weighted prescribed dose was 60 Gy (DRBE, GTV = 60 Gy) in four fractions, assuming an RBE of 1.1. Dosimetric findings were analyzed for three patient groups based on tumor-optic nerve distance and UM staging (group GrA: ≤ 3 mm, T1 T2 UM; GrB: ≤ 3 mm, T3 UM; GrC: > 3 mm, T1 T2 T3 UM). Finally, two schedules were compared on biologically effective dose (BED): both beams being delivered either the same day (TB) or on alternate days (TBalter). RESULTS All strategies resulted in dosimetrically acceptable plans. A dose reduction to the anterior structures was achieved in 23/39 cases with the two-beam plans. D25% was significantly lowered compared to SB plans by 12.4 and 15.4 Gy RBE-weighted median dose in GrA and GrB, respectively. D2% was reduced by 18.6 and 6.0 Gy RBE-weighted median dose in GrA and GrB, respectively. A cost to the optic nerve was observed with a median difference up to 3.8 Gy RBE-weighted dose in GrB. BED differences were statistically significant for all considered parameters in favor of two beams delivered the same day. CONCLUSION A two-beam strategy appears beneficial for posterior tumors abutting the optic nerve. This strategy might have a positive impact on the risk of ocular complications.
Collapse
Affiliation(s)
- Emmanuelle Fleury
- Erasmus Medical Center, Cancer Institute, Department of Radiotherapy, Rotterdam, The Netherlands; Holland Proton Therapy Center, Delft, The Netherlands.
| | - Petra Trnková
- Erasmus Medical Center, Cancer Institute, Department of Radiotherapy, Rotterdam, The Netherlands; Medical University of Vienna, Department of Radiation Oncology, Vienna, Austria
| | - Caroline van Rij
- Erasmus Medical Center, Cancer Institute, Department of Radiotherapy, Rotterdam, The Netherlands; Erasmus Medical Center, Department of Ophthalmology, Rotterdam, The Netherlands
| | | | - Yvonne Klaver
- Holland Proton Therapy Center, Delft, The Netherlands
| | - Kees Spruijt
- Holland Proton Therapy Center, Delft, The Netherlands
| | - Nicole Naus
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, The Netherlands
| | - Andras Zolnay
- Erasmus Medical Center, Cancer Institute, Department of Radiotherapy, Rotterdam, The Netherlands
| | | | - Emine Kiliç
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, The Netherlands; Erasmus Medical Center, Department of Clinical Genetics, Rotterdam, The Netherlands
| | - Mischa S Hoogeman
- Erasmus Medical Center, Cancer Institute, Department of Radiotherapy, Rotterdam, The Netherlands; Holland Proton Therapy Center, Delft, The Netherlands
| |
Collapse
|
9
|
Wulff J, Koska B, Janson M, Bäumer C, Denker A, Geismar D, Gollrad J, Timmermann B, Heufelder J. Technical Note: Impact of Beam Properties for Uveal Melanoma Proton Therapy - An In-Silico Planning Study. Med Phys 2022; 49:3481-3488. [PMID: 35218037 DOI: 10.1002/mp.15573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate the impact of beam quality in terms of distal fall-off (DFO, 90% to 10%) and lateral penumbra (LP, 80% to 20%) of single beam ocular proton treatment (OPT) and to derive resulting ideal requirements for future systems. METHODS Nine different beam models with DFO varying between 1 mm and 4 mm and LP between 1 mm and 4 mm were created. Beam models were incorporated into the RayStation with RayOcular TPS version 10 B (RaySearch Laboratories, Sweden). Each beam model was applied for eight typical clinical cases, covering different sizes and locations of uveal melanoma. Plans with and without an additional wedge were created, resulting in 117 plans with a total prescribed median dose of 60 Gy(RBE) to the CTV. Treatment plans were analyzed in terms of V20-V80 penumbra volume, D1 (dose to 1% of the volume) for optic disc and macula, optic nerve V30 (volume receiving 30 Gy(RBE), i.e. 50% of prescription), as well as average dose to lens and ciliary body. A LP dependent aperture margin was based on estimated uncertainties, ranging from 1.7 mm to 4.0 mm. RESULTS V20-V80 showed a strong influence by LP, while DFO was less relevant. The optic disc D1 reached an extra dose of up to 3000 cGy(RBE), comparing the defined technical limit of DFO = LP = 1 mm with DFO = 3 mm/ LP = 4 mm. The latter may result from a pencil-beam scanning (PBS) system with static apertures. Plans employing a wedge showed an improvement for organs at risk (OAR) sparing. CONCLUSION Plan quality is strongly influenced by initial beam parameters. The impact of LP is more pronounced when compared to DFO. The latter becomes important in the treatment of posterior tumors near the macula, optic disc or optic nerve. The plan quality achieved by dedicated OPT nozzles in single- or double-scattering design might not be achievable with modified PBS systems. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- J Wulff
- West German Proton Therapy Centre Essen (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ), Essen, Germany
| | - B Koska
- West German Proton Therapy Centre Essen (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ), Essen, Germany
| | - M Janson
- RaySearch Laboratories, Stockholm, Sweden
| | - C Bäumer
- West German Proton Therapy Centre Essen (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ), Essen, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,TU Dortmund University, Dortmund, Germany
| | - A Denker
- Helmholtz-Zentrum Berlin für Materialien und Energie, Protonentherapie, Germany.,Beuth-Hochschule für Technik, Berlin, Germany
| | - D Geismar
- West German Proton Therapy Centre Essen (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ), Essen, Germany.,Department of Particle Therapy, Essen, Germany
| | - J Gollrad
- Charité - Universitätsmedizin Berlin, Department of Radiation Oncology and Radiotherapy, Berlin, Germany
| | - B Timmermann
- West German Proton Therapy Centre Essen (WPE), Essen, Germany.,University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ), Essen, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,Department of Particle Therapy, Essen, Germany
| | - J Heufelder
- Charité - Universitätsmedizin Berlin, Department of Ophthalmology, Berlin, Germany.,Charité - Universitätsmedizin Berlin, BerlinProtonen am Helmholtz-Zentrum für Materialien und Energie, Berlin, Germany
| |
Collapse
|
10
|
Fleury E, Trnková P, Spruijt K, Herault J, Lebbink F, Heufelder J, Hrbacek J, Horwacik T, Kajdrowicz T, Denker A, Gerard A, Hofverberg P, Mamalui M, Slopsema R, Pignol J, Hoogeman M. Characterization of the HollandPTC proton therapy beamline dedicated to uveal melanoma treatment and an interinstitutional comparison. Med Phys 2021; 48:4506-4522. [PMID: 34091930 PMCID: PMC8457201 DOI: 10.1002/mp.15024] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/08/2021] [Accepted: 05/25/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Eye-dedicated proton therapy (PT) facilities are used to treat malignant intraocular lesions, especially uveal melanoma (UM). The first commercial ocular PT beamline from Varian was installed in the Netherlands. In this work, the conceptual design of the new eyeline is presented. In addition, a comprehensive comparison against five PT centers with dedicated ocular beamlines is performed, and the clinical impact of the identified differences is analyzed. MATERIAL/METHODS The HollandPTC eyeline was characterized. Four centers in Europe and one in the United States joined the study. All centers use a cyclotron for proton beam generation and an eye-dedicated nozzle. Differences among the chosen ocular beamlines were in the design of the nozzle, nominal energy, and energy spectrum. The following parameters were collected for all centers: technical characteristics and a set of distal, proximal, and lateral region measurements. The measurements were performed with detectors available in-house at each institution. The institutions followed the International Atomic Energy Agency (IAEA) Technical Report Series (TRS)-398 Code of Practice for absolute dose measurement, and the IAEA TRS-398 Code of Practice, its modified version or International Commission on Radiation Units and Measurements Report No. 78 for spread-out Bragg peak normalization. Energy spreads of the pristine Bragg peaks were obtained with Monte Carlo simulations using Geant4. Seven tumor-specific case scenarios were simulated to evaluate the clinical impact among centers: small, medium, and large UM, located either anteriorly, at the equator, or posteriorly within the eye. Differences in the depth dose distributions were calculated. RESULTS A pristine Bragg peak of HollandPTC eyeline corresponded to the constant energy of 75 MeV (maximal range 3.97 g/cm2 in water) with an energy spread of 1.10 MeV. The pristine Bragg peaks for the five participating centers varied from 62.50 to 104.50 MeV with an energy spread variation between 0.10 and 0.70 MeV. Differences in the average distal fall-offs and lateral penumbrae (LPs) (over the complete set of clinically available beam modulations) among all centers were up to 0.25 g/cm2 , and 0.80 mm, respectively. Average distal fall-offs of the HollandPTC eyeline were 0.20 g/cm2 , and LPs were between 1.50 and 2.15 mm from proximal to distal regions, respectively. Treatment time, around 60 s, was comparable among all centers. The virtual source-to-axis distance of 120 cm at HollandPTC was shorter than for the five participating centers (range: 165-350 cm). Simulated depth dose distributions demonstrated the impact of the different beamline characteristics among institutions. The largest difference was observed for a small UM located at the posterior pole, where a proximal dose between two extreme centers was up to 20%. CONCLUSIONS HollandPTC eyeline specifications are in accordance with five other ocular PT beamlines. Similar clinical concepts can be applied to expect the same high local tumor control. Dosimetrical properties among the six institutions induce most likely differences in ocular radiation-related toxicities. This interinstitutional comparison could support further research on ocular post-PT complications. Finally, the findings reported in this study could be used to define dosimetrical guidelines for ocular PT to unify the concepts among institutions.
Collapse
Affiliation(s)
- Emmanuelle Fleury
- Department of RadiotherapyErasmus MC Cancer Institute, University Medical Center RotterdamThe Netherlands
- Holland Proton Therapy CenterDelftThe Netherlands
| | - Petra Trnková
- Department of RadiotherapyErasmus MC Cancer Institute, University Medical Center RotterdamThe Netherlands
- Departement of Radiation OncologyMedical University of ViennaViennaAustria
| | - Kees Spruijt
- Holland Proton Therapy CenterDelftThe Netherlands
| | - Joël Herault
- Departement of Radiation OncologyCentre Antoine LacassagneNiceFrance
| | | | - Jens Heufelder
- Helmholtz‐Zentrum Berlin für Materialien und EnergieBerlinGermany
- Department of OphthalmologyCharité ‐ Universitätsmedizin BerlinBerlinGermany
| | - Jan Hrbacek
- Paul Scherrer Institute Center for Proton TherapyVilligenSwitzerland
| | - Tomasz Horwacik
- Institute of Nuclear PhysicsPolish Academy of SciencesKrakówPoland
| | | | - Andrea Denker
- Helmholtz‐Zentrum Berlin für Materialien und EnergieBerlinGermany
| | - Anaïs Gerard
- Departement of Radiation OncologyCentre Antoine LacassagneNiceFrance
| | - Petter Hofverberg
- Departement of Radiation OncologyCentre Antoine LacassagneNiceFrance
| | - Maria Mamalui
- Department of Radiation OncologyUniversity of FloridaGainesvilleFloridaUSA
| | - Roelf Slopsema
- Department of Radiation OncologyEmory Proton Therapy CenterAtlantaGeorgiaUSA
| | | | - Mischa Hoogeman
- Department of RadiotherapyErasmus MC Cancer Institute, University Medical Center RotterdamThe Netherlands
- Holland Proton Therapy CenterDelftThe Netherlands
| |
Collapse
|
11
|
Fleury E, Trnková P, Erdal E, Hassan M, Stoel B, Jaarma‐Coes M, Luyten G, Herault J, Webb A, Beenakker J, Pignol J, Hoogeman M. Three-dimensional MRI-based treatment planning approach for non-invasive ocular proton therapy. Med Phys 2021; 48:1315-1326. [PMID: 33336379 PMCID: PMC7986198 DOI: 10.1002/mp.14665] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 10/05/2020] [Accepted: 11/30/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To develop a high-resolution three-dimensional (3D) magnetic resonance imaging (MRI)-based treatment planning approach for uveal melanomas (UM) in proton therapy. MATERIALS/METHODS For eight patients with UM, a segmentation of the gross tumor volume (GTV) and organs-at-risk (OARs) was performed on T1- and T2-weighted 7 Tesla MRI image data to reconstruct the patient MR-eye. An extended contour was defined with a 2.5-mm isotropic margin derived from the GTV. A broad beam algorithm, which we have called πDose, was implemented to calculate relative proton absorbed doses to the ipsilateral OARs. Clinically favorable gazing angles of the treated eye were assessed by calculating a global weighted-sum objective function, which set penalties for OARs and extreme gazing angles. An optimizer, which we have named OPT'im-Eye-Tool, was developed to tune the parameters of the functions for sparing critical-OARs. RESULTS In total, 441 gazing angles were simulated for every patient. Target coverage including margins was achieved in all the cases (V95% > 95%). Over the whole gazing angles solutions space, maximum dose (Dmax ) to the optic nerve and the macula, and mean doses (Dmean ) to the lens, the ciliary body and the sclera were calculated. A forward optimization was applied by OPT'im-Eye-Tool in three different prioritizations: iso-weighted, optic nerve prioritized, and macula prioritized. In each, the function values were depicted in a selection tool to select the optimal gazing angle(s). For example, patient 4 had a T2 equatorial tumor. The optimization applied for the straight gazing angle resulted in objective function values of 0.46 (iso-weighted situation), 0.90 (optic nerve prioritization) and 0.08 (macula prioritization) demonstrating the impact of that angle in different clinical approaches. CONCLUSIONS The feasibility and suitability of a 3D MRI-based treatment planning approach have been successfully tested on a cohort of eight patients diagnosed with UM. Moreover, a gaze-angle trade-off dose optimization with respect to OARs sparing has been developed. Further validation of the whole treatment process is the next step in the goal to achieve both a non-invasive and a personalized proton therapy treatment.
Collapse
Affiliation(s)
- E. Fleury
- Department of Radiation OncologyErasmus Medical CenterRotterdamThe Netherlands
- Department of Radiation OncologyHollandPTCDelftThe Netherlands
| | - P. Trnková
- Department of Radiation OncologyErasmus Medical CenterRotterdamThe Netherlands
- Department of Radiation OncologyHollandPTCDelftThe Netherlands
| | - E. Erdal
- Department of Radiation OncologyHollandPTCDelftThe Netherlands
| | - M. Hassan
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - B. Stoel
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - M. Jaarma‐Coes
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - G. Luyten
- Department of OphthalmologyLeiden University Medical CenterLeidenThe Netherlands
| | - J. Herault
- Department of Radiation OncologyCentre Antoine LacassagneNiceFrance
| | - A. Webb
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
| | - J.‐W. Beenakker
- Department of RadiologyLeiden University Medical CenterLeidenThe Netherlands
- Department of OphthalmologyLeiden University Medical CenterLeidenThe Netherlands
| | - J.‐P. Pignol
- Department of Radiation OncologyDalhousie UniversityHalifaxCanada
| | - M. Hoogeman
- Department of Radiation OncologyErasmus Medical CenterRotterdamThe Netherlands
- Department of Radiation OncologyHollandPTCDelftThe Netherlands
| |
Collapse
|
12
|
Via R, Hennings F, Pica A, Fattori G, Beer J, Peroni M, Baroni G, Lomax A, Weber DC, Hrbacek J. Potential and pitfalls of 1.5T MRI imaging for target volume definition in ocular proton therapy. Radiother Oncol 2021; 154:53-59. [DOI: 10.1016/j.radonc.2020.08.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 12/13/2022]
|
13
|
Mathis T, Espensen CA, Caujolle J, Herault J, Fog LS, Maschi C, Kodjikian L, Baillif S, Kiilgaard JF, Thariat J. Ultra-widefield fundus photography for radiation therapy planning of ocular tumours. Acta Ophthalmol 2020; 98:e191-e196. [PMID: 31518055 DOI: 10.1111/aos.14250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 08/26/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE The use of planar ultra-widefield fundus photography (UWF) may result in distortions and inaccurate measurement. The aim of the study was to evaluate the accuracy of UWF instead of the standard narrow field (SF) for the treatment planning phase of ocular tumours. METHODS Distortions between conformal SF and UWF were assessed in 43 patients with choroidal melanoma treated with either proton therapy or brachytherapy. imagej software was used to measure distortion. RESULTS The median interquartile range ([IQR]) distortion for all cases was 3.7% [1.7-10.8]. For cases with tumours within 6 mm of the optic disc, distortions appeared clinically nonsignificant. For peripheral and/or large tumours, significantly larger distortions were observed on UWF (median 4.4% [2.7-22.6] for tumours ≥6 mm from the optic disc versus 3.3% [1.6-9.9] for those <6 mm, p = 0.04). Images can be subdivided into three groups: minimal distortion (79.1% of eyes), similar level of major distortion for both measured distances (11.6%) and distortion with unequal level of distortion between the measured distances (9.3%). CONCLUSION Distortions with UWF appeared minimal in posterior regions of the fundus and increased with the distance from the posterior pole. UWF could therefore be used for treatment planning of ocular tumours as the planned radiation dose to the macula and optic disc are not impacted.
Collapse
Affiliation(s)
- Thibaud Mathis
- Department of Ophthalmology Croix‐Rousse University Hospital Hospices Civils de Lyon Lyon France
- UMR‐CNRS 5510 Matéis Villeurbane France
| | - Charlotte A. Espensen
- Department of Ophthalmology Rigshospitalet Copenhagen Denmark
- Department of Oncology Section of Radiotherapy Rigshospitalet Copenhagen Denmark
| | | | - Joel Herault
- Department of Radiation Oncology Centre Antoine‐Lacassagne Nice France
| | - Lotte S. Fog
- Department of Ophthalmology Rigshospitalet Copenhagen Denmark
| | - Celia Maschi
- Department of Ophthalmology Pasteur II University Hospital Nice France
| | - Laurent Kodjikian
- Department of Ophthalmology Croix‐Rousse University Hospital Hospices Civils de Lyon Lyon France
- UMR‐CNRS 5510 Matéis Villeurbane France
| | - Stephanie Baillif
- Department of Ophthalmology Pasteur II University Hospital Nice France
| | | | - Juliette Thariat
- Department of Radiation Oncology Centre Francois Baclesse/ARCHADE‐ Normandie Univeristy Caen France
| |
Collapse
|
14
|
Mukkamala LK, Mishra K, Daftari I, Moshiri A, Park SS. Phase I/II randomized study of proton beam with anti-VEGF for exudative age-related macular degeneration: long-term results. Eye (Lond) 2020; 34:2271-2279. [PMID: 32055016 DOI: 10.1038/s41433-020-0807-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/09/2019] [Accepted: 10/28/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND/OBJECTIVE To determine if treatment of exudative age-related macular degeneration (eAMD) using proton beam therapy (PBT) combined with intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy is safe and effective long term. SUBJECT/METHODS Thirty eyes with newly diagnosed eAMD were enrolled in a phase I/II prospective, sham-controlled double-masked university study. Eyes were randomized 1:1:1-24 GyE, 16 GyE or sham radiation, and treated with three initial monthly intravitreal ranibizumab or bevacizumab. Subsequent anti-VEGF reinjection was based on monthly optical coherence tomography and examination for 2 years and standard of care thereafter. RESULTS A total of 23 eyes completed 2-year study follow-up, of which 16 maintained monthly follow-up. Mean best-correct visual acuity (BCVA) at 2 years was similar among treatment groups (p > 0.05). The 24 GyE group required fewer anti-VEGF injections when compared with the sham group at 2 years (4.67 ± 1.9 vs 9.67 ± 3.5; p = 0.017). Extended follow-up (mean 4 years) available in 22 eyes showed persistent reduced need for anti-VEGF therapy among eyes treated with 24 GyE compared with sham radiation (2.0 ± 1.6 vs 4.84 ± 2.4 per year, p = 0.008). New and increasing geographic atrophy (GA), noted in some eyes in all treatment groups, resulted in decreased mean BCVA from baseline for the 24 GyE group on extended follow-up (p = 0.009). Possible mild radiation retinopathy noted in 15% of eyes was not visually significant. CONCLUSIONS Initial treatment combining PBT (24 GyE) with intravitreal anti-VEGF therapy appears to decrease the need for anti-VEGF reinjection in eyes with newly diagnosed eAMD. Radiation retinopathy risk was low and does not appear visually significant. Long-term vision was limited by GA development especially in the 24 GyE group.
Collapse
Affiliation(s)
- Lekha K Mukkamala
- Vitreoretinal Service, Department of Ophthalmology & Vision Science, University of California Davis Eye Center, Sacramento, CA, USA
| | - Kavita Mishra
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Inder Daftari
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Ala Moshiri
- Vitreoretinal Service, Department of Ophthalmology & Vision Science, University of California Davis Eye Center, Sacramento, CA, USA
| | - Susanna S Park
- Vitreoretinal Service, Department of Ophthalmology & Vision Science, University of California Davis Eye Center, Sacramento, CA, USA.
| |
Collapse
|
15
|
Via R, Pella A, Romanò F, Fassi A, Ricotti R, Tagaste B, Vai A, Mastella E, Rosaria Fiore M, Valvo F, Ciocca M, Baroni G. A platform for patient positioning and motion monitoring in ocular proton therapy with a non-dedicated beamline. Phys Med 2019; 59:55-63. [PMID: 30928066 DOI: 10.1016/j.ejmp.2019.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/25/2019] [Accepted: 02/25/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE At Centro Nazionale di Adroterapia Oncologica (CNAO, Pavia, Italy) ocular proton therapy (OPT) is delivered using a non-dedicated beamline. This paper describes the novel clinical workflow as well as technologies and methods adopted to achieve accurate target positioning and verification during ocular proton therapy at CNAO. METHOD The OPT clinical protocol at CNAO prescribes a treatment simulation and a delivery phase, performed in the CT and treatment rooms, respectively. The patient gaze direction is controlled and monitored during the entire workflow by means of an eye tracking system (ETS) featuring two optical cameras and an embedded fixation diode light. Thus, the accurate alignment of the fixation light provided to the patient to the prescribed gazed direction is required for an effective treatment. As such, a technological platform based on active robotic manipulators and IR optical tracking-based guidance was developed and tested. The effectiveness of patient positioning strategies was evaluated on a clinical dataset comprising twenty patients treated at CNAO. RESULTS According to experimental testing, the developed technologies guarantee uncertainties lower than one degree in gaze direction definition by means of ETS-guided positioning. Patient positioning and monitoring strategies during treatment effectively mitigated set-up uncertainties and exhibited sub-millimetric accuracy in radiopaque markers alignment. CONCLUSION Ocular proton therapy is currently delivered at CNAO with a non-dedicated beamline. The technologies developed for patient positioning and motion monitoring have proven to be compliant with the high geometrical accuracy required for the treatment of intraocular tumors.
Collapse
Affiliation(s)
- Riccardo Via
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy.
| | - Andrea Pella
- Centro Nazionale di Adroterapia Oncologica Foundation, Pavia 27100, Italy
| | | | - Aurora Fassi
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy
| | - Rosalinda Ricotti
- Centro Nazionale di Adroterapia Oncologica Foundation, Pavia 27100, Italy
| | - Barbara Tagaste
- Centro Nazionale di Adroterapia Oncologica Foundation, Pavia 27100, Italy
| | - Alessandro Vai
- Centro Nazionale di Adroterapia Oncologica Foundation, Pavia 27100, Italy
| | - Edoardo Mastella
- Centro Nazionale di Adroterapia Oncologica Foundation, Pavia 27100, Italy
| | | | - Francesca Valvo
- Centro Nazionale di Adroterapia Oncologica Foundation, Pavia 27100, Italy
| | - Mario Ciocca
- Centro Nazionale di Adroterapia Oncologica Foundation, Pavia 27100, Italy
| | - Guido Baroni
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy
| |
Collapse
|
16
|
Slopsema RL, Mamalui M, Bolling J, Flampouri S, Yeung D, Li Z, Rutenberg MS, Dagan R. Can CT imaging improve targeting accuracy in clip-based proton therapy of ocular melanoma? Phys Med Biol 2019; 64:035010. [PMID: 30566923 DOI: 10.1088/1361-6560/aaf9c9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To evaluate the benefit of adding CT imaging to the simulation process of clip-based proton therapy of ocular melanomas. For thirty ocular melanoma cases, the clip position in the eye model was determined based on orthogonal radiographs as well as on a CT image set. The geometrical shift of the clips between the standard simulation process and standard simulation process with addition of CT imaging (CT-guided) was determined. The dosimetric impact was evaluated by developing treatment plans based on both the standard-process model and the CT-guided model. In 40% of the studied cases, the difference in clip position between eye models created with and without CT was less than 0.5 mm. This difference was more than 1 mm in 17% of cases. The dosimetric impact of shifts below 1 mm was low because these shifts did not exceed the planning margins. For the four cases with a shift of more than 1 mm a reduction in target coverage (ΔV99%) of -3% to -6% was observed. Changes in macula and optic-disc mean dose of up to 16% and 35% of the prescribed dose were seen when these structures abutted the target. Adding CT imaging to the simulation process is beneficial in select cases where discrepancies between the eye model and ophthalmology measurements occur or where a critical structure is located close to the target and improved localization accuracy is wanted. For the majority of patients, addition of CT imaging does not result in quantifiable changes in dosimetry. Nevertheless, CT imaging is a valuable tool in the quality control of the modeling and treatment-planning process of clip-based eye treatments.
Collapse
Affiliation(s)
- R L Slopsema
- University of Florida Health Proton Therapy Institute, 2015 North Jefferson Street, Jacksonville, FL 32206, United States of America. Author to whom any correspondence should be addressed
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Daftari IK, Quivey JM, Chang JS, Mishra KK. Technical Note: Feasibility study of titanium markers in choroidal melanoma localization for proton beam radiation therapy. Med Phys 2018; 45:1036-1039. [PMID: 29377168 DOI: 10.1002/mp.12764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/14/2017] [Accepted: 12/28/2017] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The purpose of this study is to explore the feasibility of the use of titanium fiducial markers to minimize the metallic artifact seen with tantalum markers which causes significant distortion on postoperative orbital CT scans. METHOD We designed and constructed the titanium markers in the shop of Crocker Nuclear Laboratory, UC Davis, CA. The markers were placed on an eyeball phantom. The eyeball was inserted into the Rando phantom in the orbital space. The Rando phantom was imaged with coplanar x rays on Nucletron simulator at UCSF, on digital panel on the eye beam line at CNL eye treatment facility and on CT scanner at UCSF. RESULTS The titanium markers can be clearly seen on the hard copy of x rays and on digital panel. The CT scan of an orbit using tantalum markers on the right eye and titanium markers on the left eye shows the metal artifact from tantalum markers. Titanium markers show very little distortion on CT images. CONCLUSION The present study describes these markers and their relative benefit in comparison with tantalum marker, which has been used for localizing ocular tumor for decades.
Collapse
Affiliation(s)
- Inder K Daftari
- Department of Radiation Oncology, University of California- San Francisco, 1600 Divisadero St., San Francisco, CA 94143, USA
| | - Jeanne M Quivey
- Department of Radiation Oncology, University of California- San Francisco, 1600 Divisadero St., San Francisco, CA 94143, USA
| | - Jennifer S Chang
- Department of Radiation Oncology, University of California- San Francisco, 1600 Divisadero St., San Francisco, CA 94143, USA
| | - Kavita K Mishra
- Department of Radiation Oncology, University of California- San Francisco, 1600 Divisadero St., San Francisco, CA 94143, USA
| |
Collapse
|
18
|
Polishchuk AL, Mishra KK, Weinberg V, Daftari IK, Nguyen JM, Cole TB, Quivey JM, Phillips TL, Char DH. Temporal Evolution and Dose-Volume Histogram Predictors of Visual Acuity After Proton Beam Radiation Therapy of Uveal Melanoma. Int J Radiat Oncol Biol Phys 2016; 97:91-97. [PMID: 27838186 DOI: 10.1016/j.ijrobp.2016.09.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/02/2016] [Accepted: 09/16/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To perform an in-depth temporal analysis of visual acuity (VA) outcomes after proton beam radiation therapy (PBRT) in a large, uniformly treated cohort of uveal melanoma (UM) patients, to determine trends in VA evolution depending on pretreatment and temporally defined posttreatment VA measurements; and to investigate the relevance of specific patient, tumor and dose-volume parameters to posttreatment vision loss. METHODS AND MATERIALS Uveal melanoma patients receiving PBRT were identified from a prospectively maintained database. Included patients (n=645) received 56 GyE in 4 fractions, had pretreatment best corrected VA (BCVA) in the affected eye of count fingers (CF) or better, with posttreatment VA assessment at specified post-PBRT time point(s). Patients were grouped according to the pretreatment BCVA into favorable (≥20/40) or unfavorable (20/50-20/400) and poor (CF) strata. Temporal analysis of BCVA changes was described, and univariate and forward stepwise multivariate logistic regression analyses were performed to identify predictors for VA loss. RESULTS Median VA follow-up was 53 months (range, 3-213 months). At 60-month follow up, among evaluable treated eyes with favorable pretreatment BCVA, 45% retained BCVA ≥20/40, whereas among evaluable treated eyes with initially unfavorable/poor BCVA, 21% had vision ≥20/100. Among those with a favorable initial BCVA, attaining BCVA of ≥20/40 at any posttreatment time point was associated with subsequent maintenance of excellent BCVA. Multivariate analysis identified volume of the macula receiving 28GyE (P<.0001) and optic nerve (P=.0004) as independent dose-volume histogram predictors of 48-month post-PBRT vision loss among initially favorable treated eyes. CONCLUSIONS Approximately half of PBRT-treated UM eyes with excellent pretreatment BCVA assessed at 5 years after treatment will retain excellent long-term vision. 28GyE macula and optic nerve dose-volume histogram parameters allow for rational treatment planning optimization that may lead to improved visual outcomes. The detailed temporal analysis with intermediate as well as long-term functional prognosis, and the relationship of outcomes with clinical and treatment planning parameters, is critical for informed care of UM patients before and after PBRT.
Collapse
Affiliation(s)
- Alexei L Polishchuk
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Kavita K Mishra
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California.
| | - Vivian Weinberg
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Inder K Daftari
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | | | - Tia B Cole
- Tumori Foundation, San Francisco, California
| | - Jeanne M Quivey
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Theodore L Phillips
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | | |
Collapse
|
19
|
Clinical Outcomes of Proton Radiotherapy for Uveal Melanoma. Clin Oncol (R Coll Radiol) 2016; 28:e17-27. [PMID: 26915706 DOI: 10.1016/j.clon.2016.01.034] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/20/2015] [Accepted: 01/05/2016] [Indexed: 02/03/2023]
|
20
|
|
21
|
De Zanet SI, Ciller C, Rudolph T, Maeder P, Munier F, Balmer A, Cuadra MB, Kowal JH. Landmark detection for fusion of fundus and MRI toward a patient-specific multimodal eye model. IEEE Trans Biomed Eng 2014; 62:532-40. [PMID: 25265602 DOI: 10.1109/tbme.2014.2359676] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ophthalmologists typically acquire different image modalities to diagnose eye pathologies. They comprise, e.g., Fundus photography, optical coherence tomography, computed tomography, and magnetic resonance imaging (MRI). Yet, these images are often complementary and do express the same pathologies in a different way. Some pathologies are only visible in a particular modality. Thus, it is beneficial for the ophthalmologist to have these modalities fused into a single patient-specific model. The goal of this paper is a fusion of Fundus photography with segmented MRI volumes. This adds information to MRI that was not visible before like vessels and the macula. This paper contributions include automatic detection of the optic disc, the fovea, the optic axis, and an automatic segmentation of the vitreous humor of the eye.
Collapse
|
22
|
Slopsema RL, Mamalui M, Zhao T, Yeung D, Malyapa R, Li Z. Dosimetric properties of a proton beamline dedicated to the treatment of ocular disease. Med Phys 2013; 41:011707. [DOI: 10.1118/1.4842455] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
23
|
Mishra KK, Daftari IK, Weinberg V, Cole T, Quivey JM, Castro JR, Phillips TL, Char DH. Risk Factors for Neovascular Glaucoma After Proton Beam Therapy of Uveal Melanoma: A Detailed Analysis of Tumor and Dose–Volume Parameters. Int J Radiat Oncol Biol Phys 2013; 87:330-6. [DOI: 10.1016/j.ijrobp.2013.05.051] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 05/25/2013] [Accepted: 05/31/2013] [Indexed: 11/29/2022]
|
24
|
Wang Z, Nabhan M, Schild SE, Stafford SL, Petersen IA, Foote RL, Murad MH. Charged Particle Radiation Therapy for Uveal Melanoma: A Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys 2013; 86:18-26. [DOI: 10.1016/j.ijrobp.2012.08.026] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 08/15/2012] [Accepted: 08/17/2012] [Indexed: 12/12/2022]
|
25
|
Tran E, Ma R, Paton K, Blackmore E, Pickles T. Outcomes of Proton Radiation Therapy for Peripapillary Choroidal Melanoma at the BC Cancer Agency. Int J Radiat Oncol Biol Phys 2012; 83:1425-31. [DOI: 10.1016/j.ijrobp.2011.10.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 09/26/2011] [Accepted: 10/04/2011] [Indexed: 11/25/2022]
|
26
|
|