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Tang C, Liu B, Yuan J, He J, Xie R, Huang M, Niu S, Liu H. Dosimetric evaluation of different planning strategies for hypofractionated whole-breast irradiation technique. Phys Med Biol 2024; 69:115025. [PMID: 38670137 DOI: 10.1088/1361-6560/ad4445] [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: 08/24/2023] [Accepted: 04/26/2024] [Indexed: 04/28/2024]
Abstract
Purpose.The dose hotspot areas in hypofractionated whole-breast irradiation (WBI) greatly increase the risk of acute skin toxicity because of the anatomical peculiarities of the breast. In this study, we presented several novel planning strategies that integrate multiple sub-planning target volumes (sub-PTVs), field secondary placement, and RapidPlan models for right-sided hypofractionated WBI.Methods.A total of 35 cases of WBI with a dose of 42.5 Gy for PTVs using tangential intensity-modulated radiotherapy (IMRT) were selected. Both PTVs were planned for simultaneous treatment using the original manual multiple sub-PTV plan (OMMP) and the original manual single-PTV plan (OMSP). The manual field secondary placement multiple sub-PTV plan (m-FSMP) with multiple objects on the original PTV and the manual field secondary placement single-objective plan (m-FSSP) were initially planned, which were distribution-based of V105 (volume receiving 105% of the prescription dose). In addition, two RapidPlan-based plans were developed, including the RapidPlan-based multiple sub-PTVs plan (r-FSMP) and the RapidPlan-based single-PTV plan (r-FSSP). Dosimetric parameters of the plans were compared, and V105 was evaluated using multivariate analysis to determine how it was related to the volume of PTV and the interval of lateral beam angles (ILBA).Results.The lowest mean V105 (5.64 ± 6.5%) of PTV was observed in m-FSMP compared to other manual plans. Upon validation, r-FSSP demonstrated superior dosimetric quality for OAR compared to the two other manual planning methods, except for V5(the volume of ipsilateral lung receiving 5 Gy) of the ipsilateral lung. While r-FSMP showed no significant difference (p = 0.06) compared to r-FSSP, it achieved the lowest V105 value (4.3 ± 4.5%), albeit with a slight increase in the dose to some OARs. Multivariate GEE linear regression showed that V105 is significantly correlated with target volume and ILBA.Conclusions.m-FSMP and r-FSMP can substantially enhance the homogeneity index (HI) and reduce V105, thereby minimizing the risk of acute skin toxicities, even though there may be a slight dose compromise for certain OARs.
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Affiliation(s)
- Chunbo Tang
- Department of Radiation Oncology, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, People's Republic of China
- Jiangxi Clinical Research Center for Cancer, Ganzhou 341000, People's Republic of China
| | - Biaoshui Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Jun Yuan
- Department of Radiation Oncology, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, People's Republic of China
- Jiangxi Clinical Research Center for Cancer, Ganzhou 341000, People's Republic of China
| | - Ji He
- School of Biomedical Engineering, Fourth Affiliated Hospital of Guangzhou, Guangzhou Medical University, Guangzhou 511495, People's Republic of China
| | - Ruilian Xie
- Jiangxi Clinical Research Center for Cancer, Ganzhou 341000, People's Republic of China
| | - Minfeng Huang
- First Clinical Medical College, Gannan Medical University, Ganzhou 341000, People's Republic of China
| | - Shanzhou Niu
- School of Mathematics and Computer Science, Gannan Normal University, Ganzhou 341000, People's Republic of China
- Ganzhou Key Laboratory of Computational Imaging , Gannan Normal University, Ganzhou 341000, People's Republic of China
| | - Hongdong Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, People's Republic of China
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Guo Y, Zhong Y, Yu L, Zhang K, Wang J, Hu W. Implementation and evaluation of an iterative-based algorithm for automatic beam angle optimization in breast cancer treatment planning. Med Dosim 2023; 49:127-138. [PMID: 37925299 DOI: 10.1016/j.meddos.2023.10.002] [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: 07/28/2023] [Revised: 09/07/2023] [Accepted: 10/05/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION A beam angle optimization (BAO) algorithm was developed to evaluate its clinical feasibility and investigate the impact of varying BAO constraints on breast cancer treatment plans. MATERIALS AND METHODS A two-part study was designed. In part 1, we retrospectively selected 20 patients treated with radiotherapy after breast-conserving surgery. For each patient, BAO plans were designed using beam angles optimized by the BAO algorithm and the same optimization constraints as manual plans. Dosimetric indices were compared between BAO and manual plans. In part 2, fifteen patients with left breast cancer were included. For each patient, three distinct cardiac constraints (mean heart dose < 5 Gy, 3 Gy or 1 Gy) were established during the BAO process to obtain three optimized beam sets which were marked as BAO_H1, BAO_H3, BAO_H5, respectively. These sets of beams were then utilized under identical IMRT constraints for planning. Comparative analysis was conducted among the three groups of plans. RESULTS For part 1, no significant differences were observed between BAO plans and manual plans in all dosimetric indices, except for ipsilateral lung V5, where BAO plans performed slightly better than manual plans (35.5% ± 5.6% vs 36.9% ± 4.3%, p = 0.034). For part 2, Stricter BAO heart constraints resulted in more perpendicular beams. However, there was no significant difference between BAO_H1, BAO_H3 and BAO_H5 with the same IMRT constraint in the heart dose. Meanwhile, the left lung dose was increased while the right breast and lung doses were decreased with stricter heart constraints in BAO. When mean heart dose < 5 Gy in IMRT constraint, the mean dose to the right lung was decreased from 0.46 Gy for BAO_H5 to 0.33 Gy for BAO_H1 (p = 0.027). CONCLUSIONS The BAO algorithm can achieve quality plans comparable to manual plans. IMRT constraints dominate the final plan dose, while varying BAO constraints alter the trade-off among structures, providing an additional degree of freedom in planning design.
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Affiliation(s)
- Ying Guo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China; Shanghai Clinical Research Center for Radiation Oncology; Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Yang Zhong
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China; Shanghai Clinical Research Center for Radiation Oncology; Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Lei Yu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China; Shanghai Clinical Research Center for Radiation Oncology; Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Kang Zhang
- United Imaging Healthcare, Shanghai, 20032, China
| | - Jiazhou Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China; Shanghai Clinical Research Center for Radiation Oncology; Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Weigang Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China; Shanghai Clinical Research Center for Radiation Oncology; Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China.
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Esposito PG, Castriconi R, Mangili P, Broggi S, Fodor A, Pasetti M, Tudda A, Di Muzio NG, del Vecchio A, Fiorino C. Knowledge-based automatic plan optimization for left-sided whole breast tomotherapy. Phys Imaging Radiat Oncol 2022; 23:54-59. [PMID: 35814259 PMCID: PMC9256826 DOI: 10.1016/j.phro.2022.06.009] [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: 12/30/2021] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 12/01/2022] Open
Abstract
Background/Purpose Tomotherapy may deliver high-quality whole breast irradiation at static angles. The aim of this study was to implement Knowledge-Based (KB) automatic planning for left-sided whole breast using this modality. Materials/Methods Virtual volumetric plans were associated to the dose distributions of 69 Tomotherapy (TT) clinical plans of previously treated patients, aiming to train a KB-model using a commercial tool completely implemented in our treatment planning system. An individually optimized template based on the resulting KB-model was generated for automatic plan optimization. Thirty patients of the training set and ten new patients were considered for internal/external validation. Fully-automatic plans (KB-TT) were generated and compared using the same geometry/number of fields of the corresponding clinical plans. Results KB-TT plans were successfully generated in 26/30 and 10/10 patients of the internal/external validation sets; for 4 patients whose original plans used only two fields, the manual insertion of one/two fields before running the automatic template was sufficient to obtain acceptable plans. Concerning internal validation, planning target volume V95%/D1%/dose distribution standard deviation improved by 0.9%/0.4Gy/0.2Gy (p < 0.05) against clinical plans; Organs at risk mean doses were also slightly improved (p < 0.05) by 0.07/0.4/0.2/0.01 Gy for left lung/heart/right breast/right lung respectively. Similarly satisfactory results were replicated in the external validation set. The resulting treatment duration was 8 ± 1 min, consistent with our clinical experience. The active planner time per patient was 5–10 minutes. Conclusion Automatic TT left-sided breast KB-plans are comparable to or slightly better than clinical plans and can be obtained with limited planner time. The approach is currently under clinical implementation.
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Cilla S, Romano C, Macchia G, Boccardi M, De Vivo LP, Morabito VE, Buwenge M, Strigari L, Indovina L, Valentini V, Deodato F, Morganti AG. Automated hybrid volumetric modulated arc therapy (HVMAT) for whole-breast irradiation with simultaneous integrated boost to lumpectomy area : A treatment planning study. Strahlenther Onkol 2021; 198:254-267. [PMID: 34767044 DOI: 10.1007/s00066-021-01873-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/17/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To develop an automated treatment planning approach for whole breast irradiation with simultaneous integrated boost using an automated hybrid VMAT class solution (HVMAT). MATERIALS AND METHODS Twenty-five consecutive patients with left breast cancer received 50 Gy (2 Gy/fraction) to the whole breast and an additional simultaneous 10 Gy (2.4 Gy/fraction) to the tumor cavity. Ipsilateral lung, heart, and contralateral breast were contoured as main organs-at-risk. HVMAT plans were inversely optimized by combining two open fields with a VMAT semi-arc beam. Open fields were setup to include the whole breast with a 2 cm flash region and to carry 80% of beams weight. HVMAT plans were compared with three tangential techniques: conventional wedged-field tangential plans (SWF), field-in-field forward planned tangential plans (FiF), and hybrid-IMRT plans (HMRT). Dosimetric differences among the plans were evaluated using Kruskal-Wallis one-way analysis of variance. Dose accuracy was validated using the PTW Octavius-4D phantom together with the 1500 2D-array. RESULTS No significant differences were found among the four techniques for both targets coverage. HVMAT plans showed consistently better PTVs dose contrast, conformity, and homogeneity (p < 0.001 for all metrics) and statistically significant reduction of high-dose breast irradiation. V55 and V60 decreased by 30.4, 26.1, and 20.8% (p < 0.05) and 12.3, 9.9, and 6.0% (p < 0.05) for SWF, FIF, and HMRT, respectively. Pretreatment dose verification reported a gamma pass-rate greater than the acceptance threshold of 95% for all HVMAT plans. In addition, HVMAT reduced the time for full planning optimization to about 20 min. CONCLUSIONS HVMAT plans resulted in superior target dose conformity and homogeneity compared to other tangential techniques. Due to fast planning time HVMAT can be applied for all patients, minimizing the impact on human or departmental resources.
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Affiliation(s)
- Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 86100, Campobasso, Italy.
| | - Carmela Romano
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 86100, Campobasso, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Mariangela Boccardi
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Livia P De Vivo
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Vittoria E Morabito
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 86100, Campobasso, Italy
| | - Milly Buwenge
- Radiation Oncology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lidia Strigari
- Medical Physics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luca Indovina
- Radiation Oncology Department, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Vincenzo Valentini
- Radiation Oncology Department, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alessio G Morganti
- Radiation Oncology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,DIMES, Alma Mater Studiorum, Bologna University, Bologna, Italy
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Castriconi R, Esposito PG, Tudda A, Mangili P, Broggi S, Fodor A, Deantoni CL, Longobardi B, Pasetti M, Perna L, Del Vecchio A, Di Muzio NG, Fiorino C. Replacing Manual Planning of Whole Breast Irradiation With Knowledge-Based Automatic Optimization by Virtual Tangential-Fields Arc Therapy. Front Oncol 2021; 11:712423. [PMID: 34504790 PMCID: PMC8423088 DOI: 10.3389/fonc.2021.712423] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/02/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To implement Knowledge Based (KB) automatic planning for right and left-sided whole breast treatment through a new volumetric technique (ViTAT, Virtual Tangential-fields Arc Therapy) mimicking conventional tangential fields (TF) irradiation. Materials and Method A total of 193 clinical plans delivering TF with wedged or field-in-field beams were selected to train two KB-models for right(R) and left(L) sided breast cancer patients using the RapidPlan (RP) tool implemented in the Varian Eclipse system. Then, a template for ViTAT optimization, incorporating individual KB-optimized constraints, was interactively fine-tuned. ViTAT plans consisted of four arcs (6 MV) with start/stop angles consistent with the TF geometry variability within our population; the delivery was completely blocked along the arcs, apart from the first and last 20° of rotation for each arc. Optimized fine-tuned KB templates for automatic plan optimization were generated. Validation tests were performed on 60 new patients equally divided in R and L breast treatment: KB automatic ViTAT-plans (KB-ViTAT) were compared against the original TF plans in terms of OARs/PTVs dose-volume parameters. Wilcoxon-tests were used to assess the statistically significant differences. Results KB models were successfully generated for both L and R sides. Overall, 1(3%) and 7(23%) out of 30 automatic KB-ViTAT plans were unacceptable compared to TF for R and L side, respectively. After the manual refinement of the start/stop angles, KB-ViTAT plans well fitted TF-performances for these patients as well. PTV coverage was comparable, while PTV D1% was improved with KB-ViTAT by R:0.4/L:0.2 Gy (p < 0.05); ipsilateral OARs Dmean were similar with a slight (i.e., few % volume) improvement/worsening in the 15–35 Gy/2–15 Gy range, respectively. KB-ViTAT better spared contralateral OARs: Dmean of contralateral OARs was 0.1 Gy lower (p < 0.05); integral dose was R:5%/L:8% lower (p < 0.05) than TF. The overall time for the automatic plan optimization and final dose calculation was 12 ± 2 minutes. Conclusions Fully automatic KB-optimization of ViTAT can efficiently replace manually optimized TF planning for whole breast irradiation. This approach was clinically implemented in our institute and may be suggested as a large-scale strategy for efficiently replacing manual planning with large sparing of time, elimination of inter-planner variability and of, seldomly occurring, sub-optimal manual plans.
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Affiliation(s)
| | | | - Alessia Tudda
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Paola Mangili
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Sara Broggi
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Andrei Fodor
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | | | | | | | - Lucia Perna
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | | | | | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
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Reduction of heart and lung normal tissue complication probability using automatic beam angle optimization and more generic optimization objectives for breast radiotherapy. Phys Imaging Radiat Oncol 2021; 18:48-50. [PMID: 34258407 PMCID: PMC8254193 DOI: 10.1016/j.phro.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/08/2021] [Accepted: 04/20/2021] [Indexed: 11/20/2022] Open
Abstract
During breast cancer radiotherapy, sparing of healthy tissue is desired. The effect of automatic beam angle optimization and generic dose fall-off objectives on dose and normal tissue complication probabilities was studied. In all patients, dose to lungs and heart showed a mean reduction of 0.4 Gy (range 0.1–1.3 Gy) and 0.2 Gy (range −0.2–0.7 Gy), respectively. These lower doses led to a statistically significant lower cumulative cardiac and lung cancer mortality risk. For smoking patients 40–45 years of age who continue to smoke, it would lead to a reduction from 3.2% ± 0.7% to 2.7% ± 0.6% (p < 0.001).
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Esposito PG, Castriconi R, Mangili P, Fodor A, Pasetti M, Di Muzio NG, Del Vecchio A, Fiorino C. Virtual Tangential-fields Arc Therapy (ViTAT) for whole breast irradiation: Technique optimization and validation. Phys Med 2020; 77:160-168. [PMID: 32866777 DOI: 10.1016/j.ejmp.2020.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/07/2020] [Accepted: 08/09/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To test the performances of a volumetric arc technique named ViTAT (Virtual Tangential-fields Arc Therapy) mimicking tangential field irradiation for whole breast radiotherapy. METHODS ViTAT plans consisted in 4 arcs whose starting/ending position were established based on gantry angle distribution of clinical plans for right and left-breast. The arcs were completely blocked excluding the first and last 20°. Different virtual bolus densities and thicknesses were preliminarily evaluated to obtain the best plan performances. For 40 patients with tumor laterality equally divided between right and left sides, ViTAT plans were optimized considering the clinical DVHs for OARs (resulting from tangential field manual planning) to constrain them: ViTAT plans were compared with the clinical tangential-fields in terms of DVH parameters for both PTV and OARs. RESULTS Distal angle values were suggested in the ranges [220°,240°] for the right-breast and [115°,135°] for the left-breast cases; medial angles were [60°,40°] for the right side and [295°,315°] for the left side, limiting the risk of collision. The optimal virtual bolus had -500 HU density and 1.5 cm thickness. ViTAT plans generated dose distributions very similar to the tangential-field plans, with significantly improved PTV homogeneity. The mean doses of ipsilateral OARs were comparable between the two techniques with minor increase of the low-dose spread in the range 2-15 Gy (few % volume); contralateral OARs were slightly better spared with ViTAT. CONCLUSION ViTAT dose distributions were similar to tangential-fields. ViTAT should allow automatic plan optimization by developing knowledge-based DVH prediction models of patients treated with tangential-fields.
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Affiliation(s)
| | - Roberta Castriconi
- Medical Physics, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - Paola Mangili
- Medical Physics, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - Andrei Fodor
- Radiotherapy, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - Marcella Pasetti
- Radiotherapy, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - Nadia G Di Muzio
- Radiotherapy, San Raffaele Hospital Scientific Institute, Milan, Italy
| | | | - Claudio Fiorino
- Medical Physics, San Raffaele Hospital Scientific Institute, Milan, Italy.
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Guo B, Shah C, Xia P. Automated planning of whole breast irradiation using hybrid IMRT improves efficiency and quality. J Appl Clin Med Phys 2019; 20:87-96. [PMID: 31743598 PMCID: PMC6909113 DOI: 10.1002/acm2.12767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/05/2019] [Accepted: 10/14/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose To develop an automated workflow for whole breast irradiation treatment planning using hybrid intensity modulated radiation therapy (IMRT) approach and to demonstrate that this workflow can improve planning quality and efficiency when compared to manual planning. Methods The auto planning framework was built based on scripting with MIM and Pinnacle systems. MIM workflows were developed to automatically segment normal structures and targets, identify landmarks for beam placement, select beam energies, and set beam configurations. Pinnacle scripts were generated from the MIM workflow to create hybrid IMRT plans automatically. Each hybrid IMRT plan included two prescriptions: a three‐dimensional (3D) prescription consisted of two open tangent beams, and an IMRT prescription consisted of two step‐and‐shoot IMRT beams. The 3D prescription delivered a full prescription dose to the maximum dose point, and the IMRT prescription was optimized to deliver a uniform dose to the entire breast while sparing dose to the normal structures. For 30 patients, the auto plans were compared with clinically accepted manual plans using the paired sample t‐test. Results The auto planning process took approximately 8 min to complete. The mean dice coefficients between auto‐segmentation and manual contours were 0.98, 0.94 and 0.88 for the lungs, heart, and PTVeval_Breast, respectively. The MUs of the auto plans was on average 13% higher than that of the manual plans. Auto planning improved plan quality significantly: percentage volume receiving 95% of the prescription dose (V95%) of the PTVeval_Breast increased from 91.5% to 93.2% (P = 0.001), V105% of the PTVeval_Breast decreased from 7.2% to 1.2% (P = 0.013), V20Gy of the ipsilateral lung decreased from 13.1% to 10.4% (P = 0.001) and mean heart dose for left‐sided breast patients decreased from 1.2 Gy to 0.9 Gy (P < 0.001). Conclusion An automated treatment planning process can make the planning process efficient with improved plan quality.
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Affiliation(s)
- Bingqi Guo
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ping Xia
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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Kisling K, Zhang L, Shaitelman SF, Anderson D, Thebe T, Yang J, Balter PA, Howell RM, Jhingran A, Schmeler K, Simonds H, du Toit M, Trauernicht C, Burger H, Botha K, Joubert N, Beadle BM, Court L. Automated treatment planning of postmastectomy radiotherapy. Med Phys 2019; 46:3767-3775. [PMID: 31077593 PMCID: PMC6739169 DOI: 10.1002/mp.13586] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/01/2019] [Accepted: 05/05/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Breast cancer is the most common cancer in women globally and radiation therapy is a cornerstone of its treatment. However, there is an enormous shortage of radiotherapy staff, especially in low‐ and middle‐income countries. This shortage could be ameliorated through increased automation in the radiation treatment planning process, which may reduce the workload on radiotherapy staff and improve efficiency in preparing radiotherapy treatments for patients. To this end, we sought to create an automated treatment planning tool for postmastectomy radiotherapy (PMRT). Methods Algorithms to automate every step of PMRT planning were developed and integrated into a commercial treatment planning system. The only required inputs for automated PMRT planning are a planning computed tomography scan, a plan directive, and selection of the inferior border of the tangential fields. With no other human input, the planning tool automatically creates a treatment plan and presents it for review. The major automated steps are (a) segmentation of relevant structures (targets, normal tissues, and other planning structures), (b) setup of the beams (tangential fields matched with a supraclavicular field), and (c) optimization of the dose distribution by using a mix of high‐ and low‐energy photon beams and field‐in‐field modulation for the tangential fields. This automated PMRT planning tool was tested with ten computed tomography scans of patients with breast cancer who had received irradiation of the left chest wall. These plans were assessed quantitatively using their dose distributions and were reviewed by two physicians who rated them on a three‐tiered scale: use as is, minor changes, or major changes. The accuracy of the automated segmentation of the heart and ipsilateral lung was also assessed. Finally, a plan quality verification tool was tested to alert the user to any possible deviations in the quality of the automatically created treatment plans. Results The automatically created PMRT plans met the acceptable dose objectives, including target coverage, maximum plan dose, and dose to organs at risk, for all but one patient for whom the heart objectives were exceeded. Physicians accepted 50% of the treatment plans as is and required only minor changes for the remaining 50%, which included the one patient whose plan had a high heart dose. Furthermore, the automatically segmented contours of the heart and ipsilateral lung agreed well with manually edited contours. Finally, the automated plan quality verification tool detected 92% of the changes requested by physicians in this review. Conclusions We developed a new tool for automatically planning PMRT for breast cancer, including irradiation of the chest wall and ipsilateral lymph nodes (supraclavicular and level III axillary). In this initial testing, we found that the plans created by this tool are clinically viable, and the tool can alert the user to possible deviations in plan quality. The next step is to subject this tool to prospective testing, in which automatically planned treatments will be compared with manually planned treatments.
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Affiliation(s)
- Kelly Kisling
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Lifei Zhang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Simona F Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - David Anderson
- Department of Radiation Oncology, University of Cape Town and Groote Schuur Hospital, Cape Town, 8000, South Africa
| | - Tselane Thebe
- Department of Radiation Oncology, University of Cape Town and Groote Schuur Hospital, Cape Town, 8000, South Africa
| | - Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Peter A Balter
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Rebecca M Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Kathleen Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, USA
| | - Hannah Simonds
- Division of Radiation Oncology, Stellenbosch University and Tygerberg Hospital, Cape Town, 7505, South Africa
| | - Monique du Toit
- Division of Medical Physics, Stellenbosch University and Tygerberg Hospital, Cape Town, 7505, South Africa
| | - Christoph Trauernicht
- Division of Medical Physics, Stellenbosch University and Tygerberg Hospital, Cape Town, 7505, South Africa
| | - Hester Burger
- Division of Medical Physics, University of Cape Town and Groote Schuur Hospital, Cape Town, 8000, South Africa
| | - Kobus Botha
- Division of Medical Physics, University of Cape Town and Groote Schuur Hospital, Cape Town, 8000, South Africa
| | - Nanette Joubert
- Division of Medical Physics, University of Cape Town and Groote Schuur Hospital, Cape Town, 8000, South Africa
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford University, Stanford, CA, 94305, USA
| | - Laurence Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
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10
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Mizuno N, Yamauchi R, Kawamori J, Itazawa T, Shimbo M, Nishimura K, Yamano T, Hatanaka S, Hariu M, Takahashi T. Evaluation of a new commercial automated planning software for tangential breast intensity-modulated radiation therapy. Radiol Phys Technol 2019; 12:249-259. [PMID: 31115835 DOI: 10.1007/s12194-019-00515-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 12/25/2022]
Abstract
Automated treatment planning may decrease the effort required in planning and promote increased routine clinical use of intensity-modulated radiation therapy (IMRT) for many breast cancer patients. The aim of this study was to evaluate a new commercial automated planning software for tangential breast IMRT by comparing it with clinical plans from whole-breast irradiation. We prospectively enrolled 150 patients with Stage 0-1 breast cancer who underwent breast-conserving surgery at our institution between September 2016 and August 2017. Total doses of 42.56 Gy in 16 fractions (n = 98) or 50 Gy in 25 fractions (n = 44) were used. All treatment plans were retrospectively re-planned using the automated breast planning (ABP) software. All automated plans generated clinically deliverable beam parameters with no patient body collision and no contralateral breast pass through. The mean homogeneity index of the automatically generated clinical target volume, percentage volume of lungs receiving dose more than 20 Gy, mean heart dose, and dose to the highest irradiated 2-cc volumes of the irradiated volume were 0.077 ± 0.019, 4.2% ± 1.2%, 142 ± 69 cGy, and 105.8% ± 1.7% (prescribed dose: 100%), respectively. The mean planning time was 4.8 ± 1.4 min. The ABP software demonstrated high clinical acceptability and treatment planning cost efficiency for tangential breast IMRT. The ABP software may be useful for delivering high-quality treatment to a majority of patients with early-stage breast cancer.
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Affiliation(s)
- Norifumi Mizuno
- Department of Radiation Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan. .,Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8550, Japan.
| | - Ryouhei Yamauchi
- Department of Radiation Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Jiro Kawamori
- Department of Radiation Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Tomoko Itazawa
- Department of Radiation Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Munefumi Shimbo
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8550, Japan
| | - Keiichiro Nishimura
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8550, Japan
| | - Takafumi Yamano
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8550, Japan
| | - Shogo Hatanaka
- Department of Radiation Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.,Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8550, Japan
| | - Masatsugu Hariu
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8550, Japan
| | - Takeo Takahashi
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8550, Japan
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11
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van Duren-Koopman MJ, Tol JP, Dahele M, Bucko E, Meijnen P, Slotman BJ, Verbakel WF. Personalized automated treatment planning for breast plus locoregional lymph nodes using Hybrid RapidArc. Pract Radiat Oncol 2018; 8:332-341. [DOI: 10.1016/j.prro.2018.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 02/19/2018] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
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12
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Anacleto A, Dias J. Data Analysis in Radiotherapy Treatments. INTERNATIONAL JOURNAL OF E-HEALTH AND MEDICAL COMMUNICATIONS 2018. [DOI: 10.4018/ijehmc.2018070103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Radiotherapy is one of the main cancer treatments available today, together with chemotherapy and surgery. Radiotherapy treatments have to be planned for each patient in an individualized manner. The knowledge acquired from one single treatment can be used to improve the treatment planning and outcome of several other patients. In the last years, attention has been drawn to the added value of using data analysis for radiotherapy treatment planning, prediction of treatment outcomes, survival analysis and quality assurance. In this article, existing literature is reviewed.
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Affiliation(s)
- Ana Anacleto
- Faculty of Economics, University of Coimbra, Coimbra, Portugal
| | - Joana Dias
- Inesc-Coimbra, CeBER, Faculty of Economics, University of Coimbra, Coimbra, Portugal
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13
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Lin H, Liu T, Shi C, Petillion S, Kindts I, Weltens C, Depuydt T, Song Y, Saleh Z, Xu XG, Tang X. Feasibility study of individualized optimal positioning selection for left-sided whole breast radiotherapy: DIBH or prone. J Appl Clin Med Phys 2018; 19:218-229. [PMID: 29436168 PMCID: PMC5849849 DOI: 10.1002/acm2.12283] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/25/2017] [Accepted: 01/09/2018] [Indexed: 12/13/2022] Open
Abstract
The deep inspiration breath hold (DIBH) and prone (P) position are two common heart-sparing techniques for external-beam radiation treatment of left-sided breast cancer patients. Clinicians select the position that is deemed to be better for tissue sparing based on their experience. This approach, however, is not always optimum and consistent. In response to this, we develop a quantitative tool that predicts the optimal positioning for the sake of organs at risk (OAR) sparing. Sixteen left-sided breast cancer patients were considered in the study, each received CT scans in the supine free breathing, supine DIBH, and prone positions. Treatment plans were generated for all positions. A patient was classified as DIBH or P using two different criteria: if that position yielded (1) lower heart dose, or (2) lower weighted OAR dose. Ten anatomical features were extracted from each patient's data, followed by the principal component analysis. Sequential forward feature selection was implemented to identify features that give the best classification performance. Nine statistical models were then applied to predict the optimal positioning and were evaluated using stratified k-fold cross-validation, predictive accuracy and receiver operating characteristic (AUROC). For heart toxicity-based classification, the support vector machine with radial basis function kernel yielded the highest accuracy (0.88) and AUROC (0.80). For OAR overall toxicities-based classification, the quadratic discriminant analysis achieved the highest accuracy (0.90) and AUROC (0.84). For heart toxicity-based classification, Breast volume and the distance between Heart and Breast were the most frequently selected features. For OAR overall toxicities-based classification, Heart volume, Breast volume and the distance between ipsilateral lung and breast were frequently selected. Given the patient data considered in this study, the proposed statistical model is feasible to provide predictions for DIBH and prone position selection as well as indicate important clinical features that affect the position selection.
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Affiliation(s)
- Hui Lin
- Nuclear Engineering and Engineering PhysicsRensselaer Polytechnic InstituteTroyUSA
| | - Tianyu Liu
- Nuclear Engineering and Engineering PhysicsRensselaer Polytechnic InstituteTroyUSA
| | - Chengyu Shi
- Department of Medical PhysicsMemorial Sloan‐Kettering Cancer CenterNew YorkUSA
| | - Saskia Petillion
- Department of Radiation OncologyUniversity Hospitals of LeuvenLeuvenBelgium
| | - Isabelle Kindts
- Department of Radiation OncologyUniversity Hospitals of LeuvenLeuvenBelgium
| | - Caroline Weltens
- Department of Radiation OncologyUniversity Hospitals of LeuvenLeuvenBelgium
| | - Tom Depuydt
- Department of Radiation OncologyUniversity Hospitals of LeuvenLeuvenBelgium
| | - Yulin Song
- Department of Medical PhysicsMemorial Sloan‐Kettering Cancer CenterNew YorkUSA
| | - Ziad Saleh
- Department of Medical PhysicsMemorial Sloan‐Kettering Cancer CenterNew YorkUSA
| | - Xie George Xu
- Nuclear Engineering and Engineering PhysicsRensselaer Polytechnic InstituteTroyUSA
| | - Xiaoli Tang
- Department of Medical PhysicsMemorial Sloan‐Kettering Cancer CenterNew YorkUSA
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14
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Individualized Selection of Beam Angles and Treatment Isocenter in Tangential Breast Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2017; 98:447-453. [DOI: 10.1016/j.ijrobp.2017.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 01/31/2017] [Accepted: 02/07/2017] [Indexed: 11/22/2022]
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15
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Chai L, Chen D, Tang XB, Ge Y, Chen Y, Li J. Real-time monitoring system with accelerator controlling: An improvement of radiotherapy monitoring based on binocular location and classification. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2017; 25:193-204. [PMID: 28234272 DOI: 10.3233/xst-17253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Real-time monitoring and amendment of patient position is important for the radiotherapy. However, using electronic portal imaging device (EPID) and cone beam computer tomography (CBCT) in the clinical practice generate different degrees of delay, so that they cannot achieve the purpose of real-time application. Meanwhile, a few products come with the function of the real-time monitoring and amendment, such as CyberKnife, which is too expensive for the common people. The objective of this study is to develop and test a novel independent system to monitor treatment center and amend the position of patient, which is applicable to most accelerators, based on binocular location. The system monitors the treatment center by tracking the markers attached to the patient. Once the treatment center shifts, the system uses the magic finger, which is developed to control the treatment bet automatically to adjust the treatment bed position. To improve the monitoring accuracy, we trained the data collected from the clinic based on SVM (Support Vector Machine). Thus, the training results assist users to adjust the feasible degree of the monitoring. The experiment results showed that using this new monitoring system, the monitoring resolution reached 0.5 mm, and the error ratio of the judgment was less than 1.5%.
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Affiliation(s)
- Lei Chai
- Department of Nuclear Science and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Da Chen
- Department of Nuclear Science and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Xiao-Bing Tang
- Department of Nuclear Science and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Yun Ge
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Ying Chen
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Jun Li
- Department of Nuclear Science and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
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16
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QuickStart radiotherapy: an inter-professional approach to expedite radiotherapy treatment in early breast cancer. JOURNAL OF RADIOTHERAPY IN PRACTICE 2015. [DOI: 10.1017/s1460396915000205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground and purposeThis study aims to develop an expedited radiotherapy (RT) process and evaluate its time savings in women requiring whole breast RT.Material and methodsAn inter-professional RT team streamlined the computed tomography (CT) simulation and treatment pathway for a ‘QuickStart’ process. Target delineation was performed by an advanced practice radiation therapist and approved by the radiation oncologist (RO) for planning. Automated breast planning software was used for treatment planning and standard quality checks were performed. To assess time savings, the initial 25 QuickStart patients were matched with women who underwent whole breast simulation on the same day (±3 days), treated using the conventional process.ResultsA total of 73 post-lumpectomy women were treated through the QuickStart process; the median consent-to-RT was 2 days (range: 0–13) and the mean CT simulation-to-RT treatment was 2 hours and 42 minutes (SD 0:30). In the subgroup analysis, QuickStart patients saved an average of 11 days from CT simulation-to-RT and had shorter median wait-times for both surgery/chemotherapy-to-RT (60 versus 38 days;p=0·002) and consultation-to-RT (7 versus 20 days;p<0·001).ConclusionsThrough inter-professional team efforts and the application of automated planning software, we have achieved a process that significantly decreases patient wait-times while maintaining the quality of whole breast RT.
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17
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Balogun OD, Formenti SC. Locally advanced breast cancer - strategies for developing nations. Front Oncol 2015; 5:89. [PMID: 25964882 PMCID: PMC4410621 DOI: 10.3389/fonc.2015.00089] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/25/2015] [Indexed: 12/29/2022] Open
Affiliation(s)
- Onyinye D Balogun
- Department of Radiation Oncology and Surgery, New York University Langone Medical Center, New York University School of Medicine , New York, NY , USA
| | - Silvia C Formenti
- Department of Radiation Oncology and Surgery, New York University Langone Medical Center, New York University School of Medicine , New York, NY , USA
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18
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Soto-Pantoja DR, Terabe M, Ghosh A, Ridnour LA, DeGraff WG, Wink DA, Berzofsky JA, Roberts DD. CD47 in the tumor microenvironment limits cooperation between antitumor T-cell immunity and radiotherapy. Cancer Res 2014; 74:6771-83. [PMID: 25297630 DOI: 10.1158/0008-5472.can-14-0037-t] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although significant advances in radiotherapy have increased its effectiveness in many cancer settings, general strategies to widen the therapeutic window between normal tissue toxicity and malignant tumor destruction would still offer great value. CD47 blockade has been found to confer radioprotection to normal tissues while enhancing tumor radiosensitivity. Here, we report that CD47 blockade directly enhances tumor immunosurveillance by CD8(+) T cells. Combining CD47 blockade with irradiation did not affect fibrosarcoma growth in T cell-deficient mice, whereas adoptive transfer of tumor-specific CD8(+) T cells restored combinatorial efficacy. Furthermore, ablation of CD8(+) T cells abolished radiotherapeutic response in immunocompetent syngeneic hosts. CD47 blockade in either target cells or effector cells was sufficient to enhance antigen-dependent CD8(+) CTL-mediated tumor cell killing in vitro. In CD47-deficient syngeneic hosts, engrafted B16 melanomas were 50% more sensitive to irradiation, establishing that CD47 expression in the microenvironment was sufficient to limit tumor radiosensitivity. Mechanistic investigations revealed increased tumor infiltration by cytotoxic CD8(+) T cells in a CD47-deficient microenvironment, with an associated increase in T cell-dependent intratumoral expression of granzyme B. Correspondingly, an inverse correlation between CD8(+) T-cell infiltration and CD47 expression was observed in human melanomas. Our findings establish that blocking CD47 in the context of radiotherapy enhances antitumor immunity by directly stimulating CD8(+) cytotoxic T cells, with the potential to increase curative responses.
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Affiliation(s)
- David R Soto-Pantoja
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland
| | - Masaki Terabe
- Vaccine Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland
| | - Arunima Ghosh
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland
| | - Lisa A Ridnour
- Radiation Biology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland
| | - William G DeGraff
- Radiation Biology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland
| | - David A Wink
- Radiation Biology Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland
| | - Jay A Berzofsky
- Vaccine Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland
| | - David D Roberts
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland.
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19
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Boylan C, Rowbottom C. A bias-free, automated planning tool for technique comparison in radiotherapy - application to nasopharyngeal carcinoma treatments. J Appl Clin Med Phys 2014; 15:4530. [PMID: 24423853 PMCID: PMC5711248 DOI: 10.1120/jacmp.v15i1.4530] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 07/25/2013] [Accepted: 07/17/2013] [Indexed: 12/01/2022] Open
Abstract
In this study a novel, user‐independent automated planning technique was developed to objectively compare volumetric‐modulated arc therapy (VMAT) and intensity‐modulated radiotherapy (IMRT) for nasopharyngeal carcinoma planning, and to determine which technique offers a greater benefit for parotid‐sparing and dose escalation strategies. Ten patients were investigated, with a standard prescription of three dose levels to the target volumes (70, 63, and 56 Gy), using a simultaneous integrated boost in 33 fractions. The automated tool was used to investigate three planning strategies with both IMRT and VMAT: clinically acceptable plan creation, parotid dose sparing, and dose escalation. Clinically acceptable plans were achieved for all patients using both techniques. For parotid‐sparing, automated planning reduced the mean dose to a greater extent using VMAT rather than IMRT (17.0 Gy and 19.6 Gy, respectively, p<0.01). For dose escalation to the mean of the main clinical target volume, neither VMAT nor IMRT offered a significant benefit over the other. The OAR‐limiting prescriptions for VMAT ranged from 84‐98 Gy, compared to 76‐110 Gy for IMRT. Employing a user‐independent planning technique, it was possible to objectively compare VMAT and IMRT for nasopharyngeal carcinoma treatment strategies. VMAT offers a parotid‐sparing improvement, but no significant benefit was observed for dose escalation to the primary target. PACS numbers: 87.55.D‐, 87.55.kd
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Affiliation(s)
- Christopher Boylan
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust.
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