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Yanagihara TK, Tepper JE, Moon AM, Barry A, Molla M, Seong J, Torres F, Apisarnthanarax S, Buckstein M, Cardenes H, Chang DT, Feng M, Guha C, Hallemeier CL, Hawkins MA, Hoyer M, Iwata H, Jabbour SK, Kachnic L, Kharofa J, Kim TH, Kirichenko A, Koay EJ, Makishima H, Mases J, Meyer JJ, Munoz-Schuffenegger P, Owen D, Park HC, Saez J, Sanford NN, Scorsetti M, Smith GL, Wo JY, Yoon SM, Lawrence TS, Reig M, Dawson LA. Defining Minimum Treatment Parameters of Ablative Radiation Therapy in Patients With Hepatocellular Carcinoma: An Expert Consensus. Pract Radiat Oncol 2024; 14:134-145. [PMID: 38244026 DOI: 10.1016/j.prro.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 01/22/2024]
Abstract
PURPOSE External beam radiation therapy (EBRT) is a highly effective treatment in select patients with hepatocellular carcinoma (HCC). However, the Barcelona Clinic Liver Cancer system does not recommend the use of EBRT in HCC due to a lack of sufficient evidence and intends to perform an individual patient level meta-analysis of ablative EBRT in this population. However, there are many types of EBRT described in the literature with no formal definition of what constitutes "ablative." Thus, we convened a group of international experts to provide consensus on the parameters that define ablative EBRT in HCC. METHODS AND MATERIALS Fundamental parameters related to dose, fractionation, radiobiology, target identification, and delivery technique were identified by a steering committee to generate 7 Key Criteria (KC) that would define ablative EBRT for HCC. Using a modified Delphi (mDelphi) method, experts in the use of EBRT in the treatment of HCC were surveyed. Respondents were given 30 days to respond in round 1 of the mDelphi and 14 days to respond in round 2. A threshold of ≥70% was used to define consensus for answers to each KC. RESULTS Of 40 invitations extended, 35 (88%) returned responses. In the first round, 3 of 7 KC reached consensus. In the second round, 100% returned responses and consensus was reached in 3 of the remaining 4 KC. The distribution of answers for one KC, which queried the a/b ratio of HCC, was such that consensus was not achieved. Based on this analysis, ablative EBRT for HCC was defined as a BED10 ≥80 Gy with daily imaging and multiphasic contrast used for target delineation. Treatment breaks (eg, for adaptive EBRT) are allowed, but the total treatment time should be ≤6 weeks. Equivalent dose when treating with protons should use a conversion factor of 1.1, but there is no single conversion factor for carbon ions. CONCLUSIONS Using a mDelphi method assessing expert opinion, we provide the first consensus definition of ablative EBRT for HCC. Empirical data are required to define the a/b of HCC.
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Affiliation(s)
- Ted K Yanagihara
- Ablative Radiotherapy Modified Delphi Steering Committee; Department of Radiation Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
| | - Joel E Tepper
- Ablative Radiotherapy Modified Delphi Steering Committee; Department of Radiation Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Andrew M Moon
- Ablative Radiotherapy Modified Delphi Steering Committee; Division of Gastroenterology and Hepatology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Aisling Barry
- Ablative Radiotherapy Modified Delphi Steering Committee; Department of Radiation Oncology, Cork University Hospital, Cork, Ireland
| | - Meritxell Molla
- Ablative Radiotherapy Modified Delphi Steering Committee; Radiation Oncology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Jinsil Seong
- Ablative Radiotherapy Modified Delphi Steering Committee; Department of Radiation Oncology, Yonsei University Medical College, Seoul, Republic of Korea
| | - Ferran Torres
- Ablative Radiotherapy Modified Delphi Steering Committee; Biostatistics Unit, Medical School, Universitat Auntònoma de Barcelona, Barcelona, Spain
| | | | - Michael Buckstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Higinia Cardenes
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | - Daniel T Chang
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Mary Feng
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Chandan Guha
- Department of Radiation Oncology, Montefiore Hospital, New York, New York
| | | | - Maria A Hawkins
- Department of Radiation Oncology, University College London, London, England
| | - Morten Hoyer
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya, Japan
| | - Salma K Jabbour
- Department of Radiation Oncology, Robert Wood Johnson Medical School, Rutgers Cancer Institute, New Brunswick, New Jersey
| | - Lisa Kachnic
- Department of Radiation Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Jordan Kharofa
- Department of Radiation Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Tae Hyun Kim
- Department of Radiation Oncology, Proton Therapy Center, National Cancer Center, Seoul, Republic of Korea
| | - Alexander Kirichenko
- Department of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania
| | - Eugene J Koay
- Department of GI Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hirokazu Makishima
- Department of Radiation Oncology, Proton Medical Research Center, University of Tsukuba, Tsukuba, Japan
| | - Joel Mases
- Radiation Oncology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Jeffrey J Meyer
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Dawn Owen
- Department of Radiation Oncology, Mayo College of Medicine, Rochester, Minnesota
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jordi Saez
- Radiation Oncology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Nina N Sanford
- Department of Radiation Oncology, University of Texas, Southwestern, Dallas, Texas
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan, Italy
| | - Grace L Smith
- Department of GI Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer Y Wo
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sang Min Yoon
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Theodore S Lawrence
- Ablative Radiotherapy Modified Delphi Steering Committee; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Maria Reig
- Ablative Radiotherapy Modified Delphi Steering Committee; Radiation Oncology Department, Hospital Clínic Barcelona, Barcelona, Spain; Liver Cancer Unit, Barcelona Clinic Liver Cancer Group, Barcelona University, Barcelona, Spain.
| | - Laura A Dawson
- Ablative Radiotherapy Modified Delphi Steering Committee; Department of Radiation Oncology, Radiation Medicine Program/University Health Network, University of Toronto, Toronto, Canada
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Pardo-Montero J, González-Crespo I, Gómez-Caamaño A, Gago-Arias A. Radiobiological Meta-Analysis of the Response of Prostate Cancer to Different Fractionations: Evaluation of the Linear-Quadratic Response at Large Doses and the Effect of Risk and ADT. Cancers (Basel) 2023; 15:3659. [PMID: 37509320 PMCID: PMC10377316 DOI: 10.3390/cancers15143659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/04/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
The purpose of this work was to investigate the response of prostate cancer to different radiotherapy schedules, including hypofractionation, to evaluate potential departures from the linear-quadratic (LQ) response, to obtain the best-fitting parameters for low-(LR), intermediate-(IR), and high-risk (HR) prostate cancer and to investigate the effect of ADT on the radiobiological response. We constructed a dataset of the dose-response containing 87 entries/16,536 patients (35/5181 LR, 32/8146 IR, 20/3209 HR), with doses per fraction ranging from 1.8 to 10 Gy. These data were fit to tumour control probability models based on the LQ model, linear-quadratic-linear (LQL) model, and a modification of the LQ (LQmod) model accounting for increasing radiosensitivity at large doses. Fits were performed with the maximum likelihood expectation methodology, and the Akaike information criterion (AIC) was used to compare the models. The AIC showed that the LQ model was superior to the LQL and LQmod models for all risks, except for IR, where the LQL model outperformed the other models. The analysis showed a low α/β for all risks: 2.0 Gy for LR (95% confidence interval: 1.7-2.3), 3.4 Gy for IR (3.0-4.0), and 2.8 Gy for HR (1.4-4.2). The best fits did not show proliferation for LR and showed moderate proliferation for IR/HR. The addition of ADT was consistent with a suppression of proliferation. In conclusion, the LQ model described the response of prostate cancer better than the alternative models. Only for IR, the LQL model outperformed the LQ model, pointing out a possible saturation of radiation damage with increasing dose. This study confirmed a low α/β for all risks.
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Affiliation(s)
- Juan Pardo-Montero
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), 15706 Santiago de Compostela, Spain
- Department of Medical Physics, Complexo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - Isabel González-Crespo
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), 15706 Santiago de Compostela, Spain
- Department of Applied Mathematics, Universidade de Santiago de Compostela, 15705 Santiago de Compostela, Spain
| | - Antonio Gómez-Caamaño
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - Araceli Gago-Arias
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), 15706 Santiago de Compostela, Spain
- Department of Medical Physics, Complexo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain
- Institute of Physics, Pontificia Universidad Católica de Chile, Santiago de Chile 7820436, Chile
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Wakisaka Y, Minami K, Okada N, Tsubouchi T, Hamatani N, Yagi M, Takashina M, Kanai T. Treatment planning of carbon ion radiotherapy for prostate cancer based on cellular experiments with PC3 human prostate cancer cells. Phys Med 2023; 107:102537. [PMID: 36780791 DOI: 10.1016/j.ejmp.2023.102537] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/10/2023] [Accepted: 01/31/2023] [Indexed: 02/13/2023] Open
Abstract
[Purpose] Treatment plans for carbon ion radiotherapy (CIRT) in Japan are designed to uniformly deliver the prescribed clinical dose based on the radiosensitivity of human salivary gland (HSG) cells to the planning target volume (PTV). However, sensitivity to carbon beams varies between cell lines, that is, it should be checked that the clinical dose distribution based on the cell radiosensitivity of the treatment site is uniform within the PTV. [Methods] We modeled the linear energy transfer (LET) dependence of the linear-quadratic (LQ) coefficients specific to prostate cancer, which accounts for the majority of CIRT. This was achieved by irradiating prostate cancer cells (PC3) with X-rays from a 4 MV-Linac and carbon beams with different LETs of 11.1-214.3 keV/μm. By using the radiosensitivity of PC3 cells derived from cellular experiments, we reconstructed prostate-cancer-specific clinical dose distributions on patient computed tomography (CT). [Results] The LQ coefficient, α, of PC3 cells was larger than that of HSG cells at low (<50 keV/μm) LET and smaller at high (>50 keV/μm) LET, which was validated by cellular experiments performed on rectangular SOBPs. The reconstructed dose distribution on patient CT was sloped when 1 fraction incident from the one side of the patient was considered, but remained uniform from the sum of 12 fractions of the left-right opposing beams (as is used in clinical practice). [Conclusion] Our study reveals the inhomogeneity of clinical doses in single-field plans calculated using the PC3 radiosensitivity data. However, this inhomogeneity is compensated by using the combination of left-right opposing beams.
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Affiliation(s)
- Yushi Wakisaka
- Osaka Heavy Ion Therapy Center, Osaka City, Osaka, Japan; Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Osaka City, Osaka, Japan.
| | - Kazumasa Minami
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Nao Okada
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Osaka City, Osaka, Japan
| | | | | | - Masashi Yagi
- Osaka Heavy Ion Therapy Center, Osaka City, Osaka, Japan; Department of Carbon Ion Radiotherapy, Osaka University Graduate School of Medicine, Osaka City, Osaka, Japan
| | | | - Tatsuaki Kanai
- Osaka Heavy Ion Therapy Center, Osaka City, Osaka, Japan; Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Osaka City, Osaka, Japan
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Fukata K, Kawamura H, Kubo N, Kanai T, Torikoshi M, Nakano T, Tashiro M, Ohno T. Retrospective comparison of rectal toxicity between carbon-ion radiotherapy and intensity-modulated radiation therapy based on treatment plan, normal tissue complication probability model, and clinical outcomes in prostate cancer. Phys Med 2021; 90:6-12. [PMID: 34521017 DOI: 10.1016/j.ejmp.2021.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 08/04/2021] [Accepted: 08/27/2021] [Indexed: 10/20/2022] Open
Abstract
This retrospective study assessed the treatment planning data and clinical outcomes for 152 prostate cancer patients: 76 consecutive patients treated by carbon-ion radiation therapy and 76 consequtive patients treated by moderate hypo-fractionated intensity-modulated photon radiation therapy. These two modalities were compared using linear quadratic model equivalent doses in 2 Gy per fraction for rectal or rectal wall dose-volume histogram, 3.6 Gy per fraction-converted rectal dose-volume histogram, normal tissue complication probability model, and actual clinical outcomes. Carbon-ion radiation therapy was predicted to have a lower probability of rectal adverse events than intensity-modulated photon radiation therapy based on dose-volume histograms and normal tissue complication probability model. There was no difference in the clinical outcome of rectal adverse events between the two modalities compared in this study.
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Affiliation(s)
- Kyohei Fukata
- Cancer Center, School of Medicine, Keio University, Tokyo, Japan; Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan; Section of Medical Physics and Engineering, Kanagawa Cancer Center, Yokohama, Japan.
| | - Hidemasa Kawamura
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan; Gunma University Heavy Ion Medical Center, Gunma, Japan
| | - Nobuteru Kubo
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Tatsuaki Kanai
- Gunma University Heavy Ion Medical Center, Gunma, Japan; Osaka Heavy Ion Therapy Center, Osaka, Japan
| | - Masami Torikoshi
- Gunma University Heavy Ion Medical Center, Gunma, Japan; International Science and Technology Center, Nur-Sultan, Kazakhstan
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan; Gunma University Heavy Ion Medical Center, Gunma, Japan; Quantum Life and Medical Science Directorate, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | | | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan; Gunma University Heavy Ion Medical Center, Gunma, Japan
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5
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Applications of Nonlinear Programming to the Optimization of Fractionated Protocols in Cancer Radiotherapy. INFORMATION 2020. [DOI: 10.3390/info11060313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The present work of review collects and evidences the main results of our previous papers on the optimization of fractionated radiotherapy protocols. The problem under investigation is presented here in a unitary framework as a nonlinear programming application that aims to determine the optimal schemes of dose fractionation commonly used in external beam radiotherapy. The radiation responses of tumor and normal tissues are described by means of the linear quadratic model. We formulate a nonlinear, non-convex optimization problem including two quadratic constraints to limit the collateral normal tissue damages and linear box constraints on the fractional dose sizes. The general problem is decomposed into two subproblems: (1) analytical determination of the optimal fraction dose sizes as a function of the model parameters for arbitrarily fixed treatment lengths; and (2) numerical determination of the optimal fraction number, and of the optimal treatment time, in different parameter settings. After establishing the boundedness of the optimal number of fractions, we investigate by numerical simulation the optimal solution behavior for experimentally meaningful parameter ranges, recognizing the crucial role of some parameters, such as the radiosensitivity ratio, in determining the optimality of hypo- or equi-fractionated treatments. Our results agree with findings of the theoretical and clinical literature.
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Ruiz B, Feng Y. Clinical and radiobiological evaluation of a method for planning target volume generation dependent on organ-at-risk exclusions in magnetic resonance imaging-based prostate radiotherapy. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2018; 8:51-56. [PMID: 33458417 PMCID: PMC7807578 DOI: 10.1016/j.phro.2018.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 11/21/2018] [Accepted: 11/22/2018] [Indexed: 12/15/2022]
Abstract
Background and purpose Due to a smaller target volume when delineating prostate on magnetic resonance imaging (MRI), margins may be too tight as compared to computed tomography (CT) delineation, potentially reducing tumor control probability (TCP) in prostate radiotherapy. This study evaluated a clinically implemented MRI-based target expansion method to provide adequate margins yet limit organ-at-risk (OAR) dose as compared to CT-based delineation. Methods and materials Patients in this study were treated to 79.2 Gy in 44 fractions via intensity modulated radiotherapy using an MRI-based expansion method, which excluded OARs when performing a 5 mm isotropic (except 4 mm posterior) expansion from gross tumor volume to clinical target volume (CTV), followed by an isotropic 5 mm expansion to generate the planning target volume (PTV). Ten cases were re-planned using CT-delineated prostate with CTV-to-PTV expansion of isotropic 8 mm, except for a 5 mm posterior expansion, with comparison of PTV volumes, TCP and normal tissue complication probability (NTCP) to the MRI-based method. Under IRB approved protocol, we retrospectively evaluated 51 patients treated with the MRI-based method for acute bladder and rectal toxicity with CTC-AE version 4.0 used for scoring. Results MRI-based PTV volume differed by 4% compared to CT-based PTV volume. Radiobiological calculated TCP of the MRI-based method was found comparable to CT-based methods with an average equivalent uniform dose of 80.5 Gy and 80.1 Gy respectively. Statistically significant decrease in bladder NTCP (toxicity Grade 2 and above for 5% complications within 5 years post radiotherapy) was observed in the MRI-based method. Outcomes data collected showed 65% and 100% of patients studied experienced Grade 0/1 bladder and rectal acute toxicity respectively. Grade 2 bladder toxicity was indicated in the remaining 35% of patients studied with no Grade 3 toxicity reported. Conclusions Results showed comparable PTV volume with MRI-based method, and NTCP was reduced while maintaining TCP. Clinically, bladder and rectal toxicities were observed to be minimal.
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Affiliation(s)
- Brian Ruiz
- Department of Radiation Oncology, Johnson City Medical Center, Johnson City, TN, USA.,Department of Physics, East Carolina University, Greenville, NC, USA
| | - Yuanming Feng
- Department of Radiation Oncology and Department of Physics, East Carolina University, Greenville, NC, USA
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Datta NR, Stutz E, Rogers S, Bodis S. Clinical estimation of α/β values for prostate cancer from isoeffective phase III randomized trials with moderately hypofractionated radiotherapy. Acta Oncol 2018; 57:883-894. [PMID: 29405785 DOI: 10.1080/0284186x.2018.1433874] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The α/β values for prostate cancer (PCa) are usually assumed to be low (1.0-1.8 Gy). This study estimated the α/β values of PCa from phase III randomized trials of conventional (CRT) versus hypofractionated (HRT) external beam radiotherapy (RT), reported as isoeffective in terms of their 5-year biochemical (BF) or biochemical and/or clinical failure (BCF) rates. MATERIAL AND METHODS The α/β for each trial was estimated from the equivalent biological effective doses using the linear-quadratic model for each of their HRT and CRT schedules. The cumulative outcomes of these trials were evaluated by meta-analysis for odds ratio (OR), risk ratio (RR) and risk difference (RD). RESULTS Eight trials from seven studies, randomized 6993 patients between CRT (n = 2941) and HRT (n = 4052). RT treatment varied between the two treatment groups in terms of dose/fraction, total dose, overall treatment time and %patients on androgen deprivation therapy (ADT). Differences in OR, RR, and RD for both BF and BCF were nonsignificant. The computed α/β ranged from 1.3 to 11.1 Gy (4.9 ± 3.9 Gy; 95% CI: 1.6-8.2). On multivariate regression, %ADT was the sole determinant of computed α/β (model R2: 0.98, p < .001). CONCLUSIONS Clinically estimated α/β for PCa from isoeffective randomized trials using known variables in the linear-quadratic expression ranged between 1.3 and 11.1 Gy. The estimated α/β values were inversely related to %ADT usage, which should be considered when planning future RT dose-fractionation schedules.
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Affiliation(s)
- Niloy R. Datta
- Center for Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Emanuel Stutz
- Center for Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Susanne Rogers
- Center for Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Stephan Bodis
- Center for Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
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Bruni C, Conte F, Papa F, Sinisgalli C. Optimal number and sizes of the doses in fractionated radiotherapy according to the LQ model. MATHEMATICAL MEDICINE AND BIOLOGY-A JOURNAL OF THE IMA 2018; 36:1-53. [DOI: 10.1093/imammb/dqx020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 12/10/2017] [Indexed: 01/18/2023]
Affiliation(s)
- C Bruni
- Istituto di Analisi dei Sistemi ed Informatica “A. Ruberti” – CNR, Via dei Taurini 19, Rome, Italy
| | - F Conte
- Istituto di Analisi dei Sistemi ed Informatica “A. Ruberti” – CNR, Via dei Taurini 19, Rome, Italy
| | - F Papa
- Istituto di Analisi dei Sistemi ed Informatica “A. Ruberti” – CNR, Via dei Taurini 19, Rome, Italy
| | - C Sinisgalli
- Istituto di Analisi dei Sistemi ed Informatica “A. Ruberti” – CNR, Via dei Taurini 19, Rome, Italy
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Clinical analysis of the approximate, 3-dimensional, biological effective dose equation in multiphase treatment plans. Med Dosim 2017; 43:11-22. [PMID: 28867367 DOI: 10.1016/j.meddos.2017.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 06/12/2017] [Accepted: 07/25/2017] [Indexed: 11/21/2022]
Abstract
A multiphase, approximate biological effective dose (BEDA) equation was introduced because most treatment planning systems (TPS) are incapable of calculating the true BED (BEDT). This work investigates the accuracy and precision of the multiphase BEDA relative to the BEDT in clinical cases. Ten patients with head and neck cancer and 10 patients with prostate cancer were studied using their treatment plans from Pinnacle3 9.2 (Philips Medical, Fitchburg, WI). The organs at risk (OARs) that were studied are the normal brain, left and right optic nerves, optic chiasm, spinal cord, brainstem, bladder, and rectum. BEDA and BEDT distributions were calculated using MATLAB 2010b (MathWorks, Natick, MA) and analyzed on a voxel basis for percent error, percent error volume histograms (PEVHs), Pearson correlation coefficient, and Bland-Altman analysis. The maximum BED values that were calculated using the BEDA and BEDT methods were also analyzed. BEDA was found to always underestimate BEDT. The accuracy and precision of BEDA distributions varied between the organs: for optic chiasm and brainstem, 50% of the patients had an overall BEDA percent error of <1%; for left and right optic nerves, rectum, and bladder, 60% to 70% of the patients had an overall BEDA percent error of <1%; and for normal brain and spinal cord, 80% of the patients had an overall BEDA percent error of <1%. BEDA distributions had maximum errors ranging from 2% to 11%, with the 11% error occurring for bladder. BEDA produced much more accurate maximum BED values with adjacent organs such as normal brain, bladder, and rectum. This study has shown that BEDA can calculate BED distributions with acceptable accuracy under certain circumstances. However, its consistency and accuracy strongly depend on the dose distributions of the different treatment phases. One should be cautious when using BEDA.
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Denis-Bacelar AM, Chittenden SJ, Murray I, Divoli A, Ralph McCready V, Dearnaley DP, O’Sullivan JM, Johnson B, Flux GD. A radiobiological model of metastatic burden reduction for molecular radiotherapy: application to patients with bone metastases. Phys Med Biol 2017; 62:2859-2870. [PMID: 28291739 PMCID: PMC5953197 DOI: 10.1088/1361-6560/aa5e6f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/05/2017] [Accepted: 02/06/2017] [Indexed: 12/26/2022]
Abstract
Skeletal tumour burden is a biomarker of prognosis and survival in cancer patients. This study proposes a novel method based on the linear quadratic model to predict the reduction in metastatic tumour burden as a function of the absorbed doses delivered from molecular radiotherapy treatments. The range of absorbed doses necessary to eradicate all the bone lesions and to reduce the metastatic burden was investigated in a cohort of 22 patients with bone metastases from castration-resistant prostate cancer. A metastatic burden reduction curve was generated for each patient, which predicts the reduction in metastatic burden as a function of the patient mean absorbed dose, defined as the mean of all the lesion absorbed doses in any given patient. In the patient cohort studied, the median of the patient mean absorbed dose predicted to reduce the metastatic burden by 50% was 89 Gy (interquartile range: 83-105 Gy), whilst a median of 183 Gy (interquartile range: 107-247 Gy) was found necessary to eradicate all metastases in a given patient. The absorbed dose required to eradicate all the lesions was strongly correlated with the variability of the absorbed doses delivered to multiple lesions in a given patient (r = 0.98, P < 0.0001). The metastatic burden reduction curves showed a potential large reduction in metastatic burden for a small increase in absorbed dose in 91% of patients. The results indicate the range of absorbed doses required to potentially obtain a significant survival benefit. The metastatic burden reduction method provides a simple tool that could be used in routine clinical practice for patient selection and to indicate the required administered activity to achieve a predicted patient mean absorbed dose and reduction in metastatic tumour burden.
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Affiliation(s)
- Ana M Denis-Bacelar
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Sarah J Chittenden
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Iain Murray
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Antigoni Divoli
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - V Ralph McCready
- Department of Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - David P Dearnaley
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Joe M O’Sullivan
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, United Kingdom
| | - Bernadette Johnson
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Glenn D Flux
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
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11
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Walsh S, Roelofs E, Kuess P, Lambin P, Jones B, Georg D, Verhaegen F. A validated tumor control probability model based on a meta-analysis of low, intermediate, and high-risk prostate cancer patients treated by photon, proton, or carbon-ion radiotherapy. Med Phys 2016; 43:734-47. [PMID: 26843237 DOI: 10.1118/1.4939260] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE A fully heterogeneous population averaged mechanistic tumor control probability (TCP) model is appropriate for the analysis of external beam radiotherapy (EBRT). This has been accomplished for EBRT photon treatment of intermediate-risk prostate cancer. Extending the TCP model for low and high-risk patients would be beneficial in terms of overall decision making. Furthermore, different radiation treatment modalities such as protons and carbon-ions are becoming increasingly available. Consequently, there is a need for a complete TCP model. METHODS A TCP model was fitted and validated to a primary endpoint of 5-year biological no evidence of disease clinical outcome data obtained from a review of the literature for low, intermediate, and high-risk prostate cancer patients (5218 patients fitted, 1088 patients validated), treated by photons, protons, or carbon-ions. The review followed the preferred reporting item for systematic reviews and meta-analyses statement. Treatment regimens include standard fractionation and hypofractionation treatments. Residual analysis and goodness of fit statistics were applied. RESULTS The TCP model achieves a good level of fit overall, linear regression results in a p-value of <0.000 01 with an adjusted-weighted-R(2) value of 0.77 and a weighted root mean squared error (wRMSE) of 1.2%, to the fitted clinical outcome data. Validation of the model utilizing three independent datasets obtained from the literature resulted in an adjusted-weighted-R(2) value of 0.78 and a wRMSE of less than 1.8%, to the validation clinical outcome data. The weighted mean absolute residual across the entire dataset is found to be 5.4%. CONCLUSIONS This TCP model fitted and validated to clinical outcome data, appears to be an appropriate model for the inclusion of all clinical prostate cancer risk categories, and allows evaluation of current EBRT modalities with regard to tumor control prediction.
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Affiliation(s)
- Seán Walsh
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC+), Maastricht 6229 ET, The Netherlands and Department of Oncology, Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford OX3 7DQ, United Kingdom
| | - Erik Roelofs
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC+), Maastricht 6229 ET, The Netherlands
| | - Peter Kuess
- Department of Radiation Oncology and Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna 1090, Austria
| | - Philippe Lambin
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC+), Maastricht 6229 ET, The Netherlands
| | - Bleddyn Jones
- Department of Oncology, Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford OX3 7DQ, United Kingdom
| | - Dietmar Georg
- Department of Radiation Oncology and Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna 1090, Austria
| | - Frank Verhaegen
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center (MUMC+), Maastricht 6229 ET, The Netherlands and Medical Physics Unit, Department of Oncology, McGill University, Montréal, Québec H4A 3J1, Canada
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12
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Balderson M, Brown D, Johnson P, Kirkby C. Under conditions of large geometric miss, tumor control probability can be higher for static gantry intensity-modulated radiation therapy compared to volume-modulated arc therapy for prostate cancer. Med Dosim 2016; 41:180-5. [PMID: 27067229 DOI: 10.1016/j.meddos.2015.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 12/04/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
Abstract
The purpose of this work was to compare static gantry intensity-modulated radiation therapy (IMRT) with volume-modulated arc therapy (VMAT) in terms of tumor control probability (TCP) under scenarios involving large geometric misses, i.e., those beyond what are accounted for when margin expansion is determined. Using a planning approach typical for these treatments, a linear-quadratic-based model for TCP was used to compare mean TCP values for a population of patients who experiences a geometric miss (i.e., systematic and random shifts of the clinical target volume within the planning target dose distribution). A Monte Carlo approach was used to account for the different biological sensitivities of a population of patients. Interestingly, for errors consisting of coplanar systematic target volume offsets and three-dimensional random offsets, static gantry IMRT appears to offer an advantage over VMAT in that larger shift errors are tolerated for the same mean TCP. For example, under the conditions simulated, erroneous systematic shifts of 15mm directly between or directly into static gantry IMRT fields result in mean TCP values between 96% and 98%, whereas the same errors on VMAT plans result in mean TCP values between 45% and 74%. Random geometric shifts of the target volume were characterized using normal distributions in each Cartesian dimension. When the standard deviations were doubled from those values assumed in the derivation of the treatment margins, our model showed a 7% drop in mean TCP for the static gantry IMRT plans but a 20% drop in TCP for the VMAT plans. Although adding a margin for error to a clinical target volume is perhaps the best approach to account for expected geometric misses, this work suggests that static gantry IMRT may offer a treatment that is more tolerant to geometric miss errors than VMAT.
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Affiliation(s)
- Michael Balderson
- Medical Physics Department, Tom Baker Cancer Centre, Calgary, Alberta; Jack Ady Cancer Centre, Lethbridge, Alberta.
| | - Derek Brown
- Medical Physics Department, Tom Baker Cancer Centre, Calgary, Alberta; Jack Ady Cancer Centre, Lethbridge, Alberta
| | - Patricia Johnson
- Medical Physics Department, Tom Baker Cancer Centre, Calgary, Alberta; Jack Ady Cancer Centre, Lethbridge, Alberta
| | - Charles Kirkby
- Medical Physics Department, Tom Baker Cancer Centre, Calgary, Alberta; Jack Ady Cancer Centre, Lethbridge, Alberta
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13
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Histopathology-derived modeling of prostate cancer tumor control probability: Implications for the dose to the tumor and the gland. Radiother Oncol 2016; 119:97-103. [DOI: 10.1016/j.radonc.2016.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 01/27/2016] [Accepted: 02/04/2016] [Indexed: 11/22/2022]
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14
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Thiruthaneeswaran N, Hoskin PJ. High dose rate brachytherapy for prostate cancer: Standard of care and future direction. Cancer Radiother 2016; 20:66-72. [PMID: 26811209 DOI: 10.1016/j.canrad.2016.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 12/14/2015] [Accepted: 12/16/2015] [Indexed: 10/22/2022]
Abstract
High dose rate brachytherapy is a highly conformal method of radiation dose escalation for prostate cancer and one of several treatment options for men with localised disease. The large doses per fraction exploit the low alpha/beta ratio of prostate cancer cells so that biological radiation dose delivered is substantially greater than that achieved with conventional external beam delivery. This review article presents contemporary data on the rationale for high dose rate brachytherapy including treatment technique and future directions.
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Affiliation(s)
- N Thiruthaneeswaran
- Cancer Centre, Mount Vernon Hospital, Rickmansworth Road, Northwood, HA6 2RN, United Kingdom
| | - P J Hoskin
- Cancer Centre, Mount Vernon Hospital, Rickmansworth Road, Northwood, HA6 2RN, United Kingdom.
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15
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Feng Y, Welsh D, McDonald K, Carruthers L, Cheng K, Montgomery D, Lawrence J, Argyle DJ, McLaughlin S, McLaren DB, Nailon WH. Identifying the dominant prostate cancer focal lesion using image analysis and planning of a simultaneous integrated stereotactic boost. Acta Oncol 2015; 54:1543-50. [PMID: 26397055 DOI: 10.3109/0284186x.2015.1063782] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Prostate cancer is now the only solid organ cancer in which therapy is commonly applied to the whole gland. One of the main challenges in adopting focal boost or true focal therapy is in the accurate mapping of cancer foci defined on magnetic resonance (MR) images onto the computerised tomography (CT) images used for radiotherapy planning. MATERIAL AND METHODS Prostate cancer patients (n = 14) previously treated at the Edinburgh Cancer Centre (ECC) were selected for this study. All patients underwent MR scanning for the purpose of diagnosis and staging. Patients received three months of androgen deprivation hormone therapy followed by a radiotherapy planning CT scan. The dominant focal prostate lesions were identified on MR scans by a radiologist and a novel image analysis approach was used to map the location of the dominant focal lesion from MR to CT. An offline planning study was undertaken on suitable patients (n = 7) to investigate boosting of the radiation dose to the tumour using a stereotactic ablative body radiotherapy (SABR) technique. RESULTS The non-rigid registration algorithm showed clinically acceptable estimates of the location of the dominant focal disease on all CT image data of patients suitable for a boost treatment. Standard rigid registration was found to produce unacceptable estimates of the dominant focal lesion on CT. A SABR boost dose of 47.5 Gy was delivered to the dominant focal lesion of all patients whilst meeting all dose-volume histogram (DVH) constraints. Normal tissue complication probability (NTCP) for the rectum decreased from 1.28% to 0.73% with this method. CONCLUSIONS These preliminary results demonstrate the potential of this image analysis method for reliably mapping dominant focal disease within the prostate from MR images onto planning CT images. Significant dose escalation using a simultaneous integrated SABR boost was achieved in all patients.
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Affiliation(s)
- Yang Feng
- a Department of Oncology Physics , Edinburgh Cancer Centre, Western General Hospital , Crewe Road South, Edinburgh , UK
| | - Daniel Welsh
- a Department of Oncology Physics , Edinburgh Cancer Centre, Western General Hospital , Crewe Road South, Edinburgh , UK
| | - Kim McDonald
- a Department of Oncology Physics , Edinburgh Cancer Centre, Western General Hospital , Crewe Road South, Edinburgh , UK
| | - Linda Carruthers
- a Department of Oncology Physics , Edinburgh Cancer Centre, Western General Hospital , Crewe Road South, Edinburgh , UK
| | - Kun Cheng
- a Department of Oncology Physics , Edinburgh Cancer Centre, Western General Hospital , Crewe Road South, Edinburgh , UK
| | - Dean Montgomery
- a Department of Oncology Physics , Edinburgh Cancer Centre, Western General Hospital , Crewe Road South, Edinburgh , UK
| | - Jessica Lawrence
- e Royal (Dick) School of Veterinary Studies, University of Edinburgh , Edinburgh , UK
| | - David J Argyle
- e Royal (Dick) School of Veterinary Studies, University of Edinburgh , Edinburgh , UK
| | - Stephen McLaughlin
- d School of Engineering and Physical Sciences, Heriot Watt University , Edinburgh , UK
| | - Duncan B McLaren
- b Department of Clinical Oncology , Edinburgh Cancer Centre, Western General Hospital , Crewe Road South, Edinburgh , UK
| | - William H Nailon
- a Department of Oncology Physics , Edinburgh Cancer Centre, Western General Hospital , Crewe Road South, Edinburgh , UK
- c School of Engineering, the University of Edinburgh, the King's Buildings , Mayfield Road, Edinburgh , UK
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16
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Buge F, Chiavassa S, Hervé C, Rigaud J, Delpon G, Supiot S. Preclinical Evaluation of Intraoperative Low-Energy Photon Radiotherapy Using Spherical Applicators in Locally Advanced Prostate Cancer. Front Oncol 2015; 5:204. [PMID: 26442216 PMCID: PMC4569969 DOI: 10.3389/fonc.2015.00204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 09/01/2015] [Indexed: 11/13/2022] Open
Abstract
Background Surgery plus adjuvant radiotherapy is standard care for locally advanced prostate cancer (stage pT3R1). Intraoperative low-energy photon radiotherapy offers several advantages over external beam radiotherapy, and several systems are now available for its delivery, using spherical applicators, which require only limited shielding. The aim of this study was to evaluate the feasibility of this technique for the prostate bed. Materials and methods Applicators were assessed using MRI image data and cadaveric dissection. In cadavers, targeted tissues, defined as a urethral section, both neurovascular bundle sections, the bladder neck and the beds of the seminal vesicles, were marked with metallic surgical clips. Distances between clips and applicator were measured using CT. A dosimetric study of the application of 12 Gy at 5 mm depth was performed using CT images of prostatectomized cadavers. Results Using MRI images from 34 prostate cancer patients, we showed that the ideal applicator diameter ranges from 45 to 70 mm. Using applicators of different sizes to encompass the prostate bed in nine cadavers, we showed that the distance between target tissues and applicator was <2 mm for all target tissues except the upper extremity of the seminal vesicles (19 mm). Dosimetric study showed a good dose distribution in all target tissues in contact with the applicator, with a low probability of rectum and bladder complication. Conclusion Intraoperative radiotherapy of the prostate bed is feasible, with good coverage of targeted tissues. Clinical study of safety and efficacy is now required.
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Affiliation(s)
- François Buge
- Department of Urology, Centre Hospitalier Universitaire de Nantes , Nantes , France
| | - Sophie Chiavassa
- Centre de Recherche en Cancérologie Nantes-Angers, INSERM U892, Université de Nantes , Nantes , France ; Department of Medical Physics, Institut de Cancérologie de l'Ouest , St-Herblain , France
| | - Chloé Hervé
- Centre de Recherche en Cancérologie Nantes-Angers, INSERM U892, Université de Nantes , Nantes , France
| | - Jérôme Rigaud
- Department of Urology, Centre Hospitalier Universitaire de Nantes , Nantes , France
| | - Grégory Delpon
- Centre de Recherche en Cancérologie Nantes-Angers, INSERM U892, Université de Nantes , Nantes , France ; Department of Medical Physics, Institut de Cancérologie de l'Ouest , St-Herblain , France
| | - Stéphane Supiot
- Centre de Recherche en Cancérologie Nantes-Angers, INSERM U892, Université de Nantes , Nantes , France ; Department of Radiation Oncology, Institut de Cancérologie de l'Ouest , St-Herblain , France
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17
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The influence of a rectal ultrasound probe on the separation between prostate and rectum in high-dose-rate brachytherapy. Brachytherapy 2015; 14:711-7. [DOI: 10.1016/j.brachy.2015.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/29/2015] [Accepted: 06/01/2015] [Indexed: 01/01/2023]
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18
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Ray KJ, Sibson NR, Kiltie AE. Treatment of Breast and Prostate Cancer by Hypofractionated Radiotherapy: Potential Risks and Benefits. Clin Oncol (R Coll Radiol) 2015; 27:420-6. [PMID: 25752244 PMCID: PMC4465964 DOI: 10.1016/j.clon.2015.02.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 01/09/2015] [Accepted: 02/13/2015] [Indexed: 11/23/2022]
Abstract
Breast cancer and prostate cancer are the most common cancers diagnosed in women and men, respectively, in the UK, and radiotherapy is used extensively in the treatment of both. In vitro data suggest that tumours in the breast and prostate have unique properties that make a hypofractionated radiotherapy treatment schedule advantageous in terms of therapeutic index. Many clinical trials of hypofractionated radiotherapy treatment schedules have been completed to establish the extent to which hypofractionation can improve patient outcome. Here we present a concise description of hypofractionation, the mathematical description of converting between conventional and hypofractionated schedules, and the motivation for using hypofractionation in the treatment of breast and prostate cancer. Furthermore, we summarise the results of important recent hypofractionation trials and highlight the limitations of a hypofractionated treatment regimen.
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Affiliation(s)
- K J Ray
- Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - N R Sibson
- Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - A E Kiltie
- Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK.
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19
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Rylander S, Polders D, Steggerda MJ, Moonen LM, Tanderup K, Van der Heide UA. Re-distribution of brachytherapy dose using a differential dose prescription adapted to risk of local failure in low-risk prostate cancer patients. Radiother Oncol 2015; 115:308-13. [DOI: 10.1016/j.radonc.2015.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 05/14/2015] [Accepted: 05/17/2015] [Indexed: 11/15/2022]
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20
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Kim H, Kim JW, Hong SJ, Rha KH, Lee CG, Yang SC, Choi YD, Suh CO, Cho J. Treatment outcome of localized prostate cancer by 70 Gy hypofractionated intensity-modulated radiotherapy with a customized rectal balloon. Radiat Oncol J 2014; 32:187-97. [PMID: 25324991 PMCID: PMC4194302 DOI: 10.3857/roj.2014.32.3.187] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 08/03/2014] [Accepted: 09/01/2014] [Indexed: 12/30/2022] Open
Abstract
Purpose We aimed to analyze the treatment outcome and long-term toxicity of 70 Gy hypofractionated intensity-modulated radiotherapy (IMRT) for localized prostate cancer using a customized rectal balloon. Materials and Methods We reviewed medical records of 86 prostate cancer patients who received curative radiotherapy between January 2004 and December 2011 at our institution. Patients were designated as low (12.8%), intermediate (20.9%), or high risk (66.3%). Thirty patients received a total dose of 70 Gy in 28 fractions over 5 weeks via IMRT (the Hypo-IMRT group); 56 received 70.2 Gy in 39 fractions over 7 weeks via 3-dimensional conformal radiotherapy (the CF-3DRT group, which served as a reference for comparison). A customized rectal balloon was placed in Hypo-IMRT group throughout the entire radiotherapy course. Androgen deprivation therapy was administered to 47 patients (Hypo-IMRT group, 17; CF-3DRT group, 30). Late genitourinary (GU) and gastrointestinal (GI) toxicity were evaluated according to the Radiation Therapy Oncology Group criteria. Results The median follow-up period was 74.4 months (range, 18.8 to 125.9 months). The 5-year actuarial biochemical relapse-free survival rates for low-, intermediate-, and high-risk patients were 100%, 100%, and 88.5%, respectively, for the Hypo-IMRT group and 80%, 77.8%, and 63.6%, respectively, for the CF-3DRT group (p < 0.046). No patient presented with acute or late GU toxicity ≥grade 3. Late grade 3 GI toxicity occurred in 2 patients (3.6%) in the CF-3DRT group and 1 patient (3.3%) in the Hypo-IMRT group. Conclusion Hypo-IMRT with a customized rectal balloon resulted in excellent biochemical control rates with minimal toxicity in localized prostate cancer patients.
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Affiliation(s)
- Hyunjung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Won Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Joon Hong
- Department of Urology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Chang-Geol Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Choul Yang
- Department of Urology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Chang-Ok Suh
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jaeho Cho
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
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Luo W, Molloy J, Aryal P, Feddock J, Randall M. Determination of prescription dose for Cs-131 permanent implants using the BED formalism including resensitization correction. Med Phys 2014; 41:024101. [PMID: 24506655 DOI: 10.1118/1.4860255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The current widely used biological equivalent dose (BED) formalism for permanent implants is based on the linear-quadratic model that includes cell repair and repopulation but not resensitization (redistribution and reoxygenation). The authors propose a BED formalism that includes all the four biological effects (4Rs), and the authors propose how it can be used to calculate appropriate prescription doses for permanent implants with Cs-131. METHODS A resensitization correction was added to the BED calculation for permanent implants to account for 4Rs. Using the same BED, the prescription doses with Au-198, I-125, and Pd-103 were converted to the isoeffective Cs-131 prescription doses. The conversion factor F, ratio of the Cs-131 dose to the equivalent dose with the other reference isotope (Fr: with resensitization, Fn: without resensitization), was thus derived and used for actual prescription. Different values of biological parameters such as α, β, and relative biological effectiveness for different types of tumors were used for the calculation. RESULTS Prescription doses with I-125, Pd-103, and Au-198 ranging from 10 to 160 Gy were converted into prescription doses with Cs-131. The difference in dose conversion factors with (Fr) and without (Fn) resensitization was significant but varied with different isotopes and different types of tumors. The conversion factors also varied with different doses. For I-125, the average values of Fr/Fn were 0.51/0.46, for fast growing tumors, and 0.88/0.77 for slow growing tumors. For Pd-103, the average values of Fr/Fn were 1.25/1.15 for fast growing tumors, and 1.28/1.22 for slow growing tumors. For Au-198, the average values of Fr/Fn were 1.08/1.25 for fast growing tumors, and 1.00/1.06 for slow growing tumors. Using the biological parameters for the HeLa/C4-I cells, the averaged value of Fr was 1.07/1.11 (rounded to 1.1), and the averaged value of Fn was 1.75/1.18. Fr of 1.1 has been applied to gynecological cancer implants with expected acute reactions and outcomes as expected based on extensive experience with permanent implants. The calculation also gave the average Cs-131 dose of 126 Gy converted from the I-125 dose of 144 Gy for prostate implants. CONCLUSIONS Inclusion of an allowance for resensitization led to significant dose corrections for Cs-131 permanent implants, and should be applied to prescription dose calculation. The adjustment of the Cs-131 prescription doses with resensitization correction for gynecological permanent implants was consistent with clinical experience and observations. However, the Cs-131 prescription doses converted from other implant doses can be further adjusted based on new experimental results, clinical observations, and clinical outcomes.
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Affiliation(s)
- Wei Luo
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky 40536
| | - Janelle Molloy
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky 40536
| | - Prakash Aryal
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky 40536
| | - Jonathan Feddock
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky 40536
| | - Marcus Randall
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky 40536
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Chanrion MA, Sauerwein W, Jelen U, Wittig A, Engenhart-Cabillic R, Beuve M. The influence of the local effect model parameters on the prediction of the tumor control probability for prostate cancer. Phys Med Biol 2014; 59:3019-40. [DOI: 10.1088/0031-9155/59/12/3019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Oliveira SM, Teixeira NJ, Fernandes L, Teles P, Vaz P. Dosimetric effect of tissue heterogeneity for (125)I prostate implants. Rep Pract Oncol Radiother 2014; 19:392-8. [PMID: 25337412 DOI: 10.1016/j.rpor.2014.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 11/26/2013] [Accepted: 03/19/2014] [Indexed: 11/29/2022] Open
Abstract
AIM To use Monte Carlo (MC) together with voxel phantoms to analyze the tissue heterogeneity effect in the dose distributions and equivalent uniform dose (EUD) for (125)I prostate implants. BACKGROUND Dose distribution calculations in low dose-rate brachytherapy are based on the dose deposition around a single source in a water phantom. This formalism does not take into account tissue heterogeneities, interseed attenuation, or finite patient dimensions effects. Tissue composition is especially important due to the photoelectric effect. MATERIALS AND METHODS The computed tomographies (CT) of two patients with prostate cancer were used to create voxel phantoms for the MC simulations. An elemental composition and density were assigned to each structure. Densities of the prostate, vesicles, rectum and bladder were determined through the CT electronic densities of 100 patients. The same simulations were performed considering the same phantom as pure water. Results were compared via dose-volume histograms and EUD for the prostate and rectum. RESULTS The mean absorbed doses presented deviations of 3.3-4.0% for the prostate and of 2.3-4.9% for the rectum, when comparing calculations in water with calculations in the heterogeneous phantom. In the calculations in water, the prostate D 90 was overestimated by 2.8-3.9% and the rectum D 0.1cc resulted in dose differences of 6-8%. The EUD resulted in an overestimation of 3.5-3.7% for the prostate and of 7.7-8.3% for the rectum. CONCLUSIONS The deposited dose was consistently overestimated for the simulation in water. In order to increase the accuracy in the determination of dose distributions, especially around the rectum, the introduction of the model-based algorithms is recommended.
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Key Words
- AAPM TG, American Association of Physicists in Medicine Task Group
- Brachytherapy
- CT, computerized tomography
- DVH, dose–volume histogram
- EBRT, external beam radiotherapy
- EUD, equivalent uniform dose
- HT, heterogeneous
- LDRBT, low dose-rate brachytherapy
- MBDCA, model-based dose calculation algorithm
- MC, Monte Carlo
- Model-based calculation algorithms
- Monte Carlo
- NTCP, normal tissue complication probability
- OAR, organ at risk
- PS, planning system
- Prostate cancer
- TCP, tumor control probability (TCP)
- Tissue heterogeneity
- W, water
- dDVH, differential dose–volume histogram
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Affiliation(s)
- Susana Maria Oliveira
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, 1169-056 Lisbon, Portugal ; Quadrantes Faro - Unidade de Radioterapia do Algarve, Rua da Associação Oncológica do Algarve, 8000-316 Faro, Portugal ; MedicalConsult, SA, Campo Grande, 56-8°A, 1700-093 Lisbon, Portugal
| | - Nuno José Teixeira
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, 1169-056 Lisbon, Portugal ; Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Av. D. João II, lote 4.69.01, 1900-096 Lisbon, Portugal
| | - Lisete Fernandes
- Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Av. D. João II, lote 4.69.01, 1900-096 Lisbon, Portugal ; Instituto Gulbenkian de Ciência, Rua da Quinta Grande, 6, 2780-156 Oeiras, Portugal ; Centro de Biodiversidade, Genómica Integrativa e Funcional, Faculdade de Ciências, Universidade de Lisboa, Edifício ICAT, Campus FCUL, Campo Grande, 1740-016 Lisbon, Portugal
| | - Pedro Teles
- IST/ITN, Instituto Superior Técnico, Universidade Técnica de Lisboa, Estrada Nacional 10, 2695-006 Bobadela LRS, Portugal
| | - Pedro Vaz
- IST/ITN, Instituto Superior Técnico, Universidade Técnica de Lisboa, Estrada Nacional 10, 2695-006 Bobadela LRS, Portugal
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Kok HP, Crezee J, Franken NA, Stalpers LJ, Barendsen GW, Bel A. Quantifying the Combined Effect of Radiation Therapy and Hyperthermia in Terms of Equivalent Dose Distributions. Int J Radiat Oncol Biol Phys 2014; 88:739-45. [DOI: 10.1016/j.ijrobp.2013.11.212] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 11/08/2013] [Accepted: 11/10/2013] [Indexed: 01/13/2023]
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Afsharpour H, Walsh S, Collins Fekete CA, Vigneault E, Verhaegen F, Beaulieu L. On the sensitivity of α/β prediction to dose calculation methodology in prostate brachytherapy. Int J Radiat Oncol Biol Phys 2014; 88:345-50. [PMID: 24411607 DOI: 10.1016/j.ijrobp.2013.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 09/16/2013] [Accepted: 11/01/2013] [Indexed: 01/13/2023]
Abstract
PURPOSE To study the relationship between the accuracy of the dose calculation in brachytherapy and the estimations of the radiosensitivity parameter, α/β, for prostate cancer. METHODS AND MATERIALS In this study, Monte Carlo methods and more specifically the code ALGEBRA was used to produce accurate dose calculations in the case of prostate brachytherapy. Equivalent uniform biologically effective dose was calculated for these dose distributions and was used in an iso-effectiveness relationship with external beam radiation therapy. RESULTS By considering different levels of detail in the calculations, the estimation for the α/β parameter varied from 1.9 to 6.3 Gy, compared with a value of 3.0 Gy suggested by the American Association of Physicists in Medicine Task Group 137. CONCLUSIONS Large variations of the α/β show the sensitivity of this parameter to dose calculation modality. The use of accurate dose calculation engines is critical for better evaluating the biological outcomes of treatments.
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Affiliation(s)
- Hossein Afsharpour
- Centre de Recherche sur le Cancer, Université Laval and Département de Radio-Oncologie, Centre Hospitalier Universitaire de Québec, Québec, QC, Canada; Centre Intégré de Cancérologie de la Montérégie, Hôpital Charles-LeMoyne, Greenfield Park, QC, Canada
| | - Sean Walsh
- Department of Radiation Oncology Maastricht Radiation Oncology (MAASTRO), GROW, University Hospital Maastricht, Maastricht, The Netherlands; Gray Institute for Radiation Oncology and Biology, The University of Oxford, The United Kingdom
| | - Charles-Antoine Collins Fekete
- Centre de Recherche sur le Cancer, Université Laval and Département de Radio-Oncologie, Centre Hospitalier Universitaire de Québec, Québec, QC, Canada
| | - Eric Vigneault
- Centre de Recherche sur le Cancer, Université Laval and Département de Radio-Oncologie, Centre Hospitalier Universitaire de Québec, Québec, QC, Canada
| | - Frank Verhaegen
- Department of Radiation Oncology Maastricht Radiation Oncology (MAASTRO), GROW, University Hospital Maastricht, Maastricht, The Netherlands; Medical Physics Unit, Department of Oncology, McGill University, Montréal, Québec, Canada
| | - Luc Beaulieu
- Centre de Recherche sur le Cancer, Université Laval and Département de Radio-Oncologie, Centre Hospitalier Universitaire de Québec, Québec, QC, Canada.
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Zaorsky NG, Harrison AS, Trabulsi EJ, Gomella LG, Showalter TN, Hurwitz MD, Dicker AP, Den RB. Evolution of advanced technologies in prostate cancer radiotherapy. Nat Rev Urol 2013; 10:565-79. [DOI: 10.1038/nrurol.2013.185] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Hennequin C, Dubray B. [Alpha/beta ratio revisited in the era of hypofractionation]. Cancer Radiother 2013; 17:344-8. [PMID: 23972468 DOI: 10.1016/j.canrad.2013.06.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 06/10/2013] [Accepted: 06/14/2013] [Indexed: 11/26/2022]
Abstract
Large doses per fraction are not recommended in daily radiotherapy due to a higher risk of late normal tissue injury. The technical refinements of modern radiotherapy and suggestions that some tumors could be sensitive to dose per fraction have renewed the interest in hypofractionated schedules. The estimation of α/β ratio value requires large samples of carefully evaluated patients in whom total and fractional doses have varied independently. Tumor repopulation has to be considered when the treatment duration is altered. Without setting aside conflicting publication, the α/β ratio values for prostate and breast (after lumpectomy) cancers could be as low as 2.5 Gy and 4 Gy, respectively. While it is too early to change our routine protocols, the time has come to conduct clinical trials comparing different fractionation schedules.
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Affiliation(s)
- C Hennequin
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefeaux, 75475 Paris, France; Université Paris Diderot Paris VII, 75475 Paris, France.
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Walsh S, van der Putten W. A TCP model for external beam treatment of intermediate-risk prostate cancer. Med Phys 2013; 40:031709. [DOI: 10.1118/1.4790469] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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