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Ng Wei Siang K, Both S, Oldehinkel E, Langendijk JA, Wagenaar D. Assessment of residual geometrical errors of clinical target volumes and their impact on dose accumulation for head and neck radiotherapy. Radiother Oncol 2023; 188:109856. [PMID: 37597803 DOI: 10.1016/j.radonc.2023.109856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE To assess the residual geometrical errors (dr) and their impact on the clinical target volumes (CTV) dose coverage for head and neck cancer (HNC) proton therapy patients. METHODS We analysed 28 HNC patients treated with 70 Gy (RBE) and 54.25 Gy (RBE) to the therapeutic CTV70 and prophylactic CTV54.25, respectively. Daily cone beam CTs were converted to high quality synthetic CTs (sCTs). The CTVs from the nominal CT were propagated to the corresponding sCTs using a hybrid deformable image registration (propagated CTVs) in RayStation 11B. For 11 patients, all propagated CTVs were reviewed by our HNC radiation oncologist (physician corrected CTVs). The residual geometrical error dr was quantified as a function of the daily CTVs volume overlap with the nominal plan CTV. The errors dr(propagated CTVs) and dr(physician corrected CTVs) and the difference in dice similarity coefficients (ΔDSC) were determined. Using clinical plans, dose coverage and the tumor control probability (TCP) for the nominal, accumulated and voxel-wise minimum scenarios were determined. RESULTS The difference in the residual geometrical error dr (propagated CTVs - physician corrected CTVs) and mean DSC (|ΔDSC|mean) were minor: Δdr(CTV70) = 0.16 mm, Δdr(CTV54.25) = 0.26 mm, |ΔDSC|mean < 0.9%. For all 28 patients, dr(CTV70) = 1.91 mm and dr(CTV54.25) = 1.90 mm. However, CTV54.25 above and below the cricoid cartilage differed substantially (1.00 mm c.f. 3.93 mm). The CTV54.25 coverage below the cricoid was then almost always lower, although the TCP of the accumulated dose was higher than the TCP of the voxel-wise minimum dose. CONCLUSIONS Setup uncertainty setting of 2 mm is possible. The feasibility of using propagated CTVs for error determination is demonstrated.
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Affiliation(s)
- Kelvin Ng Wei Siang
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands; Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, The Netherlands; Holland Proton Therapy Center, Department of Medical Physics & Informatics, Delft, The Netherlands.
| | - Stefan Both
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Edwin Oldehinkel
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Dirk Wagenaar
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
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Li Y, Rao S, Chen W, Azghadi SF, Nguyen KNB, Moran A, Usera BM, Dyer BA, Shang L, Chen Q, Rong Y. Evaluating Automatic Segmentation for Swallowing-Related Organs for Head and Neck Cancer. Technol Cancer Res Treat 2022; 21:15330338221105724. [PMID: 35790457 PMCID: PMC9340321 DOI: 10.1177/15330338221105724] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: To evaluate the accuracy of deep-learning-based
auto-segmentation of the superior constrictor, middle constrictor, inferior
constrictor, and larynx in comparison with a traditional multi-atlas-based
method. Methods and Materials: One hundred and five computed
tomography image datasets from 83 head and neck cancer patients were
retrospectively collected and the superior constrictor, middle constrictor,
inferior constrictor, and larynx were analyzed for deep-learning versus
multi-atlas-based segmentation. Eighty-three computed tomography images (40
diagnostic computed tomography and 43 planning computed tomography) were used
for training the convolutional neural network, and for atlas-based model
training. The remaining 22 computed tomography datasets were used for validation
of the atlas-based auto-segmentation versus deep-learning-based
auto-segmentation contours, both of which were compared with the corresponding
manual contours. Quantitative measures included Dice similarity coefficient,
recall, precision, Hausdorff distance, 95th percentile of Hausdorff distance,
and mean surface distance. Dosimetric differences between the auto-generated
contours and manual contours were evaluated. Subjective evaluation was obtained
from 3 clinical observers to blindly score the autosegmented structures based on
the percentage of slices that require manual modification. Results:
The deep-learning-based auto-segmentation versus atlas-based auto-segmentation
results were compared for the superior constrictor, middle constrictor, inferior
constrictor, and larynx. The mean Dice similarity coefficient values for the 4
structures were 0.67, 0.60, 0.65, and 0.84 for deep-learning-based
auto-segmentation, whereas atlas-based auto-segmentation has Dice similarity
coefficient results at 0.45, 0.36, 0.50, and 0.70, respectively. The mean 95th
percentile of Hausdorff distance (cm) for the 4 structures were 0.41, 0.57,
0.59, and 0.54 for deep-learning-based auto-segmentation, but 0.78, 0.95, 0.96,
and 1.23 for atlas-based auto-segmentation results, respectively. Similar mean
dose differences were obtained from the 2 sets of autosegmented contours
compared to manual contours. The dose–volume discrepancies and the average
modification rates were higher with the atlas-based auto-segmentation contours.
Conclusion: Swallowing-related structures are more accurately
generated with DL-based versus atlas-based segmentation when compared with
manual contours.
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Affiliation(s)
- Yimin Li
- Department of Radiation Oncology, Xiamen Radiotherapy Quality
Control Center, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology,
The First Affiliated Hospital of Xiamen University, The Third Clinical Medical
College, Fujian Medical University, Xiamen, Fujian, China
- Department of Radiation Oncology, University of California Davis Medical
Center, Sacramento, CA, USA
| | - Shyam Rao
- Department of Radiation Oncology, University of California Davis Medical
Center, Sacramento, CA, USA
| | - Wen Chen
- Department of Radiation Oncology, Xiangya Hospital, Central South
University, Changsha, China
| | - Soheila F. Azghadi
- Department of Radiation Oncology, University of California Davis Medical
Center, Sacramento, CA, USA
| | - Ky Nam Bao Nguyen
- Department of Radiation Oncology, University of California Davis Medical
Center, Sacramento, CA, USA
| | - Angel Moran
- Department of Radiation Oncology, University of California Davis Medical
Center, Sacramento, CA, USA
| | - Brittni M Usera
- Department of Radiation Oncology, University of California Davis Medical
Center, Sacramento, CA, USA
| | - Brandon A Dyer
- Department of Radiation Oncology, Legacy Health, Portland, OR, USA
| | - Lu Shang
- Department of Radiation Oncology, University of California Davis Medical
Center, Sacramento, CA, USA
| | - Quan Chen
- Department of Radiation Oncology, City of Hope comprehensive Cancer
Center, Duarte, CA, USA
- Quan Chen, PhD, Department of Radiation
Oncology, City of Hope comprehensive cancer center, Duarte, CA 91010..
| | - Yi Rong
- Department of Radiation Oncology, University of California Davis Medical
Center, Sacramento, CA, USA
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
- Yi Rong, PhD, Department of Radiation
Oncology, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA.
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Li D, Wei S, Li T, Liu Y, Cai J, Ge H. Study of Spinal Cord Substructure Expansion Margin in Esophageal Cancer. Technol Cancer Res Treat 2021; 20:15330338211024559. [PMID: 34137317 PMCID: PMC8216358 DOI: 10.1177/15330338211024559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: To analyze the setup errors and residual errors of different spinal cord parts in esophageal cancer patients and to explore the necessity of spinal cord segmental expansion. Methods and Materials: Sixty cases of esophageal cancer were included with 20 patients subdivided into the following groups: neck, chest and abdomen as per the treatment site. The patients underwent intensity modulated radiation therapy (IMRT) between 2017 and 2019. Thermoplastic mask or vacuum bag were utilized for immobilization of different groups. CTVision (Siemens CT-On-Rail system) was used to acquire pre-treatment CT, and 20 consecutive pre-treatment CT datasets were collected for data analysis for each case. Images were exported to MIM (MIM Software Inc.) for processing and data analysis. Dice coefficient, maximum Hausdorff distance and centroid coordinate values between the spinal cord contours in the pre-treatment CTs and the planning CT were calculated and extracted. The contour expansion margin value is calculated as MPRV = 1.3 ∑ total + 0.5 σ total, where ∑ total and σ total are the systematic and random error, respectively. Results: For neck, chest, abdominal segments of the spinal cord, the mean Dice coefficients (± SD) are 0.73 ± 0.06, 0.80 ± 0.06, 0.82 ± 0.06, the maximum Hausdorff distance residual error (± SD) are 4.46 ± 0.55, 3.49 ± 0.53, 3.46 ± 0.69 mm, and the mean centroid coordinate residual error (± SD) are 2.40 ± 0.53, 1.66 ± 0.47, 2.14 ± 0.95 mm, respectively. The calculated margin using residual centroid method in medial-lateral (ML), anterior-posterior (AP), and cranial-caudal (CC) direction of spinal cord in neck, chest, abdominal segments are 3.86, 5.37, 6.36 mm, 3.45, 3.83, 4.51 mm, 4.05, 4.83, 7.06 mm, respectively, and the calculated margin using residual Hausdorff method are 3.10, 5.33 and 6.15 mm, 3.30, 3.77, 4.61 mm, 3.35, 4.76, 6.87 mm, respectively. Conclusion: The setup errors and residual errors are different in each segment of the spinal cord. Different margins expansion should be applied to different segment of spinal cord.
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Affiliation(s)
- Dingjie Li
- Department of Radiation Oncology, 571884The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Shengtao Wei
- Department of Radiation Oncology, 571884The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Tian Li
- Department of Health Technology and Informatics, 26680The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Yang Liu
- Department of Radiation Oncology, 571884The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Jing Cai
- Department of Radiation Oncology, 571884The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China.,Department of Health Technology and Informatics, 26680The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Hong Ge
- Department of Radiation Oncology, 571884The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China
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Kocak Uzel E, Figen M, Uzel ÖE. Is Single Cord Irradiation Going to Be a New Standard for T1a Glottic Carcinoma? Front Oncol 2020; 10:1447. [PMID: 32974165 PMCID: PMC7481455 DOI: 10.3389/fonc.2020.01447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/08/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose and Objective: To evaluate the disease-free survival, overall survival, dosimetric, and voice handicap index (VHI) results of T1a glottic invasive squamous cell carcinoma (SCC) patients who underwent hypofractionated single vocal cord irradiation (HSVCI). Materials and Methods: The data of 18 patients with stage T1a glottic SCC were collected prospectively and analyzed retrospectively between July 2016 and July 2019. Patients were immobilized using a custom-fitted thermoplastic face and shoulder mask in hyperextension position. The CT scan was performed with 1-mm-thick slices. A planned target volume (PTV) margin of 3 mm was given to clinical target volume (CTV) in all directions, and 13 organs at risk were identified. Patients were prescribed a total of 5760–5808 cGy in 15–16 fractions. Patients had daily cone-beam computed tomography (CBCT), and the treatment was carried out with the physician. VHI test was applied to patients before and at the end of radiotherapy (RT) and 1, 2, 3, 4, and 6 months after the completion of RT. Results: Local control and overall survival rate is 100% for a median of 18 months (6–44 months) of follow-up. A patient was diagnosed with 2nd primary lung cancer and active treatment still continues. All patients completed the treatment within the scheduled time. Grade 1–2 dysphagia and dermatitis occurred in all patients, and no grade 3 and above side effects were observed. The mean values of VHI were 37.00, 39.83, 38.28, 17.17, 12.22, 8.56, and 6.06 at the beginning of RT, at the end of RT, and 1, 2, 3, 4, and 6 months after RT, respectively. Conclusion: Compared to surgery and conventional laryngeal radiotherapy, HSVCI is an alternative treatment method for T1a glottic cancer by reducing the treatment time to 3 weeks, facilitating recurrence treatment, and providing effective sound quality without compromising local control. Considering that ~80% of recurrences in glottic cancer occur within the first 2 years, 100% local control in a median of 18 months is extremely successful, but long-term follow-up is essential to observe possible late side effects.
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Affiliation(s)
- Esengul Kocak Uzel
- Radiation Oncology Department, Sisli Hamidiye Etfal Education and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Metin Figen
- Radiation Oncology Department, Sisli Hamidiye Etfal Education and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Ömer Erol Uzel
- Department of Radiation Oncology, Istanbul University-Cerrahpasa Medical Faculty, Istanbul, Turkey
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Kearney M, Coffey M, Leong A. A review of Image Guided Radiation Therapy in head and neck cancer from 2009-201 - Best Practice Recommendations for RTTs in the Clinic. Tech Innov Patient Support Radiat Oncol 2020; 14:43-50. [PMID: 32566769 PMCID: PMC7296359 DOI: 10.1016/j.tipsro.2020.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/17/2020] [Accepted: 02/11/2020] [Indexed: 02/06/2023] Open
Abstract
Radiation therapy (RT) is beneficial in Head and Neck Cancer (HNC) in both the definitive and adjuvant setting. Highly complex and conformal planning techniques are becoming standard practice in delivering increased doses in HNC. A sharp falloff in dose outside the high dose area is characteristic of highly complex techniques and geometric uncertainties must be minimised to prevent under dosage of the target volume and possible over dosage of surrounding critical structures. CTV-PTV margins are employed to account for geometric uncertainties such as set up errors and both interfraction and intrafraction motion. Robust immobilisation and Image Guided Radiation Therapy (IGRT) is also essential in this group of patients to minimise discrepancies in patient position during the treatment course. IGRT has evolved with increased 2-Dimensional (2D) and 3-Dimensional (3D) IGRT modalities available for geometric verification. 2D and 3D IGRT modalities are both beneficial in geometric verification while 3D imaging is a valuable tool in assessing volumetric changes that may have dosimetric consequences for this group of patients. IGRT if executed effectively and efficiently provides clinicians with confidence to reduce CTV-PTV margins thus limiting treatment related toxicities in patients. Accumulated exposure dose from IGRT vary considerably and may be incorporated into the treatment plan to avoid excess dose. However, there are considerable variations in the application of IGRT in RT practice. This paper aims to summarise the advances in IGRT in HNC treatment and provide clinics with recommendations for an IGRT strategy for HNC in the clinic.
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Affiliation(s)
- Maeve Kearney
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College, Dublin 2, Ireland
| | - Mary Coffey
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College, Dublin 2, Ireland
| | - Aidan Leong
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand.,Bowen Icon Cancer Centre, Wellington, New Zealand
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Mohamed ASR, Smith BD, Smith JB, Sevak P, Malek JS, Kanwar A, Browne T, Gunn GB, Garden AS, Frank SJ, Morrison WH, Phan J, Zafereo M, Skinner H, Lai SY, Hutcheson KA, Lewin JS, Hessel AE, Thekdi AA, Weber RS, Fuller CD, Rosenthal DI. Outcomes of carotid-sparing IMRT for T1 glottic cancer: Comparison with conventional radiation. Laryngoscope 2020; 130:146-153. [PMID: 30756394 PMCID: PMC6895404 DOI: 10.1002/lary.27873] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 01/19/2019] [Accepted: 01/28/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We aim to report oncologic outcomes after conventional radiotherapy (ConRT) using opposed lateral beams and intensity-modulated radiation therapy (IMRT) for tumor (T)1 nodal (N)0 T1 N0 glottic squamous cell carcinoma. STUDY DESIGN Retrospective case-control study. METHODS We retrospectively reviewed demographic, disease, and treatment characteristics for patients treated at our institution during 2000 to 2013. RESULTS One hundred fifty-three patients (71%) were treated using ConRT and 62 (29%) using IMRT. The median follow-up for all patients was 68 months. There was no statistically significant difference in 5-year local control between patients with T1a versus T1b disease (94% vs. 89%, respectively, P = 0.5). Three-year locoregional control for patients treated with ConRT was 94% compared to 97% with IMRT (P = 0.4). Three-year overall survival (OS) for patients treated with ConRT was 92.5% compared with 100% with IMRT (P = 0.1). Twelve of 14 patients with local recurrence underwent salvage surgery with 5-year ultimate locoregional control of 98.5% and 97.1% in the ConRT and IMRT cohorts, respectively (P = 0.7). Multivariate analysis showed age < 60 years (P < 0.0001) and pretreatment Eastern Cooperative Oncology Group performance status <2 (P = 0.0022) to be independent correlates of improved OS. Postradiation cerebrovascular events were in four patients in the ConRT cohort (3%), whereas no patients in the IMRT cohort suffered any events. CONCLUSION Because the oncologic outcomes for patients treated with IMRT were excellent and IMRT allows for carotid sparing, we have transitioned to IMRT as our standard for most patients with T1 glottic cancer. LEVEL OF EVIDENCE 3b Laryngoscope, 130:146-153, 2020.
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Affiliation(s)
- Abdallah S R Mohamed
- Multidisciplinary Larynx Cancer Working Group from the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
- Department of Clinical Oncology, University of Alexandria, Alexandria, Egypt
| | - Blaine D Smith
- Multidisciplinary Larynx Cancer Working Group from the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
- University of Texas McGovern Medical School, The University of Texas Graduate School of Biomedical Sciences, Houston, Texas, U.S.A
| | - Joshua B Smith
- Multidisciplinary Larynx Cancer Working Group from the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
- University of Texas McGovern Medical School, The University of Texas Graduate School of Biomedical Sciences, Houston, Texas, U.S.A
| | | | | | | | | | - G Brandon Gunn
- Multidisciplinary Larynx Cancer Working Group from the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Adam S Garden
- Multidisciplinary Larynx Cancer Working Group from the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Steven J Frank
- Multidisciplinary Larynx Cancer Working Group from the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - William H Morrison
- Multidisciplinary Larynx Cancer Working Group from the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Jack Phan
- Multidisciplinary Larynx Cancer Working Group from the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Mark Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Heath Skinner
- Multidisciplinary Larynx Cancer Working Group from the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Jan S Lewin
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Amy E Hessel
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Apurva A Thekdi
- Department of Otolaryngology, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Randal S Weber
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Clifton D Fuller
- Multidisciplinary Larynx Cancer Working Group from the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
- Medical Physics Program, The University of Texas Graduate School of Biomedical Sciences, Houston, Texas, U.S.A
| | - David I Rosenthal
- Multidisciplinary Larynx Cancer Working Group from the Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
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Shimizu H, Sasaki K, Aoyama T, Matsushima S, Isomura T, Fukuma H, Tachibana H, Kodaira T. Development of twist‐correction system for radiotherapy of head and neck cancer patients. J Appl Clin Med Phys 2019; 20:128-134. [PMID: 31222881 PMCID: PMC6612693 DOI: 10.1002/acm2.12667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 04/04/2019] [Accepted: 05/05/2019] [Indexed: 11/09/2022] Open
Abstract
To propose a concept for correcting the twist between the head and neck and the body frequently occurring in radiotherapy patients and to develop a prototype device for achieving this. Furthermore, the operational accuracy of this device under no load was evaluated. We devised a concept for correcting the twist of patients by adjustment of the three rotation (pitch, roll, and yaw) angles in two independent plates connected by a joint (fulcrum). The two plates (head and neck plate and body plate) rotate around the fulcrum by adjusting screws under each of them. A prototype device was created to materialize this concept. First, after all adjusting screws were set to the zero position, the rotation angle of each plate was measured by a digital goniometer. Repeatability was evaluated by performing 20 repeated measurements. Next, to confirm the rotational accuracy of each plate of the prototype device, the calculated rotation angles for 20 combinations of patterns of traveled distances of the adjusting screws were compared with those measured by the digital goniometer and cone‐beam computed tomography (CT). The repeatability (standard deviation: SD) of the pitch, roll, and yaw angles of the head and neck plate was 0.04°, 0.05°, and 0.03°, and the repeatability (SD) of the body plate was 0.05°, 0.04°, and 0.04°, respectively. The mean differences ± SD between the calculated and measured pitch, roll, and yaw angles for the head and neck plate with the digital goniometer were 0.00 ± 0.06°, −0.01 ± 0.06°, and −0.04 ± 0.04°, respectively. The differences for the body plate were −0.03 ± 0.04°, 0.03 ± 0.05°, and 0.02 ± 0.05°, respectively. Results of the cone‐beam CT were similar to those of the digital goniometer. The prototype device exhibited good performance regarding the rotational accuracy and repeatability under no load. The clinical implementation of this concept is expected to reduce the residual error of the patient position due to the twist.
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Affiliation(s)
- Hidetoshi Shimizu
- Department of Radiation Oncology Aichi Cancer Center Hospital Aichi Japan
- Graduate School of Radiological Technology Gunma Prefectural College of Health Sciences Gunma Japan
| | - Koji Sasaki
- Graduate School of Radiological Technology Gunma Prefectural College of Health Sciences Gunma Japan
| | - Takahiro Aoyama
- Department of Radiation Oncology Aichi Cancer Center Hospital Aichi Japan
| | - Shigeru Matsushima
- Department of Diagnostic and Interventional Radiology Aichi Cancer Center Hospital Aichi Japan
| | - Taiki Isomura
- Department of Radiation Oncology Aichi Cancer Center Hospital Aichi Japan
| | - Hiroshi Fukuma
- Department of Radiology Nagoya City University Hospital Aichi Japan
| | - Hiroyuki Tachibana
- Department of Radiation Oncology Aichi Cancer Center Hospital Aichi Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology Aichi Cancer Center Hospital Aichi Japan
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Liu Z, Liu X, Zhang F, Hu K. How much margin do we need for pelvic lymph nodes irradiation in the era of IGRT? J Cancer 2018; 9:3683-3689. [PMID: 30405837 PMCID: PMC6216005 DOI: 10.7150/jca.27220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 07/05/2018] [Indexed: 02/07/2023] Open
Abstract
Background and purpose: Image guided radiotherapy (IGRT) without 6 degree of freedom couch can only correct the translational setup errors of pelvic radiotherapy. But errors introduced by rotation and deformation of CTV can't be adjusted in most of IGRT systems. This article is to evaluate these errors and to provide recommendations on the margin needed in the era of IGRT. Material and methods: 218 patients who received pelvic radiotherapy in PUMC Hospital from 2012 to 2014 were included. A simulation CT and a CBCT were acquired for every patient. 3D and 6D registrations of CT and CBCT were applied. 9 bony landmarks were marked and distances of each landmark between CT and CBCT were measured in three directions. Results: Without image guidance, movements of landmarks in the directions of LR, AP and SI were 0.4 ± 2.5 mm, 1.3 ± 3.8 mm and 1.5 ± 5.0 mm respectively, with 3D-registration, movements were 0.0 ± 1.5 mm, 0.7± 2.8 mm and 0.6± 3.2 mm, and with 6D-registration, movements were 0.0 ± 0.5 mm, 0.2 ± 1.0 mm and 0.2 ± 1.1 mm in each direction. Conclusions: IGRT could reduce setup errors. IGRT with 6D treatment couches could further reduce setup errors compared to 3D couches. For centers without IGRT, we suggest CTV-PTV margins of 6 mm, 9 mm and 12 mm in LR, AP and SI directions respectively, margins of 3 mm, 6.5 mm and 7 mm for the use of daily IGRT with 3D couch and 2 mm, 3 mm and 3 mm for 6D couch.
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Affiliation(s)
- Zhikai Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xia Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Tong Y, Gong G, Chen J, Lu J, Liu T, Cheng P, Yin Y. The heterogeneous CTV-PTV margins should be given for different parts of tumors during tomotherapy. Oncotarget 2017; 8:89086-89094. [PMID: 29179501 PMCID: PMC5687671 DOI: 10.18632/oncotarget.21631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/07/2017] [Indexed: 11/25/2022] Open
Abstract
Objective The purpose of this study was to evaluate CTV-PTV margins of tumors for tomotherapy. Methods Setup errors were analyzed for 151 patients receiving helical tomotherapy treatment. 53 patients had head and neck tumors, 45 had thoracic tumors, 20 had abdominal tumors, and 33 had pelvic tumors. The setup errors were calculated in six directions, i.e. +X (left), -X (right), +Y (head), -Y (foot), +Z (ventral), and -Z (dorsal), after Megavoltage CT (MVCT) images were registered to simulation CT images. And then the CTV-PTV margins were calculated. Results The setup errors along the +Z direction were significantly higher than that along the –Z direction (p<0.05). The CTV-PTV margins on +X, -X, +Y, -Y, +Z, and -Z directions were asymmetric for all tumors, and the heterogeneity were more remarkable on the +Z and –Z directions. The CTV-PTV margins on +Z and –Z were 4.1 mm, 4.6 mm, 5.2 mm, and 8.4 mm; and 3.9 mm, 7.7 mm, 3.3 mm, and 7.7 mm for head and neck tumors, thoracic tumors, abdominal tumors, and pelvic tumors, respectively. Conclusions The CTV-PTV margins for patients with different types of tumors were heterogeneous during tomotherapy. The individual margins of six directions should be given for those patients who accept tomotherapy.
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Affiliation(s)
- Ying Tong
- School of Nuclear Science and Technology, University of South China, Hengyang, China
| | - Guanzhong Gong
- Radiation Physics Department of Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Jinhu Chen
- Radiation Physics Department of Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Jie Lu
- Radiation Physics Department of Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Tonghai Liu
- Radiation Physics Department of Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Pinjing Cheng
- School of Nuclear Science and Technology, University of South China, Hengyang, China
| | - Yong Yin
- Radiation Physics Department of Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
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Bhattacharjee A, Jose J, Vishwakarma GK, Kumar R. Joint modeling of missing and mismeasured measurements for computing radiotherapy margins. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2017. [DOI: 10.1016/j.cegh.2016.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Dose-volume correlates of mandibular osteoradionecrosis in Oropharynx cancer patients receiving intensity-modulated radiotherapy: Results from a case-matched comparison. Radiother Oncol 2017; 124:232-239. [PMID: 28733053 PMCID: PMC5572506 DOI: 10.1016/j.radonc.2017.06.026] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 06/22/2017] [Accepted: 06/25/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine dosimetric parameters associated with osteoradionecrosis (ORN) in oropharyngeal cancer (OPC) patients in the IMRT era. MATERIAL AND METHODS Subsequent to institutional review board approval, we identified ORN in OPC patients treated with IMRT from 2002 to 2013. 1:2 case-control matching was implemented. Mandibular dose-volume histograms (DVH) were extracted. Dosimetric parameters were compared using non-parametric stats. Recursive partitioning analysis (RPA) was done to identify DVH correlates of ORN. RESULTS 68 ORN cases and 131 controls were matched. Median follow-up was 41months and median time to development of ORN was 16months. Mandibular mean dose was significantly higher in the ORN cohort (48.1 vs 43.6Gy, p<0.0001). However, the maximum dose was not statistically different. DVH bins from V35 to V73 were all significantly higher in the ORN cohort compared with controls (p<0.0006). Two DVH parameters were identified in RPA analysis, V43 and V58. The majority (81%) of ORN cases were observed with both V44≥42% and V58≥25%. CONCLUSIONS Our data demonstrate that a wide range of DVH parameters in the intermediate and high beam path were all significantly higher in ORN patients. Mandibular V44<42% and V58<25% represent reasonable DVH constraints for IMRT plan acceptability, when tumor coverage is not compromised.
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Choi HS, Jeong BK, Jeong H, Song JH, Kim JP, Park JJ, Woo SH, Kang KM. Carotid sparing intensity modulated radiotherapy on early glottic cancer: preliminary study. Radiat Oncol J 2016; 34:26-33. [PMID: 27104164 PMCID: PMC4831966 DOI: 10.3857/roj.2016.34.1.26] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 02/05/2016] [Accepted: 03/03/2016] [Indexed: 12/11/2022] Open
Abstract
Purpose To compare the dose distribution between carotid sparing intensity modulated radiotherapy (IMRT) and opposed lateral field technique (LAFT), and to determine the effects of carotid sparing IMRT in early glottic cancer patients who have risk factors for atherosclerosis. Materials and Methods Ten early glottic cancer patients were treated with carotid sparing IMRT. For each patient, the conventional LAFT plan was developed for comparison. IMRT and LAFT plans were compared in terms of planning target volume (PTV) coverage, conformity index, homogeneity index, and the doses to planning organ at risk volume (PRV) for carotid arteries, spinal cord and pharyngeal constrictor muscle. Results Recurrence was not observed in any patients during the follow-up period. V95% for PTV showed no significant difference between IMRT and LAFT plans, while V100% was significantly higher in the IMRT plan (95.5% vs. 94.6%, p = 0.005). The homogeneity index (11.6%) and conformity index (1.4) in the IMRT plan were significantly better than those in the LAFT plans (8.5% and 5.1, respectively) (p = 0.005). The median V5Gy (90.0%), V25Gy (13.5%), and V50Gy (0%) for carotid artery PRV in the IMRT plan were significantly lower than those in the LAFT plan (99.1%, 89.0%, and 77.3%, respectively) (p = 0.005). Conclusion Our study suggests that carotid sparing IMRT can significantly decrease the dose to carotid arteries compared to LAFT, and it would be considered for early glottic cancer patient with high risk of atherosclerosis.
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Affiliation(s)
- Hoon Sik Choi
- Department of Radiation Oncology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Bae Kwon Jeong
- Department of Radiation Oncology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.; Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Hojin Jeong
- Department of Radiation Oncology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.; Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Jin Ho Song
- Department of Radiation Oncology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.; Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Jin Pyeong Kim
- Institute of Health Science, Gyeongsang National University, Jinju, Korea.; Department of Otorhinolaryngology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jung Je Park
- Institute of Health Science, Gyeongsang National University, Jinju, Korea.; Department of Otorhinolaryngology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Seung Hoon Woo
- Institute of Health Science, Gyeongsang National University, Jinju, Korea.; Department of Otorhinolaryngology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ki Mun Kang
- Department of Radiation Oncology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.; Department of Otorhinolaryngology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
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