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Winter JD, Reddy V, Li W, Craig T, Raman S. Impact of technological advances in treatment planning, image guidance, and treatment delivery on target margin design for prostate cancer radiotherapy: an updated review. Br J Radiol 2024; 97:31-40. [PMID: 38263844 PMCID: PMC11027310 DOI: 10.1093/bjr/tqad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/22/2023] [Accepted: 11/21/2023] [Indexed: 01/25/2024] Open
Abstract
Recent innovations in image guidance, treatment delivery, and adaptive radiotherapy (RT) have created a new paradigm for planning target volume (PTV) margin design for patients with prostate cancer. We performed a review of the recent literature on PTV margin selection and design for intact prostate RT, excluding post-operative RT, brachytherapy, and proton therapy. Our review describes the increased focus on prostate and seminal vesicles as heterogenous deforming structures with further emergence of intra-prostatic GTV boost and concurrent pelvic lymph node treatment. To capture recent innovations, we highlight the evolution in cone beam CT guidance, and increasing use of MRI for improved target delineation and image registration and supporting online adaptive RT. Moreover, we summarize new and evolving image-guidance treatment platforms as well as recent reports of novel immobilization strategies and motion tracking. Our report also captures recent implementations of artificial intelligence to support image guidance and adaptive RT. To characterize the clinical impact of PTV margin changes via model-based risk estimates and clinical trials, we highlight recent high impact reports. Our report focusses on topics in the context of PTV margins but also showcase studies attempting to move beyond the PTV margin recipes with robust optimization and probabilistic planning approaches. Although guidelines exist for target margins conventional using CT-based image guidance, further validation is required to understand the optimal margins for online adaptation either alone or combined with real-time motion compensation to minimize systematic and random uncertainties in the treatment of patients with prostate cancer.
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Affiliation(s)
- Jeff D Winter
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Varun Reddy
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Winnie Li
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Tim Craig
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Srinivas Raman
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
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Fu Q, Kong XC, Liu DX, Zhou K, Guo YH, Lei ZQ, Zheng CS, Yang F. Turbo Gradient and Spin Echo PROPELLER-Diffusion Weighted Imaging for Orbital Tumors: A Comparative Study With Readout-Segmented Echo-Planar Imaging. Front Neurosci 2021; 15:755327. [PMID: 34916899 PMCID: PMC8670178 DOI: 10.3389/fnins.2021.755327] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose: To qualitatively and quantitatively compare the image quality and diagnostic performance of turbo gradient and spin echo PROPELLER diffusion-weighted imaging (TGSE-PROPELLER-DWI) vs. readout-segmented echo-planar imaging (rs-EPI) in the evaluation of orbital tumors. Materials and Methods: A total of 43 patients with suspected orbital tumors were enrolled to perform the two DWIs with comparable spatial resolution on 3T. The overall image qualities, geometric distortions, susceptibility artifacts, and lesion conspicuities were scored by using a four-point scale (1, poor; 4, excellent). Quantitative measurements, including contrast-to-noise ratios (CNRs), apparent diffusion coefficients (ADCs), geometric distortion rates (GDRs), and lesion sizes, were calculated and compared. The two ADCs for differentiating malignant from benign orbital tumors were evaluated. Wilcoxon signed-rank test, Kappa statistic, and receiver operating characteristics (ROC) curves were used. Results: TGSE-PROPELLER-DWI performed superior in all subjective scores and quantitative GDR evaluation than rs-EPI (p < 0.001), and excellent interobserver agreement was obtained for Kappa value ranging from 0.876 to 1.000. ADClesion of TGSE-PROPELLER-DWI was significantly higher than those of rs-EPI (p < 0.001). Mean ADC of malignant tumors was significantly lower than that of benign tumors both in two DWIs. However, the AUC for differentiating malignant and benign tumors showed no significant difference in the two DWIs (0.860 vs. 0.854, p = 0.7448). Sensitivity and specificity could achieve 92.86% and 72.73% for TGSE-PROPELLER-DWI with a cutoff value of 1.23 × 10–3 mm2/s, and 85.71% and 81.82% for rs-EPI with a cutoff value of 0.99 × 10–3 mm2/s. Conclusion: Compared with rs-EPI, TGSE-PROPELLER-DWI showed minimized geometric distortion and susceptibility artifacts significantly improved the image quality for orbital tumors and achieved comparable diagnostic performance in differentiating malignant and benign orbital tumors.
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Affiliation(s)
- Qing Fu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xiang-Chuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Ding-Xi Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Kun Zhou
- Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Yi-Hao Guo
- MR Collaboration, Siemens Healthcare Ltd., Guangzhou, China
| | - Zi-Qiao Lei
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chuan-Sheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Fan Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Studenski MT, Delgadillo R, Xu Y, Both J, Padgett K, Abramowitz M, Ford JC, Dal Pra A, Pollack A, Dogan N. Margin verification for hypofractionated prostate radiotherapy using a novel dose accumulation workflow and iterative CBCT. Phys Med 2020; 77:154-159. [PMID: 32862068 DOI: 10.1016/j.ejmp.2020.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/20/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Hypofractionated radiotherapy for prostate cancer reduces the inconvenience of an extended treatment course but the appropriate treatment margin to ensure tumor control while minimizing toxicity is not standardized. Using a novel dose accumulation workflow with iterative CBCT (iCBCT) images, we were able to validate treatment margins. METHODS Sixteen patients treated to the prostate on a hypofractionated clinical trial were selected. Prescription dose was 3625 cGy to > 95% of the PTV in 5 fractions with a boost to 4000 cGy to the high risk GTV (if applicable). PTV margin expansion was 5 mm isotropic except 3 mm posterior, no margin for the GTV. Daily iCBCT images were obtained while practicing strict bladder and rectal filling protocols. Using a novel adaptive dose accumulation workflow, synthetic CTs were created and the daily delivered dose was recalculated. The daily dose distributions were accumulated and target coverage and organ dose were assessed. RESULTS Although the PTV coverage dropped for the accumulated dose, the prostate coverage was not compromised. The differences in bladder and anorectum dose were not significantly different. Four patients received a boost to the GTV and a significant decrease in coverage was noted in the accumulated dose. CONCLUSIONS The novel dose accumulation workflow demonstrated that daily iCBCT images can be used for dose accumulation. We found that our clinical treatment margins resulted in adequate dose to the prostate while sparing OARs. If the goal is to deliver the full dose to an intra-prostatic GTV, a margin may be appropriate.
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Affiliation(s)
- Matthew T Studenski
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136, United States.
| | - Rodrigo Delgadillo
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136, United States
| | - Yihang Xu
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136, United States
| | - Joseph Both
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136, United States
| | - Kyle Padgett
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136, United States
| | - Matthew Abramowitz
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136, United States
| | - John C Ford
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136, United States
| | - Alan Dal Pra
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136, United States
| | - Alan Pollack
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136, United States
| | - Nesrin Dogan
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136, United States
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Bergen RV, Ryner L, Essig M. Field-map correction in read-out segmented echo planar imaging for reduced spatial distortion in prostate DWI for MRI-guided radiotherapy applications. Magn Reson Imaging 2019; 67:43-49. [PMID: 31843418 DOI: 10.1016/j.mri.2019.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/15/2019] [Accepted: 12/07/2019] [Indexed: 11/15/2022]
Abstract
Diffusion-weighted echo planar imaging (DW-EPI) suffers from geometric distortion due to low phase-encoding bandwidth. Read-out segmented echo planar imaging (RS-EPI) reduces distortion but residual distortion remains in extreme cases. Additional corrections need to be applied, especially for radiotherapy applications where a high degree of accuracy is needed. In this study the use of magnetic field map corrections are assessed in DW-EPI and RS-EPI, to reduce geometric uncertainty for MRI-guided radiotherapy applications. Magnetic field maps were calculated from gradient echo images and distortion corrections were applied to RS-EPI images. Distortions were assessed in a prostate phantom by comparing to the known geometry, and in vivo using a modified Hausdorff distance metric using a T2-weighted spin echo as ground truth. Across 10 patients, field map-corrected RS-EPI reduced maximum distortion by 5 mm on average compared to DW-EPI (σ = 1.9 mm). Geometric distortions were also reduced significantly using field mapping with RS-EPI, compared to RS-EPI alone (p ≤ 0.05). The increased geometric accuracy of these techniques can potentially allow diffusion-weighted images to be fused with other MR or CT images for radiotherapy treatment purposes.
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Affiliation(s)
- Robert V Bergen
- Department of Physics & Astronomy, University of Manitoba, Canada; Medical Physics, CancerCare Manitoba, Canada
| | - Lawrence Ryner
- Department of Physics & Astronomy, University of Manitoba, Canada; Medical Physics, CancerCare Manitoba, Canada.
| | - Marco Essig
- Department of Radiology, University of Manitoba, Canada
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