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Nichols EM, Bentzen SM, Milburn M, Kesmodel SB, Bellavance E, Becker SJ, Mutaf Y, Tkaczuk K, Rosenblatt P, Feigenberg SJ. A Prospective Trial of Single-Fraction Radiation to the Tumor Bed with a Novel Breast-Specific Stereotactic Radiation Therapy Device: The GammaPod. Adv Radiat Oncol 2024; 9:101398. [PMID: 38778822 PMCID: PMC11110030 DOI: 10.1016/j.adro.2023.101398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/24/2023] [Indexed: 05/25/2024] Open
Abstract
Purpose Radiation therapy for early-stage breast cancer is typically delivered in a hypofractionated regimen to the whole breast followed by a tumor bed boost. This results in a treatment course of approximately 4 weeks. In this study, the tumor bed boost was delivered in a single fraction as part of a safety and feasibility study for FDA clearance of the device. Methods and Materials Eligible women with early-stage breast cancer underwent lumpectomy followed by radiation therapy. Patients underwent breast immobilization using a system specific to the GammaPod followed by CT simulation, boost treatment planning, and boost treatment delivery all in a single treatment day. Patients then started whole-breast radiation therapy within 1 week of the boost treatment. Patients and treatments were assessed for safety and feasibility. Acute toxicities were recorded. Results A single-fraction boost of 8 Gy was delivered to the tumor bed before a course of whole-breast radiation. The GammaPod treatment was successfully delivered to 14 of 17 enrolled patients. Acute toxicities from all radiation therapy, inclusive of the boost and whole-breast radiation, were limited to grade 1 events. Conclusions The GammaPod device successfully delivered a single-fraction boost treatment to the tumor bed with no change in expected acute toxicities. The results of this study led to FDA clearance of the device through the Investigational Device Exemption process at the FDA. The GammaPod is in clinical use at 4e institutions nationally and internationally, with additional sites pending in 2023.
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Affiliation(s)
- Elizabeth M. Nichols
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Søren M. Bentzen
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | | | | | | | | | | | | | | | - Steven J. Feigenberg
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Takanen S, Pinnarò P, Farina I, Sperati F, Botti C, Vici P, Soriani A, Marucci L, Sanguineti G. Stereotactic partial breast irradiation in primary breast cancer: A comprehensive review of the current status and future directions. Front Oncol 2022; 12:953810. [PMID: 36313648 PMCID: PMC9606691 DOI: 10.3389/fonc.2022.953810] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
In selected low-risk breast cancer patients, accelerated partial breast irradiation (APBI) may represent an alternative option to the whole breast irradiation to reduce the volume of irradiated breast and total treatment duration. In the last few years, preliminary data from clinical trials showed that stereotactic partial breast radiotherapy may have the advantage to be less invasive compared to other APBI techniques, with preliminary good results in terms of local toxicity and cosmesis: the use of magnetic resonance, fiducial markers in the tumor bed, and new breast devices support both a precise definition of the target and radiation planning.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021257856, identifier CRD42021257856.
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Affiliation(s)
- Silvia Takanen
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
- *Correspondence: Silvia Takanen, ; Ilaria Farina,
| | - Paola Pinnarò
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Ilaria Farina
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
- *Correspondence: Silvia Takanen, ; Ilaria Farina,
| | - Francesca Sperati
- Biostatistics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Claudio Botti
- Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Phase IV Studies, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Antonella Soriani
- Physics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Marucci
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Sanguineti
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
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Snider JW, Nichols EM, Mutaf YD, Chen S, Molitoris J, Diwanji T, Becker SJ, Feigenberg SJ. Reproducibility of a novel, vacuum-assisted immobilization for breast stereotactic radiotherapy. J Appl Clin Med Phys 2021; 22:8-15. [PMID: 33656237 PMCID: PMC7984473 DOI: 10.1002/acm2.13127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/12/2020] [Accepted: 10/18/2020] [Indexed: 11/13/2022] Open
Abstract
A novel, breast‐specific stereotactic radiotherapy device has been developed for delivery of highly conformal, accelerated partial breast irradiation. This device employs a unique, vacuum‐assisted, breast cup immobilization system that applies a gentle, negative pressure to the target breast with the patient in the prone position. A device‐specific patient loader is utilized for simulation scanning and device docking. Prior to clinical activation, a prospective protocol enrolled 25 patients who had been or were to be treated with breast conservation surgery and adjuvant radiotherapy for localized breast cancer. The patients underwent breast cup placement and two separate CT simulation scans. Surgical clips within the breast were mapped and positions measured against the device’s integrated stereotactic fiducial/coordinate system to confirm reproducible and durable immobilization during the simulation, treatment planning, and delivery process for the device. Of the enrolled 25 patients, 16 were deemed eligible for analysis. Seventy‐three clips (median, 4; mean, 4.6; range, 1–8 per patient) were mapped in these selected patients on both the first and second CT scans. X, Y, and Z coordinates were determined for the center point of each clip. Length of vector change in position was determined for each clip between the two scans. The mean displacement of implanted clips was 1.90 mm (median, 1.47 mm; range, 0.44–6.52 mm) (95% CI, 1.6–2.20 mm). Additional analyses stratified clips by position within the breast and depth into the immobilization cup. Overall, this effort validated the clinically utilized 3‐mm planning target volume margin for accurate, reliable, and precise employment of the device.
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Affiliation(s)
- James W Snider
- Department of Radiation Oncology, University of Alabama at Birmingham Alabama, Birmingham, AL, USA
| | - Elizabeth M Nichols
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Yildirim D Mutaf
- Department of Radiation Oncology, Kaiser Permanente, Dublin, CA, USA
| | - Shifeng Chen
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jason Molitoris
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tejan Diwanji
- Department of Radiation Oncology, University of Miami, Coral Gables, FL, USA
| | - Stewart J Becker
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Steven J Feigenberg
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
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Zheng Y, Samant P, Merill J, Chen Y, Ahmad S, Li D, Xiang L. X-ray-induced acoustic computed tomography for guiding prone stereotactic partial breast irradiation: a simulation study. Med Phys 2020; 47:4386-4395. [PMID: 32428252 PMCID: PMC7674271 DOI: 10.1002/mp.14245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 04/22/2020] [Accepted: 05/11/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The aim of this study is to investigate the feasibility of x-ray-induced acoustic computed tomography (XACT) as an image guidance tool for tracking x-ray beam location and monitoring radiation dose delivered to the patient during stereotactic partial breast irradiation (SPBI). METHODS An in-house simulation workflow was developed to assess the ability of XACT to act as an in vivo dosimetry tool for SPBI. To evaluate this simulation workflow, a three-dimensional (3D) digital breast phantom was created by a series of two-dimensional (2D) breast CT slices from a patient. Three different tissue types (skin, adipose tissue, and glandular tissue) were segmented and the postlumpectomy seroma was simulated inside the digital breast phantom. A treatment plan was made with three beam angles to deliver radiation dose to the seroma in breast to simulate SPBI. The three beam angles for 2D simulations were 17°, 90° and 159° (couch angles were 0 degrees) while the angles were 90 degrees (couch angles were 0°, 27°, 90°) in 3D simulation. A multi-step simulation platform capable of modelling XACT was developed. First, the dose distribution was converted to an initial pressure distribution. The propagation of this pressure disturbance in the form of induced acoustic waves was then modeled using the k-wave MATLAB toolbox. The waves were then detected by a hemispherical-shaped ultrasound transducer array (6320 transducer locations distributed on the surface of the breast). Finally, the time-varying pressure signals detected at each transducer location were used to reconstruct an image of the initial pressure distribution using a 3D time-reversal reconstruction algorithm. Finally, the reconstructed XACT images of the radiation beams were overlaid onto the structure breast CT. RESULTS It was found that XACT was able to reconstruct the dose distribution of SPBI in 3D. In the reconstructed 3D volumetric dose distribution, the average doses in the GTV (Gross Target Volume) and PTV (Planning Target Volume) were 86.15% and 80.89%, respectively. When compared to the treatment plan, the XACT reconstructed dose distribution in the GTV and PTV had a RMSE (root mean square error) of 2.408 % and 2.299 % over all pixels. The 3D breast XACT imaging reconstruction with time-reversal reconstruction algorithm can be finished within several minutes. CONCLUSIONS This work explores the feasibility of using the novel imaging modality of XACT as an in vivo dosimeter for SPBI radiotherapy. It shows that XACT imaging can provide the x-ray beam location and dose information in deep tissue during the treatment in real time in 3D. This study lays the groundwork for a variety of future studies related to the use of XACT as a dosimeter at different cancer sites.
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Affiliation(s)
- Yue Zheng
- Shandong Key Laboratory of Medical Physics and Image Processing & Shandong Provincial Engineering and Technical Center of Light Manipulations, School of Physics and Electronics, Shandong Normal University, Jinan 250358, China; School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Pratik Samant
- School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Jack Merill
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Yong Chen
- Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Salahuddin Ahmad
- Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Dengwang Li
- Shandong Key Laboratory of Medical Physics and Image Processing & Shandong Provincial Engineering and Technical Center of Light Manipulations, School of Physics and Electronics, Shandong Normal University, Jinan 250358, China
| | - Liangzhong Xiang
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019, USA
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Yoo S, O'Daniel J, Blitzblau R, Yin FF, Horton JK. Accuracy and efficiency of image-guided radiation therapy (IGRT) for preoperative partial breast radiosurgery. JOURNAL OF RADIOSURGERY AND SBRT 2020; 6:295-301. [PMID: 32185089 PMCID: PMC7065902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/31/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To analyze and evaluate accuracy and efficiency of IGRT process for preoperative partial breast radiosurgery. METHODS Patients were initially setup with skin marks and 5 steps were performed: (1) Initial orthogonal 2D kV images, (2) pre-treatment 3D CBCT images, (3) verification orthogonal 2D kV images, (4) treatment including mid-treatment 2D kV images (for the final 15 patients only), and (5) post-treatment orthogonal 2D kV or 3D CBCT images. Patient position was corrected at each step to align the biopsy clip and to verify surrounding soft tissue positioning. RESULTS The mean combined vector magnitude shifts and standard deviations at the 5 imaging steps were (1) 0.96 ± 0.69, (2) 0.33 ± 0.40, (3) 0.05 ± 0.12, (4) 0.15 ± 0.17, and (5) 0.27 ± 0.24 in cm. The mean total IGRT time was 40.2 ± 13.2 minutes. Each step was shortened by 2 to 5 minutes with improvements implemented. Overall, improvements in the IGRT process reduced the mean total IGRT time by approximately 20 minutes. Clip visibility was improved by implementing oblique orthogonal images. CONCLUSION Multiple imaging steps confirmed accurate patient positioning. Appropriate planning and imaging strategies improved the effectiveness and efficiency of the IGRT process for preoperative partial breast radiosurgery.
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Affiliation(s)
- Sua Yoo
- Duke University Medical Center, Durham, NC, USA
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