1
|
Zhang J, Wang Y, Bai X, Chen M. Extracting lung contour deformation features with deep learning for internal target motion tracking: a preliminary study. Phys Med Biol 2023; 68:195009. [PMID: 37586388 DOI: 10.1088/1361-6560/acf10e] [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: 05/21/2023] [Accepted: 08/16/2023] [Indexed: 08/18/2023]
Abstract
Objective. To propose lung contour deformation features (LCDFs) as a surrogate to estimate the thoracic internal target motion, and to report their performance by correlating with the changing body using a cascade ensemble model (CEM). LCDFs, correlated to the respiration driver, are employed without patient-specific motion data sampling and additional training before treatment.Approach. LCDFs are extracted by matching lung contours via an encoder-decoder deep learning model. CEM estimates LCDFs from the currently captured body, and then uses the estimated LCDFs to track internal target motion. The accuracy of the proposed LCDFs and CEM were evaluated using 48 targets' motion data, and compared with other published methods.Main results. LCDFs estimated the internal targets with a localization error of 2.6 ± 1.0 mm (average ± standard deviation). CEM reached a localization error of 4.7 ± 0.9 mm and a real-time performance of 256.9 ± 6.0 ms. With no internal anatomy knowledge, they achieved a small accuracy difference (of 0.34∼1.10 mm for LCDFs and of 0.43∼1.75 mm for CEM at the 95% confidence level) with a patient-specific lung biomechanical model and the deformable image registration models.Significance. The results demonstrated the effectiveness of LCDFs and CEM on tracking target motion. LCDFs and CEM are non-invasive, and require no patient-specific training before treatment. They show potential for broad applications.
Collapse
Affiliation(s)
- Jie Zhang
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Yajuan Wang
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Xue Bai
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Ming Chen
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, People's Republic of China
| |
Collapse
|
2
|
Borghetti P, Guerini AE, Sangalli C, Piperno G, Franceschini D, La Mattina S, Arcangeli S, Filippi AR. Unmet needs in the management of unresectable stage III non-small cell lung cancer: a review after the 'Radio Talk' webinars. Expert Rev Anticancer Ther 2022; 22:549-559. [PMID: 35450510 DOI: 10.1080/14737140.2022.2069098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Stage III non-small cell lung cancer (NSCLC) is a variable entity, encompassing bulky primary tumors, nodal involvement or both. Multidisciplinary evaluation is essential to discuss multiple treatment options, to outline optimal management and to examine the main debated topics and critical issues not addressed by current trials and guidelines that influence daily clinical practice. AREAS COVERED From March to May 2021, 5 meetings were scheduled in a webinar format titled 'Radio Talk' due to the COVID-19 pandemic; the faculty was composed of 6 radiation oncologists from 6 different Institutions of Italy, all of them were the referring radiation oncologist for lung cancer treatment at their respective departments and were or had been members of AIRO (Italian Association of Radiation Oncology) Thoracic Oncology Study Group. The topics covered included: pulmonary toxicity, cardiac toxicity, radiotherapy dose, fractionation and volumes, unfit/elderly patients, multidisciplinary management. EXPERT OPINION The debate was focused on the unmet needs triggered by case reports, personal experiences and questions; the answers were often not univocal, however, the exchange of opinion and the contribution of different centers confirmed the role of multidisciplinary management and the necessity that the most critical issues should be investigated in clinical trials.
Collapse
Affiliation(s)
- Paolo Borghetti
- Department of Radiation Oncology, University and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Andrea Emanuele Guerini
- Department of Radiation Oncology, University and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Claudia Sangalli
- Department of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gaia Piperno
- Division of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Davide Franceschini
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Salvatore La Mattina
- Department of Radiation Oncology, University and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Stefano Arcangeli
- Department of Radiation Oncology, School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Andrea Riccardo Filippi
- Department of Radiation Oncology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| |
Collapse
|
3
|
Shahzadeh S, Gholami S, Aghamiri SMR, Mahani H, Nabavi M, Kalantari F. Evaluation of normal lung tissue complication probability in gated and conventional radiotherapy using the 4D XCAT digital phantom. Comput Biol Med 2018; 97:21-29. [PMID: 29684782 DOI: 10.1016/j.compbiomed.2018.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 04/10/2018] [Accepted: 04/10/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE The present study was conducted to investigate normal lung tissue complication probability in gated and conventional radiotherapy (RT) as a function of diaphragm motion, lesion size, and its location using 4D-XCAT digital phantom in a simulation study. MATERIALS AND METHODS Different time series of 3D-CT images were generated using the 4D-XCAT digital phantom. The binary data obtained from this phantom were then converted to the digital imaging and communication in medicine (DICOM) format using an in-house MATLAB-based program to be compatible with our treatment planning system (TPS). The 3D-TPS with superposition computational algorithm was used to generate conventional and gated plans. Treatment plans were generated for 36 different XCAT phantom configurations. These included four diaphragm motions of 20, 25, 30 and 35 mm, three lesion sizes of 3, 4, and 5 cm in diameter and each tumor was placed in four different lung locations (right lower lobe, right upper lobe, left lower lobe and left upper lobe). The complication of normal lung tissue was assessed in terms of mean lung dose (MLD), the lung volume receiving ≥20 Gy (V20), and normal tissue complication probability (NTCP). RESULTS The results showed that the gated RT yields superior outcomes in terms of normal tissue complication compared to the conventional RT. For all cases, the gated radiation therapy technique reduced the mean dose, V20, and NTCP of lung tissue by up to 5.53 Gy, 13.38%, and 23.89%, respectively. CONCLUSIONS The results of this study showed that the gated RT provides significant advantages in terms of the normal lung tissue complication, compared to the conventional RT, especially for the lesions near the diaphragm.
Collapse
Affiliation(s)
- Sara Shahzadeh
- Department of Medical Radiation Engineering, Shahid Beheshti University, Tehran, Iran
| | - Somayeh Gholami
- Radiotherapy Oncology Research Centre, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Hojjat Mahani
- Research Center for Molecular and Cellular Imaging, Tehran University of Medical Science, Tehran, Iran; Radiation Application Research School, Nuclear Science and Technology Research Institute, Tehran, Iran
| | - Mansoure Nabavi
- Radiotherapy Oncology Research Centre, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Faraz Kalantari
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
4
|
Kadoya N, Ichiji K, Uchida T, Nakajima Y, Ikeda R, Uozumi Y, Zhang X, Bukovsky I, Yamamoto T, Takeda K, Takai Y, Jingu K, Homma N. Dosimetric evaluation of MLC-based dynamic tumor tracking radiotherapy using digital phantom: Desired setup margin for tracking radiotherapy. Med Dosim 2017; 43:74-81. [PMID: 28958471 DOI: 10.1016/j.meddos.2017.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 07/12/2017] [Accepted: 08/22/2017] [Indexed: 12/24/2022]
Abstract
The purpose of this study is to evaluate the dosimetric impact of the margin on the multileaf collimator-based dynamic tumor tracking plan. Furthermore, an equivalent setup margin (EM) of the tracking plan was determined according to the gated plan. A 4-dimensional extended cardiac-torso was used to create 9 digital phantom datasets of different tumor diameters (TDs) of 1, 3, and 5 cm and motion ranges (MRs) of 1, 2, and 3 cm. For each dataset, respiratory gating (30% to 70% phase) and tumor tracking treatment plans were prepared using 8-field 3-dimensional conformal radiation therapy by 4-dimensional dose calculation. The total lung V20 was calculated to evaluate the dosimetric impact for each case and to estimate the EM with the same impact on lung V20 obtained with the gating plan with a setup margin of 5 mm. The EMs for {TD = 1 cm, MR = 1 cm}, {TD = 1 cm, MR = 2 cm}, and {TD = 1 cm, MR = 3 cm} were estimated as 5.00, 4.16, and 4.24 mm, respectively. The EMs for {TD = 5 cm, MR = 1 cm}, {TD = 5 cm, MR = 2 cm}, and {TD = 5 cm, MR = 3 cm} were estimated as 4.24 mm, 6.35 mm, and 7.49 mm, respectively. This result showed that with a larger MR, the EM was found to be increased. In addition, with a larger TD, the EM became smaller. Our result showing the EMs provided the desired accuracy for multileaf collimator-based dynamic tumor tracking radiotherapy.
Collapse
Affiliation(s)
- Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Kei Ichiji
- Department of Therapeutic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomoya Uchida
- Department of Radiological Imaging and Informatics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yujiro Nakajima
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Radiotherapy, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Ryutaro Ikeda
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yosuke Uozumi
- Department of Radiological Imaging and Informatics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Xiaoyong Zhang
- Department of Electrical Engineering, Graduate School of Engineering, Tohoku University, Sendai, Japan
| | - Ivo Bukovsky
- Department of Radiological Imaging and Informatics, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Instrumentation and Control Engineering, Faculty of Mechanical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ken Takeda
- Department of Therapeutic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshihiro Takai
- Department of Radiation Oncology, Southern Tohoku BNCT Research Center, Koriyama, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriyasu Homma
- Department of Radiological Imaging and Informatics, Tohoku University Graduate School of Medicine, Sendai, Japan
| |
Collapse
|
5
|
Snyder JE, Flynn RT, Hyer DE. Implementation of respiratory-gated VMAT on a Versa HD linear accelerator. J Appl Clin Med Phys 2017; 18:152-161. [PMID: 28834109 PMCID: PMC5875827 DOI: 10.1002/acm2.12160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 04/07/2017] [Accepted: 06/05/2017] [Indexed: 11/16/2022] Open
Abstract
The accurate delivery of respiratory-gated volumetric modulated arc therapy (VMAT) treatment plans presents a challenge since the gantry rotation and collimator leaves must be repeatedly stopped and set into motion during each breathing cycle. In this study, we present the commissioning process for an Anzai gating system (AZ-733VI) on an Elekta Versa HD linear accelerator and make recommendations for successful clinical implementation. The commissioning tests include central axis dose consistency, profile consistency, gating beam-on/off delay, and comparison of gated versus nongated gamma pass rates for patient-specific quality assurance using four clinically commissioned photon energies: 6 MV, 6 FFF, 10 MV, and 10 FFF. The central axis dose constancy between gated and nongated deliveries was within 0.6% for all energies and the analysis of open field profiles for gated and nongated deliveries showed an agreement of 97.8% or greater when evaluated with a percent difference criteria of 1%. The measurement of the beam-on/off delay was done by evaluating images of a moving ball-bearing phantom triggered by the gating system and average beam-on delays of 0.22-0.29 s were observed. No measurable beam-off delay was present. Measurements of gated VMAT dose distributions resulted in decrements as high as 9% in the gamma passing rate as compared to nongated deliveries when evaluated against the planned dose distribution at 3%/3 mm. By decreasing the dose rate, which decreases the gantry speed during gated delivery, the gamma passing rates of gated and nongated treatments can be made equivalent. We present an empirically derived formula to limit the maximum dose rate during VMAT deliveries and show that by implementing a reduced dose rate, a gamma passing rate of greater than 95% (3%/3 mm) was obtained for all plan measurements.
Collapse
Affiliation(s)
- Jeffrey E. Snyder
- Department of Radiation OncologyUniversity of Iowa Hospitals and ClinicsIowa CityIA52242USA
| | - Ryan T. Flynn
- Department of Radiation OncologyUniversity of Iowa Hospitals and ClinicsIowa CityIA52242USA
| | - Daniel E. Hyer
- Department of Radiation OncologyUniversity of Iowa Hospitals and ClinicsIowa CityIA52242USA
| |
Collapse
|
6
|
Hubley E, Briscoe M, Ploquin N, Pierce G. Technical Note: A novel quality assurance test to identify gantry angle inaccuracies in respiratory-gated VMAT treatments. Med Phys 2017; 44:5075-5080. [PMID: 28777468 DOI: 10.1002/mp.12499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/19/2017] [Accepted: 07/25/2017] [Indexed: 11/11/2022] Open
Abstract
PURPOSE During respiratory-gated volumetric-modulated arc therapy (VMAT), the radiation beam is turned off each time the target exits the gating window. At the same time, the gantry slows, stops, and rewinds before the beam is turned back on. A quality assurance (QA) test was developed to detect inaccuracies in the gantry angle position between beam-off and beam-on events during respiratory-gated VMAT. METHODS Strips of Gafchromic™ EBT3 film were taped to the surface of a Capthan® 504 phantom mounted at isocenter. A homogeneous dose was delivered to the films through a 2 cm × 10 cm slit in the jaws using a respiratory-gated VMAT arc without the multileaf collimator. A periodic breathing cycle was used. Errors in gated delivery ranging from 0.5 to 5° were simulated by delivering nongated arcs with the same field size with over- and underlapping sections of 0.5-5°. The simulated errors were used to define QA levels to analyze the gated delivery. RESULTS The QA test was capable of detecting errors as small as 0.5°. The test was delivered to three Varian TrueBeam™ linacs, and no gantry angle inaccuracies greater than or equal to 0.5° were detected on any of the films. CONCLUSIONS A QA test capable of detecting gantry angle inaccuracies at beam-off and subsequent beam-on as small as 0.5° was developed and implemented for Varian TrueBeam™ linacs.
Collapse
Affiliation(s)
- Emily Hubley
- Department of Medical Physics, Tom Baker Cancer Centre, 1331 29 Street NW, Calgary, Alberta, T2N 4N2, Canada
| | - Michael Briscoe
- Department of Medical Physics, Tom Baker Cancer Centre, 1331 29 Street NW, Calgary, Alberta, T2N 4N2, Canada
| | - Nicolas Ploquin
- Department of Medical Physics, Tom Baker Cancer Centre, 1331 29 Street NW, Calgary, Alberta, T2N 4N2, Canada.,Department of Physics & Astronomy, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.,Department of Oncology, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| | - Greg Pierce
- Department of Medical Physics, Tom Baker Cancer Centre, 1331 29 Street NW, Calgary, Alberta, T2N 4N2, Canada.,Department of Physics & Astronomy, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.,Department of Oncology, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| |
Collapse
|
7
|
Ohta A, Kaidu M, Tanabe S, Utsunomiya S, Sasamoto R, Maruyama K, Tanaka K, Saito H, Nakano T, Shioi M, Takahashi H, Kushima N, Abe E, Aoyama H. Respiratory gating and multifield technique radiotherapy for esophageal cancer. Jpn J Radiol 2017; 35:95-100. [DOI: 10.1007/s11604-016-0606-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 12/08/2016] [Indexed: 12/25/2022]
|
8
|
Agrawal S, Kumar S, Maurya AK. Potential for adaptive dose escalation in radiotherapy for patients with locally advanced non-small-cell lung cancer in a low mid income setting. Br J Radiol 2017; 90:20140234. [PMID: 27897060 DOI: 10.1259/bjr.20140234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate the effect of tumour volume regression on adaptive treatment planning, reduction in doses to organs at risk (OARs) and dose escalation. METHODS 20 patients undergoing radical chemoradiotherapy were imaged in the fifth week of radiotherapy (CT_45) to evaluate differences in tumour volume regression between concurrent and sequential chemoradiotherapy. Replanning was carried out in the CT_45 in those with >20% regression (n = 10) and evaluated for change in target coverage indices (the coverage index and external volume index) and doses to the OAR [mean lung dose, V20 and V5 of whole and ipsilateral lung (MLDWL, V20WL, V5WL, MLDIL, V20IL, V5IL); mean oesophagus dose, V50oesophagus; and maximum spinal cord doses]. The feasibility of maximum dose escalation was explored keeping the limit of the OAR below their tolerance limits. RESULTS Tumour regression was higher with concurrent chemoradiotherapy as compared with sequential chemoradiotherapy (p = 0.02). With the adaptive plan, the mean coverage index improved from 0.96 (±0.14) to 1.29 (±0.36), the mean external volume index changed from 1.39(±0.60) to 1.41(±0.56) and the reduction in doses to the OARs were MLDWL 10.6%, V20WL 1.3%, V5WL 1.2%, MLDIL 6.6%, V20IL 1.5%, V5IL 2.3%, mean oesophagus dose 7%, V50oesophagus 31% and maximum cord dose 0.35%. Dose escalation was possible in four patients in CT_45. CONCLUSION There is 35% reduction in tumour volume with chemoradiotherapy at 45 Gy which allows improvement in conformality, reduction in doses to the OARs and dose escalation in 40% of patients. Advances in knowledge: This article emphasizes that adaptive planning with a single diagnostic scan at 45 Gy has the potential for improvement of radiotherapy planning indices, dose escalation while respecting the dose to the OAR. This simple strategy can be helpful in radiotherapy planning upto 60 Gy in 40% of the patients of locally advanced non-small-cell lung cancer in countries with limited resources.
Collapse
Affiliation(s)
- Sushma Agrawal
- Department of Radiotherapy, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sunil Kumar
- Department of Radiotherapy, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anil K Maurya
- Department of Radiotherapy, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|
9
|
Tinnel B, Mendonca MS, Henderson M, Cummings O, Chin-Sinex H, Timmerman R, McGarry RC. Pulmonary Hilar Stereotactic Body Radiation Therapy in the Rat. Technol Cancer Res Treat 2016; 6:425-31. [PMID: 17877431 DOI: 10.1177/153303460700600508] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Stereotactic Body Radiation therapy (SBRT) is an emerging modality of treatment for early stage non-small cell lung carcinoma. Concerns have arisen related to increased toxicities for medial tumors. We have developed a model of high dose, hypofractionated radiotherapy to the pulmonary hilum using the Leksell Gamma-Knife™. Sprague-Dawley rats received hypofractionated SBRT to the unilateral lung hilum using a custom immobilization device on the Gamma Knife. Each animal was individually scanned, treatment planned, and treated with either two 4 mm or one 8 mm collimated shots at escalating doses of 20, 40, and 80 Gy to the 50% isodose volume, encompassing the right mainstem bronchus. All animals were carefully followed post-treatment and imaged by plain film and CT. In addition, histopathological analysis of all rats was performed at selected time points. Animals treated with 4 mm collimated shots demonstrated no appreciable changes on plain films or sequential, follow-up CT scans, or histopathologically. Animals irradiated with the 8 mm collimator were less active, gained weight at a reduced rate, and demonstrated histopathological changes in 7/34 animals six months post-irradiation. Cellular atypia and interstitial pneumonitis were found, three of the seven of the animals showed clear bronchial damage and two showed vascular damage. Significant volume and time effects were found. Utilizing a novel Gamma Knife based animal model to study SBRT toxicity, it was found that the bronchus will tolerate small volumes of very high dose radiotherapy. It was postulated that radiation of the surrounding support stroma and normal tissue are important in the etiology of bronchial or hilar damage.
Collapse
Affiliation(s)
- B Tinnel
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | | | | | | | | |
Collapse
|
10
|
Respiratory gating during stereotactic body radiotherapy for lung cancer reduces tumor position variability. PLoS One 2014; 9:e112824. [PMID: 25379729 PMCID: PMC4224502 DOI: 10.1371/journal.pone.0112824] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 10/16/2014] [Indexed: 11/19/2022] Open
Abstract
PURPOSE We evaluated the effects of respiratory gating on treatment accuracy in lung cancer patients undergoing lung stereotactic body radiotherapy by using electronic portal imaging device (EPID) images. MATERIALS AND METHODS Our study population consisted of 30 lung cancer patients treated with stereotactic body radiotherapy (48 Gy/4 fractions/4 to 9 days). Of these, 14 were treated with- (group A) and 16 without gating (group B); typically the patients whose tumors showed three-dimensional respiratory motion ≧5 mm were selected for gating. Tumor respiratory motion was estimated using four-dimensional computed tomography images acquired during treatment simulation. Tumor position variability during all treatment sessions was assessed by measuring the standard deviation (SD) and range of tumor displacement on EPID images. The two groups were compared for tumor respiratory motion and position variability using the Mann-Whitney U test. RESULTS The median three-dimensional tumor motion during simulation was greater in group A than group B (9 mm, range 3-30 mm vs. 2 mm, range 0-4 mm; p<0.001). In groups A and B the median SD of the tumor position was 1.1 mm and 0.9 mm in the craniocaudal- (p = 0.24) and 0.7 mm and 0.6 mm in the mediolateral direction (p = 0.89), respectively. The median range of the tumor position was 4.0 mm and 3.0 mm in the craniocaudal- (p = 0.21) and 2.0 mm and 1.5 mm in the mediolateral direction (p = 0.20), respectively. CONCLUSIONS Although patients treated with respiratory gating exhibited greater respiratory tumor motion during treatment simulation, tumor position variability in the EPID images was low and comparable to patients treated without gating. This demonstrates the benefit of respiratory gating.
Collapse
|
11
|
The impact of respiratory gating on lung dosimetry in stereotactic body radiotherapy for lung cancer. Phys Med 2014; 30:682-9. [DOI: 10.1016/j.ejmp.2014.05.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/24/2014] [Accepted: 05/07/2014] [Indexed: 12/25/2022] Open
|
12
|
Pepin EW, Wu H, Shirato H. Use of dMLC for implementation of dynamic respiratory-gated radiation therapy. Med Phys 2014; 40:101708. [PMID: 24089898 DOI: 10.1118/1.4820534] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To simulate and evaluate the use of dynamic multileaf collimators (dMLC) in respiratory gating to compensate for baseline drift. METHODS Tumor motion tracking data from 30 lung tumors over 322 treatment fractions was analyzed with the finite state model. A dynamic respiratory gating window was established in real-time by determining the average positions during the previous two end-of-expiration breathing phases and centering the dMLC aperture on a weighted average of these positions. A simulated dMLC with physical motion constraints was used in dynamic gating treatment simulations. Fluence maps were created to provide a statistical description of radiation delivery for each fraction. Duty cycle was also calculated for each fraction. RESULTS The average duty cycle was 2.3% greater under dynamic gating conditions. Dynamic gating also showed higher fluences and less tumor obstruction. Additionally, dynamic gating required fewer beam toggles and each delivery period was longer on average than with static gating. CONCLUSIONS The use of dynamic gating showed better performance than static gating and the physical constraints of a dMLC were shown to not be an impediment to dynamic gating.
Collapse
Affiliation(s)
- Eric W Pepin
- Purdue School of Engineering Technology, IUPUI, Indianapolis, Indiana 46202
| | | | | |
Collapse
|
13
|
van Reij EJF, Dahele M, van de Ven PM, de Haan PF, Verbakel WFAR, Smit EF, Slotman BJ, Senan S. Changes in non-surgical management of stage III non-small cell lung cancer at a single institution between 2003 and 2010. Acta Oncol 2014; 53:316-23. [PMID: 23957648 DOI: 10.3109/0284186x.2013.819995] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Concurrent chemo-radiotherapy (CON-CRT) is recommended for selected patients with stage III non-small cell lung cancer (NSCLC), but utilization varies. We assessed the response to national guidelines introduced in 2004 and the impact on outcomes. MATERIAL AND METHODS Retrospective study of stage III NSCLC patients treated with radical intent non-surgical treatment during 2003-2010 in a university medical center characterized by multidisciplinary assessment, routine use of four-dimensional computed tomography for radiotherapy planning, and rapid implementation of radiotherapy advances. RESULTS Between 2003 and 2010, 319/435 (73%) patients with stage III NSCLC received (chemo) radiotherapy. The number receiving CON-CRT in successive two-year periods increased from 13/48 (27%) - 40/80 (50%) - 63/90 (70%), to 74/101 (73%). Median overall survival (OS) from start of radiotherapy was 18.6 months for CON-CRT (190/319) and 17.4 months for sequential (SEQ), typically hypofractionated, CRT (90/319) (p = 0.78). Eleven months OS with radiotherapy alone (39/319) was significantly shorter (p = 0.006). OS did not differ between the four periods (p = 0.87). CON-CRT was not over-represented in the 16% of patients dying within five months of starting radiotherapy. CONCLUSIONS Between 2003 and 2010, CON-CRT for stage III NSCLC was rapidly and safely increased. However, OS did not increase and, as practiced, did not differ between CON- or SEQ-CRT.
Collapse
Affiliation(s)
- Ellen J F van Reij
- Department of Radiation Oncology, VU University Medical Center , Amsterdam , The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Jaffray D, Kupelian P, Djemil T, Macklis RM. Review of image-guided radiation therapy. Expert Rev Anticancer Ther 2014; 7:89-103. [PMID: 17187523 DOI: 10.1586/14737140.7.1.89] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Image-guided radiation therapy represents a new paradigm in the field of high-precision radiation medicine. A synthesis of recent technological advances in medical imaging and conformal radiation therapy, image-guided radiation therapy represents a further expansion in the recent push for maximizing targeting capabilities with high-intensity radiation dose deposition limited to the true target structures, while minimizing radiation dose deposited in collateral normal tissues. By improving this targeting discrimination, the therapeutic ratio may be enhanced significantly. The principle behind image-guided radiation therapy relies heavily on the acquisition of serial image datasets using a variety of medical imaging platforms, including computed tomography, ultrasound and magnetic resonance imaging. These anatomic and volumetric image datasets are now being augmented through the addition of functional imaging. The current interest in positron-emitted tomography represents a good example of this sort of functional information now being correlated with anatomic localization. As the sophistication of imaging datasets grows, the precise 3D and 4D positions of the target and normal structures become of great relevance, leading to a recent exploration of real- or near-real-time positional replanning of the radiation treatment localization coordinates. This 'adaptive' radiotherapy explicitly recognizes that both tumors and normal tissues change position in time and space during a multiweek course of treatment, and even within a single treatment fraction. As targets and normal tissues change, the attenuation of radiation beams passing through these structures will also change, thus adding an additional level of imprecision in targeting unless these changes are taken into account. All in all, image-guided radiation therapy can be seen as further progress in the development of minimally invasive highly targeted cytotoxic therapies with the goal of substituting remote technologies for direct contact on the part of an operator or surgeon. Although data demonstrating clear-cut superiority of this new high-tech paradigm compared with more conventional radiation treatment approaches are scant, the emergence of preliminary data from several early studies shows that interest in this field is broad based and robust. As outcomes data accumulate, it is very likely that this field will continue to expand greatly. Although at present most of the work is being performed at major academic centers, the enthusiastic adoption of many of the devices and approaches being developed for this field suggest a rapid penetration into the community and the use of the technology by teams of specialists in the fields of radiation medicine, radiation physics and various branches of surgery. A recent survey of practitioners predicted very widespread adoption within the next 10 years.
Collapse
Affiliation(s)
- David Jaffray
- Princess Margaret Hospital /University of Toronto, Radiation Medicine Program, Toronto, Ontario, Canada.
| | | | | | | |
Collapse
|
15
|
Hau E, Rains M, Browne L, Muirhead R, Yeghiaian-Alvandi R. Minimal benefit of respiratory-gated radiation therapy in the management of thoracic malignancy. J Med Imaging Radiat Oncol 2013; 57:704-12. [PMID: 24283560 DOI: 10.1111/1754-9485.12088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 05/27/2013] [Indexed: 12/25/2022]
Affiliation(s)
- Eric Hau
- Department of Radiation Oncology; Westmead Hospital; Sydney New South Wales Australia
- Department of Radiation Oncology; Nepean Hospital; Sydney New South Wales Australia
- Cancer Care Centre; St George Hospital; Sydney New South Wales Australia
| | - Melissa Rains
- Department of Radiation Oncology; Nepean Hospital; Sydney New South Wales Australia
| | - Lois Browne
- Cancer Care Centre; St George Hospital; Sydney New South Wales Australia
| | - Rebecca Muirhead
- Department of Oncology; The Beatson, West of Scotland Cancer Centre; Glasgow UK
| | - Roland Yeghiaian-Alvandi
- Department of Radiation Oncology; Westmead Hospital; Sydney New South Wales Australia
- Department of Radiation Oncology; Nepean Hospital; Sydney New South Wales Australia
| |
Collapse
|
16
|
Karan T, Moiseenko V, Gill B, Horwood R, Kyle A, Minchinton AI. Radiobiological effects of altering dose rate in filter-free photon beams. Phys Med Biol 2013; 58:1075-82. [DOI: 10.1088/0031-9155/58/4/1075] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
17
|
Verbakel WF, van Reij E, Ladenius-Lischer I, Cuijpers JP, Slotman BJ, Senan S. Clinical Application of a Novel Hybrid Intensity-Modulated Radiotherapy Technique for Stage III Lung Cancer and Dosimetric Comparison With Four Other Techniques. Int J Radiat Oncol Biol Phys 2012; 83:e297-303. [DOI: 10.1016/j.ijrobp.2011.12.059] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 12/13/2011] [Accepted: 12/14/2011] [Indexed: 12/25/2022]
|
18
|
Pepin EW, Wu H, Shirato H. Dynamic gating window for compensation of baseline shift in respiratory-gated radiation therapy. Med Phys 2011; 38:1912-8. [PMID: 21626924 DOI: 10.1118/1.3556588] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To analyze and evaluate the necessity and use of dynamic gating techniques for compensation of baseline shift during respiratory-gated radiation therapy of lung tumors. METHODS Motion tracking data from 30 lung tumors over 592 treatment fractions were analyzed for baseline shift. The finite state model (FSM) was used to identify the end-of-exhale (EOE) breathing phase throughout each treatment fraction. Using duty cycle as an evaluation metric, several methods of end-of-exhale dynamic gating were compared: An a posteriori ideal gating window, a predictive trend-line-based gating window, and a predictive weighted point-based gating window. These methods were evaluated for each of several gating window types: Superior/inferior (SI) gating, anterior/posterior beam, lateral beam, and 3D gating. RESULTS In the absence of dynamic gating techniques, SI gating gave a 39.6% duty cycle. The ideal SI gating window yielded a 41.5% duty cycle. The weight-based method of dynamic SI gating yielded a duty cycle of 36.2%. The trend-line-based method yielded a duty cycle of 34.0%. CONCLUSIONS Dynamic gating was not broadly beneficial due to a breakdown of the FSM's ability to identify the EOE phase. When the EOE phase was well defined, dynamic gating showed an improvement over static-window gating.
Collapse
Affiliation(s)
- Eric W Pepin
- School of Health Sciences, Purdue University, West Lafayette, Indiana 47907, USA.
| | | | | |
Collapse
|
19
|
Dosimetric Analysis of Respiratory-Gated Radiotherapy for Hepatocellular Carcinoma. Med Dosim 2011; 36:213-8. [DOI: 10.1016/j.meddos.2010.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 02/08/2010] [Accepted: 02/08/2010] [Indexed: 11/22/2022]
|
20
|
Saito T, Sakamoto T, Oya N. Predictive factors for lung dose reduction by respiratory gating at radiotherapy for lung cancer. JOURNAL OF RADIATION RESEARCH 2010; 51:691-698. [PMID: 20940518 DOI: 10.1269/jrr.10084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This study aimed to identify factors predictive of the benefit of respiratory-gated radiotherapy. Three plans were created for 25 patients with non-small cell lung cancer, simulating the following 3 treatment scenarios. Protocol 1 was non-gated and the lung dose was calculated using 4-s slow CT (PnA), protocol 2 was also non-gated and the lung dose was calculated by CT at the end-expiration phase (PnE), and protocol 3 applied phase-based gating around end-expiration (PgE). We correlated possible predictive factors with the estimated lung dose reduction achieved by respiratory gating. The 3D clinical target volume (CTV) motion, craniocaudal CTV motion, and the craniocaudal CTV position were correlated with the reduction in V20 and the mean lung dose (p < 0.01). CTV was not significantly correlated with the estimated lung dose reduction. The area under the ROC curve (AUC) for 3D- and craniocaudal CTV motion, and craniocaudal CTV position was 1.000, 0.997, and 0.943, respectively, when the threshold for selecting patients was set at a 1% reduction of V20 and at a 0.5 Gy reduction in the mean lung dose. The results of the present study suggest that 3D CTV motion, craniocaudal CTV motion, and the craniocaudal CTV position are useful for predicting the benefit of respiratory-gated radiotherapy in lung cancer patients.
Collapse
Affiliation(s)
- Tetsuo Saito
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan.
| | | | | |
Collapse
|
21
|
Yap ML, Vinod S, Shon IH, Fowler A, Lin M, Gabriel G, Holloway L. The Registration of Diagnostic versus Planning Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Radiotherapy Planning for Non-small Cell Lung Cancer. Clin Oncol (R Coll Radiol) 2010; 22:554-60. [DOI: 10.1016/j.clon.2010.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 03/18/2010] [Accepted: 03/25/2010] [Indexed: 10/19/2022]
|
22
|
Maurer J, Pan T, Yin FF. Slow gantry rotation acquisition technique for on-board four-dimensional digital tomosynthesis. Med Phys 2010; 37:921-33. [DOI: 10.1118/1.3285291] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
|
23
|
Spoelstra FO, Pantarotto JR, van Sörnsen de Koste JR, Slotman BJ, Senan S. Role of Adaptive Radiotherapy During Concomitant Chemoradiotherapy for Lung Cancer: Analysis of Data From a Prospective Clinical Trial. Int J Radiat Oncol Biol Phys 2009; 75:1092-7. [DOI: 10.1016/j.ijrobp.2008.12.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Revised: 11/24/2008] [Accepted: 12/05/2008] [Indexed: 02/06/2023]
|
24
|
Saito T, Sakamoto T, Oya N. Comparison of gating around end-expiration and end-inspiration in radiotherapy for lung cancer. Radiother Oncol 2009; 93:430-5. [PMID: 19822373 DOI: 10.1016/j.radonc.2009.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 08/06/2009] [Accepted: 09/07/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the advantages and disadvantages of gating around end-expiration and end-inspiration. MATERIALS AND METHODS We created five irradiation protocols to treat 15 patients with lung cancer. They were non-gated irradiation (protocol 1, P1), amplitude-based gating around end-expiration (P2) and end-inspiration (P3), and phase-based gating around end-expiration (P4) and end-inspiration (P5). We compared the lung dosimetric parameters and the treatment time. RESULTS Compared to P2, in P3 the mean lung dose was reduced by 0.5+/-0.4Gy, V20 by 1.2+/-0.9%, V10 by 1.4+/-0.8%, and V5 by 1.5+/-0.9% (p<0.01). There was no statistically significant difference in these parameters between P4 and P5. At a dose rate of 600 monitor units/min (MUs/min), the average treatment time required for 100MUs was 10, 26, 64, 33, and 33 s, respectively, for P1, P2, P3, P4, and P5. CONCLUSIONS With amplitude-based gating, gating around end-inspiration (P3) produced a greater decrease in the lung dose, however, the treatment time was longest among the four gated protocols. There was no significant difference between the two phase-based gating protocols (P4 and P5) with respect to the radiation dose to the lungs and the treatment time.
Collapse
Affiliation(s)
- Tetsuo Saito
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan.
| | | | | |
Collapse
|
25
|
Fuji H, Asada Y, Numano M, Yamashita H, Nishimura T, Hashimoto T, Harada H, Asakura H, Murayama S. Residual Motion and Duty Time in Respiratory Gating Radiotherapy Using Individualized or Population-Based Windows. Int J Radiat Oncol Biol Phys 2009; 75:564-70. [DOI: 10.1016/j.ijrobp.2009.03.074] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Revised: 03/17/2009] [Accepted: 03/19/2009] [Indexed: 12/25/2022]
|
26
|
van Meerbeeck JP, Surmont VF. Stage IIIA-N2 NSCLC: A review of its treatment approaches and future developments. Lung Cancer 2009; 65:257-67. [DOI: 10.1016/j.lungcan.2009.02.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Revised: 01/10/2009] [Accepted: 02/07/2009] [Indexed: 11/29/2022]
|
27
|
Werner R, Ehrhardt J, Schmidt R, Handels H. Patient-specific finite element modeling of respiratory lung motion using 4D CT image data. Med Phys 2009; 36:1500-11. [PMID: 19544766 DOI: 10.1118/1.3101820] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Development and optimization of methods for adequately accounting for respiratory motion in radiation therapy of thoracic tumors require detailed knowledge of respiratory dynamics and its impact on corresponding dose distributions. Thus, computer aided modeling and simulation of respiratory motion have become increasingly important. In this article a biophysical approach for modeling respiratory lung motion is described: Major aspects of the process of lung ventilation are formulated as a contact problem of elasticity theory which is solved by finite element methods; lung tissue is assumed to be isotropic, homogeneous, and linearly elastic. A main focus of the article is to assess the impact of biomechanical parameters (values of elastic constants) on the modeling process and to evaluate modeling accuracy. Patient-specific models are generated based on 4D CT data of 12 lung tumor patients. Simulated motion patterns of inner lung landmarks are compared with corresponding motion patterns observed in the 4D CT data. Mean absolute differences between model-based predicted landmark motion and corresponding breathing-induced landmark displacements as observed in the CT data sets are in the order of 3 mm (end expiration to end inspiration) and 2 mm (end expiration to midrespiration). Modeling accuracy decreases with increasing tumor size both locally (landmarks close to tumor) and globally (landmarks in other parts of the lung). The impact of the values of the elastic constants appears to be small. Outcomes show that the modeling approach is an adequate strategy in predicting lung dynamics due to lung ventilation. Nevertheless, the decreased prediction quality in cases of large tumors demands further study of the influence of lung tumors on global and local lung elasticity properties.
Collapse
Affiliation(s)
- René Werner
- Department of Medical Informatics, University Medical Center Hamburg-Eppendorf Hamburg 20246, Germany.
| | | | | | | |
Collapse
|
28
|
Pantarotto JR, Piet AH, Vincent A, van Sörnsen de Koste JR, Senan S. Motion Analysis of 100 Mediastinal Lymph Nodes: Potential Pitfalls in Treatment Planning and Adaptive Strategies. Int J Radiat Oncol Biol Phys 2009; 74:1092-9. [DOI: 10.1016/j.ijrobp.2008.09.031] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 07/27/2008] [Accepted: 09/28/2008] [Indexed: 12/25/2022]
|
29
|
Bellière A, Girard N, Chapet O, Khodri M, Kubas A, Souquet PJ, Mornex F. Feasibility of high-dose three-dimensional radiation therapy in the treatment of localised non-small-cell lung cancer. Cancer Radiother 2009; 13:298-304. [PMID: 19525134 DOI: 10.1016/j.canrad.2009.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Revised: 04/03/2009] [Accepted: 04/13/2009] [Indexed: 02/07/2023]
Abstract
PURPOSE Chemoradiotherapy is the standard treatment of inoperable and/or non-resectable IIIA/B non-small-cell lung cancer (NSCLC). Aware of the necessity to increase local control in locally advanced NSCLC, we analyzed the feasibility of high-dose three-dimensional conformal radiation therapy (3D-CRT) in the treatment of localised NSCLC. PATIENTS AND METHODS We undertook a retrospective analysis of consecutive patients with non-resectable NSCLC treated with high-dose (74Gy) standard-fractionation 3D-CRT, with particular attention to the relationship between lung and heart radiation-induced toxicities. RESULTS Fifty patients (41 males, 9 females) were included. A total of 35 (70%) patients received the planned total dose of 74Gy. Patients irradiated to inferior doses interrupted the treatment because of limiting toxicities. Induction and concurrent chemotherapy was delivered to 39 (78%) and 14 (28%) patients, respectively. Eight (16%) patients experienced grade 3-4 acute lung toxicity, all of them having a history of pulmonary disease, a FEV1 below 1.6 L, and a lung V(20) of at least 25%. Three (6%) patients were deemed to experience radiation-induced cardiac toxicity. CONCLUSIONS This study assesses the feasibility of delivering a total dose of 74 Gy combined with chemotherapy in locally advanced NSCLC. High lung and heart V(20) increases the risk of radiation-induced lung and cardiac toxicity, the later being highly difficult to precisely assess, as late deaths are rarely documented, and responsibility of the treatment might be often underestimated. The precise evaluation of cardiac condition may be helpful to spare fragile patients from potentially toxic effects of high-dose radiation, especially in controlled trials.
Collapse
Affiliation(s)
- A Bellière
- Département de radiothérapie-oncologie, centre hospitalier Lyon-Sud, hospices civils de Lyon, 165 chemin du Grand-Revoyet, Pierre-Bénite cedex, France
| | | | | | | | | | | | | |
Collapse
|
30
|
Impact of Respiratory Gating Using 4-Dimensional Computed Tomography on the Dosimetry of Tumor and Normal Tissues in Patients With Thoracic Malignancies. Am J Clin Oncol 2009; 32:262-8. [DOI: 10.1097/coc.0b013e318184b33a] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
31
|
Spoelstra FO, van Sörnsen de Koste JR, Vincent A, Cuijpers JP, Slotman BJ, Senan S. An Evaluation of Two Internal Surrogates for Determining the Three-Dimensional Position of Peripheral Lung Tumors. Int J Radiat Oncol Biol Phys 2009; 74:623-9. [DOI: 10.1016/j.ijrobp.2009.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Revised: 01/02/2009] [Accepted: 01/02/2009] [Indexed: 10/21/2022]
|
32
|
Weibert K, Biller S, Georg Wendt T, Wiezorek T. Dosimetry of a linear accelerator under respiratory gating. Z Med Phys 2009; 19:136-41. [DOI: 10.1016/j.zemedi.2008.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
33
|
Grgic A, Nestle U, Schaefer-Schuler A, Kremp S, Kirsch CM, Hellwig D. FDG-PET–Based Radiotherapy Planning in Lung Cancer: Optimum Breathing Protocol and Patient Positioning—An Intraindividual Comparison. Int J Radiat Oncol Biol Phys 2009; 73:103-11. [DOI: 10.1016/j.ijrobp.2008.03.063] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2007] [Revised: 03/12/2008] [Accepted: 03/25/2008] [Indexed: 11/26/2022]
|
34
|
Radiotherapy for lung cancer: clinical impact of recent technical advances. Lung Cancer 2008; 64:1-8. [PMID: 18771814 DOI: 10.1016/j.lungcan.2008.07.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 07/07/2008] [Accepted: 07/21/2008] [Indexed: 12/25/2022]
Abstract
Radiation oncology plays an important role in the curative treatment of patients with lung cancer. New technological developments have enabled delivery of higher radiation doses while better sparing surrounding normal tissues, thereby increasing the likelihood of local control without increased toxicity. Multi-modality imaging enables better target definition, improved planning software allows for correct calculation of delivered doses, and tools to verify accurate treatment delivery are now available. A good example of the results of applying these developments is the high local control rates achieved in stage I NSCLC with stereotactic radiotherapy (SRT). These advances are rapidly becoming available outside academic institutions, and pulmonologists, surgeons and medical oncologists need to understand and critically assess the potential impact of such developments in the routine care of their patients. Aspects of cost-effectiveness of technical innovations, as well as the level of evidence required before widespread clinical implementation, will be addressed.
Collapse
|
35
|
Haasbeek CJ, Spoelstra FO, Lagerwaard FJ, van Sörnsen de Koste JR, Cuijpers JP, Slotman BJ, Senan S. Impact of Audio-Coaching on the Position of Lung Tumors. Int J Radiat Oncol Biol Phys 2008; 71:1118-23. [DOI: 10.1016/j.ijrobp.2007.11.061] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Revised: 10/22/2007] [Accepted: 11/14/2007] [Indexed: 12/25/2022]
|
36
|
Analysis of Carina Position as Surrogate Marker for Delivering Phase-Gated Radiotherapy. Int J Radiat Oncol Biol Phys 2008; 71:1111-7. [DOI: 10.1016/j.ijrobp.2007.11.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 10/22/2007] [Accepted: 11/16/2007] [Indexed: 12/25/2022]
|
37
|
Sawant A, Venkat R, Srivastava V, Carlson D, Povzner S, Cattell H, Keall P. Management of three-dimensional intrafraction motion through real-time DMLC tracking. Med Phys 2008; 35:2050-61. [PMID: 18561681 PMCID: PMC2809733 DOI: 10.1118/1.2905355] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 02/18/2008] [Accepted: 03/15/2008] [Indexed: 12/25/2022] Open
Abstract
Tumor tracking using a dynamic multileaf collimator (DMLC) represents a promising approach for intrafraction motion management in thoracic and abdominal cancer radiotherapy. In this work, we develop, empirically demonstrate, and characterize a novel 3D tracking algorithm for real-time, conformal, intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT)-based radiation delivery to targets moving in three dimensions. The algorithm obtains real-time information of target location from an independent position monitoring system and dynamically calculates MLC leaf positions to account for changes in target position. Initial studies were performed to evaluate the geometric accuracy of DMLC tracking of 3D target motion. In addition, dosimetric studies were performed on a clinical linac to evaluate the impact of real-time DMLC tracking for conformal, step-and-shoot (S-IMRT), dynamic (D-IMRT), and VMAT deliveries to a moving target. The efficiency of conformal and IMRT delivery in the presence of tracking was determined. Results show that submillimeter geometric accuracy in all three dimensions is achievable with DMLC tracking. Significant dosimetric improvements were observed in the presence of tracking for conformal and IMRT deliveries to moving targets. A gamma index evaluation with a 3%-3 mm criterion showed that deliveries without DMLC tracking exhibit between 1.7 (S-IMRT) and 4.8 (D-IMRT) times more dose points that fail the evaluation compared to corresponding deliveries with tracking. The efficiency of IMRT delivery, as measured in the lab, was observed to be significantly lower in case of tracking target motion perpendicular to MLC leaf travel compared to motion parallel to leaf travel. Nevertheless, these early results indicate that accurate, real-time DMLC tracking of 3D tumor motion is feasible and can potentially result in significant geometric and dosimetric advantages leading to more effective management of intrafraction motion.
Collapse
Affiliation(s)
- Amit Sawant
- Department of Radiation Oncology, Stanford University, Stanford, California 94305, USA.
| | | | | | | | | | | | | |
Collapse
|
38
|
Van Meerbeeck JP, De Pauw R, Tournoy K. What is the optimal treatment of stage IIIA-N2 non-small-cell lung cancer after EORTC 08941? Expert Rev Anticancer Ther 2008; 8:199-206. [PMID: 18279061 DOI: 10.1586/14737140.8.2.199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The results of a randomized trial investigating the role of local therapies after induction chemotherapy in patients with stage IIIA-N2 non-small-cell lung cancer lend themselves to a review of the available evidence and speculation about the routine and future treatment in these patients. An algorithm for future treatment is proposed.
Collapse
|
39
|
Brunetti J, Caggiano A, Rosenbluth B, Vialotti C. Technical Aspects of Positron Emission Tomography/Computed Tomography Fusion Planning. Semin Nucl Med 2008; 38:129-36. [DOI: 10.1053/j.semnuclmed.2007.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
40
|
Vedam S, Archambault L, Starkschall G, Mohan R, Beddar S. Determination of prospective displacement-based gate threshold for respiratory-gated radiation delivery from retrospective phase-based gate threshold selected at 4D CT simulation. Med Phys 2008; 34:4247-55. [PMID: 18072489 DOI: 10.1118/1.2794169] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Four-dimensional (4D) computed tomography (CT) imaging has found increasing importance in the localization of tumor and surrounding normal structures throughout the respiratory cycle. Based on such tumor motion information, it is possible to identify the appropriate phase interval for respiratory gated treatment planning and delivery. Such a gating phase interval is determined retrospectively based on tumor motion from internal tumor displacement. However, respiratory-gated treatment is delivered prospectively based on motion determined predominantly from an external monitor. Therefore, the simulation gate threshold determined from the retrospective phase interval selected for gating at 4D CT simulation may not correspond to the delivery gate threshold that is determined from the prospective external monitor displacement at treatment delivery. The purpose of the present work is to establish a relationship between the thresholds for respiratory gating determined at CT simulation and treatment delivery, respectively. One hundred fifty external respiratory motion traces, from 90 patients, with and without audio-visual biofeedback, are analyzed. Two respiratory phase intervals, 40%-60% and 30%-70%, are chosen for respiratory gating from the 4D CT-derived tumor motion trajectory. From residual tumor displacements within each such gating phase interval, a simulation gate threshold is defined based on (a) the average and (b) the maximum respiratory displacement within the phase interval. The duty cycle for prospective gated delivery is estimated from the proportion of external monitor displacement data points within both the selected phase interval and the simulation gate threshold. The delivery gate threshold is then determined iteratively to match the above determined duty cycle. The magnitude of the difference between such gate thresholds determined at simulation and treatment delivery is quantified in each case. Phantom motion tests yielded coincidence of simulation and delivery gate thresholds to within 0.3%. For patient data analysis, differences between simulation and delivery gate thresholds are reported as a fraction of the total respiratory motion range. For the smaller phase interval, the differences between simulation and delivery gate thresholds are 8 +/- 11% and 14 +/- 21% with and without audio-visual biofeedback, respectively, when the simulation gate threshold is determined based on the mean respiratory displacement within the 40%-60% gating phase interval. For the longer phase interval, corresponding differences are 4 +/- 7% and 8 +/- 15% with and without audiovisual biofeedback, respectively. Alternatively, when the simulation gate threshold is determined based on the maximum average respiratory displacement within the gating phase interval, greater differences between simulation and delivery gate thresholds are observed. A relationship between retrospective simulation gate threshold and prospective delivery gate threshold for respiratory gating is established and validated for regular and nonregular respiratory motion. Using this relationship, the delivery gate threshold can be reliably estimated at the time of 4D CT simulation, thereby improving the accuracy and efficiency of respiratory-gated radiation delivery.
Collapse
Affiliation(s)
- S Vedam
- Department of Radiation Physics, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
| | | | | | | | | |
Collapse
|
41
|
|
42
|
van Sörnsen de Koste JR, Cuijpers JP, de Geest FGM, Lagerwaard FJ, Slotman BJ, Senan S. Verifying 4D gated radiotherapy using time-integrated electronic portal imaging: a phantom and clinical study. Radiat Oncol 2007; 2:32. [PMID: 17760960 PMCID: PMC2075522 DOI: 10.1186/1748-717x-2-32] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Accepted: 08/30/2007] [Indexed: 12/25/2022] Open
Abstract
Background Respiration-gated radiotherapy (RGRT) can decrease treatment toxicity by allowing for smaller treatment volumes for mobile tumors. RGRT is commonly performed using external surrogates of tumor motion. We describe the use of time-integrated electronic portal imaging (TI-EPI) to verify the position of internal structures during RGRT delivery Methods TI-EPI portals were generated by continuously collecting exit dose data (aSi500 EPID, Portal vision, Varian Medical Systems) when a respiratory motion phantom was irradiated during expiration, inspiration and free breathing phases. RGRT was delivered using the Varian RPM system, and grey value profile plots over a fixed trajectory were used to study object positions. Time-related positional information was derived by subtracting grey values from TI-EPI portals sharing the pixel matrix. TI-EPI portals were also collected in 2 patients undergoing RPM-triggered RGRT for a lung and hepatic tumor (with fiducial markers), and corresponding planning 4-dimensional CT (4DCT) scans were analyzed for motion amplitude. Results Integral grey values of phantom TI-EPI portals correlated well with mean object position in all respiratory phases. Cranio-caudal motion of internal structures ranged from 17.5–20.0 mm on planning 4DCT scans. TI-EPI of bronchial images reproduced with a mean value of 5.3 mm (1 SD 3.0 mm) located cranial to planned position. Mean hepatic fiducial markers reproduced with 3.2 mm (SD 2.2 mm) caudal to planned position. After bony alignment to exclude set-up errors, mean displacement in the two structures was 2.8 mm and 1.4 mm, respectively, and corresponding reproducibility in anatomy improved to 1.6 mm (1 SD). Conclusion TI-EPI appears to be a promising method for verifying delivery of RGRT. The RPM system was a good indirect surrogate of internal anatomy, but use of TI-EPI allowed for a direct link between anatomy and breathing patterns.
Collapse
Affiliation(s)
| | - Johan P Cuijpers
- Department of Radiation Oncology, VU University medical center, Amsterdam, The Netherlands
| | - Frank GM de Geest
- Department of Radiation Oncology, VU University medical center, Amsterdam, The Netherlands
| | - Frank J Lagerwaard
- Department of Radiation Oncology, VU University medical center, Amsterdam, The Netherlands
| | - Ben J Slotman
- Department of Radiation Oncology, VU University medical center, Amsterdam, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, VU University medical center, Amsterdam, The Netherlands
| |
Collapse
|
43
|
PL3-02: Advances in radiation oncology. J Thorac Oncol 2007. [DOI: 10.1097/01.jto.0000282923.35347.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
44
|
Piet AHM, Lagerwaard FJ, Kunst PWA, van Sörnsen de Koste JR, Slotman BJ, Senan S. Can Mediastinal Nodal Mobility Explain the Low Yield Rates for Transbronchial Needle Aspiration Without Real-Time Imaging? Chest 2007; 131:1783-7. [PMID: 17565020 DOI: 10.1378/chest.06-2964] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The diagnostic yields with transbronchial needle aspiration (TBNA) for mediastinal nodes are highly variable. Nodal positions, as assessed on a breath-hold conventional CT scan, do not account for nodal motion. We studied nodal motion on four-dimensional (4D) CT scans. METHODS A total of 47 mediastinal nodes were identified on 4D CT scans performed for radiotherapy planning in 25 patients with lung cancer. Nodes were mainly located at stations 4R, 4L, 7, and 2R, and each identified node was contoured in all 10 phases of the 4D CT scan. Nodal motion was correlated with changes in carina position. RESULTS The mean (+/- SD) nodal diameter was 10.2 +/- 4.0 mm; and the mean nodal volume was 1.8 +/- 2.3 mL. Movement was maximal in the craniocaudal axis (mean length, 4.7 +/- 2.3 mm), and the corresponding mean mediolateral and ventrodorsal movements were 2.8 +/- 1.9 mm and 2.4 +/- 1.8 mm, respectively. The mean three-dimensional displacement of the nodal center was 6.2 +/- 2.9 mm, and it exceeded 10 mm in five nodes. The nodal mass was constantly present in only 25 +/- 14% of the region encompassing all nodal positions. The mean variation in craniocaudal distance between all nodes and the carina position during respiration was 5.3 +/- 2.1 mm (range, 2.2 to 10.5 mm). CONCLUSIONS Both nodal motion and the varying distance between the carina and nodal position may explain the lower diagnostic yields for TBNA procedures performed without real-time guidance.
Collapse
Affiliation(s)
- Anna H M Piet
- Department of Radiation Oncology, VU University Medical Center, De Boelelaan 1117, 1007 MB Amsterdam, the Netherlands
| | | | | | | | | | | |
Collapse
|
45
|
Li XA, Keall PJ, Orton CG. Respiratory gating for radiation therapy is not ready for prime time. Med Phys 2007; 34:867-70. [PMID: 17441231 DOI: 10.1118/1.2514027] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
| | | | | |
Collapse
|
46
|
Senan S, Piet A, Lagerwaard F. Involved-node radiotherapy to the mediastinum. Radiother Oncol 2007; 82:108-9; author reply 109-10. [PMID: 17125861 DOI: 10.1016/j.radonc.2006.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Accepted: 10/03/2006] [Indexed: 11/18/2022]
|