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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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Dassen MG, Janssen T, Kusters M, Pos F, Kerkmeijer LGW, van der Heide UA, van der Bijl E. Comparing adaptation strategies in MRI-guided online adaptive radiotherapy for prostate cancer: Implications for treatment margins. Radiother Oncol 2023; 186:109761. [PMID: 37348607 DOI: 10.1016/j.radonc.2023.109761] [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: 01/11/2023] [Revised: 05/26/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE To quantify the difference in accuracy of adapt-to-position (ATP), adapt-to-rotation (ATR) and adapt-to-shape (ATS) workflows used in MRI-guided online adaptive radiotherapy for prostate carcinoma (PCa) by evaluating the margins required to accommodate intra-fraction motion of the clinical target volumes for prostate (CTVpros), prostate including seminal vesicles (CTVpros + sv) and gross tumor volume (GTV). MATERIALS AND METHODS Clinical delineations of the CTVpros, CTVpros + sv and GTV of 24 patients with intermediate- and high-risk PCa, treated using ATS on a 1.5 T MR-Linac, were used for analysis. Delineations were available pre- and during beam-on. To simulate ATP and ATR workflows, we automatically generated the structures associated with these workflows using rigid transformations from the planning-MRI to the daily online MRIs. Clinical GTVs were analyzed as ATR GTVs and only ATP GTVs were simulated. Planning target volumes (PTVs) were generated with isotropic margins ranging 0.0-5.0 mm. The volumetric overlap was calculated between these PTVs and their corresponding clinical delineation on the MRI acquired during beam-on and averaged over all treatment fractions. RESULTS The PTV margin required to cover > 95% of the CTVpros was equal (2.5 mm) for all workflows. For the CTVpros + sv, this margin increased to 5.0, 4.0 and 3.5 mm in the ATP, ATR and ATS workflow, respectively. GTV coverage improved from ATP to ATR for margins up to 4.0 mm. CONCLUSION ATP, ATR and ATS workflows ensure equal coverage of the CTVpros for the current clinical margins. For the CTVpros + sv, ATS showed optimal performance. GTV coverage improves by additional adaptations to prostate rotations.
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Affiliation(s)
- Mathijs G Dassen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Tomas Janssen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Martijn Kusters
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Floris Pos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Linda G W Kerkmeijer
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Erik van der Bijl
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.
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Shortall J, Vasquez Osorio E, Green A, McWilliam A, Elumalai T, Reeves K, Johnson-Hart C, Beasley W, Hoskin P, Choudhury A, van Herk M. Dose outside of the prostate is associated with improved outcomes for high-risk prostate cancer patients treated with brachytherapy boost. Front Oncol 2023; 13:1200676. [PMID: 37397380 PMCID: PMC10311256 DOI: 10.3389/fonc.2023.1200676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
Background One in three high-risk prostate cancer patients treated with radiotherapy recur. Detection of lymph node metastasis and microscopic disease spread using conventional imaging is poor, and many patients are under-treated due to suboptimal seminal vesicle or lymph node irradiation. We use Image Based Data Mining (IBDM) to investigate association between dose distributions, and prognostic variables and biochemical recurrence (BCR) in prostate cancer patients treated with radiotherapy. We further test whether including dose information in risk-stratification models improves performance. Method Planning CTs, dose distributions and clinical information were collected for 612 high-risk prostate cancer patients treated with conformal hypo-fractionated radiotherapy, intensity modulated radiotherapy (IMRT), or IMRT plus a single fraction high dose rate (HDR) brachytherapy boost. Dose distributions (including HDR boost) of all studied patients were mapped to a reference anatomy using the prostate delineations. Regions where dose distributions significantly differed between patients that did and did-not experience BCR were assessed voxel-wise using 1) a binary endpoint of BCR at four-years (dose only) and 2) Cox-IBDM (dose and prognostic variables). Regions where dose was associated with outcome were identified. Cox proportional-hazard models with and without region dose information were produced and the Akaike Information Criterion (AIC) was used to assess model performance. Results No significant regions were observed for patients treated with hypo-fractionated radiotherapy or IMRT. Regions outside the target where higher dose was associated with lower BCR were observed for patients treated with brachytherapy boost. Cox-IBDM revealed that dose response was influenced by age and T-stage. A region at the seminal vesicle tips was identified in binary- and Cox-IBDM. Including the mean dose in this region in a risk-stratification model (hazard ratio=0.84, p=0.005) significantly reduced AIC values (p=0.019), indicating superior performance, compared with prognostic variables only. The region dose was lower in the brachytherapy boost patients compared with the external beam cohorts supporting the occurrence of marginal misses. Conclusion Association was identified between BCR and dose outside of the target region in high-risk prostate cancer patients treated with IMRT plus brachytherapy boost. We show, for the first-time, that the importance of irradiating this region is linked to prognostic variables.
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Affiliation(s)
- Jane Shortall
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Eliana Vasquez Osorio
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Andrew Green
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Alan McWilliam
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Thriaviyam Elumalai
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Kimberley Reeves
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Corinne Johnson-Hart
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - William Beasley
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Peter Hoskin
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Ananya Choudhury
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Marcel van Herk
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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Gao LR, Tian Y, Wang MS, Xia WL, Qin SR, Song YW, Wang SL, Tang Y, Fang H, Tang Y, Qi SN, Yan LL, Liu YP, Jing H, Chen B, Xing NZ, Li YX, Lu NN. Assessment of delivered dose in prostate cancer patients treated with ultra-hypofractionated radiotherapy on 1.5-Tesla MR-Linac. Front Oncol 2023; 13:1039901. [PMID: 36741014 PMCID: PMC9893501 DOI: 10.3389/fonc.2023.1039901] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/03/2023] [Indexed: 01/20/2023] Open
Abstract
Objective To quantitatively characterize the dosimetric effects of long on-couch time in prostate cancer patients treated with adaptive ultra-hypofractionated radiotherapy (UHF-RT) on 1.5-Tesla magnetic resonance (MR)-linac. Materials and methods Seventeen patients consecutively treated with UHF-RT on a 1.5-T MR-linac were recruited. A 36.25 Gy dose in five fractions was delivered every other day with a boost of 40 Gy to the whole prostate. We collected data for the following stages: pre-MR, position verification-MR (PV-MR) in the Adapt-To-Shape (ATS) workflow, and 3D-MR during the beam-on phase (Bn-MR) and at the end of RT (post-MR). The target and organ-at-risk contours in the PV-MR, Bn-MR, and post-MR stages were projected from the pre-MR data by deformable image registration and manually adapted by the physician, followed by dose recalculation for the ATS plan. Results Overall, 290 MR scans were collected (85 pre-MR, 85 PV-MR, 49 Bn-MR and 71 post-MR scans). With a median on-couch time of 49 minutes, the mean planning target volume (PTV)-V95% of all scans was 97.83 ± 0.13%. The corresponding mean clinical target volume (CTV)-V100% was 99.93 ± 0.30%, 99.32 ± 1.20%, 98.59 ± 1.84%, and 98.69 ± 1.85%. With excellent prostate-V100% dose coverage, the main reason for lower CTV-V100% was slight underdosing of seminal vesicles (SVs). The median V29 Gy change in the rectal wall was -1% (-20%-17%). The V29 Gy of the rectal wall increased by >15% was observed in one scan. A slight increase in the high dose of bladder wall was noted due to gradual bladder growth during the workflow. Conclusions This 3D-MR-based dosimetry analysis demonstrated clinically acceptable estimated dose coverage of target volumes during the beam-on period with adaptive ATS workflow on 1.5-T MR-linac, albeit with a relatively long on-couch time. The 3-mm CTV-PTV margin was adequate for prostate irradiation but occasionally insufficient for SVs. More attention should be paid to restricting high-dose RT to the rectal wall when optimizing the ATS plan.
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Affiliation(s)
- Lin-Rui Gao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Tian
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming-Shuai Wang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen-Long Xia
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shi-Rui Qin
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong-Wen Song
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Lian Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Tang
- GCP Center/Clinical Research Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Fang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Nan Qi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ling-Ling Yan
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Ping Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Jing
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nian-Zeng Xing
- Department of Urology and State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,*Correspondence: Ning-Ning Lu, ; Ye-Xiong Li, ; Nian-Zeng Xing,
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,*Correspondence: Ning-Ning Lu, ; Ye-Xiong Li, ; Nian-Zeng Xing,
| | - Ning-Ning Lu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,*Correspondence: Ning-Ning Lu, ; Ye-Xiong Li, ; Nian-Zeng Xing,
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5
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Drabble J, Das P, George B, Camilleri P, Morris A. Based on 0.35 T magnetic resonance-guided radiotherapy, what are the nonisotropic PTV margins required for conventional prostate radiotherapy? Med Dosim 2022; 47:334-341. [PMID: 35907693 DOI: 10.1016/j.meddos.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 05/31/2022] [Accepted: 06/23/2022] [Indexed: 10/16/2022]
Abstract
This study aims to calculate planning target volume (PTV) margins for the prostate and seminal vesicles (SVs) from the use of magnetic resonance-guided radiation therapy (MRgRT). And whether nonisotropic PTV margins are beneficial for these structures. Organ motion is linked to the displacement of the prostate and SVs. From the use of MRgRT, the nearby organs at risk (OAR) can be visualized both inter- and intrafraction. This study looked to determine if there is a correlation between interfractional OAR changes and displacements to the prostate and SVs. Inter- and intrafractional data from 20 consecutive prostate cancer patients treated using extreme hypofractionated 0.35 T MRgRT indicated prostate and SV motion during treatment. Tracking points (TPs) on 2D sagittal cine-MRI enabled assessment of this intrafractional motion. To determine a correlation between rectal changes and target displacements, the rectal diameter (RD) changes were compared against the displacement differences (DDs) at the prostate and SVs. Eighty percent of patients required intrafractional imaging corrections during radiotherapy, including 16/100 fractions due to rectal volume increases and 24/100 fractions due to bladder volume increases. The frequency of ≥3 mm intrafraction displacement was considerably greater in TPs in the SV than in the prostate. A moderate positive correlation (R2 = 0.417) was shown between RD changes and DDs at the level of the prostate and SVs. The PTV margins required for 90% of the patient cohort for prostate and SVs are nonuniform in different directions, and the margin is larger for SVs. Organ motion contributed toward prostate and SV displacements and showed the importance of a robust bladder and rectal-filling protocol.
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Affiliation(s)
| | | | - Ben George
- GenesisCare UK, radiotherapy, Oxford, England.
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Tetar SU, Bruynzeel AM, Verweij L, Bohoudi O, Slotman BJ, Rosario T, Palacios MA, Lagerwaard FJ. Magnetic resonance imaging-guided radiotherapy for intermediate- and high-risk prostate cancer: Trade-off between planning target volume margin and online plan adaption. Phys Imaging Radiat Oncol 2022; 23:92-96. [PMID: 35844255 PMCID: PMC9283928 DOI: 10.1016/j.phro.2022.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
Magnetic resonance-guided radiotherapy with daily plan adaptation for intermediate- and high-risk prostate cancer is time and labor intensive. Fifty adapted plans with 3 mm planning target volume (PTV)-margin were compared with non-adapted plans using 3 or 5 mm margins. Adequate (V95% ≥ 95%) prostate coverage was achieved in 49 fractions with 5 mm PTV without plan adaptation, however, coverage of the seminal vesicles (SV) was insufficient in 15 of 50 fractions. There was no insufficient coverage for prostate and SV using plan adaptation with 3 mm. Hence, daily adaptation is recommended to obtain adequate SV-coverage when using 3 mm PTV.
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Affiliation(s)
| | | | | | | | | | | | | | - Frank J. Lagerwaard
- Corresponding author at: Amsterdam UMC, location VUmc, Postbox 7057, 1007 MB Amsterdam, The Netherlands.
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Ohira S, Komiyama R, Kanayama N, Sakai K, Hirata T, Yoshikata K, Ueda Y, Miyazaki M, Nakayama M, Koizumi M, Konishi K. Improvement in bladder volume reproducibility using A-mode portable ultrasound bladder scanner in moderate-hypofractionated volumetric modulated arc therapy for prostate cancer patients. J Appl Clin Med Phys 2022; 23:e13546. [PMID: 35112479 PMCID: PMC8992960 DOI: 10.1002/acm2.13546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 01/05/2022] [Accepted: 01/16/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose This study introduced an A‐mode portable ultrasound bladder scanner, the Lilium® α‐200 (here after Lilium; Lilium Otsuka, Kanagawa, Japan), for the treatment of prostate cancer patients with hypofractionated volumetric modulated arc therapy to improve the reproducibility of bladder volume (BV). Materials and methods Thirty patients were advised to maintain full BV prior to computed tomography (CT) simulation and daily treatment. Among these, the BV of 15 patients was measured using Lilium until a BV of 80% in the simulation was achieved (with the Lilium group). Daily cone‐beam CT (CBCT) was performed for treatment. The correlation between BV measured by CBCT and Lilium was assessed. The differences in the BV and dosimetric parameters of the bladder in the CBCT versus planning CT were compared between the groups with and without Lilium. Results There was a significantly strong relationship (r = 0.796, p < 0.05) between the BVs measured using CBCT and Lilium. The relative BV ratios to simulation CT < 0.5 and > 2 were observed in 10.3% and 12.7%, respectively, of treatment sessions without Lilium group, while these ratios were 1% and 2.8%, respectively, in the Lilium group. The mean absolute difference in the range of V30Gy to V40Gy without Lilium sessions was significantly larger (p < 0.05) than that in the Lilium group. Conclusion The use of the A‐mode portable ultrasound bladder scanner significantly improved the reproducibility of the BV, resulting in few variations in the dosimetric parameters for the bladder.
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Affiliation(s)
- Shingo Ohira
- Department of Radiation OncologyOsaka International Cancer InstituteOsakaJapan
- Department of Medical Physics and EngineeringOsaka University Graduate School of MedicineSuitaJapan
| | - Riho Komiyama
- Department of Radiation OncologyOsaka International Cancer InstituteOsakaJapan
| | - Naoyuki Kanayama
- Department of Radiation OncologyOsaka International Cancer InstituteOsakaJapan
| | - Kayo Sakai
- Nursing DepartmentOsaka International Cancer InstituteOsakaJapan
| | - Takero Hirata
- Department of Radiation OncologyOsaka University Graduate School of MedicineSuitaJapan
| | - Kento Yoshikata
- Department of Radiation OncologyOsaka International Cancer InstituteOsakaJapan
| | - Yoshihiro Ueda
- Department of Radiation OncologyOsaka International Cancer InstituteOsakaJapan
| | - Masayoshi Miyazaki
- Department of Radiation OncologyOsaka International Cancer InstituteOsakaJapan
| | - Masashi Nakayama
- Department of UrologyOsaka International Cancer InstituteOsakaJapan
| | - Masahiko Koizumi
- Department of Medical Physics and EngineeringOsaka University Graduate School of MedicineSuitaJapan
| | - Koji Konishi
- Department of Radiation OncologyOsaka International Cancer InstituteOsakaJapan
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8
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Seminal vesicle inter- and intra-fraction motion during radiotherapy for prostate cancer: a review. Radiother Oncol 2022; 169:15-24. [DOI: 10.1016/j.radonc.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 01/26/2022] [Accepted: 02/02/2022] [Indexed: 01/04/2023]
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9
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Tamura H, Kobashi K, Nishioka K, Yoshimura T, Hashimoto T, Shimizu S, Ito YM, Maeda Y, Sasaki M, Yamamoto K, Tamamura H, Aoyama H, Shirato H. Dosimetric advantages of daily adaptive strategy in IMPT for high-risk prostate cancer. J Appl Clin Med Phys 2022; 23:e13531. [PMID: 35045211 PMCID: PMC8992948 DOI: 10.1002/acm2.13531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/10/2021] [Accepted: 12/28/2021] [Indexed: 11/05/2022] Open
Abstract
Purpose To evaluate the dosimetric advantages of daily adaptive radiotherapy (DART) in intensity‐modulated proton therapy (IMPT) for high‐risk prostate cancer by comparing estimated doses of the conventional non‐adaptive radiotherapy (NART) that irradiates according to an original treatment plan through the entire treatment and the DART that uses an adaptive treatment plan generated by using daily CT images acquired before each treatment. Methods Twenty‐three patients with prostate cancer were included. A treatment plan with 63 Gy (relative biological effectiveness (RBE)) in 21 fractions was generated using treatment planning computed tomography (CT) images assuming that all patients had high‐risk prostate cancer for which the clinical target volume (CTV) needs to include prostate and the seminal vesicle (SV) in our treatment protocol. Twenty‐one adaptive treatment plans for each patient (total 483 data sets) were generated using daily CT images, and dose distributions were calculated. Using a 3 mm set‐up uncertainty in the robust optimization, the doses to the CTV, prostate, SV, rectum, and bladder were compared. Results Estimated accumulated doses of NART and DART in the 23 patients were 60.81 ± 3.47 Gy (RBE) and 63.24 ± 1.04 Gy (RBE) for CTV D99 (p < 0.01), 62.99 ± 1.28 Gy (RBE) and 63.43 ± 1.33 Gy (RBE) for the prostate D99 (p = 0.2529), and 59.07 ± 5.19 Gy (RBE) and 63.17 ± 1.04 Gy (RBE) for SV D99 (p < 0.001). No significant differences were observed between NART and DART in the estimated accumulated dose for the rectum and bladder. Conclusion Compared with the NART, DART was shown to be a useful approach that can maintain the dose coverage to the target without increasing the dose to the organs at risk (OAR) using the 3 mm set‐up uncertainty in the robust optimization in patients with high‐risk prostate cancer.
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Affiliation(s)
- Hiroshi Tamura
- Department of Radiation Oncology, Graduate School of Biomedical Science and Engineering, Hokkaido University, Sapporo, Japan.,Department of Radiological Technology, Hokkaido University Hospital, Sapporo, Japan
| | - Keiji Kobashi
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan.,Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan
| | - Kentaro Nishioka
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takaaki Yoshimura
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan.,Department of Health Sciences and Technology, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Takayuki Hashimoto
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Shinichi Shimizu
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan.,Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan
| | - Yoichi M Ito
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Yoshikazu Maeda
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui, Japan
| | - Makoto Sasaki
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui, Japan
| | | | | | - Hidefumi Aoyama
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan.,Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroki Shirato
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
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10
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Lim Joon D, Chao M, Piccolo A, Schneider M, Anderson N, Handley M, Benci M, Ong WL, Daly K, Morrell R, Wan K, Lawrentschuk N, Foroudi F, Jenkins T, Angus D, Wada M, Sengupta S, Khoo V. Proximal seminal vesicle displacement and margins for prostate cancer radiotherapy. J Med Radiat Sci 2021; 68:289-297. [PMID: 33432719 PMCID: PMC8424309 DOI: 10.1002/jmrs.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 12/14/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Guidelines recommend that the proximal seminal vesicles (PrSV) should be included in the clinical target volume for locally advanced prostate cancer patients undergoing radiotherapy. Verification and margins for the prostate may not necessarily account for PrSV displacement. The purpose was to determine the inter-fraction displacement of the PrSV relative to the prostate during radiotherapy. METHODS Fiducials were inserted into the prostate, and right and left PrSV (RSV and LSV) in 30 prostate cancer patients. Correctional shifts for the prostate, right and left PrSV and pelvic bones were determined from each patient's 39 daily orthogonal portal images relative to reference digitally reconstructed radiographs. RESULTS There was a significant displacement of the RSV relative to the prostate in all directions: on average 0.38 mm (95% confidence interval (CI) 0.26 to 0.50) to the left, 0.80-0.81 mm (CI 0.68 to 0.93) superiorly and 1.51 mm (CI 1.36 to 1.65) posteriorly. The LSV was significantly displaced superiorly to the prostate 1.09-1.13 mm (CI 0.97 to 1.25) and posteriorly 1.81 mm (CI 1.67 to 1.96), but not laterally (mean 0.06, CI -0.06 to 0.18). The calculated PTV margins (left-right, superior-inferior, posterior-anterior) were 4.9, 5.3-5.6 and 4.8 mm for the prostate, 5.2, 7.1-8.0 and 9.7 mm for the RSV, and 7.2, 7.5-7.6 and 8.6 mm for the LSV. CONCLUSION There is a significant displacement of the PrSV relative to the prostate during radiotherapy. Greater margins are recommended for the PrSV compared to the prostate.
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Affiliation(s)
- Daryl Lim Joon
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | - Michael Chao
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | - Angelina Piccolo
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | | | - Nigel Anderson
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | - Monica Handley
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | - Margaret Benci
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | - Wee Loon Ong
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | - Karen Daly
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | - Rebecca Morrell
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | - Kenneth Wan
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | | | - Farshad Foroudi
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | - Trish Jenkins
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | - David Angus
- Department of UrologyAustin HealthMelbourneVic.Australia
| | - Morikatsu Wada
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
| | | | - Vincent Khoo
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness and Research CentreAustin HealthMelbourneVic.Australia
- Monash UniversityMelbourneVic.Australia
- Royal Marsden NHS Foundation TrustLondonUK
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11
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Muinck Keizer DM, Willigenburg T, der Voort van Zyp JRN, Raaymakers BW, Lagendijk JJW, Boer JCJ. Seminal vesicle intrafraction motion during the delivery of radiotherapy sessions on a 1.5 T MR-Linac. Radiother Oncol 2021; 162:162-169. [PMID: 34293410 DOI: 10.1016/j.radonc.2021.07.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 07/10/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate seminal vesicle (SV) intrafraction motion using cinematic magnetic resonance imaging (cine-MR) during the delivery of online adaptive MR-Linac radiotherapy fractions, in preparation of MR-guided extremely hypofractionated radiotherapy for intermediate to high-risk prostate cancer patients. MATERIAL AND METHODS Fifty prostate cancer patients were treated with 5 × 7.25 Gy on a 1.5 Tesla MR-Linac. 3D Cine-MR imaging was started simultaneously and acquired over the full beam-on period. Intrafraction motion in this cine-MR was determined for each SV separately with a previously validated soft-tissue contrast-based tracking algorithm. Motion statistics and coverage probability for the SVs and prostate were determined based on the obtained results. RESULTS SV motion was automatically determined during the beam-on period (approx. 10 min) for 247 fractions. SV intrafraction motion shows larger spread than prostate intrafraction motion and increases over time. This difference is especially evident in the anterior and cranial translation directions. Significant difference in rotation about the left-right axis was found, with larger rotation for the SVs than the prostate. Intra-fraction coverage probability of 99% can be achieved when using 5 mm isometric expansion for the left and right SV and 3 mm for the prostate. CONCLUSION This is the first study to investigate SV intrafraction motion during MR-guided RT sessions on an MR-Linac. We have shown that high quality 3D cine-MR imaging and SV tracking during RT is feasible with beam-on. The tracking method as described may be used as input for a fast replanning algorithm, which allows for intrafraction plan adaptation.
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Affiliation(s)
- D M Muinck Keizer
- University Medical Center Utrecht, Department of Radiotherapy, Utrecht, The Netherlands.
| | - T Willigenburg
- University Medical Center Utrecht, Department of Radiotherapy, Utrecht, The Netherlands
| | | | - B W Raaymakers
- University Medical Center Utrecht, Department of Radiotherapy, Utrecht, The Netherlands
| | - J J W Lagendijk
- University Medical Center Utrecht, Department of Radiotherapy, Utrecht, The Netherlands
| | - J C J Boer
- University Medical Center Utrecht, Department of Radiotherapy, Utrecht, The Netherlands
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12
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Take Action Protocol: A radiation therapist led approach to act on anatomical changes seen on CBCT. Tech Innov Patient Support Radiat Oncol 2021; 17:71-77. [PMID: 34007910 PMCID: PMC8110944 DOI: 10.1016/j.tipsro.2020.12.001] [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: 08/25/2020] [Revised: 10/29/2020] [Accepted: 12/01/2020] [Indexed: 11/24/2022] Open
Abstract
Take Action Protocol is an accurate RTT led method to act on anatomical changes. The Take Action Protocol gives RTTs more responsibility in IGRT treatment evaluation. RTTs experience the responsibility of decision making on anatomical changes as satisfactory. The TAP improves the balance of the workload vs. clinical relevance of anatomical changes.
Until recently Traffic Light Protocols (TLP) have been developed to recognize and react to Anatomical Changes (ACs) seen on Cone Beam Computer Tomography (CBCT) scans for the most common treatment sites. This involves alerting the Radiation Oncologist (RO), handing over findings, and RO providing the final decision, making it quite labour-intensive for the ROs as well as the Radiation Therapists (RTTs). A new approach was developed to act on ACs: the Take Action Protocol (TAP). In this protocol the RTTs do not only have a role in detecting ACs, but also decide on the appropriate action and follow up, resulting in a significant shift in responsibility. In this study we present the TAP and evaluated the benefit and outcomes of the implementation of TAP compared to the TLP. During a pilot period of six months the TAP was applied for 34 bladder and prostate patients. In 2 bladder and 6 prostate patients further decision making by an RO was required (compared to all 34 in the TLP), showing a large reduction in workload. ACs were accurately assessed by RTTs in >99% of the cases. In 5/34 patients RTTs specialized in Image Guided Radiotherapy provided additional instructions to improve accurate use of the TAP. Two surveys conducted by both ROs and RTTs on the TLP and TAP showed that the perceived involvement of the ROs and burden of responsibility for RTTs was comparable between the two protocols. The identification of patients with truly clinical relevant ACs and the adaptation of treatment for the remaining fractions improved according to ROs and RTTs responses. The TAP provides a better balance between workload and efficiency in relation to the clinical relevance of acting on ACs.
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13
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Yu VY, Keyrilainen J, Suilamo S, Beslimane I, Dresner A, Halkola A, Van der Heide UA, Tyagi N. A multi-institutional analysis of a general pelvis continuous Hounsfield unit synthetic CT software for radiotherapy. J Appl Clin Med Phys 2021; 22:207-215. [PMID: 33616303 PMCID: PMC7984497 DOI: 10.1002/acm2.13205] [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: 12/01/2020] [Revised: 01/21/2021] [Accepted: 01/28/2021] [Indexed: 11/06/2022] Open
Abstract
Purpose To validate a synthetic computed tomography (sCT) software with continuous HUs and large field‐of‐view (FOV) coverage for magnetic resonance imaging (MRI)‐only workflow of general pelvis anatomy in radiotherapy (RT). Methods An sCT software for general pelvis anatomy (prostate, rectum, and female pelvis) has been developed by Philips Healthcare and includes continuous HUs assignment along with large FOV coverage. General pelvis sCTs were generated using a two‐stack T1‐weighted mDixon fast‐field echo (FFE) sequence with a superior‐inferior coverage of 36 cm. Seventy‐seven prostate, 43 rectum, and 27 gynecological cases were scanned by three different institutions. mDixon image quality and sCTs were evaluated for soft tissue contrast by using a confidence level scale from 1 to 5 for bladder, prostate/rectum interface, mesorectum, and fiducial maker visibility. Dosimetric comparison was performed by recalculating the RT plans on the sCT after rigid registration. For 12 randomly selected cases, the mean absolute error (MAE) between sCT and CT was calculated to evaluate HU similarity, and the Pearson correlation coefficients (PCC) between the CT‐ and sCT‐generated digitally reconstructed radiographs (DRRs) were obtained for quantitative comparison. To examine geometric accuracy of sCT as a reference for cone beam CT (CBCT), the difference between bone‐based alignment of CBCT to CT and CBCT to sCT was obtained for 19 online‐acquired CBCTs from three patients. Results Two‐stack mDixon scans with large FOV did not show any image inhomogeneity or fat‐water swap artifact. Fiducials, Foley catheter, and even rectal spacer were visible as dark signal on the sCT. Average visibility confidence level (average ± standard deviation) on the sCT was 5.0 ± 0.0, 4.6 ± 0.5, 3.8 ± 0.4, and 4.0 ± 1.1 for bladder, prostate/rectum interface, mesorectum and fiducial markers. Dosimetric accuracy showed on average < 1% difference with the CT‐based plans for target and normal structures. The MAE of bone and soft tissue between the sCT and CT are 120.9 ± 15.4 HU, 33.4 ± 4.1 HU, respectively. Average PCC of all evaluated DRR pairs was 0.975. The average offset between CT and sCT as reference was (LR, AP, SI) = (0.19 ± 0.35, 0.14 ± 0.60, 0.44 ± 0.54) mm. Conclusions The continuous HU sCT software‐generated realistic sCTs and DRRs to enable MRI‐only planning for general pelvis anatomy.
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Affiliation(s)
- Victoria Y Yu
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jani Keyrilainen
- Department of Oncology and Radiotherapy & Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Sami Suilamo
- Department of Oncology and Radiotherapy & Department of Medical Physics, Turku University Hospital, Turku, Finland
| | | | | | | | - Uulke A Van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Neelam Tyagi
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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14
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Tyagi N, Zelefsky MJ, Wibmer A, Zakian K, Burleson S, Happersett L, Halkola A, Kadbi M, Hunt M. Clinical experience and workflow challenges with magnetic resonance-only radiation therapy simulation and planning for prostate cancer. Phys Imaging Radiat Oncol 2020; 16:43-49. [PMID: 33134566 PMCID: PMC7598055 DOI: 10.1016/j.phro.2020.09.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 08/24/2020] [Accepted: 09/25/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND PURPOSE Magnetic Resonance (MR)-only planning has been implemented clinically for radiotherapy of prostate cancer. However, fewer studies exist regarding the overall success rate of MR-only workflows. We report on successes and challenges of implementing MR-only workflows for prostate. MATERIALS AND METHODS A total of 585 patients with prostate cancer underwent an MR-only simulation and planning between 06/2016-06/2018. MR simulation included images for contouring, synthetic-CT generation and fiducial identification. Workflow interruptions occurred that required a backup CT, a re-simulation or an update to our current quality assurance (QA) process. The challenges were prospectively evaluated and classified into syn-CT generation, motion/artifacts in the MRs, fiducial QA and bowel preparation guidelines. RESULTS MR-only simulation was successful in 544 (93.2 %) patients. . In seventeen patients (2.9%), reconstruction of synthetic-CT failed due to patient size, femur angulation, or failure to determine the body contour. Twenty-four patients (4.1%) underwent a repeat/backup CT scan because of artifacts on the MR such as image blur due to patient motion or biopsy/surgical artifacts that hampered identification of the implanted fiducial markers. In patients requiring large coverage due to nodal involvement, inhomogeneity artifacts were resolved by using a two-stack acquisition and adaptive inhomogeneity correction. Bowel preparation guidelines were modified to address frequent rectum/gas issues due to longer MR scan time. CONCLUSIONS MR-only simulation has been successfully implemented for a majority of patients in the clinic. However, MR-CT or CT-only pathway may still be needed for patients where MR-only solution fails or patients with MR contraindications.
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Affiliation(s)
- Neelam Tyagi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, NY, NY 10065, United States
| | - Michael J. Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, NY, NY 10065, United States
| | - Andreas Wibmer
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, NY, NY 10065, United States
| | - Kristen Zakian
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, NY, NY 10065, United States
| | - Sarah Burleson
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, NY, NY 10065, United States
| | - Laura Happersett
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, NY, NY 10065, United States
| | - Aleksi Halkola
- Philips Healthcare, 595 Milner Road, Cleveland, OH 44143, United States
| | - Mo Kadbi
- Philips Healthcare, 595 Milner Road, Cleveland, OH 44143, United States
| | - Margie Hunt
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, NY, NY 10065, United States
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15
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Ghadjar P, Fiorino C, Munck Af Rosenschöld P, Pinkawa M, Zilli T, van der Heide UA. ESTRO ACROP consensus guideline on the use of image guided radiation therapy for localized prostate cancer. Radiother Oncol 2019; 141:5-13. [PMID: 31668515 DOI: 10.1016/j.radonc.2019.08.027] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/29/2019] [Indexed: 12/18/2022]
Abstract
Use of image-guided radiation therapy (IGRT) helps to account for daily prostate position changes during radiation therapy for prostate cancer. However, guidelines for the use of IGRT are scarce. An ESTRO panel consisting of leading radiation oncologists and medical physicists was assembled to review the literature and formulate a consensus guideline of methods and procedure for IGRT in prostate cases. Advanced methods and procedures are also described which the committee judged relevant to further improve clinical practice. Moreover, ranges for margins for the three most popular IGRT scenarios have been suggested as examples.
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Affiliation(s)
- Pirus Ghadjar
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Germany
| | - Claudio Fiorino
- Department of Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Per Munck Af Rosenschöld
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Michael Pinkawa
- Department of Radiation Oncology, MediClin Robert Janker Klinik, Bonn, Germany
| | - Thomas Zilli
- Department of Radiation Oncology, Geneva University Hospital, Switzerland
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiation Oncology, Leiden University Medical Center, The Netherlands.
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16
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Antico M, Prinsen P, Cellini F, Fracassi A, Isola AA, Cobben D, Fontanarosa D. Real-time adaptive planning method for radiotherapy treatment delivery for prostate cancer patients, based on a library of plans accounting for possible anatomy configuration changes. PLoS One 2019; 14:e0213002. [PMID: 30818345 PMCID: PMC6394960 DOI: 10.1371/journal.pone.0213002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/13/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE In prostate cancer treatment with external beam radiation therapy (EBRT), prostate motion and internal changes in tissue distribution can lead to a decrease in plan quality. In most currently used planning methods, the uncertainties due to prostate motion are compensated by irradiating a larger treatment volume. However, this could cause underdosage of the treatment volume and overdosage of the organs at risk (OARs). To reduce this problem, in this proof of principle study we developed and evaluated a novel adaptive planning method. The strategy proposed corrects the dose delivered by each beam according to the actual position of the target in order to produce a final dose distribution dosimetrically as similar as possible to the prescribed one. MATERIAL AND METHODS Our adaptive planning method was tested on a phantom case and on a clinical case. For the first, a pilot study was performed on an in-silico pelvic phantom. A "library" of intensity modulated RT (IMRT) plans corresponding to possible positions of the prostate during a treatment fraction was generated at planning stage. Then a 3D random walk model was used to simulate possible displacements of the prostate during the treatment fraction. At treatment stage, at the end of each beam, based on the current position of the target, the beam from the library of plans, which could reproduce the best approximation of the prescribed dose distribution, was selected and delivered. In the clinical case, the same approach was used on two prostate cancer patients: for the first a tissue deformation was simulated in-silico and for the second a cone beam CT (CBCT) taken during the treatment was used to simulate an intra-fraction change. Then, dosimetric comparisons with the standard treatment plan and, for the second patient, also with an isocenter shift correction, were performed. RESULTS For the phantom case, the plan generated using the adaptive planning method was able to meet all the dosimetric requirements and to correct for a misdosage of 13% of the dose prescription on the prostate. For the first clinical case, the standard planning method caused underdosage of the seminal vesicles, respectively by 5% and 4% of the prescribed dose, when the position changes for the target were correctly taken into account. The proposed adaptive planning method corrected any possible missed target coverage, reducing at the same time the dose on the OARs. For the second clinical case, both with the standard planning strategy and with the isocenter shift correction target coverage was significantly worsened (in particular uniformity) and some organs exceeded some toxicity objectives. While with our approach, the most uniform coverage for the target was produced and systematically the lowest toxicity values for the organs at risk were achieved. CONCLUSIONS In our proof of principle study, the adaptive planning method performed better than the standard planning and the isocenter shift methods for prostate EBRT. It improved the coverage of the treatment volumes and lowered the dose to the OARs. This planning method is particularly promising for hypofractionated IMRT treatments in which a higher precision and control on dose deposition are needed. Further studies will be performed to test more extensively the proposed adaptive planning method and to evaluate it at a full clinical level.
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Affiliation(s)
- Maria Antico
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
- Delft University of Technology, Delft, The Netherlands
- Philips Research, Oncology Solutions Department, Eindhoven, The Netherlands
| | - Peter Prinsen
- Philips Research, Oncology Solutions Department, Eindhoven, The Netherlands
| | - Francesco Cellini
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Istituto di Radiologia, Fondazione Policlinico A. Gemelli, IRCCS—Università Cattolica Sacro Cuore, Roma, Italia
| | - Alice Fracassi
- Philips Research, Oncology Solutions Department, Eindhoven, The Netherlands
- University of Rome Tor Vergata, Rome, Italy
| | - Alfonso A. Isola
- Philips Research, Oncology Solutions Department, Eindhoven, The Netherlands
| | - David Cobben
- North West Cancer Centre, Altnagelvin Hospital, Derry-Londonderry, Northern Ireland
- The University of Manchester, Division of Cancer Studies, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Clinical Oncology, Manchester, United Kingdom
| | - Davide Fontanarosa
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
- School of Clinical Sciences, Queensland University of Technology, Gardens Point Campus, Brisbane, QLD, Australia
- * E-mail:
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17
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Effect of accounting for interfractional CTV shape variations in PTV margins on prostate cancer radiation treatment plans. Phys Med 2018; 54:66-76. [DOI: 10.1016/j.ejmp.2018.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/01/2018] [Accepted: 09/20/2018] [Indexed: 11/18/2022] Open
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18
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Hargrave C, Deegan T, Bednarz T, Poulsen M, Harden F, Mengersen K. An image‐guided radiotherapy decision support framework incorporating a Bayesian network and visualization tool. Med Phys 2018; 45:2884-2897. [DOI: 10.1002/mp.12979] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/01/2018] [Accepted: 04/14/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Catriona Hargrave
- Radiation Oncology Princess Alexandra Hospital – Raymond Terrace Queensland Health Brisbane 4101 Australia
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
- School of Clinical Sciences Faculty of Health Queensland University of Technology Brisbane 4000 Australia
| | - Timothy Deegan
- Radiation Oncology Princess Alexandra Hospital – Raymond Terrace Queensland Health Brisbane 4101 Australia
| | - Tomasz Bednarz
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
- Data 61 Commonwealth Scientific and Industrial Research Organisation Brisbane 4102 Australia
- Expanded Perception and Interaction Centre University of New South Wales Paddington 2021 Australia
| | - Michael Poulsen
- Radiation Oncology Princess Alexandra Hospital – Raymond Terrace Queensland Health Brisbane 4101 Australia
- Faculty of Medicine University of Queensland Brisbane 4072 Australia
| | - Fiona Harden
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
- Hunter Industrial Medicine Maitland 2320 Australia
| | - Kerrie Mengersen
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
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Lyons CA, King RB, Osman SO, McMahon SJ, O’Sullivan JM, Hounsell AR, Jain S, McGarry CK. A novel CBCT-based method for derivation of CTV-PTV margins for prostate and pelvic lymph nodes treated with stereotactic ablative radiotherapy. Radiat Oncol 2017; 12:124. [PMID: 28778178 PMCID: PMC5543558 DOI: 10.1186/s13014-017-0859-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/21/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Traditional CTV-PTV margin recipes are not generally applicable in the situation of stereotactic ablative radiotherapy (SABR) treatments of multiple target volumes with a single isocentre. In this work, we present a novel geometric method of margin derivation based on CBCT-derived anatomical data. METHODS Twenty patients with high-risk localized prostate cancer were selected for retrospective review. Individual volumes of interest (prostate, prostate and seminal vesicles and pelvic lymph nodes) were delineated on five representative CBCTs and registered to the planning CT using two registration protocols: bone match or prostate-based soft tissue match. Margins were incrementally expanded around composite CTV structures until 95% overlap was achieved. RESULTS CTV-PTV margins of 5.2, 6.5 and 7.6 mm were required for prostate, prostate and seminal vesicles and pelvic lymph nodes respectively using a prostate matching protocol. For the prostate and seminal vesicle structures, margins calculated using our method displayed good agreement with a conventional margin recipe (within ±1.0 mm). CONCLUSIONS We have presented an alternative method of CTV-PTV margin derivation that is applicable to SABR treatments with more than one isocentric target. These results have informed an institutional trial of prostate and pelvic nodal SABR in men with high-risk localized prostate cancer.
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Affiliation(s)
- Ciara A. Lyons
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, BT7 1NN UK
- Clinical Oncology, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK
| | - Raymond B. King
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, BT7 1NN UK
- Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK
| | - Sarah O.S. Osman
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, BT7 1NN UK
- Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK
| | - Stephen J. McMahon
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, BT7 1NN UK
| | - Joe M. O’Sullivan
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, BT7 1NN UK
- Clinical Oncology, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK
| | - Alan R. Hounsell
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, BT7 1NN UK
- Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK
| | - Suneil Jain
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, BT7 1NN UK
- Clinical Oncology, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK
| | - Conor K. McGarry
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, BT7 1NN UK
- Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK
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Sheng Y, Li T, Lee WR, Yin FF, Wu QJ. Exploring the Margin Recipe for Online Adaptive Radiation Therapy for Intermediate-Risk Prostate Cancer: An Intrafractional Seminal Vesicles Motion Analysis. Int J Radiat Oncol Biol Phys 2017; 98:473-480. [DOI: 10.1016/j.ijrobp.2017.02.089] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 01/27/2017] [Accepted: 02/17/2017] [Indexed: 10/20/2022]
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Oates R, Jones D, Foroudi F, Gill S, Ramachandran P, Schneider M, Lim Joon M, Kron T. Geographical miss of the prostate during image-guided radiotherapy with a 6-mm posterior expansion margin. J Med Radiat Sci 2016; 64:97-105. [PMID: 27860454 PMCID: PMC5454331 DOI: 10.1002/jmrs.186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/09/2016] [Accepted: 06/13/2016] [Indexed: 12/25/2022] Open
Abstract
Introduction Our department commonly uses a planning target volume (PTV) expansion of 6 mm posterior and 1 cm in all other directions when treating prostate cancer patients with image‐guided radiotherapy (IGRT). This study aimed to test the adequacy of this PTV expansion by assessing geographical miss of the prostate on post‐treatment cone‐beam CT (CBCT) and identify those at risk of geographical miss. Methods Twenty‐two prostate cancer patients receiving IGRT with implanted fiducial markers underwent daily pre‐treatment orthogonal kV imaging followed by a post‐treatment CBCT for a total of 432 fractions. The prostate was outlined on all CBCTs. For each imaging set, the volume of geographic miss was measured by subtracting the PTV from the planning CT and prostate volume on the post‐treatment CBCT. Results The prostate volume moved outside the PTV by >0.01 cc in 9% of fractions (39/432). This occurred in 13 (59%) of 22 patients. Large prostates >40 cc and >50 cc had significantly more geographical miss events (both P < 0.001). Changes in rectal filling appear to be responsible for prostate motion/deformation in 82% (32/39) of fractions. Conclusions Our analysis suggests that, despite IGRT, prostate PTV margins are not adequate in some patients, particularly those with large prostates. PTV margins may be reduced in some other patients. Prostate rotation and deformation play an important role in setting margins and may not always be represented accurately by fiducial marker displacements. Individualised and adaptive margins for prostate cancer patients should be a priority for future research.
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Affiliation(s)
- Richard Oates
- Radiation Therapy Services, Peter MacCallum Cancer Centre, Bendigo, Australia.,Medical Imaging & Radiation Sciences, Monash University, Melbourne, Australia
| | - Daryl Jones
- Radiation Therapy Services, Peter MacCallum Cancer Centre, Bendigo, Australia
| | - Farshad Foroudi
- Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - Suki Gill
- Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Michal Schneider
- Medical Imaging & Radiation Sciences, Monash University, Melbourne, Australia
| | - Michael Lim Joon
- Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Tomas Kron
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia.,Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia
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Oates R, Brown A, Tan A, Foroudi F, Lim Joon M, Schneider M, Herschtal A, Kron T. Real-time Image-guided Adaptive-predictive Prostate Radiotherapy using Rectal Diameter as a Predictor of Motion. Clin Oncol (R Coll Radiol) 2016; 29:180-187. [PMID: 27780695 DOI: 10.1016/j.clon.2016.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 09/13/2016] [Accepted: 09/19/2016] [Indexed: 11/28/2022]
Abstract
AIMS To investigate a relationship between maximum rectal diameter (MRD) on pre-treatment cone beam computed tomography (CBCT) and intra-fraction prostate motion, in the context of an adaptive image-guided radiotherapy (IGRT) method. MATERIALS AND METHODS The MRD was measured on 2125 CBCTs from 55 retrospective patient datasets and related to prostate displacement from intra-fraction imaging. A linear regression model was developed to determine a threshold MRD associated with a high probability of small prostate displacement. Standard and reduced adaptive margin plans were created to compare rectum and bladder normal tissue complication probability (NTCP) with each method. RESULTS A per-protocol analysis carried out on 1910 fractions from 51 patients showed with 90% confidence that for a MRD≤3 cm, prostate displacement will be ≤5 mm and that for a MRD≤3.5 cm, prostate displacement will be ≤5.5 mm. In the first scenario, if adaptive therapy was used instead of standard therapy, median reductions in NTCP for rectum and bladder were 0.5% (from 9.5% to 9%) and 1.3% (from 6.6% to 5.3%), respectively. In the second scenario, the NTCP for rectum and bladder would have median reductions of 1.1% and 2.6%, respectively. CONCLUSIONS We have identified a potential method for adaptive prostate IGRT based upon predicting small prostate intra-fraction motion by measuring MRD on pre-treatment CBCT.
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Affiliation(s)
- R Oates
- Radiation Therapy Services, Peter MacCallum Cancer Centre, Bendigo, Victoria, Australia; Medical Imaging & Radiation Sciences, Monash University, Melbourne, Victoria, Australia.
| | - A Brown
- Radiation Oncology, Townsville Cancer Centre, Townsville, Queensland, Australia
| | - A Tan
- Radiation Oncology, Townsville Cancer Centre, Townsville, Queensland, Australia; College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - F Foroudi
- Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - M Lim Joon
- Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - M Schneider
- Medical Imaging & Radiation Sciences, Monash University, Melbourne, Victoria, Australia
| | - A Herschtal
- Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - T Kron
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia; Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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23
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Ramiandrisoa F, Duvergé L, Castelli J, Nguyen TD, Servagi-Vernat S, de Crevoisier R. [Clinical to planning target volume margins in prostate cancer radiotherapy]. Cancer Radiother 2016; 20:629-39. [PMID: 27614515 DOI: 10.1016/j.canrad.2016.07.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 07/22/2016] [Accepted: 07/27/2016] [Indexed: 02/03/2023]
Abstract
The knowledge of inter- and intrafraction motion and deformations of the intrapelvic target volumes (prostate, seminal vesicles, prostatectomy bed and lymph nodes) as well as the main organs at risk (bladder and rectum) allow to define rational clinical to planning target volume margins, depending on the different radiotherapy techniques and their uncertainties. In case of image-guided radiotherapy, prostate margins and seminal vesicles margins can be between 5 and 10mm. The margins around the prostatectomy bed vary from 10 to 15mm and those around the lymph node clinical target volume between 7 and 10mm. Stereotactic body radiotherapy allows lower margins, which are 3 to 5mm around the prostate. Image-guided and stereotactic body radiotherapy with adequate margins allow finally moderate or extreme hypofractionation.
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Affiliation(s)
- F Ramiandrisoa
- Département de radiothérapie, institut Jean-Godinot, 1, rue du Général-Kœnig, 51100 Reims, France.
| | - L Duvergé
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - J Castelli
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France; LTSI, campus de Beaulieu, université de Rennes 1, 35000 Rennes, France; Inserm U1099, campus de Beaulieu, 35000 Rennes, France
| | - T D Nguyen
- Département de radiothérapie, institut Jean-Godinot, 1, rue du Général-Kœnig, 51100 Reims, France
| | - S Servagi-Vernat
- Département de radiothérapie, institut Jean-Godinot, 1, rue du Général-Kœnig, 51100 Reims, France
| | - R de Crevoisier
- Département de radiothérapie, centre Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France; LTSI, campus de Beaulieu, université de Rennes 1, 35000 Rennes, France; Inserm U1099, campus de Beaulieu, 35000 Rennes, France
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24
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Fujioka C, Ishii K, Yamanaga T, Ogino R, Kishimoto S, Kawamorita R, Tada T, Nakajima T. Optimal bladder volume at treatment planning for prostate cancer patients receiving volumetric modulated arc therapy. Pract Radiat Oncol 2016; 6:395-401. [PMID: 27374192 DOI: 10.1016/j.prro.2016.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/11/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate optimal bladder volumes at treatment planning (TP) in prostate cancer patients who undergo volumetric modulated arc therapy (VMAT). METHODS AND MATERIALS To determine the minimum value, 122 patients were classified into 6 groups according to the bladder volume at TP: <100 mL (group 1), 100-149 mL (group 2), 150-199 mL (group 3), 200-249 mL (group 4), 250-299 mL (group 5), and ≥300 mL (group 6). Bladder volumes receiving more than 70 Gy (V70Gy) and V50Gy were calculated in each subgroup and compared with the bladder dose-volume constraints specified in our institution. To determine the maximum value, 64 patients who underwent uniform nursing interventions were classified into the same 6 groups. Bladder volumes on cone beam computed tomography (CBCT) images were measured once weekly during treatment, for a total of 8 measurements. Relative bladder volumes (bladder volume on CBCT image [mL]/bladder volume at TP [mL] × 100%) were evaluated in each of the 6 subgroups. RESULTS The upper bounds of the 95% confidence intervals of the mean V70Gy and V50Gy values in group 1 exceeded the dose constraints at our institution. The mean relative bladder volumes were 104%, 91%, 77%, 81%, 63%, and 59% in groups 1, 2, 3, 4, 5, and 6, respectively. The institutional criterion of 70% for the mean relative bladder volume was achieved in groups 1-4, but it could not be achieved in groups 5-6. Therefore, the patients in groups 2-4 met both institutional dose constraints for the bladder at TP and the institutional criterion for the mean relative bladder volume during treatment. CONCLUSIONS The optimal bladder volumes at TP were between 100 and 250 mL in this setting. Nursing intervention needs to be implemented before treatment planning to ensure that patients achieve the optimal bladder volume range.
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Affiliation(s)
- Chiaki Fujioka
- Department of Radiation Oncology, Tane General Hospital, Osaka, Japan.
| | - Kentaro Ishii
- Department of Radiation Oncology, Tane General Hospital, Osaka, Japan
| | - Toshiko Yamanaga
- Department of Radiation Oncology, Tane General Hospital, Osaka, Japan
| | - Ryo Ogino
- Department of Radiation Oncology, Tane General Hospital, Osaka, Japan
| | - Shun Kishimoto
- Department of Radiation Oncology, Tane General Hospital, Osaka, Japan
| | - Ryu Kawamorita
- Department of Radiation Oncology, Tane General Hospital, Osaka, Japan
| | - Takuhito Tada
- Department of Radiology, Izumi Municipal Hospital, Osaka, Japan
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25
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McPartlin AJ, Li XA, Kershaw LE, Heide U, Kerkmeijer L, Lawton C, Mahmood U, Pos F, van As N, van Herk M, Vesprini D, van der Voort van Zyp J, Tree A, Choudhury A. MRI-guided prostate adaptive radiotherapy - A systematic review. Radiother Oncol 2016; 119:371-80. [PMID: 27162159 DOI: 10.1016/j.radonc.2016.04.014] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/08/2016] [Accepted: 04/09/2016] [Indexed: 11/29/2022]
Abstract
Dose escalated radiotherapy improves outcomes for men with prostate cancer. A plateau for benefit from dose escalation using EBRT may not have been reached for some patients with higher risk disease. The use of increasingly conformal techniques, such as step and shoot IMRT or more recently VMAT, has allowed treatment intensification to be achieved whilst minimising associated increases in toxicity to surrounding normal structures. To support further safe dose escalation, the uncertainties in the treatment target position will need be minimised using optimal planning and image-guided radiotherapy (IGRT). In particular the increasing usage of profoundly hypo-fractionated stereotactic therapy is predicated on the ability to confidently direct treatment precisely to the intended target for the duration of each treatment. This article reviews published studies on the influences of varies types of motion on daily prostate position and how these may be mitigated to improve IGRT in future. In particular the role that MRI has played in the generation of data is discussed and the potential role of the MR-Linac in next-generation IGRT is discussed.
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Affiliation(s)
- A J McPartlin
- The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, UK
| | - X A Li
- Medical College of Wisconsin, USA
| | - L E Kershaw
- The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, UK
| | - U Heide
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, The Netherlands
| | - L Kerkmeijer
- University Medical Center Utrecht, The Netherlands
| | - C Lawton
- Medical College of Wisconsin, USA
| | - U Mahmood
- MD Anderson Cancer Center, Houston, USA
| | - F Pos
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, The Netherlands
| | - N van As
- Royal Marsden Hospital, UK; Institute of Cancer Research, UK
| | - M van Herk
- The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, UK
| | - D Vesprini
- Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | | | - A Tree
- Royal Marsden Hospital, UK
| | - A Choudhury
- The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, UK.
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26
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van der Burgt M, Bergsma L, de Vries J, Pos FJ, Kalisvaart R, Heemsbergen W, Remeijer P, van der Heide UA. Impact of tumour invasion on seminal vesicles mobility in radiotherapy of prostate cancer. Radiother Oncol 2015; 117:283-7. [DOI: 10.1016/j.radonc.2015.09.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/25/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
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27
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Qin A, Sun Y, Liang J, Yan D. Evaluation of Online/Offline Image Guidance/Adaptation Approaches for Prostate Cancer Radiation Therapy. Int J Radiat Oncol Biol Phys 2015; 91:1026-33. [DOI: 10.1016/j.ijrobp.2014.12.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 12/08/2014] [Indexed: 10/23/2022]
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28
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Oehler C, Lang S, Dimmerling P, Bolesch C, Kloeck S, Tini A, Glanzmann C, Najafi Y, Studer G, Zwahlen DR. PTV margin definition in hypofractionated IGRT of localized prostate cancer using cone beam CT and orthogonal image pairs with fiducial markers. Radiat Oncol 2014; 9:229. [PMID: 25384898 PMCID: PMC4229608 DOI: 10.1186/s13014-014-0229-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 10/03/2014] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To evaluate PTV margins for hypofractionated IGRT of prostate comparing kV/kV imaging or CBCT. PATIENTS AND METHODS Between 2009 and 2012, 20 patients with low- (LR), intermediate- (IR) and high-risk (HR) prostate cancer were treated with VMAT in supine position with fiducial markers (FM), endorectal balloon (ERB) and full bladder. CBCT's and kV/kV imaging were performed before and additional CBCT's after treatment assessing intra-fraction motion. CTVP for 5 patients with LR and CTVPSV for 5 patients with IR/HR prostate cancer were contoured independently by 3 radiation oncologists using MRI. The van Hark formula (PTV margin =2.5Σ +0.7σ) was applied to calculate PTV margins of prostate/seminal vesicles (P/PSV) using CBCT or FM. RESULTS 172 and 52 CBCTs before and after RT and 507 kV/kV images before RT were analysed. Differences between FM in CBCT or in planar kV image pairs were below 1 mm. Accounting for both random and systematic uncertainties anisotropic PTV margins were 5-8 mm for P (LR) and 6-11 mm for PSV (IR/HR). Random uncertainties like intra-fraction and inter-fraction (setup) uncertainties were of similar magnitude (0.9-1.4 mm). Largest uncertainty was introduced by CTV delineation (LR: 1-2 mm, IR/HR: 1.6-3.5 mm). Patient positioning using bone matching or ERB-matching resulted in larger PTV margins. CONCLUSIONS For IGRT CBCT or kV/kV-image pairs with FM are interchangeable in respect of accuracy. Especially for hypofractionated RT, PTV margins can be kept in the range of 5 mm or below if stringent daily IGRT, ideally including prostate tracking, is applied. MR-based CTV delineation optimization is recommended.
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Affiliation(s)
- Christoph Oehler
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland. .,Department of Radiation Oncology, Hospital Graubuenden, Chur, Switzerland.
| | - Stephanie Lang
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
| | - Peter Dimmerling
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
| | - Christian Bolesch
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
| | - Stephan Kloeck
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
| | - Alessandra Tini
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
| | - Christoph Glanzmann
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
| | - Yousef Najafi
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
| | - Gabriela Studer
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
| | - Daniel R Zwahlen
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland. .,Department of Radiation Oncology, Hospital Graubuenden, Chur, Switzerland.
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29
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Gill S, Dang K, Fox C, Bressel M, Kron T, Bergen N, Ferris N, Owen R, Chander S, Tai KH, Foroudi F. Seminal vesicle intrafraction motion analysed with cinematic magnetic resonance imaging. Radiat Oncol 2014; 9:174. [PMID: 25106679 PMCID: PMC4251603 DOI: 10.1186/1748-717x-9-174] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 07/12/2014] [Indexed: 11/10/2022] Open
Abstract
PURPOSE This study analyses seminal vesicle displacement relative to the prostate and in relation to treatment time. METHOD A group of eleven patients undergoing prostate cancer radiotherapy were imaged with a continuous 3 T cine-MRI in the standard treatment setup position. Four images were recorded every 4 seconds for 15 minutes in the sagittal plane and every 6.5 seconds for 12 minutes in the coronal plane. The prostate gland and seminal vesicles were contoured on each MRI image. The coordinates of the centroid of the prostate and seminal vesicles on each image was analysed for displacement against time. Displacements between the 2.5 percentile and 97.5 percentile (i.e. the 2.5% trimmed range) for prostate and seminal vesicle centroid displacements were measured for 3, 5, 10 and 15 minutes time intervals in the anterior-posterior (AP), left-right (LR) and superior-inferior (SI) directions. Real time prostate and seminal vesicle displacement was compared for individual patients. RESULTS The 2.5% trimmed range for 3, 5, 10 and 15 minutes for the seminal vesicle centroids in the SI direction measured 4.7 mm; 5.8 mm; 6.5 mm and 7.2 mm respectively. In the AP direction, it was 4.0 mm, 4.5 mm, 6.5 mm, and 7.0 mm. In the LR direction for 3, 5 and 10 minutes; for the left seminal vesicle, it was 2.7 mm, 2.8 mm, 3.4 mm and for the right seminal vesicle, it was 3.4 mm, 3.3 mm, and 3.4 mm. The correlation between the real-time prostate and seminal vesicle displacement varied substantially between patients indicating that the relationship between prostate displacement and seminal vesicles displacement is patient specific with the majority of the patients not having a strong relationship. CONCLUSION Our study shows that seminal vesicle motion increases with treatment time, and that the prostate and seminal vesicle centroids do not move in unison in real time, and that an additional margin is required for independent seminal vesicle motion if treatment localisation is to the prostate.
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Affiliation(s)
- Suki Gill
- />Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- />Department of Pathology, University of Melbourne, Melbourne, Australia
| | - Kim Dang
- />Radiation Therapy Services, Peter MacCallum Cancer Centre, Locked Bag 1; A’ Beckett Street, Melbourne, Australia
| | - Chris Fox
- />Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Mathias Bressel
- />Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Tomas Kron
- />Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Noelene Bergen
- />Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nick Ferris
- />Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Rebecca Owen
- />Radiation Therapy Services, Peter MacCallum Cancer Centre, Locked Bag 1; A’ Beckett Street, Melbourne, Australia
| | - Sarat Chander
- />Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- />Department of Pathology, University of Melbourne, Melbourne, Australia
| | - Keen Hun Tai
- />Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- />Department of Pathology, University of Melbourne, Melbourne, Australia
| | - Farshad Foroudi
- />Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- />Department of Pathology, University of Melbourne, Melbourne, Australia
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30
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Treatment simulations with a statistical deformable motion model to evaluate margins for multiple targets in radiotherapy for high-risk prostate cancer. Radiother Oncol 2013; 109:344-9. [DOI: 10.1016/j.radonc.2013.09.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 08/30/2013] [Accepted: 09/20/2013] [Indexed: 11/19/2022]
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31
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Thörnqvist S, Hysing LB, Zolnay AG, Söhn M, Hoogeman MS, Muren LP, Heijmen BJM. Adaptive radiotherapy in locally advanced prostate cancer using a statistical deformable motion model. Acta Oncol 2013; 52:1423-9. [PMID: 23964658 DOI: 10.3109/0284186x.2013.818249] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
UNLABELLED Daily treatment plan selection from a plan library is a major adaptive radiotherapy strategy to account for individual internal anatomy variations. This strategy depends on the initial input images being representative for the variations observed later in the treatment course. Focusing on locally advanced prostate cancer, our aim was to evaluate if residual motion of the prostate (CTV-p) and the elective targets (CTV-sv, CTV-ln) can be prospectively accounted for with a statistical deformable model based on images acquired in the initial part of treatment. METHODS Thirteen patients with locally advanced prostate cancer, each with 9-10 repeat CT scans, were included. Displacement vectors fields (DVF) obtained from contour-based deformable registration of delineations in the repeat- and planning CT scans were used to create patient-specific statistical motion models using principal component analysis (PCA). For each patient and CTV, four PCA-models were created: one with all 9-10 DVF as input in addition to models with only four, five or six DVFs as input. Simulations of target shapes from each PCA-model were used to calculate iso-coverage levels, which were converted to contours. The levels were analyzed for sensitivity and precision. RESULTS A union of the simulated shapes was able to cover at least 97%, 97% and 95% of the volumes of the evaluated CTV shapes for PCA-models using six, five and four DVFs as input, respectively. There was a decrease in sensitivity with higher iso-coverage levels, with a sharper decline for greater target movements. Apart from having the steepest decline in sensitivity, CTV-sv also displayed the greatest influence on the number of geometries used in the PCA-model. CONCLUSIONS PCA-based simulations of residual motion derived from four to six DVFs as input could account for the majority of the target shapes present during the latter part of the treatment. CTV-sv displayed the greatest range in both sensitivity and precision.
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Affiliation(s)
- Sara Thörnqvist
- Department of Medical Physics, Aarhus University Hospital , Aarhus , Denmark
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