1
|
Mulla Z, Hashem RM, AlMohamad A, Weber A, Habibullah H, Abdulmoula G, Mohiuddin MG, Ujaimi R. Effect of Body Mass Factors on Setup Displacement in Gynecological Tumors and Subsequent Impact on PTV Margins. Adv Radiat Oncol 2022; 8:101108. [DOI: 10.1016/j.adro.2022.101108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022] Open
|
2
|
Tsujii K, Ueda Y, Isono M, Miyazaki M, Teshima T, Koizumi M. Dosimetric impact of rotational setup errors in volumetric modulated arc therapy for postoperative cervical cancer. JOURNAL OF RADIATION RESEARCH 2021; 62:688-698. [PMID: 34056648 PMCID: PMC8273806 DOI: 10.1093/jrr/rrab044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/19/2021] [Indexed: 06/12/2023]
Abstract
We aimed to evaluate the impact of rotational setup errors on the doses received during postoperative volumetric-modulated arc therapy (VMAT) for cervical cancer. Overall, 121 cone-beam computed tomography (CBCT) sets from 20 patients were rigidly registered to reference computed tomography (CT) sets based on bony landmarks. The rotational setup errors (pitch, yaw and roll) were calculated. Then, 121 CT sets involving rotational setup errors were created, and the dose distribution in these CT sets were recalculated. The recalculated dosimetric parameters for the clinical target volume (CTV) and organs at risk (OAR) were compared to the reference values, and the correlation coefficients between the dosimetric parameter differences and rotational setup errors were calculated. Only the pitch setup error was moderately correlated with CTV coverage (r ≥ 0.40) and strongly correlated with V45 for the bladder (r ≥ 0.91) and V40 for the rectum, small bowel and bone marrow (r ≥ 0.91). The maximum dosimetric difference in a single fraction and overall fractions was -1.59% and -0.69% in D98 for the CTV, 11.72% and 5.17% in V45 for the bladder and -8.03% and -4.68% in V40 for the rectum, respectively. In conclusion, rotational setup errors only slightly impact dose coverage during postoperative cervical cancer VMAT. However, the pitch setup error occasionally affected the doses received by the bladder or the rectum in the overall fraction when the error was systematic. Thus, rotational setup errors should be corrected by adjusting six-degree-of-freedom (DOF) couches to reduce dosimetric differences in the OARs.
Collapse
Affiliation(s)
- Katsutomo Tsujii
- Department of Medical Physics & Engineering, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
- Varian Medical Systems, Chuo-ku, Tokyo 103-0026, Japan
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Masaru Isono
- Department of Radiation Oncology, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Masayoshi Miyazaki
- Department of Radiation Oncology, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Teruki Teshima
- Department of Radiation Oncology, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Masahiko Koizumi
- Corresponding author: Department of Medical Physics & Engineering, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan. Phone number: +81-6-6879-2570, Fax: +81-6-6879-2564, E-mail address:
| |
Collapse
|
3
|
Optimising image-guidance frequency for patients treated with volumetric-modulated arc therapy for pelvic cancer. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396920001223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Aim:
To determine the feasibility of non-daily image-guided radiotherapy (RT) with volumetric-modulated arc therapy for pelvic cancer.
Methods:
Daily cone beam computed tomography (CBCT) images data of 21 patients (542 fractions) with pelvic cancer were used to simulate 5 non-daily imaging (DL) protocols (Alternate day: AD, First 5 + Weekly: FF+WL, Weekly: WL, First 5 fractions: FF and Alternate week: AW protocol). The residual errors in the lateral (X), longitudinal (Y), and vertical (Z) directions and 3D vector shifts of each non-DL protocol were explored. The planning target volume (PTV) margins were calculated using the van Herk’s formula according to population systematic and random error. Finally, the average time of each process from the start to stop of the treatment was used to calculate the number of patients treated per day to assess the treatment delivery capacity for different imaging protocols.
Results:
The 3D vector shift for the FF+WL protocol produced the greatest proportion of residual error ≤ 0·5 cm and showed the smallest random error in all three directions. However, the FF protocol produced the greatest proportion of residual error > 0·5 cm and revealed the largest magnitudes of systematic error in all three directions. Only the AD protocol can explore the PTV margin of less than 0·5 cm in all three directions. The AW protocol showed the maximum capacity of the treatment delivery, showed the highest number of patients treated per day. In contrast, the AW protocol also affects the treatment accuracy, showed the large residual error and PTV margin.
Findings:
Reducing the frequency of image-guided RT results in a high residual error. Non-daily image-guided RT strategies for pelvic irradiation should be applied for margins more than 0·5 cm. The number of patients treated per day, residual error and PTV margin are information to determine non-daily protocol applications that balance treatment delivery capacity and treatment accuracy.
Collapse
|
4
|
Cree A, Livsey J, Barraclough L, Dubec M, Hambrock T, Van Herk M, Choudhury A, McWilliam A. The Potential Value of MRI in External-Beam Radiotherapy for Cervical Cancer. Clin Oncol (R Coll Radiol) 2018; 30:737-750. [PMID: 30209010 DOI: 10.1016/j.clon.2018.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/02/2018] [Accepted: 08/20/2018] [Indexed: 01/01/2023]
Abstract
The reference standard treatment for cervical cancer is concurrent chemoradiotherapy followed by magnetic resonance imaging (MRI)-guided brachytherapy. Improvements in brachytherapy have increased local control rates, but late toxicity remains high with rates of 11% grade ≥3. The primary clinical target volume (CTV) for external-beam radiotherapy includes the cervix and uterus, which can show significant inter-fraction motion. This means that generous margins are required to cover the primary CTV, increasing the radiation dose to organs at risk and, therefore, toxicity. A number of image-guided radiotherapy techniques (IGRT) have been developed, but motion can be random and difficult to predict prior to treatment. In light of the development of integrated MRI linear accelerators, this review discusses the potential value of MRI in external-beam radiotherapy. Current solutions for managing pelvic organ motion are reviewed, including the potential for online adaptive radiotherapy. The impacts of the use of MRI in tumour delineation and in the delivery of stereotactic ablative body radiotherapy (SABR) are highlighted. The potential role and challenges of using multi parametric MRI to guide radiotherapy are also discussed.
Collapse
Affiliation(s)
- A Cree
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust Christie Hospital, Manchester Academic Health Science Centre, Manchester M20 4BX, UK
| | - J Livsey
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK
| | - L Barraclough
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK
| | - M Dubec
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK
| | - T Hambrock
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK
| | - M Van Herk
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust Christie Hospital, Manchester Academic Health Science Centre, Manchester M20 4BX, UK
| | - A Choudhury
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust Christie Hospital, Manchester Academic Health Science Centre, Manchester M20 4BX, UK
| | - A McWilliam
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust Christie Hospital, Manchester Academic Health Science Centre, Manchester M20 4BX, UK.
| |
Collapse
|
5
|
Garibaldi C, Fodor C, Riva G, Rojas DP, Dicuonzo S, Pace E, Fanetti G, De Marco P, Dell'acqua V, Marvaso G, Leonardi MC, Lazzari R, Cattani F, Cremonesi M, Orecchia R, Jereczek-Fossa BA. Cone-beam CT-based inter-fraction localization errors for tumors in the pelvic region. Phys Med 2018. [PMID: 29519410 DOI: 10.1016/j.ejmp.2018.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate inter-fraction tumor localization errors (TE) in the RapidArc® treatment of pelvic cancers based on CBCT. Appropriate CTV-to PTV margins in a non-IGRT scenario have been proposed. METHODS Data of 928 patients with prostate, gynecological, and rectum/anal canal cancers were retrospectively analyzed to determine systematic and random localization errors. Two protocols were used: daily online IGRT (d-IGRT) and weekly IGRT. The latter consisted in acquiring a CBCT for the first 3 fractions and subsequently once a week. TE for patients who underwent d-IGRT protocol were calculated using either all CBCTs or the first 3. RESULTS The systematic (and random) TE in the AP, LL, and SI direction were: for prostate bed 2.7(3.2), 2.3(2.8) and 1.9(2.2) mm; for prostate 4.2(3.1), 2.9(2.8) and 2.3(2.2) mm; for gynecological 3.0(3.6), 2.4(2.7) and 2.3(2.5) mm; for rectum 2.8(2.8), 2.4(2.8) and 2.3(2.5) mm; for anal canal 3.1(3.3), 2.1(2.5) and 2.2(2.7) mm. CTV-to-PTV margins determined from all CBCTs were 14 mm in the AP, 10 mm in the LL and 9-9.5 mm in the SI directions for the prostate and the gynecological groups and 9.5-10.5 mm in AP, 9 mm in LL and 8-10 mm in the SI direction for the prostate bed and the rectum/anal canal groups. If assessed on the basis of the first 3 CBCTs, the calculated CTV-to-PTV margins were slightly larger. CONCLUSIONS without IGRT, large CTV-to-PTV margins up to 15 mm are required to account for inter-fraction tumor localization errors. Daily IGRT should be used for all hypo-fractionated treatments to reduce margins and avoid increased toxicity to critical organs.
Collapse
Affiliation(s)
| | - Cristiana Fodor
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Giulia Riva
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | - Damaris Patricia Rojas
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | - Samantha Dicuonzo
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Elisa Pace
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Giuseppe Fanetti
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Paolo De Marco
- Medical Physic Unit, European Institute of Oncology, Milano, Italy
| | - Veronica Dell'acqua
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | | | - Roberta Lazzari
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Federica Cattani
- Medical Physic Unit, European Institute of Oncology, Milano, Italy
| | - Marta Cremonesi
- Radiation Research Unit, European Institute of Oncology, Milano, Italy
| | - Roberto Orecchia
- Scientific Director, European Institute of Oncology, Milano, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| |
Collapse
|
6
|
Yao L, Zhu L, Wang J, Liu L, Zhou S, Jiang S, Cao Q, Qu A, Tian S. Positioning accuracy during VMAT of gynecologic malignancies and the resulting dosimetric impact by a 6-degree-of-freedom couch in combination with daily kilovoltage cone beam computed tomography. Radiat Oncol 2015; 10:104. [PMID: 25927659 PMCID: PMC4443556 DOI: 10.1186/s13014-015-0412-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 04/20/2015] [Indexed: 12/25/2022] Open
Abstract
Background To improve the delivery of radiotherapy in gynecologic malignancies and to minimize the irradiation of unaffected tissues by using daily kilovoltage cone beam computed tomography (kV-CBCT) to reduce setup errors. Methods Thirteen patients with gynecologic cancers were treated with postoperative volumetric-modulated arc therapy (VMAT). All patients had a planning CT scan and daily CBCT during treatment. Automatic bone anatomy matching was used to determine initial inter-fraction positioning error. Positional correction on a six-degrees-of-freedom (6DoF) couch was followed by a second scan to calculate the residual inter-fraction error, and a post-treatment scan assessed intra-fraction motion. The margins of the planning target volume (MPTV) were calculated from these setup variations and the effect of margin size on normal tissue sparing was evaluated. Results In total, 573 CBCT scans were acquired. Mean absolute pre-/post-correction errors were obtained in all six planes. With 6DoF couch correction, the MPTV accounting for intra-fraction errors was reduced by 3.8–5.6 mm. This permitted a reduction in the maximum dose to the small intestine, bladder and femoral head (P = 0.001, 0.035 and 0.032, respectively), the average dose to the rectum, small intestine, bladder and pelvic marrow (P = 0.003, 0.000, 0.001 and 0.000, respectively) and markedly reduced irradiated normal tissue volumes. Conclusions A 6DoF couch in combination with daily kV-CBCT can considerably improve positioning accuracy during VMAT treatment in gynecologic malignancies, reducing the MPTV. The reduced margin size permits improved normal tissue sparing and a smaller total irradiated volume.
Collapse
Affiliation(s)
- Lihong Yao
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - Lihong Zhu
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - Lu Liu
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - Shun Zhou
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - ShuKun Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - Qianqian Cao
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - Ang Qu
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - Suqing Tian
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| |
Collapse
|