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Zhou X, Shao T, Jia H, Hou L, Tang X, Yu C, Zhou C, Zhou S, Yang H. Current state, challenges, and future perspective of adaptive radiotherapy: A narrative review of nasopharyngeal carcinoma. Oral Oncol 2024; 158:107008. [PMID: 39182359 DOI: 10.1016/j.oraloncology.2024.107008] [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: 06/07/2024] [Revised: 08/08/2024] [Accepted: 08/19/2024] [Indexed: 08/27/2024]
Abstract
Patients with nasopharyngeal carcinoma often experience weight loss and tumor regression during the course of radiotherapy that lasts for up to 6-7 weeks. Adaptive radiotherapy is a systematic feedback control approach based on image-guided technology that adjusts these changes and optimizes the radiotherapy plans according to new imaging findings during treatment. There is growing evidence that adaptive radiotherapy can reduce side effects, improve the quality of life, and enhance disease control. However, the routine application of adaptive radiotherapy for nasopharyngeal remains relatively limited. This review discusses the necessity, clinical benefits, and limitations of adaptive radiotherapy, and presents the current state, challenges, and future perspective of adaptive radiotherapy strategies for nasopharyngeal carcinoma.
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Affiliation(s)
- Xiate Zhou
- Department of Radiation Oncology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Zhejiang Province 317000, China; Department of Radiation Oncology, Enze Hospital, Taizhou Enze Medical Center (Group), Zhejiang Province 317000, China; Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province 317000, China
| | - Tianchi Shao
- Department of Radiation Oncology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Zhejiang Province 317000, China; Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province 317000, China; School of Public Health and Management, Wenzhou Medical University, Zhejiang Province 325035, China
| | - Haijian Jia
- Department of Radiation Oncology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Zhejiang Province 317000, China; Department of Radiation Oncology, Enze Hospital, Taizhou Enze Medical Center (Group), Zhejiang Province 317000, China; Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province 317000, China
| | - Liqiao Hou
- Department of Radiation Oncology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Zhejiang Province 317000, China; Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province 317000, China
| | - Xingni Tang
- Department of Radiation Oncology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Zhejiang Province 317000, China; Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province 317000, China
| | - Changhui Yu
- Department of Radiation Oncology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Zhejiang Province 317000, China; Department of Radiation Oncology, Enze Hospital, Taizhou Enze Medical Center (Group), Zhejiang Province 317000, China; Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province 317000, China
| | - Chao Zhou
- Department of Radiation Oncology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Zhejiang Province 317000, China; Department of Radiation Oncology, Enze Hospital, Taizhou Enze Medical Center (Group), Zhejiang Province 317000, China; Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province 317000, China
| | - Suna Zhou
- Department of Radiation Oncology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Zhejiang Province 317000, China; Department of Radiation Oncology, Enze Hospital, Taizhou Enze Medical Center (Group), Zhejiang Province 317000, China; Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province 317000, China.
| | - Haihua Yang
- Department of Radiation Oncology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Zhejiang Province 317000, China; Department of Radiation Oncology, Enze Hospital, Taizhou Enze Medical Center (Group), Zhejiang Province 317000, China; Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang Province 317000, China.
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Chen A, Chen X, Jiang X, Wang Y, Chi F, Xie D, Zhou M. Anatomical changes and dosimetric analysis of the neck region based on FBCT for nasopharyngeal carcinoma patients during radiotherapy. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2024; 32:783-795. [PMID: 38457140 DOI: 10.3233/xst-230280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND The study aimed to investigate anatomical changes in the neck region and evaluate their impact on dose distribution in patients with nasopharyngeal carcinoma (NPC) undergoing intensity modulated radiation therapy (IMRT). Additionally, the study sought to determine the optimal time for replanning during the course of treatment. METHODS Twenty patients diagnosed with NPC underwent IMRT, with weekly pretreatment kV fan beam computed tomography (FBCT) scans in the treatment room. Metastasized lymph nodes in the neck region and organs at risk (OARs) were redelineation using the images from the FBCT scans. Subsequently, the original treatment plan (PLAN0) was replicated to each FBCT scan to generate new plans labeled as PLAN 1-6. The dose-volume histograms (DVH) of the new plans and the original plan were compared. One-way repeated measure ANOVA was utilized to establish threshold(s) at various time points. The presence of such threshold(s) would signify significant change(s), suggesting the need for replanning. RESULTS Progressive volume reductions were observed over time in the neck region, the gross target volume for metastatic lymph nodes (GTVnd), as well as the submandibular glands and parotids. Compared to PLAN0, the mean dose (Dmean) of GTVnd-L significantly increased in PLAN5, while the minimum dose covering 95% of the volume (D95%) of PGTVnd-L showed a significant decrease from PLAN3 to PLAN6. Similarly, the Dmean of GTVnd-R significantly increased from PLAN4 to PLAN6, whereas the D95% of PGTVnd-R exhibited a significant decrease during the same period. Furthermore, the dose of bilateral parotid glands, bilateral submandibular glands, brainstem and spinal cord was gradually increased in the middle and late period of treatment. CONCLUSION Significant anatomical and dosimetric changes were noted in both the target volumes and OARs. Considering the thresholds identified, it is imperative to undertake replanning at approximately 20 fractions. This measure ensures the delivery of adequate doses to target volumes while mitigating the risk of overdosing on OARs.
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Affiliation(s)
- Aoqiang Chen
- Department of Radiation Medicine, Guangdong Provincial Key Laboratory of Tropical Disease Research, NMPA Key Laboratory for Safety Evaluation of Cosmetics, School of Public Health, Southern Medical University, Guangzhou, China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xuemei Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xiaobo Jiang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yajuan Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Feng Chi
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Dehuan Xie
- Department of Radiation Oncology, Guangdong Provincial People's Hospital, Southern Medical University, Guangzhou, China
| | - Meijuan Zhou
- Department of Radiation Medicine, Guangdong Provincial Key Laboratory of Tropical Disease Research, NMPA Key Laboratory for Safety Evaluation of Cosmetics, School of Public Health, Southern Medical University, Guangzhou, China
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Effect of Body Size Change on Off-Center Cervical Point and Face Doses in Patients Undergoing Nasopharyngeal Carcinoma Radiotherapy. DISEASE MARKERS 2022; 2022:9978282. [PMID: 35510039 PMCID: PMC9061042 DOI: 10.1155/2022/9978282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/01/2022] [Indexed: 11/20/2022]
Abstract
Nasopharyngeal carcinoma (NPC) is a clinically multiple malignant tumor. At present, with the increase in the infection rate of Epstein-Barr virus, the incidence of nasopharyngeal carcinoma is also increasing day by day. To explore the effect of body size change on off-center cervical point and face doses in patients with nasopharyngeal carcinoma (NPC) undergoing radiotherapy, in total, 100 patients with NPC from January 2019 to May 2020 in our hospital were selected for retrospective analysis, and they all received intensity-modulated radiation therapy. Bodyweight, horizontal longitudinal diameter of the odontoid process, longitudinal diameter of the third cervical spine, maximum radiation dose, and average radiation dose of normal organs in the first and last treatments were assessed, and the correlation between normal organ irradiation dose and body size was analyzed. Bodyweight, horizontal longitudinal diameter of the odontoid process, and longitudinal diameter of the third cervical spine in the last treatment were lower than those in the first treatment, with a statistically significant difference. There was no statistically significant difference in the maximum normal organ irradiation dose to the left eyeball, right eyeball, left crystalline lens, right crystalline lens, and maximum irradiation dose to optic nerve between the last treatment and the first treatment. In the last treatment, the maximum dose to the left parotid gland, right parotid gland, spinal cord, and brain stem was higher than that in the first treatment. The average irradiation dose to the left eye bulb, right eye bulb, left lens, right lens, optic nerve in the last treatment, and that in the first treatment showed no significant difference. The average dose to the left parotid gland, right parotid gland, spinal cord, and brain stem in the last treatment was higher than that in the first treatment. The irradiation dose to the left parotid gland, right parotid gland, spinal cord, and brain stem was significantly negatively correlated with body weight, horizontal longitudinal diameter of the odontoid process, and longitudinal diameter of the third cervical spine. After NPC radiotherapy, the body size of patients can change, which can have different effects on irradiation doses. Therefore, the target area and dose should be corrected during treatment to ensure the efficacy and safety of the treatment.
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Zhou X, Wang W, Zhou C, Zhu J, Ding W, Chen M, Chen K, Shi Y, Chen X, Kong FM, Yang H. Long-term outcomes of replanning during intensity-modulated radiation therapy in patients with nasopharyngeal carcinoma: An updated and expanded retrospective analysis. Radiother Oncol 2022; 170:136-142. [DOI: 10.1016/j.radonc.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 02/28/2022] [Accepted: 03/05/2022] [Indexed: 10/18/2022]
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Sun Y, Liu G, Chen W, Chen T, Liu P, Zeng Q, Hong J, Wei R. Dosimetric comparisons of craniospinal axis irradiation using helical tomotherapy, volume-modulated arc therapy and intensity-modulated radiotherapy for medulloblastoma. Transl Cancer Res 2019; 8:191-202. [PMID: 35116748 PMCID: PMC8797767 DOI: 10.21037/tcr.2019.01.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/15/2019] [Indexed: 11/06/2022]
Abstract
Background To evaluate the potential dosimetric gains of helical tomotherapy (HT) versus intensity-modulated radiotherapy (IMRT) and volume-modulated arc therapy (VMAT) for craniospinal axis irradiation (CSI) of medulloblastoma. Methods A total of 36 treatment plans were calculated retrospectively for 12 patients with medulloblastoma receiving CSI using HT with TomoTherapy Hi-Art Software (Version 2.0.7) (Accuray, Madison, WI, USA). For each case, the other two different delivery techniques were re-planned with IMRT/VMAT optimized with Eclipse treatment planning system (TPS) (Version 11.0.31). Homogeneity index (HI) and conformity index (CI) of the planning target volume (PTV) and organs at risk (OARs) sparing were analyzed. Differences in plans were evaluated using paired-samples t-test for various dosimetric parameters. Results HT yielded the highest CI in all PTV coverage including PTV of gross tumor volume (PGTV) (HT: 0.7163; VMAT: 0.6688; IMRT: 0.6096), PTVbrain (HT: 0.8490; VMAT: 0.8384; IMRT: 0.7815) and PTVspine (HT: 0.5904; VMAT: 0.5862; IMRT: 0.5797). Meanwhile, HT yielded better HI in PGTV (HT: 0.0543; VMAT: 0.0759; IMRT: 0.0736), PTVbrain (HT: 0.5525; VMAT: 0.5619; IMRT: 0.5554) and PTVspine (HT: 0.0700; VMAT: 0.0782; IMRT: 0.0877). As for OARs, HT demonstrated marked superiority in critical organs including maximal/mean doses of brainstem PRV, optical chiasm and optic nerves. Conclusions For CSI of medulloblastoma, HT offers superior outcomes in terms of PTV conformity, PTV homogeneity and critical OAR sparing as compared with IMRT/VMAT.
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Affiliation(s)
- Yangqing Sun
- Department of Oncology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Gui Liu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Wen Chen
- Department of Oncology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Taili Chen
- Department of Oncology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Pei Liu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Qian Zeng
- Department of Oncology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Jidong Hong
- Department of Oncology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Rui Wei
- Department of Oncology, Xiangya Hospital, Central South University, Changsha 410008, China
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Stoiber EM, Bougatf N, Teske H, Bierstedt C, Oetzel D, Debus J, Bendl R, Giske K. Analyzing human decisions in IGRT of head-and-neck cancer patients to teach image registration algorithms what experts know. Radiat Oncol 2017. [PMID: 28637483 PMCID: PMC5480194 DOI: 10.1186/s13014-017-0842-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background In IGRT of deformable head-and-neck anatomy, patient setup corrections are derived by rigid registration methods. In practice, experienced radiation therapists often correct the resulting vectors, thus indicating a different prioritization of alignment of local structures. Purpose of this study is to transfer the knowledge experts apply when correcting the automatically generated result (pre-match) to automated registration. Methods Datasets of 25 head-and-neck-cancer patients with daily CBCTs and corresponding approved setup correction vectors were analyzed. Local similarity measures were evaluated to identify the criteria for human corrections with regard to alignment quality, analogous to the radiomics approach. Clustering of similarity improvement patterns is applied to reveal priorities in the alignment quality. Results The radiation therapists prioritized to align the spinal cord closest to the high-dose area. Both target volumes followed with second and third highest priority. The bony pre-match influenced the human correction along the crania-caudal axis. Based on the extracted priorities, a new rigid registration procedure is constructed which is capable of reproducing the corrections of experts. Conclusions The proposed approach extracts knowledge of experts performing IGRT corrections to enable new rigid registration methods that are capable of mimicking human decisions. In the future, the deduction of knowledge-based corrections for different cohorts can be established automating such supervised learning approaches.
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Affiliation(s)
- Eva Maria Stoiber
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Nina Bougatf
- National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hendrik Teske
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Christian Bierstedt
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Dieter Oetzel
- National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Debus
- National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Rolf Bendl
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.,Faculty of Computer Science, Heilbronn University, Heilbronn, Germany
| | - Kristina Giske
- Division of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany. .,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.
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Gong G, Kong X, Wang X, Zheng C, Guo Y, Yin Y. Finding of dose evaluation for organs at risk in intensity-modulated radiation therapy for nasopharyngeal carcinoma using magnetic resonance imaging. PRECISION RADIATION ONCOLOGY 2017. [DOI: 10.1002/pro6.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Guanzhong Gong
- Biomedical and Multimedia Information Technology (BMIT) research group, School of Information Technologies (SIT); The University of Sydney; New South Wales Australia
- Shandong Cancer Hospital and Institute; Jinan Shandong China
| | - Xudong Kong
- The No. 4 Hospital of Wuxi; Wuxi Jiang Su province China
| | - Xiuying Wang
- Biomedical and Multimedia Information Technology (BMIT) research group, School of Information Technologies (SIT); The University of Sydney; New South Wales Australia
| | - Chaojie Zheng
- Biomedical and Multimedia Information Technology (BMIT) research group, School of Information Technologies (SIT); The University of Sydney; New South Wales Australia
| | - Yujie Guo
- Shandong Cancer Hospital and Institute; Jinan Shandong China
| | - Yong Yin
- Shandong Cancer Hospital and Institute; Jinan Shandong China
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