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Fujinaka R, Komatsu S, Terashima K, Demizu Y, Omiya S, Kido M, Toyama H, Tokumaru S, Okimoto T, Fukumoto T. Clinical impact of spacer placement surgery with expanded polytetrafluoroethylene sheet for particle therapy. Radiat Oncol 2023; 18:173. [PMID: 37875956 PMCID: PMC10594906 DOI: 10.1186/s13014-023-02359-5] [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: 09/03/2023] [Accepted: 10/07/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Spacer placement surgery is useful in particle therapy (PT) for patients with abdominopelvic malignant tumors located adjacent to the gastrointestinal tract. This study aimed to assess the safety, efficacy, and long-term outcomes of spacer placement surgery using an expanded polytetrafluoroethylene (ePTFE) spacer. METHODS This study included 131 patients who underwent ePTFE spacer placement surgery and subsequent PT between September 2006 and June 2019. The overall survival (OS) and local control (LC) rates were calculated using Kaplan-Meier method. Spacer-related complications were classified according to the National Cancer Institute Common Terminology Criteria for Adverse Events (version 5.0). RESULTS The median follow-up period after spacer placement surgery was 36.8 months. The 3-year estimated OS and LC rates were 60.5% and 76.5%, respectively. A total of 130 patients (99.2%) were able to complete PT. Spacer-related complications of ≥ grade 3 were observed in four patients (3.1%) in the acute phase and 13 patients (9.9%) in the late phase. Ten patients (7.6%) required removal of the ePTFE spacer. CONCLUSIONS Spacer placement surgery using an ePTFE spacer for abdominopelvic malignant tumors is technically feasible and acceptable for subsequent PT. However, severe spacer-related late complications were observed in some patients. Since long-term placement of a non-absorbable ePTFE spacer is associated with risks for morbidity and infection, careful long-term follow-up and prompt therapeutic intervention are essential when complications associated with the ePTFE spacer occur. TRIAL REGISTRATION retrospectively registered.
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Affiliation(s)
- Ryosuke Fujinaka
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan
| | - Shohei Komatsu
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan.
| | - Kazuki Terashima
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Kouto, Shingu-cho, Tatsuno, 679-5165, Hyogo, Japan
| | - Yusuke Demizu
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Kouto, Shingu-cho, Tatsuno, 679-5165, Hyogo, Japan
- Department of Radiation Oncology, Hyogo Ion Beam Medical Center Kobe Proton Center, 1-6-8 Minatojimaminami-machi, Chuo-ku, Kobe, 650-0047, Hyogo, Japan
| | - Satoshi Omiya
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan
| | - Masahiro Kido
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan
| | - Hirochika Toyama
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan
| | - Sunao Tokumaru
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Kouto, Shingu-cho, Tatsuno, 679-5165, Hyogo, Japan
| | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Kouto, Shingu-cho, Tatsuno, 679-5165, Hyogo, Japan
| | - Takumi Fukumoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan
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Hirai R, Mori S, Suyari H, Tsuji H, Ishikawa H. Optimizing 3DCT image registration for interfractional changes in carbon-ion prostate radiotherapy. Sci Rep 2023; 13:7448. [PMID: 37156901 PMCID: PMC10167266 DOI: 10.1038/s41598-023-34339-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 04/27/2023] [Indexed: 05/10/2023] Open
Abstract
To perform setup procedures including both positional and dosimetric information, we developed a CT-CT rigid image registration algorithm utilizing water equivalent pathlength (WEPL)-based image registration and compared the resulting dose distribution with those of two other algorithms, intensity-based image registration and target-based image registration, in prostate cancer radiotherapy using the carbon-ion pencil beam scanning technique. We used the data of the carbon ion therapy planning CT and the four-weekly treatment CTs of 19 prostate cancer cases. Three CT-CT registration algorithms were used to register the treatment CTs to the planning CT. Intensity-based image registration uses CT voxel intensity information. Target-based image registration uses target position on the treatment CTs to register it to that on the planning CT. WEPL-based image registration registers the treatment CTs to the planning CT using WEPL values. Initial dose distributions were calculated using the planning CT with the lateral beam angles. The treatment plan parameters were optimized to administer the prescribed dose to the PTV on the planning CT. Weekly dose distributions using the three different algorithms were calculated by applying the treatment plan parameters to the weekly CT data. Dosimetry, including the dose received by 95% of the clinical target volume (CTV-D95), rectal volumes receiving > 20 Gy (RBE) (V20), > 30 Gy (RBE) (V30), and > 40 Gy (RBE) (V40), were calculated. Statistical significance was assessed using the Wilcoxon signed-rank test. Interfractional CTV displacement over all patients was 6.0 ± 2.7 mm (19.3 mm maximum standard amount). WEPL differences between the planning CT and the treatment CT were 1.2 ± 0.6 mm-H2O (< 3.9 mm-H2O), 1.7 ± 0.9 mm-H2O (< 5.7 mm-H2O) and 1.5 ± 0.7 mm-H2O (< 3.6 mm-H2O maxima) with the intensity-based image registration, target-based image registration, and WEPL-based image registration, respectively. For CTV coverage, the D95 values on the planning CT were > 95% of the prescribed dose in all cases. The mean CTV-D95 values were 95.8 ± 11.5% and 98.8 ± 1.7% with the intensity-based image registration and target-based image registration, respectively. The WEPL-based image registration was CTV-D95 to 99.0 ± 0.4% and rectal Dmax to 51.9 ± 1.9 Gy (RBE) compared to 49.4 ± 9.1 Gy (RBE) with intensity-based image registration and 52.2 ± 1.8 Gy (RBE) with target-based image registration. The WEPL-based image registration algorithm improved the target coverage from the other algorithms and reduced rectal dose from the target-based image registration, even though the magnitude of the interfractional variation was increased.
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Affiliation(s)
- Ryusuke Hirai
- National Institutes for Quantum Science and Technology, Quantum Life and Medical Science Directorate, Institute for Quantum Medical Science, Inage-ku, Chiba, 263-8555, Japan
- Corporate Research and Development Center, Toshiba Corporation, Kanagawa, 212-8582, Japan
- Department of Information and Image Sciences, Faculty of Engineering, Chiba University, Inage-ku, Chiba, 263-8522, Japan
| | - Shinichiro Mori
- National Institutes for Quantum Science and Technology, Quantum Life and Medical Science Directorate, Institute for Quantum Medical Science, Inage-ku, Chiba, 263-8555, Japan.
| | - Hiroki Suyari
- Department of Information and Image Sciences, Faculty of Engineering, Chiba University, Inage-ku, Chiba, 263-8522, Japan
| | - Hiroshi Tsuji
- QST Hospital, National Institutes for Quantum Science and Technology, Inage-ku, Chiba, 263-8555, Japan
| | - Hitoshi Ishikawa
- QST Hospital, National Institutes for Quantum Science and Technology, Inage-ku, Chiba, 263-8555, Japan
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Shin HB, Kim C, Han MC, Hong CS, Park S, Koom WS, Kim JS. Dosimetric comparison of robust angles in carbon-ion radiation therapy for prostate cancer. Front Oncol 2023; 13:1054693. [PMID: 36874141 PMCID: PMC9978491 DOI: 10.3389/fonc.2023.1054693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/27/2023] [Indexed: 02/18/2023] Open
Abstract
The objective of this study is to compare the plan robustness at various beam angles. Hence, the influence of the beam angles on robustness and linear energy transfer (LET) was evaluated in gantry-based carbon-ion radiation therapy (CIRT) for prostate cancer. 10 patients with prostate cancer were considered, and a total dose of 51.6 Gy (Relative biological effectiveness (RBE) was prescribed for the target volume in 12 fractions. Five beam field plans comprising two opposed fields with different angle pairs were characterized. Further, dose parameters were extracted, and the RBE-weighted dose and LET values for all angle pairs were compared. All plans considering the setup uncertainty satisfied the dose regimen. When a parallel beam pair was used for perturbed scenarios to take into account set-up uncertainty in the anterior direction, the LET clinical treatment volume (CTV) D 95% standard deviation was 1.5 times higher, and the standard deviation of RBE-weighted CTV D 95% was 7.9 times higher compared to an oblique pair. The oblique beam fields were superior in terms of dose sparing for the rectum compared to the dose distribution using two conventional lateral opposed fields for prostate cancer.
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Affiliation(s)
- Han-Back Shin
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Changhwan Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Cheol Han
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chae-Seon Hong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seyjoon Park
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei Severance Hospital, Seoul, Republic of Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
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Yamamoto Y, Hino A, Kurihara H, Kano K, Serizawa I, Katoh H, Hiruma T. Transitional changes of spacer materials used in carbon-ion radiation therapy. Asia Pac J Clin Oncol 2022; 18:e442-e447. [PMID: 35098680 DOI: 10.1111/ajco.13751] [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: 02/24/2021] [Accepted: 12/13/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE To evaluate the imaging findings and transitional changes in spacer materials used in carbon-ion radiation therapy MATERIALS: Medical records were retrospectively reviewed, and the maximum thickness, volume, and CT value of spacers were calculated from CT scans. Procedure-related complications were recorded. RESULTS A spacer was surgically placed in six patients in retroperitoneal, presacral, or peritoneal sites. The spacer material was polyglycolic acid (PGA) in four patients and expanded polytetrafluoroethylene (ePTFE) in two patients. The thickness of PGA spacers showed no changes in any patients within 4 weeks, but increased within 6 weeks in one patient and was unchanged or decreased in the remaining patients. PGA spacer volume decreased gradually after placement in three of four patients; this was observed at 4 months in two patients and at 6 months in one patient. The mean CT value of PGA spacers was 83 HU just after placement, and decreased gradually thereafter. Air was seen in the PGA spacers of two patients. Neither ePTFE spacer showed volume changes over time, and the mean CT value was low (mean, -53.7 HU) just after placement but increased rapidly to 145 HU at 2 months. CONCLUSION Spacer imaging findings may vary according to type and may change over time. Familiarity with these features is beneficial for diagnostic radiologists.
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Affiliation(s)
- Yayoi Yamamoto
- Department of Radiology and Interventional Radiology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Ayako Hino
- Department of Radiology and Interventional Radiology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Hiroaki Kurihara
- Department of Radiology and Interventional Radiology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Kio Kano
- Department of Radiation Oncology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Itsuko Serizawa
- Department of Radiation Oncology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Hiroyuki Katoh
- Department of Radiation Oncology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Toru Hiruma
- Department of Musculoskeletal Tumor Surgery, Kanagawa Cancer Center, Kanagawa, Japan
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Chen G, Han Y, Zhang H, Tu W, Zhang S. Radiotherapy-Induced Digestive Injury: Diagnosis, Treatment and Mechanisms. Front Oncol 2021; 11:757973. [PMID: 34804953 PMCID: PMC8604098 DOI: 10.3389/fonc.2021.757973] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/20/2021] [Indexed: 12/12/2022] Open
Abstract
Radiotherapy is one of the main therapeutic methods for treating cancer. The digestive system consists of the gastrointestinal tract and the accessory organs of digestion (the tongue, salivary glands, pancreas, liver and gallbladder). The digestive system is easily impaired during radiotherapy, especially in thoracic and abdominal radiotherapy. In this review, we introduce the physical classification, basic pathogenesis, clinical characteristics, predictive/diagnostic factors, and possible treatment targets of radiotherapy-induced digestive injury. Radiotherapy-induced digestive injury complies with the dose-volume effect and has a radiation-based organ correlation. Computed tomography (CT), MRI (magnetic resonance imaging), ultrasound (US) and endoscopy can help diagnose and evaluate the radiation-induced lesion level. The latest treatment approaches include improvement in radiotherapy (such as shielding, hydrogel spacers and dose distribution), stem cell transplantation and drug administration. Gut microbiota modulation may become a novel approach to relieving radiogenic gastrointestinal syndrome. Finally, we summarized the possible mechanisms involved in treatment, but they remain varied. Radionuclide-labeled targeting molecules (RLTMs) are promising for more precise radiotherapy. These advances contribute to our understanding of the assessment and treatment of radiation-induced digestive injury.
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Affiliation(s)
- Guangxia Chen
- Department of Gastroenterology, The First People's Hospital of Xuzhou, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University, Xuzhou, China
| | - Yi Han
- Department of Gastroenterology, The First People's Hospital of Xuzhou, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University, Xuzhou, China
| | - Haihan Zhang
- Department of Gastroenterology, The First People's Hospital of Xuzhou, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University, Xuzhou, China
| | - Wenling Tu
- The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Shuyu Zhang
- The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China.,West China Second University Hospital, Sichuan University, Chengdu, China
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Zhou J, Yang X, Chang CW, Tian S, Wang T, Lin L, Wang Y, Janopaul-Naylor JR, Patel P, Demoor JD, Bohannon D, Stanforth A, Eaton B, McDonald MW, Liu T, Patel SA. Dosimetric Uncertainties in Dominant Intraprostatic Lesion Simultaneous Boost Using Intensity Modulated Proton Therapy. Adv Radiat Oncol 2021; 7:100826. [PMID: 34805623 PMCID: PMC8581277 DOI: 10.1016/j.adro.2021.100826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/27/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose While intensity modulated proton therapy can deliver simultaneous integrated boost (SIB) to the dominant intraprostatic lesion (DIL) with high precision, it is sensitive to anatomic changes. We investigated the dosimetric effects from these changes based on pretreatment cone-beam computed tomographic (CBCT) images and identified the most important factors using a multilayer perceptron neural network (MLPNN). Methods and Materials DILs were contoured based on coregistered multiparametric magnetic resonance images for 25 previously treated prostate cancer patients. SIB plans were created with (1) prostate clinical target volume − V70 Gy = 98%; (2) DIL − V98 Gy > 95%; and (3) all organs at risk (OARs)"?> within clinical constraints. SIB plans were applied to daily CBCT-based deformed planning computed tomography (CT)"?>. DIL − V98 Gy, bladder/rectum maximum dose (Dmax) and volume changes, femur shifts, and the distance from DIL to organs at riskOARs"?> in both planning computed tomogramsCT"?> and CBCT were calculated. Wilcoxon signed-ranks tests were used to compare the changes. MLPNNs were used to model the change in ΔDIL − V98 Gy > 10% and bladder/rectum Dmax > 80 Gy, and the relative importance factors for the model were provided. The performances of the models were evaluated with receiver operating characteristic curves. Results Comparing initial plan to the average from evaluation plans, respectively, DIL − V98 Gy was 89.3% ± 19.9% versus 86.2% ± 21.3% (P = .151); bladder Dmax 71.9 ± 0.6 Gy versus 74.5 ± 2.9 Gy (P < .001); and rectum Dmax 70.1 ± 2.4 Gy versus 74.9 ± 9.1Gy (P = .007). Bladder and rectal volumes were 99.6% ± 39.5% and 112.8% ± 27.2%, respectively, of their initial volume. The femur shift was 3.16 ± 2.52 mm. In the modeling of ΔDIL V98 Gy > 10%, DIL to rectum distance changes, DIL to bladder distance changes, and rectum volume changes ratio are the 3 most important factors. The areas under the receiver operating characteristic curves were 0.89, 1.00, and 0.99 for the modeling of ΔDIL − V98 Gy > 10%, and bladder and rectum Dmax > 80 Gy, respectively. Conclusions Dosimetric changes in DIL SIB with intensity modulated proton therapy can be modeled and classified based on anatomic changes on pretreatment images by an MLPNN.
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Affiliation(s)
- Jun Zhou
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Xiaofeng Yang
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Chih-Wei Chang
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Sibo Tian
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Tonghe Wang
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Liyong Lin
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Yinan Wang
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | | | - Pretesh Patel
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - John D Demoor
- Department of Medical Physics, Georgia Institute of Technology, Atlanta, Georgia
| | - Duncan Bohannon
- Department of Medical Physics, Georgia Institute of Technology, Atlanta, Georgia
| | - Alex Stanforth
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Bree Eaton
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Mark W McDonald
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Tian Liu
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Sagar Anil Patel
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
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Magalhaes Martins P, Freitas H, Tessonnier T, Ackermann B, Brons S, Seco J. Towards real-time PGS range monitoring in proton therapy of prostate cancer. Sci Rep 2021; 11:15331. [PMID: 34321492 PMCID: PMC8319377 DOI: 10.1038/s41598-021-93612-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 06/24/2021] [Indexed: 11/09/2022] Open
Abstract
Proton therapy of prostate cancer (PCPT) was linked with increased levels of gastrointestinal toxicity in its early use compared to intensity-modulated radiation therapy (IMRT). The higher radiation dose to the rectum by proton beams is mainly due to anatomical variations. Here, we demonstrate an approach to monitor rectal radiation exposure in PCPT based on prompt gamma spectroscopy (PGS). Endorectal balloons (ERBs) are used to stabilize prostate movement during radiotherapy. These ERBs are usually filled with water. However, other water solutions containing elements with higher atomic numbers, such as silicon, may enable the use of PGS to monitor the radiation exposure of the rectum. Protons hitting silicon atoms emit prompt gamma rays with a specific energy of 1.78 MeV, which can be used to monitor whether the ERB is being hit. In a binary approach, we search the silicon energy peaks for every irradiated prostate region. We demonstrate this technique for both single-spot irradiation and real treatment plans. Real-time feedback based on the ERB being hit column-wise is feasible and would allow clinicians to decide whether to adapt or continue treatment. This technique may be extended to other cancer types and organs at risk, such as the oesophagus.
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Affiliation(s)
- Paulo Magalhaes Martins
- German Cancer Research Center - DKFZ, Heidelberg, Germany.
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Lisbon, Portugal.
| | - Hugo Freitas
- German Cancer Research Center - DKFZ, Heidelberg, Germany
- Departamento de Física e Astronomia, Faculdade de Ciências da Universidade do Porto, Porto, Portugal
| | - Thomas Tessonnier
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Benjamin Ackermann
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stephan Brons
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Joao Seco
- German Cancer Research Center - DKFZ, Heidelberg, Germany.
- Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany.
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Omi Y, Yasui K, Shimomura A, Muramatsu R, Iwata H, Ogino H, Furukawa A, Hayashi N. Dosimetric effects of quality assurance-related setup errors in passive proton therapy for prostate cancer with and without a hydrogel spacer. Radiol Phys Technol 2021; 14:328-335. [PMID: 34313911 DOI: 10.1007/s12194-021-00632-4] [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: 10/07/2020] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to evaluate the effect of quality assurance (QA)-related setup errors in passive proton therapy for prostate cancer with and without a hydrogel spacer. We used 20 typical computed tomography (CT) images of prostate cancer: 10 patients with and 10 patients without spacers. The following 12 model errors were assumed: output error ± 2%, range error ± 1 mm, setup error ± 1 mm for three directions, and multileaf collimator (MLC) position error ± 1 mm. We created verification plans with model errors and compared the prostate-rectal (PR) distance and dose indices with and without the spacer. The mean PR distance at the isocenter was 1.1 ± 1.3 mm without the spacer and 12.9 ± 2.9 mm with the spacer (P < 0.001). The mean rectum V53.5 GyE, V50 GyE, and V34.5 GyE in the original plan were 2.3%, 4.1%, and 12.1% without the spacer and 0.1%, 0.4%, and 3.3% with the spacer (P = 0.0011, < 0.001, and < 0.001). The effects of the range and lateral setup errors were small; however, the effects of the vertical/long setup and MLC error were significant in the cases without the spacer. The means of the maximum absolute change from original plans across all scenarios in the rectum V53.5 GyE, V50 GyE, and V34.5 GyE were 1.3%, 1.5%, and 2.3% without the spacer, and 0.2%, 0.4%, and 1.3% with the spacer (P < 0.001, < 0.001, and = 0.0019). This study indicated that spacer injections were also effective in reducing the change in the rectal dose due to setup errors.
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Affiliation(s)
- Yuta Omi
- Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo-cho, Anjo, Aichi, 446-8602, Japan
| | - Keisuke Yasui
- Faculty of Radiological Technology, School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Akira Shimomura
- Nagoya Proton Therapy Center, Nagoya City West Medical Center, 1-1-1, Hirate-cho, Kita-ku, Nagoya, Aichi, 462-8508, Japan
| | - Rie Muramatsu
- Nagoya Proton Therapy Center, Nagoya City West Medical Center, 1-1-1, Hirate-cho, Kita-ku, Nagoya, Aichi, 462-8508, Japan
| | - Hiromitsu Iwata
- Nagoya Proton Therapy Center, Nagoya City West Medical Center, 1-1-1, Hirate-cho, Kita-ku, Nagoya, Aichi, 462-8508, Japan
| | - Hiroyuki Ogino
- Nagoya Proton Therapy Center, Nagoya City West Medical Center, 1-1-1, Hirate-cho, Kita-ku, Nagoya, Aichi, 462-8508, Japan
| | - Akari Furukawa
- Faculty of Radiological Technology, School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Naoki Hayashi
- Faculty of Radiological Technology, School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
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Tsuchida K, Minohara S, Kusano Y, Kano K, Anno W, Takakusagi Y, Mizoguchi N, Serizawa I, Yoshida D, Imura K, Takayama Y, Kamada T, Katoh H, Ohno T. Interfractional robustness of scanning carbon ion radiotherapy for prostate cancer: An analysis based on dose distribution from daily in-room CT images. J Appl Clin Med Phys 2021; 22:130-138. [PMID: 34046997 PMCID: PMC8200452 DOI: 10.1002/acm2.13275] [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: 01/14/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 01/03/2023] Open
Abstract
Purpose We analyzed interfractional robustness of scanning carbon ion radiotherapy (CIRT) for prostate cancer based on the dose distribution using daily in‐room computed tomography (CT) images. Materials and Methods We analyzed 11 consecutive patients treated with scanning CIRT for localized prostate cancer in our hospital between December 2015 and January 2016. In‐room CT images were taken under treatment conditions in every treatment session. The dose distribution on each in‐room CT image was recalculated, while retaining the pencil beam arrangement of the initial treatment plan. Then, the dose–volume histogram (DVH) parameters including the percentage of the clinical target volume (CTV) with 95% and 90% of the prescribed dose area (V95% of CTV, V90% of CTV) and V80% of rectum were calculated. The acceptance criteria for the CTV and rectum were set at V95% of CTV ≥95%, V90% of CTV ≥98%, and V80% of rectum < 10 ml. Results V95% of CTV, V90% of CTV, and V80% of rectum for the reproduced plans were 98.8 ± 3.49%, 99.5 ± 2.15%, and 4.39 ± 3.96 ml, respectively. Acceptance of V95% of CTV, V90% of CTV, and V80% of rectum was obtained in 123 (94%), 125 (95%) and 117 sessions (89%), respectively. Acceptance of the mean dose of V95% of CTV, V90% of CTV, and V80% of rectum for each patient was obtained in 10 (91%), 10 (91%), and 11 patients (100%), respectively. Conclusions We demonstrated acceptable interfractional robustness based on the dose distribution in scanning CIRT for prostate cancer.
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Affiliation(s)
- Keisuke Tsuchida
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan.,Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Shinichi Minohara
- Section of Medical Physics and Engineering, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Yohsuke Kusano
- Section of Medical Physics and Engineering, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Kio Kano
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Wataru Anno
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Yosuke Takakusagi
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Nobutaka Mizoguchi
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Itsuko Serizawa
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Daisaku Yoshida
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Koh Imura
- Section of Medical Physics and Engineering, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Yoshiki Takayama
- Section of Medical Physics and Engineering, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Tadashi Kamada
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Hiroyuki Katoh
- Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Tang Q, Zhao F, Yu X, Wu L, Lu Z, Yan S. The role of radioprotective spacers in clinical practice: a review. Quant Imaging Med Surg 2018; 8:514-524. [PMID: 30050786 DOI: 10.21037/qims.2018.06.06] [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] [Indexed: 12/19/2022]
Abstract
The delivery of high dose radiotherapy to tumors is often limited by the proximity of the surrounding radiosensitive normal tissues, even using modern techniques such as intensity modulated radiation therapy (IMRT). Previous studies have reported that placement of a spacer can effectively displace normal tissues. So that they are some distance away from the lesion, thus allowing for the safe delivery of high-dose radiation. The application of radioprotective spacers was first reported 30 years ago regarding radiotherapy of tongue and abdominal cancers; more recently, they are increasingly being used in prostate cancer. This review focuses on the published data concerning the features of different types of spacers and their application in various tumor sites. Placement-related complications and the cost-effectiveness of the spacers are also discussed. With the increasing use of high-precision radiotherapy in clinical practice, especially the paradigm-changing stereotactic body radiotherapy (SBRT), more robust studies are warranted to further establish the role of radioprotective spacers through materials development and novel placement techniques.
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Affiliation(s)
- Qiuying Tang
- Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Feng Zhao
- Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Xiaokai Yu
- Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Lingyun Wu
- Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Zhongjie Lu
- Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Senxiang Yan
- Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
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11
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Moteabbed M, Trofimov A, Sharp GC, Wang Y, Zietman AL, Efstathiou JA, Lu HM. Proton therapy of prostate cancer by anterior-oblique beams: implications of setup and anatomy variations. Phys Med Biol 2017; 62:1644-1660. [DOI: 10.1088/1361-6560/62/5/1644] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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12
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Underwood T, Giantsoudi D, Moteabbed M, Zietman A, Efstathiou J, Paganetti H, Lu HM. Can We Advance Proton Therapy for Prostate? Considering Alternative Beam Angles and Relative Biological Effectiveness Variations When Comparing Against Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2016; 95:454-464. [DOI: 10.1016/j.ijrobp.2016.01.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 01/06/2016] [Accepted: 01/12/2016] [Indexed: 12/27/2022]
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13
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Kubota Y, Kawamura H, Sakai M, Tsumuraya R, Tashiro M, Yusa K, Kubo N, Sato H, Kawahara M, Katoh H, Kanai T, Ohno T, Nakano T. Changes in Rectal Dose Due to Alterations in Beam Angles for Setup Uncertainty and Range Uncertainty in Carbon-Ion Radiotherapy for Prostate Cancer. PLoS One 2016; 11:e0153894. [PMID: 27097041 PMCID: PMC4838308 DOI: 10.1371/journal.pone.0153894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 04/05/2016] [Indexed: 12/02/2022] Open
Abstract
Background and Purpose Carbon-ion radiotherapy of prostate cancer is challenging in patients with metal implants in one or both hips. Problems can be circumvented by using fields at oblique angles. To evaluate the influence of setup and range uncertainties accompanying oblique field angles, we calculated rectal dose changes with oblique orthogonal field angles, using a device with fixed fields at 0° and 90° and a rotating patient couch. Material and Methods Dose distributions were calculated at the standard angles of 0° and 90°, and then at 30° and 60°. Setup uncertainty was simulated with changes from −2 mm to +2 mm for fields in the anterior-posterior, left-right, and cranial-caudal directions, and dose changes from range uncertainty were calculated with a 1 mm water-equivalent path length added to the target isocenter in each angle. The dose distributions regarding the passive irradiation method were calculated using the K2 dose algorithm. Results The rectal volumes with 0°, 30°, 60°, and 90° field angles at 95% of the prescription dose were 3.4±0.9 cm3, 2.8±1.1 cm3, 2.2±0.8 cm3, and 3.8±1.1 cm3, respectively. As compared with 90° fields, 30° and 60° fields had significant advantages regarding setup uncertainty and significant disadvantages regarding range uncertainty, but were not significantly different from the 90° field setup and range uncertainties. Conclusions The setup and range uncertainties calculated at 30° and 60° field angles were not associated with a significant change in rectal dose relative to those at 90°.
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Affiliation(s)
- Yoshiki Kubota
- Gunma University Heavy Ion Medical Center, Gunma, Japan
- * E-mail:
| | | | - Makoto Sakai
- Gunma University Heavy Ion Medical Center, Gunma, Japan
| | | | | | - Ken Yusa
- Gunma University Heavy Ion Medical Center, Gunma, Japan
| | - Nobuteru Kubo
- Gunma University Heavy Ion Medical Center, Gunma, Japan
| | - Hiro Sato
- Gunma University Heavy Ion Medical Center, Gunma, Japan
| | | | | | | | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, Gunma, Japan
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14
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Pinkawa M. Current role of spacers for prostate cancer radiotherapy. World J Clin Oncol 2015; 6:189-193. [PMID: 26677428 PMCID: PMC4675900 DOI: 10.5306/wjco.v6.i6.189] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/12/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023] Open
Abstract
Radiotherapy is an established curative treatment method for prostate cancer. Optimal tumor control rates can only be achieved with high local doses, associated with a considerable risk of rectal toxicity. Apart from already widely adapted technical advances, as intensity-modulated radiation therapy, the application of spacers placed between the prostate and rectum has been increasingly used in the last years. Biodegradable spacers, including hydrogel, hyaluronic acid, collagen or an implantable balloon, can be injected or inserted in a short procedure under transrectal ultrasound guidance via a transperineal approach. A distance of about 1.0-1.5 cm is usually achieved between the rectum and prostate, excluding the rectal wall from the high isodoses. Several studies have shown well tolerated injection procedures and treatments. Apart from considerable reduction of rectal irradiation, a prospective randomized trial demonstrated a reduction of rectal toxicity after hydrogel injection in men undergoing prostate image-guided intensity-modulated radiation therapy. The results are encouraging for continuing evaluation in dose escalation, hypofractionation, stereotactic radiotherapy or re-irradiation trials in the future.
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15
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Hild S, Graeff C, Rucinski A, Zink K, Habl G, Durante M, Herfarth K, Bert C. Scanned ion beam therapy for prostate carcinoma. Strahlenther Onkol 2015; 192:118-26. [DOI: 10.1007/s00066-015-0925-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 11/11/2015] [Indexed: 12/31/2022]
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16
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Schlösser M, Rudnev V, González Ureña Á. Radio-frequency ion deflector for mass separation. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2015; 86:103302. [PMID: 26520948 DOI: 10.1063/1.4934201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Electrostatic cylindrical deflectors act as energy analyzer for ion beams. In this article, we present that by imposing of a radio-frequency modulation on the deflecting electric field, the ion transmission becomes mass dependent. By the choice of the appropriate frequency, amplitude, and phase, the deflector can be used as mass filter. The basic concept of the new instrument as well as simple mathematic relations are described. These calculations and further numerical simulations show that a mass sensitivity is achievable. Furthermore, we demonstrate the proof-of-principle in experimental measurements, compare the results to those of from a 1 m linear time-of-flight spectrometer, and comment on the mass resolution of the method. Finally, some potential applications are indicated.
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Affiliation(s)
- Magnus Schlösser
- Unidad de Láseres y Haces Moleculares, Instituto Plurisdisciplinar, Universidad Complutense de Madrid, Madrid 28040, Spain
| | - Vitaly Rudnev
- Unidad de Láseres y Haces Moleculares, Instituto Plurisdisciplinar, Universidad Complutense de Madrid, Madrid 28040, Spain
| | - Ángel González Ureña
- Unidad de Láseres y Haces Moleculares, Instituto Plurisdisciplinar, Universidad Complutense de Madrid, Madrid 28040, Spain
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