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Riou O, Prunaretty J, Michalet M. Personalizing radiotherapy with adaptive radiotherapy: Interest and challenges. Cancer Radiother 2024:S1278-3218(24)00133-1. [PMID: 39353797 DOI: 10.1016/j.canrad.2024.07.007] [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: 06/20/2024] [Accepted: 07/01/2024] [Indexed: 10/04/2024]
Abstract
Adaptive radiotherapy (ART) is a recent development in radiotherapy technology and treatment personalization that allows treatment to be tailored to the daily anatomical changes of patients. While it was until recently only performed "offline", i.e. between two radiotherapy sessions, it is now possible during ART to perform a daily online adaptive process for a given patient. Therefore, ART allows a daily customization to ensure optimal coverage of the treatment target volumes with minimized margins, taking into account only the uncertainties related to the adaptive process itself. This optimization appears particularly relevant in case of daily variations in the positioning of the target volume or of the organs at risk (OAR) associated with a proximity of these volumes and a tenuous therapeutic index. ART aims to minimize severe acute and late toxicity and allows tumor dose escalation. These new achievements have been possible thanks to technological development, the contribution of new multimodal and onboard imaging modalities and the integration of artificial intelligence tools for the contouring, planning and delivery of radiation therapy. Online ART is currently available on two types of radiotherapy machines: MR-linear accelerators and recently CBCT-linear accelerators. We will first describe the benefits, advantages, constraints and limitations of each of these two modalities, as well as the online adaptive process itself. We will then evaluate the clinical situations for which online adaptive radiotherapy is particularly indicated on MR- and CBCT-linear accelerators. Finally, we will detail some challenges and possible solutions in the development of online ART in the coming years.
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Affiliation(s)
- Olivier Riou
- Department of Radiation Oncology, Institut du cancer de Montpellier, Montpellier, France; Fédération universitaire d'oncologie radiothérapie de Méditerranée Occitanie, université de Montpellier, Montpellier, France; U1194, Inserm, Montpellier, France.
| | - Jessica Prunaretty
- Department of Radiation Oncology, Institut du cancer de Montpellier, Montpellier, France; Fédération universitaire d'oncologie radiothérapie de Méditerranée Occitanie, université de Montpellier, Montpellier, France; U1194, Inserm, Montpellier, France
| | - Morgan Michalet
- Department of Radiation Oncology, Institut du cancer de Montpellier, Montpellier, France; Fédération universitaire d'oncologie radiothérapie de Méditerranée Occitanie, université de Montpellier, Montpellier, France; U1194, Inserm, Montpellier, France
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Iramina H, Tsuneda M, Okamoto H, Kadoya N, Mukumoto N, Toyota M, Fukunaga J, Fujita Y, Tohyama N, Onishi H, Nakamura M. Multi-institutional questionnaire-based survey on online adaptive radiotherapy performed using commercial systems in Japan in 2023. Radiol Phys Technol 2024; 17:581-595. [PMID: 39028438 DOI: 10.1007/s12194-024-00828-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 07/20/2024]
Abstract
In this study, we aimed to conduct a survey on the current clinical practice of, staffing for, commissioning of, and staff training for online adaptive radiotherapy (oART) in the institutions that installed commercial oART systems in Japan, and to share the information with institutions that will implement oART systems in future. A web-based questionnaire, containing 107 questions, was distributed to nine institutions in Japan. Data were collected from November to December 2023. Three institutions each with the MRIdian (ViewRay, Oakwood Village, OH, USA), Unity (Elekta AB, Stockholm, Sweden), and Ethos (Varian Medical Systems, Palo Alto, CA, USA) systems completed the questionnaire. One institution (MRIdian) had not performed oART by the response deadline. Each institution had installed only one oART system. Hypofractionation, and moderate hypofractionation or conventional fractionation were employed in the MRIdian/Unity and Ethos systems, respectively. The elapsed time for the oART process was faster with the Ethos than with the other systems. All institutions added additional staff for oART. Commissioning periods differed among the oART systems owing to provision of beam data from the vendors. Chambers used during commissioning measurements differed among the institutions. Institutional training was provided by all nine institutions. To the best of our knowledge, this was the first survey about oART performed using commercial systems in Japan. We believe that this study will provide useful information to institutions that installed, are installing, or are planning to install oART systems.
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Affiliation(s)
- Hiraku Iramina
- Adaptive Radiotherapy Working Group (ART-WG), QA/QC Committee, Japan Society of Medical Physics, Tokyo, Japan
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto-Shi, Kyoto, 606-8507, Japan
| | - Masato Tsuneda
- Adaptive Radiotherapy Working Group (ART-WG), QA/QC Committee, Japan Society of Medical Physics, Tokyo, Japan
- Department of Radiation Oncology, MR Linac ART Division, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8670, Japan
| | - Hiroyuki Okamoto
- Adaptive Radiotherapy Working Group (ART-WG), QA/QC Committee, Japan Society of Medical Physics, Tokyo, Japan
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Noriyuki Kadoya
- Adaptive Radiotherapy Working Group (ART-WG), QA/QC Committee, Japan Society of Medical Physics, Tokyo, Japan
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai-Shi, Miyagi, 980-8574, Japan
| | - Nobutaka Mukumoto
- Adaptive Radiotherapy Working Group (ART-WG), QA/QC Committee, Japan Society of Medical Physics, Tokyo, Japan
- Department of Radiation Oncology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka-Shi, Osaka, 545-8585, Japan
| | - Masahiko Toyota
- Adaptive Radiotherapy Working Group (ART-WG), QA/QC Committee, Japan Society of Medical Physics, Tokyo, Japan
- Division of Radiology, Department of Clinical Technology, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima-Shi, Kagoshima, 890-8520, Japan
| | - Junichi Fukunaga
- Adaptive Radiotherapy Working Group (ART-WG), QA/QC Committee, Japan Society of Medical Physics, Tokyo, Japan
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka-Shi, Fukuoka, 812-8582, Japan
| | - Yukio Fujita
- Adaptive Radiotherapy Working Group (ART-WG), QA/QC Committee, Japan Society of Medical Physics, Tokyo, Japan
- Department of Radiation Oncology, MR Linac ART Division, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8670, Japan
- Department of Radiological Sciences, Komazawa University, 1-23-1 Komazawa, Setagaya-Ku, Tokyo, 154-8525, Japan
| | - Naoki Tohyama
- Department of Radiological Sciences, Komazawa University, 1-23-1 Komazawa, Setagaya-Ku, Tokyo, 154-8525, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-Shi, Yamanashi, 409-3898, Japan
| | - Mitsuhiro Nakamura
- Adaptive Radiotherapy Working Group (ART-WG), QA/QC Committee, Japan Society of Medical Physics, Tokyo, Japan.
- Department of Advanced Medical Physics, Graduate School of Medicine, Kyoto University, 53 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto-Shi, Kyoto, 606-8507, Japan.
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Wang H, Zhang X, Yue J. Multiple Abdominal Desmoplastic Small Round-Cell Tumors Treated With Fan Beam Computed Tomography-Guided Adaptive Radiotherapy (FBCT-gART): A Case Report. Cureus 2024; 16:e69785. [PMID: 39308846 PMCID: PMC11414420 DOI: 10.7759/cureus.69785] [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] [Accepted: 09/20/2024] [Indexed: 09/25/2024] Open
Abstract
Desmoplastic small round cell tumor (DSRCT) is a rare and highly aggressive soft tissue tumor that predominantly affects the abdominal and pelvic regions of adolescent males. This case report presents our clinical experience of treating a 33-year-old male with multifocal peritoneal DSRCT using fan beam computed tomography-guided adaptive radiotherapy (FBCT-gART). The patient presented with abdominal pain and was diagnosed with DSRCT following imaging and biopsy. Despite initial treatment with surgery, chemotherapy, and targeted therapy, the patient experienced multifocal peritoneal recurrence. Due to the considerable mobility of the abdominal tumors and the associated risks to adjacent critical organs, the patient underwent daily online FBCT-gART. The prescribed dose regimen was 54 Gy delivered in 27 fractions at 2 Gy per fraction; however, the patient ultimately received only 25 treatments for personal reasons. This case report evaluates the technical workflow of using FBCT-gART for DSRCT and discusses its dosimetric advantages over non-adaptive radiotherapy.
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Affiliation(s)
- Haohua Wang
- Radiation Oncology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, CHN
| | - Xiang Zhang
- Radiation Oncology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, CHN
| | - Jinbo Yue
- Radiation Oncology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, CHN
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Sievert D, D'Souza A, Zhao X, Prusator MT, Mazur T, Kim H, Hobbis D. Complex Multi-site Stereotactic Body Re-irradiation With CT-Guided Online Adaptive Radiotherapy. Cureus 2024; 16:e68559. [PMID: 39364455 PMCID: PMC11449465 DOI: 10.7759/cureus.68559] [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] [Accepted: 09/02/2024] [Indexed: 10/05/2024] Open
Abstract
Online adaptive radiotherapy optimizes a patient's treatment plan to their daily anatomy to account for inter-fraction motion. Daily target and organ-at-risk (OAR) delineation allows for optimized treatments and has been shown to have favorable outcomes in the abdominal region. Adaptive radiotherapy also has the potential to support fine control of dose in re-irradiation to OARs. Herein, we describe a complex multi-site re-irradiation case utilizing CT-guided adaptive radiotherapy. A 46-year-old man with metastatic hepatocellular carcinoma presented for re-irradiation of four metastatic lesions to the right acetabulum, T11, S2, and a gastrosplenic lymph node (gsLN). The right acetabulum, T11, and S2 lesions previously received 20 Gy in five fractions. For the current course, he was prescribed 35 Gy (T11, right acetabulum, and gsLN) and 30 Gy (S2) in five fractions. An equivalent dose in 2 Gy fractions (EQD2) was employed to assess cumulative doses for critical OARs and guide planning. The re-irradiated lesions were treated with stereotactic body radiation therapy (SBRT), and the gsLN was treated with adaptive radiotherapy. An isotoxic approach was utilized to create the scheduled and adapted plans for the gsLN. Adapted plans were created on the patient's daily anatomy as visualized on kilovoltage cone beam computed tomography and compared against the scheduled plan. Dose-volume histogram objectives were used to compare the plans, and the superior plan was chosen for delivery. The adapted plan was used for all five fractions and met all critical OAR constraints while maintaining target coverage. The use of the scheduled plan would have resulted in stomach and/or esophagus constraint violations on all five fractions. This resulted in reduced EQD2 doses of 6.4 and 12.3 Gy for the esophagus and stomach, respectively. We report the successful treatment of a patient undergoing tri-site SBRT re-irradiation with concurrent CT-guided adaptive radiotherapy to a gsLN. The adaptive treatment allowed us to meet critical OAR constraints while maintaining target coverage. Few studies have described the use of CT-guided adaptive radiotherapy in re-irradiation cases, and the potential benefit for these complex cases is evident.
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Affiliation(s)
- Domenic Sievert
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Alden D'Souza
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Xiaodong Zhao
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Michael T Prusator
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Tom Mazur
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Hyun Kim
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Dean Hobbis
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, USA
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Rechner LA, Felter M, Bekke S, Biancardo S, Rønjom MF, Pedersen M, Sjöström D, Chen IM, Sibolt P. Transition of Online Adaptive Stereotactic Radiotherapy for Pancreatic Cancer From Magnetic Resonance-Guided Linear Accelerator (MR-Linac) to State-of-the-Art Cone-Beam Computed Tomography (CBCT). Cureus 2024; 16:e68386. [PMID: 39355470 PMCID: PMC11444803 DOI: 10.7759/cureus.68386] [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] [Accepted: 09/01/2024] [Indexed: 10/03/2024] Open
Abstract
Pancreatic cancer is one of the most challenging tumor sites to treat safely and effectively with radiotherapy due to the anatomical location and aggressiveness of the disease. One modality that has shown promising results, which our institution has been employing, is online adaptive stereotactic radiotherapy using a magnetic resonance-guided linear accelerator (MR-linac). However, due to unforeseen circumstances regarding our MR-linac, it was necessary for our institution to use an alternative treatment technique. In this case report, we describe our experience using our ring-gantry linac equipped with an advanced cone-beam computed tomography (CBCT) system to treat a 61-year-old patient with advanced pancreatic cancer with CBCT-guided online adaptive stereotactic radiotherapy. In a short time period of four weeks, we prepared for this case by training with the surface scanning motion management system and developing procedures for planning and adaptation. The patient was prescribed 24 Gy in three fractions, with a risk-adapted approach using strict organ-at-risk (OAR) constraints. Daily CBCT was used for online adaptation of the plan, and the superior plan (non-adapted or adapted) was selected for treatment. For this patient, the adapted plan was chosen for all three fractions, due to OAR constraints being violated in the non-adapted plan. In summary, we found that for this patient, high-quality CBCT guidance for daily re-contouring, in combination with motion management, enabled the use of daily adaptive radiotherapy to safely deliver stereotactic radiotherapy. The results from this case report are promising, and CBCT-guided online adaptive stereotactic radiotherapy for pancreatic cancer warrants further investigation in more patients.
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Affiliation(s)
- Laura A Rechner
- Department of Oncology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, DNK
| | - Mette Felter
- Department of Oncology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, DNK
| | - Susanne Bekke
- Department of Oncology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, DNK
| | - Susan Biancardo
- Department of Oncology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, DNK
| | - Marianne F Rønjom
- Department of Oncology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, DNK
| | - Mette Pedersen
- Department of Oncology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, DNK
| | - David Sjöström
- Department of Oncology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, DNK
| | - Inna M Chen
- Department of Oncology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, DNK
| | - Patrik Sibolt
- Department of Oncology, Copenhagen University Hospital-Herlev and Gentofte, Herlev, DNK
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Lee A, Pasetsky J, Lavrova E, Wang YF, Sedor G, Li FL, Gallitto M, Garrett M, Elliston C, Price M, Kachnic LA, Horowitz DP. CT-guided online adaptive stereotactic body radiotherapy for pancreas ductal adenocarcinoma: Dosimetric and initial clinical experience. Clin Transl Radiat Oncol 2024; 48:100813. [PMID: 39149753 PMCID: PMC11324999 DOI: 10.1016/j.ctro.2024.100813] [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: 02/26/2024] [Revised: 05/28/2024] [Accepted: 06/29/2024] [Indexed: 08/17/2024] Open
Abstract
Purpose/Objectives Retrospective analysis suggests that dose escalation to a biologically effective dose of more than 70 Gy may improve overall survival in patients with pancreatic ductal adenocarcinoma (PDAC), but such treatments in practice are limited by proximity of organs at risk (OARs). We hypothesized that CT-guided online adaptive radiotherapy (OART) can account for interfraction movement of OARs and allow for safe delivery of ablative doses. Materials/Methods This is a single institution retrospective analysis of patients with PDAC treated with OART on the Ethos platform (Varian Medical Systems, a Siemens Healthineers Company, Palo Alto). All patients were treated to 40 Gy in 5 fractions. PTV overlapping with a 5 mm planning risk volume expansion on the stomach, duodenum and bowel received 25 Gy. Initial treatment plans were created conventionally. For each fraction, PTV and OAR volumes were recontoured with AI assistance after initial cone beam CT (CBCT). The adapted plan was calculated, underwent QA, and then compared to the scheduled plan. A second CBCT was obtained prior to delivery of the selected plan. Total treatment time (first CBCT to end of radiation delivery) and active physician time (first to second CBCT) were recorded. PTV_4000 V95 %, PTV_2500 V9 5%, and D0.03 cc to stomach, duodenum and bowel were reported for scheduled (S) and adapted (A) plans. CTCAEv5.0 toxicities were recorded. Statistical analysis was performed using a two-sided T test and α of 0.05. Results 21 patients with unresectable or locally-recurrent PDAC were analyzed, with a total of 105 fractions. Average total time was 29 min and 16 s (16:36-49:40) and average active physician time was 19:41 min (9:25-39:34). All fractions were treated with adapted plans. 97 % of adapted plans met PTV_4000 V95.0 % >95.0 % coverage goal and 100 % of adapted plans met OAR dose constraints. Median follow up was 6.6 months. Only 1 patient experienced acute grade 3+ toxicity directly attributable to radiation. Only 1 patient experienced late grade 3+ toxicity directly attributable to radiation. Conclusions Daily CT-based OART was associated with significantly reduced dose OARs while achieving superior PTV coverage. Given the relatively quick total treatment time, radiation delivery was generally well tolerated and easily incorporated into the clinic workflow. Our initial clinical experience demonstrates OART allows for safe dose escalation in the treatment of PDAC.
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Affiliation(s)
- Albert Lee
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, United States
- Herbert Irving Comprehensive Cancer Center Minority Underserved NCORP, New York, NY, United States
| | - Jared Pasetsky
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, United States
- Herbert Irving Comprehensive Cancer Center Minority Underserved NCORP, New York, NY, United States
| | - Elizaveta Lavrova
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, United States
| | - Yi-Fang Wang
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, United States
| | - Geoffrey Sedor
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, United States
- Herbert Irving Comprehensive Cancer Center Minority Underserved NCORP, New York, NY, United States
| | - Feng L Li
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, United States
| | - Matthew Gallitto
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, United States
- Herbert Irving Comprehensive Cancer Center Minority Underserved NCORP, New York, NY, United States
| | - Matthew Garrett
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, United States
| | - Carl Elliston
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, United States
| | - Michael Price
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, United States
| | - Lisa A Kachnic
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, United States
- Herbert Irving Comprehensive Cancer Center Minority Underserved NCORP, New York, NY, United States
| | - David P Horowitz
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, United States
- Herbert Irving Comprehensive Cancer Center Minority Underserved NCORP, New York, NY, United States
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Ristau J, Hörner-Rieber J, Körber SA. MR-linac based radiation therapy in gastrointestinal cancers: a narrative review. J Gastrointest Oncol 2024; 15:1893-1907. [PMID: 39279945 PMCID: PMC11399841 DOI: 10.21037/jgo-22-961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 08/14/2023] [Indexed: 09/18/2024] Open
Abstract
Background and Objective Magnetic resonance guided radiotherapy (MRgRT) is an emerging technological innovation with more and more institutions gaining clinical experience in this new field of radiation oncology. The ability to better visualize both tumors and healthy tissues due to excellent soft tissue contrast combined with new possibilities regarding motion management and the capability of online adaptive radiotherapy might increase tumor control rates while potentially reducing the risk of radiation-induced toxicities. As conventional computed tomography (CT)-based image guidance methods are insufficient for adaptive workflows in abdominal tumors, MRgRT appears to be an optimal method for this tumor site. The aim of this narrative review is to outline the opportunities and challenges in magnetic resonance guided radiation therapy in gastrointestinal cancers. Methods We searched for studies, reviews and conceptual articles, including the general technique of MRgRT and the specific utilization in gastrointestinal cancers, focusing on pancreatic cancer, liver metastases and primary liver cancer, rectal cancer and esophageal cancer. Key Content and Findings This review is highlighting the innovative approach of MRgRT in gastrointestinal cancer and gives an overview of the currently available literature with regard to clinical experiences and theoretical background. Conclusions MRgRT is a promising new tool in radiation oncology, which can play off several of its beneficial features in the specific field of gastrointestinal cancers. However, clinical data is still scarce. Nevertheless, the available literature points out large potential for improvements regarding dose coverage and escalation as well as the reduction of dose exposure to critical organs at risk (OAR). Further prospective studies are needed to demonstrate the role of this innovative technology in gastrointestinal cancer management, in particular trials that randomly compare MRgRT with conventional CT-based image-guided radiotherapy (IGRT) would be of high value.
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Affiliation(s)
- Jonas Ristau
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg, Germany
| | - Stefan A Körber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg, Germany
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Kim E, Park YK, Zhao T, Laugeman E, Zhao XN, Hao Y, Chung Y, Lee H. Image quality characterization of an ultra-high-speed kilovoltage cone-beam computed tomography imaging system on an O-ring linear accelerator. J Appl Clin Med Phys 2024; 25:e14337. [PMID: 38576183 PMCID: PMC11087174 DOI: 10.1002/acm2.14337] [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: 11/14/2023] [Revised: 01/23/2024] [Accepted: 03/06/2024] [Indexed: 04/06/2024] Open
Abstract
PURPOSE The quality of on-board imaging systems, including cone-beam computed tomography (CBCT), plays a vital role in image-guided radiation therapy (IGRT) and adaptive radiotherapy. Recently, there has been an upgrade of the CBCT systems fused in the O-ring linear accelerators called HyperSight, featuring a high imaging performance. As the characterization of a new imaging system is essential, we evaluated the image quality of the HyperSight system by comparing it with Halcyon 3.0 CBCT and providing benchmark data for routine imaging quality assurance. METHODS The HyperSight features ultra-fast scan time, a larger kilovoltage (kV) detector, a more substantial kV tube, and an advanced reconstruction algorithm. Imaging protocols in the two modes of operation, treatment mode with IGRT and the CBCT for planning (CBCTp) mode were evaluated and compared with Halcyon 3.0 CBCT. Image quality metrics, including spatial resolution, contrast resolution, uniformity, noise, computed tomography (CT) number linearity, and calibration error, were assessed using a Catphan and an electron density phantom and analyzed with TotalQA software. RESULTS HyperSight demonstrated substantial improvements in contrast-to-noise ratio and noise in both IGRT and CBCTp modes compared to Halcyon 3.0 CBCT. CT number calibration error of HyperSight CBCTp mode (1.06%) closely matches that of a full CT scanner (0.72%), making it suitable for adaptive planning. In addition, the advanced hardware of HyperSight, such as ultra-fast scan time (5.9 s) or 2.5 times larger heat unit capacity, enhanced the clinical efficiency in our experience. CONCLUSIONS HyperSight represented a significant advancement in CBCT imaging. With its image quality, CT number accuracy, and ultra-fast scans, HyperSight has a potential to transform patient care and treatment outcomes. The enhanced scan speed and image quality of HyperSight are expected to significantly improve the quality and efficiency of treatment, particularly benefiting patients.
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Affiliation(s)
- Euidam Kim
- Department of Radiation OncologyWashington University in St Louis School of MedicineSt LouisMissouriUSA
- Department of Nuclear EngineeringHanyang University College of EngineeringSeoulSouth Korea
| | - Yang Kyun Park
- Department of Radiation OncologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Tianyu Zhao
- Department of Radiation OncologyWashington University in St Louis School of MedicineSt LouisMissouriUSA
| | - Eric Laugeman
- Department of Radiation OncologyWashington University in St Louis School of MedicineSt LouisMissouriUSA
| | - Xiaodong Neo Zhao
- Department of Radiation OncologyWashington University in St Louis School of MedicineSt LouisMissouriUSA
| | - Yao Hao
- Department of Radiation OncologyWashington University in St Louis School of MedicineSt LouisMissouriUSA
| | - Yoonsun Chung
- Department of Nuclear EngineeringHanyang University College of EngineeringSeoulSouth Korea
| | - Hugh Lee
- Department of Radiation OncologyWashington University in St Louis School of MedicineSt LouisMissouriUSA
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Pierrard J, Deheneffe S, Dechambre D, Sterpin E, Geets X, Van Ooteghem G. Markerless liver online adaptive stereotactic radiotherapy: feasibility analysisCervantes. Phys Med Biol 2024; 69:095015. [PMID: 38565128 DOI: 10.1088/1361-6560/ad39a1] [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: 08/09/2023] [Accepted: 04/02/2024] [Indexed: 04/04/2024]
Abstract
Objective. Radio-opaque markers are recommended for image-guided radiotherapy in liver stereotactic ablative radiotherapy (SABR), but their implantation is invasive. We evaluate in thisin-silicostudy the feasibility of cone-beam computed tomography-guided stereotactic online-adaptive radiotherapy (CBCT-STAR) to propagate the target volumes without implanting radio-opaque markers and assess its consequence on the margin that should be used in that context.Approach. An emulator of a CBCT-STAR-dedicated treatment planning system was used to generate plans for 32 liver SABR patients. Three target volume propagation strategies were compared, analysing the volume difference between the GTVPropagatedand the GTVConventional, the vector lengths between their centres of mass (lCoM), and the 95th percentile of the Hausdorff distance between these two volumes (HD95). These propagation strategies were: (1) structure-guided deformable registration with deformable GTV propagation; (2) rigid registration with rigid GTV propagation; and (3) image-guided deformable registration with rigid GTV propagation. Adaptive margin calculation integrated propagation errors, while interfraction position errors were removed. Scheduled plans (PlanNon-adaptive) and daily-adapted plans (PlanAdaptive) were compared for each treatment fraction.Main results.The image-guided deformable registration with rigid GTV propagation was the best propagation strategy regarding tolCoM(mean: 4.3 +/- 2.1 mm), HD95 (mean 4.8 +/- 3.2 mm) and volume preservation between GTVPropagatedand GTVConventional. This resulted in a planning target volume (PTV) margin increase (+69.1% in volume on average). Online adaptation (PlanAdaptive) reduced the violation rate of the most important dose constraints ('priority 1 constraints', 4.2 versus 0.9%, respectively;p< 0.001) and even improved target volume coverage compared to non-adaptive plans (PlanNon-adaptive).Significance. Markerless CBCT-STAR for liver tumours is feasible using Image-guided deformable registration with rigid GTV propagation. Despite the cost in terms of PTV volumes, daily adaptation reduces constraints violation and restores target volumes coverage.
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Affiliation(s)
- Julien Pierrard
- UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), B-1200 Brussels, Belgium
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, B-1200 Brussels, Belgium
| | - Stéphanie Deheneffe
- Radiation Oncology Department, CHU-UCL-Namur, Site Sainte-Elisabeth, B-5000 Namur, Belgium
| | - David Dechambre
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, B-1200 Brussels, Belgium
| | - Edmond Sterpin
- UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), B-1200 Brussels, Belgium
- KU Leuven, Department of Oncology, Laboratory of Experimental Radiotherapy, KU Leuven, Leuven, Belgium
| | - Xavier Geets
- UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), B-1200 Brussels, Belgium
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, B-1200 Brussels, Belgium
| | - Geneviève Van Ooteghem
- UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), B-1200 Brussels, Belgium
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, B-1200 Brussels, Belgium
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Kisivan K, Farkas A, Kovacs P, Glavak C, Lukacs G, Mahr K, Szabo Z, Csima MP, Gulyban A, Toth Z, Kaposztas Z, Lakosi F. Pancreatic SABR using peritumoral fiducials, triggered imaging and breath-hold. Pathol Oncol Res 2023; 29:1611456. [PMID: 38188611 PMCID: PMC10767757 DOI: 10.3389/pore.2023.1611456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/14/2023] [Indexed: 01/09/2024]
Abstract
Background: We aim to present our linear accelerator-based workflow for pancreatic stereotactic ablative radiotherapy (SABR) in order to address the following issues: intrafractional organ motion management, Cone Beam CT (CBCT) image quality, residual errors with dosimetric consequences, treatment time, and clinical results. Methods: Between 2016 and 2021, 14 patients with locally advanced pancreatic cancer were treated with induction chemotherapy and SABR using volumetric modulated arc therapy (VMAT). Internal target volume (ITV) concept (5), phase-gated (4), or breath hold (5) techniques were used. Treatment was verified by CBCT before and after irradiation, while tumor motion was monitored and controlled by kV triggered imaging and beam hold using peritumoral surgical clips. Beam interruptions and treatment time were recorded. The CBCT image quality was scored and supplemented by an agreement analysis (Krippendorff's-α) of breath-hold CBCT images to determine the position of OARs relative to the planning risk volumes (PRV). Residual errors and their dosimetry impact were also calculated. Progression free (PFS) and overall survival (OS) were assessed by the Kaplan-Meier analysis with acute and late toxicity reporting (CTCAEv4). Results: On average, beams were interrupted once (range: 0-3) per treatment session on triggered imaging. The total median treatment time was 16.7 ± 10.8 min, significantly less for breath-hold vs. phase-gated sessions (18.8 ± 6.2 vs. 26.5 ± 13.4, p < 0.001). The best image quality was achieved by breath hold CBCT. The Krippendorff's-α test showed a strong agreement among five radiation therapists (mean K-α value: 0.8 (97.5%). The mean residual errors were <0.2 cm in each direction resulting in an average difference of <2% in dosimetry for OAR and target volume. Two patients received offline adaptation. The median OS/PFS after induction chemotherapy and SABR was 20/12 months and 15/8 months. No Gr. ≥2 acute/late RT-related toxicity was noted. Conclusion: Linear accelerator based pancreatic SABR with the combination of CBCT and triggered imaging + beam hold is feasible. Peritumoral fiducials improve utility while breath-hold CBCT provides the best image quality at a reasonable treatment time with offline adaptation possibilities. In well-selected cases, it can be an effective alternative in clinics where CBCT/MRI-guided online adaptive workflow is not available.
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Affiliation(s)
- Katalin Kisivan
- Department of Radiotherapy, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Andrea Farkas
- Department of Radiotherapy, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Peter Kovacs
- Department of Radiotherapy, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Csaba Glavak
- Department of Radiotherapy, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Gabor Lukacs
- Department of Medical Oncology, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Karoly Mahr
- Department of Medical Oncology, Zala County Szent Raphael Hospital, Zalaegerszeg, Hungary
| | - Zsolt Szabo
- Department of Medical Oncology, Zala County Szent Raphael Hospital, Zalaegerszeg, Hungary
| | - Melinda Petone Csima
- Institute of Education, Hungarian University of Agricultural and Life Sciences, Gödöllő, Hungary
- Faculty of Health Sciences, University of Pecs, Pecs, Hungary
| | - Akos Gulyban
- Department of Medical Physics, Institut Jules Bordet, Brussels, Belgium
- Radiophysics and MRI Physics Laboratory, Université Libre De Bruxelles (ULB), Brussels, Belgium
| | - Zoltan Toth
- Medicopus Nonprofit Ltd., Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
- PET Center, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Zsolt Kaposztas
- Department of Surgery, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Ferenc Lakosi
- Department of Radiotherapy, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
- Faculty of Health Sciences, University of Pecs, Pecs, Hungary
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Pierrard J, Dumont D, Dechambre D, Van den Eynde M, De Cuyper A, Van Ooteghem G. Cone-beam computed tomography-guided online-adaptive radiotherapy for inoperable right colon cancer: First in human. Tech Innov Patient Support Radiat Oncol 2023; 28:100220. [PMID: 37829146 PMCID: PMC10565851 DOI: 10.1016/j.tipsro.2023.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/29/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023] Open
Abstract
We report the case of a medically inoperable patient with localised colon cancer. Due to symptomatic bleeding, definitive radiotherapy (5 daily fractions of 5 Gy) has been performed using cone-beam computed tomography-based online-adaptive radiotherapy (ART). Online-ART enables compensation of interfraction motion of abdominal organs by performing daily delineation of organs at risk (OARs) and target volumes. Daily treatment replanning maximised target volume coverage while lowering the dose to OARs. Intrafraction variation of the tumour was still significant and had to be incorporated in the planning target volume margin computation. After the treatment, the patient did not develop any acute radiotherapy-induced adverse events and had no further rectal bleeding either at the end of the radiotherapy or at oncological follow-up 4 months later. Online-ART for colon cancer is feasible and is a valuable alternative when surgery is not an option.
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Affiliation(s)
- Julien Pierrard
- UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Damien Dumont
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - David Dechambre
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Marc Van den Eynde
- UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium
- Medical Oncology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Astrid De Cuyper
- Medical Oncology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Geneviève Van Ooteghem
- UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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12
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Price AT, Schiff JP, Laugeman E, Maraghechi B, Schmidt M, Zhu T, Reynoso F, Hao Y, Kim T, Morris E, Zhao X, Hugo GD, Vlacich G, DeSelm CJ, Samson PP, Baumann BC, Badiyan SN, Robinson CG, Kim H, Henke LE. Initial clinical experience building a dual CT- and MR-guided adaptive radiotherapy program. Clin Transl Radiat Oncol 2023; 42:100661. [PMID: 37529627 PMCID: PMC10388162 DOI: 10.1016/j.ctro.2023.100661] [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: 02/13/2023] [Revised: 06/12/2023] [Accepted: 07/20/2023] [Indexed: 08/03/2023] Open
Abstract
Introduction Our institution was the first in the world to clinically implement MR-guided adaptive radiotherapy (MRgART) in 2014. In 2021, we installed a CT-guided adaptive radiotherapy (CTgART) unit, becoming one of the first clinics in the world to build a dual-modality ART clinic. Herein we review factors that lead to the development of a high-volume dual-modality ART program and treatment census over an initial, one-year period. Materials and Methods The clinical adaptive service at our institution is enabled with both MRgART (MRIdian, ViewRay, Inc, Mountain View, CA) and CTgART (ETHOS, Varian Medical Systems, Palo Alto, CA) platforms. We analyzed patient and treatment information including disease sites treated, radiation dose and fractionation, and treatment times for patients on these two platforms. Additionally, we reviewed our institutional workflow for creating, verifying, and implementing a new adaptive workflow on either platform. Results From October 2021 to September 2022, 256 patients were treated with adaptive intent at our institution, 186 with MRgART and 70 with CTgART. The majority (106/186) of patients treated with MRgART had pancreatic cancer, and the most common sites treated with CTgART were pelvis (23/70) and abdomen (20/70). 93.0% of treatments on the MRgART platform were stereotactic body radiotherapy (SBRT), whereas only 72.9% of treatments on the CTgART platform were SBRT. Abdominal gated cases were allotted a longer time on the CTgART platform compared to the MRgART platform, whereas pelvic cases were allotted a shorter time on the CTgART platform when compared to the MRgART platform. Our adaptive implementation technique has led to six open clinical trials using MRgART and seven using CTgART. Conclusions We demonstrate the successful development of a dual platform ART program in our clinic. Ongoing efforts are needed to continue the development and integration of ART across platforms and disease sites to maximize access and evidence for this technique worldwide.
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Affiliation(s)
- Alex T. Price
- University Hospitals/Case Western Reserve University, Department of Radiation Oncology, Cleveland, OH, USA
| | - Joshua P. Schiff
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Eric Laugeman
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Borna Maraghechi
- City of Hope Orange County, Department of Radiation Oncology, Irvine, CA, USA
| | - Matthew Schmidt
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Tong Zhu
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Francisco Reynoso
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Yao Hao
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Taeho Kim
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Eric Morris
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Xiaodong Zhao
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Geoffrey D. Hugo
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Gregory Vlacich
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Carl J. DeSelm
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Pamela P. Samson
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Brian C. Baumann
- Springfield Clinic, Department of Radiation Oncology, Springfield, IL, USA
| | - Shahed N. Badiyan
- University of Texas Southwestern Medical Center, Department of Radiation Oncology, Dallas, TX, USA
| | - Clifford G. Robinson
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Hyun Kim
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Lauren E. Henke
- University Hospitals/Case Western Reserve University, Department of Radiation Oncology, Cleveland, OH, USA
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Forghani F, Ginn JS, Schiff JP, Zhu T, Marut L, Laugeman E, Maraghechi B, Badiyan SN, Samson PP, Kim H, Robinson CG, Hugo GD, Henke LE, Price AT. Knowledge-based adaptive planning quality assurance using dosimetric indicators for stereotactic adaptive radiotherapy for pancreatic cancer. Radiother Oncol 2023; 182:109603. [PMID: 36889595 DOI: 10.1016/j.radonc.2023.109603] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023]
Abstract
INTRODUCTION We aimed to develop knowledge-based tools for robust adaptive radiotherapy (ART) planning to determine on-table adaptive DVH metric variations or planning process errors for stereotactic pancreatic ART. We developed volume-based dosimetric identifiers to identify deviations of ART plans from simulation plans. MATERIALS AND METHODS Two patient cohorts who were treated on MR-Linac for pancreas cancer were included in this retrospective study; a training cohort and a validation cohort. All patients received 50 Gy in 5 fractions. PTV-OPT was generated by subtracting the critical organs plus a 5 mm-margin from PTV. Several metrics that potentially can identify failure-modes were calculated including PTV & PTV_OPT V95% and PTV & PTV_OPT D95%/D5%. The difference between each DVH metric in each adaptive plan with the DVH metric in simulation plan was calculated. The 95% confidence interval (CI) of the variations in each DVH metric was calculated for the patient training cohort. Variations in DVH metrics that exceeded the 95% CI for all fractions in training and validation cohort were flagged for retrospective investigation for root-cause analysis to determine their predictive power for identifying failure-modes. RESULTS The CIs for the PTV & PTV_OPT V95% and PTV & PTV_OPT D95%/D5% were ± 13%, ± 5%, ± 0.1, ± 0.03, respectively. We estimated the positive predictive value and negative predictive value of our method to be 77% and 89%, respectively, for the training cohort, and 80% for both in the validation cohort. DISCUSSION We developed dosimetric indicators for ART planning QA to identify population-based deviations or planning errors during online adaptive process for stereotactic pancreatic ART. This technology may be useful as an ART clinical trial QA tool and improve overall ART quality at an institution.
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Affiliation(s)
- Farnoush Forghani
- Department of Radiation Oncology, Washington University in Saint Louis School of Medicine, USA.
| | - John S Ginn
- Department of Radiation Oncology, Duke University, USA
| | - Joshua P Schiff
- Department of Radiation Oncology, Washington University in Saint Louis School of Medicine, USA
| | - Tong Zhu
- Department of Radiation Oncology, Washington University in Saint Louis School of Medicine, USA
| | - Luke Marut
- Department of Radiation Oncology, Washington University in Saint Louis School of Medicine, USA
| | - Eric Laugeman
- Department of Radiation Oncology, Washington University in Saint Louis School of Medicine, USA
| | - Borna Maraghechi
- Department of Radiation Oncology, Washington University in Saint Louis School of Medicine, USA
| | - Shahed N Badiyan
- Department of Radiation Oncology, Washington University in Saint Louis School of Medicine, USA
| | - Pamela P Samson
- Department of Radiation Oncology, Washington University in Saint Louis School of Medicine, USA
| | - Hyun Kim
- Department of Radiation Oncology, Washington University in Saint Louis School of Medicine, USA
| | - Clifford G Robinson
- Department of Radiation Oncology, Washington University in Saint Louis School of Medicine, USA
| | - Geoffrey D Hugo
- Department of Radiation Oncology, Washington University in Saint Louis School of Medicine, USA
| | - Lauren E Henke
- Department of Radiation Oncology, Washington University in Saint Louis School of Medicine, USA
| | - Alex T Price
- Department of Radiation Oncology, Washington University in Saint Louis School of Medicine, USA.
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14
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Henke LE, Fischer-Valuck BW, Rudra S, Wan L, Samson PS, Srivastava A, Gabani P, Roach MC, Zoberi I, Laugeman E, Mutic S, Robinson CG, Hugo GD, Cai B, Kim H. Prospective imaging comparison of anatomic delineation with rapid kV cone beam CT on a novel ring gantry radiotherapy device. Radiother Oncol 2023; 178:109428. [PMID: 36455686 DOI: 10.1016/j.radonc.2022.11.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A kV imager coupled to a novel, ring-gantry radiotherapy system offers improved on-board kV-cone-beam computed tomography (CBCT) acquisition time (17-40 seconds) and image quality, which may improve CT radiotherapy image-guidance and enable online adaptive radiotherapy. We evaluated whether inter-observer contour variability over various anatomic structures was non-inferior using a novel ring gantry kV-CBCT (RG-CBCT) imager as compared to diagnostic-quality simulation CT (simCT). MATERIALS/METHODS Seven patients undergoing radiotherapy were imaged with the RG-CBCT system at breath hold (BH) and/or free breathing (FB) for various disease sites on a prospective imaging study. Anatomy was independently contoured by seven radiation oncologists on: 1. SimCT 2. Standard C-arm kV-CBCT (CA-CBCT), and 3. Novel RG-CBCT at FB and BH. Inter-observer contour variability was evaluated by computing simultaneous truth and performance level estimation (STAPLE) consensus contours, then computing average symmetric surface distance (ASSD) and Dice similarity coefficient (DSC) between individual raters and consensus contours for comparison across image types. RESULTS Across 7 patients, 18 organs-at-risk (OARs) were evaluated on 27 image sets. Both BH and FB RG-CBCT were non-inferior to simCT for inter-observer delineation variability across all OARs and patients by ASSD analysis (p < 0.001), whereas CA-CBCT was not (p = 0.923). RG-CBCT (FB and BH) also remained non-inferior for abdomen and breast subsites compared to simCT on ASSD analysis (p < 0.025). On DSC comparison, neither RG-CBCT nor CA-CBCT were non-inferior to simCT for all sites (p > 0.025). CONCLUSIONS Inter-observer ability to delineate OARs using novel RG-CBCT images was non-inferior to simCT by the ASSD criterion but not DSC criterion.
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Affiliation(s)
- Lauren E Henke
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Benjamin W Fischer-Valuck
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Soumon Rudra
- Department of Radiation Oncology, Emory University, Atlanta, GA, United States
| | - Leping Wan
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Pamela S Samson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Amar Srivastava
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Prashant Gabani
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | | | - Imran Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Eric Laugeman
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Sasa Mutic
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States; Varian Medical Systems, Palo Alto, California, USA
| | - Clifford G Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Geoffrey D Hugo
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Bin Cai
- Department of Radiation Oncology, University of Texas Southwestern School of Medicine, Dallas, TX, United States
| | - Hyun Kim
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States.
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