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Sreejeev AT, Joseph D, Krishnan AS, Pasricha R, Gupta S, Ahuja R, Sharma N, Sikdar D, Raut S, Sasi A, Gupta M. Weekly assessment of volumetric and dosimetric changes during volumetric modulated arc therapy of locally advanced head and neck carcinoma: Implications for adaptive radiation therapy-A prospective study. Head Neck 2024; 46:1547-1556. [PMID: 38436506 DOI: 10.1002/hed.27710] [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: 11/06/2023] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Chemoradiation in head and neck carcinoma (HNC) shows significant anatomical resulting in erroneous dose deposition in the target or the organ at risk (OAR). Adaptive radiotherapy (ART) can overcome this. Timing of significant target and OAR changes with dosimetric impact; thus, most suitable time and frequency of ART is unclear. METHODS This dosimetric study used prospective weekly non-contrast CT scans in 12 HNC patients (78 scans). OARs and TVs were manually contoured after registration with simulation scan. Dose overlay done on each scan without reoptimization. Dosimetric and volumetric variations assessed. RESULTS Commonest site was oropharynx. Gross Tumor Volume (GTV) reduced from 47.5 ± 19.2 to 17.8 ± 10.7 cc. Nodal GTV reduced from 15.7 ± 18.8 to 4.7 ± 7.1 cc. Parotid showed mean volume loss of 35%. T stage moderately correlated with GTV regression. CONCLUSION Maximum GTV changes occurred after 3 weeks. Best time to do single fixed interval ART would be by the end of 3 weeks.
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Affiliation(s)
| | - Deepa Joseph
- Department of Radiation Oncology, AIIMS, Rishikesh, India
| | - Ajay S Krishnan
- Department of Radiation Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre, Varanasi, India
| | | | - Sweety Gupta
- Department of Radiation Oncology, AIIMS, Rishikesh, India
| | - Rachit Ahuja
- Department of Radiation Oncology, Shri Mahant Indiresh Hospital, Dehradun, India
| | - Nidhi Sharma
- Department of Radiation Oncology, AIIMS, Rishikesh, India
| | | | - Sagar Raut
- Department of Radiation Oncology, AIIMS, Rishikesh, India
| | | | - Manoj Gupta
- Department of Radiation Oncology, AIIMS, Rishikesh, India
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Ghosh Laskar S, Sinha S, Kumar A, Samanta A, Mohanty S, Kale S, Khan F, Lewis Salins S, Murthy V. Reducing Salivary Toxicity with Adaptive Radiotherapy (ReSTART): A Randomized Controlled Trial Comparing Conventional IMRT to Adaptive IMRT in Head and Neck Squamous Cell Carcinomas. Clin Oncol (R Coll Radiol) 2024; 36:353-361. [PMID: 38575432 DOI: 10.1016/j.clon.2024.03.015] [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: 12/16/2023] [Revised: 02/14/2024] [Accepted: 03/13/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND The utility of Adaptive Radiotherapy (ART) in Head and Neck Squamous Cell Carcinoma (HNSCC) remains to be ascertained. While multiple retrospective and single-arm prospective studies have demonstrated its efficacy in decreasing parotid doses and reducing xerostomia, adequate randomized evidence is lacking. METHODS AND ANALYSIS ReSTART (Reducing Salivary Toxicity with Adaptive Radiotherapy) is an ongoing phase III randomized trial of patients with previously untreated, locally advanced HNSCC of the oropharynx, larynx, and hypopharynx. Patients are randomized in a 1:1 ratio to the standard Intensity Modulated Radiotherapy (IMRT) arm {Planning Target Volume (PTV) margin 5 mm} vs. Adaptive Radiotherapy arm (standard IMRT with a PTV margin 3 mm, two planned adaptive planning at 10th and 20th fractions). The stratification factors include the primary site and nodal stage. The RT dose prescribed is 66Gy in 30 fractions for high-risk PTV and 54Gy in 30 fractions for low-risk PTV over six weeks, along with concurrent chemotherapy. The primary endpoint is to compare salivary toxicity between arms using salivary scintigraphy 12 months' post-radiation. To detect a 25% improvement in the primary endpoint at 12 months in the ART arm with a two-sided 5% alpha value and a power of 80% (and 10% attrition ratio), a sample size of 130 patients is required (65 patients in each arm). The secondary endpoints include acute and late toxicities, locoregional control, disease-free survival, overall survival, quality of life, and xerostomia scores between the two arms. DISCUSSION The ReSTART trial aims to answer an important question in Radiation Therapy for HNSCC, particularly in a resource-limited setting. The uniqueness of this trial, compared to other ongoing randomized trials, includes the PTV margins and the xerostomia assessment by scintigraphy at 12 months as the primary endpoint.
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Affiliation(s)
- S Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - S Sinha
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - A Kumar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - A Samanta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - S Mohanty
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - S Kale
- Department of Medical Physics, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - F Khan
- Clinical Research Secretariat (CRS), Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - S Lewis Salins
- Department of Radiation Oncology, Kasturba Medical College, Manipal, India.
| | - V Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
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Chen M, Wang K, Dohopolski M, Morgan H, Sher D, Wang J. TransAnaNet: Transformer-based Anatomy Change Prediction Network for Head and Neck Cancer Patient Radiotherapy. ARXIV 2024:arXiv:2405.05674v2. [PMID: 38764596 PMCID: PMC11100917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
Background Adaptive radiotherapy (ART) can compensate for the dosimetric impact of anatomic change during radiotherapy of head neck cancer (HNC) patients. However, implementing ART universally poses challenges in clinical workflow and resource allocation, given the variability in patient response and the constraints of available resources. Therefore, early identification of head and neck cancer (HNC) patients who would experience significant anatomical change during radiotherapy (RT) is of importance to optimize patient clinical benefit and treatment resources. Purpose The purpose of this study is to assess the feasibility of using a vision-transformer (ViT) based neural network to predict radiotherapy induced anatomic change of HNC patients. Methods We retrospectively included 121 HNC patients treated with definitive RT/CRT. We collected the planning CT (pCT), planned dose, CBCTs acquired at the initial treatment (CBCT01) and fraction 21 (CBCT21), and primary tumor volume (GTVp) and involved nodal volume (GTVn) delineated on both pCT and CBCTs for model construction and evaluation. A UNet-style ViT network was designed to learn the spatial correspondence and contextual information from embedded image patches of CT, dose, CBCT01, GTVp, and GTVn. The deformation vector field between CBCT01 and CBCT21 was estimated by the model as the prediction of anatomic change, and deformed CBCT01 was used as the prediction of CBCT21. We also generated binary masks of GTVp, GTVn and patient body for volumetric change evaluation. We used data from 100 patients for training and validation, and the remaining 21 patients for testing. Image and volumetric similarity metrics including mean square error (MSE), structural similarity index (SSIM), dice coefficient, and average surface distance were used to measure the similarity between the target image and predicted CBCT. Results The predicted image from the proposed method yielded the best similarity to the real image (CBCT21) over pCT, CBCT01, and predicted CBCTs from other comparison models. The average MSE and SSIM between the normalized predicted CBCT to CBCT21 are 0.009 and 0.933, while the average dice coefficient between body mask, GTVp mask, and GTVn mask are 0.972, 0.792, and 0.821 respectively. Conclusions The proposed method showed promising performance for predicting radiotherapy induced anatomic change, which has the potential to assist in the decision making of HNC Adaptive RT.
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Affiliation(s)
- Meixu Chen
- Medical Artificial Intelligence and Automation (MAIA) Lab, Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75235, USA
| | - Kai Wang
- Medical Artificial Intelligence and Automation (MAIA) Lab, Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75235, USA
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, 21201, USA
| | - Michael Dohopolski
- Medical Artificial Intelligence and Automation (MAIA) Lab, Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75235, USA
| | - Howard Morgan
- Medical Artificial Intelligence and Automation (MAIA) Lab, Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75235, USA
- Department of Radiation Oncology, Central Arkansas Radiation Therapy Institute, Little Rock, AR, 72205, USA
| | - David Sher
- Medical Artificial Intelligence and Automation (MAIA) Lab, Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75235, USA
| | - Jing Wang
- Medical Artificial Intelligence and Automation (MAIA) Lab, Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75235, USA
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Wang X, Chang Y, Pei X, Xu XG. A prior-information-based automatic segmentation method for the clinical target volume in adaptive radiotherapy of cervical cancer. J Appl Clin Med Phys 2024; 25:e14350. [PMID: 38546277 PMCID: PMC11087177 DOI: 10.1002/acm2.14350] [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: 11/07/2023] [Revised: 01/09/2024] [Accepted: 03/18/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE Adaptive planning to accommodate anatomic changes during treatment often requires repeated segmentation. In this study, prior patient-specific data was integrateda into a registration-guided multi-channel multi-path (Rg-MCMP) segmentation framework to improve the accuracy of repeated clinical target volume (CTV) segmentation. METHODS This study was based on CT image datasets for a total of 90 cervical cancer patients who received two courses of radiotherapy. A total of 15 patients were selected randomly as the test set. In the Rg-MCMP segmentation framework, the first-course CT images (CT1) were registered to second-course CT images (CT2) to yield aligned CT images (aCT1), and the CTV in the first course (CTV1) was propagated to yield aligned CTV contours (aCTV1). Then, aCT1, aCTV1, and CT2 were combined as the inputs for 3D U-Net consisting of a channel-based multi-path feature extraction network. The performance of the Rg-MCMP segmentation framework was evaluated and compared with the single-channel single-path model (SCSP), the standalone registration methods, and the registration-guided multi-channel single-path (Rg-MCSP) model. The Dice similarity coefficient (DSC), 95% Hausdorff distance (HD95), and average surface distance (ASD) were used as the metrics. RESULTS The average DSC of CTV for the deformable image DIR-MCMP model was found to be 0.892, greater than that of the standalone DIR (0.856), SCSP (0.837), and DIR-MCSP (0.877), which were improvements of 4.2%, 6.6%, and 1.7%, respectively. Similarly, the rigid body DIR-MCMP model yielded an average DSC of 0.875, which exceeded standalone RB (0.787), SCSP (0.837), and registration-guided multi-channel single-path (0.848), which were improvements of 11.2%, 4.5%, and 3.2%, respectively. These improvements in DSC were statistically significant (p < 0.05). CONCLUSION The proposed Rg-MCMP framework achieved excellent accuracy in CTV segmentation as part of the adaptive radiotherapy workflow.
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Affiliation(s)
- Xuanhe Wang
- School of Nuclear Science and TechnologyUniversity of Science and Technology of ChinaHefeiChina
| | - Yankui Chang
- School of Nuclear Science and TechnologyUniversity of Science and Technology of ChinaHefeiChina
| | - Xi Pei
- School of Nuclear Science and TechnologyUniversity of Science and Technology of ChinaHefeiChina
- Anhui Wisdom Technology Company LtmitedHefeiChina
| | - Xie George Xu
- School of Nuclear Science and TechnologyUniversity of Science and Technology of ChinaHefeiChina
- Department of Radiation OncologyThe First Affiliated Hospital of University of Science and Technology of ChinaHefeiChina
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5
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Gan Y, Langendijk JA, Oldehinkel E, Lin Z, Both S, Brouwer CL. Optimal timing of re-planning for head and neck adaptive radiotherapy. Radiother Oncol 2024; 194:110145. [PMID: 38341093 DOI: 10.1016/j.radonc.2024.110145] [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: 11/15/2023] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND AND PURPOSE Adaptive radiotherapy (ART) relies on re-planning to correct treatment variations, but the optimal timing of re-planning to account for dose changes in head and neck organs at risk (OARs) is still under investigation. We aimed to find out the optimal timing of re-planning in head and neck ART. MATERIALS AND METHODS A total of 110 head and neck cancer patients were retrospectively enrolled. A semi auto-segmentation method was applied to obtain the weekly mean dose (Dmean) to OARs. The K-nearest-neighbour method was used for missing data imputation of weekly Dmean. A dose deviation map was built using the planning Dmean and weekly Dmean values and then used to simulate different ART scenarios consisting of 1 to 6 re-plannings. The difference between accumulated Dmean and planning Dmean before re-planning (ΔDmean_acc_noART) and after re-planning (ΔDmean_acc_ART) were evaluated and compared. RESULTS Among all the OARs, supraglottic showed the largest ΔDmean_acc_noART (1.23 ± 3.13 Gy) and most cases of ΔDmean_acc_noART > 3 Gy (26 patients). The 3rd week is suggested in the optimal timing of re-planning for 10 OARs. For all the organs except arytenoid, 2 re-plannings were able to guarantee the ΔDmean_acc_ART below 3 Gy while the average |ΔDmean_acc_ART| was below 1 Gy. ART scenarios of 2_4, 3_4, 3_5 (week of re-planning separated with "_") were able to guarantee ΔDmean_acc_ART of 99 % of patients below 3 Gy simultaneously for 19 OARs. CONCLUSIONS The optimal timing of re-planning was suggested for different organs at risk in head and neck adaptive radiotherapy. Generic scenarios of timing and frequency for re-planning can be applied to guarantee the increase of accumulated mean dose within 3 Gy simultaneously for multiple organs.
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Affiliation(s)
- Yong Gan
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands; Shantou University, Cancer Hospital of Shantou University Medical College, Department of Radiotherapy, China.
| | - Johannes A Langendijk
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - Edwin Oldehinkel
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - Zhixiong Lin
- Shantou University, Cancer Hospital of Shantou University Medical College, Department of Radiotherapy, China
| | - Stefan Both
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - Charlotte L Brouwer
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
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Kraan AC, Moglioni M, Battistoni G, Bersani D, Berti A, Carra P, Cerello P, Ciocca M, Ferrero V, Fiorina E, Mazzoni E, Morrocchi M, Muraro S, Orlandi E, Pennazio F, Retico A, Rosso V, Sportelli G, Vischioni B, Vitolo V, Bisogni MG. Using the gamma-index analysis for inter-fractional comparison of in-beam PET images for head-and-neck treatment monitoring in proton therapy: A Monte Carlo simulation study. Phys Med 2024; 120:103329. [PMID: 38492331 DOI: 10.1016/j.ejmp.2024.103329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 02/13/2024] [Accepted: 03/07/2024] [Indexed: 03/18/2024] Open
Abstract
GOAL In-beam Positron Emission Tomography (PET) is a technique for in-vivo non-invasive treatment monitoring for proton therapy. To detect anatomical changes in patients with PET, various analysis methods exist, but their clinical interpretation is problematic. The goal of this work is to investigate whether the gamma-index analysis, widely used for dose comparisons, is an appropriate tool for comparing in-beam PET distributions. Focusing on a head-and-neck patient, we investigate whether the gamma-index map and the passing rate are sensitive to progressive anatomical changes. METHODS/MATERIALS We simulated a treatment course of a proton therapy patient using FLUKA Monte Carlo simulations. Gradual emptying of the sinonasal cavity was modeled through a series of artificially modified CT scans. The in-beam PET activity distributions from three fields were evaluated, simulating a planar dual head geometry. We applied the 3D-gamma evaluation method to compare the PET images with a reference image without changes. Various tolerance criteria and parameters were tested, and results were compared to the CT-scans. RESULTS Based on 210 MC simulations we identified appropriate parameters for the gamma-index analysis. Tolerance values of 3 mm/3% and 2 mm/2% were suited for comparison of simulated in-beam PET distributions. The gamma passing rate decreased with increasing volume change for all fields. CONCLUSION The gamma-index analysis was found to be a useful tool for comparing simulated in-beam PET images, sensitive to sinonasal cavity emptying. Monitoring the gamma passing rate behavior over the treatment course is useful to detect anatomical changes occurring during the treatment course.
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Affiliation(s)
- Aafke Christine Kraan
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy
| | - Martina Moglioni
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy; Dipartimento di Fisica, Università di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy.
| | - Giuseppe Battistoni
- Istituto Nazionale di Fisica Nucleare, Sezione di Milano, Via Giovanni Celoria 16, Milano, 20133, Italy
| | - Davide Bersani
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Via Pietro Giuria 1, Torino, 10125, Italy
| | - Andrea Berti
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy; Dipartimento di Fisica, Università di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy
| | - Pietro Carra
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy; Dipartimento di Fisica, Università di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy
| | - Piergiorgio Cerello
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Via Pietro Giuria 1, Torino, 10125, Italy
| | - Mario Ciocca
- Centro Nazionale di Adroterapia Oncologica, Strada Privata Campeggi 53, Pavia, 27100, Italy
| | - Veronica Ferrero
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Via Pietro Giuria 1, Torino, 10125, Italy
| | - Elisa Fiorina
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Via Pietro Giuria 1, Torino, 10125, Italy
| | - Enrico Mazzoni
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy
| | - Matteo Morrocchi
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy; Dipartimento di Fisica, Università di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy
| | - Silvia Muraro
- Istituto Nazionale di Fisica Nucleare, Sezione di Milano, Via Giovanni Celoria 16, Milano, 20133, Italy
| | - Ester Orlandi
- Centro Nazionale di Adroterapia Oncologica, Strada Privata Campeggi 53, Pavia, 27100, Italy
| | - Francesco Pennazio
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Via Pietro Giuria 1, Torino, 10125, Italy
| | - Alessandra Retico
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy
| | - Valeria Rosso
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy; Dipartimento di Fisica, Università di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy
| | - Giancarlo Sportelli
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy; Dipartimento di Fisica, Università di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy
| | - Barbara Vischioni
- Centro Nazionale di Adroterapia Oncologica, Strada Privata Campeggi 53, Pavia, 27100, Italy
| | - Viviana Vitolo
- Centro Nazionale di Adroterapia Oncologica, Strada Privata Campeggi 53, Pavia, 27100, Italy
| | - Maria Giuseppina Bisogni
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy; Dipartimento di Fisica, Università di Pisa, Largo Bruno Pontecorvo 3, Pisa, 56127, Italy
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Nuyts S, Bollen H, Eisbruch A, Strojan P, Mendenhall WM, Ng SP, Ferlito A. Adaptive radiotherapy for head and neck cancer: Pitfalls and possibilities from the radiation oncologist's point of view. Cancer Med 2024; 13:e7192. [PMID: 38650546 PMCID: PMC11036082 DOI: 10.1002/cam4.7192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/19/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Patients with head and neck cancer (HNC) may experience substantial anatomical changes during the course of radiotherapy treatment. The implementation of adaptive radiotherapy (ART) proves effective in managing the consequent impact on the planned dose distribution. METHODS This narrative literature review comprehensively discusses the diverse strategies of ART in HNC and the documented dosimetric and clinical advantages associated with these approaches, while also addressing the current challenges for integration of ART into clinical practice. RESULTS AND CONCLUSION Although based on mainly non-randomized and retrospective trials, there is accumulating evidence that ART has the potential to reduce toxicity and improve quality of life and tumor control in HNC patients treated with RT. However, several questions remain regarding accurate patient selection, the ideal frequency and timing of replanning, and the appropriate way for image registration and dose calculation. Well-designed randomized prospective trials, with a predetermined protocol for both image registration and dose summation, are urgently needed to further investigate the dosimetric and clinical benefits of ART.
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Affiliation(s)
- Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of OncologyKU LeuvenLeuvenBelgium
- Department of Radiation OncologyLeuven Cancer Institute, University Hospitals LeuvenLeuvenBelgium
| | - Heleen Bollen
- Laboratory of Experimental Radiotherapy, Department of OncologyKU LeuvenLeuvenBelgium
- Department of Radiation OncologyLeuven Cancer Institute, University Hospitals LeuvenLeuvenBelgium
| | - Avrahram Eisbruch
- Department of Radiation OncologyUniversity of MichiganAnn ArborMichiganUSA
| | - Primoz Strojan
- Department of Radiation Oncology Institute of OncologyUniversity of LjubljanaLjubljanaSlovenia
| | - William M. Mendenhall
- Department of Radiation OncologyUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Sweet Ping Ng
- Department of Radiation OncologyOlivia Newton‐John Cancer and Wellness Centre, Austin HealthMelbourneAustralia
| | - Alfio Ferlito
- Coordinator International Head and Neck Scientific GroupUdineItaly
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Blumenfeld P, Arbit E, Den R, Salhab A, Falick Michaeli T, Wygoda M, Hillman Y, Pfeffer RM, Fang M, Misrati Y, Weizman N, Feldman J, Popovtzer A. Real world clinical experience using daily intelligence-assisted online adaptive radiotherapy for head and neck cancer. Radiat Oncol 2024; 19:43. [PMID: 38555453 PMCID: PMC10981810 DOI: 10.1186/s13014-024-02436-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/25/2024] [Indexed: 04/02/2024] Open
Affiliation(s)
- Philip Blumenfeld
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel.
| | - Eduard Arbit
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Robert Den
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
- Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Israel
| | - Ayman Salhab
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Tal Falick Michaeli
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Marc Wygoda
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Yair Hillman
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Raphael M Pfeffer
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Marcel Fang
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Yael Misrati
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Noam Weizman
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Jon Feldman
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Aron Popovtzer
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
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9
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Moglioni M, Carra P, Arezzini S, Belcari N, Bersani D, Berti A, Bisogni MG, Calderisi M, Ceppa I, Cerello P, Ciocca M, Ferrero V, Fiorina E, Kraan AC, Mazzoni E, Morrocchi M, Pennazio F, Retico A, Rosso V, Sbolgi F, Vitolo V, Sportelli G. Synthetic CT imaging for PET monitoring in proton therapy: a simulation study. Phys Med Biol 2024; 69:065011. [PMID: 38373343 DOI: 10.1088/1361-6560/ad2a99] [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: 09/26/2023] [Accepted: 02/19/2024] [Indexed: 02/21/2024]
Abstract
Objective.This study addresses a fundamental limitation of in-beam positron emission tomography (IB-PET) in proton therapy: the lack of direct anatomical representation in the images it produces. We aim to overcome this shortcoming by pioneering the application of deep learning techniques to create synthetic control CT images (sCT) from combining IB-PET and planning CT scan data.Approach.We conducted simulations involving six patients who underwent irradiation with proton beams. Leveraging the architecture of a visual transformer (ViT) neural network, we developed a model to generate sCT images of these patients using the planning CT scans and the inter-fractional simulated PET activity maps during irradiation. To evaluate the model's performance, a comparison was conducted between the sCT images produced by the ViT model and the authentic control CT images-serving as the benchmark.Main results.The structural similarity index was computed at a mean value across all patients of 0.91, while the mean absolute error measured 22 Hounsfield Units (HU). Root mean squared error and peak signal-to-noise ratio values were 56 HU and 30 dB, respectively. The Dice similarity coefficient exhibited a value of 0.98. These values are comparable to or exceed those found in the literature. More than 70% of the synthetic morphological changes were found to be geometrically compatible with the ones reported in the real control CT scan.Significance.Our study presents an innovative approach to surface the hidden anatomical information of IB-PET in proton therapy. Our ViT-based model successfully generates sCT images from inter-fractional PET data and planning CT scans. Our model's performance stands on par with existing models relying on input from cone beam CT or magnetic resonance imaging, which contain more anatomical information than activity maps.
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Affiliation(s)
- Martina Moglioni
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, I-56127 Pisa, Italy
| | - Pietro Carra
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, I-56127 Pisa, Italy
| | - Silvia Arezzini
- Dipartimento di Fisica, Università di Pisa, I-56127 Pisa, Italy
| | - Nicola Belcari
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, I-56127 Pisa, Italy
| | - Davide Bersani
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
| | - Andrea Berti
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, I-56127 Pisa, Italy
| | - Maria Giuseppina Bisogni
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, I-56127 Pisa, Italy
| | | | | | - Piergiorgio Cerello
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, I-10125 Torino, Italy
| | - Mario Ciocca
- Centro Nazionale di Adroterapia Oncologica, I-27100 Pavia, Italy
| | - Veronica Ferrero
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, I-10125 Torino, Italy
| | - Elisa Fiorina
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, I-10125 Torino, Italy
| | | | - Enrico Mazzoni
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
| | - Matteo Morrocchi
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, I-56127 Pisa, Italy
| | - Francesco Pennazio
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, I-10125 Torino, Italy
| | - Alessandra Retico
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
| | - Valeria Rosso
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, I-56127 Pisa, Italy
| | | | - Viviana Vitolo
- Centro Nazionale di Adroterapia Oncologica, I-27100 Pavia, Italy
| | - Giancarlo Sportelli
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, I-56127 Pisa, Italy
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Yamashita M, Ohira S, Tanabe H, Kokubo M, Koizumi M. Correlation Between Dosimetric Parameters and Local Control in Definitive Radiotherapy for Head and Neck Cancers. In Vivo 2024; 38:819-825. [PMID: 38418123 PMCID: PMC10905467 DOI: 10.21873/invivo.13506] [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: 11/02/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND/AIM Radiotherapy (RT) outcomes are generally reported based on stage, patient background, and concomitant chemotherapy. This study aimed to investigate the effects of the prescribed dose to gross tumor volume (GTV) and the calculation algorithm on local control in definitive RT for head and neck (H&N) cancers using follow-up images after RT. PATIENTS AND METHODS This study included 154 patients with H&N cancers treated by Volumetric Modulated Arc Therapy at the Kobe City Medical Center General Hospital. Patients were classified into those receiving definitive RT (70 Gy of irradiation) and those not receiving it. Follow-up images were used to categorize the patients into the responders and non-responders groups. In the non-responders group, follow-up images were imported into the treatment planning system, and the contours of the residual or recurrent areas (local failure) were extracted and fused with computed tomography-simulated images for treatment planning. Dose evaluation parameters included maximum dose, dose administered to 1% of the volume, dose administered to 50% of the volume, dose administered to 99% of the volume (D99%), and minimum dose (Dmin) administered to the GTV. The doses to the GTV were compared between responders and non-responders. RESULTS D99% exhibited significant differences between local failure and responders and between local failure and non-responders. Dmin showed significant differences between responders and non-responders and between responders and local failure. CONCLUSION This study emphasizes the importance of verifying dose distribution in all slices of treatment planning, highlighting the need for precise assessment of the dose to the GTV in head and neck cancers.
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Affiliation(s)
- Mikiko Yamashita
- Department of Radiological Technology, Kobe City Medical Center General Hospital, Hyogo, Japan;
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shingo Ohira
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Comprehensive Radiation Oncology, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Tanabe
- Department of Radiological Technology, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Masaki Kokubo
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Masahiko Koizumi
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
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11
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Neckel N, Neckel PH, Hirt B, Doll C, Hofmann E, Nahles S, Heiland M, Kreutzer K, Koerdt S. A modified pull-through approach with a pedicled bone flap for oral and oropharyngeal cancer resection: a feasibility study. Surg Radiol Anat 2024; 46:341-352. [PMID: 38361154 PMCID: PMC10960749 DOI: 10.1007/s00276-024-03302-3] [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: 03/19/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Compromised swallowing, speaking, and local complications are the major disadvantages of established approaches to the posterior tongue and oropharynx. The mandibular split involves an esthetically unpleasant bipartition of the lower lip and is prone to bony non-union or sequestration. The conventional pull-through technique on the other hand lacks the secure reattachment of the lingually released soft tissues. METHODS The feasibility of a new modified pull-through approach was tested on three anatomical specimens. CAD/CAM cutting guides were used to design a retentive bone flap to properly refixate the genioglossus and geniohyoid muscles after the procedure. The radiographic assessment and treatment planning was performed on 12 cadavers. The entire procedure was tested surgically via dissection in three of those cases. This procedure was then applied in a clinical case. RESULTS Precise repositioning and dynamic compression of bony segments was possible reproducibly and without injury to adjacent structures. In all dissected cases, a median lingual foramen was found and in two cases vessels entering it could be dissected Radiologic anatomical landmarks were sufficient in all 12 cases to perform the clinical planning procedure. Clinically, the osteotomized segment demonstrated good blood supply and plateless repositioning was verified postoperatively via cone beam scan. CONCLUSION The method presented is safe and easy to perform. Individual cutting guides improve the safety and accuracy of the procedure, potentially eliminating the need for osteosynthesis. We provide the anatomical and radiologic basis for clinical evaluation of this pedicled bone flap procedure and present the clinical application of this modified pull-through approach.
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Affiliation(s)
- Norbert Neckel
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany.
| | - Peter H Neckel
- Institute of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Bernhard Hirt
- Institute of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Christian Doll
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
| | - Elena Hofmann
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
| | - Susanne Nahles
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
| | - Kilian Kreutzer
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
| | - Steffen Koerdt
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Hindenburgdamm 30, 13353, Berlin, Germany
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12
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Yuvnik T, Chia L, Laura OC, Tieu TT, Mahesh K, Bradley B, Daron C, Chris W. Differences in geometric patterns of failure in human papillomavirus (HPV)-associated and HPV-non-associated oropharyngeal cancer after definitive radiotherapy. Head Neck 2024; 46:552-560. [PMID: 38108534 DOI: 10.1002/hed.27606] [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: 08/25/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023] Open
Abstract
INTRODUCTION The aim of this study was to evaluate and compare the spatial pattern of locoregional recurrences in patients diagnosed with HPV-associated and HPV-non-associated oropharyngeal SCC (OPSCC) treated with definitive radiotherapy. METHODS AND MATERIALS Patients who had locoregional recurrence following definitive intensity-modulated radiation therapy were identified at a single tertiary institution. Target volumes were delineated according to the latest consensus international guidelines. Recurrences were classified into five categories based on radiotherapy dose distribution and target volume, using a previously validated methodology; type A (central high dose), type B (peripheral high dose), type C (central elective dose), type D (peripheral elective dose), and type E (extraneous dose). The types of failure were compared between p16-positive and p16-negative tumors using the Pearson chi-square test. RESULTS Fifty-eight locoregional recurrences were observed in 36 patients. The majority of recurrences were in nodal locations (66%, 38/58). Among these, 34 (59%) were classified as type A, 6 (10%) as type B, 9 (15%) as type C, 5 (9%) as type D, and 4 (7%) as type E failure. A significant difference was found in the types of failure between p16-positive and p16-negative tumors (X2 9.52, p = 0.044). p16-negative tumors were more likely to have recurrences in a peripheral location compared to p16-positive tumors (32% vs. 7%). p16-positive tumor were more likely to have extraneous recurrences (17% vs. 0%). CONCLUSION Our study results identified a significant difference in patterns of locoregional failure among patients diagnosed with oropharyngeal cancer following consensus-based tumor delineation and modern radiotherapy. Further confirmatory pattern of failure studies are required to enable greater individualization of radiotherapy for patients diagnosed with oropharyngeal malignancy in the future.
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Affiliation(s)
- Trada Yuvnik
- Calvary Mater Newcastle - Radiation Oncology, Waratah, New South Wales, Australia
- University of Sydney, Camperdown, New South Wales, Australia
| | - Low Chia
- Canberra Region Cancer Centre, Garran, Australian Capital Territory, Australia
| | - O' Connor Laura
- Calvary Mater Newcastle - Radiation Oncology, Waratah, New South Wales, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Tieu Thi Tieu
- Calvary Mater Newcastle - Radiation Oncology, Waratah, New South Wales, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Kumar Mahesh
- Calvary Mater Newcastle - Radiation Oncology, Waratah, New South Wales, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Beeksma Bradley
- Calvary Mater Newcastle - Radiation Oncology, Waratah, New South Wales, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Cope Daron
- University of Newcastle, Newcastle, New South Wales, Australia
- John Hunter Hospital - Surgical Services, New Lambton Heights, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Wratten Chris
- Calvary Mater Newcastle - Radiation Oncology, Waratah, New South Wales, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
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13
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Ribeiro LN, de Vasconcelos Carvalho M, de Oliveira Limirio JPJ, do Egito Vasconcelos BC, Moraes SLD, Pellizzer EP. Impact of low-level laser therapy on the quality of life of patients with xerostomia undergoing head and neck radiotherapy: a systematic review. Support Care Cancer 2024; 32:118. [PMID: 38244087 DOI: 10.1007/s00520-024-08325-5] [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: 10/02/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
PURPOSE To carry out a systematic review to assess whether low-level laser therapy can improve the quality of life of patients with xerostomia undergoing head and neck radiotherapy. METHODS A systematic search was performed through Embase, Medline/PubMed, Cochrane, Scopus, Web of Science, nonpeer-reviewed clinicaltrials.gov and LILACS. The strategy included clinical studies were selected that prospectively followed or evaluated the quality of life by directly comparing the use of low-level laser therapy for xerostomia induced by head and neck radiotherapy with alternative therapies without the use of a laser. The risk of bias in the studies was assessed by RoB 2.0 and Robins I. RESULTS After all application of the predetermined criteria, four studies were included, dated between the years 2014 and 2023. Three studies described as randomized clinical trials were included, one of which was a randomized pilot study and only one was a prospective clinical trial. A total of 126 patients were evaluated, all four studies used the infrared wavelength, with two studies using the combination with the red wavelength. It was observed that low-level laser therapy can change the sensation of dry mouth, improving patients' quality of life. In addition, changes related to increased stimulated and unstimulated salivary flow were also identified. CONCLUSION The use of low-level laser therapy has promising results on xerostomia, consequently improving the quality of life of patients undergoing radiotherapy in the head and neck region.
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Affiliation(s)
- Lucas Nascimento Ribeiro
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Integrated Anatomic Pathology Center, University of Pernambuco (UPE), Oswaldo Cruz University Hospital, Arnóbio Marques Street, 310 - Santo Amaro, Recife, PE, 50100-130, Brazil
| | - Marianne de Vasconcelos Carvalho
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Integrated Anatomic Pathology Center, University of Pernambuco (UPE), Oswaldo Cruz University Hospital, Arnóbio Marques Street, 310 - Santo Amaro, Recife, PE, 50100-130, Brazil.
- Department of Oral and Maxillofacial Pathology, School of Dentistry, University of Pernambuco (UPE), Cícero Monteiro Street, s/n - São Cristóvão, Arcoverde, PE, 56503-146, Brazil.
| | - João Pedro Justino de Oliveira Limirio
- Department of Dental Materials and Prosthodontics, Dental School of Araçatuba, São Paulo State University (UNESP), José Bonifácio Street 1193, Araçatuba, São Paulo, 1605000, Brazil
| | - Belmiro Cavalcanti do Egito Vasconcelos
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Pernambuco (UPE), Oswaldo Cruz University Hospital, Arnóbio Marques Street, 310 - Santo Amaro, Recife, PE, 50100-130, Brazil
| | - Sandra Lúcia Dantas Moraes
- Department of Prosthodontics, School of Dentistry, University of Pernambuco (UPE), Oswaldo Cruz University Hospital, Arnóbio Marques Street, 310 - Santo Amaro, Recife, PE, 50100-130, Brazil
| | - Eduardo Piza Pellizzer
- Department of Dental Materials and Prosthodontics, Dental School of Araçatuba, São Paulo State University (UNESP), José Bonifácio Street 1193, Araçatuba, São Paulo, 1605000, Brazil
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Abstract
Magnetic resonance imaging-guided radiation therapy (MRIgRT) has improved soft tissue contrast over computed tomography (CT) based image-guided RT. Superior visualization of the target and surrounding radiosensitive structures has the potential to improve oncological outcomes partly due to safer dose-escalation and adaptive planning. In this review, we highlight the workflow of adaptive MRIgRT planning, which includes simulation imaging, daily MRI, identifying isocenter shifts, contouring, plan optimization, quality control, and delivery. Increased utilization of MRIgRT will depend on addressing technical limitations of this technology, while addressing treatment efficacy, cost-effectiveness, and workflow training.
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Affiliation(s)
- Cecil M Benitez
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, CA
| | - Michael D Chuong
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida; Miami, FL
| | - Luise A Künzel
- National Center for Tumor Diseases (NCT), Dresden; German Cancer Research Center (DKFZ), Heidelberg; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden; Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.; OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden Rossendorf, Dresden, Germany
| | - Daniela Thorwarth
- Department of Radiation Oncology, Section for Biomedical Physics, University of Tübingen, Tübingen, Germany..
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15
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Amstutz F, Krcek R, Bachtiary B, Weber DC, Lomax AJ, Unkelbach J, Zhang Y. Treatment planning comparison for head and neck cancer between photon, proton, and combined proton-photon therapy - From a fixed beam line to an arc. Radiother Oncol 2024; 190:109973. [PMID: 37913953 DOI: 10.1016/j.radonc.2023.109973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 09/25/2023] [Accepted: 10/26/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND AND PURPOSE This study investigates whether combined proton-photon therapy (CPPT) improves treatment plan quality compared to single-modality intensity-modulated radiation therapy (IMRT) or intensity-modulated proton therapy (IMPT) for head and neck cancer (HNC) patients. Different proton beam arrangements for CPPT and IMPT are compared, which could be of specific interest concerning potential future upright-positioned treatments. Furthermore, it is evaluated if CPPT benefits remain under inter-fractional anatomical changes for HNC treatments. MATERIAL AND METHODS Five HNC patients with a planning CT and multiple (4-7) repeated CTs were studied. CPPT with simultaneously optimized photon and proton fluence, single-modality IMPT, and IMRT treatment plans were optimized on the planning CT and then recalculated and reoptimized on each repeated CT. For CPPT and IMPT, plans with different degrees of freedom for the proton beams were optimized. Fixed horizontal proton beam line (FHB), gantry-like, and arc-like plans were compared. RESULTS The target coverage for CPPT without adaptation is insufficient (average V95%=88.4 %), while adapted plans can recover the initial treatment plan quality for target (average V95%=95.5 %) and organs-at-risk. CPPT with increased proton beam flexibility increases plan quality and reduces normal tissue complication probability of Xerostomia and Dysphagia. On average, Xerostomia NTCP reductions compared to IMRT are -2.7 %/-3.4 %/-5.0 % for CPPT FHB/CPPT Gantry/CPPT Arc. The differences for IMPT FHB/IMPT Gantry/IMPT Arc are + 0.8 %/-0.9 %/-4.3 %. CONCLUSION CPPT for HNC needs adaptive treatments. Increasing proton beam flexibility in CPPT, either by using a gantry or an upright-positioned patient, improves treatment plan quality. However, the photon component is substantially reduced, therefore, the balance between improved plan quality and costs must be further determined.
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Affiliation(s)
- Florian Amstutz
- Center for Proton Therapy, Paul Scherrer Institute, Switzerland; Department of Physics, ETH Zurich, Switzerland
| | - Reinhardt Krcek
- Center for Proton Therapy, Paul Scherrer Institute, Switzerland; Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, Switzerland; Department of Radiation Oncology, University Hospital Zurich, Switzerland; Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Antony J Lomax
- Center for Proton Therapy, Paul Scherrer Institute, Switzerland; Department of Physics, ETH Zurich, Switzerland
| | - Jan Unkelbach
- Department of Radiation Oncology, University Hospital Zurich, Switzerland
| | - Ye Zhang
- Center for Proton Therapy, Paul Scherrer Institute, Switzerland.
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16
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Essers M, Mesch L, Beugeling M, Dekker J, de Kruijf W. Setup and intra-fractional motion measurements using surface scanning in head and neck cancer radiotherapy- A feasibility study. Phys Imaging Radiat Oncol 2024; 29:100563. [PMID: 38444887 PMCID: PMC10912619 DOI: 10.1016/j.phro.2024.100563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/30/2023] [Accepted: 02/15/2024] [Indexed: 03/07/2024] Open
Abstract
Background and purpose Surface-guided radiotherapy (SGRT) is applied to improve patient set-up and to monitor intra-fraction motion. Head and neck cancer (H&N) patients are usually fixated using 5-point thermoplastic masks, that are experienced as uncomfortable or even stressful. Therefore, the feasibility of irradiating H&N patients without a mask by using SGRT was examined. Material and methods Nineteen H&N patients were included in a simulation study. Once a week, before the standard treatment, a maskless treatment was simulated, using SGRT for setup and intrafraction motion monitoring. Initial patient setup accuracy and intrafraction motion was determined using ConeBeam CT (CBCT) images as well as SGRT before and after the (simulated) treatment. The clinical target volume to planning target volume (CTV-PTV) margin for intrafraction motion was calculated. Using patient questionnaires, the patient-friendliness H&N irradiation with and without mask was determined. Results Maskless setup with SGRT and CBCT was as accurate as with a mask. SGRT showed that intrafraction motion was gradual during the treatment. The CTV-PTV margin correcting for intrafraction motion was 1.7 mm for maskless treatment without interventions, and 1.2 mm if corrected for motions > 2 mm. For 19 % of fractions, the intrafraction motion, as detected by both SGRT and CBCT, was larger than 2 mm in at least one direction. Sixteen patients preferred maskless treatment, while 3 worried they would move too much. Conclusions Using SGRT and a standard head rest resulted in a patient-friendly treatment with accurate patient setup and acceptably small intrafraction motion for H&N patients.
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Affiliation(s)
- Marion Essers
- Institute Verbeeten, Medical Physics & Instrumentation, PO Box 90120, 5000 LA Tilburg, the Netherlands
| | - Lennart Mesch
- Institute Verbeeten, Radiotherapy, PO Box 90120, 5000 LA Tilburg, the Netherlands
| | - Maaike Beugeling
- Institute Verbeeten, Radiotherapy, PO Box 90120, 5000 LA Tilburg, the Netherlands
| | - Janita Dekker
- Institute Verbeeten, Medical Physics & Instrumentation, PO Box 90120, 5000 LA Tilburg, the Netherlands
| | - Willy de Kruijf
- Institute Verbeeten, Medical Physics & Instrumentation, PO Box 90120, 5000 LA Tilburg, the Netherlands
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All S, Zhong X, Choi B, Kim JS, Zhuang T, Avkshtol V, Sher D, Lin MH, Moon DH. In Silico Analysis of Adjuvant Head and Neck Online Adaptive Radiation Therapy. Adv Radiat Oncol 2024; 9:101319. [PMID: 38260220 PMCID: PMC10801641 DOI: 10.1016/j.adro.2023.101319] [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: 02/06/2023] [Accepted: 07/13/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose Recently developed online adaptive radiation therapy (OnART) systems enable frequent treatment plan adaptation, but data supporting a dosimetric benefit in postoperative head and neck radiation therapy (RT) are sparse. We performed an in silico dosimetric study to assess the potential benefits of a single versus weekly OnART in the treatment of patients with head and neck squamous cell carcinoma in the adjuvant setting. Methods and Materials Twelve patients receiving conventionally fractionated RT over 6 weeks and 12 patients receiving hypofractionated RT over 3 weeks on a clinical trial were analyzed. The OnART emulator was used to virtually adapt either once midtreatment or weekly based on the patient's routinely performed cone beam computed tomography. The planning target volume (PTV) coverage, dose heterogeneity, and cumulative dose to the organs at risk for these 2 adaptive approaches were compared with the nonadapted plan. Results In total, 13, 8, and 3 patients had oral cavity, oropharynx, and larynx primaries, respectively. In the conventionally fractionated RT cohort, weekly OnART led to a significant improvement in PTV V100% coverage (6.2%), hot spot (-1.2 Gy), and maximum cord dose (-3.1 Gy), whereas the mean ipsilateral parotid dose increased modestly (1.8 Gy) versus the nonadapted plan. When adapting once midtreatment, PTV coverage improved with a smaller magnitude (0.2%-2.5%), whereas dose increased to the ipsilateral parotid (1.0-1.1 Gy) and mandible (0.2-0.7 Gy). For the hypofractionated RT cohort, similar benefit was observed with weekly OnART, including significant improvement in PTV coverage, hot spot, and maximum cord dose, whereas no consistent dosimetric advantage was seen when adapting once midtreatment. Conclusions For head and neck squamous cell carcinoma adjuvant RT, there was a limited benefit of single OnART, but weekly adaptations meaningfully improved the dosimetric criteria, predominantly PTV coverage and dose heterogeneity. A prospective study is ongoing to determine the clinical benefit of OnART in this setting.
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Affiliation(s)
- Sean All
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Xinran Zhong
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Byongsu Choi
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Tingliang Zhuang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Vladimir Avkshtol
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - David Sher
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mu-Han Lin
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dominic H. Moon
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
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Zhou X, Zhu J, Zhou C, Wang W, Ding W, Chen M, Chen K, Li S, Chen X, Yang H. Failure patterns of locoregional recurrence after reducing target volumes in patients with nasopharyngeal carcinoma receiving adaptive replanning during intensity-modulated radiotherapy: a single-center experience in China. Radiat Oncol 2023; 18:190. [PMID: 37974274 PMCID: PMC10652536 DOI: 10.1186/s13014-023-02373-7] [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: 07/28/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Previous researches have demonstrated that adaptive replanning during intensity-modulated radiation therapy (IMRT) could enhance the prognosis of patients with nasopharyngeal carcinoma (NPC). However, the delineation of replanning target volumes remains unclear. This study aimed to evaluate the feasibility of reducing target volumes through adaptive replanning during IMRT by analyzing long-term survival outcomes and failure patterns of locoregional recurrence in NPC. METHODS This study enrolled consecutive NPC patients who received IMRT at our hospital between August 2011 and April 2018. Patients with initially diagnosed, histologically verified, non-metastatic nasopharyngeal cancer were eligible for participation in this study. The location and extent of locoregional recurrences were transferred to pretreatment planning computed tomography for dosimetry analysis. RESULTS Among 274 patients, 100 (36.5%) received IMRT without replanning and 174 (63.5%) received IMRT with replanning. Five-year rates of locoregional recurrence-free survival (LRFS) were 90.1% (95%CI, 84.8% to 95.4%) and 80.8% (95%CI, 72.0% to 89.6%) for patients with and without replanning, P = 0.045. There were 17 locoregional recurrences in 15 patients among patients with replanning, of which 1 (5.9%) was out-field and 16 (94.1%) were in-field. Among patients without replanning, 19 patients developed locoregional recurrences, of which 1 (5.3%) was out-field, 2 (10.5%) were marginal, and 16 (84.2%) were in-field. CONCLUSIONS In-field failure inside the high dose area was the most common locoregional recurrent pattern for non-metastatic NPC. Adapting the target volumes and modifying the radiation dose prescribed to the area of tumor reduction during IMRT was feasible and would not cause additional recurrence in the shrunken area.
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Affiliation(s)
- Xiate Zhou
- Department of Radiation Oncology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, Zhejiang Province, China
- Department of Radiation Oncology, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou, 317000, Zhejiang Province, China
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Taizhou, 317000, Zhejiang Province, China
| | - Jian Zhu
- Department of Radiation Oncology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, Zhejiang Province, China
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Taizhou, 317000, Zhejiang Province, China
| | - Chao Zhou
- Department of Radiation Oncology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, Zhejiang Province, China
- Department of Radiation Oncology, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou, 317000, Zhejiang Province, China
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Taizhou, 317000, Zhejiang Province, China
| | - Wei Wang
- Department of Radiation Oncology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, Zhejiang Province, China
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Taizhou, 317000, Zhejiang Province, China
| | - Weijun Ding
- Department of Radiation Oncology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, Zhejiang Province, China
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Taizhou, 317000, Zhejiang Province, China
| | - Meng Chen
- Department of Radiation Oncology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, Zhejiang Province, China
- Department of Radiation Oncology, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou, 317000, Zhejiang Province, China
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Taizhou, 317000, Zhejiang Province, China
| | - Kuifei Chen
- School of Medicine, Shaoxing University, Shaoxing City, 312000, Zhejiang Province, China
| | - Shuling Li
- School of Medicine, Shaoxing University, Shaoxing City, 312000, Zhejiang Province, China
| | - Xiaofeng Chen
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
| | - Haihua Yang
- Department of Radiation Oncology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, Zhejiang Province, China.
- Department of Radiation Oncology, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou, 317000, Zhejiang Province, China.
- Key Laboratory of Radiation Oncology of Taizhou, Radiation Oncology Institute of Enze Medical Health Academy, Department of Radiation Oncology, Taizhou Hospital Affiliated to Wenzhou Medical University, Taizhou, 317000, Zhejiang Province, China.
- School of Medicine, Shaoxing University, Shaoxing City, 312000, Zhejiang Province, China.
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Ishizawa M, Tanaka S, Takagi H, Kadoya N, Sato K, Umezawa R, Jingu K, Takeda K. Development of a prediction model for head and neck volume reduction by clinical factors, dose-volume histogram parameters and radiomics in head and neck cancer†. JOURNAL OF RADIATION RESEARCH 2023; 64:783-794. [PMID: 37466450 PMCID: PMC10516738 DOI: 10.1093/jrr/rrad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/05/2023] [Indexed: 07/20/2023]
Abstract
In external radiotherapy of head and neck (HN) cancers, the reduction of irradiation accuracy due to HN volume reduction often causes a problem. Adaptive radiotherapy (ART) can effectively solve this problem; however, its application to all cases is impractical because of cost and time. Therefore, finding priority cases is essential. This study aimed to predict patients with HN cancers are more likely to need ART based on a quantitative measure of large HN volume reduction and evaluate model accuracy. The study included 172 cases of patients with HN cancer who received external irradiation. The HN volume was calculated using cone-beam computed tomography (CT) for irradiation-guided radiotherapy for all treatment fractions and classified into two groups: cases with a large reduction in the HN volume and cases without a large reduction. Radiomic features were extracted from the primary gross tumor volume (GTV) and nodal GTV of the planning CT. To develop the prediction model, four feature selection methods and two machine-learning algorithms were tested. Predictive performance was evaluated by the area under the curve (AUC), accuracy, sensitivity and specificity. Predictive performance was the highest for the random forest, with an AUC of 0.662. Furthermore, its accuracy, sensitivity and specificity were 0.692, 0.700 and 0.813, respectively. Selected features included radiomic features of the primary GTV, human papillomavirus in oropharyngeal cancer and the implementation of chemotherapy; thus, these features might be related to HN volume change. Our model suggested the potential to predict ART requirements based on HN volume reduction .
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Affiliation(s)
- Miyu Ishizawa
- Department of Radiological Technology, Faculty of Medicine, School of Health Sciences, Tohoku University, 21 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Shohei Tanaka
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hisamichi Takagi
- Department of Radiological Technology, Faculty of Medicine, School of Health Sciences, Tohoku University, 21 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kiyokazu Sato
- Department of Radiation Technology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Ken Takeda
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
- Department of Radiological Technology, Faculty of Medicine, School of Health Sciences, Tohoku University, 21 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
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Yap LM, Jamalludin Z, Ng AH, Ung NM. A multi-center survey on adaptive radiation therapy for head and neck cancer in Malaysia. Phys Eng Sci Med 2023; 46:1331-1340. [PMID: 37470929 DOI: 10.1007/s13246-023-01303-x] [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: 04/17/2023] [Accepted: 07/12/2023] [Indexed: 07/21/2023]
Abstract
The survey is to assess the current state of adaptive radiation therapy (ART) for head and neck (H&N) cases among radiotherapy centers in Malaysia and to identify any implementation limitations. An online questionnaire was sent to all radiotherapy centers in Malaysia. The 24-question questionnaire consists of general information about the center, ART practices, and limitations faced in implementing ART. 28 out of 36 radiotherapy centers responded, resulting in an overall response rate of 78%. About 52% of the responding centers rescanned and replanned less than 5% of their H&N patients. The majority (88.9%) of the respondents reported the use Cone Beam Computed Tomography alone or in combination with other modalities to trigger the ART process. The main reasons cited for adopting ART were weight loss, changes in the immobilization fitting, and anatomical variation. The adaptation process typically occurred during week 3 or week 4 of treatment. More than half of the respondents require three days or more from re-simulation to starting a new treatment plan. Both target and organ at risk delineation on new planning CT relied heavily on manual delineation by physicians and physicists, respectively. All centers perform patient-specific quality assurance for their new adaptive plans. Two main limitations in implementing ART are "limited financial resources or equipment" and "limitation on technical knowledge". There is a need for a common consensus to standardize the practice of ART and address these limitations to improve the implementation of ART in Malaysia.
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Affiliation(s)
- Lai Mun Yap
- Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
- Department of Radiotherapy, Aurelius Hospital Nilai, 71800, Nilai, Malaysia
| | - Zulaikha Jamalludin
- Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Aik Hao Ng
- Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Ngie Min Ung
- Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
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Trada Y, Lee MT, Jameson MG, Chlap P, Keall P, Moses D, Lin P, Fowler A. Mid-treatment 18F-FDG PET imaging changes in parotid gland correlates to radiation-induced xerostomia. Radiother Oncol 2023; 186:109745. [PMID: 37330056 DOI: 10.1016/j.radonc.2023.109745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The aim of this study was to measure functional changes in parotid glands using mid-treatment FDG-PET/CT and correlate early imaging changes to subsequent xerostomia in mucosal head and neck squamous cell carcinoma patients undergoing radiotherapy. MATERIALS AND METHODS 56 patients from two prospective imaging biomarker studies underwent FDG-PET/CT at baseline and during radiotherapy (week 3). Both parotid glands were volumetrically delineated at each time point. PET parameter SUVmedian were calculated for ipsilateral and contralateral parotid glands. Absolute and relative change (Δ) in SUVmedian were correlated to moderate-severe xerostomia (CTCAE grade ≥ 2) at 6 months. Four predictive models were subsequently created using multivariate logistic regression using clinical and radiotherapy planning parameters. Model performance was calculated using ROC analysis and compared using Akaike information criterion (AIC) RESULTS: 29 patients (51.8%) developed grade ≥ 2 xerostomia. Compared to baseline, there was an increase in SUVmedian at week 3 in ipsilateral (8.4%) and contralateral (5.5%) parotid glands. Increase in ipsilateral parotid Δ SUVmedian (p = 0.04) and contralateral mean parotid dose (p = 0.04) were correlated to xerostomia. The reference 'clinical' model correlated to xerostomia (AUC 0.667, AIC 70.9). Addition of ipsilateral parotid Δ SUVmedian to the clinical model resulted in the highest correlation to xerostomia (AUC 0.777, AIC 65.4). CONCLUSION Our study shows functional changes occurring in the parotid gland early during radiotherapy. We demonstrate that integration of baseline and mid-treatment FDG-PET/CT changes in the parotid gland with clinical factors has the potential to improve xerostomia risk prediction which could be utilised for personalised head and neck radiotherapy.
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Affiliation(s)
- Yuvnik Trada
- Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW, Australia; Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
| | - Mark T Lee
- Department of Radiation Oncology, Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; South Western Clinical School, School of Medicine, University of New South Wales, NSW, Australia
| | - Michael G Jameson
- GenesisCare, Sydney, NSW, Australia; St Vincent's Clinical School, Faculty of Medicine, University NSW, Australia
| | - Phillip Chlap
- Department of Radiation Oncology, Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; South Western Clinical School, School of Medicine, University of New South Wales, NSW, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Paul Keall
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Image X Institute, University of Sydney, Sydney, NSW, Australia
| | - Daniel Moses
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, Australia; Department of Medical Imaging, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Peter Lin
- South Western Clinical School, School of Medicine, University of New South Wales, NSW, Australia; Department of Nuclear Medicine and PET, Liverpool Hospital, Liverpool, NSW, Australia; School of Medicine, Western Sydney University, NSW, Australia
| | - Allan Fowler
- Department of Radiation Oncology, Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia; South Western Clinical School, School of Medicine, University of New South Wales, NSW, Australia
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Avkshtol V, Meng B, Shen C, Choi BS, Okoroafor C, Moon D, Sher D, Lin MH. Early Experience of Online Adaptive Radiation Therapy for Definitive Radiation of Patients With Head and Neck Cancer. Adv Radiat Oncol 2023; 8:101256. [PMID: 37408672 PMCID: PMC10318268 DOI: 10.1016/j.adro.2023.101256] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/13/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose The advent of cone beam computed tomography-based online adaptive radiation therapy (oART) has dramatically reduced the barriers of adaptation. We present the first prospective oART experience data in radiation of head and neck cancers (HNC). Methods and Materials Patients with HNC receiving definitive standard fractionation (chemo)radiation who underwent at least 1 oART session were enrolled in a prospective registry study. The frequency of adaptations was at the discretion of the treating physician. Physicians were given the option of delivering 1 of 2 plans during adaptation: the original radiation plan transposed onto the cone beam computed tomography with adapted contours (scheduled), and a new adapted plan generated from the updated contours (adapted). A paired t test was used to compare the mean doses between scheduled and adapted plans. Results Twenty-one patients (15 oropharynx, 4 larynx/hypopharynx, 2 other) underwent 43 adaptation sessions (median, 2). The median ART process time was 23 minutes, median physician time at the console was 27 minutes, and median patient time in the vault was 43.5 minutes. The adapted plan was chosen 93% of the time. The mean volume in each planned target volume (PTV) receiving 100% of the prescription dose for the scheduled versus adapted plan for high-risk PTVs was 87.8% versus 95% (P < .01), intermediate-risk PTVs was 87.3% versus 97.9% (P < .01), and low-risk PTVs was 94% versus 97.8% (P < .01), respectively. The mean hotspot was also lower with adaptation: 108.8% versus 106.4% (P < .01). All but 1 organ at risk (11/12) saw a decrease in their dose with the adapted plans, with the mean ipsilateral parotid (P = .013), mean larynx (P < .01), maximum point spinal cord (P < .01), and maximum point brain stem (P = .035) reaching statistical significance. Conclusions Online ART is feasible for HNC, with significant improvement in target coverage and homogeneity and a modest decrease in doses to several organs at risk.
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Affiliation(s)
- Vladimir Avkshtol
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Boyu Meng
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chenyang Shen
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Byong Su Choi
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Chikasirimobi Okoroafor
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dominic Moon
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - David Sher
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mu-Han Lin
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
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Gan Y, Langendijk JA, van der Schaaf A, van den Bosch L, Oldehinkel E, Lin Z, Both S, Brouwer CL. An efficient strategy to select head and neck cancer patients for adaptive radiotherapy. Radiother Oncol 2023; 186:109763. [PMID: 37353058 DOI: 10.1016/j.radonc.2023.109763] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND AND PURPOSE Adaptive radiotherapy (ART) is workload intensive but only benefits a subgroup of patients. We aimed to develop an efficient strategy to select candidates for ART in the first two weeks of head and neck cancer (HNC) radiotherapy. MATERIALS AND METHODS This study retrospectively enrolled 110 HNC patients who underwent modern photon radiotherapy with at least 5 weekly in-treatment re-scan CTs. A semi auto-segmentation method was applied to obtain the weekly mean dose (Dmean) to OARs. A comprehensive NTCP-profile was applied to obtain NTCP's. The difference between planning and actual values of Dmean (ΔDmean) and dichotomized difference of clinical relevance (BIOΔNTCP) were used for modelling to determine the cut-off maximum ΔDmean of OARs in week 1 and 2 (maxΔDmean_1 and maxΔDmean_2). Four strategies to select candidates for ART, using cut-off maxΔDmean were compared. RESULTS The Spearman's rank correlation test showed significant positive correlation between maxΔDmean and BIOΔNTCP (p-value <0.001). For major BIOΔNTCP (>5%) of acute and late toxicity, 10.9% and 4.5% of the patients were true candidates for ART. Strategy C using both cut-off maxΔDmean_1 (3.01 and 5.14 Gy) and cut-off maxΔDmean_2 (3.41 and 5.30 Gy) showed the best sensitivity, specificity, positive and negative predictive values (0.92, 0.82, 0.38, 0.99 for acute toxicity and 1.00, 0.92, 0.38, 1.00 for late toxicity, respectively). CONCLUSIONS We propose an efficient selection strategy for ART that is able to classify the subgroup of patients with >5% BIOΔNTCP for late toxicity using imaging in the first two treatment weeks.
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Affiliation(s)
- Yong Gan
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, The Netherlands; Shantou University, Cancer Hospital of Shantou University Medical College, Department of Radiotherapy, China.
| | - Johannes A Langendijk
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, The Netherlands
| | - Arjen van der Schaaf
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, The Netherlands
| | - Lisa van den Bosch
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, The Netherlands
| | - Edwin Oldehinkel
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, The Netherlands
| | - Zhixiong Lin
- Shantou University, Cancer Hospital of Shantou University Medical College, Department of Radiotherapy, China
| | - Stefan Both
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, The Netherlands
| | - Charlotte L Brouwer
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, The Netherlands
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Aouadi S, Yoganathan SA, Torfeh T, Paloor S, Caparrotti P, Hammoud R, Al-Hammadi N. Generation of synthetic CT from CBCT using deep learning approaches for head and neck cancer patients. Biomed Phys Eng Express 2023; 9:055020. [PMID: 37489854 DOI: 10.1088/2057-1976/acea27] [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: 04/16/2023] [Accepted: 07/25/2023] [Indexed: 07/26/2023]
Abstract
Purpose.To create a synthetic CT (sCT) from daily CBCT using either deep residual U-Net (DRUnet), or conditional generative adversarial network (cGAN) for adaptive radiotherapy planning (ART).Methods.First fraction CBCT and planning CT (pCT) were collected from 93 Head and Neck patients who underwent external beam radiotherapy. The dataset was divided into training, validation, and test sets of 58, 10 and 25 patients respectively. Three methods were used to generate sCT, 1. Nonlocal means patch based method was modified to include multiscale patches defining the multiscale patch based method (MPBM), 2. An encoder decoder 2D Unet with imbricated deep residual units was implemented, 3. DRUnet was integrated to the generator part of cGAN whereas a convolutional PatchGAN classifier was used as the discriminator. The accuracy of sCT was evaluated geometrically using Mean Absolute Error (MAE). Clinical Volumetric Modulated Arc Therapy (VMAT) plans were copied from pCT to registered CBCT and sCT and dosimetric analysis was performed by comparing Dose Volume Histogram (DVH) parameters of planning target volumes (PTVs) and organs at risk (OARs). Furthermore, 3D Gamma analysis (2%/2mm, global) between the dose on the sCT or CBCT and that on the pCT was performed.Results. The average MAE calculated between pCT and CBCT was 180.82 ± 27.37HU. Overall, all approaches significantly reduced the uncertainties in CBCT. Deep learning approaches outperformed patch-based methods with MAE = 67.88 ± 8.39HU (DRUnet) and MAE = 72.52 ± 8.43HU (cGAN) compared to MAE = 90.69 ± 14.3HU (MPBM). The percentages of DVH metric deviations were below 0.55% for PTVs and 1.17% for OARs using DRUnet. The average Gamma pass rate was 99.45 ± 1.86% for sCT generated using DRUnet.Conclusion.DL approaches outperformed MPBM. Specifically, DRUnet could be used for the generation of sCT with accurate intensities and realistic description of patient anatomy. This could be beneficial for CBCT based ART.
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Affiliation(s)
- Souha Aouadi
- Department of Radiation Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, PO Box 3050 Doha, Qatar
| | - S A Yoganathan
- Department of Radiation Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, PO Box 3050 Doha, Qatar
| | - Tarraf Torfeh
- Department of Radiation Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, PO Box 3050 Doha, Qatar
| | - Satheesh Paloor
- Department of Radiation Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, PO Box 3050 Doha, Qatar
| | - Palmira Caparrotti
- Department of Radiation Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, PO Box 3050 Doha, Qatar
| | - Rabih Hammoud
- Department of Radiation Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, PO Box 3050 Doha, Qatar
| | - Noora Al-Hammadi
- Department of Radiation Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, PO Box 3050 Doha, Qatar
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Reiners K, Dagan R, Holtzman A, Bryant C, Andersson S, Nilsson R, Hong L, Johnson P, Zhang Y. CBCT-Based Dose Monitoring and Adaptive Planning Triggers in Head and Neck PBS Proton Therapy. Cancers (Basel) 2023; 15:3881. [PMID: 37568697 PMCID: PMC10417147 DOI: 10.3390/cancers15153881] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
PURPOSE To investigate the feasibility of using cone-beam computed tomography (CBCT)-derived synthetic CTs to monitor the daily dose and trigger a plan review for adaptive proton therapy (APT) in head and neck cancer (HNC) patients. METHODS For 84 HNC patients treated with proton pencil-beam scanning (PBS), same-day CBCT and verification CT (vfCT) pairs were retrospectively collected. The ground truth CT (gtCT) was created by deforming the vfCT to the same-day CBCT, and it was then used as a dosimetric baseline and for establishing plan review trigger recommendations. Two different synthetic CT algorithms were tested; the corrected CBCT (corrCBCT) was created using an iterative image correction method and the virtual CT (virtCT) was created by deforming the planning CT to the CBCT, followed by a low-density masking process. Clinical treatment plans were recalculated on the image sets for evaluation. RESULTS Plan review trigger criteria for adaptive therapy were established after closely reviewing the cohort data. Compared to the vfCT, the corrCBCT and virtCT reliably produced dosimetric data more similar to the gtCT. The average discrepancy in D99 for high-risk clinical target volumes (CTV) was 1.1%, 0.7%, and 0.4% and for standard-risk CTVs was 1.8%, 0.5%, and 0.5% for the vfCT, corrCBCT, and virtCT, respectively. CONCLUSION Streamlined APT has been achieved with the proposed plan review criteria and CBCT-based synthetic CT workflow.
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Affiliation(s)
- Keaton Reiners
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA; (K.R.); (R.D.); (C.B.); (P.J.)
- Medical Physics Graduate Program, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Roi Dagan
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA; (K.R.); (R.D.); (C.B.); (P.J.)
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Adam Holtzman
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Curtis Bryant
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA; (K.R.); (R.D.); (C.B.); (P.J.)
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | | | - Rasmus Nilsson
- RaySearch Laboratories, SE-103 65 Stockholm, Sweden; (S.A.); (R.N.)
| | - Liu Hong
- Ion Beam Applications S.A., 1348 Louvain-la-Neuve, Belgium;
| | - Perry Johnson
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA; (K.R.); (R.D.); (C.B.); (P.J.)
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Yawei Zhang
- University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA; (K.R.); (R.D.); (C.B.); (P.J.)
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610, USA
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Jun HW, Song CM, Park HJ, Ji YB, Tae K. Serial Changes in Parotid Gland Volume and Symptoms After Radiation Therapy in Oropharyngeal Cancer. EAR, NOSE & THROAT JOURNAL 2023:1455613231185086. [PMID: 37458107 DOI: 10.1177/01455613231185086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Objective: To evaluate the serial changes in the volume of the parotid gland and clinical symptoms after a course of radiation therapy (RT) in patients with oropharyngeal cancer. Methods: A total of 33 patients who were diagnosed with oropharyngeal cancer and had been treated with RT or concurrent chemoradiation therapy were evaluated. Parotid gland volumes were measured serially by head and neck computed tomography with contrast-enhanced images before RT, and 6 months, 1 year, and 2 years after RT. Patients also filled out EORTC (European Organization for the Research and Treatment of Cancer) QLQ-C30 questionnaires on the quality of life (QOL) at the same time. This questionnaire included questions about salivary gland function: dry mouth, sticky saliva, and taste disorder. Higher scores on EORTC questionnaire translates to worse QOL. Results: All patients received more than 60 Gy irradiation in total. The mean volume of parotid gland decreased from 23.30 mL before RT to 15.80 mL, 15.93 mL, and 16.67 mL after 6 months, 1 year, and 2 years, respectively (P < 0.001 between pre-RT and all other 3 periods). The scores on the QOL questionnaire were higher (worsened QOL) at all 3 times after radiation than in the pre-RT period. The mean score of QOL increased from pre-RT to 2 years post-RT: "dry mouth" from 1.65 to 2.70, "sticky saliva" from 1.19 to 2.00, and "taste disorder" from 1.12 to 1.94. All 3 of these parameters were correlated with the volume of the parotid gland (P < 0.005 each). Conclusions: The volume of the parotid gland decreases significantly after RT for oropharyngeal cancer and does not recover significantly for at least 2 years. There was a significant correlation between decreased parotid volume and a lower QOL involving salivation.
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Affiliation(s)
- Hyun Woong Jun
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Hae Jin Park
- Department of Radiation Oncology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Yong Bae Ji
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
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Adjogatse D, Michaelidou A, Sanchez Nieto B, Kozarski R, Sassoon I, Evans M, Rackley T, Shah S, Eaton D, Pike L, Curry S, Gould SM, Thomas C, Kong A, Petkar I, Reis-Ferreira M, Connor S, Barrington SF, Lei M, Guerrero Urbano T. Protocol letter: Intra-treatment Image Guided Adaptive Radiotherapy Dose-escalation Study (InGReS) - A Phase 1 multicentre feasibility study. Radiother Oncol 2023; 183:109645. [PMID: 36997123 DOI: 10.1016/j.radonc.2023.109645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Delali Adjogatse
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Andriana Michaelidou
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Robert Kozarski
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Isabel Sassoon
- Computer Science Department, Brunel University London, Uxbridge, UK
| | - Mererid Evans
- Department of Oncology, Velindre University NHS Trust, Cardiff, UK
| | - Thomas Rackley
- Department of Oncology, Velindre University NHS Trust, Cardiff, UK
| | - Simon Shah
- Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - David Eaton
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lucy Pike
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sorcha Curry
- King's College and Guy's and St Thomas' Hospital PET Centre, London, UK
| | - Sarah-May Gould
- King's College and Guy's and St Thomas' Hospital PET Centre, London, UK
| | - Christopher Thomas
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Anthony Kong
- Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Imran Petkar
- Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Miguel Reis-Ferreira
- Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Stephen Connor
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Radiology Guy's and St Thomas' NHS Foundation Trust, London, UK; Department of Neuroradiology, King's College Hospital, London UK
| | - Sally Fiona Barrington
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; King's College and Guy's and St Thomas' Hospital PET Centre, London, UK
| | - Mary Lei
- Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Teresa Guerrero Urbano
- Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK; King's College London, Faculty of Dentistry, Oral and Craniofacial Sciences, London, UK
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Szmul A, Taylor S, Lim P, Cantwell J, Moreira I, Zhang Y, D’Souza D, Moinuddin S, Gaze MN, Gains J, Veiga C. Deep learning based synthetic CT from cone beam CT generation for abdominal paediatric radiotherapy. Phys Med Biol 2023; 68:105006. [PMID: 36996837 PMCID: PMC10160738 DOI: 10.1088/1361-6560/acc921] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/13/2023] [Accepted: 03/30/2023] [Indexed: 04/01/2023]
Abstract
Objective. Adaptive radiotherapy workflows require images with the quality of computed tomography (CT) for re-calculation and re-optimisation of radiation doses. In this work we aim to improve the quality of on-board cone beam CT (CBCT) images for dose calculation using deep learning.Approach. We propose a novel framework for CBCT-to-CT synthesis using cycle-consistent Generative Adversarial Networks (cycleGANs). The framework was tailored for paediatric abdominal patients, a challenging application due to the inter-fractional variability in bowel filling and small patient numbers. We introduced to the networks the concept of global residuals only learning and modified the cycleGAN loss function to explicitly promote structural consistency between source and synthetic images. Finally, to compensate for the anatomical variability and address the difficulties in collecting large datasets in the paediatric population, we applied a smart 2D slice selection based on the common field-of-view (abdomen) to our imaging dataset. This acted as a weakly paired data approach that allowed us to take advantage of scans from patients treated for a variety of malignancies (thoracic-abdominal-pelvic) for training purposes. We first optimised the proposed framework and benchmarked its performance on a development dataset. Later, a comprehensive quantitative evaluation was performed on an unseen dataset, which included calculating global image similarity metrics, segmentation-based measures and proton therapy-specific metrics.Main results. We found improved performance for our proposed method, compared to a baseline cycleGAN implementation, on image-similarity metrics such as Mean Absolute Error calculated for a matched virtual CT (55.0 ± 16.6 HU proposed versus 58.9 ± 16.8 HU baseline). There was also a higher level of structural agreement for gastrointestinal gas between source and synthetic images measured using the dice similarity coefficient (0.872 ± 0.053 proposed versus 0.846 ± 0.052 baseline). Differences found in water-equivalent thickness metrics were also smaller for our method (3.3 ± 2.4% proposed versus 3.7 ± 2.8% baseline).Significance. Our findings indicate that our innovations to the cycleGAN framework improved the quality and structure consistency of the synthetic CTs generated.
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Affiliation(s)
- Adam Szmul
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Sabrina Taylor
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Pei Lim
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jessica Cantwell
- Radiotherapy, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Isabel Moreira
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Ying Zhang
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Derek D’Souza
- Radiotherapy Physics Services, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Syed Moinuddin
- Radiotherapy, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Mark N. Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jennifer Gains
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Catarina Veiga
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
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Chophy A, Gupta S, Singh P, Sharma N, Krishnan AS, Namitha RS, Roushan R, Rastogi A, Nair S, Diundi A, Raju MC, Joseph D, Gupta M. Evaluation of dosimetric and volumetric changes in target volumes and organs at risk during adaptive radiotherapy in head and neck cancer: A prospective study. J Med Imaging Radiat Sci 2023; 54:306-311. [PMID: 36868903 DOI: 10.1016/j.jmir.2023.02.005] [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: 01/09/2023] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND During radiation therapy for head and neck malignancies, most patients experience significant anatomical alterations due to loss of weight, changes in tumor volumes, and immobilization issues. Adaptive radiotherapy adapts to the patient's actual anatomy through repetitive imaging and replanning. In the present study, dosimetric and volumetric changes in target volumes and organs at risk during adaptive radiotherapy in head and neck cancer was evaluated. MATERIAL AND METHODS Thirty-four locally advanced Head and neck carcinoma patients with histologically proven Squamous Cell Carcinoma for curative treatment were included. Rescan was done at the end of 20 fractions of treatment. All quantitative data were analyzed with paired t-Test and Wilcoxon Signed Rank (Z) test. RESULTS Most patients had oropharyngeal carcinoma (52.9%). There were significant volumetric changes in all the parameters - GTV-primary (10.95, p < 0.001), GTV- nodal (5.81, p = 0.001), PTV High Risk (26.1, p < 0.001), PTV - Intermediate Risk (46.9, p = 0.006), PTV - Low Risk (43.9, p = 0.003), lateral neck diameter (0.9, p < 0.001), right parotid volumes (6.36, p < 0.001) and left parotid volumes (4.93, p < 0.001). Dosimetric changes in the organs at risk were non-significant. CONCLUSION Adaptive replanning has been seen to be labour intensive. However, the changes in the volumes of both target and the OARs credit a mid-treatment replanning to be done. Long term follow-up is required to assess locoregional control after adaptive radiotherapy in head and neck cancer.
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Affiliation(s)
- Atokali Chophy
- 6th Level, Medical College Block, Department of Radiation Oncology, AIIMS Rishikesh, India
| | - Sweety Gupta
- 6th Level, Medical College Block, Department of Radiation Oncology, AIIMS Rishikesh, India.
| | - Pragya Singh
- 6th Level, Medical College Block, Department of Radiation Oncology, AIIMS Rishikesh, India
| | - Nidhi Sharma
- 6th Level, Medical College Block, Department of Radiation Oncology, AIIMS Rishikesh, India
| | | | - R S Namitha
- 6th Level, Medical College Block, Department of Radiation Oncology, AIIMS Rishikesh, India
| | - Ravi Roushan
- 6th Level, Medical College Block, Department of Radiation Oncology, AIIMS Rishikesh, India
| | - Aviral Rastogi
- 6th Level, Medical College Block, Department of Radiation Oncology, AIIMS Rishikesh, India
| | - Sharanya Nair
- 6th Level, Medical College Block, Department of Radiation Oncology, AIIMS Rishikesh, India
| | - Arvind Diundi
- 6th Level, Medical College Block, Department of Radiation Oncology, AIIMS Rishikesh, India
| | - Merin C Raju
- 6th Level, Medical College Block, Department of Radiation Oncology, AIIMS Rishikesh, India
| | - Deepa Joseph
- 6th Level, Medical College Block, Department of Radiation Oncology, AIIMS Rishikesh, India
| | - Manoj Gupta
- 6th Level, Medical College Block, Department of Radiation Oncology, AIIMS Rishikesh, India
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Gupta T, Maheshwari G, Joshi K, Sawant P, Mishra A, Khairnar S, Patel P, Sinha S, Swain M, Budrukkar A, Ghosh-Laskar S, Agarwal JP. Image-guidance triggered adaptive radiation therapy in head and neck squamous cell carcinoma: single-institution experience and implications for clinical practice. J Med Imaging Radiat Sci 2023; 54:88-96. [PMID: 36517346 DOI: 10.1016/j.jmir.2022.11.013] [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: 09/11/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To report frequency and timing of adaptive radiotherapy (ART) and assess patient, disease, and treatment-related characteristics potentially triggering the need for such adaptive replanning in head and neck squamous cell carcinoma (HNSCC). METHODS Medical records of HNSCC patients treated with definitive intensity modulated radiation therapy (IMRT) with or without concurrent systemic chemotherapy were reviewed retrospectively to identify patients undergoing image-guidance triggered adaptive replanning. Clinico-demographic characteristics of patients undergoing ART were compared with patients treated without adaptation using the chi-square test. RESULTS Two hundred patients with squamous cell cancers of the oropharynx, larynx, or hypopharynx treated with definitive IMRT between 2014 to 2019 comprised the study cohort. Twenty-seven (13.5%) patients underwent adaptive replanning during treatment at a median of 17 fractions (inter-quartile range 14-24 fractions). There were no significant differences in the baseline patient (age, gender), disease (site of primary, staging/grouping), and treatment-related characteristics (dose-fractionation, chemotherapy usage) in patients undergoing ART compared to those treated without adaptation. Weight loss during IMRT emerged as a significant factor predicting the need for ART; patients having ≥10% weight loss from baseline were more likely to undergo treatment adaptation compared to patients with <10% weight loss (p = 0.0002). There was variable impact of ART on dose-volume statistics of organs-at-risk such parotid glands and spinal cord. CONCLUSION Image-guidance triggered ART for HNSCC is not associated with significant improvement in OAR dosimetry. However, weight loss during definitive IMRT can be a potentially useful trigger for identifying patients who are most likely to benefit from such adaptive replanning.
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Affiliation(s)
- Tejpal Gupta
- Department of 1Radiation Oncology and Medical Physics, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India.
| | - Guncha Maheshwari
- Department of 1Radiation Oncology and Medical Physics, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kishore Joshi
- Department of 1Radiation Oncology and Medical Physics, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Priya Sawant
- Department of 1Radiation Oncology and Medical Physics, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ajay Mishra
- Department of 1Radiation Oncology and Medical Physics, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sunil Khairnar
- Department of 1Radiation Oncology and Medical Physics, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Prapti Patel
- Department of 1Radiation Oncology and Medical Physics, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shwetabh Sinha
- Department of 1Radiation Oncology and Medical Physics, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Monali Swain
- Department of 1Radiation Oncology and Medical Physics, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ashwini Budrukkar
- Department of 1Radiation Oncology and Medical Physics, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sarbani Ghosh-Laskar
- Department of 1Radiation Oncology and Medical Physics, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Jai-Prakash Agarwal
- Department of 1Radiation Oncology and Medical Physics, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
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Goodburn RJ, Philippens MEP, Lefebvre TL, Khalifa A, Bruijnen T, Freedman JN, Waddington DEJ, Younus E, Aliotta E, Meliadò G, Stanescu T, Bano W, Fatemi‐Ardekani A, Wetscherek A, Oelfke U, van den Berg N, Mason RP, van Houdt PJ, Balter JM, Gurney‐Champion OJ. The future of MRI in radiation therapy: Challenges and opportunities for the MR community. Magn Reson Med 2022; 88:2592-2608. [PMID: 36128894 PMCID: PMC9529952 DOI: 10.1002/mrm.29450] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 01/11/2023]
Abstract
Radiation therapy is a major component of cancer treatment pathways worldwide. The main aim of this treatment is to achieve tumor control through the delivery of ionizing radiation while preserving healthy tissues for minimal radiation toxicity. Because radiation therapy relies on accurate localization of the target and surrounding tissues, imaging plays a crucial role throughout the treatment chain. In the treatment planning phase, radiological images are essential for defining target volumes and organs-at-risk, as well as providing elemental composition (e.g., electron density) information for radiation dose calculations. At treatment, onboard imaging informs patient setup and could be used to guide radiation dose placement for sites affected by motion. Imaging is also an important tool for treatment response assessment and treatment plan adaptation. MRI, with its excellent soft tissue contrast and capacity to probe functional tissue properties, holds great untapped potential for transforming treatment paradigms in radiation therapy. The MR in Radiation Therapy ISMRM Study Group was established to provide a forum within the MR community to discuss the unmet needs and fuel opportunities for further advancement of MRI for radiation therapy applications. During the summer of 2021, the study group organized its first virtual workshop, attended by a diverse international group of clinicians, scientists, and clinical physicists, to explore our predictions for the future of MRI in radiation therapy for the next 25 years. This article reviews the main findings from the event and considers the opportunities and challenges of reaching our vision for the future in this expanding field.
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Affiliation(s)
- Rosie J. Goodburn
- Joint Department of PhysicsInstitute of Cancer Research and Royal Marsden NHS Foundation TrustLondonUnited Kingdom
| | | | - Thierry L. Lefebvre
- Department of PhysicsUniversity of CambridgeCambridgeUnited Kingdom
- Cancer Research UK Cambridge Research InstituteUniversity of CambridgeCambridgeUnited Kingdom
| | - Aly Khalifa
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
| | - Tom Bruijnen
- Department of RadiotherapyUniversity Medical Center UtrechtUtrechtNetherlands
| | | | - David E. J. Waddington
- Faculty of Medicine and Health, Sydney School of Health Sciences, ACRF Image X InstituteThe University of SydneySydneyNew South WalesAustralia
| | - Eyesha Younus
- Department of Medical Physics, Odette Cancer CentreSunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Eric Aliotta
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Gabriele Meliadò
- Unità Operativa Complessa di Fisica SanitariaAzienda Ospedaliera Universitaria Integrata VeronaVeronaItaly
| | - Teo Stanescu
- Department of Radiation Oncology, University of Toronto and Medical Physics, Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - Wajiha Bano
- Joint Department of PhysicsInstitute of Cancer Research and Royal Marsden NHS Foundation TrustLondonUnited Kingdom
| | - Ali Fatemi‐Ardekani
- Department of PhysicsJackson State University (JSU)JacksonMississippiUSA
- SpinTecxJacksonMississippiUSA
- Department of Radiation OncologyCommunity Health Systems (CHS) Cancer NetworkJacksonMississippiUSA
| | - Andreas Wetscherek
- Joint Department of PhysicsInstitute of Cancer Research and Royal Marsden NHS Foundation TrustLondonUnited Kingdom
| | - Uwe Oelfke
- Joint Department of PhysicsInstitute of Cancer Research and Royal Marsden NHS Foundation TrustLondonUnited Kingdom
| | - Nico van den Berg
- Department of RadiotherapyUniversity Medical Center UtrechtUtrechtNetherlands
| | - Ralph P. Mason
- Department of RadiologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Petra J. van Houdt
- Department of Radiation OncologyNetherlands Cancer InstituteAmsterdamNetherlands
| | - James M. Balter
- Department of Radiation OncologyUniversity of MichiganAnn ArborMichiganUSA
| | - Oliver J. Gurney‐Champion
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam UMCUniversity of AmsterdamAmsterdamNetherlands
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An online adaptive plan library approach for intensity modulated proton therapy for head and neck cancer. Radiother Oncol 2022; 176:68-75. [PMID: 36150418 DOI: 10.1016/j.radonc.2022.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/25/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE In intensity modulated proton therapy (IMPT), the impact of setup errors and anatomical changes is commonly mitigated by robust optimization with population-based setup robustness (SR) settings and offline replanning. In this study we propose and evaluate an alternative approach based on daily plan selection from patient-specific pre-treatment established plan libraries (PLs). Clinical implementation of the PL strategy would be rather straightforward compared to daily online re-planning. MATERIALS AND METHODS For 15 head-and-neck cancer patients, the planning CT was used to generate a PL with 5 plans, robustly optimized for increasing SR: 0, 1, 2, 3, 5 mm, and 3% range robustness. Repeat CTs (rCTs) and realistic setup and range uncertainty distributions were used for simulation of treatment courses for the PL approach, treatments with fixed SR (fSR3) and a trigger-based offline adaptive schedule for 3 mm SR (fSR3OfA). Daily plan selection in the PL approach was based only on recomputed dose to the CTV on the rCT. RESULTS Compared to using fSR3 and fSR3OfA, the risk of xerostomia grade ≥ II & III and dysphagia ≥ grade III were significantly reduced with the PL. For 6/15 patients the risk of xerostomia and/or dysphagia ≥ grade II could be reduced by > 2% by using PL. For the other patients, adherence to target coverage constraints was often improved. fSR3OfA resulted in significantly improved coverage compared to PL for selected patients. CONCLUSION The proposed PL approach resulted in overall reduced NTCPs compared to fSR3 and fSR3OfA at limited cost in target coverage.
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Moglioni M, Kraan AC, Baroni G, Battistoni G, Belcari N, Berti A, Carra P, Cerello P, Ciocca M, De Gregorio A, De Simoni M, Del Sarto D, Donetti M, Dong Y, Embriaco A, Fantacci ME, Ferrero V, Fiorina E, Fischetti M, Franciosini G, Giraudo G, Laruina F, Maestri D, Magi M, Magro G, Malekzadeh E, Marafini M, Mattei I, Mazzoni E, Mereu P, Mirandola A, Morrocchi M, Muraro S, Orlandi E, Patera V, Pennazio F, Pullia M, Retico A, Rivetti A, Da Rocha Rolo MD, Rosso V, Sarti A, Schiavi A, Sciubba A, Sportelli G, Tampellini S, Toppi M, Traini G, Trigilio A, Valle SM, Valvo F, Vischioni B, Vitolo V, Wheadon R, Bisogni MG. In-vivo range verification analysis with in-beam PET data for patients treated with proton therapy at CNAO. Front Oncol 2022; 12:929949. [PMID: 36226070 PMCID: PMC9549776 DOI: 10.3389/fonc.2022.929949] [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: 04/27/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Morphological changes that may arise through a treatment course are probably one of the most significant sources of range uncertainty in proton therapy. Non-invasive in-vivo treatment monitoring is useful to increase treatment quality. The INSIDE in-beam Positron Emission Tomography (PET) scanner performs in-vivo range monitoring in proton and carbon therapy treatments at the National Center of Oncological Hadrontherapy (CNAO). It is currently in a clinical trial (ID: NCT03662373) and has acquired in-beam PET data during the treatment of various patients. In this work we analyze the in-beam PET (IB-PET) data of eight patients treated with proton therapy at CNAO. The goal of the analysis is twofold. First, we assess the level of experimental fluctuations in inter-fractional range differences (sensitivity) of the INSIDE PET system by studying patients without morphological changes. Second, we use the obtained results to see whether we can observe anomalously large range variations in patients where morphological changes have occurred. The sensitivity of the INSIDE IB-PET scanner was quantified as the standard deviation of the range difference distributions observed for six patients that did not show morphological changes. Inter-fractional range variations with respect to a reference distribution were estimated using the Most-Likely-Shift (MLS) method. To establish the efficacy of this method, we made a comparison with the Beam’s Eye View (BEV) method. For patients showing no morphological changes in the control CT the average range variation standard deviation was found to be 2.5 mm with the MLS method and 2.3 mm with the BEV method. On the other hand, for patients where some small anatomical changes occurred, we found larger standard deviation values. In these patients we evaluated where anomalous range differences were found and compared them with the CT. We found that the identified regions were mostly in agreement with the morphological changes seen in the CT scan.
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Affiliation(s)
- Martina Moglioni
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | - Aafke Christine Kraan
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- *Correspondence: Aafke Christine Kraan,
| | - Guido Baroni
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
- Politecnico di Milano, Milano, Italy
| | | | - Nicola Belcari
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | - Andrea Berti
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, Pisa, Italy
- Istituto di Scienza e Tecnologie dell’Informazione, Consiglio Nazionale delle Ricerche, Pisa, Italy
| | - Pietro Carra
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | | | - Mario Ciocca
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Angelica De Gregorio
- Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
| | - Micol De Simoni
- Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
| | - Damiano Del Sarto
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | - Marco Donetti
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Yunsheng Dong
- Istituto Nazionale di Fisica Nucleare, Sezione di Milano, Milano, Italy
- Dipartimento di Fisica, Università di Milano, Milano, Italy
| | - Alessia Embriaco
- Istituto Nazionale di Fisica Nucleare, Sezione di Pavia, Pavia, Italy
| | - Maria Evelina Fantacci
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | - Veronica Ferrero
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Torino, Italy
| | - Elisa Fiorina
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Torino, Italy
| | - Marta Fischetti
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
- Dipartimento di Scienze di Base e Applicate per l’Ingegneria, Sapienza Universit `a di Roma, Roma, Italy
| | - Gaia Franciosini
- Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
| | - Giuseppe Giraudo
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Torino, Italy
| | - Francesco Laruina
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | - Davide Maestri
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Marco Magi
- Dipartimento di Scienze di Base e Applicate per l’Ingegneria, Sapienza Universit `a di Roma, Roma, Italy
| | - Giuseppe Magro
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Etesam Malekzadeh
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
- Department of Medical Physics, Tarbiat Modares University, Teheran, Iran
| | - Michela Marafini
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
- Museo Storico della Fisica e Centro Studi e Ricerche “E. Fermi”, Roma, Italy
| | - Ilaria Mattei
- Istituto Nazionale di Fisica Nucleare, Sezione di Milano, Milano, Italy
| | - Enrico Mazzoni
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
| | - Paolo Mereu
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Torino, Italy
| | | | - Matteo Morrocchi
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | - Silvia Muraro
- Istituto Nazionale di Fisica Nucleare, Sezione di Milano, Milano, Italy
| | - Ester Orlandi
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Vincenzo Patera
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
- Dipartimento di Scienze di Base e Applicate per l’Ingegneria, Sapienza Universit `a di Roma, Roma, Italy
| | | | - Marco Pullia
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | | | - Angelo Rivetti
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Torino, Italy
| | | | - Valeria Rosso
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | - Alessio Sarti
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
- Dipartimento di Scienze di Base e Applicate per l’Ingegneria, Sapienza Universit `a di Roma, Roma, Italy
| | - Angelo Schiavi
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
- Dipartimento di Scienze di Base e Applicate per l’Ingegneria, Sapienza Universit `a di Roma, Roma, Italy
| | - Adalberto Sciubba
- Dipartimento di Scienze di Base e Applicate per l’Ingegneria, Sapienza Universit `a di Roma, Roma, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione dei Laboratori di Frascati, Frascati, Italy
| | - Giancarlo Sportelli
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, Pisa, Italy
| | | | - Marco Toppi
- Dipartimento di Scienze di Base e Applicate per l’Ingegneria, Sapienza Universit `a di Roma, Roma, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione dei Laboratori di Frascati, Frascati, Italy
| | - Giacomo Traini
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
- Museo Storico della Fisica e Centro Studi e Ricerche “E. Fermi”, Roma, Italy
| | - Antonio Trigilio
- Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
| | | | | | | | - Viviana Vitolo
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - Richard Wheadon
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, Torino, Italy
| | - Maria Giuseppina Bisogni
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, Pisa, Italy
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Gupta S, Srivastava S, Singh N, Ghosh A. Volumetric and Dosimetric Inconstancy of Parotid Glands and Tumor in Head and Neck Cancer during IMRT. Radiat Oncol 2022. [DOI: 10.5772/intechopen.104745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The treatment of head and neck cancer using external beam radiotherapy is commonly done with three field techniques, which involves bilateral parallel opposed beams and one anterior lower neck field. Conventional treatment is based on 2D fluoroscopic images where there is no facility to shield the organs at risk like parotid. The most common side effect of such conventional radiotherapy treatment is xerostomia. The incidence of radiotherapy-related xerostomia varies depending on the specific radiotherapy technique used and the dose delivered to the parotid glands. Dosimetric variation in the tumor and normal tissue including parotid glands due to volume shrinkage during intensity modulated radiotherapy is the leading challenges in radiotherapy delivery in head and neck malignancy in terms of acute and late radiation related toxicities. Therefore if the planning target volume and normal tissue anatomy are changing with time during intensity modulated radiotherapy, it would be beneficial and acceptable to adapt our treatment delivery to minimize normal tissue toxicities where it really matters.
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Rusanov B, Hassan GM, Reynolds M, Sabet M, Kendrick J, Farzad PR, Ebert M. Deep learning methods for enhancing cone-beam CT image quality towards adaptive radiation therapy: A systematic review. Med Phys 2022; 49:6019-6054. [PMID: 35789489 PMCID: PMC9543319 DOI: 10.1002/mp.15840] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 05/21/2022] [Accepted: 06/16/2022] [Indexed: 11/11/2022] Open
Abstract
The use of deep learning (DL) to improve cone-beam CT (CBCT) image quality has gained popularity as computational resources and algorithmic sophistication have advanced in tandem. CBCT imaging has the potential to facilitate online adaptive radiation therapy (ART) by utilizing up-to-date patient anatomy to modify treatment parameters before irradiation. Poor CBCT image quality has been an impediment to realizing ART due to the increased scatter conditions inherent to cone-beam acquisitions. Given the recent interest in DL applications in radiation oncology, and specifically DL for CBCT correction, we provide a systematic theoretical and literature review for future stakeholders. The review encompasses DL approaches for synthetic CT generation, as well as projection domain methods employed in the CBCT correction literature. We review trends pertaining to publications from January 2018 to April 2022 and condense their major findings - with emphasis on study design and deep learning techniques. Clinically relevant endpoints relating to image quality and dosimetric accuracy are summarised, highlighting gaps in the literature. Finally, we make recommendations for both clinicians and DL practitioners based on literature trends and the current DL state of the art methods utilized in radiation oncology. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Branimir Rusanov
- School of Physics, Mathematics and Computing, The University of Western Australia, Perth, Western Australia, 6009, Australia.,Department of Radiation Oncology, Sir Chairles Gairdner Hospital, Perth, Western Australia, 6009, Australia
| | - Ghulam Mubashar Hassan
- School of Physics, Mathematics and Computing, The University of Western Australia, Perth, Western Australia, 6009, Australia
| | - Mark Reynolds
- School of Physics, Mathematics and Computing, The University of Western Australia, Perth, Western Australia, 6009, Australia
| | - Mahsheed Sabet
- School of Physics, Mathematics and Computing, The University of Western Australia, Perth, Western Australia, 6009, Australia.,Department of Radiation Oncology, Sir Chairles Gairdner Hospital, Perth, Western Australia, 6009, Australia
| | - Jake Kendrick
- School of Physics, Mathematics and Computing, The University of Western Australia, Perth, Western Australia, 6009, Australia.,Department of Radiation Oncology, Sir Chairles Gairdner Hospital, Perth, Western Australia, 6009, Australia
| | - Pejman Rowshan Farzad
- School of Physics, Mathematics and Computing, The University of Western Australia, Perth, Western Australia, 6009, Australia.,Department of Radiation Oncology, Sir Chairles Gairdner Hospital, Perth, Western Australia, 6009, Australia
| | - Martin Ebert
- School of Physics, Mathematics and Computing, The University of Western Australia, Perth, Western Australia, 6009, Australia.,Department of Radiation Oncology, Sir Chairles Gairdner Hospital, Perth, Western Australia, 6009, Australia
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36
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Duncan S, Walker A, Kumar S, Dundas K, Bell K, Wallis A, Surjan Y, Aly F, Lee M. Novel methodology to quantify dehydration in head and neck cancer radiotherapy using DIXON MRI. J Med Radiat Sci 2022; 69:448-455. [PMID: 35762562 DOI: 10.1002/jmrs.605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Head and neck cancer (HNC) patients are at risk of weight change, due to inadequate nutrition intake or dehydration, when receiving radiotherapy (RT). This study aimed to develop methodology to measure water content changes on magnetic resonance imaging (MRI) scans of the head and neck region over the course of RT. METHODS Retrospective datasets of 54 patients were analysed. Eligible patients had been treated for HNC with cisplatin chemoradiation (CRT) or RT alone and underwent a minimum of 2 MRI scans from weeks 0, 3 and 6 of their treatment. Anatomical regions consisting of ≥90% water, on T2-weighted DIXON MRI sequences, were contoured. Water volume changes of all patients were evaluated, within an anatomically standardised external volume, by comparing the absolute water fraction volume (cc) (VEx90WF) and relative water fraction volume (%) (RelVEx90WF) at weeks 0 and 6 of RT. RESULTS There was a statistically significant difference between the RelVEx90WF at weeks 0 and 6 (P = 0.005). However, no statistically significant difference was identified between weeks 0 and 6 VEx90WF (P = 0.064). There were no statistically significant differences identified between patients who received CRT versus RT alone. CONCLUSION This study developed a novel method for measuring changes in water fraction volumes over time, using T2-weighted DIXON MRIs. The methodology created in this study requires further validation through phantom imaging, with known fat and water values.
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Affiliation(s)
- Sophie Duncan
- Medical Radiation Science (MRS), School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia.,Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Amy Walker
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Shivani Kumar
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Kylie Dundas
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Katherine Bell
- Dietetics Department, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Andrew Wallis
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia
| | - Yolanda Surjan
- Medical Radiation Science (MRS), School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia.,The University of Newcastle, College of Health and Wellbeing, Callaghan, New South Wales, Australia
| | - Farhannah Aly
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Lee
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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Tanaka S, Kadoya N, Sugai Y, Umeda M, Ishizawa M, Katsuta Y, Ito K, Takeda K, Jingu K. A deep learning-based radiomics approach to predict head and neck tumor regression for adaptive radiotherapy. Sci Rep 2022; 12:8899. [PMID: 35624113 PMCID: PMC9142601 DOI: 10.1038/s41598-022-12170-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 05/05/2022] [Indexed: 12/14/2022] Open
Abstract
Early regression—the regression in tumor volume during the initial phase of radiotherapy (approximately 2 weeks after treatment initiation)—is a common occurrence during radiotherapy. This rapid radiation-induced tumor regression may alter target coordinates, necessitating adaptive radiotherapy (ART). We developed a deep learning-based radiomics (DLR) approach to predict early head and neck tumor regression and thereby facilitate ART. Primary gross tumor volume (GTVp) was monitored in 96 patients and nodal GTV (GTVn) in 79 patients during treatment. All patients underwent two computed tomography (CT) scans: one before the start of radiotherapy for initial planning and one during radiotherapy for boost planning. Patients were assigned to regression and nonregression groups according to their median tumor regression rate (ΔGTV/treatment day from initial to boost CT scan). We input a GTV image into the convolutional neural network model, which was pretrained using natural image datasets, via transfer learning. The deep features were extracted from the last fully connected layer. To clarify the prognostic power of the deep features, machine learning models were trained. The models then predicted the regression and nonregression of GTVp and GTVn and evaluated the predictive performance by 0.632 + bootstrap area under the curve (AUC). Predictive performance for GTVp regression was highest using the InceptionResNetv2 model (mean AUC = 0.75) and that for GTVn was highest using NASNetLarge (mean AUC = 0.73). Both models outperformed the handcrafted radiomics features (mean AUC = 0.63 for GTVp and 0.61 for GTVn) or clinical factors (0.64 and 0.67, respectively). DLR may facilitate ART for improved radiation side-effects and target coverage.
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Affiliation(s)
- Shohei Tanaka
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
| | - Yuto Sugai
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Mariko Umeda
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Miyu Ishizawa
- Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Tohoku University, Sendai, Japan
| | - Yoshiyuki Katsuta
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Kengo Ito
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Ken Takeda
- Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Tohoku University, Sendai, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
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Bäumer C, Frakulli R, Kohl J, Nagaraja S, Steinmeier T, Worawongsakul R, Timmermann B. Adaptive Proton Therapy of Pediatric Head and Neck Cases Using MRI-Based Synthetic CTs: Initial Experience of the Prospective KiAPT Study. Cancers (Basel) 2022; 14:cancers14112616. [PMID: 35681594 PMCID: PMC9179385 DOI: 10.3390/cancers14112616] [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: 03/11/2022] [Revised: 05/20/2022] [Accepted: 05/20/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND AND PURPOSE Interfractional anatomical changes might affect the outcome of proton therapy (PT). We aimed to prospectively evaluate the role of Magnetic Resonance Imaging (MRI) based adaptive PT for children with tumors of the head and neck and base of skull. METHODS MRI verification images were acquired at half of the treatment course. A synthetic computed tomography (CT) image was created using this MRI and a deformable image registration (DIR) to the reference MRI. The methodology was verified with in-silico phantoms and validated using a clinical case with a shrinking cystic hygroma on the basis of dosimetric quantities of contoured structures. The dose distributions on the verification X-ray CT and on the synthetic CT were compared with a gamma-index test using global 2 mm/2% criteria. RESULTS Regarding the clinical validation case, the gamma-index pass rate was 98.3%. Eleven patients were included in the clinical study. The most common diagnosis was rhabdomyosarcoma (73%). Craniofacial tumor site was predominant in 64% of patients, followed by base of skull (18%). For one individual case the synthetic CT showed an increase in the median D2 and Dmax dose on the spinal cord from 20.5 GyRBE to 24.8 GyRBE and 14.7 GyRBE to 25.1 GyRBE, respectively. Otherwise, doses received by OARs remained relatively stable. Similarly, the target volume coverage seen by D95% and V95% remained unchanged. CONCLUSIONS The method of transferring anatomical changes from MRIs to a synthetic CTs was successfully implemented and validated with simple, commonly available tools. In the frame of our early results on a small cohort, no clinical relevant deterioration for neither PTV coverage nor an increased dose burden to OARs occurred. However, the study will be continued to identify a pediatric patient cohort, which benefits from adaptive treatment planning.
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Affiliation(s)
- Christian Bäumer
- West German Proton Therapy Centre Essen, 45147 Essen, Germany; (R.F.); (J.K.); (S.N.); (T.S.); (R.W.); (B.T.)
- University Hospital Essen, 45147 Essen, Germany
- West German Cancer Center (WTZ), 45147 Essen, Germany
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- Department of Physics, Technische Universität Dortmund, 44227 Dortmund, Germany
- Correspondence:
| | - Rezarta Frakulli
- West German Proton Therapy Centre Essen, 45147 Essen, Germany; (R.F.); (J.K.); (S.N.); (T.S.); (R.W.); (B.T.)
- University Hospital Essen, 45147 Essen, Germany
- West German Cancer Center (WTZ), 45147 Essen, Germany
- Department of Particle Therapy, 45147 Essen, Germany
| | - Jessica Kohl
- West German Proton Therapy Centre Essen, 45147 Essen, Germany; (R.F.); (J.K.); (S.N.); (T.S.); (R.W.); (B.T.)
- University Hospital Essen, 45147 Essen, Germany
- West German Cancer Center (WTZ), 45147 Essen, Germany
| | - Sindhu Nagaraja
- West German Proton Therapy Centre Essen, 45147 Essen, Germany; (R.F.); (J.K.); (S.N.); (T.S.); (R.W.); (B.T.)
- University Hospital Essen, 45147 Essen, Germany
- West German Cancer Center (WTZ), 45147 Essen, Germany
- Department of Particle Therapy, 45147 Essen, Germany
| | - Theresa Steinmeier
- West German Proton Therapy Centre Essen, 45147 Essen, Germany; (R.F.); (J.K.); (S.N.); (T.S.); (R.W.); (B.T.)
- University Hospital Essen, 45147 Essen, Germany
- West German Cancer Center (WTZ), 45147 Essen, Germany
- Department of Particle Therapy, 45147 Essen, Germany
| | - Rasin Worawongsakul
- West German Proton Therapy Centre Essen, 45147 Essen, Germany; (R.F.); (J.K.); (S.N.); (T.S.); (R.W.); (B.T.)
- University Hospital Essen, 45147 Essen, Germany
- West German Cancer Center (WTZ), 45147 Essen, Germany
- Department of Particle Therapy, 45147 Essen, Germany
- Radiation Oncology Unit, Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Nakhon 73170, Thailand
| | - Beate Timmermann
- West German Proton Therapy Centre Essen, 45147 Essen, Germany; (R.F.); (J.K.); (S.N.); (T.S.); (R.W.); (B.T.)
- University Hospital Essen, 45147 Essen, Germany
- West German Cancer Center (WTZ), 45147 Essen, Germany
- German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
- Department of Particle Therapy, 45147 Essen, Germany
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39
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Li J, Feng K, Ye L, Liu Y, Sun Y, Wu Y. Influence of radiotherapy on dental implants placed in individuals before diagnosed with head and neck cancer: focus on implant-bed-specific radiation dosage. Clin Oral Investig 2022; 26:5915-5922. [PMID: 35578112 DOI: 10.1007/s00784-022-04549-z] [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: 11/15/2021] [Accepted: 05/08/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The influence of radiotherapy on implants placed before diagnosed as head and neck cancer (HNC) is a potentially informative but poorly explored topic. The aims of this study were to investigate the influence of implant-bed-specific radiation dose on dental implants and to evaluate the impact of these implants on radiation dosimetry. MATERIAL AND METHODS We conducted a retrospective study with 58 irradiated patients that received dental implant restorations before undergoing radiation treatment for HNC. The radiological success rate and the peri-implant bone resorption values were measured radiographically at 1 and 3 years after radiotherapy. Patients with no implants matching tumor site and stage served as a control group (n = 58). RESULTS The median implant-bed-specific radiation dose was 40.3 Gy, which was significantly lower than tumor bed 62.4 Gy. An implant-bed-specific radiation dose higher than 40.0 Gy showed a significantly decreased radiologic success rate when compared to lower doses. Finally, evaluation of the radiation treatment plans revealed similar radiation hot spots in the test group of patients with implants and those of the control group. CONCLUSION Our study confirms that radiotherapy negatively worsens peri-implant bone resorption, especially for implant-bed-specific dose more than 40 Gy, and the presence of implants within the radiation fields does not alter radiation dosimetry. The findings could be clinically informative to both surgeons and radio-oncologists. CLINICAL RELEVANCE The interactions between radiotherapy and implants placed prior to radiotherapy treatment remain a largely unexplored topic. Based on the analysis of 3-dimensional modulated radiation plans, this study demonstrates the impact of implant-bed-specific radiation dose on marginal bone resorption of implants placed pre-radiation and considers the influence of these implants on radiation dosimetry. REGISTRATION NUMBER CHICTR2100051923: ( http://www.chictr.org.cn/usercenter.aspx ).
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Affiliation(s)
- Jie Li
- Department of Second Dental Clinic, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.,National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, 200011, China
| | - Kun Feng
- National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, 200011, China.,Department of Oral and Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Lijuan Ye
- Department of Second Dental Clinic, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.,National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, 200011, China
| | - Yuelian Liu
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, Netherlands
| | - Yuanyuan Sun
- Department of Second Dental Clinic, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China. .,National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, 200011, China.
| | - Yiqun Wu
- Department of Second Dental Clinic, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China. .,National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, 200011, China. .,, Shanghai, China.
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Yildiz E, Grasl S, Denk-Linnert DM, Altorjai G, Herrmann H, Grasl MC, Erovic BM, Janik S. Long-Term Swallowing Outcome and Dysphagia in Advanced Staged Head and Neck Squamous Cell Carcinomas after Radiotherapy. J Clin Med 2022; 11:jcm11102688. [PMID: 35628813 PMCID: PMC9143144 DOI: 10.3390/jcm11102688] [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: 04/03/2022] [Revised: 04/29/2022] [Accepted: 05/08/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To evaluate the impact of radiotherapy (RT) on dysphagia and long-term swallowing outcome in patients with stage III and IV head and neck squamous cell carcinomas (HNSCCs). Material and Methods: Between 2005 and 2008, 189 patients with HNSCCs underwent primary or adjuvant RT in a curative setting. Long-term swallowing outcome was evaluated in 50 patients. Among them, 26 were further eligible for prospective analysis of long-term swallowing and dysphagia outcome. Medical charts were retrospectively reviewed regarding pre- and post-treatment dysphagia (3 months after last irradiation setting) as well as persisting long-term dysphagia (2019−2021). Results: Pre-treatment dysphagia was observed in 24 (48%) of 50 patients, particularly in oropharyngeal or hypopharyngeal stage III−IV tumors (OR 9.3; p = 0.003). Conversely, 46 patients (92%) complained about post-treatment dysphagic symptoms, which were more commonly seen in patients with positive neck nodes (OR 10.5; p = 0.037). The post-treatment dysphagia rate dropped from 92% to 24% (p < 0.001) during surveillance, which was significantly linked to xerostomia (OR 5.77; p = 0.019), dysgeusia (OR 9.9; p = 0.036) and free flap reconstruction (OR 6.1; p = 0.022). Conclusion: Pretreatment dysphagia is common in advanced stage HNSCCs and almost all patients complain about dysphagia at the end of RT. Importantly, applied RT protocols did not affect long-term dysphagia, which improves significantly in the majority of patients over time. Meeting Information: Preliminary results have been presented at the 65th Annual Meeting of the Austrian Society of Otorhinolaryngology, 22−26 September 2021, Austria.
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Affiliation(s)
- Erdem Yildiz
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (E.Y.); (S.G.); (M.C.G.)
| | - Stefan Grasl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (E.Y.); (S.G.); (M.C.G.)
| | - Doris-Maria Denk-Linnert
- Department of Otorhinolaryngology, Division of Phoniatrics and Speech Language Therapy, Medical University of Vienna, 1090 Vienna, Austria;
| | - Gabriela Altorjai
- Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria; (G.A.); (H.H.)
| | - Harald Herrmann
- Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria; (G.A.); (H.H.)
| | - Matthaeus C. Grasl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (E.Y.); (S.G.); (M.C.G.)
| | - Boban M. Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria;
| | - Stefan Janik
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (E.Y.); (S.G.); (M.C.G.)
- Correspondence:
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Moyer KF, Maxwell JH, Lumley C, Manning JC, Gutt R. Skull Base Regeneration During Treatment With Chemoradiation for Nasopharyngeal Carcinoma: A Case Report. Fed Pract 2022; 39:S26-S30. [PMID: 35929008 PMCID: PMC9346574 DOI: 10.12788/fp.0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Advanced cases of nasopharyngal carcinoma can present with skull base invasion. Treatment of these advanced cases with radiotherapy poses a challenge given proximity of tumor to critical neural structures as well as concern that a skull base defect and associated complications could develop with tumor regression. CASE PRESENTATION A 34-year-old male patient presented with a 7-cm nasopharyngeal tumor invading the skull base with destruction of the clivus and intracranial extension. He underwent a course of definitive chemoradiation, requiring use of adaptive radiotherapy, that resulted in complete tumor regression and is free of disease 5 years posttreatment. Imaging done during treatment demonstrated that significant regeneration of bone occurred simultaneously with tumor regression. CONCLUSIONS This case demonstrates that it is possible for bony regeneration to occur simultaneously with tumor regression in a patient with skull base invasion by tumor, precluding the need for neurosurgical intervention.
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Affiliation(s)
| | - Jessica H. Maxwell
- Georgetown University School of Medicine Washington, DC
- Washington DC Veterans Affairs Medical Center
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Argota-Perez R, Robbins J, Green A, Herk MV, Korreman S, Vásquez-Osorio E. Evaluating principal component analysis models for representing anatomical changes in head and neck radiotherapy. Phys Imaging Radiat Oncol 2022; 22:13-19. [PMID: 35493853 PMCID: PMC9038571 DOI: 10.1016/j.phro.2022.04.002] [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: 12/15/2021] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background and purpose Anatomical changes during radiotherapy pose a challenge to robustness of plans. Principal component analysis (PCA) is commonly used to model such changes. We propose a toolbox to evaluate how closely a given PCA model can represent actual deformations seen in the patient and highlight regions where the model struggles to capture these changes. Materials and methods We propose to calculate a residual error map from the difference between an actual displacement vector field (DVF) and the closest DVF that the PCA model can produce. This was done by taking the inner product of the DVF with the PCA components from the model. As a global measure of error, the 90th percentile of the residual errors (Mres90) across the whole scan was used. As proof of principle, we demonstrated this approach on both patient-specific cases and a population-based PCA in head and neck (H&N) cancer patients. These models were created using deformation data from deformable registrations between the planning computed tomography and cone-beam computed tomography (CBCTs), and were evaluated against DVFs from registrations of CBCTs not used to create the model. Results For our example cases, the oropharyngeal and the nasal cavity regions showed the largest local residual error, indicating the PCA models struggle to predict deformations seen in these regions. Mres90 ranged from 0.4 mm to 6.3 mm across the different models. Conclusions A method to quantitatively evaluate how well PCA models represent observed anatomical changes was proposed. We demonstrated our approach on H&N PCA models, but it can be applied to other sites.
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Affiliation(s)
- Raul Argota-Perez
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Corresponding authors at: Department of Oncology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, DK-8200 Aarhus N, Denmark (Raúl Argota-Pérez). Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark (Stine Korreman).
| | - Jennifer Robbins
- The University of Manchester, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, Manchester, United Kingdom
| | - Andrew Green
- The University of Manchester, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, Manchester, United Kingdom
| | - Marcel van Herk
- The University of Manchester, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, Manchester, United Kingdom
| | - Stine Korreman
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Corresponding authors at: Department of Oncology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, DK-8200 Aarhus N, Denmark (Raúl Argota-Pérez). Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark (Stine Korreman).
| | - Eliana Vásquez-Osorio
- The University of Manchester, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, Manchester, United Kingdom
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Magnetic Resonance Guided Radiotherapy for Head and Neck Cancers. J Clin Med 2022; 11:jcm11051388. [PMID: 35268479 PMCID: PMC8911481 DOI: 10.3390/jcm11051388] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
Radiotherapy is an integral component of head/neck squamous cell carcinomas (HNSCCs) treatment, and technological developments including advances in image-guided radiotherapy over the past decades have offered improvements in the technical treatment of these cancers. Integration of magnetic resonance imaging (MRI) into image guidance through the development of MR-guided radiotherapy (MRgRT) offers further potential for refinement of the techniques by which HNSCCs are treated. This article provides an overview of the literature supporting the current use of MRgRT for HNSCC, challenges with its use, and developing research areas.
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44
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Pham TT, Whelan B, Oborn BM, Delaney GP, Vinod S, Brighi C, Barton M, Keall P. Magnetic resonance imaging (MRI) guided proton therapy: A review of the clinical challenges, potential benefits and pathway to implementation. Radiother Oncol 2022; 170:37-47. [DOI: 10.1016/j.radonc.2022.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/09/2022] [Accepted: 02/25/2022] [Indexed: 10/18/2022]
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Chen G, Cui J, Qian J, Zhu J, Zhao L, Luo B, Cui T, Zhong L, Yang F, Yang G, Zhao X, Zhou Y, Geng M, Sun J. Rapid Progress in Intelligent Radiotherapy and Future Implementation. Cancer Invest 2022; 40:425-436. [PMID: 35225723 DOI: 10.1080/07357907.2022.2044842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Radiotherapy is one of the major approaches to cancer treatment. Artificial intelligence in radiotherapy (shortly, Intelligent radiotherapy) mainly involves big data, deep learning, extended reality, digital twin, radiomics, Internet plus and Internet of Things (IoT), which establish an automatic and intelligent network platform consisting of radiotherapy preparation, target volume delineation, treatment planning, radiation delivery, quality assurance (QA) and quality control (QC), prognosis judgment and post-treatment follow-up. Intelligent radiotherapy is an interdisciplinary frontier discipline in infancy. The review aims to summary the important implements of intelligent radiotherapy in various areas and put forward the future of unmanned radiotherapy center.
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Affiliation(s)
- Guangpeng Chen
- Department of Oncology, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Jianxiong Cui
- Department of Oncology, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China.,Department of Oncology, Sichuan Provincial Crops Hospital of Chinese People's Armed Police Forces, Leshan 614000, Sichuan, P.R. China
| | - Jindong Qian
- Department of Oncology, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Jianbo Zhu
- Department of Oncology, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Lirong Zhao
- Department of Oncology, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Bangyu Luo
- Department of Oncology, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Tianxiang Cui
- Department of Oncology, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Liangzhi Zhong
- Department of Oncology, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Fan Yang
- Department of Oncology, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Guangrong Yang
- Qijiang District People's Hospital, Chongqing 401420, P.R. China
| | - Xianlan Zhao
- Department of Oncology, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Yibing Zhou
- Department of Oncology, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
| | - Mingying Geng
- Department of Cancer Center, Daping Hospital, Army Medical University, Chongqing 400042, P.R. China
| | - Jianguo Sun
- Department of Oncology, Xinqiao Hospital, Army Medical University, Chongqing 400037, P.R. China
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Lam SK, Zhang J, Zhang YP, Li B, Ni RY, Zhou T, Peng T, Cheung ALY, Chau TC, Lee FKH, Yip CWY, Au KH, Lee VHF, Chang ATY, Chan LWC, Cai J. A Multi-Center Study of CT-Based Neck Nodal Radiomics for Predicting an Adaptive Radiotherapy Trigger of Ill-Fitted Thermoplastic Masks in Patients with Nasopharyngeal Carcinoma. Life (Basel) 2022; 12:life12020241. [PMID: 35207528 PMCID: PMC8876942 DOI: 10.3390/life12020241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/02/2021] [Accepted: 12/11/2021] [Indexed: 11/30/2022] Open
Abstract
Significant lymph node shrinkage is common in patients with nasopharyngeal carcinoma (NPC) throughout radiotherapy (RT) treatment, causing ill-fitted thermoplastic masks (IfTMs). To deal with this, an ad hoc adaptive radiotherapy (ART) may be required to ensure accurate and safe radiation delivery and to maintain treatment efficacy. Presently, the entire procedure for evaluating an eligible ART candidate is time-consuming, resource-demanding, and highly inefficient. In the artificial intelligence paradigm, the pre-treatment identification of NPC patients at risk for IfTMs has become greatly demanding for achieving efficient ART eligibility screening, while no relevant studies have been reported. Hence, we aimed to investigate the capability of computed tomography (CT)-based neck nodal radiomics for predicting IfTM-triggered ART events in NPC patients via a multi-center setting. Contrast-enhanced CT and the clinical data of 124 and 58 NPC patients from Queen Elizabeth Hospital (QEH) and Queen Mary Hospital (QMH), respectively, were retrospectively analyzed. Radiomic (R), clinical (C), and combined (RC) models were developed using the ridge algorithm in the QEH cohort and evaluated in the QMH cohort using the median area under the receiver operating characteristics curve (AUC). Delong’s test was employed for model comparison. Model performance was further assessed on 1000 replicates in both cohorts separately via bootstrapping. The R model yielded the highest “corrected” AUC of 0.784 (BCa 95%CI: 0.673–0.859) and 0.723 (BCa 95%CI: 0.534–0.859) in the QEH and QMH cohort following bootstrapping, respectively. Delong’s test indicated that the R model performed significantly better than the C model in the QMH cohort (p < 0.0001), while demonstrating no significant difference compared to the RC model (p = 0.5773). To conclude, CT-based neck nodal radiomics was capable of predicting IfTM-triggered ART events in NPC patients in this multi-center study, outperforming the traditional clinical model. The findings of this study provide valuable insights for future study into developing an effective screening strategy for ART eligibility in NPC patients in the long run, ultimately alleviating the workload of clinical practitioners, streamlining ART procedural efficiency in clinics, and achieving personalized RT for NPC patients in the future.
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Affiliation(s)
- Sai-Kit Lam
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China; (S.-K.L.); (J.Z.); (Y.-P.Z.); (B.L.); (R.-Y.N.); (T.Z.); (T.P.); (A.L.-Y.C.); (L.W.-C.C.)
| | - Jiang Zhang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China; (S.-K.L.); (J.Z.); (Y.-P.Z.); (B.L.); (R.-Y.N.); (T.Z.); (T.P.); (A.L.-Y.C.); (L.W.-C.C.)
| | - Yuan-Peng Zhang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China; (S.-K.L.); (J.Z.); (Y.-P.Z.); (B.L.); (R.-Y.N.); (T.Z.); (T.P.); (A.L.-Y.C.); (L.W.-C.C.)
| | - Bing Li
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China; (S.-K.L.); (J.Z.); (Y.-P.Z.); (B.L.); (R.-Y.N.); (T.Z.); (T.P.); (A.L.-Y.C.); (L.W.-C.C.)
| | - Rui-Yan Ni
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China; (S.-K.L.); (J.Z.); (Y.-P.Z.); (B.L.); (R.-Y.N.); (T.Z.); (T.P.); (A.L.-Y.C.); (L.W.-C.C.)
| | - Ta Zhou
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China; (S.-K.L.); (J.Z.); (Y.-P.Z.); (B.L.); (R.-Y.N.); (T.Z.); (T.P.); (A.L.-Y.C.); (L.W.-C.C.)
| | - Tao Peng
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China; (S.-K.L.); (J.Z.); (Y.-P.Z.); (B.L.); (R.-Y.N.); (T.Z.); (T.P.); (A.L.-Y.C.); (L.W.-C.C.)
| | - Andy Lai-Yin Cheung
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China; (S.-K.L.); (J.Z.); (Y.-P.Z.); (B.L.); (R.-Y.N.); (T.Z.); (T.P.); (A.L.-Y.C.); (L.W.-C.C.)
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - Tin-Ching Chau
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China; (T.-C.C.); (V.H.-F.L.)
| | - Francis Kar-Ho Lee
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China; (F.K.-H.L.); (C.W.-Y.Y.); (K.-H.A.)
| | - Celia Wai-Yi Yip
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China; (F.K.-H.L.); (C.W.-Y.Y.); (K.-H.A.)
| | - Kwok-Hung Au
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China; (F.K.-H.L.); (C.W.-Y.Y.); (K.-H.A.)
| | - Victor Ho-Fun Lee
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China; (T.-C.C.); (V.H.-F.L.)
| | - Amy Tien-Yee Chang
- Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, Hong Kong, China;
| | - Lawrence Wing-Chi Chan
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China; (S.-K.L.); (J.Z.); (Y.-P.Z.); (B.L.); (R.-Y.N.); (T.Z.); (T.P.); (A.L.-Y.C.); (L.W.-C.C.)
| | - Jing Cai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China; (S.-K.L.); (J.Z.); (Y.-P.Z.); (B.L.); (R.-Y.N.); (T.Z.); (T.P.); (A.L.-Y.C.); (L.W.-C.C.)
- Correspondence:
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Grocutt L, Paterson C, Valentine RM. Adaptive dose escalated radiotherapy in oropharyngeal cancers: a treatment planning feasibility study. Radiat Oncol 2022; 17:24. [PMID: 35123516 PMCID: PMC8817487 DOI: 10.1186/s13014-022-01991-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A significant proportion of patients with poor prognosis squamous cell cancer of the oropharynx relapse loco-regionally despite radical (chemo)radiotherapy. If a predictive biomarker for disease control can be identified during treatment then individualised and adaptive treatment strategies may be employed. The aim of this study is to assess the feasibility of adaptive and dose-escalated RT to the gross tumour volume without increasing surrounding planning target volume doses and maintaining clinically acceptable organs at risk doses. MATERIALS AND METHODS Twenty representative patients with poor prognosis locally advanced OPSCC who were known to have relapsed post RT, were re-planned retrospectively using Eclipse TPS v15.5, RapidPlan™ and multi-criteria optimisation. In our centre, PTV65 is treated with 65 Gy in 30 fractions while areas at risk of containing microscopic disease (PTV54) are treated synchronously to 54 Gy in 30 fractions. The original clinical plans were re-optimised to act as controls (Group I). These plans were split into two plans of 15 fractions each, with the latter 15 fractions used to escalate the dose to the GTV to 73 Gy (Group II) and 82 Gy (Group III). Plan sums were created for the total 30 fractions to record plan evaluation parameters along with assessments of plan deliverability. RESULTS For all groups, the dose coverage at D98% and D50% for the PTVs were comparable. The D2% dose levels for PTV65-GTV increased. All dose levels associated with PTV54 remained largely unaffected by the dose escalation regimens. Conformity indices for PTV65 and PTVAll (PTV65 plus PTV54) reveal comparable target volume coverage across all three groups. Despite the GTV being escalated by 12.3% and 26.2% in groups II and III, the volume of GTV receiving > 84 Gy was considerably less than 1.75 cc. While OAR doses increased for the escalated groups, these increases were not clinically significant. CONCLUSION This planning feasibility study exploring RapidPlan™ combined with multi-criteria optimisation has demonstrated that doses to the GTV may be escalated without increasing PTV65-GTV, PTV54 or OAR doses considerably, suggesting an interventional clinical trial using this approach would be feasible.
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Affiliation(s)
- Laura Grocutt
- CRUK RadNet Glasgow, University of Glasgow, Glasgow, G61 1QH UK
- Beatson West of Scotland Cancer Centre, Radiotherapy Physics, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Claire Paterson
- CRUK RadNet Glasgow, University of Glasgow, Glasgow, G61 1QH UK
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Ronan M. Valentine
- Beatson West of Scotland Cancer Centre, Radiotherapy Physics, NHS Greater Glasgow and Clyde, Glasgow, UK
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Al-Rawi SAI, Abouelenein H, Khalil MM, Alabdei HH, Sulaiman AA, Al-Nuaimi DS, Nagdy MESEL. Evaluation of conformity and homogeneity indices consistency throughout the course of head and neck cancer treatment with and without using adaptive volumetric modulated arc radiotherapy CI and HI with and without adaptive VMAT in HNC. Adv Radiat Oncol 2022; 7:100905. [PMID: 35465630 PMCID: PMC9026624 DOI: 10.1016/j.adro.2022.100905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 01/14/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose Conformity indices (CI) and homogeneity indices (HI) are important tools for evaluating treatment plan quality. In this study, we evaluate the consistency of these indices with respect to anatomic changes undergone by patients. Methods and Materials Fifty-five patients with advanced head and neck cancer were treated with simultaneous integrated boost volumetric modulated arc therapy. The initial plan (iplan) then was projected on the new computed tomographs (CT) and 2 adaptive plans (Aplans) for each patient were performed on the new CTs. A comparison of CI and HI between the iplan, hybrid plan (Hplan), and Aplan was performed. Results There was a significant weight loss (P < .001) between CT1, CT2, and CT3, where the median weight at CT1 was 75.78 (68.95-83.42) kg, and 74.88 (68.35-82.2) kg at CT2 and 73.1 (67.6-80.7) kg at CT3. Also, gross tumor volume (GTV) showed significant decrease at CT1, CT2, and CT3. The initial GTV was 32.3 (21-58.6) cc and 28.24 (15.85-48.63) cc at CT2 and 25.12 (14.1-42.2) at CT3. In addition, there was a significant decrease in left parotid volume after 10 and 20 fractions; the median left parotid gland volume at CT1 was 31.04 (26.34-36.27) cc, then was 25.84 (19.19-28.59) cc after 10 fractions and 19.5 (13.53-22.25) cc after 20 fractions; the median right parotid volume at CT1 was 29.81 (24.6-38.75) cc and 22.38 (18.19-30.12) cc at CT2, then the volume fell to 17.74 (13.41-22.66) cc at CT3. Also, a significant increase in dose to organs at risk were noticed at Hplans, the median dose for brain stem at iplan was 5156 (4561-5324) cGy then increased to 5321 (4688-5545) cGy at Hplan1 then increased again to reach 5401 (4821-5812) cGy at Hplan2. The CI showed regression at Hplan1 and Hplan2 and then improvement at Aplan1 and Aplan2. The HI also showed regression in its value at the Hplans and then improved at the Aplans. Conclusions Based on the results, we conclude that anatomic changes such as weight loss greatly affect the quality of plan, and with Aplans, we maintained the quality of plan by sustaining the values of CI and HI as in the iplan
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Affiliation(s)
- Salam Abdulrazzaq Ibrahim Al-Rawi
- Department of Radiation Oncology, Baghdad Radiation Oncology and Nuclear Medicine Center, Baghdad Medical City Complex, Ministry of Health/Environment, Baghdad, Iraq
- Department of physics, Faculty of Science, Helwan University, Cairo, Egypt
| | | | - Magdy Mohammed Khalil
- Department of physics, Faculty of Science, Helwan University, Cairo, Egypt
- Department of Biotechnology, School of Biotechnology, Badr University in Cairo (BUC), Cairo, Egypt
| | - Haidar Hamza Alabdei
- Department of Radiation Oncology, Baghdad Radiation Oncology and Nuclear Medicine Center, Baghdad Medical City Complex, Ministry of Health/Environment, Baghdad, Iraq
- Department of Surgery, College of Medicine, Baghdad University, Baghdad, Iraq
| | - Awf Abdulrahman Sulaiman
- Department of Radiation Oncology, Baghdad Radiation Oncology and Nuclear Medicine Center, Baghdad Medical City Complex, Ministry of Health/Environment, Baghdad, Iraq
| | - Dalya Saad Al-Nuaimi
- Department of Radiation Oncology, Baghdad Radiation Oncology and Nuclear Medicine Center, Baghdad Medical City Complex, Ministry of Health/Environment, Baghdad, Iraq
- Corresponding author: Dalya Saad Al-Nuaimi
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Survival benefits for non-small cell lung cancer patients treated with adaptive radiotherapy. Radiother Oncol 2022; 168:234-240. [PMID: 35121030 DOI: 10.1016/j.radonc.2022.01.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/11/2021] [Accepted: 01/27/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Tumor match and adaptive radiotherapy based on on-treatment imaging increases the precision of RT. This allows a reduction of treatment volume and, consequently, of the dose to organs at risk. We investigate the clinical benefits of tumor match and adaptive radiotherapy for a cohort of non-small cell lung cancer patients (NSCLC). METHODS In 2013, tumor match and adaptive radiotherapy based on daily cone-beam CT scans was introduced to ensure adaption of the radiotherapy treatment plan for all patients with significant anatomical changes during radiotherapy. Before 2013, the daily cone-beam CT scans were matched on the vertebra and anatomical changes were not evaluated systematically. To estimate the effect of tumor match and adaptive radiotherapy, 439 consecutive NSCLC patients treated with definitive chemo-radiotherapy (50-66 Gy/25-33 fractions, 2010-2018) were investigated retrospectively. They were split in two groups, pre-ART (before tumor match and adaptive radiotherapy, 184 patients), and ART (after tumor match and adaptive radiotherapy, 255 patients) and compared with respect to clinical, treatment-specific and dosimetric variables (χ2 tests, Mann Whitney U tests), progression, survival and radiation pneumonits (CTCAEv3). Progression-free and overall survival as well as radiation pneumonitis were compared with log-rank tests. Hazard ratios were estimated from Cox proportional hazard regression. RESULTS No significant differences in stage (p=0.36), histology (p=0.35), PS (p=0.12) and GTV volumes (p=0.24) were observed. Concomitant chemotherapy was administered more frequently in the ART group (78%) compared to preART (64%), p<0.001. Median[range] PTV volumes decreased from 456 [71;1262] cm3 (preART) to 270 [31;1166] cm3 (ART), p<0.001, thereby significantly reducing mean doses to lungs (median, preART 16.4 [1.9;24.7] Gy, ART 12.1 [1.7;19.4] Gy, p<0.001) and heart (median, preART 8.0 [0.1;32.1] Gy, ART 4.4 [0.1;33.9] Gy, p<0.001). The incidence of RP at nine months decreased significantly with ART (50% to 20% for symptomatic RP (≥G2), 21% to 7% for severe RP (≥G3), 6% to 0.4% for lethal RP (G5), all p<0.001). The two-year progression free survival increased from 22% (preART) to 30% (ART), while the overall survival increased from 43% (preART) to 56% (ART). The median overall survival time increased from 20 (preART) to 28 months (ART). CONCLUSION Tumor match and adaptive radiotherapy significantly decreased radiation pneumonitis, while maintaining loco-regional control. Further, we observed a significantly improved progression-free and overall survival.
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Ranta P, Kytö E, Nissi L, Kinnunen I, Vahlberg T, Minn H, Haapio E, Nelimarkka L, Irjala H. Dysphagia, hypothyroidism, and osteoradionecrosis after radiation therapy for head and neck cancer. Laryngoscope Investig Otolaryngol 2022; 7:108-116. [PMID: 35155788 PMCID: PMC8823172 DOI: 10.1002/lio2.711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/26/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To analyze the long-term side effects of radiation therapy (RT) for head and neck cancer (HNC). METHODS Retrospective chart analysis of all 688 HNC patients treated during 2010-2015 at Turku University Hospital, Finland. All patients who survived for more than a year after RT/chemoRT were included (n = 233). Intensity modulated RT (IMRT) with standard fractionation was applied in each case. RESULTS One hundred and six patients (45%) reported persisting dysphagia, for which neck RT increased risk. Definitive neck RT to high-risk volume did not increase late toxicity risks compared to elective neck RT. Radiation-induced hypothyroidism (29%, n = 67) was more common among younger patients and females. Osteoradionecrosis (12%, n = 29) was more common in the oral cavity cancer group (20.7%, n = 92) compared to all other subsites. CONCLUSIONS Late toxicities of RT for HNC are common. Age, gender, tumor subsite, and neck RT affect susceptibility to long-term side effects. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Pihla Ranta
- Department of Otorhinolaryngology - Head and Neck Surgery Turku University and Turku University Hospital Turku Finland
| | - Eero Kytö
- Department of Otorhinolaryngology - Head and Neck Surgery Turku University and Turku University Hospital Turku Finland
| | - Linda Nissi
- Department of Oncology and Radiotherapy Turku University and Turku University Hospital Turku Finland
| | - Ilpo Kinnunen
- Department of Otorhinolaryngology - Head and Neck Surgery Turku University and Turku University Hospital Turku Finland
| | - Tero Vahlberg
- Department of Clinical Medicine, Biostatistics Turku University and Turku University Hospital Turku Finland
| | - Heikki Minn
- Department of Oncology and Radiotherapy Turku University and Turku University Hospital Turku Finland
| | - Eeva Haapio
- Department of Otorhinolaryngology - Head and Neck Surgery Turku University and Turku University Hospital Turku Finland
| | - Lassi Nelimarkka
- Department of Endocrinology, Division of Medicine Turku University and Turku University Hospital Turku Finland
| | - Heikki Irjala
- Department of Otorhinolaryngology - Head and Neck Surgery Turku University and Turku University Hospital Turku Finland
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