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Yun J, Kapustin D, Joseph J, Su V, Ramirez RJ, Khan MN, Chai R, Karasick M, Wiedmer C, Brandwein-Weber M, Urken ML. Improving Interdisciplinary Communication and Pathology Reporting for Head and Neck Cancer Resections: 3D Visualizations and Margin Reconciliation. Head Neck Pathol 2024; 18:78. [PMID: 39153096 PMCID: PMC11330424 DOI: 10.1007/s12105-024-01684-9] [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: 03/20/2024] [Accepted: 08/02/2024] [Indexed: 08/19/2024]
Abstract
PURPOSE Surgical pathology reports play an integral role in postoperative management of head and neck cancer patients. Pathology reports of complex head and neck resections must convey critical information to all involved clinicians. Previously, we demonstrated the utility of 3D specimen and defect scanning for communicating margin status and documenting the location of supplemental margins. We introduce a newly designed permanent pathology report which improves documentation of intraoperative margin mapping and extent of corresponding supplemental margins harvested. METHODS We test the hypothesis that gaps in understanding exist for head and neck resection pathology reports across providers. A cross-sectional exploratory study using human-centered design was implemented to evaluate the existing permanent pathology report with respect to understanding margin status. Pathologists, surgeons, radiation oncologists, and medical oncologists from United States-based medical institutions were surveyed. The results supported a redesign of our surgical pathology template, incorporating 3D specimen / defect scans and annotated radiographic images indicating the location of inadequate margins requiring supplemental margins, or indicating frankly positive margins discovered on permanent section. RESULTS Forty-seven physicians completed our survey. Analyzing surgical pathology reports, 28/47 (60%) respondents reported confusion whether re-excised supplemental margins reflected clear margins, 20/47 (43%) reported uncertainty regarding final margin status, and 20/47 (43%) reported the need for clarity regarding the extent of supplemental margins harvested intraoperatively. From this feedback, we designed a new pathology report template; 61 permanent pathology reports were compiled with this new template over a 12-month period. CONCLUSION Feedback from survey respondents led to a redesigned permanent pathology report that offers detailed visual anatomic information regarding intraoperative margin findings and exact location/size of harvested supplemental margins. This newly designed report reconciles frozen and permanent section results and includes annotated radiographic images such that clinicians can discern precise actions taken by surgeons to address inadequate margins, as well as to understand the location of areas of concern that may influence adjuvant radiation planning.
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Affiliation(s)
- Jun Yun
- THANC (Thyroid, Head & Neck Cancer) Foundation, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
| | - Danielle Kapustin
- THANC (Thyroid, Head & Neck Cancer) Foundation, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
| | - Justin Joseph
- THANC (Thyroid, Head & Neck Cancer) Foundation, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
| | - Vivian Su
- THANC (Thyroid, Head & Neck Cancer) Foundation, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
| | - Ricardo J Ramirez
- THANC (Thyroid, Head & Neck Cancer) Foundation, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
| | - Mohemmed N Khan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
| | - Raymond Chai
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
| | - Michael Karasick
- THANC (Thyroid, Head & Neck Cancer) Foundation, 10 Union Square East, Suite 5B, New York, NY, 10003, USA
| | - Christina Wiedmer
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Mark L Urken
- THANC (Thyroid, Head & Neck Cancer) Foundation, 10 Union Square East, Suite 5B, New York, NY, 10003, USA.
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 5B, New York, NY, 10003, USA.
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Alapati R, Wagoner SF, Lawrence A, Bon Nieves A, Desai A, Shnayder Y, Hamill C, Kakarala K, Neupane P, Gan G, Sykes KJ, Bur AM. Impact of Adjuvant Radiotherapy Setting on Quality-of-Life in Head and Neck Squamous Cell Carcinoma. Laryngoscope 2024; 134:3645-3655. [PMID: 38436503 DOI: 10.1002/lary.31382] [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: 12/29/2023] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To determine differences in post-treatment QoL across treatment settings in patients receiving adjuvant radiation therapy for head and neck squamous cell carcinoma (HNSCC). METHODS This was a prospective observational cohort study of patients with HNSCC initially evaluated in a head and neck surgical oncologic and reconstructive clinic at an academic medical center (AMC). Participants were enrolled prior to treatment in a prospective registry collecting demographic, social, and clinical data. Physical and social-emotional QoL (phys-QoL and soc-QoL, respectively) was measured using the University of Washington-QoL questionnaire at pre-treatment and post-treatment visits. RESULTS A cohort of 177 patients, primarily male and White with an average age of 61.2 ± 11.2 years, met inclusion criteria. Most patients presented with oral cavity tumors (n = 132, 74.6%), had non-HPV-mediated disease (n = 97, 61.8%), and were classified as Stage IVa (n = 72, 42.8%). After controlling for covariates, patients treated at community medical centers (CMCs) reported a 7.15-point lower phys-QoL compared with those treated at AMCs (95% CI: -13.96 to -0.35, p = 0.040) up to 12 months post-treatment. Additionally, patients who were treated at CMCs had a 5.77-point (-11.86-0.31, p = 0.063) lower soc-QoL score compared with those treated at an AMC, which was not statistically significant. CONCLUSION This study revealed that HNSCC patients treated with radiation at AMCs reported significantly greater phys-QoL in their first-year post-treatment compared to those treated at CMCs, but soc-QoL did not differ significantly. Further observational studies are needed to explore potential factors, including treatment planning and cancer resource engagement, behind disparities between AMCs and CMCs. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3645-3655, 2024.
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Affiliation(s)
- Rahul Alapati
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Sarah F Wagoner
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Amelia Lawrence
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Antonio Bon Nieves
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Atharva Desai
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, U.S.A
| | - Yelizaveta Shnayder
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Chelsea Hamill
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Kiran Kakarala
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
| | - Prakash Neupane
- Department of Medical Oncology, University of Kansas, Kansas City, Kansas, U.S.A
| | - Gregory Gan
- Department of Radiation Oncology, University of Kansas, Kansas City, Kansas, U.S.A
| | - Kevin J Sykes
- Baylor Scott & White, Health and Wellness Center, Dallas, Texas, U.S.A
| | - Andrés M Bur
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas, Kansas City, Kansas, U.S.A
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Patel AM, Haleem A, Maxwell R, Lukens JN, Lin A, Brody RM, Brant JA, Carey RM. Choice of Adjuvant Radiotherapy Facility in Major Salivary Gland Cancer. Laryngoscope 2024; 134:3620-3632. [PMID: 38400788 DOI: 10.1002/lary.31352] [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: 12/04/2023] [Revised: 01/16/2024] [Accepted: 02/05/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE Undergoing surgery and adjuvant radiotherapy (aRT) at the same facility has been associated with higher overall survival (OS) in head and neck squamous cell carcinoma. Our study investigates whether undergoing surgery and aRT at the same academic facility is associated with higher OS in major salivary gland cancer (MSGC). METHODS The 2006-2018 National Cancer Database was queried for patients with MSGC undergoing surgery at an academic facility and then aRT. Multivariable binary logistic and Cox proportional hazards regression models were implemented. RESULTS Of 2801 patients satisfying inclusion criteria, 2130 (76.0%) underwent surgery and aRT at the same academic facility. Residence in a less populated area (adjusted odds ratio [aOR] 1.69, 95% confidence interval [CI] 1.16-2.45), treatment without adjuvant chemotherapy (aOR 1.97, 95% CI 1.41-2.76), and aRT duration (aOR 1.02, 95% CI 1.01-1.04) were associated with undergoing surgery and aRT at different facilities on multivariable logistic regression adjusting for patient demographics, clinicopathologic features, and adjuvant therapy (p < 0.01). Five-year OS was higher in patients undergoing surgery and aRT at the same academic facility (68.8% vs. 61.9%, p < 0.001). Undergoing surgery and aRT at different facilities remained associated with worse OS on multivariable Cox regression (aHR 1.41, 95% CI 1.10-1.81, p = 0.007). CONCLUSION Undergoing surgery and aRT at the same academic facility is associated with higher OS in MSGC. Although undergoing surgery and aRT at the same academic facility is impractical for all patients, academic physicians should consider same-facility treatment for complex patients who would most benefit from clear multidisciplinary communication. LEVEL OF EVIDENCE 4 Laryngoscope, 134:3620-3632, 2024.
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Affiliation(s)
- Aman M Patel
- Department of Otolaryngology, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Afash Haleem
- Department of Otolaryngology, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Russell Maxwell
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - John N Lukens
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Alexander Lin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Robert M Brody
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, U.S.A
| | - Jason A Brant
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, U.S.A
| | - Ryan M Carey
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, U.S.A
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Clark B, Hardcastle N, Johnston LA, Korte J. Transfer learning for auto-segmentation of 17 organs-at-risk in the head and neck: Bridging the gap between institutional and public datasets. Med Phys 2024; 51:4767-4777. [PMID: 38376454 DOI: 10.1002/mp.16997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 12/04/2023] [Accepted: 01/31/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Auto-segmentation of organs-at-risk (OARs) in the head and neck (HN) on computed tomography (CT) images is a time-consuming component of the radiation therapy pipeline that suffers from inter-observer variability. Deep learning (DL) has shown state-of-the-art results in CT auto-segmentation, with larger and more diverse datasets showing better segmentation performance. Institutional CT auto-segmentation datasets have been small historically (n < 50) due to the time required for manual curation of images and anatomical labels. Recently, large public CT auto-segmentation datasets (n > 1000 aggregated) have become available through online repositories such as The Cancer Imaging Archive. Transfer learning is a technique applied when training samples are scarce, but a large dataset from a closely related domain is available. PURPOSE The purpose of this study was to investigate whether a large public dataset could be used in place of an institutional dataset (n > 500), or to augment performance via transfer learning, when building HN OAR auto-segmentation models for institutional use. METHODS Auto-segmentation models were trained on a large public dataset (public models) and a smaller institutional dataset (institutional models). The public models were fine-tuned on the institutional dataset using transfer learning (transfer models). We assessed both public model generalizability and transfer model performance by comparison with institutional models. Additionally, the effect of institutional dataset size on both transfer and institutional models was investigated. All DL models used a high-resolution, two-stage architecture based on the popular 3D U-Net. Model performance was evaluated using five geometric measures: the dice similarity coefficient (DSC), surface DSC, 95th percentile Hausdorff distance, mean surface distance (MSD), and added path length. RESULTS For a small subset of OARs (left/right optic nerve, spinal cord, left submandibular), the public models performed significantly better (p < 0.05) than, or showed no significant difference to, the institutional models under most of the metrics examined. For the remaining OARs, the public models were inferior to the institutional models, although performance differences were small (DSC ≤ 0.03, MSD < 0.5 mm) for seven OARs (brainstem, left/right lens, left/right parotid, mandible, right submandibular). The transfer models performed significantly better than the institutional models for seven OARs (brainstem, right lens, left/right optic nerve, left/right parotid, spinal cord) with a small margin of improvement (DSC ≤ 0.02, MSD < 0.4 mm). When numbers of institutional training samples were limited, public and transfer models outperformed the institutional models for most OARs (brainstem, left/right lens, left/right optic nerve, left/right parotid, spinal cord, and left/right submandibular). CONCLUSION Training auto-segmentation models with public data alone was suitable for a small number of OARs. Using only public data incurred a small performance deficit for most other OARs, when compared with institutional data alone, but may be preferable over time-consuming curation of a large institutional dataset. When a large institutional dataset was available, transfer learning with models pretrained on a large public dataset provided a modest performance improvement for several OARs. When numbers of institutional samples were limited, using the public dataset alone, or as a pretrained model, was beneficial for most OARs.
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Affiliation(s)
- Brett Clark
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nicholas Hardcastle
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Leigh A Johnston
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
- Melbourne Brain Centre Imaging Unit, University of Melbourne, Melbourne, Australia
- Graeme Clark Institute, University of Melbourne, Melbourne, Australia
| | - James Korte
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia
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Hanna GJ, Chang SSW, Siddiqui F, Bain PA, Takiar V, Ward MC, Shukla ME, Hu KS, Robbins J, Witek ME, Bakst R, Chandra RA, Galloway T, Margalit DN. Imaging and Biomarker Surveillance for Head and Neck Squamous Cell Carcinoma: A Systematic Review and American Radium Society Appropriate Use Criteria Statement. Int J Radiat Oncol Biol Phys 2024; 119:786-802. [PMID: 38168554 DOI: 10.1016/j.ijrobp.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 12/10/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024]
Abstract
Surveillance for survivors of head and neck cancer (HNC) is focused on early detection of recurrent or second primary malignancies. After initial restaging confirms disease-free status, the use of surveillance imaging for asymptomatic patients with HNC is controversial. Our objective was to comprehensively review literature pertaining to imaging and biomarker surveillance of asymptomatic patients treated for head and neck squamous cell carcinoma and to convene a multidisciplinary expert panel to provide appropriate use criteria for surveillance in representative clinical scenarios. The evidence base for the appropriate use criteria was gathered through a librarian-mediated search of literature published from 1990 to 2022 focused on surveillance imaging and circulating tumor-specific DNA for nonmetastatic head and neck squamous cell carcinoma using MEDLINE (Ovid), Embase, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials. The systematic review was reported according to PRISMA guidelines. Using the modified Delphi process, the expert panel voted on appropriate use criteria, providing recommendations for appropriate use of surveillance imaging and human papillomavirus (HPV) circulating tumor DNA. Of 5178 studies identified, 80 met inclusion criteria (5 meta-analyses/systematic reviews, 1 randomized control trial, 1 post hoc analysis, 25 prospective, and 48 retrospective cohort studies [with ≥50 patients]), reporting on 27,525 patients. No large, randomized, prospective trials examined whether asymptomatic patients who receive surveillance imaging or HPV circulating tumor DNA monitoring benefit from earlier detection of recurrence or second primary tumors in terms of disease-specific or quality-of-life outcomes. In the absence of prospective data, surveillance imaging for HNC survivors should rely on individualized recurrence-risk assessment accounting for initial disease staging, HPV disease status, and tobacco use history. There is an emerging surveillance role for circulating tumor biomarkers.
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Affiliation(s)
- Glenn J Hanna
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Steven Shih-Wei Chang
- Department of Otolaryngology Head and Neck Surgery, Henry Ford Cancer Institute and Hospital, Detroit, Michigan
| | - Farzan Siddiqui
- Department of Radiation Oncology, Henry Ford Cancer Institute and Hospital, Detroit, Michigan
| | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, Massachusetts
| | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - Matthew C Ward
- Atrium Health Levine Cancer Institute Radiation Therapy Center, Charlotte, North Carolina
| | - Monica E Shukla
- Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kenneth S Hu
- New York University Langone Hospitals, New York, New York
| | - Jared Robbins
- Radiation Oncology, College of Medicine Tucson, University of Arizona, Tucson, Arizona
| | - Matthew E Witek
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Richard Bakst
- Mount Sinai Icahn School of Medicine, New York, New York
| | - Ravi A Chandra
- Mid-Atlantic Permanente Medical Group, Kaiser Permanente Health, Rockville, Maryland
| | - Thomas Galloway
- Fox Chase Cancer Center, Temple Health, Philadelphia, Pennsylvania
| | - Danielle N Margalit
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiation Oncology, Dana-Farber Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
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Trakimas DR, Mydlarz W, Mady LJ, Koch W, Quon H, London NR, Fakhry C. Increasing radiation therapy and lower survival for human papillomavirus-related oropharynx cancer associated with a shift to community cancer center care. J Natl Cancer Inst 2024; 116:1051-1062. [PMID: 38167712 PMCID: PMC11223870 DOI: 10.1093/jnci/djad238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/20/2023] [Accepted: 11/10/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Studies have shown lower overall survival for patients with head and neck cancer treated at low-volume or community cancer centers. As the incidence of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma steadily rises in the United States, we hypothesized that a greater proportion of patients with HPV-related oropharyngeal squamous cell carcinoma is being treated at community cancer centers, with a shift toward primary nonsurgical treatment. METHODS This cohort study included patients from the US National Cancer Database who received a diagnosis of HPV-related oropharyngeal squamous cell carcinoma from 2010 to 2019 and underwent treatment at a community cancer center or academic cancer center. The proportion of patients with HPV-related oropharyngeal squamous cell carcinoma treated at community cancer centers and receiving primary nonsurgical treatment was analyzed over time. Four-year overall survival was compared between community cancer centers and academic cancer centers. RESULTS The majority (67.4%) of 20 298 patients were treated at an academic cancer center, yet the proportion of patients treated at community cancer centers increased by 10% from 2010 to 2019 (P < .01 for trend). The proportion of patients undergoing primary nonsurgical treatment increased from 62.1% to 73.7% from 2010 to 2019 (P < .01 for trend), and patients were statistically significantly more likely to undergo nonsurgical treatment at community cancer centers than at academic cancer centers (adjusted odds ratio = 1.20, 95% confidence interval = 1.18 to 1.22). Treatment at community cancer centers was associated with worse survival overall (adjusted hazard ratio = 1.19, 95% confidence interval = 1.09 to 1.31), specifically for patients receiving primary nonsurgical treatment (adjusted hazard ratio = 1.22, 95% confidence interval = 1.11 to 1.34). CONCLUSIONS Treatment of HPV-related oropharyngeal squamous cell carcinoma has recently shifted to community cancer centers, with an increase in the proportion of nonsurgical treatment and worse overall survival at these centers compared with academic cancer centers. Concentration of care for HPV-related oropharyngeal squamous cell carcinoma at academic cancer centers and dedicated head and neck cancer centers may increase access to all available treatment modalities and improve survival.
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Affiliation(s)
- Danielle R Trakimas
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Wojtek Mydlarz
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Leila J Mady
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Wayne Koch
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Harry Quon
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
- Department of Radiation Oncology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nyall R London
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Carole Fakhry
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins Hospital, Baltimore, MD, USA
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Carver A, Scaggion A, Jurado-Bruggeman D, Blanck O, Dalqvist E, Romana Giglioli F, Jenko A, Karlsson K, Staykova V, Swinnnen A, Warren S, Mancosu P, Jornet N. Treatment planning and delivery practice of lung SBRT: Results of the 2022 ESTRO physics survey. Radiother Oncol 2024; 196:110318. [PMID: 38702015 DOI: 10.1016/j.radonc.2024.110318] [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: 11/20/2023] [Revised: 03/18/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND AND PURPOSE The use of Stereotactic Body Radiation Therapy (SBRT) in lung cancer is increasing. However, there is no consensus on the most appropriate treatment planning and delivery practice for lung SBRT. To gauge the range of practice, quantify its variability and identify where consensus might be achieved, ESTRO surveyed the medical physics community. MATERIALS AND METHODS An online survey was distributed to ESTRO's physicist membership in 2022, covering experience, dose and fractionation, target delineation, dose calculation and planning practice, imaging protocols, and quality assurance. RESULTS Two-hundred and forty-four unique answers were collected after data cleaning. Most respondents were from Europe the majority of which had more than 5 years' experience in SBRT. The large majority of respondents deliver lung SBRT with the VMAT technique on C-arm Linear Accelerators (Linacs) employing daily pre-treatment CBCT imaging. A broad spectrum of fractionation schemes were reported, alongside an equally wide range of dose prescription protocols. A clear preference was noted for prescribing to 95% or greater of the PTV. Several issues emerged regarding the dose calculation algorithm: 22% did not state it while 24% neglected to specify the conditions under which the dose was calculated. Contouring was usually performed on Maximum or Average Intensity Projection images while dose was mainly computed on the latter. No clear indications emerged for plan homogeneity, complexity, and conformity assessment. Approximately 40% of the responders participated in inter-centre credentialing of SBRT in the last five years. Substantial differences emerged between high and low experience centres, with the latter employing less accurate algorithms and older equipment. CONCLUSION The survey revealed an evident heterogeneity in numerous aspects of the clinical implementation of lung SBRT treatments. International guidelines and codes of practice might promote harmonisation.
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Affiliation(s)
- Antony Carver
- University Hospitals Birmingham NHS Foundation Trust, Department of Medical Physics, Birmingham, United Kingdom
| | - Alessandro Scaggion
- Medical Physics Department, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Diego Jurado-Bruggeman
- Institut Català d'Oncologia, Medical Physics and Radiation Protection Department, Girona, Spain
| | - Oliver Blanck
- University Medical Center Schleswig-Holstein, Department of Radiation Oncology, Kiel, Germany
| | - Emmy Dalqvist
- Karolinska University Hospital, Radiotherapy Physics and Engineering, Medical Radiation Physics and Nuclear Medicine, Stockholm, Sweden; KarolinskaInstitutet, Department of Oncology-Pathology, Stockholm, Sweden
| | | | - Aljasa Jenko
- Institute of Oncology Ljubljana, Department of Radiotherapy, Ljubljana, Slovenia
| | - Kristin Karlsson
- Karolinska University Hospital, Radiotherapy Physics and Engineering, Medical Radiation Physics and Nuclear Medicine, Stockholm, Sweden; KarolinskaInstitutet, Department of Oncology-Pathology, Stockholm, Sweden
| | - Vanya Staykova
- Guy's and St Thomas' NHS Foundation Trust, Radiotherapy Physics, London, United Kingdom
| | - Ans Swinnnen
- GROW School for Oncology, Maastricht University Medical Centre+, Department of Radiation Oncology (Maastro), Maastricht, The Netherlands
| | - Samantha Warren
- Northern Centre for Cancer Care, Freeman Hospital, Department of Medical Physics, Newcastle Upon Tyne, United Kingdom
| | - Pietro Mancosu
- IRCCS Humanitas Research Hospital, Medical Physics Unit, Department of Radiotherapy and Radiosurgery, Rozzano-Milan, Italy.
| | - Nuria Jornet
- Hospital de la Santa Creu i Sant Pau, Servei de Radiofísica i Radioprotecció, Barcelona, Spain
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Zhao Y, Wang X, Phan J, Chen X, Lee A, Yu C, Huang K, Court LE, Pan T, Wang H, Wahid KA, Mohamed ASR, Naser M, Fuller CD, Yang J. Multi-modal segmentation with missing image data for automatic delineation of gross tumor volumes in head and neck cancers. Med Phys 2024. [PMID: 38896829 DOI: 10.1002/mp.17260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/22/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Head and neck (HN) gross tumor volume (GTV) auto-segmentation is challenging due to the morphological complexity and low image contrast of targets. Multi-modality images, including computed tomography (CT) and positron emission tomography (PET), are used in the routine clinic to assist radiation oncologists for accurate GTV delineation. However, the availability of PET imaging may not always be guaranteed. PURPOSE To develop a deep learning segmentation framework for automated GTV delineation of HN cancers using a combination of PET/CT images, while addressing the challenge of missing PET data. METHODS Two datasets were included for this study: Dataset I: 524 (training) and 359 (testing) oropharyngeal cancer patients from different institutions with their PET/CT pairs provided by the HECKTOR Challenge; Dataset II: 90 HN patients(testing) from a local institution with their planning CT, PET/CT pairs. To handle potentially missing PET images, a model training strategy named the "Blank Channel" method was implemented. To simulate the absence of a PET image, a blank array with the same dimensions as the CT image was generated to meet the dual-channel input requirement of the deep learning model. During the model training process, the model was randomly presented with either a real PET/CT pair or a blank/CT pair. This allowed the model to learn the relationship between the CT image and the corresponding GTV delineation based on available modalities. As a result, our model had the ability to handle flexible inputs during prediction, making it suitable for cases where PET images are missing. To evaluate the performance of our proposed model, we trained it using training patients from Dataset I and tested it with Dataset II. We compared our model (Model 1) with two other models which were trained for specific modality segmentations: Model 2 trained with only CT images, and Model 3 trained with real PET/CT pairs. The performance of the models was evaluated using quantitative metrics, including Dice similarity coefficient (DSC), mean surface distance (MSD), and 95% Hausdorff Distance (HD95). In addition, we evaluated our Model 1 and Model 3 using the 359 test cases in Dataset I. RESULTS Our proposed model(Model 1) achieved promising results for GTV auto-segmentation using PET/CT images, with the flexibility of missing PET images. Specifically, when assessed with only CT images in Dataset II, Model 1 achieved DSC of 0.56 ± 0.16, MSD of 3.4 ± 2.1 mm, and HD95 of 13.9 ± 7.6 mm. When the PET images were included, the performance of our model was improved to DSC of 0.62 ± 0.14, MSD of 2.8 ± 1.7 mm, and HD95 of 10.5 ± 6.5 mm. These results are comparable to those achieved by Model 2 and Model 3, illustrating Model 1's effectiveness in utilizing flexible input modalities. Further analysis using the test dataset from Dataset I showed that Model 1 achieved an average DSC of 0.77, surpassing the overall average DSC of 0.72 among all participants in the HECKTOR Challenge. CONCLUSIONS We successfully refined a multi-modal segmentation tool for accurate GTV delineation for HN cancer. Our method addressed the issue of missing PET images by allowing flexible data input, thereby providing a practical solution for clinical settings where access to PET imaging may be limited.
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Affiliation(s)
- Yao Zhao
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- UTHealth Houston Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xin Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- UTHealth Houston Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xinru Chen
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- UTHealth Houston Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anna Lee
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cenji Yu
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- UTHealth Houston Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kai Huang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- UTHealth Houston Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Laurence E Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- UTHealth Houston Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tinsu Pan
- UTHealth Houston Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - He Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- UTHealth Houston Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kareem Abdul Wahid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Abdalah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mohamed Naser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- UTHealth Houston Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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9
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Patel R, Patel AM, Revercomb L, Qie V, Tseng CC, Baredes S, Park RCW. Facility Volume and Changing Facilities for Postoperative Radiotherapy in Salivary Gland Cancer. Laryngoscope 2024. [PMID: 38895869 DOI: 10.1002/lary.31588] [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: 01/24/2023] [Revised: 05/14/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVES Changing location of postoperative radiotherapy (PORT) after treatment at a high-volume facility (HVF) is associated with worse survival in various head and neck cancers. Our study investigates this relationship in salivary gland cancer (SGC). METHODS The 2004-2016 National Cancer Database was queried for all cases of adult SGC treated with surgery and PORT with or without adjuvant chemotherapy. Patients with multiple cancer diagnoses, metastatic disease, or unknown PORT facility were excluded. Reporting facilities with >95th percentile annual case volume were classified as HVFs, the remainder were classified low-volume facilities (LVFs). RESULTS A total of 7885 patients met inclusion criteria, of which 418 (5.3%) were treated at an HVF. Patients treated at an HVF had higher rates clinical nodal positivity (18.2% vs. 14.0%, p < 0.001) and clinical T3/T4 (27.3% vs. 20.7%, p = 0.001) disease. Patients at HVFs changed facility for PORT at lower rates (18.9% vs. 24.5%, p = 0.009). Patients treated at an HVF had higher 5-year overall survival (5-OS) than those treated at an LVF (79.0% vs. 72.0%, p = 0.042). Patients treated at an HVF that changed PORT facility had worse 5-OS (60.8% vs. 83.2%, p < 0.001). Radiation facility change was an independent predictor of worse survival in patients treated at an HVF (HR: 8.99 [3.15-25.67], p < 0.001) but not for patients treated at a LVF (HR: 1.11 [0.98-1.25], p = 0.109). CONCLUSIONS Patients treated at an HVF changing facility for PORT for SGC experience worse survival. Our data suggest patients treated surgically at an HVF should be counseled to continue their PORT at the same institution. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- Rushi Patel
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic College of Medicine, Cleveland, Ohio, U.S.A
| | - Aman M Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Lucy Revercomb
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Vivienne Qie
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Christopher C Tseng
- Department of Otolaryngology-Head and Neck Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, U.S.A
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Richard Chan Woo Park
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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10
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Wahid KA, Sahin O, Kundu S, Lin D, Alanis A, Tehami S, Kamel S, Duke S, Sherer MV, Rasmussen M, Korreman S, Fuentes D, Cislo M, Nelms BE, Christodouleas JP, Murphy JD, Mohamed AS, He R, Naser MA, Gillespie EF, Fuller CD. Associations Between Radiation Oncologist Demographic Factors and Segmentation Similarity Benchmarks: Insights From a Crowd-Sourced Challenge Using Bayesian Estimation. JCO Clin Cancer Inform 2024; 8:e2300174. [PMID: 38870441 PMCID: PMC11214868 DOI: 10.1200/cci.23.00174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/08/2024] [Accepted: 04/03/2024] [Indexed: 06/15/2024] Open
Abstract
PURPOSE The quality of radiotherapy auto-segmentation training data, primarily derived from clinician observers, is of utmost importance. However, the factors influencing the quality of clinician-derived segmentations are poorly understood; our study aims to quantify these factors. METHODS Organ at risk (OAR) and tumor-related segmentations provided by radiation oncologists from the Contouring Collaborative for Consensus in Radiation Oncology data set were used. Segmentations were derived from five disease sites: breast, sarcoma, head and neck (H&N), gynecologic (GYN), and GI. Segmentation quality was determined on a structure-by-structure basis by comparing the observer segmentations with an expert-derived consensus, which served as a reference standard benchmark. The Dice similarity coefficient (DSC) was primarily used as a metric for the comparisons. DSC was stratified into binary groups on the basis of structure-specific expert-derived interobserver variability (IOV) cutoffs. Generalized linear mixed-effects models using Bayesian estimation were used to investigate the association between demographic variables and the binarized DSC for each disease site. Variables with a highest density interval excluding zero were considered to substantially affect the outcome measure. RESULTS Five hundred seventy-four, 110, 452, 112, and 48 segmentations were used for the breast, sarcoma, H&N, GYN, and GI cases, respectively. The median percentage of segmentations that crossed the expert DSC IOV cutoff when stratified by structure type was 55% and 31% for OARs and tumors, respectively. Regression analysis revealed that the structure being tumor-related had a substantial negative impact on binarized DSC for the breast, sarcoma, H&N, and GI cases. There were no recurring relationships between segmentation quality and demographic variables across the cases, with most variables demonstrating large standard deviations. CONCLUSION Our study highlights substantial uncertainty surrounding conventionally presumed factors influencing segmentation quality relative to benchmarks.
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Affiliation(s)
- Kareem A. Wahid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Onur Sahin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Suprateek Kundu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Diana Lin
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anthony Alanis
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Salik Tehami
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Serageldin Kamel
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Simon Duke
- Department of Radiation Oncology, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Michael V. Sherer
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Mathis Rasmussen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Stine Korreman
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - David Fuentes
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Cislo
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - John P. Christodouleas
- Department of Radiation Oncology, The University of Pennsylvania Cancer Center, Philadelphia, PA
- Elekta, Atlanta, GA
| | - James D. Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Abdallah S.R. Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Renjie He
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mohammed A. Naser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Erin F. Gillespie
- Department of Radiation Oncology, University of Washington Fred Hutchinson Cancer Center, Seattle, WA
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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11
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Gogineni E, Schaefer D, Ewing A, Andraos T, DiCostanzo D, Weldon M, Christ D, Baliga S, Jhawar S, Mitchell D, Grecula J, Konieczkowski DJ, Palmer J, Jahraus T, Dibs K, Chakravarti A, Martin D, Gamez ME, Blakaj D. Systematic Implementation of Effective Quality Assurance Processes for the Assessment of Radiation Target Volumes in Head and Neck Cancer. Pract Radiat Oncol 2024; 14:e205-e213. [PMID: 38237893 DOI: 10.1016/j.prro.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/17/2023] [Accepted: 12/01/2023] [Indexed: 02/26/2024]
Abstract
PURPOSE Significant heterogeneity exists in clinical quality assurance (QA) practices within radiation oncology departments, with most chart rounds lacking prospective peer-reviewed contour evaluation. This has the potential to significantly affect patient outcomes, particularly for head and neck cancers (HNC) given the large variance in target volume delineation. With this understanding, we incorporated a prospective systematic peer contour-review process into our workflow for all patients with HNC. This study aims to assess the effectiveness of implementing prospective peer review into practice for our National Cancer Institute Designated Cancer Center and to report factors associated with contour modifications. METHODS AND MATERIALS Starting in November 2020, our department adopted a systematic QA process with real-time metrics, in which contours for all patients with HNC treated with radiation therapy were prospectively peer reviewed and graded. Contours were graded with green (unnecessary), yellow (minor), or red (major) colors based on the degree of peer-recommended modifications. Contours from November 2020 through September 2021 were included for analysis. RESULTS Three hundred sixty contours were included. Contour grades were made up of 89.7% green, 8.9% yellow, and 1.4% red grades. Physicians with >12 months of clinical experience were less likely to have contour changes requested than those with <12 months (8.3% vs 40.9%; P < .001). Contour grades were significantly associated with physician case load, with physicians presenting more than the median number of 50 cases having significantly less modifications requested than those presenting <50 (6.7% vs 13.3%; P = .013). Physicians working with a resident or fellow were less likely to have contour changes requested than those without a trainee (5.2% vs 12.6%; P = .039). Frequency of major modification requests significantly decreased over time after adoption of prospective peer contour review, with no red grades occurring >6 months after adoption. CONCLUSIONS This study highlights the importance of prospective peer contour-review implementation into systematic clinical QA processes for HNC. Physician experience proved to be the highest predictor of approved contours. A growth curve was demonstrated, with major modifications declining after prospective contour review implementation. Even within a high-volume academic practice with subspecialist attendings, >10% of patients had contour changes made as a direct result of prospective peer review.
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Affiliation(s)
- E Gogineni
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - D Schaefer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - A Ewing
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - T Andraos
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - D DiCostanzo
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - M Weldon
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - D Christ
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - S Baliga
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - S Jhawar
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - D Mitchell
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - J Grecula
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - D J Konieczkowski
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - J Palmer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - T Jahraus
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - K Dibs
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - A Chakravarti
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - D Martin
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - M E Gamez
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - D Blakaj
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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12
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Kosugi Y, Sasai K, Murakami N, Karino T, Muramoto Y, Kawamoto T, Oshima M, Okonogi N, Takatsu J, Iijima K, Karube S, Isobe A, Hara N, Fujimaki M, Ohba S, Matsumoto F, Murakami K, Shikama N. Efficacy and safety of FDG-PET for determining target volume during intensity-modulated radiotherapy for head and neck cancer involving the oral level. EJNMMI REPORTS 2024; 8:6. [PMID: 38748042 PMCID: PMC10962625 DOI: 10.1186/s41824-024-00197-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/22/2024] [Indexed: 05/19/2024]
Abstract
PURPOSE To determine the efficacy and safety of target volume determination by 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) for intensity-modulated radiation therapy (IMRT) for locally advanced head and neck squamous cell carcinoma (HNSCC) extending into the oral cavity or oropharynx. METHODS We prospectively treated 10 consecutive consenting patients with HNSCC using IMRT, with target volumes determined by PET-CT. Gross tumor volume (GTV) and clinical target volume (CTV) at the oral level were determined by two radiation oncologists for CT, magnetic resonance imaging (MRI), and PET-CT. Differences in target volume (GTVPET, GTVCT, GTVMRI, CTVPET, CTVCT, and CTVMRI) for each modality and the interobserver variability of the target volume were evaluated using the Dice similarity coefficient and Hausdorff distance. Clinical outcomes, including acute adverse events (AEs) and local control were evaluated. RESULTS The mean GTV was smallest for GTVPET, followed by GTVCT and GTVMRI. There was a significant difference between GTVPET and GTVMRI, but not between the other two groups. The interobserver variability of target volume with PET-CT was significantly less than that with CT or MRI for GTV and tended to be less for CTV, but there was no significant difference in CTV between the modalities. Grade ≤ 3 acute dermatitis, mucositis, and dysphagia occurred in 55%, 88%, and 22% of patients, respectively, but no grade 4 AEs were observed. There was no local recurrence at the oral level after a median follow-up period of 37 months (range, 15-55 months). CONCLUSIONS The results suggest that the target volume determined by PET-CT could safely reduce GTV size and interobserver variability in patients with locally advanced HNSCC extending into the oral cavity or oropharynx undergoing IMRT. Trial registration UMIN, UMIN000033007. Registered 16 jun 2018, https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000037631.
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Affiliation(s)
- Yasuo Kosugi
- Department of Radiation Oncology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Keisuke Sasai
- Department of Radiation Oncology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Radiation Oncology, Kansai Electric Power Hospital, Osaka, Japan
| | - Naoya Murakami
- Department of Radiation Oncology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Tatsuki Karino
- Department of Radiation Oncology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yoichi Muramoto
- Department of Radiation Oncology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Terufumi Kawamoto
- Department of Radiation Oncology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Masaki Oshima
- Department of Radiation Oncology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Noriyuki Okonogi
- Department of Radiation Oncology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Jun Takatsu
- Department of Radiation Oncology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kotaro Iijima
- Department of Radiation Oncology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shuhei Karube
- Department of Radiology, Juntendo University Hospital, Tokyo, Japan
| | - Akira Isobe
- Department of Radiology, Juntendo University Hospital, Tokyo, Japan
| | - Naoya Hara
- Department of Radiology, Juntendo University Hospital, Tokyo, Japan
| | - Mitsuhisa Fujimaki
- Department of Otorhinolaryngology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Shinichi Ohba
- Department of Otorhinolaryngology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Fumihiko Matsumoto
- Department of Otorhinolaryngology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Koji Murakami
- Department of Radiology, Juntendo University, Tokyo, Japan
| | - Naoto Shikama
- Department of Radiation Oncology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Rayn K, Gokhroo G, Jeffers B, Gupta V, Chaudhari S, Clark R, Magliari A, Beriwal S. Multicenter Study of Pelvic Nodal Autosegmentation Algorithm of Siemens Healthineers: Comparison of Male Versus Female Pelvis. Adv Radiat Oncol 2024; 9:101326. [PMID: 38405314 PMCID: PMC10885554 DOI: 10.1016/j.adro.2023.101326] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/18/2023] [Indexed: 02/27/2024] Open
Abstract
Purpose The autosegmentation algorithm of Siemens Healthineers version VA 30 (AASH) (Siemens Healthineers, Erlangen, Germany) was trained and developed in the male pelvis, with no published data on its usability in the female pelvis. This is the first multi-institutional study to describe and evaluate an artificial intelligence algorithm for autosegmentation of the pelvic nodal region by gender. Methods and Materials We retrospectively evaluated AASH pelvic nodal autosegmentation in both male and female patients treated at our network of institutions. The automated pelvic nodal contours generated by AASH were evaluated by 1 board-certified radiation oncologist. A 4-point scale was used for each nodal region contour: a score of 4 is clinically usable with minimal edits; a score of 3 requires minor edits (missing nodal contour region, cutting through vessels, or including bowel loops) in 3 or fewer computed tomography slices; a score of 2 requires major edits, as previously defined but in 4 or more computed tomography slices; and a score of 1 requires complete recontouring of the region. Pelvic nodal regions included the right and left side of the common iliac, external iliac, internal iliac, obturator, and midline presacral nodes. In addition, patients were graded based on their lowest nodal contour score. Statistical analysis was performed using Fisher exact tests and Yates-corrected χ2 tests. Results Fifty-two female and 51 male patients were included in the study, representing a total of 468 and 447 pelvic nodal regions, respectively. Ninety-six percent and 99% of contours required minor edits at most (score of 3 or 4) for female and male patients, respectively (P = .004 using Fisher exact test; P = .007 using Yates correction). No nodal regions had a statistically significant difference in scores between female and male patients. The percentage of patients requiring no more than minor edits was 87% (45 patients) and 92% (47 patients) for female and male patients, respectively (P = .53 using Fisher exact test; P = .55 using Yates correction). Conclusions AASH pelvic nodal autosegmentation performed very well in both male and female pelvic nodal regions, although with better male pelvic nodal autosegmentation. As autosegmentation becomes more widespread, it may be important to have equal representation from all sexes in training and validation of autosegmentation algorithms.
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Affiliation(s)
- Kareem Rayn
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
- Varian Medical Systems Inc, Palo Alto, California
| | | | - Brian Jeffers
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Vibhor Gupta
- American Oncology Institute, Hyderabad, CA, India
| | | | - Ryan Clark
- Varian Medical Systems Inc, Palo Alto, California
| | | | - Sushil Beriwal
- Varian Medical Systems Inc, Palo Alto, California
- Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania
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14
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Heilemann G, Buschmann M, Lechner W, Dick V, Eckert F, Heilmann M, Herrmann H, Moll M, Knoth J, Konrad S, Simek IM, Thiele C, Zaharie A, Georg D, Widder J, Trnkova P. Clinical Implementation and Evaluation of Auto-Segmentation Tools for Multi-Site Contouring in Radiotherapy. Phys Imaging Radiat Oncol 2023; 28:100515. [PMID: 38111502 PMCID: PMC10726238 DOI: 10.1016/j.phro.2023.100515] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/20/2023] Open
Abstract
Background and purpose Tools for auto-segmentation in radiotherapy are widely available, but guidelines for clinical implementation are missing. The goal was to develop a workflow for performance evaluation of three commercial auto-segmentation tools to select one candidate for clinical implementation. Materials and Methods One hundred patients with six treatment sites (brain, head-and-neck, thorax, abdomen, and pelvis) were included. Three sets of AI-based contours for organs-at-risk (OAR) generated by three software tools and manually drawn expert contours were blindly rated for contouring accuracy. The dice similarity coefficient (DSC), the Hausdorff distance, and a dose/volume evaluation based on the recalculation of the original treatment plan were assessed. Statistically significant differences were tested using the Kruskal-Wallis test and the post-hoc Dunn Test with Bonferroni correction. Results The mean DSC scores compared to expert contours for all OARs combined were 0.80 ± 0.10, 0.75 ± 0.10, and 0.74 ± 0.11 for the three software tools. Physicians' rating identified equivalent or superior performance of some AI-based contours in head (eye, lens, optic nerve, brain, chiasm), thorax (e.g., heart and lungs), and pelvis and abdomen (e.g., kidney, femoral head) compared to manual contours. For some OARs, the AI models provided results requiring only minor corrections. Bowel-bag and stomach were not fit for direct use. During the interdisciplinary discussion, the physicians' rating was considered the most relevant. Conclusion A comprehensive method for evaluation and clinical implementation of commercially available auto-segmentation software was developed. The in-depth analysis yielded clear instructions for clinical use within the radiotherapy department.
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Affiliation(s)
- Gerd Heilemann
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Martin Buschmann
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Wolfgang Lechner
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Vincent Dick
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Franziska Eckert
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Martin Heilmann
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Harald Herrmann
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Matthias Moll
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Johannes Knoth
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Stefan Konrad
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Inga-Malin Simek
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Christopher Thiele
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Alexandru Zaharie
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Dietmar Georg
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Joachim Widder
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Petra Trnkova
- Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
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15
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Wahid KA, Sahin O, Kundu S, Lin D, Alanis A, Tehami S, Kamel S, Duke S, Sherer MV, Rasmussen M, Korreman S, Fuentes D, Cislo M, Nelms BE, Christodouleas JP, Murphy JD, Mohamed ASR, He R, Naser MA, Gillespie EF, Fuller CD. Determining The Role Of Radiation Oncologist Demographic Factors On Segmentation Quality: Insights From A Crowd-Sourced Challenge Using Bayesian Estimation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.30.23294786. [PMID: 37693394 PMCID: PMC10491357 DOI: 10.1101/2023.08.30.23294786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Medical image auto-segmentation is poised to revolutionize radiotherapy workflows. The quality of auto-segmentation training data, primarily derived from clinician observers, is of utmost importance. However, the factors influencing the quality of these clinician-derived segmentations have yet to be fully understood or quantified. Therefore, the purpose of this study was to determine the role of common observer demographic variables on quantitative segmentation performance. METHODS Organ at risk (OAR) and tumor volume segmentations provided by radiation oncologist observers from the Contouring Collaborative for Consensus in Radiation Oncology public dataset were utilized for this study. Segmentations were derived from five separate disease sites comprised of one patient case each: breast, sarcoma, head and neck (H&N), gynecologic (GYN), and gastrointestinal (GI). Segmentation quality was determined on a structure-by-structure basis by comparing the observer segmentations with an expert-derived consensus gold standard primarily using the Dice Similarity Coefficient (DSC); surface DSC was investigated as a secondary metric. Metrics were stratified into binary groups based on previously established structure-specific expert-derived interobserver variability (IOV) cutoffs. Generalized linear mixed-effects models using Markov chain Monte Carlo Bayesian estimation were used to investigate the association between demographic variables and the binarized segmentation quality for each disease site separately. Variables with a highest density interval excluding zero - loosely analogous to frequentist significance - were considered to substantially impact the outcome measure. RESULTS After filtering by practicing radiation oncologists, 574, 110, 452, 112, and 48 structure observations remained for the breast, sarcoma, H&N, GYN, and GI cases, respectively. The median percentage of observations that crossed the expert DSC IOV cutoff when stratified by structure type was 55% and 31% for OARs and tumor volumes, respectively. Bayesian regression analysis revealed tumor category had a substantial negative impact on binarized DSC for the breast (coefficient mean ± standard deviation: -0.97 ± 0.20), sarcoma (-1.04 ± 0.54), H&N (-1.00 ± 0.24), and GI (-2.95 ± 0.98) cases. There were no clear recurring relationships between segmentation quality and demographic variables across the cases, with most variables demonstrating large standard deviations and wide highest density intervals. CONCLUSION Our study highlights substantial uncertainty surrounding conventionally presumed factors influencing segmentation quality. Future studies should investigate additional demographic variables, more patients and imaging modalities, and alternative metrics of segmentation acceptability.
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Affiliation(s)
- Kareem A. Wahid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Onur Sahin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Suprateek Kundu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diana Lin
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anthony Alanis
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Salik Tehami
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Serageldin Kamel
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Simon Duke
- Department of Radiation Oncology, Cambridge University Hospitals, Cambridge, UK
| | - Michael V. Sherer
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | | | - Stine Korreman
- Department of Oncology, Aarhus University Hospital, Denmark
| | - David Fuentes
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Cislo
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - John P. Christodouleas
- Department of Radiation Oncology, The University of Pennsylvania Cancer Center, Philadelphia, PA, USA
- Elekta, Atlanta, GA, USA
| | - James D. Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Abdallah S. R. Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Renjie He
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mohammed A. Naser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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16
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Doolan PJ, Charalambous S, Roussakis Y, Leczynski A, Peratikou M, Benjamin M, Ferentinos K, Strouthos I, Zamboglou C, Karagiannis E. A clinical evaluation of the performance of five commercial artificial intelligence contouring systems for radiotherapy. Front Oncol 2023; 13:1213068. [PMID: 37601695 PMCID: PMC10436522 DOI: 10.3389/fonc.2023.1213068] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose/objectives Auto-segmentation with artificial intelligence (AI) offers an opportunity to reduce inter- and intra-observer variability in contouring, to improve the quality of contours, as well as to reduce the time taken to conduct this manual task. In this work we benchmark the AI auto-segmentation contours produced by five commercial vendors against a common dataset. Methods and materials The organ at risk (OAR) contours generated by five commercial AI auto-segmentation solutions (Mirada (Mir), MVision (MV), Radformation (Rad), RayStation (Ray) and TheraPanacea (Ther)) were compared to manually-drawn expert contours from 20 breast, 20 head and neck, 20 lung and 20 prostate patients. Comparisons were made using geometric similarity metrics including volumetric and surface Dice similarity coefficient (vDSC and sDSC), Hausdorff distance (HD) and Added Path Length (APL). To assess the time saved, the time taken to manually draw the expert contours, as well as the time to correct the AI contours, were recorded. Results There are differences in the number of CT contours offered by each AI auto-segmentation solution at the time of the study (Mir 99; MV 143; Rad 83; Ray 67; Ther 86), with all offering contours of some lymph node levels as well as OARs. Averaged across all structures, the median vDSCs were good for all systems and compared favorably with existing literature: Mir 0.82; MV 0.88; Rad 0.86; Ray 0.87; Ther 0.88. All systems offer substantial time savings, ranging between: breast 14-20 mins; head and neck 74-93 mins; lung 20-26 mins; prostate 35-42 mins. The time saved, averaged across all structures, was similar for all systems: Mir 39.8 mins; MV 43.6 mins; Rad 36.6 min; Ray 43.2 mins; Ther 45.2 mins. Conclusions All five commercial AI auto-segmentation solutions evaluated in this work offer high quality contours in significantly reduced time compared to manual contouring, and could be used to render the radiotherapy workflow more efficient and standardized.
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Affiliation(s)
- Paul J. Doolan
- Department of Medical Physics, German Oncology Center, Limassol, Cyprus
| | | | - Yiannis Roussakis
- Department of Medical Physics, German Oncology Center, Limassol, Cyprus
| | - Agnes Leczynski
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus
| | - Mary Peratikou
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus
| | - Melka Benjamin
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus
| | - Konstantinos Ferentinos
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Iosif Strouthos
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Constantinos Zamboglou
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus
- School of Medicine, European University Cyprus, Nicosia, Cyprus
- Department of Radiation Oncology, Medical Center – University of Freiberg, Freiberg, Germany
| | - Efstratios Karagiannis
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus
- School of Medicine, European University Cyprus, Nicosia, Cyprus
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17
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Gronberg MP, Beadle BM, Garden AS, Skinner H, Gay S, Netherton T, Cao W, Cardenas CE, Chung C, Fuentes DT, Fuller CD, Howell RM, Jhingran A, Lim TY, Marquez B, Mumme R, Olanrewaju AM, Peterson CB, Vazquez I, Whitaker TJ, Wooten Z, Yang M, Court LE. Deep Learning-Based Dose Prediction for Automated, Individualized Quality Assurance of Head and Neck Radiation Therapy Plans. Pract Radiat Oncol 2023; 13:e282-e291. [PMID: 36697347 PMCID: PMC11232032 DOI: 10.1016/j.prro.2022.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE This study aimed to use deep learning-based dose prediction to assess head and neck (HN) plan quality and identify suboptimal plans. METHODS AND MATERIALS A total of 245 volumetric modulated arc therapy HN plans were created using RapidPlan knowledge-based planning (KBP). A subset of 112 high-quality plans was selected under the supervision of an HN radiation oncologist. We trained a 3D Dense Dilated U-Net architecture to predict 3-dimensional dose distributions using 3-fold cross-validation on 90 plans. Model inputs included computed tomography images, target prescriptions, and contours for targets and organs at risk (OARs). The model's performance was assessed on the remaining 22 test plans. We then tested the application of the dose prediction model for automated review of plan quality. Dose distributions were predicted on 14 clinical plans. The predicted versus clinical OAR dose metrics were compared to flag OARs with suboptimal normal tissue sparing using a 2 Gy dose difference or 3% dose-volume threshold. OAR flags were compared with manual flags by 3 HN radiation oncologists. RESULTS The predicted dose distributions were of comparable quality to the KBP plans. The differences between the predicted and KBP-planned D1%,D95%, and D99% across the targets were within -2.53% ± 1.34%, -0.42% ± 1.27%, and -0.12% ± 1.97%, respectively, and the OAR mean and maximum doses were within -0.33 ± 1.40 Gy and -0.96 ± 2.08 Gy, respectively. For the plan quality assessment study, radiation oncologists flagged 47 OARs for possible plan improvement. There was high interphysician variability; 83% of physician-flagged OARs were flagged by only one of 3 physicians. The comparative dose prediction model flagged 63 OARs, including 30 of 47 physician-flagged OARs. CONCLUSIONS Deep learning can predict high-quality dose distributions, which can be used as comparative dose distributions for automated, individualized assessment of HN plan quality.
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Affiliation(s)
- Mary P Gronberg
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas.
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Heath Skinner
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Skylar Gay
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
| | - Tucker Netherton
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
| | - Wenhua Cao
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carlos E Cardenas
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Christine Chung
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David T Fuentes
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas; Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clifton D Fuller
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rebecca M Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tze Yee Lim
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
| | - Barbara Marquez
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
| | - Raymond Mumme
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adenike M Olanrewaju
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christine B Peterson
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ivan Vazquez
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas J Whitaker
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
| | - Zachary Wooten
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Statistics, Rice University, Houston, Texas
| | - Ming Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
| | - Laurence E Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas
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Lucido JJ, DeWees TA, Leavitt TR, Anand A, Beltran CJ, Brooke MD, Buroker JR, Foote RL, Foss OR, Gleason AM, Hodge TL, Hughes CO, Hunzeker AE, Laack NN, Lenz TK, Livne M, Morigami M, Moseley DJ, Undahl LM, Patel Y, Tryggestad EJ, Walker MZ, Zverovitch A, Patel SH. Validation of clinical acceptability of deep-learning-based automated segmentation of organs-at-risk for head-and-neck radiotherapy treatment planning. Front Oncol 2023; 13:1137803. [PMID: 37091160 PMCID: PMC10115982 DOI: 10.3389/fonc.2023.1137803] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/24/2023] [Indexed: 04/09/2023] Open
Abstract
IntroductionOrgan-at-risk segmentation for head and neck cancer radiation therapy is a complex and time-consuming process (requiring up to 42 individual structure, and may delay start of treatment or even limit access to function-preserving care. Feasibility of using a deep learning (DL) based autosegmentation model to reduce contouring time without compromising contour accuracy is assessed through a blinded randomized trial of radiation oncologists (ROs) using retrospective, de-identified patient data.MethodsTwo head and neck expert ROs used dedicated time to create gold standard (GS) contours on computed tomography (CT) images. 445 CTs were used to train a custom 3D U-Net DL model covering 42 organs-at-risk, with an additional 20 CTs were held out for the randomized trial. For each held-out patient dataset, one of the eight participant ROs was randomly allocated to review and revise the contours produced by the DL model, while another reviewed contours produced by a medical dosimetry assistant (MDA), both blinded to their origin. Time required for MDAs and ROs to contour was recorded, and the unrevised DL contours, as well as the RO-revised contours by the MDAs and DL model were compared to the GS for that patient.ResultsMean time for initial MDA contouring was 2.3 hours (range 1.6-3.8 hours) and RO-revision took 1.1 hours (range, 0.4-4.4 hours), compared to 0.7 hours (range 0.1-2.0 hours) for the RO-revisions to DL contours. Total time reduced by 76% (95%-Confidence Interval: 65%-88%) and RO-revision time reduced by 35% (95%-CI,-39%-91%). All geometric and dosimetric metrics computed, agreement with GS was equivalent or significantly greater (p<0.05) for RO-revised DL contours compared to the RO-revised MDA contours, including volumetric Dice similarity coefficient (VDSC), surface DSC, added path length, and the 95%-Hausdorff distance. 32 OARs (76%) had mean VDSC greater than 0.8 for the RO-revised DL contours, compared to 20 (48%) for RO-revised MDA contours, and 34 (81%) for the unrevised DL OARs.ConclusionDL autosegmentation demonstrated significant time-savings for organ-at-risk contouring while improving agreement with the institutional GS, indicating comparable accuracy of DL model. Integration into the clinical practice with a prospective evaluation is currently underway.
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Affiliation(s)
- J. John Lucido
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
- *Correspondence: J. John Lucido,
| | - Todd A. DeWees
- Department of Health Sciences Research, Mayo Clinic, Phoenix, AZ, United States
| | - Todd R. Leavitt
- Department of Health Sciences Research, Mayo Clinic, Phoenix, AZ, United States
| | - Aman Anand
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Chris J. Beltran
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United States
| | | | - Justine R. Buroker
- Research Services, Comprehensive Cancer Center, Mayo Clinic, Rochester, MN, United States
| | - Robert L. Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Olivia R. Foss
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Angela M. Gleason
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Teresa L. Hodge
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | | | - Ashley E. Hunzeker
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Nadia N. Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Tamra K. Lenz
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | | | | | - Douglas J. Moseley
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Lisa M. Undahl
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Yojan Patel
- Google Health, Mountain View, CA, United States
| | - Erik J. Tryggestad
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | | | | | - Samir H. Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
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Bollen H, Willems S, Wegge M, Maes F, Nuyts S. Benefits of automated gross tumor volume segmentation in head and neck cancer using multi-modality information. Radiother Oncol 2023; 182:109574. [PMID: 36822358 DOI: 10.1016/j.radonc.2023.109574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/08/2023] [Accepted: 02/12/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE Gross tumor volume (GTV) delineation for head and neck cancer (HNC) radiation therapy planning is time consuming and prone to interobserver variability (IOV). The aim of this study was (1) to develop an automated GTV delineation approach of primary tumor (GTVp) and pathologic lymph nodes (GTVn) based on a 3D convolutional neural network (CNN) exploiting multi-modality imaging input as required in clinical practice, and (2) to validate its accuracy, efficiency and IOV compared to manual delineation in a clinical setting. METHODS Two datasets were retrospectively collected from 150 clinical cases. CNNs were trained for GTV delineation with consensus delineation as ground truth, with either single (CT) or co-registered multi-modal (CT + PET or CT + MRI) imaging data as input. For validation, GTVs were delineated on 20 new cases by two observers, once manually, once by correcting the delineations generated by the CNN. RESULTS Both multi-modality CNNs performed better than the single-modality CNN and were selected for clinical validation. Mean Dice Similarity Coefficient (DSC) for (GTVp, GTVn) respectively between automated and manual delineations was (69%, 79%) for CT + PET and (59%,71%) for CT + MRI. Mean DSC between automated and corrected delineations was (81%,89%) for CT + PET and (69%,77%) for CT + MRI. Mean DSC between observers was (76%,86%) for manual delineations and (95%,96%) for corrected delineations, indicating a significant decrease in IOV (p < 10-5), while efficiency increased significantly (48%, p < 10-5). CONCLUSION Multi-modality automated delineation of GTV of HNC was shown to be more efficient and consistent compared to manual delineation in a clinical setting and beneficial over a single-modality approach.
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Affiliation(s)
- Heleen Bollen
- KU Leuven, Dept. Oncology, Laboratory of Experimental Radiotherapy, & UZ Leuven, Radiation Oncology, B-3000 Leuven, Belgium.
| | - Siri Willems
- KU Leuven, Dept. ESAT, Processing Speech and Images (PSI), & UZ Leuven, Medical Imaging Research Center, B-3000 Leuven, Belgium
| | - Marilyn Wegge
- KU Leuven, Dept. Oncology, Laboratory of Experimental Radiotherapy, & UZ Leuven, Radiation Oncology, B-3000 Leuven, Belgium
| | - Frederik Maes
- KU Leuven, Dept. ESAT, Processing Speech and Images (PSI), & UZ Leuven, Medical Imaging Research Center, B-3000 Leuven, Belgium
| | - Sandra Nuyts
- KU Leuven, Dept. Oncology, Laboratory of Experimental Radiotherapy, & UZ Leuven, Radiation Oncology, B-3000 Leuven, Belgium
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Abiri A, Pang JC, Roman K, Goshtasbi K, Birkenbeuel JL, Kuan EC, Tjoa T, Haidar YM. Facility Volume as a Prognosticator of Survival in Locally Advanced Papillary Thyroid Cancer. Laryngoscope 2023; 133:443-450. [PMID: 35822421 PMCID: PMC9837308 DOI: 10.1002/lary.30280] [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: 12/21/2021] [Revised: 04/26/2022] [Accepted: 06/13/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To evaluate the influence of facility case-volume on survival in patients with locally advanced papillary thyroid cancer (PTC), and to identify prognostic case-volume thresholds for facilities managing this patient population. STUDY DESIGN Retrospective database study. METHODS The 2004-2017 National Cancer Database was queried for patients receiving definitive surgery for locally advanced PTC. Using K-means clustering and multivariable Cox proportional-hazards (CPH) regression, two groups with distinct spectrums of facility case-volumes were generated. Multivariable CPH regression and Kaplan-Meier analysis assessed for the influence of facility case-volume and the prognostic value of its stratification on overall survival (OS). RESULTS Of 48,899 patients treated at 1304 facilities, there were 34,312 (70.2%) females and the mean age was 48.0 ± 16.0 years. Increased facility volume was significantly associated with reduced all-cause mortality (HR 0.996; 95% CI, 0.992-0.999; p = 0.008). Five facility clusters were generated, from which two distinct cohorts were identified: low (LVF; <27 cases/year) and high (HVF; ≥27 cases/year) facility case-volume. Patients at HVFs were associated with reduced mortality compared to those at LVFs (HR 0.791; 95% CI, 0.678-0.923, p = 0.003). Kaplan-Meier analysis of propensity score-matched N0 and N1 patients demonstrated higher OS in HVF cohorts (all p < 0.001). CONCLUSIONS Facility case-volume was an independent predictor of improved OS in locally advanced PTC, indicating a possible survival benefit at high-volume medical centers. Specifically, independent of a number of sociodemographic and clinical factors, facilities that treated ≥27 cases per year were associated with increased OS. Patients with locally advanced PTC may, therefore, benefit from referrals to higher-volume facilities. LEVEL OF EVIDENCE 4 Laryngoscope, 133:443-450, 2023.
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Affiliation(s)
- Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Jonathan C Pang
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Kelsey Roman
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Jack L Birkenbeuel
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Tjoson Tjoa
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Yarah M Haidar
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
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21
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Zhang H, Cha EE, Lynch K, Gennarelli R, Brower J, Sherer MV, Golden DW, Chimonas S, Korenstein D, Gillespie EF. Attitudes and access to resources and strategies to improve quality of radiotherapy among US radiation oncologists: A mixed methods study. J Med Imaging Radiat Oncol 2022; 66:993-1002. [PMID: 35650174 PMCID: PMC9532345 DOI: 10.1111/1754-9485.13423] [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: 01/03/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We aimed to assess contouring-related practices among US radiation oncologists and explore how access to and use of resources and quality improvement strategies vary based on individual- and organization-level factors. METHODS We conducted a mixed methods study with a sequential explanatory design. Surveys were emailed to a random 10% sample of practicing US radiation oncologists. Participating physicians were invited to a semi-structured interview. Kruskal-Wallis and Wilcoxon rank-sum tests and a multivariable regression model were used to evaluate associations. Interview data were coded using thematic content analysis. RESULTS Survey overall response rate was 24%, and subsequent completion rate was 97%. Contouring-related questions arise in ≥50% of clinical cases among 73% of respondents. Resources accessed first include published atlases (75%) followed by consulting another radiation oncologist (60%). Generalists access consensus guidelines more often than disease-site specialists (P = 0.04), while eContour.org is more often used by generalists (OR 4.3, 95% CI 1.2-14.8) and younger physicians (OR 1.33 for each 5-year increase, 95% CI 1.08-1.67). Common physician-reported barriers to optimizing contour quality are time constraints (58%) and lack of access to disease-site specialists (21%). Forty percent (40%, n = 14) of physicians without access to disease-site specialists indicated it could facilitate the adoption of new treatments. Almost all (97%) respondents have formal peer review, but only 43% have contour-specific review, which is more common in academic centres (P = 0.02). CONCLUSION Potential opportunities to improve radiation contour quality include improved access to disease-site specialists and contour-specific peer review. Physician time must be considered when designing new strategies.
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Affiliation(s)
- Helen Zhang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elaine E. Cha
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kathleen Lynch
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Renee Gennarelli
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jeffrey Brower
- Radiation Oncology Associates–New England, Manchester, NH
| | - Michael V. Sherer
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Daniel W. Golden
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL
| | - Susan Chimonas
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Deborah Korenstein
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Erin F. Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY
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22
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Katsoulakis E, Kudner R, Chapman C, Park J, Puckett L, Solanki A, Kapoor R, Hagan M, Kelly M, Palta J, Tishler R, Hitchcock Y, Chera B, Feygelman V, Walker G, Sher D, Kujundzic K, Wilson E, Dawes S, Yom SS, Harrison L. Consensus Quality Measures and Dose Constraints for Head and Neck Cancer with an emphasis on Oropharyngeal and Laryngeal Cancer from the Veterans Affairs Radiation Oncology Quality Surveillance Program and American Society for Radiation Oncology Expert Panel. Pract Radiat Oncol 2022; 12:409-423. [PMID: 35667551 DOI: 10.1016/j.prro.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/09/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Safeguarding high-quality care using evidence-based radiation therapy for patients with head and neck cancer is crucial to improving oncologic outcomes, including survival and quality of life. METHODS AND MATERIALS The Veterans Administration (VA) National Radiation Oncology Program established the VA Radiation Oncology Quality Surveillance Program (VAROQS) to develop clinical quality measures (QM) in head and neck cancer. As part of the development of QM, the VA commissioned, along with the American Society for Radiation Oncology, a blue-ribbon panel comprising experts in head and neck cancer, to develop QM. RESULTS We describe the methods used to develop QM and the final consensus QM, as well as aspirational and surveillance QM, which capture all aspects of the continuum of patient care from initial patient work-up, radiation treatment planning and delivery, and follow-up care, as well as dose volume constraints. CONCLUSION These QM are intended for use as part of ongoing quality surveillance for veterans receiving radiation therapy throughout the VA as well as outside the VA. They may also be used by the non-VA community as a basic measure of quality care for head and neck cancer patients receiving radiation.
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Affiliation(s)
- Evangelia Katsoulakis
- Department of Radiation Oncology, James A. Haley Veterans Affairs Health care System, Tampa, Florida.
| | - Randi Kudner
- American Society for Radiation Oncology, Arlington, Virginia
| | | | - John Park
- University of Missouri Kansas City and Kansas City VA Medical Center, Kansas City, Missouri
| | - Lindsay Puckett
- Medical College of Wisconsin and Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | - Abhi Solanki
- Hines VA Medical Center and Loyola University, Chicago, Illinois
| | - Rishabh Kapoor
- Virginia Commonwealth University and Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Michael Hagan
- VHA National Radiation Oncology Program Office, Richmond, Virginia
| | - Maria Kelly
- VHA National Radiation Oncology Program Office, Richmond, Virginia
| | - Jatinder Palta
- Virginia Commonwealth University and Hunter Holmes McGuire VA Medical Center, Richmond, Virginia; VHA National Radiation Oncology Program Office, Richmond, Virginia
| | - Roy Tishler
- Beth Israel Deaconess Medical Center Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | - Emily Wilson
- American Society for Radiation Oncology, Arlington, Virginia
| | - Samantha Dawes
- American Society for Radiation Oncology, Arlington, Virginia
| | - Sue S Yom
- University of California, San Francisco, San Francisco, California
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23
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Meccariello G, Catalano A, Cammaroto G, Iannella G, Vicini C, Hao SP, De Vito A. Treatment Options in Early Stage (Stage I and II) of Oropharyngeal Cancer: A Narrative Review. Medicina (B Aires) 2022; 58:medicina58081050. [PMID: 36013517 PMCID: PMC9415053 DOI: 10.3390/medicina58081050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/22/2022] Open
Abstract
Objective: to show an overview on the treatments’ options for stage I and II oropharyngeal carcinomasquamous cell carcinoma (OPSCC). Background: The traditional primary treatment modality of OPSCC at early stages is intensity modulated radiation therapy (IMRT). Trans-oral robotic surgery (TORS) has offered as an alternative, less invasive surgical option. Patients with human papilloma virus (HPV)-positive OPSCC have distinct staging with better overall survival in comparison with HPV-negative OPSCC patients. Methods: a comprehensive review of the English language literature was performed using PubMed, EMBASE, the Cochrane Library, and CENTRAL electronic databases. Conclusions: Many trials started examining the role of TORS in de-escalating treatment to optimize functional consequences while maintaining oncologic outcome. The head–neck surgeon has to know the current role of TORS in HPV-positive and negative OPSCC and the ongoing trials that will influence its future implementation. The feasibility of this treatment, the outcomes ensured, and the side effects are key factors to consider for each patient. The variables reported in this narrative review are pieces of a bigger puzzle called tailored, evidence-based driven medicine. Future evidence will help in the construction of robust and adaptive algorithms in order to ensure the adequate treatment for the OPSCC at early stages.
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Affiliation(s)
- Giuseppe Meccariello
- Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Health Local Agency Romagna, 47121 Forlì, Italy
| | - Andrea Catalano
- Otolaryngology Unit, University of Ferrara, 44121 Ferrara, Italy
| | - Giovanni Cammaroto
- Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Health Local Agency Romagna, 47121 Forlì, Italy
| | - Giannicola Iannella
- Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Health Local Agency Romagna, 47121 Forlì, Italy
| | - Claudio Vicini
- Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Health Local Agency Romagna, 47121 Forlì, Italy
| | - Sheng-Po Hao
- Department of Otolaryngology Head and Neck Surgery, Shin Kong Wu Ho-Su Memorial Hospital, School of Medicine, Fu-Jen University, Taipei 111, Taiwan
| | - Andrea De Vito
- Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Santa Maria delle Croci Hospital, Health Local Agency of Romagna, 48121 Ravenna, Italy
- Correspondence:
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24
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Mohamad I, Hosni A, Abu-Hijlih R, Al Mousa A, Al-Rimawi D, Abuhijla F. Moving Experience from North America to Developing Country to Approach a Desired Level of Quality Assurance in Head and Neck Radiation Therapy. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1036-1042. [PMID: 33128212 DOI: 10.1007/s13187-020-01917-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 02/07/2023]
Abstract
Evidence is lacking correlation between head and neck (HN) radiation oncology fellowship training and quality assurance (QA) round decision for plan modifications. This study was conducted to identify the association between training and changes in QA decisions. From 2007 to 2018, data on HN cancer cases presented at departmental QA rounds were prospectively collected. Then, we retrospectively analyzed the collected data to determine the impact of fellowship training on QA decisions. Cases were divided into pre-fellowship group (January 2007-September 2014) and post-fellowship group (October 2014-December 2018). Multivariable analysis (MVA) evaluated variables that could be associated with decreased frequencies of QA modification rates. From 2007 to 2018, 1266 HN cancer patients were identified; 728 patients were in the pre-fellowship group and 538 patients in the post-fellowship group. On MVA, fellowship training transformed QA decisions from more to less modifications (modified vs. approved; OR, 0.135; 95% CI, 0.076-0.240; p = 0.0001), increased approval rate for advanced T and N categories (T3-4 vs. T0-T2; OR, 0.798; 95% CI, 1.892-4.929; p = 0.0001 and N2-3 vs. N0-1; OR, 0.865; 95% CI, 1.454-3.423; p = 0.0002). By type of modification, fellowship training demonstrated a statistically significant reduction in rates of several types of modification that include target volume definition, target volume delineation, and dose (all p < 0.05). Our study determines the impact of the HN radiation oncology fellowship on decreased QA modification rates.
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Affiliation(s)
- Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center, PO Box 1269, Amman, 11941, Jordan.
| | - Ali Hosni
- The Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ramiz Abu-Hijlih
- Department of Radiation Oncology, King Hussein Cancer Center, PO Box 1269, Amman, 11941, Jordan
| | - Abdellatif Al Mousa
- Department of Radiation Oncology, King Hussein Cancer Center, PO Box 1269, Amman, 11941, Jordan
| | - Dalia Al-Rimawi
- Department of Biostatistics, King Hussein Cancer Center, Amman, Jordan
| | - Fawzi Abuhijla
- Department of Radiation Oncology, King Hussein Cancer Center, PO Box 1269, Amman, 11941, Jordan
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25
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Fekadu A, Rick TJ, Tigeneh W, Kantelhardt EJ, Incrocci L, Jemal A. Clinicopathology and Treatment Patterns of Head and Neck Cancers in Ethiopia. JCO Glob Oncol 2022; 8:e2200073. [PMID: 35939776 PMCID: PMC9470133 DOI: 10.1200/go.22.00073] [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] [Indexed: 12/01/2022] Open
Abstract
Head and neck cancers are the third most common cancers treated with radiation in Ethiopia. There is, however, a lack of published data on clinical and pathological characteristics and treatment patterns of head and neck cancers in the country. The objective of the study was to assess clinical and pathological characteristics and treatment patterns of head and neck cancers at Tikur Anbessa Specialized Hospital, which housed the only radiotherapy facility in Ethiopia during the study period. Curative radiation dosing for #headandneck #cancer in #Ethiopia is challenged by the limitations of 2D radiation and long wait times. @JCOGO_ASCO
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Affiliation(s)
- Adugna Fekadu
- Department of Radiation Oncology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tara J. Rick
- Department of Radiation Oncology, Erasmus MC, Rotterdam, the Netherlands
| | | | | | - Luca Incrocci
- Department of Radiation Oncology, Erasmus MC, Rotterdam, the Netherlands
| | - Ahmedin Jemal
- Surveillance and Health Service Research, American Cancer Society, Atlanta, GA
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26
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Yao Y, Chen C, Cai Z, Liu G, Ding C, Lim D, Chao D, Feng Z. Screen identifies fasudil as a radioprotector on human fibroblasts. Toxicol Res (Camb) 2022; 11:662-672. [PMID: 36051660 PMCID: PMC9424713 DOI: 10.1093/toxres/tfac042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 07/24/2023] Open
Abstract
Background Radioprotectors safeguard biological system exposed to ionizing radiation (IR) by protecting normal cells from radiation damage during radiotherapy. Due to the toxicity and limited clinical utility of the present radioprotectors, it prompts us to identify novel radioprotectors that could alleviate IR-induced cytotoxicity of normal tissues. Aims and Methods To identify new radioprotectors, we screened a chemical molecular library comprising 253 compounds in normal human fibroblasts (HFs) or 16HBE cells upon IR by CCK-8 assays and clonogenic survival assays. Fasudil was identified as a potential effective radioprotector. Results The results indicated that Fasudil exerts radioprotective effects on HFs against IR-induced DNA double-strand breaks (DSBs) through the regulation of DSB repair. Fasudil increased homologous recombination (HR) repair by 45.24% and decreased non-homologous end-joining (NHEJ) by 63.88% compared with untreated cells, without affecting changes to cell cycle profile. We further found that fasudil significantly facilitated the expression and foci formation of HR core proteins such as Rad51 and BRCA1 upon IR, and decreased the expression of NHEJ-associated proteins such as DNA-PKcs at 24 h post-IR. Conclusion Our study identified fasudil as a novel radioprotector that exert radioprotective effects on normal cells through regulation of DSB repair by promoting HR repair.
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Affiliation(s)
- Yanling Yao
- Department of Occupational Health and Occupational Medicine, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
| | - Chen Chen
- Department of Occupational Health and Occupational Medicine, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
| | - Zuchao Cai
- Department of Occupational Health and Occupational Medicine, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
| | - Guochao Liu
- Department of Occupational Health and Occupational Medicine, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
| | - Chenxia Ding
- Department of Occupational Health and Occupational Medicine, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
| | - David Lim
- Health services Management, School of Science and Health, Translational Health Research Institute, Western Sydney University, Campbelltown 1797, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park 5042, Australia
| | - Dong Chao
- Corresponding author: Department of Occupational Health and Occupational Medicine, The Public Health School, Cheeloo College of Medicine, Shandong University, Shandong, Jinan 250012, China. ;
| | - Zhihui Feng
- Corresponding author: Department of Occupational Health and Occupational Medicine, The Public Health School, Cheeloo College of Medicine, Shandong University, Shandong, Jinan 250012, China. ;
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27
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Development and Clinical Implementation of an Automated Virtual Integrative Planner for Radiation Therapy of Head and Neck Cancer. Adv Radiat Oncol 2022; 8:101029. [PMID: 36578278 PMCID: PMC9791598 DOI: 10.1016/j.adro.2022.101029] [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: 12/21/2021] [Accepted: 07/10/2022] [Indexed: 12/31/2022] Open
Abstract
Purpose Head and neck (HN) radiation (RT) treatment planning is complex and resource intensive. Deviations and inconsistent plan quality significantly affect clinical outcomes. We sought to develop a novel automated virtual integrative (AVI) knowledge-based planning application to reduce planning time, increase consistency, and improve baseline quality. Methods and Materials An in-house write-enabled script was developed from a library of 668 previously treated HN RT plans. Prospective hazard analysis was performed, and mitigation strategies were implemented before clinical release. The AVI-planner software was retrospectively validated in a cohort of 52 recent HN cases. A physician panel evaluated planning limitations during initial deployment, and feedback was enacted via software refinements. A final second set of plans was generated and evaluated. Kolmogorov-Smirnov test in addition to generalized evaluation metric and weighted experience score were used to compare normal tissue sparing between final AVI planner versus respective clinically treated and historically accepted plans. A t test was used to compare the interactive time, complexity, and monitor units for AVI planner versus manual optimization. Results Initially, 86% of plans were acceptable to treat, with 10% minor and 4% major revisions or rejection recommended. Variability was noted in plan quality among HN subsites, with high initial quality for oropharynx and oral cavity plans. Plans needing revisions were comprised of sinonasal, nasopharynx, P-16 negative squamous cell carcinoma unknown primary, or cutaneous primary sites. Normal tissue sparing varied within subsites, but AVI planner significantly lowered mean larynx dose (median, 18.5 vs 19.7 Gy; P < .01) compared with clinical plans. AVI planner significantly reduced interactive optimization time (mean, 2 vs 85 minutes; P < .01). Conclusions AVI planner reliably generated clinically acceptable RT plans for oral cavity, salivary, oropharynx, larynx, and hypopharynx cancers. Physician-driven iterative learning processes resulted in favorable evolution in HN RT plan quality with significant time savings and improved consistency using AVI planner.
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Ladbury C, Liu J, Nelson R, Amini A, Maghami E, Sampath S. Prognostic Impact of Primary Tumor Extent and Postoperative Radiation Facility Location in Major Salivary Gland Malignancies. Cureus 2022; 14:e24038. [PMID: 35547406 PMCID: PMC9090204 DOI: 10.7759/cureus.24038] [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] [Accepted: 04/11/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction The treatment of primary salivary malignancies often requires a multimodality approach. The purpose of this analysis was to evaluate the interaction between primary tumor extent and the treatment location of postoperative radiotherapy (PORT) in patients with primary salivary malignancies with respect to survival outcomes. Methods Patients with primary salivary malignancies who underwent upfront surgery followed by radiation were queried in the National Cancer Database (NCDB). Patients were stratified by pathologic T stage and whether PORT was performed at the same or different facility as the definitive surgery. Survival outcomes were compared using the Kaplan-Meier method and Cox proportional hazards regression. Results A total of 5,553 patients were selected, of which 1,159 had pathologic T4 (pT4) tumors. Patients who received PORT at the same facility compared with a different facility demonstrated superior overall survival (OS) on log-rank analysis (p=0.003). On subgroup analysis, patients with pT4 tumors had superior OS (p=0.015), whereas patients with smaller T1-3 tumors did not. PORT receipt at the same surgical facility was not a significant predictor of OS on multivariable analysis when all patients were included (p=0.057). However, among patients with pT4 tumors, OS was improved in patients who got PORT at the same facility as their surgery (p=0.015), with 10-year survival rates of 38.3 (95% confidence interval (CI): 33%-44%) versus 31% (95%CI: 24%-38%). Conclusion OS was improved in patients with primary salivary malignancies who received PORT at the same facility as their surgery, but the difference appears to be primarily driven by patients with pT4 primary tumors.
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Transoral robotic surgery for oropharyngeal cancer in the era of chemoradiation therapy. Auris Nasus Larynx 2022; 49:535-546. [DOI: 10.1016/j.anl.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/26/2021] [Accepted: 01/18/2022] [Indexed: 12/26/2022]
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30
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Goshtasbi K, Vasudev M, Torabi SJ, Roman K, Abiri A, Lehrich BM, Hsu FPK, Kuan EC. The influence of facility volume and type on esthesioneuroblastoma treatment and outcomes. Int Forum Allergy Rhinol 2021; 12:1056-1059. [PMID: 34908249 DOI: 10.1002/alr.22948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA
| | - Milind Vasudev
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA
| | - Sina J Torabi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA
| | - Kelsey Roman
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA
| | - Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA
| | - Brandon M Lehrich
- Medical Scientist Training Program, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA, USA
| | - Frank P K Hsu
- Department of Neurological Surgery, University of California, Irvine, CA, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA
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31
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Muzumder S, Srikantia N, Udayashankar AH, Kainthaje PB, Sebastian MGJ, Raj JM. Late toxicities in locally advanced head and neck squamous cell carcinoma treated with intensity modulated radiation therapy. Radiat Oncol J 2021; 39:184-192. [PMID: 34610657 PMCID: PMC8497871 DOI: 10.3857/roj.2020.00913] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 05/03/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose The study aims to report late toxicities in locally advanced head-and-neck squamous cell carcinoma (LAHNSCC) treated with intensity-modulated radiation therapy (IMRT). Materials and Methods A retrospective study was conducted on 103 patients of LAHNSCC treated with IMRT. We analyzed the cumulative incidence of late xerostomia, dysphagia, and aspiration at an interval of 6-month, 1-year, 2-year, and 3-year from the start of IMRT. Results At a median follow up of 4.2 years (interquartile range, 3.5 to 6 years), the cumulative incidence of grade ≥2 late xerostomia was 5.5%, dysphagia was 6.9%, and aspiration was 11.1%. Logistic regression showed that Dmean of ≥26 Gy to parotids had higher risk of xerostomia (hazard ratio [HR] = 5.19; 95% confidence interval [CI], 1.90–14.22; p = 0.001). Late dysphagia was associated with Dmean of ≥45 Gy to pharyngeal constrictors (PC) (HR = 7; 95% CI, 1.84–26.61; p =0.004), ≥55 Gy to larynx (HR = 3.25; 95% CI, 1.15–9.11; p = 0.025), and adjuvant RT (HR = 5.26; 95% CI, 1.85–14.87; p = 0.002). Aspiration was associated with Dmean of ≥45 Gy to larynx (HR = 6.5; 95% CI, 1.93–21.88; p = 0.003), Dmean of ≥55 Gy to PC (HR = 3.54; 95% CI, 1.25–9.98; p = 0.017), and patients having late dysphagia (HR = 4.37; 95% CI, 1.55–12.31; p = 0.005). conclusions IMRT is a feasible radiation delivery technique in LAHNSCC with a decreased late toxicity profile.
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Affiliation(s)
- Sandeep Muzumder
- Department of Radiation Oncology, St. John's Medical College and Hospital, Bengaluru, Karnataka, India
| | - Nirmala Srikantia
- Department of Radiation Oncology, St. John's Medical College and Hospital, Bengaluru, Karnataka, India
| | - Avinash H Udayashankar
- Department of Radiation Oncology, St. John's Medical College and Hospital, Bengaluru, Karnataka, India
| | - Prashanth Bhat Kainthaje
- Department of Radiation Oncology, St. John's Medical College and Hospital, Bengaluru, Karnataka, India
| | - M G John Sebastian
- Department of Radiation Oncology, St. John's Medical College and Hospital, Bengaluru, Karnataka, India
| | - John Michael Raj
- Department of Biostatistics, St John's Medical College, Bengaluru, Karnataka, India
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Bollen H, van der Veen J, Laenen A, Nuyts S. Recurrence Patterns After IMRT/VMAT in Head and Neck Cancer. Front Oncol 2021; 11:720052. [PMID: 34604056 PMCID: PMC8483718 DOI: 10.3389/fonc.2021.720052] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/30/2021] [Indexed: 01/04/2023] Open
Abstract
Purpose Intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT), two advanced modes of high-precision radiotherapy (RT), have become standard of care in the treatment of head and neck cancer. The development in RT techniques has markedly increased the complexity of target volume definition and accurate treatment delivery. The aim of this study was to indirectly investigate the quality of current TV delineation and RT delivery by analyzing the patterns of treatment failure for head and neck cancer patients in our high-volume RT center. Methods Between 2004 and 2014, 385 patients with pharyngeal, laryngeal, and oral cavity tumors were curatively treated with primary RT (IMRT/VMAT). We retrospectively investigated locoregional recurrences (LRR), distant metastases (DM), and overall survival (OS). Results Median follow-up was 6.4 years (IQR 4.7–8.3 years) during which time 122 patients (31.7%) developed LRR (22.1%) and DM (17.7%). The estimated 2- and 5-year locoregional control was 78.2% (95% CI 73.3, 82.3) and 74.2% (95% CI 69.0, 78.8). One patient developed a local recurrence outside the high-dose volume and five patients developed a regional recurrence outside the high-dose volume. Four patients (1.0%) suffered a recurrence in the electively irradiated neck and two patients had a recurrence outside the electively irradiated neck. No marginal failures were observed. The estimated 2- and 5-year DM-free survival rates were 83.3% (95% CI 78.9, 86.9) and 80.0% (95% CI 75.2, 84.0). The estimated 2- and 5-year OS rates were 73.6% (95% CI 68.9, 77.8) and 52. 6% (95% CI 47.3, 57.6). Median OS was 5.5 years (95% CI 4.5, 6.7). Conclusion Target volume definition and treatment delivery were performed accurately, as only few recurrences occurred outside the high-dose regions and no marginal failures were observed. Research on dose intensification and identification of high-risk subvolumes might decrease the risk of locoregional relapses. The results of this study may serve as reference data for comparison with future studies, such as dose escalation or proton therapy trials.
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Affiliation(s)
- Heleen Bollen
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Julie van der Veen
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Leuven Biostatistics and Statistical Bioinformatics Center, KU Leuven, Leuven, Belgium
| | - Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
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Amini A, Verma V, Simone CB, Chetty IJ, Chun SG, Donington J, Edelman MJ, Higgins KA, Kestin LL, Movsas B, Rodrigues GB, Rosenzweig KE, Rybkin II, Slotman BJ, Wolf A, Chang JY. American Radium Society Appropriate Use Criteria for Radiation Therapy in Oligometastatic or Oligoprogressive Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2021; 112:361-375. [PMID: 34571054 DOI: 10.1016/j.ijrobp.2021.09.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/02/2021] [Accepted: 09/10/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Recent randomized studies have suggested improvements in progression-free and overall survival with the addition of stereotactic body radiation therapy (SBRT, also known as SABR) in patients with oligometastatic non-small cell lung cancer. Given the novelty and complexity of incorporating SBRT in the oligometastatic setting, the multidisciplinary American Radium Society Lung Cancer Panel was assigned to create appropriate use criteria on SBRT as part of consolidative local therapy for patients with oligometastatic and oligoprogressive non-small cell lung cancer. METHODS AND MATERIALS A review of the current literature was conducted from January 1, 2008, to December 25, 2020, using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to systematically search the PubMed database to retrieve a comprehensive set of relevant articles. RESULTS Based on representation in existing randomized trials, the panel defined the term "oligometastasis" as ≤3 metastatic deposits (not including the primary tumor) in the previously untreated setting or after first-line systemic therapy after the initial diagnosis. "Oligoprogression" also referred to ≤3 discrete areas of progression in the setting of prior or ongoing receipt of systemic therapy. In all appropriate patients, the panel strongly recommends enrollment in a clinical trial whenever available. For oligometastatic disease, administering first-line systemic therapy followed by consolidative radiation therapy (to all sites plus the primary/nodal disease) is preferred over up-front radiation therapy. Owing to a dearth of data, the panel recommended that consolidative radiation therapy be considered on a case-by-case basis for 4 to 5 sites of oligometastatic disease, driver mutation-positive oligometastatic disease without progression on up-front targeted therapy, and oligoprogressive cases. CONCLUSIONS Although SBRT/SABR appears to be both safe and effective in treating patients with limited metastatic sites of disease, many clinical circumstances require individualized management and strong multidisciplinary discussion on account of the limited existing data.
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Affiliation(s)
- Arya Amini
- City of Hope National Medical Center, Duarte, California.
| | - Vivek Verma
- The University of Texas, M.D. Anderson Cancer Center, Houston, Texas
| | - Charles B Simone
- New York Proton Center, New York, New York; Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Stephen G Chun
- The University of Texas, M.D. Anderson Cancer Center, Houston, Texas
| | | | - Martin J Edelman
- Fox Chase Comprehensive Cancer Center, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | - Benjamin J Slotman
- Amsterdam University Medical Center, De Boelelaan, Amsterdam, The Netherlands
| | - Andrea Wolf
- Mount Sinai School of Medicine, New York, New York
| | - Joe Y Chang
- The University of Texas, M.D. Anderson Cancer Center, Houston, Texas
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Zhu D, Wong A, Oh EJ, Ahn S, Wotman M, Sahai T, Bottalico D, Frank D, Tham T. Impact of Treatment Parameters on Racial Survival Differences in Oropharyngeal Cancer: National Cancer Database Study. Otolaryngol Head Neck Surg 2021; 166:1134-1143. [PMID: 34399637 DOI: 10.1177/01945998211035056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate how differences in treatment parameters account for survival differences between races of patients with oropharyngeal squamous cell carcinoma (OPSCC). STUDY DESIGN Retrospective cohort study. SETTING National Cancer Database. METHODS Data of patients with OPSCC undergoing radiation therapy (RT) or concurrent chemoradiation therapy as primary treatment were obtained from the National Cancer Database from 2004 to 2016. We analyzed 4 treatment-related time intervals to determine their impact on survival between races when controlling for human papilloma virus (HPV) status. Cox proportional hazards models, stepwise logistic regressions, covariate adjustments, and propensity score matching were performed. RESULTS A total of 3152 patients were identified (2877 White, 275 Black). In HPV- cases, Black patients with prolonged radiation duration had a significantly worse overall survival as compared with White patients (hazard ratio, 1.77; 95% CI, 1.03-3.05; P = .039). In a logistic regression model, the only covariate that was significantly associated with prolonged RT was facility type. When further adjusted for facility type, the survival difference between Black and White patients with HPV- status and prolonged RT times was no longer significant (hazard ratio, 1.55; 95% CI, 0.90-2.69; P = .116). CONCLUSIONS There is a significant disparity in overall survival between Black and White patients with HPV- OPSCC when RT duration is prolonged. Clinicians should be aware of the negative impact of prolonged RT, especially in Black patients, so that they can attempt to decrease treatment-related time intervals. Facility type was also found to affect the outcomes of patients with OPSCC, and efforts should be made to improve patient access to well-equipped, high-volume facilities.
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Affiliation(s)
- Daniel Zhu
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Amanda Wong
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Eun Jeong Oh
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Seungjun Ahn
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Michael Wotman
- Department of Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Tanmay Sahai
- Department of Hematology and Oncology, Lenox Hill Hospital, New York, New York, USA
| | - Danielle Bottalico
- Department of Otolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Douglas Frank
- Department of Otolaryngology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Tristan Tham
- Department of Otolaryngology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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35
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Amini A, Morgan R, Meyer E, Fakhoury K, Ladbury C, Bickett T, McDermott JD, Stokes W, Karam SD. Outcomes between intensity-modulated radiation therapy versus 3D-conformal in early stage glottic cancer. Head Neck 2021; 43:3393-3403. [PMID: 34382714 DOI: 10.1002/hed.26841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/01/2021] [Accepted: 07/29/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The purpose of this study is to evaluate practice patterns and outcomes between intensity-modulated radiation therapy (IMRT) and 3D-conformal radiation (3D-CRT) in early stage glottic cancer. METHODS The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used to identify and compare patient and disease profiles, mortality, and toxicity in patients with T1-2 larynx cancer undergoing definitive radiation (RT). RESULTS A total of 1520 patients underwent definitive radiation with 3D-CRT (n = 1309) or IMRT (n = 211). Non-white race, those with a Charlson Comorbidity Index ≥2, T2 disease, and those treated at community practices were more likely to undergo IMRT. Rates of IMRT increased from 2006 to 2015, while relative rates of 3D-CRT decreased. Two-year CSS was superior with 3D-CRT (hazard ratio [HR], 0.38; 95% confidence interval [CI], 0.22-0.65; p < 0.001). There was no difference in OS between 3D-CRT and IMRT (p = 0.119). CONCLUSIONS Patients receiving 3D-CRT had improved CSS compared to IMRT with no difference in OS.
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Affiliation(s)
- Arya Amini
- Department of Radiation Oncology, City of Hope Cancer Center, Duarte, California, USA
| | - Rustain Morgan
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Elisabeth Meyer
- Department of Health Systems Management and Policy, Colorado Comprehensive Cancer Center, University of Colorado, Aurora, Colorado, USA
| | - Kareem Fakhoury
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Colton Ladbury
- Department of Radiation Oncology, City of Hope Cancer Center, Duarte, California, USA
| | - Thomas Bickett
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jessica D McDermott
- Department of Medical Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - William Stokes
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Weeks KS, Lynch CF, Pagedar N. Trends in Cancer Treatment for Oral Cavity, Oropharynx, and Larynx in 2016 Versus 2009: SEER Patterns of Care Studies. Ann Otol Rhinol Laryngol 2021; 131:629-639. [PMID: 34365844 DOI: 10.1177/00034894211037194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine if there was a higher percentage of patients treated surgically and with advanced radiotherapy in 2016 (N = 897) versus 2009 (N = 1136), the patient and tumor characteristics associated with surgical care and advanced radiotherapy, and if chemotherapy or targeted agent use varied over time for squamous cell carcinoma of the head and neck. METHODS We utilized Surveillance Epidemiology and End Results Patterns of Care datasets. Rao-Scott Chi-square tests and logistic regressions were applied to determine differences in surgery, advanced radiotherapy (RT), and chemotherapy by year. RESULTS There was a lower prevalence of surgery only treatment in 2016 versus 2009 with exception of oral cavity stages IVB/IVC and unknown, and larynx stage unknown. Advanced RT was more common in 2016 for patients receiving definitive RT among all sites, excluding stages I/II glottic larynx. Among each site (oral cavity, oropharynx, and larynx) lower stage was associated with increased odds of surgery. Among each site, advanced RT was more common in patients receiving definitive versus postoperative RT. For the larynx site, 2016 versus 2009 was associated with greater odds of advanced RT. Systemic treatment with fluorouracil, taxanes, or cetuximab was less prevalent in 2016. CONCLUSION In 2016 versus 2009, there was largely not a higher percentage of patients treated surgically. There was a higher prevalence of advanced RT for definitive care. Further investigations of these patterns are needed, including trend analysis.
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Affiliation(s)
- Kristin S Weeks
- Medical Scientist Training Program, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Charles F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Nitin Pagedar
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, USA
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Ma Z, Umezawa R, Yamamoto T, Ishikawa Y, Takahashi N, Takeda K, Suzuki Y, Tang L, Ito K, Kadoya N, Jingu K. IMRT improves local control in patients with nasopharyngeal carcinoma compared with conventional radiotherapy: propensity score-matched analysis. Jpn J Clin Oncol 2021; 51:1444-1451. [PMID: 34250545 DOI: 10.1093/jjco/hyab100] [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: 04/14/2021] [Accepted: 06/15/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND It is still controversial whether intensity-modulated radiotherapy has an obvious advantage over conventional radiotherapy. The purposes of this study were to evaluate prognostic factors in pre-treatment characteristics for nasopharyngeal carcinoma and to compare treatment outcomes in patients who received intensity-modulated radiotherapy and patients who received two-dimensional radiotherapy or three-dimensional radiotherapy. METHODS We reviewed patients with nasopharyngeal carcinoma who received chemoradiotherapy in our hospital during the period from 2000 to 2017, and we excluded patients who had a history of surgery for nasopharyngeal carcinoma and those who had distant metastases before treatment. A total of 72 patients who were treated by radiotherapy with concurrent chemotherapy were enrolled. All of the patients were irradiated with a total dose of 58-70 Gy. Overall survival, locoregional control and progression-free survival rates were compared in the groups treated by intensity-modulated radiotherapy and two-dimensional/three-dimensional radiotherapy. Propensity score matching was performed to homogenize the two groups. RESULTS The median follow-up period was 62.5 months. After propensity score matching, in patients treated with intensity-modulated radiotherapy, the 5-year rate of overall survival, locoregional control and progression-free survival were 73.5, 95.2 and 72.7%, respectively. In patients treated with two-dimensional/three-dimensional radiotherapy, the 5-year rate of overall survival, locoregional control and progression-free survival were 69.1, 67.7 and 51.8%, respectively. There was a significant difference between the groups only in locoregional control. Late toxicities of grade 2 or higher were occurred in 38.5 and 24.2% of the patients treated by two-dimensional/three-dimensional radiotherapy and intensity-modulated radiotherapy, respectively. CONCLUSIONS Our results suggested that intensity-modulated radiotherapy is more effective than two-dimensional/three-dimensional radiotherapy in patients with nasopharyngeal carcinoma, especially in locoregional control.
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Affiliation(s)
- Zichang Ma
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yojiro Ishikawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuya Takeda
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yu Suzuki
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Liuwei Tang
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kengo Ito
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Cha E, Elguindi S, Onochie I, Gorovets D, Deasy JO, Zelefsky M, Gillespie EF. Clinical implementation of deep learning contour autosegmentation for prostate radiotherapy. Radiother Oncol 2021; 159:1-7. [DOI: 10.1016/j.radonc.2021.02.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/29/2021] [Accepted: 02/24/2021] [Indexed: 12/17/2022]
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Heilbroner SP, Xanthopoulos EP, Buono D, Carrier D, Durkee BY, Corradetti M, Wang TJC, Neugut AI, Hershman DL, Cheng SK. Efficacy and cost of high-frequency IGRT in elderly stage III non-small-cell lung cancer patients. PLoS One 2021; 16:e0252053. [PMID: 34043677 PMCID: PMC8158910 DOI: 10.1371/journal.pone.0252053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 05/07/2021] [Indexed: 11/19/2022] Open
Abstract
Background High-frequency image-guided radiotherapy (hfIGRT) is ubiquitous but its benefits are unproven. We examined the cost effectiveness of hfIGRT in stage III non-small-cell lung cancer (NSCLC). Methods We selected stage III NSCLC patients ≥66 years old who received definitive radiation therapy from the Surveillance, Epidemiology, and End-Results-Medicare database. Patients were stratified by use of hfIGRT using Medicare claims. Predictors for hfIGRT were calculated using a logistic model. The impact of hfIGRT on lung toxicity free survival (LTFS), esophageal toxicity free survival (ETFS), cancer-specific survival (CSS), overall survival (OS), and cost of treatment was calculated using Cox regressions, propensity score matching, and bootstrap methods. Results Of the 4,430 patients in our cohort, 963 (22%) received hfIGRT and 3,468 (78%) did not. By 2011, 49% of patients were receiving hfIGRT. Predictors of hfIGRT use included treatment with intensity-modulated radiotherapy (IMRT) (OR = 7.5, p < 0.01), recent diagnosis (OR = 51 in 2011 versus 2006, p < 0.01), and residence in regions where the Medicare intermediary allowed IMRT (OR = 1.50, p < 0.01). hfIGRT had no impact on LTFS (HR 0.97; 95% CI 0.86–1.09), ETFS (HR 1.05; 95% CI 0.93–1.18), CSS (HR 0.94; 95% CI 0.84–1.04), or OS (HR 0.95; 95% CI 0.87–1.04). Mean radiotherapy and total medical costs six months after diagnosis were $17,330 versus $15,024 (p < 0.01) and $71,569 versus $69,693 (p = 0.49), respectively. Conclusion hfIGRT did not affect clinical outcomes in elderly patients with stage III NSCLC but did increase radiation cost. hfIGRT deserves further scrutiny through a randomized controlled trial.
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Affiliation(s)
- Samuel P. Heilbroner
- Department of Radiation Oncology, New York Presbyterian Hospital, New York, New York, United States of America
| | - Eric P. Xanthopoulos
- University of Wisconsin - Beloit Health Cancer Center, Beloit, Wisconsin, United States of America
| | - Donna Buono
- Herbert Irving Comprehensive Cancer Center, New York, New York, United States of America
| | - Daniel Carrier
- Department of Radiation Oncology, New York Presbyterian Hospital, New York, New York, United States of America
| | - Ben Y. Durkee
- Department of Radiation Oncology, University of Wisconsin–Madison, Madison, Wisconsin, United States of America
| | | | - Tony J. C. Wang
- Department of Radiation Oncology, New York Presbyterian Hospital, New York, New York, United States of America
| | - Alfred I. Neugut
- Herbert Irving Comprehensive Cancer Center, New York, New York, United States of America
| | - Dawn L. Hershman
- Herbert Irving Comprehensive Cancer Center, New York, New York, United States of America
| | - Simon K. Cheng
- Department of Radiation Oncology, New York Presbyterian Hospital, New York, New York, United States of America
- * E-mail:
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Sherer MV, Lin D, Elguindi S, Duke S, Tan LT, Cacicedo J, Dahele M, Gillespie EF. Metrics to evaluate the performance of auto-segmentation for radiation treatment planning: A critical review. Radiother Oncol 2021; 160:185-191. [PMID: 33984348 DOI: 10.1016/j.radonc.2021.05.003] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/01/2021] [Accepted: 05/03/2021] [Indexed: 12/18/2022]
Abstract
Advances in artificial intelligence-based methods have led to the development and publication of numerous systems for auto-segmentation in radiotherapy. These systems have the potential to decrease contour variability, which has been associated with poor clinical outcomes and increased efficiency in the treatment planning workflow. However, there are no uniform standards for evaluating auto-segmentation platforms to assess their efficacy at meeting these goals. Here, we review the most frequently used evaluation techniques which include geometric overlap, dosimetric parameters, time spent contouring, and clinical rating scales. These data suggest that many of the most commonly used geometric indices, such as the Dice Similarity Coefficient, are not well correlated with clinically meaningful endpoints. As such, a multi-domain evaluation, including composite geometric and/or dosimetric metrics with physician-reported assessment, is necessary to gauge the clinical readiness of auto-segmentation for radiation treatment planning.
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Affiliation(s)
- Michael V Sherer
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, United States
| | - Diana Lin
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Sharif Elguindi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Simon Duke
- Department of Oncology, Cambridge University Hospitals, United Kingdom
| | - Li-Tee Tan
- Department of Oncology, Cambridge University Hospitals, United Kingdom
| | - Jon Cacicedo
- Department of Radiation Oncology, Cruces University Hospital/BioCruces Health Research Institute, Osakidetza, Barakaldo, Spain
| | - Max Dahele
- Department of Radiation Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Erin F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, United States.
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Chamberlain M, Krayenbuehl J, van Timmeren JE, Wilke L, Andratschke N, Garcia Schüler H, Tanadini-Lang S, Guckenberger M, Balermpas P. Head and neck radiotherapy on the MR linac: a multicenter planning challenge amongst MRIdian platform users. Strahlenther Onkol 2021; 197:1093-1103. [PMID: 33891126 PMCID: PMC8604891 DOI: 10.1007/s00066-021-01771-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/22/2021] [Indexed: 11/30/2022]
Abstract
Purpose Purpose of this study is to evaluate plan quality on the MRIdian (Viewray Inc., Oakwood Village, OH, USA) system for head and neck cancer (HNC) through comparison of planning approaches of several centers. Methods A total of 14 planners using the MRIdian planning system participated in this treatment challenge, centrally organized by ViewRay, for one contoured case of oropharyngeal carcinoma with standard constraints for organs at risk (OAR). Homogeneity, conformity, sparing of OARs, and other parameters were evaluated according to The International Commission on Radiation Units and Measurements (ICRU) recommendations anonymously, and then compared between centers. Differences amongst centers were assessed by means of Wilcoxon test. Each plan had to fulfil hard constraints based on dose–volume histogram (DVH) parameters and delivery time. A plan quality metric (PQM) was evaluated. The PQM was defined as the sum of 16 submetrics characterizing different DVH goals. Results For most dose parameters the median score of all centers was higher than the threshold that results in an ideal score. Six participants achieved the maximum number of points for the OAR dose parameters, and none had an unacceptable performance on any of the metrics. Each planner was able to achieve all the requirements except for one which exceeded delivery time. The number of segments correlated to improved PQM and inversely correlated to brainstem D0.1cc and to Planning Target Volume1 (PTV) D0.1cc. Total planning experience inversely correlated to spinal canal dose. Conclusion Magnetic Resonance Image (MRI) linac-based planning for HNC is already feasible with good quality. Generally, an increased number of segments and increasing planning experience are able to provide better results regarding planning quality without significantly prolonging overall treatment time. Supplementary Information The online version of this article (10.1007/s00066-021-01771-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Madalyne Chamberlain
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
| | - Jerome Krayenbuehl
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | | | - Lotte Wilke
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | | | | | | | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
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Estimation of monitor unit through analytical method for dynamic IMRT using control points as an effective parameter. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396921000017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Introduction:
The control points (CP) play a significant role in the delivery of segmented based Intensity-Modulated Radiation Therapy (IMRT) delivery, particularly in dynamic mode. The number of segments is determined by control points and these segments will transfer from one to the other either during beam ON called dynamic delivery or during beam OFF called static delivery or step and shoot. This study was aimed at indirect estimation of the total monitor units (MU) to be delivered per field by exploiting the control points and also to find the MUs at any nth segment.
Materials and methods:
This study was performed in the Eclipse treatment planning software version 13.8.0. The details of control points, metre set weight per segment, leaf positions for each segment, field size, etc. were taken into consideration.
Results:
TPS calculated MU value and analytically estimated MU value were compared and the percentage of difference was estimated. The overall mean percentage of deviation was 1·03% between the TPS calculated method and the analytical method. The paired sample t-test was performed and, p-value <0·05, no significant difference was found. The analytical relationship determined to estimate the total number of MU delivered for any nth control point was also evaluated.
Conclusion:
The control points are a potential parameter in the conventional IMRT delivery. Through this study, we have addressed the indirect method to estimate the monitor units delivered per segment.
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Xiang M, Gensheimer MF, Pollom EL, Holsinger FC, Colevas AD, Le QT, Beadle BM. Prolongation of definitive head and neck cancer radiotherapy: Survival impact and predisposing factors. Radiother Oncol 2020; 156:201-208. [PMID: 33383061 DOI: 10.1016/j.radonc.2020.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE To quantify the survival impact of prolongation of definitive radiotherapy (RT) for head and neck cancer in a national, modern cohort, and to identify predictive factors for prolongation. MATERIALS AND METHODS The National Cancer Database was queried for adults with non-metastatic cancer of the nasopharynx, oropharynx, larynx, or hypopharynx diagnosed 2004-2015, treated with definitive RT to 66-70 Gy in 30-35 fractions at 2-2.2 Gy per fraction. Multivariable Cox regression and propensity score matching were used to model the survival impact of RT prolongation, adjusting for potential confounders such as age and comorbidity. Predictors of RT prolongation were identified using multivariable multinomial logistic regression. RESULTS In total, 36,367 patients were identified. As a continuous variable, RT prolongation increased the relative hazard of death by 2% per day (P < .0001). In the matched cohorts, patients with short (4-8 days) or long prolongation (>8 days) had lower absolute 4-year overall survival by 4% and 12%, respectively (P < .0001), while prolongation of 1-3 days was not significantly adverse. Major predictors of increased risk of prolongation were administration of systemic therapy, baseline comorbidity, lack of private insurance, and tumor/nodal stage. Conversely, higher facility volume was significantly protective, with a 55% lower risk of long prolongation within the topmost quartile (>11.5 patients/year). CONCLUSION RT prolongation, especially >8 days, is significantly deleterious. Systemic therapy and facility volume were major predictors. Early identification of patients at increased risk of treatment interruptions may facilitate implementation of preventive measures.
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Affiliation(s)
- Michael Xiang
- Radiation Oncology, University of California, Los Angeles, United States; Palo Alto Veterans Affairs Hospital, United States
| | | | - Erqi L Pollom
- Radiation Oncology, Stanford University, United States; Palo Alto Veterans Affairs Hospital, United States
| | | | | | - Quynh-Thu Le
- Radiation Oncology, Stanford University, United States
| | - Beth M Beadle
- Radiation Oncology, Stanford University, United States.
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Zhang H, Cha EE, Lynch K, Cahlon O, Gomez DR, Shaverdian N, Gillespie EF. Radiation Oncologist Perceptions of Telemedicine from Consultation to Treatment Planning: A Mixed-Methods Study. Int J Radiat Oncol Biol Phys 2020; 108:421-429. [PMID: 32890525 PMCID: PMC7462757 DOI: 10.1016/j.ijrobp.2020.07.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/04/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Telemedicine was rapidly implemented for initial consultations and radiation treatment planning in the wake of the coronavirus disease 2019 (COVID-19) pandemic. In this study, we explore utilization of and physician perspectives on this approach in an attempt to identify patient populations that may benefit most from virtual care. METHODS AND MATERIALS This is a mixed-methods study with a convergent design. Approximately 6 to 8 weeks after implementation of telemedicine, all radiation oncologists in a single academic radiation oncology department were invited to participate in either semistructured interviews with embedded survey questions or a concurrently administered survey only. Rapid qualitative analysis was used to identify common themes, and quantitative data was assessed using descriptive statistics and univariable analyses. RESULTS At the apex of the pandemic, 92% of radiation oncology visits were conducted via telemedicine. In total, 51 of 61 radiation oncologists participated in the study (response rate 84%). Most (71%) reported no difference in ability to treat cancer appropriately via telemedicine, which was more common among specialized physicians (P = .01) but not those with higher visit volume or years of experience. Over half (55%) perceived no difference or even improvement in overall visit quality with telemedicine. Virtual visits were deemed acceptable for a median of 70% to 96% of patients, which varied by disease site. Need for physical examination, and availability of an acceptable proxy, factored into telemedicine acceptability. Most (88%) found telemedicine better than expected, but opinions were split on how telemedicine would affect physician burnout. Almost all (96%) foresaw a role for telemedicine beyond the pandemic and would opt for a median of 50% (interquartile range 20%-66%) of visits conducted via telemedicine. CONCLUSIONS Among radiation oncologists in an academic setting, telemedicine was perceived to be highly appropriate and acceptable for most patients. Future studies should focus on identifying the 5% to 30% of patients whose care may be optimized with in-person visits, and if there is alignment with patient preferences.
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Affiliation(s)
- Helen Zhang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elaine E Cha
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kathleen Lynch
- Department of Psychiatry and Behavioral Science, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Oren Cahlon
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Narek Shaverdian
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erin F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York; Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, New York.
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Lai TY, Yeh CM, Hu YW, Liu CJ. Hospital volume and physician volume in association with survival in patients with nasopharyngeal cancer after radiation therapy. Radiother Oncol 2020; 151:190-199. [DOI: 10.1016/j.radonc.2020.07.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/23/2020] [Accepted: 07/23/2020] [Indexed: 02/08/2023]
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Sullivan CB, Al-Qurayshi Z, Anderson CM, Seaman AT, Pagedar NA. Factors Associated With the Choice of Radiation Therapy Treatment Facility in Head and Neck Cancer. Laryngoscope 2020; 131:1019-1025. [PMID: 32846018 DOI: 10.1002/lary.29033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/15/2020] [Accepted: 07/29/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To analyze the clinicodemographic characteristics and treatment outcomes of patients receiving postoperative radiation therapy (PORT) at a different treatment facility rather than the initial surgical facility for head and neck cancer. STUDY DESIGN Retrospective cohort analysis. METHODS Utilizing the National Cancer Data Base, 2004 to 2015, patients with a diagnosis of oral cavity/oropharyngeal, hypopharyngeal, and laryngeal squamous cell carcinoma were studied. Multivariate analysis was completed with multivariate regression and Cox proportional hazard model, and survival outcomes were examined using Kaplan-Meier analysis. RESULTS A total of 15,181 patients who had surgery for a head and neck cancer at an academic/research center were included in the study population. Of the study population, 4,890 (32.2%) patients completed PORT at a different treatment facility. Treatment at a different facility was more common among patients who were ≥65 years old, white, Medicare recipients, those with a greater distance between residence and surgical treatment facility, and with lower income within area of residence (each P < .05). Overall survival was worse in patients completing PORT at a different treatment facility versus at the institution where surgery was completed (61.9% vs. 66.4%; P = .002). CONCLUSIONS PORT at a different facility was more common in older individuals, Medicare recipients, those with greater distance to travel, and lower-income individuals. Completing PORT outside the hospital where surgery was performed was associated with inferior survival outcomes among head and neck cancer patients. LEVEL OF EVIDENCE 3 Laryngoscope, 131:1019-1025, 2021.
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Affiliation(s)
- Christopher B Sullivan
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Zaid Al-Qurayshi
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Carryn M Anderson
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Aaron T Seaman
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Nitin A Pagedar
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
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Teitelbaum JI, Issa K, Barak IR, Ackall FY, Jung SH, Jang DW, Abi Hachem R. Sinonasal Squamous Cell Carcinoma Outcomes: Does Treatment at a High-Volume Center Confer Survival Benefit? Otolaryngol Head Neck Surg 2020; 163:986-991. [DOI: 10.1177/0194599820935395] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective To determine whether treatment of sinonasal squamous cell carcinoma (SCC) at a high-volume facility affects survival. Study Design Retrospective database analysis. Setting National Cancer Database (2004-2014). Subjects and Methods The National Cancer Database was queried for sinonasal SCC from 2004 to 2014. Patient demographics, tumor characteristics and classification, resection margins, treatment regimen, and facility case-specific volume—averaged per year and grouped in tertiles as low (0%-33%), medium (34%-66%), and high (67%-100%)—were compared. Overall survival was compared with Cox proportional hazards regression analysis. Results A total of 3835 patients treated for sinonasal SCC between 2004 and 2014 were identified. Therapeutic options included surgery alone (18.6%), radiotherapy (RT) alone (29.1%), definitive chemoradiation (15.4%), surgery with adjuvant RT (22.8%), and combinations (14.1%) of the aforementioned treatments. Patients who underwent surgery with adjuvant RT had better overall survival (hazard ratio [HR], 0.74; P < .001; 95% CI, 0.63-0.86). As for treatment volume per facility, 7.4% of patients were treated at a low-volume center, 17.5% at a medium-volume center, and 75.1% at a high-volume center. Univariate analysis showed that treatment at a high-volume facility conferred a significantly better overall survival (HR, 0.77; P = .002). Multivariable Cox proportional hazards regression analysis, adjusting for age, sex, tumor classification, and treatment regimen, demonstrated that patients who underwent treatment at a high-volume facility (HR, 0.81; P < .001) had significantly improved survival. Conclusion This study shows a better overall survival for sinonasal SCC treated at high-volume centers. Further study may be needed to understand the effect of case volume on the paradigms of sinonasal SCC management.
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Affiliation(s)
- Jordan I. Teitelbaum
- Division of Rhinology and Skull Base Surgery, Department of Head and Neck Surgery and Communication Sciences, Duke University Health System, Durham, North Carolina, USA
| | - Khalil Issa
- Division of Rhinology and Skull Base Surgery, Department of Head and Neck Surgery and Communication Sciences, Duke University Health System, Durham, North Carolina, USA
| | - Ian R. Barak
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Feras Y. Ackall
- Division of Rhinology and Skull Base Surgery, Department of Head and Neck Surgery and Communication Sciences, Duke University Health System, Durham, North Carolina, USA
| | - Sin-Ho Jung
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - David W. Jang
- Division of Rhinology and Skull Base Surgery, Department of Head and Neck Surgery and Communication Sciences, Duke University Health System, Durham, North Carolina, USA
| | - Ralph Abi Hachem
- Division of Rhinology and Skull Base Surgery, Department of Head and Neck Surgery and Communication Sciences, Duke University Health System, Durham, North Carolina, USA
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Margalit DN, Karam SD, Chua MLK, Anderson C, Kimple RJ. Four Influential Clinical Trials in Human Papilloma Virus-Associated Oropharynx Cancer. Int J Radiat Oncol Biol Phys 2020; 106:893-899. [PMID: 32171456 DOI: 10.1016/j.ijrobp.2019.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/16/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Danielle N Margalit
- Department of Radiation Oncology, Head and Neck Oncology Program, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts.
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado School of Medicine, Denver, Colorado
| | - Melvin L K Chua
- Division of Radiation Oncology and Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - Carryn Anderson
- Department of Radiation Oncology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Randall J Kimple
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Gamez ME, Blakaj A, Zoller W, Bonomi M, Blakaj DM. Emerging Concepts and Novel Strategies in Radiation Therapy for Laryngeal Cancer Management. Cancers (Basel) 2020; 12:cancers12061651. [PMID: 32580375 PMCID: PMC7352689 DOI: 10.3390/cancers12061651] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 12/19/2022] Open
Abstract
Laryngeal squamous cell carcinoma is the second most common head and neck cancer. Its pathogenesis is strongly associated with smoking. The management of this disease is challenging and mandates multidisciplinary care. Currently, accepted treatment modalities include surgery, radiation therapy, and chemotherapy—all focused on improving survival while preserving organ function. Despite changes in smoking patterns resulting in a declining incidence of laryngeal cancer, the overall outcomes for this disease have not improved in the recent past, likely due to changes in treatment patterns and treatment-related toxicities. Here, we review emerging concepts and novel strategies in the use of radiation therapy in the management of laryngeal squamous cell carcinoma that could improve the relationship between tumor control and normal tissue damage (therapeutic ratio).
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Affiliation(s)
- Mauricio E. Gamez
- Division of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (W.Z.); (D.M.B.)
- Correspondence:
| | - Adriana Blakaj
- Department of Therapeutic Radiology, Yale School of Medicine, 35 Park St., New Haven, CT 06519, USA;
| | - Wesley Zoller
- Division of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (W.Z.); (D.M.B.)
| | - Marcelo Bonomi
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Wexner Medical Center, 320 West 10th Avenue, Columbus, OH 43210, USA;
| | - Dukagjin M. Blakaj
- Division of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (W.Z.); (D.M.B.)
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Anakwenze CP, McGovern S, Taku N, Liao K, Boyce-Fappiano DR, Kamiya-Matsuoka C, Ghia A, Chung C, Trifiletti D, Ferguson SD, Li J, Yeboa DN. Association Between Facility Volume and Overall Survival for Patients with Grade II Meningioma after Gross Total Resection. World Neurosurg 2020; 141:e133-e144. [PMID: 32407910 DOI: 10.1016/j.wneu.2020.05.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The role of adjuvant radiation after gross total resection (GTR) for grade II meningioma is evolving, prompting further evaluation in NRG-BN003, a phase 3 national trial. Furthermore, the relationship between facility volume and outcomes in patients with grade II meningioma after GTR has not been examined at a national level. We aim to assess overall survival (OS) of patients with grade II meningioma after GTR by surgical case volume and OS by receipt of adjuvant radiation. METHODS We used the National Cancer Database to identity 2823 patients diagnosed with grade II meningioma who underwent GTR. Propensity score matching was applied to balance covariates in patients with grade II meningioma after GTR stratified by adjuvant radiation status. Multivariable logistic regression was used to assess factors associated with radiation receipt. Kaplan-Meier and log-rank tests were used to assess OS by facility volume. RESULTS As facility volume increased, OS increased, with a 5-year OS of 72.8% for facilities with GTR grade II meningioma volumes of ≤8 cases per decade and 87.5% for >8 cases per decade (P < 0.0001). There was no difference in 5-year OS between GTR alone and GTR with adjuvant radiation (84.8% vs. 86.4%; P = 0.151). Covariates significantly associated with radiation receipt included facility location, facility volume, distance, and tumor size. CONCLUSIONS Treatment at higher surgical case volume facilities is associated with improved OS for GTR grade II meningioma. These facilities also have more patients receiving adjuvant radiation. However, we observed no difference in OS between adjuvant radiation and surgery alone.
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Affiliation(s)
- Chidinma P Anakwenze
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Susan McGovern
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nicolette Taku
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kaiping Liao
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David R Boyce-Fappiano
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carlos Kamiya-Matsuoka
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amol Ghia
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Caroline Chung
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Daniel Trifiletti
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Sherise D Ferguson
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jing Li
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Debra Nana Yeboa
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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