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Salari E, Wang J, Wynne JF, Chang CW, Wu Y, Yang X. Artificial intelligence-based motion tracking in cancer radiotherapy: A review. J Appl Clin Med Phys 2024:e14500. [PMID: 39194360 DOI: 10.1002/acm2.14500] [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: 09/15/2023] [Revised: 07/13/2024] [Accepted: 07/27/2024] [Indexed: 08/29/2024] Open
Abstract
Radiotherapy aims to deliver a prescribed dose to the tumor while sparing neighboring organs at risk (OARs). Increasingly complex treatment techniques such as volumetric modulated arc therapy (VMAT), stereotactic radiosurgery (SRS), stereotactic body radiotherapy (SBRT), and proton therapy have been developed to deliver doses more precisely to the target. While such technologies have improved dose delivery, the implementation of intra-fraction motion management to verify tumor position at the time of treatment has become increasingly relevant. Artificial intelligence (AI) has recently demonstrated great potential for real-time tracking of tumors during treatment. However, AI-based motion management faces several challenges, including bias in training data, poor transparency, difficult data collection, complex workflows and quality assurance, and limited sample sizes. This review presents the AI algorithms used for chest, abdomen, and pelvic tumor motion management/tracking for radiotherapy and provides a literature summary on the topic. We will also discuss the limitations of these AI-based studies and propose potential improvements.
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Affiliation(s)
- Elahheh Salari
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Jing Wang
- Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jacob Frank Wynne
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Chih-Wei Chang
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Yizhou Wu
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Xiaofeng Yang
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
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Li X, Wang H, Xu L, Kuang Y. PET/SPECT/Spectral-CT/CBCT imaging in a small-animal radiation therapy platform: A Monte Carlo study-Part II: Biologically guided radiotherapy. Med Phys 2024; 51:3619-3634. [PMID: 38517359 DOI: 10.1002/mp.17036] [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: 08/17/2023] [Revised: 01/18/2024] [Accepted: 03/05/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND This study addresses the technical gap between clinical radiation therapy (RT) and preclinical small-animal RT, hindering the comprehensive validation of innovative clinical RT approaches in small-animal models of cancer and the translation of preclinical RT studies into clinical practices. PURPOSE The main aim was to explore the feasibility of biologically guided RT implemented within a small-animal radiation therapy (SART) platform, with integrated quad-modal on-board positron emission tomography (PET), single-photon emission computed tomography, photon-counting spectral CT, and cone-beam CT (CBCT) imaging, in a Monte Carlo model as a proof-of-concept. METHODS We developed a SART workflow employing quad-modal imaging guidance, integrating multimodal image-guided RT and emission-guided RT (EGRT). The EGRT algorithm was outlined using positron signals from a PET radiotracer, enabling near real-time adjustments to radiation treatment beams for precise targeting in the presence of a 2-mm setup error. Molecular image-guided RT, incorporating a dose escalation/de-escalation scheme, was demonstrated using a simulated phantom with a dose painting plan. The plan involved delivering a low dose to the CBCT-delineated planning target volume (PTV) and a high dose boosted to the highly active biological target volume (hBTV) identified by the 18F-PET image. Additionally, the Bayesian eigentissue decomposition method illustrated the quantitative decomposition of radiotherapy-related parameters, specifically iodine uptake fraction and virtual noncontrast (VNC) electron density, using a simulated phantom with Kidney1 and Liver2 inserts mixed with an iodine contrast agent at electron fractions of 0.01-0.02. RESULTS EGRT simulations generated over 4,000 beamlet responses in dose slice deliveries and illustrated superior dose coverage and distribution with significantly lower doses delivered to normal tissues, even with a 2-mm setup error introduced, demonstrating the robustness of the novel EGRT scheme compared to conventional image-guided RT. In the dose-painting plan, doubling the dose to the hBTV while maintaining a low dose for the PTV resulted in an organ-at-risk (OAR) dose comparable to the low-dose treatment for the PTV alone. Furthermore, the decomposition of radiotherapy-related parameters in Kidney1 and Liver2 inserts, including iodine uptake fractions and VNC electron densities, exhibited average relative errors of less than 1.0% and 2.5%, respectively. CONCLUSIONS The results demonstrated the successful implementation of biologically guided RT within the proposed quad-model image-guided SART platform, with potential applications in preclinical RT and adaptive RT studies.
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Affiliation(s)
- Xiadong Li
- Medical Imaging and Translational Medicine laboratory, Department of Radiotherapy, Affiliated Hangzhou Cancer Hospital, Westlake University School of Medicine, Hangzhou, Zhejiang, China
| | - Hui Wang
- Medical Imaging and Translational Medicine laboratory, Department of Radiotherapy, Affiliated Hangzhou Cancer Hospital, Westlake University School of Medicine, Hangzhou, Zhejiang, China
- Medical Physics Program, University of Nevada, Las Vegas, Nevada, USA
| | - Lixia Xu
- Medical Imaging and Translational Medicine laboratory, Department of Radiotherapy, Affiliated Hangzhou Cancer Hospital, Westlake University School of Medicine, Hangzhou, Zhejiang, China
| | - Yu Kuang
- Medical Physics Program, University of Nevada, Las Vegas, Nevada, USA
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Shimomura A, Wu T, Rusu I, Kishan AU, Tree AC, Solanki AA, Liauw SL. Monitoring Intrafraction Motion of the Prostate During Radiation Therapy: Suggested Practice Points From a Focused Review. Pract Radiat Oncol 2024; 14:146-153. [PMID: 37875222 DOI: 10.1016/j.prro.2023.08.017] [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: 02/27/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE External beam radiation therapy to the prostate is typically delivered after verification of prostatic position with image guidance. Prostate motion can occur during the delivery of each radiation treatment between the time of localization imaging and completion of treatment. The objective of this work is to review the literature on intrafraction motion (IFM) of the prostate during radiation therapy and offer clinical recommendations on management. METHODS AND MATERIALS A comprehensive literature review was conducted on prostate motion during prostate cancer radiation therapy. Information was organized around 3 key clinical questions, followed by an evidence-based recommendation. RESULTS IFM of the prostate during radiation therapy is typically ≤3 mm and is unlikely to compromise prostate dosimetry to a clinically meaningful degree for men treated in a relatively short treatment duration with planning target volume (PTV) margins of ≥3 to 5 mm. IFM of 5 mm or more has been observed in up to ∼10% of treatment fractions, with limited dosimetric effect related to the infrequency of occurrence and longer fractionation of therapy. IFM can be monitored in continuous or discontinuous fashion with a variety of imaging platforms. Correction of IFM may have the greatest value when tighter PTV margins are desired (such as with stereotactic body radiation therapy or intraprostatic nodule boosting), ultrahypofractionated courses, or when treatment time exceeds several minutes. CONCLUSIONS This focused review summarizes literature and provides practical recommendations regarding IFM in the treatment of prostate cancer with external beam radiation therapy.
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Affiliation(s)
- Aoi Shimomura
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, Illinois
| | - Tianming Wu
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, Illinois
| | - Iris Rusu
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, Illinois
| | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, California
| | - Alison C Tree
- The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Division of Radiotherapy and Imaging, Institute of Cancer Research, Sutton, United Kingdom
| | - Abhishek A Solanki
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, Illinois
| | - Stanley L Liauw
- Department of Radiation and Cellular Oncology, University of Chicago Medicine, Chicago, Illinois.
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Fink CA, Buchele C, Baumann L, Liermann J, Hoegen P, Ristau J, Regnery S, Sandrini E, König L, Rippke C, Bonekamp D, Schlemmer HP, Debus J, Koerber SA, Klüter S, Hörner-Rieber J. Dosimetric benefit of online treatment plan adaptation in stereotactic ultrahypofractionated MR-guided radiotherapy for localized prostate cancer. Front Oncol 2024; 14:1308406. [PMID: 38425342 PMCID: PMC10902126 DOI: 10.3389/fonc.2024.1308406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
Background Apart from superior soft tissue contrast, MR-guided stereotactic body radiation therapy (SBRT) offers the chance for daily online plan adaptation. This study reports on the comparison of dose parameters before and after online plan adaptation in MR-guided SBRT of localized prostate cancer. Materials and methods 32 consecutive patients treated with ultrahypofractionated SBRT for localized prostate cancer within the prospective SMILE trial underwent a planning process for MR-guided radiotherapy with 37.5 Gy applied in 5 fractions. A base plan, derived from MRI simulation at an MRIdian Linac, was registered to daily MRI scans (predicted plan). Following target and OAR recontouring, the plan was reoptimized based on the daily anatomy (adapted plan). CTV and PTV coverage and doses at OAR were compared between predicted and adapted plans using linear mixed regression models. Results In 152 out of 160 fractions (95%), an adapted radiation plan was delivered. Mean CTV and PTV coverage increased by 1.4% and 4.5% after adaptation. 18% vs. 95% of the plans had a PTV coverage ≥95% before and after online adaptation, respectively. 78% vs. 100% of the plans had a CTV coverage ≥98% before and after online adaptation, respectively. The D0.2cc for both bladder and rectum were <38.5 Gy in 93% vs. 100% before and after online adaptation. The constraint at the urethra with a dose of <37.5 Gy was achieved in 59% vs. 93% before and after online adaptation. Conclusion Online adaptive plan adaptation improves target volume coverage and reduces doses to OAR in MR-guided SBRT of localized prostate cancer. Online plan adaptation could potentially further reduce acute and long-term side effects and improve local failure rates in MR-guided SBRT of localized prostate cancer.
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Affiliation(s)
- Christoph A. Fink
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Carolin Buchele
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Lukas Baumann
- Institute of Medical Biometry (IMBI), University of Heidelberg, Heidelberg, Germany
| | - Jakob Liermann
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Philipp Hoegen
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jonas Ristau
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Sebastian Regnery
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Elisabetta Sandrini
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Carolin Rippke
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - David Bonekamp
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Side Heidelberg, Heidelberg, Germany
| | | | - Juergen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Side Heidelberg, Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan A. Koerber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Department of Radiation Oncology, Barmherzige Brueder Hospital Regensburg, Regensburg, Germany
| | - Sebastian Klüter
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Bae BK, Kim JE, Pyo H, Hong SN, Park W. Long-term findings of rectal endoscopy and rectal bleeding after moderately hypofractionated, intensity-modulated radiotherapy for prostate cancer. Sci Rep 2023; 13:22099. [PMID: 38092835 PMCID: PMC10719280 DOI: 10.1038/s41598-023-43202-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 09/21/2023] [Indexed: 12/17/2023] Open
Abstract
To present rectal endoscopic findings and toxicity after definitive moderately hypofractionated, intensity-modulated radiotherapy (IMRT) for prostate cancer. We retrospectively reviewed patients who underwent IMRT for prostate cancer and underwent post-radiotherapy endoscopies between 2008 and 2018. Endoscopic findings were reviewed and graded using Vienna Rectoscopy Score (VRS). We have analyzed the association between endoscopic findings and rectal bleeding, and investigated risk factors for rectal bleeding. Total 162 patients met the inclusion criteria of this study. There was a trend of VRS worsening during the initial 3 years after radiotherapy followed by recovery. Rectal bleeding was highest at 1 year after radiotherapy and improved thereafter. The 5-year cumulative incidence of grade ≥ 2 rectal bleeding was 14.8%. In the multivariable Cox regression analysis, cardiovascular disease (hazard ratio [HR] 2.732, P = 0.037), rectal wall V65 (HR 1.158, P = 0.027), and VRS ≥ 3 in first post-radiotherapy endoscopy (HR 2.573, P = 0.031) were significant risk factors for rectal bleeding. After IMRT for prostate cancer, VRS and rectal bleeding worsened over 1-3 years after radiotherapy and recovered. Cardiovascular disease, rectal wall V65, and VRS ≥ 3 in first post-radiotherapy endoscopy were significant risk factors for rectal bleeding.
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Affiliation(s)
- Bong Kyung Bae
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Radiation Oncology, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Ji Eun Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hongryull Pyo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Noh Hong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Benitez CM, Steinberg ML, Cao M, Qi XS, Lamb JM, Kishan AU, Valle LF. MRI-Guided Radiation Therapy for Prostate Cancer: The Next Frontier in Ultrahypofractionation. Cancers (Basel) 2023; 15:4657. [PMID: 37760626 PMCID: PMC10526919 DOI: 10.3390/cancers15184657] [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: 07/30/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Technological advances in MRI-guided radiation therapy (MRIgRT) have improved real-time visualization of the prostate and its surrounding structures over CT-guided radiation therapy. Seminal studies have demonstrated safe dose escalation achieved through ultrahypofractionation with MRIgRT due to planning target volume (PTV) margin reduction and treatment gating. On-table adaptation with MRI-based technologies can also incorporate real-time changes in target shape and volume and can reduce high doses of radiation to sensitive surrounding structures that may move into the treatment field. Ongoing clinical trials seek to refine ultrahypofractionated radiotherapy treatments for prostate cancer using MRIgRT. Though these studies have the potential to demonstrate improved biochemical control and reduced side effects, limitations concerning patient treatment times and operational workflows may preclude wide adoption of this technology outside of centers of excellence. In this review, we discuss the advantages and limitations of MRIgRT for prostate cancer, as well as clinical trials testing the efficacy and toxicity of ultrafractionation in patients with localized or post-prostatectomy recurrent prostate cancer.
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Affiliation(s)
| | | | | | | | | | | | - Luca F. Valle
- Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095-6951, USA (X.S.Q.)
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Titone F, Restaino S, Moretti E, Vullo G, Poli A, Arcieri M, Paglietti C, Tonetto F, Parisi G, Barbui E, Trovò M, Scambia G, Driul L, Vizzielli G. Fiducial markers in adjuvant setting for a patient affected by endometrial cancer: a case report. Front Oncol 2023; 13:1174675. [PMID: 37711202 PMCID: PMC10498116 DOI: 10.3389/fonc.2023.1174675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 08/04/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction Intermediate-high and high-risk endometrial cancer often require adjuvant treatments such as radiotherapy (RT) or brachitherapy (BT) to reduce the risk of loco-regional relapse. Inter- and intra-fraction variability of internal pelvic anatomy are possibly the largest source of error affecting pelvic RT. The implantation of Fiducial Makers (FMs) in the vaginal cuff of patients receiving RT or BT could help patient daily setup, image guidance and intra-fraction detection of the radiation targets. Clinical case We have evaluated the case of an 80-year-old woman treated with surgery for endometrioid adenocarcinoma G2 (stage pT1b Nx LVSI+) who underwent adjuvant pelvic IMRT after the implantation of vaginal cuff FMs. CT-simulation Treatment Planning and IGRT strategy Patient underwent planning CT scan 10 days after FMs implantation. RT consisted of 45Gy in 25 daily fractions to pelvic lymph nodes and surgical bed with simultaneous integrated boost up to 52.5Gy to the vaginal cuff and the upper two-thirds of the vagina. Cone beam Computed Tomography (CBCT) was acquired prior to every RT fraction for IGRT. Bladder and rectum were re-contoured on every CBCTs. Bladder and rectal volumes and median shifts were reported on a prospective database to quantify the impact of the pelvic organ variations. Results The patient reported no discomfort during the FMs implantation, and no complications were seen. No evidence of FMs migration was reported. Bladder and rectal volumes planned contours were 245 and 55.3cc. Median bladder volumes for approved and "not acceptable" CBCTs were 222cc (range: 130-398) and 131cc (range: 65-326), respectively. Median rectal volumes for approved and "not acceptable" CBCTs were 75cc (range: 58-117) and 90cc (range: 54-189), respectively. The median values of the anterior-posterior, superior-inferior, lateral direction shifts were 3.4, 1.8 and 2.11 mm, respectively. Conclusion In our clinical case, the implantation of FMs in the vaginal cuff of a patient who underwent pelvic adjuvant RT was well tolerated and reported no complications. The use of IGRT procedures based on FMs surrogating the vaginal vault may reduce inter-observer variability and pave the way for adaptive strategies or stereotactic treatments as external beam pelvic boost in gynecological field.
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Affiliation(s)
- Francesca Titone
- Radiation Oncology Unit, Department of Oncology, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Stefano Restaino
- Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Eugenia Moretti
- Medical Physics Unit, Department of Oncology, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Gianluca Vullo
- Radiation Oncology Unit, Department of Oncology, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Alice Poli
- Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Martina Arcieri
- Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
- Department of Biomedical, Dental, Morphological and Functional Imaging Science, University of Messina, Messina, Italy
| | - Chiara Paglietti
- Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Fabrizio Tonetto
- Radiation Oncology Unit, Department of Oncology, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giuseppe Parisi
- Radiation Oncology Unit, Department of Oncology, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Elisa Barbui
- Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Marco Trovò
- Radiation Oncology Unit, Department of Oncology, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giovanni Scambia
- Dipartimento per le Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, Unità Operativa Complessa (UOC) Ginecologia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a carattere Scientifico (IRCCS), Rome, Italy
| | - Lorenza Driul
- Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Giuseppe Vizzielli
- Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
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Brown K, Ghita M, Prise KM, Butterworth KT. Feasibility and guidelines for the use of an injectable fiducial marker (BioXmark ®) to improve target delineation in preclinical radiotherapy studies using mouse models. F1000Res 2023; 12:526. [PMID: 38799243 PMCID: PMC11116939 DOI: 10.12688/f1000research.130883.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Preclinical models of radiotherapy (RT) response are vital for the continued success and evolution of RT in the treatment of cancer. The irradiation of tissues in mouse models necessitates high levels of precision and accuracy to recapitulate clinical exposures and limit adverse effects on animal welfare. This requirement has been met by technological advances in preclinical RT platforms established over the past decade. Small animal RT systems use onboard computed tomography (CT) imaging to delineate target volumes and have significantly refined radiobiology experiments with major 3Rs impacts. However, the CT imaging is limited by the differential attenuation of tissues resulting in poor contrast in soft tissues. Clinically, radio-opaque fiducial markers (FMs) are used to establish anatomical reference points during treatment planning to ensure accuracy beam targeting, this approach is yet to translate back preclinical models. METHODS We report on the use of a novel liquid FM BioXmark ® developed by Nanovi A/S (Kongens Lyngby, Denmark) that can be used to improve the visualisation of soft tissue targets during beam targeting and minimise dose to surrounding organs at risk. We present descriptive protocols and methods for the use of BioXmark ® in experimental male and female C57BL/6J mouse models. RESULTS These guidelines outline the optimum needle size for uptake (18-gauge) and injection (25- or 26-gauge) of BioXmark ® for use in mouse models along with recommended injection volumes (10-20 µl) for visualisation on preclinical cone beam CT (CBCT) scans. Injection techniques include subcutaneous, intraperitoneal, intra-tumoral and prostate injections. CONCLUSIONS The use of BioXmark ® can help to standardise targeting methods, improve alignment in preclinical image-guided RT and significantly improve the welfare of experimental animals with the reduction of normal tissue exposure to RT.
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Affiliation(s)
- Kathryn Brown
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, BT9 7AE, UK
| | - Mihaela Ghita
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, BT9 7AE, UK
| | - Kevin M Prise
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, BT9 7AE, UK
| | - Karl T Butterworth
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, BT9 7AE, UK
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Leitão ALA, Fonda UDS, Buchpiguel CA, Willegaignon J, Sapienza MT. Validation of automated image co-registration integrated into in-house software for voxel-based internal dosimetry on single-photon emission computed tomography images. Radiol Bras 2023; 56:137-144. [PMID: 37564075 PMCID: PMC10411763 DOI: 10.1590/0100-3984.2022.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/30/2023] [Indexed: 08/12/2023] Open
Abstract
Objective To develop an automated co-registration system and test its performance, with and without a fiducial marker, on single-photon emission computed tomography (SPECT) images. Materials and Methods Three SPECT/CT scans were acquired for each rotation of a Jaszczak phantom (to 0°, 5°, and 10° in relation to the bed axis), with and without a fiducial marker. Two rigid co-registration software packages-SPM12 and NMDose-coreg-were employed, and the percent root mean square error (%RMSE) was calculated in order to assess the quality of the co-registrations. Uniformity, contrast, and resolution were measured before and after co-registration. The NMDose-coreg software was employed to calculate the renal doses in 12 patients treated with 177Lu-DOTATATE, and we compared those with the values obtained with the Organ Level INternal Dose Assessment for EXponential Modeling (OLINDA/EXM) software. Results The use of a fiducial marker had no significant effect on the quality of co-registration on SPECT images, as measured by %RMSE (p = 0.40). After co-registration, uniformity, contrast, and resolution did not differ between the images acquired with fiducial markers and those acquired without. Preliminary clinical application showed mean total processing times of 9 ± 3 min/patient for NMDose-coreg and 64 ± 10 min/patient for OLINDA/EXM, with a strong correlation between the two, despite the lower renal doses obtained with NMDose-coreg. Conclusion The use of NMDose-coreg allows fast co-registration of SPECT images, with no loss of uniformity, contrast, or resolution. The use of a fiducial marker does not appear to increase the accuracy of co-registration on phantoms.
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Affiliation(s)
| | - Uysha de Souza Fonda
- Hospital das Clínicas - Faculdade de Medicina da
Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
| | - Carlos Alberto Buchpiguel
- Department of Radiology and Oncology - Faculdade de Medicina da
Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - José Willegaignon
- Department of Nuclear Medicine - Instituto do Câncer do
Estado de São Paulo (Icesp), São Paulo, SP, Brazil
| | - Marcelo Tatit Sapienza
- Department of Radiology and Oncology - Faculdade de Medicina da
Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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Kuo HC, Della-Biancia C, Damato AL, Happersett L, Lim SB, Cerviño LI, Shasha D, Berry S. Clinical Experience and Feasibility of Using 2D-kVimage Online Intervention in the Ultrafractionated Stereotactic Radiation Treatment of Prostate Cancer. Pract Radiat Oncol 2023; 13:e308-e318. [PMID: 36476984 PMCID: PMC11253237 DOI: 10.1016/j.prro.2022.10.014] [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: 05/10/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE This study reports clinical experience and feasibility of using a 2-dimensional (2D)-kV image system with online intervention in the ultrafractionated stereotactic body radiation treatment (UF-SBRT) of prostate cancer. METHODS AND MATERIALS Fifteen patients with prostate cancer who had a low- to intermediate-risk marker implanted received UF-SBRT with online 2D-kV image tracking and a manual beam interruption strategy with a 2-mm motion threshold. A total of 180 kV paired setup images and 1272 intrabeam 2D-kV images were analyzed to evaluate the setup deviation and intratreatment target deviation. Correlation of expected treatment interruptions with a set of parameters (eg, image and treatment time; direction of deviation) was performed (Spearman test). A subset of the data from 22 fractions was re-evaluated to check the differences in analysis results between using the planning position and using the pretreatment setup position as a reference. Margins based on the derived system and random errors were calculated to evaluate the feasibility of the workflow in ensuring prostate coverage during treatment. RESULTS Mean target motion in 3D propagated from 1.0 mm (setup at 0 minutes) to 2.0 mm (beam on at 7 minutes) to 2.4 mm (end at 13.5 minutes). Out of 75 fractions, 50 were found to require beam interruption. Interruption had a strong correlation with prostate motion along the longitudinal direction and had moderate correlation with prostate motion along the vertical direction and the prostate's treatment starting position along vertical and longitudinal directions. Using the pretreatment position as a reference for intrabeam monitoring, the magnitude of motion deviation from the reference position was reduced by 0.3 mm at a vertical direction and 0.4 mm at lateral and longitudinal directions. The calculated 3D margin to ensure target coverage was 3.7 mm, 4.6 mm, and 5.0 mm in lateral, vertical, and longitudinal directions, respectively. CONCLUSIONS Prostate motion propagated over time. It is feasible to use a 2D-kV online intrabeam monitoring system with a proper intervention scheme to perform UF-SBRT for prostate cancer.
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Affiliation(s)
- Hsiang-Chi Kuo
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Cesar Della-Biancia
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Antonio L Damato
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Laura Happersett
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Seng Boh Lim
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Laura I Cerviño
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel Shasha
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean Berry
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
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Reynaud T, Ben Aicha I, Carignan D, Pelchat C, Fiset C, Foster W, Martin AG, Vigneault E. Infection after prostatic transrectal fiducial marker implantation for image guided radiation therapy. Cancer Radiother 2023; 27:214-218. [PMID: 37080858 DOI: 10.1016/j.canrad.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 04/22/2023]
Abstract
PURPOSE The aim of this retrospective study is to assess the risk of infection after transrectal ultrasound-guided fiducial marker insertion for image-guided radiotherapy of prostate cancer. MATERIAL AND METHODS Between January 2016 and December 2020, 829 patients scheduled for intensity-modulated radiotherapy for prostate cancer had an intraprostatic fiducial marker transrectal implantation under ultrasound guidance by radiation-oncologists specialized in brachytherapy. Patients received standard oral prophylactic antibiotic with quinolone. If Gram negative bacteria resistant to quinolone were detected at the time of the prostate cancer biopsies, the antibioprophylaxis regimen was modified accordingly. The resistance to quinolone screening test was not repeated before fiducial marker insertion. Infectious complications were assessed with questionnaires at the time of CT-planning and medical record reviewed. Toxicity was evaluated according to CTCAE v5.0. RESULTS The median time between fiducial marker implantation and evaluation was 10 days (range: 0-165 days). Four patients (0.48%) developed urinary tract infection related to the procedure, mostly with Gram-negative bacteria resistant to quinolone (75%). Three had a grade 2 infection, and one patient experienced a grade 3 urosepsis. The quinolone-resistance status was known for two patients (one positive and one negative) and was unknown for the other two patients prior to fiducial marker implantation. CONCLUSION Intraprostatic transrectal fiducial marker implantation for image-guided radiotherapy is well tolerated with a low rate of infection. With such a low rate of infection, there is no need to repeat the search of Gram-negative bacteria resistant to quinolone before fiducial marker implantation if it was done at the time of prostate biopsies. Optimal antibioprophylaxis should be adapted to the known status of Gram-negative bacteria resistant to quinolone.
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Affiliation(s)
- T Reynaud
- Département de radio-oncologie et Centre de recherche CHU de Québec-université Laval, centre intégré de cancérologie, 2260, boulevard Henri-Bourassa, Québec, QC G1G 5X1, Canada; CHU de Québec-université Laval, Research Centre, Québec, Canada; CHU de Saint-Etienne, Department of radiotherapy, Saint-Priest-en-Jarez, France
| | - I Ben Aicha
- Département de radio-oncologie et Centre de recherche CHU de Québec-université Laval, centre intégré de cancérologie, 2260, boulevard Henri-Bourassa, Québec, QC G1G 5X1, Canada; CHU de Québec-université Laval, Research Centre, Québec, Canada
| | - D Carignan
- CHU de Québec-université Laval, Research Centre, Québec, Canada
| | - C Pelchat
- Département de radio-oncologie et Centre de recherche CHU de Québec-université Laval, centre intégré de cancérologie, 2260, boulevard Henri-Bourassa, Québec, QC G1G 5X1, Canada
| | - C Fiset
- Département de radio-oncologie et Centre de recherche CHU de Québec-université Laval, centre intégré de cancérologie, 2260, boulevard Henri-Bourassa, Québec, QC G1G 5X1, Canada
| | - W Foster
- Département de radio-oncologie et Centre de recherche CHU de Québec-université Laval, centre intégré de cancérologie, 2260, boulevard Henri-Bourassa, Québec, QC G1G 5X1, Canada
| | - A-G Martin
- Département de radio-oncologie et Centre de recherche CHU de Québec-université Laval, centre intégré de cancérologie, 2260, boulevard Henri-Bourassa, Québec, QC G1G 5X1, Canada; CHU de Québec-université Laval, Research Centre, Québec, Canada
| | - E Vigneault
- Département de radio-oncologie et Centre de recherche CHU de Québec-université Laval, centre intégré de cancérologie, 2260, boulevard Henri-Bourassa, Québec, QC G1G 5X1, Canada; CHU de Québec-université Laval, Research Centre, Québec, Canada.
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12
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Chuong MD, Palm RF, Tjong MC, Hyer DE, Kishan AU. Advances in MRI-Guided Radiation Therapy. Surg Oncol Clin N Am 2023; 32:599-615. [PMID: 37182995 DOI: 10.1016/j.soc.2023.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Image guidance for radiation therapy (RT) has evolved over the last few decades and now is routinely performed using cone-beam computerized tomography (CBCT). Conventional linear accelerators (LINACs) that use CBCT have limited soft tissue contrast, are not able to image the patient's internal anatomy during treatment delivery, and most are not capable of online adaptive replanning. RT delivery systems that use MRI have become available within the last several years and address many of the imaging limitations of conventional LINACs. Herein, the authors review the technical characteristics and advantages of MRI-guided RT as well as emerging clinical outcomes.
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Affiliation(s)
- Michael D Chuong
- Department of Radiation Oncology, Miami Cancer Institute, 8900 North Kendall Drive, Miami, FL 33176, USA.
| | - Russell F Palm
- Department of Radiation Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Michael C Tjong
- Department of Radiation Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Daniel E Hyer
- Department of Radiation Oncology, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, 1338 S Hope Street, Los Angeles, CA 90015, USA
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13
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Ma CMC, Shan G, Hu W, Price RA, Chen L. A new target localization method for image-guided radiation therapy of prostate cancer. Phys Med 2023; 107:102550. [PMID: 36870203 DOI: 10.1016/j.ejmp.2023.102550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/24/2023] [Accepted: 02/18/2023] [Indexed: 03/06/2023] Open
Abstract
In imaged-guided radiation therapy (IGRT), target localization is usually done with rigid-body registration based on anatomy matching. Problems arise when the target volume can only be matched partially due to inter-fractional organ motion and deformation, resulting in deteriorated target coverage and critical structure sparing. A new target localization method is investigated in which the treatment target volume is aligned with the prescription isodose surface. Our study included 15 prostate patients previously treated with intensity-modulated radiation therapy (IMRT). Patient setup and target localization were performed using a CT-on-rails system before and after the IMRT treatment. IMRT plans were generated on the original simulation CTs (15) and the same MUs and leaf sequences were used to compute the dose distributions on post-treatment CTs (98) with the isocenter adjustments based on either anatomical structure matching or prescription isodose surface alignment. When patients were aligned with the traditional anatomy matching method, the dose to 95% of the CTV, D95, received 74.0 - 77.6 Gy and the minimum CTV dose, Dmin, was 61.9 - 71.6 Gy, respectively, in the cumulative dose distributions. The rectal dose-volume constraints were violated in 35.7% of the treatment fractions. When patients were aligned using the new localization method, the dose to 95% of the CTV, D95, received 74.0 - 78.2 Gy and the minimum CTV dose, Dmin, was 68.4 - 71.6 Gy, respectively, in the cumulative dose distributions. The rectal dose-volume constraints were violated in 17.3% of the treatment fractions. Traditional IGRT target localization based on anatomy matching is effective for population-based PTV margins but not ideal for those patients with large inter-fractional prostate rotation/deformation due to large rectal and bladder volume variation. The new method using the prescription isodose surface to align the target volume could improve the target coverage and rectal sparing for these patients, which can be implemented clinically to improve target dose delivery accuracy.
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Affiliation(s)
- C M Charlie Ma
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States.
| | - Guoping Shan
- Department of Radiation Physics, Zhejiang Key Lab of Radiation Oncology, Hangzhou, China
| | - Wei Hu
- Department of Radiation Oncology, Taizhou Central Hospital, Zhejiang, China
| | - Robert A Price
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Lili Chen
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States
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14
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Kaur G, Lehmann J, Greer PB, Martin J, Simpson J. Clinical validation of the Varian Truebeam intra-fraction motion review (IMR) system for prostate treatment guidance. Phys Eng Sci Med 2023; 46:131-140. [PMID: 36472802 DOI: 10.1007/s13246-022-01204-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
This study quantified the performance of Intra-fraction Motion Review (IMR) during prostate Stereotactic Body Radiotherapy (SBRT) treatments. IMR was evaluated using prostate motion data from patients treated in an SBRT clinical trial (PROMETHEUS, NCT00587990).IMR measured prostate displacements were compared to those of two 3D motion management methods: Kilovoltage Intra-fraction Motion management (KIM) and MV/kV triangulation. A planning study assessing the impact of a defined prostate motion (2-5 mm) on the PTV coverage with and without IMR was performed. A clinically relevant IMR search region for prostate cancer SBRT treatments was determined using a customised anthropomorphic pelvis phantom with implanted gold seeds and a motion platform. IMR showed submillimeter agreement with corresponding 2D projections from both KIM and MV/kV triangulation. However, IMR detected actual displacements consistently in considerably fewer frames than KIM (3D), with the actual numbers depending on the settings. The Default Search Region (DSR) method employing a circular search region proved superior to user-contoured structures in detecting clinically relevant prostate motion. Reducing the DSR search region radius can reduce the impact of the 2D nature of IMR and improve the detectability of actual motion (by 10% per 0.5 mm reduction) but must be balanced against increased beam interruptions from minor, clinically irrelevant motion. The use of IMR for SBRT prostate treatments has the potential to improve target dose coverage (minimum dose to 98% of the PTV, D98%) by > 20% compared to treatment without IMR. Calculated D98% of IMR monitored treatments with motion was within 1.5% of plans without motion.
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Affiliation(s)
- Guneet Kaur
- Department of Radiation Oncology, The Mater Hospital, Rocklands Road, Crows Nest, Sydney, NSW, 2065, Australia.
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, NSW, Australia.
| | - Joerg Lehmann
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, NSW, Australia
- School of Information and Physical Sciences, College of Engineering, Science and Environment, University of Newcastle, Newcastle, NSW, Australia
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia
| | - Peter B Greer
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, NSW, Australia
- School of Information and Physical Sciences, College of Engineering, Science and Environment, University of Newcastle, Newcastle, NSW, Australia
| | - Jarad Martin
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, NSW, Australia
| | - John Simpson
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Newcastle, NSW, Australia
- School of Information and Physical Sciences, College of Engineering, Science and Environment, University of Newcastle, Newcastle, NSW, Australia
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15
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Mäkelä P, Wright C, Anttinen M, Boström PJ, Blanco Sequeiros R. Safety and efficacy of MRI-guided transurethral ultrasound ablation for radiorecurrent prostate cancer in the presence of gold fiducial markers. Acta Radiol 2023; 64:1228-1237. [PMID: 35748746 DOI: 10.1177/02841851221108292] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Safety and efficacy of ultrasound prostate ablation for radiorecurrent prostate cancer (PCa) in the presence of gold fiducial markers has not been previously reported. PURPOSE To evaluate safety, functional, and early-stage oncological outcomes for patients with gold fiducial markers undergoing salvage magnetic resonance imaging (MRI)-guided transurethral ultrasound ablation (sTULSA) for radiorecurrent PCa. MATERIAL AND METHODS Data were acquired from an ethics-approved, single-center phase-1 study. Eight patients with 18 total gold fiducial markers inside the planned treatment volume were identified. MRI controls were performed at three and 12 months, followed by PSMA-PET-CT imaging and biopsies at 12 months. A control cohort of 13 patients who underwent sTULSA without markers were also identified for safety profile comparison. Adverse events were reported using the Clavien-Dindo classification, and questionnaires including EPIC-26, IPSS, and IIEF-5 were collected. RESULTS Of 18 markers, 2 (11%) were directly responsible for poor ultrasound penetration. However, there were no local recurrences at 12 months. PSA, prostate volume, and non-perfused volume all decreased over time. At 12 months, 11/18 (61%) of fiducial markers had disappeared via sloughing. The adverse event profile was similar between both patient cohorts, and when controlled for ablation type, no statistical difference in functional outcomes between the two cohorts was observed. CONCLUSION Patients with radiorecurrent PCa with intraprostatic gold fiducial markers can be successfully treated with TULSA. The early-stage efficacy of sTULSA for patients with intraprostatic gold markers is encouraging and the safety profile is unaffected by marker presence.
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Affiliation(s)
- Pietari Mäkelä
- Department of Diagnostic Radiology, 60652Turku University Hospital, Turku, Finland
| | - Cameron Wright
- Department of Diagnostic Radiology, 60652Turku University Hospital, Turku, Finland
- Department of Urology, 60652Turku University Hospital, Turku, Finland
| | - Mikael Anttinen
- Department of Urology, 60652Turku University Hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, 60652Turku University Hospital, Turku, Finland
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16
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Lu Q, Guo D, Wei Y, Zheng J, Li J. Role of gastrointestinal ultrasound in image-guided radiation therapy: A review. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2023. [DOI: 10.1016/j.jrras.2022.100520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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17
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Moreau M, Richards G, Yasmin-Karim S, Narang A, Deville C, Ngwa W. A liquid immunogenic fiducial eluter for image-guided radiotherapy. Front Oncol 2022; 12:1020088. [PMID: 36620560 PMCID: PMC9812550 DOI: 10.3389/fonc.2022.1020088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Fiducials are routinely used to provide image-guidance during radiotherapy. Here, a new nanoparticle-based liquid immunogenic fiducial is investigated for its potential to provide image-guidance, while also enhancing treatment outcomes. Methods This fiducial, liquid immunogenic fiducial eluter (LIFE) biomaterial, is formulated with natural biodegradable polymers, chitosan and sodium alginate with radio-sensitizing nanoparticles, and immunoadjuvant like anti-CD40 monoclonal antibody. Once administered intra-tumorally, this liquid smart radiotherapy biomaterial congeals within the calcium rich tumor microenvironment. The potential use of LIFE biomaterial for providing image guidance in magnetic resonance imaging (MRI) and computed tomography (CT) was investigated over different time period in a pre-clinical tumored mouse model. Results Results showed that the LIFE biomaterial can provide both MRI contrast and CT imaging contrast over 3-weeks, with gradual decrease of the contrast over time, as the LIFE biomaterial biodegrades. Results also showed the LIFE biomaterial significantly slowed tumor growth and prolonged mice survival (p < 0.0001) over time. Discussion The results highlight the potential use of the LIFE biomaterial as a multi-functional smart radiotherapy biomaterial that could be developed and optimized for hypo-fractionated radiotherapy applications and combining radiotherapy with immunoadjuvants.
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Affiliation(s)
- Michele Moreau
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States,Department of Radiation Oncology and Molecular Radiation Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, United States,Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States,*Correspondence: Michele Moreau, ; Wilfred Ngwa,
| | - Geraud Richards
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Sayeda Yasmin-Karim
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Amol Narang
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Curtiland Deville
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Wilfred Ngwa
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States,Department of Radiation Oncology and Molecular Radiation Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, United States,Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States,*Correspondence: Michele Moreau, ; Wilfred Ngwa,
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18
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Robards S, Brown A, Pain T, Patel D, Tan A, Carter H. A value-based approach to prostate cancer image-guidance in a regional radiation therapy centre: a cost-minimisation analysis. Tech Innov Patient Support Radiat Oncol 2022; 24:131-136. [PMID: 36561985 PMCID: PMC9763936 DOI: 10.1016/j.tipsro.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background and objectives Usual practice for the insertion of prostate fiducial markers involves at least one week delay between insertion and simulation. An evidence-based practice change was implemented whereby fiducial marker insertion occurred on the same day as radiotherapy simulation. The aim of this study was to quantify the health service costs and clinical outcomes associated with this practice change. Methods A cost-minimisation analysis was undertaken from the perspective of the local health service. A retrospective chart audit was conducted to collect data on 149 patients in the pre-implementation cohort and 138 patients in the post-implementation cohort. Associated costs with insertion and simulation were calculated and compared across the two cohorts; this included subsided travel costs for rural and remote patients. Fiducial marker positions on planning CT and first treatment CBCT were measured for all patients as the surrogate clinical outcome measure for oedema. Results The health service saved an average of AU$ 361 (CI $311 - $412) per patient after the practice change. There was no significant difference in fiducial marker position pre- and post- implementation (p < 0.05). Conclusion The practice change to perform insertion and radiotherapy simulation on the same day resulted in substantial savings to the health system, without compromising clinical outcomes. The decrease in number of required patient attendances is of real consequence to rural and remote populations. The practice change increases both the value and accessibility of best-practice health care to those most at risk of missing out.
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Affiliation(s)
- Shannon Robards
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Amy Brown
- Townsville Hospital and Health Service, Townsville, Queensland, Australia,Corresponding author at: PO Box 670, Townsville University Hospital, Queensland 4815, Australia
| | - Tilley Pain
- Townsville Hospital and Health Service, Townsville, Queensland, Australia,James Cook University, Townsville, Queensland, Australia
| | - Deepti Patel
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Alex Tan
- Townsville Hospital and Health Service, Townsville, Queensland, Australia,James Cook University, Townsville, Queensland, Australia
| | - Hannah Carter
- Queensland University of Technology, Brisbane, Queensland, Australia
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Lee JW, Chung MJ. Prostate only radiotherapy using external beam radiotherapy: A clinician's perspective. World J Clin Cases 2022; 10:10428-10434. [PMID: 36312490 PMCID: PMC9602254 DOI: 10.12998/wjcc.v10.i29.10428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/12/2022] [Accepted: 08/30/2022] [Indexed: 02/05/2023] Open
Abstract
Prostate-only radiotherapy (PORT) is widely used as the definitive treatment for localized prostate cancer. Prostate cancer has an α/β ratio; therefore, radiotherapy (RT) with a large fraction size is biologically effective for tumor control. The current external beam RT technique for PORT has been improved from three-dimensional conformal RT to intensity-modulated, stereotactic body, and image-guided RTs. These methods are associated with reduced radiation exposure to normal tissues, decreasing urinary and bowel toxicity. Several trials have shown improved local control with dose escalation through the aforementioned methods, and the efficacy and safety of intensity-modulated and stereotactic body RTs have been proven. However, the management of RT in patients with prostate cancer has not been fully elucidated. As a clinician, there are several concerns regarding the RT volume and dose considering the patient's age and comorbidities. Therefore, this review aimed to discuss the radiobiological basis and external beam technical advancements in PORT for localized prostate cancer from a clinician's perspective.
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Affiliation(s)
- Jeong Won Lee
- Department of Radiation Oncology, Daegu Catholic University School of Medicine, Daegu 42472, South Korea
| | - Mi Joo Chung
- Department of Radiation Oncology, Hanyang University Hanmaeum Changwon Hospital, Changwon 51139, South Korea
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Castelluccia A, Mincarone P, Tumolo MR, Sabina S, Colella R, Bodini A, Tramacere F, Portaluri M, Leo CG. Economic Evaluations of Magnetic Resonance Image-Guided Radiotherapy (MRIgRT): A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710800. [PMID: 36078513 PMCID: PMC9517760 DOI: 10.3390/ijerph191710800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/17/2022] [Accepted: 08/20/2022] [Indexed: 05/06/2023]
Abstract
OBJECTIVES This review systematically summarizes the evidence on the economic impact of magnetic resonance image-guided RT (MRIgRT). METHODS We systematically searched INAHTA, MEDLINE, and Scopus up to March 2022 to retrieve health economic studies. Relevant data were extracted on study type, model inputs, modeling methods and economic results. RESULTS Five studies were included. Two studies performed a full economic assessment to compare the cost-effectiveness of MRIgRT with other forms of image-guided radiation therapy. One study performed a cost minimization analysis and two studies performed an activity-based costing, all comparing MRIgRT with X-ray computed tomography image-guided radiation therapy (CTIgRT). Prostate cancer was the target condition in four studies and hepatocellular carcinoma in one. Considering the studies with a full economic assessment, MR-guided stereotactic body radiation therapy was found to be cost effective with respect to CTIgRT or conventional or moderate hypofractionated RT, even with a low reduction in toxicity. Conversely, a greater reduction in toxicity is required to compete with extreme hypofractionated RT without MR guidance. CONCLUSIONS This review highlights the great potential of MRIgRT but also the need for further evidence, especially for late toxicity, whose reduction is expected to be the real added value of this technology.
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Affiliation(s)
- Alessandra Castelluccia
- Radiation Oncology, Department of Radiotherapy, Hospital “A. Perrino”, ASL Brindisi, 72100 Brindisi, Italy
| | - Pierpaolo Mincarone
- Institute for Research on Population and Social Policies, National Research Council, 72100 Brindisi, Italy
- MOVE-Mentis s.r.l., 47522 Cesena, Italy
- Correspondence: ; Tel.: +39-3289168745
| | - Maria Rosaria Tumolo
- Department of Biological and Environmental Sciences and Technology, University of Salento, 73100 Lecce, Italy
| | - Saverio Sabina
- MOVE-Mentis s.r.l., 47522 Cesena, Italy
- Institute of Clinical Physiology, National Research Council, 73100 Lecce, Italy
| | - Riccardo Colella
- Department of Engineering for Innovation, University of Salento, 73100 Lecce, Italy
| | - Antonella Bodini
- Institute for Applied Mathematics and Information Technologies “E. Magenes”, National Research Council, 20133 Milan, Italy
| | - Francesco Tramacere
- Radiation Oncology, Department of Radiotherapy, Hospital “A. Perrino”, ASL Brindisi, 72100 Brindisi, Italy
| | - Maurizio Portaluri
- Radiation Oncology, Department of Radiotherapy, Hospital “A. Perrino”, ASL Brindisi, 72100 Brindisi, Italy
| | - Carlo Giacomo Leo
- MOVE-Mentis s.r.l., 47522 Cesena, Italy
- Institute of Clinical Physiology, National Research Council, 73100 Lecce, Italy
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21
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Laughlin BS, Silva AC, Vora SA, Keole SR, Wong WW, Schild MH, Schild SE. Long-term outcomes of prostate intensity-modulated radiation therapy incorporating a simultaneous intra-prostatic MRI-directed boost. Front Oncol 2022; 12:921465. [PMID: 36033460 PMCID: PMC9399820 DOI: 10.3389/fonc.2022.921465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/18/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose/objectives This retrospective study demonstrates the long-term outcomes of treating prostate cancer using intensity modulated (IMRT) with incorporation of MRI-directed boost. Materials/methods From February 2009 to February 2013, 78 men received image-guided IMRT delivering 77.4 Gy in 44 fractions with simultaneously integrated boost to 81-83 Gy to an MRI-identified lesion. Patients with intermediate-risk or high-risk prostate cancer were recommended to receive 6 and 24-36 months of adjuvant hormonal therapy, respectively. Results Median follow-up was 113 months (11-147). There were 18 low-risk, 43 intermediate-risk, and 17 high-risk patients per NCCN risk stratification included in this study. Adjuvant hormonal therapy was utilized in 32 patients (41%). The 10-year biochemical control rate for all patients was 77%. The 10-year biochemical control rates for low-risk, intermediate-risk, and high-risk diseases were 94%, 81%, and 88%, respectively (p = 0.35). The 10-year rates of local control, distant control, and survival were 99%, 88%, and 66%, respectively. Of 25 patients who died, only four (5%) died of prostate cancer. On univariate analysis, T-category and pretreatment PSA level were associated with distant failure rate (p = 0.02). There was no grade =3 genitourinary and gastrointestinal toxicities that persisted at the last follow-up. Conclusions This study demonstrated the long-term efficacy of using MRI to define an intra-prostatic lesion for SIB to 81-83Gy while treating the entire prostate gland to 77.4 Gy with IMRT. Our study confirms that modern MRI can be used to locally intensify dose to prostate tumors providing high long-term disease control while maintaining favorable long-term toxicity.
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Affiliation(s)
- Brady S. Laughlin
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Alvin C. Silva
- Department of Radiology, Mayo Clinic, Phoenix, AZ, United States
| | - Sujay A. Vora
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Sameer R. Keole
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - William W. Wong
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | | | - Steven E. Schild
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
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22
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Vanhanen A, Reinikainen P, Kapanen M. Radiation-induced prostate swelling during SBRT of the prostate. Acta Oncol 2022; 61:698-704. [PMID: 35435111 DOI: 10.1080/0284186x.2022.2062682] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Reduced planning target volume (PTV) margins are commonly used in stereotactic body radiotherapy (SBRT) of the prostate. In addition, MR-only treatment planning is becoming more common in prostate radiotherapy and compared to CT-MRI-based contouring results in notable smaller clinical target volume (CTV). Tight PTV margins coupled with MR-only planning raise a concern whether the margins are adequate enough to cover possible volumetric changes of the prostate. The aim of this study was to evaluate the volumetric change of the prostate and its effect on PTV margin during 5x7.25 Gy SBRT of the prostate. MATERIAL AND METHODS Twenty patients were included in the study. Three MRI scans, first prior to treatment (baseline), second after third fraction (mid-treatment) and third after fifth fraction (end-treatment) were acquired for each patient. Prostate contours were delineated on each MRI scan and used to assess the prostate volume and maximum prostate diameter on left-right (LR), anterior-posterior (AP) and superior-inferior (SI) directions at baseline, mid- and end-treatment. RESULTS Median (IQR) change in the prostate volume relative to the baseline was 12.0% (3.1, 17.7) and 9.2% (2.0, 18.9) at the mid- and end-treatment, respectively, and the change was statistically significant (p = 0.004 and p = 0.020, respectively). Compared to the baseline, median increase in the maximum LR, SI and AP prostate diameters were 0.8, 2.3 and 1.5 mm at mid-treatment, and 0.5, 2.5 and 2.3 mm at end-treatment, respectively. CONCLUSION If prostate contouring is based solely on MRI (e.g., in MR-only protocol), additional margin of 1-2 mm should be considered to account for prostate swelling. The study is part of clinical trial NCT02319239.
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Affiliation(s)
- Antti Vanhanen
- Department of Oncology, Unit of Radiotherapy, Tampere University Hospital, Tampere, Finland
- Department of Medical Physics, Medical Imaging Center, Tampere University Hospital, Tampere, Finland
| | - Petri Reinikainen
- Department of Oncology, Unit of Radiotherapy, Tampere University Hospital, Tampere, Finland
| | - Mika Kapanen
- Department of Medical Physics, Medical Imaging Center, Tampere University Hospital, Tampere, Finland
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23
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SBRT for Localized Prostate Cancer: CyberKnife vs. VMAT-FFF, a Dosimetric Study. Life (Basel) 2022; 12:life12050711. [PMID: 35629378 PMCID: PMC9144859 DOI: 10.3390/life12050711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 12/14/2022] Open
Abstract
In recent years, stereotactic body radiation therapy (SBRT) has gained popularity among clinical methods for the treatment of medium and low risk prostate cancer (PCa), mainly as an alternative to surgery. The hypo-fractionated regimen allows the administration of high doses of radiation in a small number of fractions; such a fractionation is possible by exploiting the different intrinsic prostate radiosensitivity compared with the surrounding healthy tissues. In addition, SBRT treatment guaranteed a better quality of life compared with surgery, avoiding risks, aftermaths, and possible complications. At present, most stereotactic prostate treatments are performed with the CyberKnife (CK) system, which is an accelerator exclusively dedicated for stereotaxis and it is not widely spread in every radiotherapy centre like a classic linear accelerator (LINAC). To be fair, a stereotactic treatment is achievable also by using a LINAC through Volumetric Modulated Arc Therapy (VMAT), but some precautions must be taken. The aim of this work is to carry out a dosimetric comparison between these two methodologies. In order to pursue such a goal, two groups of patients were selected at Instituto Nazionale Tumori—IRCCS Fondazione G. Pascale: the first group consisting of ten patients previously treated with a SBRT performed with CK; the second one was composed of ten patients who received a hypo-fractionated VMAT treatment and replanned in VMAT-SBRT flattening filter free mode (FFF). The two SBRT techniques were rescaled at the same target coverage and compared by normal tissue sparing, dose distribution parameters and delivery time. All organs at risk (OAR) constraints were achieved by both platforms. CK exhibits higher performances in terms of dose delivery; nevertheless, the general satisfying dosimetric results and the significantly shorter delivery time make VMAT-FFF an attractive and reasonable alternative SBRT technique for the treatment of localized prostate cancer.
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24
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Lapierre A, Hennequin C, Beneux A, Belhomme S, Benziane N, Biston MC, Crehange G, de Crevoisier R, Dumas JL, Fawzi M, Lisbona A, Pasquier D, Pelissier S, Graff-Cailleaud P, Pommier P, Sargos P, Simon JM, Supiot S, Tantot F, Chapet O. Highly hypofractionated schedules for localized prostate cancer: Recommendations of the GETUG radiation oncology group. Crit Rev Oncol Hematol 2022; 173:103661. [PMID: 35341986 DOI: 10.1016/j.critrevonc.2022.103661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/25/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT) has become treatment option for localized prostate cancer but the evidence base remains incomplete. Several clinical studies, both prospective and retrospective, have been published. However, treatment techniques, target volumes and dose constraints lack consistency between studies. Based on the current available literature, the French Genito-Urinary Group (GETUG) suggests that.
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Affiliation(s)
- Ariane Lapierre
- Ariane Lapierre: Département of de radiothérapie oncologie, centre hospitalier universitaire Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université de Lyon, 69000 Lyon, France
| | - Christophe Hennequin
- Christophe Hennequin: Department of Radiation Oncology, Hôpital Saint-Louis, 75475, Paris, France
| | - Amandine Beneux
- Amandine Beneux: Service de Physique Médicale et de Radioprotection, centre hospitalier universitaire Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - Sarah Belhomme
- Sarah Belhomme: Radiation Oncology Department, Bergonie Institute, 229, cours de l'Argonne, 33076 Bordeaux Cedex, France
| | - Nicolas Benziane
- Nicolas Benziane: Radiation Oncology Department, Bergonie Institute, 229, cours de l'Argonne, 33076 Bordeaux Cedex, France
| | - Marie-Claude Biston
- Marie-Claude Biston: Léon Bérard Cancer Center, University of Lyon, France; Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA, Lyon, France
| | - Gilles Crehange
- Gilles Crehange: Département de radiothérapie oncologique, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Renaud de Crevoisier
- Renaud de Crevoisier: Département de Radiothérapie, Centre Eugène Marquis, Rennes
| | - Jean-Luc Dumas
- Jean-luc Dumas: Institut Curie, Radiotherapy department / Medical physics, 26 rue d'Ulm, 75005 PARIS cedex, France
| | - Maher Fawzi
- Maher Fawzi: Institut Curie, Site Saint Cloud, Service de Radiotherapie, 35, rue Dailly 92210 Saint Cloud
| | - Albert Lisbona
- Albert Lisbona: Medical Physics Department Institut de Cancérologie de l'Ouest, Bd J. Monod, 44805 Saint Herblain France
| | - David Pasquier
- David Pasquier: Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille; CRIStAL UMR 9189, Lille University
| | | | - Pierre Graff-Cailleaud
- Pierre Graff-Cailleaud: University Institute of Cancer Toulouse-Oncopôle, Toulouse, France
| | - Pascal Pommier
- Pascal Pommier: Radiotherapy Department, Centre Léon Bérard, Lyon, France
| | - Paul Sargos
- Paul Sargos: Radiation Oncology Department, Bergonie Institute, Bordeaux, France
| | - Jean-Marc Simon
- Jean-Marc Simon: Department of Radiotherapy, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Paris, France
| | - Stéphane Supiot
- Stéphane Supiot: Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, St-Herblain, France
| | | | - Olivier Chapet
- Département of de radiothérapie oncologie, centre hospitalier universitaire Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université de Lyon, 69000 Lyon, France
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25
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Gawlik-Jakubczak T. Simple method for correcting imperfectly placed fiducial markers for image-guided radiotherapy technologies of the prostate cancer. Urol Ann 2022; 14:395-397. [PMID: 36505987 PMCID: PMC9731194 DOI: 10.4103/ua.ua_177_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/04/2022] [Indexed: 12/15/2022] Open
Abstract
One of the main method of treating prostate cancer is radiotherapy . Contemporary techniques as IGRT concentrate on proper delivery and exact delineation of the target. We present the simple method of correction the visualisation of gold markers implanted before radiotherapy . In the case when one or two seeds were located imperfectly or were lost with stool or urine we implant additional seeds which create the spatial figure recognised in CT and MRI . Implantation of additional seeds is safe and very simple method which can "rescue" sense of image guided procedure in the case of unfavourable primary fiducial seeds location.
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Affiliation(s)
- Teresa Gawlik-Jakubczak
- Department of Urology, Medical University in Gdańsk, Gdańsk, Poland,Address for correspondence: Dr. Teresa Gawlik-Jakubczak, Department of Urology, Medical University in Gdańsk, Smoluchowskiego 17 (Street), Gdańsk 80-214, Poland. E-mail:
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26
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Wright C, Mäkelä P, Anttinen M, Sainio T, Boström PJ, Blanco Sequeiros R. Fiducial markers and their impact on ablation outcome for patients treated with MR-guided transurethral ablation (TULSA): a retrospective technical analysis. Int J Hyperthermia 2021; 38:1677-1684. [PMID: 34927517 DOI: 10.1080/02656736.2021.2008519] [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] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES Fiducial markers improve accuracy in external beam radiation therapy (EBRT) for treatment of prostate cancer (PCa). However, many patients recur after EBRT necessitating additional treatment, such as MR-guided transurethral ultrasound ablation (TULSA). Residual markers may compromise TULSA through ultrasound field distortions and generation of local susceptibility artifacts. The objective was to investigate how markers affect the ablation outcome during clinical TULSA treatments. SUBJECTS AND METHODS A retrospective analysis was performed on nine patients with radiorecurrent PCa and residual markers who received TULSA. The MR susceptibility artifact was quantified as a function of marker type, size and orientation, in particular for thermometry. The spatial distribution of markers inside the prostate was recorded, and the resulting impact on the thermal dose was measured. The thermal dose measurements were directly compared to the residual enhancing prostatic tissue observed on the immediate and control post-TULSA contrast enhanced (CE) image. RESULTS Successful thermal dose accumulation to the target boundary occurred for 14/20 (70%) of markers, confirmed with CE imaging. Gold markers situated simultaneously close to the urethra (≤12 mm) and far from the target boundary (≥13 mm) reduced the ultrasound depth of heating. Nitinol markers produced large, hypointense artifacts that disrupted thermometry and compromised treatment. Artifacts from gold markers were less pronounced, but when located near the target boundary, also affected treatment. CONCLUSION Marker composition, orientation and location inside the prostate can all potentially impact treatment outcome. Proper patient selection through detailed MRI screening is critical to ensure successful radiorecurrent PCa treatment outcomes with TULSA.
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Affiliation(s)
- Cameron Wright
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland.,Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Pietari Mäkelä
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Mikael Anttinen
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Teija Sainio
- Department of Medical Physics and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Roberto Blanco Sequeiros
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
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27
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Motley R, Fielding AL, Ramachandran P. A feasibility study on the development and use of a deep learning model to automate real-time monitoring of tumor position and assessment of interfraction fiducial marker migration in prostate radiotherapy patients. Biomed Phys Eng Express 2021; 8. [PMID: 34715689 DOI: 10.1088/2057-1976/ac34da] [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: 08/18/2021] [Accepted: 10/29/2021] [Indexed: 11/11/2022]
Abstract
PurposeThe aim of this study was to assess the feasibility of the development and training of a deep learning object detection model for automating the assessment of fiducial marker migration and tracking of the prostate in radiotherapy patients.Methods and MaterialsA fiducial marker detection model was trained on the YOLO v2 detection framework using approximately 20,000 pelvis kV projection images with fiducial markers labelled. The ability of the trained model to detect marker positions was validated by tracking the motion of markers in a respiratory phantom and comparing detection data with the expected displacement from a reference position. Marker migration was then assessed in 14 prostate radiotherapy patients using the detector for comparison with previously conducted studies. This was done by determining variations in intermarker distance between the first and subsequent fractions in each patient.ResultsOn completion of training, a detection model was developed that operated at a 96% detection efficacy and with a root mean square error of 0.3 pixels. By determining the displacement from a reference position in a respiratory phantom, experimentally and with the detector it was found that the detector was able to compute displacements with a mean accuracy of 97.8% when compared to the actual values. Interfraction marker migration was measured in 14 patients and the average and maximum ± standard deviation marker migration were found to be 2.0±0.9 mm and 2.3±0.9 mm, respectively.ConclusionThis study demonstrates the benefits of pairing deep learning object detection, and image-guided radiotherapy and how a workflow to automate the assessment of organ motion and seed migration during prostate radiotherapy can be developed. The high detection efficacy and low error make the advantages of using a pre-trained model to automate the assessment of the target volume positional variation and the migration of fiducial markers between fractions.
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Affiliation(s)
- Ryan Motley
- Radiation Oncology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, 4102, AUSTRALIA
| | - Andrew L Fielding
- School Chemistry Physics and Mechanical Engineering, Queensland University of Technology, GPO Box 2434, Brisbane, Queensland, 4001, AUSTRALIA
| | - Prabhakar Ramachandran
- Radiation Oncology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Woolloongabba, Queensland, 4102, AUSTRALIA
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28
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Han-Oh S, Ding K, Song D, Narang A, Wong J, Rong Y, Bliss D. Feasibility study of fiducial marker localization using microwave radar. Med Phys 2021; 48:7271-7282. [PMID: 34482551 DOI: 10.1002/mp.15197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 08/05/2021] [Accepted: 08/21/2021] [Indexed: 11/11/2022] Open
Abstract
PURPOSE We explore the potential use of radar technology for fiducial marker tracking for monitoring of respiratory tumor motion during radiotherapy. Historically microwave radar technology has been widely deployed in various military and civil aviation applications to provide detection, position, and tracking of single or multiples objects from far away and even through barriers. Recently, due to many advantages of the microwave technology, it has been successfully demonstrated to detect breast tumor, and to monitor vital signs in real time such as breathing signals or heart rates. We demonstrate a proof-of-concept for radar-based fiducial marker tracking through the synthetic human tissue phantom. METHODS We performed a series of experiments with the vector network analyzer (VNA) and wideband directional horn antenna. We considered the frequency range from 2.0 to 6.0 GHz, with a maximum power of 3 dBm. A horn antenna, transmitting and receiving radar pulses, was connected to the vector network analyzer to probe a gold fiducial marker through a customized synthetic human tissue phantom, consisting of 1-mm thickness of skin, 5-mm fat, and 25-mm muscle layers. A 1.2 × 10-mm gold fiducial marker was exploited as a motion surrogate, which was placed behind the phantom and statically positioned with an increment of 12.7 mm to simulate different marker displacements. The returned signals from the marker were acquired and analyzed to evaluate the localization accuracy as a function of the marker position. RESULTS The fiducial marker was successfully localized at various measurement positions through a simplified phantom study. The averaged localization accuracy across measurements was 3.5 ± 1.3 mm, with a minimum error of 1.9 mm at the closest measurement location and a maximum error of 4.9 mm at the largest measurement location. CONCLUSIONS We demonstrated that the 2-6 GHz radar can penetrate through the attenuating tissues and localize a fiducial marker. This successful feasibility study establishes a foundation for further investigation of radar technology as a non-ionizing tumor localization device for radiotherapy.
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Affiliation(s)
- Sarah Han-Oh
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University of School of Medicine, Baltimore, Maryland, USA
| | - Kai Ding
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University of School of Medicine, Baltimore, Maryland, USA
| | - Daniel Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University of School of Medicine, Baltimore, Maryland, USA
| | - Amol Narang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University of School of Medicine, Baltimore, Maryland, USA
| | - John Wong
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University of School of Medicine, Baltimore, Maryland, USA
| | - Yu Rong
- School of Electrical, Computer and Energy Engineering, Arizona State University, Tempe, Arizona, USA
| | - Daniel Bliss
- School of Electrical, Computer and Energy Engineering, Arizona State University, Tempe, Arizona, USA
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29
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Brooks RL, McCallum HM, Pearson RA, Pilling K, Wyatt J. Are cone beam CT image matching skills transferrable from planning CT to planning MRI for MR-only prostate radiotherapy? Br J Radiol 2021; 94:20210146. [PMID: 33914617 PMCID: PMC8248228 DOI: 10.1259/bjr.20210146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objectives: Treatment verification for MR-only planning has focused on fiducial marker matching, however, these are difficult to identify on MR. An alternative is using the MRI for soft-tissue matching with cone beam computed tomography images (MR-CBCT). However, therapeutic radiographers have limited experience of MRI. This study aimed to assess transferability of therapeutic radiographers CT-CBCT prostate image matching skills to MR-CBCT image matching. Methods: 23 therapeutic radiographers with 3 months–5 years’ experience of online daily CT-CBCT soft-tissue matching prostate cancer patients participated. Each observer completed a baseline assessment of 10 CT-CBCT prostate soft-tissue image matches, followed by 10 MR-CBCT prostate soft-tissue image match assessment. A MRI anatomy training intervention was delivered and the 10 MR-CBCT prostate soft-tissue image match assessment was repeated. Limits of agreement were calculated as the disagreement of the observers with mean of all observers. Results: Limits of agreement at CT-CBCT baseline were 2.8 mm, 2.8 mm, 0.7 mm (vertical, longitudinal, lateral). MR-CBCT matches prior to training were 3.3 mm, 3.1 mm, 0.9 mm, and after training 2.6 mm, 2.4 mm, 1.1 mm (vertical, longitudinal, lateral). Results show similar limits of agreement across the assessments, and variation reduced following the training intervention. Conclusion: This suggests therapeutic radiographers’ prostate CBCT image matching skills are transferrable to a MRI planning scan, since MR-CBCT matching has comparable observer variation to CT-CBCT matching. Advances in knowledge: This is the first publication assessing interobserver MR-CBCT prostate soft tissue matching in an MR-only pathway.
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Affiliation(s)
- Rachel L Brooks
- Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Hazel M McCallum
- Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Rachel A Pearson
- Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Pilling
- Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jonathan Wyatt
- Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
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30
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Ma TM, Lamb JM, Casado M, Wang X, Basehart TV, Yang Y, Low D, Sheng K, Agazaryan N, Nickols NG, Cao M, Steinberg ML, Kishan AU. Magnetic resonance imaging-guided stereotactic body radiotherapy for prostate cancer (mirage): a phase iii randomized trial. BMC Cancer 2021; 21:538. [PMID: 33975579 PMCID: PMC8114498 DOI: 10.1186/s12885-021-08281-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 05/02/2021] [Indexed: 02/07/2023] Open
Abstract
Background Stereotactic body radiotherapy (SBRT) is becoming increasingly used in treating localized prostate cancer (PCa), with evidence showing similar toxicity and efficacy profiles when compared with longer courses of definitive radiation. Magnetic resonance imaging (MRI)-guided radiotherapy has multiple potential advantages over standard computed tomography (CT)-guided radiotherapy, including enhanced prostate visualization (abrogating the need for fiducials and MRI fusion), enhanced identification of the urethra, the ability to track the prostate in real-time, and the capacity to perform online adaptive planning. However, it is unknown whether these potential advantages translate into improved outcomes. This phase III randomized superiority trial is designed to prospectively evaluate whether toxicity is lower after MRI-guided versus CT-guided SBRT. Methods Three hundred men with localized PCa will be randomized in a 1:1 ratio to SBRT using CT or MRI guidance. Randomization will be stratified by baseline International Prostate Symptom Score (IPSS) (≤15 or > 15) and prostate gland volume (≤50 cc or > 50 cc). Five fractions of 8 Gy will be delivered to the prostate over the course of fourteen days, with or without hormonal therapy and elective nodal radiotherapy (to a dose of 5 Gy per fraction) as per the investigator’s discretion. The primary endpoint is the incidence of physician-reported acute grade ≥ 2 genitourinary (GU) toxicity (during the first 90 days after SBRT), as assessed by the CTCAE version 4.03 scale. Secondary clinical endpoints include incidence of acute grade ≥ 2 gastrointestinal (GI) toxicity, 5-year cumulative incidences of physician-reported late grade ≥ 2 GU and GI toxicity, temporal changes in patient-reported quality of life (QOL) outcomes, 5-year biochemical recurrence-free survival and the proportion of fractions of MRI-guided SBRT in which online adaptive radiotherapy is used. Discussion The MIRAGE trial is the first randomized trial comparing MRI-guided with standard CT-guided SBRT for localized PCa. The primary hypothesis is that MRI-guided SBRT will lead to an improvement in the cumulative incidence of acute grade ≥ 2 GU toxicity when compared to CT-guided SBRT. The pragmatic superiority design focused on an acute toxicity endpoint will allow an early comparison of the two technologies. Trial registration Clinicaltrials.gov identifier: NCT04384770. Date of registration: May 12, 2020. https://clinicaltrials.gov/ct2/show/NCT04384770 Protocol version Version 2.1, Aug 28, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08281-x.
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Affiliation(s)
- Ting Martin Ma
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - James M Lamb
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - Maria Casado
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - Xiaoyan Wang
- Department of Medicine Statistics Core, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - T Vincent Basehart
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - Yingli Yang
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - Daniel Low
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - Ke Sheng
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - Nzhde Agazaryan
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - Nicholas G Nickols
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - Minsong Cao
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - Michael L Steinberg
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA. .,Department of Urology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite # B265, Medical Plaza Driveway, Los Angeles, CA, 90095, USA.
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A phantom study to contrast and compare polymer and gold fiducial markers in radiotherapy simulation imaging. Sci Rep 2021; 11:8931. [PMID: 33903651 PMCID: PMC8076319 DOI: 10.1038/s41598-021-88300-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/06/2021] [Indexed: 11/15/2022] Open
Abstract
To assess visibility and artifact characteristics of polymer fiducials compared to standard gold fiducials for radiotherapy CT and MRI simulation. Three gold and three polymer fiducials were inserted into a CT and MRI tissue-equivalent phantom that approximated the prostate cancer radiotherapy configuration. The phantom and fiducials were imaged on CT and MRI. Images were assessed in terms of fiducial visibility and artifact. ImageJ was employed to quantify the pixel gray-scale of each fiducial and artifact. Fiducial gray-scale histograms and profiles were generated for analysis. Objective measurements of the contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), and artifact index (AI) were calculated. The CT images showed that the gold fiducials are visually brighter, with greater contrast than the polymer. The higher peak values illustrate this in the line profiles. However, they produce bright radiating and dark shadowing artifacts. This is depicted by the greater width of line profiles and the disruption of phantom area profiles. Quantitatively this results in greater percentile ranges of the histograms. Furthermore, for CT, gold had a higher CNR than polymer, relative to the phantom. However, the gold CNR and SNR were degraded by the greater artifact and thus AI. Both fiducials were visible on MRI and had similar histograms and profiles that were also reflected in comparable CNR, SNR and AI. Polymer fiducials were well visualized in a phantom on CT and MR and produce less artifact than the gold fiducials. Polymer markers could enhance the quality and accuracy of radiotherapy co-registration and planning but require clinical confirmation.
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Surgical challenges and considerations in Tri-modal therapy for muscle invasive bladder cancer. Urol Oncol 2021; 40:442-450. [PMID: 33642229 DOI: 10.1016/j.urolonc.2021.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 12/13/2020] [Accepted: 01/08/2021] [Indexed: 01/20/2023]
Abstract
Trimodal therapy (TMT) for muscle invasive bladder cancer has become an accepted alternative to radical cystectomy and has become integrated into national guidelines as standard a treatment option. The urologist plays a critical role in proper patient selection, thorough transurethral resection, ongoing cystoscopic surveillance and management of local recurrences. There exists multiple patient related and tumor related factors, which contribute to the selection of TMT vs. radical cystectomy for a patient with muscle invasive bladder cancer. Although the ideal patient for TMT has a tumor which can undergo a visibly complete resection, has no associated hydronephrosis, does not invade the prostatic urethra and is not associated with diffuse carcinoma in situ throughout the bladder, select patients who do not meet all these criteria can still be successfully treated with this approach. A multidisciplinary approach including urology, radiation oncology and medical oncology is paramount with clear communication of tumor location, timing of chemoradiation and repeat cystoscopic resection followed by surveillance. Nonmuscle invasive bladder cancer recurrences can occur in up to 26% of patients after completion of TMT, with many being treated by routine and standard therapy for non-muscle invasive bladder cancer. However, in this population after TMT, early salvage cystectomy should be considered in those with adverse features, including T1 disease, tumor greater than 3 cm, CIS, or lymphovascular invasion. Salvage cystectomy can be performed for local recurrences with acceptable oncologic control and no clear evidence of any greater risk of early complications; however, there may be a slightly increased risk for late complications, namely small bowel obstruction, ureteral stricture, and parastomal hernia. An understanding of these surgical considerations is of utmost importance to the treating urologist in selecting and managing a patient through TMT.
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Goudschaal K, Beeksma F, Boon M, Bijveld M, Visser J, Hinnen K, van Kesteren Z. Accuracy of an MR-only workflow for prostate radiotherapy using semi-automatically burned-in fiducial markers. Radiat Oncol 2021; 16:37. [PMID: 33608008 PMCID: PMC7893889 DOI: 10.1186/s13014-021-01768-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/11/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The benefit of MR-only workflow compared to current CT-based workflow for prostate radiotherapy is reduction of systematic errors in the radiotherapy chain by 2-3 mm. Nowadays, MRI is used for target delineation while CT is needed for position verification. In MR-only workflows, MRI based synthetic CT (sCT) replaces CT. Intraprostatic fiducial markers (FMs) are used as a surrogate for the position of the prostate improving targeting. However, FMs are not visible on sCT. Therefore, a semi-automatic method for burning-in FMs on sCT was developed. Accuracy of MR-only workflow using semi-automatically burned-in FMs was assessed and compared to CT/MR workflow. METHODS Thirty-one prostate cancer patients receiving radiotherapy, underwent an additional MR sequence (mDIXON) to create an sCT for MR-only workflow simulation. Three sources of accuracy in the CT/MR- and MR-only workflow were investigated. To compare image registrations for target delineation, the inter-observer error (IOE) of FM-based CT-to-MR image registrations and soft-tissue-based MR-to-MR image registrations were determined on twenty patients. Secondly, the inter-observer variation of the resulting FM positions was determined on twenty patients. Thirdly, on 26 patients CBCTs were retrospectively registered on sCT with burned-in FMs and compared to CT-CBCT registrations. RESULTS Image registration for target delineation shows a three times smaller IOE for MR-only workflow compared to CT/MR workflow. All observers agreed in correctly identifying all FMs for 18 out of 20 patients (90%). The IOE in CC direction of the center of mass (COM) position of the markers was within the CT slice thickness (2.5 mm), the IOE in AP and RL direction were below 1.0 mm and 1.5 mm, respectively. Registrations for IGRT position verification in MR-only workflow compared to CT/MR workflow were equivalent in RL-, CC- and AP-direction, except for a significant difference for random error in rotation. CONCLUSIONS MR-only workflow using sCT with burned-in FMs is an improvement compared to the current CT/MR workflow, with a three times smaller inter observer error in CT-MR registration and comparable CBCT registration results between CT and sCT reference scans. Trial registry Medical Research Involving Human Subjects Act (WMO) does apply to this study and was approved by the Medical Ethics review Committee of the Academic Medical Center. Registration number: NL65414.018.18. Date of registration: 21-08-2018.
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Affiliation(s)
- Karin Goudschaal
- Department of Radiation Oncology, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - F. Beeksma
- Department of Radiation Oncology, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - M. Boon
- Department of Radiation Oncology, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - M. Bijveld
- Department of Radiation Oncology, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - J. Visser
- Department of Radiation Oncology, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - K. Hinnen
- Department of Radiation Oncology, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Z. van Kesteren
- Department of Radiation Oncology, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
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Nicosia L, Sicignano G, Rigo M, Figlia V, Cuccia F, De Simone A, Giaj-Levra N, Mazzola R, Naccarato S, Ricchetti F, Vitale C, Ruggieri R, Alongi F. Daily dosimetric variation between image-guided volumetric modulated arc radiotherapy and MR-guided daily adaptive radiotherapy for prostate cancer stereotactic body radiotherapy. Acta Oncol 2021; 60:215-221. [PMID: 32945701 DOI: 10.1080/0284186x.2020.1821090] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIM To evaluate differences between MR-guided daily-adaptive RT (MRgRT) and image-guided RT (IGRT) with or without fiducial markers in prostate cancer (PCa) stereotactic body radiotherapy (SBRT) in terms of dose distribution on critical structures. MATERIAL AND METHODS Two hundred treatment sessions in 40 patients affected by low and intermediate PCa were evaluated. The prescribed dose was 35 Gy in 5 fractions delivered on alternate days. MRgRT patients (10) were daily recontoured, re-planned, and treated with IMRT technique. IGRT patients without (20) and with (10) fiducials were matched on soft tissues or fiducials and treated with VMAT technique. Respective CBCTs were retrospectively delineated and the prescribed plan was overlaid for dosimetric analysis. The daily dose for rectum, bladder, and prostate was registered. RESULTS MRgRT resulted in a significantly lower rate of constraints violation as compared to IGRT without fiducials, especially for rectum V28Gy, rectum V32Gy, rectum V35Gy, rectum Dmax, and bladder Dmax. IGRT with fiducials reported high accuracy levels, comparable to MRgRT. MRgRT and IGRT with fiducials reported no significant prostate CTV underdosage, while IGRT without fiducials was associated with occasional cases of prostate CTV under dosage. CONCLUSION MR-guided daily-adaptive SBRT seems a feasible and accurate strategy for treating prostate cancer with ablative doses. IGRT with the use of fiducials provides a comparable level of accuracy and acceptable real-dose distribution over treatment fractions. Future study will provide additional data regarding the tolerability and the clinical outcome of this new technological approach.
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Affiliation(s)
- Luca Nicosia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Italy
| | - Gianluisa Sicignano
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Italy
| | - Michele Rigo
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Italy
| | - Vanessa Figlia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Italy
| | - Francesco Cuccia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Italy
| | - Antonio De Simone
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Italy
| | - Niccolò Giaj-Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Italy
| | - Rosario Mazzola
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Italy
| | - Stefania Naccarato
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Italy
| | - Francesco Ricchetti
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Italy
| | - Claudio Vitale
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Italy
| | - Ruggero Ruggieri
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Italy
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, Italy
- University of Brescia
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Burbadge C, Kasanda E, Bildstein V, Dublin G, Olaizola B, Höhr C, Mücher D. Proton therapy range verification method via delayed γ-ray spectroscopy of a molybdenum tumour marker. Phys Med Biol 2021; 66:025005. [PMID: 32998122 DOI: 10.1088/1361-6560/abbd16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this work, a new method of range verification for proton therapy (PT) is experimentally demonstrated for the first time. If a metal marker is implanted near the tumour site, its response to proton activation will result in the emission of characteristic γ rays. The relative intensity of γ rays originating from competing fusion-evaporation reaction channels provides a unique signature of the average proton energy at the marker, and by extension the beam's range, in vivo and in real time. The clinical feasibility of this method was investigated at the PT facility at TRIUMF with a proof-of-principle experiment which irradiated a naturally-abundant molybdenum foil at various proton beam energies. Delayed characteristic γ rays were measured with two Compton-shielded LaBr3 scintillators. The technique was successfully demonstrated by relating the relative intensity of two γ-ray peaks to the energy of the beam at the Mo target, opening the door to future clinical applications where the range of the beam can be verified in real time.
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Affiliation(s)
- C Burbadge
- Department of Physics, University of Guelph, 50 Stone Rd E, Guelph, Ontario, N1G 2W1, Canada
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Determination of the CTV-PTV margin for prostate cancer radiotherapy depending on the prostate gland positioning control method. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2020. [DOI: 10.2478/pjmpe-2020-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Objective: The objective of the study was to determine the correct CTV-PTV margin, depending on the method used to verify the PG position. In the study, 3 methods of CBCT image superimposition were assessed as based on the location of the prostate gland (CBCT images), a single gold marker, and pubic symphysis respectively.
Materials and methods: The study group consisted of 30 patients undergoing irradiation therapy at the University Hospital in Zielona Góra. The therapy was delivered using the VMAT (Volumetric Modulated Arc Therapy) protocol. CBCT image-based superimposition (prostate-based alignment) was chosen as the reference method. The uncertainty of the PG positioning method was determined and the margin to be used was determined for the CBCT-based reference method. Then, changes in the position of the prostate gland relative to these determined using the single marker and pubic symphysis-based methods were determined. The CTV-PTV margin was calculated at the root of the sum of the squares for the doubled value of method uncertainty for the CBCT image-based alignment method and the value of the difference between the locations of planned and actual isocenters as determined using the method of interest and the CBCT-based alignment method for which the total number of differences accounted for 95% of all differences.
Results: The CTV-PTV margins to be used when the prostate gland is positioned using the CBCT imaging, single marker, and pubic symphysis-based methods were determined. For the CBCT-based method, the following values were obtained for the Vrt, Lng, and Lat directions respectively: 0.43 cm, 0.48 cm, 0.29 cm. For the single marker-based method, the respective values were 0.7 cm, 0.88 cm, and 0.44 cm whereas for the pubic symphysis-based method these were 0.65 cm, 0.76 cm, and 0.46 cm.
Conclusions: Regardless of the method, the smallest margin values were obtained for the lateral direction, with the CBCT-based method facilitating the smallest margins to be used. The largest margins were obtained using the single marker-based alignment method.
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Kao J, Karwowski P, Pettit J, Barney AK, Atalla C. Multiparametric prostate MRI-based intensity-modulated radiation therapy guided by prostatic calcifications. Br J Radiol 2020; 93:20200571. [PMID: 32846099 DOI: 10.1259/bjr.20200571] [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] Open
Abstract
OBJECTIVES The optimal technique to administer image-guided radiation therapy for prostate cancer remains poorly defined. This study assessed outcomes after multiparametric prostate MRI-based planning was delivered with image-guided radiation therapy using prostatic calculi observed on cone beam CT (CBCT). METHODS Between January 2015 and December 2017, 94 consecutive patients were treated with CBCT-based image-guided radiation therapy (IGRT) without fiducial markers. MRI was routinely incorporated for target delineation and intraprostatic tumor nodules were boosted to allow reduced doses to normal appearing prostate. The primary endpoint was the prevalence of prostatic calcifications while toxicity and biochemical control were secondary endpoints. RESULTS Median follow-up was 39.7 months with 82% NCCN intermediate to very high risk. Intraprostatic calculi were noted in 68% of patients. The 3-year biochemical control, late grade ≥2 rectal toxicity and late grade ≥2 urinary toxicity rates were 96%, 3 and 7%, respectively. Biochemical control and toxicity were not significantly impacted by the presence of prostatic calculi. CONCLUSION Prostatic calcifications can serve as natural fiducial markers to allow for non-invasive IGRT for prostate cancer with promising early disease control and toxicity outcomes. ADVANCES IN KNOWLEDGE Prostate calcification-guided IGRT is technically feasible.
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Affiliation(s)
- Johnny Kao
- Department of Radiation Oncology, Good Samaritan Hospital Medical Center, West Islip, New York, United States
| | - Pawel Karwowski
- Department of Radiation Oncology, Good Samaritan Hospital Medical Center, West Islip, New York, United States
| | - Jeffrey Pettit
- Department of Radiation Oncology, Good Samaritan Hospital Medical Center, West Islip, New York, United States
| | - Austin Kevin Barney
- Department of Radiation Oncology, Good Samaritan Hospital Medical Center, West Islip, New York, United States
| | - Christopher Atalla
- Division of Urology, Good Samaritan Hospital Medical Center, West Islip, New York, United States
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Webster A, Appelt A, Eminowicz G. Image-Guided Radiotherapy for Pelvic Cancers: A Review of Current Evidence and Clinical Utilisation. Clin Oncol (R Coll Radiol) 2020; 32:805-816. [DOI: 10.1016/j.clon.2020.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/18/2020] [Accepted: 09/30/2020] [Indexed: 02/07/2023]
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Abstract
AIM/OBJECTIVES/BACKGROUND The American College of Radiology (ACR) and the American Society for Radiation Oncology (ASTRO) have jointly developed the following practice parameter for image-guided radiation therapy (IGRT). IGRT is radiation therapy that employs imaging to maximize accuracy and precision throughout the entire process of treatment delivery with the goal of optimizing accuracy and reliability of radiation therapy to the target, while minimizing dose to normal tissues. METHODS The ACR-ASTRO Practice Parameter for IGRT was revised according to the process described on the ACR website ("The Process for Developing ACR Practice Parameters and Technical Standards," www.acr.org/ClinicalResources/Practice-Parametersand-Technical-Standards) by the Committee on Practice Parameters of the ACR Commission on Radiation Oncology in collaboration with the ASTRO. Both societies then reviewed and approved the document. RESULTS This practice parameter is developed to serve as a tool in the appropriate application of IGRT in the care of patients with conditions where radiation therapy is indicated. It addresses clinical implementation of IGRT including personnel qualifications, quality assurance standards, indications, and suggested documentation. CONCLUSIONS This practice parameter is a tool to guide clinical use of IGRT and does not make recommendations on site-specific IGRT directives. It focuses on the best practices and principles to consider when using IGRT effectively, especially with the significant increase in imaging data that is now available with IGRT. The clinical benefit and medical necessity of the imaging modality and frequency of IGRT should be assessed for each patient.
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Yorke AA, Solis D, Guerrero T. A feasibility study to estimate optimal rigid-body registration using combinatorial rigid registration optimization (CORRO). J Appl Clin Med Phys 2020; 21:14-22. [PMID: 33068076 PMCID: PMC7700946 DOI: 10.1002/acm2.12965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 02/29/2020] [Accepted: 05/28/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose Clinical image pairs provide the most realistic test data for image registration evaluation. However, the optimal registration is unknown. Using combinatorial rigid registration optimization (CORRO) we demonstrate a method to estimate the optimal alignment for rigid‐registration of clinical image pairs. Methods Expert selected landmark pairs were selected for each CT/CBCT image pair for six cases representing head and neck, thoracic, and pelvic anatomic regions. Combination subsets of a k number of landmark pairs (k‐combination set) were generated without repeat to form a large set of k‐combination sets (k‐set) for k = 4,8,12. The rigid transformation between the image pairs was calculated for each k‐combination set. The mean and standard deviation of these transformations were used to derive final registration for each k‐set. Results The standard deviation of registration output decreased as the k‐size increased for all cases. The joint entropy evaluated for each k‐set of each case was smaller than those from two commercially available registration programs indicating a stronger correlation between the image pair after CORRO was used. A joint histogram plot of all three algorithms showed high correlation between them. As further proof of the efficacy of CORRO the joint entropy of each member of 30 000 k‐combination sets in k = 4 were calculated for one of the thoracic cases. The minimum joint entropy was found to exist at the estimated mean of registration indicating CORRO converges to the optimal rigid‐registration results. Conclusions We have developed a methodology called CORRO that allows us to estimate optimal alignment for rigid‐registration of clinical image pairs using a large set landmark point. The results for the rigid‐body registration have been shown to be comparable to results from commercially available algorithms for all six cases. CORRO can serve as an excellent tool that can be used to test and validate rigid registration algorithms.
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Affiliation(s)
- Afua A Yorke
- Department of Radiation Oncology, UW Medicine, Seattle, WA, USA.,Department of Radiation Oncology, Beaumont Health, Royal Oak, MI, USA
| | - David Solis
- Department of Radiation Oncology, Beaumont Health, Royal Oak, MI, USA.,Department of Physics, Mary Bird Perkins Cancer Center, Baton Rouge, LA, USA
| | - Thomas Guerrero
- Department of Radiation Oncology, UW Medicine, Seattle, WA, USA.,Department of Radiation Oncology, Beaumont Health, Royal Oak, MI, USA.,Oakland University William Beaumont School of Medicine Rochester Hills, Auburn Hills, MI, USA
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Shan G, Hu W, Chen L, Price RA, Ma CMC. Dosimetric evaluation of image-guided radiation therapy for prostate cancer. Med Dosim 2020; 46:117-126. [PMID: 33020024 DOI: 10.1016/j.meddos.2020.09.007] [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: 05/19/2020] [Revised: 09/17/2020] [Accepted: 09/19/2020] [Indexed: 11/26/2022]
Abstract
The aim of this study was to investigate the dosimetric accuracy of imaged-guided radiation therapy for prostate patients using the in-room computed tomography (CT) target localization technique. A Siemens CT-on-rails system was used for patient setup and target localization for intensity-modulated radiation therapy (IMRT) of prostate cancer. Fifteen previously treated prostate patients were included in this retrospective study. CT-on-Rails scans were performed before and after the IMRT treatment under local IRB approval. A total of 15 original simulation CT scans and 98 post-treatment CT scans were contoured by the same oncologist to delineate the prostate target, bladder, and rectum. IMRT plans were generated on the original simulation CTs and the same MUs and leaf sequences were used to compute the dose distributions using post-treatment CTs. Varian Velocity deformable registration was used for the summation of the fractional doses and the cumulative doses were compared with the planned doses. For the 15 patients investigated, the mean isocenter shift was up to 4.0 mm in the left-right direction, 5.9 mm in the anterior-posterior direction and 5.6 mm in the superior-inferior direction due to interfractional organ motion. The mean rectal volume varied from 0.6 to 1.73 times and the mean bladder volume varied from 0.59 to 3.65 times between simulation and the end of treatment. The prescription dose to 95% of the PTV, Dp, was set to 76 Gy for all treatment plans. The dose to 95% of the clinical treatment volume (CTV), D95, was 74.0 to 77.6 Gy and the minimum CTV dose, Dmin, was 61.0 to 71.6 Gy, respectively, in the cumulative dose distributions. Detailed analyses showed that 7.1% of the treatment fractions had cold spots (< 85% of Dp) in the peripheral CTV, leading to Dmin < 64 Gy in the cumulative dose distributions for 4 patients. The rectal dose-volume constraints were violated in 35.7% of the treatment fractions while the bladder dose was much improved in 82.7% of the treatment fractions. The current IGRT procedure for patient setup and target localization using rigid-body registration based on contour/anatomy matching is effective for population-based PTV margins. For a small group of patients, specific PTV margins and/or real-time target monitoring/tracking will be necessary due to significant prostate deformation/rotation caused by inter- and intrafractional bladder and rectal volume variation.
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Affiliation(s)
- Guoping Shan
- Department of Radiation Physics, Zhejiang Key Lab of Radiation Oncology, Hangzhou, China
| | - Wei Hu
- Department of Radiation Oncology, Taizhou Central Hospital, Zhejiang, China
| | - Lili Chen
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Robert A Price
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - C-M Charlie Ma
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Cuccia F, Alongi F. Reply to Ghaffari et al. "In regard to Cuccia et al.: impact of hydrogel peri-rectal spacer insertion on prostate gland intra-fraction motion during 1.5 T MR-guided stereotactic body radiotherapy.". Radiat Oncol 2020; 15:213. [PMID: 32907601 PMCID: PMC7488142 DOI: 10.1186/s13014-020-01659-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 08/31/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Francesco Cuccia
- Advanced Radiation Oncology Department, Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.
| | - Filippo Alongi
- Advanced Radiation Oncology Department, Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.,University of Brescia, Brescia, Italy
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Liang X, Zhao W, Hristov DH, Buyyounouski MK, Hancock SL, Bagshaw H, Zhang Q, Xie Y, Xing L. A deep learning framework for prostate localization in cone beam CT-guided radiotherapy. Med Phys 2020; 47:4233-4240. [PMID: 32583418 PMCID: PMC10823910 DOI: 10.1002/mp.14355] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 01/31/2024] Open
Abstract
PURPOSE To develop a deep learning-based model for prostate planning target volume (PTV) localization on cone beam computed tomography (CBCT) to improve the workflow of CBCT-guided patient setup. METHODS A two-step task-based residual network (T2 RN) is proposed to automatically identify inherent landmarks in prostate PTV. The input to the T2 RN is the pretreatment CBCT images of the patient, and the output is the deep learning-identified landmarks in the PTV. To ensure robust PTV localization, the T2 RN model is trained by using over thousand sets of CT images with labeled landmarks, each of the CTs corresponds to a different scenario of patient position and/or anatomy distribution generated by synthetically changing the planning CT (pCT) image. The changes, including translation, rotation, and deformation, represent vast possible clinical situations of anatomy variations during a course of radiation therapy (RT). The trained patient-specific T2 RN model is tested by using 240 CBCTs from six patients. The testing CBCTs consists of 120 original CBCTs and 120 synthetic CBCTs. The synthetic CBCTs are generated by applying rotation/translation transformations to each of the original CBCT. RESULTS The systematic/random setup errors between the model prediction and the reference are found to be <0.25/2.46 mm and 0.14/1.41° in translation and rotation dimensions, respectively. Pearson's correlation coefficient between model prediction and the reference is higher than 0.94 in translation and rotation dimensions. The Bland-Altman plots show good agreement between the two techniques. CONCLUSIONS A novel T2 RN deep learning technique is established to localize the prostate PTV for RT patient setup. Our results show that highly accurate marker-less prostate setup is achievable by leveraging the state-of-the-art deep learning strategy.
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Affiliation(s)
- Xiaokun Liang
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305 USA
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055 China
| | - Wei Zhao
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305 USA
| | - Dimitre H. Hristov
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305 USA
| | | | - Steven L. Hancock
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305 USA
| | - Hilary Bagshaw
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305 USA
| | - Qin Zhang
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305 USA
| | - Yaoqin Xie
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055 China
| | - Lei Xing
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305 USA
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Piling Gold in the Prostate. ACG Case Rep J 2020; 7:e00426. [PMID: 32766368 PMCID: PMC7357711 DOI: 10.14309/crj.0000000000000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/08/2020] [Indexed: 11/17/2022] Open
Abstract
Radiation beams precisely directed at a tumor can attenuate the radiation to contiguous tissues. Image-guided radiation therapy using fiducials allows accurate delineation of tumor location. Traditionally, fiducials in the prostate have been placed by urologists or radiation oncologists. With the evolution of endoscopic ultrasound (EUS), fiducials have been successfully placed under the EUS guidance in different organs. In this case series, fiducials were placed in 3 patients with prostate cancer. All patients completed their radiation therapy, and no complications were reported except mild dysuria in one case. EUS-guided fiducial placement is safe and offers a new modality for fiducial placement in the prostate.
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45
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Wang T, Inubushi S, Ikeo N, Mukai T, Okumura K, Akasaka H, Yada R, Yoshida K, Miyawaki D, Ishihara T, Nakaoka A, Sasaki R. Novel artifact-robust and highly visible zinc solid fiducial marker for kilovoltage x-ray image-guided radiation therapy. Med Phys 2020; 47:4703-4710. [PMID: 32696571 DOI: 10.1002/mp.14412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To develop a novel biocompatible solid fiducial marker that prevents radiopaque imaging artifacts and also maintains high imaging contrast for kilovoltage x-ray image-guided radiation therapy. METHODS The fiducial marker was made of pure zinc. An in-house water-equivalent phantom was designed to evaluate artifacts and visibility under various simulated treatment scenarios. Image artifacts were quantitatively assessed in terms of the metal artifact index (MAI) on kilovoltage computed tomography (CT) and cone-beam CT (CBCT) scans. Marker visibility was evaluated on two types of kilovoltage planar x-ray images in terms of the contrast-to-background ratio (CBR). Comparisons with a conventional gold fiducial marker were conducted. RESULTS The use of zinc rather than a gold marker mitigates imaging artifacts. The MAI near the zinc marker decreased by 76, 79, and 77 % in CT, and by 77 (81), 74 (80), and 79 (85) % in CBCT full-fan (half-fan) scans, when using one-, two-, and three-marker phantom settings, respectively. The high-contrast part of the zinc marker exhibited CBRs above 2.00 for 28/32 exposures under four (lung, tissue, low-density bone, and high-density bone) different simulation scenarios, making its visibility comparable to that of the gold marker (30/32 exposures with CBRs > 2.00). CONCLUSIONS We developed a biocompatible, artifact-robust, and highly visible solid zinc fiducial marker. Although further evaluation is needed in clinical settings, our findings suggest its feasibility and benefits for kilovoltage x-ray image-guided radiation therapy.
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Affiliation(s)
- Tianyuan Wang
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuouku, Kobe, Hyogo, 650-0017, Japan
| | - Sachiko Inubushi
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuouku, Kobe, Hyogo, 650-0017, Japan
| | - Naoko Ikeo
- Department of Mechanical Engineering, Kobe University Graduate School of Engineering Faculty of Engineering, 1-1 Rokkodai-cho, Kobe, Hyogo, 657-8501, Japan
| | - Toshiji Mukai
- Department of Mechanical Engineering, Kobe University Graduate School of Engineering Faculty of Engineering, 1-1 Rokkodai-cho, Kobe, Hyogo, 657-8501, Japan
| | - Keisuke Okumura
- Centre for Radiology and Radiation Oncology, Kobe University Hospital, 7-5-2 Kusunokicho, Chuouku, Kobe, Hyogo, 650-0017, Japan
| | - Hiroaki Akasaka
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuouku, Kobe, Hyogo, 650-0017, Japan
| | - Ryuichi Yada
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuouku, Kobe, Hyogo, 650-0017, Japan
| | - Kenji Yoshida
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuouku, Kobe, Hyogo, 650-0017, Japan
| | - Daisuke Miyawaki
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuouku, Kobe, Hyogo, 650-0017, Japan
| | - Takeaki Ishihara
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuouku, Kobe, Hyogo, 650-0017, Japan
| | - Ai Nakaoka
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuouku, Kobe, Hyogo, 650-0017, Japan
| | - Ryohei Sasaki
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuouku, Kobe, Hyogo, 650-0017, Japan
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Cuccia F, Mazzola R, Nicosia L, Figlia V, Giaj-Levra N, Ricchetti F, Rigo M, Vitale C, Mantoan B, De Simone A, Sicignano G, Ruggieri R, Cavalleri S, Alongi F. Impact of hydrogel peri-rectal spacer insertion on prostate gland intra-fraction motion during 1.5 T MR-guided stereotactic body radiotherapy. Radiat Oncol 2020; 15:178. [PMID: 32698843 PMCID: PMC7376654 DOI: 10.1186/s13014-020-01622-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/15/2020] [Indexed: 12/12/2022] Open
Abstract
Background The assessment of organ motion is a crucial feature for prostate stereotactic body radiotherapy (SBRT). Rectal spacer may represent a helpful device in order to outdistance rectal wall from clinical target, but its impact on organ motion is still a matter of debate. MRI-Linac is a new frontier in radiation oncology as it allows a superior visualization of the real-time anatomy of the patient and the current highest level of adaptive radiotherapy. Methods We present data regarding a total of 100 fractions in 20 patients who underwent MRI-guided prostate SBRT for low-to-intermediate risk prostate cancer with or without spacer. Translational and rotational shifts were computed on the pre- and post-treatment MRI acquisitions referring to the delivery position for antero-posterior, latero-lateral and cranio-caudal direction, and assessed using the Mann-Whitney U-Test. Results All patients were treated with a five sessions schedule (35 Gy/5fx) using MRI-Linac for a median fraction treatment time of 50 min (range, 46–65). In the entire study sample, median rotational displacement was 0.1° in cranio-caudal, − 0.002° in latero-lateral and 0.01° in antero-posterior direction; median translational shift was 0.11 mm in cranio-caudal, − 0.24 mm in latero-lateral and − 0.22 mm in antero-posterior. A significant difference between spacer and no-spacer patients in terms of rotational shifts in the antero-posterior direction (p = 0.033) was observed; also for translational shifts a positive trend was detected in antero-posterior direction (p = 0.07), although with no statistical significance. We observed statistically significant differences in the pre-treatment planning phase in favor of the spacer cohort for several rectum dose constraints: rectum V32Gy < 5% (p = 0.001), V28 Gy < 10% (p = 0.001) and V18Gy < 35% (p = 0.039). Also for bladder V35 Gy < 1 cc, the use of spacer provided a dosimetric advantage compared to the no-spacer subpopulation (p = 0.04). Furthermore, PTV V33.2Gy > 95% was higher in the spacer cohort compared to the no-spacer one (p = 0.036). Conclusion In our experience, the application of rectal hydrogel spacer for prostate SBRT resulted in a significant impact on rotational antero-posterior shifts contributing to limit prostate intra-fraction motion. Further studies with larger sample size and longer follow-up are required to confirm this ideally favorable effect and to assess any potential impact on clinical outcomes.
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Affiliation(s)
- Francesco Cuccia
- Advanced Radiation Oncology Deparment, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy.
| | - Rosario Mazzola
- Advanced Radiation Oncology Deparment, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Luca Nicosia
- Advanced Radiation Oncology Deparment, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Vanessa Figlia
- Advanced Radiation Oncology Deparment, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Niccolò Giaj-Levra
- Advanced Radiation Oncology Deparment, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Francesco Ricchetti
- Advanced Radiation Oncology Deparment, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Michele Rigo
- Advanced Radiation Oncology Deparment, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Claudio Vitale
- Advanced Radiation Oncology Deparment, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Beatrice Mantoan
- Advanced Radiation Oncology Deparment, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Antonio De Simone
- Advanced Radiation Oncology Deparment, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Gianluisa Sicignano
- Advanced Radiation Oncology Deparment, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Ruggero Ruggieri
- Advanced Radiation Oncology Deparment, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Stefano Cavalleri
- Urology Division, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Filippo Alongi
- Advanced Radiation Oncology Deparment, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy.,University of Brescia, Brescia, Italy
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Vanhanen A, Poulsen P, Kapanen M. Dosimetric effect of intrafraction motion and different localization strategies in prostate SBRT. Phys Med 2020; 75:58-68. [PMID: 32540647 DOI: 10.1016/j.ejmp.2020.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 05/04/2020] [Accepted: 06/06/2020] [Indexed: 01/02/2023] Open
Abstract
The aim of this study was to evaluate the dosimetric effect of continuous motion monitoring based localization (Calypso, Varian Medical Systems), gating and intrafraction motion correction in prostate SBRT. Delivered doses were modelled by reconstructing motion inclusive dose distributions for different localization strategies. Actually delivered dose (strategy A) utilized initial Calypso localization, CBCT and additional pre-treatment motion correction by kV-imaging and Calypso, and gating during the irradiation. The effect of gating was investigated by simulating non-gated treatments (strategy B). Additionally, non-gated and single image-guided (CBCT) localization was simulated (strategy C). A total of 308 fractions from 22 patients were reconstructed. The dosimetric effect was evaluated by comparing motion inclusive target and risk organ dose-volume parameters to planned values. Motion induced dose deficits were seen mainly in PTV and CTV to PTV margin regions, whereas CTV dose deficits were small in all strategies: mean ± SD difference in CTVD99% was -0.3 ± 0.4%, -0.4 ± 0.6% and -0.7 ± 1.2% in strategies A, B and C, respectively. Largest dose deficits were seen in individual fractions for strategy C (maximum dose reductions were -29.0% and -7.1% for PTVD95% and CTVD99%, respectively). The benefit of gating was minor, if additional motion correction was applied immediately prior to irradiation. Continuous motion monitoring based localization and motion correction ensured the target coverage and minimized the OAR exposure for every fraction and is recommended to use in prostate SBRT. The study is part of clinical trial NCT02319239.
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Affiliation(s)
- A Vanhanen
- Department of Oncology, Unit of Radiotherapy, Tampere University Hospital, POB-2000, 33521 Tampere, Finland; Department of Medical Physics, Medical Imaging Center, Tampere University Hospital, POB-2000, 33521 Tampere, Finland.
| | - P Poulsen
- Department of Oncology and Danish Center for Particle Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 25, Entrance B3, 8200 Aarhus N, Denmark
| | - M Kapanen
- Department of Oncology, Unit of Radiotherapy, Tampere University Hospital, POB-2000, 33521 Tampere, Finland; Department of Medical Physics, Medical Imaging Center, Tampere University Hospital, POB-2000, 33521 Tampere, Finland
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Evaluation of a Novel Liquid Fiducial Marker, BioXmark ®, for Small Animal Image-Guided Radiotherapy Applications. Cancers (Basel) 2020; 12:cancers12051276. [PMID: 32443537 PMCID: PMC7280978 DOI: 10.3390/cancers12051276] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/17/2022] Open
Abstract
BioXmark® (Nanovi A/S, Denmark) is a novel fiducial marker based on a liquid, iodine-based and non-metallic formulation. BioXmark® has been clinically validated and reverse translated to preclinical models to improve cone-beam CT (CBCT) target delineation in small animal image-guided radiotherapy (SAIGRT). However, in phantom image analysis and in vivo evaluation of radiobiological response after the injection of BioXmark® are yet to be reported. In phantom measurements were performed to compare CBCT imaging artefacts with solid fiducials and determine optimum imaging parameters for BioXmark®. In vivo stability of BioXmark® was assessed over a 5-month period, and the impact of BioXmark® on in vivo tumour response from single-fraction and fractionated X-ray exposures was investigated in a subcutaneous syngeneic tumour model. BioXmark® was stable, well tolerated and detectable on CBCT at volumes ≤10 µL. Our data showed imaging artefacts reduced by up to 84% and 89% compared to polymer and gold fiducial markers, respectively. BioXmark® was shown to have no significant impact on tumour growth in control animals, but changes were observed in irradiated animals injected with BioXmark® due to alterations in dose calculations induced by the sharp contrast enhancement. BioXmark® is superior to solid fiducials with reduced imaging artefacts on CBCT. With minimal impact on the tumour growth delay, BioXmark® can be implemented in SAIGRT to improve target delineation and reduce set-up errors.
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49
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Fawzy R, Abdel-Malek R, Metwaly M, Abdelaziz O, Seleem A. Evaluation of target volume margins for radiotherapy of prostate implanted with fiducial markers. Radiol Phys Technol 2020; 13:152-159. [DOI: 10.1007/s12194-020-00563-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 10/24/2022]
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50
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Singhrao K, Ruan D, Fu J, Gao Y, Chee G, Yang Y, King C, Hu P, Kishan AU, Lewis JH. Quantification of fiducial marker visibility for MRI-only prostate radiotherapy simulation. Phys Med Biol 2020; 65:035015. [PMID: 31881546 DOI: 10.1088/1361-6560/ab65db] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
To objectively compare the suitability of MRI pulse sequences and commercially available fiducial markers (FMs) for MRI-only prostate radiotherapy simulation. Most FMs appear as small signal voids in MRI images making them difficult to differentiate from tissue heterogeneities such as calcifications. In this study we use quantitative metrics to objectively evaluate the visibility of FMs in 27 patients and an anthropomorphic phantom with a variety of standard clinical MRI pulse sequences and commercially available FMs. FM visibility was quantified using the local contrast-to-noise-ratio (lCNR), the difference between the 80th and 20th percentile iso-intensity FM volumes (V fall) and the largest iso-intensity volume that can be distinguished from background: apparent-marker-volume (AMV). A larger lCNR and AMV, and smaller V fall represents a more easily identifiable FM. The number of non-marker objects visualized by each pulse sequence was calculated using FM-derived template-matching. The FM-based target-registration-error (TRE) between each MRI and the planning-CT image was calculated. Fiducial marker visibility was rated by two medical physicists with over three years of experience examining MRI-only prostate simulation images. The rater's classification accuracy was quantified using the F 1 score, which is the harmonic mean of the rater's precision and recall. These quantitative metrics and human observer ratings were used to evaluate FM identifiability in images from nine subtypes of T 1-weighted, T 2-weighted and gradient echo (GRE) pulse sequences in a 27-patient study. A phantom study was conducted to quantify the visibility of 8 commercially available FMs. In the patient study, the largest mean lCNR and AMV and, smallest normalized V fall were produced by the 3.0 T multiple-echo GRE pulse sequence (T 1-VIBE, 2° flip angle, 1.23 ms and 2.45 ms echo-times). This pulse sequence produced no false marker detections and TREs less than 2 mm in the left-right, anterior-posterior and cranial-caudal directions, respectively. Human observers rated the 1.23 ms echo-time GRE images with the best average marker visibility score of 100% and an F 1 score of 1. In the phantom study, the Gold-Anchor GA-200X-20-B (deployed in a folded configuration) produced the largest sequence averaged lCNR and AMV measurements at 16.1 and 16.7 mm3, respectively. Using quantitative visibility and distinguishability metrics and human observer ratings, the patient study demonstrated that multiple-echo GRE images produced the best gold FM visibility and distinguishability. The phantom study demonstrated that markers manufactured from platinum or iron-doped gold quantitatively produced superior visibility compared to their pure gold counterparts.
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Affiliation(s)
- Kamal Singhrao
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA 90095, United States of America
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