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Dupont F, Dechambre D, Sterpin E. Evaluation of safety margins for cone beam CT-based adaptive prostate radiotherapy. Phys Med 2024; 121:103368. [PMID: 38663348 DOI: 10.1016/j.ejmp.2024.103368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
Adaptive radiotherapy is characterized by the use of a daily imaging system, such as CBCT (Cone-Beam Computed Tomography) images to re-optimize the treatment based on the daily anatomy and position of the patient. By systematically re-delineating the Clinical Target Volume (CTV) at each fraction, target delineation uncertainty features a random component instead of a pure systematic. The goal of this work is to identify the random and systematic contributions of the delineation error and compute a new relevant Planning Target Volume (PTV) safety margin. 169 radiotherapy sessions from 10 prostate cancer patients treated on the Varian ETHOS treatment system have been analyzed. Intra-patient and inter-patient delineation variabilities were computed in six directions, by considering the prostate as a rigid, non-rotating volume. By doing so, we were able to directly compare the delineations done by the physicians on daily CBCT images with the initial delineation done on the CT-sim and MRI, and sort them by direction using the polar coordinates of the points. The computed variabilities were then used to compute a PTV margin based on Van Herk margin recipe. The total margin computed with random and systematic delineation uncertainties was of 2.7, 2.4, 5.6, 4.8, 4.9 and 3.6 mm in the left, right, anterior, posterior, cranial and caudal directions, respectively. According to our results, the gain offered by the separation of the delineation uncertainty into systematic and random contributions due to the adaptive delineation process justifies a reduction of the PTV margin down to 3 to 5 mm in every direction.
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Affiliation(s)
- Florian Dupont
- UCLouvain, Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium; Cliniques Universitaires Saint-Luc (CUSL), Nuclear Medicine Department, Brussels, Belgium.
| | - David Dechambre
- Cliniques Universitaires Saint-Luc (CUSL), Radiotherapy Department, Brussels, Belgium
| | - Edmond Sterpin
- UCLouvain, Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium; KU Leuven, Department of Oncology, Laboratory of Experimental Radiotherapy, Leuven, Belgium; Particle Therapy Interuniversity Center Leuven (ParTICLe), Leuven, Belgium
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2
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Winter JD, Reddy V, Li W, Craig T, Raman S. Impact of technological advances in treatment planning, image guidance, and treatment delivery on target margin design for prostate cancer radiotherapy: an updated review. Br J Radiol 2024; 97:31-40. [PMID: 38263844 PMCID: PMC11027310 DOI: 10.1093/bjr/tqad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/22/2023] [Accepted: 11/21/2023] [Indexed: 01/25/2024] Open
Abstract
Recent innovations in image guidance, treatment delivery, and adaptive radiotherapy (RT) have created a new paradigm for planning target volume (PTV) margin design for patients with prostate cancer. We performed a review of the recent literature on PTV margin selection and design for intact prostate RT, excluding post-operative RT, brachytherapy, and proton therapy. Our review describes the increased focus on prostate and seminal vesicles as heterogenous deforming structures with further emergence of intra-prostatic GTV boost and concurrent pelvic lymph node treatment. To capture recent innovations, we highlight the evolution in cone beam CT guidance, and increasing use of MRI for improved target delineation and image registration and supporting online adaptive RT. Moreover, we summarize new and evolving image-guidance treatment platforms as well as recent reports of novel immobilization strategies and motion tracking. Our report also captures recent implementations of artificial intelligence to support image guidance and adaptive RT. To characterize the clinical impact of PTV margin changes via model-based risk estimates and clinical trials, we highlight recent high impact reports. Our report focusses on topics in the context of PTV margins but also showcase studies attempting to move beyond the PTV margin recipes with robust optimization and probabilistic planning approaches. Although guidelines exist for target margins conventional using CT-based image guidance, further validation is required to understand the optimal margins for online adaptation either alone or combined with real-time motion compensation to minimize systematic and random uncertainties in the treatment of patients with prostate cancer.
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Affiliation(s)
- Jeff D Winter
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Varun Reddy
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Winnie Li
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Tim Craig
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Srinivas Raman
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
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3
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Snyder J, Smith B, Aubin JS, Shepard A, Hyer D. Simulating an intra-fraction adaptive workflow to enable PTV margin reduction in MRIgART volumetric modulated arc therapy for prostate SBRT. Front Oncol 2024; 13:1325105. [PMID: 38260830 PMCID: PMC10800949 DOI: 10.3389/fonc.2023.1325105] [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: 10/20/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose This study simulates a novel prostate SBRT intra-fraction re-optimization workflow in MRIgART to account for prostate intra-fraction motion and evaluates the dosimetric benefit of reducing PTV margins. Materials and methods VMAT prostate SBRT treatment plans were created for 10 patients using two different PTV margins, one with a 5 mm margin except 3 mm posteriorly (standard) and another using uniform 2 mm margins (reduced). All plans were prescribed to 36.25 Gy in 5 fractions and adapted onto each daily MRI dataset. An intra-fraction adaptive workflow was simulated for the reduced margin group by synchronizing the radiation delivery with target position from cine MRI imaging. Intra-fraction delivered dose was reconstructed and prostate DVH metrics were evaluated under three conditions for the reduced margin plans: Without motion compensation (no-adapt), with a single adapt prior to treatment (ATP), and lastly for intra-fraction re-optimization during delivery (intra). Bladder and rectum DVH metrics were compared between the standard and reduced margin plans. Results As expected, rectum V18 Gy was reduced by 4.4 ± 3.9%, D1cc was reduced by 12.2 ± 6.8% (3.4 ± 2.3 Gy), while bladder reductions were 7.8 ± 5.6% for V18 Gy, and 9.6 ± 7.3% (3.4 ± 2.5 Gy) for D1cc for the reduced margin reference plans compared to the standard PTV margin. For the intrafraction replanning approach, average intra-fraction optimization times were 40.0 ± 2.9 seconds, less than the time to deliver one of the four VMAT arcs (104.4 ± 9.3 seconds) used for treatment delivery. When accounting for intra-fraction motion, prostate V36.25 Gy was on average 96.5 ± 4.0%, 99.1 ± 1.3%, and 99.6 ± 0.4 for the non-adapt, ATP, and intra-adapt groups, respectively. The minimum dose received by the prostate was less than 95% of the prescription dose in 84%, 36%, and 10% of fractions, for the non-adapt, ATP, and intra-adapt groups, respectively. Conclusions Intra-fraction re-optimization improves prostate coverage, specifically the minimum dose to the prostate, and enables PTV margin reduction and subsequent OAR sparing. Fast re-optimizations enable uninterrupted treatment delivery.
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Affiliation(s)
- Jeffrey Snyder
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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Meyers SM, Winter JD, Obeidi Y, Chung P, Menard C, Warde P, Fong H, McPartlin A, Parameswaran S, Berlin A, Bayley A, Catton C, Craig T. A feasibility study of adaptive radiation therapy for postprostatectomy prostate cancer. Med Dosim 2023; 49:150-158. [PMID: 37985297 DOI: 10.1016/j.meddos.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 10/13/2023] [Accepted: 10/21/2023] [Indexed: 11/22/2023]
Abstract
Postoperative prostate radiotherapy requires large planning target volume (PTV) margins to account for motion and deformation of the prostate bed. Adaptive radiation therapy (ART) can incorporate image-guidance data to personalize PTVs that maintain coverage while reducing toxicity. We present feasibility and dosimetry results of a prospective study of postprostatectomy ART. Twenty-one patients were treated with single-adaptation ART. Conventional treatments were delivered for fractions 1 to 6 and adapted plans for the remaining 27 fractions. Clinical target volumes (CTVs) and small bowel delineated on fraction 1 to 4 CBCT were used to generate adapted PTVs and planning organ-at-risk (OAR) volumes for adapted plans. PTV volume and OAR dose were compared between ART and conventional using Wilcoxon signed-rank tests. Weekly CBCT were used to assess the fraction of CTV covered by PTV, CTV D99, and small bowel D1cc. Clinical metrics were compared using a Student's t-test (p < 0.05 significant). Offline adaptive planning required 1.9 ± 0.4 days (mean ± SD). ART decreased mean adapted PTV volume 61 ± 37 cc and bladder wall D50 compared with conventional treatment (p < 0.01). The CTV was fully covered for 96% (97%) of fractions with ART (conventional). Reconstructing dose on weekly CBCT, a nonsignificant reduction in CTV D99 was observed with ART (94%) compared to conventional (96%). Reduced CTV D99 with ART was significantly correlated with large anterior-posterior rectal diameter on simulation CT. ART reduced the number of fractions exceeding our institution's small bowel D1c limit from 14% to 7%. This study has demonstrated the feasibility of offline ART for post-prostatectomy cancer. ART facilitates PTV volume reduction while maintaining reasonable CTV coverage and can reduce the dose to adjacent normal tissues.
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Affiliation(s)
- Sandra M Meyers
- Department of Radiation Medicine and Applied Sciences, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Jeff D Winter
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | | | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia Menard
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Padraig Warde
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Heng Fong
- The Ministry of Health Malaysia, Daerah Timur Laut, Penang, Malaysia
| | - Andrew McPartlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | | | - Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Bayley
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Charles Catton
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Tim Craig
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
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Umbarkar P, Kannan V, Anand VJ, Deshpande S, Hinduja R, Babu V, Naidu S, Jadhav O, Jejurkar A. A comparative study of rectal volume variation in patients with prostate cancer: A tertiary care center study. Radiography (Lond) 2023; 29:845-850. [PMID: 37399732 DOI: 10.1016/j.radi.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Every day variations in rectal filling in prostate cancer radiotherapy can significantly alter the delivered dose distribution from what was intended. The goal of this study was to see if the time of treatment delivery affected the rectal filling. METHODS This is a retrospective study which included 50 patients with localized prostate cancer treated with volumetric modulated arc therapy (VMAT) to the primary and regional lymph nodes. Cone Beam Computed Tomography (CBCT) image-sets were done for all patient's daily setup verification. The radiation therapist contoured the rectum on all CBCT image sets. The rectal volumes delineated on CBCT and the planning CT image sets were compared. The change in rectal volumes between morning and afternoon treatments were calculated and compared. RESULTS A total of 1000 CBCT image sets were obtained on 50 patients in the morning and afternoon. The percentage variation of the CBCT rectal volumes over the planning CT scan was 16.57% in the AM group and 24.35% in the PM group. CONCLUSION The percentage change in rectal volume was significantly lesser in AM group compared to PM group and therefore morning treatments may result in dose distribution that is close to the intended dose distribution. IMPLICATIONS FOR PRACTICE In prostate cancer radiotherapy our study suggests that a simple technique of changing the time of treatment from afternoon to morning can help to reduce the rectal volume.
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Affiliation(s)
- P Umbarkar
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - V Kannan
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - V J Anand
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - S Deshpande
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - R Hinduja
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - V Babu
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - S Naidu
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - O Jadhav
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - A Jejurkar
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
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Arumugam S, Wong K, Do V, Sidhom M. Reducing the margin in prostate radiotherapy: optimizing radiotherapy with a general-purpose linear accelerator using an in-house position monitoring system. Front Oncol 2023; 13:1116999. [PMID: 37519807 PMCID: PMC10373585 DOI: 10.3389/fonc.2023.1116999] [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: 12/06/2022] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose To study the feasibility of optimizing the Clinical Target Volume to Planning Target Volume (CTV-PTV) margin in prostate radiotherapy(RT) with a general-purpose linear accelerator using an in-house developed position monitoring system, SeedTracker. Methods A cohort of 30 patients having definitive prostate radiotherapy treated within an ethics-approved prospective trial was considered for this study. The intrafraction prostate motion and the position deviations were measured using SeedTracker system during each treatment fraction. Using this data the CTV-PTV margin required to cover 90% of the patients with a minimum of 95% of the prescription dose to CTV was calculated using van Herk's formula. The margin calculations were performed for treatment scenarios both with and without applying the position corrections for observed position deviations. The feasibility of margin reduction with real-time monitoring was studied by assessing the delivered dose that incorporates the actual target position during treatment delivery and comparing it with the planned dose. This assessment was performed for plans generated with reduced CTV-PTV margin in the range of 7mm-3mm. Results With real-time monitoring and position corrections applied the margin of 2.0mm, 2.1mm and 2.1mm in LR, AP and SI directions were required to meet the criteria of 90% population to receive 95% of the dose prescription to CTV. Without position corrections applied for observed position deviations a margin of 3.1mm, 4.0mm and 3.0mm was required in LR, AP and SI directions to meet the same criteria. A mean ± SD reduction of 0.5 ± 1.8% and 3 ± 7% of V60 for the rectum and bladder can be achieved for every 1mm reduction of PTV margin. With position corrections applied, the CTV D99 can be delivered within -0.2 ± 0.3 Gy of the planned dose for plans with a 3mm margin. Without applying corrections for position deviations the CTV D99 was reduced by a maximum of 1.1 ± 1.1 Gy for the 3mm margin plan and there was a statistically significant difference between planned and delivered dose for 3mm and 4mm margin plans. Conclusion This study demonstrates the feasibility of reducing the margin in prostate radiotherapy with SeedTracker system without compromising the dose delivery accuracy to CTV while reducing dose to critical structures.
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Affiliation(s)
- Sankar Arumugam
- Department of Medical Physics, Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Karen Wong
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Viet Do
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Mark Sidhom
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
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7
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Yu H, Wang C, Wu L, Zhou Z, Wang Y, Li W, Yuan H, Lu Z, Yan D, Chen S, Wang X, Yan S. A novel hydrogel orthotopic injection model in moderately hypofractionated radiation therapy for prostate cancer: Adaptive degradation and durable imaging. Front Oncol 2023; 12:1077900. [PMID: 36713508 PMCID: PMC9880553 DOI: 10.3389/fonc.2022.1077900] [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: 10/23/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023] Open
Abstract
Purpose Moderately hypofractionated radiotherapy (MHRT) holds an important position in prostate cancer management. Existing hydrogel spacers can protect the rectum from radiation damage, but need improvement. We explored the application of a novel hydrogel in MHRT with adaptive degradation and durable imaging functions. Methods and materials The hydrogels were irradiated with 6MV x-ray to detect the radio-resistance property. Male SD rats (n=45) underwent hydrogel injection between the prostate and rectum. CT was used for investigating the novel spacer's degradation and imaging functions over three months. The hydrogel's radiation-attenuation properties and biocompatibility were further assessed. Results Hydrogel weight and volume remained stable for six weeks post-injection. After MHRT ended, the hydrogel showed accelerated degradation characteristics and remained in the body for at most three months. CT values of hydrogels exceeded 300 Hounsfield units (HU) throughout treatment, significantly higher than in surrounding normal tissues. A significant dose drop behind the hydrogel was observed post-implantation. Biocompatibility tests of hydrogel found it safe enough for living organisms. Conclusions The novel hydrogel application was fully adaptable to prostate cancer MHRT modalities, largely stable during treatment, rapidly degraded after radiotherapy ended, and consistently maintained superior imaging performance and biocompatibility. This novel spacer will be an effective tool in the era of hypofractionated radiotherapy.
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Affiliation(s)
- Hao Yu
- Department of Radiation Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Cheng Wang
- College of Materials Science & Engineering, Zhejiang University of Technology, Hangzhou, Zhejiang, China
| | - Lingyun Wu
- Department of Radiation Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ziyang Zhou
- Department of Radiation Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yiqi Wang
- Department of Radiation Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wenxiang Li
- Department of Radiation Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Huili Yuan
- College of Materials Science & Engineering, Zhejiang University of Technology, Hangzhou, Zhejiang, China
| | - Zeyi Lu
- Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Danfang Yan
- Department of Radiation Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Si Chen
- College of Materials Science & Engineering, Zhejiang University of Technology, Hangzhou, Zhejiang, China,*Correspondence: Senxiang Yan, ; Xu Wang, ; Si Chen,
| | - Xu Wang
- College of Materials Science & Engineering, Zhejiang University of Technology, Hangzhou, Zhejiang, China,*Correspondence: Senxiang Yan, ; Xu Wang, ; Si Chen,
| | - Senxiang Yan
- Department of Radiation Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,*Correspondence: Senxiang Yan, ; Xu Wang, ; Si Chen,
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Goddard L, Jeong K, Tang J, Garg M, Tomé WA. Reducing PTV margins for prostate SBRT with motion compensation and gating techniques. J Appl Clin Med Phys 2022; 24:e13861. [PMID: 36478148 PMCID: PMC10113684 DOI: 10.1002/acm2.13861] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/10/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
The purpose of this study is to investigate the dosimetric accuracy of prostate SBRT when motion is considered. To account for target movement, motion compensation and gating techniques were investigated with PTV margins reduced to 2 mm. To allow for dosimetric measurements a Delta4 phantom, Gafchromic film, and Hexamotion motion platform were utilized. Four motion files were utilized that represent a range of motions. Analysis of measured prostate motions for fifteen patients was performed to ensure detected motions were similar to those previously reported and motion files utilized were suitable. Five patient plans were utilized to allow for the effects of MLC and target motion interplay to be investigated. For both motion compensation and gating techniques, plans were delivered to the stationary phantom and for each of four motion types with/without compensation/gating enabled. Using a 3%, 2 mm and 80% threshold gamma criteria, film measurements had an average pass rate of 80.5% for uncorrected deliveries versus 96.0% for motion compensated deliveries. For gated techniques average pass rates increased from 89.9% for uncorrected to 94.8% with gating enabled. Measurements with the Delta4 arrays were analyzed with a 3%, 2 mm and 10% threshold dose. An average pass rate of 83.8% was measured for uncorrected motions versus 94.8% with motion compensation. For the gated technique an average pass rate of 87.2% was found for uncorrected motions versus 96.9% with gating enabled. These results show that very high gamma pass rates are achievable when motion compensation or gating techniques are applied. When target motion is not accounted for shifts up to 5 mm in planned versus delivered isodose distributions were found. However, when motion compensation, or gated techniques were applied, much smaller differences between planned and delivered isodose distributions were found. With these techniques dose delivery accuracy is greatly improved, allowing for PTV margins to be reduced.
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Affiliation(s)
- Lee Goddard
- Department of Radiation Oncology Montefiore Medical Center Bronx New York USA
- Albert Einstein College of Medicine Bronx New York USA
| | - Kyoungkeun Jeong
- Department of Radiation Oncology Montefiore Medical Center Bronx New York USA
- Albert Einstein College of Medicine Bronx New York USA
| | - Justin Tang
- Department of Radiation Oncology Montefiore Medical Center Bronx New York USA
- Albert Einstein College of Medicine Bronx New York USA
| | - Madhur Garg
- Department of Radiation Oncology Montefiore Medical Center Bronx New York USA
- Albert Einstein College of Medicine Bronx New York USA
| | - Wolfgang A. Tomé
- Department of Radiation Oncology Montefiore Medical Center Bronx New York USA
- Albert Einstein College of Medicine Bronx New York USA
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9
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Delgadillo R, Spieler BO, Deana AM, Ford JC, Kwon D, Yang F, Studenski MT, Padgett KR, Abramowitz MC, Dal Pra A, Stoyanova R, Dogan N. Cone-beam CT delta-radiomics to predict genitourinary toxicities and international prostate symptom of prostate cancer patients: a pilot study. Sci Rep 2022; 12:20136. [PMID: 36418901 PMCID: PMC9684516 DOI: 10.1038/s41598-022-24435-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/15/2022] [Indexed: 11/24/2022] Open
Abstract
For prostate cancer (PCa) patients treated with definitive radiotherapy (RT), acute and late RT-related genitourinary (GU) toxicities adversely impact disease-specific quality of life. Early warning of potential RT toxicities can prompt interventions that may prevent or mitigate future adverse events. During intensity modulated RT (IMRT) of PCa, daily cone-beam computed tomography (CBCT) images are used to improve treatment accuracy through image guidance. This work investigated the performance of CBCT-based delta-radiomic features (DRF) models to predict acute and sub-acute International Prostate Symptom Scores (IPSS) and Common Terminology Criteria for Adverse Events (CTCAE) version 5 GU toxicity grades for 50 PCa patients treated with definitive RT. Delta-radiomics models were built using logistic regression, random forest for feature selection, and a 1000 iteration bootstrapping leave one analysis for cross validation. To our knowledge, no prior studies of PCa have used DRF models based on daily CBCT images. AUC of 0.83 for IPSS and greater than 0.7 for CTCAE grades were achieved as early as week 1 of treatment. DRF extracted from CBCT images showed promise for the development of models predictive of RT outcomes. Future studies will include using artificial intelligence and machine learning to expand CBCT sample sizes available for radiomics analysis.
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Affiliation(s)
- Rodrigo Delgadillo
- grid.26790.3a0000 0004 1936 8606Department of Radiation Oncology, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL 33136 USA
| | - Benjamin O. Spieler
- grid.26790.3a0000 0004 1936 8606Department of Radiation Oncology, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL 33136 USA
| | - Anthony M. Deana
- grid.26790.3a0000 0004 1936 8606Department of Biomedical Engineering, University of Miami, Miami, FL USA
| | - John C. Ford
- grid.26790.3a0000 0004 1936 8606Department of Radiation Oncology, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL 33136 USA
| | - Deukwoo Kwon
- grid.267308.80000 0000 9206 2401Center for Clinical and Translational Sciences, The University of Texas Health Science Center at Houston, Houston, TX USA
| | - Fei Yang
- grid.26790.3a0000 0004 1936 8606Department of Radiation Oncology, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL 33136 USA
| | - Matthew T. Studenski
- grid.26790.3a0000 0004 1936 8606Department of Radiation Oncology, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL 33136 USA
| | - Kyle R. Padgett
- grid.26790.3a0000 0004 1936 8606Department of Radiation Oncology, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL 33136 USA
| | - Matthew C. Abramowitz
- grid.26790.3a0000 0004 1936 8606Department of Radiation Oncology, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL 33136 USA
| | - Alan Dal Pra
- grid.26790.3a0000 0004 1936 8606Department of Radiation Oncology, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL 33136 USA
| | - Radka Stoyanova
- grid.26790.3a0000 0004 1936 8606Department of Radiation Oncology, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL 33136 USA
| | - Nesrin Dogan
- grid.26790.3a0000 0004 1936 8606Department of Radiation Oncology, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL 33136 USA
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Wang S, Tang W, Luo H, Jin F, Wang Y. The Role of Image-guided Radiotherapy in Prostate Cancer: A Systematic Review and Meta-Analysis. Clin Transl Radiat Oncol 2022; 38:81-89. [DOI: 10.1016/j.ctro.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/12/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
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11
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Patient Reported Outcomes for Quality of Life (QOL) By Expanded Prostate Cancer Index (EPIC) on Average 15 Years Post Treatment. Clin Transl Radiat Oncol 2022; 36:56-62. [PMID: 35813938 PMCID: PMC9256969 DOI: 10.1016/j.ctro.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 11/20/2022] Open
Abstract
Reported here are patient reported outcomes to 15.8 median years of follow up for initial therapy including brachytherapy, external beam radiotherapy, and radical prostatectomy. Differences within each domain across modalities differences were generally preserved beyond 6 years of follow up. Limited changes in quality of life over time suggest that shorter interval changes are largely representative of persistent changes in quality of life. Costly and time consuming reporting of long term quality of life beyond 2–5 years may be limited value in future studies.
Objective/purpose Previously patient reported quality of life (QOL) was reported in men with prostate cancer a mean 2 and 6 years post treatment with open radical prostatectomy (RP), 3D conformal radiation therapy (3D CRT), or 125I low dose rate (LDR) brachytherapy (BT). Herein we update the results 15 years post-treatment QOL. Materials/methods The Expanded Prostate Cancer Index (EPIC) domains were scored with differences evaluated at a median 15.8 years follow up based upon mean EPIC summary domains by ANOVA with pairwise post-hoc comparisons adjusted for age. Patient differences of current survey from first cross-section are reported as median change in summary score for each treatment group at median of 2.2 and 6.0, and 15.8 years. Results Among men still alive response rate was 52% in BT, 60% in 3D CRT, and 62% in RP resulting in 30, 41, and 330 QOL questionnaires to evaluate for each corresponding modality at median follow up of 15.8 years. Men were a mean 75.3, 83.6, and 79.3 years of age after RP, 3DCRT, and BT, respectively. At a median of 15.8 years, there were largely persistent differences in EPIC domains without substantial evolution in QoL from middle time points. Persistent worsening in urinary irritative and bowel domain with 3DRT or BT compared to RP. Trend towards worse urinary incontinence with RP were noted without statistical differences within radiotherapy options. Conclusion As the EPIC patient reported outcomes with the longest follow-up, these data uniquely reveal temporal trends from 2 to 15 years post treatment. However, the treatment modalities of open RP, 3D CRT without image guidance or intensity modulation, and BT without peripheral loading or MRI guidance may not reflect modern techniques.
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Yang B, Yuan J, Poon DM, Geng H, Lam WW, Cheung KY, Yu SK. Assessment of planning target volume margins in 1.5 T magnetic resonance‐guided stereotactic body radiation therapy for localized prostate cancer. PRECISION RADIATION ONCOLOGY 2022. [DOI: 10.1002/pro6.1155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Bin Yang
- Medical Physics Department Hong Kong Sanatorium & Hospital Happy Valley Hong Kong China
| | - Jing Yuan
- Research Department Hong Kong Sanatorium & Hospital Happy Valley Hong Kong China
| | - Darren M.C. Poon
- Comprehensive Oncology Centre Hong Kong Sanatorium & Hospital Happy Valley Hong Kong China
| | - Hui Geng
- Medical Physics Department Hong Kong Sanatorium & Hospital Happy Valley Hong Kong China
| | - Wai Wang Lam
- Medical Physics Department Hong Kong Sanatorium & Hospital Happy Valley Hong Kong China
| | - Kin Yin Cheung
- Medical Physics Department Hong Kong Sanatorium & Hospital Happy Valley Hong Kong China
| | - Siu Ki Yu
- Medical Physics Department Hong Kong Sanatorium & Hospital Happy Valley Hong Kong China
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Saini S, Patnaikuni S, Chandola R, Chandrakar P, Chaudhary V. Normal tissue risk estimation using biological knowledge-based fuzzy logic in volumetric modulated Arc therapy of prostate cancer: Rectum. J Med Phys 2022; 47:126-135. [PMID: 36212203 PMCID: PMC9543004 DOI: 10.4103/jmp.jmp_91_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 01/20/2022] [Accepted: 01/22/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: Most radiotherapy patients with prostate cancer are treated with volumetric modulated arc therapy (VMAT). Advantages of VMAT may be limited by daily treatment uncertainties such as setup errors, internal organ motion, and deformation. The position and shape of prostate target as well as normal organ, i.e., rectum volume around the target, may change during the course of treatment. The aim of the present work is to estimate rectal toxicity estimation using a novel two-level biological knowledge-based fuzzy logic method. Both prostate and rectal internal motions as well as setup uncertainties are considered without compromising target dose distribution in the present study. Materials and Methods: The Mamdani-type fuzzy logic framework was considered in two levels. The prostate target volume changes from minimum to maximum during the course of treatment. In the first level, the fuzzy logic was applied for determining biological acceptable target margin using tumor control probability and normal tissue complication probability (NTCP) parameters based on prostate target motion limits, and then, fuzzy margin was derived. The output margin of first-level fuzzy logic was compared to currently used margins. In second-level fuzzy, rectal volume variation with weekly analysis of cone-beam computed tomography (CBCT) was considered. The biological parameter (NTCP) was calculated corresponding to rectal subvolume variation with weekly CBCT image analysis. Using irradiated volume versus organ risk relationship from treatment planning, the overlapped risk volumes were estimated. Fuzzy rules and membership function were used based on setup errors, asymmetrical nature of organ motion, and limitations of normal tissue toxicity in Mamdani-type Fuzzy Inference System. Results: For total displacement, standard errors of prostate ranging from 0 to 5 mm range were considered in the present study. In the first level, fuzzy planning target volume (PTV) margin was found to be similar or up to 0.5 mm bigger than the conventional margin, but taking the modeling uncertainty into account resulted in a good match between the calculated fuzzy PTV margin and conventional margin formulations under error 0–5 mm standard deviation (SD) range. With application of fuzzy margin obtained from first-level fuzzy, overlapped rectal volumes and corresponding NTCP values were fuzzified in second-level fuzzy using rectal volume variations. The final risk factor (RF) of rectum was qualitatively assessed and found clinically acceptable for each fractional volume of irradiated to total volume and relevant NTCP values. The reason may be at 5 mm SD displacement error range, NTCP values would be within acceptable limit without compromising the tumor dose distribution though the confounding factors such as organ motion, deformation of rectum, and in-house image matching protocols exist. Conclusion: A new approach of two-level fuzzy logic may be suitable to estimate possible organ-at-risk (OAR) toxicity biologically without compromising tumor volume that includes both prostate target and OAR rectum deformation even at displacement standard errors of prostate ranging from 0 to 5 mm range which was considered in the present study. Using proposed simple and fast method, there is an interplay between volume-risk relationship and NTCP of OARs to judge real-time normal organ risk level or alter the treatment margins, particularly concern to individual factors such as comorbidities, genetic predisposition, and other lifestyle choices even at high displacement errors >5 mm SD range.
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Lübeck Christiansen R, Dysager L, Rønn Hansen C, Robenhagen Jensen H, Schytte T, Junker Nyborg C, Smedegaard Bertelsen A, Nielsen Agergaard S, Mahmood F, Hansen S, Hansen O, Brink C, Bernchou U. Online adaptive radiotherapy potentially reduces toxicity for high-risk prostate cancer treatment. Radiother Oncol 2021; 167:165-171. [PMID: 34923034 DOI: 10.1016/j.radonc.2021.12.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/22/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE With daily, MR-guided online adapted radiotherapy (MRgART) it may be possible to reduce the PTV in pelvic RT. This study investigated the potential reduction in normal tissue complication probability (NTCP) of MRgART compared to standard radiotherapy for high-risk prostate cancer. MATERIALS AND METHODS Twenty patients treated with 78 Gy to the prostate and 56 Gy to elective pelvic lymph nodes were included. VMAT plans were generated with standard clinical PTV margins. Additionally to the planning MR, patients had three MRI scans during treatment to simulate an MRgART. A reference plan with PTV margins determined for MRgART was created per patient and adapted to each of the following MRs. Adapted plans were warped to the planning MR for dose accumulation. The standard plan was rigidly registered to each adaptation MR before it was warped to the planning MR for dose accumulation. Dosimetric impact was compared by DVH analysis and potential clinical effects were assessed by NTCP modeling. RESULTS MRgART yielded statistically significant lower doses for the bladder wall, rectum and peritoneal cavity, compared to the standard RT, which translated into reduced median risks of urine incontinence (ΔNTCP 2.8%), urine voiding pain (ΔNTCP 2.8%) and acute gastrointestinal toxicity (ΔNTCP 17.4%). Mean population accumulated doses were as good or better for all investigated OAR when planned for MRgART as standard RT. CONCLUSION Online adapted radiotherapy may reduce the dose to organs at risk in high-risk prostate cancer patients, due to reduced PTV margins. This potentially translates to significant reductions in the risks of acute and late adverse effects.
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Affiliation(s)
- Rasmus Lübeck Christiansen
- Department of Clinical Research, University of Southern Denmark; Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital.
| | - Lars Dysager
- Department of Oncology, Odense University Hospital
| | - Christian Rønn Hansen
- Department of Clinical Research, University of Southern Denmark; Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital
| | | | - Tine Schytte
- Department of Clinical Research, University of Southern Denmark; Department of Oncology, Odense University Hospital
| | | | | | | | - Faisal Mahmood
- Department of Clinical Research, University of Southern Denmark; Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital
| | | | - Olfred Hansen
- Department of Clinical Research, University of Southern Denmark; Department of Oncology, Odense University Hospital
| | - Carsten Brink
- Department of Clinical Research, University of Southern Denmark; Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital
| | - Uffe Bernchou
- Department of Clinical Research, University of Southern Denmark; Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital
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Persson E, Emin S, Scherman J, Jamtheim Gustafsson C, Brynolfsson P, Ceberg S, Gunnlaugsson A, Olsson LE. Investigation of the clinical inter-observer bias in prostate fiducial marker image registration between CT and MR images. Radiat Oncol 2021; 16:150. [PMID: 34399806 PMCID: PMC8365967 DOI: 10.1186/s13014-021-01865-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/17/2021] [Indexed: 01/17/2023] Open
Abstract
Background and purpose Inter-modality image registration between computed tomography (CT) and magnetic resonance (MR) images is associated with systematic uncertainties and the magnitude of these uncertainties is not well documented.
The purpose of this study was to investigate the potential uncertainty of gold fiducial marker (GFM) registration for localized prostate cancer and to estimate the inter-observer bias in a clinical setting. Methods
Four experienced observers registered CT and MR images for 42 prostate cancer patients. Manual GFM identification was followed by a landmark-based registration. The absolute difference between observers in GFM identification and the displacement of the clinical target volume (CTV) was investigated. The CTV center of mass (CoM) vector displacements, DICE-index and Hausdorff distances for the observer registrations were compared against a clinical baseline registration. The time allocated for the manual registrations was compared. Results Absolute difference in GFM identification between observers ranged from 0.0 to 3.0 mm. The maximum CTV CoM displacement from the clinical baseline was 3.1 mm. Displacements larger than or equal to 1 mm, 2 mm and 3 mm were 46%, 18% and 4%, respectively. No statistically significant difference was detected between observers in terms of CTV displacement. Median DICE-index and Hausdorff distance for the CTV, with their respective ranges were 0.94 [0.70–1.00] and 2.5 mm [0.7–8.7]. Conclusions Registration of CT and MR images using GFMs for localized prostate cancer patients was subject to inter-observer bias on an individual patient level. A CTV displacement as large as 3 mm occurred for individual patients. These results show that GFM registration in a clinical setting is associated with uncertainties, which motivates the removal of inter-modality registrations in the radiotherapy workflow and a transition to an MRI-only workflow for localized prostate cancer.
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Affiliation(s)
- Emilia Persson
- Radiation Physics, Department of Hematology, Oncology, and Radiation Physics , Skåne University Hospital, Klinikgatan 5, 221 85, Lund, Sweden. .,Department of Translational Medicine, Medical Radiation Physics, Lund University, Carl Bertil Laurellsgata 9, 205 02, Malmö, Sweden.
| | - Sevgi Emin
- Radiation Physics, Department of Hematology, Oncology, and Radiation Physics , Skåne University Hospital, Klinikgatan 5, 221 85, Lund, Sweden
| | - Jonas Scherman
- Radiation Physics, Department of Hematology, Oncology, and Radiation Physics , Skåne University Hospital, Klinikgatan 5, 221 85, Lund, Sweden
| | - Christian Jamtheim Gustafsson
- Radiation Physics, Department of Hematology, Oncology, and Radiation Physics , Skåne University Hospital, Klinikgatan 5, 221 85, Lund, Sweden.,Department of Translational Medicine, Medical Radiation Physics, Lund University, Carl Bertil Laurellsgata 9, 205 02, Malmö, Sweden
| | - Patrik Brynolfsson
- Department of Translational Medicine, Medical Radiation Physics, Lund University, Carl Bertil Laurellsgata 9, 205 02, Malmö, Sweden
| | - Sofie Ceberg
- Department of Medical Radiation Physics, Lund University, Barngatan 4, 222 85, Lund, Sweden
| | - Adalsteinn Gunnlaugsson
- Radiation Physics, Department of Hematology, Oncology, and Radiation Physics , Skåne University Hospital, Klinikgatan 5, 221 85, Lund, Sweden
| | - Lars E Olsson
- Radiation Physics, Department of Hematology, Oncology, and Radiation Physics , Skåne University Hospital, Klinikgatan 5, 221 85, Lund, Sweden.,Department of Translational Medicine, Medical Radiation Physics, Lund University, Carl Bertil Laurellsgata 9, 205 02, Malmö, Sweden
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16
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Kilian-Meneghin J, Ma T, Kumaraswamy L. Impact of prostate focused alignment on planned pelvic lymph node dose. J Appl Clin Med Phys 2021; 22:27-35. [PMID: 34231945 PMCID: PMC8292696 DOI: 10.1002/acm2.13092] [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: 11/21/2018] [Revised: 09/13/2019] [Accepted: 10/06/2019] [Indexed: 11/11/2022] Open
Abstract
Purpose Prostate patients with positive lymph node margins receive an initial course of 45 Gy to the planning target volume (PTV) comprised of prostate, seminal vesicles, and lymph nodes with a 1‐cm margin. The prostate is localized via implanted fiducial markers before each fraction is delivered using portal‐imaging. However, the pelvic lymph nodes are affixed to the bony anatomy and are not mobile in concert with the prostate. The aim of this study was to determine whether a significant difference in pelvic lymph node coverage exists between planned and delivered external beam therapy treatments for these patients. Methods The recorded prostate motions were gathered for 19 patients; conjointly the pelvic lymph node motions were determined by manual registration of the bony anatomy in the kV‐images. The difference between the prostate and the bony anatomy coordinates was input into Eclipse as field shifts to represent the deviation in planned vs delivered pelvic lymph node coverage. Results Structure volume at V(100) was recorded for each patient for two structures: summed pelvic lymph nodes (LN CTV) and pelvic lymph nodes +1 cm margin (LN PTV) to express their contribution to the PTV. For the LN PTV, the average difference between the planned coverage and calculated delivered coverage was 3.5%, with a paired t‐test value of P = 0.005. Based upon bony anatomy registration, 26% of patients received less than 95% dose coverage using V(100) criteria for LN PTV. Dose value differences between the two plans at minimum were 6.96 ± 6.23 Gy, at mean were 0.54 ± 0.40 Gy, and at maximum were 0.10 ± 0.29 Gy. For the LN CTV, the average difference between the planned coverage and calculated delivered coverage was 1%, with a paired t‐test value of P = 0.53. Conclusions The results indicate a significant difference exists between the planned coverage and calculated delivered coverage for the LN PTV. There was no significant difference found for the LN CTV. We conclude that lymph node motion must be considered with the prostate motion when aligning patients before each fraction.
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Affiliation(s)
| | - Tianjun Ma
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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17
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Ryczkowski A, Piotrowski T. Forecasting of the composite dose for organs at risk and solid targets with random movements during different image-guided scenarios of the photon radiation therapy. Solution for the Varian therapeutic line. ACTA ACUST UNITED AC 2021; 26:489-494. [PMID: 34277106 PMCID: PMC8281900 DOI: 10.5603/rpor.a2021.0051] [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: 10/04/2020] [Accepted: 02/23/2021] [Indexed: 11/26/2022]
Abstract
Background This study aims to develop a useful tool for robust plan analysis which includes the effects of soft tissue deformations on simulated dose distributions. The solution was benchmarked in the light of the commercial method implemented in EclipseTM treatment planning system (TPS). Materials and methods Study was carried out on data of one patient with prostate-restricted cancer. The workflow of the procedure developed focused on three executive elements: in-house script to create a set of artificial CT images and for movement simulation of the CT V; the VelocityTM software for the calculations of the deformation matrixes and, then, to generate deformed CT sets; the EclipseTM TPS for dose re-calculations and analysis. Two scenarios were examined — first when the recalculation was done for the original geometry and second, when the isocentre from the original plan geometry was moved according to the movement of the CT V. The dose distributions were analysed on dose volume histograms (DVHs) in the light of the results obtained from the method implemented in the EclipseTM TPS. Results The DVHs from our methods are more informative than the DVH from commercially implemented tools. For the first scenario, the highest impact on dose uncertainty has boundary positions of the CT V to the CT V-PTV margin. Using the second scenario, it is the relation of the CT V position to the whole body that has the highest effect on dose uncertainty. Conclusion Our method enables a more accurate analysis of the treatment plan robustness than the method currently implemented in EclipseTM TPS.
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Affiliation(s)
- Adam Ryczkowski
- Department of Medical Physics, Greater Poland Cancer Centre, Poznań, Poland.,Department of Electroradiology, Poznań University of Medical Sciences, Poznań, Poland
| | - Tomasz Piotrowski
- Department of Medical Physics, Greater Poland Cancer Centre, Poznań, Poland.,Department of Electroradiology, Poznań University of Medical Sciences, Poznań, Poland
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Greco C, Stroom J, Vieira S, Mateus D, Cardoso MJ, Soares A, Pares O, Pimentel N, Louro V, Nunes B, Kociolek J, Fuks Z. Reproducibility and accuracy of a target motion mitigation technique for dose-escalated prostate stereotactic body radiotherapy. Radiother Oncol 2021; 160:240-249. [PMID: 33992627 DOI: 10.1016/j.radonc.2021.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE To quantitate the accuracy, reproducibility and prostate motion mitigation efficacy rendered by a target immobilization method used in an intermediate-risk prostate cancer dose-escalated 5×9Gy SBRT study. MATERIAL AND METHODS An air-inflated (150 cm3) endorectal balloon and Foley catheter with three electromagnetic beacon transponders (EBT) were used to mitigate and track intra-fractional target motion. A 2 mm margin was used for PTV expansion, reduced to 0 mm at the interface with critical OARs. EBT-detected ≥ 2 mm/5 s motions mandated treatment interruption and target realignment prior to completion of planned dose delivery. Geometrical uncertainties were measured with an in-house ESAPI script. RESULTS Quantitative data were obtained in 886 sessions from 189 patients. Mean PTV dose was 45.8 ± 0.4 Gy (D95 = 40.5 ± 0.4 Gy). A mean of 3.7 ± 1.7 CBCTs were acquired to reach reference position. Mean treatment time was 19.5 ± 12 min, 14.1 ± 11 and 5.4 ± 5.9 min for preparation and treatment delivery, respectively. Target motion of 0, 1-2 and >2 mm/10 min were observed in 59%, 30% and 11% of sessions, respectively. Temporary beam-on hold occurred in 7.4% of sessions, while in 6% a new reference CBCT was required to correct deviations. Hence, all sessions were completed with application of the planned dose. Treatment preparation time > 15 min was significantly associated with the need of a second reference CBCT. Overall systematic and random geometrical errors were in the order of 1 mm. CONCLUSION The prostate immobilization technique explored here affords excellent accuracy and reproducibility, enabling normal tissue dose sculpting with tight PTV margins.
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Affiliation(s)
- Carlo Greco
- The Champalimaud Centre for the Unknown, Lisbon, Portugal.
| | - Joep Stroom
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Sandra Vieira
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Dalila Mateus
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | | | - Ana Soares
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Oriol Pares
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Nuno Pimentel
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Vasco Louro
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Beatriz Nunes
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | | | - Zvi Fuks
- The Champalimaud Centre for the Unknown, Lisbon, Portugal; Memorial Sloan Kettering Cancer Center, New York, USA
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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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20
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Study of normal tissue dosimetric benefit using asymmetric margin-based biological fuzzy decision making: volumetric modulated arc therapy of prostate cancer. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396920000904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractAim:Radiation therapy has historically used margins for target volume to ensure dosimetric planning criteria. The size of margin for a given treatment site is still uncertain particularly for moving targets along with set-up variations leading to a fuzziness of target volume. In this study, we have estimated the dosimetric benefit of normal structures using biological-based optimal margins. The treatment margins are derived by knowledge-based fuzzy logic technique which is considering the radiotherapy uncertainties in treatment planning.Materials and methods:All treatment plans were performed using stepped increments of asymmetric margins to estimate prostate radiobiological indices such as tumour control probability (TCP) and normal tissue complication probability (NTCP). An absolute NTCP of 5% was considered to be the maximum acceptable value while TCP of 85% was considered to be the minimal acceptable limit for each volumetric modulated arc therapy (VMAT) plan of localised prostate cancer radiotherapy. Results were used to formulate rules and membership functions for Mamdani-type fuzzy inference system (FIS). In implementing the rules for the fuzzy system for ΔNTCP values above 10%, the PTV margin was not permitted to exceed 5 mm to avoid rectal complications due to margin selection. The new margins were applied in VMAT planning of prostate cancer for standard displacement errors. The dosimetric results of normal tissue predictors were estimated such as organ mean doses, rectum V60 (volume receiving 60 Gy), bladder V65 (volume receiving 65 Gy) and other clinically significant dose–volume indicators and compared with VMAT plans using current margin formulations.Results:Dosimetric results compared well to the results obtained by current techniques. Good agreement was obtained between proposed fuzzy model margins and currently used margins in lower error magnitude, but significant results were observed at higher error magnitude when organ toxicity concerned without compromising the target volumes.Findings:The new margins may be helpful to estimate possible outcomes of normal tissue complications and thus may improve complication free survival particularly when organ motion errors are inevitable, case by case.
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Mesko S, Wang H, Tung S, Wang C, Pasalic D, Ning MS, Pezzi TA, Moreno AC, Reddy JP, Garden AS, Rosenthal DI, Gunn GB, Frank SJ, Fuller CD, Morrison W, Su SY, Hanna E, Phan J. SABR for Skull Base Malignancies: A Systematic Analysis of Set-Up and Positioning Accuracy. Pract Radiat Oncol 2020; 10:363-371. [DOI: 10.1016/j.prro.2020.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/10/2020] [Accepted: 02/15/2020] [Indexed: 02/06/2023]
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22
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Noël G, Thariat J, Antoni D. [Uncertainties in the current concept of radiotherapy planning target volume]. Cancer Radiother 2020; 24:667-675. [PMID: 32828670 DOI: 10.1016/j.canrad.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/01/2020] [Accepted: 06/07/2020] [Indexed: 12/12/2022]
Abstract
The planning target volume is an essential notion in radiotherapy, that requires a new conceptualization. Indeed, the variability and diversity of the uncertainties involved or improved with the development of the new modern technologies and devices in radiotherapy suggest that random and systematic errors cannot be currently generalized. This article attempts to discuss these various uncertainties and tries to demonstrate that a redefinition of the concept of planning target volume toward its personalization for each patient and the robustness notion are likely an improvement basis to take into account the radiotherapy uncertainties.
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Affiliation(s)
- G Noël
- Service d'oncologie radiothérapie, Institut de cancérologie Strasbourg Europe (Icans), 17, rue Albert-Calmette, 67033 Strasbourg, France.
| | - J Thariat
- Département de radiothérapie, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France; Association Advance Resource Centre for Hadrontherapy in Europe (Archade), 3, avenue General-Harris, 14000 Caen, France; Laboratoire de physique corpusculaire, Institut national de physique nucléaire et de physique des particules (IN2P3), 6, boulevard Maréchal-Juin, 14000 Caen, France; École nationale supérieure d'ingénieurs de Caen (ENSICaen), 6, boulevard Maréchal-Juin, CS 45053 14050 Caen cedex 4, France; Centre national de la recherche scientifique (CNRS), UMR 6534, 6, boulevard Maréchal-Juin, 14000 Caen, France; Université de Caen Normandie (Unicaen), esplanade de la Paix, CS 14032, 14032 Caen, France
| | - D Antoni
- Service d'oncologie radiothérapie, Institut de cancérologie Strasbourg Europe (Icans), 17, rue Albert-Calmette, 67033 Strasbourg, France
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23
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Effectiveness of rectal displacement devices in managing prostate motion: a systematic review. Strahlenther Onkol 2020; 197:97-115. [DOI: 10.1007/s00066-020-01633-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/05/2020] [Indexed: 12/12/2022]
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24
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Gleeson I. A comparison of a moderately hypofractionated IMRT planning technique used in a randomised UK external beam radiotherapy trial with an in-house technique for localised prostate cancer. Rep Pract Oncol Radiother 2020; 25:360-366. [PMID: 32256220 DOI: 10.1016/j.rpor.2020.03.010] [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: 09/30/2019] [Revised: 12/26/2019] [Accepted: 03/10/2020] [Indexed: 11/18/2022] Open
Abstract
AIM To compare the radiotherapy technique used in a randomised trial with VMAT and an in-house technique for prostate cancer. BACKGROUND Techniques are evolving with volumetric modulated arc therapy (VMAT) commonly used. The CHHiP trial used a 3 PTV forward planned IMRT technique (FP_CH). Our centre has adopted a simpler two PTV technique with locally calculated margins. MATERIALS AND METHODS 25 patients treated with FP_CH to 60 Gy in 20 fractions were re-planned with VMAT (VMAT_CH) and a two PTV protocol (VMAT_60/52 and VMAT_60/48). Target coverage, conformity index (CI), homogeneity index (HI), monitor units (MU) and dose to the rectum, bladder, hips and penile bulb were compared. RESULTS PTV coverage was high for all techniques. VMAT_CH plans had better CI than FP_CH (p ≤ 0.05). VMAT_60/52/48 plans had better CI than VMAT_CH. FP_CH had better HI and fewer MU than VMAT (p ≤ 0.05). More favourable rectum doses were found for VMAT _CH than FP_CH (V48.6, V52.8, V57, p ≤ 0.05) with less difference for bladder (p ≥ 0.05). Comparing VMAT_CH to VMAT_60/52/48 showed little differences for the bladder and rectum but VMAT_CH had larger penile bulb doses (V40.8, V48.6, mean, D2, p ≤ 0.05). Femoral head doses (V40.8) were similarly low for all techniques (p = ≥ 0.05). CONCLUSION VMAT produced more conformal plans with smaller rectum doses compared to FP_CH albeit worse HI and more MU. VMAT_60/52 and VMAT_60/48 plans had similar rectal and bladder doses to VMAT_CH but better CI and penile bulb doses which may reduce toxicity.
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Affiliation(s)
- Ian Gleeson
- Department of Medical Physics, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
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25
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Patnaikuni SK, Saini SM, Chandola RM, Chandrakar P, Chaudhary V. Study of Asymmetric Margins in Prostate Cancer Radiation Therapy Using Fuzzy Logic. J Med Phys 2020; 45:88-97. [PMID: 32831491 PMCID: PMC7416865 DOI: 10.4103/jmp.jmp_110_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/18/2020] [Accepted: 04/23/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The purpose of present study is to estimate asymmetric margins of prostate target volume based on biological limitations with help of knowledge based fuzzy logic considering the effect of organ motion and setup errors. MATERIALS AND METHODS A novel application of fuzzy logic modelling technique considering radiotherapy uncertainties including setup, delineation and organ motion was used in this study to derive margins. The new margin was applied in prostate cancer treatment planning and the results compared very well to current techniques Here volumetric modulated arc therapy treatment plans using stepped increments of asymmetric margins of planning target volume (PTV) were performed to calculate the changes in prostate radiobiological indices and results were used to formulate the rule based and membership function for Mamdani-type fuzzy inference system. The optimum fuzzy rules derived from input data, the clinical goals and knowledge-based conditions imposed on the margin limits. The PTV margin obtained using the fuzzy model was compared to the commonly used margin recipe. RESULTS For total displacement standard errors ranging from 0 to 5 mm the fuzzy PTV margin was found to be up to 0.5 mm bigger than the vanHerk derived margin, however taking the modelling uncertainty into account results in a good match between the PTV margin calculated using our model and the one based on van Herk et al. formulation for equivalent errors of up to 5 mm standard deviation (s. d.) at this range. When the total displacement standard errors exceed 5 mm s. d., the fuzzy margin remained smaller than the van Herk margin. CONCLUSION The advantage of using knowledge based fuzzy logic is that a practical limitation on the margin size is included in the model for limiting the dose received by the critical organs. It uses both physical and radiobiological data to optimize the required margin as per clinical requirement in real time or adaptive planning, which is an improvement on most margin models which mainly rely on physical data only.
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Affiliation(s)
- Santosh Kumar Patnaikuni
- Department of Physics, National Institute of Technology, Raipur, Chhattisgarh, India
- Department of Radiotherapy, Pt. JNM Medical College, Raipur, Chhattisgarh, India
| | - Sapan Mohan Saini
- Department of Physics, National Institute of Technology, Raipur, Chhattisgarh, India
| | | | - Pradeep Chandrakar
- Department of Radiotherapy, Pt. JNM Medical College, Raipur, Chhattisgarh, India
| | - Vivek Chaudhary
- Department of Radiotherapy, Pt. JNM Medical College, Raipur, Chhattisgarh, India
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26
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Snoj Z, Gill AB, Rundo L, Sushentsev N, Barrett T. Three-dimensional MRI evaluation of the effect of bladder volume on prostate translocation and distortion. Radiol Oncol 2020; 54:48-56. [PMID: 31940289 PMCID: PMC7087418 DOI: 10.2478/raon-2020-0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/19/2019] [Indexed: 11/20/2022] Open
Abstract
Background The accuracy of any radiation therapy delivery is limited by target organ translocation and distortion. Bladder filling is one of the recognised factors affecting prostate translocation and distortion. The purpose of our study was to evaluate the effect of bladder volume on prostate translocation and distortion by using detailed three-dimensional prostate delineation on MRI. Patients and methods Fifteen healthy male volunteers were recruited in this prospective, institutional review board-approved study. Each volunteer underwent 4 different drinking preparations prior to imaging, with MR images acquired pre- and post-void. MR images were co-registered by using bony landmarks and three-dimensional contouring was performed in order to assess the degree of prostate translocation and distortion. According to changes in bladder or rectum distention, subdivisions were made into bladder and rectal groups. Studies with concomitant change in both bladder and rectal volume were excluded. Results Forty studies were included in the bladder volume study group and 8 in the rectal volume study group. The differences in rectal volumes yielded higher levels of translocation (p < 0.01) and distortion (p = 0.02) than differences in bladder volume. Moderate correlation of prostate translocation with bladder filling was shown (r = 0.64, p < 0.01). There was no important prostate translocation when bladder volume change was < 2-fold (p < 0.01). Moderate correlation of prostate distortion with bladder filling was shown (r = 0.61, p < 0.01). Conclusions Bladder volume has a minimal effect on prostate translocation and effect on prostate distortion is negligible. Prostate translocation may be minimalised if there is < 2-fold increase in the bladder volume.
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Affiliation(s)
- Ziga Snoj
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK
- Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Andrew B. Gill
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK
- Department of Medical Physics, Cambridge University Hospitals, Cambridge, UK
| | - Leonardo Rundo
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Centre, Cambridge, UK
| | - Nikita Sushentsev
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK
- CamPARI Clinic, Addenbrooke’s Hospital and University of Cambridge, Cambridge, UK
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27
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Ghadjar P, Fiorino C, Munck Af Rosenschöld P, Pinkawa M, Zilli T, van der Heide UA. ESTRO ACROP consensus guideline on the use of image guided radiation therapy for localized prostate cancer. Radiother Oncol 2019; 141:5-13. [PMID: 31668515 DOI: 10.1016/j.radonc.2019.08.027] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/29/2019] [Indexed: 12/18/2022]
Abstract
Use of image-guided radiation therapy (IGRT) helps to account for daily prostate position changes during radiation therapy for prostate cancer. However, guidelines for the use of IGRT are scarce. An ESTRO panel consisting of leading radiation oncologists and medical physicists was assembled to review the literature and formulate a consensus guideline of methods and procedure for IGRT in prostate cases. Advanced methods and procedures are also described which the committee judged relevant to further improve clinical practice. Moreover, ranges for margins for the three most popular IGRT scenarios have been suggested as examples.
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Affiliation(s)
- Pirus Ghadjar
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Germany
| | - Claudio Fiorino
- Department of Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Per Munck Af Rosenschöld
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Michael Pinkawa
- Department of Radiation Oncology, MediClin Robert Janker Klinik, Bonn, Germany
| | - Thomas Zilli
- Department of Radiation Oncology, Geneva University Hospital, Switzerland
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiation Oncology, Leiden University Medical Center, The Netherlands.
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28
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Yock AD, Mohan R, Flampouri S, Bosch W, Taylor PA, Gladstone D, Kim S, Sohn J, Wallace R, Xiao Y, Buchsbaum J. Robustness Analysis for External Beam Radiation Therapy Treatment Plans: Describing Uncertainty Scenarios and Reporting Their Dosimetric Consequences. Pract Radiat Oncol 2019; 9:200-207. [PMID: 30562614 PMCID: PMC6571070 DOI: 10.1016/j.prro.2018.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/24/2018] [Accepted: 12/08/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE With external beam radiation therapy, uncertainties in treatment planning and delivery can result in an undesirable dose distribution delivered to the patient that can compromise the benefit of treatment. Techniques including geometric margins and probabilistic optimization have been used effectively to mitigate the effects of uncertainties. However, their broad application is inconsistent and can compromise the conclusions derived from cross-technique and cross-modality comparisons. METHODS AND MATERIALS Conventional methods to deal with treatment planning and delivery uncertainties are described, and robustness analysis is presented as a framework that is applicable across treatment techniques and modalities. RESULTS This report identifies elements that are imperative to include when conducting a robustness analysis and describing uncertainties and their dosimetric effects. CONCLUSION The robustness analysis approach described here is presented to promote reliable plan evaluation and dose reporting, particularly during clinical trials conducted across institutions and treatment modalities.
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Affiliation(s)
- Adam D Yock
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Radhe Mohan
- University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Stella Flampouri
- University of Florida, Health Proton Therapy Institute, Jacksonville, Florida
| | | | - Paige A Taylor
- University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - David Gladstone
- Geisel School of Medicine at Dartmouth, Hannover, New Hampshire
| | - Siyong Kim
- Virginia Commonwealth University, Richmond, Virginia
| | - Jason Sohn
- Allegheny Health Network, Pittsburgh, Pennsylvania
| | | | - Ying Xiao
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeff Buchsbaum
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
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29
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Ghaffari H, Navaser M, Mofid B, Mahdavi SR, Mohammadi R, Tavakol A. Fiducial markers in prostate cancer image-guided radiotherapy. Med J Islam Repub Iran 2019; 33:15. [PMID: 31086794 PMCID: PMC6504932 DOI: 10.34171/mjiri.33.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Indexed: 12/25/2022] Open
Abstract
Background: Image-guided radiotherapy (IGRT) is recommended to reduce the risk of geometrical miss when modern radiotherapy technologies with high grades of conformity are used. The purpose of this study was to evaluate the efficacy of fiducial markers (FMs) for electronic portal imaging in prostate cancer radiotherapy in term of evaluating the complications associated with FMs implantation, quantifying inter-fraction prostate motion, and determination of optimal planning target volume (PTV) margins.
Methods: In this single institution, prospective, consecutive study, 27 patients underwent implantation of three-gold seed FMs into the prostate gland before prostate radiotherapy. Prior to computed tomography planning, all patients were asked to report any complication associated with FMs implantation that have experienced to date. Daily pre-treatment electronic portal images were captured, and prostate position errors were corrected if they were greater than 2 mm along three translational directions. Optimal PTV expansions were computed using van Herk formula [PTV-margin= 2.5Σ + 0.7σ].
Results: FMs implantation was successful with an acceptable toxicity profile in all patients. Without IGRT, margins of 5.4 mm, 5.8 mm and 5.5 mm, in vertical, longitudinal and lateral directions, respectively, are needed for a 95% confidence level of complete clinical target volume (CTV) coverage in each treatment session. The PTV margins of 3.0 mm, 3.3 mm and 4.0 mm in corresponding directions were calculated when FMs based electronic portal imaging was applied.
Conclusion: FMs based electronic portal imaging is an effective tool for prostate cancer IGRT.
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Affiliation(s)
- Hamed Ghaffari
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Navaser
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Mofid
- Department of Radiation Oncology, Shohada-e-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seied Rabi Mahdavi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Mohammadi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Asieh Tavakol
- Department of Medical Physics, Roshana Radiotherapy Cancer Center, Tehran, Iran
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30
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Ruiz B, Feng Y. Clinical and radiobiological evaluation of a method for planning target volume generation dependent on organ-at-risk exclusions in magnetic resonance imaging-based prostate radiotherapy. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2018; 8:51-56. [PMID: 33458417 PMCID: PMC7807578 DOI: 10.1016/j.phro.2018.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 11/21/2018] [Accepted: 11/22/2018] [Indexed: 12/15/2022]
Abstract
Background and purpose Due to a smaller target volume when delineating prostate on magnetic resonance imaging (MRI), margins may be too tight as compared to computed tomography (CT) delineation, potentially reducing tumor control probability (TCP) in prostate radiotherapy. This study evaluated a clinically implemented MRI-based target expansion method to provide adequate margins yet limit organ-at-risk (OAR) dose as compared to CT-based delineation. Methods and materials Patients in this study were treated to 79.2 Gy in 44 fractions via intensity modulated radiotherapy using an MRI-based expansion method, which excluded OARs when performing a 5 mm isotropic (except 4 mm posterior) expansion from gross tumor volume to clinical target volume (CTV), followed by an isotropic 5 mm expansion to generate the planning target volume (PTV). Ten cases were re-planned using CT-delineated prostate with CTV-to-PTV expansion of isotropic 8 mm, except for a 5 mm posterior expansion, with comparison of PTV volumes, TCP and normal tissue complication probability (NTCP) to the MRI-based method. Under IRB approved protocol, we retrospectively evaluated 51 patients treated with the MRI-based method for acute bladder and rectal toxicity with CTC-AE version 4.0 used for scoring. Results MRI-based PTV volume differed by 4% compared to CT-based PTV volume. Radiobiological calculated TCP of the MRI-based method was found comparable to CT-based methods with an average equivalent uniform dose of 80.5 Gy and 80.1 Gy respectively. Statistically significant decrease in bladder NTCP (toxicity Grade 2 and above for 5% complications within 5 years post radiotherapy) was observed in the MRI-based method. Outcomes data collected showed 65% and 100% of patients studied experienced Grade 0/1 bladder and rectal acute toxicity respectively. Grade 2 bladder toxicity was indicated in the remaining 35% of patients studied with no Grade 3 toxicity reported. Conclusions Results showed comparable PTV volume with MRI-based method, and NTCP was reduced while maintaining TCP. Clinically, bladder and rectal toxicities were observed to be minimal.
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Affiliation(s)
- Brian Ruiz
- Department of Radiation Oncology, Johnson City Medical Center, Johnson City, TN, USA.,Department of Physics, East Carolina University, Greenville, NC, USA
| | - Yuanming Feng
- Department of Radiation Oncology and Department of Physics, East Carolina University, Greenville, NC, USA
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31
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Hirose K, Sato M, Hatayama Y, Kawaguchi H, Komai F, Sohma M, Obara H, Suzuki M, Tanaka M, Fujioka I, Ichise K, Takai Y, Aoki M. The potential failure risk of the cone-beam computed tomography-based planning target volume margin definition for prostate image-guided radiotherapy based on a prospective single-institutional hybrid analysis. Radiat Oncol 2018; 13:106. [PMID: 29880006 PMCID: PMC5992771 DOI: 10.1186/s13014-018-1043-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/02/2018] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to evaluate the impact of markerless on-board kilovoltage (kV) cone-beam computed tomography (CBCT)-based positioning uncertainty on determination of the planning target volume (PTV) margin by comparison with kV on-board imaging (OBI) with gold fiducial markers (FMs), and to validate a methodology for the evaluation of PTV margins for markerless kV-CBCT in prostate image-guided radiotherapy (IGRT). Methods A total of 1177 pre- and 1177 post-treatment kV-OBI and 1177 pre- and 206 post-treatment kV-CBCT images were analyzed in 25 patients who received prostate IGRT with daily localization by implanted FMs. Intrafractional motion of the prostate was evaluated between each pre- and post-treatment image with these two different techniques. The differences in prostate deviations and intrafractional motions between matching by FM in kV-OBI (OBI-FM) and matching by soft tissues in kV-CBCT (CBCT-ST) were compared by Bland-Altman limits of agreement. Compensated PTV margins were determined and compensated by references. Results Mean differences between OBI-FM and CBCT-ST in the anterior to posterior (AP), superior to inferior (SI), and left to right (LR) directions were − 0.43 ± 1.45, − 0.09 ± 1.65, and − 0.12 ± 0.80 mm, respectively, with R2 = 0.85, 0.88, and 0.83, respectively. Intrafractional motions obtained from CBCT-ST were 0.00 ± 1.46, 0.02 ± 1.49, and 0.15 ± 0.64 mm, respectively, which were smaller than the results from OBI-FM, with 0.43 ± 1.90, 0.12 ± 1.98, and 0.26 ± 0.80 mm, respectively, with R2 = 0.42, 0.33, and 0.16, respectively. Bland-Altman analysis showed a significant proportional bias. PTV margins of 1.5 mm, 1.4 mm, and 0.9 mm for CBCT-ST were calculated from the values of CBCT-ST, which were also smaller than the values of 3.15 mm, 3.66 mm, and 1.60 mm from OBI-FM. The practical PTV margin for CBCT-ST was compensated with the values from OBI-FM as 4.1 mm, 4.8 mm, and 2.2 mm. Conclusions PTV margins calculated from CBCT-ST might be underestimated compared to the true PTV margins. To determine a reliable CBCT-ST-based PTV margin, at least the systemic error Σ and the random error σ for on-line matching errors need to be investigated by supportive preliminary FM evaluation at least once.
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Affiliation(s)
- Katsumi Hirose
- Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan. .,Department of Radiation Oncology, Southern Tohoku BNCT Research Center, 7-10, Yatsuyamada, Koriyama, Fukushima, 963-8052, Japan.
| | - Mariko Sato
- Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yoshiomi Hatayama
- Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Hideo Kawaguchi
- Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Fumio Komai
- Division of Radiology, Hirosaki University Hospital, 53 Hon-cho, Hirosaki, Aomori, 036-8563, Japan
| | - Makoto Sohma
- Division of Radiology, Hirosaki University Hospital, 53 Hon-cho, Hirosaki, Aomori, 036-8563, Japan
| | - Hideki Obara
- Division of Radiology, Hirosaki University Hospital, 53 Hon-cho, Hirosaki, Aomori, 036-8563, Japan
| | - Masashi Suzuki
- Division of Radiology, Hirosaki University Hospital, 53 Hon-cho, Hirosaki, Aomori, 036-8563, Japan
| | - Mitsuki Tanaka
- Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Ichitaro Fujioka
- Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Koji Ichise
- Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yoshihiro Takai
- Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.,Department of Radiation Oncology, Southern Tohoku BNCT Research Center, 7-10, Yatsuyamada, Koriyama, Fukushima, 963-8052, Japan
| | - Masahiko Aoki
- Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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32
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Zhang J, Chen Y, Chen Y, Wang C, Cai J, Chu K, Jin J, Ge Y, Huang X, Guan Y, Li W. A Noninvasive Body Setup Method for Radiotherapy by Using a Multimodal Image Fusion Technique. Technol Cancer Res Treat 2018; 16:1187-1193. [PMID: 29333959 PMCID: PMC5762088 DOI: 10.1177/1533034617740302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose: To minimize the mismatch error between patient surface and immobilization system for tumor location by a noninvasive patient setup method. Materials and Methods: The method, based on a point set registration, proposes a shift for patient positioning by integrating information of the computed tomography scans and that of optical surface landmarks. An evaluation of the method included 3 areas: (1) a validation on a phantom by estimating 100 known mismatch errors between patient surface and immobilization system. (2) Five patients with pelvic tumors were considered. The tumor location errors of the method were measured using the difference between the proposal shift of cone-beam computed tomography and that of our method. (3) The collected setup data from the evaluation of patients were compared with the published performance data of other 2 similar systems. Results: The phantom verification results showed that the method was capable of estimating mismatch error between patient surface and immobilization system in a precision of <0.22 mm. For the pelvic tumor, the method had an average tumor location error of 1.303, 2.602, and 1.684 mm in left–right, anterior–posterior, and superior–inferior directions, respectively. The performance comparison with other 2 similar systems suggested that the method had a better positioning accuracy for pelvic tumor location. Conclusion: By effectively decreasing an interfraction uncertainty source (mismatch error between patient surface and immobilization system) in radiotherapy, the method can improve patient positioning precision for pelvic tumor.
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Affiliation(s)
- Jie Zhang
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Ying Chen
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Yunxia Chen
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Chenchen Wang
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Jing Cai
- 2 Department of Radiotherapy, Nantong Tumor Hospital, Nantong, China
| | - Kaiyue Chu
- 2 Department of Radiotherapy, Nantong Tumor Hospital, Nantong, China
| | - Jianhua Jin
- 2 Department of Radiotherapy, Nantong Tumor Hospital, Nantong, China
| | - Yun Ge
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Xiaolin Huang
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Yue Guan
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Weifeng Li
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
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33
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Vickress J, Lock M, Lo S, Yartsev S. Potential benefit of rotational radiation therapy. Future Oncol 2017; 13:873-874. [PMID: 28067056 DOI: 10.2217/fon-2016-0535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Jason Vickress
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Michael Lock
- Department of Medical Biophysics, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada.,London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada
| | - Simon Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Slav Yartsev
- Department of Medical Biophysics, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada.,London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada
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