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Zhang Y, Alshaikhi J, Tan W, Royle G, Bär E. A probability model for anatomical robust optimisation in head and neck cancer proton therapy. Phys Med Biol 2022; 68. [PMID: 36562611 DOI: 10.1088/1361-6560/aca877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/02/2022] [Indexed: 12/03/2022]
Abstract
Objective.Develop an anatomical model based on the statistics of the population data and evaluate the model for anatomical robust optimisation in head and neck cancer proton therapy.Approach.Deformable image registration was used to build the probability model (PM) that captured the major deformation from patient population data and quantified the probability of each deformation. A cohort of 20 nasopharynx patients was included in this retrospective study. Each patient had a planning CT and 6 weekly CTs during radiotherapy. We applied the model to 5 test patients. Each test patient used the remaining 19 training patients to build the PM and estimate the likelihood of a certain anatomical deformation to happen. For each test patient, a spot scanning proton plan was created. The PM was evaluated using proton spot location deviation and dose distribution.Main results. Using the proton spot range, the PM can simulate small non-rigid variations in the first treatment week within 0.21 ± 0.13 mm. For overall anatomical uncertainty prediction, the PM can reduce anatomical uncertainty from 4.47 ± 1.23 mm (no model) to 1.49 ± 1.08 mm at week 6. The 95% confidence interval (CI) of dose metric variations caused by actual anatomical deformations in the first week is -0.59% ∼ -0.31% for low-risk CTD95, and 0.84-3.04 Gy for parotidDmean. On the other hand, the 95% CI of dose metric variations simulated by the PM at the first week is -0.52 ∼ -0.34% for low-risk CTVD95, and 0.58 ∼ 2.22 Gy for parotidDmean.Significance.The PM improves the estimation accuracy of anatomical uncertainty compared to the previous models and does not depend on the acquisition of the weekly CTs during the treatment. We also provided a solution to quantify the probability of an anatomical deformation. The potential of the model for anatomical robust optimisation is discussed.
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Affiliation(s)
- Ying Zhang
- Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London WC1E 6BT, United Kingdom
| | - Jailan Alshaikhi
- Saudi Proton Therapy Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Wenyong Tan
- Department of Oncology, Shenzhen Hospital of Southern Medical University Shenzhen 518101, People's Republic of China
| | - Gary Royle
- Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London WC1E 6BT, United Kingdom
| | - Esther Bär
- Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London WC1E 6BT, United Kingdom.,University College London Hospitals NHS Foundation Trust, Radiotherapy Physics, 250 Euston Road, London NW1 2PG, United Kingdom
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Zhang Y, McGowan Holloway S, Zoë Wilson M, Alshaikhi J, Tan W, Royle G, Bär E. DIR-based models to predict weekly anatomical changes in head and neck cancer proton therapy. Phys Med Biol 2022; 67:095001. [PMID: 35316795 PMCID: PMC10437002 DOI: 10.1088/1361-6560/ac5fe2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 11/12/2022]
Abstract
Objective. We proposed two anatomical models for head and neck patients to predict anatomical changes during the course of radiotherapy.Approach. Deformable image registration was used to build two anatomical models: (1) the average model (AM) simulated systematic progressive changes across the patient cohort; (2) the refined individual model (RIM) used a patient's CT images acquired during treatment to update the prediction for each individual patient. Planning CTs and weekly CTs were used from 20 nasopharynx patients. This dataset included 15 training patients and 5 test patients. For each test patient, a spot scanning proton plan was created. Models were evaluated using CT number differences, contours, proton spot location deviations and dose distributions.Main results. If no model was used, the CT number difference between the planning CT and the repeat CT at week 6 of treatment was on average 128.9 Hounsfield Units (HU) over the test population. This can be reduced to 115.5 HU using the AM, and to 110.5 HU using the RIM3(RIM, updated at week (3). When the predicted contours from the models were used, the average mean surface distance of parotid glands can be reduced from 1.98 (no model) to 1.16 mm (AM) and 1.19 mm (RIM3) at week 6. Using the proton spot range, the average anatomical uncertainty over the test population reduced from 4.47 ± 1.23 (no model) to 2.41 ± 1.12 mm (AM), and 1.89 ± 0.96 mm (RIM3). Based on the gamma analysis, the average gamma index over the test patients was improved from 93.87 ± 2.48 % (no model) to 96.16 ± 1.84% (RIM3) at week 6.Significance. The AM and the RIM both demonstrated the ability to predict anatomical changes during the treatment. The RIM can gradually refine the prediction of anatomical changes based on the AM. The proton beam spots provided an accurate and effective way for uncertainty evaluation.
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Affiliation(s)
- Ying Zhang
- Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London WC1E 6BT, United Kingdom
| | - Stacey McGowan Holloway
- CRUK RadNet Glasgow, University of Glasgow, Beatson West of Scotland Cancer Centre, Radiotherapy Physics, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Megan Zoë Wilson
- Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London WC1E 6BT, United Kingdom
| | - Jailan Alshaikhi
- Saudi Proton Therapy Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Wenyong Tan
- Department of Oncology, Shenzhen Hospital of Southern Medical University Shenzhen 518101, People's Republic of China
| | - Gary Royle
- Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London WC1E 6BT, United Kingdom
| | - Esther Bär
- Department of Medical Physics and Biomedical Engineering, University College London, Gower Street, London WC1E 6BT, United Kingdom
- University College London Hospitals NHS Foundation Trust, Radiotherapy Physics, 250 Euston Road, London NW1 2PG, United Kingdom
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Li Y, Zang J, Liu J, Luo S, Wang J, Hou B, Zhao L, Shi M. Residual Volume of Lymph Nodes During Chemoradiotherapy Based Nomogram to Predict Survival of Nasopharyngeal Carcinoma Patient Receiving Induction Chemotherapy. Front Oncol 2021; 11:739103. [PMID: 34552881 PMCID: PMC8451592 DOI: 10.3389/fonc.2021.739103] [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: 07/10/2021] [Accepted: 08/16/2021] [Indexed: 01/22/2023] Open
Abstract
Purpose To accurately stratify nasopharyngeal carcinoma (NPC) patients who were benefit from induction chemotherapy (IC) followed by chemoradiotherapy (CCRT), we established residual volume of lymph nodes during chemoradiotherapy based nomogram to predict survival for NPC patients. Methods Cox regression analysis were used to evaluate predictive effects of tumor volume parameters. Multivariate Cox regression analysis was used to identify the prognostic factors, and nomogram models were developed to predict survival of NPC patients receiving IC followed by CCRT. Results Compared with other tumor volumetric parameters, midRT GTVnd was the best predictive factor for OS (HR: 1.043, 95%CI: 1.031-1.055), PFS (HR: 1.040, 95%CI: 1.030- 1.051), and DMFS (HR: 1.046, 95%CI: 1.034 – 1.059) according to the HR of Cox regression analysis. Based on multivariate analysis, three nomograms included midRT GTVnd were constructed to predict 4-year survival. The C-index of nomograms for each survival endpoints were as follow (training cohort vs. validation cohort): 0.746 vs. 0.731 for OS; 0.747 vs. 0.735 for PFS; 0.768 vs. 0.729 for DMFS, respectively. AUC showed a good discriminative ability. Calibration curves demonstrated a consistence between actual results and predictions. Decision curve analysis (DCA) showed that the nomograms had better clinical predictive effects than current TNM staging system. Conclusion We identified the best volumetric indicator associated with prognosis was the residual volume of lymph nodes at the fourth week of chemoradiotherapy for patients receiving IC followed by CCRT. We developed and validated three nomograms to predict specific probability of 4-year OS, PFS and DMFS for NPC patient receiving IC followed by CCRT.
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Affiliation(s)
- Yan Li
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jian Zang
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jingyi Liu
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Shanquan Luo
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jianhua Wang
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Bingxin Hou
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lina Zhao
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Mei Shi
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Wu RWK, Chu ESM, Yuen JWM, Huang Z. Comparative study of FosPeg® photodynamic effect on nasopharyngeal carcinoma cells in 2D and 3D models. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2020; 210:111987. [PMID: 32801063 DOI: 10.1016/j.jphotobiol.2020.111987] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 07/21/2020] [Accepted: 08/04/2020] [Indexed: 12/24/2022]
Abstract
Photodynamic Therapy (PDT) offers an alternative option for the treatment of nasopharyngeal carcinoma (NPC). The utilization of 3-dimensional (3D) culture model might provide better understanding of PDT effects on NPC cells. The aim of this in vitro study was to compare PDT effect on NPC cells using 2D and 3D models. Two 3D culture models were established using liquid overlay method with agarose base (MCL) and hanging drop method (MCS). PDT was carried out using the combination of FosPeg® and 652 nm laser in 3D and conventional 2D models. The effects of 3D culture size and morphology on the uptake and distribution of sensitizer and gene expression were examined. Photocytotoxity, mode of cell death, and protein expression were compared for 2D and 3D models. Regular and irregular NPC spheroids were obtained from MCL and MCS methods, respectively. A significantly down-regulation of LMP1 mRNA were observed in MCL spheroid. The sensitizer uptake in 3D spheroids was half of 2D culture. More sensitizers were required to obtain IC50 in 3D spheroids. Apoptosis, necrosis and autophagosomes were detected in PDT treated 2D and 3D cells. Different protein expression patterns were observed in 2D and 3D models. FosPeg® PDT is effective in killing NPC cells. MCL-derived 3D spheroid model is more suitable for the evaluation of PDT killing mechanisms.
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Affiliation(s)
- Ricky Wing Kei Wu
- School of Medical and Health Sciences, Tung Wah College, Hong Kong, China.
| | | | - John Wai Man Yuen
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
| | - Zheng Huang
- Biomedical Photonics Center, MOE Key Laboratory of Photonics Science and Technology for Medicine, School of OptoElectronic and Information Engineering, Fujian Normal University, Fuzhou, Hong Kong, China
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[Adaptive radiotherapy for nasopharyngeal carcinomas: Where are we?]. Bull Cancer 2020; 107:565-573. [PMID: 32245602 DOI: 10.1016/j.bulcan.2019.12.013] [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: 05/02/2019] [Revised: 12/17/2019] [Accepted: 12/30/2019] [Indexed: 11/21/2022]
Abstract
Modern high-precision radiotherapy techniques have recently incorporated the notion of anatomical variations of the patient during treatment and have tried to adapt the treatment planning to them. Adaptive radiotherapy for nasopharyngeal tumors is starting to prove its benefit nowadays. His interest is constantly being evaluated. The variations encountered during the treatment are both geometric and dosimetric. They are represented by a reduction in the macroscopic tumors volume, a change in its position and a consequent dosimetric impact. The changes also concern organs at risk with a reduction of glandular structure volumes, and a different position which increases their doses. Delivered doses to noble structures (brainstem and spinal cord) may also increase. However, difficulties are encountered in its realization. There is a problem to perfectly reproduce the patient position during the second acquisition, which impacts the fusion quality between the two CT scans. This generates an imprecision in the definition of the same treatment isocentre on the second scanner. Also, there is a difficulty in accumulated doses calculation. The indication of adaptive radiotherapy remains a subject of controversy. It should be proposed for a subgroup of patients who could benefit from this new strategy. We present here an update on the state of the art of adaptive radiotherapy for nasopharyngeal cancer.
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Mnejja W, Daoud H, Fourati N, Sahnoun T, Siala W, Farhat L, Daoud J. Dosimetric impact on changes in target volumes during intensity-modulated radiotherapy for nasopharyngeal carcinoma. Rep Pract Oncol Radiother 2020; 25:41-45. [PMID: 31889919 PMCID: PMC6931189 DOI: 10.1016/j.rpor.2019.12.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/11/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND AND PURPOSE To assess anatomic changes during intensity modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC) and to determine its dosimetric impact. PATIENTS AND METHODS Twenty patients treated with IMRT for NPC were enrolled in this study. A second CT was performed at 38 Gy. Manual contouring of the macroscopic tumor volumes (GTV) and the planning target volumes (PTV) were done on the second CT. We recorded the volumes of the different structures, D98 %, the conformity, and the homogeneity indexes for each PTV. Volume percent changes were calculated. RESULTS We observed a significant reduction in tumor volumes (58.56 % for the GTV N and 29.52 % for the GTV T). It was accompanied by a significant decrease in the D98 % for the 3 PTV (1.4 Gy for PTV H, p = 0.007; 0.3 Gy for PTV I, p = 0.03 and 1.15 Gy for PTV L, p = 0 0.0066). In addition, we observed a significant reduction in the conformity index in the order of 0.02 (p = 0.001) and 0.01 (p = 0.007) for PTV H and PTV I, respectively. The conformity variation was not significant for PTV L. Moreover, results showed a significant increase of the homogeneity index for PTV H (+ 0.03, p = 0.04) and PTV L (+ 0.04, p = 0.01). CONCLUSION Tumor volume reduction during the IMRT of NPC was accompanied by deterioration of the dosimetric coverage for the different target volumes. It is essential that a careful adaptation of the treatment plan be considered during therapy for selected patients.
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Key Words
- Anatomic changes
- CI, Conformity Indice
- CTV (H), High Risk Clinical Target Volume
- CTV (I), Intermediate Risk Clinical Target Volume
- CTV (L), Low Risk Clinical Target Volume
- CTV, Clinical Target Volume
- CTint, Initial CT
- CTmi, Mid-treatment CT
- Dose distribution.
- GTV, Gross Tumor Volume
- HI, Homogeneity Indice
- ID, Dice Index
- IMRT, Intensity Modulated Radiation Therapy
- Intensity modulated radiotherapy
- NPC, Nasopharyngeal Carcinoma
- Nasopharyngeal carcinoma
- OAR, Organs At Risk
- PTV (H), High Risk Planning Target Volume
- PTV (I), Intermediate Risk Planning Target Volume
- PTV (L), Low Risk Planning Target Volume
- PTV, Planning Target Volume
- Vi, Initial Volume
- Vm, Mid-treatment Volume
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Affiliation(s)
- Wafa Mnejja
- Radiotherapy Department, Habib Bourguiba Hospital, Sfax, Tunisia
- Faculty of Medicine Sfax University, Sfax, Tunisia
| | - Hend Daoud
- Radiotherapy Department, Habib Bourguiba Hospital, Sfax, Tunisia
- Faculty of Medicine Sfax University, Sfax, Tunisia
| | - Nejla Fourati
- Radiotherapy Department, Habib Bourguiba Hospital, Sfax, Tunisia
- Faculty of Medicine Sfax University, Sfax, Tunisia
| | - Tarek Sahnoun
- Radiotherapy Department, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Wicem Siala
- Radiotherapy Department, Habib Bourguiba Hospital, Sfax, Tunisia
- Faculty of Medicine Sfax University, Sfax, Tunisia
| | - Leila Farhat
- Radiotherapy Department, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Jamel Daoud
- Radiotherapy Department, Habib Bourguiba Hospital, Sfax, Tunisia
- Faculty of Medicine Sfax University, Sfax, Tunisia
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Shi L, Du FL, Sun ZW, Zhang L, Chen YY, Xie TM, Li PJ, Huang S, Dong BQ, Zhang MM. Radiation-induced gray matter atrophy in patients with nasopharyngeal carcinoma after intensity modulated radiotherapy: a MRI magnetic resonance imaging voxel-based morphometry study. Quant Imaging Med Surg 2018; 8:902-909. [PMID: 30505719 DOI: 10.21037/qims.2018.10.09] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Gray matter (GM) damage after radiotherapy (RT) in nasopharyngeal carcinoma (NPC) patients can result in cognitive impairment, while there may be no visible brain tissue change according to the conventional magnetic resonance imaging (MRI). This study investigated radiation-induced GM volume differences between NPC patients who received RT and those who did not. Methods High-resolution brain structural MRI data from two groups of patients were acquired. The pre-RT group was composed of 56 newly diagnosed but not yet medically treated NPC patients, while the after-RT group consisted of 40 NPC patients who had completed RT more than 1 year ago. Voxel-based morphometry (VBM) was applied to assess GM volumes. Two sample t-test was used to analyze GM volumes voxel-by-voxel using the VBM8 toolbox built in the SPM software. Radiation-induced cortical volume alteration in all NPC patients after RT and dosimetry of 36 patients were analyzed. Results Compared to pre-treatment group, cortical volumes of GM were significantly smaller in the left hippocampus, the right pulvinar and the right middle temporal gyrus (MTG, P<0.001, AlphaSim correction, cluster size ≥157). The mean dose (Dmean) for bilateral hippocampal heads were significantly higher than other different parts of the brain (P<0.001). No significant correlations between the GM volume in any brain regions and the mean dose of corresponding position of these brain regions were observed (P>0.05). Conclusions Radiation to the NPC patients can not only induce damage of the hippocampus, but also other secondary damages of GM.
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Affiliation(s)
- Lei Shi
- Department of Radiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China.,Department of Radiology, Zhejiang Cancer Hospital, Hangzhou 310022, China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Feng-Lei Du
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Zong-Wen Sun
- Department of Oncology, Jining No.1 People's Hospital, Jining 272000, China
| | - Lan Zhang
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, Hangzhou 310014, China
| | - Yuan-Yuan Chen
- Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Tie-Ming Xie
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou 310022, China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Pei-Jing Li
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Shuang Huang
- Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Bai-Qiang Dong
- Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Min-Ming Zhang
- Department of Radiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
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Tan W, Wang Y, Yang M, Amos RA, Li W, Ye J, Gary R, Shen W, Hu D. Analysis of geometric variation of neck node levels during image-guided radiotherapy for nasopharyngeal carcinoma: recommended planning margins. Quant Imaging Med Surg 2018; 8:637-647. [PMID: 30211031 DOI: 10.21037/qims.2018.08.03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background To quantify the geometrical changes of each neck nodal level (NNL) and estimate the geometric planning target volume (PTV) margin during image-guided radiotherapy (IGRT) for nasopharyngeal cancer (NPC). Methods Twenty patients with locally advanced NPC underwent one planning computed tomography (CTplan) and 6 weekly repeat CT (CTrep) scans during chemoradiotherapy. Each CTrep was rigidly registered to the CTplan. All the NNLs were manually delineated in each transverse CT section. When comparing the NNL in CTrep with CTplan, their volumes, displacement of the center of the mass, and the shortest perpendicular distance (SPD) were automatically calculated. This was followed by calculation of the systematic and random errors, overlapping index (OI), and dice similarity coefficient (DSC). With PTVs isotropically expanded from NNL by 1, 2, 3, 4, and 5 mm, they were compared with NNL itself; OI >0.95 was defined as the acceptable geometrical coverage. The Mann-Whitney test was used for statistical analysis. Results All volumes, OI, and DSC of the NNLs (not including level IA) showed a linear decrease over time throughout the treatment course. The volume of NNLs decreased by 1-6% in the first week and 10-21% in the sixth week. The mean SPD was 1.3-1.7 and 1.9-3.5 mm in the first and sixth week respectively. The DSCs for nodal level IB, II, III, and IV were >0.7 and that of level V was <0.7 throughout the treatment course. For level IA and VI, DSC was <0.7 after the 2nd week. To maintain the OI >0.95, 2-5 mm was needed to expand the different NNLs. Conclusions The geometrical changes of each NNL are substantial and the necessary margin of 2-5 mm depended on individual NNL is needed to maintain geometrical coverage throughout the course of IGRT for NPC.
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Affiliation(s)
- Wenyong Tan
- Department of Oncology, Shenzhen Hospital of Southern Medical University, Shenzhen 518101, China.,Clinical Research Center, The Second Clinical College (Shenzhen People Hospital), Jinan University, Shenzhen 518020, China.,Department of Radiation Oncology, Hubei Cancer Hospital, Wuhan 430079, China
| | - Yingjie Wang
- Department of Radiation Oncology, Air Force General Hospital, Beijing 100142, China
| | - Ming Yang
- Clinical Research Center, The Second Clinical College (Shenzhen People Hospital), Jinan University, Shenzhen 518020, China.,Shenzhen Jingmai Medical Scientific and Technique Company, Shenzhen 518052, China
| | - Richard A Amos
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
| | - Weihao Li
- Clinical Research Center, The Second Clinical College (Shenzhen People Hospital), Jinan University, Shenzhen 518020, China
| | - Jianzeng Ye
- Clinical Research Center, The Second Clinical College (Shenzhen People Hospital), Jinan University, Shenzhen 518020, China
| | - Royle Gary
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK
| | - Weixi Shen
- Department of Oncology, Shenzhen Hospital of Southern Medical University, Shenzhen 518101, China
| | - Desheng Hu
- Department of Radiation Oncology, Hubei Cancer Hospital, Wuhan 430079, China
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