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Salim N, Loyko I, Tumanova K, Stolbovoy A, Levkina O, Prokofev I. Stereotactic radiotherapy for uveal melanoma: A case report. Mol Clin Oncol 2024; 20:23. [PMID: 38357672 PMCID: PMC10865074 DOI: 10.3892/mco.2024.2721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
Uveal melanoma (UM) is the most common primary intraocular malignancy worldwide. Surgical intervention and radiation therapy (RT) are the primary treatment options. Given the complexity and cosmetic discomfort associated with eye enucleation, this method is less frequently used. As a result, RT, including photon therapy, proton therapy and brachytherapy, has become the treatment of choice. Traditionally, plaque brachytherapy has been the most commonly used in clinical practice. However, the question of which type of radiation therapy is the most effective, safe, commonly available and cost-effective remains open. The present study provided a follow-up analysis of a patient with UM who was treated using the image-guided volumetric modulated arc therapy (IG-VMAT) technique. A complete response without complications and symptom relief were noted one and a half years after treatment. The present findings suggest that photon external beam radiotherapy using the IG-VMAT technique may offer a viable and safe alternative for the management of UM. This approach potentially sidesteps the complex and morbid aspects of surgical intervention and plaque brachytherapy. Owing to the limited sample size, a more robust understanding of the efficacy and safety of this treatment will require the analysis of additional cases. Further research with a larger cohort is essential to validate these preliminary observations.
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Affiliation(s)
- Nidal Salim
- Institute of Oncology, European Medical Center, Moscow 129090, Russia
- Radiation Therapy Department, Russian Medical Academy of Continuous Professional Education, Moscow 125993, Russia
| | - Ilya Loyko
- Institute of Oncology, European Medical Center, Moscow 129090, Russia
| | - Kristina Tumanova
- Institute of Oncology, European Medical Center, Moscow 129090, Russia
| | - Aleksander Stolbovoy
- Institute of Oncology, European Medical Center, Moscow 129090, Russia
- Radiation Therapy Department, Russian Medical Academy of Continuous Professional Education, Moscow 125993, Russia
| | - Oksana Levkina
- Ophthalmology Department, European Medical Center, Moscow 129090, Russia
| | - Igor Prokofev
- Institute of Oncology, European Medical Center, Moscow 129090, Russia
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Serarslan A, Daştan Y, Aksu T, Yıldız RE, Gürsel B, Meydan D, Okumuş NÖ. Ninety-degree angled collimator: a dosimetric study related to dynamic intensity-modulated radiotherapy in patients with endometrial carcinoma. BMC Cancer 2023; 23:515. [PMID: 37280543 DOI: 10.1186/s12885-023-11033-8] [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: 03/09/2023] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Our purpose was to ensure that the dose constraints of the organs at risk (OARs) were not exceeded while increasing the prescription dose to the planning target volume (PTV) from 45 to 50.4 Gray (Gy) with the dynamic intensity-modulated radiotherapy (IMRT) technique. While trying for this purpose, a new dynamic IMRT technique named 90° angled collimated dynamic IMRT (A-IMRT) planning was developed by us. METHODS This study was based on the computed tomography data sets of 20 patients with postoperatively diagnosed International Federation of Gynecology and Obstetrics stage 2 endometrial carcinoma. For each patient, conventional dynamic IMRT (C-IMRT, collimator angle of 0° at all gantry angles), A-IMRT (collimator angle of 90° at gantry angles of 110°, 180°, 215°, and 285°), and volumetric modulated arc therapy (VMAT) were planned. Planning techniques were compared with parameters used to evaluate PTV and OARs via dose-volume-histogram analysis using the paired two-tailed Wilcoxon's signed-rank test; p < 0.05 was considered indicative of statistical significance. RESULTS All plans achieved adequate dose coverage for PTV. Although the technique with the lowest mean conformality index was A-IMRT (0.76 ± 0.05) compared to both C-IMRT (0.79 ± 0.04, p = 0.000) and VMAT (0.83 ± 0.03, p = 0.000), it protected the OARs especially the bladder (V45 = 32.84 ± 2.03 vs. 44.21 ± 6.67, p = 0.000), rectum (V30 = 56.18 ± 2.05 vs. 73.80 ± 4.75, p = 0.000) and both femoral heads (V30 for right = 12.19 ± 1.34 vs. 21.42 ± 4.03, p = 0.000 and V30 for left = 12.58 ± 1.48 vs. 21.35 ± 4.16, p = 0.000) better than C-IMRT. While the dose constraints of the bladder, rectum and bilateral femoral heads were not exceeded in any patient with A-IMRT or VMAT, they were exceeded in 19 (95%), 20 (100%) and 20 (100%) patients with C-IMRT, respectively. CONCLUSIONS OARs are better protected when external beam radiotherapy is applied to the pelvis at a dose of 50.4 Gy by turning the collimator angle to 90° at some gantry angles with the dynamic IMRT technique in the absence of VMAT.
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Affiliation(s)
- Alparslan Serarslan
- Department of Radiation Oncology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, 55139, Turkey.
| | - Yalçın Daştan
- Department of Radiation Oncology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, 55139, Turkey
| | - Telat Aksu
- Department of Radiation Oncology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, 55139, Turkey
| | - Rana Elif Yıldız
- Department of Radiation Oncology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, 55139, Turkey
| | - Bilge Gürsel
- Department of Radiation Oncology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, 55139, Turkey
| | - Deniz Meydan
- Department of Radiation Oncology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, 55139, Turkey
| | - Nilgün Özbek Okumuş
- Department of Radiation Oncology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, 55139, Turkey
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Hunte SO, Clark CH, Zyuzikov N, Nisbet A. Volumetric modulated arc therapy (VMAT): a review of clinical outcomes—what is the clinical evidence for the most effective implementation? Br J Radiol 2022; 95:20201289. [PMID: 35616646 PMCID: PMC10162061 DOI: 10.1259/bjr.20201289] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Modern conformal radiation therapy using techniques such as modulation, image guidance and motion management have changed the face of radiotherapy today offering superior conformity, efficiency, and reproducibility to clinics worldwide. This review assesses the impact of these advanced radiotherapy techniques on patient toxicity and survival rates reported from January 2017 to September 2020. The main aims are to establish if dosimetric and efficiency gains correlate with improved survival and reduced toxicities and to answer the question ‘What is the clinical evidence for the most effective implementation of VMAT?’. Compared with 3DCRT, improvements have been reported with VMAT in prostate, locally advanced cervical carcinoma and various head and neck applications, leading to the shift in technology to VMAT. Other sites such as thoracic neoplasms and nasopharyngeal carcinomas have observed some improvement with VMAT although not in line with improved dosimetric measures, and the burden of toxicity and the incidence of cancer related deaths remain high, signaling the need to further mitigate toxicity and increase survival. As technological advancement continues, large randomised long-term clinical trials are required to determine the way-forward and offer site-specific recommendations. These studies are usually expensive and time consuming, therefore utilising pooled real-world data in a prospective nature can be an alternative solution to comprehensively assess the efficacy of modern radiotherapy techniques.
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Affiliation(s)
- Sherisse Ornella Hunte
- Radiotherapy Department, Cancer Centre of Trinidad and Tobago, St James, Trinidad and Tobago
- University of the West Indies, St. Augustine, Trinidad & Tobago
| | - Catharine H Clark
- Radiotherapy Physics, UCLH NHS Foundation Trust, London, UK
- Metrology for Medical Physics National Physical Laboratory, Teddington, UK
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | | | - Andrew Nisbet
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
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Garcia GA, Charlson ES, Kolseth C, Kim N, Kossler AL. Ocular, Orbital, and Adnexal Toxicity With High-dose Volumetric Modulated Arc Radiation Therapy for Orbital Malignancies. Ophthalmic Plast Reconstr Surg 2022; 38:132-137. [PMID: 34284423 PMCID: PMC10838403 DOI: 10.1097/iop.0000000000002001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Conventional modalities of external-beam radiation therapy (EBRT) are associated with high incidences of severe vision-threatening ocular and orbital toxicities when used to treat orbital malignancies. We investigate toxicities associated with high-dose volumetric modulated arc therapy (VMAT), a commonly used contemporary treatment modality for these tumors. METHODS Retrospective analysis of malignant orbital tumors managed with adjuvant high-dose VMAT preceded by globe-salvaging surgical therapy (GST) or exenteration. Dosimetric quantitation of target volumes and critical structures was performed. Incidence and severity of ocular, orbital, and adnexal toxicities were evaluated and assessed with regard to conventional EBRT toxicities for orbital malignancies described in the literature. RESULTS Eighty-four subjects (mean age = 65.9 ± 9.7 years) were included (N = 48 and N = 36 in GST and exenteration subgroups, respectively). Mean dose was 64.8 ± 2.1 Gy to the planning target volume. Dosing to critical structures typically did not surpass known tissue tolerance limits. Median follow up was 18.3 months. Visual acuity in the GST subgroup was not significantly different after VMAT (0.25 ± 0.06) compared with baseline (0.23 ± 0.02; P = 0.302). Whereas severe toxicities reported by major systematic analyses in the literature with older EBRT modalities were relatively common-for example, retinopathy (16-40%), optic neuropathy (16%), and corneal perforation (13%)-toxicities with VMAT were typically mild and less common. The most common toxicities with VMAT were mild dry eye (81.3%; 39/48), cataract (21.1%; 8/38 phakic eyes), and periocular dermatitis (15.5%; 13/84). Vision-threatening toxicities, including severe corneal pathologies, retinopathy, or optic neuropathy, were rare. There were no contralateral ocular or adnexal toxicities. CONCLUSIONS High-dose VMAT for orbital malignancies demonstrated low incidence and severity of eye-related toxicity, in contradistinction to adverse events reported from conventional forms of radiotherapy.
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Affiliation(s)
- Giancarlo A Garcia
- Department of Ophthalmology, Byers Eye Institute at Stanford University, Palo Alto, California, U.S.A
| | - Emily S Charlson
- Department of Ophthalmology, Pacific Eye Associates and California Pacific Medical Center, San Francisco, California, U.S.A
| | - Clinton Kolseth
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Namju Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Andrea L Kossler
- Department of Ophthalmology, Byers Eye Institute at Stanford University, Palo Alto, California, U.S.A
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Macchia G, Nardangeli A, Laliscia C, Fodor A, Draghini L, Gentile PC, D’Agostino GR, Balcet V, Bonome P, Ferioli M, Autorino R, Vicenzi L, Raguso A, Borghesi S, Ippolito E, Di Cataldo V, Cilla S, Perrucci E, Campitelli M, Gambacorta MA, Deodato F, Scambia G, Ferrandina G. Stereotactic body radiotherapy in oligometastatic cervical cancer (MITO-RT2/RAD study): a collaboration of MITO, AIRO GYN, and MaNGO groups. Int J Gynecol Cancer 2022; 32:732-739. [DOI: 10.1136/ijgc-2021-003237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
ObjectiveThis retrospective, multicenter study analyzes the efficacy and safety of stereotactic body radiotherapy in a large cohort of patients with oligometastatic/persistent/recurrent cervical cancer.MethodsA standardized data collection from several radiotherapy centers that treated patients by stereotactic body radiotherapy between March 2006 and February 2021 was set up. Clinical and stereotactic body radiotherapy parameters were collected. Objective response rate was defined as a composite of complete and partial response, while clinical benefit included objective response rate plus stable disease. Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer and Common Terminology Criteria for Adverse Events scales were used to grade toxicities. The primary endpoints were the rate of complete response to stereotactic body radiotherapy, and the 2 year actuarial local control rate on a ‘per lesion’ basis. The secondary end points were progression-free survival and overall survival, as well as toxicity.ResultsA total of 83 patients with oligometastatic/persistent/recurrent cervical cancer bearing 125 lesions treated by stereotactic body radiotherapy at 15 different centers were selected for analysis. Of the sites of metastatic disease, lymph node metastases were most common (55.2%), followed by parenchyma lesions (44.8%). Median total dose was 35 Gy (range 10–60), in five fractions (range 1–10), with a median dose/fraction of 7 Gy (range 4–26). Complete, partial, and stable response were found in 73 (58.4%), 29 (23.2%), and 16 (12.8%) lesions, respectively, reaching 94.4% of the clinical benefit rate. Forty-six (55.4%) patients had a complete response. Patients achieving complete response on a ‘per lesion’ basis experienced a 2 year actuarial local control rate of 89.0% versus 22.1% in lesions not achieving complete response (p<0.001). The 2 year actuarial progression-free survival rate was 42.5% in patients with complete response versus 7.8% in patients with partial response or stable or progressive disease (p=0.001). The 2 year actuarial overall survival rate was 68.9% in patients with complete response versus 44.3% in patients with partial response or stable or progressive disease (p=0.015). Fifteen patients (18.1%) had mild acute toxicity, totaling 29 side events. Late toxicity was documented in four patients (4.8%) totaling seven adverse events.ConclusionOur analysis confirmed the efficacy of stereotactic body radiotherapy in oligometastatic/persistent/recurrent cervical cancer patients. The low toxicity profile encourages the wider use of stereotactic body radiotherapy in this setting.
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McKay MJ, Taubman KL, Lee S, Scott AM. Radiotherapy planning of lymphomas: role of metabolic imaging with PET/CT. Ann Nucl Med 2022; 36:162-171. [PMID: 35028879 DOI: 10.1007/s12149-021-01703-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022]
Abstract
Accurate target delineation is an absolute requirement for modern radiotherapy planning. Historically, structural imaging modalities have been used for this purpose, but there is a considerable role for functional imaging with PET/CT to contribute in this area. PET/CT's role in radiotherapy planning is well established and its use is indispensable in the clinical management of the lymphomas, particularly Hodgkin Lymphoma. A crucial use of PET/CT is as a baseline scan for delineation of the initial lymphomatous involvement, since this will determine the contouring of the gross-, clinical- and planning-target volumes (GTV, CTV, PTV). This article reviews the principles of contemporary radiotherapy, examines the evidence for the contribution of PET/CT to radiotherapy planning in lymphoma and the practicalities and challenges of applying this powerful technology to this situation.
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Affiliation(s)
- Michael J McKay
- Northern Cancer Service, North West Cancer Centre, Burnie, TAS, 7320, Australia. .,Olivia Newton-John Cancer Research Institute, School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia. .,Rural Clinical School, Northwest Regional Hospital, University of Tasmania, Burnie, TAS, 7320, Australia.
| | - Kim L Taubman
- Department of Medical Imaging, St Vincents Hospital, Fitzroy, VIC, 3065, Australia
| | - Szeting Lee
- Department of Molecular Imaging and Therapy, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Andrew M Scott
- Olivia Newton-John Cancer Research Institute, School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia.,Department of Molecular Imaging and Therapy, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, VIC, 3052, Australia
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7
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Yoosuf AM, Ahmad MB, AlShehri S, Alhadab A, Alqathami M. Investigation of optimum minimum segment width on VMAT plan quality and deliverability: A comprehensive dosimetric and clinical evaluation using DVH analysis. J Appl Clin Med Phys 2021; 22:29-40. [PMID: 34592787 PMCID: PMC8598144 DOI: 10.1002/acm2.13417] [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: 04/19/2021] [Revised: 06/23/2021] [Accepted: 08/24/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose Minimum segment width (MSW) plays a fundamental role in the shaping of optimized apertures and creation of segments of varying sizes and shapes in complex radiotherapy treatment plans. The purpose of this work was to study the effect of MSW on dose distribution in patients planned with VMAT for various treatment sites using dose volume histogram (DVH) analysis. Materials and methods For the validation of optimum MSW, 125 clinical treatment plans were evaluated. Five groups were identified (brain, head and neck, thorax, pelvis, and extremity), and five cases were chosen from each group. For each case, five plans were created with different MSW (0.5, 0.8, 1.0, 1.25, and 1.5 cm). The quality of treatment plans created using different MSW were compared using dosimetric indicators such as target coverage (D98—dose to 98% of the planning target volume (PTV), maximum dose (D2—maximum dose to 2% of the PTV), monitor units (MU), and DVH parameters related to organs at risk (OAR). The effect of the MSW on delivery accuracy was quantitatively analyzed using the measured fluence utilizing ionization chamber‐based transmission detector and model‐based dose verification system. Traditional global gamma analysis (2%, 2 mm) and dose volume information was gathered for the PTV and organs at risk and compared for different MSWs. Results A total of 125 plans were created and compared across five groups. In terms of treatment plan quality, the plans using MSW of 0.5 cm was found to be superior in all groups. PTV coverage (D98) decreased significantly (p < 0.05) as the MSW increased. Similarly, the maximum dose (D2) was found to be increased significantly (p < 0.05) as the MSW increased from 0.5 cm, with MSW of 1.5 cm being the least in terms of plan quality for both PTVs and OARs. In terms of plan deliverability using DVH analysis, treatment planning system (TPS) compared to measured fluence, VMAT plans produced with MSW of 0.5 cm showed a better dosimetric index and a smaller deviation for both PTVs and OARs. The deliverability of the plans deteriorated as the MSW increased. Conclusion Dose volume histogram (DVH) analysis demonstrated that treatment plans with minimal MSW showed better plan quality and deliverability and provided clinical relevance as compared to gamma index analysis.
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Affiliation(s)
- Ab Mohamed Yoosuf
- Department of Radiation Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Muhammad Bilal Ahmad
- Department of Radiation Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Salem AlShehri
- Department of Radiation Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulrahman Alhadab
- Department of Radiation Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Mamdouh Alqathami
- Department of Radiation Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Makino T, Izumi K, Iwamoto H, Mizokami A. Treatment Strategies for High-Risk Localized and Locally Advanced and Oligometastatic Prostate Cancer. Cancers (Basel) 2021; 13:cancers13174470. [PMID: 34503280 PMCID: PMC8430548 DOI: 10.3390/cancers13174470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary The definitions of locally advanced and oligometastatic prostate cancer are ambiguous, and there are no standard treatments for these. Although multidisciplinary treatment combining systemic and local treatment may be effective, there are many unresolved issues such as the choice of local treatment, use of new endocrine agents and chemotherapy, and selection of optimal patients. The present article discusses the definitions, diagnoses, and treatment of very high-risk prostate cancer and oligometastatic prostate cancer. Abstract Despite the significant advances in the treatment of high-risk prostate cancer, patients with very high-risk features such as being locally advanced (clinical stage T3–4 or minimal nodal involvement), having a high Gleason pattern, or with oligometastasis may still have a poor prognosis despite aggressive treatment. Multidisciplinary treatment with both local and systemic therapies is thought to be effective, however, unfortunately, there is still no standard treatment. However, in recent years, local definitive therapy using a combination of radiotherapy and androgen deprivation is being supported by several randomized clinical trials. This study reviews the current literature with a focus on the definition of very high-risk prostate cancer, the role of modern imaging, and its treatment options.
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Affiliation(s)
- Tomoyuki Makino
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa 920-8640, Ishikawa, Japan; (T.M.); (H.I.); (A.M.)
- Department of Urology, Ishikawa Prefectural Central Hospital, Kanazawa 920-8530, Ishikawa, Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa 920-8640, Ishikawa, Japan; (T.M.); (H.I.); (A.M.)
- Correspondence: ; Tel.: +81-76-265-2393; Fax: +81-76-234-4263
| | - Hiroaki Iwamoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa 920-8640, Ishikawa, Japan; (T.M.); (H.I.); (A.M.)
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa 920-8640, Ishikawa, Japan; (T.M.); (H.I.); (A.M.)
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Lifetime radiation-induced sarcoma risk in patients subjected to IMRT or VMAT for uterine cervix carcinoma. Phys Eng Sci Med 2021; 44:573-579. [PMID: 33909230 DOI: 10.1007/s13246-021-01002-5] [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: 11/25/2020] [Accepted: 04/14/2021] [Indexed: 01/08/2023]
Abstract
This study was conducted to estimate the lifetime radiation-induced bone and soft tissue sarcoma risks from intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) for uterine cervix carcinoma. 13 cervical cancer patients were included. The bone and soft tissue structures were defined on patients' treatment planning computed tomography (CT) scans. Both CT-based IMRT and VMAT plans with 6 MV photons delivering 45 Gy to the target site were designed for each patient. The organ equivalent dose (OED) and the lifetime attributable risk (LAR) for developing bone or soft tissue sarcoma were estimated using treatment planning data and a non-linear mechanistic model. The estimation method did not consider the survival rates following radiotherapy and the use of brachytherapy treatments. The patient-specific OEDs of the bone structure from IMRT and VMAT were 2.33-2.83 and 2.34-2.82 Gy, respectively. The corresponding values for the soft tissue structure were 1.27-1.70 and 1.32-1.73 Gy. An insignificant difference was found between the patient-specific OEDs and the directly proportional sarcoma risks (bone: P = 0.07; soft tissue: P = 0.38). The LAR for the development of a bone sarcoma varied from 0.05 to 0.16% by the patient's age during irradiation and the applied treatment delivery technique. The corresponding LAR range for radiation-induced soft-tissue sarcoma was 0.08-0.27%. The above LARs resulted in a relative risk of more than 1.20 indicating that IMRT or VMAT may lead to a considerable risk increase of developing bone or soft tissue sarcoma exceeding 20% in respect to the current incidence of these malignancies in unexposed population.
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Rashid A, Ahmad Z, Memon MA, Hashim ASM. Volumetric Modulated Arc Therapy (VMAT): A modern radiotherapy technique - A single institutional experience. Pak J Med Sci 2021; 37:355-361. [PMID: 33679913 PMCID: PMC7931288 DOI: 10.12669/pjms.37.2.2647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 09/12/2020] [Accepted: 11/29/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate VMAT plans for conformity and homogeneity of radiation dose to the target in order to share our experience as a pioneering institute to use VMAT technology in Pakistan. METHODS Since December 2014 to January 2018, 530 patients of various anatomical sites were treated by VMAT technique at Neurospinal Cancer Care Institute (NCCI) Karachi Pakistan. ERGO++ planning system (Version 1.7.2) was used to develop VMAT plans with single or multiple arcs by the rotation of couch and gantry. The plans were evaluated by calculating Conformity Index (CI) and Homogeneity Index (HI) and critical organ (OARs) doses of individual tumor sites. RESULTS The average CI of various sites was 1.4 (range: 1.0-2.0) and average HI of various sites was 1.20 (range: 1.07-1.374), respective critical organ doses were adequately achieved. CONCLUSIONS VMAT treatment planning technique showed good conformal and homogeneous target coverage with sparing of organs at risk and reduced treatment delivery time. With these features, safety of VMAT technique may allow its routine clinical use, though it is still under investigation in many areas.
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Affiliation(s)
- Azhar Rashid
- Dr. Azhar Rashid, MBBS, FCPS, MSc. Clinical & Radiation Oncologist, Department of Radiation Oncology (Stereotactic Radiosurgery), Neurospinal & Cancer Care Institute (NCCI), M.A Jinnah Road, Saddar, Karachi, Pakistan
| | - Zaeem Ahmad
- Mr. Zaeem Ahmed, MSc Physics Medical Physicist, Department of Radiation Oncology (Stereotactic Radiosurgery), Neurospinal & Cancer Care Institute (NCCI), M.A Jinnah Road, Saddar, Karachi, Pakistan
| | - Muhammad Ali Memon
- Dr. Muhammad Ali Memom, MBBS, FCPS. Clinical & Radiation Oncologist, Department of Radiation Oncology (Stereotactic Radiosurgery), Neurospinal & Cancer Care Institute (NCCI), M.A Jinnah Road, Saddar, Karachi, Pakistan
| | - Abdul Sattar M Hashim
- Dr. Abdul Sattar M Hashim, MBBS, MD, PhD. Chief Neurosurgeon, Department of Stereotactic Radiosurgery/Neurosurgery, Neurospinal & Cancer Care Institute (NCCI), M.A Jinnah Road, Saddar, Karachi, Pakistan
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11
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Teng X, Chen Y, Zhang Y, Ren L. Respiratory deformation registration in 4D-CT/cone beam CT using deep learning. Quant Imaging Med Surg 2021; 11:737-748. [PMID: 33532273 PMCID: PMC7779910 DOI: 10.21037/qims-19-1058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 09/25/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND To investigate the feasibility of using a supervised convolutional neural network (CNN) to register phase-to-phase deformable vector field of lung 4D-CT/4D-cone beam CT for 4D dose accumulation, contour propagation, motion modeling, or target verification. METHODS We built a CNN-based deep learning method to register the deformation field directly between phases of patients' 4D-CT or 4D-cone beam CT. The input consists of patch pairs of two phases, while the output is the corresponding deformation field that registers the patch pairs. The centers of the patch pairs were uniformly sampled across the lung, and the size of the patches was chosen to cover the range of the respiratory motion. The network was trained to generate deformation field that matches with the reference deformation field generated by VelocityAI (Varian). The network is structured with four convolutional layers, two average pooling layers, and two fully connected layers. Half mean squared error is applied to guide the study as loss function. Nine patients with eleven sets of 4D-CT/cone beam CT image volumes were used for training and testing. The performance of the network was validated with intra-patient and inter-patient setups. RESULTS Registered images were generated with Velocity deformation field and the CNN deformation field, respectively. Main anatomic features such as the main vessels and the diaphragm matched well between two deformed images. In the diaphragm region, the coefficients of cross-correlation, root mean squared error, and structural similarity index measure (SSIM) between deformed images registered by CNN and VelocityAI was calculated. The cross-correlation was above 0.9 for all the intra-patient cases. CONCLUSIONS Patch-based deep learning methods achieved comparable deformable registration accuracy as VelocityAI. Compared to VelocityAI, the deep learning method is fully automatic and faster without user dependency, which makes it more preferable in clinical applications.
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Affiliation(s)
| | - Yingxuan Chen
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Yawei Zhang
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Lei Ren
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
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Burgess JT, Rose M, Boucher D, Plowman J, Molloy C, Fisher M, O'Leary C, Richard DJ, O'Byrne KJ, Bolderson E. The Therapeutic Potential of DNA Damage Repair Pathways and Genomic Stability in Lung Cancer. Front Oncol 2020; 10:1256. [PMID: 32850380 PMCID: PMC7399071 DOI: 10.3389/fonc.2020.01256] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/17/2020] [Indexed: 12/16/2022] Open
Abstract
Despite advances in our understanding of the molecular biology of the disease and improved therapeutics, lung cancer remains the most common cause of cancer-related deaths worldwide. Therefore, an unmet need remains for improved treatments, especially in advanced stage disease. Genomic instability is a universal hallmark of all cancers. Many of the most commonly prescribed chemotherapeutics, including platinum-based compounds such as cisplatin, target the characteristic genomic instability of tumors by directly damaging the DNA. Chemotherapies are designed to selectively target rapidly dividing cells, where they cause critical DNA damage and subsequent cell death (1, 2). Despite the initial efficacy of these drugs, the development of chemotherapy resistant tumors remains the primary concern for treatment of all lung cancer patients. The correct functioning of the DNA damage repair machinery is essential to ensure the maintenance of normal cycling cells. Dysregulation of these pathways promotes the accumulation of mutations which increase the potential of malignancy. Following the development of the initial malignancy, the continued disruption of the DNA repair machinery may result in the further progression of metastatic disease. Lung cancer is recognized as one of the most genomically unstable cancers (3). In this review, we present an overview of the DNA damage repair pathways and their contributions to lung cancer disease occurrence and progression. We conclude with an overview of current targeted lung cancer treatments and their evolution toward combination therapies, including chemotherapy with immunotherapies and antibody-drug conjugates and the mechanisms by which they target DNA damage repair pathways.
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Affiliation(s)
- Joshua T Burgess
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Maddison Rose
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Didier Boucher
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Jennifer Plowman
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Christopher Molloy
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Mark Fisher
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Connor O'Leary
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia.,Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Derek J Richard
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Kenneth J O'Byrne
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia.,Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Emma Bolderson
- Cancer & Ageing Research Program, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at the Translational Research Institute (TRI), Queensland University of Technology (QUT), Brisbane, QLD, Australia.,Princess Alexandra Hospital, Brisbane, QLD, Australia
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ITV versus mid-ventilation for treatment planning in lung SBRT: a comparison of target coverage and PTV adequacy by using in-treatment 4D cone beam CT. Radiat Oncol 2020; 15:54. [PMID: 32127010 PMCID: PMC7055092 DOI: 10.1186/s13014-020-01496-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 02/18/2020] [Indexed: 12/25/2022] Open
Abstract
Background The internal target volume (ITV) approach and the mid-ventilation (MidV) concept are the two main respiratory motion-management strategies under free breathing. The purpose of this work was to compare the actual in-treatment target coverage during volumetric modulated arctherapy (VMAT) delivered through both ITV-based and MidV-based planning target volume (PTV) and to provide knowledge in choosing the optimal PTV for stereotactic body radiotherapy (SBRT) for lung lesions. Methods and materials Thirty-two lung cancer patients treated by a VMAT technique were included in the study. For each fraction, the mean time-weighted position of the target was localized by using a 4-dimensional cone-beam CT (4D-CBCT)-based image guidance procedure. The respiratory-correlated location of the gross tumor volume (GTV) during treatment delivery was determined for each fraction by using in-treatment 4D-CBCT images acquired concurrently with VMAT delivery (4D-CBCTin-treat). The GTV was delineated from each of the ten respiratory phase-sorted 4D-CBCTin-treat datasets for each fraction. We defined target coverage as the average percentage of the GTV included within the PTV during the patient’s breathing cycle averaged over the treatment course. Target coverage and PTVs were reported for a MidV-based PTV (PTVMidV) using dose-probabilistic margins and three ITV-based PTVs using isotropic margins of 5 mm (PTVITV + 5mm), 4 mm (PTVITV + 4mm) and 3 mm (PTVITV + 3mm). The in-treatment baseline displacements and target motion amplitudes were reported to evaluate the impact of both parameters on target coverage. Results Overall, 100 4D-CBCTin-treat images were analyzed. The mean target coverage was 98.6, 99.6, 98.9 and 97.2% for PTVMidV, PTVITV + 5mm, PTVITV + 4mm and PTVITV + 3mm, respectively. All the PTV margins led to a target coverage per treatment higher than 95% in at least 90% of the evaluated cases. Compared to PTVITV + 5mm, PTVMidV, PTVITV + 4mm and PTVITV + 3mm had mean PTV reductions of 16, 19 and 33%, respectively. Conclusion When implementing VMAT with 4D-CBCT-based image guidance, an ITV-based approach with a tighter margin than the commonly used 5 mm margin remains an alternative to the MidV-based approach for reducing healthy tissue exposure in lung SBRT. Compared to PTVMidV, PTVITV + 3mm significantly reduced the PTV while still maintaining an adequate in-treatment target coverage.
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Jankarashvili N, Kakhadze S, Topeshashvili M, Turkiasvili L, Tchiabrishvili M. Neoadjuvant volumetric modulated arc radiochemotherapy with a simultaneous integrated boost technique compared to standard chemoradiation for locally advanced rectal cancer. Turk J Med Sci 2019; 49:1484-1489. [PMID: 31651118 PMCID: PMC7018366 DOI: 10.3906/sag-1812-185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 08/07/2019] [Indexed: 12/23/2022] Open
Abstract
Background/aim The present study aimed to examine whether the combination of neoadjuvant volumetric modulated arc radiotherapy (VMAT) using simultaneous integrated boost (SIB-VMAT) techniques and chemotherapy with capecitabine is associated with better clinical and dosimetric outcomes compared to the standard treatment. Materials and methods The study included 59 patients with cT2–T4 rectal cancer. In the standard arm, patients (n = 37) were treated preoperatively with image-guided VMAT plus capecitabine. In the SIB arm, patients (n = 22) were treated with the SIB-VMAT technique plus capecitabine. All patients underwent radical surgical resection after neoadjuvant radiochemotherapy. Results In the standard arm, cT0N0 was reached in 12 patients (32.4%), primary tumor clinical downstaging was observed in 22 patients (59.5%), and disease stability was achieved in 3 patients (8.1%). In the SIB arm, cT0N0 was reached in 15 patients (68.2%), primary tumor clinical downstaging was observed in 6 patients (27.3%), and disease stability was achieved in 1 patient (4.5%) (P = 0.028). Complete pathological response was observed in 11 patients (29.7%) in the standard arm and in 13 patients (59.1%) in the SIB arm (P = 0.026). In the SIB arm mild diarrhea appeared in 59.1%, moderate in 40.9%, and severe in 0% of the cases. In the standard arm mild, moderate, and severe diarrhea rates were in 54.1%, 43.2%, and 2.7%, respectively. In the SIB arm mild, moderate, and severe cystitis appeared in 63.6%, 22.7%, and 13.6%, while in the standard group mild cystitis developed in 67.6%, moderate in 24.3%, and severe in 8.1%. Mild, moderate, and severe radiation dermatitis rates were 45.5%, 45.5%, and 9.1% in the SIB group and 40.5%, 48.6%, and 10.8% in the standard group, respectively. Conclusion The SIB-VMAT technique is effective and safe for irradiating locally advanced rectal cancer. Its effectiveness is expressed in higher clinical and pathological complete response rates and safety with the same rates of acute toxicity.
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Affiliation(s)
- Natalia Jankarashvili
- Department of Radiation Oncology, Academician F. Todua Medical Center-Research Institute of Clinical Medicine, Tbilisi, Georgia
| | - Sophio Kakhadze
- Department of Radiology, Academician F. Todua Medical Center-Research Institute of Clinical Medicine, Tbilisi, Georgia
| | - Maia Topeshashvili
- Department of Radiation Oncology, Academician F. Todua Medical Center-Research Institute of Clinical Medicine, Tbilisi, Georgia
| | - Lasha Turkiasvili
- Department of Radiation Oncology, Academician F. Todua Medical Center-Research Institute of Clinical Medicine, Tbilisi, Georgia
| | - Mariam Tchiabrishvili
- Department of Radiation Oncology, Academician F. Todua Medical Center-Research Institute of Clinical Medicine, Tbilisi, Georgia
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Macchia G, Lazzari R, Colombo N, Laliscia C, Capelli G, D'Agostino GR, Deodato F, Maranzano E, Ippolito E, Ronchi S, Paiar F, Scorsetti M, Cilla S, Ingargiola R, Huscher A, Cerrotta AM, Fodor A, Vicenzi L, Russo D, Borghesi S, Perrucci E, Pignata S, Aristei C, Morganti AG, Scambia G, Valentini V, Jereczek-Fossa BA, Ferrandina G. A Large, Multicenter, Retrospective Study on Efficacy and Safety of Stereotactic Body Radiotherapy (SBRT) in Oligometastatic Ovarian Cancer (MITO RT1 Study): A Collaboration of MITO, AIRO GYN, and MaNGO Groups. Oncologist 2019; 25:e311-e320. [PMID: 32043791 DOI: 10.1634/theoncologist.2019-0309] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 08/23/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Recent studies have reported improvement of outcomes (progression-free survival, overall survival, and prolongation of androgen deprivation treatment-free survival) with stereotactic body radiotherapy (SBRT) in non-small cell lung cancer and prostate cancer. The aim of this retrospective, multicenter study (MITO RT-01) was to define activity and safety of SBRT in a very large, real-world data set of patients with metastatic, persistent, and recurrent ovarian cancer (MPR-OC). MATERIALS AND METHODS The endpoints of the study were the rate of complete response (CR) to SBRT and the 24-month actuarial local control (LC) rate on "per-lesion" basis. The secondary endpoints were acute and late toxicities and the 24-month actuarial late toxicity-free survival. Objective response rate (ORR) included CR and partial response (PR). Clinical benefit (CB) included ORR and stable disease (SD). Toxicity was evaluated by the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) and Common Terminology Criteria for Adverse Events (CTCAE) scales, according to center policy. Logistic and Cox regression were used for the uni- and multivariate analysis of factors predicting clinical CR and actuarial outcomes. RESULTS CR, PR, and SD were observed in 291 (65.2%), 106 (23.8%), and 33 (7.4%) lesions, giving a rate of CB of 96.4%. Patient aged ≤60 years, planning target volume (PTV) ≤18 cm3 , lymph node disease, and biologically effective dose α/β10 > 70 Gy were associated with higher chance of CR in the multivariate analysis. With a median follow-up of 22 months (range, 3-120), the 24-month actuarial LC rate was 81.9%. Achievement of CR and total dose >25 Gy were associated with better LC rate in the multivariate analysis. Mild toxicity was experienced in 54 (20.7%) patients; of 63 side effects, 48 were grade 1, and 15 were grade 2. The 24-month late toxicity-free survival rate was 95.1%. CONCLUSIONS This study confirms the activity and safety of SBRT in patients with MPR-OC and identifies clinical and treatment parameters able to predict CR and LC rate. IMPLICATIONS FOR PRACTICE This study aimed to define activity and safety of stereotactic body radiotherapy (SBRT) in a very large, real life data set of patients with metastatic, persistent, recurrent ovarian cancer (MPR-OC). Patient age <60 years, PTV <18 cm3 , lymph node disease, and biologically effective dose α/β10 >70 Gy were associated with higher chance of complete response (CR). Achievement of CR and total dose >25 Gy were associated with better local control (LC) rate. Mild toxicity was experienced in 20.7% of patients. In conclusion, this study confirms the activity and safety of SBRT in MPR-OC patients and identifies clinical and treatment parameters able to predict CR and LC rate.
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Affiliation(s)
- Gabriella Macchia
- Fondazione "Giovanni Paolo II," Unità Operativa di Radioterapia, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Roberta Lazzari
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Nicoletta Colombo
- Division of Medical Gynecologic Oncology, IEO European Institute of Oncology, IRCCS and University of Milan-Bicocca, Milan, Italy
| | - Concetta Laliscia
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Giovanni Capelli
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Italy
| | - Giuseppe Roberto D'Agostino
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Hospital, IRCSS, Rozzano, Milan, Italy
| | - Francesco Deodato
- Fondazione "Giovanni Paolo II," Unità Operativa di Radioterapia, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | | | - Edy Ippolito
- Department of Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Sara Ronchi
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Fabiola Paiar
- Department of Translational Medicine, Division of Radiation Oncology, University of Pisa, Pisa, Italy
| | - Marta Scorsetti
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Hospital, IRCSS, Rozzano, Milan, Italy
- Humanitas University, Department of Biomedical Sciences, Rozzano, Milano, Italy
| | - Savino Cilla
- Fondazione "Giovanni Paolo II," Unità Operativa di Fisica Medica, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Rossana Ingargiola
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Alessandra Huscher
- U.O. di Radioterapia Oncologica "Guido Berlucchi," Fondazione Poliambulanza, Brescia, Italy
| | - Anna Maria Cerrotta
- Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrei Fodor
- Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Lisa Vicenzi
- Department of Oncology and Radiotherapy, Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
| | | | - Simona Borghesi
- Radiotherapy Department, Azienda USL Toscana sud est, San Donato Hospital-Arezzo, Italy
| | - Elisabetta Perrucci
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Sandro Pignata
- Istituto Nazionale Tumori di Napoli, Fondazione Pascale IRCCS, Naples, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Alessio Giuseppe Morganti
- Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unità Operativa Complessa Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy
- Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Roma, Italy
| | - Vincenzo Valentini
- Fondazione "Giovanni Paolo II," Unità Operativa di Radioterapia, Università Cattolica del Sacro Cuore, Campobasso, Italy
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unità Operativa Complessa di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Roma, Italy
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Gabriella Ferrandina
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unità Operativa Complessa Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy
- Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Roma, Italy
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Kakade NR, Kumar R, Sharma SD, Datta D. Equivalence of silver and gold nanoparticles for dose enhancement in nanoparticle-aided brachytherapy. Biomed Phys Eng Express 2019. [DOI: 10.1088/2057-1976/ab3d0c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Antico M, Prinsen P, Cellini F, Fracassi A, Isola AA, Cobben D, Fontanarosa D. Real-time adaptive planning method for radiotherapy treatment delivery for prostate cancer patients, based on a library of plans accounting for possible anatomy configuration changes. PLoS One 2019; 14:e0213002. [PMID: 30818345 PMCID: PMC6394960 DOI: 10.1371/journal.pone.0213002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/13/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE In prostate cancer treatment with external beam radiation therapy (EBRT), prostate motion and internal changes in tissue distribution can lead to a decrease in plan quality. In most currently used planning methods, the uncertainties due to prostate motion are compensated by irradiating a larger treatment volume. However, this could cause underdosage of the treatment volume and overdosage of the organs at risk (OARs). To reduce this problem, in this proof of principle study we developed and evaluated a novel adaptive planning method. The strategy proposed corrects the dose delivered by each beam according to the actual position of the target in order to produce a final dose distribution dosimetrically as similar as possible to the prescribed one. MATERIAL AND METHODS Our adaptive planning method was tested on a phantom case and on a clinical case. For the first, a pilot study was performed on an in-silico pelvic phantom. A "library" of intensity modulated RT (IMRT) plans corresponding to possible positions of the prostate during a treatment fraction was generated at planning stage. Then a 3D random walk model was used to simulate possible displacements of the prostate during the treatment fraction. At treatment stage, at the end of each beam, based on the current position of the target, the beam from the library of plans, which could reproduce the best approximation of the prescribed dose distribution, was selected and delivered. In the clinical case, the same approach was used on two prostate cancer patients: for the first a tissue deformation was simulated in-silico and for the second a cone beam CT (CBCT) taken during the treatment was used to simulate an intra-fraction change. Then, dosimetric comparisons with the standard treatment plan and, for the second patient, also with an isocenter shift correction, were performed. RESULTS For the phantom case, the plan generated using the adaptive planning method was able to meet all the dosimetric requirements and to correct for a misdosage of 13% of the dose prescription on the prostate. For the first clinical case, the standard planning method caused underdosage of the seminal vesicles, respectively by 5% and 4% of the prescribed dose, when the position changes for the target were correctly taken into account. The proposed adaptive planning method corrected any possible missed target coverage, reducing at the same time the dose on the OARs. For the second clinical case, both with the standard planning strategy and with the isocenter shift correction target coverage was significantly worsened (in particular uniformity) and some organs exceeded some toxicity objectives. While with our approach, the most uniform coverage for the target was produced and systematically the lowest toxicity values for the organs at risk were achieved. CONCLUSIONS In our proof of principle study, the adaptive planning method performed better than the standard planning and the isocenter shift methods for prostate EBRT. It improved the coverage of the treatment volumes and lowered the dose to the OARs. This planning method is particularly promising for hypofractionated IMRT treatments in which a higher precision and control on dose deposition are needed. Further studies will be performed to test more extensively the proposed adaptive planning method and to evaluate it at a full clinical level.
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Affiliation(s)
- Maria Antico
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
- Delft University of Technology, Delft, The Netherlands
- Philips Research, Oncology Solutions Department, Eindhoven, The Netherlands
| | - Peter Prinsen
- Philips Research, Oncology Solutions Department, Eindhoven, The Netherlands
| | - Francesco Cellini
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Istituto di Radiologia, Fondazione Policlinico A. Gemelli, IRCCS—Università Cattolica Sacro Cuore, Roma, Italia
| | - Alice Fracassi
- Philips Research, Oncology Solutions Department, Eindhoven, The Netherlands
- University of Rome Tor Vergata, Rome, Italy
| | - Alfonso A. Isola
- Philips Research, Oncology Solutions Department, Eindhoven, The Netherlands
| | - David Cobben
- North West Cancer Centre, Altnagelvin Hospital, Derry-Londonderry, Northern Ireland
- The University of Manchester, Division of Cancer Studies, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Clinical Oncology, Manchester, United Kingdom
| | - Davide Fontanarosa
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
- School of Clinical Sciences, Queensland University of Technology, Gardens Point Campus, Brisbane, QLD, Australia
- * E-mail:
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Gabani P, Fischer-Valuck BW, Robinson CG, Wilson DB, Michalski JM. Stereotactic Body Radiation Therapy for the Treatment of Primary Cardiac Angiosarcoma Causing Hemodynamic Instability. Pract Radiat Oncol 2019; 9:5-8. [PMID: 30611463 DOI: 10.1016/j.prro.2018.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/24/2018] [Accepted: 07/28/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Prashant Gabani
- Department of Radiation Oncology, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri
| | - Benjamin W Fischer-Valuck
- Department of Radiation Oncology, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri
| | - Clifford G Robinson
- Department of Radiation Oncology, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri
| | - David B Wilson
- Division of Pediatric Hematology and Oncology, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri
| | - Jeff M Michalski
- Department of Radiation Oncology, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri.
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Fehniger J, Schiff PB, Pothuri B. Successful treatment of platinum refractory ovarian clear cell carcinoma with secondary cytoreductive surgery and implantable transponder placement to facilitate targeted volumetric arc radiation therapy. Gynecol Oncol Rep 2018; 27:11-14. [PMID: 30555884 PMCID: PMC6275169 DOI: 10.1016/j.gore.2018.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 11/29/2022] Open
Abstract
We describe a case of the first successful treatment of platinum refractory clear cell ovarian cancer with secondary cytoreductive surgery and placement of Calypso transponders to facilitate post-operative volumetric arc radiation therapy. In the setting of both primary and recurrent disease, patients with clear cell ovarian cancer are less responsive to standard chemotherapy and those treated with radiation therapy may have improved outcomes compared to the use of other treatment modalities. Volumetric arc radiation therapy with implantable transponders is feasible, and allows for the targeted treatment of sites of metastatic disease while limiting toxicity to surrounding structures and can be considered for patients with recurrent ovarian cancer and oligometastatic disease. Post-operative VMAT is feasible for patients with recurrent ovarian cancer. VMAT minimizes toxicity and facilitates radiation therapy delivery. Implantable transponders are a novel approach for targeted radiation therapy.
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Affiliation(s)
- Julia Fehniger
- New York University Langone Health, Division of Gynecologic Oncology, 240 East 38th Street, New York, NY, USA
| | - Peter B Schiff
- New York University Langone Health, Department of Radiation Oncology, 160 East 34th Street, New York, NY, USA
| | - Bhavana Pothuri
- New York University Langone Health, Division of Gynecologic Oncology, 240 East 38th Street, New York, NY, USA
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Hoffmann M, Pacey J, Goodworth J, Laszcyzk A, Ford R, Chick B, Greenham S, Westhuyzen J. Analysis of a volumetric-modulated arc therapy (VMAT) single phase prostate template as a class solution. Rep Pract Oncol Radiother 2018; 24:92-96. [PMID: 30505239 DOI: 10.1016/j.rpor.2018.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/26/2018] [Accepted: 10/28/2018] [Indexed: 12/31/2022] Open
Abstract
Aim To assess a class solution template for volumetric-modulated arc therapy (VMAT) for prostate cancer using plan analysis software. Background VMAT is a development of intensity-modulated radiotherapy (IMRT) with potential advantages for the delivery of radiotherapy (RT) in prostate cancer. Class solutions are increasingly used for facilitating RT planning. Plan analysis software provides an objective tool for evaluating class solutions. Materials and methods The class solution for VMAT was based on the current static field IMRT template. The plans of 77 prostate cancer patients were evaluated using a set of in-house plan quality metrics (scores) (PlanIQ™, Sun Nuclear Corporation). The metrics compared the class solution for VMAT planning with the IMRT template and the delivered clinical plan (CP). Eight metrics were associated with target coverage and ten with organs-at-risk (OAR). Individual metrics were summed and the combined scores were subjected to non-parametric analysis. The low-dose wash for both static IMRT and VMAT plans were evaluated using 40 Gy and 25 Gy isodose volumes. Results VMAT plans were of equal or better quality than the IMRT template and CP for target coverage (combined score) and OAR combined score. The 40 Gy isodose volume was marginally higher with VMAT than IMRT (4.9%) but lower than CP (-6.6%)(P = 0.0074). The 25 Gy volume was significantly lower with VMAT than both IMRT (-32.7%) and CP (-34.4%)(P < 0.00001). Conclusions Automated VMAT planning for prostate cancer is feasible and the plans are equal to or better than the current IMRT class solution and the delivered clinical plan.
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Affiliation(s)
- Matthew Hoffmann
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Port Macquarie, New South Wales, Australia
| | - Jacqueline Pacey
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Josie Goodworth
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Andrea Laszcyzk
- Department of Radiation Oncology, Northern New South Wales Cancer Institute, Lismore, New South Wales, Australia
| | - Richard Ford
- Department of Radiation Oncology, Northern New South Wales Cancer Institute, Lismore, New South Wales, Australia
| | - Brendon Chick
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Port Macquarie, New South Wales, Australia
| | - Stuart Greenham
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Justin Westhuyzen
- Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
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21
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Muñoz-Montplet C, Marruecos J, Buxó M, Jurado-Bruggeman D, Romera-Martínez I, Bueno M, Vilanova JC. Dosimetric impact of Acuros XB dose-to-water and dose-to-medium reporting modes on VMAT planning for head and neck cancer. Phys Med 2018; 55:107-115. [DOI: 10.1016/j.ejmp.2018.10.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 10/19/2018] [Accepted: 10/30/2018] [Indexed: 11/28/2022] Open
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22
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Cilla S, Deodato F, Ianiro A, Macchia G, Picardi V, Buwenge M, Cammelli S, Zamagni A, Valentini V, Morganti AG. Partially ablative radiotherapy (PAR) for large mass tumors using simultaneous integrated boost: A dose-escalation feasibility study. J Appl Clin Med Phys 2018; 19:35-43. [PMID: 30220111 PMCID: PMC6236838 DOI: 10.1002/acm2.12427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/12/2018] [Indexed: 12/22/2022] Open
Abstract
Purpose This study aimed to assess the feasibility to plan and deliver highly heterogeneous doses to symptomatic large tumors using volumetric modulated arc therapy (VMAT) and simultaneous integrated boost (SIB) during a short course palliative accelerated radiotherapy. Methods A patient with a large symptomatic chordoma infiltrating the right gluteal region was selected. A modified SIB treatment was implemented to irradiate the central volume of the tumor (boost target volume, BTV) up to 10 Gy/fraction in a dose escalation trial while maintaining the remaining tumor volume (planning target volume, PTV) and the surrounding healthy tissues within 5 Gy/fraction in twice daily fractions for two consecutive days. Four SIB plans were generated in the dual‐arc modality; a basal dose of 20 Gy was prescribed to the PTV, while the BTV was boosted up to 40 Gy. For comparison purposes, plans obtained with a sequential boost (SEQ plans) were also generated. All plans were optimized to deliver at least 95% of the prescription dose to the targets. Dose contrast index (DCI), conformity index (CI), integral dose (ID), and the irradiated body volumes at 5, 10, and 20 Gy were evaluated. Results At equal targets coverage, SIB plans provided major improvement in DCI, CI, and ID with respect to SEQ plans. When BTV dose escalated up to 200% of PTV prescription, DCI resulted in 66% for SIB plans and 37% for SEQ plans; the ID increase was only 11% for SIB plans (vs 27% for SEQ plans) and the increase in healthy tissues receiving more than 5, 10, and 20 Gy was less than 2%. Pretreatment dose verification reported a γ‐value passing rate greater than 95% with 3%(global)‐2 mm. Conclusion A modified SIB technique is dosimetrically feasible for large tumors, where doses higher than the tolerance dose of healthy tissues are necessary to increase the therapeutic gain.
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Affiliation(s)
- Savino Cilla
- Medical Physics Unit, Fondazione di Ricerca e Cura Giovanni Paolo II - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Fondazione di Ricerca e Cura Giovanni Paolo II - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Anna Ianiro
- Medical Physics Unit, Fondazione di Ricerca e Cura Giovanni Paolo II - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Fondazione di Ricerca e Cura Giovanni Paolo II - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Vincenzo Picardi
- Radiation Oncology Unit, Fondazione di Ricerca e Cura Giovanni Paolo II - Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Milly Buwenge
- Radiation Oncology Department, DIMES Università di Bologna - Ospedale S.Orsola Malpighi, Bologna, Italy
| | - Silvia Cammelli
- Radiation Oncology Department, DIMES Università di Bologna - Ospedale S.Orsola Malpighi, Bologna, Italy
| | - Alice Zamagni
- Radiation Oncology Department, DIMES Università di Bologna - Ospedale S.Orsola Malpighi, Bologna, Italy
| | - Vincenzo Valentini
- Radiation Oncology Unit, Fondazione di Ricerca e Cura Giovanni Paolo II - Università Cattolica del Sacro Cuore, Campobasso, Italy.,Radiation Oncology Department, Policlinico Universitario A. Gemelli - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alessio G Morganti
- Radiation Oncology Department, DIMES Università di Bologna - Ospedale S.Orsola Malpighi, Bologna, Italy
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23
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Iqbal MS, Richmond N, Ogilvie A, Pilling K, Willis N, Byrne J, Walker C, West N. Dosimetric evaluation of VMAT for palliative radiotherapy for non-small cell lung carcinoma. Br J Radiol 2018; 91:20180146. [PMID: 29888967 DOI: 10.1259/bjr.20180146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: To compare the dosimetric consequences of volumetric modulated arc therapy (VMAT) for high-dose palliative thoracic radiotherapy through comparison with conventionally used isocentric parallel opposed pair (POP) of fields. METHODS: 20 consecutive patients with non-small cell lung cancer who received 36 Gy in 12 fractions using a POP technique were re-planned using a single VMAT arc. Salient dosimetric parameters were compared between the plans using a paired t-test. RESULTS: VMAT demonstrated dosimetric superiority; all PTV dose parameters were significantly improved and importantly the volume of normal lung receiving a high dose was also significantly reduced (mean volume of normal lung receiving 36 Gy was 12.9% in POP vs 1.8% in VMAT, p < 0.005). CONCLUSION: The standard POP technique does not take into account tissue densities which results in higher doses to the normal tissue outside the target volume and reduced conformity to the PTV. ADVANCES IN KNOWLEDGE: With the help of modern VMAT techniques, it is possible to effectively achieve highly conformal dose delivery which may provide an opportunity to escalate the dose to the tumour in this group of patients.
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Affiliation(s)
- Muhammad Shahid Iqbal
- 1 Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
| | - Neil Richmond
- 2 Department of Radiotherapy Physics, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
| | - Audrey Ogilvie
- 3 Department of Therapeutic Radiography, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
| | - Karen Pilling
- 3 Department of Therapeutic Radiography, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
| | - Nicholas Willis
- 4 Department of Radiotherapy Dosimetry, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
| | - John Byrne
- 2 Department of Radiotherapy Physics, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
| | - Christopher Walker
- 2 Department of Radiotherapy Physics, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
| | - Nicholas West
- 2 Department of Radiotherapy Physics, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
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Rosario T, van der Weide L, Admiraal M, Piet M, Slotman B, Cuijpers J. Toward planning target volume margin reduction for the prostate using intrafraction motion correction with online kV imaging and automatic detection of implanted gold seeds. Pract Radiat Oncol 2018; 8:422-428. [PMID: 29907506 DOI: 10.1016/j.prro.2018.04.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 04/13/2018] [Accepted: 04/21/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE The imaging application Auto Beam Hold (ABH) allows for the online analysis of 2-dimensional kV images acquired during treatment. ABH can automatically detect fiducial markers and initiate a beam interrupt. In this study, we investigate the practical use and results of this intrafraction monitoring tool for patients with prostate cancer who have implanted gold seeds treated with a RapidArc technique. METHODS AND MATERIALS A total of 105 patients were included. For setup, the seeds were lined up using 2 orthogonal 2-dimensional kV images. After the setup procedure, ABH was applied at an interval of 3 seconds. The software requires a maximum-allowed deviation to be defined for each seed, which is referred to as a deviation limit (DL). Online, the ABH application evaluates the position of the seeds and indicates for each seed whether or not it exceeds the DL. Patients were divided in 3 groups. For the first group ABH was used with the DL at 6 mm, which corresponds to the planning target volume (PTV) margin. For the second group, the DL was set at 5 mm with an unchanged PTV margin of 6 mm. For the third group, the PTV margin was reduced to 5 mm with a DL of 5 mm. Offline, we performed an analysis of the number of beam stops and resulting re-setups. RESULTS ABH initiated a beam interrupt 223 times (13%) during a total of 1736 sessions. By decreasing the DL from 6 mm to 5 mm, the amount of workload for re-setups increased from 6% (group 1) to 14% (groups 2 and 3). Re-setup, 3-dimensional shifts larger than the PTV margin were found in 44%, 35%, and 45% for groups 1,2, and 3, respectively. CONCLUSIONS Intrafraction imaging of prostate position during treatment using automatic detection of implanted gold seeds was successfully implemented. PTV margins were safely reduced from 6mm to 5mm without a substantial increase in workload.
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Affiliation(s)
- Tezontl Rosario
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Lineke van der Weide
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Marjan Admiraal
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Maartje Piet
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Ben Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Johan Cuijpers
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
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Dolera M, Malfassi L, Carrara N, Finesso S, Marcarini S, Mazza G, Pavesi S, Sala M, Urso G. Volumetric Modulated Arc (Radio) Therapy in Pets Treatment: The "La Cittadina Fondazione" Experience. Cancers (Basel) 2018; 10:E30. [PMID: 29364837 PMCID: PMC5836062 DOI: 10.3390/cancers10020030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/29/2017] [Accepted: 01/16/2018] [Indexed: 12/31/2022] Open
Abstract
Volumetric Modulated Arc Therapy (VMAT) is a modern technique, widely used in human radiotherapy, which allows a high dose to be delivered to tumor volumes and low doses to the surrounding organs at risk (OAR). Veterinary clinics takes advantage of this feature due to the small target volumes and distances between the target and the OAR. Sparing the OAR permits dose escalation, and hypofractionation regimens reduce the number of treatment sessions with a simpler manageability in the veterinary field. Multimodal volumes definition is mandatory for the small volumes involved and a positioning device precisely reproducible with a setup confirmation is needed before each session for avoiding missing the target. Additionally, the elaborate treatment plan must pursue hard constraints and objectives, and its feasibility must be evaluated with a per patient quality control. The aim of this work is to report results with regard to brain meningiomas and gliomas, trigeminal nerve tumors, brachial plexus tumors, adrenal tumors with vascular invasion and rabbit thymomas, in comparison with literature to determine if VMAT is a safe and viable alternative to surgery or chemotherapy alone, or as an adjuvant therapy in pets.
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Affiliation(s)
- Mario Dolera
- La Cittadina Fondazione Studi e Ricerche Veterinarie, 26014 Romanengo, Italy.
| | - Luca Malfassi
- La Cittadina Fondazione Studi e Ricerche Veterinarie, 26014 Romanengo, Italy.
| | - Nancy Carrara
- La Cittadina Fondazione Studi e Ricerche Veterinarie, 26014 Romanengo, Italy.
| | - Sara Finesso
- La Cittadina Fondazione Studi e Ricerche Veterinarie, 26014 Romanengo, Italy.
| | - Silvia Marcarini
- La Cittadina Fondazione Studi e Ricerche Veterinarie, 26014 Romanengo, Italy.
| | - Giovanni Mazza
- La Cittadina Fondazione Studi e Ricerche Veterinarie, 26014 Romanengo, Italy.
| | - Simone Pavesi
- La Cittadina Fondazione Studi e Ricerche Veterinarie, 26014 Romanengo, Italy.
| | - Massimo Sala
- La Cittadina Fondazione Studi e Ricerche Veterinarie, 26014 Romanengo, Italy.
| | - Gaetano Urso
- Azienda Socio Sanitaria Territoriale della provincia di Lodi, 26841 Casalpusterlengo, Italy.
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Aoki S, Yamashita H, Haga A, Nawa K, Imae T, Takahashi W, Abe O, Nakagawa K. Flattening filter-free technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy: A clinical comparison with the flattening filter technique. Oncol Lett 2018; 15:3928-3936. [PMID: 29563993 DOI: 10.3892/ol.2018.7809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 12/13/2017] [Indexed: 12/25/2022] Open
Abstract
The present study sought to evaluate the impact of the flattening filter-free (FFF) technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy. Its clinical safety and availability were compared with the flattening filter (FF) method. The cases of 65 patients who underwent lung volumetric modulated arc therapy-stereotactic body radiotherapy (VMAT-SBRT) using FF or FFF techniques were reviewed. A total of 55 Gy/4 fractions (fr) was prescribed for peripheral lesions or 56 Gy/7 fr for central lesions. The total monitor units (MU), treatment time, dose to tumors, dose to organs at risk, tumor control (local control rate, overall survival, progression-free survival) and adverse events between cases treated with FF and cases treated with the FFF technique were compared. A total of 35 patients were treated with conventional FF techniques prior to November 2014 and 30 patients were treated with FFF techniques after this date. It was revealed that the beam-on time was significantly shortened by the FFF technique (P<0.01). Other factors were similar for FFF and FF plans in respect to conformity (P=0.95), homogeneity (P=0.20) and other dosimetric values, including total MU and planning target volume/internal target volume coverage. The median follow-up period was 18 months (range, 2-35). One-year local control rates were 97.1 and 90.0% in the FF group and FFF groups, respectively (P=0.33). Grade 3 pneumonitis was observed in 5.8% of FF patients and 3.4% of FFF patients (P=1.00). No other adverse events ≥grade 3 were observed. The results of the study suggest that VMAT-SBRT using the FFF technique shortens the treatment time for lung SBRT while maintaining a high local control rate with low toxicity.
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Affiliation(s)
- Shuri Aoki
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Hideomi Yamashita
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Akihiro Haga
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Kanabu Nawa
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Toshikazu Imae
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Wataru Takahashi
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Osamu Abe
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Keiichi Nakagawa
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
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Volumetric modulated arc therapy (VMAT) to deliver nodal irradiation in breast cancer patients. Med Oncol 2017; 35:1. [PMID: 29209826 DOI: 10.1007/s12032-017-1061-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 11/21/2017] [Indexed: 01/15/2023]
Abstract
To evaluate feasibility, safety, toxicity profile and dosimetric results of volumetric modulated arc therapy (VMAT) to deliver regional nodal irradiation (RNI) after either mastectomy or breast conservation (BCS) in high-risk breast cancer patients. Between January 2015 and January 2017, a total of 45 patients were treated with VMAT to deliver RNI together with whole breast or post-mastectomy radiotherapy. The fractionation schedule comprised 50 Gy in 25 fractions given to supraclavicular and axillary apex nodes and to whole breast (after BCS) or chest wall (after mastectomy). Two opposite 50°-60° width arcs were employed for breast ad chest wall irradiation, while a single VMAT arc was used for nodal treatment. Treatment was generally well tolerated. Acute skin toxicity was G2 in 13.3% of patients. Late skin toxicity consisted of G1 induration/fibrosis in six patients (13.3%) and G2 in 1 (2.2%). Dosimetric results were consistent in terms of both target coverage and normal tissue sparing. In conclusion, VMAT proved to be a feasible, safe and effective strategy to deliver RNI in breast cancer patients after either BCS or mastectomy with promising dosimetric results and a mild toxicity profile.
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