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Huang S, Mai X, Liu H, Sun W, Zhu J, Du J, Lin X, Du Y, Zhang K, Yang X, Huang X. Plan quality and treatment efficiency assurance of two VMAT optimization for cervical cancer radiotherapy. J Appl Clin Med Phys 2023; 24:e14050. [PMID: 37248800 PMCID: PMC10562038 DOI: 10.1002/acm2.14050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/21/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023] Open
Abstract
To investigate the difference of the fluence map optimization (FMO) and Stochastic platform optimization (SPO) algorithm in a newly-introduced treatment planning system (TPS). METHODS 34 cervical cancer patients with definitive radiation were retrospectively analyzed. Each patient has four plans: FMO with fixed jaw plans (FMO-FJ) and no fixed jaw plans (FMO-NFJ); SPO with fixed jaw plans (SPO-FJ) and no fixed jaw plans (SPO-NFJ). Dosimetric parameters, Modulation Complexity Score (MCS), Gamma Pass Rate (GPR) and delivery time were analyzed among the four plans. RESULTS For target coverage, SPO-FJ plans are the best ones (P ≤ 0.00). FMO plans are better than SPO-NFJ plans (P ≤ 0.00). For OARs sparing, SPO-FJ plans are better than FMO plans for mostly OARs (P ≤ 0.04). Additionally, SPO-FJ plans are better than SPO-NFJ plans (P ≤ 0.02), except for rectum V45Gy. Compared to SPO-NFJ plans, the FMO plans delivered less dose to bladder, rectum, colon V40Gy and pelvic bone V40Gy (P ≤ 0.04). Meanwhile, the SPO-NFJ plans showed superiority in MU, delivery time, MCS and GPR in all plans. In terms of delivery time and MCS, the SPO-FJ plans are better than FMO plans. FMO-FJ plans are better than FMO-NFJ plans in delivery efficiency. MCSs are strongly correlated with PCTV length, which are negatively with PCTV length (P ≤ 0.03). The delivery time and MUs of the four plans are strongly correlated (P ≤ 0.02). Comparing plans with fixed or no fixed jaw in two algorithms, no difference was found in FMO plans in target coverage and minor difference in Kidney_L Dmean, Mu and delivery time between PCTV width≤15.5 cm group and >15.5 cm group. For SPO plans, SPO-FJ plans showed more superiority in target coverage and OARs sparing than the SPO-NFJ plans in the two groups. CONCLUSIONS SPO-FJ plans showed superiority in target coverage and OARs sparing, as well as higher delivery efficiency in the four plans.
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Affiliation(s)
- Sijuan Huang
- Department of Radiation Oncology, Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and TherapyGuangzhouGuangdongChina
| | - Xiuying Mai
- Department of Radiation Oncology, Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and TherapyGuangzhouGuangdongChina
| | - Hongdong Liu
- Department of Radiation Oncology, Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and TherapyGuangzhouGuangdongChina
| | - Wenzhao Sun
- Department of Radiation Oncology, Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and TherapyGuangzhouGuangdongChina
| | - Jinhan Zhu
- Department of Radiation Oncology, Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and TherapyGuangzhouGuangdongChina
| | - Jinlong Du
- Department of Radiation Oncology, Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and TherapyGuangzhouGuangdongChina
| | - Xi Lin
- Department of Radiation Oncology, Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and TherapyGuangzhouGuangdongChina
- School of Biomedical EngineeringGuangzhou Xinhua CollegeGuangzhouGuangdongChina
| | - Yujie Du
- Department of Radiation Oncology, Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and TherapyGuangzhouGuangdongChina
| | | | - Xin Yang
- Department of Radiation Oncology, Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and TherapyGuangzhouGuangdongChina
| | - Xiaoyan Huang
- Department of Radiation Oncology, Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and TherapyGuangzhouGuangdongChina
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Torii A, Tomita N, Kuno M, Nishio M, Yamada Y, Takaoka T, Okazaki D, Niwa M, Kita N, Takano S, Murao T, Ogawa Y, Hiwatashi A. Intensity-modulated radiation therapy with the central shielding technique for patients with uterine cervical cancer†. JOURNAL OF RADIATION RESEARCH 2023:rrad039. [PMID: 37321676 DOI: 10.1093/jrr/rrad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/25/2023] [Indexed: 06/17/2023]
Abstract
We aimed to examine outcomes and toxicities of intensity-modulated radiation therapy (IMRT) with the central shielding (CS) technique for patients with uterine cervical cancer. This retrospective study included 54 patients with International Federation of Gynecology and Obstetrics IB-IVA cancer. Whole pelvic radiotherapy or extended-field radiotherapy were performed at the dose of 50.4 Gy in 28 fractions with helical tomotherapy (HT). Six patients had para-aortic lymph node metastases. The CS technique with HT was utilized after a total dose of 28.8-41.4 Gy to reduce doses to the rectum and bladder. The prescribed dose of intracavitary brachytherapy was mainly 18-24 Gy in three or four fractions at point A. Concurrent chemotherapy was used for 47 patients (87%). Median follow-up time was 56 months. Seventeen patients (31%) developed recurrence. The recurrence of the cervix was observed in two patients (4%). The 5-year rates of the locoregional control, progression-free survival (PFS) and overall survival were 79, 66 and 82%, respectively. Among several factors evaluated, histological type of adenocarcinoma was only a significantly worse prognostic factor for PFS by multivariate analysis (hazard ratio, 4.9 [95% confidence interval, 1.3-18], P = 0.018). Grade 2 or higher late toxicities were observed in nine patients (17%). Two patients (4%) each had grade 3 proctitis and grade 3 ileus, respectively. No grade 4 toxicity or treatment-related death was observed. The results suggest that IMRT with the CS technique allows a high local control without increasing the risk of complications for cervical cancer patients.
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Affiliation(s)
- Akira Torii
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Natsuo Tomita
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Mayu Kuno
- Department of Radiation Oncology, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558, Japan
| | - Masahiro Nishio
- Department of Radiation Oncology, Kasugai Municipal Hospital, 1-1-1 Takaki-cho, Kasugai, Aichi 486-8510, Japan
| | - Yuki Yamada
- Department of Radiation Oncology, Konan Kosei Hospital, 137 Ohmatsubara, Takaya-cho, Konan, Aichi 483-8704, Japan
| | - Taiki Takaoka
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Dai Okazaki
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Masanari Niwa
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Nozomi Kita
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Seiya Takano
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Takayuki Murao
- Department of Radiation Oncology, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi 491-8558, Japan
| | - Yasutaka Ogawa
- Department of Radiation Oncology, Kasugai Municipal Hospital, 1-1-1 Takaki-cho, Kasugai, Aichi 486-8510, Japan
| | - Akio Hiwatashi
- Department of Radiation Oncology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
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Itami J, Murakami N, Watanabe M, Sekii S, Kasamatsu T, Kato S, Hirowatari H, Ikushima H, Ando K, Ohno T, Okamoto H, Okuma K, Igaki H. Combined Interstitial and Intracavitary High-Dose Rate Brachytherapy of Cervical Cancer. Front Oncol 2022; 11:809825. [PMID: 35096614 PMCID: PMC8793862 DOI: 10.3389/fonc.2021.809825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/16/2021] [Indexed: 12/05/2022] Open
Abstract
High-dose-rate brachytherapy by remote afterloading is now performed under three-dimensional image guidance by CT or MRI. Three-dimensional image-guided brachytherapy in cervical cancer disclosed that the traditional intracavitary brachytherapy by Manchester method cannot deliver an adequate dose to the large tumor with resulting local recurrence. To improve the local control rate, combined interstitial and intracavitary (hybrid) brachytherapy can increase the dose to the large parametrial involvement without increasing the dose to the rectum and bladder. Whether hybrid brachytherapy can be performed safely on a multi-institutional basis remains to be studied. From 2015, phase I/II study of hybrid brachytherapy was launched in Japan, and it was revealed that hybrid brachytherapy can be performed safely and with a high quality of radiation dose distribution in a multi-institutional study. In Japan, the number of patients undergoing hybrid brachytherapy in cervical cancer is rapidly rising. Education and clinical trial are very important to establish hybrid brachytherapy in the management of cervical cancer.
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Affiliation(s)
- Jun Itami
- Shin-Matsudo Accuracy Radiation Therapy Center, Shin-Matsudo Central General Hospital, Chiba, Japan.,Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Miho Watanabe
- Department of Radiology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shuhei Sekii
- Department of Radiation Oncology, Hyogo Prefectural Cancer Center, Hyogo, Japan
| | - Takahiro Kasamatsu
- Department of Gynecology, Tokyo Metropolitan Bokuto Hospital, Tokyo, Japan
| | - Shingo Kato
- Department of Radiation Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Hisako Hirowatari
- Department of Radiation Oncology, Tokyo Rinkai Hospital, Tokyo, Japan
| | - Hitoshi Ikushima
- Department of Radiation Oncology, Tokushima University Faculty of Medicine, Tokushima, Japan
| | - Ken Ando
- Department of Radiation Oncology, Gunma Cancer Center, Gunma, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hiroyuki Okamoto
- Department of Medical Physics, National Cancer Center Hospital, Tokyo, Japan
| | - Kae Okuma
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
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