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Malinen E, Hysing LB, Waldeland E, Muren LP. Bridging imaging and therapy: the role of medical physics in development of precision cancer care. Acta Oncol 2017; 56:757-760. [PMID: 28464737 DOI: 10.1080/0284186x.2017.1316869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Eirik Malinen
- Department of Physics, University of Oslo, Oslo, Norway
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - Liv Bolstad Hysing
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
- Department of Physics and Technology, University of Bergen, Bergen, Norway
| | - Einar Waldeland
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - Ludvig Paul Muren
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
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Datta NR, Puric E, Schneider R, Weber DC, Rogers S, Bodis S. Could hyperthermia with proton therapy mimic carbon ion therapy? Exploring a thermo-radiobiological rationale. Int J Hyperthermia 2014; 30:524-30. [DOI: 10.3109/02656736.2014.963703] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Glimelius B. Neo-adjuvant radiotherapy in rectal cancer. World J Gastroenterol 2013; 19:8489-8501. [PMID: 24379566 PMCID: PMC3870494 DOI: 10.3748/wjg.v19.i46.8489] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 10/18/2013] [Accepted: 11/03/2013] [Indexed: 02/06/2023] Open
Abstract
In rectal cancer treatment, attention has focused on the local primary tumour and the regional tumour cell deposits to diminish the risk of a loco-regional recurrence. Several large randomized trials have also shown that combinations of surgery, radiotherapy and chemotherapy have markedly reduced the risk of a loco-regional recurrence, but this has not yet had any major influence on overall survival. The best results have been achieved when the radiotherapy has been given preoperatively. Preoperative radiotherapy improves loco-regional control even when surgery has been optimized to improve lateral clearance, i.e., when a total mesorectal excision has been performed. The relative reduction is then 50%-70%. The value of radiotherapy has not been tested in combination with more extensive surgery including lateral lymph node clearance, as practised in some Asian countries. Many details about how the radiotherapy is performed are still open for discussion, and practice varies between countries. A highly fractionated radiation schedule (5 Gy × 5), proven efficacious in many trials, has gained much popularity in some countries, whereas a conventionally fractionated regimen (1.8-2.0 Gy × 25-28), often combined with chemotherapy, is used in other countries. The additional therapy adds morbidity to the morbidity that surgery causes, and should therefore be administered only when the risk of loco-regional recurrence is sufficiently high. The best integration of the weakest modality, to date the drugs (conventional cytotoxics and biologicals) is not known. A new generation of trials exploring the best sequence of treatments is required. Furthermore, there is a great need to develop predictors of response, so that treatment can be further individualized and not solely based upon clinical factors and anatomic imaging.
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Grau C, Høyer M, Alber M, Overgaard J, Lindegaard JC, Muren LP. Biology-guided adaptive radiotherapy (BiGART)--more than a vision? Acta Oncol 2013; 52:1243-7. [PMID: 23984809 DOI: 10.3109/0284186x.2013.829245] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Cai Grau
- Department of Oncology, Aarhus University Hospital , Aarhus , Denmark
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Amelio D, Winter M, Habermehl D, Jäkel O, Debus J, Combs SE. Analysis of inter- and intrafraction accuracy of a commercial thermoplastic mask system used for image-guided particle radiation therapy. JOURNAL OF RADIATION RESEARCH 2013; 54 Suppl 1:i69-i76. [PMID: 23824130 PMCID: PMC3700507 DOI: 10.1093/jrr/rrt038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/11/2013] [Accepted: 03/21/2013] [Indexed: 06/02/2023]
Abstract
The present paper reports and discusses the results concerning both the inter- and intrafraction accuracy achievable combining the immobilization system employed in patients with head-and-neck, brain and skull base tumors with image guidance at our particle therapy center. Moreover, we investigated the influence of intrafraction time on positioning displacements. A total of 41 patients treated between January and July 2011 represented the study population. All the patients were immobilized with a tailored commercial thermoplastic head mask with standard head-neck rest (HeadSTEP(®), IT-V). Patient treatment position was verified by two orthogonal kilovoltage images acquired through a ceiling imaging robot (Siemens, Erlangen, Germany). The analysis of the applied daily corrections during the first treatment week before and after treatment delivery allowed the evaluation of the interfraction and intrafraction reproducibility of the thermoplastic mask, respectively. Concerning interfraction reproducibility, translational and rotational systematic errors (Σs) were ≤ 2.2 mm and 0.9º, respectively; translational and rotational random errors (σs) were ≤ 1.6 mm and 0.6º, respectively. Regarding the intrafraction accuracy translational and rotational Σs were ≤ 0.4 mm and 0.4º, respectively; translational and rotational σs were ≤ 0.5 mm and 0.3º, respectively. Concerning the time-intrafraction displacements correlation Pearson coefficient was 0.5 for treatment fractions with time between position checks less than or equal to median value, and 0.2 for those with time between position controls longer than the median figure. These results suggest that intrafractional patient motion is smaller than interfractional patient motion. Moreover, we can state that application of different imaging verification protocols translate into a relevant difference of accuracy for the same immobilization device. The magnitude of intrafraction displacements correlates with the time for short treatment sessions or during the early phase of long treatment delivery.
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Affiliation(s)
- Dante Amelio
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg, Germany.
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Thörnqvist S, Muren LP, Bentzen L, Hysing LB, Høyer M, Grau C, Petersen JBB. Degradation of target coverage due to inter-fraction motion during intensity-modulated proton therapy of prostate and elective targets. Acta Oncol 2013; 52:521-7. [PMID: 23409771 DOI: 10.3109/0284186x.2012.752860] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Internal target and organ motion during treatment is a challenge in radiotherapy (RT) of the prostate and the involved elective targets, with residual motion being present also following image-guidance strategies. The aim of this study was to investigate organ motion-induced dose degradations for the prostate, seminal vesicle and the pelvic lymph node when treating these targets with proton therapy, using different image-guidance and delivery strategies. MATERIAL AND METHODS Four patients were selected from a larger series as they displayed large inter-fractional variation in bladder and rectum volume. Intensity-modulated proton therapy plans were generated using both simultaneous integrated and sequential boost delivery. For each technique, three isotropic margin expansions (in the range of 4-10 mm) were evaluated for the clinical target volume of prostate (CTV-p), seminal vesicles (CTV-sv) and lymph nodes (CTV-ln). Simulation of the dose degradations for all treatment plans were based on dose re-calculations for the 8-9 repeat CTs available for each patient, after applying rigid registrations to reproduce set-up based on either intra-prostatic fiducials or bony anatomy. RESULTS The simulated dose received by 99% of the target volume (D(99)) and generalized equivalent dose (gEUD) showed substantial inter-patient variations. For 40% of the investigated scenarios, the patient average simulated D(99) for all targets were within 2 GyE from the planned dose. The largest difference between simulated and planned dose was seen for the CTV-sv when using SIB delivery, with an average relative reduction in D(99) of 13% and 15% for the largest margin expansion, when positioned using fiducials and bony anatomy, respectively. CONCLUSIONS The most severe dose degradations were found for CTV-sv, but they were also evident for CTV-ln. The degradations could not be completely resolved, neither by using the largest margin expansion nor with the choice of set-up. With fiducial set-up CTV-p was robust against the inter-fraction changes.
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Affiliation(s)
- Sara Thörnqvist
- Department of Medical Physics, Aarhus University Hospital,
Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital,
Aarhus, Denmark
| | - Ludvig P. Muren
- Department of Medical Physics, Aarhus University Hospital,
Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital,
Aarhus, Denmark
| | - Lise Bentzen
- Department of Oncology, Aarhus University Hospital,
Aarhus, Denmark
| | - Liv B. Hysing
- Department of Oncology and Medical Physics, Haukeland University Hospital,
Bergen, Norway
| | - Morten Høyer
- Department of Medical Physics, Aarhus University Hospital,
Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital,
Aarhus, Denmark
| | - Cai Grau
- Department of Medical Physics, Aarhus University Hospital,
Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital,
Aarhus, Denmark
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Muren LP, Rossi C, Hug E, Lee A, Glimelius B. Establishing and expanding the indications for proton and particle therapy. Acta Oncol 2013; 52:459-62. [PMID: 23477358 DOI: 10.3109/0284186x.2013.770167] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ludvig P. Muren
- Department of Medical Physics, Aarhus University/Aarhus University Hospital,
Aarhus, Denmark
- Department of Physics and Technology, University of Bergen,
Bergen, Norway
| | - Carl Rossi
- Scripps Proton Radiotherapy Center,
San Diego, California, USA
| | - Eugen Hug
- Procure Proton Therapy Centers,
New York, New York, USA
| | - Andrew Lee
- Proton Therapy Center, Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center,
Houston, Texas, USA
| | - Bengt Glimelius
- Department of Radiology, Oncology and Radiation Science, Uppsala University,
Uppsala, Sweden
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Kessel KA, Bougatf N, Bohn C, Habermehl D, Oetzel D, Bendl R, Engelmann U, Orecchia R, Fossati P, Pötter R, Dosanjh M, Debus J, Combs SE. Connection of European particle therapy centers and generation of a common particle database system within the European ULICE-framework. Radiat Oncol 2012; 7:115. [PMID: 22828013 PMCID: PMC3464964 DOI: 10.1186/1748-717x-7-115] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 07/24/2012] [Indexed: 11/16/2022] Open
Abstract
Background To establish a common database on particle therapy for the evaluation of clinical studies integrating a large variety of voluminous datasets, different documentation styles, and various information systems, especially in the field of radiation oncology. Methods We developed a web-based documentation system for transnational and multicenter clinical studies in particle therapy. 560 patients have been treated from November 2009 to September 2011. Protons, carbon ions or a combination of both, as well as a combination with photons were applied. To date, 12 studies have been initiated and more are in preparation. Results It is possible to immediately access all patient information and exchange, store, process, and visualize text data, any DICOM images and multimedia data. Accessing the system and submitting clinical data is possible for internal and external users. Integrated into the hospital environment, data is imported both manually and automatically. Security and privacy protection as well as data validation and verification are ensured. Studies can be designed to fit individual needs. Conclusions The described database provides a basis for documentation of large patient groups with specific and specialized questions to be answered. Having recently begun electronic documentation, it has become apparent that the benefits lie in the user-friendly and timely workflow for documentation. The ultimate goal is a simplification of research work, better study analyses quality and eventually, the improvement of treatment concepts by evaluating the effectiveness of particle therapy.
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Affiliation(s)
- Kerstin A Kessel
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
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Glimelius B. Multidisciplinary treatment of patients with rectal cancer: Development during the past decades and plans for the future. Ups J Med Sci 2012; 117:225-36. [PMID: 22512246 PMCID: PMC3339554 DOI: 10.3109/03009734.2012.658974] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
In rectal cancer treatment, both the local primary and the regional and systemic tumour cell deposits must be taken care of in order to improve survival. The three main treatments, surgery, radiotherapy, and chemotherapy, each with their own advantages and limitations, must then be combined to improve results. Several large randomized trials have shown that combinations of the modalities have markedly reduced the loco-regional recurrences, but have not yet had any major influence on overall survival. The best integration of the weakest modality, to date the drugs (conventional cytotoxics and biologicals), is not known. A new generation of trials exploring the best sequence of treatments is required. Furthermore, treatment of rectal cancer is administered to populations of individuals, based upon clinical factors and imaging, and can presently not be further individualized. There is an urgent need to develop response predictors.
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Affiliation(s)
- Bengt Glimelius
- Department of Radiology, Oncology and Radiation Science, Uppsala University, Akademiska Sjukhuset, Uppsala, Sweden.
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