1
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Tvilum M, Lutz CM, Knap MM, Hoffmann L, Khalil AA, Holt MI, Kandi M, Schmidt HH, Appelt AL, Alber M, Møller DS. Different benefits of adaptive radiotherapy for different histologies of NSCLC. Acta Oncol 2023; 62:1426-1432. [PMID: 37796133 DOI: 10.1080/0284186x.2023.2260944] [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: 06/02/2023] [Accepted: 09/14/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Adenocarcinoma (AC) and squamous cell carcinoma (SCC) are the most frequent histological subtypes of non-small cell lung cancer (NSCLC). The aim of this study was to investigate how patients with AC and SCC benefit from image-guided adaptive radiotherapy (ART) with tumour match. MATERIAL AND METHODS Consecutive patients diagnosed with AC or SCC of the lung treated with definitive chemo-radiotherapy before and after the implementation of ART and tumour match were retrospectively included for analyses. Data collection included baseline patient and treatment characteristics in addition to clinical data on radiation pneumonitis (RP), failure, and survival. Patients were divided into four categories based on their histology and treatment before (n = 173 [89 AC and 84 SCC]) and after implementation of ART (n = 240 [141 AC and 99 SCC]). RESULTS Median follow-up was 5.7 years for AC and 6.3 years for SCC. Mean lung dose decreased for both histologies with ART, whereas mean heart dose only decreased for patients with AC. Incidences of grade 3 and 5 RP decreased for both histologies with ART. Loco-regional failure (LRF) rates decreased significantly for patients with SCC after ART (p = .04), no significant difference was observed for AC. Overall survival (OS) increased significantly for SCC after ART (p < .01): the 2-year OS increased from 31.0% (95% confidence interval [CI] [22.5-42.6]) to 54.5% (95% CI [45.6-65.3]). No significant effect on OS was observed for patients with AC. CONCLUSION ART and tumour match in the radiotherapeutic treatment of patients with locally advanced NSCLC primarily led to decreased LRF and improved OS for patients with SCC.
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Affiliation(s)
- Marie Tvilum
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Lone Hoffmann
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | | | - Maria Kandi
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Ane L Appelt
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
- Leeds Cancer Centre, St James's University Hospital, Leeds, UK
| | - Markus Alber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg University Hospital, Heidelberg, Germany
| | - Ditte S Møller
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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2
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Zhou S, Meng Y, Sun X, Jin Z, Feng W, Yang H. The critical components for effective adaptive radiotherapy in patients with unresectable non-small-cell lung cancer: who, when and how. Future Oncol 2022; 18:3551-3562. [PMID: 36189758 DOI: 10.2217/fon-2022-0291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Adaptive radiotherapy (ART) is a new radiotherapy technology based on image-guided radiation therapy technology, used to avoid radiation overexposure to residual tumors and the surrounding normal tissues. Tumors undergoing the same radiation doses and modes can occur unequal shrinkage due to the variation of response times to radiation doses in different patients. To perform ART effectively, eligible patients with a high probability of benefits from ART need to be identified. Confirming the precise timetable for ART in every patient is another urgent problem to be resolved. Moreover, the outcomes of ART are different depending on the various image guidance used. This review discusses 'who, when and how' as the three key factors involved in the most effective implementation for the management of ART.
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Affiliation(s)
- Suna Zhou
- Key Laboratory of Radiation Oncology, The Affiliated Taizhou Hospital, Wenzhou Medical University, Taizhou, 317000, Zhejiang, PR China.,Department of Radiation Oncology, Xi'an No.3 Hospital, the Affiliated Hospital of Northwest University, Xi'an, Shanxi, 710018, PR China
| | - Yinnan Meng
- Key Laboratory of Radiation Oncology, The Affiliated Taizhou Hospital, Wenzhou Medical University, Taizhou, 317000, Zhejiang, PR China.,Department of Radiation Oncology, The Affiliated Taizhou Hospital, Wenzhou Medical University, Taizhou, 317000, Zhejiang, PR China
| | - Xuefeng Sun
- Key Laboratory of Radiation Oncology, The Affiliated Taizhou Hospital, Wenzhou Medical University, Taizhou, 317000, Zhejiang, PR China.,Department of Radiation Oncology, The Affiliated Taizhou Hospital, Wenzhou Medical University, Taizhou, 317000, Zhejiang, PR China
| | - Zhicheng Jin
- Key Laboratory of Radiation Oncology, The Affiliated Taizhou Hospital, Wenzhou Medical University, Taizhou, 317000, Zhejiang, PR China.,Department of Radiation Oncology, The Affiliated Taizhou Hospital, Wenzhou Medical University, Taizhou, 317000, Zhejiang, PR China
| | - Wei Feng
- Department of Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, PR China
| | - Haihua Yang
- Key Laboratory of Radiation Oncology, The Affiliated Taizhou Hospital, Wenzhou Medical University, Taizhou, 317000, Zhejiang, PR China.,Department of Radiation Oncology, The Affiliated Taizhou Hospital, Wenzhou Medical University, Taizhou, 317000, Zhejiang, PR China
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Shepherd M, Graham S, Ward A, Zwart L, Cai B, Shelley C, Booth J. Pathway for radiation therapists online advanced adapter training and credentialing. Tech Innov Patient Support Radiat Oncol 2021; 20:54-60. [PMID: 34917781 PMCID: PMC8665404 DOI: 10.1016/j.tipsro.2021.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/15/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Abstract
Online Adaptive Radiation Therapy (oART) provides a solution to account for daily patient variations, but wide spread implementation is hindered by human resources and training. Physicians can mentor Radiation Therapists (RTTs) through traditional tasks such as contouring and plan approval. With evidence-based credentialing activities, decision support aids and ‘on-call’ caveats, RTTs can lead the oART workflow and a ‘Clinician-Lite’ approach. Compliance with legislative, regulatory and medico-legal governing bodies can be addressed through post-graduate study, advanced practice pathways, exemptions and delegation of task.
Online adaptive radiotherapy (oART) is an emerging advanced treatment option for cancer patients worldwide. Current oART practices using magnetic resonance (MR) and cone beam computed tomography (CBCT) based imaging are resource intensive and require physician presence, which is a barrier to widespread implementation. Global evidence demonstrates Radiation Therapists (RTTs) can lead the oART workflow with decision support tools and on ‘on-call’ caveats in a ‘clinician-lite’ approach without significantly compromising on treatment accuracy, speed or patient outcomes. With careful consideration of jurisdictional regulations and guidance from the multi-disciplinary team, RTTs can elevate beyond traditional scopes of practice. By implementing robust and evidence-based credentialing activities, they enable service sustainability and expand the real-world gains of adaptive radiotherapy to a greater number of cancer patients worldwide. This work summarises the evidence for RTT-led oART treatments and proposes a pathway for training and credentialing.
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Affiliation(s)
- Meegan Shepherd
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Reserve Rd, St Leonard, NSW 2065, Australia
| | - Siobhan Graham
- Queen's Hospital, BHRUT NHS Trust, Rom Valley Way, Romford RM1 0AG, UK
| | - Amy Ward
- Queen's Hospital, BHRUT NHS Trust, Rom Valley Way, Romford RM1 0AG, UK
| | - Lissane Zwart
- Medisch Spectrum Twente (MST), Koningstraat 1, 7512 KZ Enschede, Netherlands
| | - Bin Cai
- UT Southwestern Medical Center, Harry Hines Blvd, Dallas, TX 75390, USA
| | | | - Jeremy Booth
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Reserve Rd, St Leonard, NSW 2065, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, Camperdown, NSW 2004, Australia
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McNair HA, Joyce E, O'Gara G, Jackson M, Peet B, Huddart RA, Wiseman T. Radiographer-led online image guided adaptive radiotherapy: A qualitative investigation of the therapeutic radiographer role. Radiography (Lond) 2021; 27:1085-1093. [PMID: 34006442 PMCID: PMC8497277 DOI: 10.1016/j.radi.2021.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/06/2021] [Accepted: 04/25/2021] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Online MRI guided adaptive radiotherapy (MRIgRT) is resource intensive. To maintain and increase uptake traditional roles and responsibilities may need refining. This novel study aims to provide an in-depth understanding and subsequent impact of the roles required to deliver on-line adaptive MRIgRT by exploring the current skills and knowledge of radiographers. METHOD A purposive sampling approach was used to invite radiographers, clinicians and physicists from centres with experience of MRIgRT to participate. Focus Group Interviews were conducted with two facilitators using a semi-structure interview guide (Appendix 1). Four researchers independently familiarised themselves and coded the data using framework analysis. A consensus thematic framework of ptive Radiotherapy codes and categories was agreed and systematically applied. RESULTS Thirty participants took part (Radiographers: N = 18, Physicists: N = 9 and Clinicians: N = 3). Three key themes were identified: 'Current MRIgRT', 'Training' and 'Future Practice'. Current MRIgRT identified a variation in radiographers' roles and responsibilities with pathways ranging from radiographer-led, clinician-light-led and MDT-led. The consensus was to move towards radiographer-led with the need to have a robust on-call service heavily emphasised. Training highlighted the breadth of knowledge required by radiographers including MRI, contouring, planning and dosimetry, and treatment experience. Debate was presented over timing and length of training required. Future Practice identified the need to have radiographers solely deliver MRIgRT, to reduce staff present which was seen as a main driver, and time and resources to train radiographers seen as the main barriers. CONCLUSION Radiographer-led MRIgRT is an exciting development because of the potential radiographer role development. A national training framework created collaboratively with all stakeholders and professions involved would ensure consistency in skills and knowledge. IMPLICATIONS FOR PRACTICE Role development and changes in education for therapeutic radiographers.
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Affiliation(s)
- H A McNair
- Royal Marsden NHS Foundation Trust, United Kingdom; Institute of Cancer Research, United Kingdom.
| | - E Joyce
- Royal Marsden NHS Foundation Trust, United Kingdom
| | - G O'Gara
- Royal Marsden NHS Foundation Trust, United Kingdom
| | - M Jackson
- St George's University of London, United Kingdom
| | - B Peet
- Royal Marsden NHS Foundation Trust, United Kingdom
| | - R A Huddart
- Institute of Cancer Research, United Kingdom
| | - T Wiseman
- Royal Marsden NHS Foundation Trust, United Kingdom
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5
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Daly M, Moinuddin SA, Petkar S, Jani Z, McGeady K, Hawkins M. A decision tool for radiographer-led abdominal image-guided stereotactic ablative body radiotherapy - Experience from a single institution. Tech Innov Patient Support Radiat Oncol 2021; 19:33-36. [PMID: 34401538 PMCID: PMC8349902 DOI: 10.1016/j.tipsro.2021.07.004] [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: 04/30/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
A CBCT decision tool was developed for radiographer-led IGRT for abdominal SABR. This tool increased the confidence of radiographers undertaking online CBCT IGRT. Median online review time was reduced by 1m 8s.
A decision tool for radiographer-led image-guided radiotherapy (IGRT) using cone-beam CT (CBCT) for abdominal stereotactic radiotherapy was developed and successfully implemented in a single department. The confidence of 7 therapeutic radiographers when undertaking online CBCT review increased, and the pooled median online match time was reduced by 1 m 8 s. While this may be advantageous for abdominal SABR, further evaluation of this work in a larger cohort is required to validate these results.
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Affiliation(s)
- Mairead Daly
- University College London Hospitals NHS Trust, United Kingdom
| | | | - Shabnam Petkar
- University College London Hospitals NHS Trust, United Kingdom
| | - Zankhana Jani
- University College London Hospitals NHS Trust, United Kingdom
| | - Kathryn McGeady
- University College London Hospitals NHS Trust, United Kingdom
| | - Maria Hawkins
- University College London Hospitals NHS Trust, United Kingdom.,University College London, United Kingdom
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6
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Webster A, Hafeez S, Lewis R, Griffins C, Warren-Oseni K, Patel E, Hansen VN, Hall E, Huddart R, Miles E, McNair HA. The Development of Therapeutic Radiographers in Imaging and Adaptive Radiotherapy Through Clinical Trial Quality Assurance. Clin Oncol (R Coll Radiol) 2021; 33:461-467. [PMID: 33766503 DOI: 10.1016/j.clon.2021.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/29/2021] [Accepted: 02/17/2021] [Indexed: 02/06/2023]
Abstract
AIMS Adaptive radiotherapy (ART) is an emerging advanced treatment option for bladder cancer patients. Therapeutic radiographers (RTTs) are central to the successful delivery of this treatment. The purpose of this work was to evaluate the image-guided radiotherapy (IGRT) and ART experience of RTTs before participating in the RAIDER trial. A plan of the day (PoD) quality assurance programme was then implemented. Finally, the post-trial experience of RTTs was evaluated, together with the impact of trial quality assurance participation on their routine practice. MATERIALS AND METHODS A pre-trial questionnaire to assess the experience of the RTT staff group in IGRT and ART in bladder cancer was sent to each centre. Responses were grouped according to experience. The PoD quality assurance programme was implemented, and the RAIDER trial commenced. During stage 1 of the trial, RTTs reported difficulties in delivering PoD and the quality assurance programme was updated accordingly. A follow-up questionnaire was sent assessing experience in IGRT and ART post-trial. Any changes in routine practice were also recorded. RESULTS The experience of RTTs in IGRT and ART pre-trial varied. For centres deemed to have RTTs with more experience, the initial PoD quality assurance programme was streamlined. For RTTs without ART experience, the full quality assurance programme was implemented, of which 508 RTTs completed. The quality assurance programme was updated (as the trial recruited) and it was mandated that at least one representative RTT (regardless of pre-trial experience) participated in the update in real-time. The purpose of the updated quality assurance programme was to provide further support to RTTs in delivering a complex treatment. Engagement with the updated quality assurance programme was high, with RTTs in 24/33 centres participating in the real-time online workshop. All 33 UK centres reported all RTTs reviewed the updated training offline. Post-trial, the RTTs' experience in IGRT and ART was increased. CONCLUSION Overall, 508 RTTs undertook the PoD quality assurance programme. There was a high engagement of RTTs in the PoD quality assurance programme and trial. RTTs increased their experience in IGRT and ART and subsequently updated their practice for bladder cancer and other treatment sites.
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Affiliation(s)
- A Webster
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, London, UK.
| | - S Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - R Lewis
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - C Griffins
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | | | - E Patel
- University College Hospital, London, UK
| | - V N Hansen
- Odense University Hospital, Odense, Denmark
| | - E Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - R Huddart
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - E Miles
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, London, UK
| | - H A McNair
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
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7
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Kong V, Hansen VN, Hafeez S. Image-guided Adaptive Radiotherapy for Bladder Cancer. Clin Oncol (R Coll Radiol) 2021; 33:350-368. [PMID: 33972024 DOI: 10.1016/j.clon.2021.03.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022]
Abstract
Technological advancement has facilitated patient-specific radiotherapy in bladder cancer. This has been made possible by developments in image-guided radiotherapy (IGRT). Particularly transformative has been the integration of volumetric imaging into the workflow. The ability to visualise the bladder target using cone beam computed tomography and magnetic resonance imaging initially assisted with determining the magnitude of inter- and intra-fraction target change. It has led to greater confidence in ascertaining true anatomy at each fraction. The increased certainty of dose delivered to the bladder has permitted the safe reduction of planning target volume margins. IGRT has therefore improved target coverage with a reduction in integral dose to the surrounding tissue. Use of IGRT to feed back into plan and dose delivery optimisation according to the anatomy of the day has enabled adaptive radiotherapy bladder solutions. Here we undertake a review of the stepwise developments underpinning IGRT and adaptive radiotherapy strategies for external beam bladder cancer radiotherapy. We present the evidence in accordance with the framework for systematic clinical evaluation of technical innovations in radiation oncology (R-IDEAL).
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Affiliation(s)
- V Kong
- Radiation Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - V N Hansen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - S Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK.
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Kavanaugh J, Roach M, Ji Z, Fontenot J, Hugo GD. A method for predictive modeling of tumor regression for lung adaptive radiotherapy. Med Phys 2021; 48:2083-2094. [PMID: 33035365 DOI: 10.1002/mp.14529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/04/2020] [Accepted: 08/20/2020] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The purpose of this work is to create a decision support methodology to predict when patients undergoing radiotherapy treatment for locally advanced lung cancer would potentially benefit from adaptive radiotherapy. The proposed methodology seeks to eliminate the manual subjective review by developing an automated statistical learning model to predict when tumor regression would trigger implementation of adaptive radiotherapy based on quantified anatomic changes observed in individual patients on-treatment cone beam computed tomographies (CTs). This proposed process seeks to improve the efficacy and efficiency of both the existing manual and automated adaptive review processes for locally advanced stage III lung cancer. METHODS A predictive algorithm was developed as a decision support tool to determine the potential utility of mid-treatment adaptive radiotherapy based on anatomic changes observed on 1158 daily CBCT images across 43 patients. The anatomic changes on each axial slice within specified regions-of-interest were quantified into a single value utilizing imaging similarity criteria comparing the daily CBCT to the initial simulation CT. The range of the quantified metrics for each fraction across all axial slices are reduced to specified quantiles, which are used as the predictive input to train a logistic regression algorithm. A "ground-truth" of the need for adaptive radiotherapy based on tumor regression was evaluated systematically on each of the daily CBCTs and used as the classifier in the logistic regression algorithm. Accuracy of the predictive model was assessed utilizing both a tenfold cross validation and an independent validation dataset, with the sensitivity, specificity, and fractional accuracy compared to the ground-truth. RESULTS The sensitivity and specificity for the individual daily fractions ranged from 87.9%-94.3% and 91.9%-98.6% for a probability threshold of 0.2-0.5, respectively. The corresponding average treatment fraction difference between the model predictions and assessed ART "ground-truth" ranged from -2.25 to -0.07 fractions, with the model predictions consistently predicting the potential need for ART earlier in the treatment course. By initially utilizing a lower probability threshold, the higher sensitivity minimizes the chance of false negative by alerting the clinician to review a higher number of questionable cases. CONCLUSIONS The proposed methodology accurately predicted the first fraction at which individual patients may benefit from ART based on quantified anatomic changes observed in the on-treatment volumetric imaging. The generalizability of the proposed method has potential to expand to additional modes of adaptive radiotherapy for lung cancer patients with observed underlying anatomic changes.
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Affiliation(s)
- James Kavanaugh
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Michael Roach
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Zhen Ji
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Jonas Fontenot
- Department of Physics, Mary Bird Perkins Cancer Center, Baton Rouge, LA, 70809, USA.,Department of Physics and Astronomy, Louisiana State University and Agricultural and Mechanical College, Baton Rouge, LA, 70803-4001, USA
| | - Geoffrey D Hugo
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
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Bertholet J, Anastasi G, Noble D, Bel A, van Leeuwen R, Roggen T, Duchateau M, Pilskog S, Garibaldi C, Tilly N, García-Mollá R, Bonaque J, Oelfke U, Aznar MC, Heijmen B. Patterns of practice for adaptive and real-time radiation therapy (POP-ART RT) part II: Offline and online plan adaption for interfractional changes. Radiother Oncol 2020; 153:88-96. [PMID: 32579998 PMCID: PMC7758781 DOI: 10.1016/j.radonc.2020.06.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE The POP-ART RT study aims to determine to what extent and how intrafractional real-time respiratory motion management (RRMM), and plan adaptation for interfractional anatomical changes (ART) are used in clinical practice and to understand barriers to implementation. Here we report on part II: ART using more than one plan per target per treatment course. MATERIALS AND METHODS A questionnaire on the current practice of ART, wishes for expansion or implementation, and barriers to implementation was distributed worldwide. Four types of ART were discriminated: daily online replanning, online plan library, protocolled offline replanning (all three based on a protocol), and ad-hoc offline replanning. RESULTS The questionnaire was completed by 177 centres from 40 countries. ART was used by 61% of respondents (31% with protocol) for a median (range) of 3 (1-8) tumour sites. CBCT/MVCT was the main imaging modality except for online daily replanning (11 users) where 10 users used MR. Two thirds of respondents wished to implement ART for a new tumour site; 40% of these had plans to do it in the next 2 years. Human/material resources and technical limitations were the main barriers to further use and implementation. CONCLUSIONS ART was used for a broad range of tumour sites, mainly with ad-hoc offline replanning and for a median of 3 tumour sites. There was a large interest in implementing ART for more tumour sites, mainly limited by human/material resources and technical limitations. Daily online replanning was primarily performed on MR-linacs.
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Affiliation(s)
- Jenny Bertholet
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, United Kingdom; Division of Medical Radiation Physics, Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Gail Anastasi
- Department of Medical Physics, Royal Surrey County Hospital, St. Luke's Cancer Centre, Guildford, United Kingdom
| | - David Noble
- Cancer Research UK VoxTox Research Group, University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, United Kingdom
| | - Arjan Bel
- Amsterdam UMC, Department of Radiation Oncology, The Netherlands
| | - Ruud van Leeuwen
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Toon Roggen
- Applied Research, Varian Medical Systems Imaging Laboratory GmbH, Dättwil, Switzerland
| | | | - Sara Pilskog
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway; Department of Physics and Technology, University of Bergen, Norway
| | - Cristina Garibaldi
- IEO, European Institute of Oncology IRCCS, Unit of Radiation Research, Milan, Italy
| | - Nina Tilly
- Elekta Instruments AB, Stockholm, Sweden; Medical Radiation Physics, Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | - Rafael García-Mollá
- Servicio de Radiofísica y Protección Radiológica, Consorcio Hospital General Universitario de Valencia, Spain
| | - Jorge Bonaque
- Servicio de Radiofísica y Protección Radiológica, Consorcio Hospitalario Provincial de Castellón, Castelló de la Plana, Spain
| | - Uwe Oelfke
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, United Kingdom
| | - Marianne C Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, United Kingdom; Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Ben Heijmen
- Erasmus MC Cancer Institute, Department of Radiation Oncology, Rotterdam, The Netherlands
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Webster A, Appelt A, Eminowicz G. Image-Guided Radiotherapy for Pelvic Cancers: A Review of Current Evidence and Clinical Utilisation. Clin Oncol (R Coll Radiol) 2020; 32:805-816. [DOI: 10.1016/j.clon.2020.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/18/2020] [Accepted: 09/30/2020] [Indexed: 02/07/2023]
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11
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Duffton A, Li W, Forde E. The Pivotal Role of the Therapeutic Radiographer/Radiation Therapist in Image-guided Radiotherapy Research and Development. Clin Oncol (R Coll Radiol) 2020; 32:852-860. [PMID: 33087296 DOI: 10.1016/j.clon.2020.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/21/2020] [Accepted: 09/22/2020] [Indexed: 12/24/2022]
Abstract
The ability to personalise radiotherapy to fit the individual patient and their diagnosis has been realised through technological advancements. There is now more opportunity to utilise these technologies and deliver precision radiotherapy for more patients. Image-guided radiotherapy (IGRT) has enabled users to safely and accurately plan, treat and verify complex cases; and deliver a high dose to the target volume, while minimising dose to normal tissue. Rapid changes in IGRT have required a multidisciplinary team (MDT) approach, carefully deciding optimum protocols to achieve clinical benefit. Therapeutic radiographer/radiation therapists (RTTs) play a pivotal role in this MDT. There is already a great deal of evidence that illustrates the contribution of RTTs in IGRT development; implementation; quality assurance; and maintaining training and competency programmes. Often this has required the RTT to undertake additional roles and responsibilities. These publications show how the profession has evolved, expanding the scope of practice. There are now more opportunities for RTT-led IGRT research. This is not only undertaken in the more traditional aspects of practice, but in recent times, more RTTs are becoming involved in imaging biomarkers research and radiomic analysis. The aim of this overview is to describe the RTT contribution to the ongoing development of IGRT and to showcase some of the profession's involvement in IGRT research.
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Affiliation(s)
- A Duffton
- Department of Radiotherapy, Beatson West of Scotland Cancer Centre, Glasgow, UK.
| | - W Li
- University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - E Forde
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, The University of Dublin, Dublin, Ireland
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Vogin G, Fauvel M, Hossu G, Beaumont M, Micard E, Feltgen K, Androni ML, Moerschel E, Gillet N, Beuret F, Tonnelet R, Texeira P. Assessing the neuroanatomy knowledge and spatial ability of radiotherapy technologist undergraduates using an interactive volumetric simulation tool-the RadioLOG project. Eur Radiol 2020; 31:2132-2143. [PMID: 33037914 DOI: 10.1007/s00330-020-07351-1] [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: 05/17/2020] [Revised: 08/24/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the use of a volumetric image display simulation tool (VDST) for the evaluation of applied radiological neuroanatomy knowledge and spatial understanding of radiotherapy technologist (RTT) undergraduates. METHODS Ninety-two third-year RTT students from three French RTT schools took an examination using software that allows visualization of multiple volumetric image series. To serve as a reference, 77 first- and second-year undergraduates, as well as ten senior neuroradiologists, took the same examination. The test included 13 very-short-answer questions (VSAQ) and 21 exercises in which examinees positioned markers onto preloaded brain MR images from a healthy volunteer. The response time was limited. Each correct answer scored 100 points, with a maximum possible test score of 3,400 (VSAQ = 1,300; marker exercise = 2,100). Answers were marked automatically for the marker positioning exercise and semi-automatically for the VSAQs against prerecorded expected answers. RESULTS Overall, the mean test score was 1,787 (150-3,300) and the standard deviation was 781. Scores were highly significantly different between all evaluated groups (p < 0.001). The interoperator reproducibility was 0.90. All the evaluated groups could be discriminated by VSAQ, marker, and overall total scores independently (p ≤ 0.0001 to 0.001). The test was able to discriminate between the three schools either by VSAQ scores (p < 0.001 to 0.02) or by overall total score (p < 0.001 to 0.05). CONCLUSION This software is a high-quality evaluation tool for the assessment of radiological neuroanatomy knowledge and spatial understanding in RTT undergraduates. KEY POINTS • This VDST allows volumetric image analysis of MR studies. • A high reliability test could be created with this tool. • Test scores were strongly associated with the examinee expertise level.
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Affiliation(s)
- Guillaume Vogin
- Department of Radiation Therapy, Institut de Cancérologie de Lorraine, Vandoeuvre Les Nancy, France. .,Centre François Baclesse, Centre National de Radiothérapie du Grand-Duché de Luxembourg, Boîte postale 436, L-4005, Esch sur Alzette, Luxembourg. .,UMR 7365 CNRS-UL, IMoPA, Vandoeuvre Les Nancy, France.
| | - Marc Fauvel
- INSERM CIC-IT 1433, CHRU Nancy, Nancy, France
| | | | | | | | | | | | | | | | | | | | - Pedro Texeira
- INSERM CIC-IT 1433, CHRU Nancy, Nancy, France.,Guilloz Imaging Department, Central Hospital, CHRU Nancy, Nancy, France
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Bleeker M, Goudschaal K, Bel A, Sonke JJ, Hulshof MCCM, van der Horst A. Feasibility of cone beam CT-guided library of plans strategy in pre-operative gastric cancer radiotherapy. Radiother Oncol 2020; 149:49-54. [PMID: 32387491 DOI: 10.1016/j.radonc.2020.04.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE The stomach displays large anatomical changes in size, shape and position, which implies the need for plan adaptation for gastric cancer patients who receive pre-operative radiotherapy. We evaluated the feasibility and necessity of a CBCT-guided library of plans (LoP) strategy in gastric cancer radiotherapy. METHODS Eight gastric cancer patients treated with 24-25 fractions of single-plan radiotherapy with daily CBCT imaging were included. The target was delineated on the pre-treatment CT and first 5 CBCTs to create a patient-specific LoP. Plan selections were performed by 12 observers in a training stage (2-3 CBCTs per patient) and an assessment stage (17 CBCTs per patient). The observers were asked to select the smallest plan that encompassed the target on the CBCT. A total of 136 plan selections were evaluated in the assessment stage. RESULTS Delineations on CBCTs showed that in 90% of the 40 delineated fractions part of the CTV was outside the PTV based on the pre-treatment CT. At least two-thirds of the observers agreed on the selected plan in 65.2% and 70% of the fractions in the training stage and the assessment stage, respectively. For each patient, at least two different plans from the LoP were the most selected plan. CONCLUSION A CBCT-guided patient-specific LoP strategy is feasible for gastric cancer patients, yielding good agreement in plan selections. Unless generous margins are used to avoid frequent geometric misses, it is likely that part of the target will be missed with single-plan radiotherapy.
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Affiliation(s)
- Margot Bleeker
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Karin Goudschaal
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Arjan Bel
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maarten C C M Hulshof
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Astrid van der Horst
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Alexander S, Hopkins N, Lalondrelle S, Taylor A, Titmarsh K, McNair H. RTT-led IGRT for cervix cancer; training, implementation and validation. Tech Innov Patient Support Radiat Oncol 2019; 12:41-49. [PMID: 32095554 PMCID: PMC7033802 DOI: 10.1016/j.tipsro.2019.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/18/2019] [Accepted: 10/31/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION IGRT in cervical cancer treatment delivery is complex due to significant target and organs at risk (OAR) motion. Implementing image assessment of soft-tissue target and OAR position to improve accuracy is recommended. We report the development and refinement of a training and competency programme (TCP), leading to on-line Radiation Therapist (RTT) led soft-tissue assessment, evaluated by a prospective audit. METHODS AND MATERIALS The TCP comprised didactic lectures and practical sessions, supported by a comprehensive workbook. The content was decided by a team comprised of Clinical Oncologists, RTTs, and Physicists. On completion of training, RTT soft-tissue review proficiency (after bony anatomy registration) was assessed against a clinician gold-standard from a database of 20 cervical cancer CBCT images. Reviews were graded pass or fail based on PTV coverage assessment and decision taken in concordance with the gold-standard. Parity was set at ≥80% agreement.The initial TCP (stage one) focussed on offline verification and decision making. Sixteen RTTs completed this stage, four achieved ≥80%. This was not sufficient to support clinical implementation.The TCP was redesigned, more stringent review guidelines and greater anatomy teaching was added. TCP stage two focussed on online verification and decision making supported by a decision flowchart. Twenty-one RTTs completed this TCP, all achieved ≥80%. This supported clinical implementation of RTT-led soft-tissue review under prospective audit conditions.The prospective audit was conducted between March 2017 and August 2017. Daily online review was performed by two trained RTTs. Online review and decision making proficiency was evaluated by a clinician. RESULTS Thirteen patients were included in the audit. Daily online RTT-led IGRT was achieved for all 343 fractions. Two-hundred CBCT images were reviewed offline by the clinician; the mean number of reviews per patient was 15. 192/200 (96%) RTT image reviews were in agreement with clinician review, presenting excellent concordance. DISCUSSION AND CONCLUSION Multidisciplinary involvement in training development, redesign of the TCP and inclusion of summative competency assessment were important factors to support RTT skill development. Consequently, RTT-led cervical cancer soft-tissue IGRT was clinically implemented in the hospital.
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Affiliation(s)
| | - N. Hopkins
- The Royal Marsden NHS Foundation Trust, United Kingdom
| | - S. Lalondrelle
- The Royal Marsden NHS Foundation Trust, United Kingdom
- The Institute of Cancer Research, United Kingdom
| | - A. Taylor
- The Royal Marsden NHS Foundation Trust, United Kingdom
- The Institute of Cancer Research, United Kingdom
| | - K. Titmarsh
- Formerly Kingston and St Georges University of London, United Kingdom
| | - H.A. McNair
- The Royal Marsden NHS Foundation Trust, United Kingdom
- The Institute of Cancer Research, United Kingdom
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Jensen NBK, Assenholt MS, Fokdal LU, Vestergaard A, Schouboe A, Kjaersgaard EB, Boejen A, Nyvang L, Lindegaard JC, Tanderup K. Cone beam computed tomography-based monitoring and management of target and organ motion during external beam radiotherapy in cervical cancer. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2018; 9:14-20. [PMID: 33458421 PMCID: PMC7807672 DOI: 10.1016/j.phro.2018.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 12/18/2022]
Abstract
Background and purpose Organ motion is a challenge during high-precision external beam radiotherapy in cervical cancer, and improved strategies for treatment adaptation and monitoring of target dose coverage are needed. This study evaluates a cone beam computed tomography (CBCT)-based approach. Materials and methods In twenty-three patients, individualized internal target volumes (ITVs) were generated from pre-treatment MRI and CT scans with full and empty bladders. The target volumes encompassed high-risk clinical target volume (CTV-T HR) (gross tumor volume + remaining cervix) and low risk (LR) CTV-T (CTV-T HR + uterus + parametriae + upper vagina). Volumetric Modulated Arc Therapy (VMAT) was used to deliver a dose of 45 Gy in 25 fractions. CBCTs were used for setup and for radiation therapists (RTTs) to evaluate the target coverage (inside/outside the planning target volume). CBCTs were reviewed offline. Estimates of the dose delivered with minimum (point) doses across all fractions to CTV-T HR (aim 42.75 Gy) and CTV-T LR (aim 40 Gy) were assessed. In patients with insufficient dose coverage, re-plans were generated based on previous imaging. Results Median (range) of the ITV-margins (mean of anterior-posterior margins) related to uterus and cervix was 1.2 (0.5–2.2 and 1.0–2.1) cm. RTTs were able to assess the target coverage in 90% of all CBCTs (505/563). With re-planning, one patient had considerable benefit (12.7 Gy increase of minimum dose) to CTV-T LR_vagina, four patients had improved dose to the CTV-T LR_uterus (1.2–1.8 Gy), and 3 patients did not benefit from re-planning. Conclusions Daily CBCT-based monitoring of target coverage by the RTTs has proven safe with limited workload. It allows for reduction in the treated volumes without compromising the target dose coverage.
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Affiliation(s)
| | | | - Lars Ulrik Fokdal
- Department of Oncology, Aarhus University Hospital, Dk-8000 Aarhus C., Denmark
| | - Anne Vestergaard
- Danish Centre for Particle Therapy, Aarhus University Hospital, Dk-8000 Aarhus C., Denmark
| | - Annette Schouboe
- Danish Centre for Particle Therapy, Aarhus University Hospital, Dk-8000 Aarhus C., Denmark
| | | | - Annette Boejen
- Department of Oncology, Aarhus University Hospital, Dk-8000 Aarhus C., Denmark
| | - Lars Nyvang
- Department of Medical Physics, Aarhus University Hospital, Dk-8000 Aarhus C., Denmark
| | | | - Kari Tanderup
- Department of Oncology, Aarhus University Hospital, Dk-8000 Aarhus C., Denmark
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International audit of Virtual Environment for Radiotherapy Training usage. JOURNAL OF RADIOTHERAPY IN PRACTICE 2017. [DOI: 10.1017/s146039691700022x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractIntroductionThe Virtual Environment for Radiotherapy Training (VERT) is a high-fidelity simulation hardware and software resource that replicates the expensive and high-pressure clinical environment of a radiotherapy treatment machine. The simulation allows students to gain confidence with clinical techniques in a safe and unpressured academic environment before clinical placement. The aim of this study was to establish the current and future role of VERT and explore the potential for collaborative resource development and research.MethodsAn anonymous online survey was made available to all users of the software internationally (n=52). A mixture of fixed and open response questions gathered usage data and user feedback.ResultsThe study had a 90% response rate (n=47). Most participants (78·5%) used the resource 1 day/week or less; around 8,000 hours worldwide. It was clear that most participants used the simulation resource to help student to either gain understanding of concepts and techniques or to gain practice with techniques and practical skills. There was good support for collaborative resource development, deployment and evaluation to help VERT users to fully exploit its range of pedagogical uses.ConclusionsThis audit demonstrated high levels of engagement and enthusiasm for collaborative resource development and ongoing research among the radiotherapy simulation community. Adoption of an international Academic Community of Practice for collaborative simulation resource deployment and support may be of significant value and is worthy of further discussion and consideration.
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Grau C, Høyer M, Poulsen PR, Muren LP, Korreman SS, Tanderup K, Lindegaard JC, Alsner J, Overgaard J. Rethink radiotherapy - BIGART 2017. Acta Oncol 2017; 56:1341-1352. [PMID: 29148908 DOI: 10.1080/0284186x.2017.1371326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Cai Grau
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Høyer
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Ludvig Paul Muren
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Kari Tanderup
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jan Alsner
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
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The normal tissue sparing potential of an adaptive plan selection strategy for re-irradiation of recurrent rectal cancer. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2017. [DOI: 10.1016/j.phro.2017.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lutkenhaus LJ, Vestergaard A, Bel A, Høyer M, Hulshof MCCM, van Leeuwen CM, Casares-Magaz O, Petersen JB, Søndergaard J, Muren LP. A biological modeling based comparison of two strategies for adaptive radiotherapy of urinary bladder cancer. Acta Oncol 2016; 55:1009-15. [PMID: 27100215 DOI: 10.3109/0284186x.2016.1151548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Adaptive radiotherapy is introduced in the management of urinary bladder cancer to account for day-to-day anatomical changes. The purpose of this study was to determine whether an adaptive plan selection strategy using either the first four cone beam computed tomography scans (CBCT-based strategy) for plan creation, or the interpolation of bladder volumes on pretreatment CT scans (CT-based strategy), is better in terms of tumor control probability (TCP) and normal tissue sparing while taking the clinically applied fractionation schedules also into account. Material and methods With the CT-based strategy, a library of five plans was created. Patients received 55 Gy to the bladder tumor and 40 Gy to the non-involved bladder and lymph nodes, in 20 fractions. With the CBCT-based strategy, a library of three plans was created, and patients received 70 Gy to the tumor, 60 Gy to the bladder and 48 Gy to the lymph nodes, in 30-35 fractions. Ten patients were analyzed for each adaptive plan selection strategy. TCP was calculated applying the clinically used fractionation schedules, as well as a rescaling of the dose from 55 to 70 Gy for the CT-based strategy. For rectum and bowel, equivalent doses in 2 Gy fractions (EQD2) were calculated. Results The CBCT-based strategy resulted in a median TCP of 75%, compared to 49% for the CT-based strategy, the latter improving to 72% upon rescaling the dose to 70 Gy. A median rectum V30Gy (EQD2) of 26% [interquartile range (IQR): 8-52%] was found for the CT-based strategy, compared to 58% (IQR: 55-73%) for the CBCT-based strategy. Also the bowel doses were lower with the CT-based strategy. Conclusions Whereas the higher total bladder TCP for the CBCT-based strategy is due to prescription differences, the adaptive strategy based on CT scans results in the lowest rectum and bowel cavity doses.
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Affiliation(s)
- L. J. Lutkenhaus
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - A. Vestergaard
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - A. Bel
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - M. Høyer
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - M. C. C. M. Hulshof
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - C. M. van Leeuwen
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - O. Casares-Magaz
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - J. B. Petersen
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - J. Søndergaard
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - L. P. Muren
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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A Multidisciplinary Evaluation of a Web-based eLearning Training Programme for SAFRON II (TROG 13.01): a Multicentre Randomised Study of Stereotactic Radiotherapy for Lung Metastases. Clin Oncol (R Coll Radiol) 2016; 28:e101-8. [PMID: 27116931 DOI: 10.1016/j.clon.2016.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/25/2016] [Accepted: 03/01/2016] [Indexed: 12/31/2022]
Abstract
AIMS In technically advanced multicentre clinical trials, participating centres can benefit from a credentialing programme before participating in the trial. Education of staff in participating centres is an important aspect of a successful clinical trial. In the multicentre study of fractionated versus single fraction stereotactic ablative body radiotherapy in lung oligometastases (TROG 13.01), knowledge transfer of stereotactic ablative body radiotherapy techniques to the local multidisciplinary team is intended as part of the credentialing process. In this study, a web-based learning platform was developed to provide education and training for the multidisciplinary trial teams at geographically distinct sites. MATERIALS AND METHODS A web-based platform using eLearning software consisting of seven training modules was developed. These modules were based on extracranial stereotactic theory covering the following discrete modules: Clinical background; Planning technique and evaluation; Planning optimisation; Four-dimensional computed tomography simulation; Patient-specific quality assurance; Cone beam computed tomography and image guidance; Contouring organs at risk. Radiation oncologists, medical physicists and radiation therapists from hospitals in Australia and New Zealand were invited to participate in this study. Each discipline was enrolled into a subset of modules (core modules) and was evaluated before and after completing each module. The effectiveness of the eLearning training will be evaluated based on (i) knowledge retention after participation in the web-based training and (ii) confidence evaluation after participation in the training. Evaluation consisted of a knowledge test and confidence evaluation using a Likert scale. RESULTS In total, 130 participants were enrolled into the eLearning programme: 81 radiation therapists (62.3%), 27 medical physicists (20.8%) and 22 radiation oncologists (16.9%). There was an average absolute improvement of 14% in test score (P < 0.001) after learning. This score improvement compared with initial testing was also observed in the long-term testing (>4 weeks) after completing the modules (P < 0.001). For most there was significant increase in confidence (P < 0.001) after completing all the modules.
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