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Jaikuna T, Wilson F, Azria D, Chang-Claude J, De Santis MC, Gutiérrez-Enríquez S, van Herk M, Hoskin P, Kotzki L, Lambrecht M, Lingard Z, Seibold P, Seoane A, Sperk E, Paul Symonds R, Talbot CJ, Rancati T, Rattay T, Reyes V, Rosenstein BS, de Ruysscher D, Vega A, Veldeman L, Webb A, West CML, Aznar MC, Vasquez Osorio E. Optimising inter-patient image registration for image-based data mining in breast radiotherapy. Phys Imaging Radiat Oncol 2024; 32:100635. [PMID: 39310222 PMCID: PMC11413750 DOI: 10.1016/j.phro.2024.100635] [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: 07/20/2024] [Revised: 08/19/2024] [Accepted: 08/20/2024] [Indexed: 09/25/2024] Open
Abstract
Background and purpose Image-based data mining (IBDM) requires spatial normalisation to reference anatomy, which is challenging in breast radiotherapy due to variations in the treatment position, breast shape and volume. We aim to optimise spatial normalisation for breast IBDM. Materials and methods Data from 996 patients treated with radiotherapy for early-stage breast cancer, recruited in the REQUITE study, were included. Patients were treated supine (n = 811), with either bilateral or ipsilateral arm(s) raised (551/260, respectively) or in prone position (n = 185). Four deformable image registration (DIR) configurations for extrathoracic spatial normalisation were tested. We selected the best-performing DIR configuration and further investigated two pathways: i) registering prone/supine cohorts independently and ii) registering all patients to a supine reference. The impact of arm positioning in the supine cohort was quantified. DIR accuracy was estimated using Normalised Cross Correlation (NCC), Dice Similarity Coefficient (DSC), mean Distance to Agreement (MDA), 95 % Hausdorff Distance (95 %HD), and inter-patient landmark registration uncertainty (ILRU). Results DIR using B-spline and normalised mutual information (NMI) performed the best across all evaluation metrics. Supine-supine registrations yielded highest accuracy (0.98 ± 0.01, 0.91 ± 0.04, 0.23 ± 0.19 cm, 1.17 ± 1.18 cm, 0.51 ± 0.26 cm for NCC, DSC, MDA, 95 %HD, and ILRU), followed by prone-prone and supine-prone registrations. Arm positioning had no significant impact on registration performance. For the best DIR strategy, uncertainty of 0.44 and 0.81 cm in the breast and shoulder regions was found. Conclusions B-spline algorithm using NMI and registered supine and prone cohorts independently provides the most optimal spatial normalisation strategy for breast IBDM.
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Affiliation(s)
- Tanwiwat Jaikuna
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Christie NHS Foundation Trust Hospital, Manchester, United Kingdom
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Fiona Wilson
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Christie NHS Foundation Trust Hospital, Manchester, United Kingdom
| | - David Azria
- University Federation of Radiation Oncology of Mediterranean Occitanie, Montpellier Cancer Institute ICM, Université Montpellier, INSERM 1194 IRCM, Montpellier, France
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Germany
| | | | - Sara Gutiérrez-Enríquez
- Hereditary Cancer Genetics Group, Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron Hospital Campus, Barcelona, Spain
| | - Marcel van Herk
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Christie NHS Foundation Trust Hospital, Manchester, United Kingdom
| | - Peter Hoskin
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Christie NHS Foundation Trust Hospital, Manchester, United Kingdom
| | - Lea Kotzki
- University Federation of Radiation Oncology of Mediterranean Occitanie, Gard Cancer Institute ICG, CHU Caremeau, Nimes, France
| | | | - Zoe Lingard
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Christie NHS Foundation Trust Hospital, Manchester, United Kingdom
| | - Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Alejandro Seoane
- Medical Physics Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Elena Sperk
- Department of Radiation Oncology, Mannheim Cancer Center, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - R Paul Symonds
- Leicester Cancer Research Centre, University of Leicester, United Kingdom
| | | | - Tiziana Rancati
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tim Rattay
- Leicester Cancer Research Centre, University of Leicester, United Kingdom
| | - Victoria Reyes
- Radiation Oncology Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Barry S. Rosenstein
- Department of Radiation Oncology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Dirk de Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - Ana Vega
- Fundación Pública Galega de Medicina Xenómica, Grupo de Medicina Xenómica (USC), Santiago de Compostela, Spain
- Instituto de Investigación Sanitaria de, Santiago de Compostela, Spain
- Biomedical Network on Rare Diseases (CIBERER), Spain
| | - Liv Veldeman
- Ghent University Hospital, Department of Radiation Oncology, Ghent, Belgium
| | - Adam Webb
- Department of Genetics and Genome Biology, University of Leicester, United Kingdom
| | - Catharine ML West
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Christie NHS Foundation Trust Hospital, Manchester, United Kingdom
| | - Marianne C Aznar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Christie NHS Foundation Trust Hospital, Manchester, United Kingdom
| | - Eliana Vasquez Osorio
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Christie NHS Foundation Trust Hospital, Manchester, United Kingdom
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Gaito S, Cella L, France A, Monti S, Whitfield G, Sitch P, Burnet N, Smith E, Palma G, Aznar M. Incidence of alopecia in brain tumour patients treated with pencil scanning proton therapy and validation of existing NTCP models. Radiother Oncol 2024; 199:110462. [PMID: 39069083 DOI: 10.1016/j.radonc.2024.110462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND AND PURPOSE Radiation-induced alopecia (RIA) is one of the most frequent and upsetting cosmetic side effects after radiotherapy (RT) for brain cancer. We report the incidence of RIA in a cohort of brain tumours patients treated with Proton Therapy (PT) and externally validate published NTCP models of grade 2 (G2) RIA for their implementation in clinical practice. METHODS Data for patients treated for brain tumours with scanning beam PT between 2018 and 2022 were extracted. Acute, late and permanent RIA events were evaluated according to CTCAE 5.0. Lyman-Kutcher-Burman (LKB) and multivariable logistic regression (MLR) published models were computed from the relative dose-surface histogram of the scalp. External validity of models was assessed in terms of discrimination and calibration. RESULTS In the 264 patients analysed, rates of any grade acute (≤90 days after PT completion), late (>90 days) and permanent RIA (persisting for> 12 months) were 61.8 %, 24.7 % and 14.4 %, respectively. In our independent cohort, LKB- and MLR-NTCP showed a good discrimination for G2 RIA (0.71≤ROC-AUC≤0.83) while model calibration was unsatisfactory possibly due to a different outcome evaluation between training and validation cohorts, as well as differences in clinical and treatment related variables between the two groups. CONCLUSIONS Despite the reasonable sensitivity and specificity of the NTCP models for RIA in the validation cohort, our study emphasizes the significance of differences between the cohorts utilized for model development and validation. Specifically, variations in the reporting of clinical outcomes inevitably jeopardize the validation of NTCP models. A standardize and objective RIA scoring system is essential.
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Affiliation(s)
- Simona Gaito
- Proton Clinical Outcomes Unit, The Christie Proton Beam Therapy Center, Manchester, United Kingdom; Division of Cancer Sciences, School of Medical Science, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Laura Cella
- Institute of Biostructures and Bioimaging, National Research Council, Naples, Italy.
| | - Anna France
- Proton Clinical Outcomes Unit, The Christie Proton Beam Therapy Center, Manchester, United Kingdom
| | - Serena Monti
- Institute of Biostructures and Bioimaging, National Research Council, Naples, Italy
| | - Gillian Whitfield
- Division of Cancer Sciences, School of Medical Science, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom; Proton Beam Therapy Centre. The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Peter Sitch
- Proton Clinical Outcomes Unit, The Christie Proton Beam Therapy Center, Manchester, United Kingdom; Proton Beam Therapy Centre. The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Neil Burnet
- Proton Beam Therapy Centre. The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Ed Smith
- Proton Clinical Outcomes Unit, The Christie Proton Beam Therapy Center, Manchester, United Kingdom; Division of Cancer Sciences, School of Medical Science, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom; Proton Beam Therapy Centre. The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Giuseppe Palma
- Institute of Nanotechnology, National Research Council, Lecce, Italy
| | - Marianne Aznar
- Division of Cancer Sciences, School of Medical Science, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom
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3
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Herr DJ, Yin H, Bergsma D, Dragovic AF, Matuszak M, Grubb M, Dominello M, Movsas B, Kestin LL, Boike T, Bhatt A, Hayman JA, Jolly S, Schipper M, Paximadis P. Factors associated with acute esophagitis during radiation therapy for lung cancer. Radiother Oncol 2024; 197:110349. [PMID: 38815695 DOI: 10.1016/j.radonc.2024.110349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 04/30/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Limiting acute esophagitis remains a clinical challenge during the treatment of locally advanced non-small cell lung cancer (NSCLC). METHODS Demographic, dosimetric, and acute toxicity data were prospectively collected for patients undergoing definitive radiation therapy +/- chemotherapy for stage II-III NSCLC from 2012 to 2022 across a statewide consortium. Logistic regression models were used to characterize the risk of grade 2 + and 3 + esophagitis as a function of dosimetric and clinical covariates. Multivariate regression models were fitted to predict the 50 % risk of grade 2 esophagitis and 3 % risk of grade 3 esophagitis. RESULTS Of 1760 patients, 84.2 % had stage III disease and 85.3 % received concurrent chemotherapy. 79.2 % of patients had an ECOG performance status ≤ 1. Overall rates of acute grade 2 + and 3 + esophagitis were 48.4 % and 2.2 %, respectively. On multivariate analyses, performance status, mean esophageal dose (MED) and minimum dose to the 2 cc of esophagus receiving the highest dose (D2cc) were significantly associated with grade 2 + and 3 + esophagitis. Concurrent chemotherapy was associated with grade 2 + but not grade 3 + esophagitis. For all patients, MED of 29 Gy and D2cc of 61 Gy corresponded to a 3 % risk of acute grade 3 + esophagitis. For patients receiving chemotherapy, MED of 22 Gy and D2cc of 50 Gy corresponded to a 50 % risk of acute grade 2 + esophagitis. CONCLUSIONS Performance status, concurrent chemotherapy, MED and D2cc are associated with acute esophagitis during definitive treatment of NSCLC. Models that quantitatively account for these factors can be useful in individualizing radiation plans.
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Affiliation(s)
- Daniel J Herr
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States.
| | - Huiying Yin
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Derek Bergsma
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States; St. Mary's Hospital, Lacks Cancer Center, Grand Rapids, MI, United States
| | - Aleksandar F Dragovic
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States; Department of Radiation Oncology, Brighton Center for Specialty Care, Brighton, MI, United States
| | - Martha Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Margaret Grubb
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Michael Dominello
- Department of Radiation Oncology, Karmanos Cancer Institute, Detroit, MI, United States
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, United States
| | - Larry L Kestin
- MHP Radiation Oncology Institute/GenesisCare USA, Farmington Hills, MI, United States
| | - Thomas Boike
- MHP Radiation Oncology Institute/GenesisCare USA, Farmington Hills, MI, United States
| | - Amit Bhatt
- Department of Radiation Oncology, Karmanos Cancer Institute at McLaren Greater Lansing, Lansing, MI, United States
| | - James A Hayman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Matthew Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States; Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States.
| | - Peter Paximadis
- Department of Radiation Oncology, Corewell Health South, St. Joseph, MI, United States
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Chao PJ, Chang CH, Wu JJ, Liu YH, Shiau J, Shih HH, Lin GZ, Lee SH, Lee TF. Improving Prediction of Complications Post-Proton Therapy in Lung Cancer Using Large Language Models and Meta-Analysis. Cancer Control 2024; 31:10732748241286749. [PMID: 39307562 PMCID: PMC11418344 DOI: 10.1177/10732748241286749] [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: 06/20/2024] [Revised: 08/26/2024] [Accepted: 09/06/2024] [Indexed: 09/25/2024] Open
Abstract
PURPOSE This study enhances the efficiency of predicting complications in lung cancer patients receiving proton therapy by utilizing large language models (LLMs) and meta-analytical techniques for literature quality assessment. MATERIALS AND METHODS We integrated systematic reviews with LLM evaluations, sourcing studies from Web of Science, PubMed, and Scopus, managed via EndNote X20. Inclusion and exclusion criteria ensured literature relevance. Techniques included meta-analysis, heterogeneity assessment using Cochran's Q test and I2 statistics, and subgroup analyses for different complications. Quality and bias risk were assessed using the PROBAST tool and further analyzed with models such as ChatGPT-4, Llama2-13b, and Llama3-8b. Evaluation metrics included AUC, accuracy, precision, recall, F1 score, and time efficiency (WPM). RESULTS The meta-analysis revealed an overall effect size of 0.78 for model predictions, with high heterogeneity observed (I2 = 72.88%, P < 0.001). Subgroup analysis for radiation-induced esophagitis and pneumonitis revealed predictive effect sizes of 0.79 and 0.77, respectively, with a heterogeneity index (I2) of 0%, indicating that there were no significant differences among the models in predicting these specific complications. A literature assessment using LLMs demonstrated that ChatGPT-4 achieved the highest accuracy at 90%, significantly outperforming the Llama3 and Llama2 models, which had accuracies ranging from 44% to 62%. Additionally, LLM evaluations were conducted 3229 times faster than manual assessments were, markedly enhancing both efficiency and accuracy. The risk assessment results identified nine studies as high risk, three as low risk, and one as unknown, confirming the robustness of the ChatGPT-4 across various evaluation metrics. CONCLUSION This study demonstrated that the integration of large language models with meta-analysis techniques can significantly increase the efficiency of literature evaluations and reduce the time required for assessments, confirming that there are no significant differences among models in predicting post proton therapy complications in lung cancer patients.
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Affiliation(s)
- Pei-Ju Chao
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chu-Ho Chang
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
| | - Jyun-Jie Wu
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
| | - Yen-Hsien Liu
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
| | - Junping Shiau
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
| | - Hsin-Hung Shih
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
| | - Guang-Zhi Lin
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
| | - Shen-Hao Lee
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
| | - Tsair-Fwu Lee
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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McWilliam A, Palma G, Abravan A, Acosta O, Appelt A, Aznar M, Monti S, Onjukka E, Panettieri V, Placidi L, Rancati T, Vasquez Osorio E, Witte M, Cella L. Voxel-based analysis: Roadmap for clinical translation. Radiother Oncol 2023; 188:109868. [PMID: 37683811 DOI: 10.1016/j.radonc.2023.109868] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/11/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023]
Abstract
Voxel-based analysis (VBA) allows the full, 3-dimensional, dose distribution to be considered in radiotherapy outcome analysis. This provides new insights into anatomical variability of pathophysiology and radiosensitivity by removing the need for a priori definition of organs assumed to drive the dose response associated with patient outcomes. This approach may offer powerful biological insights demonstrating the heterogeneity of the radiobiology across tissues and potential associations of the radiotherapy dose with further factors. As this methodological approach becomes established, consideration needs to be given to translating VBA results to clinical implementation for patient benefit. Here, we present a comprehensive roadmap for VBA clinical translation. Technical validation needs to demonstrate robustness to methodology, where clinical validation must show generalisability to external datasets and link to a plausible pathophysiological hypothesis. Finally, clinical utility requires demonstration of potential benefit for patients in order for successful translation to be feasible. For each step on the roadmap, key considerations are discussed and recommendations provided for best practice.
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Affiliation(s)
- Alan McWilliam
- The Division of Cancer Sciences, The University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK.
| | - Giuseppe Palma
- Institute of Nanotechnology, National Research Council, Lecce, Italy.
| | - Azadeh Abravan
- The Division of Cancer Sciences, The University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - Oscar Acosta
- University Rennes, CLCC Eugène Marquis, INSERM, LTSI - UMR 1099, F-35000, Rennes, France
| | - Ane Appelt
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Marianne Aznar
- The Division of Cancer Sciences, The University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - Serena Monti
- Institute of Biostructures and Bioimaging, National Research Council, Naples, Italy
| | - Eva Onjukka
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Sweden
| | - Vanessa Panettieri
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3010, Australia
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Tiziana Rancati
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Eliana Vasquez Osorio
- The Division of Cancer Sciences, The University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - Marnix Witte
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Laura Cella
- Institute of Biostructures and Bioimaging, National Research Council, Naples, Italy
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Sosa-Marrero C, Acosta O, Pasquier D, Thariat J, Delpon G, Fiorino C, Rancatti T, Malard O, Foray N, de Crevoisier R. Voxel-wise analysis: A powerful tool to predict radio-induced toxicity and potentially perform personalised planning in radiotherapy. Cancer Radiother 2023; 27:638-642. [PMID: 37517974 DOI: 10.1016/j.canrad.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023]
Abstract
Dose - volume histograms have been historically used to study the relationship between the planned radiation dose and healthy tissue damage. However, this approach considers neither spatial information nor heterogenous radiosensitivity within organs at risk, depending on the tissue. Recently, voxel-wise analyses have emerged in the literature as powerful tools to fully exploit three-dimensional information from the planned dose distribution. They allow to identify anatomical subregions of one or several organs in which the irradiation dose is associated with a given toxicity. These methods rely on an accurate anatomical alignment, usually obtained by means of a non-rigid registration. Once the different anatomies are spatially normalised, correlations between the three-dimensional dose and a given toxicity can be explored voxel-wise. Parametric or non-parametric statistical tests can be performed on every voxel to identify the voxels in which the dose is significantly different between patients presenting or not toxicity. Several anatomical subregions associated with genitourinary, gastrointestinal, cardiac, pulmonary or haematological toxicity have already been identified in the literature for prostate, head and neck or thorax irradiation. Voxel-wise analysis appears therefore first particularly interesting to increase toxicity prediction capability by identifying specific subregions in the organs at risk whose irradiation is highly predictive of specific toxicity. The second interest is potentially to decrease the radio-induced toxicity by limiting the dose in the predictive subregions, while not decreasing the dose in the target volume. Limitations of the approach have been pointed out.
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Affiliation(s)
- C Sosa-Marrero
- Université de Rennes, CLCC Eugène-Marquis, Inserm, LTSI - UMR 1099, 35000 Rennes, France
| | - O Acosta
- Université de Rennes, CLCC Eugène-Marquis, Inserm, LTSI - UMR 1099, 35000 Rennes, France
| | - D Pasquier
- Radiotherapy Department, centre Oscar-Lambret, 59000 Lille, France; Université de Lille, CNRS, école centrale de Lille, Cristal UMR 9189, Lille, France
| | - J Thariat
- Department of Radiation Oncology, centre François-Baclesse, 14000 Caen, France
| | - G Delpon
- Medical physics department, institut de cancérologie de l'Ouest, IMT Atlantique, Nantes université, CNRS/IN2P3, Subatech, Nantes, France
| | - C Fiorino
- Medical Physics, San Raffaele Scientific Institute, Via Olgettina 690, 20132 Milan, Italy
| | - T Rancatti
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - O Malard
- Service de chirurgie oto-rhinolaryngologique (ORL) et chirurgie cervicofaciale, Hôtel-Dieu, CHU de Nantes, Nantes, France
| | - N Foray
- Centre Léon-Bérard, Inserm U1296 "Radiation: Defense/Health/Environment", 69008 Lyon, France
| | - R de Crevoisier
- Université de Rennes, CLCC Eugène-Marquis, Inserm, LTSI - UMR 1099, 35000 Rennes, France; Département de radiothérapie, centre Eugène-Marquis, 35000 Rennes, France.
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Kim Y, Chamseddine I, Cho Y, Kim JS, Mohan R, Shusharina N, Paganetti H, Lin S, Yoon HI, Cho S, Grassberger C. Neural network based ensemble model to predict radiation induced lymphopenia after concurrent chemo-radiotherapy for non-small cell lung cancer from two institutions. Neoplasia 2023; 39:100889. [PMID: 36931040 PMCID: PMC10025955 DOI: 10.1016/j.neo.2023.100889] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/10/2022] [Accepted: 02/13/2023] [Indexed: 03/17/2023]
Abstract
The use of adjuvant Immune Checkpoint Inhibitors (ICI) after concurrent chemo-radiation therapy (CCRT) has become the standard of care for locally advanced non-small cell lung cancer (LA-NSCLC). However, prolonged radiotherapy regimens are known to cause radiation-induced lymphopenia (RIL), a long-neglected toxicity that has been shown to correlate with response to ICIs and survival of patients treated with adjuvant ICI after CCRT. In this study, we aim to develop a novel neural network (NN) approach that integrates patient characteristics, treatment related variables, and differential dose volume histograms (dDVH) of lung and heart to predict the incidence of RIL at the end of treatment. Multi-institutional data of 139 LA-NSCLC patients from two hospitals were collected for training and validation of our suggested model. Ensemble learning was combined with a bootstrap strategy to stabilize the model, which was evaluated internally using repeated cross validation. The performance of our proposed model was compared to conventional models using the same input features, such as Logistic Regression (LR) and Random Forests (RF), using the Area Under the Curve (AUC) of Receiver Operating Characteristics (ROC) curves. Our suggested model (AUC=0.77) outperformed the comparison models (AUC=0.72, 0.74) in terms of absolute performance, indicating that the convolutional structure of the network successfully abstracts additional information from the differential DVHs, which we studied using Gradient-weighted Class Activation Map. This study shows that clinical factors combined with dDVHs can be used to predict the risk of RIL for an individual patient and shows a path toward preventing lymphopenia using patient-specific modifications of the radiotherapy plan.
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Affiliation(s)
- Yejin Kim
- Department of Nuclear and Quantum Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea; Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ibrahim Chamseddine
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Yeona Cho
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Radhe Mohan
- Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Nadya Shusharina
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Steven Lin
- Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Seungryong Cho
- Department of Nuclear and Quantum Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea.
| | - Clemens Grassberger
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Salans M, Houri J, Karunamuni R, Hopper A, Delfanti R, Seibert TM, Bahrami N, Sharifzadeh Y, McDonald C, Dale A, Moiseenko V, Farid N, Hattangadi-Gluth JA. The relationship between radiation dose and bevacizumab-related imaging abnormality in patients with brain tumors: A voxel-wise normal tissue complication probability (NTCP) analysis. PLoS One 2023; 18:e0279812. [PMID: 36800342 PMCID: PMC9937457 DOI: 10.1371/journal.pone.0279812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/15/2022] [Indexed: 02/18/2023] Open
Abstract
PURPOSE Bevacizumab-related imaging abnormality (BRIA), appearing as areas of restricted diffusion on magnetic resonance imaging (MRI) and representing atypical coagulative necrosis pathologically, has been observed in patients with brain tumors receiving radiotherapy and bevacizumab. We investigated the role of cumulative radiation dose in BRIA development in a voxel-wise analysis. METHODS Patients (n = 18) with BRIA were identified. All had high-grade gliomas or brain metastases treated with radiotherapy and bevacizumab. Areas of BRIA were segmented semi-automatically on diffusion-weighted MRI with apparent diffusion coefficient (ADC) images. To avoid confounding by possible tumor, hypoperfusion was confirmed with perfusion imaging. ADC images and radiation dose maps were co-registered to a high-resolution T1-weighted MRI and registration accuracy was verified. Voxel-wise normal tissue complication probability analyses were performed using a logistic model analyzing the relationship between cumulative voxel equivalent total dose in 2 Gy fractions (EQD2) and BRIA development at each voxel. Confidence intervals for regression model predictions were estimated with bootstrapping. RESULTS Among 18 patients, 39 brain tumors were treated. Patients received a median of 4.5 cycles of bevacizumab and 1-4 radiation courses prior to BRIA appearance. Most (64%) treated tumors overlapped with areas of BRIA. The median proportion of each BRIA region of interest volume overlapping with tumor was 98%. We found a dose-dependent association between cumulative voxel EQD2 and the relative probability of BRIA (β0 = -5.1, β1 = 0.03 Gy-1, γ = 1.3). CONCLUSIONS BRIA is likely a radiation dose-dependent phenomenon in patients with brain tumors receiving bevacizumab and radiotherapy. The combination of radiation effects and tumor microenvironmental factors in potentiating BRIA in this population should be further investigated.
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Affiliation(s)
- Mia Salans
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, United States of America
| | - Jordan Houri
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, United States of America
- Carl E. Ravin Advanced Imaging Laboratories, Duke University, Durham, North Carolina, United States of America
| | - Roshan Karunamuni
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, United States of America
| | - Austin Hopper
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, United States of America
| | - Rachel Delfanti
- Department of Radiology, University of California San Diego, La Jolla, California, United States of America
| | - Tyler M. Seibert
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, United States of America
- Department of Bioengineering, University of California San Diego, La Jolla, California, United States of America
| | - Naeim Bahrami
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, United States of America
| | - Yasamin Sharifzadeh
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, United States of America
| | - Carrie McDonald
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, United States of America
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | - Anders Dale
- Department of Radiology, University of California San Diego, La Jolla, California, United States of America
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | - Vitali Moiseenko
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, United States of America
| | - Nikdokht Farid
- Department of Radiology, University of California San Diego, La Jolla, California, United States of America
| | - Jona A. Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, United States of America
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Palma G, Cella L, Monti S. Technical note: MAMBA-Multi-pAradigM voxel-Based Analysis: A computational cookbot. Med Phys 2023; 50:2317-2322. [PMID: 36732900 DOI: 10.1002/mp.16260] [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: 05/28/2022] [Revised: 01/03/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Voxel-Based (VB) analysis embraces a multifaceted ensemble of sophisticated techniques, lying at the boundary between image processing and statistical modeling, that allow for a frequentist inference of pathophysiological properties anchored to an anatomical reference. VB methods has been widely adopted in neuroimaging studies and, more recently, they are gaining momentum in radiation oncology research. However, the price for the power of VB analysis is the complexity of the underlying mathematics and algorithms. PURPOSE In this paper, we present the Multi-pAradigM voxel-Based Analysis (MAMBA) toolbox, which is intended for a flexible application of VB analysis in a wide variety of scenarios in medical imaging and radiation oncology. METHODS The MAMBA toolbox is implemented in Matlab. It provides open-source functions to compute VB statistical models of the input data, according to a great variety of regression schemes, and to derive VB maps of the observed significance level, performing a non-parametric permutation inference. The toolbox allows for including VB and global outcomes, as well as an arbitrary amount of VB and global Explanatory Variables (EVs). In addition, the Matlab Parallel Computing Toolbox is exploited to take advantage of the perfect parallelizability of most workloads. RESULTS The use of MAMBA was demonstrated by means of several realistic examples on a synthetic dataset mimicking a radiation oncology scenario. CONCLUSION MAMBA is an open-source toolbox, freely available for academic and non-commercial purposes. It is designed to make state-of-the-art VB analysis accessible to research scientists without the programming resources needed to build from scratch their own software solutions. At the same time, the source code is handed out for more experienced users to complement their own tools, also customizing user-defined models. MAMBA guarantees high generality and flexibility in the design of the statistical models, significantly expanding on the features of available free tools for VB analysis. The presented toolbox aims at increasing the reach of VB studies as well as the sharing of research results.
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Affiliation(s)
- Giuseppe Palma
- Institute of Nanotechnology, National Research Council, Lecce, Italy
| | - Laura Cella
- Institute of Biostructures and Bioimaging, National Research Council, Napoli, Italy
| | - Serena Monti
- Institute of Biostructures and Bioimaging, National Research Council, Napoli, Italy
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Mazonakis M, Tzanis E, Lyraraki E, Damilakis J. Automatic Radiobiological Comparison of Radiation Therapy Plans: An Application to Gastric Cancer. Cancers (Basel) 2022; 14:cancers14246098. [PMID: 36551582 PMCID: PMC9776876 DOI: 10.3390/cancers14246098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
(1) Aim: This study was conducted to radiobiologically compare radiotherapy plans for gastric cancer with a newly developed software tool. (2) Methods: Treatment planning was performed on two computational phantoms simulating adult male and female patients. Three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans for gastric cancer were generated with three-photon beam energies. The equivalent uniform dose (EUD), tumor control probability (TCP) of the target and normal tissue control probability (NTCP) of eight different critical organs were calculated. A new software was employed for these calculations using the EUD-based model and dose-volume-histogram data. (3) Results: The IMRT and VMAT plan led to TCPs of 51.3-51.5%, whereas 3D-CRT gave values up to 50.2%. The intensity-modulated techniques resulted in NTCPs of (5.3 × 10-6-3.3 × 10-1)%. The corresponding NTCPs from 3D-CRT were (3.4 × 10-7-7.4 × 10-1)%. The above biological indices were automatically calculated in less than 40 s with the software. (4) Conclusions: The direct and quick radiobiological evaluation of radiotherapy plans is feasible using the new software tool. The IMRT and VMAT reduced the probability of the appearance of late effects in most of the surrounding critical organs and slightly increased the TCP compared to 3D-CRT.
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Affiliation(s)
- Michalis Mazonakis
- Department of Medical Physics, Faculty of Medicine, University of Crete, 71003 Iraklion, Greece
- Correspondence:
| | - Eleftherios Tzanis
- Department of Medical Physics, Faculty of Medicine, University of Crete, 71003 Iraklion, Greece
| | - Efrossyni Lyraraki
- Department of Radiation Oncology, University Hospital of Iraklion, 71110 Iraklion, Greece
| | - John Damilakis
- Department of Medical Physics, Faculty of Medicine, University of Crete, 71003 Iraklion, Greece
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Fjellanger K, Rossi L, Heijmen BJM, Pettersen HES, Sandvik IM, Breedveld S, Sulen TH, Hysing LB. Patient selection, inter-fraction plan robustness and reduction of toxicity risk with deep inspiration breath hold in intensity-modulated radiotherapy of locally advanced non-small cell lung cancer. Front Oncol 2022; 12:966134. [PMID: 36110942 PMCID: PMC9469652 DOI: 10.3389/fonc.2022.966134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background State-of-the-art radiotherapy of locally advanced non-small cell lung cancer (LA-NSCLC) is performed with intensity-modulation during free breathing (FB). Previous studies have found encouraging geometric reproducibility and patient compliance of deep inspiration breath hold (DIBH) radiotherapy for LA-NSCLC patients. However, dosimetric comparisons of DIBH with FB are sparse, and DIBH is not routinely used for this patient group. The objective of this simulation study was therefore to compare DIBH and FB in a prospective cohort of LA-NSCLC patients treated with intensity-modulated radiotherapy (IMRT). Methods For 38 LA-NSCLC patients, 4DCTs and DIBH CTs were acquired for treatment planning and during the first and third week of radiotherapy treatment. Using automated planning, one FB and one DIBH IMRT plan were generated for each patient. FB and DIBH was compared in terms of dosimetric parameters and NTCP. The treatment plans were recalculated on the repeat CTs to evaluate robustness. Correlations between ΔNTCPs and patient characteristics that could potentially predict the benefit of DIBH were explored. Results DIBH reduced the median Dmean to the lungs and heart by 1.4 Gy and 1.1 Gy, respectively. This translated into reductions in NTCP for radiation pneumonitis grade ≥2 from 20.3% to 18.3%, and for 2-year mortality from 51.4% to 50.3%. The organ at risk sparing with DIBH remained significant in week 1 and week 3 of treatment, and the robustness of the target coverage was similar for FB and DIBH. While the risk of radiation pneumonitis was consistently reduced with DIBH regardless of patient characteristics, the ability to reduce the risk of 2-year mortality was evident among patients with upper and left lower lobe tumors but not right lower lobe tumors. Conclusion Compared to FB, DIBH allowed for smaller target volumes and similar target coverage. DIBH reduced the lung and heart dose, as well as the risk of radiation pneumonitis and 2-year mortality, for 92% and 74% of LA-NSCLC patients, respectively. However, the advantages varied considerably between patients, and the ability to reduce the risk of 2-year mortality was dependent on tumor location. Evaluation of repeat CTs showed similar robustness of the dose distributions with each technique.
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Affiliation(s)
- Kristine Fjellanger
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
- Institute of Physics and Technology, University of Bergen, Bergen, Norway
| | - Linda Rossi
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ben J. M. Heijmen
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Inger Marie Sandvik
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Sebastiaan Breedveld
- Department of Radiotherapy, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Turid Husevåg Sulen
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Liv Bolstad Hysing
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
- Institute of Physics and Technology, University of Bergen, Bergen, Norway
- *Correspondence: Liv Bolstad Hysing,
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Radiation Therapy in Thoracic Tumors: Recent Trends and Current Issues. Cancers (Basel) 2022; 14:cancers14112706. [PMID: 35681686 PMCID: PMC9179547 DOI: 10.3390/cancers14112706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022] Open
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