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Nakayama M, Sekii S, Miyazaki E, Oya T, Nishikawa R, Geso M. Dosimetric impact of VMAT delivery angles for early glottic cancer treatment. Med Dosim 2024:S0958-3947(24)00022-0. [PMID: 38729843 DOI: 10.1016/j.meddos.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/08/2024] [Accepted: 04/08/2024] [Indexed: 05/12/2024]
Abstract
This study investigates the dosimetric effects of different gantry rotation angles used in volumetric modulated arc therapy (VMAT) for early glottic carcinoma. VMAT treatment plans using full-arc, half-arc, and partial-arc gantry rotation angles were generated from 22 computed tomography datasets of early-stage (T1-2N0) glottic laryngeal cancer. Dosimetric parameters associated with the planning target volume (PTV) and organs at risk (OARs), specifically the carotid arteries and thyroid, were compared. To assess the robustness of the VMAT plans, dose variations were analyzed by introducing positional shifts of 1, 3, and 5 mm from the isocenter of each plan along the superior-inferior, left-right, and anterior-posterior axes. Furthermore, we examined the size of the PTV, the air cavity volume within the PTV, and the variability of the beam path length through the gantry angles to investigate their correlations with PTV dose variations in the presence of positioning errors. Compared to full-arc and half-arc plans, the dosimetric parameters of partial-arc plans were found to be higher in PTV (D2%, D5%, D50%, and Dmean) and lower in OARs, while their dose variations of OAR parameters were greater for positioning errors. In addition, a correlation was observed between PTV size and PTV dose variations. Air cavity volume and depth variability were also correlated with some PTV parameters, depending on the arc plan. The results presented in this study suggest that the partial-arc gantry angles can allow higher PTV doses while minimizing OAR doses in VMAT treatment planning for early glottic cancer. However, the small delivery angles may lead to greater dose variations in the OARs when positioning errors occur.
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Affiliation(s)
- Masao Nakayama
- Division of Radiation Therapy, Kita-Harima Medical Center, Ono, Hyogo 675-1392, Japan; Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe City, Hyogo 650-0017, Japan; Discipline of Medical Radiations, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria 3083, Australia.
| | - Shuhei Sekii
- Division of Radiation Therapy, Kita-Harima Medical Center, Ono, Hyogo 675-1392, Japan; Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe City, Hyogo 650-0017, Japan
| | - Eiichi Miyazaki
- Division of Radiation Therapy, Kita-Harima Medical Center, Ono, Hyogo 675-1392, Japan
| | - Tomohiko Oya
- Division of Radiation Therapy, Kita-Harima Medical Center, Ono, Hyogo 675-1392, Japan
| | - Ryo Nishikawa
- Division of Radiation Therapy, Kita-Harima Medical Center, Ono, Hyogo 675-1392, Japan; Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe City, Hyogo 650-0017, Japan
| | - Moshi Geso
- Discipline of Medical Radiations, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria 3083, Australia
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Kodaira T, Kagami Y, Shikama N. In Reply to Yamazaki et al. Int J Radiat Oncol Biol Phys 2024; 118:865-866. [PMID: 38340771 DOI: 10.1016/j.ijrobp.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/02/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Yoshikazu Kagami
- Department of Radiation Oncology, Showa University School of Medicine, Tokyo, Japan
| | - Naoto Shikama
- Department of Radiation Oncology, Juntendo University, Tokyo, Japan
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Kodaira T, Kagami Y, Machida R, Shikama N, Sekino Y, Ito Y, Ishikura S, Saito Y, Matsumoto Y, Konishi K, Murakami N, Akimoto T, Fukushima Y, Toshiyasu T, Katano A, Nagata Y, Ogawa H, Uno T, Hamamoto Y, Nishimura Y, Mizowaki T. Long-Term Follow-up of a Randomized Controlled Trial on Accelerated Radiation Therapy Versus Standard Fractionated Radiation Therapy for Early Glottic Cancer (JCOG0701A3). Int J Radiat Oncol Biol Phys 2023; 117:1118-1124. [PMID: 37414261 DOI: 10.1016/j.ijrobp.2023.06.251] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/22/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE We previously reported the primary results of JCOG0701, a randomized, multicenter, phase 3, noninferiority trial comparing accelerated fractionation (Ax) to standard fractionation (SF) for early glottic cancer. In the primary results, although the similar efficacy of 3-year progression-free survival and toxicity of Ax compared with SF was observed, the noninferiority of Ax was not confirmed statistically. To evaluate the long-term follow-up results of JCOG0701, we conducted JCOG0701A3 as an ancillary study of JCOG0701. METHODS AND MATERIALS In JCOG0701, 370 patients were randomly assigned to receive SF of 66 to 70 Gy (33-35 fractions; n = 184) or Ax of 60 to 64.8 Gy (25-27 fractions; n = 186). The data cutoff date for this analysis was in June 2020. Overall survival, progression-free survival, and late adverse events including central nervous system ischemia were analyzed. RESULTS With a median follow-up period of 7.1 years (range, 0.1-12.4), progression-free survival of the SF and Ax arms were 76.2% and 78.2% at 5 years and 72.7% and 74.8% at 7 years (P = .44). OS of the SF and Ax arms were 92.7% and 89.6% at 5 years and 90.8% and 86.5% at 7 years (P = .92). Among 366 patients with a protocol treatment, the cumulative incidence of late adverse events of the SF and Ax arms were 11.9% and 7.4% at 8 years (hazard ratio, 0.53; 95% CI, 0.28-1.01; P = .06). Central nervous system ischemia of grade 2 or higher was observed in 4.1% for the SF arm and 1.1% for the Ax arm (P = .098). CONCLUSIONS After long-term follow-up, Ax showed comparable efficacy to SF and a tendency for better safety. Ax may be suitable for early glottic cancer because of its convenience in minimizing treatment time, cost, and labor.
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Affiliation(s)
- Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center, Nagoya, Japan.
| | - Yoshikazu Kagami
- Department of Radiation Oncology, Showa University School of Medicine, Tokyo, Japan
| | - Ryunosuke Machida
- JCOG Data Center/Operation office, National Cancer Center Hospital, Tokyo, Japan
| | - Naoto Shikama
- Department of Radiation Oncology, Juntendo University, Tokyo, Japan
| | - Yuta Sekino
- JCOG Data Center/Operation office, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshinori Ito
- Department of Radiation Oncology, Showa University School of Medicine, Tokyo, Japan
| | - Satoshi Ishikura
- Division of Radiation Oncology, Tokyo Bay Makuhari Clinic for Advanced Imaging, Cancer Screening, and High-Precision Radiotherapy, Chiba, Japan
| | - Yoshihiro Saito
- Department of Radiation Oncology, Saitama Cancer Center Hospital, Saitama, Japan
| | - Yasuo Matsumoto
- Department of Radiation Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Koji Konishi
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tetsuo Akimoto
- Department of Radiation, National Cancer Center Hospital East, Oncology, Kashiwa, Japan
| | - Yuuki Fukushima
- Department of Radiology, Sapporo Medical University, Sapporo, Japan
| | - Takashi Toshiyasu
- Department of Radiation Oncology, Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Atsuto Katano
- Department of Radiology, University of Tokyo Hospital, Tokyo, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Hiroshima University, Hiroshima, Japan
| | - Hirofumi Ogawa
- Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takashi Uno
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Yasushi Hamamoto
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Lin YH, Cheng JY, Huang BS, Luo SD, Lin WC, Chou SY, Juang PJ, Li SH, Huang EY, Wang YM. Significant Reduction in Vertebral Artery Dose by Intensity Modulated Proton Therapy: A Pilot Study for Nasopharyngeal Carcinoma. J Pers Med 2021; 11:jpm11080822. [PMID: 34442466 PMCID: PMC8400425 DOI: 10.3390/jpm11080822] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 11/18/2022] Open
Abstract
Intensity modulated proton therapy (IMPT) with the vertebral artery (VA)-sparing technique has been initially proposed in our institution. This pilot study was conducted to compare the dose to VAs between IMPT and volumetric-modulated arc therapy (VMAT) for patients with nasopharyngeal carcinoma (NPC). A total of six patients with NPC treated by IMPT were enrolled in the study. Target volumes and organs at risk (OARs) were delineated, including 12 samples of right and left VAs, respectively, for each patient. Treatment planning by IMPT and dual-arc VMAT was carried out for comparison. The IMPT plan significantly reduced VA mean dose, V10, V20, V30, V40, and V50, compared to the VMAT plan in all 12 samples (p < 0.001). The average mean dose to VAs for IMPT was 35.2% (23.4–46.9%), which was less compared to VMAT (p < 0.001). Adequate dose coverage was achieved with both IMPT and VMAT plans for three different dose levels of target volumes for all patients. IMPT significantly reduces VA dose while maintaining adequate dose coverage of all target volumes. For patients with head and neck cancer who seek to preserve their blood flow to the brain in order to decrease late vascular and neurologic sequelae, IMPT should be considered. A prospective study with longer follow-up is ongoing to confirm our preliminary results.
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Affiliation(s)
- Yun-Hsuan Lin
- Department of Radiation Oncology and Proton & Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-H.L.); (J.-Y.C.); (B.-S.H.); (S.-Y.C.); (P.-J.J.); (S.-H.L.); (E.-Y.H.)
| | - Jen-Yu Cheng
- Department of Radiation Oncology and Proton & Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-H.L.); (J.-Y.C.); (B.-S.H.); (S.-Y.C.); (P.-J.J.); (S.-H.L.); (E.-Y.H.)
| | - Bing-Shen Huang
- Department of Radiation Oncology and Proton & Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-H.L.); (J.-Y.C.); (B.-S.H.); (S.-Y.C.); (P.-J.J.); (S.-H.L.); (E.-Y.H.)
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
- Department of Radiation Oncology, Xiamen Chang Gung Hospital, Xiamen 361126, China
| | - Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan;
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan;
| | - Shang-Yu Chou
- Department of Radiation Oncology and Proton & Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-H.L.); (J.-Y.C.); (B.-S.H.); (S.-Y.C.); (P.-J.J.); (S.-H.L.); (E.-Y.H.)
| | - Pei-Jiuan Juang
- Department of Radiation Oncology and Proton & Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-H.L.); (J.-Y.C.); (B.-S.H.); (S.-Y.C.); (P.-J.J.); (S.-H.L.); (E.-Y.H.)
| | - Shen-Hao Li
- Department of Radiation Oncology and Proton & Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-H.L.); (J.-Y.C.); (B.-S.H.); (S.-Y.C.); (P.-J.J.); (S.-H.L.); (E.-Y.H.)
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Eng-Yen Huang
- Department of Radiation Oncology and Proton & Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-H.L.); (J.-Y.C.); (B.-S.H.); (S.-Y.C.); (P.-J.J.); (S.-H.L.); (E.-Y.H.)
- Department of Radiation Oncology, Xiamen Chang Gung Hospital, Xiamen 361126, China
- School of Traditional Chinese Medicine, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan
| | - Yu-Ming Wang
- Department of Radiation Oncology and Proton & Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (Y.-H.L.); (J.-Y.C.); (B.-S.H.); (S.-Y.C.); (P.-J.J.); (S.-H.L.); (E.-Y.H.)
- Department of Radiation Oncology, Xiamen Chang Gung Hospital, Xiamen 361126, China
- School of Traditional Chinese Medicine, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan
- Correspondence: ; Tel.: +886-(7)-7317123 (ext. 7000); Fax: +886-(7)-7322813
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Lee JW, Lee JE, Park J, Sohn JH, Ahn D. Hypofractionated radiotherapy for early glottic cancer: a retrospective interim analysis of a single institution. Radiat Oncol J 2019; 37:82-90. [PMID: 31266289 PMCID: PMC6610011 DOI: 10.3857/roj.2019.00143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/17/2019] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To evaluate the results of hypofractionated radiotherapy (HFX) for early glottic cancer. MATERIALS AND METHODS Eighty-five patients with cT1-2N0M0 squamous cell carcinoma of the glottis who had undergone HFX, performed using intensity-modulated radiotherapy (IMRT, n = 66) and three-dimensional conformal radiotherapy (3D CRT, n = 19) were analyzed. For all patients, radiotherapy was administered at 60.75 Gy in 27 fractions. Forty-three patients received a simultaneous integrated boost (SIB) of 2.3-2.5 Gy per tumor fraction. RESULTS The median follow-up duration was 29.9 months (range, 5.5 to 76.5 months). All patients achieved complete remission at a median of 50 days after the end of radiotherapy (range, 14 to 206 days). The 5-year rates for locoregional recurrence-free survival was 88.1%, and the 5-year overall survival rate was 86.2%. T2 stage was a prognostic factor for locoregional recurrencefree survival after radiotherapy (p = 0.002). SIB for the tumor did not affect disease control and survival (p = 0.191 and p = 0.387, respectively). No patients experienced acute or chronic toxicities of ≥grade 3. IMRT significantly decreased the dose administered to the carotid artery as opposed to 3D CRT (V35, p < 0.001; V50, p < 0.001). Conclusions Patients treated with HFX achieved acceptable locoregional disease control rates and overall survival rates compared with previous HFX studies. A fraction size of 2.25 Gy provided good disease control regardless of SIB administration.
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Affiliation(s)
- Jeong Won Lee
- Department of Radiation Oncology, Catholic University of Daegu, School of Medicine, Daegu, Korea
| | - Jeong Eun Lee
- Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Junhee Park
- Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jin Ho Sohn
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dongbin Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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Partial Laryngeal IMRT for T2N0 Glottic Cancer: Impact of Image Guidance and Radiation Therapy Intensification. Int J Radiat Oncol Biol Phys 2018; 102:941-949. [DOI: 10.1016/j.ijrobp.2018.03.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/08/2018] [Accepted: 03/22/2018] [Indexed: 11/23/2022]
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Liao W, Zhou H, Fan S, Zheng Y, Zhang B, Zhao Z, Xiao S, Bai S, Liu J. Comparison of Significant Carotid Stenosis for Nasopharyngeal Carcinoma between Intensity-Modulated Radiotherapy and Conventional Two-Dimensional Radiotherapy. Sci Rep 2018; 8:13899. [PMID: 30224668 PMCID: PMC6141472 DOI: 10.1038/s41598-018-32398-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 08/31/2018] [Indexed: 12/24/2022] Open
Abstract
Radiotherapy (RT) serves as the most efficient treatment for nasopharyngeal carcinoma (NPC) and can cause carotid stenosis. This work compared the incidence of significant carotid stenosis between intensity-modulated radiotherapy (IMRT) and two-dimensional conventional radiotherapy (2D-RT) for NPC and explored the risk factors. We retrospectively reviewed 233 cases with NPC who underwent carotid ultrasound post IMRT or 2D-RT from 2006 to 2015. The incidence of significant stenosis after RT was 19.3%. Significant stenosis was identified in 20 (14.6%) of 137 patients treated with IMRT and 25 (26.0%) of 96 patients with 2D-RT, respectively (p = 0.035). Multivariate logistic analysis indicated age (odds ratio = 1.054, 95% CI = 1.011-1.099, p = 0.014), radiation technique (IMRT) (odds ratio = 0.471, 95%CI = 0.241-0.919, p = 0.027) and time interval (odds ratio = 1.068, 95%CI = 1.033-1.105, p = 0.001) as independent predictors for significant carotid stenosis. Our study suggests that IMRT was associated with decreased incidence of significant carotid stenosis versus 2D-RT for NPC. Prevention and carotid ultrasound should be considered for older NPC survivors with longer interval from RT, especially those treated with 2D-RT.
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Affiliation(s)
- Wang Liao
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, 02478, USA
| | - Haihong Zhou
- Department of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524000, China
| | - Shengnuo Fan
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Yuqiu Zheng
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Bei Zhang
- Department of Neurology, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, 510080, China
| | - Zhongyan Zhao
- Department of Neurology, People's Hospital of Hainan Province, Haikou, 570311, China
| | - Songhua Xiao
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Shoumin Bai
- Department of Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
| | - Jun Liu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
- Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China.
- Laboratory of RNA and Major Diseases of Brain and Heart, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
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Yu T, Wee CW, Choi N, Wu HG, Kang HC, Park JM, Kim JI, Kim JH, Kwon TK, Chung EJ. Study design and early result of a phase I study of SABR for early-stage glottic cancer. Laryngoscope 2018; 128:2560-2565. [DOI: 10.1002/lary.27226] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 03/06/2018] [Accepted: 03/20/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Tosol Yu
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Chan Woo Wee
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Noorie Choi
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Hong-Gyun Wu
- Institute of Radiation Medicine, Medical Research Center; Seoul National University; Seoul Republic of Korea
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institution; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Hyun-Cheol Kang
- Institute of Radiation Medicine, Medical Research Center; Seoul National University; Seoul Republic of Korea
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institution; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Jong Min Park
- Institute of Radiation Medicine, Medical Research Center; Seoul National University; Seoul Republic of Korea
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institution; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Jung-In Kim
- Institute of Radiation Medicine, Medical Research Center; Seoul National University; Seoul Republic of Korea
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institution; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Jin Ho Kim
- Institute of Radiation Medicine, Medical Research Center; Seoul National University; Seoul Republic of Korea
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institution; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Tack-Kyun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul Republic of Korea
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Optimal collimator rotation based on the outline of multiple brain targets in VMAT. Radiat Oncol 2018; 13:88. [PMID: 29739431 PMCID: PMC5941375 DOI: 10.1186/s13014-018-1039-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/30/2018] [Indexed: 12/11/2022] Open
Abstract
Background The aim of this study was to investigate the dosimetric quality in volumetric modulated arc therapy (VMAT) plans with optimal collimator angles that can represent the outline of multiple brain targets. Methods Twenty patients with multiple target volumes in the brain cases were selected retrospectively. To better represent the outline of the multiple brain targets, four conformal arc plans were generated for each patient using one full arc with four collimator settings. The optimal collimator angles calculated from the integrated multi-leaf collimator (MLC) aperture that had the smallest aperture size for certain collimator settings of the conformal arc plan were selected. VMAT plans with the optimal collimator angles with angular sections of 40° and 60° (Colli-VMAT (40°), Colli-VMAT (60°)) were generated, followed by evaluation of field sizes, dose-volumetric parameters and total monitor units (MUs). Results Patient-averaged values of field sizes for Colli-VMAT (40°) (111.5 cm2) were lowest and 1.3 times smaller than those for Std-VMAT (143.6 cm2). Colli-VMAT plans improved sparing of most normal organs but for brain stem and left parotid gland. For the total MUs, the averaged values obtained with the Colli-VMAT (40°) (390 ± 148 MU) were smaller than those obtained with the Std-VMAT (472 ± 235 MU). Conclusions The Colli-VMAT plans with smaller angular sections could be suitable in the clinic for multiple brain targets as well as for irregularly shaped targets. Determination of the optimal collimator rotation generally showed good normal tissue sparing and MU reduction for multiple brain targets.
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Choi HS, Jo GS, Chae JP, Lee SB, Kim CH, Jeong BK, Jeong H, Lee YH, Ha IB, Kang KM, Song JH. Defining the Optimal Time of Adaptive Replanning in Prostate Cancer Patients with Weight Change during Volumetric Arc Radiotherapy: A Dosimetric and Mathematical Analysis Using the Gamma Index. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2017; 2017:4149591. [PMID: 29403539 PMCID: PMC5748323 DOI: 10.1155/2017/4149591] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/24/2017] [Accepted: 11/06/2017] [Indexed: 12/25/2022]
Abstract
We evaluated the changes in the dose distribution of radiation during volumetric arc radiotherapy (VMAT), to determine the right time for adaptive replanning in prostate cancer patients with progressive weight (WT) changes. Five prostate cancer patients treated with VMAT were selected for dosimetric analysis. On the original computed tomography images, nine artificial body contours were created to reflect progressive WT changes. Combined with three different photon energies (6, 10, and 15-MV), 27 comparable virtual VMAT plans were created per patient. The dosimetric analysis included evaluation of target coverage (D95%, Dmax), conformity index, homogeneity index, and organs at risk doses. The dose differences among the plans were determined using the gamma index analysis and were compared with the dosimetric analysis. Mean D95% became lower than 98% when body contour expanded by 2.0 cm or more and Dmax became higher than 107% when body contour contracted by 1.5 cm or more in 10-MV plans. This cut-off values correlated well with gamma index analysis results. Adaptive replanning should, therefore, be considered if the depth of body contour becomes 1.5 cm smaller (WT loss) or 2.0 cm larger (WT gain) in patients treated by VMAT with 10-MV photons.
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Affiliation(s)
- Hoon Sik Choi
- Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, Republic of Korea
| | - Guang Sub Jo
- Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, Republic of Korea
| | - Jong Pyo Chae
- Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, Republic of Korea
| | - Sang Bong Lee
- Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, Republic of Korea
| | - Chul Hang Kim
- Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, Republic of Korea
| | - Bae Kwon Jeong
- Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
- Institute of Health Science, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - Hojin Jeong
- Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
- Institute of Health Science, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - Yun Hee Lee
- Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
- Institute of Health Science, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - In Bong Ha
- Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
| | - Ki Mun Kang
- Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
- Institute of Health Science, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - Jin Ho Song
- Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, Republic of Korea
- Institute of Health Science, Gyeongsang National University, Jinju 52727, Republic of Korea
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11
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Park JM, Park SY, Chun M, Kim ST. On-site audits to investigate the quality of radiation physics of radiation therapy institutions in the Republic of Korea. Phys Med 2017; 40:110-114. [PMID: 28784573 DOI: 10.1016/j.ejmp.2017.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/30/2017] [Accepted: 07/30/2017] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To investigate and improve the domestic standard of radiation therapy in the Republic of Korea. METHODS On-site audits were performed for 13 institutions in the Republic of Korea. Six items were investigated by on-site visits of each radiation therapy institution, including collimator, gantry, and couch rotation isocenter check; coincidence between light and radiation fields; photon beam flatness and symmetry; electron beam flatness and symmetry; physical wedge transmission factors; and photon beam and electron beam outputs. RESULTS The average deviations of mechanical collimator, gantry, and couch rotation isocenter were less than 1mm. Those of radiation isocenter were also less than 1mm. The average difference between light and radiation fields was 0.9±0.6mm for the field size of 20cm×20cm. The average values of flatness and symmetry of the photon beams were 2.9%±0.6% and 1.1%±0.7%, respectively. Those of electron beams were 2.5%±0.7% and 0.6%±1.0%, respectively. Every institutions showed wedge transmission factor deviations less than 2% except one institution. The output deviations of both photon and electron beams were less than ±3% for every institution. CONCLUSIONS Through the on-site audit program, we could effectively detect an inappropriately operating linacs and provide some recommendations. The standard of radiation therapy in Korea is expected to improve through such on-site audits.
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Affiliation(s)
- Jong Min Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Center for Convergence Research on Robotics, Advanced Institutes of Convergence Technology, Suwon, Republic of Korea
| | - So-Yeon Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Center for Convergence Research on Robotics, Advanced Institutes of Convergence Technology, Suwon, Republic of Korea
| | - Minsoo Chun
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang-Tae Kim
- Nuclear Emergency Division, Radiation Protection and Emergency Preparedness Bureau, Nuclear Safety and Security Commission, Seoul, Republic of Korea.
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12
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Yeo SG. Primary lung sarcoma treated with stereotactic ablative radiotherapy: a case report. Onco Targets Ther 2017; 10:3285-3288. [PMID: 28740403 PMCID: PMC5505615 DOI: 10.2147/ott.s138595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Primary lung sarcoma (PLS) is an extremely rare, very aggressive malignancy. Surgical removal is considered the treatment of choice, and patients who have been given conventional radiotherapy have had inferior outcomes. This study is the first describing a case of PLS treated with stereotactic ablative radiotherapy (SABR), which precisely targets a small tumor with a markedly higher biologically effective dose than conventional radiotherapy. The patient was an 82-year-old man who was diagnosed with primary lung leiomyosarcoma based on radiology, pathology, and immunohistochemical examinations. The PLS was located in the right lower lobe and measured 2.5 cm. No regional nodal or distant organ metastasis was observed. He was inoperable medically. The SABR was performed using volumetric modulated arc therapy and a dose of 56 Gy in four fractions. Follow-up computed tomography 2 months after SABR revealed a complete tumor response. The toxicity was limited to mild respiratory symptoms. The patient is alive and has had no evidence of disease for 2 years. This study suggests that SABR can be a safe and effective treatment option for PLS.
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Affiliation(s)
- Seung-Gu Yeo
- Department of Radiation Oncology, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Cheonan, Republic of Korea
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13
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Gamma analysis with a gamma criterion of 2%/1 mm for stereotactic ablative radiotherapy delivered with volumetric modulated arc therapy technique: a single institution experience. Oncotarget 2017; 8:76076-76084. [PMID: 29100293 PMCID: PMC5652687 DOI: 10.18632/oncotarget.18530] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/02/2017] [Indexed: 01/13/2023] Open
Abstract
To report a single-institution experience of gamma evaluations with 2%/1 mm for stereotactic ablative radiotherapy (SABR) delivered with volumetric modulated arc therapy (VMAT) technique, from January 2014 to January 2016. A total of 168 SABR VMAT plans were analyzed with a gamma criterion of 2%/1 mm, a threshold value of 10%, and a tolerance level of 90%. Of the 168 cases, four cases failed with 2%/1 mm. The average passing rate was 97.0% ± 2.5%. Three of the four failed cases showed passing rates higher than 90%, which was achieved by shifting the measuring device by 1 mm in the left-to-right or anterior-to-posterior directions. One failed case showed a passing rate higher than 90%, which was achieved by changing the threshold value from 10% to 5%, leading to an increase in the number of tested points from 26 to 51. Concerns regarding the high susceptibility of the gamma criterion of 2%/1 mm to setup errors of the measuring device are unnecessary based on our two-year experience, since only four cases failed with the 2%/1 mm from a total of 168 clinical cases. Therefore, the gamma criterion of 2%/1 mm could be successfully applied in the clinic with its high sensitivity to detect errors in VMAT plans.
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14
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Ahn BS, Park SY, Park JM, Choi CH, Chun M, Kim JI. Dosimetric effects of sectional adjustments of collimator angles on volumetric modulated arc therapy for irregularly-shaped targets. PLoS One 2017; 12:e0174924. [PMID: 28384262 PMCID: PMC5383152 DOI: 10.1371/journal.pone.0174924] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 03/18/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To calculate an optimal collimator angle at each of sectional arcs in a full-arc volumetric modulated arc therapy (VMAT) plan and evaluate dosimetric quality of these VMAT plans comparing full-arc VMAT plans with a fixed collimator angle. METHODS Seventeen patients who had irregularly-shaped target in abdominal, head and neck, and chest cases were selected retrospectively. To calculate an optimal collimator angle at each of sectional arcs in VMAT, integrated MLC apertures which could cover all shapes of target determined by beam's-eye view (BEV) within angular sections were obtained for each VMAT plan. The angular sections were 40°, 60°, 90° and 120°. When the collimator settings were rotated at intervals of 2°, we obtained the optimal collimator angle to minimize area size difference between the integrated MLC aperture and collimator settings with 5 mm-margins to the integrated MLC aperture. The VMAT plans with the optimal collimator angles (Colli-VMAT) were generated in the EclipseTM. For comparison purposes, one full-arc VMAT plans with a fixed collimator angles (Std-VMAT) were generated. The dose-volumetric parameters and total MUs were evaluated. RESULTS The mean dose-volumetric parameters for target volume of Colli-VMAT were comparable to Std-VMAT. Colli-VMAT improved sparing of most normal organs but for brain stem, compared to Std-VMAT for all cases. There were decreasing tendencies in mean total MUs with decreasing angular section. The mean total MUs for Colli-VMAT with the angular section of 40° (434 ± 95 MU, 317 ± 81 MU, and 371 ± 43 MU for abdominal, head and neck, and chest cases, respectively) were lower than those for Std-VMAT (654 ± 182 MU, 517 ± 116 MU, and 533 ± 25 MU, respectively). CONCLUSIONS For an irregularly-shaped target, Colli-VMAT with the angular section of 40° reduced total MUs and improved sparing of normal organs, compared to Std-VMAT.
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Affiliation(s)
- Beom Seok Ahn
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Yeon Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Jong Min Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- Center for Convergence Research on Robotics, Advanced Institutes of Convergence Technology, Suwon, Republic of Korea
| | - Chang Heon Choi
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Minsoo Chun
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Jung-in Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
- * E-mail:
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15
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Choi CH, Park SY, Kim JI, Kim JH, Kim K, Carlson J, Park JM. Quality of tri-Co-60 MR-IGRT treatment plans in comparison with VMAT treatment plans for spine SABR. Br J Radiol 2016; 90:20160652. [PMID: 27781486 DOI: 10.1259/bjr.20160652] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To investigate the plan quality of tri-Co-60 intensity-modulated radiation therapy (IMRT) plans for spine stereotactic ablative radiotherapy (SABR). METHODS A total of 20 patients with spine metastasis were retrospectively selected. For each patient, a tri-Co-60 IMRT plan and a volumetric-modulated arc therapy (VMAT) plan were generated. The spinal cords were defined based on MR images for the tri-Co-60 IMRT, while isotropic 1-mm margins were added to the spinal cords for the VMAT plans. The VMAT plans were generated with 10-MV flattening filter-free photon beams of TrueBeam STx™ (Varian Medical Systems, Palo Alto, CA), while the tri-Co-60 IMRT plans were generated with the ViewRay™ system (ViewRay inc., Cleveland, OH). The initial prescription dose was 18 Gy (1 fraction). If the tolerance dose of the spinal cord was not met, the prescription dose was reduced until the spinal cord tolerance dose was satisfied. RESULTS The mean dose to the target volumes, conformity index and homogeneity index of the VMAT and tri-Co-60 IMRT were 17.8 ± 0.8 vs 13.7 ± 3.9 Gy, 0.85 ± 0.20 vs 1.58 ± 1.29 and 0.09 ± 0.04 vs 0.24 ± 0.19, respectively. The integral doses and beam-on times were 16,570 ± 1768 vs 22,087 ± 2.986 Gy cm3 and 3.95 ± 1.13 vs 48.82 ± 10.44 min, respectively. CONCLUSION The tri-Co-60 IMRT seems inappropriate for spine SABR compared with VMAT. Advances in knowledge: For spine SABR, the tri-Co-60 IMRT is inappropriate owing to the large penumbra, large leaf width and low dose rate of the ViewRay system.
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Affiliation(s)
- Chang Heon Choi
- 1 Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.,2 Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea.,3 Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Yeon Park
- 1 Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.,2 Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea.,3 Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-In Kim
- 1 Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.,2 Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea.,3 Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin Ho Kim
- 1 Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.,2 Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea.,3 Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyubo Kim
- 4 Department of Radiation Oncology, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Joel Carlson
- 5 Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
| | - Jong Min Park
- 1 Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.,2 Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea.,3 Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.,6 Center for Convergence Research on Robotics, Advance Institutes of Convergence Technology, Suwon, Republic of Korea
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