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Tan IZ, Mitchell A, McNair H, Dunlop A, Herbert T, Nartey J, Lawes R, O'Connell N, De-Colle C, Han K, Hahn E, Nelms B, Russell N, Kirby A. A Multicenter Study of Clinical to Planning Target Volume Margins for Adjuvant Partial Breast Irradiation Delivered on the 1.5T MR-Linear Accelerator. Int J Radiat Oncol Biol Phys 2023; 117:e725. [PMID: 37786112 DOI: 10.1016/j.ijrobp.2023.06.2237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Adjuvant partial breast irradiation (APBI) for early-stage breast cancer patients delivered on a conventional Linac commonly uses a clinical to planning target volume (CTV-PTV) margin of 10 mm. Published data suggest this margin could be reduced using an MR-guided workflow. This study quantifies the CTV to PTV margin for APBI delivered on the 1.5T MR-Linac (MRL) using an Adapt to Position (ATP) workflow. MATERIALS/METHODS All target contouring was done as per the IMPORT LOW trial and MRL Consortium guidelines. The CTV is the tumor bed defined by surgical clips including postsurgical changes. A single center cohort of ten patients was used to assess delineation error on ProKnow DS v1.28.0 by measuring CTV contour displacements on the CT planning scans (pCT) delineated by five breast radiation oncologists. All other error components were measured on treatment planning software on another single center cohort of ten patients. Target deformation error was measured as surgical clip displacements between the pCT and daily pre-treatment (pre-Tx) MRI scans. Intrafraction motion was determined by the CTV displacement between pre- and post-treatment MRIs (post-Tx) in available paired images from five patients. Matching error was estimated as the interobserver variation of three MRL radiographers registering the pCT with daily pre-Tx MRI. Technical delivery accuracy was estimated using the results from routine quality assurance measurements. Beam penumbral width (p) was estimated from the clinical treatment plans. The systematic (Σ) and random errors (σ) for each component were calculated in the left/right (X), superior/inferior (Y) and anterior/posterior (Z) directions. The contribution of these errors to the PTV margin, M was calculated using van Herk's formula with α and β being 2.50 and 1.64 respectively. RESULTS For APBI using an MRL ATP workflow, a CTV-PTV margin of 5.7 to 7.6 mm is required to achieve a 90% confidence of CTV coverage by the 95% isodose. Individual error components are in. Table 1 delineation error remains the largest component of error. CONCLUSION A minimum CTV-PTV margin of 6-8 mm is required for APBI using an MRL ATP workflow. Although smaller than margins used in conventional Linacs, the clinical benefits (in terms of fibrosis risk) of treating APBI patients on an MRL are likely to be modest. Further margin reductions may be possible using an "Adapt to Shape" workflow with daily online recontouring.
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Affiliation(s)
- I Z Tan
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - A Mitchell
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - H McNair
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - A Dunlop
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - T Herbert
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - J Nartey
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - R Lawes
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | | | - C De-Colle
- Tübingen University Hospital, Tübingen, Germany
| | - K Han
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - E Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - B Nelms
- Canis Lupus LLC, Merrimac, WI
| | - N Russell
- Dutch Cancer Institute, Amsterdam, The Netherlands
| | - A Kirby
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
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Lawes R, Barnes H, Herbert T, Mitchell A, Nill S, Oelfke U, Pathmanathan A, Smith GA, Sritharan K, Tree A, McNair H, Dunlop A. MRI-guided adaptive radiotherapy for prostate cancer: When do we need to account for intra-fraction motion? Clin Transl Radiat Oncol 2022; 37:85-88. [PMID: 36118123 PMCID: PMC9471961 DOI: 10.1016/j.ctro.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/01/2022] [Accepted: 09/04/2022] [Indexed: 12/03/2022] Open
Abstract
A shift of the daily plan can mitigate target position changes that occur between daily MR acquisition and treatment for MR-linac radiotherapy, but increases the session time. We demonstrated that our workflow strategy and decision-making process, to determine whether a subsequent shift is necessary, is appropriate.
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Affiliation(s)
- R. Lawes
- Royal Marsden NHS Foundation Trust, United Kingdom
| | - H. Barnes
- Royal Marsden NHS Foundation Trust, United Kingdom
| | - T. Herbert
- Royal Marsden NHS Foundation Trust, United Kingdom
| | - A. Mitchell
- Royal Marsden NHS Foundation Trust, United Kingdom
| | - S. Nill
- Joint Department of Physics, Royal Marsden NHS Foundation Trust, and Institute of Cancer Research, United Kingdom
| | - U. Oelfke
- Joint Department of Physics, Royal Marsden NHS Foundation Trust, and Institute of Cancer Research, United Kingdom
| | - A. Pathmanathan
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, United Kingdom
| | | | - K. Sritharan
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, United Kingdom
| | - A. Tree
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, United Kingdom
| | - H.A. McNair
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, United Kingdom
| | - A. Dunlop
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, United Kingdom
- Joint Department of Physics, Royal Marsden NHS Foundation Trust, and Institute of Cancer Research, United Kingdom
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Smith G, Dunlop A, Alexander S, Barnes H, Herbert T, Lawes R, Murray J, Pathmanathan A, Patel P, Sritharan K, Sundahl N, Westley R, Tree A, McNair H. OC-0465 A comparison of doctor and therapeutic radiographer (RTT) prostate contours on T2 weighted MRI. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02601-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Alexander S, Lawes R, Adair Smith G, Barnes H, Hanson I, Herbert T, Huddart R, Lacey C, McNair H, Mitchell A, Nill S, Ockwell C, Oelfke U, Taylor H, Wetscherek A, Aitken K, Hunt A. PH-0164 Abdominal compression; development of a non-gated pancreas MRIgRT workflow. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07256-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Barnes H, Alexander S, Bower L, Ehlers J, Gani C, Herbert T, Lawes R, Krause P, øller M, Morgan T, Nowee M, Smith G, van Triest B, Tyagi N, Whiteside L, McNair H. PD-0798 Development and results of a patient-reported treatment experience questionnaire on a 1.5 T MR-Linac. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07077-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chick J, Mitchell A, Sullivan J, Herbert T, Lawes R, McNair H, Schmidt M, Nill S, Kirby A, Oelfke U. PO-1766: A clinical solution for electron streaming shielding for partial breast treatments on Unity MRlinac. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01784-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mitchell R, Dunlop A, Chick J, Mohajer J, Goodwin E, Nill S, Lawes R, Herbert T, Kirby A, Oelfke U. PO-1437: Treatment plan robustness analysis for high field MR-linac partial breast plans. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01455-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hunt A, Hanson I, Dunlop A, Bower L, Barnes H, Chick J, Herbert T, Lawes R, McNair H, Mitchell A, Mohajer J, Morgan T, Smith G, Nill S, Oelfke U, Huddart R, Hafeez S. OC-0469: MR-guided online adaptive radiotherapy for muscle invasive bladder cancer: First UK experience. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00491-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hunt A, Hanson I, Dunlop A, Barnes H, Bower L, Chick J, Cruickshank C, Hall E, Herbert T, Lawes R, McQuaid D, McNair H, Mitchell A, Mohajer J, Morgan T, Oelfke U, Smith G, Nill S, Huddart R, Hafeez S. Feasibility of magnetic resonance guided radiotherapy for the treatment of bladder cancer. Clin Transl Radiat Oncol 2020; 25:46-51. [PMID: 33015380 PMCID: PMC7522378 DOI: 10.1016/j.ctro.2020.09.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/03/2020] [Accepted: 09/06/2020] [Indexed: 12/15/2022] Open
Abstract
Whole bladder magnetic resonance image-guided radiotherapy using the 1.5 Telsa MR-linac is feasible. Full online adaptive planning workflow based on the anatomy seen at each fraction was performed. This was delivered within 45 min. Intra-fraction bladder filling did not compromise target coverage. Patients reported acceptable tolerance of treatment.
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Affiliation(s)
- A. Hunt
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - I. Hanson
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - A. Dunlop
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - H. Barnes
- The Royal Marsden NHS Foundation Trust, London, UK
| | - L. Bower
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - J. Chick
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - C. Cruickshank
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - E. Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - T. Herbert
- The Royal Marsden NHS Foundation Trust, London, UK
| | - R. Lawes
- The Royal Marsden NHS Foundation Trust, London, UK
| | - D. McQuaid
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - H. McNair
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - A. Mitchell
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - J. Mohajer
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - T. Morgan
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - U. Oelfke
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - G. Smith
- The Royal Marsden NHS Foundation Trust, London, UK
| | - S. Nill
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - R. Huddart
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - S. Hafeez
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
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Lawes R, Carter E, Hussein M, Murray J, McNair HA. Retrospective audit of inter-fraction motion for pelvic node radiotherapy in prostate cancer patients. Radiography (Lond) 2020; 27:266-271. [PMID: 32830012 DOI: 10.1016/j.radi.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Pelvic lymph nodes move independently to the prostate. When delivering radiotherapy to prostate and pelvic lymph nodes, daily inter- and intra-fraction anatomical changes need to be accounted for. Planning target volume (PTV) margins, grown from the pelvic lymph node clinical target volume need to be determined, to account for this variation in position. METHODS Twenty patients who had daily online image guided radiotherapy to prostate and pelvic lymph nodes between April and December 2018 were selected. Ten pre-treatment verification images using cone beam CT from each patient were registered to pelvic bone anatomy, prostate soft tissue or fiducial markers and pelvic lymph node soft tissue to assess the accuracy of treatment delivery. Population systematic and random errors and PTV margins were calculated. RESULTS PTV margins of 0.4 cm, 0.4 cm and 0.7 cm left-right (LR), superior-inferior (SI) and anterior-posterior (AP) respectively were derived for the pelvic lymph nodes when registering to prostate. PTV margins of 0.3 cm, 0.2 cm and 0.4 cm LR, SI and AP respectively were derived for the pelvic lymph nodes when registering to bone. There was a posterior systematic shift of the prostate during the treatment course. CONCLUSION There is differential motion of pelvic lymph nodes to prostate and in the era of prostate and pelvic radiotherapy for patients with node positive prostate cancer; there is increasing importance in the accuracy of dose delivery to the involved lymph node. Hence, this group of patients may benefit from personalised radiotherapy PTV margins, especially if the involved pelvic lymph node is within the anterior part of the clinical target volume. IMPLICATIONS FOR PRACTICE Optimisation of dose delivery to the pelvic lymph nodes when prioritising the prostate in prostate and pelvic lymph node image guided radiotherapy.
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Affiliation(s)
- R Lawes
- Radiotherapy, Royal Marsden NHS Foundation Trust, UK.
| | - E Carter
- Radiotherapy, Royal Marsden NHS Foundation Trust, UK
| | - M Hussein
- Radiotherapy, Royal Marsden NHS Foundation Trust, UK
| | - J Murray
- Radiotherapy, Royal Marsden NHS Foundation Trust, UK; Academic Urology Unit, Royal Marsden NHS Foundation Trust, UK; Institute of Cancer Research, UK
| | - H A McNair
- Radiotherapy, Royal Marsden NHS Foundation Trust, UK; Institute of Cancer Research, UK
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Shiarli AM, Brown S, Cobben D, Wetscherek A, Dubec M, Herbert T, Smith G, Lawes R, Barnes H, Faivre-Finn C, McDonald F. MRI image acquisition on the MR-Linac for patients with locally advanced lung cancer (LALC). Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30111-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Pathmanathan A, Bower L, Creasey H, Dunlop A, Hall E, Hanson I, Herbert T, Lawes R, McQuaid D, McNair H, Mitchell A, Smith G, Huddart R, Oelfke U, Nill S, Tree A. EP-1566 MR-guided online adaptive radiotherapy: First experience in the UK. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31986-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Smith GA, Herbert T, Lawes R, Creasey H, Dunlop A, Mitchell A, Pathmanathan A, Bower L, Hanson I, McQuaid D, Huddart R, Oelfke U, Nill S, Tree A, McNair H. EP-2173 Bladder filling in patients undergoing prostate radiotherapy on the MR-linac. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32593-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Otter S, Wedlake L, McNair H, Lawes R, Juman C, Andreyev J, Stewart A, Gulliford S. Defining Bowel and Nonsigmoid Bowel Dose Volume Constraints for Pelvic Radiation Therapy in GI Malignancies. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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