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Alexander S, Oelfke U, Westley R, McNair H, Tree A. Prostate cancer image guided radiotherapy: Why the commotion over rectal volume and motion? Clin Transl Radiat Oncol 2023; 43:100685. [PMID: 37842073 PMCID: PMC10570575 DOI: 10.1016/j.ctro.2023.100685] [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: 09/08/2023] [Accepted: 09/24/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Distended rectums on pre-radiotherapy scans are historically associated with poorer outcomes in patients treated with two-dimensional IGRT. Subsequently, strict rectal tolerances and preparation regimes were implemented. Contemporary IGRT, daily online registration to the prostate, corrects interfraction motion but intrafraction motion remains. We re-examine the need for rectal management strategies when using contemporary IGRT by quantifying rectal volume and its effect on intrafraction motion. Materials and methods Pre and during radiotherapy rectal volumes and intrafraction motion were retrospectively calculated for 20 patients treated in 5-fractions and 20 treated in 20-fractions. Small (rectal volume at planning-CT ≤ median), and large (volume > median) subgroups were formed, and rectal volume between timepoints and subgroups compared. Rectal volume and intrafraction motion correlation was examined using Spearman's rho. Intrafraction motion difference between small and large subgroups and between fractions with rectal volume < or ≥ 90 cm3 were assessed. Results Median rectal volume was 74 cm3, 64 cm3 and 65 cm3 on diagnostic-MRI, planning-CT and treatment imaging respectively (ns). No significant correlation was found between patient's rectal volume at planning-CT and median intrafraction motion, nor treatment rectal volume and intrafraction motion for individual fractions. No significant difference in intrafraction motion between small and large subgroups presented and for fractions where rectal volume breached 90 cm3, motion during that fraction was not significantly greater. Conclusion Larger rectal volumes before radiotherapy and during treatment did not cause greater intrafraction motion. Findings support the relaxation of strict rectal diameter tolerances and do not support the need for rectal preparation when delivering contemporary IGRT to the prostate.
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Affiliation(s)
- S.E. Alexander
- The Royal Marsden NHS Foundation Trust, United Kingdom and The Institute of Cancer Research, United Kingdom
| | - U. Oelfke
- The Joint Department of Physics, the Royal Marsden Hospital and the Institute of Cancer Research, United Kingdom
| | - R. Westley
- The Royal Marsden NHS Foundation Trust, United Kingdom and The Institute of Cancer Research, United Kingdom
| | - H.A. McNair
- The Royal Marsden NHS Foundation Trust, United Kingdom and The Institute of Cancer Research, United Kingdom
| | - A.C. Tree
- The Royal Marsden NHS Foundation Trust, United Kingdom and The Institute of Cancer Research, United Kingdom
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Alexander S, Oelfke U, McNair H, Tree A. GI factors, potential to predict prostate motion during radiotherapy; a scoping review. Clin Transl Radiat Oncol 2023; 40:100604. [PMID: 36936470 PMCID: PMC10020110 DOI: 10.1016/j.ctro.2023.100604] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/27/2023] Open
Abstract
Purpose A scoping literature review was conducted to identify gastrointestinal (GI) factors most likely to influence prostate motion during radiotherapy. We proffer that patient specific measurement of these GI factors could predict motion uncertainty during radiotherapy, facilitating personalised care by optimising treatment technique e.g., daily adaption or via bespoke patient pre-habilitation and preparation. Methods The scoping review was undertaken as per JBI guidelines. Searches were conducted across four databases: Ovid Medline®, EMBASE, CINAHL and EBSCO discovery. Articles written in English from 2010-present were included. Those pertaining to paediatrics, biological women exclusively, infectious and post-treatment GI morbidity and diet were excluded.Common GI factors impacting men were identified and related symptoms, incidence and measurement tools examined. Prevalence among persons with prostate cancer was explored and suitable assessment tools discussed. Results A preliminary search identified four prominent GI-factors: mental health, co-morbidity and medication, physical activity, and pelvic floor disorder. The scoping search found 3644 articles; 1646 were removed as duplicates. A further 1249 were excluded after title and abstract screening, 162 remained subsequent to full text review: 42 mental health, 53 co-morbidity and medication, 39 physical activity and 28 pelvic floor disorder.Six GI factors prevalent in the prostate cancer population and estimated most likely to influence prostate motion were identified: depression, anxiety, diabetes, obesity, low physical activity, and pelvic floor disorder. Reliable, quick, and easy to use tools are available to quantify these factors. Conclusion A comprehensive GI factor assessment package suitable to implement into the radiotherapy clinic has been created. Unveiling these GI factors upfront will guide improved personalisation of radiotherapy.
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Affiliation(s)
- S.E. Alexander
- The Royal Marsden NHS Foundation Trust, United Kingdom and The Institute of Cancer Research, United Kingdom
| | - U. Oelfke
- The Joint Department of Physics, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, United Kingdom
| | - H.A. McNair
- The Royal Marsden NHS Foundation Trust, United Kingdom and The Institute of Cancer Research, United Kingdom
| | - A.C. Tree
- The Royal Marsden NHS Foundation Trust, United Kingdom and The Institute of Cancer Research, United Kingdom
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Ingle M, White I, Chick J, Stankiewicz H, Mitchell A, Barnes H, Herbert T, Nill S, Oelfke U, Huddart R, Ng-Cheng-Hin B, Hafeez S, Lalondrelle S, Dunlop A, Bhide S. Understanding the Benefit of Magnetic Resonance-guided Adaptive Radiotherapy in Rectal Cancer Patients: a Single-centre Study. Clin Oncol (R Coll Radiol) 2023; 35:e135-e142. [PMID: 36336579 DOI: 10.1016/j.clon.2022.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/01/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
AIMS Neoadjuvant chemoradiotherapy followed by surgery is the mainstay of treatment for patients with rectal cancer. Standard clinical target volume (CTV) to planning target volume (PTV) margins of 10 mm are used to accommodate inter- and intrafraction motion of target. Treating on magnetic resonance-integrated linear accelerators (MR-linacs) allows for online manual recontouring and adaptation (MRgART) enabling the reduction of PTV margins. The aim of this study was to investigate motion of the primary CTV (CTVA; gross tumour volume and macroscopic nodes with 10 mm expansion to cover microscopic disease) in order to develop a simultaneous integrated boost protocol for use on MR-linacs. MATERIALS AND METHODS Patients suitable for neoadjuvant chemoradiotherapy were recruited for treatment on MR-linac using a two-phase technique; only the five phase 1 fractions on MR-linac were used for analysis. Intrafraction motion of CTVA was measured between pre-treatment and post-treatment MRI scans. In MRgART, isotropically expanded pre-treatment PTV margins from 1 to 10 mm were rigidly propagated to post-treatment MRI to determine overlap with 95% of CTVA. The PTV margin was considered acceptable if overlap was >95% in 90% of fractions. To understand the benefit of MRgART, the same methodology was repeated using a reference computed tomography planning scan for pre-treatment imaging. RESULTS In total, nine patients were recruited between January 2018 and December 2020 with T3a-T4, N0-N2, M0 disease. Forty-five fractions were analysed in total. The median motion across all planes was 0 mm, demonstrating minimal intrafraction motion. A PTV margin of 3 and 5mm was found to be acceptable in 96 and 98% of fractions, respectively. When comparing to the computed tomography reference scan, the analysis found that PTV margins to 5 and 10 mm only acceptably covered 51 and 76% of fractions, respectively. CONCLUSION PTV margins can be reduced to 3-5 mm in MRgART for rectal cancer treatment on MR-linac within an simultaneous integrated boost protocol.
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Affiliation(s)
- M Ingle
- The Royal Marsden Hospital NHS Trust, London, UK; The Institute of Cancer Research, London, UK.
| | - I White
- Guys and St Thomas NHS Trust, London, UK
| | - J Chick
- The Royal Marsden Hospital NHS Trust, London, UK
| | | | - A Mitchell
- The Royal Marsden Hospital NHS Trust, London, UK
| | - H Barnes
- The Royal Marsden Hospital NHS Trust, London, UK
| | - T Herbert
- The Royal Marsden Hospital NHS Trust, London, UK
| | - S Nill
- The Institute of Cancer Research, London, UK
| | - U Oelfke
- The Institute of Cancer Research, London, UK
| | - R Huddart
- The Royal Marsden Hospital NHS Trust, London, UK; The Institute of Cancer Research, London, UK
| | | | - S Hafeez
- The Royal Marsden Hospital NHS Trust, London, UK; The Institute of Cancer Research, London, UK
| | - S Lalondrelle
- The Royal Marsden Hospital NHS Trust, London, UK; The Institute of Cancer Research, London, UK
| | - A Dunlop
- The Royal Marsden Hospital NHS Trust, London, UK
| | - S Bhide
- The Royal Marsden Hospital NHS Trust, London, UK; The Institute of Cancer Research, London, UK
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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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Alexander SE, McNair HA, Oelfke U, Huddart R, Murray J, Pathmanathan A, Patel P, Sritharan K, van As N, Tree AC. Prostate Volume Changes during Extreme and Moderately Hypofractionated Magnetic Resonance Image-guided Radiotherapy. Clin Oncol (R Coll Radiol) 2022; 34:e383-e391. [PMID: 35469741 DOI: 10.1016/j.clon.2022.03.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/04/2022] [Accepted: 03/30/2022] [Indexed: 11/16/2022]
Abstract
AIMS Prostate morphological changes during external beam radiotherapy are poorly understood. Excellent soft-tissue visualisation offered by magnetic resonance image-guided radiotherapy (MRIgRT) provides an opportunity to better understand such changes. The aim of this study was to quantify prostate volume and dimension changes occurring during extreme and moderately hypofractionated schedules. MATERIALS AND METHODS Forty prostate cancer patients treated on the Unity 1.5 Tesla magnetic resonance linear accelerator (MRL) were retrospectively reviewed. The cohort comprised patients treated with 36.25 Gy in five fractions (n = 20) and 60 Gy in 20 fractions (n = 20). The volume of the delineated prostates on reference planning computed tomography (fused with MRI) and daily T2-weighted 2-min session images acquired on Unity were charted. Forty planning computed tomography and 500 MRL prostate volumes were evaluated. The mean absolute and relative change in prostate volume during radiotherapy was compared using a paired t-test (P value <0.01 considered significant to control for multiple comparisons). The maximum dimension of the delineated prostate was measured in three isocentric planes. RESULTS Significant prostate volume changes, relative to MRL imaging fraction 1 (MRL#1), were seen at all time points for the five-fraction group. The peak mean relative volume increase was 21% (P < 0.001), occurring at MRL#3 and MRL#4 after 14.5 and 21.75 Gy, respectively. Prostate expansion was greatest in the superior-inferior direction; the peak mean maximal extension was 5.9 mm. The maximal extension in the left-right and anterior-posterior directions measured 1.1 and 2.2 mm, respectively. For the 20-fraction group, prostate volume increased relative to MRL#1, for all treatment time points. The mean relative volume increase was 11% (P < 0.001) at MRL#5 after 12 Gy, it then fluctuated between 8 and 13%. From MRL#5 to MRL#20, the volume increase was significant (P < 0.01) for 12 of 16 time points calculated. The peak mean maximal extension in the superior-inferior direction was 3.1 mm. The maximal extension in the left-right and anterior-posterior directions measured 1.7 and 3.7 mm, respectively. CONCLUSION Significant prostate volume and dimension changes occur during extreme and moderately hypofractionated radiotherapy. The extent of change was greater during extreme hypofractionation. MRIgRT offers the opportunity to reveal, quantify and correct for this deformation.
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Affiliation(s)
- S E Alexander
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK.
| | - H A McNair
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK
| | - U Oelfke
- The Joint Department of Physics, The Royal Marsden Hospital and the Institute of Cancer Research, London, UK
| | - R Huddart
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK
| | - J Murray
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK
| | - A Pathmanathan
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK
| | - P Patel
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK
| | - K Sritharan
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK
| | - N van As
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK
| | - A C Tree
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK
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Mitchell A, Ingle M, Smith G, Chick J, Diamantopoulos S, Goodwin E, Herbert T, Huddart R, McNair H, Oelfke U, Nill S, Dunlop A, Hafeez S. Feasibility of tumour-focused adaptive radiotherapy for bladder cancer on the MR-linac. Clin Transl Radiat Oncol 2022; 35:27-32. [PMID: 35571274 PMCID: PMC9092067 DOI: 10.1016/j.ctro.2022.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/07/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 11/23/2022] Open
Abstract
Bladder tumour-focused magnetic resonance image-guided adaptive radiotherapy using a 1.5 Tesla MR-linac is feasible. A full online workflow adapting to anatomy at each fraction is achievable in approximately 30 min. Intra-fraction bladder filling did not compromise target coverage with the class solution employed.
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Affiliation(s)
- A. Mitchell
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - M. Ingle
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - G. Smith
- The Royal Marsden NHS Foundation Trust, London, UK
| | - J. Chick
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - S. Diamantopoulos
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - E. Goodwin
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - T. Herbert
- 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
| | - H. McNair
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - U. Oelfke
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - S. Nill
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - A. Dunlop
- The Joint Department of Physics, The Institute of Cancer Research and 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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Alexander S, Chick J, Herbert T, Huddart R, Ingle M, Mitchell A, Nill S, Oelfke U, Dunlop A, Hafeez S. MO-0312 Systematic multi-disciplinary sequence evaluation for integration into the MR-linac workflow. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02344-1] [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: 11/24/2022]
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Bainbridge H, Dunlop A, McQuaid D, Gulliford S, Gunapala R, Ahmed M, Locke I, Nill S, Oelfke U, McDonald F. A Comparison of Isotoxic Dose-escalated Radiotherapy in Lung Cancer with Moderate Deep Inspiration Breath Hold, Mid-ventilation and Internal Target Volume Techniques. Clin Oncol (R Coll Radiol) 2022; 34:151-159. [PMID: 34503896 DOI: 10.1016/j.clon.2021.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/31/2021] [Accepted: 08/23/2021] [Indexed: 12/25/2022]
Abstract
AIMS With interest in normal tissue sparing and dose-escalated radiotherapy in the treatment of inoperable locally advanced non-small cell lung cancer, this study investigated the impact of motion-managed moderate deep inspiration breath hold (mDIBH) on normal tissue sparing and dose-escalation potential and compared this to planning with a four-dimensional motion-encompassing internal target volume or motion-compensating mid-ventilation approach. MATERIALS AND METHODS Twenty-one patients underwent four-dimensional and mDIBH planning computed tomography scans. Internal and mid-ventilation target volumes were generated on the four-dimensional scan, with mDIBH target volumes generated on the mDIBH scan. Isotoxic target dose-escalation guidelines were used to generate six plans per patient: three with a target dose cap and three without. Target dose-escalation potential, normal tissue complication probability and differences in pre-specified dose-volume metrics were evaluated for the three motion-management techniques. RESULTS The mean total lung volume was significantly greater with mDIBH compared with four-dimensional scans. Lung dose (mean and V21 Gy) and mean heart dose were significantly reduced with mDIBH in comparison with four-dimensional-based approaches, and this translated to a significant reduction in heart and lung normal tissue complication probability with mDIBH. In 20/21 patients, the trial target prescription dose cap of 79.2 Gy was achievable with all motion-management techniques. CONCLUSION mDIBH aids lung and heart dose sparing in isotoxic dose-escalated radiotherapy compared with four-dimensional planning techniques. Given concerns about lung and cardiac toxicity, particularly in an era of consolidation immunotherapy, reduced normal tissue doses may be advantageous for treatment tolerance and outcome.
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Affiliation(s)
- H Bainbridge
- Department of Radiotherapy at The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK
| | - A Dunlop
- Joint Department of Physics at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK
| | - D McQuaid
- Joint Department of Physics at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK
| | - S Gulliford
- Joint Department of Physics at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK
| | - R Gunapala
- Department of Statistics at The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - M Ahmed
- Department of Radiotherapy at The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK
| | - I Locke
- Department of Radiotherapy at The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - S Nill
- Joint Department of Physics at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK
| | - U Oelfke
- Joint Department of Physics at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK
| | - F McDonald
- Department of Radiotherapy at The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK.
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Oelfke U. SP-0702 Online adaptive therapy: From CBCT to MRI and the other way around. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08680-1] [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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Goodwin E, Nilawar R, Nill S, Oelfke U. PO-1756 Real time motion-including dose reconstruction on the MR-Linac. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08207-4] [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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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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Bernstein D, Taylor A, Nill S, Imseeh G, Kothari G, Llewelyn M, De Paepe KN, Rockall A, Shiarli AM, Oelfke U. An Inter-observer Study to Determine Radiotherapy Planning Target Volumes for Recurrent Gynaecological Cancer Comparing Magnetic Resonance Imaging Only With Computed Tomography-Magnetic Resonance Imaging. Clin Oncol (R Coll Radiol) 2021; 33:307-313. [PMID: 33640196 PMCID: PMC8051139 DOI: 10.1016/j.clon.2021.02.003] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/11/2021] [Accepted: 02/05/2021] [Indexed: 11/25/2022]
Abstract
AIMS Target delineation uncertainty is arguably the largest source of geometric uncertainty in radiotherapy. Several factors can affect it, including the imaging modality used for delineation. It is accounted for by applying safety margins to the target to produce a planning target volume (PTV), to which treatments are designed. To determine the margin, the delineation uncertainty is measured as the delineation error, and then a margin recipe used. However, there is no published evidence of such analysis for recurrent gynaecological cancers (RGC). The aims of this study were first to quantify the delineation uncertainty for RGC gross tumour volumes (GTVs) and to calculate the associated PTV margins and then to quantify the difference in GTV, delineation uncertainty and PTV margin, between a computed tomography-magnetic resonance imaging (CT-MRI) and MRI workflow. MATERIALS AND METHODS Seven clinicians delineated the GTV for 20 RGC tumours on co-registered CT and MRI datasets (CT-MRI) and on MRI alone. The delineation error, the standard deviation of distances from each clinician's outline to a reference, was measured and the required PTV margin determined. Differences between using CT-MRI and MRI alone were assessed. RESULTS The overall delineation error and the resulting margin were 3.1 mm and 8.5 mm, respectively, for CT-MRI, reducing to 2.5 mm and 7.1 mm, respectively, for MRI alone. Delineation errors and therefore the theoretical margins, varied widely between patients. MRI tumour volumes were on average 15% smaller than CT-MRI tumour volumes. DISCUSSION This study is the first to quantify delineation error for RGC tumours and to calculate the corresponding PTV margin. The determined margins were larger than those reported in the literature for similar patients, bringing into question both current margins and margin calculation methods. The wide variation in delineation error between these patients suggests that applying a single population-based margin may result in PTVs that are suboptimal for many. Finally, the reduced tumour volumes and safety margins suggest that patients with RGC may benefit from an MRI-only treatment workflow.
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Affiliation(s)
- D Bernstein
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK.
| | - A Taylor
- Gynaecology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - S Nill
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, London, UK
| | - G Imseeh
- Gynaecology Unit, Royal Marsden NHS Foundation Trust, London, UK; Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, London, UK
| | - G Kothari
- Gynaecology Unit, Royal Marsden NHS Foundation Trust, London, UK; Peter MacCallum Cancer Center, Melbourne, Victoria, Australia
| | - M Llewelyn
- Gynaecology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - K N De Paepe
- Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, London, UK; Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Rockall
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, UK; Department of Surgery and Cancer, Imperial College London, London, UK
| | - A-M Shiarli
- Gynaecology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - U Oelfke
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, London, UK
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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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15
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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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16
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Eiben B, Tran E, Wetscherek A, Shiarli A, Bertholet J, Oelfke U, McClelland J. OC-0338: High-resolution image reconstruction and motion modelling for a lung cancer patient on an MRLinac. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00362-5] [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: 11/28/2022]
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17
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Gurney-Champion O, Kieselmann J, Kee W, Ng-Cheng-Hin B, Newbold K, Harrington K, Oelfke U. OC-0344: Automatic contouring of diffusion-weighted MRI from an MR-Linac using a convolutional neural network. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00368-6] [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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18
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Distefano G, Bertholet J, Poulsen P, Roggen T, Garibaldi C, Tilly N, Booth J, Oelfke U, Heijmen B, Aznar M. OC-0703: Patterns of practice for adaptive and realtime radiation therapy: part I intra-fraction motion. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00725-8] [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: 11/26/2022]
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19
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Oelfke U. SP-0629: For the motion (there is no future for ART without an MR-linac). Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00651-4] [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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20
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Bertholet J, Distefano G, Noble D, Bel A, VanLeeuwen R, Roggen T, Duchateau M, Thørnqvist S, Garibaldi C, Tilly N, Mollá RG, Bonaque J, Oelfke U, Aznar M, Heijmen B. PD-0311: Patterns of practice for adaptive and real-time radiation therapy part II: interfractional changes. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00335-2] [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: 10/22/2022]
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21
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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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22
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Nill S, Hanson I, Costa F, Menten M, Wetscherek A, Oelfke U. PO-1595: MR guided tumour tracking on a high field MR Linac: feasibility and first experimental results. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01613-3] [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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23
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Costa F, Doran SJ, Hanson IM, Adamovics J, Nill S, Oelfke U. Edge effects in 3D dosimetry: characterisation and correction of the non-uniform dose response of PRESAGE ®. Phys Med Biol 2020; 65:095003. [PMID: 32143198 DOI: 10.1088/1361-6560/ab7d52] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Previous work has shown that PRESAGE® can be used successfully to perform 3D dosimetric measurements of complex radiotherapy treatments. However, measurements near the sample edges are known to be difficult to achieve. This is an issue when the doses at air-material interfaces are of interest, for example when investigating the electron return effect (ERE) present in treatments delivered by magnetic resonance (MR)-linac systems. To study this effect, a set of 3.5 cm-diameter cylindrical PRESAGE® samples was uniformly irradiated with multiple dose fractions, using either a conventional linac or an MR-linac. The samples were imaged between fractions using an optical-CT, to read out the corresponding accumulated doses. A calibration between TPS-predicted dose and optical-CT pixel value was determined for individual dosimeters as a function of radial distance from the axis of rotation. This data was used to develop a correction that was applied to four additional samples of PRESAGE® of the same formulation, irradiated with 3D-CRT and IMRT treatment plans, to recover significantly improved 3D measurements of dose. An alternative strategy was also tested, in which the outer surface of the sample was physically removed prior to irradiation. Results show that for the formulation studied here, PRESAGE® samples have a central region that responds uniformly and an edge region of 6-7 mm where there is gradual increase in dosimeter response, rising to an over-response of 24%-36% at the outer boundary. This non-uniform dose response increases in both extent and magnitude over time. Both mitigation strategies investigated were successful. In our four exemplar studies, we show how discrepancies at edges are reduced from 13%-37% of the maximum dose to between 2 and 8%. Quantitative analysis shows that the 3D gamma passing rates rise from 90.4, 69.3, 63.7 and 43.6% to 97.3, 99.9, 96.7 and 98.9% respectively.
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Affiliation(s)
- F Costa
- Joint Department of Physics, The Institute of Cancer Research and Royal Marsden Hospital and, London SM2 5NG, United Kingdom. Author to whom any correspondence should be addressed
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24
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Goodwin E, Nill S, Oelfke U. EP-1806 Commissioning an Independent Dose Calculation System for the Unity MR-Linac. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32226-1] [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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25
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Hanson I, Nill S, Chick J, Oelfke U. PO-1035 Linac commissioning methodology for the Elekta Unity MR Linac. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31455-0] [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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26
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Tran E, Eiben B, Wetscherek A, Oelfke U, Meedt G, Hawkes D, McClelland J. OC-0413 MR-derived signals for respiratory motion models evaluated using sagittal and coronal datasets. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30833-3] [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: 11/15/2022]
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27
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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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28
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Cobben D, Bainbridge H, Belderbos J, Cheung P, Dubec M, Gomez D, Gore E, Knowles E, Lalezari F, Oelfke U, Sonke J, Tijssen R, Van Es C, Van Herk M, Wetscherek A, McDonald F, Faivre-Finn C. EP-1346 A framework for systematic clinical evaluation of the MR-linac for treatment of lung cancer patients. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31766-9] [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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29
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Bertholet J, Hunt A, Dunlop A, Bird T, Mitchell A, Oelfke U, Nill S, Aitken K. EP-1856 Dose escalation potential for hypofractionated radiotherapy in locally advanced pancreatic cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32276-5] [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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30
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Llewelyn M, Smyth G, Lavan N, Nill S, Oelfke U, Mandeville H. PO-0874 The feasibility of MR-Linac treatment planning in childhood abdominal Neuroblastoma. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31294-0] [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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31
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McQuaid D, Niliwar R, Mohajer J, Goodwin E, Nill S, Oelfke U. EP-2014 Decision Support System for Checking Online Adaptive Treatments on the Elekta Unity. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32434-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: 10/26/2022]
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32
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Bertholet J, Eiben B, Menten M, Tran E, Hawkes D, Nill S, McClelland J, Oelfke U. OC-0296 Validation of motion-including dose reconstruction on a ground-truth time-resolved moving anatomy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30716-9] [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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33
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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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34
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Chick J, Hanson I, Nill S, Oelfke U. EP-2110 Developing a QA programme for the Elekta Unity MR-linac. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32530-7] [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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35
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Cobben D, Bainbridge H, Belderbos J, Cheung P, Dubec M, Gomez D, Gore E, Knowles E, Lalezari F, Oelfke U, Sonke J, Tijssen R, Van Es C, Van Herk M, Wetscherek A, Mcdonald F, Faivre-Finn C. A framework for systematic clinical evaluation of technical innovations in lung cancer patients treated on the MR-linac (MRL). Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30184-9] [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: 11/26/2022]
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36
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Lavan NA, Saran FH, Oelfke U, Mandeville HC. Adopting Advanced Radiotherapy Techniques in the Treatment of Paediatric Extracranial Malignancies: Challenges and Future Directions. Clin Oncol (R Coll Radiol) 2019; 31:50-57. [PMID: 30361128 DOI: 10.1016/j.clon.2018.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/01/2018] [Indexed: 12/25/2022]
Abstract
Geometric uncertainties in radiotherapy are conventionally addressed by defining a safety margin around the radiotherapy target. Misappropriation of such margins could result in disease recurrence from geometric miss or unnecessary irradiation of normal tissue. Numerous quantitative organ motion studies in adults have been published, but the first paediatric-specific studies were only published in recent years. In the very near future, intensity-modulated proton beam therapy and magnetic resonance-guided radiotherapy will be clinically implemented in the UK. Such techniques offer the ability to deliver radiotherapy to the pinnacle of precision and accuracy, if geometric uncertainty relating to internal organ motion and deformation can be optimally managed. The optimal margin to account for internal organ motion in children remains largely undefined. Continuing efforts to characterise motion in children and young people is necessary to optimally define safety margins and to realise the full potential of intensity-modulated radiotherapy, magnetic resonance-guided radiotherapy and intensity-modulated proton beam therapy. This overview offers a timely review of published reports on paediatric organ motion, in anticipation of the increasing application of advanced radiotherapy techniques in paediatric radiotherapy.
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Affiliation(s)
- N A Lavan
- The Institute of Cancer Research, Sutton, UK.
| | - F H Saran
- The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - U Oelfke
- Joint Department of Physics at the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Sutton, UK
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37
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Hunt A, Hansen VN, Oelfke U, Nill S, Hafeez S. Adaptive Radiotherapy Enabled by MRI Guidance. Clin Oncol (R Coll Radiol) 2018; 30:711-719. [PMID: 30201276 DOI: 10.1016/j.clon.2018.08.001] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 08/10/2018] [Accepted: 08/20/2018] [Indexed: 12/11/2022]
Abstract
Adaptive radiotherapy (ART) strategies systematically monitor variations in target and neighbouring structures to inform treatment-plan modification during radiotherapy. This is necessary because a single plan designed before treatment is insufficient to capture the actual dose delivered to the target and adjacent critical structures during the course of radiotherapy. Magnetic resonance imaging (MRI) provides superior soft-tissue image contrast over current standard X-ray-based technologies without additional radiation exposure. With integrated MRI and radiotherapy platforms permitting motion monitoring during treatment delivery, it is possible that adaption can be informed by real-time anatomical imaging. This allows greater treatment accuracy in terms of dose delivered to target with smaller, individualised treatment margins. The use of functional MRI sequences would permit ART to be informed by imaging biomarkers, so allowing both personalised geometric and biological adaption. In this review, we discuss ART solutions enabled by MRI guidance and its potential gains for our patients across tumour types.
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Affiliation(s)
- A Hunt
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - V N Hansen
- The Institute of Cancer Research, London, UK; Joint Department of Physics, The Royal Marsden NHS Foundation Trust, London, UK
| | - U Oelfke
- The Institute of Cancer Research, London, UK; Joint Department of Physics, The Royal Marsden NHS Foundation Trust, London, UK
| | - S Nill
- The Institute of Cancer Research, London, UK; Joint Department of Physics, 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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38
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Abstract
Margins are employed in radiotherapy treatment planning to mitigate the dosimetric effects of geometric uncertainties for the clinical target volume (CTV). Unfortunately, whilst the use of margins can increase the probability that sufficient dose is delivered to the CTV, it can also result in delivering high dose of radiation to surrounding organs at risk (OARs). We expand on our previous work on beam-dependent margins and propose a novel adaptive margin concept, where margins are moulded away from selected OARs for better OAR-high-dose sparing, whilst maintaining similar dose coverage probability to the CTV. This, however, comes at a cost of a larger irradiation volume, and thus can negatively impact other structures. We investigate the impact of the adaptive margin concept when applied to prostate radiotherapy treatments, and compare treatment plans generated using our beam-dependent margins without adaptation, with adaption from the rectum and with adaptation from both the rectum and bladder. Five prostate patients were used in this planning study. All plans achieved similar dose coverage probability, and were able to ensure at least 90% population coverage with the target receiving at least 95% of the prescribed dose to [Formula: see text]. We observed overall better high-dose sparing to OARs that were considered when using the adapted beam-dependent PTVs, with the degree of sparing dependent on both the number of OARs under consideration as well as the relative position between the CTV and the OARs.
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Affiliation(s)
- H S Tsang
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5NG, United Kingdom
| | - C P Kamerling
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5NG, United Kingdom
| | - P Ziegenhein
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5NG, United Kingdom
| | - S Nill
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5NG, United Kingdom
| | - U Oelfke
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5NG, United Kingdom
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39
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Cobben D, Bainbridge H, Belderbos J, Cheung P, Dubec M, Gomez D, Gore E, Knowles E, Lalezari F, Oelfke U, Sonke J, Tijssen R, Van Es C, Van Herk M, Wetscherek A, Mcdonald F, Faivre-Finn C. P3.01-26 A Framework for Systematic Clinical Evaluation of Technical Innovations in Lung Cancer Patients Treated on the MR-Linac (MRL). J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1586] [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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40
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Kieselmann JP, Kamerling CP, Burgos N, Menten MJ, Fuller CD, Nill S, Cardoso MJ, Oelfke U. Geometric and dosimetric evaluations of atlas-based segmentation methods of MR images in the head and neck region. Phys Med Biol 2018; 63:145007. [PMID: 29882749 PMCID: PMC6296440 DOI: 10.1088/1361-6560/aacb65] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/01/2018] [Accepted: 06/08/2018] [Indexed: 11/19/2022]
Abstract
Owing to its excellent soft-tissue contrast, magnetic resonance (MR) imaging has found an increased application in radiation therapy (RT). By harnessing these properties for treatment planning, automated segmentation methods can alleviate the manual workload burden to the clinical workflow. We investigated atlas-based segmentation methods of organs at risk (OARs) in the head and neck (H&N) region using one approach that selected the most similar atlas from a library of segmented images and two multi-atlas approaches. The latter were based on weighted majority voting and an iterative atlas-fusion approach called STEPS. We built the atlas library from pre-treatment T1-weighted MR images of 12 patients with manual contours of the parotids, spinal cord and mandible, delineated by a clinician. Following a leave-one-out cross-validation strategy, we measured the geometric accuracy by calculating Dice similarity coefficients (DSC), standard and 95% Hausdorff distances (HD and HD95), and the mean surface distance (MSD), whereby the manual contours served as the gold standard. To benchmark the algorithm, we determined the inter-observer variability (IOV) between three observers. To investigate the dosimetric effect of segmentation inaccuracies, we implemented an auto-planning strategy within the treatment planning system Monaco (Elekta AB, Stockholm, Sweden). For each set of auto-segmented OARs, we generated a plan for a 9-beam step and shoot intensity modulated RT treatment, designed according to our institution's clinical H&N protocol. Superimposing the dose distributions on the gold standard OARs, we calculated dose differences to OARs caused by delineation differences between auto-segmented and gold standard OARs. We investigated the correlations between geometric and dosimetric differences. The mean DSC was larger than 0.8 and the mean MSD smaller than 2 mm for the multi-atlas approaches, resulting in a geometric accuracy comparable to previously published results and within the range of the IOV. While dosimetric differences could be as large as 23% of the clinical goal, treatment plans fulfilled all imposed clinical goals for the gold standard OARs. Correlations between geometric and dosimetric measures were low with R2 < 0.5. The geometric accuracy and the ability to achieve clinically acceptable treatment plans indicate the suitability of using atlas-based contours for RT treatment planning purposes. The low correlations between geometric and dosimetric measures suggest that geometric measures alone are not sufficient to predict the dosimetric impact of segmentation inaccuracies on treatment planning for the data utilised in this study.
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Affiliation(s)
- J P Kieselmann
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden
NHS Foundation Trust, London, United
Kingdom
| | - C P Kamerling
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden
NHS Foundation Trust, London, United
Kingdom
| | - N Burgos
- University
College London, Centre for Medical Image Computing, London,
United Kingdom
- Inria, Aramis project-team, Institut du Cerveau et de la Moelle
épinière, Sorbonne Université, Paris,
France
| | - M J Menten
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden
NHS Foundation Trust, London, United
Kingdom
| | - C D Fuller
- Department of Radiation Oncology,
MD Anderson Cancer Center,
Houston, TX, United States of America
| | - S Nill
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden
NHS Foundation Trust, London, United
Kingdom
| | - M J Cardoso
- University
College London, Centre for Medical Image Computing, London,
United Kingdom
- School of
Biomedical Engineering and Imaging Sciences, King’s College,
London, United Kingdom
| | - U Oelfke
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden
NHS Foundation Trust, London, United
Kingdom
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41
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Kieselmann JP, Kamerling CP, Burgos N, Menten MJ, Fuller CD, Nill S, Cardoso MJ, Oelfke U. Geometric and dosimetric evaluations of atlas-based segmentation methods of MR images in the head and neck region. Phys Med Biol 2018; 63:145007. [PMID: 29882749 PMCID: PMC6296440 DOI: 10.1088/1361-6560/aacb65;145007] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Owing to its excellent soft-tissue contrast, magnetic resonance (MR) imaging has found an increased application in radiation therapy (RT). By harnessing these properties for treatment planning, automated segmentation methods can alleviate the manual workload burden to the clinical workflow. We investigated atlas-based segmentation methods of organs at risk (OARs) in the head and neck (H&N) region using one approach that selected the most similar atlas from a library of segmented images and two multi-atlas approaches. The latter were based on weighted majority voting and an iterative atlas-fusion approach called STEPS. We built the atlas library from pre-treatment T1-weighted MR images of 12 patients with manual contours of the parotids, spinal cord and mandible, delineated by a clinician. Following a leave-one-out cross-validation strategy, we measured the geometric accuracy by calculating Dice similarity coefficients (DSC), standard and 95% Hausdorff distances (HD and HD95), and the mean surface distance (MSD), whereby the manual contours served as the gold standard. To benchmark the algorithm, we determined the inter-observer variability (IOV) between three observers. To investigate the dosimetric effect of segmentation inaccuracies, we implemented an auto-planning strategy within the treatment planning system Monaco (Elekta AB, Stockholm, Sweden). For each set of auto-segmented OARs, we generated a plan for a 9-beam step and shoot intensity modulated RT treatment, designed according to our institution's clinical H&N protocol. Superimposing the dose distributions on the gold standard OARs, we calculated dose differences to OARs caused by delineation differences between auto-segmented and gold standard OARs. We investigated the correlations between geometric and dosimetric differences. The mean DSC was larger than 0.8 and the mean MSD smaller than 2 mm for the multi-atlas approaches, resulting in a geometric accuracy comparable to previously published results and within the range of the IOV. While dosimetric differences could be as large as 23% of the clinical goal, treatment plans fulfilled all imposed clinical goals for the gold standard OARs. Correlations between geometric and dosimetric measures were low with R2 < 0.5. The geometric accuracy and the ability to achieve clinically acceptable treatment plans indicate the suitability of using atlas-based contours for RT treatment planning purposes. The low correlations between geometric and dosimetric measures suggest that geometric measures alone are not sufficient to predict the dosimetric impact of segmentation inaccuracies on treatment planning for the data utilised in this study.
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Affiliation(s)
- J P Kieselmann
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden
NHS Foundation Trust, London, United
Kingdom,
| | - C P Kamerling
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden
NHS Foundation Trust, London, United
Kingdom
| | - N Burgos
- University
College London, Centre for Medical Image Computing, London,
United Kingdom,Inria, Aramis project-team, Institut du Cerveau et de la Moelle
épinière, Sorbonne Université, Paris,
France
| | - M J Menten
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden
NHS Foundation Trust, London, United
Kingdom
| | - C D Fuller
- Department of Radiation Oncology,
MD Anderson Cancer Center,
Houston, TX, United States of America
| | - S Nill
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden
NHS Foundation Trust, London, United
Kingdom
| | - M J Cardoso
- University
College London, Centre for Medical Image Computing, London,
United Kingdom,School of
Biomedical Engineering and Imaging Sciences, King’s College,
London, United Kingdom
| | - U Oelfke
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden
NHS Foundation Trust, London, United
Kingdom
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Lavan N, Mc Quaid D, Smyth G, Vaidya S, Saran F, Oelfke U, Mandeville H. EP-2031: Kidney motion in children and young people quantified using 4DCT deformable registration. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32340-5] [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: 11/26/2022]
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Tran E, Eiben B, Wetscherek A, Collins D, Oelfke U, Meedt G, Hawkes D, McClelland J. OC-0411: Investigation of MRI-derived surrogate signals for modelling respiratory motion on an MRI-Linac. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30721-7] [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: 10/14/2022]
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44
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Steel H, Box C, Oelfke U, Bartzsch S. PV-0568: Remarkable normal tissue sparing effects are seen in vitro in response to microbeam radiation. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30878-8] [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: 10/14/2022]
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45
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Bertelsen A, Hanson I, Nill S, Bernchou U, Hansen V, Brink C, Oelfke U. PO-1011: Precision of the optically controlled Multi Leaf Collimator (MLC) on a high field MR linac. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31321-5] [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: 10/14/2022]
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46
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Eiben B, Tran E, Menten M, Wetscherek A, Hawkes D, Oelfke U, McClelland J. EP-2135: Statistical motion masks to identify sliding surfaces for motion models used on an MR-Linac. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32444-7] [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: 10/14/2022]
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Nill S, Oelfke U. SP-0238: Daily replanning strategies. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30548-6] [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: 10/14/2022]
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48
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Brueningk S, Costa M, Box C, Rivens I, Nill S, Oelfke U, Ter Haar G. EP-2335: 3D tumour spheroids as an alternative to clonogenic assays for predicting radiation response in vivo. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32644-6] [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: 11/28/2022]
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Brown S, Van Herk M, Chuter R, Falk S, Kirkby K, Mackay R, Harrington K, Cosgrove V, Gray A, Hall E, Hawkins M, Hawkes D, Henry A, Maughan T, Nutting C, Oelfke U, Royle G, Sebag-Montefiore D, Sharma R, Van Den Heuvel F, Faivre-Finn C. Advanced Radiotherapy Technologies Network in the UK (ART-NET) – focus on lung cancer. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30166-1] [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: 10/18/2022]
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Brüningk S, Powathil G, Ziegenhein P, Ijaz J, Rivens I, Nill S, Chaplain M, Oelfke U, Ter Haar G. Combining radiation with hyperthermia: a multiscale model informed by in vitro experiments. J R Soc Interface 2018; 15:20170681. [PMID: 29343635 PMCID: PMC5805969 DOI: 10.1098/rsif.2017.0681] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/18/2017] [Indexed: 12/23/2022] Open
Abstract
Combined radiotherapy and hyperthermia offer great potential for the successful treatment of radio-resistant tumours through thermo-radiosensitization. Tumour response heterogeneity, due to intrinsic, or micro-environmentally induced factors, may greatly influence treatment outcome, but is difficult to account for using traditional treatment planning approaches. Systems oncology simulation, using mathematical models designed to predict tumour growth and treatment response, provides a powerful tool for analysis and optimization of combined treatments. We present a framework that simulates such combination treatments on a cellular level. This multiscale hybrid cellular automaton simulates large cell populations (up to 107 cells) in vitro, while allowing individual cell-cycle progression, and treatment response by modelling radiation-induced mitotic cell death, and immediate cell kill in response to heating. Based on a calibration using a number of experimental growth, cell cycle and survival datasets for HCT116 cells, model predictions agreed well (R2 > 0.95) with experimental data within the range of (thermal and radiation) doses tested (0-40 CEM43, 0-5 Gy). The proposed framework offers flexibility for modelling multimodality treatment combinations in different scenarios. It may therefore provide an important step towards the modelling of personalized therapies using a virtual patient tumour.
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Affiliation(s)
- S Brüningk
- Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - G Powathil
- Department of Mathematics, College of Science, Swansea University, Swansea,, UK
| | - P Ziegenhein
- Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - J Ijaz
- Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - I Rivens
- Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - S Nill
- Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - M Chaplain
- School of Mathematics and Statistics, University of St Andrews, St Andrews, UK
| | - U Oelfke
- Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - G Ter Haar
- Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
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