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Jin Y, Shimizu S, Li Y, Yao Y, Liu X, Si H, Sakurai H, Xiao W. Proton therapy (PT) combined with concurrent chemotherapy for locally advanced non-small cell lung cancer with negative driver genes. Radiat Oncol 2023; 18:189. [PMID: 37974211 PMCID: PMC10652584 DOI: 10.1186/s13014-023-02372-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE To discuss the optimal treatment modality for inoperable locally advanced Non-Small Cell Lung Cancer patients with poor physical status, impaired cardio-pulmonary function, and negative driver genes, and provide clinical evidence. MATERIALS AND METHODS Retrospective analysis of 62 cases of locally advanced non-small cell lung cancer patients with negative driver genes treated at Tsukuba University Hospital(Japan) and Qingdao University Affiliated Hospital(China).The former received proton therapy with concurrent chemotherapy, referred to as the proton group, with 25 cases included; while the latter underwent X-ray therapy with concurrent chemoradiotherapy followed by 1 year of sequential immunomodulatory maintenance therapy, referred to as the X-ray group, with 37 cases included.The treatment response and adverse reactions were assessed using RECIST v1.1 criteria and CTCAE v3.0, and radiotherapy planning and evaluation of organs at risk were performed using the CB-CHOP method.All data were subjected to statistical analysis using GraphPad Prism v9.0, with a T-test using P < 0.05 considered statistically significant. RESULTS (1)Target dose distribution: compared to the X-ray group, the proton group exhibited smaller CTV and field sizes, with a more pronounced bragg peak.(2)Organs at risk dose: When comparing the proton group to the X-ray group, lung doses (V5, V20, MLD) and heart doses (V40, Dmax) were lower, with statistical significance (P < 0.05), while spinal cord and esophagus doses showed no significant differences between the two groups (P > 0.05).(3)Treatment-related toxicities: The incidence of grade 3 or higher adverse events in the proton group and X-ray group was 28.6% and 4.2%, respectively, with a statistically significant difference (P < 0.05). In terms of the types of adverse events, the proton group primarily experienced esophagitis and pneumonia, while the X-ray group primarily experienced pneumonia, esophagitis, and myocarditis. Both groups did not experience radiation myelitis or esophagotracheal fistula.(4)Efficacy evaluation: The RR in the proton group and X-ray group was 68.1% and 70.2%, respectively (P > 0.05), and the DCR was 92.2% and 86.4%, respectively (P > 0.05), indicating no significant difference in short-term efficacy between the two treatment modalities.(5)Survival status: The PFS in the proton group and X-ray group was 31.6 ± 3.5 months (95% CI: 24.7 ~ 38.5) and 24.9 ± 1.55 months (95% CI: 21.9 ~ 27.9), respectively (P > 0.05), while the OS was 51.6 ± 4.62 months (95% CI: 42.5 ~ 60.7) and 33.1 ± 1.99 months (95% CI: 29.2 ~ 37.1), respectively (P < 0.05).According to the annual-specific analysis, the PFS rates for the first to third years in both groups were as follows: 100%, 56.1% and 32.5% for the proton group vs. 100%, 54.3% and 26.3% for the X-ray group. No statistical differences were observed at each time point (P > 0.05).The OS rates for the first to third years in both groups were as follows: 100%, 88.2%, 76.4% for the proton group vs. 100%, 91.4%, 46.3% for the X-ray group. There was no significant difference in the first to second years (P > 0.05), but the third year showed a significant difference (P < 0.05). Survival curve graphs also depicted a similar trend. CONCLUSION There were no significant statistical differences observed between the two groups in terms of PFS and OS within the first two years. However, the proton group demonstrated a clear advantage over the X-ray group in terms of adverse reactions and OS in the third year. This suggests a more suitable treatment modality and clinical evidence for populations with frail health, compromised cardio-pulmonary function, post-COVID-19 sequelae, and underlying comorbidities.
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Affiliation(s)
- Yonglong Jin
- Department of Radiotherapy, The Affiliated Hospital of Qingdao University, Qingdao, China
- School of Public Health, Qingdao University, Qingdao, China
| | - Shosei Shimizu
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, Japan
- Department of Radiotherapy, YIZHOU Cancer Hospital, Qingdao, China
| | - Yinuo Li
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yuan Yao
- Graduate School of Environmental Science, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Xiguang Liu
- Department of Radiotherapy, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hongzong Si
- School of Public Health, Qingdao University, Qingdao, China
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, Japan.
| | - Wenjing Xiao
- Department of Radiotherapy, The Affiliated Hospital of Qingdao University, Qingdao, China.
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Qiu T, Shi Y, He M, Wang W, Meng J, Ding J, Wang W, Li S, Li K, Liu J. Phosphorylated bush sophora root polysaccharides protect the liver in duck viral hepatitis by preserving mitochondrial function. Int J Biol Macromol 2023; 245:125419. [PMID: 37364809 DOI: 10.1016/j.ijbiomac.2023.125419] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023]
Abstract
In order to ascertain the mechanism underlying the therapeutic efficacy of Bush sophora root polysaccharides (BSRPS) and phosphorylated Bush sophora root polysaccharides (pBSRPS) in the treatment of in duck viral hepatitis (DVH), an investigation was conducted to assess the protective impact of BSRPS and pBSRPS against duck hepatitis A virus type 1 (DHAV-1) induced mitochondrial dysfunction both in vivo and vitro. The BSRPS underwent modification through the utilization of the sodium trimetaphosphate - sodium tripolyphosphate method, and was subsequently characterized though Fourier infrared spectroscopy and scanning electron microscopy. Following this, the degree of mitochondrial oxidative damage and dysfunction was described through the use of fluorescence probes and various antioxidative enzyme assay kits. Furthermore, the utilization of transmission electron microscopy facilitated the observation of alterations in the mitochondrial ultrastructure within the liver tissue. Our findings demonstrated that both BSRPS and pBSRPS effectively mitigated mitochondrial oxidative stress and conserved mitochondrial functionality, as evidenced by heightened antioxidant enzyme activity, augmented ATP production, and stabilized mitochondrial membrane potential. Meanwhile, the histological and biochemical examinations revealed that the administration of BSRPS and pBSRPS resulted in a reduction of focal necrosis and infiltration of inflammatory cells, thereby mitigating liver injury. Additionally, both BSRPS and pBSRPS exhibited the ability to maintain liver mitochondrial membrane integrity and enhance the survival rate of ducklings infected with DHAV-1. Notably, pBSRPS demonstrated superior performance in all aspects of mitochondrial function compared to BSRPS. The findings indicated that maintaining mitochondrial homeostasis is a crucial factor in DHAV-1 infections, and the administration of BSRPS and pBSRPS may mitigate mitochondrial dysfunction and safeguard liver function.
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Affiliation(s)
- Tianxin Qiu
- MOE Joint International Research Laboratory of Animal Health and Food Safety and Traditional Chinese Veterinary medicine research Center, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, PR China
| | - Yu Shi
- MOE Joint International Research Laboratory of Animal Health and Food Safety and Traditional Chinese Veterinary medicine research Center, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, PR China
| | - Miao He
- MOE Joint International Research Laboratory of Animal Health and Food Safety and Traditional Chinese Veterinary medicine research Center, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, PR China
| | - Wenjia Wang
- MOE Joint International Research Laboratory of Animal Health and Food Safety and Traditional Chinese Veterinary medicine research Center, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, PR China
| | - Jinwu Meng
- MOE Joint International Research Laboratory of Animal Health and Food Safety and Traditional Chinese Veterinary medicine research Center, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, PR China
| | - Jinxue Ding
- MOE Joint International Research Laboratory of Animal Health and Food Safety and Traditional Chinese Veterinary medicine research Center, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, PR China
| | - Weiran Wang
- MOE Joint International Research Laboratory of Animal Health and Food Safety and Traditional Chinese Veterinary medicine research Center, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, PR China
| | - Siya Li
- MOE Joint International Research Laboratory of Animal Health and Food Safety and Traditional Chinese Veterinary medicine research Center, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, PR China
| | - Kun Li
- MOE Joint International Research Laboratory of Animal Health and Food Safety and Traditional Chinese Veterinary medicine research Center, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, PR China
| | - Jiaguo Liu
- MOE Joint International Research Laboratory of Animal Health and Food Safety and Traditional Chinese Veterinary medicine research Center, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, PR China.
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Fontbonne C, Fontbonne JM, Azemar N. Espadon, an R package for automation, exploitation and processing of DICOM files in medical physics and clinical research. Phys Med 2023; 109:102580. [PMID: 37100009 DOI: 10.1016/j.ejmp.2023.102580] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/22/2023] [Accepted: 04/05/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION One of the main issues in the field of clinical research is to enhance clinical databases with information from imaging (CT, MR, PET-scan), contouring (RTstruct), or produced by TPS such as dose distribution (RTdose) or treatment plans (RTplan). To perform these analyses automatically, we propose the new open-source package "espadon", developed in R environment. This package also opens up numerous perspectives for TPS-independant calculation, automation and processing of DICOM data. RESULTS The espadon package converts DICOM objects into espadon objects. Several tools have been developed to manipulate these objects and extract the desired information. In addition to decode DICOM files and pseudonomize them, the great advantage of espadon is that it presents the links between patient data (images, structures, treatment plans) in a didactic way, respecting the dates of the examinations. It can visualize volumes or structures in 2D or 3D, resample volumes, segment them, and change geometric frames of reference. It integrates dose-volume histogram functions on a selection, with Monte Carlo calculations of random shifts of contours. It offers the automatic calculation of several usual radiotherapy indices, as well as the calculation of Gamma and Chi indices. CONCLUSIONS Espadon is a toolkit designed to be easily used by radiotherapists, medical physicists or students. Espadon's functions are implemented in an R script, and allow the automatic extraction or calculation of data from DICOM files, which can be used for statistical modelling or machine-learning in the R environment. This package is available on the Comprehensive R Archive Network (CRAN) repository.
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Affiliation(s)
- Cathy Fontbonne
- Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, LPC Caen UMR6534, F-14000 Caen, France.
| | - Jean-Marc Fontbonne
- Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, LPC Caen UMR6534, F-14000 Caen, France.
| | - Nathan Azemar
- Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, LPC Caen UMR6534, F-14000 Caen, France.
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Wang B, Liu J, Zhang X, Wang Z, Cao Z, Lu L, Lv W, Wang A, Li S, Wu X, Dong X. Prognostic value of 18F-FDG PET/CT-based radiomics combining dosiomics and dose volume histogram for head and neck cancer. EJNMMI Res 2023; 13:14. [PMID: 36779997 PMCID: PMC9925656 DOI: 10.1186/s13550-023-00959-6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/26/2023] [Indexed: 02/14/2023] Open
Abstract
OBJECTIVES By comparing the prognostic performance of 18F-FDG PET/CT-based radiomics combining dose features [Includes Dosiomics feature and the dose volume histogram (DVH) features] with that of conventional radiomics in head and neck cancer (HNC), multidimensional prognostic models were constructed to investigate the overall survival (OS) in HNC. MATERIALS AND METHODS A total of 220 cases from four centres based on the Cancer Imaging Archive public dataset were used in this study, 2260 radiomics features and 1116 dosiomics features and 8 DVH features were extracted for each case, and classified into seven different models of PET, CT, Dose, PET+CT, PET+Dose, CT+Dose and PET+CT+Dose. Features were selected by univariate Cox and Spearman correlation coefficients, and the selected features were brought into the least absolute shrinkage and selection operator (LASSO)-Cox model. A nomogram was constructed to visually analyse the prognostic impact of the incorporated dose features. C-index and Kaplan-Meier curves (log-rank analysis) were used to evaluate and compare these models. RESULTS The cases from the four centres were divided into three different training and validation sets according to the hospitals. The PET+CT+Dose model had C-indexes of 0.873 (95% CI 0.812-0.934), 0.759 (95% CI 0.663-0.855) and 0.835 (95% CI 0.745-0.925) in the validation set respectively, outperforming the rest models overall. The PET+CT+Dose model did well in classifying patients into high- and low-risk groups under all three different sets of experiments (p < 0.05). CONCLUSION Multidimensional model of radiomics features combining dosiomics features and DVH features showed high prognostic performance for predicting OS in patients with HNC.
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Affiliation(s)
- Bingzhen Wang
- grid.413851.a0000 0000 8977 8425Department of Biomedical Engineering, Chengde Medical University, Chengde, Hebei China
| | - Jinghua Liu
- Department of Nursing, Chengde Central Hospital, Chengde, Hebei China ,grid.11142.370000 0001 2231 800XDepartment of Nursing, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Xiaolei Zhang
- grid.413851.a0000 0000 8977 8425Department of Biomedical Engineering, Chengde Medical University, Chengde, Hebei China
| | - Zhongxiao Wang
- grid.413851.a0000 0000 8977 8425Department of Biomedical Engineering, Chengde Medical University, Chengde, Hebei China
| | - Zhendong Cao
- grid.413851.a0000 0000 8977 8425Department of Radiology, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei China
| | - Lijun Lu
- grid.284723.80000 0000 8877 7471School of Biomedical Engineering and Guangdong Provincal Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, Guangdong China
| | - Wenbing Lv
- grid.440773.30000 0000 9342 2456Department of Electronic Engineering, Information School, Yunnan University, Kunming, Yunnan China
| | - Aihui Wang
- grid.413851.a0000 0000 8977 8425Department of Nuclear Medicine, The Affiliated Hospital of Chengde Medical University, Chengde, Hebei China
| | - Shuyan Li
- grid.413851.a0000 0000 8977 8425Department of Biomedical Engineering, Chengde Medical University, Chengde, Hebei China
| | - Xiaotian Wu
- grid.413851.a0000 0000 8977 8425Department of Biomedical Engineering, Chengde Medical University, Chengde, Hebei China
| | - Xianling Dong
- Department of Biomedical Engineering, Chengde Medical University, Chengde, Hebei, China. .,Hebei International Research Center of Medical-Engineering, Chengde Medical University, Chengde, Hebei, China.
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Akino Y, Shiomi H, Higashinaka N, Kouno T, Mabuchi N, Isohashi F, Seo Y, Fujiwara K, Tamenaga S, Ogawa K. Evaluation of Lung and Liver Tumor Dose Coverage Treated With the CyberKnife Synchrony System With Consideration of Measured Tracking Errors. Anticancer Res 2023; 43:231-238. [PMID: 36585211 DOI: 10.21873/anticanres.16154] [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: 11/16/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIM Lung and liver tumor dose coverage was evaluated for the CyberKnife synchrony respiratory tracking system (SRTS) with consideration of the motion tracking accuracy measured for motion patterns of individual patients. PATIENTS AND METHODS Seven treatment plans of six cases treated with the SRTS were evaluated. The motion phantom was moved with the motion data derived from the treatment log files. A laser emitted from the linac head to the moving phantom block was recorded with a webcam, and the tracking accuracy was evaluated. The dose volume histogram (DVH) of planning target volume (PTV) and gross tumor volume (GTV) were calculated by a pencil beam algorithm with shifting the beams with Gaussian random numbers mimicking the measured tracking errors. RESULTS The tracking errors measured with the motion phantom in the lateral direction were within ±2 mm for 90% of beam-on time. The tracking errors in the longitudinal direction were within ±3.0 mm and ±1.1 mm for 90% and 50% of beam-on time, respectively. Although one case showed a decrease in the dose covering 95% of PTV (D95%) by 1.8%, the change in the dose covering 99% of GTV (D99%) was within 1%. CONCLUSION This study evaluated the motion tracking errors of the SRTS by a motion phantom moved with the patients' respiration signal, and the impact of the tracking errors on the target coverage was calculated. Even for respiratory patterns with large maximum tracking errors, sufficient GTV coverage is achievable if the beam is accurately delivered for high percentage of beam-on time.
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Affiliation(s)
- Yuichi Akino
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Japan; .,Soseikai CyberKnife Center, Kyoto, Japan
| | - Hiroya Shiomi
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Japan.,Soseikai CyberKnife Center, Kyoto, Japan
| | | | | | | | - Fumiaki Isohashi
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuji Seo
- Department of Carbon Ion Radiotherapy, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kei Fujiwara
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Setsuo Tamenaga
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Japan
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Itonaga T, Sugahara S, Mikami R, Saito T, Yamada T, Kurooka M, Shiraishi S, Okubo M, Saito K. Evaluation of the relationship between the range of radiation-induced lung injury on CT images after IMRT for stage I lung cancer and dosimetric parameters. Ann Med 2021; 53:267-273. [PMID: 33430616 PMCID: PMC7877951 DOI: 10.1080/07853890.2020.1869297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This study evaluated the correlation between radiation-induced lung injury (RILI) and dosimetric parameters on computed tomography (CT) images of stage I non-small cell lung cancer (NSCLC) patients undergoing intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS Sixty-three stage I NSLC patients who underwent IMRT were enrolled in the study. The patients underwent CT within 6 months (acute phase) and 1.5 years (late phase) after radiotherapy. These were fused with the planned irradiation CT. The range of RILI was measured from 10% to 100%, with an IC in 10% increments. RESULTS The median interval from completion of radiotherapy to acute and late phase CT was 92 and 440 days, respectively. The median RILI ranges of the acute and late phases were in the 80% (20-100%) and 70% dose regions (20-100%), respectively. The significantly narrower range of RILI when lung V20 in the acute phase was less than 19.2% and that of V5 in the late phase was less than 27.6% at the time of treatment planning. CONCLUSIONS This study showed that RILI occurred in a localized range in stage I NSCLC patients who underwent IMRT. The range of RILI was correlated with V20 in the acute phase and V5 in the late phase. KEY MESSAGES RILI correlated with V20 in acute and V5 in late phase. The shadow of RILI occurred in 80% dose region in acute and 70% in late phase. No relationship exists between radiographic changes in RILI and PTV volume.
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Affiliation(s)
- Tomohiro Itonaga
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku, Japan
| | - Shinji Sugahara
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku, Japan
| | - Ryuji Mikami
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku, Japan
| | - Tatsuhiko Saito
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku, Japan
| | - Takafumi Yamada
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku, Japan
| | - Masahiko Kurooka
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku, Japan
| | - Sachika Shiraishi
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku, Japan
| | - Mitsuru Okubo
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku, Japan
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku, Japan
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Yoosuf AM, Ahmad MB, AlShehri S, Alhadab A, Alqathami M. Investigation of optimum minimum segment width on VMAT plan quality and deliverability: A comprehensive dosimetric and clinical evaluation using DVH analysis. J Appl Clin Med Phys 2021; 22:29-40. [PMID: 34592787 PMCID: PMC8598144 DOI: 10.1002/acm2.13417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/23/2021] [Accepted: 08/24/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose Minimum segment width (MSW) plays a fundamental role in the shaping of optimized apertures and creation of segments of varying sizes and shapes in complex radiotherapy treatment plans. The purpose of this work was to study the effect of MSW on dose distribution in patients planned with VMAT for various treatment sites using dose volume histogram (DVH) analysis. Materials and methods For the validation of optimum MSW, 125 clinical treatment plans were evaluated. Five groups were identified (brain, head and neck, thorax, pelvis, and extremity), and five cases were chosen from each group. For each case, five plans were created with different MSW (0.5, 0.8, 1.0, 1.25, and 1.5 cm). The quality of treatment plans created using different MSW were compared using dosimetric indicators such as target coverage (D98—dose to 98% of the planning target volume (PTV), maximum dose (D2—maximum dose to 2% of the PTV), monitor units (MU), and DVH parameters related to organs at risk (OAR). The effect of the MSW on delivery accuracy was quantitatively analyzed using the measured fluence utilizing ionization chamber‐based transmission detector and model‐based dose verification system. Traditional global gamma analysis (2%, 2 mm) and dose volume information was gathered for the PTV and organs at risk and compared for different MSWs. Results A total of 125 plans were created and compared across five groups. In terms of treatment plan quality, the plans using MSW of 0.5 cm was found to be superior in all groups. PTV coverage (D98) decreased significantly (p < 0.05) as the MSW increased. Similarly, the maximum dose (D2) was found to be increased significantly (p < 0.05) as the MSW increased from 0.5 cm, with MSW of 1.5 cm being the least in terms of plan quality for both PTVs and OARs. In terms of plan deliverability using DVH analysis, treatment planning system (TPS) compared to measured fluence, VMAT plans produced with MSW of 0.5 cm showed a better dosimetric index and a smaller deviation for both PTVs and OARs. The deliverability of the plans deteriorated as the MSW increased. Conclusion Dose volume histogram (DVH) analysis demonstrated that treatment plans with minimal MSW showed better plan quality and deliverability and provided clinical relevance as compared to gamma index analysis.
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Affiliation(s)
- Ab Mohamed Yoosuf
- Department of Radiation Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Muhammad Bilal Ahmad
- Department of Radiation Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Salem AlShehri
- Department of Radiation Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulrahman Alhadab
- Department of Radiation Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Mamdouh Alqathami
- Department of Radiation Oncology, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Hoffmann E, Paulsen F, Schaedle P, Zips D, Gani C, Rammensee HG, Gouttefangeas C, Eckert F. Radiotherapy planning parameters correlate with changes in the peripheral immune status of patients undergoing curative radiotherapy for localized prostate cancer. Cancer Immunol Immunother 2021. [PMID: 34269847 DOI: 10.1007/s00262-021-03002-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/28/2021] [Indexed: 12/12/2022]
Abstract
Purpose The influence of radiotherapy on patient immune cell subsets has been established by several groups. Following a previously published analysis of immune changes during and after curative radiotherapy for prostate cancer, this analysis focused on describing correlations of changes of immune cell subsets with radiation treatment parameters. Patients and methods For 13 patients treated in a prospective trial with radiotherapy to the prostate region (primary analysis) and five patients treated with radiotherapy to prostate and pelvic nodal regions (exploratory analysis), already published immune monitoring data were correlated with clinical data as well as radiation planning parameters such as clinical target volume (CTV) and volumes receiving 20 Gy (V20) for newly contoured volumes of pelvic blood vessels and bone marrow. Results Most significant changes among immune cell subsets were observed at the end of radiotherapy. In contrast, correlations of age and CD8+ subsets (effector and memory cells) were observed early during and 3 months after radiotherapy. Ratios of T cells and T cell proliferation compared to baseline correlated with CTV. Early changes in regulatory T cells (Treg cells) and CD8+ effector T cells correlated with V20 of blood vessels and bone volumes. Conclusions Patient age as well as radiotherapy planning parameters correlated with immune changes during radiotherapy. Larger irradiated volumes seem to correlate with early suppression of anti-cancer immunity. For immune cell analysis during normofractionated radiotherapy and correlations with treatment planning parameters, different time points should be looked at in future projects. Trial registration number: NCT01376674, 20.06.2011 Supplementary Information The online version contains supplementary material available at 10.1007/s00262-021-03002-6.
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Zhang Y, Jabbour SK, Zhang A, Liu B, Yue NJ, Biswal NC. Proton beam therapy can achieve lower vertebral bone marrow dose than photon beam therapy during chemoradiation therapy of esophageal cancer. Med Dosim 2021; 46:229-235. [PMID: 33454170 DOI: 10.1016/j.meddos.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/17/2019] [Revised: 11/17/2020] [Accepted: 12/15/2020] [Indexed: 01/06/2023]
Abstract
Chemoradiation therapy plays an important role in both the neoadjuvant and definitive management of esophageal cancer (EC). Prior studies have suggested that advanced planning techniques can better spare organs at risk including the heart. Although multiple toxicities can result from esophageal radiotherapy, one less studied acute toxicity is that of myelosuppression, which can result, in part, from the combination of chemotherapy and incidental radiotherapy administration to the vertebral bodies (VBs), which abut the posterior aspect of the esophagus, especially in the lower thoracic esophagus. Traditionally, VB bone marrow doses are not accounted during EC radiation therapy planning. We sought to compare the doses to VBs between proton and photon radiation therapy as part of chemoradiation therapy for EC treatment. By reducing doses to the vertebrae, radiation therapy can decrease treatment-related myelosuppression, which can avoid delays or chemotherapy dose reductions in therapy, which likely affect long-term patient survival. Dose constraints are not routinely employed for bone marrow in radiation treatment planning. In our previous work, we identified thresholds to avoid grade ≥3 leukopenia, including VB V10Gy, VB V20Gy, and a mean VB dose (MVD) of 18.8 Gy. Herein we perform a retrospective dosimetric planning study comparing passive- or double-scattering proton beam therapy (PS-PBT), volumetric-modulated arc therapy (VMAT) (photon-based), and intensity-modulated radiation therapy (IMRT) (photon-based) in 25 patients with locally advanced EC who were treated originally with photon RT at our institution between 2011 and 2016. The aforementioned dose constraints were included in the retrospective planning process for PS-PBT, VMAT, and IMRT to determine the feasibility of achieving these VB constraints while maintaining reasonable target coverage and planned, consistent constraints to other organs at risk including lungs, spinal cord, and stomach. PS-PBT plans were found to achieve lower doses for VB V10Gy, V20Gy, and MVD than VMAT and static IMRT plans while achieving the same target coverage. PS-PBT resulted in lower organs at risk dosimetric parameters than the photon plans, with p < 0.0001. Student's paired t-test p-values in favor of proton therapy's ability to spare organs were as follows: for PS-PBT vs VMAT and PS-PBT vs IMRT in mean doses for lung, liver, and VB and VB V10Gy and VB V20Gy were all <0.001 (Bonferroni corrected α=0.017). One-way ANOVA found that VB doses (VB V10Gy, VB V20Gy, and MVD) were significantly lower for proton therapy (p < 0.006) among the 3 planning techniques.
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Affiliation(s)
- Yin Zhang
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey 08901, USA
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey 08901, USA
| | - Andrew Zhang
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey 08901, USA
| | - Bo Liu
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey 08901, USA
| | - Ning J Yue
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey 08901, USA
| | - Nrusingh C Biswal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey 08901, USA; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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10
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Levillain H, Burghelea M, Derijckere ID, Guiot T, Gulyban A, Vanderlinden B, Vouche M, Flamen P, Reynaert N. Combined quality and dose-volume histograms for assessing the predictive value of 99mTc-MAA SPECT/CT simulation for personalizing radioembolization treatment in liver metastatic colorectal cancer. EJNMMI Phys 2020; 7:75. [PMID: 33315160 PMCID: PMC7736450 DOI: 10.1186/s40658-020-00345-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 11/30/2020] [Indexed: 01/19/2023] Open
Abstract
Background The relationship between the mean absorbed dose delivered to the tumour and the outcome in liver metastases from colorectal cancer patients treated with radioembolization has already been presented in several studies. The optimization of the personalized therapeutic activity to be administered is still an open challenge. In this context, how well the 99mTc-MAA SPECT/CT predicts the absorbed dose delivered by radioembolization is essential. This work aimed to analyse the differences between predictive 99mTc-MAA-SPECT/CT and post-treatment 90Y-microsphere PET/CT dosimetry at different levels. Dose heterogeneity was compared voxel-to-voxel using the quality-volume histograms, subsequently used to demonstrate how it could be used to identify potential clinical parameters that are responsible for quantitative discrepancies between predictive and post-treatment dosimetry. Results We analysed 130 lesions delineated in twenty-six patients. Dose-volume histograms were computed from predictive and post-treatment dosimetry for all volumes: individual lesion, whole tumoural liver (TL) and non-tumoural liver (NTL). For all dose-volume histograms, the following indices were extracted: D90, D70, D50, Dmean and D20. The results showed mostly no statistical differences between predictive and post-treatment dosimetries across all volumes and for all indices. Notably, the analysis showed no difference in terms of Dmean, confirming the results from previous studies. Quality factors representing the spread of the quality-volume histogram (QVH) curve around 0 (ideal QF = 0) were determined for lesions, TL and NTL. QVHs were classified into good (QF < 0.18), acceptable (0.18 ≤ QF < 0.3) and poor (QF ≥ 0.3) correspondence. For lesions and TL, dose- and quality-volume histograms are mostly concordant: 69% of lesions had a QF within good/acceptable categories (40% good) and 65% of TL had a QF within good/acceptable categories (23% good). For NTL, the results showed mixed results with 48% QF within the poor concordance category. Finally, it was demonstrated how QVH analysis could be used to define the parameters that predict the significant differences between predictive and post-treatment dose distributions. Conclusion It was shown that the use of the QVH is feasible in assessing the predictive value of 99mTc-MAA SPECT/CT dosimetry and in estimating the absorbed dose delivered to liver metastases from colorectal cancer via 90Y-microspheres. QVH analyses could be used in combination with DVH to enhance the predictive value of 99mTc-MAA SPECT/CT dosimetry and to assist personalized activity prescription. Supplementary Information The online version contains supplementary material available at 10.1186/s40658-020-00345-4.
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Affiliation(s)
- Hugo Levillain
- Medical Physics Department, Jules Bordet Institute, Université Libre de Bruxelles, 1 Rue Héger-Bordet, B-1000, Brussels, Belgium. .,Nuclear Medicine Department, Jules Bordet Institute, Université Libre de Bruxelles, 1 Rue Héger-Bordet, 1000, Brussels, Belgium.
| | - Manuela Burghelea
- Medical Physics Department, Jules Bordet Institute, Université Libre de Bruxelles, 1 Rue Héger-Bordet, B-1000, Brussels, Belgium
| | - Ivan Duran Derijckere
- Nuclear Medicine Department, Jules Bordet Institute, Université Libre de Bruxelles, 1 Rue Héger-Bordet, 1000, Brussels, Belgium
| | - Thomas Guiot
- Medical Physics Department, Jules Bordet Institute, Université Libre de Bruxelles, 1 Rue Héger-Bordet, B-1000, Brussels, Belgium
| | - Akos Gulyban
- Medical Physics Department, Jules Bordet Institute, Université Libre de Bruxelles, 1 Rue Héger-Bordet, B-1000, Brussels, Belgium
| | - Bruno Vanderlinden
- Medical Physics Department, Jules Bordet Institute, Université Libre de Bruxelles, 1 Rue Héger-Bordet, B-1000, Brussels, Belgium
| | - Michael Vouche
- Department of Radiology, Jules Bordet Institute, Université Libre de Bruxelles, 1 Rue Héger-Bordet, 1000, Brussels, Belgium
| | - Patrick Flamen
- Nuclear Medicine Department, Jules Bordet Institute, Université Libre de Bruxelles, 1 Rue Héger-Bordet, 1000, Brussels, Belgium
| | - Nick Reynaert
- Medical Physics Department, Jules Bordet Institute, Université Libre de Bruxelles, 1 Rue Héger-Bordet, B-1000, Brussels, Belgium
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Xiao L, Yang G, Chen J, Yang Y, Meng X, Wang X, Wu Q, Huo Z, Yu Q, Yu J, Kong FMS, Yuan S. Comparison of predictive powers of functional and anatomic dosimetric parameters for radiation-induced lung toxicity in locally advanced non-small cell lung cancer. Radiother Oncol 2019; 129:242-248. [PMID: 30471708 DOI: 10.1016/j.radonc.2018.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 03/11/2018] [Revised: 08/01/2018] [Accepted: 09/10/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate the predictive value of the perfusion (Q) single-photon emission computed tomography (SPECT)-weighted dose-function histogram (DFH) obtained mid-treatment (mid-Tx) with radiotherapy (RT) for radiation-induced lung toxicity (RILT) in patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS The study population consisted of NSCLC patients who were undergoing RT treatment and enrolled in prospective imaging studies. Q-SPECT was performed prior to and during RT (at ∼40-45 Gy). A baseline dose-volume histogram (DVH) and mid-Tx DVH based on simulation CT as well as a baseline DFH and mid-Tx DFH based on Q-SPECT were calculated. Only patients with stage III NSCLC and visible functional lung (FL) changes on the mid-Tx scan were eligible for this enriched analysis. RILT was graded according to a reported scale. RESULTS Forty-two stage III NSCLC patients met the criteria for inclusion. The accumulative incidence of grade ≥2 RILT was 31% in this high-risk population. Significant differences in functional metrics such as functional lung volume FV5-FV20 at increments of 5 Gy and functional MLD (FMLD) were observed between patients with and without grade ≥2 RILT (p < 0.05). Similar results were also obtained for anatomical metrics from V5-V20 and MLD (p < 0.05). The areas under the receiver operating characteristic curves (AUCs) ranged from 0.724to 0.812 for baseline DVH parameters, from 0.745 to 0.830 for mid-Tx DVH parameters, from 0.764 to 0.878 for baseline DFH parameters, and from 0.767 to 0.891 for mid-Tx DFH parameters. Further principal components analysis showed that the AUCs were 0.814/0.817 and 0.790/0.857 for baseline/mid-Tx DVH and baseline/mid-Tx DFH, respectively. CONCLUSIONS Mid-Tx DFH parameters based on Q-SPECT were significantly elevated in patients with grade ≥2 RILT in this study population. Among the metrics compared, mid-Tx DFH seemed to have better predictive accuracy, but this difference did not reach statistical difference.
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Affiliation(s)
- Linlin Xiao
- Shandong Cancer Hospital and Institute-Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China; Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guoren Yang
- Shandong Cancer Hospital and Institute-Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Jinhu Chen
- Shandong Cancer Hospital and Institute-Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Yuchen Yang
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Xue Meng
- Shandong Cancer Hospital and Institute-Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Xiaohui Wang
- Shandong Cancer Hospital and Institute-Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Qingwei Wu
- Shandong Cancer Hospital and Institute-Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Zongwei Huo
- Shandong Cancer Hospital and Institute-Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Qingxi Yu
- Shandong Cancer Hospital and Institute-Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Jinming Yu
- Shandong Cancer Hospital and Institute-Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China; Shandong Academy of Medical Sciences, Jinan, China
| | - Feng-Ming Spring Kong
- Department of Radiation Oncology, Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, USA.
| | - Shuanghu Yuan
- Shandong Cancer Hospital and Institute-Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China; Shandong Academy of Medical Sciences, Jinan, China.
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12
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Naismith OF, Griffin C, Syndikus I, South C, Mayles H, Mayles P, Khoo V, Scrase C, Graham J, Hassan S, Hall E, Dearnaley DP; CHHiP Investigators. Forward- and Inverse-Planned Intensity-Modulated Radiotherapy in the CHHiP Trial: A Comparison of Dosimetry and Normal Tissue Toxicity. Clin Oncol (R Coll Radiol) 2019; 31:600-10. [PMID: 31178346 DOI: 10.1016/j.clon.2019.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/21/2019] [Accepted: 03/27/2019] [Indexed: 02/07/2023]
Abstract
AIMS The CHHiP (Conventional or Hypofractionated High-dose Intensity Modulated Radiotherapy In Prostate Cancer; CRUK/06/016) trial investigated hypofractionated radiotherapy for localised prostate cancer. Forward- (FP) or inverse-planned (IP) intensity-modulated techniques were permitted. Dose-volume histogram and toxicity data were compared to explore the effects of planning method. MATERIALS AND METHODS In total, 337 participants with intermediate-risk disease and prospectively collected toxicity data were included. Patients were matched on prostate and rectum/bladder volumes and on radiotherapy dose for toxicity comparisons. The primary outcome was grade 2 or higher Radiation Therapy Oncology Group (RTOG) bowel or bladder toxicity at 2 years. RESULTS IP patients had smaller volumes of rectum irradiated to 50-70 Gy (P < 0.001); FP patients had smaller volumes of bladder irradiated to 74 Gy (P = 0.001). Acute grade 2 + bowel toxicity was worse with FP (27/53 [52%]; 11/53 [21%] IP; P = 0.0002); with no significant differences in acute urinary toxicity. At 2 years, RTOG grade 2 + bowel toxicity rates were FP 0/53 and IP 2/53 and RTOG grade 2 + bladder rates were FP 0/54 and IP 1/57. CONCLUSIONS Significant differences were found between dose-volume histograms from FP and IP methods. IP may result in small reductions in acute bowel toxicity but both techniques were associated with low rates of late radiotherapy side-effects.
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13
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Xu H, Lu J, Wang J, Fan J, Hu W. Implement a knowledge-based automated dose volume histogram prediction module in Pinnacle 3 treatment planning system for plan quality assurance and guidance. J Appl Clin Med Phys 2019; 20:134-140. [PMID: 31343821 PMCID: PMC6698760 DOI: 10.1002/acm2.12689] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/18/2018] [Accepted: 07/08/2019] [Indexed: 11/16/2022] Open
Abstract
Purpose This work aims to develop a knowledge‐based automated dose volume histogram (DVH) prediction module that serves as a plan quality evaluation tool and treatment planning guidance in commercial Pinnacle3 treatment planning system (Philips Radiation Oncology Systems, Fitchburg, WI, USA). Methods The knowledge‐based automated DVH prediction module was developed with kernel density estimation (KDE) method and applied for Pinnacle3 treatment planning system. Treatment plan data from 20 esophageal cancer cases were used for creating a module to predict DVHs. Twenty additional esophageal clinical plans were evaluated on the developed module. Predicted DVHs were compared with manual ones. Differences between the predicted and achieved DVHs were analyzed. Results The plan evaluation module was successfully implemented in Pinnacle3 treatment planning system. Strong linear correlations were found between predicted and achieved DVH for organs at risk. Suboptimal treatment plan quality could be improved according to the predicted DVHs by the module. Conclusion The knowledge‐based automated DVH prediction module implemented in Pinnacle3 could be used to efficiently evaluate the treatment plan quality and as guidance for further plan optimization.
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Affiliation(s)
- Hao Xu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiayu Lu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiazhou Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiawei Fan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weigang Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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14
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Abstract
Background The PRIMO system is a computer software that allows the Monte Carlo simulation of linear accelerators and the estimation of the subsequent absorbed dose distributions in phantoms and computed tomographies. The aim of this work is to validate the methods incorporated in PRIMO to evaluate the deviations introduced in the dose distributions by errors in the positioning of the leaves of the multileaf collimator recorded in the dynalog files during patient treatment. Methods The reconstruction of treatment plans from Varian’s dynalog files was implemented in the PRIMO system. Dose distributions were estimated for volumetric-modulated arc therapy clinical cases of prostate and head&neck using the PRIMO fast Monte Carlo engine DPM. Accuracy of the implemented reconstruction methods was evaluated by comparing dose distributions obtained from the simulations of the plans imported from the treatment planning system with those obtained from the simulations of the plans reconstructed from the expected leaves positions recorded in the dynalog files. The impact on the dose of errors in the positions of the leaves was evaluated by comparing dose distributions estimated for plans reconstructed from expected leaves positions with dose distributions estimated from actual leaves positions. Gamma pass rate (GPR), a hereby introduced quantity named percentage of agreement (PA) and the percentage of voxels with a given systematic difference (α/Δ) were the quantities used for the comparisons. Errors were introduced in leaves positions in order to study the sensitivity of these quantities. Results A good agreement of the dose distributions obtained from the plan imported from the TPS and from the plan reconstructed from expected leaves positions was obtained. Not a significantly better agreement was obtained for an imported plan with an increased number of control points such as to approximately match the number of records in the dynalogs. When introduced errors were predominantly in one direction, the methods employed in this work were sensitive to dynalogs with root-mean-square errors (RMS) ≥0.2 mm. Nevertheless, when errors were in both directions, only RMS >1.2 mm produced detectable deviations in the dose. The PA and the α/Δ showed more sensitive to errors in the leaves positions than the GPR. Conclusions Methods to verify the accuracy of the radiotherapy treatment from the information recorded in the Varian’s dynalog files were implemented and verified in this work for the PRIMO system. Tolerance limits could be established based on the values of PA and α/Δ. GPR 3,3 is not recommended as a solely evaluator of deviations introduced in the dose by errors captured in the dynalog files.
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Affiliation(s)
- Miguel Rodriguez
- Centro Médico Paitilla, Calle 53 y ave. Balboa, Panama City, Panama.,Instituto de Investigaciones Científicas y de Alta Tecnología, INDICASAT-AIP, City of Knowledge, Building 219, Panama City, Panama
| | - Lorenzo Brualla
- West German Proton Therapy Centre (WPE), Hufelandstraße 55, Essen, D-45147, Germany. .,West German Cancer Center (WTZ), Hufelandstraße 55, Essen, D-45147, Germany. .,University Hospital Essen, Hufelandstraße 55, Essen, D-45147, Germany. .,Universität Duisburg-Essen. Medizinische Fakultät, Hufelandstraße 55, Essen, D-45147, Germany.
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15
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Rijkmans EC, Marijnen CAM, van Triest B, Ketelaars M, Cats A, Inderson A, van den Ende RPJ, Laman MS, Kerkhof EM, Nout RA. Predictive factors for response and toxicity after brachytherapy for rectal cancer; results from the HERBERT study. Radiother Oncol 2019; 133:176-182. [PMID: 30935576 DOI: 10.1016/j.radonc.2019.01.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 10/10/2018] [Revised: 01/24/2019] [Accepted: 01/27/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE The HERBERT study was a dose-finding feasibility study of a high-dose rate endorectal brachytherapy (HDREBT) boost after external beam radiotherapy (EBRT) in elderly patients with rectal cancer who were unfit for surgery. This analysis evaluates the association of patient, tumor and dosimetric parameters with tumor response and toxicity after HDREBT in definitive radiotherapy for rectal cancer. PATIENTS AND METHODS The HERBERT study included 38 inoperable patients with T2-3N0-1 rectal cancer. Thirteen fractions of 3 Gy EBRT were followed by three weekly HDREBT applications of 5-8 Gy per fraction. Clinical and dosimetric parameters were tested for correlation with clinical complete response (cCR), sustained partial/complete response (SR), patient reported bowel symptoms, physician reported acute and late proctitis (CTCAE v3) and endoscopically scored toxicity. RESULTS Thirty-five patients completed treatment and were included in the current analyses. Twenty of 33 evaluable patients achieved a cCR, the median duration of a sustained response was 32 months. Tumor volume at diagnosis showed a strong association with clinical complete response (OR 1.15; p = 0.005). No dose-response correlation was observed in this cohort. Prescribed dose to the brachytherapy CTV (D90) correlated with acute and late physician reported proctitis while CTV volume, CTV width and high dose regions in the CTV (D1cc/D2cc) were associated with endoscopic toxicity at the tumor site. CONCLUSION Tumor volume is the most important predictive factor for tumor response and a higher dose to the brachytherapy CTV increases the risk of severe clinically and endoscopically observed proctitis after definitive radiotherapy in elderly patients with rectal cancer.
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Affiliation(s)
- Eva C Rijkmans
- Leiden University Medical Center LUM, Department of Radiation Oncology, the Netherlands.
| | - Corrie A M Marijnen
- Leiden University Medical Center LUM, Department of Radiation Oncology, the Netherlands
| | - Baukelien van Triest
- The Netherlands Cancer Institute, Department of Radiotherapy, Amsterdam, the Netherlands
| | - Martijn Ketelaars
- Leiden University Medical Center LUM, Department of Radiation Oncology, the Netherlands
| | - Annemieke Cats
- The Netherlands Cancer Institute, Department of Gastrointestinal Oncology, Amsterdam, the Netherlands
| | - Akin Inderson
- Leiden University Medical Center LUMC, Department of Gastroenterology and Hepatology Leiden, the Netherlands
| | - Roy P J van den Ende
- Leiden University Medical Center LUM, Department of Radiation Oncology, the Netherlands
| | - Mirjam S Laman
- Leiden University Medical Center LUM, Department of Radiation Oncology, the Netherlands
| | - Ellen M Kerkhof
- Leiden University Medical Center LUM, Department of Radiation Oncology, the Netherlands
| | - Remi A Nout
- Leiden University Medical Center LUM, Department of Radiation Oncology, the Netherlands
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16
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Cutright D, Gopalakrishnan M, Roy A, Panchal A, Mittal BB. DVH Analytics: A DVH database for clinicians and researchers. J Appl Clin Med Phys 2018; 19:413-427. [PMID: 30032488 PMCID: PMC6123141 DOI: 10.1002/acm2.12401] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/13/2018] [Accepted: 05/22/2018] [Indexed: 12/25/2022] Open
Abstract
In this study, we build a vendor-agnostic software application capable of importing and analyzing non-image-based DICOM files for various radiation treatment modalities (i.e., DICOM RT Dose, RT Structure, and RT Plan files). Dose-volume histogram (DVH) and planning data are imported into a SQL database, and methods are provided to manage, edit, view, and download data. Furthermore, the software provides various analytical tools for plan evaluations, plan comparisons, benchmarking, and plan outcome predictions. DVH Analytics is developed using Python, including libraries such as pydicom, dicompyler, psycopg2, SciPy, Statsmodels, and Bokeh for parsing DICOM files, computing DVHs, communicating with a PostgreSQL database, performing statistical analyses, and creating a web-based user interface. This software is open-source and compatible with Windows, Mac OS, and Linux. For proof-of-concept, a database with over 3,000 DVHs from a single physician's head & neck practice was built. From these data, differences in means, correlations, and temporal trends in dose to multiple organs-at-risk (OARs) were observed. Furthermore, an example of the predictive regression tool is reported, where a model was constructed to predict maximum dose to brainstem based on minimum distance from planning target volume (PTV) and treatment beam source-to-skin distance (SSD). With DVH Analytics, we have developed a free, open-source software program to parse, organize, and analyze non-image-based DICOM data for use in a radiation oncology setting. Furthermore, this software can be used to generate statistical models for the purposes of quality control or outcome predictions and correlations.
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Affiliation(s)
- Dan Cutright
- Department of Radiation Oncology, Warren Alpert Medical School, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - Mahesh Gopalakrishnan
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Arkajyoti Roy
- Department of Applied Statistics and Operations Research, Bowling Green State University, Bowling Green, OH, USA.,Department of Management Science and Statistics, University of Texas at San Antonio, San Antonio, TX, USA
| | - Aditya Panchal
- Department of Radiation Oncology, Northwestern Medicine Chicago Proton Center, Warrenville, IL, USA
| | - Bharat B Mittal
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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17
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Said MM, Nilsson P, Ceberg CP. Corrigendum to "Analysis of dose heterogeneity using subvolume- DVH". Phys Med Biol 2018; 63:089501. [PMID: 29521277 DOI: 10.1088/1361-6560/aab569] [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] [Indexed: 11/12/2022]
Abstract
The dose-volume histogram (DVH) is universally used in radiation therapy for
its highly efficient way of summarizing three-dimensional dose distributions.
An apparent limitation that is inherent to standard histograms is the loss of
spatial information, e.g. it is no longer possible to tell where low- and highdose
regions are, and whether they are connected or disjoint. Two methods
for overcoming the spatial fragmentation of low- and high-dose regions are
presented, both based on the gray-level size zone matrix, which is a two-dimensional histogram describing the frequencies of connected regions of
similar intensities.
The first approach is a quantitative metric which can be likened to
a homogeneity index. The large cold spot metric (LCS) is here defined to
emphasize large contiguous regions receiving too low a dose; emphasis is
put on both size, and deviation from the prescribed dose. In contrast, the
subvolume-DVH (sDVH) is an extension to the standard DVH and allows for
a qualitative evaluation of the degree of dose heterogeneity. The information
retained from the two-dimensional histogram is overlaid on top of the DVH
and the two are presented simultaneously. Both methods gauge the underlying
heterogeneity in ways that the DVH alone cannot, and both have their own
merits-the sDVH being more intuitive and the LCS being quantitative.
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Affiliation(s)
- Mohammed Mosad Said
- Department of Hematology, Oncology and Radiation Physiscs, Skanes universitetssjukhus Lund, Lund, 221 85, SWEDEN
| | - Per Nilsson
- Department of Hematology, Oncology and Radiation Physiscs, Skanes Universitetssjukhus, Lund, SWEDEN
| | - Crister P Ceberg
- Department of Clinical Sciences Lund, Lund University, Lund, SWEDEN
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Abstract
Introduction: Three-dimensional (3D) treatment planning of patient undergoing radiotherapy uses complex and meticulous computational algorithms. These algorithms use 3D voxel data of the patient to calculate the radiation dose distribution and display it over the CT image dataset for treatment plan evaluation. Aims and Objective: The purpose of the present study is the development and implementation of radiobiological evaluation of the radiotherapy treatment plan incorporating the tissue-specific radiobiological parameters. Material and Method: An indigenous program was written in MATLAB® software (version 2011b of Mathworks Inc.) to extract the patient treatment plan data from DICOM-RT files which are exported from the treatment planning system. CT-, Structures- and Dose-Cube matrices are reconstructed from the exported patient plan data. BED and EQD2 based dose volume histograms (DVHs), colorwash and iso-effective dose curves were generated from the physical Dose-Cube using the linear-quadratic (LQ) formalism and tissue-specific radiobiological parameters (α/β). Results and Conclusion: BED-and EQD2-colorwash and iso-effective curves along with BED and EQD2 dose volume histograms provide superior radiobiological information as compared to those of physical doses. This study provides supplementary recipes of radiobiological doses along with the physical doses which are useful for the evaluation of complex radiotherapy treatment plan of the patients.
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Affiliation(s)
- Gaganpreet Singh
- Centre for Medical Physics, Panjab University, Chandigarh, India
| | - Arun S Oinam
- Department of Radiotherapy, PGIMER, Chandigarh, India
| | - Rose Kamal
- Centre for Medical Physics, Panjab University, Chandigarh, India
| | - Bhumika Handa
- Centre for Medical Physics, Panjab University, Chandigarh, India
| | - Vivek Kumar
- Centre for Medical Physics, Panjab University, Chandigarh, India
| | - Bhavana Rai
- Department of Radiotherapy, PGIMER, Chandigarh, India
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Pappas EP, Alshanqity M, Moutsatsos A, Lababidi H, Alsafi K, Georgiou K, Karaiskos P, Georgiou E. MRI-Related Geometric Distortions in Stereotactic Radiotherapy Treatment Planning: Evaluation and Dosimetric Impact. Technol Cancer Res Treat 2017; 16:1120-1129. [PMID: 29332453 PMCID: PMC5762079 DOI: 10.1177/1533034617735454] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In view of their superior soft tissue contrast compared to computed tomography, magnetic resonance images are commonly involved in stereotactic radiosurgery/radiotherapy applications for target delineation purposes. It is known, however, that magnetic resonance images are geometrically distorted, thus deteriorating dose delivery accuracy. The present work focuses on the assessment of geometric distortion inherent in magnetic resonance images used in stereotactic radiosurgery/radiotherapy treatment planning and attempts to quantitively evaluate the consequent impact on dose delivery. The geometric distortions for 3 clinical magnetic resonance protocols (at both 1.5 and 3.0 T) used for stereotactic radiosurgery/radiotherapy treatment planning were evaluated using a recently proposed phantom and methodology. Areas of increased distortion were identified at the edges of the imaged volume which was comparable to a brain scan. Although mean absolute distortion did not exceed 0.5 mm on any spatial axis, maximum detected control point disposition reached 2 mm. In an effort to establish what could be considered as acceptable geometric uncertainty, highly conformal plans were utilized to irradiate targets of different diameters (5-50 mm). The targets were mispositioned by 0.5 up to 3 mm, and dose–volume histograms and plan quality indices clinically used for plan evaluation and acceptance were derived and used to investigate the effect of geometrical uncertainty (distortion) on dose delivery accuracy and plan quality. The latter was found to be strongly dependent on target size. For targets less than 20 mm in diameter, a spatial disposition of the order of 1 mm could significantly affect (>5%) plan acceptance/quality indices. For targets with diameter greater than 2 cm, the corresponding disposition was found greater than 1.5 mm. Overall results of this work suggest that efficacy of stereotactic radiosurgery/radiotherapy applications could be compromised in case of very small targets lying distant from the scanner’s isocenter (eg, the periphery of the brain).
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Affiliation(s)
- Eleftherios P Pappas
- 1 Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Argyris Moutsatsos
- 1 Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Konstantinos Georgiou
- 1 Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Pantelis Karaiskos
- 1 Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Georgiou
- 1 Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Kubo N, Saitoh JI, Shimada H, Shirai K, Kawamura H, Ohno T, Nakano T. Dosimetric comparison of carbon ion and X-ray radiotherapy for Stage IIIA non-small cell lung cancer. J Radiat Res 2016; 57:548-554. [PMID: 27242341 PMCID: PMC5045075 DOI: 10.1093/jrr/rrw041] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 03/12/2016] [Indexed: 05/04/2023]
Abstract
The present study compared the dose-volume histograms of patients with Stage IIIA non-small cell lung cancer (NSCLC) treated with carbon ion radiotherapy with those of patients treated with X-ray radiotherapy. Patients with Stage IIIA NSCLC (n = 10 patients for each approach) were enrolled. Both radiotherapy plans were calculated with the same targets and organs at risk on the same CT. The treatment plan for the prophylactic lymph node and primary tumor (PTV1) delivered 40 Gy for X-ray radiotherapy and 40 Gy (relative biological effectiveness; RBE) for carbon ion radiotherapy. The total doses for the primary tumor and clinically positive lymph nodes (PTV2) were 60 Gy for X-ray radiotherapy and 60 Gy (RBE) for carbon ion radiotherapy. The homogeneity indexes for PTV1 and PTV2 were superior for carbon ion radiotherapy in comparison with X-ray radiotherapy (PTV1, 0.57 vs 0.65, P = 0.009; PTV2, 0.07 vs 0.16, P = 0.005). The normal lung mean dose, V5, V10 and V20 for carbon ion radiotherapy were 7.7 Gy (RBE), 21.4%, 19.7% and 17.0%, respectively, whereas the corresponding doses for X-ray radiotherapy were 11.9 Gy, 34.9%, 26.6% and 20.8%, respectively. Maximum spinal cord dose, esophageal maximum dose and V50, and bone V10, V30 and V50 were lower with carbon ion radiotherapy than with X-ray radiotherapy. The present study indicates that carbon ion radiotherapy provides a more homogeneous target dose and a lower dose to organs at risk than X-ray radiotherapy for Stage IIIA non-small cell lung cancer.
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Affiliation(s)
- Nobuteru Kubo
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Jun-Ichi Saitoh
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hirofumi Shimada
- Gunma University Heavy Ion Medical Center, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Katsuyuki Shirai
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hidemasa Kawamura
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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Hadad K, Saeedi-Moghadam M, Zeinali-Rafsanjani B. Voxel dosimetry: Comparison of MCNPX and DOSXYZnrc Monte Carlo codes in patient specific phantom calculations. Technol Health Care 2016; 25:29-35. [PMID: 27447407 DOI: 10.3233/thc-161240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Dose evaluation with two Monte Carlo codes using patient specific voxel phantom is presented in this paper. We employ both MCNPX and DOSXYZnrc to perform dosimetry for mathematical voxel phantoms generated by our in-house developed voxel phantom generator and EGSnrc/CTCreate respectively. MATERIAL AND METHOD Our case study was a 2.5 × 2.4 × 2.4 cm3 tumor in the middle lobe of right lung of a male patient exposed to 6MV parallel beam. In order to compare these Monte Carlo codes with together gross tumor volume (GTV) and organ at risks (OAR) doses and dose volume histograms (DVH) were calculated. RESULTS Comparing the mean absorbed dose results (in Gy) from both codes indicates that gross tumor volume, heart and spinal cord have 2% to 10% difference. The 10% difference between the codes were from the spinal cord region where was not in the therapy beam and it just received the scatter radiation. The dose volume DVH obtained from DOSXYZnrc results demonstrate a milder slope compared with MCNPX DVHs. CONCLUSION It was revealed that MCNPX has some advantages in comparison to DOSXYZnrc, but it is important to consider that for equal precision in voxel dosimetry calculation, DOSXYZnrc runs faster than MCNPX and it is a great advantage.
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Affiliation(s)
- Kamal Hadad
- Department of Nuclear Engineering, School of Mechanical Engineering, Shiraz University, Shiraz, Iran
| | - Mahdi Saeedi-Moghadam
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Banafsheh Zeinali-Rafsanjani
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Nuclear Medicine and Molecular Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Katsuta Y, Kadoya N, Fujita Y, Shimizu E, Matsunaga K, Matsushita H, Majima K, Jingu K. Quantification of residual dose estimation error on log file-based patient dose calculation. Phys Med 2016; 32:701-5. [PMID: 27162084 DOI: 10.1016/j.ejmp.2016.04.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/02/2016] [Accepted: 04/29/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The log file-based patient dose estimation includes a residual dose estimation error caused by leaf miscalibration, which cannot be reflected on the estimated dose. The purpose of this study is to determine this residual dose estimation error. METHODS AND MATERIALS Modified log files for seven head-and-neck and prostate volumetric modulated arc therapy (VMAT) plans simulating leaf miscalibration were generated by shifting both leaf banks (systematic leaf gap errors: ±2.0, ±1.0, and ±0.5mm in opposite directions and systematic leaf shifts: ±1.0mm in the same direction) using MATLAB-based (MathWorks, Natick, MA) in-house software. The generated modified and non-modified log files were imported back into the treatment planning system and recalculated. Subsequently, the generalized equivalent uniform dose (gEUD) was quantified for the definition of the planning target volume (PTV) and organs at risks. RESULTS For MLC leaves calibrated within ±0.5mm, the quantified residual dose estimation errors that obtained from the slope of the linear regression of gEUD changes between non- and modified log file doses per leaf gap are in head-and-neck plans 1.32±0.27% and 0.82±0.17Gy for PTV and spinal cord, respectively, and in prostate plans 1.22±0.36%, 0.95±0.14Gy, and 0.45±0.08Gy for PTV, rectum, and bladder, respectively. CONCLUSIONS In this work, we determine the residual dose estimation errors for VMAT delivery using the log file-based patient dose calculation according to the MLC calibration accuracy.
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Affiliation(s)
- Yoshiyuki Katsuta
- Department of Radiology, Takeda General Hospital, Aizuwakamatsu, Japan; Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Yukio Fujita
- Department of Radiation Oncology, Tokai University Graduate School of Medicine, Isehara, Japan
| | - Eiji Shimizu
- Department of Radiology, Takeda General Hospital, Aizuwakamatsu, Japan
| | - Kenichi Matsunaga
- Department of Radiology, Takeda General Hospital, Aizuwakamatsu, Japan
| | - Haruo Matsushita
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuhiro Majima
- Department of Radiology, Takeda General Hospital, Aizuwakamatsu, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Xu Z, Wang IZ, Kumaraswamy LK, Podgorsak MB. Evaluation of dosimetric effect caused by slowing with multi-leaf collimator (MLC) leaves for volumetric modulated arc therapy (VMAT). Radiol Oncol 2016; 50:121-8. [PMID: 27069458 PMCID: PMC4825334 DOI: 10.1515/raon-2016-0008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/19/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND This study is to report 1) the sensitivity of intensity modulated radiation therapy (IMRT) QA method for clinical volumetric modulated arc therapy (VMAT) plans with multi-leaf collimator (MLC) leaf errors that will not trigger MLC interlock during beam delivery; 2) the effect of non-beam-hold MLC leaf errors on the quality of VMAT plan dose delivery. MATERIALS AND METHODS Eleven VMAT plans were selected and modified using an in-house developed software. For each control point of a VMAT arc, MLC leaves with the highest speed (1.87-1.95 cm/s) were set to move at the maximal allowable speed (2.3 cm/s), which resulted in a leaf position difference of less than 2 mm. The modified plans were considered as 'standard' plans, and the original plans were treated as the 'slowing MLC' plans for simulating 'standard' plans with leaves moving at relatively lower speed. The measurement of each 'slowing MLC' plan using MapCHECK®2 was compared with calculated planar dose of the 'standard' plan with respect to absolute dose Van Dyk distance-to-agreement (DTA) comparisons using 3%/3 mm and 2%/2 mm criteria. RESULTS All 'slowing MLC' plans passed the 90% pass rate threshold using 3%/3 mm criteria while one brain and three anal VMAT cases were below 90% with 2%/2 mm criteria. For ten out of eleven cases, DVH comparisons between 'standard' and 'slowing MLC' plans demonstrated minimal dosimetric changes in targets and organs-at-risk. CONCLUSIONS For highly modulated VMAT plans, pass rate threshold (90%) using 3%/3mm criteria is not sensitive in detecting MLC leaf errors that will not trigger the MLC leaf interlock. However, the consequential effects of non-beam hold MLC errors on target and OAR doses are negligible, which supports the reliability of current patient-specific IMRT quality assurance (QA) method for VMAT plans.
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Affiliation(s)
| | | | - Lalith K Kumaraswamy
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY 14263
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Noufal MP, Abdullah KK, Niyas P, Sankaran TS, Sasindaran PR. Analysis of Dosimetric Impacts of Cone Beam Computed Tomography-Based Volumetric Modulated Arc Therapy Planning. J Med Imaging Radiat Sci 2016; 47:160-170. [PMID: 31047180 DOI: 10.1016/j.jmir.2015.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/04/2015] [Revised: 11/09/2015] [Accepted: 12/11/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To quantify the Hounsfield unit (HU) variations between computed tomography (CT) and cone beam CT (CBCT) and study its impact on volumetric modulated arc therapy (VMAT) plans. METHODS HU number variations in CT and CBCT images were evaluated using the Catphan-504 phantom, and changes in seven different materials within the phantom (air, polymethylpentene, low-density polyethylene, polystyrene, acrylic, Delrin, and Teflon) were studied. The HU variations in half-fan and full-fan modes of CBCT were evaluated. The effect of variations in the shape of the body cross sections was assessed by reducing the body of the Catphan by 0.5 cm and 1.0 cm. CBCT-based VMAT plans in 27 patients (10 prostate, 10 brain, and 7 head and neck (HN)) were compared with corresponding CT-based plans. The dosimetric variations were assessed referring to different points on the dose volume histogram (D5%, D50%, and D95% for PTVs and D1%, Dmax, and Dmean for organs at risk). The relative percentage of difference (ΔD (%)) between CT- and CBCT-based VMAT plans were examined on these points. To evaluate the dosimetric accuracy, dose distributions were compared using Omnipro-I'mRT software. The VMAT plans were evaluated based on 3 mm-3%, 2 mm-2%, and 1 mm-1% gamma criteria. RESULTS The HU difference in CT and CBCT was highest for air, Delrin, and Teflon, whereas the difference was less than 20 HU for the other materials. The dose volume histograms of both CT- and CBCT-based plans were in excellent agreement in both phantom and patients, except in HN cases where the difference was 7%. The average 3 mm-3% gamma pass points in brain, prostate, and HN patients were 97 ± 0.2%, 96 ± 0.06%, and 93.3 ± 1.1%, respectively. The gamma pass rates reduced to 88.8 ± 0.06%, 91 ± 0.04%, and 79 ± 6% in 2 mm-2%, and further declined to 76.6 ± 0.09%, 75.2 ± 0.5%, and 60 ± 6% using the stringent 1 mm-1% gamma criteria for brain, prostate, and HN cases, respectively. CONCLUSION Based on the results of this study, it is our belief that CBCT images can be used as a tool for evaluating the dosimetric variation in patient VMAT plans.
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Affiliation(s)
- Manthala Padannayil Noufal
- Department of Medical Physics and Radiotherapy, Baby Memorial Hospital, Calicut, India; Department of Physics, Farook College, Calicut, India; University of Calicut, Malapuram, Kerala, India.
| | | | - Puzhakal Niyas
- Department of Medical Physics and Radiotherapy, Baby Memorial Hospital, Calicut, India; Department of Physics, Farook College, Calicut, India; University of Calicut, Malapuram, Kerala, India
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Murakami N, Kobayashi K, Nakamura S, Wakita A, Okamoto H, Tsuchida K, Kashihara T, Harada K, Yamada M, Sekii S, Takahashi K, Umezawa R, Inaba K, Ito Y, Igaki H, Itami J. A total EQD2 greater than 85 Gy for trachea and main bronchus D2cc being associated with severe late complications after definitive endobronchial brachytherapy. J Contemp Brachytherapy 2015; 7:363-8. [PMID: 26622242 DOI: 10.5114/jcb.2015.54968] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/06/2015] [Indexed: 12/03/2022] Open
Abstract
Purpose The endobronchial brachytherapy (EBBT) is an established treatment method for tumors of the tracheobronchial system, however, little is known about the tolerance dose for organ at risk (OAR) in EBBT. The purpose of this study is to analyze patients with superficial bronchial carcinoma treated with definitive EBBT, and to investigate a relationship between late complications and dose for OAR. Material and methods Endobronchial brachytherapy was performed 6 Gy per fraction for three to four fractions with or without external beam radiation therapy (EBRT). For the purpose of dosimetric analysis, the wall of the lower respiratory tract (LRT: trachea, main bronchus, and lobar bronchiole), trachea, and main bronchus (TMB) was extracted. D0.5cc, D1cc, and D2cc of LRT and TMB were calculated in each EBBT session and added together. V100, V150, and V200 of LRT were also calculated. Results Between March 2008 and April 2014, EBBT was performed in 14 patients for curative intent. The 2-year overall survival (OS), progression-free survival (PFS), and local recurrence free survival (LRFS) was 82.1%, 77.9%, and 91.7%, respectively. There was one patient with grade 5, one grade 4, and three grade 3 obstruction of trachea or bronchus. The mean EQD2 of LRT D2cc, TMB D2cc, D1cc, and D0.5cc of patients with or without late severe respiratory complications was significantly different between two groups (p = 0.018, 0.008, 0.009, and 0.013, respectively). The 2-year incidence rates of late severe complications in patients with TMB D2cc ≤ 85 Gy in EQD2 and > 85 Gy were 0% and 83.3%, respectively with a statistically significance (p = 0.014). Conclusions It was discovered that TMB D2cc > 85 Gy in EQD2 is a strong risk factor for severe late respiratory complication after EBBT.
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Ohno T, Oshiro Y, Mizumoto M, Numajiri H, Ishikawa H, Okumura T, Terunuma T, Sakae T, Sakurai H. Comparison of dose-volume histograms between proton beam and X-ray conformal radiotherapy for locally advanced non-small-cell lung cancer. J Radiat Res 2015; 56:128-33. [PMID: 25368341 PMCID: PMC4572589 DOI: 10.1093/jrr/rru082] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/18/2014] [Accepted: 08/19/2014] [Indexed: 05/21/2023]
Abstract
The purpose of this study was to compare the parameters of the dose-volume histogram (DVH) between proton beam therapy (PBT) and X-ray conformal radiotherapy (XCRT) for locally advanced non-small-cell lung cancer (NSCLC), according to the tumor conditions. A total of 35 patients having NSCLC treated with PBT were enrolled in this analysis. The numbers of TNM stage and lymph node status were IIB (n = 3), IIIA (n = 15) and IIIB (n = 17), and N0 (n = 2), N1 (n = 4), N2 (n = 17) and N3 (n = 12), respectively. Plans for XCRT were simulated based on the same CT, and the same clinical target volume (CTV) was used based on the actual PBT plan. The treatment dose was 74 Gy-equivalent dose (GyE) for the primary site and 66 GyE for positive lymph nodes. The parameters were then calculated according to the normal lung dose, and the irradiation volumes of the doses (Vx) were compared. We also evaluated the feasibility of both plans according to criteria: V5 ≥ 42%, V20 ≥ 25%, mean lung dose ≥ 20 Gy. The mean normal lung dose and V5 to V50 were significantly lower in PBT than in XCRT. The differences were greater with the more advanced nodal status and with the larger CTV. Furthermore, 45.7% of the X-ray plans were classified as inadequate according to the criteria, whereas 17.1% of the proton plans were considered unsuitable. The number of inadequate X-ray plans increased in cases with advanced nodal stage. This study indicated that some patients who cannot receive photon radiotherapy may be able to be treated using PBT.
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Affiliation(s)
- Toshiki Ohno
- Departments of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yoshiko Oshiro
- Departments of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masashi Mizumoto
- Departments of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Haruko Numajiri
- Departments of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hitoshi Ishikawa
- Departments of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Toshiyuki Okumura
- Departments of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Toshiyuki Terunuma
- Departments of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takeji Sakae
- Departments of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hideyuki Sakurai
- Departments of Radiation Oncology and Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
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Grassi E, Fioroni F, Ferri V, Mezzenga E, Sarti MA, Paulus T, Lanconelli N, Filice A, Versari A, Iori M. Quantitative comparison between the commercial software STRATOS(®) by Philips and a homemade software for voxel-dosimetry in radiopeptide therapy. Phys Med 2014; 31:72-9. [PMID: 25457430 DOI: 10.1016/j.ejmp.2014.10.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 10/02/2014] [Accepted: 10/05/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Targeted radionuclide therapy is a rapidly growing modality. A few commercial treatment planning systems are entering the market. However, some in-house systems are currently developed for a more flexible and customized dosimetry calculation at voxel-level. For this purpose, we developed a novel software, VoxelMed, and performed a comparison with the software STRATOS. METHODS The validation of both of them was undertaken using radioactive phantoms with different volume inserts. A cohort of 10 patients was also studied after a therapeutic administration of (177)Lu-labelled radiopeptides. The activity, number of disintegrations, absorbed dose and dose-volume histogram (DVH) were calculated for the phantoms and the kidneys in patients, which were the main critical organs at risk in this study. RESULTS In phantoms the absorbed doses computed with VoxelMed and STRATOS agree within 5%. In patients at the voxel-level the absorbed dose to kidneys (VoxelMed: mean 0.66 Gy/GBq) showed a limited difference of 5%, but with a remarkable range (-40%, +60%) between the two software packages. Voxel-dosimetry allows to estimate the dose non-homogeneities in volumes, which may be evaluated through DVHs. CONCLUSION This study demonstrates that a fully 3D voxel-dosimetry with multiple SPECT images is feasible by using home-made or commercial software package and absorbed dose results obtained are similar. The main difference between the studied tools was observed in the activity integration method (effective vs physical half-time to time activity curve tail). We believe that an effective half-time integration method produces a more accurate approximation of clinical uptake and resultant dosimetry.
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Affiliation(s)
- E Grassi
- Medical Physics Dept., IRCCS - S. Maria Nuova Hospital, Viale Risorgimento 80, I-42123 Reggio Emilia, Italy.
| | - F Fioroni
- Medical Physics Dept., IRCCS - S. Maria Nuova Hospital, Viale Risorgimento 80, I-42123 Reggio Emilia, Italy
| | - V Ferri
- Medical Physics Dept., IRCCS - S. Maria Nuova Hospital, Viale Risorgimento 80, I-42123 Reggio Emilia, Italy
| | - E Mezzenga
- Medical Physics Dept., IRCCS - S. Maria Nuova Hospital, Viale Risorgimento 80, I-42123 Reggio Emilia, Italy
| | - M A Sarti
- Medical Physics Dept., IRCCS - S. Maria Nuova Hospital, Viale Risorgimento 80, I-42123 Reggio Emilia, Italy
| | - T Paulus
- Philips Technologie GmbH Innovative Technologies, Pauwelsstr. 17, 52074 Aachen, Germany
| | - N Lanconelli
- Dept. of Physics, University of Bologna, I-40126 Bologna, Italy
| | - A Filice
- Nuclear Medicine Dept., IRCCS - S. Maria Nuova Hospital, Viale Risorgimento 80, I-42123 Reggio Emilia, Italy
| | - A Versari
- Nuclear Medicine Dept., IRCCS - S. Maria Nuova Hospital, Viale Risorgimento 80, I-42123 Reggio Emilia, Italy
| | - M Iori
- Medical Physics Dept., IRCCS - S. Maria Nuova Hospital, Viale Risorgimento 80, I-42123 Reggio Emilia, Italy
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Pedicini P, Strigari L, Benassi M, Caivano R, Fiorentino A, Nappi A, Salvatore M, Storto G. Critical dose and toxicity index of organs at risk in radiotherapy: analyzing the calculated effects of modified dose fractionation in non-small cell lung cancer. Med Dosim 2013; 39:23-30. [PMID: 24239409 DOI: 10.1016/j.meddos.2013.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 02/26/2013] [Revised: 06/28/2013] [Accepted: 08/14/2013] [Indexed: 12/25/2022]
Abstract
To increase the efficacy of radiotherapy for non-small cell lung cancer (NSCLC), many schemes of dose fractionation were assessed by a new "toxicity index" (I), which allows one to choose the fractionation schedules that produce less toxic treatments. Thirty-two patients affected by non resectable NSCLC were treated by standard 3-dimensional conformal radiotherapy (3DCRT) with a strategy of limited treated volume. Computed tomography datasets were employed to re plan by simultaneous integrated boost intensity-modulated radiotherapy (IMRT). The dose distributions from plans were used to test various schemes of dose fractionation, in 3DCRT as well as in IMRT, by transforming the dose-volume histogram (DVH) into a biological equivalent DVH (BDVH) and by varying the overall treatment time. The BDVHs were obtained through the toxicity index, which was defined for each of the organs at risk (OAR) by a linear quadratic model keeping an equivalent radiobiological effect on the target volume. The less toxic fractionation consisted in a severe/moderate hyper fractionation for the volume including the primary tumor and lymph nodes, followed by a hypofractionation for the reduced volume of the primary tumor. The 3DCRT and IMRT resulted, respectively, in 4.7% and 4.3% of dose sparing for the spinal cord, without significant changes for the combined-lungs toxicity (p < 0.001). Schedules with reduced overall treatment time (accelerated fractionations) led to a 12.5% dose sparing for the spinal cord (7.5% in IMRT), 8.3% dose sparing for V20 in the combined lungs (5.5% in IMRT), and also significant dose sparing for all the other OARs (p < 0.001). The toxicity index allows to choose fractionation schedules with reduced toxicity for all the OARs and equivalent radiobiological effect for the tumor in 3DCRT, as well as in IMRT, treatments of NSCLC.
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Affiliation(s)
- Piernicola Pedicini
- Service of Medical Physics, I.R.C.C.S. Regional Cancer Hospital C.R.O.B, Rionero in Vulture, Italy.
| | - Lidia Strigari
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy
| | - Marcello Benassi
- Service of Medical Physics, Scientific Institute of Tumours of Romagna I.R.S.T., Meldola, Italy
| | - Rocchina Caivano
- Service of Medical Physics, I.R.C.C.S. Regional Cancer Hospital C.R.O.B, Rionero in Vulture, Italy
| | - Alba Fiorentino
- U.O. of Radiotherapy, I.R.C.C.S. Regional Cancer Hospital C.R.O.B., Rionero in Vulture, Italy
| | - Antonio Nappi
- U.O. of Nuclear Medicine, I.R.C.C.S. Regional Cancer Hospital C.R.O.B., Rionero in Vulture, Italy
| | - Marco Salvatore
- U.O. of Nuclear Medicine, I.R.C.C.S. SDN Foundation, Naples, Italy
| | - Giovanni Storto
- U.O. of Nuclear Medicine, I.R.C.C.S. Regional Cancer Hospital C.R.O.B., Rionero in Vulture, Italy
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Eaton BR, Kim HS, Schreibmann E, Schuster DM, Galt JR, Barron B, Kim S, Liu Y, Landry J, Fox T. Quantitative dosimetry for yttrium-90 radionuclide therapy: tumor dose predicts fluorodeoxyglucose positron emission tomography response in hepatic metastatic melanoma. J Vasc Interv Radiol 2013; 25:288-95. [PMID: 24269792 DOI: 10.1016/j.jvir.2013.08.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [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: 05/08/2013] [Revised: 08/15/2013] [Accepted: 08/26/2013] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To assess a new method for generating patient-specific volumetric dose calculations and analyze the relationship between tumor dose and positron emission tomography (PET) response after radioembolization of hepatic melanoma metastases. METHODS AND MATERIALS Yttrium-90 ((90)Y) bremsstrahlung single photon emission computed tomography (SPECT)/computed tomography (CT) acquired after (90)Y radioembolization was convolved with published (90)Y Monte Carlo estimated dose deposition kernels to create a three-dimensional dose distribution. Dose-volume histograms were calculated for tumor volumes manually defined from magnetic resonance imaging or PET/CT imaging. Tumor response was assessed by absolute reduction in maximum standardized uptake value (SUV(max)) and total lesion glycolysis (TLG). RESULTS Seven patients with 30 tumors treated with (90)Y for hepatic metastatic melanoma with available (90)Y SPECT/CT and PET/CT before and after treatment were identified for analysis. The median (range) for minimum, mean, and maximum dose per tumor volume was 16.9 Gy (5.7-43.5 Gy), 28.6 Gy (13.8-65.6 Gy) and 36.6 Gy (20-124 Gy), respectively. Response was assessed by fluorodeoxyglucose PET/CT at a median time after treatment of 2.8 months (range, 1.2-7.9 months). Mean tumor dose (P = .03) and the percentage of tumor volume receiving ≥ 50 Gy (P < .01) significantly predicted for decrease in tumor SUV(max), whereas maximum tumor dose predicted for decrease in tumor TLG (P < .01). CONCLUSIONS Volumetric dose calculations showed a statistically significant association with metabolic tumor response. The significant dose-response relationship points to the clinical utility of patient-specific absorbed dose calculations for radionuclide therapy.
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Affiliation(s)
- Bree R Eaton
- Department of Radiation Oncology, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322; Winship Cancer Institute, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322.
| | - Hyun S Kim
- Department of Radiology and Imaging Sciences, Divisions of Interventional Radiology and Image Guided Medicine, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322; Winship Cancer Institute, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322
| | - Eduard Schreibmann
- Department of Radiation Oncology, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322; Winship Cancer Institute, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322
| | - David M Schuster
- Divisions of Nuclear Medicine and Molecular Imaging, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322; Winship Cancer Institute, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322
| | - James R Galt
- Divisions of Nuclear Medicine and Molecular Imaging, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322
| | - Bruce Barron
- Divisions of Nuclear Medicine and Molecular Imaging, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322; Winship Cancer Institute, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322
| | - Sungjin Kim
- Departments of Biostatistics and Bioinformatics, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322; Winship Cancer Institute, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322
| | - Yuan Liu
- Departments of Biostatistics and Bioinformatics, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322; Winship Cancer Institute, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322
| | - Jerome Landry
- Department of Radiation Oncology, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322; Winship Cancer Institute, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322
| | - Tim Fox
- Department of Radiation Oncology, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322; Winship Cancer Institute, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322
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