1
|
Şenkesen Ö, Tezcanlı E, Alkaya F, İspir B, Çatlı S, Yeşil A, Bezirganoglu E, Turan S, Köksal C, Güray G, Hacıislamoğlu E, Durmuş İF, Çavdar Ş, Aksu T, Çolak N, Küçükmorkoç E, Doğan M, Ercan T, Karaköse F, Alpan V, Ceylan C, Poyraz G, Nalbant N, Kınay Ş, İpek S, Kayalılar N, Tatlı H, Zhu M. Current practices of craniospinal irradiation techniques in Turkey: a comprehensive dosimetric analysis. Radiat Oncol 2024; 19:49. [PMID: 38627747 PMCID: PMC11022438 DOI: 10.1186/s13014-024-02435-4] [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: 01/03/2024] [Accepted: 03/23/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE This study evaluates various craniospinal irradiation (CSI) techniques used in Turkish centers to understand their advantages, disadvantages and overall effectiveness, with a focus on enhancing dose distribution. METHODS Anonymized CT scans of adult and pediatric patients, alongside target volumes and organ-at-risk (OAR) structures, were shared with 25 local radiotherapy centers. They were tasked to develop optimal treatment plans delivering 36 Gy in 20 fractions with 95% PTV coverage, while minimizing OAR exposure. The same CT data was sent to a US proton therapy center for comparison. Various planning systems and treatment techniques (3D conformal RT, IMRT, VMAT, tomotherapy) were utilized. Elekta Proknow software was used to analyze parameters, assess dose distributions, mean doses, conformity index (CI), and homogeneity index (HI) for both target volumes and OARs. Comparisons were made against proton therapy. RESULTS All techniques consistently achieved excellent PTV coverage (V95 > 98%) for both adult and pediatric patients. Tomotherapy closely approached ideal Dmean doses for all PTVs, while 3D-CRT had higher Dmean for PTV_brain. Tomotherapy excelled in CI and HI for PTVs. IMRT resulted in lower pediatric heart, kidney, parotid, and eye doses, while 3D-CRT achieved the lowest adult lung doses. Tomotherapy approached proton therapy doses for adult kidneys and thyroid, while IMRT excelled for adult heart, kidney, parotid, esophagus, and eyes. CONCLUSION Modern radiotherapy techniques offer improved target coverage and OAR protection. However, 3D techniques are continued to be used for CSI. Notably, proton therapy stands out as the most efficient approach, closely followed by Tomotherapy in terms of achieving superior target coverage and OAR protection.
Collapse
Affiliation(s)
- Öznur Şenkesen
- Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey.
- Department of Radiation Oncology, Acıbadem Ataşehir Hospital, Acıbadem Mehmet Ali Aydınlar University, Kayışdağı Cad. No:32, Ataşehir, Istanbul, Turkey.
| | - Evrim Tezcanlı
- Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
- Department of Radiation Oncology, Acıbadem Altunizade Hospital, Istanbul, Turkey
| | - Fadime Alkaya
- Health Sciences Institute, Istanbul Medipol University, Istanbul, Turkey
| | - Burçin İspir
- Department of Radiation Oncology, Acıbadem Adana Hospital, Adana, Turkey
| | - Serap Çatlı
- Radiation Oncology Department, Gazi University, Ankara, Turkey
| | - Abdullah Yeşil
- Department of Radiation Oncology, Medicana Bursa Hospital, Bursa, Turkey
| | | | - Sezgi Turan
- Department of Radiation Oncology, Neolife Medical Center, Istanbul, Turkey
| | - Canan Köksal
- Department of Radiation Oncology, Istanbul University Oncology Institute, Istanbul, Turkey
| | - Gülay Güray
- Department of Radiation Oncology, Medikal Park Bahçelievler Hospital, Istanbul, Turkey
| | - Emel Hacıislamoğlu
- Department of Radiation Oncology, Karadeniz Technical University Farabi Hospital, Trabzon, Turkey
| | - İsmail Faruk Durmuş
- Department of Radiation Oncology, Yeni Yuzyıl University Gaziosmanpasa Hospital, Istanbul, Turkey
| | - Şeyma Çavdar
- Department of Radiation Oncology, Medicana Ankara Hospital, Ankara, Turkey
| | - Telat Aksu
- Department of Radiation Oncology, Ondokuz Mayıs University, Samsun, Turkey
| | - Nurten Çolak
- Department of Radiation Oncology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Esra Küçükmorkoç
- Department of Radiation Oncology, Anadolu Medical Center, Istanbul, Turkey
| | - Mustafa Doğan
- Department of Radiation Oncology, Trakya University, Edirne, Turkey
| | - Tülay Ercan
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Fatih Karaköse
- Department of Radiation Oncology, Koc University Hospital, Istanbul, Turkey
| | - Vildan Alpan
- Department of Radiation Oncology, American Hospital, Istanbul, Turkey
| | - Cemile Ceylan
- Department of Radiation Oncology, Istanbul Onkology Hospital, Istanbul, Turkey
| | - Gökhan Poyraz
- Department of Radiation Oncology, Medipol University Hospital, Istanbul, Turkey
| | - Nilgül Nalbant
- Department of Radiation Oncology, Basaksehir Cam Ve Sakura City Hospital, Istanbul, Turkey
| | - Şeyda Kınay
- Department of Radiation Oncology, Dokuz Eylul University, İzmir, Turkey
| | - Servet İpek
- Department of Radiation Oncology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Namık Kayalılar
- Department of Radiation Oncology, Acıbadem Maslak Hospital, Istanbul, Turkey
| | - Hamza Tatlı
- Elekta Instrument AB, Barbaros Mah. Begonya Sok. Nidakule, Ataşehir, Istanbul, Turkey
| | - Mingyao Zhu
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
2
|
Toya R, Fukugawa Y, Saito T, Matsuyama T, Yoshida R, Murakami D, Orita Y, Nakayama H, Oya N. Radiation Therapy Oncology Group 8502 "QUAD shot" regimen using volumetric modulated arc therapy for incurable head and neck cancer. Oral Oncol 2024; 151:106752. [PMID: 38518555 DOI: 10.1016/j.oraloncology.2024.106752] [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: 11/03/2023] [Revised: 02/21/2024] [Accepted: 03/07/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVES We aimed to evaluate the outcomes of the Radiation Therapy Oncology Group 8502 "QUAD shot" regimen using volumetric modulated arc therapy (VMAT) for incurable head and neck cancer (HNC). MATERIALS AND METHODS We included 105 patients with HNC in the study, undergoing at least one QUAD shot regimen cycle. We planned the radiotherapy using VMAT with 6 MV photons. One QUAD shot cycle included 14.8 Gy in 4 fractions with at least 6-hour intervals over 2 consecutive days, repeated every 3-6 weeks up to 3 cycles. RESULTS We completed 1, 2, and 3 cycles in 11 (10 %), 17 (16 %), and 77 (73 %) patients, respectively. We concurrently performed systemic therapy in 13 (12 %) patients. Tumor response was observed in 92 (88 %) patients and at least one symptom relief in 51 (71 %) of 72 patients. We observed an overall response (tumor response or symptom relief) in 98 (93 %) patients with all patients who completed 3 cycles achieving it. The median overall survival (OS) was 6.8 months. Our multivariate analysis revealed that non-squamous cell carcinoma (p < 0.001), T category of 0-2 (p = 0.021), and 3 QUAD shot cycles (p < 0.001) were independent prognostic factors of better OS. We observed Grade 3 toxicity in 2 (2 %) patients while no ≥ Grade 4 acute or ≥ Grade 3 late toxicity. CONCLUSIONS The QUAD shot regimen using VMAT exerts appropriate palliative effect in patients with incurable HNC. Treatment with higher QUAD shot cycle number would be recommended for better treatment outcomes.
Collapse
Affiliation(s)
- Ryo Toya
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan; Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
| | - Yoshiyuki Fukugawa
- Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
| | - Tetsuo Saito
- Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
| | - Tomohiko Matsuyama
- Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
| | - Ryoji Yoshida
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
| | - Daizo Murakami
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
| | - Yorihisa Orita
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
| | - Hideki Nakayama
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
| | - Natsuo Oya
- Department of Radiation Oncology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
| |
Collapse
|
3
|
Gauter-Fleckenstein B, Schönig S, Mertens L, Oppitz H, Siebenlist K, Ehmann M, Fleckenstein J. Effect of simultaneous integrated boost concepts on photoneutron and distant out-of-field doses in VMAT for prostate cancer. Strahlenther Onkol 2024; 200:219-229. [PMID: 37707518 PMCID: PMC10876496 DOI: 10.1007/s00066-023-02138-x] [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: 04/16/2023] [Accepted: 08/08/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND A simultaneous integrated boost (SIB) may result in increased out-of-field (DOOF) and photoneutron (HPN) doses in volumetric modulated arc therapy (VMAT) for prostate cancer (PCA). This work therefore aimed to compare DOOF and HPN in flattened (FLAT) and flattening filter-free (FFF) 6‑MV and 10-MV VMAT treatment plans with and without SIB. METHODS Eight groups of 30 VMAT plans for PCA with 6 MV or 10 MV, with or without FF and with uniform (2 Gy) or SIB target dose (2.5/3.0 Gy) prescriptions (CONV, SIB), were generated. All 240 plans were delivered on a slab-phantom and compared with respect to measured DOOF and HPN in 61.8 cm distance from the isocenter. The 6‑ and 10-MV flattened VMAT plans with conventional fractionation (6- and 10-MV FLAT CONV) served as standard reference groups. Doses were analyzed as a function of delivered monitor units (MU) and weighted equivalent square field size Aeq. Pearson's correlation coefficients between the presented quantities were determined. RESULTS The SIB plans resulted in decreased HPN over an entire prostate RT treatment course (10-MV SIB vs. CONV -38.2%). Omission of the flattening filter yielded less HPN (10-MV CONV -17.2%; 10-MV SIB -22.5%). The SIB decreased DOOF likewise by 39% for all given scenarios, while the FFF mode reduced DOOF on average by 60%. A strong Pearson correlation was found between MU and HPN (r > 0.9) as well as DOOF (0.7 < r < 0.9). CONCLUSION For a complete treatment, SIB reduces both photoneutron and OOF doses to almost the same extent as FFF deliveries. It is recommended to apply moderately hypofractionated 6‑MV SIB FFF-VMAT when considering photoneutron or OOF doses.
Collapse
Affiliation(s)
- Benjamin Gauter-Fleckenstein
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany.
| | - Sebastian Schönig
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany
| | - Lena Mertens
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany
| | - Hans Oppitz
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany
| | - Kerstin Siebenlist
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany
| | - Michael Ehmann
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany
| | - Jens Fleckenstein
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany
| |
Collapse
|
4
|
Zou Z, Gong C, Zeng L, Guan Y, Huang B, Yu X, Liu Q, Zhang M. Invertible and Variable Augmented Network for Pretreatment Patient-Specific Quality Assurance Dose Prediction. J Imaging Inform Med 2024; 37:60-71. [PMID: 38343215 DOI: 10.1007/s10278-023-00930-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 03/02/2024]
Abstract
Pretreatment patient-specific quality assurance (prePSQA) is conducted to confirm the accuracy of the radiotherapy dose delivered. However, the process of prePSQA measurement is time consuming and exacerbates the workload for medical physicists. The purpose of this work is to propose a novel deep learning (DL) network to improve the accuracy and efficiency of prePSQA. A modified invertible and variable augmented network was developed to predict the three-dimensional (3D) measurement-guided dose (MDose) distribution of 300 cancer patients who underwent volumetric modulated arc therapy (VMAT) between 2018 and 2021, in which 240 cases were randomly selected for training, and 60 for testing. For simplicity, the present approach was termed as "IVPSQA." The input data include CT images, radiotherapy dose exported from the treatment planning system, and MDose distribution extracted from the verification system. Adam algorithm was used for first-order gradient-based optimization of stochastic objective functions. The IVPSQA model obtained high-quality 3D prePSQA dose distribution maps in head and neck, chest, and abdomen cases, and outperformed the existing U-Net-based prediction approaches in terms of dose difference maps and horizontal profiles comparison. Moreover, quantitative evaluation metrics including SSIM, MSE, and MAE demonstrated that the proposed approach achieved a good agreement with ground truth and yield promising gains over other advanced methods. This study presented the first work on predicting 3D prePSQA dose distribution by using the IVPSQA model. The proposed method could be taken as a clinical guidance tool and help medical physicists to reduce the measurement work of prePSQA.
Collapse
Affiliation(s)
- Zhongsheng Zou
- Department of Electronic Information Engineering, Nanchang University, Nanchang, China
| | - Changfei Gong
- Department of Radiation Oncology, 1st Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lingpeng Zeng
- Department of Electronic Information Engineering, Nanchang University, Nanchang, China
| | - Yu Guan
- Department of Electronic Information Engineering, Nanchang University, Nanchang, China
| | - Bin Huang
- Department of Electronic Information Engineering, Nanchang University, Nanchang, China
| | - Xiuwen Yu
- Department of Electronic Information Engineering, Nanchang University, Nanchang, China
| | - Qiegen Liu
- Department of Electronic Information Engineering, Nanchang University, Nanchang, China.
| | - Minghui Zhang
- Department of Electronic Information Engineering, Nanchang University, Nanchang, China.
| |
Collapse
|
5
|
Noda M, Taguchi S, Shiraishi K, Fujimura T, Naito A, Kawai T, Kamei J, Akiyama Y, Yamada Y, Sato Y, Yamada D, Nakagawa T, Yamashita H, Nakagawa K, Abe O, Fukuhara H, Kume H. Six-year outcomes of robot-assisted radical prostatectomy versus volumetric modulated arc therapy for localized prostate cancer: A propensity score-matched analysis. Strahlenther Onkol 2024:10.1007/s00066-023-02192-5. [PMID: 38180494 DOI: 10.1007/s00066-023-02192-5] [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: 09/24/2023] [Accepted: 12/17/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Although robot-assisted radical prostatectomy (RARP) and intensity-modulated radiotherapy are the leading respective techniques of prostatectomy and radiotherapy for localized prostate cancer, almost no study has directly compared their outcomes; none have compared mortality outcomes. METHODS We compared 6‑year outcomes of RARP (n = 500) and volumetric modulated arc therapy (VMAT, a rotational intensity-modulated radiotherapy, n = 360) in patients with cT1-4N0M0 prostate cancer. We assessed oncological outcomes, namely overall survival (OS), cancer-specific survival (CSS), radiological recurrence-free survival (rRFS), and biochemical recurrence-free survival (bRFS), using propensity score matching (PSM). We also assessed treatment-related complication outcomes of prostatectomy and radiotherapy. RESULTS The median follow-up duration was 79 months (> 6 years). PSM generated a matched cohort of 260 patients (130 per treatment group). In the matched cohort, RARP and VMAT showed equivalent results for OS, CSS, and rRFS: both achieved excellent 6‑year outcomes for OS (> 96%), CSS (> 98%), and rRFS (> 91%). VMAT had significantly longer bRFS than RARP, albeit based on different definitions of biochemical recurrence. Regarding complication outcomes, patients who underwent RARP had minimal (2.6%) severe perioperative complications and achieved excellent continence recovery (91.6 and 68.8% of the patients achieved ≤ 1 pad/day and pad-free, respectively). Patients who underwent VMAT had an acceptable rate (20.0%) of grade ≥ 2 genitourinary complications and a very low rate (4.4%) of grade ≥ 2 gastrointestinal complications. CONCLUSION On the basis of PSM after a 6-year follow-up, RARP and VMAT showed equivalent and excellent oncological outcomes, as well as acceptable complication profiles.
Collapse
Affiliation(s)
- Michio Noda
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Satoru Taguchi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan.
| | - Kenshiro Shiraishi
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | | | - Akihiro Naito
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan
| | - Taketo Kawai
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Jun Kamei
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan
| | - Yoshiyuki Akiyama
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan
| | - Yuta Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan
| | - Yusuke Sato
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan
| | - Daisuke Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan
| | - Tohru Nakagawa
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Hideomi Yamashita
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Keiichi Nakagawa
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroshi Fukuhara
- Department of Urology, Kyorin University School of Medicine, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan
| |
Collapse
|
6
|
Ogata T, Aibe N, Kimoto T, Takenaka T, Suzuki G, Yamada K, Yamazaki H. Comparative dosimetric study of spot-scanning proton therapy versus volumetric-modulated radiation therapy for extrahepatic bile duct cancer. Med Dosim 2023; 49:46-49. [PMID: 37925300 DOI: 10.1016/j.meddos.2023.10.004] [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: 07/28/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 11/06/2023]
Abstract
This study aimed to compare the dose distributions and clarify the dosimetric characteristics of spot-scanning proton therapy (SSPT) and photon volumetric modulated arc therapy (VMAT) for extrahepatic bile duct cancer (EBDC). This retrospective study included 10 patients with EBDC treated with real-time image-gated SSPT. Using the simultaneous integrated boost technique, the 2 prescription dose levels for planning target volumes were 72.6 and 44 Gy, delivered in 22 fractions. Plan quality comparisons were conducted by analyzing various parameters, including homogeneity, conformity, dose to organs at risk, and normal tissue complication probability (NTCP) for radiation-induced liver damage (RILD). The target dose distributions using SSPT were almost equivalent to those achieved using photon VMAT. There was a significant reduction in all liver dose parameters, the NTCP value for RILD, and kidney dose (mean, V12 Gy, and V18 Gy) in SSPT than in photon VMAT. No significant differences were observed in the intestinal doses in the high-dose area. Thus, compared with photon VMAT, SSPT for EBDC significantly reduced radiation doses to the liver and kidneys and has shown potential clinical benefits of reduced radiation-induced toxicity.
Collapse
Affiliation(s)
- Toshiyuki Ogata
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan.
| | - Norihiro Aibe
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan
| | - Takuya Kimoto
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan
| | - Tadashi Takenaka
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan
| | - Gen Suzuki
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan
| | - Kei Yamada
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan
| | - Hideya Yamazaki
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan
| |
Collapse
|
7
|
He L, Peng X, Chen N, Wei Z, Wang J, Liu Y, Xiao J. Automated treatment planning for liver cancer stereotactic body radiotherapy. Clin Transl Oncol 2023; 25:3230-3240. [PMID: 37097529 DOI: 10.1007/s12094-023-03196-4] [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: 11/26/2022] [Accepted: 04/07/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE To evaluate the quality of fully automated stereotactic body radiation therapy (SBRT) planning based on volumetric modulated arc therapy, which can reduce the reliance on historical plans and the experience of dosimetrists. METHODS Fully automated re-planning was performed on twenty liver cancer patients, automated plans based on automated SBRT planning (ASP) program and manual plans were conducted and compared. One patient was randomly selected and evaluate the repeatability of ASP, ten automated and ten manual SBRT plans were generated based on the same initial optimization objectives. Then, ten SBRT plans were generated for another selected randomly patient with different initial optimization objectives to assess the reproducibility. All plans were clinically evaluated in a double-blinded manner by five experienced radiation oncologists. RESULTS Fully automated plans provided similar planning target volume dose coverage and statistically better organ at risk sparing compared to the manual plans. Notably, automated plans achieved significant dose reduction in spinal cord, stomach, kidney, duodenum, and colon, with a median dose of D2% reduction ranging from 0.64 to 2.85 Gy. R50% and Dmean of ten rings for automated plans were significantly lower than those of manual plans. The average planning time for automated and manual plans was 59.8 ± 7.9 min vs. 127.1 ± 16.8 min (- 67.3 min). CONCLUSION Automated planning for SBRT, without relying on historical data, can generate comparable or even better plan quality for liver cancer compared with manual planning, along with better reproducibility, and less clinically planning time.
Collapse
Affiliation(s)
- Ling He
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingchen Peng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Na Chen
- School of Pharmacy, Chengdu Medical College, Xindu Avenue No. 783, Chengdu, 610500, Sichuan, China
| | - Zhigong Wei
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jingjing Wang
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yingtong Liu
- Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan, China
| | - Jianghong Xiao
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
8
|
Katsuta T, Murakami Y, Kawahara D, Miyoshi S, Imano N, Hirokawa J, Nishibuchi I, Nagata Y. Novel simulation for dosimetry impact of diaphragm respiratory motion in four-dimensional volumetric modulated arc therapy for esophageal cancer. Radiother Oncol 2023; 187:109849. [PMID: 37562552 DOI: 10.1016/j.radonc.2023.109849] [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: 02/08/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND AND PURPOSE The diaphragm respiratory motion (RM) could impact the target dose robustness in the lower esophageal cancer (EC). We aimed to develop a framework evaluating the impact of different RM patterns quantitatively in one patient, by creating virtual four-dimensional computed-tomography (v4DCT) images, which could lead to tailored treatment for the breathing pattern. We validated virtual 4D radiotherapy (v4DRT) along with exploring the acceptability of free-breathing volumetric modulated arc therapy (FB-VMAT). METHODS AND MATERIALS We assessed 10 patients with superficial EC through their real 4DCT (r4DCT) scans. v4DCT images were derived from the end-inhalation computed tomography (CT) image (reference CT) and the v4DRT dose was accumulated dose over all phases. r4DRT diaphragm shifts were applied with magnitudes derived from r4DCT scans; clinical target volume (CTV) dose of v4DRT was compared with that of r4DRT to validate v4DRT. CTV dosage modifications and planning organ at risk volume (PRV) margins of the spinal cord were examined with the diaphragm movement. The percentage dose differences (ΔDx) were determined between the v4DRT and the dose calculated on the reference CT image. RESULTS The CTV ΔDx between the r4DRT and v4DRT were within 1% in cases with RM ≦ 15 mm. The average ΔD100% and ΔDmean of the CTV ranging from 5 to 15 mm of diaphragm motion was 0.3% to 1.7% and 0.1% to 0.4%, respectively. All CTV index changes were within 3% and ΔD1cc and ΔD2cc of Cord PRV were within 1%. CONCLUSION We postulate a novel method for evaluating the CTV robustness, comparable to the conventional r4DCT method under the diaphragm RM ≦ 15 mm permitting an impact of within 3% in FB-VMAT for EC on the CTV dose distribution.
Collapse
Affiliation(s)
- Tsuyoshi Katsuta
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yuji Murakami
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Daisuke Kawahara
- Section of Radiation Therapy, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Shota Miyoshi
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Nobuki Imano
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Junichi Hirokawa
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Ikuno Nishibuchi
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| |
Collapse
|
9
|
Hirotaki K, Tomizawa K, Moriya S, Oyoshi H, Raturi V, Ito M, Sakae T. Fully automated volumetric modulated arc therapy planning for locally advanced rectal cancer: feasibility and efficiency. Radiat Oncol 2023; 18:147. [PMID: 37670390 PMCID: PMC10481560 DOI: 10.1186/s13014-023-02334-0] [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: 06/14/2023] [Accepted: 08/21/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Volumetric modulated arc therapy (VMAT) for locally advanced rectal cancer (LARC) has emerged as a promising technique, but the planning process can be time-consuming and dependent on planner expertise. We aimed to develop a fully automated VMAT planning program for LARC and evaluate its feasibility and efficiency. METHODS A total of 26 LARC patients who received VMAT treatment and the computed tomography (CT) scans were included in this study. Clinical target volumes and organs at risk were contoured by radiation oncologists. The automatic planning program, developed within the Raystation treatment planning system, used scripting capabilities and a Python environment to automate the entire planning process. The automated VMAT plan (auto-VMAT) was created by our automated planning program with the 26 CT scans used in the manual VMAT plan (manual-VMAT) and their regions of interests. Dosimetric parameters and time efficiency were compared between the auto-VMAT and the manual-VMAT created by experienced planners. All results were analyzed using the Wilcoxon signed-rank sum test. RESULTS The auto-VMAT achieved comparable coverage of the target volume while demonstrating improved dose conformity and uniformity compared with the manual-VMAT. V30 and V40 in the small bowel were significantly lower in the auto-VMAT compared with those in the manual-VMAT (p < 0.001 and < 0.001, respectively); the mean dose of the bladder was also significantly reduced in the auto-VMAT (p < 0.001). Furthermore, auto-VMAT plans were consistently generated with less variability in quality. In terms of efficiency, the auto-VMAT markedly reduced the time required for planning and expedited plan approval, with 93% of cases approved within one day. CONCLUSION We developed a fully automatic feasible VMAT plan creation program for LARC. The auto-VMAT maintained target coverage while providing organs at risk dose reduction. The developed program dramatically reduced the time to approval.
Collapse
Affiliation(s)
- Kouta Hirotaki
- Doctoral Program in Medical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
- Department of Radiological Technology, National Cancer Center Hospital East, Chiba, Japan
| | - Kento Tomizawa
- Department of Radiation Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, 277-8577, Kashiwa, Chiba, Japan.
| | | | - Hajime Oyoshi
- Department of Radiological Technology, National Cancer Center Hospital East, Chiba, Japan
| | - Vijay Raturi
- Department of Radiation Oncology, Apollomedics Hospital, Lucknow, India
| | - Masashi Ito
- Department of Radiological Technology, National Cancer Center Hospital East, Chiba, Japan
| | - Takeji Sakae
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| |
Collapse
|
10
|
Öztürk HF, Arslan SA, Gani Z, Aras D, Tezcan Y. From organ at risk to target organ: Dosimetric comparison of myocardial stereotactic ablative body radiotherapy between helical tomotherapy and volumetric arc therapy for refractory ventricular tachycardia. Med Dosim 2023; 48:293-298. [PMID: 37673728 DOI: 10.1016/j.meddos.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/19/2023] [Accepted: 08/03/2023] [Indexed: 09/08/2023]
Abstract
Ventricular tachycardia (VT) is an important type of arrhythmia with a risk of sudden death. Although implanted cardiac defibrillation and radiofrequency ablation are used together with medical treatments for VT, the treatment options are limited in cases that do not respond to them. Stereotactic ablative body radiotherapy (SABR) applied to VT substrates in resistant cases is an emerging treatment with positive results. Such clinical results have increased the interest in this subject. However, the ideal treatment device and method have not yet been described for this therapy, which is generally applied at a single fraction using various devices and methods. Herein, treatment planning was conducted for a total of 8 patients (11 VT substrates) using the Varian TrueBeam EDGE and TomoTherapy Radixact devices at a single center, and the results were compared dosimetrically. The Wilcoxon-signed rank test was used for the statistical analysis, and mean values were expressed as medians and interquartile ranges (IQRs). In the volumetric modulated arc therapy (VMAT) and helical tomotherapy (HT) plans, the plan coverages and conformity indexes were similar; meanwhile, the homogeneity indexes were 0.10 (IQR = 0.05) and 0.07 (IQR = 0.05), respectively, and were significantly better in the HT plan (p = 0.02). The gradient indexes were 3.18 (IQR = 0.8) and 5.33 (IQR = 3.68) in the VMAT and HT plans, respectively, and were significantly better in the VMAT plan. For the organs at risk, similar doses were observed. The maximum doses for the stomach and esophagus and the mean doses for the left lung and both lungs were significantly lower in the VMAT plan. Similarly, the maximum and mean doses for the cardiac substructures and great vessels were significantly lower in the VMAT plan. More homogeneous plans were obtained in HT, while a faster dose reduction and lower critical organ dose were observed in VMAT. Reasonable myocardial SABR plans could be obtained with both techniques. The effects of the dosimetric differences on the clinical outcomes should be evaluated in prospective clinical studies.
Collapse
Affiliation(s)
- Hüseyin Furkan Öztürk
- Department of Radiation Oncology, Yıldırım Beyazıt University, Ankara 06800, Turkey.
| | - Suheyla Aytaç Arslan
- Department of Radiation Oncology, Yıldırım Beyazıt University, Ankara 06800, Turkey
| | - Zerrin Gani
- Department of Radiation Oncology, Ankara Bilkent City Hospital, Ankara 06800, Turkey
| | - Dursun Aras
- Department of Cardiology, İstanbul Medipol University Bahçelievler Hospital, Istanbul 34196, Turkey
| | - Yılmaz Tezcan
- Department of Radiation Oncology, Yıldırım Beyazıt University, Ankara 06800, Turkey
| |
Collapse
|
11
|
Xiang G, Xu C, Chai G, Lyu B, Li Z, Wang B, Shi M, Zhao L. Re-irradiation for local primary-recurrence esophageal squamous cell carcinoma treated with IMRT/VMAT. Radiat Oncol 2023; 18:114. [PMID: 37430276 DOI: 10.1186/s13014-023-02265-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/15/2023] [Indexed: 07/12/2023] Open
Abstract
PURPOSE Local primary-recurrence of esophageal squamous cell carcinoma (ESCC) after definitive treatment has the potential for increasing overall survival with re-irradiation (Re-RT), especially with advanced technique. This study aimed to evaluate the efficacy and toxicities of Re-RT using intensity-modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT) for local primary-recurrence of ESCC. MATERIALS AND METHODS A total of 130 ESCC patients with local primary-recurrence from Xijing hospital between 2008 and 2021 were enrolled and 30 patients underwent IMRT/VMAT based salvage Re-RT. Cox regression analysis was used to analyze the prognostic factors for overall survival (OS) and after recurrence survival (ARS). The toxicities of 30 patients receiving Re-RT were also assessed. RESULTS The median OS and ARS of the 130 recurrent patients were 21 months (1-164 months) and 6 months (1-142 months). The 1-, 2-, and 3-year OS rates were 81.5%, 39.2%, and 23.8%, respectively. Besides, the 1-, 2-, and 3-year ARS rates were 30.0%, 10%, and 6.2%. Multivariate analysis showed that Re-RT ± chemotherapy (p = 0.043) and chemotherapy alone (p < 0.001) and esophageal stents (p = 0.004) were independent prognostic factors for OS. The median OS of 30 patients treated with Re-RT were significantly better than that of 29 patients treated with chemotherapy (34.5 months vs. 22 months, p = 0.030). Among 30 ESCC patients treated with Re-RT, the median OS and ARS were 34.5 months (range 12-163 months) and 6 months (range 1-132 months), respectively. The recurrence-free interval (RFI) (> 12 months) and initial radiation dose (> 60 Gy) were significantly associated with improved OS. Radiation esophagitis (Grade 1-2) occurred in 16 patients and myelosuppression (Grade1-2) occurred in 10 patients. Grade 3 toxicities (radiation esophagitis and myelosuppression) were only 13.3%. There were no grade 4 toxicities. CONCLUSION Our results demonstrated that IMRT/VMAT-based Re-RT was an effective therapeutic option for ESCC patients with local primary-recurrence compared with chemotherapy alone or without any treatment. Re-RT had improved OS but unfavorable ARS.
Collapse
Affiliation(s)
- Geng Xiang
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China
| | - Chunsheng Xu
- Department of Gastrointestinal Surgery, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China
| | - Guangjin Chai
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China
| | - Bo Lyu
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China
| | - Zhaohui Li
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China
| | - Bin Wang
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China
| | - Mei Shi
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China.
| | - Lina Zhao
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, Shaanxi, China.
| |
Collapse
|
12
|
Serarslan A, Daştan Y, Aksu T, Yıldız RE, Gürsel B, Meydan D, Okumuş NÖ. Ninety-degree angled collimator: a dosimetric study related to dynamic intensity-modulated radiotherapy in patients with endometrial carcinoma. BMC Cancer 2023; 23:515. [PMID: 37280543 DOI: 10.1186/s12885-023-11033-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Our purpose was to ensure that the dose constraints of the organs at risk (OARs) were not exceeded while increasing the prescription dose to the planning target volume (PTV) from 45 to 50.4 Gray (Gy) with the dynamic intensity-modulated radiotherapy (IMRT) technique. While trying for this purpose, a new dynamic IMRT technique named 90° angled collimated dynamic IMRT (A-IMRT) planning was developed by us. METHODS This study was based on the computed tomography data sets of 20 patients with postoperatively diagnosed International Federation of Gynecology and Obstetrics stage 2 endometrial carcinoma. For each patient, conventional dynamic IMRT (C-IMRT, collimator angle of 0° at all gantry angles), A-IMRT (collimator angle of 90° at gantry angles of 110°, 180°, 215°, and 285°), and volumetric modulated arc therapy (VMAT) were planned. Planning techniques were compared with parameters used to evaluate PTV and OARs via dose-volume-histogram analysis using the paired two-tailed Wilcoxon's signed-rank test; p < 0.05 was considered indicative of statistical significance. RESULTS All plans achieved adequate dose coverage for PTV. Although the technique with the lowest mean conformality index was A-IMRT (0.76 ± 0.05) compared to both C-IMRT (0.79 ± 0.04, p = 0.000) and VMAT (0.83 ± 0.03, p = 0.000), it protected the OARs especially the bladder (V45 = 32.84 ± 2.03 vs. 44.21 ± 6.67, p = 0.000), rectum (V30 = 56.18 ± 2.05 vs. 73.80 ± 4.75, p = 0.000) and both femoral heads (V30 for right = 12.19 ± 1.34 vs. 21.42 ± 4.03, p = 0.000 and V30 for left = 12.58 ± 1.48 vs. 21.35 ± 4.16, p = 0.000) better than C-IMRT. While the dose constraints of the bladder, rectum and bilateral femoral heads were not exceeded in any patient with A-IMRT or VMAT, they were exceeded in 19 (95%), 20 (100%) and 20 (100%) patients with C-IMRT, respectively. CONCLUSIONS OARs are better protected when external beam radiotherapy is applied to the pelvis at a dose of 50.4 Gy by turning the collimator angle to 90° at some gantry angles with the dynamic IMRT technique in the absence of VMAT.
Collapse
Affiliation(s)
- Alparslan Serarslan
- Department of Radiation Oncology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, 55139, Turkey.
| | - Yalçın Daştan
- Department of Radiation Oncology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, 55139, Turkey
| | - Telat Aksu
- Department of Radiation Oncology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, 55139, Turkey
| | - Rana Elif Yıldız
- Department of Radiation Oncology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, 55139, Turkey
| | - Bilge Gürsel
- Department of Radiation Oncology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, 55139, Turkey
| | - Deniz Meydan
- Department of Radiation Oncology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, 55139, Turkey
| | - Nilgün Özbek Okumuş
- Department of Radiation Oncology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, 55139, Turkey
| |
Collapse
|
13
|
Kachhwaha A, Tiwari R, Gayen S, Manna S, Solanki A, Devnani B, Pareek P. Comparison of sequential versus simultaneous integrated boost of volumetric modulated arc therapy in treatment of oropharyngeal carcinoma. Cancer Treat Res Commun 2023; 36:100721. [PMID: 37301126 DOI: 10.1016/j.ctarc.2023.100721] [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: 01/18/2023] [Revised: 04/28/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Volumetric modulated arc therapy (VMAT) is a useful treatment technique that can reduce treatment time while producing improved dose distribution to target structures. The main aim of the study is to evaluate the outcome of oropharyngeal cancer patients treated with VMAT, sequential (SEQ) versus simultaneous integrated boost (SIB) technique in terms of survival and failures and to assess late radiation toxicities with their dosimetric parameters. MATERIAL AND METHODS Total 54 patients of histologically proved oropharyngeal cancer patients treated by definitive radiotherapy using VMAT technique in January 2019 to December 2020 were followed up and evaluated in terms of survival, patterns of failure and late radiation toxicities by RTOG toxicity criteria. RESULTS After a median follow up of 12 months, overall survival (OS) and disease free survival (DFS) were 64.8% and 48.1% respectively. In terms of patterns of failure, 44.4% showed local recurrence, 7.4% as regional relapse and 3.7% showed distant metastasis. While comparing sequential versus SIB, no significant difference was found in OS (64.9% vs. 59.8%, p = 0.689), DFS (52.8% vs. 35.3%, p = 0.266), local control (LC) (58.3% vs. 47.1%, p = 0.437) and regional control (RC) (94.3% vs. 88.2%, p = 0.151) respectively. Among late radiation toxicities, the most common were xerostomia (42.2% for SEQ and 24.2% for SIB group), dysphagia (33.3% for SEQ and 15.1% for SIB group) and hoarseness of voice (15.1% for SEQ and 12.1% for SIB group). CONCLUSION SIB technique proved better than SEQ technique in terms of pattern of failure or late toxicity, but no significant difference can be reported.
Collapse
Affiliation(s)
| | | | - Sanjib Gayen
- Dept of Radiation Oncology, AIIMS, Jodhpur, India
| | | | | | | | | |
Collapse
|
14
|
Son S, Park SY. Progressive resolution optimizer (PRO) predominates over photon optimizer (PO) in sparing of spinal cord for spine SABR VMAT plans. BMC Cancer 2023; 23:445. [PMID: 37194056 DOI: 10.1186/s12885-023-10925-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 05/06/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND we assessed the performance of the optimization algorithms by comparing volumetric modulated arc therapy generated by a progressive resolution optimized (VMATPRO) and photon optimizer (VMATPO) in terms of plan quality, MU reduction, sparing of the spinal cord (or cauda equina), and plan complexity. METHODS Fifty-seven patients who received spine stereotactic ablative radiotherapy (SABR) with tumors located in the cervical, thoracic, and lumbar spine were retrospectively selected. For each patient, VMATPRO and VMATPO with two full arcs were generated with using the PRO and PO algorithms. For dosimetric evaluation, the dose-volumetric (DV) parameters of the planning target volume (PTV), organs at risk (OARs), the corresponding planning organs at risk (PRV), and 1.5-cm ring structure surrounding the PTV (Ring1.5 cm) were calculated for all VMAT plans. The total number of monitor units (MUs) and the modulation complexity score for the VMAT (MCSv) were compared. To investigate the correlations of OAR sparing to plan complexity, Pearson's and Spearman's correlation tests were conducted between the two algorithms (PO - PRO, denoted as Δ) in the DV parameters for normal tissues, total MUs, and MCSv. RESULTS For the PTVs, Target conformity and dose homogeneity in the PTVs of VMATPRO were better than those of VMATPO with statistical significance. For the spinal cords (or cauda equine) and the corresponding PRVs, all of the DV parameters for VMATPRO were markedly lower than those for VMATPO, with statistical significance (all p < 0.0001). Among them, the difference in the maximum dose to the spinal cord between VMATPRO and VMATPO was remarkable (9.04 Gy vs. 11.08 Gy with p < 0.0001). For Ring1.5 cm, no significant difference in V115% for VMATPRO and VMATPO was observed. CONCLUSIONS The use of VMATPRO resulted in improved coverage and uniformity of dose to the PTV, as well as OARs sparing, compared with that of VMATPO for cervical, thoracic, and lumbar spine SABR. Better dosimetric plan quality generated by the PRO algorithm was observed to result in higher total MUs and plan complexity. Therefore, careful evaluation of its deliverability should be performed with caution during the routine use of the PRO algorithm.
Collapse
Affiliation(s)
- Sangjun Son
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.
| | - So-Yeon Park
- Department of Radiation Oncology, Veterans Health Service Medical Center, Seoul, Republic of Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
| |
Collapse
|
15
|
Rosenbrock J, Baues C, Kreis M, Fouassi R, Celik E, Paffenholz P, Pfister D, Heidenreich A, Marnitz S. Toxicity of dose-escalated radiotherapy up to 84 Gy for prostate cancer. Strahlenther Onkol 2023. [PMID: 36930248 DOI: 10.1007/s00066-023-02060-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 02/12/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE The outcome of radiotherapy (RT) for prostate cancer (PCA) depends on the delivered dose. While the evidence for dose-escalated RT up to 80 gray (Gy) is well established, there have been only few studies examining dose escalation above 80 Gy. We initiated the present study to assess the safety of dose escalation up to 84 Gy. METHODS In our retrospective analysis, we included patients who received dose-escalated RT for PCA at our institution between 2016 and 2021. We evaluated acute genitourinary (GU) and gastrointestinal (GI) toxicity as well as late GU and GI toxicity. RESULTS A total of 86 patients could be evaluated, of whom 24 patients had received 80 Gy and 62 patients 84 Gy (35 without pelvic and 27 with pelvic radiotherapy). Regarding acute toxicities, no > grade 2 adverse events occurred. Acute GU/GI toxicity of grade 2 occurred in 12.5%/12.5% of patients treated with 80 Gy, in 25.7%/14.3% of patients treated with 84 Gy to the prostate only, and in 51.9%/12.9% of patients treated with 84 Gy and the pelvis included. Late GU/GI toxicity of grade ≥ 2 occurred in 4.2%/8.3% of patients treated with 80 Gy, in 7.1%/3.6% of patients treated with 84 Gy prostate only, and in 18.2%/0% of patients treated with 84 Gy pelvis included (log-rank test p = 0.358). CONCLUSION We demonstrated that dose-escalated RT for PCA up to 84 Gy is feasible and safe without a significant increase in acute toxicity. Further follow-up is needed to assess late toxicity and survival.
Collapse
|
16
|
Hu J, Zou L, Gu S, Wang N, Cui F, Zhang S, Yin C, Cai Y, Gou C, Wu Z. [Study on the sensitivity of a volumetric modulated arc therapy plan verification equipment on multi-leaf collimator opening and closing errors and its gamma pass rate limit]. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi 2023; 40:133-140. [PMID: 36854558 DOI: 10.7507/1001-5515.202112018] [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] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
To investigate the γ pass rate limit of plan verification equipment for volumetric modulated arc therapy (VMAT) plan verification and its sensitivity on the opening and closing errors of multi-leaf collimator (MLC), 50 cases of nasopharyngeal carcinoma VMAT plan with clockwise and counterclockwise full arcs were randomly selected. Eight kinds of MLC opening and closing errors were introduced in 10 cases of them, and 80 plans with errors were generated. Firstly, the plan verification was conducted in the form of field-by-field measurement and true composite measurement. The γ analysis with the criteria of 3% dose difference, distance to agreement of 2 mm, 10% dose threshold, and absolute dose global normalized conditions were performed for these fields. Then gradient analysis was used to investigate the sensitivity of field-by-field measurement and true composite measurement on MLC opening and closing errors, and the receiver operating characteristic curve (ROC) was used to investigate the optimal threshold of γ pass rate for identifying errors. Tolerance limits and action limits for γ pass rates were calculated using statistical process control (SPC) method for another 40 cases. The error identification ability using the tolerance limit calculated by SPC method and the universal tolerance limit (95%) were compared with using the optimal threshold of ROC. The results show that for the true composite measurement, the clockwise arc and the counterclockwise arc, the descent gradients of the γ passing rate with per millimeter MLC opening error are 10.61%, 7.62% and 6.66%, respectively, and the descent gradients with per millimeter MLC closing error are 9.75%, 7.36% and 6.37%, respectively. The optimal thresholds obtained by the ROC method are 99.35%, 97.95% and 98.25%, respectively, and the tolerance limits obtained by the SPC method are 98.98%, 97.74% and 98.62%, respectively. The tolerance limit calculated by SPC method is close to the optimal threshold of ROC, both of which could identify all errors of ±2 mm, while the universal tolerance limit can only partially identify them, indicating that the universal tolerance limit is not sensitive on some large errors. Therefore, considering the factors such as ease of use and accuracy, it is suggested to use the true composite measurement in clinical practice, and to formulate tolerance limits and action limits suitable for the actual process of the institution based on the SPC method. In conclusion, it is expected that the results of this study can provide some references for institutions to optimize the radiotherapy plan verification process, set appropriate pass rate limit, and promote the standardization of plan verification.
Collapse
Affiliation(s)
- Jinyou Hu
- Key Laboratory of Radiation Physics and Technology of the Ministry of Education, Institute of Nuclear Science and Technology, Sichuan University, Chengdu 610064, P. R. China.,Cancer Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, P. R. China
| | - Lian Zou
- Cancer Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, P. R. China
| | - Shaoxian Gu
- Key Laboratory of Radiation Physics and Technology of the Ministry of Education, Institute of Nuclear Science and Technology, Sichuan University, Chengdu 610064, P. R. China
| | - Ningyu Wang
- Key Laboratory of Radiation Physics and Technology of the Ministry of Education, Institute of Nuclear Science and Technology, Sichuan University, Chengdu 610064, P. R. China
| | - Fengjie Cui
- Key Laboratory of Radiation Physics and Technology of the Ministry of Education, Institute of Nuclear Science and Technology, Sichuan University, Chengdu 610064, P. R. China
| | - Shengyuan Zhang
- Key Laboratory of Radiation Physics and Technology of the Ministry of Education, Institute of Nuclear Science and Technology, Sichuan University, Chengdu 610064, P. R. China
| | - Chu'ou Yin
- Key Laboratory of Radiation Physics and Technology of the Ministry of Education, Institute of Nuclear Science and Technology, Sichuan University, Chengdu 610064, P. R. China
| | - Yunzhu Cai
- Key Laboratory of Radiation Physics and Technology of the Ministry of Education, Institute of Nuclear Science and Technology, Sichuan University, Chengdu 610064, P. R. China
| | - Chengjun Gou
- Key Laboratory of Radiation Physics and Technology of the Ministry of Education, Institute of Nuclear Science and Technology, Sichuan University, Chengdu 610064, P. R. China
| | - Zhangwen Wu
- Key Laboratory of Radiation Physics and Technology of the Ministry of Education, Institute of Nuclear Science and Technology, Sichuan University, Chengdu 610064, P. R. China
| |
Collapse
|
17
|
Racka I, Majewska K, Winiecki J. Three-dimensional conformal radiotherapy (3D-CRT) vs. volumetric modulated arc therapy (VMAT) in deep inspiration breath-hold (DIBH) technique in left-sided breast cancer patients-comparative analysis of dose distribution and estimation of projected secondary cancer risk. Strahlenther Onkol 2023; 199:90-101. [PMID: 35943553 DOI: 10.1007/s00066-022-01979-2] [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: 12/23/2021] [Accepted: 07/07/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE The purpose of this study was to compare two techniques of irradiation of left-sided breast cancer patients who underwent breast-conserving surgery, three-dimensional conformal radiotherapy technique (3D-CRT) and volumetric modulated arc therapy (VMAT), in terms of dose distribution in the planning target volume (PTV) and organs at risk (OARs). The second aim of the study was estimation of the projected risk of radiation-induced secondary cancer for both radiotherapy techniques. MATERIALS AND METHODS For 25 patients who underwent CT simulation in deep inspiration breath-hold (DIBH), three treatment plans were generated: one using a three-dimensional conformal radiotherapy technique and two using volumetric modulated arc therapy. First VMAT-DIBH geometry consisted of three partial arcs (ARC-DIBH 3A) and second consisted of four partial arcs (ARC-DIBH 4A). Cumulative dose-volume histograms (DVHs) were used to compare dose distributions within the PTV and OARs (heart, left anterior descending coronary artery [LAD], ipsilateral and contralateral lung [IL, CL], and contralateral breast [CB]). Normal tissue complication probabilities (NTCPs) and organ equivalent doses (OEDs) were calculated using the differential DVHs. Excess absolute risks (EARs) for second cancers were estimated using Schneider's full mechanistic dose-response model. RESULTS All plans fulfilled the criterium for PTV V95% ≥ 95%. The PTV coverage, homogeneity, and conformity indices were significantly better for VMAT-DIBH. VMAT showed a significantly increased mean dose and V5Gy for all OARs, but reduced LAD Dmax by 15 Gy. For IL, CL, and CB, the 3D-CRT DIBH method achieved the lowest values of EAR: 28.38 per 10,000 PYs, 2.55 per 10,000 PYs, and 4.48 per 10,000 PYs (p < 0.001), compared to 40.29 per 10,000 PYs, 15.62 per 10,000 PYs, and 23.44 per 10,000 PYs for ARC-DIBH 3A plans and 41.12 per 10,000 PYs, 15.59 per 10,000 PYs, and 22.73 per 10,000 PYs for ARC-DIBH 4A plans. Both techniques provided negligibly low NTCPs for all OARs. CONCLUSION The study shows that VMAT-DIBH provides better OAR sparing against high doses. However, the large low-dose-bath (≤ 5 Gy) is still a concern due to the fact that a larger volume of normal tissues exposed to lower doses may increase a radiation-induced risk of secondary cancer.
Collapse
Affiliation(s)
- Iga Racka
- Medical Physics Department, Prof. Franciszek Łukaszczyk Memorial Oncology Centre in Bydgoszcz, Bydgoszcz, Poland.
| | - Karolina Majewska
- Medical Physics Department, Prof. Franciszek Łukaszczyk Memorial Oncology Centre in Bydgoszcz, Bydgoszcz, Poland
| | - Janusz Winiecki
- Medical Physics Department, Prof. Franciszek Łukaszczyk Memorial Oncology Centre in Bydgoszcz, Bydgoszcz, Poland.,Clinic of Oncology and Brachytherapy, Collegium Medicum in Bydgoszcz, Nicholas Copernicus University in Torun, Bydgoszcz, Poland
| |
Collapse
|
18
|
Jia-Mahasap B, Madla C, Sripan P, Chitapanarux I, Tharavichitkul E, Chakrabandhu S, Klunklin P, Onchan W. Stereotactic radiosurgery for limited brain metastasis using three different techniques: helical tomotherapy, volumetric modulated arc therapy, and cone-based LINAC radiosurgery. Radiat Oncol J 2022; 40:232-241. [PMID: 36606300 PMCID: PMC9830036 DOI: 10.3857/roj.2022.00136] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 10/06/2022] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Specific radiation delivered to tumors by stereotactic radiosurgery (SRS) has become widely used in the treatment of brain metastasis. This study aimed to compare radiation therapy planning and its parameters from SRS using three different modalities: helical tomotherapy (HT), volumetric modulated arc therapy (VMAT), and cone-based linac radiosurgery (Cone-based). MATERIALS AND METHODS Each contouring dataset of patents who experienced one to four brain metastasis received SRS in our center was re-planned to create radiation therapy planning in all three treatment systems (HT, VMAT, and Cone-based). The parameters of conformity index (CI), homogeneity index (HI), CI50, and gradient index (CGI) were analyzed to compare the effects of the three techniques. Decision score analysis was used to evaluate the performance on dosimetric and organs-at-risk parameters among the different techniques by applying the Cone-based technique as a benchmark. RESULTS A total of 21 patients with 39 lesions were included in this study. The results from the decision score analysis demonstrated statistically identical CI, CI50, and CGI values between Cone-based and VMAT for single lesions. For multiple lesions, VMAT also provided better CI when compared to Cone-based technique while HT exhibited the poorest dosimetric parameters. Moreover, VMAT exhibited the lowest BrainV5Gy value and displayed the shortest beam-on time calculation. CONCLUSION We have conducted a comprehensive comparison of SRS planning approaches. The Cone-based technique revealed the highest HI value, while VMAT provided the best estimated beam-on time value. HT displayed a feasible SRS modality for single lesions, but not for multiple lesions.
Collapse
Affiliation(s)
- Bongkot Jia-Mahasap
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,Correspondence: Bongkot Jia-Mahasap Department of Radiology, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, SriPoom, Muang, Chiang Mai, Thailand. Tel: +66(0)53935450 E-mail:
| | - Chakri Madla
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Patumrat Sripan
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Imjai Chitapanarux
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ekkasit Tharavichitkul
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Somvilai Chakrabandhu
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pitchayaponne Klunklin
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wimrak Onchan
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
19
|
Bartlett GK, Njeh CF, Huang KC, DesRosiers C, Guo G. VMAT partial arc technique decreases dose to organs at risk in whole pelvic radiotherapy for prostate cancer when compared to full arc VMAT and IMRT. Med Dosim 2022; 48:8-15. [PMID: 36319515 DOI: 10.1016/j.meddos.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/16/2022] [Indexed: 11/05/2022]
Abstract
Whole pelvic radiotherapy (WPRT) can sterilize microscopic lymph node metastases in treatment of prostate cancer. WPRT, compared to prostate only radiotherapy (PORT), is associated with increased acute gastrointestinal, and hematological toxicities. To further explore minimizing normal tissue toxicities associated with WPRT in definitive IMRT for prostate cancer, this planning study compared dosimetric differences between static 9-field-IMRT, full arc VMAT, and mixed partial-full arc VMAT techniques. In this retrospective study, 12 prostate cancer patients who met the criteria for WPRT were randomly selected for this study. The initial volume, PTV46, included the prostate, seminal vesicles, and pelvic nodes with margin and was prescribed to 4600 cGy. The cone-down volume, PTV78, included the prostate and proximal seminal vesicles with margin to a total dose of 7800 cGy. For each CT image set, 3 plans were generated for each of the PTVs: an IMRT plan, a full arc (FA) VMAT plan, and a mixed partial-full arc (PFA) VMAT plan, using 6MV photons energy. According to RTOG protocols none of the plans had a major Conformity Index (CI) violation by any of the 3 planning techniques. PFA plan had the best mean CI index of 1.00 and significantly better than IMRT (p = 0.03) and FA (p = 0.007). For equivalent PTV coverage, the average composite gradient index of the PFA plans was better than the IMRT and the FA plans with values 1.92, 2.03, and 2.01 respectively. The defference was statistically significant between PFA/IMRT and PFA/FA, with p- values of < 0.001. The IMRT plans and the PFA plans provided very similar doses to the rectum, bladder, sigmoid colon, and femoral heads, which were lower than the dose in the FA plans. There was a significant decrease in the mean dose to the rectum from 4524 cGy with the FA to 4182 cGy with the PFA and 4091 cGy with IMRT (p < 0.001). The percent of rectum receiving 4000 cGy was also the highest with FA at 66.1% compared to 49.9% (PFA) and 47.5% (IMRT). There was a significant decrease in the mean dose to the bladder from 3922 cGy (FA) to 3551 cGy (PFA) and 3612 cGy (IMRT) (p < 0.001). The percent of bladder receiving 4000 cGy was also the highest with FA at 45.4% compared to 36.6% (PFA) and 37.4% (IMRT). The average mean dose to the sigmoid colon decreased from 4177 cGy (FA) to 3893 cGy (PFA) and 3819 cGy (IMRT). The average mean dose to the femoral heads decreased from 2091 cGy (FA) to 2026 cGy (PFA) and 1987 cGy (IMRT). Considering the improvement in plan quality indices recorded in this study including the dose gradient and the dose to organs at risk, mixed partial-full arc plans may be the preferred VMAT treatment technique over full arc plans for prostate cancer treatments that include nodal volumes.
Collapse
Affiliation(s)
- Gregory K Bartlett
- Radiation Oncology Department, Indiana University, 535 Barnhill Drive, Indianapolis, IN, 45202
| | - Christopher F Njeh
- Radiation Oncology Department, Indiana University, 535 Barnhill Drive, Indianapolis, IN, 45202.
| | - Ke C Huang
- Radiation Oncology Department, Indiana University, 535 Barnhill Drive, Indianapolis, IN, 45202
| | - Colleen DesRosiers
- Radiation Oncology Department, Indiana University, 535 Barnhill Drive, Indianapolis, IN, 45202
| | - Gordon Guo
- Radiation Oncology Department, Indiana University, 535 Barnhill Drive, Indianapolis, IN, 45202
| |
Collapse
|
20
|
Franceschini D, Cozzi L, Fogliata A, Marini B, Di Cristina L, Dominici L, Spoto R, Franzese C, Navarria P, Comito T, Reggiori G, Tomatis S, Scorsetti M. Training and validation of a knowledge-based dose-volume histogram predictive model in the optimisation of intensity-modulated proton and volumetric modulated arc photon plans for pleural mesothelioma patients. Radiat Oncol 2022; 17:150. [PMID: 36028862 PMCID: PMC9419376 DOI: 10.1186/s13014-022-02119-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the performance of a narrow-scope knowledge-based RapidPlan (RP) model for optimisation of intensity-modulated proton therapy (IMPT) and volumetric modulated arc therapy (VMAT) plans applied to patients with pleural mesothelioma. Second, estimate the potential benefit of IMPT versus VMAT for this class of patients. METHODS A cohort of 82 patients was retrospectively selected; 60 were used to "train" a dose-volume histogram predictive model; the remaining 22 provided independent validation. The performance of the RP models was benchmarked, comparing predicted versus achieved mean and near-to-maximum dose for all organs at risk (OARs) in the training set and by quantitative assessment of some dose-volume metrics in the comparison of the validation RP-based data versus the manually optimised training datasets. Treatment plans were designed for a prescription dose of 44 Gy in 22 fractions (proton doses account for a fixed relative biological effectiveness RBE = 1.1). RESULTS Training and validation RP-based plans resulted dosimetrically similar for both VMAT and IMPT groups, and the clinical planning aims were met for all structures. The IMPT plans outperformed the VMAT ones for all OARs for the contra-lateral and the mean and low dose regions for the ipsilateral OARs. Concerning the prediction performance of the RP models, the linear regression for the near-to-maximum dose resulted in Dachieved = 1.03Dpredicted + 0.58 and Dachieved = 1.02Dpredicted + 1.46 for VMAT and IMPT, respectively. For the mean dose it resulted: Dachieved = 0.99Dpredicted + 0.34 and Dachieved = 1.05Dpredicted + 0.27 respectively. In both cases, the linear correlation between prediction and achievement is granted with an angular coefficient deviating from unity for less than 5%. Concerning the dosimetric comparison between manual plans in the training cohort and RP-based plans in the validation cohort, no clinical differences were observed for the target volumes in both the VMAT and IMPT groups. Similar consistency was observed for the dose-volume metrics analysed for the OAR. This proves the possibility of achieving the same quality of plans with manual procedures (the training set) or with automated RP-based methods (the validation set). CONCLUSION Two models were trained and validated for VMAT and IMPT plans for pleural mesothelioma. The RP model performance resulted satisfactory as measured by the agreement between predicted and achieved (after full optimisation) dose-volume metrics. The IMPT plans outperformed the VMAT plans for all the OARs (with different intensities for contra- or ipsilateral structures). RP-based planning enabled the automation of part of the optimisation and the harmonisation of the dose-volume results between training and validation. The IMPT data showed a systematic significant dosimetric advantage over VMAT. In general, using an RP-based approach can simplify the optimisation workflow in these complex treatment indications without impacting the quality of plans.
Collapse
Affiliation(s)
- Davide Franceschini
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, 20089, Milan-Rozzano, Italy
| | - Luca Cozzi
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, 20089, Milan-Rozzano, Italy. .,Department of Biomedical Sciences, Humanitas University, Milan-Rozzano, Italy.
| | - Antonella Fogliata
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, 20089, Milan-Rozzano, Italy
| | - Beatrice Marini
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, 20089, Milan-Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Milan-Rozzano, Italy
| | - Luciana Di Cristina
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, 20089, Milan-Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Milan-Rozzano, Italy
| | - Luca Dominici
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, 20089, Milan-Rozzano, Italy
| | - Ruggero Spoto
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, 20089, Milan-Rozzano, Italy
| | - Ciro Franzese
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, 20089, Milan-Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Milan-Rozzano, Italy
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, 20089, Milan-Rozzano, Italy
| | - Tiziana Comito
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, 20089, Milan-Rozzano, Italy
| | - Giacomo Reggiori
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, 20089, Milan-Rozzano, Italy
| | - Stefano Tomatis
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, 20089, Milan-Rozzano, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, 20089, Milan-Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Milan-Rozzano, Italy
| |
Collapse
|
21
|
Gopalakrishnan Z, Bhasi S, P R, Menon SV, B S, Thayil AG, Nair RK. Dosimetric comparison of analytical anisotropic algorithm and the two dose reporting modes of Acuros XB dose calculation algorithm in volumetric modulated arc therapy of carcinoma lung and carcinoma prostate. Med Dosim 2022; 47:280-287. [PMID: 35690544 DOI: 10.1016/j.meddos.2022.04.007] [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: 12/10/2021] [Revised: 03/18/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
Volumetric Modulated Arc Therapy (VMAT) is an important modality for radical radiotherapy of all major treatment sites. This study aims to compare Analytical Anisotropic Algorithm (AAA) and the two dose-reporting modes of Acuros XB (AXB) algorithm -the dose to medium option (Dm) and the dose to water option (Dw) in Volumetric Modulated Arc Therapy (VMAT) of carcinoma lung and carcinoma prostate. We also compared the measured dose with Treatment Planning System calculated dose for AAA and the two dose reporting options of Acuros XB using Electronic Portal Imaging Device (EPID) and ArcCHECK phantom. Treatment plans of twenty patients each who have already undergone radiotherapy for cancer of lung and cancer of prostate were selected for the study. Three sets of VMAT plans were generated in Eclipse Treatment Planning System (TPS), one with AAA and two plans with Acuros-Dm and Acuros-Dw options. The Dose Volume Histograms (DVHs) were compared and analyzed for Planning Target Volume (PTV) and critical structures for all the plans. Verification plans were created for each plan and measured doses were compared with TPS calculated doses using EPID and ArcCHECK phantom for all the three algorithms. For lung plans, the mean dose to PTV in the AXB-Dw plans was higher by 1.7% and in the AXB-Dm plans by 0.66% when compared to AAA plans. For prostate plans, the mean dose to PTV in the AXB-Dw plans was higher by 3.0% and in the AXB-Dm plans by 1.6% when compared to AAA plans. There was no difference in the Conformity Index (CI) between AAA and AXB-Dm and between AAA and AXB-Dw plans for both sites. But the homogeneity worsened in AXB-Dw and AXB-Dm plans when compared to AAA plans for both sites. AXB-Dw calculated higher dose values for PTV and all the critical structures with significant differences with one or two exceptions. Point dose measurements in ArcCHECK phantom showed that AXB-Dm and AXB-Dw options showed very small deviations with measured dose distributions than AAA for both sites. Results of EPID QA also showed better pass rates for AXB-Dw and AXB-Dm than AAA for both sites when gamma analysis was done for 3%/3 mm and 2%/2 mm criteria. With reference to the results, it is always better to choose Acuros algorithm for dose calculations if it is available in the TPS. AXB-Dw plans showed very high dose values in the PTV when compared to AAA and AXB-Dm in both sites studied. Also, the volume of PTV receiving 107% dose was significantly high in AXB-Dw plans compared to AXB-Dm plans in sites involving high density bones. Considering the results of dosimetric comparison and QA measurements, it is always better to choose AXB-Dm algorithm for dose calculations for all treatment sites especially when high density bony structures and complex treatment techniques are involved. For patient specific QA purposes, choosing AXB-Dm or AXB-Dw does not make any significant difference between calculated and measured dose distributions.
Collapse
Affiliation(s)
- Zhenia Gopalakrishnan
- Division of Radiation Physics, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011, India
| | - Saju Bhasi
- Division of Radiation Physics, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011, India
| | - Raghukumar P
- Division of Radiation Physics, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011, India.
| | - Sharika V Menon
- Division of Radiation Physics, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011, India
| | - Sarin B
- Division of Radiation Physics, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011, India
| | - Anna George Thayil
- Division of Radiation Physics, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011, India
| | - Raghuram K Nair
- SUT Royal Hospital, Ulloor, Thiruvananthapuram, Kerala 695011, India
| |
Collapse
|
22
|
Cheng YK, Kuo SH, Yen HH, Wu JH, Chen YC, Huang MY. The prognostic significance of pretreatment squamous cell carcinoma antigen levels in cervical cancer patients treated by concurrent chemoradiation therapy and a comparison of dosimetric outcomes and clinical toxicities between tomotherapy and volumetric modulated arc therapy. Radiat Oncol 2022; 17:91. [PMID: 35549962 PMCID: PMC9097430 DOI: 10.1186/s13014-022-02063-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/09/2021] [Accepted: 05/02/2022] [Indexed: 12/05/2022] Open
Abstract
Background To analyze the prognostic factors associated with stage IB-IVA cervical cancer in patients who underwent concurrent chemoradiation therapy (CCRT) and to compare the clinical toxicities and dosimetric parameters of organs at risk between the different radiotherapy techniques. Methods This retrospective study enrolled 93 patients with stage IB-IVA cervical cancer who underwent definitive CCRT between April 2009 and December 2017. Nine patients (9.7%) received 3DCRT, 43 patients (46.2%) underwent VMAT, and 41 patients (44.1%) received tomotherapy, and all of them followed by brachytherapy using a 2D planning technique. The treatment outcomes and related prognostic factors were analyzed. We also compared the clinical toxicities and dosimetric parameters between the different techniques used for the last 30 patients. Results With a median follow-up of 52.0 months, the 5-year overall survival (OS), progression-free survival (PFS), locoregional recurrence–free survival (LRRFS), and distant metastases–free survival (DMFS) were analyzed. In a Cox proportional hazards regression model, pretreatment SCC Ag > 10 ng/mL was a significant prognostic factor for PFS (hazard ratio [HR] 2.20; 95% confidence interval [CI] 1.03–4.70; P = 0.041), LRRFS (HR, 3.48; 95% CI 1.07–11.26; P = 0.038), and DMFS (HR 2.80; 95% CI 1.02–7.67; P = 0.045). Increasing the rectal volume receiving a radiation dose exceeding 30 Gy (V30 of rectum; odds ratio [OR] 1.15; 95% CI 1.10–1.30; P = 0.03) was associated with a higher possibility of ≥ Grade 2 acute radiation therapy (RT)-related diarrhea. The median rectal V30 values were 56.4%, 97.5%, and 86.5% for tomotherapy, 3-dimensional conformal radiation therapy (3DCRT), and volumetric modulated arc therapy (VMAT), respectively (P < 0.001). In addition, the chance of experiencing ≥ Grade 2 acute diarrhea were 10.0%, 66.7%, and 54.5% for tomotherapy, 3DCRT, and VMAT, respectively (P = 0.029). Conclusions Patients with pretreatment SCC Ag ≤ 10 ng/mL have better PFS, LRRFS, and DMFS than those with pretreatment SCC Ag > 10 ng/mL. The rectal V30 is a significant predictor of severe acute diarrhea. Tomotherapy significantly decreased the rectal V30, reducing the severity of acute RT-related diarrhea during external beam RT. Trial registration This study was approved by the institutional review board at Kaohsiung Medical University Hospital. The registration number is KMUHIRB-E(I)-20190054 and retrospectively registered on 2019/3.
Collapse
Affiliation(s)
- Yuan-Kai Cheng
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shih-Hsun Kuo
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Heng-Hsuan Yen
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jing-Hu Wu
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Chieh Chen
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Yii Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Department of Radiation Oncology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Tzyou 1st Road, Kaohsiung, 80708, Taiwan.
| |
Collapse
|
23
|
Bedford JL, Hanson IM. A recurrent neural network for rapid detection of delivery errors during real-time portal dosimetry. Phys Imaging Radiat Oncol 2022; 22:36-43. [PMID: 35493850 PMCID: PMC9048084 DOI: 10.1016/j.phro.2022.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/04/2022] [Accepted: 03/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background and purpose Real-time portal dosimetry compares measured images with predicted images to detect delivery errors as the radiotherapy treatment proceeds. This work aimed to investigate the performance of a recurrent neural network for processing image metrics so as to detect delivery errors as early as possible in the treatment. Materials and methods Volumetric modulated arc therapy (VMAT) plans of six prostate patients were used to generate sequences of predicted portal images. Errors were introduced into the treatment plans and the modified plans were delivered to a water-equivalent phantom. Four different metrics were used to detect errors. These metrics were applied to a threshold-based method to detect the errors as soon as possible during the delivery, and also to a recurrent neural network consisting of four layers. A leave-two-out approach was used to set thresholds and train the neural network then test the resulting systems. Results When using a combination of metrics in conjunction with optimal thresholds, the median segment index at which the errors were detected was 107 out of 180. When using the neural network, the median segment index for error detection was 66 out of 180, with no false positives. The neural network reduced the rate of false negative results from 0.36 to 0.24. Conclusions The recurrent neural network allowed the detection of errors around 30% earlier than when using conventional threshold techniques. By appropriate training of the network, false positive alerts could be prevented, thereby avoiding unnecessary disruption to the patient workflow.
Collapse
Affiliation(s)
- James L. Bedford
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5PT, UK
| | | |
Collapse
|
24
|
Kato T, Ono T, Narita Y, Komori S, Murakami M. Dose-volume comparison of intensity modulated proton therapy and volumetric modulated arc therapy for cervical esophageal cancer. Med Dosim 2022:S0958-3947(22)00023-1. [PMID: 35346554 DOI: 10.1016/j.meddos.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 11/22/2022]
Abstract
Proton therapy for cervical esophageal cancer has many issues to be considered, such as the physiological curvature of the spine and the large range change from the neck to the trunk. We clarified the dosimetric characteristics of intensity modulated proton therapy (IMPT) for cervical esophageal cancer by comparing with volumetric modulated arc therapy (VMAT). Ten patients with cervical esophageal cancer were retrospectively planned for VMAT, 2-field IMPT (2F-IMPT), and 3-field IMPT (3F-IMPT). All plans were optimized to reach clinically acceptable levels. For planning target volume (PTV) coverage, 95% of the PTV should be covered by 95% of the prescription dose, unless the spinal cord limit is violated. The organs at risk included the lung, spinal cord, larynx, skin, and whole body. The prescription dose was 60 Gy relative biological effectiveness (RBE) in 30 fractions to the PTV. We compared the results according to dose-volume metrics. Significant dose reductions were achieved at lung doses, especially at low dose volumes of 20 Gy RBE or less in IMPT plans compared with VMAT plans (p < 0.05). Although the spinal cord PRV was below the tolerance level, the results were also significantly higher in VMAT plans than in IMPT plans (p < 0.001). Spinal cord PRV Dmean was significantly higher in 3F-IMPT than in 2F-IMPT (p < 0.001). In addition, it was confirmed that the integral whole body dose can be dramatically reduced in IMPT plans compared with VMAT plans. Both of 2F-IMPT and 3F-IMPT could effectively reduce spinal cord dose, as well as low integral whole body dose to a certain extent, while maintaining similar target coverage compared to VMAT. IMPT could be a promising treatment technique for patients with cervical esophageal cancer.
Collapse
|
25
|
Tambe NS, Pires IM, Moore CS, Wieczorek A, Upadhyay S, Beavis AW. Predicting personalised and progressive adaptive dose escalation to gross tumour volume using knowledge-based planning models for inoperable advanced-stage non-small cell lung cancer patients treated with volumetric modulated arc therapy. Biomed Phys Eng Express 2022; 8. [PMID: 35189613 DOI: 10.1088/2057-1976/ac56eb] [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: 12/07/2021] [Accepted: 02/21/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Increased radiation doses could improve local control and overall survival of lung cancer patients, however, this could be challenging without exceeding organs at risk (OAR) dose constraints especially for patients with advanced-stage disease. Increasing OAR doses could reduce the therapeutic ratio and quality of life. It is therefore important to investigate methods to increase the dose to target volume without exceeding OAR dose constraints. METHODS Gross tumour volume (GTV) was contoured on synthetic computerised tomography (sCT) datasets produced using the Velocity adaptive radiotherapy software for eleven patients. The fractions where GTV volume decreased compared to that prior to radiotherapy (reference plan) were considered for personalised progressive dose escalation. The dose to the adapted GTV (GTVAdaptive) was increased until OAR doses were affected (as compared to the original clinical plan). Planning target volume (PTV) coverage was maintained for all plans. Doses were also escalated to the reference plan (GTVClinical) using the same method. Adapted, dose-escalated, plans were combined to estimate accumulated dose, D99 (dose to 99%) of GTVAdapted, PTV D99 and OAR doses and compared with those in the original clinical plans. Knowledge-based planning (KBP) model was developed to predict D99 of the adapted GTV with OAR doses and PTV coverage kept similar to the original clinical plans; prediction accuracy and model verification were performed using further data sets. RESULTS Compared to the original clinical plan, dose to GTV was significantly increased without exceeding OAR doses. Adaptive dose-escalation increased the average D99 to GTVAdaptive by 15.1Gy and 8.7Gy compared to the clinical plans. The KBP models were verified and demonstrated prediction accuracy of 0.4% and 0.7% respectively. CONCLUSION Progressive adaptive dose escalation can significantly increase the dose to GTV without increasing OAR doses or compromising dose to microscopic disease. This may increase overall survival without increasing toxicities.
Collapse
Affiliation(s)
- Nilesh S Tambe
- Radiation Physics Department, Hull University Teaching Hospitals NHS Trust, Queens Centre For Oncology And Haematology, Castle Hill Hospital, Castle Road, Cottingham, HU16 5JQ, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Isabel M Pires
- Biomedical Sciences, University of Hull, Cottingham Road,, Hardy Building,, Hull, Kingston upon Hull, HU6 7RX, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Craig Steven Moore
- Medical Physics, Hull University Teaching Hospitals NHS Trust, Queens Centre, Castle Hill Hospital, Cottingham, Hull, HU16 5LH, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Andrzej Wieczorek
- Hull University Teaching Hospitals NHS Trust, Department of Clinical Oncology, The Queen's Centre, Cottingham, Hull, Kingston upon Hull, HU3 2JZ, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Sunil Upadhyay
- Clinical Oncology Department, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital,, Queen's Centre for Oncology and Hematology, Castle Road, Cottingham, Kingston upon Hull, HU16 5JQ, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Andrew W Beavis
- Department of Radiotherapy Physics, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Hull, Kingston upon Hull, HU3 2JZ, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| |
Collapse
|
26
|
Uehara T, Monzen H, Tamura M, Inada M, Otsuka M, Doi H, Matsumoto K, Nishimura Y. Feasibility study of volumetric modulated arc therapy with Halcyon™ linac for total body irradiation. Radiat Oncol 2021; 16:236. [PMID: 34906180 PMCID: PMC8670260 DOI: 10.1186/s13014-021-01959-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/24/2021] [Accepted: 11/29/2021] [Indexed: 01/11/2023] Open
Abstract
Background The use of total body irradiation (TBI) with linac-based volumetric modulated arc therapy (VMAT) has been steadily increasing. Helical tomotherapy has been applied in TBI and total marrow irradiation to reduce the dose to critical organs, especially the lungs. However, the methodology of TBI with Halcyon™ linac remains unclear. This study aimed to evaluate whether VMAT with Halcyon™ linac can be clinically used for TBI. Methods VMAT planning with Halcyon™ linac was conducted using a whole-body computed tomography data set. The planning target volume (PTV) included the body cropped 3 mm from the source. A dose of 12 Gy in six fractions was prescribed for 50% of the PTV. The organs at risk (OARs) included the lens, lungs, kidneys, and testes. Results The PTV D98%, D95%, D50%, and D2% were 8.9 (74.2%), 10.1 (84.2%), 12.6 (105%), and 14.2 Gy (118%), respectively. The homogeneity index was 0.42. For OARs, the Dmean of the lungs, kidneys, lens, and testes were 9.6, 8.5, 8.9, and 4.4 Gy, respectively. The V12Gy of the lungs and kidneys were 4.5% and 0%, respectively. The Dmax of the testes was 5.8 Gy. Contouring took 1–2 h. Dose calculation and optimization was performed for 3–4 h. Quality assurance (QA) took 2–3 h. The treatment duration was 23 min. Conclusions A planning study of TBI with Halcyon™ to set up VMAT-TBI, dosimetric evaluation, and pretreatment QA, was established. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01959-3.
Collapse
Affiliation(s)
- Takuya Uehara
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Science, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
| | - Mikoto Tamura
- Department of Medical Physics, Graduate School of Medical Science, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Masahiro Inada
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Masakazu Otsuka
- Department of Medical Physics, Graduate School of Medical Science, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Hiroshi Doi
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Kenji Matsumoto
- Department of Medical Physics, Graduate School of Medical Science, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osaka, Japan
| |
Collapse
|
27
|
Cilla S, Romano C, Macchia G, Boccardi M, De Vivo LP, Morabito VE, Buwenge M, Strigari L, Indovina L, Valentini V, Deodato F, Morganti AG. Automated hybrid volumetric modulated arc therapy (HVMAT) for whole-breast irradiation with simultaneous integrated boost to lumpectomy area : A treatment planning study. Strahlenther Onkol 2021; 198:254-267. [PMID: 34767044 DOI: 10.1007/s00066-021-01873-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/17/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To develop an automated treatment planning approach for whole breast irradiation with simultaneous integrated boost using an automated hybrid VMAT class solution (HVMAT). MATERIALS AND METHODS Twenty-five consecutive patients with left breast cancer received 50 Gy (2 Gy/fraction) to the whole breast and an additional simultaneous 10 Gy (2.4 Gy/fraction) to the tumor cavity. Ipsilateral lung, heart, and contralateral breast were contoured as main organs-at-risk. HVMAT plans were inversely optimized by combining two open fields with a VMAT semi-arc beam. Open fields were setup to include the whole breast with a 2 cm flash region and to carry 80% of beams weight. HVMAT plans were compared with three tangential techniques: conventional wedged-field tangential plans (SWF), field-in-field forward planned tangential plans (FiF), and hybrid-IMRT plans (HMRT). Dosimetric differences among the plans were evaluated using Kruskal-Wallis one-way analysis of variance. Dose accuracy was validated using the PTW Octavius-4D phantom together with the 1500 2D-array. RESULTS No significant differences were found among the four techniques for both targets coverage. HVMAT plans showed consistently better PTVs dose contrast, conformity, and homogeneity (p < 0.001 for all metrics) and statistically significant reduction of high-dose breast irradiation. V55 and V60 decreased by 30.4, 26.1, and 20.8% (p < 0.05) and 12.3, 9.9, and 6.0% (p < 0.05) for SWF, FIF, and HMRT, respectively. Pretreatment dose verification reported a gamma pass-rate greater than the acceptance threshold of 95% for all HVMAT plans. In addition, HVMAT reduced the time for full planning optimization to about 20 min. CONCLUSIONS HVMAT plans resulted in superior target dose conformity and homogeneity compared to other tangential techniques. Due to fast planning time HVMAT can be applied for all patients, minimizing the impact on human or departmental resources.
Collapse
Affiliation(s)
- Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 86100, Campobasso, Italy.
| | - Carmela Romano
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 86100, Campobasso, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Mariangela Boccardi
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Livia P De Vivo
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Vittoria E Morabito
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 86100, Campobasso, Italy
| | - Milly Buwenge
- Radiation Oncology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lidia Strigari
- Medical Physics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luca Indovina
- Radiation Oncology Department, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Vincenzo Valentini
- Radiation Oncology Department, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alessio G Morganti
- Radiation Oncology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,DIMES, Alma Mater Studiorum, Bologna University, Bologna, Italy
| |
Collapse
|
28
|
Okada H, Ito M, Minami Y, Nakamura K, Asai A, Adachi S, Takeuchi A, Oshima Y, Suzuki K. Automatic one-click planning for hippocampal-avoidance whole-brain irradiation in RayStation. Med Dosim 2021:S0958-3947(21)00087-X. [PMID: 34686403 DOI: 10.1016/j.meddos.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/21/2021] [Accepted: 09/14/2021] [Indexed: 11/20/2022]
Abstract
This study aimed to verify the accuracy of auto-contouring and auto-dose optimization for hippocampal-avoidance whole-brain radiation therapy (HA-WBRT). Head computed tomography (CT) images of 15 patients were selected. The regions of interest, containing the brain, hippocampus, eyes, and lacrimal glands, were contoured manually and automatically on CT images. They were compared and evaluated for concordance rates using the Simpson coefficient. To verify the performance of dose optimization, auto-dose planning was compared with manual planning for 15 cases. All optimization plans were performed using the volumetric modulated arc therapy technique. The automatically contoured brain showed a very high concordance rate with the manually contoured brain; the Simpson coefficient was 0.990 ± 0.01. Contrastingly, the concordance rate of the hippocampal contour was low at 0.642 ± 0.15 (right) and 0.500 ± 0.16 (left); however, the rate improved to 0.871 ± 0.09 (right) and 0.852 ± 0.11 (left) with an additional 3-mm margin. For 2% of each planning target volume with the prescribed dose (D2%) and Dmean, there was no significant difference between the automatic and manual plans (35.50 Gy vs 35.23 Gy; p = 0.233 and 33.09 Gy vs 32.84 Gy; p = 0.073, respectively). The D98% was significantly better for the manual plan than for the automatic plan (25.49 Gy vs 26.11 Gy; p < 0.01). Dmax and D100% for the hippocampus did not show any significant difference between the automatic and manual plans (15.65, 16.09 Gy (right, left) vs 15.51, 15.80 Gy; p = 0.804, 0.233 and 8.08, 8.03 Gy vs 8.13, 8.01 Gy; p = 0.495, 1 respectively). The accuracy of auto-contouring for HA-WBRT can be guaranteed by providing an appropriate margin, and the precision of the auto-dose optimization was comparable to that of the manual plan.
Collapse
|
29
|
Miura H, Nakao M, Doi Y, Ozawa S, Kenjo M, Nagata Y. Treatment planning comparison between dynamic wave arc and volumetric modulated arc therapies for prostate-cancer treatment. Med Dosim 2021:S0958-3947(21)00076-5. [PMID: 34538693 DOI: 10.1016/j.meddos.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/05/2021] [Accepted: 08/08/2021] [Indexed: 11/21/2022]
Abstract
The aim of this study was to compare the quality of dynamic wave arc (DWA) and coplanar volumetric modulated arc therapy (co-VMAT) plans for the treatment of localized prostate cancer. The planning target volume (PTV)-rectum, a section of the PTV comprising the PTV minus that of the rectum, received 78 Gy in 39 fractions as the mean dose to the PTV-rectum. The DWA and co-VMAT plans were generated for each patient using the RayStation treatment planning system for the Vero4DRT system. The PTV-rectum dose (D95%: the percent dose irradiating 95% of the volume), homogeneity index (HI), conformity index (CI), as well as doses to the bladder wall, rectum wall (V10-70 Gy: the percent volume receiving 10-70 Gy), and bilateral femoral heads of the DWA and co-VMAT plans were compared. The output monitor unit (MU) and delivery time obtained for each set of plans were also investigated. In terms of target coverage, the DWA plans provided an average D95% of 75.5 Gy, which was comparable to the co-VMAT-plan D95% of 75.2 Gy (p < 0.05). The HI was significantly better with the DWA. As for the DWA plans, the bladder-wall volume receiving 10, 20, 30, and 40 Gy (V10-40 Gy) was significantly smaller than that of the co-VMAT plans, and the volume of the rectal wall receiving 10 Gy (V10Gy) was significantly larger than that of the co-VMAT plans. The DWA plans yielded a reduced dose to the bilateral femoral heads compared with the co-VMAT plans (p < 0.05). The values of the CI and MU, and the delivery time exhibited no significant differences between the DWA and co-VMAT plans. The DWA plan is a feasible treatment option for prostate cancer radiotherapy.
Collapse
|
30
|
Veselsky T, Syruckova T, Kindlova A, Osmancikova P. Pituitary adenoma treatment plan quality comparison between linear accelerator volumetric modulated arc therapy and Leksell Gamma Knife® radiosurgery. Med Dosim 2021; 46:440-448. [PMID: 34312022 DOI: 10.1016/j.meddos.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/16/2021] [Accepted: 06/14/2021] [Indexed: 11/26/2022]
Abstract
The aim of this study was to compare radiosurgical treatment plan quality of a linear accelerator with Leksell Gamma Knife (LGK) for pituitary adenoma irradiation. Thirty pituitary adenoma patients were evaluated in this study. Treatment plans were prepared on LGK and stereotactic linear accelerator Varian TrueBeam STx. Volumetric Modulated Arc Therapy (VMAT) plans (21 plans with 2 coplanar arcs and 9 plans with 4 non-coplanar arcs) were calculated for linear accelerator. All the plans were evaluated in terms of conformity, selectivity, gradient index and organ at risk (OAR) sparing. VMAT produced dosimetrically comparable treatment plans to LGK regarding conformity and selectivity (New Conformity Index (NCI): 1.76 ± 0.65 for 4 arc VMAT, 2.33 ± 1,16 for 2 arc VMAT and 1.96 ± 0.71 for LGK; Selectivity Index (SI): 0.63 ± 0.16 for 4 arc VMAT, 0.51 ± 0.16 for 2 arc VMAT and 0.58 ± 0.17 for LGK). Gradient index (GI) was superior for LGK plans (GI: 2.74 ± 0.20 for LGK and 5.28 ± 2.29 for 4 arc VMAT). OAR sparing for optics, brainstem, and hypophysis was similar for both modalities while target volume coverage was maintained the same. Finally, treatment time resulted in favor of VMAT plans (in this study VMAT plans were almost 5 times faster than LGK treatment regarding beam on time). According to the results of this study stereotactic linear accelerator with VMAT treatment could be used as a reasonable alternative to LGK for pituitary adenoma radiosurgery but only if the same head fixation method accuracy and target volume delineation are maintained for both modalities.
Collapse
Affiliation(s)
- T Veselsky
- Motol University Hospital, Oncology Clinic, Prague 5, Czech Republic; Military University Hospital, Department of Radiation Therapy, Prague 6, Czech Republic; Na Homolce Hospital, Medical Physics Department, Prague 5, Czech Republic.
| | - T Syruckova
- Czech Technical University in Prague, Faculty of Biomedical Engineering, Kladno, Czech Republic
| | - A Kindlova
- Motol University Hospital, Oncology Clinic, Prague 5, Czech Republic
| | - P Osmancikova
- Motol University Hospital, Oncology Clinic, Prague 5, Czech Republic; Czech Technical University in Prague, Faculty of Nuclear Sciences and Physical Engineering, Department of Dosimetry and Application of Ionizing Radiation, Prague 110 00, Czech Republic
| |
Collapse
|
31
|
Lempart M, Benedek H, Jamtheim Gustafsson C, Nilsson M, Eliasson N, Bäck S, Munck af Rosenschöld P, Olsson LE. Volumetric modulated arc therapy dose prediction and deliverable treatment plan generation for prostate cancer patients using a densely connected deep learning model. Phys Imaging Radiat Oncol 2021; 19:112-119. [PMID: 34401537 PMCID: PMC8353474 DOI: 10.1016/j.phro.2021.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 05/17/2021] [Revised: 07/02/2021] [Accepted: 07/14/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Radiation therapy treatment planning is a manual, time-consuming task that might be accelerated using machine learning algorithms. In this study, we aimed to evaluate if a triplet-based deep learning model can predict volumetric modulated arc therapy (VMAT) dose distributions for prostate cancer patients. MATERIALS AND METHODS A modified U-Net was trained on triplets, a combination of three consecutive image slices and corresponding segmentations, from 160 patients, and compared to a baseline U-Net. Dose predictions from 17 test patients were transformed into deliverable treatment plans using a novel planning workflow. RESULTS The model achieved a mean absolute dose error of 1.3%, 1.9%, 1.0% and ≤ 2.6% for clinical target volume (CTV) CTV_D100%, planning target volume (PTV) PTV_D98%, PTV_D95% and organs at risk (OAR) respectively, when compared to the clinical ground truth (GT) dose distributions. All predicted distributions were successfully transformed into deliverable treatment plans and tested on a phantom, resulting in a passing rate of 100% (global gamma, 3%, 2 mm, 15% cutoff). The dose difference between deliverable treatment plans and GT dose distributions was within 4.4%. The difference between the baseline model and our improved model was statistically significant (p < 0.05) for CVT_D100%, PTV_D98% and PTV_D95%. CONCLUSION Triplet-based training improved VMAT dose distribution predictions when compared to 2D. Dose predictions were successfully transformed into deliverable treatment plans using our proposed treatment planning procedure. Our method may automate parts of the workflow for external beam prostate radiation therapy and improve the overall treatment speed and plan quality.
Collapse
Affiliation(s)
- Michael Lempart
- Radiation Physics, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Department of Translational Sciences, Medical Radiation Physics, Lund University, Malmö, Sweden
| | - Hunor Benedek
- Radiation Physics, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Christian Jamtheim Gustafsson
- Radiation Physics, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Department of Translational Sciences, Medical Radiation Physics, Lund University, Malmö, Sweden
| | - Mikael Nilsson
- Centre for Mathematical Sciences, Lund University, Lund, Sweden
| | - Niklas Eliasson
- Radiation Physics, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Sven Bäck
- Radiation Physics, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Per Munck af Rosenschöld
- Radiation Physics, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Lars E. Olsson
- Radiation Physics, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Department of Translational Sciences, Medical Radiation Physics, Lund University, Malmö, Sweden
| |
Collapse
|
32
|
Ho QA, Stea B. Innovations in radiotherapy and advances in immunotherapy for the treatment of brain metastases. Clin Exp Metastasis 2021; 39:225-230. [PMID: 34138383 DOI: 10.1007/s10585-021-10104-z] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
Radiotherapy for brain metastases has evolved tremendously over the past four decades, allowing for improved intracranial control of disease with reduced neurotoxicity. The main technological advance was provided by volumetric modulated arc therapy (VMAT), a computer-controlled delivery method that has opened the door for single-isocenter multi-metastases stereotactic radiosurgery (SRS) and hippocampal avoidance whole brain radiation therapy (HA-WBRT). Other notable advances have occurred in the combination of immune checkpoint inhibitors (ICI) and radiosurgery. When these two modalities are combined in the proper sequence (within 30 days from each other), it provides promising results in the treatment of intracranial metastases from melanoma. There is emerging evidence of a synergistic interaction between ICI and SRS, providing better intracranial tumor control and lengthening the survival of patients afflicted by this common complication of cancer.
Collapse
Affiliation(s)
- Quoc-Anh Ho
- Department of Radiation Oncology, University of Arizona, Tucson, AZ, 85719, USA. .,University of Arizona Cancer Center, University of Arizona, Tucson, AZ, 85719, USA.
| | - Baldassarre Stea
- Department of Radiation Oncology, University of Arizona, Tucson, AZ, 85719, USA.,University of Arizona Cancer Center, University of Arizona, Tucson, AZ, 85719, USA
| |
Collapse
|
33
|
Tanaka S, Kadoya N, Umezawa R, Nemoto H, Katsuta Y, Ito K, Takeda K, Jingu K. Evaluation of the dosimetric impact of heart function-based volumetric modulated arc therapy planning in patients with esophageal cancer. Radiol Phys Technol 2021; 14:279-87. [PMID: 34101136 DOI: 10.1007/s12194-021-00623-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
Radiotherapy for esophageal cancer entails high-dose irradiation of the myocardium owing to its close anatomical proximity to the esophagus. This study aimed to evaluate the dosimetric impact of functional avoidance planning for the myocardium with volumetric-modulated arc therapy (VMAT) in patients with esophageal cancer and determine the feasibility of functional planning. Ten patients with early stage esophageal cancer were included in this study. The prescribed dose was 60 Gy administered in 30 fractions. An experienced physician contoured the left ventricle (LV) of the myocardium. For each patient, an anatomical plan (non-LV-sparing plan) and a functional plan (LV-sparing plan) were created using the VMAT. In the functional plan, the mean percentage of LV volume receiving a dose of ≥ 30 and ≥ 40 Gy was 6.0% ± 6.7% and 2.4% ± 2.7%, respectively, whereas in the anatomical plan, they were 11.7% ± 13.1% and 4.9% ± 6.5%, respectively. There were no significant differences with respect to the dose to the hottest 1 cm3 of the planning target volume (PTV) and the minimum dose of the gross tumor volume and the dosimetric parameters of other normal tissues between the anatomical and functional plans. We compared the anatomical and functional plans of patients with esophageal cancer undergoing VMAT. Our results demonstrated that the functional plan reduced the dose to the LV with no significant differences in the organs at risk and PTV, indicating that avoidance planning can be safely performed when administering VMAT in patients with esophageal cancer.
Collapse
|
34
|
Placidi L, Nardini M, Cusumano D, Boldrini L, Chiloiro G, Romano A, Votta C, Antonelli MV, Valentini V, Indovina L. VMAT-like plans for magnetic resonance guided radiotherapy: Addressing unmet needs. Phys Med 2021; 85:72-78. [PMID: 33979726 DOI: 10.1016/j.ejmp.2021.05.002] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/29/2021] [Accepted: 05/03/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE VMAT delivery technique is currently not applicable to Magnetic Resonance-guided radiotherapy (MRgRT) hybrid systems. Aim of this study is to evaluate an innovative VMAT-like (VML) delivery technique. MATERIAL AND METHODS First, planning and dosimetric evaluation of the MRgRT VML treatment have been performed on 10 different disease sites and the results have been compared with the corresponding IMRT plans. Then, in the second phase, 10 of the most dosimetrically challenging locally advanced pancreas treatment plans have been retrospectively re-planned using the VML approach to explore the potentiality of this new delivery technique. Finally, VML robustness was evaluated and compared with the IMRT plans, considering a lateral positioning error of ± 5 mm. RESULTS In phase one, all VML plans were within constraint for all OARs. When PTV coverage is considered, in the 50% of the cases VML PTV coverage is equal or higher than in IMRT plan. In the remaining 50%, the highest target under coverage difference in comparison with IMRT plan is -1.71%. The mean and maximum treatment time differences (VML-IMRT) is 0.2 min and 3.1 min respectively. In phase two, the treatment time variation (VML-IMRT), shows a mean, maximum and minimum variations of 1.3, 4.6 and -0.6 min respectively. All VML plans have a better target coverage if compared with IMRT plans, keeping in any case the OARs constraints within tolerance. VML doesn't increase plan robustness. CONCLUSION VMAT-like treatment approach appeared to be an efficient planning solution and it was decided to clinically implement it in daily practice, especially in the frame of hypo fractionated treatments.
Collapse
Affiliation(s)
- L Placidi
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Nardini
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - D Cusumano
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy.
| | - L Boldrini
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy
| | - G Chiloiro
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy
| | - A Romano
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy
| | - C Votta
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy
| | - M V Antonelli
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy
| | - V Valentini
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Indovina
- Fondazione Policlinico Universitario ''A. Gemelli'' IRCCS, Roma, Italy
| |
Collapse
|
35
|
Mazonakis M, Lyraraki E, Damilakis J. Lifetime radiation-induced sarcoma risk in patients subjected to IMRT or VMAT for uterine cervix carcinoma. Phys Eng Sci Med 2021; 44:573-9. [PMID: 33909230 DOI: 10.1007/s13246-021-01002-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/14/2021] [Indexed: 01/08/2023]
Abstract
This study was conducted to estimate the lifetime radiation-induced bone and soft tissue sarcoma risks from intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) for uterine cervix carcinoma. 13 cervical cancer patients were included. The bone and soft tissue structures were defined on patients' treatment planning computed tomography (CT) scans. Both CT-based IMRT and VMAT plans with 6 MV photons delivering 45 Gy to the target site were designed for each patient. The organ equivalent dose (OED) and the lifetime attributable risk (LAR) for developing bone or soft tissue sarcoma were estimated using treatment planning data and a non-linear mechanistic model. The estimation method did not consider the survival rates following radiotherapy and the use of brachytherapy treatments. The patient-specific OEDs of the bone structure from IMRT and VMAT were 2.33-2.83 and 2.34-2.82 Gy, respectively. The corresponding values for the soft tissue structure were 1.27-1.70 and 1.32-1.73 Gy. An insignificant difference was found between the patient-specific OEDs and the directly proportional sarcoma risks (bone: P = 0.07; soft tissue: P = 0.38). The LAR for the development of a bone sarcoma varied from 0.05 to 0.16% by the patient's age during irradiation and the applied treatment delivery technique. The corresponding LAR range for radiation-induced soft-tissue sarcoma was 0.08-0.27%. The above LARs resulted in a relative risk of more than 1.20 indicating that IMRT or VMAT may lead to a considerable risk increase of developing bone or soft tissue sarcoma exceeding 20% in respect to the current incidence of these malignancies in unexposed population.
Collapse
|
36
|
Wall PDH, Fontenot JD. Quality assurance-based optimization (QAO): Towards improving patient-specific quality assurance in volumetric modulated arc therapy plans using machine learning. Phys Med 2021; 87:136-143. [PMID: 33775567 DOI: 10.1016/j.ejmp.2021.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 10/05/2020] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Previous literature has shown general trade-offs between plan complexity and resulting quality assurance (QA) outcomes. However, existing solutions for controlling this trade-off do not guarantee corresponding improvements in deliverability. Therefore, this work explored the feasibility of an optimization framework for directly maximizing predicted QA outcomes of plans without compromising the dosimetric quality of plans designed with an established knowledge-based planning (KBP) technique. MATERIALS AND METHODS A support vector machine (SVM) was developed - using a database of 500 previous VMAT plans - to predict gamma passing rates (GPRs; 3%/3mm percent dose-difference/distance-to-agreement with local normalization) based on selected complexity features. A heuristic, QA-based optimization (QAO) framework was devised by utilizing the SVM model to iteratively modify mechanical treatment features most commonly associated with suboptimal GPRs. Specifically, leaf gaps (LGs) <50 mm were widened by random amounts, which impacts all aperture-based complexity features. 13 prostate KBP-guided VMAT plans were optimized via QAO using user-specified maximum LG displacements before corresponding changes in predicted GPRs and dose were assessed. RESULTS Predicted GPRs increased by an average of 1.14 ± 1.25% (p = 0.006) with QAO using a 3 mm maximum random LG displacement. There were small differences in dose, resulting in similarly small changes in tumor control probability (maximum increase = 0.05%) and normal tissue complication probabilities in the bladder, rectum, and femoral heads (maximum decrease = 0.2% in the rectum). CONCLUSION This study explored the feasibility of QAO and warrants future investigations of further incorporating QA endpoints into plan optimization.
Collapse
Affiliation(s)
- Phillip D H Wall
- Department of Physics and Astronomy, Louisiana State University and Agricultural and Mechanical College, 202 Tower Drive, Baton Rouge, LA 70803-4001, USA.
| | - Jonas D Fontenot
- Department of Physics and Astronomy, Louisiana State University and Agricultural and Mechanical College, 202 Tower Drive, Baton Rouge, LA 70803-4001, USA; Department of Physics, Mary Bird Perkins Cancer Center, 4950 Essen Lane, Baton Rouge, LA 70809, USA
| |
Collapse
|
37
|
Wang M, Gu H, Hu J, Liang J, Xu S, Qi Z. Evaluation of a highly refined prediction model in knowledge-based volumetric modulated arc therapy planning for cervical cancer. Radiat Oncol 2021; 16:58. [PMID: 33752699 PMCID: PMC7983216 DOI: 10.1186/s13014-021-01783-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/21/2020] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
Background and purpose To explore whether a highly refined dose volume histograms (DVH) prediction model can improve the accuracy and reliability of knowledge-based volumetric modulated arc therapy (VMAT) planning for cervical cancer. Methods and materials The proposed model underwent repeated refining through progressive training until the training samples increased from initial 25 prior plans up to 100 cases. The estimated DVHs derived from the prediction models of different runs of training were compared in 35 new cervical cancer patients to analyze the effect of such an interactive plan and model evolution method. The reliability and efficiency of knowledge-based planning (KBP) using this highly refined model in improving the consistency and quality of the VMAT plans were also evaluated. Results The prediction ability was reinforced with the increased number of refinements in terms of normal tissue sparing. With enhanced prediction accuracy, more than 60% of automatic plan-6 (AP-6) plans (22/35) can be directly approved for clinical treatment without any manual revision. The plan quality scores for clinically approved plans (CPs) and manual plans (MPs) were on average 89.02 ± 4.83 and 86.48 ± 3.92 (p < 0.001). Knowledge-based planning significantly reduced the Dmean and V18 Gy for kidney (L/R), the Dmean, V30 Gy, and V40 Gy for bladder, rectum, and femoral head (L/R). Conclusion The proposed model evolution method provides a practical way for the KBP to enhance its prediction ability with minimal human intervene. This highly refined prediction model can better guide KBP in improving the consistency and quality of the VMAT plans.
Collapse
Affiliation(s)
- Mingli Wang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - Huikuan Gu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - Jiang Hu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - Jian Liang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - Sisi Xu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - Zhenyu Qi
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China. .,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China. .,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China.
| |
Collapse
|
38
|
Chao M, Coburn N, Cosgriff E, Brown C, Van Tilburg K, Hayden A. A predictive model for determining rectum and bladder dose constraints in prostate volumetric modulated arc therapy. Med Dosim 2021; 46:269-273. [PMID: 33726940 DOI: 10.1016/j.meddos.2021.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/17/2020] [Revised: 11/22/2020] [Accepted: 02/05/2021] [Indexed: 10/21/2022]
Abstract
Generic dose-volume constraints of the rectum/bladder (R/B) are used in inverse planning to reduce doses to these organs for patients undergoing prostate radiotherapy. A retrospective study was undertaken to assess correlations between the overlap of the R/B with the planning target volume (PTV) and the dose received during planning to organs at risk (OARs). Data for 105 prostate cancer patients who had volumetric modulated arc therapy (VMAT) to the intact prostate and proximal seminal vesicles at Nepean Cancer Care Centre from 2011 to 2015 were analyzed. R/B volume, R/B-PTV overlap volume, and R/B-PTV overlap percent metrics were collected with VMAT planning objectives. Characteristics were evaluated for correlation with different planning outcomes. The percentage overlap between the R/B and PTV were highly correlated to the doses to the relevant OAR, with a coefficient of determination (R2) of 0.63 for the rectum volume percentage receiving more than 75 Gy (RV75Gy) and R2 of 0.91 for the bladder volume percentage receiving more than 70 Gy (BV70Gy). We identified a cut-off value of 10.14% (sensitivity 84.62%, specificity 80.43%) as predictive of RV75Gy < 10% and a cut-off of 7.95% (sensitivity 97.62%, specificity 92.06%) as predictive of BV70Gy < 15%. A 95% prediction interval assisted in identifying individualized R/B planning goals. The R/B-PTV percentage overlap has a high reliability in estimating sparing of the R/B. This prediction model can be used to improve planning efficiency and create customised automated OAR planning goals in prostate VMAT plans. By doing this, the radiation doses received by these OARs can be minimized.
Collapse
Affiliation(s)
- Menglei Chao
- Nepean Cancer Care Centre, Nepean Hospital, Kingswood, New South Wales, 2747, Australia.
| | - Natalie Coburn
- Nepean Cancer Care Centre, Nepean Hospital, Kingswood, New South Wales, 2747, Australia
| | - Eireann Cosgriff
- Nepean Cancer Care Centre, Nepean Hospital, Kingswood, New South Wales, 2747, Australia
| | - Chris Brown
- NHMRC Clinical Trials Centre, The University of Sydney, Campbelltown, New South Wales, Australia
| | - Kevin Van Tilburg
- Nepean Cancer Care Centre, Nepean Hospital, Kingswood, New South Wales, 2747, Australia
| | - Amy Hayden
- Nepean Cancer Care Centre, Nepean Hospital, Kingswood, New South Wales, 2747, Australia; Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia
| |
Collapse
|
39
|
Lai J, Liu J, Zhao J, Li A, Liu S, Deng Z, Tan Q, Wang H, Jia Y, Lei K, Zhou L. Effective method to reduce the normal brain dose in single-isocenter hypofractionated stereotactic radiotherapy for multiple brain metastases. Strahlenther Onkol 2021; 197:592-600. [PMID: 33725135 DOI: 10.1007/s00066-021-01757-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/05/2020] [Accepted: 02/15/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Island blocking and dose leakage problems will lead to unnecessary irradiation to normal brain tissue (NBT) in hypofractionated stereotactic radiotherapy (HSRT) for multiple brain metastases (BM) with single-isocenter volumetric modulated arc therapy (VMAT). The present study aimed at investigating whether reducing the number of metastases irradiated by each arc beam could minimize these two problems. MATERIALS AND METHODS A total of 32 non-small-cell lung cancer (NSCLC) patients with multiple BM received HSRT (24-36 Gy/3 fractions) with single-isocenter VMAT, where each arc beam only irradiated partial metastases (pm-VMAT), were enrolled in this retrospective study. Conventional single-isocenter VMAT plans, where each arc beam irradiated whole metastases (wm-VMAT), was regenerated and compared with pm-VMAT plans. Furthermore, the clinical efficacy and toxicities were evaluated. RESULTS Pm-VMAT achieved similar target coverage as that with wm-VMAT, with better dose fall-off (P < 0.001) and NBT sparing (P < 0.001). However, pm-VMAT resulted in more monitor units (MU) and longer beam-on time (P < 0.001). The intracranial objective response rate and disease control rate for all patients were 75% and 100%, respectively. The local control rates at 1 year and 2 year were 96.2% and 60.2%, respectively. The median progression-free survival and overall survival were 10.3 months (95% confidence interval [CI] 6.8-13.2) and 18.5 months (95% CI 15.9-20.1), respectively. All treatment-related adverse events were grade 1 or 2, and 3 lesions (2.31%) from 2 patients (6.25%) demonstrated radiation necrosis after HSRT. CONCLUSION HSRT with pm-VMAT is effective and has limited toxicities for NSCLC patients with multiple BM. Pm-VMAT could provide better NBT sparing while maintaining target dose coverage.
Collapse
Affiliation(s)
- Jialu Lai
- Department of Radiotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37, Guoxue Lane, 610041, Chengdu, Sichuan, China
| | - Jia Liu
- Department of Oncology, Chengdu First People' Hospital, 18, Wanxiang North Road, 610041, Chengdu, Sichuan, China
| | - Jianling Zhao
- Department of Radiotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37, Guoxue Lane, 610041, Chengdu, Sichuan, China
| | - An Li
- Department of Radiotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37, Guoxue Lane, 610041, Chengdu, Sichuan, China
| | - Shoupeng Liu
- Department of Radiotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37, Guoxue Lane, 610041, Chengdu, Sichuan, China
| | - Zhonghua Deng
- Department of Radiotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37, Guoxue Lane, 610041, Chengdu, Sichuan, China
| | - Qiaoyue Tan
- Department of Radiotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37, Guoxue Lane, 610041, Chengdu, Sichuan, China
| | - Haitao Wang
- Department of Radiotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37, Guoxue Lane, 610041, Chengdu, Sichuan, China
| | - Yuming Jia
- Department of Oncology, Yibin Second People' Hospital, 96, North Street, 644000, Yibin, Sichuan, China
| | - Kaijian Lei
- Department of Oncology, Yibin Second People' Hospital, 96, North Street, 644000, Yibin, Sichuan, China
| | - Lin Zhou
- Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37, Guoxue Lane, 610041, Chengdu, Sichuan, China.
| |
Collapse
|
40
|
Li C, Tao C, Bai T, Li Z, Tong Y, Zhu J, Yin Y, Lu J. Beam complexity and monitor unit efficiency comparison in two different volumetric modulated arc therapy delivery systems using automated planning. BMC Cancer 2021; 21:261. [PMID: 33691654 PMCID: PMC7945217 DOI: 10.1186/s12885-021-07991-6] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 02/28/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND To investigate the beam complexity and monitor unit (MU) efficiency issues for two different volumetric modulated arc therapy (VMAT) delivery technologies for patients with left-sided breast cancer (BC) and nasopharyngeal carcinoma (NPC). METHODS Twelve left-sided BC and seven NPC cases were enrolled in this study. Each delivered treatment plan was optimized in the Pinnacle3 treatment planning system with the Auto-Planning module for the Trilogy and Synergy systems. Similar planning dose objectives and beam configurations were used for each site in the two different delivery systems to produce clinically acceptable plans. The beam complexity was evaluated in terms of the segment area (SA), segment width (SW), leaf sequence variability (LSV), aperture area variability (AAV), and modulation complexity score (MCS) based on the multileaf collimator sequence and MU. Plan delivery and a gamma evaluation were performed using a helical diode array. RESULTS With similar plan quality, the average SAs for the Trilogy plans were smaller than those for the Synergy plans: 55.5 ± 21.3 cm2 vs. 66.3 ± 17.9 cm2 (p < 0.05) for the NPC cases and 100.7 ± 49.2 cm2 vs. 108.5 ± 42.7 cm2 (p < 0.05) for the BC cases, respectively. The SW was statistically significant for the two delivery systems (NPC: 6.87 ± 1.95 cm vs. 6.72 ± 2.71 cm, p < 0.05; BC: 8.84 ± 2.56 cm vs. 8.09 ± 2.63 cm, p < 0.05). The LSV was significantly smaller for Trilogy (NPC: 0.84 ± 0.033 vs. 0.86 ± 0.033, p < 0.05; BC: 0.89 ± 0.026 vs. 0.90 ± 0.26, p < 0.05). The mean AAV was significantly larger for Trilogy than for Synergy (NPC: 0.18 ± 0.064 vs. 0.14 ± 0.037, p < 0.05; BC: 0.46 ± 0.15 vs. 0.33 ± 0.13, p < 0.05). The MCS values for Trilogy were higher than those for Synergy: 0.14 ± 0.016 vs. 0.12 ± 0.017 (p < 0.05) for the NPC cases and 0.42 ± 0.106 vs. 0.30 ± 0.087 (p < 0.05) for the BC cases. Compared with the Synergy plans, the average MUs for the Trilogy plans were larger: 828.6 ± 74.1 MU and 782.9 ± 85.2 MU (p > 0.05) for the NPC cases and 444.8 ± 61.3 MU and 393.8 ± 75.3 MU (p > 0.05) for the BC cases. The gamma index agreement scores were never below 91% using 3 mm/3% (global) distance to agreement and dose difference criteria and a 10% lower dose exclusion threshold. CONCLUSIONS The Pinnacle3 Auto-Planning system can optimize BC and NPC plans to achieve the same plan quality using both the Trilogy and Synergy systems. We found that these two systems resulted in different SAs, SWs, LSVs, AAVs and MCSs. As a result, we suggested that the beam complexity should be considered in the development of further methodologies while optimizing VMAT autoplanning.
Collapse
Affiliation(s)
- Chengqiang Li
- Department of Radiation Oncology Physics, Shandong Cancer Hospital and Institute, Cancer Hospital affiliated to Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Cheng Tao
- Department of Radiation Oncology Physics, Shandong Cancer Hospital and Institute, Cancer Hospital affiliated to Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Tong Bai
- Department of Radiation Oncology Physics, Shandong Cancer Hospital and Institute, Cancer Hospital affiliated to Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Zhenjiang Li
- Department of Radiation Oncology Physics, Shandong Cancer Hospital and Institute, Cancer Hospital affiliated to Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Ying Tong
- Department of Radiation Oncology Physics, Shandong Cancer Hospital and Institute, Cancer Hospital affiliated to Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Jian Zhu
- Department of Radiation Oncology Physics, Shandong Cancer Hospital and Institute, Cancer Hospital affiliated to Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Yong Yin
- Department of Radiation Oncology Physics, Shandong Cancer Hospital and Institute, Cancer Hospital affiliated to Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China.
| | - Jie Lu
- Department of Radiation Oncology Physics, Shandong Cancer Hospital and Institute, Cancer Hospital affiliated to Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China.
| |
Collapse
|
41
|
Sun T, Lin X, Zhang G, Qiu Q, Li C, Yin Y. Treatment planning comparison of volumetric modulated arc therapy with the trilogy and the Halcyon for bilateral breast cancer. Radiat Oncol 2021; 16:35. [PMID: 33602267 PMCID: PMC7890882 DOI: 10.1186/s13014-021-01763-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 10/10/2020] [Accepted: 02/11/2021] [Indexed: 12/12/2022] Open
Abstract
Background The Halcyon is a new machine from the Varian company. The purpose of this study was to evaluate the dosimetry of the Halcyon in treatment of bilateral breast cancer with volumetric modulated arc therapy. Methods On CT images of 10 patients with bilateral breast cancer, four Halcyon plans with different setup fields were generated, and dosimetric comparisons using Bonferroni’s multiple comparisons test were conducted among the four plans. Whole and partial arc plans on the Trilogy and the Halcyon, referred to as T-4arc, T-8arc, H-4arc and H-8arc, were designed. The prescription dose was 50 Gy in 2-Gy fractions. All plans were designed with the Eclipse version 15.5 treatment planning system. The dosimetric differences between whole and partial arc plans in the same accelerator were compared using the Mann–Whitney U test. The better Halcyon plan was selected for the further dosimetric comparison of the plan quality and delivery efficiency between the Trilogy and the Halcyon. Results Halcyon plans with high‐quality megavoltage cone beam CT setup fields increased the Dmean, D2 and V107 of the planning target volume (PTV) and the V5 and Dmean of the heart, left ventricle (LV) and lungs compared with other Halcyon setup plans. The mean dose and low dose volume of the heart, lungs and liver were significantly decreased in T-8arc plans compared to T-4arc plans. In terms of the V5, V20, V30, V40 and Dmean of the heart, the V20, V30, V40 and Dmean of the LV, the V30, V40, Dmax and Dmean of the left anterior descending artery (LAD), and the V5 and V40 of lungs, H-8arc was significantly higher than H-4arc (p < 0.05). Compared with the Trilogy’s plans, the Halcyon’s plans reduced the high-dose volume of the heart and LV but increased the mean dose of the heart. For the dose of the LAD and the V20 and V30 of lungs, there was no significant difference between the two accelerators. Compared with the Trilogy, plans on the Halcyon significantly increased the skin dose but also significantly reduced the delivery time. Conclusion For the Halcyon, the whole-arc plans have more dosimetric advantages than partial-arc plans in bilateral breast cancer radiotherapy. Although the mean dose of the heart and the skin dose are increased, the doses of the cardiac substructure and other OARs are comparable to the Trilogy, and the delivery time is significantly reduced.
Collapse
Affiliation(s)
- Tao Sun
- Department of Radiation Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Xiutong Lin
- Department of Radiation Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Guifang Zhang
- Department of Radiation Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Qingtao Qiu
- Department of Radiation Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Chengqiang Li
- Department of Radiation Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Yong Yin
- Department of Radiation Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China.
| |
Collapse
|
42
|
Sakurai T, Takamatsu S, Shibata S, Taka M, Ishiyama M, Yamazaki M, Kojima H, Mizokami A, Kumano T, Gabata T. Incidence and dosimetric predictive factors of late rectal toxicity after low-dose-rate brachytherapy combined with volumetric modulated arc therapy in high-risk prostate cancer at a single institution: Retrospective study. Brachytherapy 2021; 20:584-94. [PMID: 33485811 DOI: 10.1016/j.brachy.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/20/2020] [Accepted: 12/12/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of this study is to investigate the incidence of rectal toxicity and to identify the associated dosimetric predictive parameters after I-125 seed low-dose-rate brachytherapy (LDR-BT) combined with volumetric modulated arc therapy (VMAT) and dose constraints. METHODS AND MATERIALS In total, 110 patients with high-risk prostate cancer received 110 Gy LDR-BT, followed by 45 Gy VMAT. Rectal toxicity was recorded according to Common Terminology Criteria for Adverse Events v.4.03. The dosimetric factors associated with LDR-BT and VMAT were analyzed to determine their relationship with rectal toxicity. Receiver operating characteristic (ROC) curve analysis was performed for ≥ grade 2 (G2) rectal toxicity prediction. RESULTS The follow-up duration was 10.1-115.2 months (median 60.5 months). Seven patients had G2 rectal hemorrhage, and none of the patients had grade 3 rectal hemorrhage. In the univariate analysis, the rectal volume receiving 100% of the prescribed dose (rV100) (p < 0.001), the dose covering 2 cc of the rectum (rD2cc) during LDR-BT (p = 0.002), and the combined rD2cc during LDR-BT and VMAT (p = 0.001) were identified as predictors of G2 rectal hemorrhage. In the ROC curve analysis, the cutoff value was 0.46 cc for rV100, 74.0 Gy for rD2cc, and 86.8 GyEQD2 for combined rD2cc. CONCLUSION Predictors of late ≥ G2 rectal hemorrhage are rV100, rD2cc, and combined rD2cc. The incidence of rectal toxicity is low and acceptable in this setting and is highly dependent on the rectal dose of LDR-BT. The use of higher-quality LDR-BT and VMAT dose constraints may further reduce the rate of rectal hemorrhage.
Collapse
|
43
|
Harrer C, Ullrich W, Wilkens JJ. Prediction of multi-criteria optimization (MCO) parameter efficiency in volumetric modulated arc therapy (VMAT) treatment planning using machine learning (ML). Phys Med 2021; 81:102-113. [PMID: 33445122 DOI: 10.1016/j.ejmp.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/30/2020] [Revised: 12/01/2020] [Accepted: 12/05/2020] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To predict the impact of optimization parameter changes on dosimetric plan quality criteria in multi-criteria optimized volumetric-modulated-arc therapy (VMAT) planning prior to optimization using machine learning (ML). METHODS A data base comprising a total of 21,266 VMAT treatment plans for 44 cranial and 18 spinal patient geometries was generated. The underlying optimization algorithm is governed by three highly composite parameters which model a combination of important aspects of the solution. Patient geometries were parametrized via volume- and shape properties of the voxel objects and overlap-volume histograms (OVH) of the planning-target-volume (PTV) and a relevant organ-at-risk (OAR). The impact of changes in one of the three optimization parameters on the maximally achievable value range of five dosimetric properties of the resulting dose distributions was studied. To predict the extent of this impact based on patient geometry, treatment site, and current parameter settings prior to optimization, three different ML-models were trained and tested. Precision-recall curves, as well as the area-under-curve (AUC) of the resulting receiver-operator-characteristic (ROC) curves were analyzed for model assessment. RESULTS Successful identification of parameter regions resulting in a high variability of dosimetric plan properties depended on the choice of geometry features, the treatment indication and the plan property under investigation. AUC values between 0.82 and 0.99 could be achieved. The best average-precision (AP) values obtained from the corresponding precision/recall curves ranged from 0.71 to 0.99. CONCLUSIONS Machine learning models trained on a database of pre-optimized treatment plans can help finding relevant optimization parameter ranges prior to optimization.
Collapse
Affiliation(s)
- Christian Harrer
- Physics Department, Technical University of Munich, 85748 Garching, Germany; Brainlab AG, 81829 München, Germany.
| | | | - Jan J Wilkens
- Physics Department, Technical University of Munich, 85748 Garching, Germany; Department of Radiation Oncology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, 81675 München, Germany
| |
Collapse
|
44
|
Nakano H, Tanabe S, Yamada T, Utsunomiya S, Takizawa T, Sakai M, Sasamoto R, Sakai H, Nakano T, Saito H, Ohta A, Kaidu M, Ishikawa H. Maximum distance in single-isocenter technique of stereotactic radiosurgery with rotational error using margin-based analysis. Radiol Phys Technol 2021; 14:57-63. [PMID: 33393057 DOI: 10.1007/s12194-020-00602-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/05/2020] [Revised: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 12/11/2022]
Abstract
Through geometrical simulation, we evaluated the effect of rotational error in patient setup on geometrical coverage and calculated the maximum distance between the isocenter and target, where the clinical PTV margin secures geometrical coverage with a single-isocenter technique. We used simulated spherical GTVs with diameters of 1.0 (GTV 1), 1.5 (GTV 2), 2.0 (GTV 3), and 3.0 cm (GTV 4). The location of the target center was set such that the distance between the target and isocenter ranged from 0 to 15 cm. We created geometrical coverage vectors so that each target was entirely covered by 100% of the prescribed dose. The vectors of the target positions were simultaneously rotated within a range of 0°-2.0° around the x-, y-, and z-axes. For each rotational error, the reduction in geometrical coverage of the targets was calculated and compared with that obtained for a rotational error of 0°. The tolerance value of the geometrical coverage reduction was defined as 5% of the GTV. The maximum distance that satisfied the 5% tolerance value for different values of rotational error at a clinical PTV margin of 0.1 cm was calculated. When the rotational errors were 0.5° for a 0.1 cm PTV margin, the maximum distances were as follows: GTV 1: 7.6 cm; GTV 2: 10.9 cm; GTV 3: 14.3 cm; and GTV 4: 21.4 cm. It might be advisable to exclude targets that are > 7.6 cm away from the isocenter with a single-isocenter technique to satisfy the tolerance value for all GTVs.
Collapse
Affiliation(s)
- Hisashi Nakano
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Japan.
| | - Satoshi Tanabe
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Japan
| | - Takumi Yamada
- Section of Radiology, Department of Clinical Support, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Japan
| | - Satoru Utsunomiya
- Department of Radiological Technology, Niigata University Graduate School of Health Sciences, 2-746 Asahimachi-dori, Chuo-ku, Niigata, Japan
| | - Takeshi Takizawa
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Japan.,Department of Radiation Oncology, Niigata Neurosurgical Hospital, Yamada, Nishi-ku, Niigata, 3057, Japan
| | - Madoka Sakai
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Japan
| | - Ryuta Sasamoto
- Department of Radiological Technology, Niigata University Graduate School of Health Sciences, 2-746 Asahimachi-dori, Chuo-ku, Niigata, Japan
| | - Hironori Sakai
- Section of Radiology, Department of Clinical Support, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Japan
| | - Toshimichi Nakano
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Japan
| | - Hirotake Saito
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Japan
| | - Atsushi Ohta
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Japan
| | - Motoki Kaidu
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Japan
| | - Hiroyuki Ishikawa
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Japan
| |
Collapse
|
45
|
Franceschini D, Loi M, Chiola I, Arculeo S, Marzo M, Fernandes B, Masci G, Torrisi R, Tinterri C, Testori A, Santoro A, Scorsetti M. Preliminary Results of a Randomized Study on Postmenopausal Women With Early Stage Breast Cancer: Adjuvant Hypofractionated Whole Breast Irradiation Versus Accelerated Partial Breast Irradiation (HYPAB Trial). Clin Breast Cancer 2020; 21:231-238. [PMID: 33121891 DOI: 10.1016/j.clbc.2020.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The purpose of this study was to report preliminary data of a randomized phase III trial comparing hypofractionated whole breast irradiation (HWBI) and accelerated partial breast irradiation (APBI) using volumetric modulated arc therapy (VMAT). MATERIAL AND METHODS The HYPAB trial enrolled postmenopausal women with biopsy-proven infiltrating breast cancer, clinically negative axilla, single T1 to T2 tumors, who were treated with breast-conserving surgery. Patients were randomized 1:1 after surgery to HWBI (40.5 Gy whole breast, 48.0 Gy to surgical bed, 15 fractions over 3 weeks) or APBI (30 Gy delivered in 5 fractions of 6 Gy given on alternate days on the surgical bed). Cosmetic outcome was the primary end point of the study. RESULTS A total of 172 patients were enrolled. After a median follow-up of 36 months, 5 local failures and 3 locoregional failures were recorded, with no difference between the 2 treatment arms. Use of HWBI as compared with APBI was significantly correlated with increased incidence of overall (62% vs. 14%; P < .001) and grade 2 (18% vs. 1%; P < .001) acute skin toxicity. APBI was correlated with a lower incidence of overall late toxicity as compared with HWBI (18% vs. 41%; P = .001), but no significant difference was found in term of occurrence of grade 2 events (1% vs. 4%; P = NS). At comparative assessment between baseline and post-radiotherapy evaluation, impairment in cosmetic outcome was reported in 19 (11%) patients. Owing to premature closure of the study, no per-protocol comparison between the treatment arms was performed. CONCLUSION APBI with the VMAT technique is safe and feasible, with lower acute toxicity when compared with HWBI.
Collapse
Affiliation(s)
- Davide Franceschini
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy.
| | - Mauro Loi
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Ilaria Chiola
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Simona Arculeo
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Marco Marzo
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Bethania Fernandes
- Pathology Department, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Giovanna Masci
- Medical Oncology Department, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Rosalba Torrisi
- Medical Oncology Department, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Corrado Tinterri
- Breast Surgery Department, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Alberto Testori
- Breast Surgery Department, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Armando Santoro
- Medical Oncology Department, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy; Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy; Humanitas University, Department of Biomedical Sciences, Milan, Italy
| |
Collapse
|
46
|
Ono S, Ueda Y, Inui S, Isono M, Ohira S, Murata S, Miyazaki M, Teshima T. Dosimetric impact of baseline drift in volumetric modulated arc therapy with breath holding. Rep Pract Oncol Radiother 2020; 25:703-708. [PMID: 32684857 PMCID: PMC7358624 DOI: 10.1016/j.rpor.2020.06.004] [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: 12/11/2019] [Revised: 04/17/2020] [Accepted: 06/01/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND We investigated the change of dose distributions in volumetric modulated arc therapy (VMAT) under baseline drift (BD) during breath holding. MATERIALS AND METHODS Ten VMAT plans recalculated to a static field at a gantry angle of 0° were prepared for measurement with a 2D array device and five original VMAT plans were prepared for measurement with gafchromic films. These measurement approaches were driven by a waveform reproducing breath holding with BD. We considered breath holding times of 15 and 10 s, and BD at four speeds; specifically, BD0 (0 mm/s), BD0.2 (0.2 mm/s), BD0.3 (0.3 mm/s), and BD0.4 (0.4 mm/s). The BD was periodically reproduced from the isocenter along the craniocaudal direction and the shift during breath holding (ShiftBH) ranged 0-6 mm.The dose distribution of BD0.2, BD0.3 and BD0.4 were compared to that of BD0 using gamma analysis with the criterion of 2%/2 mm. RESULTS The mean pass rates of each ShiftBH were 99.8% and 98.9% at 0 mm, 96.8% and 99.4% at 2 mm, 94.9% and 98.6% at 3 mm, 91.5% and 98.4% at 4 mm, 70.8% and 94.1% at 4.5 mm, and 55.0% and 83.6% at 6 mm for the array and film measurements, respectively. CONCLUSION We found significant differences in ShiftBH above 4 mm (ρ < 0.05). Hence, it is recommended that breath holding time should be shortened for patients to preserve the reproducibility of dose distributions.
Collapse
Affiliation(s)
- Shunsuke Ono
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuou-ku, Osaka, 537-8567, Japan
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuou-ku, Osaka, 537-8567, Japan
| | - Shoki Inui
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuou-ku, Osaka, 537-8567, Japan
| | - Masaru Isono
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuou-ku, Osaka, 537-8567, Japan
| | - Shingo Ohira
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuou-ku, Osaka, 537-8567, Japan
| | - Seiya Murata
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuou-ku, Osaka, 537-8567, Japan
| | - Masayoshi Miyazaki
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuou-ku, Osaka, 537-8567, Japan
| | - Teruki Teshima
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuou-ku, Osaka, 537-8567, Japan
| |
Collapse
|
47
|
He L, Xiao J, Wei Z, He Y, Wang J, Guan H, Mu X, Peng X. Toxicity and dosimetric analysis of nasopharyngeal carcinoma patients undergoing radiotherapy with IMRT or VMAT: A regional center's experience. Oral Oncol 2020; 109:104978. [PMID: 32861986 DOI: 10.1016/j.oraloncology.2020.104978] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/08/2020] [Revised: 07/22/2020] [Accepted: 08/10/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To observe the differences of dosimetric parameters and late toxicities in Nasopharyngeal Carcinoma (NPC) patients treated with intensity-modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT), which may provide the selective basis about radiation technology in clinical practices. METHODS AND MATERIALS Dosimetric parameters and late toxicities were collected and retrospectively analyzed from 627 NPC patients (stage as I-IVA/IVB) between January 2010 and December 2015. RESULTS The median D2 of all targets and D50 of PGTVnd (regional lymph nodes) were lower in VAMT than those in IMRT, while the median D95 and D98 of PGTVnx (primary lesions) were higher in VMAT than those in IMRT (p < 0.05). Superior sparing of the organs at risk were observed in VMAT. The maximum dose of the brainstem, spinal cord, temporal lobes, temporomandibular joint, optic chiasm, and lens were lower in VMAT than those in IMRT, where the median dose reduction ranged from 0.56 to 3.56 Gy (p < 0.05). Meanwhile, the median parotid glands V30 in VMAT was reduced by approximately 2% compared to that in IMRT (p = 0.027). Regarding the late toxicities, ototoxicity, trismus, and temporal lobe injury were reduced by VMAT (p < 0.05). Furthermore, the late toxicities were correlative with the radiation dose of the corresponding OARs (p < 0.05). CONCLUSION For NPC treatment plans, the VMAT might provide not only more favorable dose distributions of targets but also better sparing of normal tissue than observed in IMRT. Furthermore, VMAT possibly provides less treatment-related late toxicities such as ototoxicity, trismus, and temporal lobe injury.
Collapse
Affiliation(s)
- Ling He
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jianghong Xiao
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Zhigong Wei
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yan He
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jingjing Wang
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Hui Guan
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiaoli Mu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xingchen Peng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
| |
Collapse
|
48
|
Ueda Y, Monzen H, Fukunaga JI, Ohira S, Tamura M, Suzuki O, Inui S, Isono M, Miyazaki M, Sumida I, Ogawa K, Teshima T. Characterization of knowledge-based volumetric modulated arc therapy plans created by three different institutions' models for prostate cancer. Rep Pract Oncol Radiother 2020; 25:1023-1028. [PMID: 33390859 DOI: 10.1016/j.rpor.2020.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/26/2020] [Accepted: 08/14/2020] [Indexed: 11/17/2022] Open
Abstract
Background The aim of this study was to clarify factors predicting the performance of knowledge-based planning (KBP) models in volume modulated arc therapy for prostate cancer in terms of sparing the organ at risk (OAR). Materials and methods In three institutions, each KBP model was trained by more than 20 library plans (LP) per model. To validate the characterization of each KBP model, 45 validation plans (VP) were calculated by the KBP system. The ratios of overlap between the OAR volume and the planning target volume (PTV) to the whole organ volume (Voverlap/Vwhole) were analyzed for each LP and VP. Regression lines between dose-volume parameters (V90, V75, and V50) and Voverlap/Vwhole were evaluated. The mean OAR dose, V90, V75, and V50 of LP did not necessarily match those of VP. Results In both the rectum and bladder, the dose-volume parameters for VP were strongly correlated with Voverlap/Vwhole at institutes A, B, and C (R > 0.74, 0.85, and 0.56, respectively). Except in the rectum at institute B, the slopes of the regression lines for LP corresponded to those for VP. For dose-volume parameters for the rectum, the ratios of slopes of the regression lines in VP to those in LP ranged 0.51-1.26. In the bladder, most ratios were less than 1.0 (mean: 0.77). Conclusion For each OAR, each model made distinct dosimetric characterizations in terms of Voverlap/Vwhole. The relationship between dose-volume parameters and Voverlap/Vwhole of OARs in LP predicts the KBP models' performance sparing OARs.
Collapse
Affiliation(s)
- Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka 537-8567, Japan
- Department of Radiation Oncology, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0071, Japan
| | - Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2 Onohigashi, Osakasayama, Osaka 589-8511, Japan
| | - Jun-Ichi Fukunaga
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Shingo Ohira
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka 537-8567, Japan
| | - Mikoto Tamura
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2 Onohigashi, Osakasayama, Osaka 589-8511, Japan
| | - Osamu Suzuki
- Department of Radiation Oncology, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0071, Japan
| | - Shoki Inui
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka 537-8567, Japan
| | - Masaru Isono
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka 537-8567, Japan
| | - Masayoshi Miyazaki
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka 537-8567, Japan
| | - Iori Sumida
- Department of Radiation Oncology, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0071, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0071, Japan
| | - Teruki Teshima
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka 537-8567, Japan
| |
Collapse
|
49
|
Cozzi L, Vanderstraeten R, Fogliata A, Chang FL, Wang PM. The role of a knowledge based dose-volume histogram predictive model in the optimisation of intensity-modulated proton plans for hepatocellular carcinoma patients : Training and validation of a novel commercial system. Strahlenther Onkol 2020; 197:332-342. [PMID: 32676685 DOI: 10.1007/s00066-020-01664-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/15/2020] [Accepted: 06/29/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To investigate the performance of a knowledge-based RapidPlan, for optimisation of intensity-modulated proton therapy (IMPT) plans applied to hepatocellular cancer (HCC) patients. METHODS A cohort of 65 patients was retrospectively selected: 50 were used to "train" the model, while the remaining 15 provided independent validation. The performance of the RapidPlan model was benchmarked against manual optimisation and was also compared to volumetric modulated arc therapy (RapidArc) photon plans. A subanalysis appraised the performance of the RapidPlan model applied to patients with lesions ≤300 cm3 or larger. Quantitative assessment was based on several metrics derived from the constraints of the NRG-GI003 clinical trial. RESULTS There was an equivalence between manual plans and RapidPlan-optimised IMPT plans, which outperformed the RapidArc plans. The planning dose-volume objectives were met on average for all structures except for D0.5 cm3 ≤30 Gy in the bowels. Limiting the results to the class-solution proton plans (all values in Gy), the data for manual plans vs RapidPlan-based IMPT plans, respectively, showed the following: D99% to the target of 47.5 ± 1.4 vs 47.2 ± 1.2; for organs at risk, the mean dose to the healthy liver was 6.7 ± 3.6 vs 6.7 ± 3.7; the mean dose to the kidneys was 0.2 ± 0.5 vs 0.1 ± 0.2; D0.5 cm3 for the bowels was 33.4 ± 16.4 vs 30.2 ± 16.0; for the stomach was 17.9 ± 19.9 vs 14.9 ± 18.8; for the oesophagus was 17.9 ± 15.1 vs 14.9 ± 13.9; for the spinal cord was 0.5 ± 1.6 vs 0.2 ± 0.7. The model performed similarly for cases with small or large lesions. CONCLUSION A knowledge-based RapidPlan model was trained and validated for IMPT. The results demonstrate that RapidPlan can be trained adequately for IMPT in HCC. The quality of the RapidPlan-based plans is at least equivalent compared to what is achievable with manual planning. RapidPlan also confirmed the potential to optimise the quality of the proton therapy results, thus reducing the impact of operator planning skills on patient results.
Collapse
Affiliation(s)
- Luca Cozzi
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, 20089, Milan-Rozzano, Italy. .,Department of Biomedical Sciences, Humanitas University, Rozzano, Italy.
| | | | - Antonella Fogliata
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, 20089, Milan-Rozzano, Italy
| | - Feng-Ling Chang
- Radiation Oncology Department, Asian University Hospital, Taichung, Taiwan, Province of China
| | - Po-Ming Wang
- Radiation Oncology Department, Asian University Hospital, Taichung, Taiwan, Province of China
| |
Collapse
|
50
|
Xie Y, Bourgeois D, Guo B, Zhang R. Comparison of conventional and advanced radiotherapy techniques for left-sided breast cancer after breast conserving surgery. Med Dosim 2020; 45:e9-e16. [PMID: 32646715 DOI: 10.1016/j.meddos.2020.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 02/08/2020] [Revised: 04/22/2020] [Accepted: 05/20/2020] [Indexed: 12/18/2022]
Abstract
Whole breast radiotherapy (WBRT) after breast conserving surgery is the standard treatment to prevent recurrence and metastasis of early stage breast cancer. This study aims to compare seven WBRT techniques including conventional tangential, field-in-field (FIF), hybrid intensity-modulated radiotherapy (IMRT), IMRT, standard volumetric modulated arc therapy (STD-VMAT), noncoplanar VMAT (NC-VMAT), and multiple arc VMAT (MA-VMAT). Fifteen patients who were previously diagnosed with left-sided early stage breast cancer and treated in our clinic were selected for this study. WBRT plans were created for these patients and were evaluated based on target coverage and normal tissue toxicities. All techniques produced clinically acceptable WBRT plans. STD-VMAT delivered the lowest mean dose (1.1 ± 0.3 Gy) and the lowest maximum dose (7.3 ± 4.9 Gy) to contralateral breast, and the second lowest lifetime attributable risk (LAR) (4.1 ± 1.4%) of secondary contralateral breast cancer. MA-VMAT delivered the lowest mean dose to lungs (4.9 ± 0.9 Gy) and heart (5.5 ± 1.2 Gy), exhibited the lowest LAR (1.7 ± 0.3%) of secondary lung cancer, normal tissue complication probability (NTCP) (1.2 ± 0.2%) of pneumonitis, risk of coronary events (RCE) (10.3 ± 2.7%), and LAR (3.9 ± 1.3%) of secondary contralateral breast cancer. NC-VMAT plans provided the most conformal target coverage, the lowest maximum lung dose (46.2 ± 4.1 Gy) and heart dose (41.1 ± 5.4 Gy), and the second lowest LAR (1.8 ± 0.4%) of secondary lung cancer and RCE (10.5 ± 2.8%). MA-VMAT and NC-VMAT could be the preferred techniques for early stage breast cancer patients after breast conserving surgery.
Collapse
Affiliation(s)
- Yibo Xie
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, LA, USA
| | - Daniel Bourgeois
- Department of Radiation Oncology, Mary Bird Perkins Cancer Center, Baton Rouge, LA, USA
| | - Beibei Guo
- Department of Experimental Statistics, Louisiana State University, Baton Rouge, LA, USA
| | - Rui Zhang
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, LA, USA; Department of Radiation Oncology, Mary Bird Perkins Cancer Center, Baton Rouge, LA, USA.
| |
Collapse
|