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Guo B, Stephans K, Godley A, Kolar M, Magnelli A, Tendulkar R, Mian O, Majkszak D, Xia P. Transperineal ultrasound is a good alternative for intra-fraction motion monitoring for prostate stereotactic body radiotherapy. J Appl Clin Med Phys 2023; 24:e14021. [PMID: 37144947 PMCID: PMC10562017 DOI: 10.1002/acm2.14021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/27/2023] [Accepted: 04/16/2023] [Indexed: 05/06/2023] Open
Abstract
PURPOSES To report our experience in a prospective study of implementing a transperineal ultrasound system to monitor intra-fractional prostate motion for prostate stereotactic body radiotherapy (SBRT). MATERIAL AND METHODS This IRB-approved prospective study included 23 prostate SBRT patients treated between 04/2016 and 11/2019 at our institution. The prescription doses were 36.25 Gy to the Low-Dose planning target volume (LD-PTV) and 40 Gy to the High-Dose PTV (HD-PTV) in five fractions with 3 mm planning margins. The transperineal ultrasound system was successfully used in 110 of the 115 fractions. For intra-fraction prostate motion, the real-time prostate displacements measured by ultrasound were exported for analysis. The percentage of time prostate movement exceeded a 2 mm threshold was calculated for each fraction of all patients. T-test was used for all statistical comparisons. RESULTS Ultrasound image quality was adequate for prostate delineation and prostate motion tracking. The setup time for each fraction under ultrasound-guided prostate SBRT was 15.0 ± 4.9 min and the total treatment time per fraction was 31.8 ± 10.5 min. The presence of an ultrasound probe did not compromise the contouring of targets or critical structures. For intra-fraction motion, prostate movement exceeded 2 mm tolerance in 23 of 110 fractions for 11 of 23 patients. For all fractions, the mean percentage of time when the prostate moved more than 2 mm in any direction during each fraction was 7%, ranging from 0% to 62% of a fraction. CONCLUSION Ultrasound-guided prostate SBRT is a good option for intra-fraction motion monitoring with clinically acceptable efficiency.
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Affiliation(s)
- Bingqi Guo
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - Kevin Stephans
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - Andrew Godley
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - Matt Kolar
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - Anthony Magnelli
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - Rahul Tendulkar
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - Omar Mian
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - David Majkszak
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
| | - Ping Xia
- Department of Radiation OncologyTaussig Cancer CenterCleveland ClinicClevelandOhioUSA
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Rossi L, Breedveld S, Heijmen B. Per-fraction planning to enhance optimization degrees of freedom compared to the conventional single-plan approach. Phys Med Biol 2023; 68:175014. [PMID: 37524087 DOI: 10.1088/1361-6560/acec27] [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: 11/15/2022] [Accepted: 07/31/2023] [Indexed: 08/02/2023]
Abstract
Objective. In conventional radiotherapy, a single treatment plan is generated pre-treatment, and delivered in daily fractions. In this study, we propose to generate different treatment plans for all fractions ('Per-fraction' planning) to reduce cumulative organs at risk (OAR) doses. Per-fraction planning was compared to the 'Conventional' single-plan approach for non-coplanar 4 × 9.5 Gy prostate stereotactic body radiation therapy (SBRT).Approach. An in-house application for fully automated, non-coplanar multi-criterial treatment planning with integrated beam angle and fluence optimization was used for plan generations. For the Conventional approach, a single 12-beam non-coplanar IMRT plan with individualized beam angles was generated for each of the 20 included patients. In Per-fraction planning, four fraction plans were generated for each patient. For each fraction, a different set of patient-specific 12-beam configurations could be automatically selected. Per-fraction plans were sequentially generated by adding dose to already generated fraction plan(s). For each fraction, the cumulative- and fraction dose were simultaneously optimized, allowing some minor constraint violations in fraction doses, but not in cumulative.Main results. In the Per-fraction approach, on average 32.9 ± 3.1 [29;39] unique beams per patient were used. PTV doses in the separate Per-fraction plans were acceptable and highly similar to those in Conventional plans, while also fulfilling all OAR hard constraints. When comparing total cumulative doses, Per-fraction planning showed improved bladder sparing for all patients with reductions in Dmean of 22.6% (p= 0.0001) and in D1cc of 2.0% (p= 0.0001), reductions in patient volumes receiving 30% and 50% of the prescribed dose of 54.7% and 6.3%, respectively, and a 3.1% lower rectum Dmean (p= 0.007). Rectum D1cc was 4.1% higher (p= 0.0001) and Urethra dose was similar.Significance. In this proof-of-concept paper, Per-fraction planning resulted in several dose improvements in healthy tissues compared to the Conventional single-plan approach, for similar PTV dose. By keeping the number of beams per fraction the same as in Conventional planning, reported dosimetric improvements could be obtained without increase in fraction durations. Further research is needed to explore the full potential of the Per-fraction planning approach.
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Affiliation(s)
- Linda Rossi
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands
| | - Sebastiaan Breedveld
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands
| | - Ben Heijmen
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands
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Sevillano D, Hervás A, García-Fuentes JD, Vallejo C, López F, Colmenares R, Capuz AB, Morís R, Cámara M, Galiano P, Williamson S, Chillida R, Béjar MJ, Prieto D, García-Vicente F. The use of a thin guide-wire for urethral definition in prostate SBRT treatments with Cyberknife. J Appl Clin Med Phys 2023:e14006. [PMID: 37097754 PMCID: PMC10402662 DOI: 10.1002/acm2.14006] [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: 09/20/2022] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 04/26/2023] Open
Abstract
PURPOSE To study and analyze the effect of the use of a thin guide-wire instead of a Foley catheter for urethral definition in prostate stereotactic body radiation therapy (SBRT) treatments and to compare treatment parameters in both situations. MATERIAL AND METHODS Thirty-seven prostate SBRT patients were employed in this study. A Foley catheter was employed in nine of them, and a guide-wire was employed in the other 28 patients. For each of the 28 patients in which the guide-wire was employed, a comparison between urethral positions in both situations was performed, allowing for a margin definition of the urethra when a Foley catheter was employed. Displacements of the prostate during treatment were obtained, allowing for an analysis of prostate positions in both situations. Also, different treatment parameters such as the number of treatment interruptions, couch movements performed, and x-rays needed were gathered. RESULTS Large differences between urethral positions can be found in the anterior-posterior (AP) directions compared to those in the lateral (LAT) direction. Differences are also larger in areas closer to the base of the prostate, where margins applied in the case of using a Foley catheter are 16 mm with a mean displacement of 6 mm in the posterior direction. No differences in the treatment parameters were found during treatment in both situations. The difference found in absolute prostate pitch rotations suggests that the Foley catheter provokes a shift of the prostate position, which does not occur when employing the guide-wire. CONCLUSIONS Foley catheters shift the urethral position, making them a wrong surrogate of the urethra when no catheters are present. The margins needed to assess uncertainties introduced by the use of a Foley catheter are larger than those usually applied. The use of a Foley catheter did not present any additional difficulty during treatment delivery in terms of images employed or interruptions produced.
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Affiliation(s)
- David Sevillano
- Medical Physics Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Asunción Hervás
- Radiation Oncology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Juan D García-Fuentes
- Medical Physics Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Carmen Vallejo
- Radiation Oncology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Fernando López
- Radiation Oncology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Rafael Colmenares
- Medical Physics Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Ana Belén Capuz
- Medical Physics Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Rafael Morís
- Medical Physics Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Miguel Cámara
- Medical Physics Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Pablo Galiano
- Medical Physics Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Sandra Williamson
- Medical Physics Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Rubén Chillida
- Medical Physics Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - María Josefa Béjar
- Medical Physics Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Daniel Prieto
- Medical Physics Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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Jayarathna S, Shen X, Chen RC, Li HH, Guida K. The effect of integrating knowledge-based planning with multicriteria optimization in treatment planning for prostate SBRT. J Appl Clin Med Phys 2023:e13940. [PMID: 36827178 DOI: 10.1002/acm2.13940] [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: 10/10/2022] [Revised: 12/21/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Knowledge-based planning (KBP) and multicriteria optimization (MCO) are two powerful tools to assist treatment planners in achieving optimal target coverage and organ-at-risk (OAR) sparing. The purpose of this work is to investigate if integrating MCO with conventional KBP can further improve treatment plan quality for prostate cancer stereotactic body radiation therapy (SBRT). A two-phase study was designed to investigate the impact of MCO and KBP in prostate SBRT treatment planning. The first phase involved the creation of a KBP model based on thirty clinical SBRT plans, generated by manual optimization (KBP_M). A ten-patient validation cohort was used to compare manual, MCO, and KBP_M optimization techniques. The next phase involved replanning the original model cohort with additional tradeoff optimization via MCO to create a second model, KBP_MCO. Plans were then generated using linear integration (KBP_M+MCO), non-linear integration (KBP_MCO), and a combination of integration methods (KBP_MCO+MCO). All plans were analyzed for planning target volume (PTV) coverage, OAR constraints, and plan quality metrics. Comparisons were generated to evaluate plan and model quality. Phase 1 highlighted the necessity of KBP and MCO in treatment planning, as both optimization methods improved plan quality metrics (Conformity and Heterogeneity Indices) and reduced mean rectal dose by 2 Gy, as compared to manual planning. Integrating MCO with KBP did not further improve plan quality, as little significance was seen over KBP or MCO alone. Principal component score (PCS) fitting showed KBP_MCO improved bladder and rectum estimated and modeled dose correlation by 5% and 22%, respectively; however, model improvements did not significantly impact plan quality. KBP and MCO have shown to reduce OAR dose while maintaining desired PTV coverage in this study. Further integration of KBP and MCO did not show marked improvements in treatment plan quality while requiring increased time in model generation and optimization time.
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Affiliation(s)
- Sandun Jayarathna
- Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, KS, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xinglei Shen
- Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, KS, USA
| | - Ronald C Chen
- Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, KS, USA
| | - H Harold Li
- Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, KS, USA
| | - Kenny Guida
- Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, KS, USA
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Yan C, Guo B, Tendulkar R, Xia P. Contour similarity and its implication on inverse prostate SBRT treatment planning. J Appl Clin Med Phys 2022; 24:e13809. [PMID: 36300837 PMCID: PMC9924104 DOI: 10.1002/acm2.13809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 08/01/2022] [Accepted: 09/13/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Success of auto-segmentation is measured by the similarity between auto and manual contours that is often quantified by Dice coefficient (DC). The dosimetric impact of contour variability on inverse planning has been rarely reported. The main aim of this study is to investigate whether automatically generated organs-at-risk (OARs) could be used in inverse prostate stereotactic body radiation therapy (SBRT) planning and whether the dosimetric parameters are still clinically acceptable after radiation oncologists modify the OARs. METHODS AND MATERIALS Planning computed tomography images from 10 patients treated with SBRT for prostate cancer were selected and automatically segmented by commercially available atlas-based software. The automatically generated OAR contours were compared with the manually drawn contours. Two volumetric modulated arc therapy (VMAT) plans, autoRec-VMAT (where only automatically generated rectums were used in optimization) and autoAll-VMAT (where automatically generated OARs were used in inverse optimization) were generated. Dosimetric parameters based on the manually drawn PTV and OARs were compared with the clinically approved plans. RESULTS The DCs for the rectum contours varied from 0.55 to 0.74 with a mean value of 0.665. Differences of D95 of the PTV between autoRec-VMAT and manu-VMAT plans varied from 0.03% to -2.85% with a mean value of -0.64%. Differences of D0.03cc of manual rectum between the two plans varied from -0.86% to 9.94% with a mean value of 2.71%. D95 of PTV between autoAll-VMAT and manu-VMAT plans varied from 0.28% to -2.9% with a mean value -0.83%. Differences of D0.03cc of manual rectum between the two plans varied from -0.76% to 6.72% with a mean value of 2.62%. CONCLUSION Our study implies that it is possible to use unedited automatically generated OARs to perform initial inverse prostate SBRT planning. After radiation oncologists modify/approve the OARs, the plan qualities based on the manually drawn OARs are still clinically acceptable, and a re-optimization may not be needed.
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Affiliation(s)
- Chenyu Yan
- Department of Radiation OncologyCleveland Clinic FoundationClevelandOhioUSA
| | - Bingqi Guo
- Department of Radiation OncologyCleveland Clinic FoundationClevelandOhioUSA
| | - Rahul Tendulkar
- Department of Radiation OncologyCleveland Clinic FoundationClevelandOhioUSA
| | - Ping Xia
- Department of Radiation OncologyCleveland Clinic FoundationClevelandOhioUSA
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Murthy V, Adsul K, Maitre P, Singhla A, Singh P, Panigrahi G, Raveendran V, Phurailatpam R. Acute and late toxicity of prostate-only or pelvic SBRT in prostate cancer: A Comparative Study. Int J Radiat Oncol Biol Phys 2022; 114:275-282. [PMID: 35724773 DOI: 10.1016/j.ijrobp.2022.05.050] [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: 03/15/2022] [Revised: 05/13/2022] [Accepted: 05/28/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the urinary and gastrointestinal toxicity with or without the inclusion of pelvic nodal regions in patients treated with extreme hypofractionated stereotactic radiotherapy (SBRT) for prostate cancer. METHODS Patients treated with definitive SBRT for non-metastatic adenocarcinoma prostate were identified from prospectively maintained institutional database, and details of radiotherapy volume, dose, acute and late adverse effects were analyzed. Symptoms of acute (within 90 days of completing SBRT) and late gastrointestinal and urinary toxicities were graded using CTCAE version 5.0. Each symptom was scored according to the worst reported grading during treatment and follow-up period. Cumulative toxicity rates between prostate-only SBRT (PO-SBRT) and whole pelvic SBRT (WP-SBRT) were compared using chi-square test. RESULTS Total 220 patients were analyzed (PO-SBRT=118, WP-SBRT=102), with a median follow-up of 28 months (IQR 14-40). Most patients had locally advanced disease (PO-SBRT 60% high risk and 40% intermediate risk, WP-SBRT 79% node positive and 21% high risk). Median SBRT dose was 36.25Gy (IQR 35-36.25) to the prostate (EQD2=90.6Gy, a/b=1.5Gy) and simultaneous integrated 25Gy to the pelvis (EQD2=46.3Gy) in five fractions on alternate days. No grade 3-4 acute toxicities were observed except one grade 3 urinary obstruction (PO-SBRT). WP-SBRT was associated with significantly higher acute grade 2 gastrointestinal toxicity (29.4% vs 14.7%, p=0.008) and late grade 2 urinary toxicity (45.6% vs 25.0%, p=0.003). Both the groups had low incidence of late grade 3 toxicities (urinary 2.5%, gastrointestinal 1%). CONCLUSION WP-SBRT was associated with significantly higher acute gastrointestinal and late urinary toxicity as compared to PO-SBRT, though overall incidence of severe toxicity was low.
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Affiliation(s)
| | | | | | | | | | | | - Vysakh Raveendran
- Department of Medical Physics, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Reena Phurailatpam
- Department of Medical Physics, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai, India
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Crotteau K, Lu W, Berry S, Happersett L, Burleson S, Cai W. Retrospective analysis of MV-kV imaging-based fiducial tracking in prostate SBRT treatment. J Appl Clin Med Phys 2022; 23:e13593. [PMID: 35338574 PMCID: PMC9195013 DOI: 10.1002/acm2.13593] [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: 08/23/2021] [Revised: 02/02/2022] [Accepted: 03/04/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Motion management is critical for prostate stereotactic body radiotherapy (SBRT) due to its high fractional dose and proximity to organs at risk. This study seeks to quantify the advantages of MV-kV tracking over kV imaging alone through a retrospective analysis of over 300 patients who underwent prostate SBRT treatment using MV-kV tracking. METHODS An MV-kV imaging-based fiducial tracking technique has been developed at our institute and become a standard clinical practice. This technique calculates three-dimensional (3D) fiducial displacement in real time from orthogonal kV and MV images acquired simultaneously. The patient will be repositioned if for two consecutive MV-kV data points, the motion is larger than a tolerance of 1.5 mm in any of the lateral, superior-inferior, and/or anterior-posterior directions. This study retrospectively analyzed detected 3D motions using an MV-kV approach of 324 patients who recently underwent prostate SBRT treatments. An algorithm was developed to recover the 2D motion components as if they were detected by kV or MV imaging alone. RESULTS Our results indicated that out-of-tolerance motions were primarily limited to the range of 1.5-3 mm (>95%). The motions are primarily anterior-posterior and superior-inferior, with less than 14.8% of the occurrences in the lateral direction. Compared to out-of-tolerance occurrences detected by MV-kV approach, kV alone caught 46.6% of motions in all three directions, and MV alone caught 46.7%. kV alone shows an overall missing rate of 45.8% for superior-inferior motions and 38.6% for lateral motions. It is also demonstrated that the detectability of motion in specific directions greatly depends on gantry angles, as does the missing rate. CONCLUSIONS Our study demonstrated that MV-kV imaging-based intrafraction motion tracking is superior to single kV imaging for prostate SBRT in clinical practice.
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Affiliation(s)
- Kevin Crotteau
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Radiation Oncology, Northwell Health, New Hyde Park, New York, USA
| | - Wei Lu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sean Berry
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Laura Happersett
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sarah Burleson
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Weixing Cai
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Schipaanboord BWK, Giżyńska MK, Rossi L, de Vries KC, Heijmen BJM, Breedveld S. Fully automated treatment planning for MLC-based robotic radiotherapy. Med Phys 2021; 48:4139-4147. [PMID: 34037258 PMCID: PMC8457110 DOI: 10.1002/mp.14993] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/06/2021] [Accepted: 05/14/2021] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To propose and validate a fully automated multicriterial treatment planning solution for a CyberKnife® equipped with an InCiseTM 2 multileaf collimator. METHODS The AUTO BAO plans are generated using fully automated prioritized multicriterial optimization (AUTO MCO) of pencil-beam fluence maps with integrated noncoplanar beam angle optimization (BAO), followed by MLC segment generation. Both the AUTO MCO and segmentation algorithms have been developed in-house. AUTO MCO generates for each patient a single, high-quality Pareto-optimal IMRT plan. The segmentation algorithm then accurately mimics the AUTO MCO 3D dose distribution, while considering all candidate beams simultaneously, rather than replicating the fluence maps. Pencil-beams, segment dose depositions, and final dose calculations are performed with a stand-alone version of the clinical dose calculation engine. For validation, AUTO BAO plans were generated for 33 prostate SBRT patients and compared to reference plans (REF) that were manually generated with the commercial treatment planning system (TPS), in absence of time pressure. REF plans were also compared to AUTO RB plans, for which fluence map optimization was performed for the beam angle configuration used in the REF plan, and the segmentation could use all these beams or only a subset, depending on the dosimetry. RESULTS AUTO BAO plans were clinically acceptable and dosimetrically similar to REF plans, but had on average reduced numbers of beams ((beams in AUTO BAO)/(beams in REF) (relative improvement): 24.7/48.3 (-49%)), segments (59.5/98.9 (-40%)), and delivery times (17.1/22.3 min. (-23%)). Dosimetry of AUTO RB and REF were also similar, but AUTO RB used on average fewer beams (38.0/48.3 (-21%)) and had on average shorter delivery times (18.6/22.3 min. (-17%)). Delivered Monitor Units (MU) were similar for all three planning approaches. CONCLUSIONS A new, vendor-independent optimization workflow for fully automated generation of deliverable high-quality CyberKnife® plans was proposed, including BAO. Compared to manual planning with the commercial TPS, fraction delivery times were reduced by 5.3 min. (-23%) due to large reductions in beam and segment numbers.
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Affiliation(s)
- Bastiaan W K Schipaanboord
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Zuid Holland, 3015GD, The Netherlands
| | - Marta K Giżyńska
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Zuid Holland, 3015GD, The Netherlands
| | - Linda Rossi
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Zuid Holland, 3015GD, The Netherlands
| | - Kim C de Vries
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Zuid Holland, 3015GD, The Netherlands
| | - Ben J M Heijmen
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Zuid Holland, 3015GD, The Netherlands
| | - Sebastiaan Breedveld
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Zuid Holland, 3015GD, The Netherlands
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9
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Sharfo AWM, Rossi L, Dirkx MLP, Breedveld S, Aluwini S, Heijmen BJM. Complementing Prostate SBRT VMAT With a Two-Beam Non-Coplanar IMRT Class Solution to Enhance Rectum and Bladder Sparing With Minimum Increase in Treatment Time. Front Oncol 2021; 11:620978. [PMID: 33816253 PMCID: PMC8018286 DOI: 10.3389/fonc.2021.620978] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/01/2021] [Indexed: 01/05/2023] Open
Abstract
Purpose Enhance rectum and bladder sparing in prostate SBRT with minimum increase in treatment time by complementing dual-arc coplanar VMAT with a two-beam non-coplanar IMRT class solution (CS). Methods For twenty patients, an optimizer for automated multi-criterial planning with integrated beam angle optimization (BAO) was used to generate dual-arc VMAT plans, supplemented with five non-coplanar IMRT beams with individually optimized orientations (VMAT+5). In all plan generations, reduction of high rectum dose had the highest priority after obtaining adequate PTV coverage. A CS with two most preferred directions in VMAT+5 and largest rectum dose reductions compared to dual-arc VMAT was then selected to define VMAT+CS. VMAT+CS was compared with automatically generated i) dual-arc coplanar VMAT plans (VMAT), ii) VMAT+5 plans, and iii) IMRT plans with 30 patient-specific non-coplanar beam orientations (30-NCP). Plans were generated for a 4 x 9.5 Gy fractionation scheme. Differences in PTV doses, healthy tissue sparing, and computation and treatment delivery times were quantified. Results For equal PTV coverage, VMAT+CS, consisting of dual-arc VMAT supplemented with two fixed, non-coplanar IMRT beams with fixed Gantry/Couch angles of 65°/30° and 295°/-30°, significantly reduced OAR doses and the dose bath, compared to dual-arc VMAT. Mean relative differences in rectum Dmean, D1cc, V40GyEq and V60GyEq were 19.4 ± 10.6%, 4.2 ± 2.7%, 34.9 ± 20.3%, and 39.7 ± 23.2%, respectively (all p<0.001). There was no difference in bladder D1cc, while bladder Dmean reduced by 17.9 ± 11.0% (p<0.001). Also, the clinically evaluated urethra D5%, D10%, and D50% showed small, but statistically significant improvements. All patient VX with X = 2, 5, 10, 20, and 30 Gy were reduced with VMAT+CS, with a maximum relative reduction for V10Gy of 19.0 ± 7.3% (p<0.001). Total delivery times with VMAT+CS only increased by 1.9 ± 0.7 min compared to VMAT (9.1 ± 0.7 min). The dosimetric quality of VMAT+CS plans was equivalent to VMAT+5, while optimization times were reduced by a factor of 25 due to avoidance of individualized BAO. Compared to VMAT+CS, the 30-NCP plans were only favorable in terms of dose bath, at the cost of much enhanced optimization and delivery times. Conclusions The proposed two-beam non-coplanar class solution to complement coplanar dual-arc VMAT resulted in substantial plan quality improvements for OARs (especially rectum) and reduced irradiated patient volumes with minor increases in treatment delivery times.
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Affiliation(s)
- Abdul Wahab M Sharfo
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands
| | - Linda Rossi
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands
| | - Maarten L P Dirkx
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands
| | - Sebastiaan Breedveld
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands
| | - Shafak Aluwini
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, Netherlands
| | - Ben J M Heijmen
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands
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10
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Carrasquilla M, Creswell ML, Pepin AN, Wang E, Forsthoefel M, McGunigal M, Bullock E, Lei S, Collins BT, Lischalk JW, Esposito G, Aghdam N, Kumar D, Suy S, Leger P, Hankins RA, Dawson NA, Collins SP. Rationale for Involved Field Stereotactic Body Radiation Therapy-Enhanced Intermittent Androgen Deprivation Therapy in Hormone-Sensitive Nodal Oligo-Recurrent Prostate Cancer Following Prostate Stereotactic Body Radiation Therapy. Front Oncol 2021; 10:606260. [PMID: 33537236 PMCID: PMC7848164 DOI: 10.3389/fonc.2020.606260] [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: 09/14/2020] [Accepted: 11/25/2020] [Indexed: 12/31/2022] Open
Abstract
Lymph node recurrent prostate cancer is a common clinical scenario that is likely to increase significantly with the widespread adoption of novel positron emission tomography (PET) agents. Despite increasing evidence that localized therapy is disease modifying, most men with lymph node recurrent prostate cancer receive only systemic therapy with androgen deprivation therapy (ADT). For men who receive localized therapy the intent is often to delay receipt of systemic therapy. Little evidence exists on the optimal combination of local and systemic therapy in this patient population. In this hypothesis generating review, we will outline the rationale and propose a framework for combining involved field SBRT with risk adapted intermittent ADT for hormone sensitive nodal recurrent prostate cancer. In patients with a limited number of nodal metastases, involved field stereotactic body radiation therapy (SBRT) may have a role in eliminating castrate-resistant clones and possibly prolonging the response to intermittent ADT. We hypothesize that in a small percentage of patients, such a treatment approach may lead to long term remission or cure.
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Affiliation(s)
- Michael Carrasquilla
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | | | - Abigail N. Pepin
- George Washington University School of Medicine, Washington, DC, United States
| | - Edina Wang
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Matthew Forsthoefel
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Mary McGunigal
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Elizabeth Bullock
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Brian T. Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Jonathan W. Lischalk
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Giuseppe Esposito
- Department of Nuclear Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Nima Aghdam
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Deepak Kumar
- Biotechnology Research Institute, North Carolina Central University, Durham, NC, United States
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
| | - Paul Leger
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, United States
| | - Ryan A. Hankins
- Department of Urology, Georgetown University Hospital, Washington, DC, United States
| | - Nancy A. Dawson
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, United States
| | - Sean P. Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States
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11
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Miszczyk L, Namysł-Kaletka A, Napieralska A, Kraszkiewicz M, Miszczyk M, Woźniak G, Stąpór-Fudzińska M, Głowacki G, Tukiendorf A. Stereotactic Ablative Radiotherapy for Prostate Cancer-The Treatment Results of 500 Patients and Analysis of Failures. Technol Cancer Res Treat 2019; 18:1533033819870815. [PMID: 31462169 PMCID: PMC6716176 DOI: 10.1177/1533033819870815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
OBJECTIVE Stereotactic ablative radiotherapy is a very promising approach for the treatment of patients with prostate cancer. The aim of this study was to evaluate the clinical tolerance, effectiveness, patterns of failure, and attempt to define predictive factors based on our experience. METHODS The cohort consists of 264 low-risk and 236 intermediate-risk consecutive patients treated at one institution. Prostate-specific antigen (PSA), adverse effects, and androgen deprivation therapy (ADT) usage were noted. RESULTS Median follow-up was 31.3 months. Over 90% of the patients reported no gastrointestinal toxicity. There were 4 occurrences of G3+ sequelae. 75% patients had no genitourinary toxicity at first month, and up to 90% during the rest of follow-up, with only 1 case of G3 adverse event. The toxicity was more pronounced in patients with higher PSA concentrations. Prior to stereotactic ablative radiotherapy, the mean PSA was 7.59 and 277 patients used ADT. The PSA decreased for up to 20 months before reaching a plateau. The decline was slower, and PSA levels were higher in patients without ADT. A total of 15 treatment failures occured in a median time of 19.9 months. Higher PSA concentrations were connected with higher failure rates, even in the first month and prior to reaching Phoenix criterion. CONCLUSION CyberKnife-based stereotactic ablative radiotherapy of low-risk and intermediate-risk prostate cancer patients is an effective and well-tolerated modality of treatment. PSA is the most important predictive factor. The evolution of PSA concentration in a particular subgroup of patients suggests that ADT in intermediate-risk cases could improve long-term results.
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Affiliation(s)
- Leszek Miszczyk
- 1 Radiotherapy Department, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Agnieszka Namysł-Kaletka
- 1 Radiotherapy Department, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Aleksandra Napieralska
- 1 Radiotherapy Department, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Małgorzata Kraszkiewicz
- 1 Radiotherapy Department, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Marcin Miszczyk
- 2 Third Radio-Chemotherapy Ward, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Grzegorz Woźniak
- 1 Radiotherapy Department, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Małgorzata Stąpór-Fudzińska
- 3 Treatment Planning Department, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Grzegorz Głowacki
- 1 Radiotherapy Department, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Andrzej Tukiendorf
- 4 Faculty of Health Sciences, Wroclaw Medical University, Wrocław, Poland
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12
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Freeman D, Dickerson G, Perman M. Multi-institutional registry for prostate cancer radiosurgery: a prospective observational clinical trial. Front Oncol 2015; 4:369. [PMID: 25657929 PMCID: PMC4302811 DOI: 10.3389/fonc.2014.00369] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 09/29/2014] [Accepted: 12/04/2014] [Indexed: 11/13/2022] Open
Abstract
Objective: To report on the design, methodology, and early outcome results of a multi-institutional registry study of prostate cancer radiosurgery. Methods: The Registry for Prostate Cancer Radiosurgery (RPCR) was established in 2010 to further evaluate the efficacy and toxicity of prostate radiosurgery (SBRT) for the treatment of clinically localized prostate cancer. Men with prostate cancer were asked to voluntarily participate in the registry. Demographic, baseline medical, and treatment-related data were collected and stored electronically in a Health Insurance Portability and Accountability Act-compliant database, maintained by Advertek, Inc. Enrolled men were asked to complete short, multiple choice questionnaires regarding their bowel, bladder, and sexual function. Patient-reported outcome forms were collected at baseline and at regular intervals (every 3–6 months) following treatment. Serial prostate-specific antigen measurements were obtained at each visit and included in the collected data. Results: From July 2010 to July 2013, nearly 2000 men from 45 participating sites were enrolled in the registry. The majority (86%) received radiosurgery as monotherapy. At 2 years follow-up, biochemical disease-free survival was 92%. No Grade 3 late urinary toxicity was reported. One patient developed Grade 3 gastrointestinal toxicity (rectal bleeding). Erectile function was preserved in 80% of men <70 years old. Overall compliance with data entry was 64%. Conclusion: Stereotactic radiosurgery is an alternative option to conventional radiotherapy for the treatment of organ-confined prostate cancer. The RPCR represents the collective experience of multiple institutions, including community-based cancer centers, with outcome results in keeping with published, prospective trials of prostate SBRT.
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Affiliation(s)
| | | | - Mark Perman
- South Florida Radiation Oncology , Stuart, FL , USA
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