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Prabhu AV, Peterman M, Kesaria A, Samanta S, Crownover R, Lewis GD. Virtual reality technology: A potential tool to enhance brachytherapy training and delivery. Brachytherapy 2023; 22:709-715. [PMID: 37679242 DOI: 10.1016/j.brachy.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/08/2023] [Accepted: 07/27/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Arpan V Prabhu
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Melissa Peterman
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Anam Kesaria
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Santanu Samanta
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Richard Crownover
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Gary D Lewis
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR.
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Patterson TT, McGinity M, Crownover R, Grandhi R. Remote Development of Symptomatic Intracranial Cavernous Malformation After Stereotactic Radiosurgery. Cureus 2022; 14:e21635. [PMID: 35233313 PMCID: PMC8881241 DOI: 10.7759/cureus.21635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
Cavernous hemangiomas, or cavernomas, are vascular malformations that affect about 0.1-0.5% of the population and usually result from sporadic or familial mutations of genes involved with endothelial cell junctions. They are histologically described as dilated vascular clusters, and they may occur in various areas of the body. Cavernomas of the central nervous system can generate localizing symptoms, including focal neurological defects, headaches, seizures, and hemorrhage. Radiation-induced cavernomas (RICs) have been described in the literature since 1994 and have been more frequently described in children. Although there has been speculation about the pathophysiology of RICs, no consensus exists in the literature, and pathological evaluation of RICs remains sparsely reported. We present the case of a 63-year-old patient who underwent stereotactic radiosurgery for treatment of an intracranial arteriovenous malformation (AVM) and subsequently developed a symptomatic RIC seven years later that required microresection. Clinicians should exercise diligence when monitoring patients with a history of intracranial radiation because of growing evidence supporting cavernomas as potential late-stage sequelae.
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Brenner AJ, Pandey R, Chiou J, Floyd J, Surapreneni P, Kaklamani V, Lathrop K, Crownover R, Tiziani S. Abstract PD13-05: Delivery and activity of SN-38 by sacituzumab govitecan in breast cancer brain metastases. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-pd13-05] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Sacituzumab Govitecan (SG, TRODELVY™) is an FDA approved antibody drug conjugate for treatment of metastatic triple negative breast cancer (TNBC). SG has payload and linker characteristics preferable for CNS delivery including a pH hydrolysable, a payload (SN-38) that is the active 1000-fold more potent than the parent compound CPT-11 and crosses the blood brain barrier. Our preliminary data showed SG activity in intracranial xenografts leading to our hypothesis that SG would achieve concentration of SN-38 within the breast cancer brain metastases (BCBM) that would be therapeutically relevant. METHODS: We undertook a single center, prospective, window of opportunity trial (NCT03995706) to examine the concentrations of SG, SN-38, and SN-38G in tumors patients undergoing craniotomy for BCBM (n=20) or recurrent glioblastoma (rGBM, n=10). A single dose of SG was administered at 10mg/kg IV the day prior to craniotomy. Tumor was collected and [SN-38] was analyzed via mass spectrometry (UHPLC-HRMS). following recovery patients resumed SG at 10mg/kg IV days 1 and 8 of 21 day cycle and were assessed for response or progression every third cycle by MRI. RESULTS: To date 21 patients have been treated, including 11 BCBM and 10 rGBM. UHPLC-HRMS analysis was performed in the first 10 tumors (n=4 and 6 respectively). For BCBM, total concentration of SN-38 varied from 173nM to 1160nM, with a mean concentration of 626nM. All GBM patients had residual measurable disease and 4 breast patients had measurable disease. With a median follow-up of 12 weeks from the first postoperative cycle in the first 14 patients, 2 partial responses from each group were observed (ORR of 28% and 50% at 12 weeks respectively). Updated results will be presented. CONCLUSIONS: SG achieves therapeutically relevant concentrations of SN-38 at 150-fold mean IC50s for BCBM. Early intracranial responses are encouraging and merit further evaluation. A multi-center trial of SG for HER2 negative BCBM (SWOG S2007) will be enrolling soon.
Citation Format: Andrew J Brenner, Renu Pandey, Jennifer Chiou, John Floyd, Prathiba Surapreneni, Virginia Kaklamani, Kate Lathrop, Richard Crownover, Stefano Tiziani. Delivery and activity of SN-38 by sacituzumab govitecan in breast cancer brain metastases [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD13-05.
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Affiliation(s)
| | - Renu Pandey
- 2UT Austin Livestrong Cancer Center, Austin, TX
| | | | - John Floyd
- 1UT Health Mays Cancer Center, San Antonio, TX
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Brenner A, Floyd J, Pandey R, Chiou J, Surapreneni P, Kaklamani V, lathrop K, Crownover R, Caron JL, Tiziani S. CTNI-07. DELIVERY AND ACTIVITY OF SN-38 BY SACITUZUMAB GOVITECAN IN CNS TUMORS. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Sacituzumab Govitecan (SG, TRODELVY™) is an antibody drug conjugate, with payload and linker characteristics preferable for CNS delivery. SG utilizes a pH hydrolysable linker, allowing SN-38 to be released at the tumor site. SN-38 is the active component of Irinotecan and 1000-fold more potent than the parent compound. We observed SG activity in intracranial xenografts and hypothesized that SG would achieve therapeutically relevant concentration of SN-38 within the CNS.
METHODS
We performed a prospective, single center, window of opportunity trial (NCT03995706) to examine the intra-tumoral concentrations of SG, SN-38, and SN-38G in patients undergoing craniotomy for breast cancer brain metastases (BCBM, n=10) or recurrent glioblastoma (rGBM, n=10). Patients received a single dose of SG at 10mg/kg IV the day prior to craniotomy and tumor collected. [SN-38] was analyzed via mass spectrometry (UHPLC-HRMS). Patients resumed SG 10mg/kg IV days 1 and 8 of 21 day cycle following recovery and were assessed every third cycle by MRI using RANO criteria.
RESULTS
To date 16 patients have been treated, including 8 BCBM and 8 rGBM. UHPLC-HRMS analysis was performed in the first 10 tumors (n=4 and 6 respectively). For the rGBM patients, total concentration of SN-38 varied from 93nM to 680nM, with a mean concentration of 420nM. For BCBM, total concentration of SN-38 varied from 173nM to 1160nM, with a mean concentration of 626nM. All GBM patients had residual measurable disease and 4 breast patients had measurable disease. With a median follow-up of 12 weeks from the first postoperative cycle in the first 14 patients, 2 partial responses from each group were observed (ORR of 28% and 50% at 12 weeks respectively).
CONCLUSIONS
SG achieves therapeutically relevant concentrations of SN-38 at 40-fold mean IC50s for GBM, and 150-fold mean IC50s for BCBM. Early intracranial responses are encouraging and merit further evaluation.
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Affiliation(s)
- Andrew Brenner
- Mays Cancer Center UT Health Science Center, San Antonio, San Antonio, TX, USA
| | - John Floyd
- UT Health San Antonio, San Antonio, TX, USA
| | - Renu Pandey
- University of Texas at Austin, Austin, TX, USA
| | | | | | | | - Kate lathrop
- UT Health Science Center, San Antonio, San Antonio, TX, USA
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Rembish J, Myers P, Kirby N, Saenz D, Rasmussen K, Crownover R, Papanikolaou N, Stathakis S. An evaluation of Pencil Beam vs Monte Carlo calculations for intracranial stereotactic radiosurgery. J BUON 2020; 25:2731-2736. [PMID: 33455120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To compare the accuracy of two separate models when calculating dose distributions in patients undergoing stereotactic radiosurgery (SRS) treatment for brain cancer. METHODS For this comparison, two dose calculation algorithms were evaluated on two different treatment planning systems (TPS): Elekta's Monaco Version 5.11.00 Monte Carlo Gold Standard XVMC algorithm and Brainlab's iPlan Pencil Beam algorithm. The DICOM files of 11 patients with a total of 19 targets were exported from iPlan and then imported into Monaco to be recalculated. Using the dose distributions of the original (pencil beam/PB) and recalculated (Monte Carlo/MC) plans, four indices for plan quality were evaluated: coverage (Q), conformity index (CIRTOG), homogeneity index (HI), and gradient index (GI). RESULTS There was a significant difference in the CIRTOG and HI between the two TPS calculations. However, the magnitude of these differences is often not substantial enough to cause the plan to fall outside of RTOG protocol deviation limits. Only 3 of the 19 targets had CIRTOG values which moved to a new level of deviation, and these targets were unique in terms of size (<0.1 cm3). CONCLUSION It was found that the difference between systems is often not enough to cause the plan to fall outside of RTOG protocol deviation limits. This is an indication that a PB-based treatment planning system is sufficient for the mostly homogeneous conditions of intracranial SRS planning when the target is larger than 0.1 cm3. If below 0.1 cm3, the prescribing physician may need to evaluate TPS differences.
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Affiliation(s)
- Jacob Rembish
- UT Health San Antonio Department of Radiation Oncology, San Antonio, Texas, USA
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Brenner A, Pandey R, Chiou J, Floyd J, Garcia M, Surapaneni P, Kaklamani V, Lathrop K, Crownover R, Caron J, Tiziani S. 373MO Delivery and activity of SN-38 by sacituzumab govitecan in CNS tumours. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bergamo AM, Kauweloa K, Gan G, Shi Z, Daniels J, Crownover R, Narayanasamy G, Stathakis S, Mavroidis P, Papanikolaou N, Gutierrez A. Correlation between Biological Effective Dose and Radiation-induced Liver Disease from Hypofractionated Radiotherapy. J Med Phys 2019; 44:185-190. [PMID: 31576066 PMCID: PMC6764171 DOI: 10.4103/jmp.jmp_54_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The prevention of radiation-induced liver disease (RILD) is very significant in ensuring a safe radiation treatment and high quality of life. Aims and Objectives The purpose of this study is to investigate the correlation of physical and biological effective dose (BED) metrics with liver toxicity from hypo-fractionated liver radiotherapy. Materials and Methods 41 hypo-fractionated patients in 2 groups were evaluated for classic radiation-induced liver disease (RILD) and chronic RILD, respectively. Patients were graded for effective toxicity (post-treatment minus pre-treatment) using the Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Physical dose (PD) distributions were converted to BED. The V10Gy, V15Gy, V20Gy, V25Gy and V30Gy physical dose-volume metrics were used in the analysis together with their respective BED-converted metrics of V16.7Gy3, V30Gy3, V46.7Gy3, V66.7Gy3 and V90Gy3. All levels were normalized to their respective patient normal liver volumes (NLV) and evaluated for correlation to RILD. Results were measured quantitatively using R2 regression analysis. Results The classic RILD group had median follow-up time of 1.9 months and the average PD-NLV normalized V10Gy, V15Gy, V20Gy, V25Gy and V30Gy metrics per grade were plotted against RILD yielding R2 correlations of 0.84, 0.72, 0.73, 0.65 and 0.70, respectively while the BED-volume metrics of V16.7Gy3, V30Gy3, V46.7Gy3, V66.7Gy3 and V90Gy3 resulted in correlation values of 0.84, 0.74, 0.66, 0.78 and 0.74, respectively. BED compared to PD showed a statistically significant (p=.03) increase in R2 for the classic RILD group. Chronic RILD group had median follow-up time of 12.3 months and the average PD-NLV normalized V10Gy, V15Gy, V20Gy, V25Gy and V30Gy metrics per grade were plotted against RILD grade yielding R2 correlations of 0.48, 0.92, 0.88, 0.90 and 0.99 while the BED-volume metrics of V16.7Gy3, V30Gy3, V46.7Gy3, V66.7Gy3 and V90Gy3 resulted in correlation values of 0.43, 0.94, 0.99, 0.21 and 0.00, respectively. Conclusion The strong correlations of the V10Gy and V15Gy PD-volume metrics as well as the V16.7Gy3 (BED of V10Gy) to both classic and chronic RILD imply the appropriateness of the current 15Gy evaluation level for liver toxicity with hypo-fractionated treatments.
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Affiliation(s)
- Angelo M Bergamo
- Department of Internal Medicine, Division of Radiation Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Kevin Kauweloa
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Gregory Gan
- Department of Internal Medicine, Division of Radiation Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Zheng Shi
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Janeen Daniels
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Richard Crownover
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ganesh Narayanasamy
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sotirios Stathakis
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Panayiotis Mavroidis
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Niko Papanikolaou
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Alonso Gutierrez
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Galvan E, Crownover R. GENE-03. CASE REPORT: CHOROID PLEXUS CARCINOMA TREATED WITH STEREOTACTIC RADIOSURGERY IN 2-YEAR-OLD WITH LI FRAUMENI SYNDROME. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz036.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eva Galvan
- UT Health Mays Cancer Center, San Antonio, TX, USA
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Stathakis S, Narayanasamy G, Licon AL, Myers P, Li Y, Crownover R, Papanikolaou N. A dosimetric comparison between volumetric-modulated arc therapy and dynamic conformal arc therapy in SBRT. J BUON 2019; 24:838-843. [PMID: 31128044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE The purpose of this study was to investigate the dosimetric equivalency of dynamic conformal arc therapy (DCAT) against volumetric modulated arc therapy (VMAT) plans in stereotactic body radiation therapy (SBRT) of lung and liver lesions and to examine if efficiency can be increased. METHODS Nineteen patients previously treated for lung and liver cancer lesions with SBRT were included. Organs at risk (OAR) and targets were contoured by a single radiation oncologist. All plans were optimized by the same dosimetrist using ELEKTA Monaco treatment planning system version 5.0 for 6MV flattening filter free (FFF) photon beam in a VersaHD (ELEKTA, Crawley, UK). A VMAT and DCAT plan was optimized using the same objectives using coplanar arcs of 225o arc span. RESULTS All plans have achieved the target and OAR planning objectives. The target dose conformity was comparable (mean VMAT PTVr=1.3 and DCAT PTVr=1.4), and the low dose spillage were similar (mean VMAT R50=4.5 and DCAT R50=4.6). However, monitor units (MU) for DCAT plans were lower by 2.5 times on average than VMAT plans. It was observed that in 75% of cases where OARs overlapped with the PTV, maximum doses to OAR were higher in VMAT than DCAT plans, but the difference was not significant. Patient specific quality assurance (QA) plans were measured using the Scandidos Delta4 phantom and gamma analysis performed using 2mm distance to agreement (DTA) and 2% dose difference yielded more than 95% passing rates on both VMAT and DCAT plans. CONCLUSIONS DCAT delivery for lung and liver SBRT is a dosimetrically equivalent and an efficient alternative to VMAT plans.
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Affiliation(s)
- Sotirios Stathakis
- Department of Radiation Oncology, Mays Cancer Center, University of Texas Health San Antonio, TX 78229, USA
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Saenz DL, Crownover R, Stathakis S, Papanikolaou N. A dosimetric analysis of a spine SBRT specific treatment planning system. J Appl Clin Med Phys 2018; 20:154-159. [PMID: 30461183 PMCID: PMC6333144 DOI: 10.1002/acm2.12499] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 06/24/2018] [Revised: 10/12/2018] [Accepted: 10/23/2018] [Indexed: 11/12/2022] Open
Abstract
Purpose The Brainlab Elements treatment planning system utilizes distinct modules for treatment planning specific to stereotactic treatment sites including single or multiple brain lesions as well as spine. This work investigates the hypothesis that an optimization tailored specifically to spine can in fact create dosimetrically superior plans to those created in more general use treatment planning systems (TPS). Methods Ten spine patients at our institution were replanned in Brainlab Elements, Phillips Pinnacle3, and Elekta Monaco. The planning target volume (PTV) included the vertebral body (in either the thoracic or lumbar spine), pedicles, and transverse processes. In all plans, the target was prescribed 20 Gy to 95% of the PTV. Objectives for the study included D5%<25 Gy and spinal cord D0.035cc < 14 Gy. Plans were evaluated by the satisfaction of the objectives as well total monitor units (MU), gradient index (GI), conformity index (CI), and dose gradient (distance between 100% and 50% isodose lines) in a selected slice between the vertebral body and spinal cord. Results All TPS produced clinically acceptable plans. The sharpest dose gradient was achieved with Elements (mean 3.3 ± 0.2 mm). This resulted in lowest spinal cord maximum point doses (6.6 ± 1.0 Gy). Gradient indices were also the smallest for Elements (3.6 ± 0.5). Further improvement in gradient index and spinal cord sparing were not performed due to the subsequent violation of the PTV D5% < 25 Gy constraint or the loss of conformity due to the loss of coverage at the PTV‐spinal canal interface. Conclusions Brainlab Elements planning which relies on arc duplication to specifically optimize for spine anatomy did result in dosimetrically superior plans while holding prescription levels constant. While any planning system can improve upon specific dosimetric objectives, the simultaneous satisfaction of all constraints was best achieved with Brainlab Elements.
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Affiliation(s)
- Daniel L Saenz
- University of Texas Health San Antonio, Mays Cancer Center, San Antonio, TX, USA
| | - Richard Crownover
- University of Texas Health San Antonio, Mays Cancer Center, San Antonio, TX, USA
| | - Sotirios Stathakis
- University of Texas Health San Antonio, Mays Cancer Center, San Antonio, TX, USA
| | - Niko Papanikolaou
- University of Texas Health San Antonio, Mays Cancer Center, San Antonio, TX, USA
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Laura Licon A, Defoor D, Ford J, Crownover R, Li Y, Ha C, Eng T, Jones W, Mavroidis P, Papanikolaou N, Stathakis S. A quantitative measure for radiation treatment plan quality. J BUON 2018; 23:1460-1466. [PMID: 30570873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To develop and validate an intensity modulated radiation therapy (IMRT) treatment plan quantitative score using QUANTEC dose/volume parameters to assess plan quality. METHODS 132 IMRT and volumetric modulated Arc therapy (VMAT) patient plans of various treatment sites were evaluated. The optimized plan's dose volume histogram (DVH) was exported to Velocity for evaluation. The proposed scoring was based on calculating the shortest distance from the QUANTEC objective to the DVH line of each organ. Each plan was normalized against the ideal plan where the organs at risk (OARs) received no dose and hence the distance between the QUANTEC objective and the DVH line was maximized. These normalized scores enabled the comparison of the quality of plans across treatment sites and dosimetrists. The scores were plotted and statistically analyzed to serve as a basis for future research. RESULTS The score for each treatment site was evaluated and the average percentage scores±SD were found to be 43.5 ± 21.0, 33.3 ± 31.7, 42.6 ± 23.3, 40.2 ± 24.4, 33.5 ± 23.5 for the sites of abdomen, brain, chest, head/neck, and pelvis respectively. Differences in scores between the treatment sites were largely attributed to OAR segmentation and proximity of the OAR to the planning target volume (PTV). Small score differences between dosimetrists were attributed to the number of plans they have completed. CONCLUSION This approach allows comparison of patient treatments which will help improve patient care and treatment outcomes. A larger sample of treatment plans is being evaluated to investigate the effect of dosimetrist's experience on plan quality.
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McConnell KA, Marston T, Zehren BE, Lirani A, Stanley DN, Bishop A, Crownover R, Eng T, Shi Z, Li Y, Baacke D, Kirby N, Rasmussen K, Papanikolaou N, Gutierrez AN. Dosimetric Evaluation of Pinnacle's Automated Treatment Planning Software to Manually Planned Treatments. Technol Cancer Res Treat 2018; 17:1533033818780064. [PMID: 29909735 PMCID: PMC6024492 DOI: 10.1177/1533033818780064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction: With the advent of complex treatment techniques like volumetric modulated arc therapy, there has been increasing interest in treatment planning technologies aimed at reducing planning time. One of these such technologies is auto-planning, which is an automated planning module within Pinnacle3. This study seeks to retrospectively evaluate the dosimetric quality of auto-planning-derived treatment plans as they compare to manual plans for intact prostate, prostate and lymph nodes, and brain treatment sites. Materials and Methods: Previous clinical plans were used to generate site-specific auto-planning templates. These templates were used to compare the 3 evaluated treatment sites. Plans were replanned using auto-planning and compared to the clinically delivered plans. For the planning target volume, the following metrics were evaluated: homogeneity index, conformity index, D2cc, Dmean, D2%, D98%, and multiple dose fall-off parameters. For the organs at risk, D2cc, Dmean, and organ-specific clinical metrics were evaluated. Statistical differences were evaluated using a Wilcoxon paired signed-rank test with a significance level of 0.05. Statistically significant (P < 0.05) differences were noted in organs at risk sparing. Results: For the prostate, there was as much as 6.8% reduction in bladder Dmean and 23.5% reduction in penile bulb Dmean. For the prostate + lymph nodes, decreases in Dmean values ranging from 4.1% in the small bowel to 22.3% in the right femoral head were observed. For brain, significant improvements were observed in Dmax and Dmean to most organs at risk. Conclusion: Our study showed improved organs at risk sparing in most organs while maintaining planning target volume coverage. Overall, auto-planning can generate plans that delivered the same target coverage as the clinical plans but offered significant reductions in mean dose to organs at risk.
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Affiliation(s)
- Kristen A McConnell
- 1 Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Tyler Marston
- 1 Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Brianna Elizabeth Zehren
- 1 Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Aziz Lirani
- 1 Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Dennis N Stanley
- 1 Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Aaron Bishop
- 1 Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Richard Crownover
- 1 Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Tony Eng
- 1 Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Zheng Shi
- 1 Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ying Li
- 1 Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Diana Baacke
- 1 Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Neil Kirby
- 1 Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Karl Rasmussen
- 1 Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Niko Papanikolaou
- 1 Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Alonso N Gutierrez
- 1 Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,2 Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
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Fakhreddine M, Parameswaran A, Floyd J, Brenner A, Crownover R. RTHP-23. ADJUVANT THERAPY FOR HIGH-RISK WHO GRADE II OLIGODENDROGLIOMA AFTER RTOG 9802: A SURVEY OF CURRENT PRACTICE. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Narayanasamy G, Stathakis S, Gutierrez AN, Pappas E, Crownover R, Floyd JR, Papanikolaou N. A Systematic Analysis of 2 Monoisocentric Techniques for the Treatment of Multiple Brain Metastases. Technol Cancer Res Treat 2017; 16:639-644. [PMID: 27612917 PMCID: PMC5665155 DOI: 10.1177/1533034616666998] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 01/14/2016] [Revised: 05/16/2016] [Accepted: 07/28/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In this treatment planning study, we compare the plan quality and delivery parameters for the treatment of multiple brain metastases using 2 monoisocentric techniques: the Multiple Metastases Element from Brainlab and the RapidArc volumetric-modulated arc therapy from Varian Medical Systems. METHODS Eight patients who were treated in our institution for multiple metastases (3-7 lesions) were replanned with Multiple Metastases Element using noncoplanar dynamic conformal arcs. The same patients were replanned with the RapidArc technique in Eclipse using 4 noncoplanar arcs. Both techniques were designed using a single isocenter. Plan quality metrics (conformity index, homogeneity index, gradient index, and R50%), monitor unit, and the planning time were recorded. Comparison of the Multiple Metastases Element and RapidArc plans was performed using Shapiro-Wilk test, paired Student t test, and Wilcoxon signed rank test. RESULTS A paired Wilcoxon signed rank test between Multiple Metastases Element and RapidArc showed comparable plan quality metrics and dose to brain. Mean ± standard deviation values of conformity index were 1.8 ± 0.7 and 1.7 ± 0.6, homogeneity index were 1.3 ± 0.1 and 1.3 ± 0.1, gradient index were 5.0 ± 1.8 and 5.1 ± 1.9, and R50% were 4.9 ± 1.8 and 5.0 ± 1.9 for Multiple Metastases Element and RapidArc plans, respectively. Mean brain dose was 2.3 and 2.7 Gy for Multiple Metastases Element and RapidArc plans, respectively. The mean value of monitor units in Multiple Metastases Element plan was 7286 ± 1065, which is significantly lower than the RapidArc monitor units of 9966 ± 1533 ( P < .05). CONCLUSION For the planning of multiple brain lesions to be treated with stereotactic radiosurgery, Multiple Metastases Element planning software produced equivalent conformity, homogeneity, dose falloff, and brain V12 Gy but required significantly lower monitor units, when compared to RapidArc plans.
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Affiliation(s)
- Ganesh Narayanasamy
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, TX
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Sotirios Stathakis
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, TX
| | - Alonso N. Gutierrez
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, TX
| | | | - Richard Crownover
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, TX
| | - John R. Floyd
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, TX
| | - Niko Papanikolaou
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, TX
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Fountzilas C, Chang K, Hernandez B, Michalek J, Crownover R, Floyd J, Mahalingam D. Clinical characteristics and treatment outcomes of patients with colorectal cancer who develop brain metastasis: a single institution experience. J Gastrointest Oncol 2017; 8:55-63. [PMID: 28280609 DOI: 10.21037/jgo.2016.12.11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The development of brain metastasis (BM) in patients with colorectal cancer (CRC) is a rare and late event. We sought to investigate the clinical characteristics, disease course and safety using biologic agents in our patients with CRC who develop brain metastases. METHODS A retrospective review of patients with CRC with brain metastases treated at our institution from 01/2005-01/2015 was performed. Survival analysis was performed using the Kaplan-Meier method. RESULTS Forty patients were included in the analysis. Median age was 55.5 years, 67.5% were males, and 28% had a KRAS mutation. Twenty-four percent were treatment-naive at the time of BM diagnosis. Patients had a median of two brain lesions. Sixty-five percent of the patients were treated with radiotherapy alone, 22.5% had both surgical resection and brain radiotherapy. Median overall survival was 3.2 months after development of BM. Overall survival was longer in patients who received combined modality local therapy compared to patients treated with surgical resection or radiotherapy alone. Patients who received systemic treatment incorporating biologics following development of BM had a median overall survival of 18.6 months. Overall, the administration of biologic agents was safe and well tolerated. CONCLUSIONS In summary, BM is an uncommon and late event in the natural history of metastatic CRC. The ability to deliver combined-modality local brain therapy as well as availability of more systemic therapy options appear to lead to improved outcomes.
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Affiliation(s)
- Christos Fountzilas
- Cancer Therapy and Research Center, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Katherine Chang
- Cancer Therapy and Research Center, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Brian Hernandez
- Cancer Therapy and Research Center, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Joel Michalek
- Cancer Therapy and Research Center, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Richard Crownover
- Cancer Therapy and Research Center, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - John Floyd
- Cancer Therapy and Research Center, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Devalingam Mahalingam
- Cancer Therapy and Research Center, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
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Gutierrez A, Stanley D, Papanikolaou N, Crownover R. SU-F-J-22: Lung VolumeVariability Assessed by Bh-CBCT in 3D Surface Image Guided Deep InspirationBreath Hold (DIBH) Radiotherapy for Left-Sided Breast Cancer. Med Phys 2016. [DOI: 10.1118/1.4955930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Licon A, Ford J, Defoor D, Crownover R, Li Y, Ha C, Eng T, Jones W, Papanikolaou N, Stathakis S, Mavroidis P. SU-F-T-411: A Quantitative Parameter for Treatment Plan Quality. Med Phys 2016. [DOI: 10.1118/1.4956596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Shiao J, Gutierrez A, Patel A, Harris A, Washburn K, Halff G, Lopera J, Sharkey F, Crownover R. OC-0444: Stereotactic body radiotherapy of hepatocellular carcinoma lesions in liver transplant candidates. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31693-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ghahremani S, Chavez R, Li Y, Crownover R, Baacke D, Papanikolaou N, Stathakis S. SU-E-T-435: Flattening Filter Free Beams for Head and Neck IMRT and VMAT Optimization. Med Phys 2015. [DOI: 10.1118/1.4924796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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20
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Pappas E, Papanikolaou N, Gutierrez A, Kirby N, Mavroidis P, Efstathopoulos E, Makris D, Crownover R, Stathakis S. SU-E-T-80: A Study of the Effect of Dose Grid Resolution On Stereotactic Plan Evaluation as a Function of Target Size. Med Phys 2015. [DOI: 10.1118/1.4924441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Papanikolaou N, Narayanasamy G, Stathakis S, Pappas E, Kirby N, Mavroidis P, Crownover R, Gutierrez A. SU-E-T-85: A Systematic Analysis of Mono-Isocentric Techniques for the Treatment of Multiple Metastasis. Med Phys 2015. [DOI: 10.1118/1.4924446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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22
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Bergamo A, Kauweloa K, Daniels J, Crownover R, Mavroidis P, Papanikolaou N, Gutierrez A. SU-E-P-52: Dose-Volume Toxicity Analysis of Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma. Med Phys 2015. [DOI: 10.1118/1.4923986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Tuohy R, Bosse C, Mavroidis P, Shi Z, Crownover R, Papanikolaou N, Stathakis S. SU-E-T-86: Comparison of Two Commercially Available Programs for the Evaluation of Delivered Daily Dose Using Cone Beam CT (CBCT). Med Phys 2014. [DOI: 10.1118/1.4888416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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24
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Bosse C, Tuohy R, Mavroidis P, Shi Z, Crownover R, Papanikolaou N, Stathakis S. SU-E-T-94: Daily Fraction Dose Recalculation Based On Rigid Registration Using Cone Beam CT. Med Phys 2014. [DOI: 10.1118/1.4888424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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25
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Tuohy R, Bosse C, Mavroidis P, Shi Z, Crownover R, Papanikolaou N, Stathakis S. Deformable image and dose registration evaluation using two commercial programs. Int J Cancer Ther Oncol 2014. [DOI: 10.14319/ijcto.0202.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Bosse C, Tuohy R, Mavroidis P, Shi Z, Crownover R, Gutierrez A, Papanikolaou N, Stathakis S. Daily fraction dose recalculation based on rigid registration using Cone Beam CT. Int J Cancer Ther Oncol 2014. [DOI: 10.14319/ijcto.0202.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Kauweloa K, Papanikolaou N, Stathakis S, Esquivel C, Crownover R, Mavroidis P. SU-E-T-714: Analysis of Two Overall Biological Effective Dose (OBED) Calculation Methods and Their Impact On the Accurate Determination of the Maximum Biological Effective Dose (BED) in Multi-Phase Treatment Plans. Med Phys 2013. [DOI: 10.1118/1.4815141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Stathakis S, Mavroidis P, Markovic M, Esquivel C, Myers P, Crownover R, Li Y, Papanikolaou N. SU-E-T-226: SRT/SBRT Patient Specific QA with a New High Resolution 2D Detector Array. Med Phys 2013. [DOI: 10.1118/1.4814661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Stathakis S, Mavroidis P, Esquivel C, Myers P, Li Y, Crownover R, Papanikolaou N. SU-D-105-02: Small Field SRS/SBRT Patient Specific QA at Extended SSD. Med Phys 2013. [DOI: 10.1118/1.4813998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Gutierrez A, Stathakis S, Crownover R, Esquivel C, Papanikolaou N. SU-E-J-132: Inter-Fractional Setup Accuracy of the Body Pro-Lok™ System for Hypo-Fractionated Liver Radiotherapy Using Novalis Tx™. Med Phys 2011. [DOI: 10.1118/1.3611899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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31
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Roland T, Shi C, Liu Y, Crownover R, Mavroidis P, Papanikolaou N. Tradeoffs for assuming rigid target motion in Mlc-based real time target tracking radiotherapy: a dosimetric and radiobiological analysis. Technol Cancer Res Treat 2010; 9:199-210. [PMID: 20218742 DOI: 10.1177/153303461000900209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
We report on our assessment of two types of real time target tracking modalities for lung cancer radiotherapy namely (1) single phase propagation (SPP) where motion compensation assumes a rigid target and (2) multi-phase propagation (MPP) where motion compensation considers a deformable target. In a retrospective study involving 4DCT volumes from six (n=6) previously treated lung cancer patients, four-dimensional treatment plans representative of the delivery scenarios were generated per modality and the corresponding dose distributions were derived. The modalities were then evaluated (a) Dosimetrically for target coverage adequacy and normal tissue sparing by computing the mean GTV dose, relative conformity gradient index (CGI), mean lung dose (MLD) and lung V(2)0; (b) Radiobiologically by calculating the biological effective uniform dose (D) for the target and organs at risk (OAR) and the complication free tumor control probability (P(+)). As a reference for the comparative study, we included a 4D Static modality, which was a conventional approach to account for organ motion and involved the use of individualized motion margins. With reference to the 4D Static modality, the average percent decrease in lung V(20) and MLD were respectively (13.1-/+6.9) % and (11.4-/+ 5.6)% for the MPP modality, whereas for the SPP modality they were (9.4-/+6.2) % and (7.2-/+4.7) %. On the other hand, the CGI was observed to improve by 15.3-/+13.2 and 9.6-/+10.0 points for the MPP and SPP modalities, respectively while the mean GTV dose agreed to better than 3% difference across all the modalities. A similar trend was observed in the radiobiological analysis where the P(+) improved on average by (6.7-/+4.9) % and (4.1-/+3.6) % for the MPP and SPP modalities, respectively while the D computed for the OAR decreased on average by (6.2-/+3.6) % and (3.8-/+3.5) % for the MPP and SPP tracking modalities, respectively. The D calculated for the GTV for all the modalities was in agreement to better than 2% difference. In general, respiratory motion induces target displacement and deformation and therefore the complex MPP real time target tracking modality is the preferred. On the other hand, the SPP approach affords simplicity in implementation at the expense of failing to account for target deformation. Radiobiological and dosimetric analyses enabled us to investigate the consequences of failing to compensate for deformation and assess the impact if any on the clinical outcome. While it is not possible to draw any general conclusions on a small patient cohort, our study suggests that the two tracking modalities can lead to comparable clinical outcomes and as expected are advantageous when compared with the static conventional modality.
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Affiliation(s)
- T Roland
- Department of Radiological Sciences, University of Texas Health Science Center, San Antonio, TX, USA.
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Su FC, Shi C, Mavroidis P, Goytia V, Crownover R, Rassiah-Szegedi P, Papanikolaou N. Assessing four-dimensional radiotherapy planning and respiratory motion-induced dose difference based on biologically effective uniform dose. Technol Cancer Res Treat 2009; 8:187-200. [PMID: 19445536 DOI: 10.1177/153303460900800303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Four-dimensional (4D) radiotherapy is considered as a feasible and ideal solution to accommodate intra-fractional respiratory motion during conformal radiation therapy. With explicit inclusion of the temporal changes in anatomy during the imaging, planning, and delivery of radiotherapy, 4D treatment planning in principle provides better dose conformity. However, the clinical benefits of developing 4D treatment plans in terms of tumor control rate and normal tissue complication probability as compared to other treatment plans based on CT images of a fixed respiratory phase remains mostly unproven. The aim of our study is to comprehensively evaluate 4D treatment planning for nine lung tumor cases with both physical and biological measures using biologically effective uniform dose (D =) together with complication-free tumor control probability, P+. Based on the examined lung cancer patients and PTV margin applied, we found similar but not identical curves of DVH, and slightly different mean doses in tumor (up to 1.5%) and normal tissue in all cases when comparing 4D, P0%, and P50% plans. When it comes to biological evaluations, we did not observe definitively PTV size dependence in P+ among these nine lung cancer patients with various sizes of PTV. Moreover, it is not necessary that 4D plans would have better target coverage or higher P+ as compared to a fixed phase IMRT plan. However, on the contrary to significant deviations in P+ (up to 14.7%) observed if delivering the IMRT plan made at end-inhalation incorrectly at end-exhalation phase, we estimated the overall P+, PB, and PI for 4D composite plans that have accounted for intra-fractional respiratory motion.
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Affiliation(s)
- F-C Su
- Radiation Oncology Department, Cancer Therapy and Research Center, San Antonio, TX 78229, USA
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Su FC, Shi C, Crownover R, Swanson G, Papanikolaou N. Dosimetric Impacts of Gantry Angle Misalignment on Prostate Cancer Treatment using Helical Tomotherapy. Technol Cancer Res Treat 2008; 7:287-93. [DOI: 10.1177/153303460800700403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
During helical tomotherapy, gantry angle accuracy is one of the vital geometric factors that assure accurate dose delivery to the target and organs at risk adjacent to it. The purpose of this study is to investigate the dosimetric impact of gantry angle misalignment on the target volume and critical organs during helical tomotherapy treatment. Five prostate cases were chosen to calculate the effects of gantry angle deviations on both patient-specific delivery quality assurance (DQA) and helical tomotherapy treatment plans. For DQA plans, the cheese phantom was rotated for up to +/- 5° from the preset position to simulate the gantry angle deviations during tomotherapy. Point doses at 5 mm below the isocenter and the dose distribution for each gantry angle were measured and reconstructed, respectively. For helical tomotherapy treatment plans, the same gantry misalignment effect was simulated by adjusting the automatic roll correction for up to +/- 5° using Planned Adaptive software. Variations of dose volume histograms (DVHs) and isodose lines were evaluated for both target and critical organs. There was no significant difference found, however, among the point dose measurements for gantry rotation up to +/- 5° in DQA plans. Shifts of isodose lines could be observed for gantry rotations larger than +/- 2°. Dosimetric discrepancies (less than 2%) were also found among DVHs of the PTV in the cases when gantry angle misalignment was larger than +/- 2°. However, for DVHs of either bladder or rectum under different gantry rotations, no significant differences were detected when gantry angle errors were up to +/- 5°. In summary, point dose measurements alone cannot reveal the dosimetric deviation due to gantry angle misalignment in DQA plans. For a 5° gantry deviation, the dose to PTV increased by 0.5% comparing to the planned dose. The influence on organs at risk, i.e., rectum and bladder, is also negligible. Further studies are needed on the dosimetric impacts of gantry angle deviations for other treatment sites.
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Affiliation(s)
- Fan-Chi Su
- Department of Radiological Sciences University of Texas Health Science Center at San Antonio 7703 Floyd Curl Drive San Antonio, TX 78229, USA
| | - Chengyu Shi
- Radiation Oncology Department Cancer Therapy and Research Center 7979 Wurzbach Road San Antonio, TX 78229, USA
| | - Richard Crownover
- Radiation Oncology Department Cancer Therapy and Research Center 7979 Wurzbach Road San Antonio, TX 78229, USA
| | - Gregory Swanson
- Radiation Oncology Department Cancer Therapy and Research Center 7979 Wurzbach Road San Antonio, TX 78229, USA
| | - Niko Papanikolaou
- Radiation Oncology Department Cancer Therapy and Research Center 7979 Wurzbach Road San Antonio, TX 78229, USA
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Whyte RI, Crownover R, Murphy MJ, Martin DP, Rice TW, DeCamp MM, Rodebaugh R, Weinhous MS, Le QT. Stereotactic radiosurgery for lung tumors: preliminary report of a phase I trial. Ann Thorac Surg 2003; 75:1097-101. [PMID: 12683544 DOI: 10.1016/s0003-4975(02)04681-7] [Citation(s) in RCA: 269] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Stereotactic radiosurgery is well established for the treatment of intracranial neoplasms but its use for lung tumors is novel. METHODS Twenty-three patients with biopsy-proven lung tumors were recruited into a two-institution, dose-escalation, phase I clinical trial using a frameless stereotactic radiosurgery system (CyberKnife). Fifteen patients had primary lung tumors and 8 had metastatic tumors. The age range was 23 to 87 years (mean, 63 years). After undergoing computed tomography-guided percutaneous placement of two to four small metal fiducials directly into the tumor, patients received 1,500 cGY of radiation in a single fraction using a linear accelerator mounted on a computer-controlled robotic arm. Safety, feasibility, and efficacy were studied. RESULTS Nine patients were treated with a breath-holding technique, and 14 with a respiratory-gating, automated, robotic technique. Tumor size ranged from 1 to 5 cm in maximal diameter. There were four complications related to fiducial placement: three pneumothoraces requiring chest tube insertion and one emphysema exacerbation. There were no grade 3 to 5 radiation-related complications. Follow-up ranged from 1 to 26 months (mean, 7.0 months). Radiographic response was scored as complete in 2 patients, partial in 15, stable in 4, and progressive in 2. Four patients died of non-treatment-related causes at 1, 5, 9, and 11 months after radiation. CONCLUSIONS Single-fraction stereotactic radiosurgery is safe and feasible for the treatment of selected lung tumors. Additional studies are planned to investigate the optimal radiation dose, best motion-suppression technique, and overall treatment efficacy.
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Affiliation(s)
- Richard I Whyte
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California 94305-5407, USA.
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Chidiac T, Budd GT, Pelley R, Sandstrom K, McLain D, Elson P, Crownover R, Marks K, Muschler G, Joyce M, Zehr R, Bukowski R. Phase II trial of liposomal doxorubicin (Doxil) in advanced soft tissue sarcomas. Invest New Drugs 2000; 18:253-9. [PMID: 10958594 DOI: 10.1023/a:1006429907449] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To assess the objective response rate, toxicity experienced, progression-free survival, and overall survival of patients with previously untreated advanced soft tissue sarcomas treated with a liposomal doxorubicin formulation (Doxil). METHODS Patients with metastatic or recurrent soft tissue sarcoma who had received no prior chemotherapy for advanced disease were treated with liposomal doxorubicin (Doxil) according to a two stage accrual design. Doxil was administered at 50 mg/m2 every 4 weeks. A total of 15 patients were treated and are evaluable for response and toxicity. RESULTS The male/female ratio was 7/8, the median age was 60 years (34-75) and the ECOG performance status was 0-1 in >90% of patients. Leiomyosarcoma (7/15) and malignant fibrous histiocytoma (2/15) were the most common histologic diagnoses. No objective responses were observed in the 15 evaluable patients. No lethal toxicity occurred. Grade 3-4 leukopenia or neutropenia were reported in 3/15 (20%) patients. Grade 3 mucositis or hand-foot syndrome occurred in 2/15 (13%) and 1/15 (7%) patients respectively and seemed more severe in older patients. The median time to progression was 1.9 months (range 0.9-6.2). Twelve patients have now died. The Kaplan-Meier estimate of median overall survival is 12.3 months. As called for in the study design, accrual was terminated because no responses were obtained in the first 15 patients. CONCLUSION Though well-tolerated, Doxil given according to this dose and schedule to patients with advanced soft tissue sarcoma had no significant therapeutic activity. A correlation between older age and skin/mucosal toxicity of Doxil is suggested in this study but needs confirmation. Future investigations of Doxil in soft tissue sarcomas should use a different schedule and dose.
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Affiliation(s)
- T Chidiac
- The Taussig Cancer Center, Cleveland Clinic Foundation, OH 44195, USA
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Affiliation(s)
- S Ayhan
- The Cleveland Clinic Foundation, Cleveland, OH, USA
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Chen QS, Crownover R, Weinhous MS. Response to “Comment on ‘Subunity coordinate translation with Fourier transform to achieve efficient and quality three-dimensional medical image interpolation’ ” [Med. Phys. 27, 818-820 (2000)]. Med Phys 2000. [DOI: 10.1118/1.598947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Chen QS, Crownover R, Weinhous MS. Subunity coordinate translation with Fourier transform to achieve efficient and quality three-dimensional medical image interpolation. Med Phys 1999; 26:1776-82. [PMID: 10505864 DOI: 10.1118/1.598681] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A new approach to the interpolation of three-dimensional (3D) medical images is presented. Instead of going through the conventional interpolation scheme where the continuous function is first reconstructed from the discrete data set and then resampled, the interpolation is achieved with a subunity coordinate translation technique. The original image is first transformed into the spatial-frequency domain. The phase of the transform is then modified with n-1 linear phase terms in the axial direction to achieve n-1 subunity coordinate translations with a distance 1/n, where n is an interpolation ratio, following the phase shift theorem of Fourier transformation. All the translated images after inverse Fourier transformation are then interspersed in turn into the original image. Since windowing plays an important role in the process, different window functions have been studied and a proper recommendation is provided. The interpolation quality produced with the present method is as good as that with the sampling (sinc) function, while the efficiency, thanks to the fast Fourier transformation, is very much improved. The approach has been validated with both computed tomography (CT) and magnetic resonance (MR) images. The interpolations of 3D CT and MR images are demonstrated.
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Affiliation(s)
- Q S Chen
- Department of Radiation Oncology, The Cleveland Clinic Foundation, Ohio 44195, USA
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