Pub Date : 2023-04-20DOI: 10.1017/S1460396923000146
M. Goss, C. Champ, M. Trombetta, Parisa Shamsesfandabadi, Valerie DeMartino, R. Wegner, S. Beriwal, Veronica Eisen
Abstract Introduction: This study compared dose metrics between tangent breast plans calculated with the historical standard collapsed cone (CC) and the more accurate Monte Carlo (MC) algorithms. The intention was to correlate current plan quality metrics from the currently used CC algorithm with doses calculated using the more accurate MC algorithm. Methods: Thirteen clinically treated patients, whose plans had been calculated using the CC algorithm, were identified. These plans were copied and recalculated using the MC algorithm. Various dose metrics were compared for targets and the time necessary to perform each calculation. Special consideration was given to V105%, as this is increasingly being used as a predictor of skin toxicity and plan quality. Finally, both the CC and MC plans for 4 of the patients were delivered onto a dose measurement phantom used to analyse quality assurance (QA) pass rates. These pass rates, using various evaluation criteria, were also compared. Results: Metrics such as the PTVeval D95% and V95% showed a variation of 6% or less between the CC and MC plans, while the PTVeval V100% showed variation up to 20%. The PTVeval V105% showed a relative increase of up to 593% after being recalculated with MC. The time necessary to perform calculations was 76% longer on average for CC plans than for those recalculated using MC. On average, the QA pass rates using 2%2mm and 3%3mm gamma criteria for CC plans were lower (19·2% and 5·5%, respectively) than those recalculated using MC. Conclusion: Our study demonstrates MC-calculated PTVeval V105% values are significantly higher than those calculated using CC. PTVeval V105% is often used as a benchmark for acceptable plan quality and a predictor of acute toxicity. We have also shown that calculation times for MC are comparable to those for CC. Therefore, what is considered acceptable PTVeval V105% criteria should be redefined based on more accurate MC calculations.
{"title":"The comparison of collapsed cone and Monte Carlo algorithms in tangential breast planning","authors":"M. Goss, C. Champ, M. Trombetta, Parisa Shamsesfandabadi, Valerie DeMartino, R. Wegner, S. Beriwal, Veronica Eisen","doi":"10.1017/S1460396923000146","DOIUrl":"https://doi.org/10.1017/S1460396923000146","url":null,"abstract":"Abstract Introduction: This study compared dose metrics between tangent breast plans calculated with the historical standard collapsed cone (CC) and the more accurate Monte Carlo (MC) algorithms. The intention was to correlate current plan quality metrics from the currently used CC algorithm with doses calculated using the more accurate MC algorithm. Methods: Thirteen clinically treated patients, whose plans had been calculated using the CC algorithm, were identified. These plans were copied and recalculated using the MC algorithm. Various dose metrics were compared for targets and the time necessary to perform each calculation. Special consideration was given to V105%, as this is increasingly being used as a predictor of skin toxicity and plan quality. Finally, both the CC and MC plans for 4 of the patients were delivered onto a dose measurement phantom used to analyse quality assurance (QA) pass rates. These pass rates, using various evaluation criteria, were also compared. Results: Metrics such as the PTVeval D95% and V95% showed a variation of 6% or less between the CC and MC plans, while the PTVeval V100% showed variation up to 20%. The PTVeval V105% showed a relative increase of up to 593% after being recalculated with MC. The time necessary to perform calculations was 76% longer on average for CC plans than for those recalculated using MC. On average, the QA pass rates using 2%2mm and 3%3mm gamma criteria for CC plans were lower (19·2% and 5·5%, respectively) than those recalculated using MC. Conclusion: Our study demonstrates MC-calculated PTVeval V105% values are significantly higher than those calculated using CC. PTVeval V105% is often used as a benchmark for acceptable plan quality and a predictor of acute toxicity. We have also shown that calculation times for MC are comparable to those for CC. Therefore, what is considered acceptable PTVeval V105% criteria should be redefined based on more accurate MC calculations.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44747879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-19DOI: 10.1017/S146039692300016X
Ali Rasouli, Mahmud Naraqi Arani, A. Aliasgharzadeh, Bagher Farhood
Abstract Background: Adjacent radiation fields are applied in some radiotherapeutic cases. When using these radiation fields, considerable dose errors across the junction of radiation fields are possible. Therefore, it is necessary to evaluate the accuracy of the dose calculated by treatment planning system (TPS) when using the adjacent radiation fields. The present study aimed to quantify the dose calculation accuracy of ISOgray TPS for the photon-photon adjacent fields. Materials and methods: To assess the accuracy of dose calculations, the dose profiles were first measured by a Semiflex ionization chamber at 1, 1·5, 5 and 10 cm depths for different field sizes (6 × 6, 10 × 10 and 20 × 20 cm2), source to surface distances (SSDs) (90, 100 and 110 cm) and beam angles (0º, 15º, 30º and 45º). In the second step, the data at corresponding depths were extracted from the ISOgray TPS. Finally, the dosimetric performance of TPS was evaluated using a gamma index analysis. Results: The overall dose calculation accuracy of ISOgray TPS was within the acceptable range for the build-up region (with acceptance criteria of dose difference (DD) = 15% and distance to agreement (DTA) = 3 mm) and the depths after the build-up region (with acceptance criteria of DD = 5% and DTA = 3 mm). Moreover, the overall accuracy of dose calculations was not affected by the field size and the SSD. It was also shown that the accuracy of dose calculations was similar for the adjacent radiation fields with beam angles of 0º, 15 º and 30 º, while a considerable decrease in the pass rate values is obtained for the adjacent radiation field with 45 º beam angle. A more detailed analysis of the findings revealed that the accuracy of dose calculations in the match line regions of the adjacent radiation fields for 1 cm beam profiles was within the acceptable range; however, it declined for other depths. Conclusions: The findings showed that the overall dose calculation accuracy of ISOgray TPS was acceptable for evaluated adjacent radiation fields. However, the accuracy of dose calculations in the match line regions of the adjacent radiation fields for the depth after build-up was not within the acceptable range.
{"title":"Evaluation of dose calculation accuracy of a commercial radiotherapy treatment planning system for adjacent radiation fields","authors":"Ali Rasouli, Mahmud Naraqi Arani, A. Aliasgharzadeh, Bagher Farhood","doi":"10.1017/S146039692300016X","DOIUrl":"https://doi.org/10.1017/S146039692300016X","url":null,"abstract":"Abstract Background: Adjacent radiation fields are applied in some radiotherapeutic cases. When using these radiation fields, considerable dose errors across the junction of radiation fields are possible. Therefore, it is necessary to evaluate the accuracy of the dose calculated by treatment planning system (TPS) when using the adjacent radiation fields. The present study aimed to quantify the dose calculation accuracy of ISOgray TPS for the photon-photon adjacent fields. Materials and methods: To assess the accuracy of dose calculations, the dose profiles were first measured by a Semiflex ionization chamber at 1, 1·5, 5 and 10 cm depths for different field sizes (6 × 6, 10 × 10 and 20 × 20 cm2), source to surface distances (SSDs) (90, 100 and 110 cm) and beam angles (0º, 15º, 30º and 45º). In the second step, the data at corresponding depths were extracted from the ISOgray TPS. Finally, the dosimetric performance of TPS was evaluated using a gamma index analysis. Results: The overall dose calculation accuracy of ISOgray TPS was within the acceptable range for the build-up region (with acceptance criteria of dose difference (DD) = 15% and distance to agreement (DTA) = 3 mm) and the depths after the build-up region (with acceptance criteria of DD = 5% and DTA = 3 mm). Moreover, the overall accuracy of dose calculations was not affected by the field size and the SSD. It was also shown that the accuracy of dose calculations was similar for the adjacent radiation fields with beam angles of 0º, 15 º and 30 º, while a considerable decrease in the pass rate values is obtained for the adjacent radiation field with 45 º beam angle. A more detailed analysis of the findings revealed that the accuracy of dose calculations in the match line regions of the adjacent radiation fields for 1 cm beam profiles was within the acceptable range; however, it declined for other depths. Conclusions: The findings showed that the overall dose calculation accuracy of ISOgray TPS was acceptable for evaluated adjacent radiation fields. However, the accuracy of dose calculations in the match line regions of the adjacent radiation fields for the depth after build-up was not within the acceptable range.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45338284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-20DOI: 10.1017/S1460396923000122
S. Roy, B. Sarkar, Anirudh Pradhan
ABSTRACT Introduction: This study aimed to quantify the difference in setup margin in cone beam computed tomography (CBCT) setup imaging, utilising the van Herk formula for two different image registration methods. Two alternative techniques of registration, bony landmark (BL) matching and soft tissue matching (ST) for head and neck cancer patients, were investigated. Methods: This study included 30 head and neck cancer patients who received a simultaneous integrated boost of 54–60–66 Gy in 30 fractions, using volumetric modulated arc treatment. A total of 867 CBCT images were acquired during patient setup and further analysed for setup margin calculation. A region of interest was described using a clip box between the reference and CBCT image to calculate the patient’s positional inaccuracy in three translational directions, X, Y and Z, where X was mediolateral, Y was the cranial-caudal, and Z was the anterior-posterior direction in the patient-based coordinate system, respectively. The shifts were captured by altering the BL and ST matching, and the setup margin was calculated using the van Herk formula (=2·5Σ + 0·7σ where Σ was the systematic and σ was the random error). Results: The difference between bony and ST matching in most cases was observed to be 1·4 mm in all translational directions at a 95% confidence interval and <1° in all rotational directions. The rotational error was found to be below the action level (±3°); hence, no corrections related to rotational error were made. The translational setup margin for bone and ST-based registration was X (BL) = 4·6 mm, X (ST) = 4·4 mm, Y (BL) = 6·3 mm, Y (ST) = 4·7 mm, Z (BL) = 3·0 mm, Z (ST) = 3·6mm. Conclusion: Two distinct registration approaches for head-neck patient setup did not yield any significant difference in the setup margin calculation. A suitable approach for CBCT and reference CT registration technique was required for the setup margin calculation. Confusion in selecting the correct image registration procedure can result in incorrect treatment execution. The compatibility of the two registration approaches was established in this study. Image fusion was neutralised before the second match (ST) to avoid hysteresis. For setup verification using CBCT for the head and neck region, both bone and ST registration were compatible for setup verification.
摘要简介:本研究旨在利用两种不同图像配准方法的van Herk公式，量化锥形束计算机断层扫描(CBCT)设置成像中设置边界的差异。研究了头颈部肿瘤患者的骨标记(BL)匹配和软组织匹配(ST)两种可选的配准技术。方法:本研究包括30例头颈癌患者，他们同时接受了54-60-66 Gy的30次综合增强，采用体积调制电弧治疗。在患者设置期间共获得867张CBCT图像，并进一步分析设置裕度计算。在参考图像和CBCT图像之间使用夹盒描述感兴趣区域，以计算患者在三个平移方向(X, Y和Z)上的位置不准确性，其中X为中外侧，Y为颅尾，Z为以患者为基础的坐标系中的前后方向。通过改变BL和ST匹配来捕获位移，并使用van Herk公式计算设置余量(=2·5Σ + 0.7 Σ，其中Σ为系统误差，Σ为随机误差)。结果:在大多数情况下，骨与ST匹配在所有平移方向上的差异在95%置信区间内为1.4 mm，在所有旋转方向上的差异<1°。发现转动误差低于动作水平(±3°);因此，没有对旋转误差进行修正。骨与ST基配准的平移设置余量为X (BL) = 4.6 mm, X (ST) = 4.4 mm, Y (BL) = 6.3 mm, Y (ST) = 4.7 mm, Z (BL) = 3.0 mm, Z (ST) = 3.6 mm。结论:头颈部患者设置的两种不同注册方法在设置裕度计算上没有显著差异。建立余量计算需要一种适合于CBCT和参考CT配准技术的方法。在选择正确的图像配准程序时的混淆可能导致错误的处理执行。本研究确定了两种配准方法的相容性。在第二次匹配(ST)之前对图像融合进行了中和，以避免迟滞。对于使用CBCT对头部和颈部区域进行设置验证，骨和ST注册都兼容于设置验证。
{"title":"Comparative analysis of setup margin calculation in cone beam CT, by van Herk formula, using two different image registration methods","authors":"S. Roy, B. Sarkar, Anirudh Pradhan","doi":"10.1017/S1460396923000122","DOIUrl":"https://doi.org/10.1017/S1460396923000122","url":null,"abstract":"ABSTRACT Introduction: This study aimed to quantify the difference in setup margin in cone beam computed tomography (CBCT) setup imaging, utilising the van Herk formula for two different image registration methods. Two alternative techniques of registration, bony landmark (BL) matching and soft tissue matching (ST) for head and neck cancer patients, were investigated. Methods: This study included 30 head and neck cancer patients who received a simultaneous integrated boost of 54–60–66 Gy in 30 fractions, using volumetric modulated arc treatment. A total of 867 CBCT images were acquired during patient setup and further analysed for setup margin calculation. A region of interest was described using a clip box between the reference and CBCT image to calculate the patient’s positional inaccuracy in three translational directions, X, Y and Z, where X was mediolateral, Y was the cranial-caudal, and Z was the anterior-posterior direction in the patient-based coordinate system, respectively. The shifts were captured by altering the BL and ST matching, and the setup margin was calculated using the van Herk formula (=2·5Σ + 0·7σ where Σ was the systematic and σ was the random error). Results: The difference between bony and ST matching in most cases was observed to be 1·4 mm in all translational directions at a 95% confidence interval and <1° in all rotational directions. The rotational error was found to be below the action level (±3°); hence, no corrections related to rotational error were made. The translational setup margin for bone and ST-based registration was X (BL) = 4·6 mm, X (ST) = 4·4 mm, Y (BL) = 6·3 mm, Y (ST) = 4·7 mm, Z (BL) = 3·0 mm, Z (ST) = 3·6mm. Conclusion: Two distinct registration approaches for head-neck patient setup did not yield any significant difference in the setup margin calculation. A suitable approach for CBCT and reference CT registration technique was required for the setup margin calculation. Confusion in selecting the correct image registration procedure can result in incorrect treatment execution. The compatibility of the two registration approaches was established in this study. Image fusion was neutralised before the second match (ST) to avoid hysteresis. For setup verification using CBCT for the head and neck region, both bone and ST registration were compatible for setup verification.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41824854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-13DOI: 10.1017/S1460396922000449
My-Lien Nguyen, Kazi T. Afrin, Patrick Newbury, C. Henson, Salahuddin Ahmad
Abstract Aim: The aim of our study is to retrospectively report the radiobiological aspects for intensity-modulated proton therapy (IMPT) against intensity-modulated radiation therapy (IMRT) for patients with head and neck cancer treated at our institution. A secondary goal is to reinforce current model-based approaches to head and neck cancer patient selection for IMPT. Materials and Methods: Eighteen patients were evaluated with prescription doses ranging from 50 to 70 Gy delivered in 2 Gy per fraction. The dose volume histograms (DVH) were used to calculate equivalent uniform dose (EUD), tumour control probability (TCP) and normal tissue complication probability (NTCP) for biophysical comparison using mechanistic mathematical dose response models. Absolute values of TCP and NTCP were then compared between IMPT and IMRT. Results: The dose models demonstrate a minimal radiobiological advantage for IMPT compared to IMRT in treating head and neck cancers. Absolute values of TCP were slightly higher, while absolute values of NTCP were slightly lower for IMPT versus IMRT. Conclusions: Further studies are needed to determine if the radiobiological advantage indeed translates to a therapeutic advantage for patients.
{"title":"Comparison of intensity-modulated proton therapy (IMPT) versus intensity-modulated radiation therapy (IMRT) for the treatment of head and neck cancer based on radiobiological modelling","authors":"My-Lien Nguyen, Kazi T. Afrin, Patrick Newbury, C. Henson, Salahuddin Ahmad","doi":"10.1017/S1460396922000449","DOIUrl":"https://doi.org/10.1017/S1460396922000449","url":null,"abstract":"Abstract Aim: The aim of our study is to retrospectively report the radiobiological aspects for intensity-modulated proton therapy (IMPT) against intensity-modulated radiation therapy (IMRT) for patients with head and neck cancer treated at our institution. A secondary goal is to reinforce current model-based approaches to head and neck cancer patient selection for IMPT. Materials and Methods: Eighteen patients were evaluated with prescription doses ranging from 50 to 70 Gy delivered in 2 Gy per fraction. The dose volume histograms (DVH) were used to calculate equivalent uniform dose (EUD), tumour control probability (TCP) and normal tissue complication probability (NTCP) for biophysical comparison using mechanistic mathematical dose response models. Absolute values of TCP and NTCP were then compared between IMPT and IMRT. Results: The dose models demonstrate a minimal radiobiological advantage for IMPT compared to IMRT in treating head and neck cancers. Absolute values of TCP were slightly higher, while absolute values of NTCP were slightly lower for IMPT versus IMRT. Conclusions: Further studies are needed to determine if the radiobiological advantage indeed translates to a therapeutic advantage for patients.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48792855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-13DOI: 10.1017/S1460396923000134
Kristen Duke, Salahuddin Ahmad, A. Lau
Abstract Background: This investigation quantifies the dose enhancement effect and dose distribution modifications due to the presence of high-z nanospheres in a proton beam. Methods: Various proton pencil beams of therapeutic energies (60–226 MeV) and spatial distribution of 2·7 mm spot size diameter were simulated onto a water phantom utilising the TOPAS Monte Carlo toolkit version 3.6.1. The simulation modelled either water or nanospheres of high-z materials (gold, silver or platinum) at the location of the Bragg Peak (BP) to compare the differences of the resulting dose distributions. Results: The introduction of the nanospheres increases the maximum dose, narrows the BP and shifts the BP location upstream compared to the water phantom with no nanospheres. Conclusions: This work shows that the local dose can be enhanced with the use of high-z nanoparticles in proton therapy, thereby increasing patient safety and decreasing side effects with the same amount of delivered radiation.
{"title":"A Monte Carlo study of the dose enhancement effects of high-z foils in proton therapy","authors":"Kristen Duke, Salahuddin Ahmad, A. Lau","doi":"10.1017/S1460396923000134","DOIUrl":"https://doi.org/10.1017/S1460396923000134","url":null,"abstract":"Abstract Background: This investigation quantifies the dose enhancement effect and dose distribution modifications due to the presence of high-z nanospheres in a proton beam. Methods: Various proton pencil beams of therapeutic energies (60–226 MeV) and spatial distribution of 2·7 mm spot size diameter were simulated onto a water phantom utilising the TOPAS Monte Carlo toolkit version 3.6.1. The simulation modelled either water or nanospheres of high-z materials (gold, silver or platinum) at the location of the Bragg Peak (BP) to compare the differences of the resulting dose distributions. Results: The introduction of the nanospheres increases the maximum dose, narrows the BP and shifts the BP location upstream compared to the water phantom with no nanospheres. Conclusions: This work shows that the local dose can be enhanced with the use of high-z nanoparticles in proton therapy, thereby increasing patient safety and decreasing side effects with the same amount of delivered radiation.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46880924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-09DOI: 10.1017/S1460396922000322
Sankalp Singh, N. Bisht, A. Sarin, Rekha Vashisht, Nishant Lohia, Vikas Gupta, G. Trivedi
Abstract Introduction: Head and neck cancers (HNCs) are some of the commonest cases requiring palliative radiotherapy (PRT) in an Indian radiotherapy practice. A variety of PRT protocols have been explored with varying success. Methods: The study objective was to evaluate the efficacy and tolerability of a short-course hypofractionated PRT schedule in HNC patients in terms of symptom relief, tumour response, acute side effects and survival and to compare results with other PRT regimens. All patients received 30 Gy in 10 fractions over 2 weeks followed by another 20 Gy in 5 fractions after a 4 weeks gap. Results: Seventy-five percent of patients completed both phases of treatment. Symptom relief was seen in 71% (pain) to 76% (dysphagia) of patients. Tumour response was recorded in 73% of patients. At 12 months, the mean overall survival was 10·29 months for patients who responded to PRT compared to 7·87 months for those who did not. Results were comparable to other regimens reported in the literature, but no radiobiological advantage of a higher dose was discernible. Conclusions: Short-course hypofractionated PRT is effective in reducing tumour burden and relieving symptoms in HNC patients and possibly in lengthening survival. Selection of any schedule should be decided by treating oncologists based on clinical, logistic and socio-economic factors.
{"title":"Use of split-course hypofractionated radiotherapy in palliative treatment of head and neck cancers: how does our regimen compare with others?","authors":"Sankalp Singh, N. Bisht, A. Sarin, Rekha Vashisht, Nishant Lohia, Vikas Gupta, G. Trivedi","doi":"10.1017/S1460396922000322","DOIUrl":"https://doi.org/10.1017/S1460396922000322","url":null,"abstract":"Abstract Introduction: Head and neck cancers (HNCs) are some of the commonest cases requiring palliative radiotherapy (PRT) in an Indian radiotherapy practice. A variety of PRT protocols have been explored with varying success. Methods: The study objective was to evaluate the efficacy and tolerability of a short-course hypofractionated PRT schedule in HNC patients in terms of symptom relief, tumour response, acute side effects and survival and to compare results with other PRT regimens. All patients received 30 Gy in 10 fractions over 2 weeks followed by another 20 Gy in 5 fractions after a 4 weeks gap. Results: Seventy-five percent of patients completed both phases of treatment. Symptom relief was seen in 71% (pain) to 76% (dysphagia) of patients. Tumour response was recorded in 73% of patients. At 12 months, the mean overall survival was 10·29 months for patients who responded to PRT compared to 7·87 months for those who did not. Results were comparable to other regimens reported in the literature, but no radiobiological advantage of a higher dose was discernible. Conclusions: Short-course hypofractionated PRT is effective in reducing tumour burden and relieving symptoms in HNC patients and possibly in lengthening survival. Selection of any schedule should be decided by treating oncologists based on clinical, logistic and socio-economic factors.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45344337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-08DOI: 10.1017/S1460396922000437
A. Robinson, I. Gleeson, Thankamma Ajithkuma
Abstract Introduction: This study aimed to systematically review the literature to synthesise and summarise whether using knowledge-based planning (KBP) can improve the planning of stereotactic radiotherapy treatments. Methods: A systematic literature search was carried out using Medline, Scopus and Cochrane databases to evaluate the use of KBP planning in stereotactic radiotherapy. Three hundred twenty-five potential studies were identified and screened to find 25 relevant studies. Results: Twenty-five studies met the inclusion criteria. Where a commercial KBP was used, 72.7% of studies reported a quality improvement, and 45.5% reported a reduction in planning time. There is evidence that when used as a quality control tool, KBP can highlight stereotactic plans that need revision. In studies that use KBP as the starting point for radiotherapy planning optimisation, the radiotherapy plans generated are typically equal to or superior to those planned manually. Conclusions: There is evidence that KBP has the potential to improve the quality and speed of stereotactic radiotherapy planning. Further research is required to accurately quantify such systems’ quality improvements and time savings. Notably, there has been little research into their use for prostate, spinal or liver stereotactic radiotherapy, and research in these areas would be desirable. It is recommended that future studies use the ICRU 91 level 2 reporting format and that blinded physician review could add a qualitative assessment of KBP system performance.
{"title":"Can the use of knowledge-based planning systems improve stereotactic radiotherapy planning? A systematic review","authors":"A. Robinson, I. Gleeson, Thankamma Ajithkuma","doi":"10.1017/S1460396922000437","DOIUrl":"https://doi.org/10.1017/S1460396922000437","url":null,"abstract":"Abstract Introduction: This study aimed to systematically review the literature to synthesise and summarise whether using knowledge-based planning (KBP) can improve the planning of stereotactic radiotherapy treatments. Methods: A systematic literature search was carried out using Medline, Scopus and Cochrane databases to evaluate the use of KBP planning in stereotactic radiotherapy. Three hundred twenty-five potential studies were identified and screened to find 25 relevant studies. Results: Twenty-five studies met the inclusion criteria. Where a commercial KBP was used, 72.7% of studies reported a quality improvement, and 45.5% reported a reduction in planning time. There is evidence that when used as a quality control tool, KBP can highlight stereotactic plans that need revision. In studies that use KBP as the starting point for radiotherapy planning optimisation, the radiotherapy plans generated are typically equal to or superior to those planned manually. Conclusions: There is evidence that KBP has the potential to improve the quality and speed of stereotactic radiotherapy planning. Further research is required to accurately quantify such systems’ quality improvements and time savings. Notably, there has been little research into their use for prostate, spinal or liver stereotactic radiotherapy, and research in these areas would be desirable. It is recommended that future studies use the ICRU 91 level 2 reporting format and that blinded physician review could add a qualitative assessment of KBP system performance.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49022719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-08DOI: 10.1017/S1460396923000055
S. Roy, B. Sarkar, Anirudh Pradhan, A. Munshi, R. Chauhan
Abstract Purpose: Patient wait time for every single fraction of every patient treated at our centre for the past year has been presented in this study. The waiting time data were analysed across different treatment sites and modalities. Materials and Methods: Between March 2021 and March 2022, all patients and their corresponding recorded measurements of waiting time were analysed. Times recorded included check-in time (CK), scheduled time to start treatment (SC) and beam-on time for the first beam of therapy (ST). SPSS version 18 was used for statistical calculations, correlations and assessing significance. Results: A total of 181 patients were treated during this duration. The total number of radiotherapy (RT) sessions recorded was 3011. Out of these 3011 sessions, number of times treated by rapid arc (RA), intensity-modulated radiotherapy (IMRT), three-dimensional conformal radiotherapy (3DCRT), stereotactic body radiotherapy (SBRT), stereotactic radiosurgery and stereotactic radiotherapy (SRS/SRT) were 68.18%, 30.19%, 0.167%, 0.565% and 0.19%, respectively. The mean (± standard deviation) times for scheduled time to start treatment (SC) to check-in time (CK), SC to ST (beam-on time for the first beam of treatment), CK to ST and (CK or SC) to ST were −14 ± 48 min, 6 ± 50 min, 19 ± 24 min and −4 ± 31 min, respectively. Conclusion: Patient wait times during RT were presented in this study. This study covered the daily waiting times before RT during modern-day RT treatment sessions. This vast series of consecutive patient data will be a valuable resource for the future planning and management of any modern RT department.
{"title":"Patient wait times for daily outpatient radiotherapy appointments (a single-centre study)","authors":"S. Roy, B. Sarkar, Anirudh Pradhan, A. Munshi, R. Chauhan","doi":"10.1017/S1460396923000055","DOIUrl":"https://doi.org/10.1017/S1460396923000055","url":null,"abstract":"Abstract Purpose: Patient wait time for every single fraction of every patient treated at our centre for the past year has been presented in this study. The waiting time data were analysed across different treatment sites and modalities. Materials and Methods: Between March 2021 and March 2022, all patients and their corresponding recorded measurements of waiting time were analysed. Times recorded included check-in time (CK), scheduled time to start treatment (SC) and beam-on time for the first beam of therapy (ST). SPSS version 18 was used for statistical calculations, correlations and assessing significance. Results: A total of 181 patients were treated during this duration. The total number of radiotherapy (RT) sessions recorded was 3011. Out of these 3011 sessions, number of times treated by rapid arc (RA), intensity-modulated radiotherapy (IMRT), three-dimensional conformal radiotherapy (3DCRT), stereotactic body radiotherapy (SBRT), stereotactic radiosurgery and stereotactic radiotherapy (SRS/SRT) were 68.18%, 30.19%, 0.167%, 0.565% and 0.19%, respectively. The mean (± standard deviation) times for scheduled time to start treatment (SC) to check-in time (CK), SC to ST (beam-on time for the first beam of treatment), CK to ST and (CK or SC) to ST were −14 ± 48 min, 6 ± 50 min, 19 ± 24 min and −4 ± 31 min, respectively. Conclusion: Patient wait times during RT were presented in this study. This study covered the daily waiting times before RT during modern-day RT treatment sessions. This vast series of consecutive patient data will be a valuable resource for the future planning and management of any modern RT department.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48960413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-06DOI: 10.1017/S1460396922000383
M. Mallory, K. Kauweloa, H. Staecker, P. Camarata, R. Chamoun, Rishi Neeranjun, R. Badkul, M. Tennapel, Shary Shelton, Fen Wang
Abstract Introduction: This study was aimed to evaluate the outcomes of patients with large (>2 cm in great diameter) vestibular schwannomas (VSs) treated with hypofractionated stereotactic radiotherapy (HFSRT) compared to small (<2 cm) ones and the impact of debulking surgery prior to radiation for large VSs. Methods: Fifty-nine patients with VSs treated with HFSRT (25 Gy in 5 fractions) were evaluated by tumour size and surgical status. Patients were divided based on tumour size: small VSs (n = 42) and large VSs (n = 17). The large group was further divided into the groups of pre-treatment debulking surgery (n = 8) and no surgery (n = 9). Rates of tumour control, brainstem necrosis and neurologic dysfunction were assessed following treatment. Pre-surgical magnetic resonance imaging (MRI) were used to generate hypothetical HFSRT plans to compare the effect of debulking surgery on dosimetry. Normal tissue complication probability (NTCP) modelling was performed to compare toxicity probabilities with and without surgical debulking in large VSs. Results: There was no statistical difference of tumour control rate between small and large VSs with 100% for small tumours and 94·1% for large tumours (p = 0·12), respectively. In large VSs patient, the tumour control rate of HFSRT was 100% (8/8) for surgically debulked patients and 89% (8/9) for non-surgically debulked patients (p = 0·35). There were no patients who experienced brainstem necrosis or progression of facial and trigeminal nerve symptoms after HFSRT in the entire groups of patients. Surgical debulking large VSs did not change the maximum point dose of brainstem (p = 0·98), but significantly decreased volumes of VSs and changed the minimum dose to the hottest 0·5 cc of tumour (p = 0·016) as well as the volume receiving at least 23 Gy (p = 0·023). NTCP modelling revealed very low rates (average < 1%) of brainstem toxicity with or without surgical debulking, but there was a significant difference favoring surgery (p < 0·05). Conclusions: HFSRT is a safe and effective treatment for both small and large VSs and is a viable option for patients with large VSs who cannot undergo surgery, if NTCP of pre-debulking HFSRT dosimetry is lower.
{"title":"Hypofractionated stereotactic radiotherapy for large vestibular schwannomas and the impact of pre-radiation debulking surgery on dosimetry and clinical outcomes","authors":"M. Mallory, K. Kauweloa, H. Staecker, P. Camarata, R. Chamoun, Rishi Neeranjun, R. Badkul, M. Tennapel, Shary Shelton, Fen Wang","doi":"10.1017/S1460396922000383","DOIUrl":"https://doi.org/10.1017/S1460396922000383","url":null,"abstract":"Abstract Introduction: This study was aimed to evaluate the outcomes of patients with large (>2 cm in great diameter) vestibular schwannomas (VSs) treated with hypofractionated stereotactic radiotherapy (HFSRT) compared to small (<2 cm) ones and the impact of debulking surgery prior to radiation for large VSs. Methods: Fifty-nine patients with VSs treated with HFSRT (25 Gy in 5 fractions) were evaluated by tumour size and surgical status. Patients were divided based on tumour size: small VSs (n = 42) and large VSs (n = 17). The large group was further divided into the groups of pre-treatment debulking surgery (n = 8) and no surgery (n = 9). Rates of tumour control, brainstem necrosis and neurologic dysfunction were assessed following treatment. Pre-surgical magnetic resonance imaging (MRI) were used to generate hypothetical HFSRT plans to compare the effect of debulking surgery on dosimetry. Normal tissue complication probability (NTCP) modelling was performed to compare toxicity probabilities with and without surgical debulking in large VSs. Results: There was no statistical difference of tumour control rate between small and large VSs with 100% for small tumours and 94·1% for large tumours (p = 0·12), respectively. In large VSs patient, the tumour control rate of HFSRT was 100% (8/8) for surgically debulked patients and 89% (8/9) for non-surgically debulked patients (p = 0·35). There were no patients who experienced brainstem necrosis or progression of facial and trigeminal nerve symptoms after HFSRT in the entire groups of patients. Surgical debulking large VSs did not change the maximum point dose of brainstem (p = 0·98), but significantly decreased volumes of VSs and changed the minimum dose to the hottest 0·5 cc of tumour (p = 0·016) as well as the volume receiving at least 23 Gy (p = 0·023). NTCP modelling revealed very low rates (average < 1%) of brainstem toxicity with or without surgical debulking, but there was a significant difference favoring surgery (p < 0·05). Conclusions: HFSRT is a safe and effective treatment for both small and large VSs and is a viable option for patients with large VSs who cannot undergo surgery, if NTCP of pre-debulking HFSRT dosimetry is lower.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42342060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-03DOI: 10.1017/S1460396922000425
Sarah Jayne Griffiths
Abstract Introduction: A patient experience survey was undertaken as part of the role of the Macmillan Consultant Therapy Radiographer for the bone and brain metastases patients to inform future development of the service. Method: A questionnaire was developed and approved by the Trust’s local Questionnaire, Interview and Survey Group to survey the experiences and satisfaction of the service including the informed consent process, radiotherapy appointments and overall experience and satisfaction. The survey used qualitative and quantitative methods, including Likert Scales and free comment boxes. The responses were analysed by counting the frequency of each response and identifying any themes in free text responses. Results: Most patients were satisfied with the consent process with 1/36 patients reporting a lack of understandable information and 4/36 wanting more side effect information. The option of plan and treat was a preference of 53% of patients due to travelling back and forth to the centre; however, only 6% stated that they wanted two separate appointments. Ninety-four percent of patients felt that they had complete confidence and trust in the professional who consented them and 86% did not feel fully involved in the decision-making process. Overall, the service was rated as 10/10 by 61% of patients (n = 36). Conclusions: The patients surveyed were satisfied with their experience of the Palliative Radiotherapy Service; however, it needs to be developed further to meet the needs and expectations of the service users.
{"title":"A review of the results from a patient experience survey of the palliative radiotherapy bone metastases service","authors":"Sarah Jayne Griffiths","doi":"10.1017/S1460396922000425","DOIUrl":"https://doi.org/10.1017/S1460396922000425","url":null,"abstract":"Abstract Introduction: A patient experience survey was undertaken as part of the role of the Macmillan Consultant Therapy Radiographer for the bone and brain metastases patients to inform future development of the service. Method: A questionnaire was developed and approved by the Trust’s local Questionnaire, Interview and Survey Group to survey the experiences and satisfaction of the service including the informed consent process, radiotherapy appointments and overall experience and satisfaction. The survey used qualitative and quantitative methods, including Likert Scales and free comment boxes. The responses were analysed by counting the frequency of each response and identifying any themes in free text responses. Results: Most patients were satisfied with the consent process with 1/36 patients reporting a lack of understandable information and 4/36 wanting more side effect information. The option of plan and treat was a preference of 53% of patients due to travelling back and forth to the centre; however, only 6% stated that they wanted two separate appointments. Ninety-four percent of patients felt that they had complete confidence and trust in the professional who consented them and 86% did not feel fully involved in the decision-making process. Overall, the service was rated as 10/10 by 61% of patients (n = 36). Conclusions: The patients surveyed were satisfied with their experience of the Palliative Radiotherapy Service; however, it needs to be developed further to meet the needs and expectations of the service users.","PeriodicalId":44597,"journal":{"name":"Journal of Radiotherapy in Practice","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48122787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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